Health

Summary

Mr C complained about the care and treatment given to his son (Mr A) in the month before he died. Mr A had two consultations at the practice during this period. During the consultations he expressed concern about his mental health. At his second appointment he saw a locum GP, who noted that his mood was lower. They discussed whether he should be off work, and he was prescribed anti-depressants. He also completed two questionnaires in a public place within the practice. He later reported to Mr C that he had found it difficult to complete these in such a public place. Nine days later Mr A took his own life. The GPs involved both met with Mr C and his family in the weeks after his death, and a significant event analysis (SEA) was conducted four months later.

Mr C complained that Mr A was not given enough support when he needed it, that he should have been signed off work, and that the locum GP should have had greater involvement in the SEA.

We sought independent advice from one of our GP advisers, who reviewed Mr A's notes. She said that, on the basis of these notes, the discussions at both appointments had been reasonable, that due consideration had been given to Mr A's symptoms, and that his subsequent death could not have been predicted. The adviser was also satisfied that the SEA was in line with NHS guidance.

We considered that, while Mr A's death was tragic and a sad loss for his family, the care and treatment he had from the practice was reasonable, and the GPs involved could not have predicted that his mental health would decline as it did. We were satisfied that the SEA had been conducted in a reasonable manner, and appropriately took into consideration a report provided by the locum GP.

Summary

Mrs C complained that GPs at the practice failed to provide her late husband (Mr C) with appropriate treatment over an eight month period. Mr C had reported symptoms of stomach pains and cramps and, despite changes to his diet and medication, the symptoms persisted. Eventually Mr C asked to be referred to a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas) where it was diagnosed that he had a bowel blockage which turned out to be cancerous. The practice said that Mr C had shown signs of severe diverticulitis (a disease of the digestive system) for many years but had refused to give permission for investigations during that time. It was only recently that he had given permission for a referral to be made to hospital specialists who confirmed the diagnosis. Mrs C did not believe that the practice had sent reminder letters to Mr C and said that the practice should have followed this up.

We took independent advice from one of our GP advisers. We found that the practice had acted appropriately in that they had documented that they had advised Mr C of the risks should he fail to have further investigations carried out. They also explained what further investigations were required and that it was his decision whether or not to agree to the further investigations and that he should reconsider the options at regular intervals. The practice were not responsible for arranging the further investigations but would have referred Mr C to hospital specialists who would decide which further investigations were appropriate.

Summary

Ms C complained to the practice about treatment that her son (Mr A) had received. She was unhappy with the response that she received and information that was provided about the principal dentist at the practice.

After investigating, we upheld Ms C's complaint. We considered that although the response to her complaint about treatment addressed her concerns adequately, there were a number of other complaints handling failings. We found that the response letter did not refer Ms C to us if she remained dissatisfied with her complaint and that the practice's complaints handling procedure was not in line with the relevant Scottish Government guidance. We also found that there had been a failure to advise Ms C of changes to the staff structure at the practice in a timely fashion.

Recommendations

We recommended that the practice:

• issue a written apology to Ms C, acknowledging the failings our investigation found;
• review staff training needs, to ensure complaints are appropriately coordinated and responded to; and
• review the complaints handling procedure to ensure that it reflects the requirements of the Scottish Government's 'Can I help you?' guidance.

Summary

Mrs C complained to us about some dental treatment she had at the practice that she had been referred to. She had a wisdom tooth removed, and during the process, a filling came out of the adjacent tooth, and part of the tooth broke off. The dentist advised Mrs C to see her own dentist to have the damaged tooth seen to. Mrs C complained that the treatment on her wisdom tooth must have been done badly, otherwise the neighbouring tooth would not have been damaged.

We took independent dental advice in relation to Mrs C's dental treatment. Our adviser noted that both Mrs C's dentist and the dentist carrying out the extraction had told her that she had tooth decay. He said that this made her teeth more vulnerable to damage during a dental procedure. He also noted that Mrs C had been told that the procedure of removing her wisdom tooth involved some risk of damage to adjacent teeth. However, there was no evidence that the tooth adjacent to the wisdom tooth was known to be decayed, and there was no record of Mrs C being warned of the risk to this tooth in particular, given its proximity to the wisdom tooth.

We concluded that there was no evidence that the dental treatment had been carried out inappropriately, so we did not uphold the complaint. However, we were critical that the records indicated that the dentist had not been clear during the consenting process of the risks to the adjacent tooth, or noted specifically whether there was any decay in that tooth.

Recommendations

We recommended that the board:

• feed back the findings of this investigation to the staff involved, for reflection and learning, particularly in relation to ensuring patients are fully informed of the risks of a procedure, and that appropriate records are kept; and
• apologise to Mrs C that they failed to give clear information about the risks involved in the procedure when she was giving consent.

Summary

Mrs C complained about the care the board provided to her late husband (Mr C) when he attended the Western General Hospital for a scan. Mr C suffered from terminal cancer and had widespread pain which severely restricted his mobility. Mrs C said that Mr C's consultant had recommended he be transferred to hospital with specialist equipment which she said had not happened. She also complained that the mobile scanning unit was not suitable for Mr C due to his restricted mobility and that it did not have appropriate lifting equipment; and that a record was not made of Mr C having fallen in the mobile scanner unit.

We took independent advice from our nursing adviser and found that, although the consultant did not specify any specialist equipment, he had indicated an ambulance would be appropriate to transport Mr C to the mobile scanning unit, so we upheld Mrs C's complaint that this did not happen. We also found that the board had accepted that Mr C's mobility needs could not be met at the mobile scanning unit because it did not have the equipment he needed for being mobilised. However, we did not identify clear evidence to show that Mr C had fallen, so we did not uphold this aspect of the complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings identified; and
• provide evidence that the learning from this case has been discussed at a multi-disciplinary meeting and fed back to staff.

Summary

Mrs C attended the emergency department at Edinburgh Royal Infirmary with severe back pain and difficulty in walking. She complained that she should have had an urgent scan which would have identified that she needed to be referred for surgery. Mrs C also felt that the examination by the emergency doctor was inadequate.

We took independent advice from one of our advisers who is a consultant in emergency medicine. We found minor shortcomings with some aspects of Mrs C's examination. However, as there was no evidence of major motor weakness, we found that there was no failure in not arranging a scan at that time. We concluded that it was reasonable to discharge Mrs C from hospital with the advice to see her GP for a follow-up.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his daughter (Miss A). He said that the practice had failed to act on Miss A's symptoms despite a history of abnormal smears and his view was that there was a delay in diagnosing cancer. Mr C also complained that during her treatment Miss A was asked to re-register with another practice as she had moved home and had therefore moved out of the practice catchment area. The practice had reasoned that Miss A may have needed access to district nurses which they would not have been able to provide if Miss A was outwith their area. Mr C felt this was insensitive.

The practice provided records that showed that they had issued an urgent referral and their view was that they had taken appropriate action. We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The complaint about treatment was not upheld. The adviser also said that although under the General Medical Services contract the practice had the right to ask Miss A to re-register with another GP as she had moved out of their catchment area, it was inappropriate to ask her to do so given that she was undergoing treatment and that she would be unlikely to need the services of district nurses. Therefore, we upheld the complaint about the timing of the practice’s request to re-register.

Recommendations

We recommended that the practice:

• provide Miss A with a written apology for the timing of their request that she re-register with another practice; and
• review their policy to ensure that any administrative request takes account of the clinical care and any treatment that the patient is undergoing.

Summary

Mrs C complained that her mother (Mrs A) did not receive adequate care during two admissions to hospital. Mrs A underwent surgery in Monklands Hospital to repair a fractured hip, before being transferred to Wester Moffat Hospital for rehabilitation. Mrs C complained that her mother had not been provided with reasonable nutrition at Wester Moffat Hospital, and that there had been a failure to take the appropriate steps in either hospital to prevent the development of pressure ulcers. Mrs C also felt an unacceptable standard of catheter care had been provided at Wester Moffat Hospital and that the board had taken an excessive and unreasonable length of time to respond to her complaint.

We took independent advice from our nursing adviser. The advice we received was that the evidence showed a reasonable standard of nutritional care was provided. Although there were gaps in the records, the board had recognised this failing and taken steps to address it. These gaps were not sufficient to show inadequate nutritional care. The advice said, however, that the standard of skin care was inadequate and nursing staff had failed to implement fully the recommendations of the specialist review of Mrs A's pressure ulcers. This represented an unacceptable standard of care.

Our investigation found that the standard of nutritional and catheter care was reasonable, but the standard of skin care was not. We also found the board's response was unreasonably delayed due to the reduced availability of a key member of staff, and a failure to progress the complaint in their absence.

Recommendations

We recommended that the board:

• apologise for the failings identified;
• provide evidence that the findings of the investigation have been shared with senior staff and the failure by the board to identify inadequacies in the nursing care discussed;
• provide evidence of the on-going SSKIN education and training (a care plan for pressure ulcer prevention) being provided to nursing staff; and
• remind all nursing staff of the importance of responding fully to complaints.

Summary

Mrs C complained about a delay in providing treatment in the ear, nose and throat (ENT) clinic at Wishaw General Hospital. Her GP referred her with a suspected acoustic neuroma (a benign tumour on one of the nerves connecting the inner ear to the brain) and she was frustrated at having to attend multiple appointments before receiving a diagnosis. She was seen first by audiology, then an ENT doctor reviewed her and she attended again for a scan, before being seen by ENT again to discuss the results. These four separate attendances occurred over a five-month period. Her scan result was normal and confirmed that she did not have an acoustic neuroma.

The board treated the audiology and ENT appointments as separate specialist referrals and, therefore, as two separate events for the purposes of treatment time targets. This meant that, in their view, the relevant waiting targets had been met. They noted that referrals to ENT were vetted and, if patients met certain criteria, they were sent to audiology. They advised that audiology can often meet patients' clinical needs and, where this is the case, no onward referral to ENT is necessary.

We took independent advice from both a GP adviser and a consultant ENT surgeon. It was noted that Mrs C's GP had referred her specifically to ENT with a particular concern. We were advised that a direct appointment to audiology was common practice and in line with relevant guidance. However, the board's vetting criteria did not appear to match up with this guidance. The advice we received indicated that it would only be appropriate to treat an audiology appointment as a separate specialist referral if audiology were able to fully investigate and decide on treatment for the concern in question. This was not the case with Mrs C and it appeared that it was always going to be necessary for her to see an ENT doctor in order to be fully assessed. As such, the audiology appointment appeared to be a routine precursor to the ENT assessment and should not have been viewed as a separate event. We concluded that Mrs C's overall wait within the ENT clinic system was unreasonable and we upheld the complaint.

Recommendations

We recommended that the board:

• take steps to ensure that ENT waiting times are accurately categorised and provide us with details of the action taken;
• review their ENT and audiology referral process to ensure it is reasonable and takes account of relevant guidance;
• consider introducing a system of writing to patients when assessment results are normal, to avoid causing unnecessary anxiety for them while waiting for a follow-up appointment to discuss these results; and
• issue a written apology to Mrs C for the failings we found.

Summary

Mrs C's father (Mr A) was diagnosed with cancer, and underwent surgery followed by a course of chemotherapy. About six months later, Mr A began experiencing new symptoms, and a scan was arranged. Mr A was told that the scan showed 'no evidence of recurrence', and he was discharged (with a follow-up planned for four to six weeks). However, Mr A's symptoms continued and he was admitted as an emergency a few days later, and underwent further surgery. While Mr A thought the surgery was to address symptoms resulting from his previous surgery, the surgery found that Mr A's cancer had returned and he was given a purely palliative procedure. Mr A passed away a few months later.

Mrs C was concerned that her father was told he was 'all clear' after the chemotherapy, only to find out his cancer had returned six months after this. Mrs C was also concerned that her father was not given regular scans, and she queried how the scan he was given could show no return of the cancer, when Mr A was found to have cancer just a few days later.

After taking independent medical advice, we upheld Mrs C's complaints. While we found no evidence Mr A was given incorrect information about being 'all clear' from cancer following chemotherapy, there was also no evidence that he was offered information about his prognosis and the high possibility of recurrence at this time. In relation to Mrs C's concerns about scans, we found that the board had undertaken reasonable follow-up of Mr A, consistent with national guidance (which did not require regular scanning). However, we found that, although the scan showed a possibility that the cancer had returned, the consultant surgeon did not share this with Mr A, which was unreasonable.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings our investigation found;
• feed back our findings on the lack of communication and record-keeping about post-treatment prognosis to the surgical and oncology staff involved in Mr A's care; and
• ensure the consultant surgeon involved reflects on the findings of our investigation as part of their next annual appraisal.