Health

Summary

Mrs C complained about the care her son (Mr A) received from Cornhill Hospital in 2014. Mrs C was unhappy that Mr A's anti-psychotic medication was reduced and that his short-term detention under mental health legislation was revoked.

We took independent advice on this case from two mental health specialists. We found that it was reasonable for the medication to be reduced given that Mr A had not shown signs of psychosis or mood disturbances during his hospital admission. We also found that the decision to revoke the short-term detention was appropriate and in accordance with mental health legislation which sets out that at all times the least restrictive option is consistent with best practice.

Summary

Miss C had an ovarian cyst. A referral was made for it to be drained and possibly removed. The surgeon reviewed Miss C's notes the day before the operation was due to be carried out. They determined the procedure was inappropriate in the circumstances and that removal of both ovaries was recommended in guidelines produced by the Royal College of Obstetricians and Gynaecologists. Miss C was unaware of this change until she arrived at Aberdeen Royal Infirmary the following morning. After discussion, the operation went ahead. Miss C subsequently complained that consent was not properly obtained and that inappropriate treatment had been provided in light of her existing conditions, particularly fibromyalgia (a long-term condition that causes pain all over the body).

After taking independent advice from one of our advisers, who is a consultant gynaecologist, we upheld Miss C's complaint about consent. We found that the guidelines recommended removal of both ovaries in most cases but said that this should be determined by the wishes of the patient. The adviser considered that as it had been clear that Miss C had concerns, removal of just the affected ovary should have been discussed as a compromise, but this did not happen. We considered that Miss C should have been offered this information as part of the consent process. The adviser also highlighted concerns about the consent procedure, although it was noted that some changes had taken place following Miss C's complaint.

In relation to Miss C's other complaint, the adviser explained that there is a large volume of literature on the effects of hormones on fibromyalgia, but that most of the findings are contradictory. It was therefore considered that it would have been impossible to assess if the removal of both ovaries would affect Miss C's existing conditions and we did not uphold this complaint.

Recommendations

We recommended that the board:

• issue Miss C with an apology for the failure to advise her of the option of removing the affected ovary only; and
• review the process for obtaining consent, taking the adviser's comments into account.

Summary

Mrs C complained to us about the care and treatment her late father (Mr A) received at Aberdeen Royal Infirmary before his death from a urological cancer (relating to the urinary system and male reproductive system) that had spread through his body. Mrs C said that the urology care and treatment the board had provided to her father over a number of years had been inadequate. We took independent advice on this aspect of Mrs C's complaint from a number of medical advisers who are specialists in various relevant fields. We found that, although communication with Mr A and his family could have been better, there had been no major failings in relation to the urology service's care and treatment of Mr A. We did not uphold this complaint.

Mrs C also complained about the care and treatment the board had provided to her father over a number of years for his abdominal symptoms. We upheld this complaint, as we found that there had been a delay in carrying out a colonoscopy (examination of the bowel with a camera on a flexible tube) or alternative investigations. Although this led to a four-month delay in diagnosing Mr A's rectal tumour, there was no impact on the overall outcome, as the tumour was benign (non-cancerous). Mr A's urological cancer had already spread to other parts of his body by that time.

Mrs C also complained that the board had provided inadequate care and treatment to her father in the last few weeks of his life. Although we found that the care Mr A had received in relation to his visual problems had not been adequate, we found that the end of life care provided to him had been reasonable overall. We did not uphold this aspect of the complaint.

Finally, Mrs C complained about the board's handling of her complaint. We found that the board's former medical director should have ensured that Mrs C's correspondence to him was dealt with as a complaint rather than trying to deal with the matter personally. We also found that comments the former medical director had made to Mrs C in an email had been inappropriate, and that it had also been inappropriate to send Mrs C a gift voucher. In view of this, we upheld this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mrs C for the failings we identified;
• take steps to make the surgical staff responsible for the delay in the colonoscopy or alternative investigations being carried out aware of our decision on this matter and consider if the matter should be discussed at their annual appraisal;
• make the staff in the gastroenterology team aware of our comments on communication with Mrs C and Mr A;
• provide us with evidence that steps have been taken to improve the care delivered to patients with visual impairments since Mr A was in hospital; and
• provide evidence to us that the recommendations made in relation to their investigation into the former medical director's actions have been implemented.

Summary

Mrs C complained that her brother (Mr A), who has mental health problems, was able to access alcohol and/or illicit drugs while he was a patient in the Forth Valley Royal Hospital. Mr A did not give his consent for Mrs C to pursue her complaint on his behalf with the board or us, so we were unable to investigate her specific concerns. However, we did investigate the matter in general terms to ensure that the board had sufficiently robust policies and procedures in place to address the types of concerns Mrs C was raising.

We took independent advice from a mental health nursing adviser. We reviewed the relevant national legislation, the Mental Health (Care and Treatment)(Scotland) Act 2003 and the Mental Health (Safety and Security)(Scotland) Regulations 2005. The adviser was satisfied that the board's policies and procedures complied with the legislation and were practical, clear and reasonable. In these specific circumstances, we were unable to determine if the policies and procedures had been followed in Mr A's case. However, we were satisfied that the policies and procedures were sufficiently robust to ensure patient safety if used appropriately.

Summary

Mr C complained that the decision to stop his prescription for co-codamol was unreasonable. He said he had been prescribed the medication for around two years for arthritis but the doctor stopped it without explaining why.

We reviewed Mr C's medical records and we took independent advice from a medical adviser who is a GP. We found that the prison health centre doctor took the decision to stop Mr C's prescription for co-codamol because there was no medical evidence available to indicate that he had arthritis. The adviser told us that the doctor's decision was reasonable. They also confirmed that the doctor prescribed another suitable medication for Mr C's muscular and bone pain.

In light of this information, we did not uphold Mr C's complaint.

Summary

Mrs C complained on behalf of her son (Mr A) who had been admitted to Forth Valley Royal Hospital with chronic liver disease. Mrs C said she believed the care and treatment provided to her son had been inadequate, highlighting poor dietary input as a particular concern. Mrs C also said the decision to discharge him had been inappropriate, as he had refused all treatment at home and died a few days later.

We took independent medical advice on Mr A's treatment and discharge. The adviser said that Mr A had been provided with all treatments short of a liver transplant. The advice noted that Mr A had been adamant that he wished to be discharged and that he was prepared to refuse to eat or drink in order to achieve this. Although it was arguable Mr A should have been made to discharge himself, he had been provided with follow-up care as an out-patient. Mr A had refused to engage with this treatment.

We found Mr A's care and treatment had been reasonable and that the decision to discharge him was also, on balance, reasonable.

Summary

Mr C complained to us about the care and treatment he had received from the board at a prison health centre in relation to his stomach pains. We took independent advice from a medical adviser. We found that the care provided to Mr C in relation to his stomach pains had been of a reasonable standard and we did not uphold the complaint.

Mr C also complained that the board failed to provide a reasonable response to his complaints about this. We were satisfied that the board had acted in line with their complaints procedure and that they had issued a reasonable response to Mr C's concerns. In view of this, we did not uphold this aspect of Mr C's complaint.

Summary

Mr C complained to us that staff at Forth Valley Royal Hospital had removed a cannula (a small tube inserted into the body that can be used to drain fluid or to give medication) against his will when he was being discharged from hospital. We took independent advice on the complaint from a medical adviser. We found that it had been reasonable for staff to remove the cannula, as there was a risk of infection. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the board failed to deal with his complaints about this appropriately. He had complained to a prison health centre and they sent the complaint to the board's complaints handling team to respond. However, the complaints handling team did not receive the complaint and, as a result, Mr C did not receive an acknowledgement or a response to his complaint at that time. He had to write to the board again and faced a significant delay before receiving a response to the complaint. Some of the information in the board's response was also factually inaccurate. In view of this, we upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failings identified;
• provide evidence that they have taken steps to ensure that all complaints referred by prison health centres to their Patient Relations and Complaints Service are received and responded to; and
• remind complaints handling staff that responses to complaints must be factually accurate.

Summary

Over a period of time, Ms C began to experience constant bloating, was unable to lose weight and was concerned about other symptoms. She attended her GP, who examined her stomach and said there was excess fluid but he was not concerned. The GP's note of this consultation said that Ms C was doing well with her diet, had lost three stone, but felt she was putting weight on despite not changing anything. He arranged routine blood tests which came back normal. Ms C's symptoms got worse. A few weeks later she attended a different GP. The GP found what she thought was a cyst on Ms C's left ovary and a scan confirmed this. Surgery removed a very large (30 centimetres by 24 centimetres) cyst. Ms C complained that the care and treatment she received from the first GP was inadequate.

We sought independent advice from a GP adviser. The adviser considered the relevant General Medical Council (GMC), Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Health and Care Excellence (NICE) guidance. They concluded that the note of the appointment was not of a reasonable standard as it was sparse in detail, showed evidence of only a very limited recorded history, and no evidence of a medical examination. The adviser explained that Ms C's symptoms required examination and follow-up, neither of which was recorded. They also considered that the note did not show evidence of good communication or working in partnership with patients so it was not of a reasonable standard. The adviser explained that, in line with SIGN and NICE guidance on the investigations needed to exclude ovarian cancer, Ms C should have had a particular blood test and a scan. Therefore, we found that reasonable investigations were not carried out.

We upheld Ms C's complaint and made several recommendations.

Recommendations

We recommended that the practice:

• ensure the GP apologises to Ms C for the specific failings identified by our investigation;
• ensure the GP familiarises himself with the SIGN and NICE guidelines in relation to the presenting features of possible ovarian cancer, and identifies this as a learning need for his yearly appraisal;
• ensure the GP reviews his medical record-keeping and provides evidence of improvement;
• ensure the GP reviews and reflects on his communication with patients; and
• ensure they make certain their complaints handling procedure is fully compliant with the Patient Rights (Scotland) Act 2011 and the Scottish Government 'Can I help you?' guidance.

Summary

Miss C complained about the board after using their Ayrshire Doctors on Call (ADOC) out-of-hours service twice. She was unhappy with the treatment she received as, on the first occasion, her gallstones were misdiagnosed as muscular pain. The second time she received the correct diagnosis, but was sent home with painkillers and asked to attend her GP the next morning.

We took independent advice from a medical adviser who is a GP. The adviser said that the treatment Miss C received on her second presentation was reasonable. She was given the correct diagnosis and her symptoms did not justify an emergency hospital submission. Therefore, the correct course of action was to direct her to her GP to arrange an ultrasound scan. However, based on the symptoms Miss C presented with on the first occasion, the adviser considered the diagnosis of muscular pain she received from a nurse practitioner was not reasonable. The adviser felt that further investigation or a referral to the GP should have been made. As such, we upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Miss C for the failings identified;
• share the outcome of this complaint with relevant ADOC staff; and
• discuss the issues identified with the nurse practitioner to assess whether any additional learning is required in the assessment and diagnosis of acute abdominal pain.