Health

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mrs A) about care and treatment provided by a dentist. Mrs A said that when she visited the dentist, he x-rayed her jaw and told her there was a gap in it, but it was nothing to worry about. However, Mrs A later found out she had a cancerous tumour which caused a break in her jaw bone, for which she needed treatment.

We looked at Mrs A's clinical records, and took independent advice from our dental adviser. We found that, based on the records, the dentist had provided adequate care and treatment in the circumstances. The dentist had told Mrs A that she had some bone loss in her jaw, and about the possible causes of mouth ulcers. He advised Mrs A to return after two weeks to check if her symptoms had improved. He had said that if the symptoms had not improved at the review appointment in two weeks' time, he would refer her to hospital for further investigations, which could include investigation for an oral tumour. However, even though the dental practice contacted Mrs A to arrange a review appointment, she did not return.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mrs A), who had injured her knee in a heavy fall whilst on holiday. She was taken to a local hospital, where the injury was treated as a sprain. She then returned home and went to the accident and emergency department of Wishaw General Hospital next day. Mrs A was assessed, but the swelling around her knee made a full examination impossible. Mrs A was reviewed there again five days later, and damage to her ligaments was suspected. She was referred to the orthopaedic (dealing with conditions involving the musculoskeletal system) fracture clinic for further assessment.

Mrs A was seen by an orthopaedic consultant, who considered it likely that she had a fracture of her knee cap, so the leg was put in plaster. Mrs A said that she repeatedly returned to the hospital, as the cast was causing her severe discomfort. She also said she repeatedly informed medical staff that her knee felt unstable and 'caved in'. Although Mrs A was first seen in July 2012 it was not until November 2012, when she started physiotherapy, that she was diagnosed with several torn knee ligaments, requiring surgical repair.

Mrs C complained to us that Mrs A’s knee was never properly examined and staff ignored her (Mrs A’s) concerns. She also said Mrs A had suffered needlessly due to the delay in diagnosing her injury and had lost income as she had to take time off work.

We took independent advice from an expert in orthopaedic and trauma surgery. He said that it was normal to wait until the swelling had gone down before attempting to examine a badly injured knee joint. He said, however, that the record of Mrs A's treatment was inadequate and there was no evidence that her knee was properly examined. Our investigation found that while the initial treatment Mrs A had received was reasonable, overall her care and treatment was not of an acceptable standard. We found that although this did not ultimately affect the outcome of her surgery, she had suffered pain and discomfort due to an avoidable delay in diagnosing her injury.

Recommendations

We recommended that the board:

• remind orthopaedic staff of the importance of a thorough, documented examination of an injury as clinically appropriate;
• apologise for the failings identified in our investigation; and
• remind staff of the importance of clear and detailed clinical record-keeping.

Summary

Mrs C's late mother (Mrs A) was admitted to Hairmyres Hospital on numerous occasions during 2012 due to heart problems. She was admitted from mid September to early October with unstable angina and, following admission to another ward a week later, she was under the care of a cardiologist (heart specialist) who thought she might have a chest infection and said that antibiotics should be prescribed. Mrs C said that while on this ward Mrs A was unable to eat and was prescribed large amounts of medication for heartburn and acid reflux. On the day of her discharge, Mrs A was seen by a dietician who noted that her food intake was poor and that Mrs A disliked hospital food. Antibiotics were not prescribed. Shortly after discharge, Mrs A's GP diagnosed her with a chest infection, and prescribed antibiotics. Mrs A was re-admitted to hospital by emergency ambulance three days after being discharged and died six days later. The death certificate stated the cause of death as infection of unknown origin, acute kidney injury (abrupt loss of kidney function), chronic renal impairment (gradual loss of kidney function), recent myocardial infarction (heart attack) and ischaemic heart disease (when the arteries narrow).

Mrs C complained that when Mrs A was discharged, she was already suffering from the infection that contributed to her death, and that communication by staff was inadequate. She was also concerned about what she described as the appalling meals being served to vulnerable people and said that it was unacceptable that families had to feed their relatives in hospital.

We found the board unreasonably failed to carry out a test and to prescribe antibiotic treatment, so we upheld this complaint. However, we noted the independent advice of our medical adviser who said that, although not prescribing antibiotics was a significant medical failure, even if they had been prescribed earlier they would not have had a significant effect on the outcome. Nonetheless, this caused a great deal of distress to Mrs C who was left with uncertainty about its impact on Mrs A's death. Problems with communication also meant that it appeared Mrs C and her family were unaware of how unwell Mrs A was during her second last admission to hospital.

In relation to the complaint about dietary requirements, we found no evidence of any shortcomings in respect of food and nutrition. Our investigation found that Mrs A was referred to a dietician at the right time, was seen within a reasonable time and that food and fluids charts were started when appropriate.

Recommendations

We recommended that the board:

• carry out a significant event analysis to address why a c-reactive protein test was not carried out, why antibiotics were not commenced and the communication failure; and
• apologise to Mrs C for the failures identified.

Summary

Mr C, who is a Member of Parliament, complained on behalf of his constituent (Mrs B) about the care and treatment that her father (Mr A) received at Kilsyth Victoria Cottage Hospital. The hospital is a rehabilitation facility, and medical cover is provided by GPs from a local medical practice. Mr A was admitted to the hospital because of general weakness and after having fallen at home. He remained there for approximately six weeks before being discharged to a nursing home. Mrs B was dissatisfied that her father was given dihydrocodeine (strong pain relief) for a chest infection, which she felt made him unwell. Mrs B also felt that her father was discharged from hospital too early.

In responding to the complaint, the board explained that the dihydrocodeine had been prescribed for pain relief and not for a chest infection. They also said that Mr A's discharge was appropriate as his observations (including his temperature, blood pressure, pulse and oxygen levels) were satisfactory.

We took independent advice on Mr A's case from our GP medical advisers. Our investigation found that the records made by medical staff about why dihydrocodeine had been prescribed were poor. The drug prescribing sheet recorded that it was prescribed for pain, but there was no record showing where the pain was located or how bad it was. However, the board provided further evidence that Mr A had sustained a fracture after falling several months earlier and was prescribed dihydrocodeine four times a day for this, indefinitely. We concluded that it was reasonable to prescribe dihydrocodeine and that the dosage was appropriately changed to an 'as required' basis, and so we did not uphold this complaint.

In terms of Mr A's discharge from hospital, we found a lack of detailed entries by the GPs to show that they assessed Mr A's condition properly during his admission, and that he was not reviewed by a GP on the day he was discharged, despite having had a high temperature for three days. We were critical of this, and also noted that although the board told us that Mr A's observations were satisfactory they also said that they were not within his usual range. We, therefore, upheld this complaint as we could not conclude from the evidence that Mr A's discharge was reasonable.

Recommendations

We recommended that the board:

• emphasise to GPs at the hospital the necessity of clearly recording the reasons for prescribing medication in the clinical records, and that the nursing staff accurately record a patient's level of pain;
• apologise to Mr C for the failings identified in our investigation;
• draw to the attention of medical staff at the hospital the importance of ensuring discharge paperwork has been checked and signed by medical staff; and
• carry out an audit of clinical records at the hospital to ensure the medical staff are recording sufficient information regarding a patient's medical history, general condition and examinations carried out.

Summary

Mrs C complained about the care and treatment that her late mother (Mrs A) received in Belford Hospital. Mrs A had been admitted to hospital after collapsing. She was discharged home some fifteen days later with a package of care, and was later moved to respite care. Her condition, however, deteriorated and she died about a month after being discharged home. Mrs C said that hospital staff did not encourage Mrs A to eat or drink; did not tell her if Mrs A had a urine infection while she was in hospital; did not go through the discharge medication with her, and discharged Mrs A before she was ready.

We took independent advice on this complaint from our nursing adviser, who said that hospital staff had taken reasonable steps to encourage Mrs A to eat and drink, and there was no evidence that she had a urine infection. We also found that, taking into account the detailed notes and the fact that Mrs A was medically fit for discharge, it had been appropriate to discharge her home with a package of care in place. We found that, on balance, the level of communication with Mrs C had been reasonable. Although there was no record that the discharge medication was explained to Mrs C, this would not always be recorded. In view of all of this, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that a community nurse's actions in respect of Mrs A's catheter (a thin tube used to drain and collect urine from the bladder) were unreasonable. Mrs A had a long-term catheter and this meant that there was a high risk of urinary infection. Good hygiene and prevention were, therefore, important. Mrs C said that the community nurses failed to change the catheter when it was reported to be badly blocked with sediment.

We found that a catheter care plan had been completed, which was good practice, and a good record of the care required. Our nursing adviser also said that community nurses had provided good care in relation to the catheter and had followed the guidance in the care plan. Changing the catheter when it was initially noted to have a lot of sedimentation might have caused further trauma, distress and a higher risk of infection. We considered that the care and treatment by the community nursing team in relation to the catheter had been reasonable.

Summary

Mrs C complained on behalf of her husband (Mr C) about a home visit by a GP from their local health centre. Mrs C felt the GP did not provide her husband with adequate care and treatment. She said that the GP was in her house for less than five minutes, did not carry out medical checks properly, and did not arrange for Mr C to go to hospital. Instead, the GP arranged for a rehabilitation team and social work to visit Mr C later that day. In response to the complaint, the GP said that Mr C declined the offer of admission to hospital, which was why she arranged the visit from the rehabilitation team and social work. The rehabilitation team contacted the GP and said Mr C now agreed with being admitted to hospital, and so the GP arranged this. Mrs C felt, however, that the delay was because of the GP's actions and complained to us.

We looked at the information Mrs C sent us, as well as information from the GP, including Mr C's medical records. We also took independent advice from our GP adviser. We could not reconcile the different recollections of exactly what was said and done during the visit. Our adviser looked at Mr C's medical records, however, and found that they showed that the GP provided reasonable care and treatment during it, and had acted correctly after the rehabilitation team contacted her. Our adviser also said there was no clinical indication that Mr C should have been admitted to hospital more quickly than he was.

Summary

Mr C complained that when he attended two dermatology appointments, the consultant reported that she had concerns about two moles on his back. Mr C pointed out that there was a further mole which was causing him concern and he felt the consultant was being dismissive about this. The consultant agreed to investigate the three moles and it turned out that the first two were benign but the third was cancerous. Mr C was concerned that the consultant had not taken his fears seriously, and said that had he not pursued the matter it could have had serious consequences for him.

As part of our investigation we took independent advice from one of our medical advisers. They said that clinicians have to use their clinical judgement in a reasonable manner. In this case, the consultant thought that only two moles required further consideration but in view of the concerns raised at the appointments, she agreed to also look at the third mole. The adviser said that it can be difficult for clinicians to determine whether a mole looks problematic, and whether there is a need for further investigations. Although the consultant did not have any immediate concerns about the third mole, she did agree to further investigation when it was pointed out to her, and the result confirmed Mr C's concerns. We found that the consultant acted appropriately on his concerns, and found no evidence that she failed to exercise her clinical judgement in a reasonable manner.

Summary

Miss C complained that her dental practice had decided to remove her from their patient list without providing her with treatment for a three month period in accordance with national guidance. She also told us that she made a complaint to the practice in 2012 and that she had not been told the outcome.

We found that, although the practice had the right to give notice of removal from the list, they also had a statutory duty to provide dental treatment for a three month period after their decision. Their final letter to Miss C did not mention this, and so gave the impression that termination would take effect immediately. We also found that the practice did not deal with the previous complaint appropriately and should have told Miss C of the outcome of their investigation into that complaint.

Recommendations

We recommended that the practice:

• remind staff of their obligation to provide dental treatment for a period of three months after their intention to withdraw from a continuing care arrangement and to communicate this to the patient;
• apologise to Miss C for the failure to explain that dental treatment would continue for a period of three months or until she registered at another dental practice;
• remind staff of their obligations under the NHS complaints procedure; and
• apologise to Miss C for the failure to respond to her complaint in an appropriate manner.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she went to an out-of-hours GP service. Mrs C said that the doctor there did not properly assess Mrs A's new symptoms and consider them in the context of her recent medical history. Two days later, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that the doctor had made reasonable records of her examination of Mrs A, and had recognised the important details of Mrs A's recent medical history. She had made logical and reasonable decisions, which were in line with current guidance. Although we recognised that Mrs A's death was sudden and unexpected and caused great distress to Mrs C and her family, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she attended an emergency appointment at a GP practice. She said that the doctor concerned did not take proper account of Mrs A's recent medical history, nor did she examine her legs but merely accepted Mrs A's home GP's diagnosis of phlebitis (inflammation of the vein). Mrs C said that this was a missed opportunity to consider a diagnosis of deep vein thrombosis (a blood clot in a vein). Shortly afterwards, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that Mrs A had been appropriately examined and that the symptoms and examination had led to the GP making a reasonable diagnosis of phlebitis. All of this was clearly noted in Mrs A's records. We noted that the practice had since carried out a significant event analysis and looked again at their protocol for assessing leg pain.