Health

Summary

Mr C sustained an injury to his right hip/leg, which he said was caused when he fell off a chair. Mr C attended the prison health centre regarding his injury on several occasions. Mr C complained that the prison health centre failed to provide him with appropriate care and treatment. He said there was an unreasonable delay in the prison health centre carrying out an x-ray of his hip. He also said the prison doctor inappropriately failed to see him at a scheduled appointment.

We obtained independent medical advice on the complaint from one of our advisers who is a GP. The evidence showed that Mr C had seven consultations with medical staff at the prison health centre over a four week period following his injury. Our adviser said that Mr C's assessment and management by the health centre staff was of a reasonable standard. She explained that Mr C's symptoms and risk factors were not consistent with a hip or pelvis fracture. She said an x-ray was not clinically necessary in Mr C's case and instead seemed to have been arranged after his request, rather than because of clinical suspicion of fracture. As such, she did not consider that Mr C's x-ray should have been done more quickly.

The board said Mr C's scheduled appointment with the prison doctor was cancelled because of security and health and safety reasons. Our adviser explained that health and safety decisions were taken in the best interests of both prisoners and staff and the prison heath centre's actions were reasonable.

Summary

Ms C said that after having two teeth filled, she began to experience progressively worsening pain. She said that this prevented her sleeping and caused her much distress. However, she said that her dental practice refused to provide her with further treatment on the basis that they considered the cause of her pain to be as a consequence of complex regional pain syndrome (a poorly understood condition where the person experiences persistent and debilitating pain) for which she had been diagnosed in 2008.

Ms C then left the practice. She said that the next day she attended an emergency appointment with another dentist. They determined that she had some decay, a dying nerve and a bleeding root canal and she was given treatment which she said provided immediate relief. She then complained that the original dentist failed to treat her appropriately.

We took independent advice from one of our dental advisers. The investigations showed that given Ms C's symptoms, the source of her pain had been difficult to establish and diagnose and that, in the circumstances, it had been reasonable to suggest that the cause was complex regional pain syndrome. We also established while an x-ray might have helped with a diagnosis, the dentist concerned had, nevertheless, provided Ms C with reasonable care and treatment. The complaint was not upheld.

Summary

Mrs C was referred by her GP to the Acute Medical Unit of Ninewells Hospital after reporting a ten-day history of increasing chest and upper abdominal pain. She was admitted in the afternoon and blood tests and a measurement of her heart-rate were taken. She was then reviewed by a consultant later in the evening who told Mrs C that her condition was 'not cardiac' (not related to her heart). The blood test results were not available during this review and were not checked until the following morning. Mrs C was placed on a heart monitor overnight but when she needed to use the lavatory, she was taken off the monitor and not reconnected when she returned to bed. Mrs C was reviewed the following morning by a different consultant who told her that the blood test results confirmed she had had a heart attack.

Mrs C complained to us about the care and treatment she received from the board; about entries in her medical records; and about the response to her complaints.

Our investigation, which included taking independent advice from a medical adviser and a nursing adviser, found that while some of her care and treatment was reasonable, there were some failings. In particular, the delay in reviewing the blood test results and in not reconnecting Mrs C to the heart monitor were not considered to be reasonable.

Mrs C was also concerned that there were inaccuracies and/or fabrications in her medical records but we found no evidence of this. There was one entry which related to blood test results for another patient which had been entered into Mrs C's records. The board had acknowledged this and although we upheld this complaint, we made no recommendations in view of remedial action already taken.

Finally, Mrs C was concerned that the responses to her complaints had been unreasonable. While our investigation identified that some improvement could be made, we also found that genuine efforts had been made to address Mrs C's concerns.

Recommendations

We recommended that the board:

• take action to ensure that all medical staff on the Acute Medical Unit are reminded of the importance of following up and/or chasing test results, and undertaking all tests recommended or ordered during a patient assessment;
• take action to ensure that all nursing staff on the Acute Medical Unit are reminded of the importance of patients being kept on, or immedicately reattached to, cardiac monitors while under investigation / observation for a suspected cardiac event;
• issue a further written apology for the failings we identified; and
• take action to ensure that all staff involved in complaints handling are made aware of current and relevant guidance on apology.

Summary

Mr C complained that the board had handled his request for surgery under local anaesthetic unreasonably. This was because Mr C wanted to have his operation under a local anaesthetic but the board's surgeon only offered him a general or spinal anaesthetic. Mr C went to a private hospital to have his operation done under a local anaesthetic and he wanted the board to reimburse the cost.

We considered whether Mr C's treatment was reasonable in the circumstances at the time, which meant we would not uphold his complaint solely because he disagreed with the board or felt the treatment he received was not the best possible. We took independent medical advice from our adviser, who is a surgeon, who told us that the board's surgeon was entitled to refuse to operate under a local anaesthetic and that he had sought a second opinion from two of his colleagues. Although the board did not confirm to Mr C that none of their surgeons would have operated under a local anaesthetic until after he complained to them, we considered he could reasonably have followed this up with the board before choosing to have private surgery done.

Mr C also referred to the NHS website's reference to patient choices, but we did not consider this amounted to a universal guarantee that a patient would always get their preferred treatment. In light of the clear advice we received, we did not consider the evidence indicated that the board handled Mr C's request for a local anaesthetic unreasonably and we did not uphold his complaint.

Summary

Mrs C complained that the board failed to properly execute her sterilisation procedure following caesarean section – she became pregnant some months later. She said the board also failed to inform her of the risks involved in the sterilisation procedure and the alternative procedures for contraception.

We obtained independent medical advice on the complaint from one of our advisers, a consultant obstetrician and gynaecologist.

Our adviser explained that sterilisation at caesarean section had a known failure rate, even when properly performed. She said that the method of sterilisation used in Mrs C's case – the filschie clip method (where clips were applied to both fallopian tubes) - was widely used and there was no evidence that Mrs C's sterilisation was not properly performed.

Based on the documentary evidence contained in Mrs C's medical records, our adviser concluded that the board did not unreasonably fail to advise Mrs C of the risks involved in the sterilisation procedure. However, we were concerned that there appeared to be limited evidence of the counselling Mrs C received prior to her operation and that there was no evidence that she was provided with written information on the procedure and its risks, in accordance with the guidelines.

Although it was noted on the consent form for Mrs C's operation that the alternative procedures for contraception were discussed with her, there was nothing in her medical records to detail what alternatives might have been discussed. The guidelines in this area stated 'counselling and advice on sterilisation procedures should be provided'. We considered it would have been reasonable for this to have taken place prior to making Mrs C making her decision on the type of contraceptive procedure she wished to receive, but there was nothing in her records to say this happened.

Recommendations

We recommended that the board:

• feed back our decision on the complaint about the failure to advise Mrs C about contraceptive options to the staff involved;
• consider how best to demonstrate the full range of verbal and written information provided to women undergoing sterilisation and advise this office of their conclusions; and
• provide Mrs C with a written apology for failing to properly advise her of her options with regards to contraceptive methods.

Summary

Ms C, whose first language is not English, complained that she did not receive appropriate treatment for an injury to her left knee at the Royal Infirmary of Edinburgh after she suffered a fall.

We took independent advice from one of our medical advisers, who found that there was a lack of evidence of a physical examination of Ms C's knee at one of the out-patient clinic appointments she attended and there was an initial failure to diagnose that Ms C had sustained an anterior cruciate ligament injury to her knee. However, our adviser considered the delay in diagnosis was not unreasonable and did not adversely affect the eventual outcome and that, overall, the management and treatment of Ms C's knee injury was appropriate and in keeping with accepted medical practice. Furthermore, there was no evidence that an interpreter not being present at Ms C's clinic appointments adversely affected the treatment she received. We accepted this advice and we did not uphold Ms C's complaint.

However, when Ms C complained to the board about her treatment, she had asked the board for the reply to her complaint to be translated into her first language and also for a meeting to discuss her complaint with an interpreter being present, which the board declined to do. While there was no requirement on the board to meet with Ms C to discuss her complaint, we were of the view that declining Ms C's requests was not in keeping with the principles of the board's interpretation and translation guidelines, so we made some recommendations about this.

Recommendations

We recommended that the board:

• apologise to Ms C for the failures in the way they dealt with her complaint;
• draw to the attention of the relevant clinical staff our adviser's comments regarding the lack of evidence of a physical examination of Ms C's knee at her clinic appointment;
• draw their interpretation and translation guidelines to the attention of the clinical staff Ms C saw; and
• ensure that their interpretation and translation guidelines are taken into account by staff when they are dealing with a complaint from a patient whose first language is not English.

Summary

Mr C complained that his prison health centre revealed information about his health to Scottish Prison Service (SPS) staff. Mr C also complained about the board's response to his complaint.

We looked at the board's investigation, and at an SPS investigation that was carried out in partnership with the board. The investigations concluded that no member of board staff was involved in revealing information about Mr C and, in the absence of any evidence to the contrary, it was not possible to dispute this. We found that the board's investigation of, and response to, Mr C's complaint were reasonable in the circumstances. We did not uphold Mr C's complaints.

Summary

Mrs A, who had cancer, was admitted to Monklands Hospital as an emergency. Her daughter (Ms C) complained that although it was known that Mrs A was at risk from Deep Vein Thrombosis (DVT - a blood clot in a vein), she was not given preventative drugs. Ms C said that as a consequence, Mrs A developed DVT with bilateral emboli (blood clots on both lungs) and required painful, daily injections until her death a few months later.

We took independent advice from a consultant physician and the complaint was investigated. This showed that Mrs A had been at risk from DVT and accordingly, she should have been started on preventative medication in line with standard guidelines. Despite the board saying that their decision not to give the preventative medication was likely to have been because Mrs A was anaemic and they were concerned about blood loss, there was no record which stated this in her medical notes, nor had any alternative, mechanical methods of prevention been discussed. In light of our findings, we upheld Ms C's complaint.

Recommendations

We recommended that the board:

• make a formal apology in recognition of their failure to treat Mrs A appropriately; and
• consider incorporating printed boxes for preventative medication into their notes and drug charts - and adding a prompt to ask the doctor to annotate a reason if this was not prescribed.

Summary

Mrs C complained that she was not offered reasonable treatment by the board for urinary retention problems she developed following hip surgery, when she was referred to them from another health board. She also said there were unreasonable delays in her accessing treatment from the board.

We obtained independent medical advice on this case from two of our advisers: a consultant urologist and an urologically trained nurse.

Our urologist adviser said it was common practice for a consultant to accept patients either by referral by phone or letter and then, based on the clinical need, to arrange further assessment/investigations prior to seeing a patient, as happened in Mrs C's case. However, our adviser considered that if Mrs C could have been seen earlier to explain the reasons for arranging investigations and home assessments and to provide reassurance prior to her out-patient consultation, further distress could have been potentially prevented.

Our nursing adviser explained that the actions of the nursing staff were exactly what she would have expected and said Mrs C's treatment was in line with the guidelines in this area.

Both our advisers found that the timescale for Mrs C's treatment was satisfactory and acceptable and could find no evidence to suggest that there was an unreasonable lack of urgency about her situation which resulted in her being left with long term health problems. However, although we didn't uphold Mrs C's complaints about her treatment, we considered that their communication with her about her treatment could have been much better and that their failing in this area resulted in increased distress and anxiety for Mrs C so we made two recommendations.

Recommendations

We recommended that the board:

• feed back the advisers' comments on communication with Mrs C to the clinical and nursing staff involved; and
• provide Mrs C with a written apology for failing to communicate clearly with her about her proposed treatment.

Summary

Ms C complained about the care and treatment provided by her former dental practice in relation to the fitting of a bridge (a device to replace a missing tooth or teeth).

Ms C complained that the bridge had not been fitted properly and was loose from the start; that it did not match the colour of her other teeth; that she was not told that an existing crown would have to be removed to accommodate the bridge; and that the whole process had not been adequately explained to her.

Our investigation included taking independent advice from one of our dental advisers and a review of Ms C's dental records from her former and current dental practices. Our adviser was of the view that the care and treatment provided to Ms C was reasonable and appropriate. Ms C had attended the practice for a number of years and had difficulty with the teeth in question since 2004. The adviser was of the opinion that all treatment options had been discussed with Ms C and sufficient information had been provided to her to enable her to make fully informed decisions about her treatment.