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Mr C complained about Stobhill Hospital's administrative arrangements of his wife (Mrs C)'s treatment. During the course of our investigation, Mr C withdrew his complaint.
Mrs C was unhappy with the care and treatment provided to her late mother (Mrs A) when she was admitted to Glasgow Royal Infirmary to repair her broken hip. She complained about failure to manage Mrs A's diabetes, poor wound management, and failure to take appropriate action when Mrs A's condition deteriorated. Mrs A had fallen at home, and had surgery to repair her hip the following day. She developed an infection and had two more surgical procedures, including removal of a hip implant that had been inserted during the first operation. Her condition deteriorated, however, and just over a month after going into hospital she was admitted to the intensive care unit (ICU) where she died three days later.
Our investigation included taking independent advice from two of our medical advisers, a consultant orthopaedic surgeon and a consultant in critical care. We found that Mrs A's condition had been appropriately monitored and managed with specialist advice being taken from the diabetic and ICU teams when necessary. Mrs A's diabetes was known to be unstable before she went into hospital and it was difficult to control while she was there. The advisers said that this would have made her prone to infection, and that in turn, infection could have made her diabetes more difficult to control. They were satisfied that appropriate action was taken to monitor and address this, including asking the diabetes specialist nurse and a specialist registrar to review Mrs A several times.
The advisers were satisfied that the care and treatment of Mrs A's wound infection was reasonable. There were no clear indications of infection until almost two weeks after the operation and until then appropriate action was taken to investigate and address the symptoms that Mrs A was displaying. When her condition deteriorated further, the advisers said that Mrs A was appropriately reviewed by the ICU team and then transferred to the ICU. Our investigation found that, overall, the care and treatment provided to Mrs A was reasonable, appropriate, timely and in line with standard practice and national guidance.
Ms C complained that the board had not funded a place for her at a charitable health support organisation. The board fund a limited amount of places, but individuals can also choose to pay for the service themselves. Ms C said that she thought she had been referred for a funded place, but when she became aware that she had not been, she paid for the service herself and asked the board to refund her. The board said that they would not refund her as she did not meet the criteria for funding and that this had been made clear to her.
We found evidence that Ms C had been told she would not meet the criteria and that she had decided to arrange a place herself. We, therefore, found that Ms C was informed that no place had been booked for her and did not uphold the complaint.
Mrs C complained about the care and treatment she received at Aberdeen Royal Infirmary for autoimmune haemolytic anaemia (AHA - a blood disorder). Mrs C's medical history included high blood pressure for which she had been prescribed simvastatin (used to treat high cholesterol, which can cause high blood pressure). When Mrs C was diagnosed with AHA, she was treated by the haematology team (specialists in blood disorders). She was prescribed steroids (a group of drugs used to treat various conditions) to stabilise her haemoglobin levels (a measure of the red blood cells in the blood). This is the accepted first-line treatment for AHA. The accepted second-line treatment is removal of the spleen (an organ which helps to fight infection) and this was recommended to Mrs C. She agreed to this reluctantly, as she thought that the simvastatin tablets were causing the AHA symptoms.
Our investigation included taking independent advice from one of our medical advisers, who is a consultant haematologist (blood specialist). The adviser found no evidence that the simvastatin tablets were linked to the AHA, although some of their common side effects are similar to AHA symptoms. The adviser said it was reasonable that doctors did not tell Mrs C to stop taking the simvastatin before her spleen was removed. Although Mrs C felt that her condition was unchanged after the operation, our adviser noted that doctors were then able to reduce her steroid dosage to zero.
We did, however, find problems in communication between the medical team and Mrs C, and in the taking of her consent for the operation. She had reluctantly agreed to the operation and signed a consent form. However, as she was sure the simvastatin was the cause of her symptoms, she then tried to discuss this with hospital doctors. She felt that she was being ignored, and spoke to her GP who contacted the hospital to say that Mrs C had changed her mind about the operation. However, when she next went to the clinic, the hospital doctor that Mrs C's GP had spoken to told her that she had to have the operation which then went ahead. Our adviser was concerned that although the consent form would still have been legally valid, doctors did not revisit the issue of consent in the light of Mrs C's concerns. We were also unable to find a record in Mrs C's notes of the discussions about the pros and cons of the operation.
We recommended that the board:
Mrs C's stepfather (Mr A) was diagnosed with advanced bowel cancer and received chemotherapy (a treatment where medicine is used to kill cancer cells). Mrs C said that he attended the medical practice regularly over the two years leading up to his diagnosis, during which time his health deteriorated. Mrs C believed that his symptoms were indicative of cancer and that he should have been investigated for this sooner. She also complained that the GP made a routine - instead of an emergency - referral for a colonoscopy and gastroscopy (a fibre-optic telescope looking into both the upper and lower parts of the bowel). After Mr A was diagnosed with bowel cancer, he attended the practice with a sore leg. His wife contacted the oncology department (who specialise in treating patients who have cancer) at the local hospital (the first hospital), who arranged a scan that showed that he had a blood clot in his leg and lung, and the following year his health began to deteriorate significantly.
Mrs C said that there was a failure by healthcare professionals in the community to provide a discussed and implemented care plan about support throughout Mr A's illness and end of life care. Mr A wanted to receive end of life care at home but at no time was he consulted about his wishes or preferred place to die. He had a number of admissions to hospital due to blood clots and his deteriorating condition. In the last month of his life, it was noted in the GP records that chemotherapy treatment had stopped due to progression of the disease. During his last admission to the first hospital, Mrs C said a doctor told them surgical intervention was not possible and the aim was to get Mr A's pain under control and discharge him home. However, Mr A's wife received a phone call several days later saying that her husband would be transferred to a second hospital where he would be under the care of his GP practice. Mr A remained unresponsive for several days, and his GP said Mr A was dying, but did not tell the family that he had decided that Mr A should no longer be given oral medication. Several days later, the family became distressed at Mr A's condition, and his GP told the family it was difficult to say how much longer he had to live. Mr A died shortly after.
Mrs C complained that the practice failed to refer Mr A to a specialist consultant within a reasonable time, failed to diagnose the blood clots he developed and that the communication and support was not reasonable. In relation to her complaint about the care provided by GPs when Mr A was a patient at the second hospital, Mrs C said she had concerns about prescription of medication and that Mr A was unresponsive for an unreasonable length of time.
After taking independent advice from one of our medical advisers, we found it was unlikely that Mr A would have had bowel cancer symptoms until around 18 months before his diagnosis, and there was no evidence that his medical problems were not reasonably assessed and dealt with. However, the medical adviser said that Mr A should have been referred urgently to hospital at one point in light of his warning symptoms and we upheld this complaint. We found that the practice's management of Mr A in relation to his blood clots was reasonable. We upheld the complaint about end of life care, as our adviser said that while it was not the sole responsibility of the GP to have such discussions with patients, they should ensure it was done within a reasonable time. In this case, the practice's failure to coordinate an appropriate end of life care plan compounded Mr A's and his family's distress at what was happening.
Our adviser said that there was a shared responsibility between the practice and the consultant oncologist (a doctor who specialises in treating patients who have cancer) to ensure that Mr A and his wife understood why chemotherapy was stopped. While we found that communication was on the whole reasonable, particularly in relation to stopping all medication and likely timescale of death, the failing around the decision to stop chemotherapy was significant because it meant that later discussions about treatment involved palliative care (care solely to prevent suffering), and we upheld this complaint.
Finally, we did not uphold Mrs C's complaint that medical staff at the second hospital (which was provided by GPs from the practice) failed to provide Mr A with appropriate medical care, as we found that the care and treatment provided in relation to pain relief was reasonable.
We recommended that the practice:
Ms C complained about her dentist. In particular, she said that his care and treatment had been unreasonable and inappropriate and that this caused her pain and upset. Ms C also said that the dentist had delayed in making a referral for her to a dental clinic and that when she attended the clinic, the referral was unnecessary. She further said that unsuccessful work had been carried out on one of her teeth which then had to be extracted at her own expense.
We took independent advice from a senior dental practitioner and our investigation showed that when Ms C first saw the dentist it was for an emergency appointment. She was immediately given appropriate treatment. She attended again and after an x-ray, treatment options were discussed and Ms C made decisions about her preferred treatment. Later, because a problem with one of her teeth was not settling, it was agreed with Ms C that she should be seen at a dental clinic and a referral was immediately made. However, the dental clinic had problems with their email and it was not received. As soon as this was discovered, the dentist made a further referral and Ms C was seen. Although she complained about her treatment it was established that it had been reasonable and appropriate in the circumstances.
Ms C complained that her dentist failed to examine her or treat her reasonably or appropriately. She said that it was only shortly afterwards, when she changed to a new dentist, that she learned the extent of her problems, which she said the first dentist had allowed to develop.
We took independent advice from a senior dental practitioner and we found that as the appointment concerned had been on an emergency basis, Ms C had been given immediate treatment on the particular problem she presented with. The appointment was not routine, and so the dentist had not been expected to make a full examination of Ms C's mouth. We found the treatment he gave her had been appropriate in the circumstances.
Mr C complained about the nursing care and treatment provided to his late wife (Mrs C) and also complained that when her condition deteriorated she was not transferred to the Intensive Treatment Unit (ITU). Mrs C had a previous medical history which included Type II diabetes, heart disease, and kidney problems and she had been progressively unwell several months before she was admitted to Forth Valley Royal Hospital. At that time she was complaining of a six-week history of breathlessness, an unproductive cough, reduced exercise tolerance, and increasing leg oedema (swelling due to fluid retention). Mrs C was treated with drugs to fight infection and to reduce fluid retention but her condition failed to respond and she died around four weeks after being admitted.
We took independent medical advice from one of the Ombudsman's nursing advisers and a consultant who specialises in care of the elderly. We found that although the nursing treatment was reasonable, appropriate and timely, there were some failings in the nursing care provided including failure to appropriately supervise Mrs C when she was self-administering her insulin (a drug used to treat diabetes); to deal appropriately with urine samples; and to communicate the seriousness of Mrs C's condition to Mr C and members of the family. These failings had already been acknowledged and apologised for by the board in their responses to Mr C's complaint to them, and an action plan had been implemented to address the issues, including ongoing staff education. Therefore, although on balance we upheld this aspect of Mr C's complaint, we did not make any recommendations as we considered that appropriate action had already been taken by the board.
On the medical treatment provided to Mrs C, our consultant adviser said that Mrs C received appropriate assessments, investigations, specialist reviews and modifications of treatment where required. On the specific issue of transfer to the ITU, we found that when Mrs C's condition deteriorated, she had been appropriately reviewed and her treatment was modified accordingly. She was then reviewed shortly after by an ITU consultant. By the time of the ITU review, Mrs C's condition had improved and then remained clinically stable, although she was still very unwell, for the next few days. The decision was taken that admission to the ITU would be unlikely to achieve any further improvement in Mrs C's condition and we considered that this was a reasonable decision, so we did not uphold this aspect of Mr C's complaint.
Mr C complained because he felt a nurse had inappropriately disclosed his medical information at a meeting with prison staff. He also complained about the way the board handled his complaints.
In response to our enquiries, the board confirmed the nurse discussed issues in relation to Mr C at the meeting but she did not disclose any medical information. They also confirmed that Mr C had given instructions to the board that his information should not be shared but those instructions were given after the meeting in question had taken place. The board provided a copy of a patient registration form that Mr C signed when he was received into the prison healthcare system which advised him that the NHS may need to share information about his health and medication with people outside the NHS, such as prison staff. In light of this, we did not uphold his complaint about this.
However, in looking at the board's handling of Mr C's complaints, the evidence available confirmed that they did not respond to some of them and for those they did respond to, they could have provided a fuller reply. We upheld this part of Mr C's complaint.
We recommended that the board:
Mrs C was admitted to Forth Valley Royal Hospital suffering from shortness of breath and oedema (swelling) caused by fluid retention due to her chronic (long-term) congestive heart failure. She also suffered from kidney disease and insulin-dependent diabetes. Despite treatment, Mrs C died some two weeks later, and her husband (Mr C) then complained about her care and treatment. As he held power of attorney (PoA - a legal document appointing someone to act or make decisions for another person) for Mrs C, Mr C said it was inappropriate for staff to speak to his wife alone about her condition and treatment, and he complained that he and his family were not kept informed about her care and treatment.
We took independent advice on Mr C's complaint from two of our advisers, a doctor and a nurse, and we also reviewed the relevant legislation and medical guidance. Mr C was concerned that one of the drugs (furosemide) that his wife was prescribed for fluid retention was making her worse and contributing to the worsening of her kidney disease. National guidance says that this is the recommended first-line treatment, but that it can cause kidney damage and needs to be carefully monitored. We found that it was monitored and that when Mrs C's kidney function continued to deteriorate the drug was stopped. Mr C also had concerns that Mrs C's diabetes was not being appropriately managed but this was not supported by the evidence in the medical and nursing notes, and there was evidence of regular reviews by a diabetic nurse specialist and a dietician. We were, therefore, satisfied that the care and treatment provided to Mrs C was reasonable, appropriate and timely.
In relation to the PoA and general communication issues, the PoA clearly stated that it was to be invoked only if Mrs C lacked capacity - this is in line with the relevant legislation (the Adults with Incapacity (Scotland) Act 2000). Guidance issued by the General Medical Council (GMC) and Nursing and Midwifery Council (NMC) (the governing bodies for doctors and nurses respectively) says that a patient should be deemed to have capacity to make decisions about their care unless it can be demonstrated that they do not. There was ample evidence within Mrs C's notes that staff considered her to have capacity, so we took the view that it was reasonable and appropriate for staff to discuss care and treatment with Mrs C herself and to act upon her wishes. We also found evidence of numerous discussions between medical and nursing staff with members of the family, including Mr C. In light of this, we did not uphold Mr C's complaint.