Health

Summary

Mrs C complained about the care and treatment that her late father (Mr A) received at Raigmore Hospital. Mr A was admitted there after having been unwell for around three weeks and having been treated by his GP for a chest infection. His condition had deteriorated and he was found to have pneumonia and kidney damage. Mr A had a past medical history of lung cancer and an abdominal aortic aneurysm (a bulge in a blood vessel caused by a weakness in the vessel wall). At first, he responded well to treatment in the high dependency unit. He was moved to a ward, but his condition deteriorated. Mr A got much worse six days after moving to the ward and did not recover. No post-mortem was carried out, but his deterioration was consistent with the aneurysm having burst. Mrs C said that although the treatment in the high dependency unit was exemplary, she felt that staff took too long to establish that Mr A's aneurysm had ruptured. She felt that the treatment provided in the ward was poor and that staff did not communicate adequately with Mr A's family. She was also unhappy with the board's handling of her complaint.

We found that Mr A's aneurysm had been scanned early in his admission and was found to be enlarged, but intact. However, doctors agreed that, in the event of a rupture, no surgery could be performed. We took independent advice from one of our medical advisers, who said that the clinical records showed that staff treating Mr A on the ward were aware of this and that their decision-making would be affected by the fact that no treatment could be provided for the aneurysm. On the day of Mr A's deterioration, staff clearly considered a ruptured aneurysm as a possible cause. However, they also considered his symptoms to be consistent with constipation. As Mr A could be treated for constipation, we found it appropriate that this was done in the first instance. Once he deteriorated further, staff concluded that a ruptured aneurysm was the most likely diagnosis and Mr A was made comfortable and treatment was withdrawn. We found this to be reasonable and did not uphold Mrs C's complaint about his care and treatment.

We were, however, critical of the board's communication with the family. A number of conversations between staff and relatives were not documented and there was little evidence to suggest that the family were made aware of the treatment being carried out, or involved in conversations about Mr A's care. With regard to the board's complaints handling, we were generally satisfied with the thoroughness of their responses. However, some incorrect information was included in their first letter to Mrs C and they failed to contact her when their investigation carried on longer than expected.

Recommendations

We recommended that the board:

• apologise to Mr A's family for failing to communicate adequately with them;
• remind their nursing and clinical staff of the importance of informing and involving relatives in the patient's care and of properly recording all discussions held with relatives; and
• apologise to Mr A's family for their poor handling of the family's formal complaint.

Summary

Ms C said that, when she had eyelid surgery as a day patient, Raigmore Hospital did not provide her or her GP with a discharge letter. There was confusion about where her stitches would be removed, and who would remove them, and it was only when Ms C asked her GP about this that the fact that there was no discharge letter was picked up. Ms C also needed further clinical care for her eye before the stitches could be removed, as it had not healed correctly. For this she at first went to another hospital, before deciding to go to the accident and emergency department of Raigmore Hospital, where she had successful corrective surgery.

We took independent advice from one of our medical advisers, who examined all the evidence provided. After taking account of his advice alongside all the documentation from Ms C and the board, we upheld the complaint. The adviser said that Ms C had received appropriate treatment and advice at the hospitals, but there appeared to be a lack of clarity as to what and with whom follow-up arrangements were to be made. This was made worse when the hospital did not provide a discharge letter. We also found that the board had not fully responded to Ms C's complaint.

Recommendations

We recommended that the board:

• ensure that in similar circumstances patients are appropriately advised on follow-up arrangements following ophthalmology treatment (treatment relating to the eye); and
• advise the Ombudsman on the steps taken to ensure that the failures in the computerised generation of the discharge letter in this case do not happen again.

Summary

Miss C complained about the care and treatment she received at Raigmore Hospital. Miss C said that when she arrived at the accident and emergency department (A&E) with abdominal (stomach) pain, her symptoms were not taken seriously enough and staff dismissed her view that she had an ulcer, even when she told them she had been treated for one in the past. She also said that after she was transferred to a ward, staff inappropriately gave her a drug, which she said caused her ulcer to bleed or perforate (break open the stomach wall) and her pain to treble, resulting in her needing immediate surgery. Miss C said that, as a result of the board's failings, she had to have an operation that she did not need and now has an unnecessary scar.

We obtained independent advice on this case from one of our medical advisers, a consultant surgeon specialising in gastrointestinal (digestive system) surgery. The adviser said that the consultant who initially examined Miss C in A&E mistakenly concluded that her bowel might have been obstructed. However, as the consultant was not sure of that diagnosis, he correctly sought advice from the surgical team and organised a prompt referral to the on-call senior surgical trainee for further assessment and observation.

The senior surgical trainee, however, failed to recognise that Miss C's signs and symptoms suggested peritonitis (inflammation of the lining of the abdomen) and despite these signs, placed undue reliance on the x-ray appearance of possible constipation. He failed to seek advice from the consultant gastrointestinal surgeon and/or arrange further investigations. He prescribed a drug that was advised against, given Miss C's condition, and which may have exacerbated her pain. The adviser explained that Miss C's ulcer had almost certainly perforated when she initially went to A&E and so it was highly unlikely that the treatment she received from the board influenced her need for surgical intervention. However, the senior surgical trainee's failure to make the correct diagnosis meant that Miss C's pain was prolonged unnecessarily, and we upheld her complaint.

Recommendations

We recommended that the board:

• provide Miss C with a written apology for the failings identified in this case;
• feed back our decision to all staff involved; and
• ensure that the senior surgical trainee uses our decision letter on this case as part of his training record and discusses it with his educational supervisor as part of a reflective case-based discussion.

Summary

Mrs C complained about the medical and nursing care and treatment provided to her late husband (Mr C) under the Liverpool Care Pathway (LCP - a care planning system for dying patients) when he was in Raigmore Hospital. Mr C had suffered a spontaneous intracranial haemorrhage (bleeding within the skull), the effects of which had possibly been magnified by warfarin (a type of medicine that is given to stop clots forming in the blood) that he had, appropriately, been taking.

We took independent advice from one of our medical advisers who explained, after examining Mr C's medical records, that the prospects of any sort of meaningful recovery from such a severe brain injury were non-existent. The records showed that the doctor's conclusion had been that Mr C's condition had deteriorated, and the family had accepted this and that the implementation of the LCP would be appropriate. The adviser said that the principal aims of the LCP were to ensure that patients who were dying were not subjected to unnecessary investigations such as blood tests that would not alter the outcome, but that they would receive all care necessary to maintain their comfort and relieve any distress. In view of this, we found that it had been reasonable to place Mr C on the LCP and then to keep him on it. We also found that the LCP had been implemented appropriately.

In addition, we found that the medical and nursing care records indicated that Mr C received good and entirely appropriate care while he was in hospital. There were also detailed records of discussions with Mrs C and her family. In view of all of this, we did not uphold Mrs C's complaint.

Summary

Mr C, who is a prisoner, complained that the prison health centre would not prescribe the pain relief medication that he was receiving before he went to prison, and that the medication they did prescribe was inadequate.

We explained to Mr C that medication decisions by prison health centres will not automatically be the same as such decisions in the past. For example, some medications are not considered appropriate for use in prison because of their particular potential for abuse in a prison setting. It is for the prison health centre to carry out their own assessment of the individual and decide what, if any, medication or other treatment would be appropriate.

In Mr C's case, we looked at the board's policy on prescribing pain relief in prisons, and at Mr C's medical records. We found that he had had an appropriate assessment. We also took independent advice from one of our medical advisers, who said that the decision about what action to take had been medically appropriate, including the reasons for the medication that was prescribed for Mr C. We did not, therefore, uphold his complaint.

Summary

Mrs C complained to us about aspects of treatment provided to her mother (Mrs A) by GPs at her medical practice. She was concerned that at a home visit a GP did not admit Mrs A to hospital, although later she had to go there. When Mrs A was discharged from hospital there was a problem with her medication.

Our investigation found that although the GP's records were not as thorough as they should have been, which we pointed out to the practice, she had carried out a reasonable assessment of Mrs A at the home visit and that at that time there was no clinical reason for a hospital admission. We took independent advice from one of our medical advisers, who said the GP had used her clinical judgement in a reasonable manner and had provided appropriate advice about what the family should do if Mrs A's health deteriorated over the weekend. We also found that the practice acted reasonably when told that Mrs A needed additional medication, and that her care was not compromised by a slight delay in obtaining the medication when it was not in stock at the local pharmacy.

Summary

Ms C, who is an advocacy worker, complained to us on behalf of her client (Mr A). Mr A said that he had complained to the board some time ago about care and treatment he received. Having received no reply, he asked Ms C to complain on his behalf. For a period of around 15 months the advocacy service tried to make Mr A's complaints or receive updates on them. Having received no response they then complained to us.

After making enquiries of the board, we found evidence that they received most of the letters and emails sent by the advocacy worker between September 2012 and November 2013, but that of 15 contacts, only four were directly responded to. Having considered the circumstances and the content of the letters and emails, we considered this unreasonable and we upheld the complaint. The board had, however, taken action before we became involved to try to ensure that a similar situation would not recur, so our recommendations related only to apologies for the failure.

Recommendations

We recommended that the board:

• apologise to Mr A that they did not respond reasonably to complaints and subsequent correspondence raised on his behalf; and
• apologise to Ms C that they did not respond reasonably to complaints and subsequent correspondence raised on Mr A's behalf.

Summary

Mr C sustained an injury during spinal surgery and after further surgery his consultant neurosurgeon phoned the spinal injuries unit in the Southern General Hospital and discussed the possibility of Mr C being admitted. When a written referral was made, however, Mr C was refused admission. His MP corresponded with the board about this asking for an explanation and, in responding, the board said that the director of the spinal injuries unit had investigated the complaint.

Mr C then complained to us that the unit had unreasonably altered their decision to accept his referral and that its director had inappropriately been appointed to investigate his complaint. Our investigation found that, although there had clearly been a discussion about Mr C's condition, there was no specific evidence that the unit had agreed to accept the referral during the phone call, and we concluded that there was no evidence that a decision had been altered. Although we did not uphold Mr C’s complaints, we found that the initial use of the term 'investigated' in relation to the director's role was misleading, although his actual role (in providing a summary, comments and feedback) was appropriate. We made a recommendation about this.

Recommendations

We recommended that the board:

• alter their standing response wording to ensure that staff involved in providing information and comments as part of the complaints handling process are not referred to as having 'investigated' the complaint.

Summary

Mr C, who is a prisoner, complained that the board stopped his pain medication after he was sent to prison. The medication (gabapentin) had been prescribed by his GP. However, Mr C was also on methadone (a drug used medically as a heroin substitute). Doctors in the prison told him that it was recommended that methadone and gabapentin were not prescribed together, and prescribed a different medication for his pain.

After taking independent advice from one of our medical advisers, we found that there was potential for harm if the doctors in the prison had continued to prescribe gabapentin while Mr C was still on high doses of methadone. The prison doctors had also offered reasonable pain killing alternatives when the gabapentin was stopped. In view of this, we did not uphold Mr C's complaint.

Summary

Mr C suffers from excessive sweating over most of his body, and was referred to a dermatologist (a specialist in diseases of the skin, hair and nails). At the dermatology appointment at Inverclyde Royal Hospital, a consultant dermatologist examined Mr C but said there was no treatment they could offer him. He was unhappy about this and complained to the board.

We took independent advice from one of our medical advisers, also a consultant dermatologist, who reviewed the board's response to Mr C's complaint as well as the relevant medical records. He explained that to say there was no treatment that could be offered was incorrect. He said that, in Mr C's circumstances, he would have expected the consultant to have considered an anticholinergic drug (a drug that blocks the action of a particular neurotransmitter in the brain). We upheld Mr C's complaint. Although we were aware that the appointment had been a difficult one, there was no evidence that an anticholinergic drug was considered or discussed with Mr C there, and the information he was given was incorrect.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified; and
• share this letter with the consultant concerned and ask them to reflect on their actions.