Health

Summary

Mrs C complained about the care and treatment her husband (Mr C) had received from the board in relation to brain tumours. We took independent advice on this part of her complaint from one of our medical advisers, who is a consultant neurosurgeon. We found that it had been reasonable not to give Mr C radiotherapy after a tumour had been removed at the Western Infirmary. However, Mr C had also been receiving other treatment that would have increased the risk of early or more rapid progression of a recurrent tumour. We found that it had been unreasonable for the board to wait eleven months before carrying out a follow-up scan. In view of this, we upheld this part of Mrs C's complaint. When the follow-up scan was then carried out, it showed a large recurrent tumour.

Mrs C also complained about the nursing care provided to Mr C whilst he was in the Southern General and Beatson Hospital. We took independent advice on this from a nursing adviser and we found that the care provided had been reasonable so we did not uphold this aspect of her complaint. Mrs C also said that the board had failed to adequately explain Mr C's condition and prognosis. Whilst the evidence in relation to this was not conclusive, the comments made by the consultant about the information given to the family were somewhat vague, and Mr and Mrs C had not fully understood what the consultant was trying to say. We found that, on balance, the information had not been satisfactorily communicated to Mr and Mrs C and so we upheld this aspect of the complaint. Finally, Mrs C complained about the board's handling of her complaint. We found that the board's response had been difficult to understand. It contained too much medical terminology and jargon that was not adequately explained. We upheld this part of her complaint for this reason.

Recommendations

We recommended that the board:

• issue a written apology to Mrs C for the failings we identified;
• make the relevant staff involved in Mr C's care and treatment aware of our findings; and
• remind the staff involved in the handling of Mrs C's complaint that responses to complaints should be clear and easy to understand.

Summary

Ms C complained that the board failed to adequately manage her Von Willebrand Disease (VWD – an inherited bleeding disorder) when she was admitted to Aberdeen Royal Infirmary for gall bladder surgery. She said she had previously been given medication for her VWD before dental treatment and treatment for cancer, but said this did not happen for her gall bladder surgery. Ms C also complained that the board failed to communicate properly with her about her VWD when she was in hospital.

We obtained independent medical advice on Ms C’s case from a consultant haematologist with specific expertise in blood clotting disorders. Our adviser said that Ms C’s VWF levels (levels of a blood protein which helps blood to clot) were checked on the day of her surgery and found to be within the normal range. As a result, the board decided not to treat Ms C with a concentrated form of the clotting agent, but to have it ready in case any problems arose. Our adviser said that this approach was reasonable.

The board apologised for the lack of communication with Ms C about her VWD and said that staff should have explained and discussed her condition with her. Our adviser said that communication could have been improved by checking Ms C’s VWF levels the day before surgery, rather than on the day of her surgery, and making a decision on whether she required treatment with the concentrated form of the clotting agent at that time. This would have allowed more time for discussion with Ms C about VWD and the proposed treatment, and at a less stressful time than on the day of her operation. This would have increased the chances of Ms C understanding and accepting the apparently conflicting advice about the management of her condition. We were critical of the board in this regard.

Recommendations

We recommended that the board:

• feed back our decision on the complaint about the board's communication regarding VWD to the staff involved.

Summary

Mr C complained to us on behalf of his daughter (Mrs A) in relation to two assessments she had at Forth Valley Royal Hospital’s psychiatric services. Mrs A’s mental health was deteriorating, and her family initially sought help for her from a GP, who referred her for a psychiatric assessment. She was subsequently sent home, so her family sought GP assistance again. Following a home visit, Mrs A was again referred for a psychiatric assessment, with a very similar outcome. Mr C complained that the family were only given the opportunity to explain why they were so concerned about Mrs A after her second psychiatric assessment, when they insisted on speaking to the doctor.

We took independent advice on this complaint from one of our advisers in psychiatry. The adviser was critical that Mrs A’s family were not expressly involved in either of the assessments. He said that this should be a standard part of such assessments. He also noted that insufficient weight was given to the GP’s concerns and findings. He noted that the first GP had done a detailed assessment and history, and this was not fully considered during either of Mrs A’s psychiatric assessments. The adviser noted that both doctors who assessed Mrs A were trainees, and expressed concern that there was insufficient documentation as to why Mrs A did not meet the criteria for detention at hospital. He also found that the plan for future follow-up was not practical and did not sufficiently involve her carers.

We considered the advice we received, and found that the psychiatric assessments had not been sufficiently robust. We therefore concluded that she was not given a reasonable standard of treatment. We also noted that the failings in this case potentially put Mrs A at significant risk, as her family no longer felt able to keep her safe.

Recommendations

We recommended that the board:

• review the training for those involved in emergency assessments to ensure it highlights the importance of a corroborative history from relatives and carers; the concerns and findings of GPs; full documentation of consideration of a patient for detention in hospital, including clear links to the legal criteria for that detention; and a practical plan when a patient is not detained, involving carers, and including advice and guidance on potential future action;
• remind existing staff involved in emergency assessments of the requirements specified above; and
• apologise to Mr C and to Mrs A for the failings identified, for the distress they caused, and for the risks that these led to for Mrs A.

Summary

Mr A was referred by his GP to the ear, nose and throat clinic at Forth Valley Royal Hospital with a swelling below his left ear. This was found to be cancerous and Mr A was referred to another health board for surgery. This surgery resulted in extensive facial disfigurement and Mr A's daughter (Mrs C) complained that the board failed to explain the extent of Mr A's cancer and the impact the surgery would have on him. Mrs C also complained about delays following surgery in arranging onward referrals for Mr A to various specialists.

The board apologised that Mr A and his family were not adequately prepared for the life-changing results of the surgery, and they developed an improvement plan to address the concerns raised. They noted that their consultations with Mr A occurred at a very early stage in the process of preparing him for major surgery. They indicated that their role was to provide an overview and the intention was for a more detailed explanation to be provided by the board who were carrying out the surgery.

We took independent medical advice from a consultant maxillofacial surgeon (doctor specialising in the treatment of diseases affecting the mouth, jaws, face and neck). The adviser confirmed that the board carrying out the surgery were responsible for explaining the procedure and obtaining informed consent. He considered that the board had appropriately carried out their duties in this case. However, he noted that the communication between the two boards appeared to be lacking. He found no evidence of a formal referral to the other board having been made and he considered there was a lack of clarity regarding the respective role of each board. This also applied to the handover between the cancer nurse specialists at each board, which meant that relevant patient information literature was not given to Mr A. The absence of clear lines of responsibility also resulted in a delay in arranging relevant onward referrals following surgery. We accepted the advice we received and upheld the complaints, recommending that the board further develop their action plan in light of our findings.

Recommendations

We recommended that the board:

• develop their action plan further to take account of the failings this investigation has identified and the adviser's suggestions for areas of improvement.

Summary

Mr C complained that the board failed to prescribe him specific medication for his drug addiction, and that his drug worker did not listen to his concerns.

We looked at Mr C’s medical records, and we took independent advice from one of our medical advisers. We found that the prison health centre kept detailed records of consultations with Mr C, and that they took his state of health into account when deciding not to prescribe him the specific medication he wanted. The records confirmed that assessments carried out by Mr C’s drug worker were appropriate. We concluded that the prison health centre’s actions were reasonable in the circumstances, and that the care provided by them was of a reasonable standard. We did not uphold Mr C’s complaint.

Summary

Miss C complained to the medical practice because she said the doctor had inappropriately told her mother (Mrs A) at a consultation that she had been diagnosed with dementia. Miss C said the doctor repeated the diagnosis of dementia to both herself and her father in further phone calls. However, it was confirmed that Mrs A did not have dementia. The doctor denied telling Mrs A and her family that she had been diagnosed with dementia. Instead, the doctor said she advised that there was a possible diagnosis.

Having reviewed the related medical information, the evidence available suggested dementia was being explored as a possible diagnosis and at no point was it confirmed as having been diagnosed. We did not see any evidence to suggest that the doctor, or any of the other clinicians involved in Mrs A's case, had confirmed a diagnosis of dementia. Therefore, we did not uphold the complaint.

Summary

Mrs C had been receiving medication prescribed by her medical practice for around ten years. However, the practice reviewed her medication and decided to stop it. Mrs C complained to us about the decision to stop her medication and the practice’s response to her complaint.

We looked at the practice’s complaints file and Mrs C’s medical records, as well as taking independent advice from one of our GP advisers. Relevant guidance stated that medical practices should review medication periodically. We found that the practice had done so, while also taking advice from appropriate specialists. In addition, the practice had offered Mrs C an alternative, which was to receive her medication on a private prescription.

Although the practice’s response to Mrs C’s complaint could have provided some additional information, it dealt with the key point of why they would no longer prescribe the medication to her, which we decided was reasonable in the circumstances. We did not uphold Mrs C’s complaints.

Summary

Mr C had treatment to extract two teeth. Immediately after the treatment, he complained about the treatment received and that the dentist had failed to take reasonable account of his hearing condition. He complained that his dentist took too long to carry out the extractions and that he did not appear able to carry out the extractions. He also said that he had advised his dentist of his need to lip read in order to fully understand what was being said to him. However, during the procedure, the dentist had continued to speak to him with a mask on.

We took independent advice from our dental adviser, who said that the treatment Mr C received was reasonable and appropriate and that, while the extractions had taken some time, this was reasonable in this case. Our adviser explained that guidance issued by Health Protection Scotland requires dentists to wear full personal protection equipment (PPE), including a mask, during any operative procedure. As such, he considered that it would not have been reasonable to expect the dentist to repeatedly stop the procedure and remove his mask to speak to the patient. This would have required the dentist to remove his PPE, undertake hand hygiene and put on new PPE on each occasion that he stopped to speak to the patient. However, we were mindful of Fife NHS Board's advice that requires staff to respect disabilities. We considered that, in the circumstances, consideration should have been given to offering Mr C the services of an advocate/translator/interpreter or similar. This would have ensured that he fully understood what was being said to him during the procedure.

Recommendations

We recommended that the dentist:

• reflect on this case to guide future practice to ensure that a patient's communication needs are being met. In particular, that in a similar situation consideration should be given to offering a patient the services of an advocate/translator/interpreter or similar who could speak to the patient without wearing a mask.

Summary

Mr C raised concerns about the care and treatment he received when he attended the practice in 2014. In particular, he complained that the practice had failed to take reasonable account of his hearing condition. He said the dental nurse had spoken to him while standing behind him and, as a result, he had been unable to lip read. In addition, she had roughly moved his head. He also complained about the handling of his complaint.

During our investigation we found no evidence that the dental nurse had roughly moved Mr C's head or spoken to him while standing behind him. We were satisfied that, in line with the practice's policy, the dental nurse was required to wear a mask during the treatment. We were pleased that the dental nurse had re-read the relevant guidelines to try to prevent a similar situation occurring in the future. However, we considered that had a translator been present, as detailed in Fife NHS Board's policy, Mr C's communication needs would have been fully met.

We were also critical of the handling of Mr C's complaint and we made a number of recommendations to improve how the practice communicates with patients, and how they deal with complaints.

Recommendations

We recommended that the dentist:

• reiterate the apology offered in a letter to this office to Mr C;
• review the Disability Policy to ensure that the communication needs of patients are being met in line with Fife NHS Board's policy on Equality and Human Rights;
• apologise for the failures identified in this case in relation to complaints handling; and
• review procedures to ensure that the practice deals with complaints in accordance with the NHS complaints procedure.

Summary

Ms C complained about the care she received when she attended A&E at Crosshouse Hospital. She also complained about the care she received from the out-of-hours service at Ayrshire Central Hospital. Ms C presented with abdominal pains and was diagnosed with a viral infection. She was prescribed painkillers and anti-sickness medication, and was then discharged. She was later diagnosed with acute appendicitis (inflammation of the appendix) and underwent surgery to have her appendix removed.

We sought independent advice from one of our advisers who specialises in emergency medicine, and one of our GP advisers. They both noted that appendicitis is difficult to diagnose as the symptoms it often presents with are similar to many other, more common, conditions. The views of the advisers were that, on both occasions, Ms C was examined thoroughly and given the correct advice and medication based on her symptoms at the time. Therefore, we did not uphold the complaint.