Health

Summary

Mr C complained about the physiotherapy and orthopaedic care he received from Forth Valley Royal Hospital after dislocating his knee-cap. He said that staff ignored his on-going symptoms and that he should have had a scan of his knee to identify what was causing him persistent pain. He was concerned that a locum orthopaedic specialist had wrongly diagnosed a meniscal tear (damage to cartilage in the knee) rather than a loose fragment under the knee-cap.

We took independent advice on this case from two of our advisers, one of whom is a physiotherapist and the other a consultant orthopaedic surgeon. We found that the physiotherapy management of Mr C's injury was in accordance with guidance on managing patients who have dislocated their knee-cap for the first time.

Whilst the board said that it would have been appropriate for Mr C to have had a scan prior to surgery, we did not consider that the diagnosis of a meniscal tear was unreasonable given that loose fragment can have similar symptoms. Furthermore, both meniscal tears and loose fragments can be treated by the surgery that Mr C underwent. We also considered that it was reasonable to proceed to surgery without a scan given that Mr C's symptoms were not resolving and were affecting his ability to work.

Summary

Mr C complained on behalf of his mother (Mrs A). He said Mrs A's GP practice had not diagnosed quickly enough that the symptoms she was suffering from were side effects of the medication she had been prescribed. Mr C said these side effects were well known. He did not believe the practice had been as aware as they should have been of these side effects, which had caused Mrs A unnecessary and prolonged suffering.

We took independent advice from a GP adviser on the care and treatment provided. The adviser said that the practice had reasonably considered Mrs A's ill health to be the result of a possible reoccurrence of breast cancer and had sought to rule this out. However, under national guidance for prescribing this medication, the practice should have been monitoring Mrs A's lung and liver function and they had failed to do so. The adviser noted the practice had subsequently taken all reasonable steps to address the failings in this case.

We found that the practice had not provided reasonable care and treatment, but they had taken the appropriate action to address this. We made no further recommendations.

Summary

Mr C complained about Victoria Hospital on behalf of his mother (Mrs A). He said that Mrs A had been prescribed a drug which had had serious side effects, causing liver damage and breathing difficulties. Mr C believed that these side effects were well known enough that they should have been considered sooner. Mrs A had been admitted to hospital by ambulance due to breathlessness, but was discharged with antibiotics. She was admitted again a few days later, but it took a further six days for the cause of her symptoms to be accurately identified.

We took independent advice from a specialist in emergency medicine, who said that Mrs A had been appropriately assessed on both admissions to hospital. The side effects she had were very rare, and it had been reasonable for medical staff to rule out more immediately dangerous and common causes for her breathlessness.

Summary

Ms C had gallbladder surgery at the Victoria Hospital. She was discharged without further follow-up but started to experience pain from a wound site. She was referred back to the board by her GP and had further surgery to address this. She was discharged the same day by nursing staff. Ms C complained that she had not been given a follow-up appointment following her initial surgery. She complained that her discharge at the second procedure was inappropriate as she was not reviewed by a member of the medical team. Ms C was also concerned that the board had failed to provide her with appropriate treatment following a further referral from her GP.

After taking independent advice from a nursing adviser and a consultant surgeon, we did not uphold Ms C's complaint about discharge. In relation to her concerns about the lack of follow-up after the first surgery, the surgical adviser confirmed that it is established practice not to offer a clinic appointment in such cases. Regarding the second procedure, we found that it is normal practice for patients to be discharged from day surgery cases without being seen by a doctor. The nursing adviser confirmed that appropriate checks had been carried out before Ms C's discharge. We noted that the board had taken learning from Ms C's complaint and were addressing her concerns about information that was provided to patients at discharge. Although we did not uphold this complaint, we made two recommendations to the board about the action they have taken.

We also did not uphold Ms C's complaint about the treatment she received following her GP referral. The surgical adviser considered that this had been appropriately managed.

Recommendations

We recommended that the board:

• provide evidence to confirm what action has been taken to improve the provision of information to patients on discharge; and
• advise us on the outcome of deliberations on offering patients the choice to see a doctor before discharge.

Summary

Mr C complained to the board about the care and treatment he received from a prison health centre for on-going back pain. He was unhappy that the doctor had not done enough to manage his pain or deal with the cause of it. The pain relief medication and physiotherapy were not helping, and he wanted another back operation.

We took independent advice from a GP adviser. We found that the doctor had followed Scottish guidance on the management of back pain, and prescribing painkillers and physiotherapy was appropriate given his symptoms. When Mr C reported that his pain was not improving with these measures, the doctor then referred him for surgical review. We concluded that the care and treatment was reasonable.

Summary

Miss C took her young son to A&E at Crosshouse Hospital as he was suffering from breathing problems and chest pain. A doctor arranged for a chest x-ray. He said there was no infection and discharged Miss C's son. Nearly a month later, Miss C's GP contacted her about a letter from the hospital stating that her son's x-ray had been misread. It said that he had pneumonia and required antibiotics. Miss C complained to the board about the delay in being told the x-ray had been misread. She said that her son's health had suffered as a result of this.

The board wrote to Miss C and apologised for the delay in notifying the GP of the x-ray report. While the x-ray had been interpreted initially by a doctor in A&E, this interpretation was incorrect. This was only found when the x-ray was formally reported on some 25 days later. A letter was then sent to the GP with the accurate report. The board offered an unreserved apology for the delay in reporting the x-ray, which was due to a combination of staff vacancies and demand on the service at that time. The board have since obtained additional support in an effort to reduce waiting times for imaging reports. The board said that the doctor who incorrectly interpreted the x-ray would be spoken to about their actions. They also said that the case would be discussed at clinical governance and audit meetings in order that lessons could be learned.

We took independent advice from a medical adviser who is a specialist in emergency medicine. The adviser confirmed that the time taken to formally report the x-ray was unacceptable even if there were staffing issues. We upheld the complaint. As the board had already apologised for the delay and had taken action to prevent a repeat occurrence, no recommendations were made.

Summary

Miss C complained that the board failed to provide appropriate medical treatment when she attended Crosshouse Hospital with a knee injury. At the hospital, she had been reviewed by the on-call doctor for orthopaedics (the medical specialism for conditions involving the musculoskeletal system). The doctor arranged for her to attend a knee clinic three days later. We took independent advice from a medical adviser, who is a consultant orthopaedic surgeon. We found that it had been appropriate to refer Miss C to the knee clinic and that this appointment had been arranged promptly. Consequently, we did not uphold this aspect of Miss C's complaint.

Then, six days after attending the hospital, Miss C had an operation on her knee. Afterwards, she continued to have pain and stiffness in her knee. She was referred to a physiotherapist, and for tests to check if she had a blood clot in a vein. She then saw the orthopaedic surgeon who had carried out the operation. The surgeon was concerned that Miss C might have complex regional pain syndrome (CRPS - an uncommon form of chronic pain, usually affecting a limb and typically developing after an injury, surgery, stroke or heart attack; the pain is out of proportion to the severity of the initial injury). The surgeon prescribed medication and referred Miss C for more physiotherapy. When this failed to improve things, the surgeon decided that Miss C had CRPS and referred her to a pain clinic and for hydrotherapy (the use of water in pain relief and the treatment of disease). However, Miss C decided to attend a private hospital and subsequently had further surgery. She complained to us about the treatment she received from the board in the months after her initial operation.

Based on the advice we received, we found that Miss C's operation was carried out satisfactorily and that her follow-up appointments were timely, appropriate and reasonably managed. We also found that the board had carried out adequate investigations regarding the pain and stiffness in Miss C's knee. Therefore, we did not uphold this aspect of her complaint.

Summary

Mr C complained about the medical care he had received while in prison. This related to the medication he was receiving for an old wound, and he also said that the board failed to provide appropriate follow-up treatment after an operation he had. Mr C also complained that the board failed to provide him with appropriate treatment for his depression, anxiety, post-traumatic stress and for his lack of sleep.

During our investigation, we took independent advice from a medical adviser, who is a GP. The complaint was investigated and showed that the treatment given to Mr C was reasonable and appropriate. The advice we received was that the management of his pain from the old wound was of a reasonable standard, entailed using appropriate evidence-based treatments, and that there was a regular review of his medical condition. In addition, the advice we received was that Mr C received reasonable follow-up care after his operation, and that he was receiving reasonable treatment and assessment of his mental health problems. Finally, we found no evidence that the board failed to provide appropriate treatment for his sleep difficulties.

Summary

Mr C said that his GP had referred him to hospital for a rheumatology appointment but that the rheumatology consultant had rejected the referral as he did not think it would have been of benefit to Mr C. Mr C said he had then been told by a pain management consultant that there was nerve root damage. Mr C had complained to the board. The board's response to Mr C's complaint explained that the initial referral was actioned quickly but there was no indication from the referral letter that Mr C's problems were due to inflammation (which would have triggered a referral to rheumatology). The rheumatology consultant had contacted Mr C's GP at the time and the GP had not advised him that Mr C's condition had changed. Mr C complained to us that the board had failed to adequately respond to his formal complaint.

We took independent advice from one of our advisers who told us that the nerve root damage described was not evidence of inflammation and as such the actions of the rheumatology consultant were appropriate. It was also noted that on receipt of the rheumatology consultant's letter, the GP had recorded that he also did not feel that a rheumatology assessment was appropriate. We found that the board's response to the formal complaint was appropriate and so we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her husband (Mr C) received at University Hospital Ayr following his admission with acute abdominal pain. In particular, she was aggrieved that a CT scan (computerised tomography - a scan that uses x-rays and a computer to create detailed images of the inside of the body) had not been carried out when he was first admitted to hospital. She complained that the delay in carrying out investigations and treatment had caused Mr C unnecessary suffering for three days.

During our investigation, we took independent advice from a consultant general surgeon. We found that the treatment given to Mr C was reasonable and appropriate. The advice we received was that there had been no delay in diagnosing and starting appropriate treatment, and there was no indication that a CT scan should have been carried out earlier than day three of Mr C's admission. Our adviser was satisfied that the CT scan and subsequent surgery which both took place on day three of Mr C's admission to hospital were carried out within a reasonable timeframe.