Health

Summary

Mrs C had a history of longstanding abdominal (stomach) pain. She complained that, despite an operation, she had never been given an explanation for her pain or for the procedures she had subsequently undergone and she had not been given a definitive diagnosis. Mrs C said that she remains in pain and suffers panic attacks and depression. She complained to the board who said that there was no surgically treatable cause for her ongoing pain and symptoms, and that she had been referred to a pain clinic to try to help her. They did, however, acknowledge some problems with communication and said procedures had been put in place to avoid this happening again.

We took independent advice from a surgeon about this case. Our adviser said that since her operation all Mrs C's treatment had been reasonable and appropriate. Despite many investigations, however, it had not been possible to determine the exact cause of her pain, and our adviser confirmed that there was no surgically treatable cause. However, there was evidence that communication between the board and Mrs C was confused and that there had been a delay in informing her of the outcome of a scan, so we upheld this aspect of her complaint.

Recommendations

We recommended that the board:

• make a formal apology to Mrs C for their shortcomings; and
• confirm to us that they are satisfied that the new procedures put in place will prevent such a recurrence.

Summary

Mr C complained about the treatment he received in Forth Valley Royal Hospital, Stirling Community Hospital and Falkirk Community Hospital. He said that the board had inappropriately continued with phototherapy (ultraviolet light treatment) he was receiving for a skin condition after he experienced an adverse reaction. He did not think that he should have had this treatment in the first place because of his skin type and believed that this led to him getting skin cancer. After taking independent advice from one of our medical advisers, we found that the board had assessed Mr C's skin type before starting the treatment, and because of it had selected a very gentle regime. Our adviser said that it was appropriate to undertake phototherapy as long as the protocol was followed and caution taken. We found that the protocol had been followed, and the medical adviser did not consider that the phototherapy had caused Mr C's skin cancer. We did not uphold this part of Mr C's complaint.

Mr C also complained that when he was referred for treatment of his skin cancer, the surgeon initially forgot to remove a skin lesion (an area of abnormal tissue) on his neck. We found that the surgeon had been concerned that a lesion on Mr C's scalp was the primary source of the cancer and had prioritised removing this. Our adviser pointed out that if there are time constraints on an operating list, it is reasonable to prioritise clinical treatments. Mr C also said that there was a delay in administering antibiotics for the skin graft applied during the operation. However, we found that antibiotics are not prescribed routinely when skin grafts are applied and we did not uphold this part of the complaint.

Mr C then complained about the ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) treatment he had received. We found that the treatment was appropriate and timely and resolved Mr C's problems, so we did not uphold this complaint. However, we upheld his complaint about delay in arranging for his hearing to be assessed. We did not make any recommendations in relation to this, as the board had already apologised to him for the delay and had outlined the steps they were taking to try to reduce waiting times.

Summary

Mr C is elderly and has dementia. His wife (Mrs C) complained to us about failings in her husband's nursing care during a stay at Cameron House Hospital. These included delays in taking Mr C to the toilet, delay in receiving medication for constipation; lack of stimulation; failure to supervise Mr C, which led to him falling several times; and poor nutrition, which caused him to lose weight. Mrs C said that her husband had suffered a urine infection and that nursing staff did not ask a doctor to test him for this and that he contracted MRSA (a bacterial infection resistant to a number of widely used antibiotics). She was unhappy with the attitude of nursing staff, both towards her and Mr C, and said that they failed to communicate with her about Mr C's care.

We took independent advice from a nursing adviser who said, after considering Mr C's medical records, that his care was reasonable. However, the adviser said that it was clear that staff failed to appropriately communicate with Mrs C about her husband's care and treatment. In addition, there was a failure to ensure Mrs C's views were listened to and acted on. The board had accepted there were some failings in how members of staff communicated with Mrs C, and in record-keeping. They had apologised to Mrs C and put an action plan into place to deal with this.

We took the view that this failure in communication understandably led to a breakdown in the relationship between Mrs C and nursing staff, causing Mrs C to lose confidence in the staff caring for her husband. We accepted that Mrs C had a genuine belief that there was a failure to meet Mr C's care needs. In addition, we also found that there was a lack of support and reassurance from nursing staff to help Mrs C cope with the distressing and worsening nature of Mr C's dementia. We were critical of the apparent lack of empathy by staff, given that caring for relatives is a key part of the healthcare professionals' role. We upheld Mrs C's complaint and made two recommendations for further action.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failings identified; and
• provide a copy of the action plan and an updated report on the implementation of the plan.

Summary

Mr C was Mrs A's carer, and complained on her behalf that a community health partnership did not identify that she had an infected leg wound. Mr C said that district nurses did not maintain the dressings appropriately, and an ulcer became infected. He also said that Mrs A's GP failed to diagnose the infection. Mrs A was later admitted to hospital, where she developed sepsis (a serious blood infection).

We took independent advice from two advisers; one a GP and the other a specialist in district nursing. Our GP adviser noted the condition of Mrs A's leg ulcer when she was examined by the GP, and said there was no evidence at the time of the examination, or when Mrs A was admitted to hospital, that her ulcer had become infected. Our adviser also clarified that the source of Mrs A's sepsis was never identified when she was in hospital.

Our district nursing adviser reviewed the care and treatment Mrs A was given by district nursing staff prior to her admission to hospital. This adviser explained the expectations around treatment of leg ulcers, and said that it was appropriate for staff to replace Mrs A's dressings every two days. She said that Mrs A's care and treatment was in line with national guidance and good clinical judgement, and our decision reflected this advice.

Summary

Mr C complained about the treatment he received at the Victoria Hospital over a period of months. He was admitted there suffering from stomach pains. He had an operation to treat a blockage in his bowel and was discharged, although he was readmitted soon after and operated on again. Mr C remained in the hospital and his condition deteriorated further, resulting in two more operations and a series of significant complications. He said that this had a substantial effect on him, including memory loss, mood swings and depression. He now struggles to work, and felt these complications could have been avoided had his care and treatment been of a higher standard.

As part of our investigation we took independent medical advice from an experienced surgeon. He acknowledged how serious Mr C's complications had been but said they were not due to medical or surgical failings. He said there had not been a delay in Mr C's operations and explained that one of them had only become necessary following Mr C's sudden deterioration. In addition, he explained that surgery prior to this sudden deterioration would have been inappropriate.

Although we recognised how significant this matter had been for Mr C and his family, our role was to consider whether the evidence available indicated that his treatment was unreasonable in the circumstances at the time. Importantly, this did not include the benefit of hindsight. Although we took Mr C's concerns into account, we did not find that there had been any failing in care, or unreasonable treatment.

Summary

Mr C had concerns that, when his late mother-in-law (Mrs A) was discharged from hospital to a nursing home, staff failed to inform the family about the existence of the NHS continuing healthcare procedure and that as a result there were financial implications for Mrs A. The board maintained that Mrs A's medical records contained details about communication with Mrs A's family about her discharge from hospital and that the family were satisfied that placement in a nursing home was appropriate. We upheld the complaint as we found that, although the records showed that there were frequent discussions with Mrs A's family about the plans for her discharge, there was no specific mention of the NHS continuing healthcare procedure.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failure to advise the family that there was an appeals procedure where there is a disagreement about the decision to provide NHS continuing healthcare;
• issue a written apology to Mr C for the failure to specifically record at discharge that consideration had been given to NHS continuing healthcare; and
• remind staff of the requirement to communicate with patients and carers about the procedure for NHS continuing healthcare and ensure that decisions are recorded in the medical records.

Summary

Mr C complained that the prison health centre were failing to prescribe appropriate pain medication for his knee. He was due to start a detox programme and because of that, the decision was taken to stop the pain medication he was being prescribed and to provide an alternative.

We examined Mr C's medical records and we took independent medical advice from one of our GP advisers. They explained that the steps taken by the prison health centre in Mr C's case were appropriate because the effects of the pain medication he was being prescribed would have been blocked by the effects of the detox programme. Our adviser also confirmed that the alternative pain medication prescribed to Mr C was appropriate. We accepted the view of our adviser and we did not uphold Mr C's complaint.

Summary

Ms C had a complex medical history including extensive long-standing urological (urinary tract) problems dating back to childhood. She had her left kidney removed, with a segment of the tube that carries urine from the kidney to the bladder (ureteric stump) being left in place. In October 2012, Ms C's GP referred her to a urologist at Ailsa Hospital for recurrent urinary tract infections and to a consultant surgeon because of gastroentology (digestive system) symptoms including abdominal pain, bloating, variation in bowel habit, diarrhoea and intermittent rectal bleeding. Following investigations, the ureteric stump was removed in March 2013 and Ms C's urological problems improved. However, her gastroenterology symptoms continued and in October 2013 she was diagnosed with irritable bowel syndrome.

Ms C complained that her urological symptoms were not investigated within a reasonable time and that there was an unreasonable delay in removing the ureteric stump. She also believed that her urological and gastroenterological symptoms were related and was concerned about her continuing severe gastroenterological symptoms, which she said worsened after the surgery to remove the ureteric stump and were not properly investigated. Finally, Ms C complained that she had not been told about the diagnosis of irritable bowel syndrome.

We took independent advice on this case from two of our medical advisers. Turning first to the care and treatment in relation to Ms C's gastroenterology symptoms, our adviser said that Ms C was appropriately investigated and treated for her symptoms. In relation to her urology symptoms, the advice we accepted was that this too was reasonable. Both our medical advisers pointed out that Ms C had a complex medical history and that, in relation to her urological condition, her case was rare and unusual. However, we found that the board appropriately arranged for further follow-up for her gastrointestinal problems. Ms C felt strongly that both sets of symptoms were directly linked, but our medical advisers said there was no evidence that this was the case. We were concerned that there was no direct evidence in Ms C's medical records that the diagnosis of irritable bowel syndrome was discussed with her, but we noted that the board had taken steps to address this. We were satisfied by the evidence from the medical records that, with the exception of this, the standard of care and treatment was reasonable.

Summary

Miss C complained to us on behalf of her son (Mr A). She said that the board had failed to provide reasonable care and treatment to him after he injured his nose. Mr A had several appointments in the board's ear, nose and throat (ENT) and maxillofacial (the specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) departments after he sustained the injury.

We took independent advice on the complaint from one of our medical advisers, who is an experienced ENT surgeon. We found that the board had initially taken reasonable action to investigate Mr A's problems. However, we found that staff in the ENT department had failed to identify that an x-ray that had been carried out suggested a disease in one of his sinuses. They had then not taken action to investigate this further, and in view of this, we upheld this aspect of Miss C's complaint.

Miss C also complained about the way in which the board handled a complaint from Mr A's representative about the matter. We found that they had delayed in issuing a response, and had failed to keep Mr A's representative updated when the response was delayed.

Recommendations

We recommended that the board:

• apologise to Mr A for the failure to adequately investigate the condition affecting his sinus;
• take steps to arrange an urgent ENT appointment for Mr A in order that the matter can be investigated;
• review the reporting of images in the ENT department to ensure these are appropriately reported;
• make the staff involved in Mr A's care in the ENT department aware of our finding on this matter;
• remind the staff involved in handling the complaint that they should keep complainants updated when there is a delay in a response being issued; and
• apologise to Mr A for the complaints handling failures.

Summary

Mr A had suffered a morphine overdose and become unwell. An ambulance was called and the crew assessed Mr A. He was nauseous and vomiting, had abdominal (stomach) pains and was unable to keep down food or drink. He was taken to Perth Royal Infirmary, where he was triaged and sent to the out-of-hours service. He was assessed there by a primary care nurse, and deemed fit to be discharged.

His niece (Mrs C) complained on behalf of Mr A. She said that when Mr A had been discharged he had phoned her and was confused and disorientated. Mrs C complained that her uncle was not reasonably assessed at the hospital and should not have been discharged.

During our investigation we took independent advice from both a GP adviser and a nursing adviser. Both advisers expressed concerns that the assessment of Mr A was not thorough. The nursing adviser was concerned that Mr A's recent morphine overdose history was not noted and that his abdomen was not examined, in light of the pain reported to the ambulance crew. The GP adviser was also concerned that Mr A was not assessed for dehydration due to his inability to keep down liquids. In light of the advice we received, we upheld Mrs C's complaints.

Recommendations

We recommended that the board:

• share the outcome of this investigation with the practitioner concerned to reflect on assessment and record-keeping; and
• apologise to Mr A for the failings identified.