Health

Summary

Miss C complained about a dentist. The dental practice acknowledged her complaint and told her they intended to respond within 21 days. On the 21st day they wrote to her saying that they needed more time to reach a decision, and would respond within around two weeks. They provided a final response around two weeks later. Miss C complained that the time taken by the practice to respond had been unreasonable. Our investigation found that the practice's complaints procedure said they would seek to respond within ten working days and would give reasons for any requirement to extend this. As the practice had not given Miss C such reasons we upheld the complaint.

Recommendations

We recommended that the practice:

• apologise to Miss C that they did not give her reasons for the delay in responding to her complaint; and
• review their complaints procedure in line with NHS Scotland's Can I Help You? guidance.

Summary

Mrs C complained that she had been refused cosmetic surgery based on an incorrect mental health diagnosis. She also said that the investigation into her complaint was not thorough.

In our investigation, we considered the information provided by Mrs C and the board, along with her medical records, as well as obtaining independent advice from one of our medical advisers. The board said that they had not diagnosed a condition but, rather, had used a particular condition to explain Mrs C's symptoms. Our adviser recognised this but, as the symptoms were used as the reason to refuse surgery, took the view that the diagnosis was implicit. Our adviser also said that the diagnosis was clinically disputable, and so we upheld Mrs C's complaint about this.

We found that the board dealt with her complaint in line with normal procedures, but our adviser pointed out that during their investigation they had not picked up that there had been a significant misinterpretation of the government guidelines about such treatment (the adult exceptional aesthetic referral protocol). We were concerned that they did not identify this, and we also upheld this complaint.

Recommendations

We recommended that the board:

• make a full written apology to Mrs C for the shortcomings we found in relation to her diagnosis; and
• remind relevant staff of the importance of ensuring that reasoning and decision-making in relation to cosmetic surgery is in line with the guidance and exclusion criteria set out in the updated adult exceptional aesthetic referral protocol.

Summary

Ms C had surgery on her foot to treat bunions at Ninewells Hospital. She complained that the operation did not relieve her pain and discomfort, but made it worse, and so the operation was unsuccessful. After treatment, other possible surgical options were discussed with her, but Ms C was anxious about having further surgery without assurances that she would be properly assessed and treated in future. She was particularly concerned that no x-rays were taken before or after her operation.

During our investigation, the board were unable to explain why they took no

x-rays before surgery. We took independent advice from one of our medical advisers, who said that although it was not mandatory, it was normal practice to take x-rays. Because they were not taken, the adviser was not able to say with certainty whether the procedure Ms C had was appropriate. We were also critical of the board for not properly recording Ms C's consent for the surgery. The procedure carried out was different from that to which she consented and we were concerned that Ms C might not have been properly advised of the procedures involved in this or the potential for failure.

Recommendations

We recommended that the board:

• apologise to Ms C for the failures to x-ray her or record her consent as part of the initial assessment of her suitability for surgery; and
• consider whether there are wider implications for the failings identified in this case, and advise us of the actions taken to address this recommendation and any outcomes.

Summary

Mr C complained on behalf of his wife (Mrs C) that the Scottish Ambulance Service did not adequately demonstrate that they had taken remedial action in response to his complaint. Mr C told us that his wife was visited at home by her GP, who thought she might have had a stroke. Mr C said that at 11:45, the GP called for an ambulance to arrive within four hours, but that Mrs C had to wait for seven and a half hours before an ambulance arrived. Mr C said he was satisfied that the service had investigated his complaint but, given the seriousness of his wife's condition, he wanted an assurance that the service's procedures and attitudes had changed for the better.

We looked at the information provided by Mr C and the service, and took independent advice from one of our medical advisers. We found that the service had taken the remedial action that they outlined in their response to Mr C's complaint. They had reviewed Mrs C's case, including the phone calls made and the relevant electronic records, as well as speaking to the supervisor involved and taking follow-up action with them. We were satisfied that the information in the service's response was reasonable and that they had done what they said they would.

Summary

Mr C, who is a doctor, complained on behalf of his friend (Mr A). Mr A had phoned Mr C because he had pain in his chest and arm. Mr C was concerned that his friend was having a heart attack, so he phoned for an ambulance. The crew assessed Mr A, including carrying out an electrocardiograph (ECG - a test that records the electrical activity of the heart). They found no indicators of a heart attack, and Mr A decided not to go to hospital. When Mr C heard this, he was very concerned and phoned for another ambulance. At this point his call was transferred to NHS 24, who went on to speak to Mr A before sending another ambulance. Mr A was taken to hospital and was found to have had a heart attack. Mr C then complained that the first crew did not assess Mr A properly and take him to hospital.

The Scottish Ambulance Service said that Mr A had not been taken to hospital in the first ambulance at his own request. However, they also noted that the crew did not make sufficiently thorough records of the tests they carried out and their visit.

We sought independent advice from a paramedic, who said that the first call was taken and prioritised appropriately, and that the service appropriately sent an emergency ambulance. He also considered that, given the finding of the tests when they assessed Mr A, it was reasonable for the crew's assessment to override Mr C's phone assessment. Mr C's second phone call was also appropriately handled, given the evidence available. We did not uphold the complaint, as although we found that the first crew were not told that a doctor had assessed Mr A by phone, and did not keep sufficient records of their interaction with Mr A, we were satisfied that they appropriately assessed his condition. We also noted that the service had reminded ambulance crews that they should make sure they evidence all of their clinical actions, particularly where a patient is not being taken to hospital.

Summary

Mr C, who is a doctor, complained about the Scottish Ambulance Service's response to a call he made to them when his wife (Mrs C) awoke one night with an irregular heartbeat. Mr C reviewed her condition and was concerned that her symptoms indicated she needed immediate medical assessment and possibly treatment. He called for an ambulance, but was not happy with the response. He was taken through the standard triage procedures, despite explaining that he was a doctor and was with the patient. After a discussion with a clinical adviser, a non-emergency ambulance was sent, and Mrs C was taken to hospital.

The service said that they had a protocol for calls from doctors, but as Mr C was not practicing at the time of the call, they treated him as if he were a member of the public, and took him through the normal triage procedures. They also explained that they were in the process of redesigning their triage process for calls from health professionals, and would take this case into consideration during that process.

We obtained independent advice on the complaint from a paramedic, who said that the service should have taken greater account of Mr C's assessment of his wife's condition. This would have enabled the clinical adviser to override normal protocols, and request an emergency ambulance for Mrs C. As they did not do this, we upheld the complaint.

Recommendations

We recommended that the service:

• provide an action plan for the re-design of protocols for handling ambulance calls from health care professionals; and
• apologise to Mr C for not handling his call more appropriately, and for not sending an emergency ambulance.

Summary

Ms C was the carer for her late employer (Ms A). When Ms A became unwell late at night with nausea, diarrhoea and abdominal (stomach) pains, Ms C requested an ambulance. She was referred to NHS 24 and a nurse called back and arranged for an out-of-hours (OOH) GP visit. About an hour and a half later, Ms C called NHS 24 again as Ms A's pain was worsening, at which point the OOH doctors arrived. They examined Ms A, provided medication and advised Ms C and Ms A to call back should Ms A's condition worsen. When Ms C's colleague took over caring for Ms A in the morning, she contacted NHS 24 and was told to call Ms A's medical practice. Ms A's GP visited, after which Ms A was admitted to hospital, where she later died.

Ms C complained about the care and treatment that Ms A received from both the OOH GP service and NHS 24. Ms C was of the view that if Ms A had been taken to hospital sooner, the outcome might have been better. She also thought that the OOH doctors provided inadequate pain relief, and was unhappy that she had to contact NHS 24 again (rather than being able to contact the doctor directly).

Our role was to consider whether – on the basis of the available evidence - the care provided to Ms A was reasonable. We took independent advice on the case from one of our medical advisers, who is a GP. The adviser reviewed the evidence, and explained that NHS 24 had not acted unreasonably in arranging for the OOH GPs to attend. He said that the records showed that the doctors examined Ms A and appeared to have discussed a possible hospital admission with her. The adviser was also satisfied that the OOH doctor gave appropriate advice by advising Ms A to call back should her condition worsen. His overall view was that the care provided was of a reasonable standard. Although we recognised how difficult and distressing this had been for Ms C, in the light of the advice we received we did not uphold her complaints.

Summary

Mrs C complained about the care given to her husband (Mr C) during two admissions to St John's Hospital. In particular, she was unhappy with the content of the discharge letters and complained that the content of these had adversely influenced her husband's treatment. She was also unhappy with the board's handling of her complaints about this.

As part of our investigation, we obtained independent advice from one of our advisers, who is a consultant physician in acute internal medicine. After taking this advice we found no evidence that Mr C had not received appropriate care during the admissions and that there was no evidence that his treatment was in any way influenced by the discharge letters. Our adviser said that the discharge letters were medically appropriate, and that Mr C had been thoroughly examined, investigated and diagnosed before each discharge. The decisions to discharge him were also reasonable and appropriate.

The board accepted that, while they had responded to Mrs C's initial complaint in line with their complaints procedure, they had not met their time standards in responding to her second complaint, and they apologised for this. We also found that although, in response to Mrs C's continuing concerns, they had obtained a second opinion about Mr C's clinical care, they had failed to address all the issues she raised in her complaint.

Recommendations

We recommended that the board:

• remind staff of the need to adhere to the timescale for responding under the NHS complaints procedure; and
• ensure that complaint responses address the issues raised in a complaint.
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Summary

Ms C was the carer for her late employer (Ms A). When Ms A became unwell late at night with nausea, diarrhoea and abdominal (stomach) pains, Ms C requested an ambulance. She was referred to NHS 24 and a nurse called back and arranged for an out-of-hours (OOH) GP visit. About an hour and a half later, Ms C called NHS 24 again as Ms A's pain was worsening, at which point the OOH doctors arrived. They examined Ms A, provided medication and advised Ms C and Ms A to call back should Ms A's condition worsen. When Ms C's colleague took over caring for Ms A in the morning, she contacted NHS 24 and was told to call Ms A's medical practice. Ms A's GP visited, after which Ms A was admitted to hospital, where she later died.

Ms C complained about the care and treatment that Ms A received from both the OOH GP service and NHS 24. Ms C was of the view that if Ms A had been taken to hospital sooner, the outcome might have been better. She also thought that the OOH doctors provided inadequate pain relief, and was unhappy that she had to contact NHS 24 again (rather than being able to contact the doctor directly).

Our role was to consider whether – on the basis of the available evidence - the care provided to Ms A was reasonable. We took independent advice on the case from one of our medical advisers, who is a GP. The adviser reviewed the evidence, and explained that NHS 24 had not acted unreasonably in arranging for the OOH doctors to attend. He said that the records showed that the doctors examined Ms A and appeared to have discussed a possible hospital admission with her. The adviser was also satisfied that the OOH doctor gave appropriate advice by advising Ms A to call back should her condition worsen. His overall view was that the care provided was of a reasonable standard. Although we recognised how difficult and distressing this had been for Ms C, in the light of the advice we received we did not uphold her complaints.

Summary

Mrs C's late aunt (Miss A) had severe chronic obstructive airways disease (a disease in which airflow to the lungs is restricted). Miss A was admitted to Hairmyres Hospital as an emergency with respiratory failure. A doctor reviewed her the next day, and moved her to the medical high dependency unit (HDU). Medical staff recommended that Miss A should have a CT scan (a scan that uses a computer to produce an image of the body). However, Miss A declined this, as she was anxious about being unable to lie down due to her breathing difficulties. A doctor prescribed anti-anxiety medication, and a consultant respiratory physician discussed options with Miss A for helping her undergo the scan. During Miss A's admission, staff also noticed that she was having difficulty swallowing. Medical staff stopped her non-essential medications, and prescribed a mouth wash and thrush treatment. They were concerned about Miss A's nutrition and fluid intake, and arranged for review by a dietician, but Miss A declined nasogastric feeding (where a narrow plastic tube is placed through the nose, directly into the stomach). Two weeks after admission, Miss A was transferred to a different ward, where she died a few hours later.

Mrs C complained about Miss A's care and treatment. She was concerned that medical staff had mocked Miss A for complaining, and had not taken time to understand her anxiety about the scan. Mrs C was also unhappy with the nursing care. She said Miss A was often left in soiled clothing, was not dressed in her clothes that the family had provided, and was often left without drinking water. She also said that Miss A's cards were repeatedly taken down and returned to the locker drawer after the family had displayed them, soiled bedding was left on her bed, and on one occasion she was left without blankets. Mrs C said that communication was poor, and that nurses thought Miss A was refusing medication when actually she was unable to swallow. Mrs C was concerned that Miss A was moved to a side room on one occasion without the family being informed, and was unfit to be moved to a new ward on the day she died.

After taking independent advice on this complaint from a medical adviser and a nursing adviser, we upheld Mrs C's complaint. There was nothing in the medical records to substantiate some of Mrs C's concerns. There was evidence that Miss A's overall care was of a reasonable standard, and doctors and nurses had spent appropriate time with her, discussing her concerns and encouraging her to accept treatment. However, the advisers said that the level of communication with the family about Miss A's treatment and end of life care fell below the level of care they could reasonably expect. Although we were satisfied that most aspects of Miss A's care were reasonable, we were critical of the failure to communicate appropriately with her family and, on balance, upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Miss A's family for failing to communicate effectively with them about Miss A's health and care; and
• raise the findings in this report with the doctors concerned, for reflection.