Health

Summary

Mrs C complained that doctors at Monklands Hospital did not examine her mother (Mrs A)'s ear for infection, or do a CT scan (computerised tomography: a scan which uses x-rays and a computer to create detailed images of the inside of the body), when she went to the hospital's emergency receiving unit. Mrs C felt that hospital staff did not take all steps to ensure that Mrs A received the best care.

We looked at Mrs A's medical records, and we took independent advice from one of our medical advisers. We also took into account relevant clinical guidance in Scotland about the diagnosis and management of headache in adults. The guidance referred to 'red flag' features, some of which could have applied in Mrs A's case given what was recorded in her medical and nursing records. We concluded that a CT scan should have been carried out, or at least the relevant hospital staff should have specifically recorded the decision not to perform a CT scan, in line with the guidelines. We also found that hospital staff should have examined Mrs A's ear for infection. We upheld Mrs C's complaints.

Recommendations

We recommended that the board:

• apologise to Mrs C and Mrs A's family for the failings identified in our investigation;
• remind relevant staff, in particular locum consultants who usually work elsewhere in the UK, of the specific national guidelines which are used in Scotland; and
• make reasonable efforts to share the result of our investigation with the staff involved.

Summary

Mrs C complained about the treatment she received when she was admitted to Monklands Hospital to have a blockage in her bowel investigated. This was examined in the operating theatre and the blockage was resolved there and then. However, Mrs C experienced excruciating pain and complained that she was not given an anaesthetic for the procedure. She said the consultant ignored her requests to stop. She also complained that she was asked to sign a consent form on her way to theatre, and she raised concerns about the board's handling of her subsequent complaint.

We took independent advice from a consultant colorectal (relating to the colon and rectum) surgeon. We were advised that Mrs C could have been offered anaesthesia or sedation for the procedure. The adviser noted that Mrs C was already taking strong pain medication when she was admitted, potentially indicating that she may have wished to receive something to control her pain during the procedure. We upheld this complaint.

The adviser confirmed that it was not appropriate for Mrs C's consent to have been obtained on her way to theatre, which the board had already acknowledged. We identified inconsistencies in relation to what happened during the procedure. The board said both that the consultant had stopped when asked by Mrs C, and that they had proceeded with Mrs C's verbal consent, but neither of these scenarios was documented in the operation note. We concluded that the informed consent process was not handled reasonably and we upheld this complaint.

We also upheld the complaint about the way the board handled Mrs C's complaint to them. There was an unreasonable delay that the board had already acknowledged and apologised for. We noted that there were omissions and inconsistencies in the board's response, and that it was overly technical in parts. We also noted that the board had not sought comments from relevant medical and nursing staff who were involved, and that could potentially have added value to the board's complaint investigation.

Recommendations

We recommended that the board:

• bring this decision to the attention of the consultant and team, and ask them to reflect on their decision not to offer Mrs C sedation or anaesthesia;
• review their process for obtaining informed consent, taking account of the failings this investigation has identified and relevant guidance in this area;
• ask the consultant to reflect on their operation note from this procedure with a view to identifying areas for improvement and ensuring that any significant interactions are documented in order to avoid similar future uncertainty;
• review their handling of Mrs C's complaint in order to identify areas for improvement and ensure compliance with their statutory responsibilities as set out in the Can I Help You? guidance; and
• apologise to Mrs C for the failings this investigation has identified.

Summary

Mrs C's father (Mr A) visited the practice on several occasions with stomach problems. Although an endoscopy (an investigation of the stomach using a camera) was considered early on, Mr A was instead treated for stress and anxiety for about six months, before an endoscopy was arranged. The endoscopy led to a diagnosis of stomach cancer.

Mrs C raised concerns that Mr A was not referred for an endoscopy sooner, and referred to an online article that recommended urgent referral for patients over 55 with unexplained and persistent dyspepsia (indigestion).

After taking independent medical advice from a GP adviser, we did not uphold Mrs C's complaints. Our adviser considered the GP's actions were consistent with the national guidance on dyspepsia, and reasonable in light of the information known at the time. Our adviser said that Mr A's dyspepsia was not unexplained, as he had been diagnosed with stress (and there were several factors that supported this diagnosis, including that Mr A's symptoms seemed to respond to medication for this). Our adviser also noted that the GP had appropriately checked for any 'alarm features' and regularly checked Mr A's blood tests. When Mr A's blood test showed an abnormality, he was appropriately referred for an endoscopy.

Summary

After Ms C was diagnosed with Lyme Disease (an infection transmitted by the bite of ticks) in 2014, she complained that her GP practice had failed to identify the symptoms of the condition at a consultation a year earlier. Ms C said that in 2013 she presented with a tick bite and large surrounding rash on her arm but the doctor she saw on that occasion did not offer her blood tests or antibiotics. Ms C was concerned that an electronic record of the consultation differed to the hand written entry by that doctor in her medical records and that a second doctor did not put accurate information in a referral letter to an infectious diseases specialist. Ms C also complained that a health care assistant was unprofessional with matters related to her blood test in 2014.

We took independent advice from one of our medical advisers who is a GP, and found that there was no evidence to indicate that Ms C had a bite mark on her arm or that the rash was typical of that associated with Lyme Disease. We considered, on balance, that the first doctor's assessment, diagnosis and suggested treatment were reasonable at the time. We also found that the electronic medical record did not differ materially from the handwritten record. Furthermore, the referral letter to the infectious disease specialist was consistent with the recorded entries in the medical records and were not inaccurate or misleading.

We concluded that it was good practice that the health care assistant had sought advice from a senior colleague regarding the blood test and took steps to appraise himself of the laboratory guidance. Whilst it was difficult for us to comment on the discussions between Ms C and the health care assistant, we obtained electronic records which provided an audit of the likely advice that Ms C was given by him during a phone conversation about the blood results.

We, therefore, did not uphold the complaints.

Summary

Mrs C, who is an advice worker, complained on behalf of Mrs A about the care and treatment she received at Caithness General Hospital in 2004/05 for a lump in her breast. In August 2013, Mrs A had a routine mammogram and was referred for further tests, after which she was diagnosed with breast cancer in the area that had been examined in 2004/05. Mrs A was concerned about the lack of communication by the surgeon in 2004/05 in relation to some test results which indicated an abnormality. She also complained that a procedure for exploring whether there was any sign of malignancy (cancer cells) was not properly performed; that she was wrongly advised that the lump would never be cancerous; and that she should have been kept under continual review.

The board found no failings in the treatment given in 2004/05. However, they acknowledged that there were failings by the surgeon in the record-keeping of one of her procedures, and that there was a lack of evidence that the results of a test which indicated an abnormality (but not malignancy) had been explained to her.

We took independent advice on this case from one of our medical advisers. We found that Mrs A was given appropriate investigations in accordance with national guidance in place at the time. However, we were critical of the poor record-keeping by the surgeon and the failure to explain all of Mrs A's test results. Therefore, we upheld this aspect. We did not identify evidence to support that Mrs A was given misleading information about the lump and, even though there was an abnormality in one of the tests, this was not a reason to keep her under continual review.

Recommendations

We recommended that the board:

• share with the surgeon the importance of ensuring test results are fully explained to patients and provide evidence that informed consent has been obtained where relevant.

Summary

Miss C complained that the board had unreasonably removed her pet from her property and had also failed to gain her consent to search her property.

We took independent advice from one of our mental health advisers. Our investigation found that, in the circumstances, the action taken to arrange for Miss C's pet to go into foster care was reasonable, but that it had not been reasonable to ask her to make a decision about the long-term future of her pet without allowing sufficient time to consider this and give her informed consent.

Our investigation also found that, given the concern about Miss C's welfare and safety at that time, it had been reasonable to search Miss C's home and remove medication. However, the record-keeping was unreasonable.

Recommendations

We recommended that the board:

• apologise for the failings identified in this case;
• ensure that the relevant staff reflect on the adviser's comments on the advisability of seeking permission to remove a pet permanently without allowing time to adequately consider the long-term consequences of such a decision; and
• ensure that the staff involved in Miss C's care review the adviser's comments about the standard of record-keeping and advise us of any action plan arising from this. Also, that consideration be given to putting in place consent and search policies to support the consent form.

Summary

Mrs C complained about the mental health care and treatment provided to her late son, as well as the lack of support for her and her family, the lack of family involvement in the critical incident review (CIR) following her son's death, and the delay in providing her with a copy of the CIR report. Mrs C also complained to the General Medical Council (GMC) about the psychiatrist involved in her son's care. The GMC investigated, and decided to take no action.

We decided not to re-investigate those matters which had already been considered by the GMC. However, we agreed to investigate some issues which had not been looked at by the GMC, including the conduct of a mental health assessment, the support provided to the family, and the complaints about the CIR.

After taking independent mental health advice, we upheld three of Mrs C's complaints. We found that the board unreasonably failed to include Mrs C in the CIR process and that the delay of over six months in providing Mrs C with a copy of the CIR report was unreasonable. However, we accepted that the board had apologised for this delay and taken appropriate steps to improve their CIR process.

We also found the board had not provided reasonable support for Mrs C and her family as carers. While the board had since amended their paperwork to improve involvement of carers at the assessment stage, we did not consider this was sufficient to prevent a recurrence, as the meaningful involvement of a person's relatives should be on-going, rather than completed as a one-off exercise.

In relation to the mental health assessment of April 2011, we found this had been conducted reasonably, and we did not uphold this complaint. However, we were concerned that there had been a delay in arranging a referral to a psychiatrist following this assessment, and we raised our concerns about this with the board.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings our investigation found; and
• advise us how they will ensure on-going carer involvement, in light of our adviser's comments.

Summary

Mr C complained that the prison health centre unreasonably refused to prescribe him detoxification medication. The board advised that a nurse carried out a number of assessments on Mr C which confirmed that he was not showing signs of withdrawal from drugs. Therefore, it was decided there was no medical need for him to be prescribed detoxification medication. We took independent advice from one of our GP advisers who confirmed that the care provided to Mr C appeared to be appropriate. Therefore, we did not uphold his complaint.

Summary

Miss C complained to her mother (Mrs A)'s medical practice about how they dealt with Mrs A in the last two days of her life. Miss C then complained to us that a GP failed to diagnose and treat Mrs A's condition; that reception staff wrongly referred her mother to NHS 24 rather than arranging for a house call from a GP; and about the practice's handling of her complaint.

We looked at the practice's file on Miss C's complaint and at Mrs A's medical records, and we took independent advice from one of our GP advisers. We found that Mrs A had a number of risk factors for a heart condition, and we decided that the GP should have taken these into account by reviewing Mrs A's blood pressure and pulse, given the possibility of a heart-related cause for her symptoms. We concluded that the assessment and treatment provided by the GP was not of a reasonable standard. We also concluded, on the balance of the available evidence, that reception staff were wrong to refer Mrs A to NHS 24, rather than offering an emergency appointment at the practice or a home visit from the on-call GP. We also found that the practice's handling of Miss C's complaint was not in keeping with the principles set out in the national NHS complaints handling guidance. We upheld Miss C's complaints.

Recommendations

We recommended that the practice:

• apologise to Miss C for not providing a reasonable standard of care, treatment and service to Mrs A;
• apologise to Miss C for the failure to deal with her complaint adequately;
• provide us with evidence of how practice medical staff learned from this case;
• review the practice protocol for late calls and emergency appointments; and
• refresh their understanding of national complaints guidance and review their complaints procedure to ensure that the procedure, and staff practice in dealing with complaints, is in line with the guidance.

Summary

Mr C complained on behalf of his brother (Mr A) that the board failed to diagnose Mr A's testicular torsion (the twisting of a testicle, which shuts off the blood supply and can result in the loss of the testicle) and inappropriately discharged him from the Southern General Hospital. Mr A later had to have a testicle surgically removed. Mr C was also unhappy with the board's handling of his complaint.

We found that, as acknowledged by the board, there was a series of failings when Mr A was in hospital. The main issue was that an on-call urologist (a doctor who treats conditions of the urinary tract) should have examined Mr A in person to exclude or confirm testicular torsion. We also found that hospital staff who were asked to comment on Mr C's complaint agreed that Mr A should not have been discharged without being examined by the urologist and being given an ultrasound scan (a scan that uses sound waves to create images of structures inside the body). A lack of available beds may have been a factor in Mr A's discharge.

We found that the board's investigation of Mr C's complaint was reasonably thorough, and their letter to him acknowledged failings and apologised for them. However, we found that the investigation was missing a statement from the doctor who took the decision to discharge Mr A. This was an important aspect of the events in question because it was this doctor who raised the issue about there being no available beds. In our view, the lack of evidence from this doctor compromised the board's investigation. We upheld all of Mr C's complaints.

Recommendations

We recommended that the board:

• share widely within the urology service the circumstances of Mr A's care;
• discuss the details of this case with the on-call urologist;
• share the circumstances of Mr A's care with the out-of-hours service and the emergency department;
• explain to us why a statement was not obtained from the doctor who discharged Mr A;
• ensure that the details of this case are discussed with the doctor who discharged Mr A; and
• provide us with confirmation regarding the availability of beds in relation to Mr A's discharge.