Health

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.

Summary

Ms C complained that she had not been provided with pain relieving injections for her chronic back pain within the 18 week referral to treatment target. Ms C was initially offered injections to block the nerve with a combination of steroids and anaesthetic. A trial was carried out first, however, using just the anaesthetic, in order to ensure she would respond to these injections, as not all patients find them effective. The board did not accept her treatment had missed this target significantly, as Ms C had received the trial injection some 20 weeks after referral.

Although Ms C did respond to the trial injections, she did not wish to continue with this treatment pathway as she said she wished to proceed with surgical denervation (the blocking of a nerve supply through surgical intervention), which she had discussed as an option at an earlier consultation. When she was told a referral would need to be made to another board area for this procedure, Ms C also complained to us that she had been unreasonably refused a denervation procedure locally.

We took independent advice from a medical adviser, who is a specialist in pain medicine. The adviser said the board's definition of what constituted treatment was unreasonable and contradicted their own patient pathway information. Ms C's assessment of the delay she had experienced in receiving the injection was reasonable. We found that the board had already taken some action to address the delays experienced by Ms C, but that it was unreasonable for them not to accept that her delay had exceeded 30 weeks before she received the full injection treatment. We found the board had failed to write to Ms C as they were obliged to by NHS Scotland guidance when the 18 week target was breached, so we upheld Ms C's complaint about the unreasonable delay in treatment. However, our adviser said that it had not been unreasonable for the board not to provide a denervation service locally, as this was a specialised procedure, which needed to be carried out regularly to ensure optimum results, so we did not uphold Ms C's complaint about this.

Recommendations

We recommended that the board:

• provide details of their review into the delays Ms C experienced and evidence of the action they are taking to avoid a reoccurrence including the information provided to patients; and
• apologise unreservedly for the failure to provide treatment within a reasonable timescale.

Summary

Mrs C complained about the care and treatment she received for endometrial cancer (cancer in the lining of the womb) between April 2011 and March 2012 at Raigmore Hospital. Specifically, she was concerned that she was not given enough information about the cancer and her treatment options. She also raised concerns about the treatment she received in 2011 and about delays in surgery going ahead after evidence of cancer was identified in 2012. Mrs C also complained about inaccuracies in the board's response to her complaint.

We found the record-keeping by the staff involved in Mrs C's care and treatment was of an appropriate standard and reflected reasonable attempts to help her understand the diagnosis and treatment plan. We considered that this was done within a reasonable timescale after she presented with abnormal symptoms in 2011. The board also ensured Mrs C had the opportunity to discuss her concerns about her care with relevant specialists.

We took independent advice on her case from one of our medical advisers who found that the treatment given in 2011 was appropriate and in line with national guidance. Our adviser said that there were certain factors that had to be properly considered before decisions could be made regarding Mrs C's care, because of the risk to her life. Whilst we noted a slight delay in a second opinion being sought after it was indicated in 2012 that there was residual evidence of the cancer, this did not impact on Mrs C's outcome as the cancer was in the early stages and had not spread. We also found that it was not clear whether the results of an abnormal scan were highlighted to the gynaecology team through the multi-disciplinary team process. Although the subsequent delay did not have any impact on Mrs C's prognosis, it is important that radiology staff acknowledge that the referring team may not have the experience to interpret any identified abnormalities and action these appropriate. Whilst we made a recommendation to address this, we concluded that there were justified reasons why the management of her care took time to consider and did not uphold the complaint.

We did not identify any significant inaccuracies in the board's written response to the complaint.

Recommendations

We recommended that the board:

• review the current arrangements for multi-disciplinary team meetings to ensure that there are processes in place for abnormal scan or x-ray results to be flagged and actioned as appropriate.

Summary

Miss C complained that when she attended the out-of-hours service at the Royal Alexandra Hospital with chest pains the doctor diagnosed that she was suffering from flu-like symptoms. The following day the chest pains remained and she was admitted to hospital having suffered a heart attack. Miss C said that she had reported a family history of heart trouble and that she had had ECGs (electrocardiographs - tests to record the electrical activity of the heart) taken previously at the hospital. She felt the doctor should have taken note of this and conducted further tests.

We took independent advice from one of our GP advisers and determined that the doctor who saw Miss C when she attended the out-of-hours service had carried out an appropriate assessment based on the symptoms which were recorded. There was no indication from the medical records that Miss C had reported the previous ECGs or family history of heart problems. The symptoms which Miss C presented with were not indicative of a patient suffering a heart attack. We did not uphold the complaint.

Summary

Mr C complained that for a period of over three months he attended the practice with symptoms of a painful and swollen foot and that they did not refer him to hospital for specialist advice. Initially he was referred to A&E where he was diagnosed as suffering from deep vein thrombosis (a blood clot in the vein). The pain became so unbearable that Mr C again attended A&E where an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) was arranged and this showed that he had peripheral artery disease (narrowing of the arteries which affects the legs). Mr C had had to endure surgery and believed that the practice should have referred him back to the hospital sooner.

We took independent advice from a GP adviser. The adviser said that it appeared that Mr C had developed acute ischaemia (lack of blood supply) of his right limb and that this usually occurs as a sudden event on the background of a patient having peripheral vascular disease (a common condition in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles). However, although the practice had recorded Mr C's continuing symptoms (indicative of peripheral vascular disease) they failed to undertake appropriate investigations themselves or make a referral to the vascular clinic. Our adviser pointed out that although the practice failed to provide Mr C with reasonable care for his peripheral vascular disease his requirement for surgery was as a result of an acute event which could not have been predicted. We upheld the complaint.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings we identified; and
• share this report with all GPs at the practice and reflect on the adviser's comments.

Summary

Mr C attended his dentist for a routine check-up. During this check-up the dentist intended to scale and polish Mr C's teeth (a procedure where tartar build-up is removed from the gumline). Mr C refused, as a previous treatment had caused sensitivity to his teeth. The dentist advised Mr C that if he was unable to perform the treatment necessary then he could no longer provide treatment to Mr C and would remove him from his patient list.

Mr C complained that the dentist had not followed the correct procedures in de-registering him and the reason for de-registering him was unreasonable.

We sought independent advice from a dental adviser. The adviser explained the procedure for de-registering a patient, which involves contacting the local health board. The dentist was unable to provide evidence the correct procedure was followed and we upheld this complaint and made recommendations.

The adviser said that it was an individual clinical decision for the dentist to make about whether the relationship had broken down to the point where they could no longer treat the patient. Therefore, we did not uphold Mr C's second complaint.

Recommendations

We recommended that the dentist:

• revise the guidance on de-registering patients; and
• put in place a system for evidencing that the correct procedure is followed.

Summary

Mr C complained about the care his father (Mr A) received at the Royal Alexandra Hospital's A&E department after attending there with a severe headache. Specifically, Mr C complained that Mr A was not reviewed by a doctor for several hours and there was a delay in taking a CT scan of his head (computerised tomography scan: a specialised x-ray). Mr A had a subarachnoid haemorrhage (SAH: a bleed on the brain). He was transferred to a hospital with specialised services where he suffered a seizure and died.

The board said that Mr A was seen by a doctor within ten minutes of arriving at A&E and that an immediate CT scan had not been performed as Mr A's neurological examination was normal. However, he was admitted to a medical ward with the intention of carrying out a CT scan. The board considered whether there were any lessons to be learned. Consequently, the department have lowered the threshold for when a CT scan should be arranged if a SAH is suspected when neurological examination is normal.

We took independent advice from two of our medical advisers and found that Mr A was assessed promptly by an emergency doctor who had suspected a SAH. However, we were critical that the board would normally only arrange a scan if there was a neurological decline. We considered a scan should have been arranged as soon as the doctor suspected a SAH in line with national guidance. In any case, when Mr A's condition declined in A&E, a CT scan was not arranged until a further decline happened several hours later on the ward.

We were also critical that there was no record to show that the doctor had discussed the merits of arranging a CT scan with the on-call consultant. This was not in line with the General Medical Council's good practice guidance on record-keeping.

Recommendations

We recommended that the board:

• apologise to the family for failing to arrange a timeous CT scan in line with national guidance;
• review their local protocol on the management of headaches to ensure it is in accordance with national guidance; and
• draw to the attention of the emergency doctor the importance of recording discussions about the management of patients in line with good practice.