Health

Summary

Mr C's son (Master A) was diagnosed with epilepsy in 2013, and was being treated by a consultant neurologist from another NHS board. In January 2014 Master A was having significant episodes, and Mr C's GP contacted hospitals in both NHS boards for advice. The GP received some conflicting advice as, because of his age, Master A was regarded by some services as an adult and by others as a child. The Southern General Hospital said that they dealt with adults and advised the GP to contact the board's children's hospital, but the GP did not do so as they understood that the children's hospital only dealt with younger patients. The board's response to Mr C's complaint indicated that had the GP contacted that hospital, Master A would have been seen there. However, he was not taken to hospital at that time.

Master A's condition did not improve and four days later Mr C took him to A&E at the Southern General Hospital. Master A was assessed and examined, and diagnosed with hyperventilation (abnormally fast breathing), but was not found to have had a seizure. He was discharged without treatment and was told to go to his GP and his consultant neurologist for follow-up (he already had an appointment scheduled with the consultant). Mr C was not satisfied with this and complained to the board about a lack of neurology service. He was dissatisfied with their responses and with the time taken to investigate his concerns.

Our investigation included taking independent medical advice from one of our advisers, who is an A&E consultant. We found that staff assessed and examined Master A appropriately, and that their decisions about discharging him were clinically reasonable. It did take some time for the board to respond to the complaints, but these were complex and involved consulting staff from various departments. For the most part Mr C was kept informed of the progress of the investigation and the timescales set out in NHS Scotland guidance on complaints handling were met. On one occasion this did not happen and we brought this to the board's attention, but we did not uphold Mr C's complaints.

Summary

Mr C said that when he arrived in prison he was in a poor state of mental health, and he complained about the time it took to see a doctor and a psychiatrist. He was also unhappy that he was refused specific medication for his attention deficit hyperactivity disorder (ADHD) and said that he got no benefit from the medication that was prescribed.

We took independent medical advice from two advisers, one a GP and the other a mental health specialist. We found that Mr C was seen by an experienced doctor the day after he arrived in the prison, and a reasonable assessment of his physical and mental state was made. In addition, there was no indication that Mr C needed to urgently see a psychiatrist. We also found that, given his medical history, the medication he was prescribed for agitation and ADHD was appropriate, and in line with national guidance.

Summary

Mrs C complained about the care and treatment she received in the Royal Alexandra Hospital. She had been transferred there from a community hospital in another board's area after injuring her upper back and neck.

We obtained independent advice on the complaint from one of our medical advisers, after which we upheld both of Mrs C's complaints. We found that although Mrs C was triaged (triage is the process of deciding which patients should be treated first based on how sick or seriously injured they are) within ten minutes of arriving in the hospital, there was some confusion about whether the orthopaedics team (who deal with conditions involving the musculoskeletal system) were told that she had been transferred there. She was not seen by a doctor from that team until nearly four hours after her arrival. During this time, staff in A&E failed to escalate the matter to ensure that she was seen by a clinician, and failed to record her neurological status. After Mrs C was eventually seen by the orthopaedics team, there was then a further 45-minute delay before she was reviewed by a more senior doctor and an additional delay in obtaining a CT scan (a scan that uses a computer to produce an image of the body).

We also found that, although it had been reasonable for staff to carry out a rectal examination (a physical examination during which a doctor or nurse inserts a finger into the rectum/back passage) to assess the extent of Mrs C's spinal injury, this was not adequately explained to her. The overall quality of the medical notes was good, but there was a failure in relation to the prescription of morphine in the drug chart. There was also a delay in arranging an ambulance for Mrs C when it was decided that she should be transferred to the national spinal injuries unit.

Mrs C also complained about the board's handling of her complaint. We found that their investigation into the problems in her care was inadequate. There was no in-depth review of the communication failures that caused the delay in her being reviewed by the orthopaedics team, and formal statements had not been taken from the key members of staff involved in her care and treatment to establish their views directly. As a result of all of this, opportunities both to identify a possible cause of the poor experience she had and to learn and rectify behaviours and improve care for the next patient were lost. In addition, the board delayed in responding to the complaint.

Recommendations

We recommended that the board:

• carry out an significant clinical incident review regarding the care and treatment provided to Mrs C;
• remind staff in the orthopaedics team to clearly explain the need for a rectal examination to patients before it is carried out;
• provide evidence that they have taken steps to try to prevent the recurrence of the problems that occurred in relation to the handling of Mrs C's complaint; and
• issue a written apology to Mrs C for the failings identified during our investigation.

Summary

Mr C complained about the board's handling of his complaint. He had tried to speak to staff about a friend in hospital, and complained that the staff gave him inaccurate information about the board's policy on restrictions on providing information about patients. When the board investigated the complaint they also provided inaccurate information in their response, although they still maintained that staff were acting in the patient's best interests.

We found that the board had apologised for the inaccurate information and that all staff had been made aware of the correct procedure to follow in future. However, we were concerned that the investigation into Mr C's complaint took six months and should have been resolved much earlier.

Recommendations

We recommended that the board:

• apologise to Mr C for the time taken to resolve his complaint.

Summary

Mr C had been diagnosed with alopecia (hair loss) when he was a child. His condition deteriorated and progressed over the years to the extent that he has now been diagnosed with alopecia universalis (a condition were a patient has no body hair). He complained that his GP failed to show him any sympathy or understanding and that the effectiveness of the prescriptions he was given was not reviewed. He said that he was not referred to a dermatologist until his condition had reached a stage where little could be done.

We took independent advice from a dermatology adviser and found that Mr C had been treated reasonably and appropriately in accordance with the symptoms he presented with; there was no evidence to suggest that his GP had been either unsympathetic or showed a lack of understanding. His medication was monitored and Mr C had declined some treatment which would have led to an earlier hospital referral.

In the circumstances, we did not uphold Mr C's complaint.

Summary

Mrs C, who is an advice worker, complained on behalf of her clients (Mr and Mrs A) that there was a delay in diagnosing Mr A's cancer.

During our investigation, we took independent advice from one of our medical advisers, following which we upheld Mrs C's complaint. The adviser said that there was an unreasonable delay in the diagnosis of Mr A's cancer. Two abnormal chest x-rays should have been reported to the clinicians caring for Mr A, which would have prompted them to consider further investigations. This did not happen and was a failure in care. We noted that the board had accepted that the diagnosis of cancer should have been reached sooner, which might have enabled treatment to have started earlier and afforded Mr A an improved outcome. We noted that the matter was to be discussed by the appropriate clinical staff to increase staff awareness of this type of situation and to take more appropriate action in the future.

Recommendations

We recommended that the board:

• report back to us on the outcome of the discrepancy meeting attended by the Head of Radiology to discuss this case.

Summary

Mrs C's stepfather (Mr A) was diagnosed with advanced bowel cancer in 2011 and had chemotherapy (a treatment where medicine is used to kill cancerous cells). In 2012, he was admitted to Aberdeen Royal Infirmary twice. Mrs C said that during the second admission a doctor told Mr A his chemotherapy had been positive but that he would not receive any more in view of problems with blood clots. Mrs C said that they later found out that it was stopped because his cancer had progressed. Mr A was admitted to hospital for a third and final time several weeks later. Mrs C said that staff failed to provide a discussed and implemented care plan about support throughout Mr A's illness and end of life care. She said that Mr A wanted to be with his wife (Mrs A) and receive end of life care at home, but was not consulted about his wishes or where he preferred to die. Mrs C said a doctor said that the aim was to get Mr A's pain under control and discharge him home. However, Mrs A received a phone call several days later telling her that he would be transferred to Peterhead Community Hospital under the care of his medical practice. Mrs C said that Mrs A was not told before the transfer that her husband was deteriorating significantly. He died six days later.

Mrs C said that clinical staff at Aberdeen Royal Infirmary failed to involve Mr A and his family in the transfer decision and failed to discuss the likely outcome for him, or the possibility that he could be cared for at home. In relation to her complaint about nursing staff at the community hospital, Mrs C said that they failed to provide a reasonable standard of care in terms of communication, personal care and dignity.

After taking independent advice from two of our advisers - a GP and a nurse - we found that staff failed to involve Mrs A and the GP in the decision to transfer Mr A to the community hospital. Given Mr A's condition, we were also concerned that he was not in a position to have an informed and reasoned discussion with medical staff about the transfer or to let them know his end of life care wishes. Although there was evidence that the likely outcome was discussed with Mr A and his family, there was no detailed record of Mr and Mrs A's understanding of this, as there should have been. Nor was there an anticipatory care plan which would have contained their wishes about where Mr A would prefer to die.

In relation to Mrs C's complaint about Mr A's personal care in the community hospital, we could not reconcile the differing accounts of what happened. Our nursing adviser said that the overall standard of care was reasonable, although in the absence of evidence we could not reach a judgement on Mr A's levels of hydration (fluid replacement). Having considered the medical records, we were satisfied that these clearly showed that the level of communication about Mr A's condition was reasonable. Similarly, we were satisfied that the care and support from district nurses was reasonable although there was no evidence that staff completed or referred to an end of life care plan. However, our nursing adviser said that a district nurse would not be expected to write an end of life care plan alone.

Recommendations

We recommended that the board:

• bring the failures our investigation identified to the attention of the relevant health care professionals involved in the transfer decision;
• provide evidence of how they intend to address the failings in relation to anticipatory care planning for end of life;
• bring the failures our investigation identified to the attention of the relevant health care professionals involved in discussions with Mr A and his family, and ensure they are raised as part of their annual appraisal; and
• provide the results of their review into their processes and procedures around communication and end of life care.

Summary

Mr C was diagnosed with alopecia (hair loss) as a child. It became progressively worse and he now suffers from alopecia universalis (a condition where a patient has no body hair). Mr C's GP referred him to Aberdeen Royal Infirmary where he saw a consultant dermatologist. Mr C complained about the care and treatment he was given which he believed was neither reasonable nor appropriate. He said that he had been forced to take medication that was ineffective and possibly had long-term side effects. He questioned his treatment plan and said that he had not been properly reviewed. Mr C was unhappy that he had not been prescribed an experimental treatment and said that the board did not provide him with appropriate support.

We took independent medical advice on the complaint from a dermatology specialist. Our adviser said that alopecia universalis has a very poor prognosis and that there is little or nothing that is effective in its treatment. The treatment given to Mr C was reasonable and appropriate and in accordance with his symptoms but, given the devastating consequences of this condition, we upheld his complaints as our adviser said that the board did not go as far as could have been reasonably expected to treat him. They did not seek support from neighbouring health board services or try to establish whether there were medical trials that might assist him. Their follow-up was poor, as a consequence of which he was effectively discharged and lost his wig entitlement, and had to visit his GP again for a further referral. Our adviser said that the board were, however, correct to refuse him the unlicensed treatment that he sought.

Recommendations

We recommended that the board:

• make a formal apology for their oversights in this matter;
• bring our findings to the consultant dermatologist's attention for him to reflect upon;
• make a formal apology in recognition of these failures; and
• emphasise to staff the importance of responding to complaints in a full and timely manner.

Summary

Mr C complained because he said the prison health centre had unreasonably stopped or reduced his medication. In particular, he said that omeprazole (medication for stomach acid) and vitamin B had not been prescribed. He also said his diabetic medication had been reduced without explanation.

The board confirmed that prisoners were responsible for reordering some medication themselves, including omeprazole. They also confirmed that the health centre at Mr C's previous prison had stopped his prescription for vitamin B. The prison doctor confirmed that he prescribed Mr C's diabetic medication to be taken twice a day, rather than three times. He was unsure why he had reduced the medication but confirmed that he had since increased the dosage back to three times a day.

We took independent medical advice, and asked our adviser whether the decision to reduce Mr C's diabetic medication was reasonable. Our adviser noted the doctor's comments and suggested that the reduction had most probably occurred as a result of an error when writing up the prescription. The adviser said it would be unusual to reduce a patient's diabetic medication without close monitoring or evidence of improvement in blood sugar levels. They also said that because Mr C's medication was increased after he reported raised sugar levels, he was unlikely to have suffered any harm. In light of the evidence, and having considered the views of our medical adviser, we did not uphold Mr C's complaint, although we made a recommendation.

Recommendations

We recommended that the board:

• apologise to Mr C for the possible error when writing his prescription for his diabetic medication.

Summary

Mrs C told us that she suffers from fibromyalgia (a long-term condition that causes pain all over the body) and attends a pain clinic. In 2012, she began to experience further pain, which she did not believe was as a result of fibromyalgia. She said that she was virtually suicidal but that clinicians failed to investigate alternative sources for her pain and continued to treat her for fibromyalgia. She said that she should have been x-rayed or scanned and that the board's failure to do so meant that the true nature of the problems with her spine were not identified.

We took independent medical advice from consultants in rheumatology and orthopaedics. We found that while it was more than likely that Mrs C had fibromyalgia, her diagnosis had not been confirmed by a specialist. When Mrs C began to suffer further pain, advice was taken from another practitioner who admitted that this was not his area of expertise. Our advisers said that while the subsequent advice given to Mrs C was mostly correct, it may have been misleading and advice should have been sought from a specialist. Doctors did not carry out further investigations into her pain to exclude either another diagnosis or a further illness.

Although our advisers did not agree that Mrs C needed an x-ray or scan, we upheld her complaint, as we found that the board had failed to carry out an appropriate investigation into her pain.

Recommendations

We recommended that the board:

• make a formal apology for their shortcomings;
• review their system for diagnosing fibromyalgia and confirm to us that they are satisfied that it is fit for purpose and sufficiently robust;
• ensure that details of the complaint are brought to the attention of the speciality doctor and the associate specialist concerned; and
• consider our adviser's comments about including reference to cervical spondylosis (neck pain caused by age related wear and tear) in the diagnosis.