Health

Summary

Ms C complained about the care and treatment her late father (Mr A) received at the Royal Northern Infirmary. She said the board failed to provide adequate nursing care for her father and unreasonably failed to diagnose his broken collarbone and stroke.

We obtained independent advice on the case from a nurse adviser and a GP adviser. Our nursing adviser said Mr A's fluid balance and food intake, repeat fall assessments and care planning fell short of what should have been in place. However, she said that even if these areas of Mr A's care had been up to standard, the outcome may not have changed. Our adviser said the board's response to Ms C's complaint was poor and she would have expected the board to have recognised their shortcomings, and to have apologised and ensured lessons had been learned.

Our GP adviser said there was documented evidence in Mr A's medical records of a review of his condition after each of his falls by a clinical member of staff. She noted that the documentation of the examination and assessment was thorough and of a reasonable standard. She said the doctor who attended to Mr A noted his on-going confusion, poor mobility and number of recent falls. The doctor identified that Mr A's condition had deteriorated and arranged transfer to Raigmore Hospital for further investigation. The doctor also identified that Mr A may have had a stroke and correctly referred him to Raigmore Hospital for a scan. Our adviser said this was reasonable management and was in accordance with relevant guidelines.

Recommendations

We recommended that the board:

• feed back our decision on this case to the nursing staff involved;
• remind their nursing staff about the importance of falls assessment and care planning; and
• provide Ms C with a written apology for the failings identified.

Summary

Mrs C complained that the board had neither diagnosed nor treated her eye condition reasonably. She also felt they had not given her sufficient information about medication she was prescribed previously (Mrs C felt she should have been made aware of the possible visual side effect, as her medication was ultimately thought to have contributed to her subsequent eye condition). She was also unhappy with the board's response to her complaint.

Mrs C's complaint made it clear how strongly she felt about this matter and how much her condition had affected her. Although we recognised that and took it into account, our role was to consider whether the board's steps were reasonable in the circumstances at the time. We took independent medical advice from three advisers – a GP, an ophthalmologist (a doctor who examines, diagnoses and treats diseases and injuries in and around the eye) and a rheumatologist. They all thought that medical staff had, overall, taken reasonable steps to diagnose and treat Mrs C's condition. This included the steps taken at her medical practice and also at Raigmore Hospital.

In terms of Mrs C's historic medication, our medical advice was that the side effect she highlighted and appeared to have suffered was very rare and, in addition, it was associated with a pre-existing medical condition Mrs C had. The evidence indicated that she was given the standard information leaflet at the time she was prescribed her medication. Although we recognised that this leaflet may not have been as detailed as Mrs C may have liked, we did not consider this meant that clinical staff had acted unreasonably. In terms of the board's response to Mrs C's complaint, we had to consider whether any inaccuracies, viewed as a whole and within context, were enough to make it unreasonable. Our medical advice was clear that Mrs C had suffered from a rare and complicated condition and this was reflected in the detailed correspondence. Although we recognised that any discrepancies would be frustrating we felt, on the whole, that the board reasonably sought to address Mrs C's queries. We did not uphold this complaint.

Summary

Ms C complained about the standard of nursing care provided to her mother (Mrs A) during an admission to Glasgow Royal Infirmary. Ms C felt her mother had been over-sedated with morphine when she was not in pain; was denied food; and that staff had labelled Ms C as being abusive towards them. The board felt that Mrs A received appropriate nursing care but were aware that Ms C found the situation difficult.

We took independent advice from one of our nursing advisers. Our adviser was satisfied with the level of nursing care provided in relation to the morphine and nutrition issues. It was also recorded that the staff found Ms C to be distressed. We did not uphold the complaint as the nursing care was appropriate and was in line with what the board had explained. However, we acknowledged that Ms C had found the situation distressing.

Summary

Ms C complained that a GP and a nurse had acted unreasonably by failing to provide treatment to remove ear wax. Ms C had attended the practice on three occasions with compacted wax. Initially, her ears were not syringed as it was suspected she may have had an infection. On the third occasion, she was referred to a community-based NHS treatment area for ear irrigation, however, there were no appointments available in the following month. We sought independent advice from one of our nursing advisers. Our adviser found that the evidence indicated that the care and treatment was reasonable and in keeping with best practice. We did not uphold the complaint.

Ms C also complained about the way the practice had handled her complaint. Specifically, she was unhappy that there had been a delay in responding to her complaint, and that the response she received to a 16-page letter was inadequate. Ms C sent two letters - the first was responded to within 20 working days. The second (which raised some new issues) took three months to respond to. We recommended that the practice apologise to Ms C for the delay in responding to her second letter. Following careful review of the practice's response to Ms C's 16-page letter, we concluded that the response was appropriate and adequate. We considered that the overall handling of the complaint was reasonable and, therefore, we did not uphold the complaint. However, as the practice's complaints handling procedure was not in line with Scottish Government guidance, we made a recommendation to address this.

Ms C also complained that a member of reception staff failed to tell the truth about what had happened when Ms C returned to the practice after visiting the NHS treatment area. She was also unhappy that the receptionist discussed confidential information in the waiting room in front of other patients. There was no objective evidence to support Ms C's version of events and, therefore, we could not uphold the complaint. We were pleased to note that the practice had issued reminders to staff about patients not being led to believe that discussions have occurred when they have not. The practice had also reminded staff that discussion of sensitive and confidential information should take place in a private area of the practice.

Recommendations

We recommended that the practice:

• ensure the complaints handling procedure is fully compliant with the Patient Rights (Scotland) 2011 Act and the Scottish Government's 'Can I help you?' guidance; and
• apologise to Ms C for the delay in responding to her second letter.

Summary

Ms C was charged by her dental practice for a missed appointment. Ms C felt this was unreasonable in the circumstances and complained to the practice about this. She was dissatisfied with the practice's response and made further complaints. Following a subsequent visit to the practice she and her daughter were removed from the practice's treatment list. Ms C complained about this and was dissatisfied with the response she received. She complained further and also received a reminder for a check-up despite her having been removed from the practice's treatment list. Ms C complained about these matters but did not receive a response from the practice. She raised her complaints with this office.

We attempted to resolve the matter but this was unsuccessful. Following consideration we decided that the practice's actions in charging Ms C for the missed appointment, failing to send a reminder for an appointment and sending two copies of the letter advising Ms C that she had been removed from their treatment list were not unreasonable. We also found that there was insufficient evidence to determine whether the practice had refused to treat Ms C's daughter due to Ms C's outstanding debt. However, we did decide that the practice's actions in refusing Ms C's request for a meeting to discuss her complaints, the process by which they removed Ms C from their treatment list, their response to Ms C's complaints and their having sent her a reminder for a check-up after they had removed her from the treatment list were unreasonable and upheld these aspects of the complaint.

Recommendations

We recommended that the practice:

• apologise to Ms C for the failures we identified; and
• undertake training with all practice staff in relation to the removal of patients from treatment lists and the practice's complaints procedure.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) during an admission to the Royal Alexandra Hospital. She said that staff at the hospital delayed in attending to Mrs A and in providing her with treatment, and that she was given too much fluid intravenously. Mrs C believed this all contributed to Mrs A's death. Mrs C also complained that there were delays in transferring Mrs A to a treatment ward which she said was also to her detriment.

We took independent advice from a consultant in emergency medicine and we found that while Mrs A had been assessed in the emergency department as an urgent case to be seen within an hour, she was not seen until after two hours of arrival on the ward. It also took 11 hours to transfer her to a ward for treatment which was far too long for someone who was sick, elderly and frail. Furthermore, Mrs A had been given a litre of saline solution which was too aggressive given that she was known to have pre-existing heart disease. For these reasons, we upheld the complaint. However, there was no evidence to suggest that the failures identified had contributed to Mrs A's death.

Recommendations

We recommended that the board:

• make a formal apology to Mrs C recognising the shortcomings identified;
• satisfy themselves that such delays in the emergency department could not happen again and advise us of the processes since put in place to avoid this; and
• ensure that our findings are brought to the attention of the doctors and staff in the emergency department for them to consider further.

Summary

Mrs C had some metal work removed from her hip at the Southern General Hospital with the aid of an epidural anaesthetic. Afterwards, she said that she had not properly regained feeling in her right leg and that she had problems urinating. She said that she had been discharged from hospital too soon and that reasonable investigations had not been made into her symptoms.

She complained to the board but they were of the view that her discharge had been appropriate and that all reasonable investigations had been undertaken into her continuing problems. Mrs C was unhappy and complained to us.

We took independent advice from a consultant trauma and orthopaedic surgeon. We found that on the day of her discharge, Mrs C had been reviewed by a physiotherapist and assessed as safe to go home; her condition was improving and no further interventions were planned by medical staff. Thereafter, Mrs C's complaints about her leg and urination were extensively investigated with scans, nerve conduction studies, blood tests and a lumbar puncture being carried out. She had reported that her condition was improving. In the circumstances, we did not uphold Mrs C's complaint.

Summary

Mrs C complained that when she was admitted to the Western Infirmary with increasing shortness of breath and a productive cough (a cough that produces mucus and phlegm), she was assessed by a clinical nurse specialist (CNS) who said that she could be discharged home that day under the Early Supported Discharge (ESD) service. Mrs C had concerns that she was not fit for discharge and she remained in hospital until she was further assessed by a doctor as being fit for discharge. Mrs C was transferred to Gartnavel General Hospital prior to her discharge home. Mrs C complained that the CNS should not have assessed her as being fit for discharge and that when she arrived at Gartnavel Hospital her portable oxygen cylinder was found to be not working. She said that it must not have been checked at the Western Infirmary.

We took independent advice from our nursing adviser and found that the CNS was an appropriate health professional who was qualified to assess Mrs C and that her decision that Mrs C was fit for discharge, further to medical review, was appropriate. We made no finding on the complaint as to whether the oxygen cylinder was working on discharge from the Western Infirmary as there was no substantive evidence to establish when the oxygen cylinder stopped working. This may have occurred at the time Mrs C was being taken from the Western General or in transit during the hospital transfer.

Summary

Miss C said she attended the practice for a check-up with the dentist and he removed a tooth which had been causing her pain for some time. She said she suffered extreme pain after the extraction and attended the practice again for an emergency appointment with the dentist. Miss C complained that the dentist unreasonably dismissed the pain she was feeling in her gum and unreasonably failed to notice and treat a hole in her gum. She also complained that the practice manager unreasonably failed to answer her questions about her treatment by the dentist in the practice's written response to her complaint.

We obtained independent dental advice on Miss C's complaint from a senior dental practitioner. Our adviser said Miss C's dentist reasonably diagnosed that Miss C had a dry socket (a well-recognised complication of tooth extraction, characterised by increasingly severe pain in and around the extraction site, usually starting 24 to 48 hours post-operatively) and treated it in line with the guidelines and established good practice – suggesting that the pain in her gum was not dismissed.

As we were not present at Miss C's appointment, it was not possible for us to say if there was a hole in her gum which the dentist then failed to treat. Given this and our adviser's view that the dentist's treatment of Miss C's condition was reasonable, we did not conclude that the dentist unreasonably failed to notice or treat a hole in Miss C's gum.

However, in terms of the complaints handling, we considered that on balance the practice manager's response did not address all the points Miss C made and was not a full response to her complaint. We were also concerned that the practice manager deemed Miss C's letter of complaint to be for information only and initially failed to issue a response, when the letter's contents indicated that a written response was required.

Recommendations

We recommended that the dentist:

• feed back our decision on Miss C's complaint to the staff involved; and
• provide Miss C with a written apology for failing to provide a full response to her letter of complaint.

Summary

Mr C complained to us that staff had failed to carry out an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) when he attended Glasgow Royal Infirmary after injuring his back at work. Although a junior doctor who examined Mr C had recorded that an x-ray and MRI scan should be considered, Mr C was then reviewed by a consultant orthopaedic surgeon, who decided that they were not required. Mr C continued to suffer from back problems and considered that he would have received treatment for this earlier if an MRI scan had been carried out on the day he injured his back.

We took independent advice on Mr C's complaint from a medical adviser who is an experienced consultant in trauma and orthopaedic surgery, with a specialist interest in lumbar spine problems. We found that an MRI should be carried out on patients where surgery is being considered because of escalating pain and/or neurological deficit or those in whom the pain has persisted for several weeks (this is usually a minimum of six weeks with no improvement). We found that it was reasonable that an MRI scan was not carried out when Mr C attended hospital on the day he injured his back. It was also appropriate not to carry out an x-ray at that time. We therefore did not uphold Mr C's complaint.