Health

Summary

Mrs C complained about the mental health care and treatment that her child had received. Mrs C considered that her concerns about autistic spectrum disorders and physical factors had not been taken into account by the board. She was also concerned that her child was not seen soon enough and was not assessed by appropriate staff. While recognising the complexity and severity of her child's condition, the board did not find evidence to support Mrs C's concerns during their consideration of her complaint.

After taking independent advice from a psychiatric adviser specialising in child and adolescent mental health, we found that the actions taken by the board were reasonable. There was no evidence that there had been unreasonable delays in the assessment of Mrs C's child, or that the care and treatment provided was inappropriate. The adviser highlighted that the board’s liaison with another service was good and found nothing to suggest that the child had been misdiagnosed.

Summary

Mrs C, who is an advice worker, complained on behalf of Mr A about the care and treatment he received from the medical practice. Mrs C said Mr A, who has cerebral palsy, was seen by doctors at the practice for a year with sharp abdominal pains but the practice failed to diagnose that Mr A had a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall). Mrs C also complained that one of the doctors at the practice failed to carry out a physical examination of Mr A at one of the appointments.

We obtained independent medical advice from one of our GP advisers. They said that they could see no evidence in Mr A’s medical records that he had either the symptoms or signs of a hernia during the 12 months that he was seen by the practice, and that the hernia identified at the end of the 12 months was most likely a new presentation. We found that Mr A was provided with a reasonable standard of care by the practice.

Our adviser also explained that there was no requirement for a patient to be examined for a chronic condition every time they attended a GP practice and that if a patient presented with new symptoms or a significant change, then an examination would be reasonable. When Mr A was seen by the doctor, he did not present with any new symptoms, and as he had been seen 24 hours previously by a senior surgical doctor at Perth Royal Infirmary for an examination, we did not consider it unreasonable that the doctor did not physically examine Mr A. We did not uphold Mrs C's complaints.

Summary

Mr C complained that when he called the out-of-hours (OOH) service, the first GP he spoke to did not provide proper care or treatment. Mr C said the GP had been unable to access his medical records and had refused to admit him to hospital, offering an appointment at the OOH centre, which Mr C could not attend because of the level of pain he was suffering. When Mr C had called the OOH service the following morning, a second GP arranged for an ambulance to take him to hospital, where his knee was then treated. Mr C said the second GP had told him that the first GP would have been able to access his medical records and that hospital admission was the only appropriate treatment for his knee.

We took independent advice from one of our GP advisers. They said that Mr C did not constitute an emergency case, and that the first GP had acted appropriately by not admitting him to hospital. The second GP had not followed procedure in arranging Mr C's admission for treatment which meant that Mr C had an unreasonable expectation of what the first GP should have done. We found that the first GP had acted reasonably and in line with the board's policies in the care and treatment he had provided. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C complained that there was a delay in his GP practice diagnosing him with skin cancer. He also said that they did not take his concerns seriously and that there was a delay in him receiving medication for nerve damage.

We took independent advice from one of our medical advisers who is a GP and found that the GP practice provided Mr C with a reasonable standard of treatment, making referrals to hospital specialists based on his symptoms. Whilst we were critical that Mr C could have been referred to a dermatology specialist sooner, this was not a significant delay. Furthermore, we did not consider it had any material impact on the time it would have taken for him to be seen. In addition, there was evidence to show that reasonable attempts were made by the GP practice to communicate with Mr C following his surgery. Although the GP practice apologised for the delay in giving Mr C his medication, we found that they were not entirely at fault. However, we upheld Mr C's complaint that the GP practice did not provide him with appropriate explanations about the reasons for the delay in prescribing his medication.

Summary

Mrs C complained about the care and treatment that her late mother-in-law (Mrs A) had received. Mrs A had been referred to an orthopaedic consultant (a doctor who specialises in conditions involving the musculoskeletal system) and was seen in January 2013. She was re-referred by her GP practice in May 2013 but was not seen again until late July 2013. Mrs A died of widespread secondary cancer in October 2013, having been diagnosed a matter of weeks previously.

Our role was to assess whether the evidence indicated that Mrs A’s treatment was reasonable in the circumstances at the time. We took independent advice from our medical adviser, who said the steps taken by the orthopaedic consultant had been reasonable. In light of the symptoms Mrs A displayed in January 2013, the advice we received was that it would not have been normal practice to have carried out additional investigations for cancer.

The board did, however, acknowledge their delay in arranging Mrs A’s second appointment (the GP practice’s re-referral appeared not to have been acted upon promptly). We considered this to have been unreasonable and, although the advice was that this did not affect Mrs A’s overall outcome, the board acknowledged that earlier diagnosis would have led to better pain control and palliative care. We recognised the importance of receiving such care and so, on balance, we upheld Mrs C’s complaint because of the delayed second appointment and its possible impact on Mrs A’s palliative care. We also made two recommendations.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings we identified; and
• send us evidence of the steps taken to address referrals promptly and their effect.

Summary

Mrs C complained that the board had delayed in arranging an appointment for her to have a tooth extracted. She had seen a dentist from the board about the tooth and the dentist considered that the tooth needed to be taken out. Mrs C wanted to know if there was any way that the tooth could be saved and the dentist referred her to a consultant in restorative dentistry to discuss this. The consultant examined the tooth and then wrote to the dentist to say that the tooth should be taken out as soon as possible. After receiving the letter, the dentist contacted Mrs C to say that the tooth would be extracted at her next arranged appointment, a few weeks later. Mrs C considered that the tooth should have been extracted without delay. She contacted NHS 24 for advice over the following weekend and an emergency hospital appointment was arranged for her to have the tooth extracted.

We took independent advice on the complaint from a dental adviser. We found that it had been reasonable for the dentist to decide to wait until Mrs C's next appointment to extract the tooth. There was no evidence in the records to suggest that Mrs C was in such pain that an emergency appointment was required. We did not uphold this aspect of her complaint.

Mrs C also complained that the board had failed to phone her back when she contacted them for advice after the tooth had been taken out. There was no evidence that staff did call Mrs C back about this and we upheld this aspect of her complaint. We also upheld Mrs C's complaint about how the board had handled her complaint. However, we were satisfied that the board had apologised and learned lessons from these failings, and we did not make any recommendations.

Summary

Mr C complained about the way he was treated by an ambulance crew who attended his home following a fall. He felt that the crew had handled him badly, and said that they did not fit a neck brace or transport him to the ambulance using a stretcher. On arrival at hospital it was established that Mr C had suffered a fracture of the second vertebra. The board explained that the crew had carried out a thorough assessment and could not detect any tenderness to the vertebrae of Mr C's neck or back, and there were no signs of nervous system damage. There was some mild tenderness on the left side of the neck but this was over the soft tissue area. Current UK guidelines say immobilisation is not required if there is no central spinal tenderness. The crew decided there was no requirement for a neck brace based on the symptoms reported, and no detectable signs of spinal injury at the time.

We sought independent advice from a medical adviser with experience in the training of paramedics. The adviser had no concerns about the actions of the ambulance crew, and was satisfied that they had acted in accordance with the guidelines concerning the treatment of patients with neck and back injuries.

Summary

Mr C underwent a magnetic resonance imaging (MRI) scan (scan used to diagnose health conditions that affect organs, tissue and bone) at the Western General Hospital to investigate back pain he was experiencing. The report of the scan did not mention the presence of an aortic aneurysm (a swelling of the main blood vessel leading away from the heart, down the body). It was only when a further MRI scan was taken two years later that the aneurysm was noted and operated on. Mr C complained that this was unreasonable.

We found that, in their response to the complaint, the board had recognised the error. The error occurred because, while the aneurysm was visible on initial scans (taken to ensure that the full MRI scan would be taken in the correct place), in the main images the aneurysm was largely obscured by images of the spine. The board had discussed this finding with the reporting radiologist (a doctor specialising in medical imaging) and submitted it to the department meeting for wider discussion about the importance of assessing the initial images thoroughly. The board had apologised to Mr C.

We took independent advice from one of our medical advisers. They confirmed that the board should have noted the presence of the aneurysm. The adviser was satisfied that the action taken by the board since the error was brought to their attention was reasonable. However, they suggested that the reporting radiologist discuss the case at their annual appraisal. We agreed with this view. We recommended that this happen and upheld the complaint.

Recommendations

We recommended that the board:

• ensure the radiologist concerned discusses this case at their annual appraisal.

Summary

Ms C complained that she had been provided with an unreasonable service by the board's orthotic service (service that designs, makes and fits devices to support or control a part of the body). She said she had been provided with substandard footwear, and that she had suffered unacceptable delays whilst trying to arrange an appointment. Ms C was unhappy that the board had failed to communicate with her properly, resulting in unnecessary travel for appointments which were cancelled on her arrival. She also complained that it had taken an unreasonable length of time to fit her orthotic footwear when it was delivered.

We took independent advice on this complaint, which stated that the standard of communication with Ms C was not acceptable and that Ms C's notes were not maintained to a professional standard. There was, however, no set time-frame for fitting specialist footwear and Ms C had not been treated unreasonably in this respect.

Our investigation found the board had unreasonably delayed in providing Ms C with an appointment, although there was no evidence the delay was as severe as Ms C suggested. We also found that the board had failed to communicate appropriately with Ms C. We did not find the length of time taken to fit Ms C's specialist footwear was unreasonable.

Recommendations

We recommended that the board:

• remind staff involved in this case of the importance of communicating timeously with patients, especially when an appointment requires cancellation;
• remind all staff of the importance of responding timeously to requests for appointments;
• remind staff of the importance of recording any delays in requesting appointments; and
• apologise for the failures identified in this investigation.

Summary

Mrs C complained that the board had failed to carry out appropriate investigations to identify the cause of her severe weight loss, decline in cognition and reduced mobility, when she was admitted to the Royal Infirmary of Edinburgh on two occasions. She said that staff only seemed to be interested in her brain injury, which was already being dealt with by staff at another hospital. We took independent advice on this part of her complaint from one of our medical advisers, who is a consultant in geriatric and general medicine.

We found that staff in the hospital had carried out appropriate levels of investigations and had made appropriate referrals to other specialities. They had considered Mrs C's condition and problems appropriately and there was no evidence that they focused unreasonably on one part of her health and failed to address others. Other aspects of her care were reasonable and, consequently, we did not uphold the complaint.

Mrs C also complained that staff had failed to provide her with an appropriate level of nursing care. We obtained independent advice from a nursing adviser on this complaint and found that some aspects of her nursing care had been reasonable. However, Mrs C had developed a pressure ulcer whilst in the hospital and we found that she should have received better care in relation to this. There should also have been further discussion with Mr and Mrs C about her personal hygiene needs. In addition, her food charts had not been fully completed. We upheld this aspect of Mrs C's complaint. That said, we did not make any recommendations to the board, as we found that they had apologised to Mrs C for these failings, and we had made recommendations to the board that addressed these failings in similar cases previously.