Health

Summary

Miss C said that although she had been attending her GP since January 2013, he failed to take her concerns and symptoms seriously. She said that it was not until she attended the surgery with her partner in August 2014 that she was referred to a hospital consultant. She was then diagnosed with a brain tumour.

The complaint was investigated and we took independent advice from a medical adviser who is a GP. We found that early in 2013, Miss C's optician had written to her GP asking him to arrange for her to see an ophthalmologist (a doctor who specialises in diseases and injuries in and around the eye). He did so and Miss C attended the ophthalmology clinic. She remained in ophthalmology care until her discharge four months later. After that, Miss C saw her GP twice, both times for shoulder complaints. It was not until she attended her GP in August 2014 complaining of previously unrecorded symptoms that the possibility of a brain tumour was suspected and then diagnosed following her referral to hospital. We found no evidence of delay or a failure to treat appropriately.

Taking all of this into account, whilst recognising the challenges Miss C has had to face, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment received by her late husband (Mr C) while he was a patient at Raigmore Hospital. Mr C underwent surgery to treat colon cancer but he continued to experience health problems and had a number of readmissions over the course of the following months. Around five months after surgery, investigations showed a recurrence of Mr C's cancer. He was admitted to a hospice for palliative care and died two months later. Mrs C raised concerns about the steps taken to investigate her husband's ongoing symptoms and pain following the surgery. She also complained about a lack of planned follow-up action, including the omission of a referral to oncology.

We obtained independent advice from a consultant colorectal and general surgeon, who considered that the investigations undertaken during Mr C's admissions were reasonable and consistent with applicable guidance. The adviser noted that it was unfortunate that the investigations did not detect the recurrence of Mr C's cancer earlier but did not consider that this was due to a failing on the part of the board. We accepted this advice and did not uphold this complaint.

In relation to the decision not to refer Mr C to oncology following his surgery, the board indicated that the multi-disciplinary team had not felt that he would be fit enough to undergo chemotherapy. They noted that this was discussed with Mr C at the time but this discussion was not recorded in the clinical records. They acknowledged that it might have been useful for Mr C and his family to have met an oncologist to discuss the risks and benefits of chemotherapy and they apologised that this was not arranged. While accepting that Mr C was unlikely to have been fit enough for chemotherapy within the relevant time period, the adviser agreed that the opportunity to speak to an oncologist should have been considered. The adviser was critical of the board's failure to record their discussion with Mr C and noted that this was not consistent with the General Medical Council (GMC)'s guidelines on record-keeping. In the circumstances, we upheld this complaint.

Recommendations

We recommended that the board:

• reflect on the record-keeping failure highlighted in this case and take steps to ensure staff adhere to the relevant GMC guidelines in this area.

Summary

Mrs C, who is an advocacy worker, complained on behalf of her client (Mrs B). Mrs B said that her mother (Mrs A) was left without proper care and support from her local medical practice. She said that they failed to recognise the seriousness of Mrs A's condition and she died as a consequence.

We took independent advice from a medical adviser who is a GP. We found that Mrs A had very complex medical problems. She had severe artery disease and had already had a leg amputated above the knee. She also had severe heart disease. Mrs A was being cared for in the community. When the practice were alerted to the fact that she had a small necrotic area (a patch of dead tissue) on her leg stump which had been there for three to four weeks, a GP assessed Mrs A at home and decided that she be reviewed urgently. A day later, the practice were advised that the affected area was deteriorating. Contact was attempted with both Mrs A and the warden of her accommodation but this proved impossible as neither answered the phone. A home visit was then arranged for the next day. Meanwhile, Mrs A was taken into hospital where she died a few days later. We did not uphold the complaint as we were satisfied that the practice had taken all reasonable action in the circumstances.

Summary

Mrs C complained on behalf of her mother (Mrs A). Mrs A had been diagnosed late with Hodgkin lymphoma (a type of cancer of the lymphatic system, a network of vessels and glands throughout the body). Mrs C believed that the practice had failed to spot clear symptoms of the disease over an extended period.

We took independent advice from a medical adviser who is a GP. The adviser reviewed Mrs A's medical records in detail. They noted that some of the tests Mrs C believed should have been performed could only be requested by a specialist following review in hospital. The adviser stated that Mrs A had not presented with typical symptoms of Hodgkin lymphoma and her existing medical conditions had made her diagnosis more complex. Mrs A had not met the criteria for referral under Scottish cancer referral guidelines and had been referred urgently for investigation by the practice on several occasions.

We found that the practice had provided a reasonable standard of care and treatment to Mrs A. We found there was no evidence that symptoms of Hodgkin lymphoma had been overlooked, or that referrals should have been made sooner.

Summary

Mr C was referred to the ear nose and throat (ENT) department at the board by his GP following symptoms of hoarseness. He was examined at an out-patient appointment where no sinister findings were identified and was discharged back into the care of his GP. Mr C's symptoms persisted and his GP made a further ENT referral. This was assessed by a consultant who made a referral to speech and language therapy (SALT). Mr C was seen at a SALT out-patient appointment some time later and potential malignancy was identified in his voice box. An appointment with an ENT consultant was arranged for the following day. Mr C was subsequently diagnosed with cancer and underwent surgery to remove his voice box. Mr C complained that a proper examination had not been carried out during his initial appointment, that it was inappropriate to refer him to SALT following the further referral from his GP and that there was an unreasonable delay in offering him an ENT appointment following the further GP referral.

After taking independent advice from an adviser, who is a consultant surgeon specialising in head and neck cancers, we did not uphold Mr C's complaints. The advice we received was that all necessary examinations had been carried out during the initial appointment and that it was appropriate to refer Mr C to SALT following the further referral from his GP. We found that there was no reference in the ENT consultant's referral to SALT for follow-up after the assessment but noted that Mr C had had an ENT consultation the next day in any case. We made a recommendation to the board to draw the adviser's comments on this to the attention of the ENT consultant.

Recommendations

We recommended that the board:

• make the relevant consultant aware of the adviser's comments on ENT follow-up following SALT referrals and recording neck examinations.

Summary

Mrs C complained about the care and treatment provided to a resident (Mr A) of the care home she managed when he was admitted to Glasgow Western Infirmary to have a catheter fitted. Mr A had dementia. Medical staff had to make a number of attempts to fit the catheter, which distressed Mr A. Mrs C said that staff failed to provide adequate care when they attempted to insert a catheter and properly manage his pain. She also said that staff failed to provide Mr A with adequate sustenance and communicate with his carer as they should have done.

We took independent advice from a nursing adviser. We found that the board failed to provide Mr A with adequate sustenance or communicate with his carer as they should have done, particularly given Mr A's dementia. However, we found no evidence that the placement of a catheter was unreasonable (although we appreciated how distressing an experience this was for Mr A) or that staff had failed to manage his pain.

Recommendations

We recommended that the board:

• consider and report on steps taken to address the failings we identified;
• bring the nursing adviser's comments about communication to the attention of relevant staff; and
• apologise for the failures we identified.

Summary

Mrs C complained about the treatment her mother (Mrs A) received from the practice. Mrs A had been unwell with cold/flu-like symptoms and a sore chest. She was prescribed antibiotics and advised to return if there was no improvement so that a chest x-ray could be arranged. Mrs A returned a few days later as she was still unwell. No shortness of breath or chest pain was noted and Mrs A was sent for a chest x-ray. The next day, Mrs A requested a home visit but was asked to attend at the practice following a phone conversation with a doctor. During the consultation, Mrs A collapsed. Cardiopulmonary resuscitation (CPR) was started and an ambulance was called but Mrs A died. Later, the family had difficulties in arranging a time to speak with a doctor about what had happened. Mrs C complained about the clinical treatment that was provided as she considered there was a failure to diagnose Mrs A's heart attack or take appropriate action. She also complained that the practice had failed to communicate adequately following Mrs A's death.

After taking independent advice from one of our medical advisers, who is a GP, we did not uphold Mrs C's complaint about the treatment provided. The adviser considered that the standard of care provided to Mrs A was reasonable and that practice staff had tried to resuscitate her to the best of their ability. We found that there is no formal requirement for practices to have a defibrillator available and that defibrillation would not have saved Mrs A's life. However, we did make a recommendation that the practice consider obtaining a defibrillator.

We found the practice had acknowledged failings in their communication with the family and had apologised for this. We noted that their protocol had been updated to prevent a recurrence of such an error in future. We upheld this element of Mrs C's complaint, but in light of the action already taken by the practice, we did not make any recommendations about this.

Recommendations

We recommended that the practice:

• consider obtaining access to a defibrillator for use in emergency situations.

Summary

Mr C complained to us about the care and treatment he received from Stobhill Hospital when he had a circumcision operation. He complained that he had received poor treatment from nursing staff immediately after his operation. When he developed an infection in the wound, he sought specialist input. However, he complained that the surgeon did not examine him properly and dismissed his concerns. He returned to the same surgeon two more times over the following year, and was told that the wound had healed and nothing could be done to improve his discomfort. Mr C was then referred to a different surgeon who identified an issue with the way the scar had healed. He had another procedure which corrected this problem. Mr C said this should have been identified earlier. He also raised concerns about the way his complaint was handled.

We took independent advice from a nursing adviser and an adviser specialising in urology (relating to the urinary system and male reproductive system). They reviewed the care and treatment Mr C had received. The urology adviser noted that there was very little evidence that Mr C had been appropriately informed of the risks involved in the procedure prior to providing consent. However, he was satisfied that the operation was conducted appropriately, and that the follow-up consultations were reasonable. He said that the differences in the conclusions of the two surgeons related to their professional opinions about the scar, and this was reasonable. The nursing adviser was satisfied that nurses had monitored Mr C appropriately after his operation, and noted that the concerns he raised were not evident from his medical records.

We concluded that, while Mr C's operation had been reasonable, it appeared that he was not given enough information to provide informed consent, so the procedure was not conducted appropriately. We were satisfied that Mr C's subsequent examinations were reasonable. However, we found that the board had not provided a reasonable response when Mr C first raised concerns. When he persisted with his complaint, the board then took too long in providing a final response.

Recommendations

We recommended that the board:

• consider revising their leaflet for patients having circumcision taking into account the guidance from the British Association of Urological Surgeons and the Royal College of Surgeons;
• take steps to ensure adequate information is provided on the risks and potential complications of this procedure at an appropriate time prior to any decision being made to proceed with it, and that this is recorded;
• feed back the findings of this investigation to relevant staff; and
• apologise to Mr C for the failings identified.

Summary

Mrs C complained about the care her daughter (Miss A) received from Parkhead Hospital for anorexia nervosa. Mrs C was dissatisfied that Miss A lost weight in hospital and was not given enough calories. She said that the re-feeding plan was not tailored to meet Miss A's needs and that staff did not respond properly to the concerns she raised at the time of the hospital admission.

We took independent advice on this case from two of our advisers experienced in working with patients who have eating disorders, one of whom is a dietician and the other a mental health nurse. We found that there was an appropriate re-feeding plan and measures in place which were in line with national guidance. However, for approximately two weeks, Miss A's calorie intake was not in accordance with the re-feeding plan which the board acknowledged and apologised for. We also identified that the records made by the nursing staff should have been more detailed, and that there was insufficient historical information documented about Miss A's background and whether any psychological therapies had been offered to her or the family.

We considered that there was evidence to show that staff had listened to concerns raised by the family about Miss A's preference to have liquid nutritional supplements instead of solid food. Furthermore, an agreement had been reached for Miss A to follow the re-feeding plan rather than have a feeding tube put in place.

Recommendations

We recommended that the board:

• ensure their re-feeding policy includes guidance on offering psychological therapies and support to patients and their families; and
• draw to the attention of nursing staff involved in Miss A's care the importance of documenting relevant information related to a patient's behaviours, weight and family background.

Summary

Mr C's daughter (Ms A) gave birth to a baby boy. Her pregnancy had been normal until the 32nd week when her blood pressure was noted to be high. She was monitored for pre-eclampsia (a pregnancy-related condition involving a combination of raised blood pressure and protein in the urine). Following the birth, Ms A suffered episodes of diarrhoea. This appeared to resolve and she was discharged home with her new baby. Midwives visited her at home over the following days and noted that she had had further episodes of sickness and diarrhoea, but again these were noted to have resolved.

Nine days after the birth, Ms A advised the attending midwife that she was unwell with tiredness, light-headedness, diarrhoea and vomiting. The midwife also recorded concerns about the baby's weight. Whilst arrangements were made for the baby to go back into hospital for checks, Ms A advised that she would attend her GP. Ms A became increasingly unwell and called Mr C for assistance. He took her to the Royal Alexandra Hospital where her condition continued to worsen. Ms A died of sepsis (infection in the blood) eleven days after giving birth to her son.

Mr C raised a number of complaints about the board's monitoring of Ms A's condition, the midwives' failure to note how ill Ms A was, and their failure to take Ms A back to hospital at the same time as her son. In each instance, we were satisfied that, based on the information available to staff at the time, there was no indication of a serious underlying condition. We acknowledged that the board had already highlighted some issues and had taken action to prevent these from happening again. We did not consider that these issues would have impacted on Ms A's care.