Health

Summary

Mrs C had a hip replacement a few years ago which initially seemed to be successful. In early 2013, Mrs C attended her medical practice with pain in her thigh that was preventing her from bending to put her shoes on or driving. She was prescribed painkillers for a possible muscle or ligament injury and advised to rest. Mrs C's pain continued and she was sent for an x-ray which was reported as normal by a radiologist (a specialist in x-rays). The pain got no better and Mrs C was referred to a specialist. Some months after initially attending the practice, Mrs C contacted them to ask for a referral to a private hospital. Later that month, the practice arranged crutches for Mrs C as she was struggling to walk, and she was seen by the private consultant a few days later. He considered that the x-ray showed a possible issue and made suggestions for further investigations at an NHS hospital. These were carried out the following month and showed that Mrs C's replacement hip had become loose, causing the thigh bone to fracture. Mrs C complained that the practice failed to diagnose the cause of the pain in her thigh.

We took independent advice from one of our medical advisers, who is a GP. The adviser reviewed Mrs C's medical records and said that although the x-ray was normal, the fact that she continued to suffer from pain and visited the practice on several occasions should have prompted them to carry out further

x-rays, particularly when she had to be given crutches to walk. We, therefore, upheld her complaint.

Recommendations

We recommended that the practice:

• ensure that GPs familiarise themselves with the diagnosis and management of hip fracture, paying particular reference to the need to reassess patients who may clinically present with a fracture but have a negative x-ray;
• carry out a significant event meeting to discuss this clinical incident and any lessons that can be learned; and
• apologise to Mrs C for failing to take reasonable steps to diagnose the cause of her pain.

Summary

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A), about the care and treatment of Mrs A's late husband (Mr A). A GP from the medical practice had examined Mr A earlier in the day and prescribed antibiotic tablets and a throat spray. Mrs C complained that the GP then failed to reattend Mr and Mrs A's home to visit Mr A when he began having breathing difficulties. Mr A died later that day.

We took independent advice on this case from one of our medical advisers. Our adviser explained that the GP recorded a thorough history and examination in keeping with an upper respiratory infection. She said that the GP examined Mr A's chest and noted that it was clear. With regards to Mrs A's specific concern about the GP's failure to reattend, the adviser reviewed the notes relating to a phone call and was satisfied that it did not contain anything to suggest an increasing severity of Mr A's condition. Based on the advice received, we were satisfied that the GP's care and treatment was reasonable.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr C) following his diagnosis and treatment for cancer in 2010. Mr C was diagnosed with cancer of the oesophagus (gullet), and in November 2010 had chemotherapy (treatment with toxic drugs to kill or reduce cancer cells) and surgery. He attended regular follow-up appointments, firstly with the surgeon who treated him, and then with a nurse specialist from the surgeon's team. During these appointments Mr C reported that he was suffering nausea and 'gagging' when eating and that although he had a reduced appetite, he was forcing himself to eat to try to regain his health. In the late summer of 2012 he became increasingly unwell and his GP referred him back to the surgeon.

The surgeon reviewed Mr C and ordered a computerised tomography scan (CT scan - which uses a computer to produce an image of the body), which took place in early October. As Mr A continued to deteriorate, he was admitted to Raigmore Hospital a few days later. When the scan was reviewed Mr C was diagnosed with a recurrence of his cancer, which was inoperable. He died later that month after being transferred to a hospice.

During our investigation we took independent advice from a medical adviser who is a cancer specialist with experience of oesophageal cancers. Mrs C told us that she was concerned that no CT scan was carried out after surgery to confirm that all the cancer had been removed, and that regular CT scanning was not part of the follow-up programme. The adviser said that there is no scan or test that can definitely say that all cancer has been removed and, similarly, national guidance on the management of oesophageal cancers did not recommend regular CT scanning as no benefit has been found in this. The board's local follow-up protocol mirrored that guidance. The adviser also said that Mr C's ongoing symptoms were common in patients who have had oesophageal cancers, and can take a year or more to settle down. The adviser noted that the symptoms were recorded and monitored and that relevant advice, for example from a dietician, had been given. We were satisfied that Mr C was appropriately followed up and that, when he became unwell, the board took appropriate and timely action to investigate this.

Summary

Mr C complained that a prison health centre unreasonably stopped medication that he had previously been prescribed.

We took independent advice from one of our medical advisers, who reviewed Mr C's medical records. These noted that he said he was tired and having difficulty in waking up, and that the health centre told him that it was not sensible to continue taking the medication (a sleeping tablet). Our adviser said that this medication is only intended for short-term use. In light of the advice we received, we considered that the health centre doctor provided a reasonable standard of care and that the decision to stop Mr C's medication was appropriate in the circumstances.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mr A) who was not satisfied with the care and treatment provided to his late wife (Mrs A) at the Beatson Oncology Centre. Mrs A was diagnosed with local and secondary breast cancer in 2003 and was treated first with chemotherapy (a treatment where medicine is used to kill cancerous cells) although this had little effect. She was then treated successfully with hormonal therapy. In 2006 a new tumour developed and an alternative hormonal treatment was prescribed. Scans in 2007 showed no progression in the secondary cancer but the tumour had increased slightly. The tumour continued to grow slowly and in 2009 Mrs A's hormonal treatment was changed again, the tumour was surgically removed and she was treated with radiotherapy (a treatment using high-energy radiation). Two years later, scans revealed that the cancer had spread to her liver and she started a course of chemotherapy. Mrs A continued to feel unwell and was eventually admitted to the centre suffering from confusion, breathlessness and swollen legs. Staff tried to find the cause of Mrs A's symptoms but she died about two months later.

Our investigation included taking independent advice from three of our advisers - a consultant oncologist (cancer specialist); a palliative care consultant (end of life care specialist); and a senior nurse. We found that the care and treatment provided to Mrs A had been reasonable, appropriate and timely. When her cancer initially failed to respond to chemotherapy the treatment was changed, and this controlled the progression of the disease in the early stages. When a further tumour was found in 2006, appropriate treatment and follow-up was undertaken. Again, when the cancer was found to have spread, appropriate treatment was started to try to address this, although it was unsuccessful. Overall, the advisers were satisfied that the medical and nursing care provided to Mrs A were reasonable.

There were some problems with communication between staff and Mr A and his family, in particular towards the end of Mrs A's life when the family said that she had been put on an informal end of life care pathway similar to the Liverpool Care Pathway (a protocol used to guide staff caring for patients who are nearing the end of their life, by treating symptoms and trying to ensure patients remain comfortable and die with dignity). The advisers, however, found no evidence in the medical records that Mrs A was put on an end of life care pathway, and were satisfied that the care she received towards the end of her life was appropriate, and took account of her needs and symptoms.

Summary

Mr C requires regular blood sampling due to the medication that he is prescribed. At one appointment there was difficulty obtaining a blood sample and Mr C was in pain. He attended his GP who referred him to a neurologist who diagnosed nerve damage, possibly caused by the attempt to take blood. Mr C complained that the board had not provided him with a reasonable standard of care and that they had not properly responded to his complaint.

We took independent medical advice on this complaint from our nursing adviser. Our investigation found that the board had apologised for the distress caused and had made arrangements for Mr C to have future blood samples taken by another team. We considered these actions to be reasonable and did not uphold the complaint. However, we did not consider the time taken by the board to respond to Mr C's complaint to be reasonable, so we upheld this aspect of his complaint and recommended that the board apologise to Mr C for the delay.

Recommendations

We recommended that the board:

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

Summary

Ms C, an advice worker, complained on behalf of her client (Mrs A) who had concerns about her late husband (Mr A)'s, treatment at the Royal Alexandra Hospital. Ms C complained to the board about numerous issues including a breakdown in communications from staff about Mr A's deterioration, and inadequate treatment. Ms C also said the board had not addressed all of Mrs A's concerns. The board, when considering Ms C's complaint, decided that there were grounds to conduct a significant clinical incident review (SCI) and on completion forwarded a copy of the report to Ms C.

We found that, while the board's decision to hold a SCI was an indication they had taken the complaint seriously, they failed to address all the concerns Ms C raised. They simply referred her to the SCI report and apologised for other failings, but did not specify what they would do to prevent this happening again. We also had concerns about the time taken to provide a final response to the complaint.

Recommendations

We recommended that the board:

• apologise to Mrs A for the failings in communication which we have identified; and
• revisit this complaint and issue a further response which specifically addresses the issues raised with appropriate explanations, and provide information about actions which will be taken to prevent a similar occurrence happening again.

Summary

Mrs C attended at an out-of-hours (OOH) service at Monklands Hospital on two separate occasions suffering from pain across her lower back and abdomen. The OOH service provides access to GPs outwith normal working times. On the first occasion Mrs C was diagnosed with a possible abdominal aortic aneurism (a weak point in the large artery that carries blood from the heart, causing it to balloon out) or lower abdominal pain with an unknown cause. She was referred directly to a surgeon at the hospital. Tests ruled out an aneurism and Mrs C was sent home with antibiotics for a urinary tract infection.

On the second occasion, just over a month later, two potential diagnoses were recorded, renal colic (pain caused by kidney stones) or a possible pelvic mass. Mrs C was given a painkilling injection, encouraged to drink lots of fluids and sent home with advice to return if her pain worsened. She was also advised to contact her own GP on the next working day to arrange an ultrasound scan of the possible mass.

After a referral from her GP, Mrs C was discovered to have an ovarian cyst (a swelling on the ovary) and was diagnosed with cancer of the left ovary. She complained that neither of the doctors who examined her admitted her to hospital for assessment and that, had this happened, the ovarian cyst would have been picked up earlier.

After taking advice on this case from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser explained that both the doctors who saw Mrs C at the OOH service provided a reasonable standard of care and that her symptoms had not been typical of ovarian cancer.

Recommendations

We recommended that the board:

• ensure that the adviser's comments regarding the management and investigation of suspected pelvic mass (including the benefit of pelvic examinations) are fed back to the relevent doctor.

Summary

Mr C complained that the board had failed to investigate his concerns about a number of issues affecting his daughter (Miss A)'s clinical treatment. These included whether appropriate clinicians were involved, the method of transfer used to another facility, information about hospital equipment and that staff had said that he had been verbally abusive.

Our investigation found that the board treated Mr C's complaints seriously and had devoted a large amount of staff resources in an effort to address his concerns. They had agreed to appoint new clinical staff, provided explanations about the accuracy of hospital equipment and explained why staff had felt uncomfortable about Mr C's behaviour.

Summary

Mrs C's mother (Mrs A) had a history of urinary problems. She was referred for a CT scan of her kidneys in 2011 which highlighted a mass on her kidney. Further tests diagnosed cancer, and a plan was made to discuss this with Mrs A at her next scheduled appointment. Before this could happen, however, Mrs A became unwell and was admitted to Gartnavel Hospital, where a doctor told her about the cancer. A cystoscopy and uteroscopy (examinations of the tubes that carry urine and the kidneys, using a narrow tube-like telescopic camera) were performed but it was not possible to obtain tissue samples for further analysis. Mrs A was discharged home and attended follow-up clinics. Following a multi-disciplinary team discussion about Mrs A's case, it was decided that she should have surgery, but the operation she needed was not routine. Before it could be arranged, Mrs A was admitted to hospital again, as she had suffered a suspected stroke. A scan showed an acute intracerebral bleed (where blood suddenly bursts into brain tissue). Staff felt that this was indicative of a brain tumour, so they started radiotherapy (a treatment using high-energy radiation) and postponed treating Mrs A's kidney tumour. It was later found that Mrs A did not have a brain tumour. Mrs A died shortly afterward.

Mrs C complained that there were delays in diagnosing and treating Mrs A's kidney tumour. She also complained about the misdiagnosis of a brain tumour, explaining that this diagnosis caused Mrs A to enter a deep depression.

After taking independent advice from two of our medical advisers - a cancer specialist and a kidney specialist - we found that Mrs A's clinical treatment was largely good. We did find that there were unacceptable delays to two diagnostic scans, but there was nothing to suggest that this had any impact on Mrs A's overall prognosis (the forecast of the likely outcome of her condition). We accepted advice that, based on the evidence available to the clinical team, the diagnosis of a brain tumour was reasonable and that it was reasonable to start radiotherapy. That said, we were critical of the board's communication with Mrs A about her diagnosis and the treatment she received.

Recommendations

We recommended that the board:

• apologise to Mrs C that the overall time from the first suspicion of cancer to proposed treatment exceeded 62 days in her mother's case; and
• apologise to Mrs C that her mother was not advised sooner of the scan results.