Health

Summary

Ms C complained that her GP practice had failed to diagnose her or refer her appropriately, despite consistent reports of stomach pain. This pain persisted until she was diagnosed with Helicobacter infection (Helicobacter pylori is a germ that can live in the stomach), and it was successfully treated. Ms C said she felt she had been ignored and treated with a lack of respect. Ms C added that, even once Helicobacter infection had been diagnosed, she felt the practice had not treated her within a reasonable time-frame.

We took independent advice from one of our GP advisers. The advice received was that the practice had followed national guidelines in its attempts to diagnose and treat Ms C for the pain she was experiencing. The practice performed the appropriate tests on Ms C and it was noted that, on occasion, she had declined medical advice and declined appropriate referrals, which would have speeded up her diagnosis.

On the basis of the advice received, we found that the practice had acted reasonably and that they had not delayed in referring Ms C for specialist opinion.

Summary

Mrs C complained on behalf of her husband (Mr C) about his care and treatment in Monklands Hospital. In particular, she believed that an x-ray taken immediately before his admission showed sufficient evidence of respiratory problems that he should not have been allowed home, only to be admitted the next day as an emergency. She further complained that, once in hospital, Mr C should have been kept in either intensive care or in a high-dependency unit, and not moved between wards as he was. Mrs C also said that insufficient care was taken to prevent him falling, and that a nil-by-mouth (NBM) instruction was ignored.

We took independent clinical advice from two advisers, a consultant respiratory and general physician and a nursing adviser. We found that Mr C had been discharged after his x-ray without the results being seen or taken into account, and without him being given appropriate treatment. In light of this, this part of his complaint was upheld. Similarly, we found that staff did not adhere to an NBM instruction and this complaint was also upheld. However, after he was admitted to hospital, all ward transfers were made with Mr C's medical condition in mind and were all appropriate. The evidence also showed that staff took all reasonable steps to prevent Mr C from acquiring pressure ulcers or from falling.

Recommendations

We recommended that the board:

• bring the comments of the consultant respiratory and general physician to the attention of the consultant neurologist concerned;
• make a formal apology for their communication failures;
• remind relevant staff (nurses and doctors) of the necessity of good, clear communication;
• apologise to Mr and Mrs C for their failure to follow Mr C's NBM instruction; and
• emphasise to relevant staff the importance of following a NBM instruction.

Summary

Mrs C complained on behalf of her mother (Mrs A) about the care and treatment she received at Monklands Hospital in 2013 and 2014 for liver-related disease. Specifically, she complained that a specialist procedure was not performed in 2013 and the aftercare arrangements were poor; that during a second admission in 2014 Mrs A's condition continued to deteriorate until she was transferred to a different hospital where a liver transplant was performed; and that she was malnourished prior to the transplant.

In their complaint response, the board did not identify failings in the care and treatment but acknowledged that communication with the family could have been better.

We took independent advice from two of our medical advisers, a consultant gastroenterologist (who specialises in the treatment of conditions affecting the liver, intestine and pancreas) and a consultant gastroenterologist and hepatologist (who specialises in liver disease). We found that the treatment given in 2013 was in line with national guidance and, whilst there were records to show that there was an appropriate discharge plan in place, there was no evidence to demonstrate that this had been explained to either Mrs A or her family. Furthermore, given that Mrs A had abnormal blood tests, we were critical that the consultant who discharged her failed to reasonably monitor her. Therefore, we upheld this aspect of the complaint and made three recommendations. We considered that the care given in 2014 was appropriate and, having also taken independent advice from our nursing adviser, we found that there were factors that impacted on Mrs A's ability to take oral nutrition and we did not uphold this aspect.

Recommendations

We recommended that the board:

• apologise to Mrs A for the lack of communication surrounding her discharge plan;
• review their procedures for arranging follow-up clinic appointments and for reviewing abnormal blood results, specific to this case, to identify any learning; and
• share the failings identified with relevant staff.

Summary

Mrs C complained about the treatment her father (Mr A) received from the board. In 2013 Mr A began to experience difficulties with his mobility and memory. Mr A was referred to the board's Falls, Stroke and Memory clinic at Coathill Hospital where he was seen by a consultant. A CT scan (computerised tomography scan) was arranged, which showed some shrinkage of the brain. The consultant referred Mr A for an MRI scan (magnetic resonance imaging scan - a more detailed scan than the CT scan). However, the radiologists questioned whether the scan was required, as they did not feel that an MRI would provide any additional useful information. They suggested a discussion with the referring consultant, however, Mrs C said that this did not take place.

Mr A was disappointed that the MRI scan did not go ahead and arranged for the scan privately. This resulted in a diagnosis of vascular Parkinsonism (a form of Parkinson's disease, a progressive neurological condition in which part of the brain becomes more damaged over many years). Mrs C complained that the radiologists inappropriately rejected a test that had been identified as necessary by Mr A’s consultant.

We took independent medical advice from one of our advisers. We accepted the advice that the consultant's decision to request an MRI scan was reasonable but that it is a radiologist’s duty to ensure that patients are not subjected to unnecessary imaging. When a radiologist believes imaging might be unnecessary, they should get clarification on the need for it. We were satisfied that a discussion did take place between the referring consultant and radiology, and that it was agreed that the MRI would not necessarily add anything to the diagnosis that had already been made. Whilst we found that Mr A’s treatment may have differed slightly had the MRI been carried out, we did not consider there to be a significant impact on his treatment.

We were critical of the board’s handling of Mrs C’s formal complaint and made a recommendation to address this.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings in complaints handling which have been identified in this report.

Summary

Mrs C complained on behalf of her sister (Ms A) about the continence nursing care she had received during a stay in Campbeltown Hospital. During the first few months at the hospital, a catheter was used to manage Ms A's continence. Mrs C complained to the board about urinary care issues that arose during this period including urinary tract infections. Following their investigation of Mrs C's complaint, the board apologised for the lack of involvement of a specialist continence care nurse and, more generally, for the wider record-keeping for Ms A.

After taking independent advice from a nursing adviser, we upheld Mrs C's complaint. We found that, while many aspects of Ms A's urinary nursing care were appropriate, the lack of involvement of a specialist continence nurse and record-keeping matters (such as a lack of evidence that the continuing need for a catheter was reviewed) meant that, overall, the care could not be considered as reasonable.

Recommendations

We recommended that the board:

• apologise to Mrs C directly for the specific record-keeping issues they highlighted; and
• provide evidence of the action taken by the clinical services manager at Campbeltown Hospital to prevent recurrence of these events.

Summary

Mrs C complained about the care her late daughter (Miss C) received from her former GP practice between January and August 2011 after Miss C was diagnosed with a brain tumour in July 2012. Mrs C was concerned that Miss C was misdiagnosed with depression and, given that her symptoms (headaches, dizziness, tiredness and dilating pupils) were getting progressively worse, she should have been referred for a brain scan. Mrs C also provided evidence to show that Miss C had been unwell at college and had attended another medical facility.

We took independent advice from one of our medical advisers who is a GP. Based on their advice, we found that the initial diagnosis of vertigo was reasonable based on the symptoms of dizziness and abnormal eye movements. It was also noted that Miss C had described symptoms of anxiety which were explored by the practice, and the reasons for this were plausible. We did not find evidence in any of the records made of the eleven GP consultations, the records made by the college, or medical facility, that Miss C had reported suffering from headaches or that her condition was getting progressively worse. We found that Miss C's symptoms were not consistent with the symptoms of brain tumour set out in the relevant Scottish guidelines for referring patients for urgent assessment (such as for a brain scan). We concluded that this was a tragic case where Miss C's symptoms were not clearly typical of a brain tumour.

Summary

Mrs C complained about the pregnancy care she received from Raigmore Hospital. She said that the hospital failed to perform basic medical tests and that there was an inappropriate evaluation of her health which resulted in her pregnancy loss. Mrs C had a past history of thyroid problems and she complained that the management of this problem had been unreasonable. Mrs C also complained that no examination was carried out after her pregnancy loss to make sure everything was all right.

We took independent advice from a consultant obstetrician and gynaecologist. Our investigation found that overall the care and treatment given to Mrs C was reasonable, including the care and treatment Mrs C received when she attended the hospital with bleeding. The advice we received was that the hospital had also reasonably managed Mrs C's thyroid levels and there was no evidence that the loss of her pregnancy was caused by her thyroid condition or its treatment. We were also satisfied that, as Mrs C's pregnancy loss had occurred abroad, the hospital had not been aware of the situation until they contacted Mrs C when she missed a number of appointments. When responding to Mrs C's complaint, the board offered a further appointment to discuss what further investigations were appropriate at that time. In light of our findings, we did not uphold Mrs C’s complaint.

Summary

Mr C complained on behalf of his father (Mr A) who had suffered a stroke following a bleed in his brain which required specialist surgery. He was left with dense weakness in his left side with no active movement. Mr A was an in-patient at Raigmore Hospital for a number of months while he underwent rehabilitation in their stroke unit. When he was discharged, Mr A received physiotherapy at York Day Hospital. He was later seen by a consultant in stroke rehabilitation medicine and a specialist physiotherapist. Mr A also received other physiotherapy in the community. Mr C was unhappy with the range, intensity and frequency of the physiotherapy that Mr A received and complained that the board had failed to provide appropriate rehabilitation following his stroke. The board considered that the rehabilitation they provided was reasonable.

After taking independent advice from a medical adviser who is a consultant in stroke medicine and rehabilitation, we found that the clinical rehabilitation treatment that Mr A had received was appropriate. The advice highlighted an area where communication with the family could have been better but, overall, we considered this element of Mr A's care to be reasonable. We also took independent advice from a physiotherapist specialising in neurological rehabilitation and acute neurology (the science of the nerves and the nervous system, especially of the diseases affecting them). Overall, the range, intensity and frequency of Mr A's physiotherapy was found to be reasonable and the adviser considered that a holistic approach had been taken in relation to his treatment. The physiotherapy advice highlighted a single area of concern where there was no record that an issue identified during an assessment at York Day Hospital was monitored. After taking all the information about Mr A's rehabilitation care and treatment into account, we did not uphold Mr C's complaint but made a recommendation to the board to ensure that lessons are learned from the advisers' comments.

Recommendations

We recommended that the board:

• draw the comments of the medical adviser on communication and the physiotherapy adviser on best practice to the attention of relevant staff.

Summary

Mrs C had a hysterectomy (surgery to remove the womb) for a fibroid uterus at the Royal Alexandra Hospital. She said she then suffered an infection, was in severe pain, and had bladder problems. Mrs C was discharged home and later visited her GP who gave antibiotics for a urine infection. The following month, Mrs C attended a follow-up appointment at the hospital and was diagnosed with a vesico-vaginal fistula (an abnormal opening connecting the vagina to the urinary tract). She had to have further surgery to repair it. She was dissatisfied with her treatment and that a fistula had occurred, which had a very detrimental effect on many aspects of her life. Mrs C complained that the fact that she had suffered a vesico-vaginal fistula should have been discovered while she was an in-patient, and she should not have been discharged given her condition.

We took independent advice from a medical adviser. We found that the post-operative care and treatment provided was reasonable, as was the decision to discharge Mrs C, and that it was also reasonable to assume that the fistula developed as a later complication.

Summary

Ms C complained that when she first registered with her new GP she had difficulty in getting an appointment. When she first saw a GP, two weeks after joining the medical practice, she was refused a prescription for regular medication for various conditions as her medical notes had not yet been transferred from her old practice. Ms C also complained that she was removed from the practice list for alleged abusive behaviour, and that the practice failed to deal with her subsequent complaints.

We took independent advice from one of our GP advisers. They told us that records can sometimes take up to 12 weeks to be transferred between NHS practices when a patient changes GP. Therefore, it is common practice for basic information, including details of repeat medications, to be faxed over to the new practice to prevent any delays in prescriptions being issued. The adviser was particularly concerned that Ms C was on medication that can have serious withdrawal symptoms if stopped suddenly. We upheld this aspect of Ms C's complaint.

On the issue of Ms C being removed from the practice list, there was evidence that the staff at the practice found Ms C's behaviour, at times, to be unacceptable. While there does not have to be any intention to behave in an unacceptable way by the patient, where a GP considers that a patient's behaviour is unacceptable, they have the right to ask for that patient to be removed from their list. We did not uphold this aspect of Ms C's complaint.

In relation to the handling of the complaint, Ms C said that she had hand-delivered four letters of complaint between October and December 2014 but the practice said they had no record of the letters being received by any staff member. Following contact with our office, the letters were copied to the practice and were dealt with within the timescales laid down by the NHS guidance on complaints handling. We did not uphold this aspect of Ms C's complaint.

Recommendations

We recommended that the practice:

• issue a written apology for the failings identified; and
• implement a system for contacting the previous practice of NHS patients transferring to them to obtain basic details of previous medical history and regular medications.