Health

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.

Summary

Mr C's wife (Mrs C) was referred to Wishaw General Hospital by her GP. She had been experiencing severe abdominal (stomach) pain and back pain. She was known to have an abdominal aortic aneurysm (a weak point in the blood vessels, causing them to bulge or balloon out) but when her GP examined her he felt another mass in her abdomen. Mrs C saw a consultant surgeon, who could not feel the mass and, after checking a recent scan, discharged Mrs C with pain medication. Mrs C continued to experience severe pain. Nine days later she was readmitted to the hospital as an emergency, and was found to have a bowel perforation (a hole in the bowel). As she was not fit for surgery, palliative care (care provided solely to prevent or relieve suffering) was put in place, and Mrs C died five days after being admitted. Mr C complained that, had the surgeon conducted a more thorough examination, the severity of his wife's condition might have been identified and she might have been treated.

We took independent advice on this case from one of our medical advisers, who is a consultant colorectal (bowel) surgeon. We found that the records taken by the surgeon who examined Mrs C were sparse and of poor quality. The surgeon had provided us with a separate written statement detailing the examination and findings, which our adviser found reasonable in the circumstances. However, the lack of contemporaneous notes cast doubt as to how much consideration the surgeon gave to Mrs C's underlying ongoing symptoms. Although we considered it reasonable for Mrs C to be discharged home after the initial examination, we were critical of the board for not arranging urgent follow-up tests to establish the source of her symptoms.

Recommendations

We recommended that the board:

• apologise to Mr C for the issues highlighted in our decision letter;
• discuss Mrs C's case with the consultant surgeon at their next appraisal; and
• remind the consultant surgeon and her team of the importance of maintaining detailed medical records.

Summary

Mrs C complained about the treatment she received from her dentist when she attended with a broken tooth. She complained that the dentist removed a remaining part of her tooth without her consent, that he used a local anaesthetic, which she had asked not be used, and that he performed root canal treatment and inserted a crown poorly. She also complained that her complaint about this was inadequately handled.

After taking independent advice from our dental adviser we found that the remaining part of Mrs C's tooth could not be saved and it was reasonable for the dentist to remove it. No formal written consent was required for this, but we noted that the dentist did not seek verbal consent, which would have been good practice. We were satisfied with the choice of local anaesthetics he used and found that an alternative was used because Mrs C said she had had an adverse reaction to the standard anaesthetic. However, we were critical that the dentist did not properly document his use of this, and of the work he carried out to prepare Mrs C's tooth for a crown. The root canal filling did not fill the entire root, leaving space for infection. Furthermore, the dentist perforated the filling material with the post that was inserted to hold the new crown. We upheld Mrs C's complaints about these aspects.

We also found that Mrs C's complaint was not handled in line with the complaints procedure in place in the dentist's practice at the time. However, that procedure was not fit for purpose and Mrs C's complaint was actually handled in line with the level of service that we would expect patients to receive. As such, we found the complaints handling to be reasonable.

Recommendations

We recommended that the dentist:

• apologise to Mrs C for the issues highlighted in our decision letter;
• reimburse Mrs C any charges for her dental treatment on the dates in question;
• take note of our adviser's comments about Mrs C's root canal treatment, post preparation, and the recording of the use of local anaesthetics with a view to identifying any points of learning for future treatment; and
• ensure that his current procedure for handling complaints is in line with NHS Scotland guidance.

Summary

Miss C and Mr C had twice taken their son (Master A) to a medical practice with hay fever symptoms. These persisted despite treatment with two different forms of antihistamines, and assessment by an ophthalmologist (a doctor who examines, diagnoses and treats diseases and injuries in and around the eye) that there was nothing apparently wrong with his eyes. Miss C and Mr C then took their son to a hospital out-of-hours service, where they were seen by the same GP they saw at their practice, as he was working as a locum. At this appointment, the doctor was concerned that Master A's symptoms were persisting despite treatment, and referred him to a paediatrician (a doctor dealing with the medical care of infants, children and young people).

Miss C and Mr C complained that, at the appointment, the GP made an inappropriate remark about them seeing him at the hospital as well as at his surgery. They were also concerned that the GP had not done enough to diagnose their son's condition and make a more urgent referral. We sought independent advice from one of our medical advisers, who is an experienced GP. The adviser said that the GP had clearly been concerned about Master A's condition, and that his referral was appropriate, given Master A's symptoms. He also said that if the doctor had made the comments suggested, this was unprofessional and inappropriate. However, we did not find evidence to uphold this concern. We found that Master A's care and treatment was appropriate.

Summary

Mrs C has a complex medical history. She told us that because she had been experiencing extreme pain in her feet (to the extent that she could not walk) she needed to contact her medical practice on a number of occasions. She complained about a lack of support from the GPs at the practice. In particular, she said that, despite telling a GP that tramadol (a drug used to treat moderate to moderately severe pain) did not work for her, he continued to prescribe it. Another GP refused her a dosette box (a pill organiser that helps people on multiple medications to take these at the right time) and prescribed an anti-inflammatory gel, which she said the pain clinic she had previously attended had told her not to use. Mrs C said that both GPs left her without support and in great pain.

We obtained independent advice from one of our medical advisers, who is a GP. After taking all the relevant information into account, including the complaints correspondence and Mrs C's medical records, we did not uphold Mrs C's complaints. We found that she was previously prescribed tramadol for chronic pain, and the new, acute pain she was experiencing had a different cause. Our adviser said that this pain might respond differently to tramadol, so the prescription was not unreasonable. Similarly, an anti-inflammatory gel could be used safely where anti-inflammatory tablets could not. Although Mrs C wanted a dosette box, we found that she did not qualify for this under the health board's criteria.