Health

Summary

Mrs C complained about the treatment received by her late father (Mr A) during two admissions to Hairmyres Hospital and at an interim out-patient appointment. During his first admission, Mr A was diagnosed with cirrhosis of the liver (scarring of the liver). He was then seen by a nurse specialist in an out-patient clinic. He was re-admitted via A&E two days later and was treated for sepsis, but his condition declined rapidly and he died the following day.

Mrs C complained that adequate investigations were not carried out during Mr A's first admission. We obtained independent advice from one of our medical advisers, who considered that Mr A had been appropriately assessed. We did not uphold this complaint. Mrs C also raised concerns that the discharge was not discussed with her family and they were not given information regarding Mr A's new diagnosis. The board agreed that more could have been done and they agreed to discuss this at a forthcoming nurse debrief meeting. However, the adviser noted that this failing still needed to be addressed from a medical point of view. We upheld this complaint.

Mrs C was unhappy that the nurse specialist did not arrange to re-admit Mr A. The adviser said re-admission should have been arranged when results from blood tests taken at the out-patient clinic became available. This did not happen and we upheld this complaint. Mrs C also complained that there was a delay in admitting Mr A when he subsequently attended A&E. The adviser confirmed that Mr A received appropriate treatment during his wait and we did not uphold this complaint. Finally, Mrs C complained of a delay in releasing Mr A's body to the undertaker. We considered that this had been arranged within a reasonable timeframe and we did not uphold this complaint.

Recommendations

We recommended that the board:

• review the communication by medical staff surrounding Mr A's discharge, with a view to making improvements, and report back to us with their findings;
• draw this decision to the attention of the nurse specialist and develop an action plan to address the concern that admission was delayed in this case. They should notify us when this has been done; and
• apologise to Mrs C and her family for the identified delay in arranging to re-admit Mr A to hospital.

Summary

Mrs C complained about the care her late mother (Mrs A) received in Wishaw General Hospital following her hip replacement. Mrs C had been concerned that Mrs A – who had advanced dementia - had become dehydrated while in the hospital, that it had taken too long for her to be discharged and that her urine infection was not treated properly.

Our role was to assess whether the evidence indicated that Mrs A's treatment was reasonable in the circumstances. We took independent medical advice from a geriatrician and a nurse, both of whom felt that clinical staff had been aware of the possibility of dehydration. The medical advice we received was that staff had responded to Mrs C's concerns and had given Mrs A a fluid drip, even though there was no evidence of significant dehydration. Taking everything into account, we did not uphold Mrs C's first complaint.

Both advisers explained that it can take time to make the necessary arrangements to discharge a patient. However, our geriatrician adviser felt that the time taken between the necessary equipment being put in place in Mrs A's home and her being discharged from hospital was too long. We upheld this complaint and made one recommendation. Finally, the medical advice we received explained the difficulty in diagnosing a urinary tract infection. It also outlined the balance to be struck between not over treating somebody with antibiotics and not missing a chance to provide appropriate treatment (the adviser felt that balance had been struck appropriately for Mrs A). While we took account of Mrs C's concerns, we did not uphold her complaint about this.

Recommendations

We recommended that the board:

• remind staff, in circumstances where appropriate arrangements have been made for a patient's discharge, of the importance of taking a proactive approach.

Summary

Mr C complained to the health board that a staff member accessed his patient record without authorisation. Mr C complained to us about the time taken for the board to deal with his complaint, and that the board's response did not answer his concerns.

In replying to our enquiry, the board acknowledged failings in how they had handled Mr C's complaint. Board staff failed to recognise that the internal disciplinary process about the staff member involved was a separate issue from providing a response to Mr C's complaint; this failure led to the delay in responding to Mr C. In addition, the board should have provided Mr C with a clear explanation of how these matters were being dealt with, and that they could not tell him the outcome of the disciplinary process, much sooner than they did. We upheld Mr C's complaint.

Recommendations

We recommended that the board:

• provide us with confirmation that the staff who dealt with Mr C's complaint acknowledge where things went wrong, so they will not repeat these errors in future.

Summary

Mr C raised numerous concerns about the way that the practice dealt with an incident when he attended the practice. There was a difference of opinion between Mr C and the staff about what had occurred. Mr C subsequently had a meeting with the practice to discuss his concerns and he was accompanied by an independent witness. Mr C complained to this office that the practice had failed to provide a note of the meeting or provide specific information relevant to the practice's investigation into his complaint. In particular, he wanted to know whether the practice staff had been spoken to prior to the practice contacting the Medical and Dental Defence Union of Scotland (MDDUS) for advice.

We found that although the practice were trying to be helpful in arranging the meeting, they did not provide all the information which was requested. This appeared to be the result of a misunderstanding by the practice staff. The information would have assisted Mr C in determining whether he was going to consider further action in an effort to resolve his concerns. We also found that the practice had failed to include our contact details in their final letter of response which is a requirement under the NHS complaints procedure. We upheld Mr C's complaints.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings which have been identified in this investigation;
• respond to the issue as to whether staff were spoken to prior to contact with MDDUS; and
• remind staff who are responsible for responding to formal complaints to remember to include our contact details in their final response letters.

Summary

Mrs C said that following gastric band surgery (a procedure where a band is used to reduce the stomach's size, so a smaller amount of food is required to result in feeling full), her complaints about discomfort and difficulty swallowing were ignored by medical staff. The band then slipped, which caused her significant internal damage and, as a result, she required major surgery which involved removing her entire stomach. Mrs C said she had not been seen appropriately by the consultant responsible for her care and that much of her post-operative care had been provided via a nurse-led clinic.

The board said Mrs C was provided with the appropriate level of care, and that nurse-led clinics were standard practice. The board said they did not wish to minimise the seriousness of Mrs C's subsequent band slippage, but that this could not have been predicted from the symptoms she presented with following her operation.

We took independent medical advice. The advice we received was that Mrs C's concerns were taken seriously and that the appropriate investigations were carried out to identify the cause of her symptoms. Unfortunately the band slippage, whilst a recognised complication in a small number of cases, could not have been predicted. The nurse-led clinic was an appropriate setting for Mrs C's post-operative care and had, on occasion, accessed medical staff as required in order to assess her condition.

We found there was no evidence that the care provided was not appropriate and in line with the relevant clinical guidance.

Summary

Ms C complained that her medical practice unreasonably continued to prescribe a medication to her for significantly longer than they should have. She felt the practice should have informed her about the updated guidance on this medication, and she was also concerned that they had unreasonably failed to note that she was receiving double prescriptions.

We obtained independent advice from a GP adviser, who said that prescribing this medication long-term was appropriate for Ms C's condition, although this medication was not recommended for long-term use for other conditions. We found that the practice acted reasonably in prescribing this medication for Ms C. We also noted that Ms C's prescribing had been regularly reviewed in line with the relevant guidance. We noted that, for a period, Ms C was obtaining a double prescription but, when this was brought to the attention of the practice, they correctly stopped the repeat prescription, and placed her on a fortnightly acute prescription. As we were satisfied with the practice's actions in this case, we did not uphold the complaint.

Summary

Miss C's father (Mr A) was admitted to Glasgow Royal Infirmary from another hospital where he had been admitted earlier following a fall at home. Mr A was admitted to A&E and then moved to a ward. Mr A died several days after his admission.

Miss C was concerned that many mistakes and problems had occurred during Mr A's admission to Glasgow Royal Infirmary. Miss C met with the board who accepted there had been a number of failures in Mr A's care and treatment, and offered apologies for these. They also shared information with Miss C about actions taken to discuss failings identified with staff, and the procedures put in place to help avoid any repeat for other patients in the future. Miss C, however, remained concerned.

We took independent advice from a medical adviser and a nursing adviser.

Our medical adviser said that on admission, Mr A was noted to have had a fall, underlying liver disease, vomiting and diarrhoea, and a new acute kidney injury. Our medical adviser said that Mr A's medical records were comprehensive and that, overall, his care was of a good standard. However, our medical adviser also said there was a failure to prescribe continuous fluids, and to record and monitor Mr A's fluid balance which, in a patient with vomiting and diarrhoea and a diagnosis of acute kidney injury, were serious failings.

Our nursing adviser said that, overall, Mr A's nursing records and charts were of a good standard and there was a reasonable level of communication with Mr A's family. However, she also considered there was a serious failure in the recording and monitoring of Mr A's fluids by nursing staff. Therefore, Mr A's nursing care had fallen short of the expected standard in relation to the recording and monitoring of his fluid balance.

Recommendations

We recommended that the board:

• provide evidence of policies for fluid balance documentation and of compliance with such policies for the A&E department and the ward involved in this case at Glasgow Royal Infirmary.

Summary

Mrs C complained that there were unreasonable delays in her being diagnosed and treated for functional neurological disorder (a problem with the functioning of the nervous system). She also felt that the board's response to her complaint was inadequate, mainly in that there were inaccuracies regarding her care.

The board did not identify any failings in the care but acknowledged that there had been some incorrect dates given in their response to her complaint.

We took independent advice from two of our medical advisers and concluded that Mrs C received timely assessments with treatment given within a reasonable timescale (about a month after the final diagnosis was reached). We also considered that the board's overall responses adequately responded to the complaint with an apology given for the minor inaccuracies.

Summary

Mr C complained about the care provided to his late father (Mr A) at Aberdeen Royal Infirmary. Mr A was blind, elderly and frail. He had cancer. Early in 2014 he had had many emergency admissions to hospital and in May 2014 he was admitted again. During his stay he experienced two heart attacks and was noticed to have become increasingly more agitated. Mr A required the lavatory and was assisted there by two members of staff and, at his insistence, he was given privacy. However, he fell and broke his hip. After that his condition declined. Due to this, it was not possible for him to undergo surgery and he died. Mr C believed that Mr A should not have been left unattended and he considered that this contributed to his death.

We investigated the complaint and took independent advice from our nursing adviser. We found that while there was a difficult balance to strike between safety and allowing someone dignity and privacy, in this case, because of Mr A's blindness and medical conditions, he should not have been left alone. We upheld the complaint.

Recommendations

We recommended that the board:

• provide an update of the actions/action plan they instigated since the complaint in order to ensure that their staff have the skills and resources to manage older people with delirium.

Summary

Miss C attended an orthodontic clinic for treatment in 2008 and had braces fitted. She was discharged in 2011 but in 2014 returned to say that part of the retainer had cracked. The clinic offered to repair this but said that it would have to be paid for privately as Miss C had already had one course of paid-for NHS treatment. Miss C felt she should not have to pay for private treatment because she felt that her initial NHS treatment had not been completed adequately, and she was of school age when her treatment started in 2008.

We took independent advice from one of our dental advisers who found no evidence to show that Miss C's course of treatment between 2008 and 2011 was unreasonable. Furthermore, from the evidence available, we found that Miss C did not meet the criteria for NHS-funded treatment when she re-attended the practice in 2014.