Health

Summary

Mr C, a member of the Scottish Parliament, complained on behalf of one of his constituents (Ms A) about the care and treatment she received following an operation at Gartnavel General Hospital. He said that the plans for Ms A's discharge home were inadequate and that there was a failure to ensure that she was technically able to deal with the catheter (a thin tube used to drain and collect urine from the bladder) that was a consequence of the operation. He also complained that there was a failure to review her in a timely manner, that arrangements for reviews were confused, that Ms A's concerns about her operation were dismissed and that the operation had not greatly improved her condition.

The complaint was investigated and carefully considered all the relevant documentation (including all the complaints correspondence and Ms A's clinical records). We also obtained independent advice on Ms A's care and treatment from one of our medical advisers, a consultant urological surgeon (dealing with issues of the urinary tract).

Our investigation showed that the clinical aspects of Ms A's care and treatment were reasonable, as were her discharge plans. We found no evidence to suggest that her concerns about her operation had been dismissed. However, plans to review her were frustrated by confused administration and poor communication between departments which no doubt caused Ms A unnecessary stress and inconvenience at what must have been a difficult time. This was unacceptable and amounted to a service failure, and we upheld the complaint.

Recommendations

We recommended that the board:

• make a formal apology to Ms A for the added stress she experienced;
• confirm to the Ombudsman that procedures for making x-ray appointments are now effective and robust, and advise of the actions taken to ensure this; and
• advise the Ombudsman that they are satisfied that the communications problems affecting Ms A's appointments have now been addressed.

Summary

Ms C said that when she attended for her six-monthly check up at the dental practice, she reported a problem with a tooth where she had previously had root canal treatment. The dentist said that she had a slight infection and that she needed more work on the tooth. Ms C then complained that the treatment was not carried out in a reasonable way, and that the dentist had not had a proper x-ray done before starting the work. When Ms C raised these matters with the dentist, she said he behaved inappropriately and removed her from his list.

After obtaining independent advice from one of our dental advisers, we did not uphold Ms C's complaints. The adviser said that the records showed that an x-ray was taken to establish the working length of the tooth and the length of the filling required. This x-ray did not need to be ready on the day it was taken, but on the day the filling was to be done, and was the x-ray that Ms C (incorrectly) thought had not worked. Ms C also got an infection in the tooth, which was not uncommon, and the dentist had treated it appropriately with antibiotics. Ms C had disputed her care with the dentist and did not accept his explanations about it. The dentist then decided that in his view, as the trust between them had broken down, it would be more appropriate for Ms C to change dentist. Our investigation confirmed that, given the circumstances, he was entitled to do this.

Summary

Ms C, who is an advocacy worker, complained on behalf of her client, Mrs A. Mrs A went to her dentist with toothache. She was examined, but decided not to have treatment because of the complexity of the problems. Early the next month, the dentist referred Mrs A to the dental hospital. They referred her there again about two weeks later for an emergency appointment, and made a further referral some four days after that. The assessment consultation for this last referral was not until two months after the date of referral. Mrs A said that despite then going to the dental hospital a number of times, she did not receive appropriate treatment until some eight months after she first went to her dentist with toothache. Throughout this period, she made a number of calls to NHS 24 because she was in considerable pain.

Mrs A complained about the delay in treatment, and said her dentist provided all relevant information to allow treatment to proceed at the time of the third referral. She said that the delay was particularly unreasonable because she was pregnant and in pain.

We took independent advice on this case from one of our dental advisers. They said that while the board failed to meet the national 18-week target in relation to the third referral, they did tell Mrs A of the likely delays, and provided advice about what she could do to be treated more quickly. The adviser also said that Mrs A's pregnancy did not necessarily mean that she was a priority patient, and that it was the responsibility of her dentist to manage her pain while waiting for treatment. In light of the board's failure to meet the target, we upheld the complaint but we did not make any recommendations as the board have introduced a new system for appointments, with the aim of ensuring that target times are met in future.

Summary

Mrs C complained that she saw a nurse at her medical practice twice to report a lump on her breast but nothing was done. In between these appointments, she attended a mobile breast screening clinic for a mammogram (an x-ray of the breast) and, after being recalled for further investigations, she was diagnosed with breast cancer. When she raised concerns with the practice about not being referred, they said there was no trace of the first appointment having taken place. They also said that at the second appointment the nurse did not consider that any action was necessary, as Mrs C's mammogram was already being followed up by the breast clinic.

We took independent advice from our GP adviser who, having reviewed the records, confirmed that there was no evidence of the first appointment taking place. He could see no apparent discrepancies in the records and noted that the practice appeared to have conducted a thorough search. With regards to the second appointment, he advised that there would have been no merit in the practice taking further action as Mrs C was already in the screening system and was awaiting follow-up. In the circumstances, we did not uphold the complaint.

Summary

Ms C complained that after reconstructive breast surgery, there was an avoidable delay by staff at the Royal Alexandria Hospital in diagnosing that she was suffering from a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue). She said that she complained several times to staff at the hospital that there was a large protrusion on her waist on the side of the reconstruction and that she was in pain, but that this was not addressed appropriately. Ms C also said there was an unreasonable delay of five months between an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body) that showed there was a problem, and a CT scan (a scan that uses a computer to produce an image of the body) that confirmed she had a hernia.

We obtained advice on this case from one of our medical advisers, a general surgeon with a specialist interest in breast surgery. The adviser said that in the 12 months following surgery, the board acted in an appropriate and reasonably timely manner in dealing with Ms C's symptoms, as the likelihood was that the underlying cause of the pain and swelling was commonly recognised complications of her surgery. The adviser said it would not have been acceptable to carry out surgery based on the results of the ultrasound, without a CT scan to help identify the problem.

The adviser confirmed, however, that there was an unacceptable delay between the ultrasound report 12 months after surgery and the CT scan report that confirmed the hernia more than five months later. Ms C suffered a prolonged period of pain and discomfort from her hernia as a result. The adviser noted that Ms C's hernia was recorded by the board as having increased in size during the three months following the ultrasound report. However, he explained that such hernias were generally slow growing, wide necked and very rarely life threatening and that the delay did not change the final outcome in Ms C's case.

Recommendations

We recommended that the board:

• feed back our decision on this case to the staff involved to ensure that a similar situation does not occur in future; and
• provide Ms C with a written apology for the failures identified in our report.

Summary

Mr C complained about the care and treatment that his late mother (Mrs A) had when she was admitted to Seafield Hospital. He said he was concerned about her breathing, and, when he did not feel reassured by nursing staff that her condition was unchanged, he asked that a doctor be called. When the doctor arrived, he examined Mrs A, and concluded that no further action was needed.

Having considered the relevant medical records, we accepted independent advice from one of our medical advisers that Mrs A's care and treatment was of a reasonable standard. The adviser said that the doctor had noted that Mrs A was breathing at a relatively normal rate, there were normal levels of oxygen in her blood, and he did not hear anything abnormal in her chest. We decided that the actions of the medical staff were appropriate as we found no evidence that further treatment or assessment were needed.

Summary

Mrs C's young son (Master A) was referred to a speech and language therapy service. Two blocks of treatment were provided and, due to Mrs C's concerns about her son's speech, a second opinion on his treatment was sought in the first month of the second block of treatment. The service did not feel that Master A needed further direct therapy after the second block of treatment, and he was instead seen for a review every three months. Mrs C was unhappy with this and at these appointments asked for additional materials to work on with her son at home. The service, however, were not prepared to provide these. Mrs C emailed them expressing her dissatisfaction and requesting the materials be provided, which the service treated as a formal complaint. Mrs C was unhappy with the outcome of this and complained to us that her son was not provided with adequate care and treatment and that the response to her complaint was inaccurate and insensitive, and implied that she had refused treatment for him.

We took independent advice from one of our advisers, a specialist in working with children with speech difficulties. She said that the service's approach was largely correct and in line with their published guidelines. She also said that, although the service had acted correctly when deciding whether or not to provide materials for home working, they should have taken account of Mrs C's concerns about her son's speech and her determination to work with him at home. We did not uphold the complaint as our investigation found that the service provided a reasonable standard of care and treatment to Master A, although we did make a recommendation based on our adviser's comments. We also found that the language used in the response to Mrs C's complaint was appropriate, and that the letter did not contain any factual inaccuracies about the provision of treatment or the family's engagement with it.

Recommendations

We recommended that the board:

• consider reviewing their guidelines to ensure parental concerns are considered when additional materials for home working are requested.

Summary

Mr C's late wife (Mrs C) had cancer and was terminally ill. After one of their daughters phoned the medical practice, a GP prescribed a strong morphine-based liquid painkiller. The family also phoned community services, and a community nurse visited Mrs C at home the following week. A few days later, another phone consultation was held with another GP who ordered an electrocardiogram (a test that measures the electrical activity of the heart). Further visits were made by a community nurse and the family agreed that a 'just in case' box (containing medicines that may be needed to help relieve a patient's unpleasant or distressing symptoms while being looked after at home) should be provided. Early the following month, one of Mrs C's daughters was concerned about her condition and spoke to the duty GP at the medical practice, who advised the family to use painkillers and said that Mrs C would be reviewed the following week. When a GP then visited Mrs C at home, they noted that she was at the terminal stage of her illness, and Mrs C died later that day.

Mr C complained about the way that GPs at the medical practice dealt with Mrs C's medical problems, saying that they did not visit and relied on the community nurses instead. He said that his wife was in severe pain and great distress. For four weeks she was not examined by a doctor and additional medication was not prescribed, as the community nurse was not able to prescribe medication. The family accepted that a 'just in case' box was in the house, but Mr C said that they did not know at what point to give Mrs C the medication and that a GP should have provided an explanation.

We took independent advice from one of our medical advisers, after which we upheld the complaint. We found that the medication and explanation provided were reasonable but that, by not visiting Mrs C, the practice failed to provide her with a reasonable standard of care. This led to a great deal of distress for her family, and made a very difficult time worse for them during the final stages of her illness. The adviser also said that while there was evidence that use of the 'just in case' box was explained to the family, it would have been reasonable for this to have been reinforced and for staff to have checked that the family understood what to do.

Recommendations

We recommended that the practice:

• review their management of patients with advanced cancer in light of our adviser's comments; and
• apologise to Mr C for the failures identified.

Summary

Mrs C, who is an advocacy worker, complained on behalf of a client (Ms B) about the care and treatment that Ms B's late father-in-law (Mr A) received from a GP practice run by the board. Mrs C said they did not provide reasonable care and treatment to Mr A, did not discuss his intended treatment at a home visit and did not reasonably respond to Ms B's complaints.

We obtained independent advice on the complaint from one of our medical advisers, who is a GP. The adviser said that while the care and treatment from the practice was largely reasonable, he was concerned about the care and treatment a doctor provided during the home visit. Mr A's symptoms had deteriorated and the doctor should have examined him, assessed his pain (including the likely causes) and examined his abdomen before giving him an injection. As a result there was a failure to appropriately manage Mr A's pain and distress and to assess whether his care required re-prioritising, including whether he needed to be admitted to hospital.

The board had said that the doctor gave assurances that, to the best of his recollection, he had provided a full explanation to Mr A before giving him the injection. However, we found no evidence of this in the papers the board sent us, and it was not clear when a statement could have been made, as we could see no evidence that the board consulted the doctor after Ms B complained. The General Medical Council guidance on consent requires doctors to explain proposed treatment and check that their explanation has been understood. We found no evidence to support the board's assertion that either of these things happened.

The evidence also showed several failings by the board in handling the complaints. They did not treat an initial complaint made by Mr A's wife as a formal complaint, they did not update Ms B on the progress of their investigation of her complaints and they did not tell her that she had a right to bring her complaint to us. We also noted that the board's complaints handling procedure did not accurately reflect the current NHS Scotland guidance on acknowledgment letters, investigation reports or timescales.

Recommendations

We recommended that the board:

• bring our decisions to the attention of the doctor and ensure that he reflects on our adviser's conclusions at his next performance review meeting;
• ensure the practice provide Ms B and her family with a written apology for failing to adequately assess Mr A at the home visit;
• ensure the practice provide Ms B with a written apology for failing to ensure that Mr A was given an adequate explanation of his treatment at the home visit and consent obtained;
• review their complaints handling procedure to ensure it is compliant with current NHS Scotland Guidance 'Can I help you?'; and
• provide Ms B with a written apology for failing to properly handle and investigate her concerns.

Summary

Mr C, who is a prisoner, complained that there was a delay in getting dental care and treatment, and that when he did get care and treatment it was inadequate.

We got Mr C's clinical records from the board, and took independent advice from our dental adviser. Mr C was seen often by a dentist and a dental hygienist, and we found no evidence of unreasonable delay. The records showed that Mr C's dental treatment was reasonable, and he had declined treatment that might have helped deal with an abscess.