Health

Summary

Mrs C said that she had moved to a new GP surgery, where her symptoms had been quickly diagnosed as due to hyperthyroidism (excess thyroid hormone). Mrs C then complained to her former GP practice that she had reported the same symptoms to them for the past two years but they had failed to reach the true diagnosis. She complained that she may have been prescribed inappropriate medication.

The practice maintained that they had provided appropriate treatment based on the symptoms reported at the time. They apologised for the failure to order a set of blood tests on one occasion and said this was caused by an administrative failure. They said that it was not possible to say that hyperthyroidism was present at that time.

We sought independent advice from a GP adviser. The adviser considered that, other than the failure to carry out specific blood tests on one occasion, the practice had performed appropriate investigations in an effort to reach a diagnosis. The symptoms which Mrs C had shown during the period were not classically suggestive of hyperthyroidism. The adviser did not think it was a failure that the GPs at the practice were not alerted to a possible alternative diagnosis. We did not uphold the complaint.

Summary

Mr C complained that the treatment provided to him for his shoulder injury was unreasonable. In particular, he said the health centre had only prescribed him pain relief, and had not arranged for him to have a scan or referred him for physiotherapy.

We found that Mr C had been assessed by a doctor several times due to his shoulder pain, and that medication for his pain had been prescribed. We took independent advice from a GP adviser on whether the treatment provided to Mr C was reasonable. The adviser noted that Mr C had indicated he had muscle pain but there were no concerns about swelling, bruising or restricted movement. The adviser explained that symptoms like these would have indicated trauma or a fracture. As Mr C did not have those symptoms, the adviser considered it was reasonable for the doctor to treat Mr C's shoulder pain with painkillers. The adviser also said that referral to a physiotherapist was not necessary because Mr C had a full range of movement in his shoulder joint. The adviser also said a scan was not necessary because Mr C did not have symptoms to suggest he had a fracture.

In light of the evidence available, we did not uphold Mr C's complaint.

Summary

Mr C visited the practice about his cough. He was referred for an x-ray, which took place the following day. Mr C contacted the practice three times for the results and was told that they had not arrived. Mr C's symptoms worsened and he was admitted to hospital with pneumonia and heart failure. Mr C complained that the practice did not have adequate procedures in place to identify that his x-ray report was missing.

Normally, a paper copy of the x-ray report would be sent to the practice and uploaded to the practice's information management system. In this case, for reasons we were unable to establish, the report was not uploaded. This suggests the report may not have been received. The GP at the practice was able to access the report through the hospital's computer system when they realised that the report had not been received. However, the GP was only prompted to do this after receiving notification of Mr C's hospitalisation.

The practice apologised to Mr C and explained that there was a gap in their protocols for occasions when information was not received in the normal way. They explained that they had updated their protocols for dealing with patient phone calls regarding x-ray results. The new protocol meant that, if a patient contacted the practice three weeks or more after an x-ray for which no report had been received, reception staff would advise the GP who requested the x-ray. The GP would then check for the report on the hospital's computer system. The practice were also piloting a new process to keep copies of x-ray requests with the aim of ensuring the practice followed up on any results not received after four weeks.

We took independent advice from a GP adviser. We found that the practice did not have adequate procedures in place to identify that Mr C's x-ray report was missing and so we upheld his complaint. We recognised that the practice had apologised and made changes to their protocols to prevent a recurrence, and we felt that there were no further actions required.

Summary

Mrs C complained on behalf of her sister (Miss A) about care received from her GP practice on two occasions. Mrs C complained that the practice did not thoroughly investigate Miss A's symptoms and did not provide reasonable treatment.

We took independent advice from a medical adviser. The adviser said that, based on the consultation notes, the care Miss A received was of a reasonable standard, and we did not uphold the complaint.

Summary

Miss C complained about treatment she received at the Glasgow Dental Hospital. She provided a copy of the board’s response to her complaint. Our initial view was that the actions the board said they took in response to her complaint were reasonable. These actions were, firstly, that a clinician would review Miss C’s case and bring to the attention of all staff the need for clear and open communication with all patients. Secondly, Miss C’s case would be used as a learning opportunity with staff.

We asked the board for evidence of the actions they took. We found that the review of Miss C’s case by the clinician was done as part of the board’s investigation into her complaint. The board should have told Miss C that the clinician had reviewed her case as part of their investigation, rather than promising future action which had, in fact, already happened for a different purpose. The board were unable to provide us with sufficient evidence that the other actions had been carried out. We upheld Miss C’s complaint, and recommended that the board take the actions they told her they would.

Recommendations

We recommended that the board:

• bring to the attention of all staff within the service the need for clear and open communication with all patients;
• ensure that Miss C's case is used as a learning tool with staff; and
• ensure that Miss C's case is discussed with the dentist involved.

Summary

Mr C complained that the board unreasonably failed to repair a hernia (where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall) above his navel during surgery at Glasgow Royal Infirmary. He said that, after the operation, his hernia was still in place and the scar from the operation was located below his navel, rather than above it. Mr C was concerned that his hernia had not been operated on at all. He said that he repeatedly asked to speak to a member of the operating team about this but no one came to see him. Mr C also said that the board provided an inadequate response to his complaint.

We obtained independent medical advice from a consultant in general and colorectal surgery. The adviser said that the notes of Mr C’s original operation, together with the notes from the operation to finally repair the hernia the following year, indicated that the consultant did operate on the hernia above Mr C’s navel during the original operation. The adviser said that the location of Mr C’s surgical scar below his navel did not mean that his hernia was not operated on. The adviser explained that it was standard practice to make an incision in the natural skin crease just below the navel when repairing a hernia around the navel. However, the adviser said that Mr C’s hernia was inadequately fixed as it was present after his surgery.

We considered that the evidence in the nursing notes suggested that Mr C did ask to speak to a member of the surgical team after his operation. We accepted the adviser’s view that there was a failure by the board to communicate with Mr C at this time. We also found that the board did not appropriately investigate and address each element of Mr C’s complaint.

Recommendations

We recommended that the board:

• take steps to contact the consultant and feed back our decision on this case;
• feed back the failing identified in Mr C's complaint about complaints handling to the staff involved; and
• provide Mr C with a written apology for the failings identified in our investigation.

Summary

Mrs C complained that a trans-abdominal (TA) ultrasound scan (performed by passing the scanning device over the abdomen) she had received at Glasgow Royal Infirmary had not been properly carried out. As a result, she had been forced to seek private treatment. This had consisted of a gynaecological (relating to the female genital tract) examination and a trans-vaginal (TV) ultrasound scan (performed through the vagina, using a slim probe), as well as a TA scan. Three gynaecological problems were identified which Mrs C said the board would have identified if the scan had been done properly. Mrs C also complained that the board had failed to respond to her complaint properly.

We received independent advice from a consultant sonographer (a doctor who performs and analyses diagnostic ultrasound tests). The adviser said that the board's appointment times were too short to carry out the two separate types of scan needed in this case. The adviser noted, however, that of the problems identified during the private consultation, only one would have been apparent had Mrs C received both types of scan. We were advised that the outcome for Mrs C would not, therefore, have been different had she received both types of scan.

We found that, although there was no evidence the short appointment had caused Mrs C harm, she had not received the appropriate scans for her gynaecological condition. We found that the board had, however, responded appropriately to Mrs C's complaint.

Recommendations

We recommended that the board:

• review its standing operating procedures to ensure they provide greater clarity on when a trans-vaginal scan should be performed;
• review the time allocated for ultrasound appointments taking into account any relevant guidance; and
• apologise for the failings we identified.

Summary

Mrs C complained to us about the nursing care that her father (Mr A) received at the Royal Alexandra Hospital. We took independent advice on this complaint from a nursing adviser. We found that there had been some problems on the ward in relation to communication and drug administration. However, we found that the nursing care provided to Mr A had been reasonable overall, as were the arrangements made for his discharge. We did not uphold this aspect of the complaint.

Mrs C also complained that the board had not appropriately assessed her father for NHS continuing care (a package of care provided and solely funded by the NHS) when he had been discharged from hospital. She also considered that they had not dealt appropriately with her request for a review of the decision that her father was not entitled to NHS continuing care. We took independent advice on this aspect of the complaint from a medical adviser who is a consultant in acute medicine for older people and general medicine. We found that the initial assessment of Mr A for NHS continuing care and the subsequent reviews were all appropriate. Although some incorrect dates were used in the board's correspondence, and some of the documentation was not fully completed, we also found that the communication with the family had been reasonable overall. In view of this, we did not uphold this aspect of the complaint.

Summary

Mr C complained about the treatment provided for a wrist injury that his client (Mr A) suffered while overseas.

Mr A attended hospital overseas where his wrist was put in a cast. He was told to attend hospital on his return home, which he did. The doctor arranged x-rays of the fracture and changed the cast. Mr A was reviewed a week later, and the cast was changed again. Mr A was reviewed four weeks later and told his wrist had healed (although the joint was tilted back slightly). He was discharged. However, Mr A continued to suffer symptoms of pain and loss of movement in his wrist, which he said were worse than his pre-existing symptoms from an old injury. He attended a private hospital, where he was told that his fracture had healed badly, and he had corrective surgery, which improved his symptoms. Mr A complained to the board about his initial care.

The board acknowledged that Mr A’s fracture had healed with the wrist tilted slightly, but said this was satisfactory. The board noted Mr A’s history of wrist pain going back to his old injury, and said that his pain was due to the new fracture exacerbating his osteoarthritis from the old injury.

After taking independent advice from a consultant orthopaedic (relating to the musculoskeletal system) surgeon, we upheld Mr C’s complaint. The adviser said the early x-rays clearly showed Mr A’s fracture was unstable and likely to heal badly, and the board should have offered Mr A the option of surgery at that stage (to prevent the fracture healing badly). The adviser also said that the badly healed fracture was the likely cause of Mr A’s additional pain and symptoms, and the board should not have discharged Mr A without offering him corrective surgery.

Recommendations

We recommended that the board:

• issue a written apology to Mr A, acknowledging that the treatment for his wrist fracture was unsatisfactory; and
• ensure this complaint is raised with the consultants involved as part of their annual appraisals, and that any training needs are addressed.

Summary

Mrs C had a hysterectomy (surgery to remove the uterus (womb)) at Aberdeen Royal Infirmary. She was later discharged and made an appointment with her local hospital (which is in another NHS board area) to have her wound clips removed. A short time after the removal of the clips, once Mrs C had returned home, her wound split open and she had to be admitted to hospital for emergency surgery. Mrs C complained to the board that it was unreasonable that her wound had reopened and that the discharge arrangements were not reasonable.

We took independent advice from a medical adviser, who is a consultant gynaecologist. We did not uphold Mrs C's complaint about her wound reopening. The adviser agreed with the board's own view that this is a recognised, but rare, complication of abdominal surgery. We upheld Mrs C's second complaint regarding discharge arrangements. The adviser considered that there was evidence of leakage from the wound prior to Mrs C's discharge which was not acted on appropriately. During their own investigation, the board had identified failings with the information provided to Mrs C when she was discharged from hospital. However, the advice we received found some remaining issues with the discharge advice and the checklist that the board introduced as a result. We made three recommendations in relation to this.

Recommendations

We recommended that the board:

• issue a written apology to Mrs C, acknowledging the failings our investigation has identified;
• ensure there is feedback to relevant staff on the findings of our investigation; and
• review their checklist and discharge advice for patients who have undergone hysterectomies, in view of the adviser’s comments.