Health

Summary

Miss C complained on behalf of her late mother (Mrs A). Miss C complained that Mrs A's dressings were not changed regularly enough, that the board failed to communicate with her regarding how ill her mother was and, in particular, that Mrs A had signed a do not attempt cardiopulmonary resuscitation (DNACPR) order. Miss C also complained that after her mother's death, she had asked nursing staff to re-dress her mother and this request had not been carried out. Miss C said the board took an unreasonable amount of time to respond to her complaint.

We took independent advice from one of our nursing advisers. The adviser said Mrs A's dressings should have been more closely monitored, so we upheld this complaint. However, as the board had already acknowledged this and taken appropriate action, we did not make a recommendation.

Our adviser noted that Mrs A was competent and able to make decisions about her own care. The DNACPR order had been properly communicated and administered by staff. It was for Mrs A to decide if she wanted to discuss this with anyone else. We did not uphold this complaint.

Regarding Miss C's request for her mother to be re-dressed, we noted that the nurse Miss C spoke to had assured her this would be done by mortuary staff. When the mortuary were contacted, however, they did not believe it would be appropriate for them to carry out this request and passed it on to the undertaker. We were critical that the board had assured Miss C that this request would be carried out. However, the adviser's view was that the decision taken by the mortuary staff was reasonable and was taken to ensure Mrs A's dignity. We did not uphold this complaint.

The board had explained that the reason for the delay in responding to Miss C was caused when staff continued to request information from a doctor who no longer worked for the board. For that reason, we upheld the complaint and made one recommendation.

Recommendations

We recommended that the board:

• reflect on why staff were not alerted to the fact that the doctor had left the board, and how this might be avoided in future.

Summary

Ms C complained about the care and treatment she received from her GP practice. She had an operation to fit a catheter, during which she sustained an injury to her bowel. This injury was not identified at the time and she subsequently experienced a lot of pain. She consulted the practice and a number of tests were carried out but the damage to her bowel was not diagnosed. It was not detected until she was admitted to hospital two months after her initial surgery. Further surgery was carried out to correct the damage. Ms C complained about the practice's failure to diagnose the bowel injury. She also complained that the practice refused to prescribe two drugs that had been recommended by hospital specialists; that they failed to appropriately treat her urine infections and that they failed to provide the hospital with details of her medical condition prior to an emergency attendance.

We took independent advice from one of our GP advisers. Our adviser considered that the tests the practice carried out were reasonable and that the damage to Ms C's bowel would have been difficult to diagnose. However, as Ms C's pain was not resolving and no cause for this pain was identified, the adviser considered that further assessment should have been arranged. She stressed the importance of keeping a wide differential diagnosis in mind when investigating unexplained symptoms in patients (a systematic method of diagnosing a disorder that lacks unique symptoms or signs). We accepted the advice we received and upheld this complaint. We recommended that this should be fed back to the doctor concerned.

We did not uphold Ms C's other complaints. Our adviser noted that the practice had not prescribed the two drugs recommended by specialists as they were concerned about potential interactions with other drugs Ms C was taking. Our adviser considered that this was reasonable and in line with safe clinical practice. She also noted that the urine tests in question had produced no evidence of infection and that no treatment was, therefore, required. Finally, she noted that the practice spoke with the hospital and faxed details to them prior to Ms C's emergency attendance. We therefore concluded that the actions of the practice were reasonable in this regard.

Recommendations

We recommended that the practice:

• issue a written apology to Ms C, acknowledging the failings identified; and
• confirm that the doctor in question will discuss our findings as part of their yearly appraisal and ensure that they reflect on the importance of keeping a wide differential diagnosis in mind when investigating unexplained symptoms in patients.

Summary

Mrs C complained about the way the medical practice handled two phone calls when she became ill while on holiday. During the first call, which was made by her son, Mrs C felt that the receptionist concentrated too much on the fact that she was currently outside the practice area and that she should seek an appointment with a local GP practice. Mrs C did so and the GP diagnosed quinsy on her tonsil (a complication of tonsillitis where an abscess forms between a tonsil and the throat). Mrs C phoned the practice the following day to arrange an appointment for when she returned home. She was informed that there were no pre-bookable appointments available for the next two days. Mrs C felt that the reception staff should have sought advice from a doctor rather than make decisions about whether her medical condition could wait until an appointment was available.

We sought independent clinical advice from a GP adviser who felt that the practice had handled both calls appropriately. During the first call, her son was advised that Mrs C should seek a medical opinion from a local GP in order that her condition could be assessed. During the second call we found that the receptionist had accurately explained the process for making appointments. We did not uphold the complaint.

Summary

Mr C complained about the treatment provided to his late father (Mr A) when he was admitted to Biggart Hospital for a mental health assessment. While in hospital, Mr A's condition deteriorated and he stopped eating and drinking. His medication was amended but Mr A subsequently died of an infection. Mr C felt that Mr A's deterioration was due to the medication prescribed for his mental health problems. He also said that, despite repeatedly reporting his concerns to staff, they did not take his views into account.

The board said that Mr A had been prescribed appropriate medication for his mental health issues, that his medications were continually monitored, and that they were amended in view of the changes to Mr A's clinical condition. They also explained that there was evidence of regular communication with Mr C.

After taking independent advice from a medical adviser who is a consultant in old age psychiatry, we did not uphold Mr C's complaint. We found that the doctors involved in Mr A's care provided appropriate treatment for his physical and mental health symptoms. The medications prescribed were appropriate, and were closely monitored and amended when required. We also found that the staff were fully aware of Mr C's concerns about his father's treatment, and that they took these concerns into account when setting up the treatment plan.

Summary

Mr C said that the board failed to follow Scottish Government procedures on NHS continuing healthcare which resulted in his father (Mr A) not being assessed for continuing healthcare when he should have been. Mr C said that if an assessment had been carried out, Mr A would have had care provided by the NHS and would not have had to pay around £45,000 for residential care in a private nursing home.

We took independent advice from one of our medical advisers, who specialises in care of the elderly. We found that Mr A did not meet the criteria for continuing care. Having said that, the process was not as clear as it should have been to Mr C. The board accepted that the decision about whether or not to provide NHS continuing care should be fully explained to the family at the time of an assessment. The board took this issue forward with healthcare staff. Given that the guidance has been superseded and the process changed since June 2015, and that the communication issue had been taken forward by the board, we made no recommendations.

Summary

Mr C received treatment from the board's mental health team over a number of years. He complained to the board about the accuracy of his diagnosis and about frequent changes to his medication. He also questioned whether he should have been prescribed anti-psychotic medication as he felt this had an adverse effect on his condition.

The board met with Mr C to discuss his concerns, but they did not respond to him in writing due to concerns about the impact this may have had on his mental health. Mr C complained about the lack of a formal response to his complaint. He also asked us to investigate his concerns about his medication regime.

We sought independent advice from a medical adviser who is a mental health specialist. We found that the board appropriately assessed Mr C's symptoms and took into account information provided by him when prescribing medication. His medication was altered on a number of occasions as a result of this, but in each case we were satisfied that the board worked in line with national guidance.

We were critical of the board's handling of Mr C's complaint. We acknowledged their concerns about the impact of a written response on his mental health, but we found their approach to be inconsistent because Mr C's consultant had written to him with a detailed report on his condition. We felt that a formal response from the board would have been appropriate and that their communication generally could have been better.

Recommendations

We recommended that the board:

• review their practices for monitoring side effects for patients being treated for schizophrenia and ensure that they are working in line with national standards;
• apologise to Mr C for their poor handling of his complaint; and
• review their handling of Mr C's complaint with a view to improving the quality and consistency of their communication with patients with mental health issues.

Summary

Mr C complained because he felt the care and treatment he received from the prison health centre was unreasonable. In particular, Mr C said that since taking his prescribed methadone he had been feeling ill. Mr C said a doctor concluded that he should not be prescribed methadone and made arrangements for an alternative medication to be prescribed. However, before that happened, Mr C was reviewed by another doctor who decided that the prescription for methadone should continue. Mr C was unhappy with that decision because he felt he was allergic to the medication.

The board explained to Mr C that, following review, the doctor considered the symptoms he had were not because of the methadone and there were other potential causes that needed to be excluded. The doctor suggested Mr C undergo further assessment with the mental health team, and offered treatment to reduce the symptoms he was suffering, which Mr C declined. In addition, the doctor concluded that Mr C's symptoms were not severe enough to justify changing treatment.

We took independent advice from one of our GP advisers and asked for their view on whether the care and treatment provided to Mr C had been reasonable. Our adviser considered that Mr C had been thoroughly assessed by the doctor. She also reviewed Mr C's medical records and noted he had a long history of multiple drug misuse. Our adviser commented that, in her view, with Mr C's history of multiple drug misuse and then stopping all drugs in favour of methadone, his symptoms could reasonably be interpreted by the doctor as having been related to drug withdrawal. As such, she said that the options offered to him – mental health assessment and a trial of allergy medication – and the reasons for not prescribing the alternative medication were reasonable. Our adviser commented that she could see no evidence that Mr C was not adequately assessed by an appropriate professional or that the treatment offered was inappropriate.

In light of the evidence available in Mr C's case and our adviser's view, which we accepted, we did not uphold the complaint.

Summary

Ms C, who is an advice worker, complained on behalf of her client, whose husband (Mr A) had died following two hospital admissions at Perth Royal Infirmary a short period apart. Mr A had suffered two strokes in quick succession. Ms C complained that he had not been diagnosed quickly enough with a stroke on his first admission. On his second admission, Ms C complained that Mr A was not provided with medical review quickly enough and that nursing staff were slow to address his obvious pain and distress. As a result, although the family accepted that his second stroke was terminal, Ms C said that they were subjected to an unnecessarily distressing and undignified experience.

We took independent advice from a nursing adviser and a medical adviser. The medical advice stated that Mr A had received the appropriate medical care on both admissions. On his first admission, he had presented with a complex combination of medical problems, including pneumonia and infection. The decision had been taken to stabilise his condition, which was reasonable in the circumstances. Our adviser said that his stroke had been diagnosed inside a reasonable time-frame. During his second admission, we found that Mr A had been provided with a medical review within the limits imposed by the responding doctor's clinical commitments. Our nursing adviser said there were shortcomings in the nursing care provided to Mr A, but that the board had recognised and apologised for these. The board had provided an action plan, which our adviser felt addressed the shortcomings identified and were able to evidence that it was being put into action.

We found that Mr A had received reasonable medical care, although his nursing care had fallen below a reasonable standard. In view of the actions already taken by the board, however, we made no recommendations.

Summary

Mr C complained about the care and treatment that his wife (Mrs C) had received from the GP practice before her death from bowel cancer. Mr C said that Mrs C had attended the practice on a number of occasions over a three-year period with abdominal pain. He said that the practice had failed to provide Mrs C with appropriate treatment and had delayed in referring her to a specialist.

We took independent advice on Mr C's complaint from one of our medical advisers, who is a general practitioner. We found that Mrs C had initially attended the practice on a number of occasions with heart burn/dyspepsia (persistent or recurrent abdominal discomfort or pain located in the upper abdomen). Heart burn/dyspepsia are not clinical symptoms identified in patients presenting with bowel cancer and Mrs C had received appropriate treatment for this.

Mrs C had subsequently attended the practice with symptoms of abdominal pain, change in bowel habit and anaemia. She was then urgently referred to the colorectal service in line with the relevant guidelines and was diagnosed with bowel cancer. We found that Mrs C had attended the practice with two different sets of symptoms, which were not related. The practice had provided a reasonable standard of care to Mrs C and we did not identify any failings. We did not uphold the complaint.

Summary

Ms C complained to us on behalf of her partner (Mr A), who had a history of gastroenterological problems (problems with the digestive system). Ms C had previously complained to the board about the care and treatment that Mr A was receiving from them. Ms C then made a second complaint which was considered during this investigation. Ms C complained that the board had not provided reasonable care and treatment to Mr A in the period covered by the complaint. Ms C was dissatisfied that they had been unable to reach a diagnosis for Mr A's condition, and was also concerned that her previous complaint had impacted on the subsequent care that Mr A received.

After taking independent advice from one of our medical advisers, who is a gastroenterology consultant, we did not uphold this complaint. The adviser considered that, overall, the care and treatment provided by the board was reasonable. We did find that the doctor/patient relationship with one of the consultants who had been treating Mr A had broken down. Following this, although a letter was sent to Mr A's GP explaining the situation, the consultant did not arrange a referral to another consultant. The adviser said this had no impact on Mr A as the GP made a referral instead, but we have made a recommendation to draw this point to the attention of the relevant consultant. We found no evidence that Ms C's prior complaint had affected the medical treatment provided to Mr A.

Recommendations

We recommended that the board:

• bring the adviser's comments about onward referral when the doctor/patient relationship has broken down to the attention of the relevant consultant.