Health

Summary

Mr C complained that the board unreasonably refused to prescribe him a specific type of medication, that his prescription was stopped without him seeing the prison doctor, and that the board had failed to respond to his complaints appropriately.

Mr C had fallen one evening and cut his head, which resulted in him attending hospital for stitches. When nursing staff attended his cell, Mr C had fewer tablets of his prescribed medication than he should have had but he said this was because the remaining tablets were in a safe in his friend's cell. Mr C said he had previously had his medication stolen and, to try to prevent this from happening again, his friend kept some tablets for him. Mr C provided the remaining tablets the next morning but said he was then told his medication would be stopped. Mr C felt this was unfair.

As part of our investigation we took independent medical advice from one of our GP advisers. They said if the board had a policy about concealment of medication or patients not keeping their own medication - and Mr C had been made aware of it - then they could not say refusing to prescribe the medication was unreasonable. The board provided a copy of a contract Mr C had signed and it said he would neither give his medication to anyone else nor keep another person's medication in his possession. It also said if Mr C breached its terms then his medication would be reviewed and possibly stopped. Although Mr C outlined his concerns about his medication possibly being stolen, we considered the contract clear that he should not have given it to someone else. We did not uphold this complaint.

Despite this, our adviser said they would have expected additional records relating to the decision to have stopped Mr C's medication. They were concerned Mr C had to seek the reason for it being stopped (rather than him being told directly) and pointed to some inaccuracies in one of the prison health centre's responses to Mr C's complaint. That letter had said Mr C was admitted to hospital with a suspected overdose, yet there was no other record of this. We also took independent advice from our nursing adviser, who also saw no evidence that Mr C had been to hospital with an overdose. Although we did not consider these errors automatically meant medical staff had considered inaccurate information when reviewing Mr C's medication – his medical records did not mention a suspected overdose - the advice we received was that it was unreasonable Mr C had to seek the reason for the change to his prescription. We upheld Mr C's second complaint.

Finally, Mr C's complaints should have been acknowledged in three working days. The board's internal records were unclear as to whether this had happened and, as above, one response from the health centre contained factual inaccuracies. The board's responses were almost identical to each other, which we found particularly concerning in light of the apparent errors in the health centre's response. We felt that did little to evidence the thoroughness of the board's investigation and we upheld this complaint.

Recommendations

We recommended that the board:

• ensure that clinical staff are reminded of the relevant General Medical Council guidance for prescribing medication in terms of patient communication;
• review the matter so the prescribing GP, if inaccurate information influenced his decision to stop Mr C's medication (such as him having been admitted to hospital with an overdose), revisits that decision;
• ensure the health centre team reflect on the inaccuracies identified in their handwritten response to Mr C's complaint and take steps to prevent this happening again; and
• conduct a review of their handling of Mr C's complaints and confirm to us any areas for improvement identified for future complaints handling.

Summary

Mrs C complained that the board failed to take reasonable steps to mobilise her father (Mr A) during his stay in the Western General Hospital.

During our investigation, we took independent advice from three of our medical advisers, a consultant physician, a physiotherapist and a nursing adviser, after which we upheld Mrs C's complaint. The consultant physician said that the medical care Mrs C's father received was generally of a high standard and that the decision to discharge him had been reasonable. However, we were concerned that there was no reference in Mr A's medical records to the decision to prescribe him a second antidepressant. In addition, the physiotherapist said that Mr A did not appear to have received much in the way of mobility input during his first month in hospital and that physiotherapy care fell below what would be considered an acceptable standard. Physiotherapy treatment received later was, however, appropriate and acceptable.

There also appeared to be a lack of communication between physiotherapy, the medical team and the nursing team and a lack of coherent mobility planning involving the whole multi-disciplinary team. Our nursing adviser said that, while some aspects of Mr A's nursing care were reasonable, there were some failings in relation to record-keeping which made it difficult to establish some key aspects of the care provided, particularly in terms of his mobilisation and his confusion.

Recommendations

We recommended that the board:

• ensure that relevant staff members are made aware of our adviser's comments in relation to the use of a formal depression score to aid decision-making around antidepressant treatment, and given the opportunity to reflect on these for their future practice;
• bring the issues raised in this complaint to the attention of the physiotherapy staff involved to see if lessons can be learned and report back to us;
• consider including a section on mobility on the standard care plan;
• ensure that our adviser's comments about the lack of communication between physiotherapy and the medical and nursing team and a lack of coherent mobility plan involving the whole multi-disciplinary team are brought to the attention of the relevant staff;
• provide evidence of the systems in place to monitor the standard of record-keeping in relation to nursing and physiotherapy care, to ensure that assessment, care planning and evaluation of care delivery does reflect individual care needs; and
• apologise for the failings identified.

Summary

Mrs C complained that her husband (Mr C) received inadequate medical and nursing treatment after being admitted to the Western General Hospital. She was particularly concerned by a decision to place him on the Liverpool Care Pathway (LCP: a form of end of life care) which provides palliative care (care provided solely to prevent or relieve suffering). Mrs C believed that this decision hastened her husband's death, and pointed out that a hospice referral form appeared to give him a prognosis (forecast) of at least six months.

Our investigation found that Mr C had been admitted with a urine infection. He was, however, also suffering from advanced lung cancer, which had spread to his brain. Although his urine infection was successfully treated, Mr C deteriorated rapidly and a scan of his brain revealed that the cancer had spread faster and further than previously thought. We took independent medical advice from two advisers: a consultant oncologist (cancer specialist), and a nursing adviser. Our oncologist adviser said that Mr C's treatment had been reasonable and that the decision to place him on the LCP was appropriate. Our nursing adviser said Mr C had received a reasonable standard of nursing treatment. We found no evidence that Mr C was not treated appropriately.

Summary

Mr C complained about the care and treatment he received at Hairmyres Hospital after an operation to remove a stoma (a surgically made pouch on the outside of the body) and re-connect his bowel. He also complained that staff (particularly the consultant surgeon) did not communicate well with his wife while Mr C was on a post-surgery ward.

After his operation, Mr C was sick, and his wife raised concerns about his condition. It was initially thought that his bowel had stopped working properly. However, six days after his operation, Mr C's condition deteriorated rapidly. He was taken for a scan, which showed that the join in his bowel was leaking. This led to sepsis (a blood infection). Mr C had an emergency operation to reinstate his stoma and clean his abdominal cavity, and was transferred to intensive care for recovery. He suffered an acute kidney injury as a result of his sepsis.

We took independent advice from our gastrointestinal surgery adviser. The adviser said that the consultant had acted appropriately in terms of the care given to Mr C after his first operation, and that it was reasonable to transfer Mr C to a general post-surgery ward. However, the adviser was critical of the level of communication between the consultant and Mr C and his wife, particularly about the information given to Mr C prior to surgery, and when his condition was deteriorating. We found that the medical notes made no references to discussions between the consultant and Mr C or his wife.

We were satisfied that the care and treatment that Mr C received were reasonable, but the poor standard of communication meant that Mr C and his wife did not fully understand what was happening and why. We were also critical of the consultant's record-keeping, and that the board did not do enough to establish what had happened in their own investigation into the complaint, because they had not sought comments from the consultant, who had been a locum (temporary) consultant.

Recommendations

We recommended that the board:

• remind clinical staff involved in this case of their responsibilities to maintain records of discussions with patients and their relatives;
• take steps to contact the consultant to discuss our findings, in particular in relation to informed consent, communication and record-keeping; and
• apologise to Mr C and his family for their failures in relation to communication, record-keeping and complaints handling, and for the stress and anxiety this caused.

Summary

Miss C, a caseworker for an MSP, complained on behalf of a constituent (Mrs B). Mrs B was unhappy with the care and treatment provided to her late father (Mr A) at Hairmyres Hospital in relation to his symptoms (he had intermittent choking problems and a blocked bile duct), his lung cancer, and related nursing care. Tests in 2010 showed abnormalities in Mr A's lungs, but he was not diagnosed with lung cancer until December 2012. Mrs B was concerned about the delay in diagnosing this, and about the investigations and treatment decisions in relation to her father's swallowing difficulties.

We took independent advice from two medical advisers. Our advisers said that Mr A's cancer was diagnosed within a reasonable time, referrals to hospital were dealt with promptly and related treatment decisions were reasonable. The care and treatment of his blocked bile duct was also appropriate. Both advisers said that Mr A's medical history was complex, and that part of the difficulty was that not all his problems were directly linked and many medical specialities were involved. We did not uphold the complaint about his medical care.

We did, however, uphold the complaint about nursing care. Mrs B was concerned about provision of nutrition and fluids, pain relief, and aspects of personal care. She also complained that nursing staff failed to inform Mr A's GP of his death, which the family found distressing. We took independent advice on this from our nursing adviser, who said that although care in respect of many of the aspects that caused Mrs B concern was reasonable, there were failures in monitoring Mr A's fluid and nutrition. Given the significance of these to Mr A's medical problems, we were critical of this. There were also record-keeping shortcomings - nursing staff failed to record what was done to address the family's concerns about one admission to hospital, and did not contact Mr A's GP to let them know about his death.

Finally, Miss C complained that the family's communication needs were not met and that they were left unclear about what was happening. We found, however, that Mr A's medical records contained a number of entries about communication with him and his family. In relation to one aspect (the advice the family received about Mr A's pacemaker) the board accepted that this was incorrect and apologised for the distress this caused. Having considered all the evidence available, however, we were satisfied that the overall standard of communication was reasonable, and we did not uphold this complaint.

Recommendations

We recommended that the board:

• ensure the failures this investigation identified are raised with relevant health care professionals;
• inform us of the actions taken to address the failures in relation to fluid and nutrition monitoring and record-keeping (including informing relevant healthcare professionals of a patient's death); and
• apologise for the failures this investigation identified.

Summary

Ms C complained on behalf of her client (Ms A) about the care and treatment provided to Ms A for anorexia nervosa (an eating disorder) when she was admitted to New Craigs Hospital (a psychiatric hospital). Ms A had been placed on a short term detention certificate and her medical records show that on admission she had a low body mass index. It was also noted that she was at high risk of refeeding syndrome (a potentially lethal disorder that can occur when a person is recovering from a period of starvation), and it was decided that refeeding should take place in a medical unit at another hospital. There were, however, no beds available there at that point. Ms A was sipping water and was aware of the plan to transfer her to the other hospital, where she might be fed with a nasogastric tube (a narrow tube passed into the stomach through the nose). However, she was not admitted there until five days later. By this time her mental and physical state had deteriorated, and she had lost weight and become unresponsive.

Ms C complained that despite suffering from anorexia and a low body mass index, Ms A was not offered anything to eat or drink for four days. She said that as Ms A was under a short term detention order, staff could and should have started nasogastric feeding. Ms C also said it was inappropriate to transport Ms A in a patient transport vehicle instead of an ambulance, given her serious condition.

We took independent advice on this case from two of our medical advisers. We found that the medical records indicated that Ms A was offered food and fluids, and that it was reasonable to monitor her and allow voluntary feeding instead of nasogastric feeding, particularly in light of the risk of refeeding syndrome. Although, given the nature of her medical needs, our advisers said that Ms A should have been admitted to the medical unit sooner, we were satisfied that the evidence showed that her care and treatment at New Craigs Hospital were reasonable. In the circumstances, we did not uphold the complaint but made a recommendation in light of the advice we received.

In relation to whether Ms A should have been transferred by emergency ambulance, we found that the medical records showed that her condition, while significant, did not indicate that this was required and that it was reasonable to provide the patient transport vehicle, with ambulance assistants.

Recommendations

We recommended that the board:

• review the response from the other hospital in light of one of our adviser's comments to see if any lessons can be learned.

Summary

Mrs C's child had a history of behavioural problems, and was referred to the board's community paediatric department for assessment. A number of developmental disorders were considered and ruled out and a plan put in place to seek further information from the child's school before deciding what follow-up action might be required. Due to staff leaving the department, a period of eight months went by before the case was progressed, and it was a further two months before the board contacted Mrs C telling her that no concerns had been raised about her child, who had been discharged. Mrs C continued to be concerned about her child's behaviour and sought a further assessment. This ultimately led to the child being diagnosed with high functioning autism / Asperger's syndrome.

Mrs C complained to us about the delay in diagnosis and about poor communication from the board. We upheld her complaint about delay. We found that the initial assessment of her child was not in line with national guidance for the assessment of children and young adults with autism disorders. Autism should have been considered and developmental disorders should not have been ruled out before information was gathered from the school. We found the eight-month delay before the case was progressed unreasonable, and there was a further excessive delay after Mrs C's child was referred back to the community paediatric department.

We were critical of the board for not communicating with Mrs C for ten months while the case did not progress, but overall found their communication to be reasonable.

Recommendations

We recommended that the board:

• apologise to the family for the delay in diagnosis;
• draw our findings to the attention of their community paediatric staff and remind them of the relevant guidelines; and
• review their practices for providing staff cover in instances of planned retirement to ensure that services to patients are not unreasonably disrupted.

Summary

Mr C complained that the board failed to provide him with adequate care and treatment following his admission to A&E at Raigmore Hospital with stroke symptoms. Mr C said that he was not given a thrombolysis injection ('clot buster' therapy which may reverse neurological deficit) and raised concerns about CT scans (scans that use a computer to produce an image of the body) and the prescription of perindopril (a blood pressure lowering agent).

We obtained independent medical advice from a consultant in emergency medicine (adviser 1) and a consultant in general and elderly medicine with a special interest in stroke medicine (adviser 2). Adviser 2 said that thrombolysis was not indicated at any point in Mr C's treatment and would not have been likely to result in Mr C having a better recovery. Had it been indicated, however, it was clear that by the time this was determined it would have been too late to safely administer it. Adviser 1 identified unreasonable delays in A&E and said it was not clear that the nurse who assessed Mr C recognised that his symptoms might be due to a stroke. The advisers found no evidence that the appropriate assessment tool was used when triaging Mr C (deciding where he should be treated based on his condition), and there was also an error in completing a checklist for stroke thrombolysis.

Delays in treatment resulted in an unreasonable delay in a CT scan being carried out. However, our advisers said there was no requirement for the board to carry out a second scan after what Mr C believed was a second stroke after he arrived at hospital. Adviser 2 said that a blood pressure lowering agent such as perindopril should have been prescribed for Mr C on discharge. The board acknowledged their failing in this area and took appropriate remedial action.

Recommendations

We recommended that the board:

• feed back our decision on Mr C's complaint to the staff involved;
• review their care pathway for identification of patients with a suspected stroke and escalation of care in A&E at Raigmore Hospital to ensure patients with a suspected stroke are appropriately triaged and assessed in line with Scottish Intercollegiate Guidelines Network guidance; and
• provide Mr C with a written apology for the failings identified.

Summary

Ms C had complained to us, through her solicitors, about the treatment she had received from the board. However, we learned that Ms C was taking legal action against the board in relation to the events of the complaint. Under the Scottish Public Services Ombudsman Act 2002, it would not be our practice to investigate a complaint where legal action was being taken. The complaint was, therefore, closed without further investigation.

Summary

Mrs C contacted her medical practice to get the flu vaccine for her young son. The practice provided an appointment three weeks away, but Mrs C asked if an earlier appointment would be available as her son had some outstanding health conditions. The practice said there was no urgency for the appointment so an earlier appointment was not offered.

Mrs C complained that the practice had not considered her son's individual health conditions, as they should have. She also complained that they had unreasonably told her she could leave the practice and did not respond to her complaint reasonably.

We took independent advice from one of our medical advisers. The adviser was satisfied that Mrs C's son did not exhibit any of the conditions which would qualify him as a priority patient to get the flu vaccine. For this reason, we did not uphold this complaint.

We also could not establish from the evidence available, the context in which the option to leave the practice was brought up and did not uphold this complaint. While we decided the practice had, on balance, reasonably responded to the complaint we did note areas for improvement and made a recommendation to address this.

Recommendations

We recommended that the practice:

• include, in final complaint replies, information about how a patient can progress their complaint if they remain unhappy.