Health

Summary

Mr C had had a childhood illness that resulted in facial paralysis. Over the years, he had undergone a number of surgical procedures to improve his facial appearance. However, he complained he had been left with increased paralysis, loss of function and facial pain. He said that his appearance was worse and he had suffered nerve damage. He was at a loss to understand how this had happened and questioned the care and treatment he had been given. He complained to the board, who said that all the procedures undertaken were done with his informed consent and that his treatment was appropriate to his condition.

In investigating the complaint, we took independent advice from a specialist surgeon and a pain specialist, as well as carefully considering all the relevant information, including all the correspondence and Mr C's clinical records. Although we understood Mr C's concerns, the advice we received was that the treatment he had was appropriate and of a good standard, and the clinical notes confirmed that it was fully discussed with him in advance. When Mr C complained, his concerns and symptoms were appropriately and sympathetically dealt with. However, as the pain consultant said there were alternative methods of pain control that it might be helpful for Mr C to try, we made a recommendation about this.

Recommendations

We recommended that the board:

• give consideration to the provision of non-pharmacological means of pain control for Mr C.

Summary

Mrs C complained about the care and treatment her late mother (Mrs A) received at the Western Infirmary, Gartnavel General Hospital and Victoria Infirmary. Mrs A was initially admitted to the Western when she fell and fractured her hip. She had a hip replacement operation and was transferred to Gartnavel. Mrs C said that as Mrs A had developed pressure ulcers on her foot she was discharged home too soon, only to be admitted to the Victoria two days later, having fallen again. Mrs C had further concerns about the care of the pressure ulcers and a lack of physiotherapy, and said that her mother was again discharged too soon because she then had several more falls and had to go back to hospital.

We took independent advice on this case from three of our advisers (specialising in nursing, physiotherapy and acute medicine for older people). Mrs A had been assessed as being at high risk of developing pressure ulcers, but we found no evidence that nursing staff at Gartnavel and Victoria hospitals monitored her for this. Although a special pressure relieving boot was provided after the pressure ulcer was identified, staff did not start a wound chart to monitor and assess the ulcer as they should have done. We concluded that the nursing care in both these hospitals fell below a reasonable standard, and was not in accordance with guidance issued by NHS Quality Improvement Scotland. The board also acknowledged a delay of around 12 days in Mrs A starting physiotherapy in the Victoria after she had a short period of illness. We said that this was unreasonable, and prolonged her stay there.

In relation to Mrs A's discharge from Gartnavel, our adviser said that in itself a fall shortly after discharge would not mean the discharge was inappropriate. Although we were highly critical of the board for having lost some of Mrs A's medical records, we decided that evidence from the physiotherapy, occupational therapy and nursing records showed that Mrs A's mobility was reasonably assessed, and no significant changes were noted before she was discharged. In addition, there was evidence showing that the second discharge from the Victoria was appropriate and referrals had been made for Mrs A to continue to have her needs assessed at home.

Recommendations

We recommended that the board:

• audit a sample of patient records at Gartnavel General Hospital and the Victoria Infirmary to ensure skin risk assessments are being conducted, and appropriate care plans are in place in accordance with NHS Quality Improvement Scotland guidance;
• ensure patients in the Victoria Infirmary are promptly reviewed by physiotherapy after a period of sickness;
• apologise to Mrs C for losing Mrs A's medical records and for failing to identify that they were missing when responding to the complaint;
• review their practice on the storage of patients' medical records to prevent a recurrence of failing to store medical records securely; and
• ensure patients are referred in good time to the appropriate community rehabilitation team in preparation for discharge from Gartnavel General Hospital.

Summary

Mrs C complained on behalf of her sister-in-law (Mrs A) that the board cancelled Mrs A's facial reconstruction surgery at Aberdeen Royal Infirmary, and did not provide a reasonable explanation for this. From what Mrs C described, this was clearly an upsetting experience for Mrs A.

We looked at information from Mrs C and the board, and took independent advice from one of our medical advisers. We found that the board cancelled the operation because at the time there were not enough nurses to staff the intensive care bed that Mrs A needed afterwards, because of emergency admissions. The board said that this was not what they would have wanted for Mrs A, but that they had to put her safety first. They also explained to us what they had done to deal with demand for post-operative intensive care beds in future. Although we understood why Mrs A had found this distressing, we did not uphold Mrs C's complaints, as we found that the cancellation was not unreasonable in the circumstances, and that the board had provided a reasonable explanation of why it happened.

Summary

Mr C was unhappy with the care and treatment he received when he attended A&E at Aberdeen Royal Infirmary. He said that NHS 24 had told him to attend a primary care service next to A&E, and an appointment had been made for him to be seen just under two hours later. He cancelled this, however, and instead called an ambulance to take him to A&E. He said the care and treatment he received was unreasonable, that a senior charge nurse had assessed him as only being 'in some discomfort' and he was escorted from A&E to the primary care department.

We obtained Mr C's medical records and after taking independent advice from one of our medical advisers, who is a hospital doctor, we did not uphold the complaint. We found that staff had accurately assessed Mr C's pain and discomfort, had correctly followed their triage policy (triage is the process of deciding which patients should be treated first, based on how sick or seriously injured they are) and referred him appropriately to the primary care department.

Summary

A clinician at the prison health centre told Mr C, who is a prisoner, that he appeared to have a toenail infection and that she would let the health centre GP know, who might prescribe treatment. However, despite Mr C sending a number of written reminders on complaint forms, nothing happened. Mr C also complained that, despite his reminders, the health centre did not deal with his complaint. Our investigation showed that the complaint had not been answered appropriately, and when Mr C complained to the board, they replied to an earlier complaint that he had made on an unrelated matter.

When we became involved, this error came to light. Even then, the board did not say that they intended to put matters right, for example by arranging for Mr C to be re-examined and for any appropriate treatment to be given. Nor did they give any indication that they would be taking action in relation to the health centre's replies to the complaint. We upheld all Mr C's complaints, as we considered what had happened to be unreasonable.

Recommendations

We recommended that the board:

• apologise to Mr C for the clinical shortcoming our investigation identified;
• apologise to Mr C for the shortcomings we identified in the way in which the prison health centre and board's complaints staff handled his complaint;
• tell us what action they will take to help prevent a recurrence of the situation; and
• provide us with evidence that they have reviewed the complaints handling shortcomings we identified, and have taken action to help prevent a recurrence.

Summary

Mr C, who is a prisoner, told us that he suffered from severe pain that restricted his ability to leave his cell. He said that gabapentin (pain-killing medication) had been effective in controlling this and complained that the prison health centre had stopped his prescription for it and prescribed various alternative medications. He said these had not helped with his pain and had in fact made him more unwell. He acknowledged that there were security implications about having gabapentin in the prison environment but said that he was prepared to take it under supervision.

We took independent advice on this complaint from one of our medical advisers, who is a GP. After reading Mr C's medical records, he said that there was evidence, from these and by Mr C's own admission, of him misusing medication and sourcing drugs from other prisoners. The adviser explained that, as well as the security implications, this dramatically increased the risk of drug interactions which could, in some cases, be fatal. He noted that it was important for there to be trust between the patient and doctor before a drug with dangerous side effects and the potential for abuse could reasonably be prescribed. In addition, he said Mr C was potentially suffering from the recognised side effects of gabapentin and that he was participating in a methadone programme, on which it was important to allow doctors to remove any medications they felt he should not continue. In the circumstances, we found that it was reasonable that the doctors discontinued the prescription.

Summary

Miss C was diagnosed as having labrynthitis (an inner ear infection affecting hearing and balance). She found this very debilitating and had to take time off work. She went to A&E at Stirling Royal Infirmary twice and after the second time she had a scan, which was reported as normal. Her problems continued and her GP made an urgent referral for her to attend the hospital's ear, nose and throat (ENT) department. Miss C said that the person she saw (who she described as a nurse) told her that everything was normal and that she could stop taking the medication she had been prescribed. She was discharged. Miss C said she had since learned that she should have been weaned off her medication slowly, and she questioned the care and treatment she had received. She complained that this was inadequate and contributed to her illness and the length of time she was ill.

We obtained independent advice from one of our medical advisers, who is a consultant ENT surgeon, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that, contrary to Miss C's belief, when she attended ENT she was seen by a specialist doctor who advised her to stop taking her medication and said that her condition would improve with time. Although Miss C said that she understood that she had to wean herself off this medication, this was not the case. We found that Miss C had been assessed and treated entirely appropriately, and we did not uphold her complaint.

Summary

Miss C said that she first went to her medical practice about continuing dizziness in April 2011 and was diagnosed with labrynthitis (an inner ear infection affecting hearing and balance). Worsening headaches led her to attend the emergency department in her local hospital and she then had a scan, which was normal. Miss C said her symptoms got worse and she was no longer able to work. The practice made an urgent referral for her to attend a hospital clinic, but after examination and tests everything was found to be normal and the clinic reassured her that her condition would improve over time. She continued to feel ill, however, left the practice, and complained that despite many visits there, they did little to help her. She said that they should have made more timely referrals for her to receive a specialist opinion.

We obtained independent advice from one of our medical advisers, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that over the period concerned, Miss C attended the practice regularly and doctors made a referral for her to be seen urgently at the hospital ear, nose and throat department. She had had a normal scan and further examination and tests confirmed labrynthitis. She was referred to physiotherapy for therapy to retrain her brain to deal with the problems associated with dizziness. We decided that the GPs provided her with good care and support and tried alternative medication for her.

Summary

Mrs C cared for her late husband (Mr C) at home with assistance from carers, district nurses, Mr C's GP and the board's palliative care (care provided solely to prevent or relieve suffering) team when necessary. On the day Mr C died, Mrs C had phoned the board's palliative care line as her husband was in severe pain. An out-of-hours (OOH) GP arrived within 47 minutes of her call to provide pain relief to Mr C, who died around an hour later. Mrs C complained about the length of time it took for the OOH GP to attend and administer the pain relief.

The palliative care line is part of the board's OOH service and it helps palliative care patients to get help without having to go through NHS 24. It is not an emergency service but the board aims to respond to priority calls within one hour. Mr C was visited within 47 minutes of Mrs C's phone call and, even although Mr C was in a lot of pain, we concluded that this was within a reasonable timescale. We noted that when a palliative care patient is nearing the end of their life, an anticipatory pack of medication is often provided to help with distressing symptoms, such as pain, nausea, agitation and breathlessness. This is, however, a decision for the primary care team involved in the patient's care, not the OOH service. Although we did not uphold the complaint, we made recommendations to address our concerns about this.

Recommendations

We recommended that the board:

• ensure that the relevant primary care team review whether anticipatory care planning was in place for Mr C in line with NHS Scotland Palliative Care Guidelines (March 2012) and, if any areas of improvement are identified, prepare an action plan for implementation.

Summary

Mrs C went to her GP twice after noticing a lump in her abdomen. She complained to us that he did not perform appropriate examinations to establish the cause of her symptoms and did not offer her a NHS referral.

Mrs C said that the doctor was dismissive of her concerns about the lump, and she asked him to give her a private referral for specialist opinion. This resulted in a diagnosis of ovarian cancer. She said that there had been a delay in diagnosis and that, had she not insisted on a private referral, there would have been further delay. The GP said that he had carried out appropriate examinations and that it was his intention to make a NHS referral but Mrs C had insisted on a private referral.

We took independent advice on the complaints from one of our medical advisers, who is a GP. As our investigation found that the GP had carried out appropriate clinical assessments and made an appropriate referral, we did not uphold the complaint. We did not make any recommendations, although we did point out to the GP that if a similar situation arises in future he should record why a private referral has been requested and agreed.