Health

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.

Summary

Mrs C's daughter (Ms A) was admitted to Forth Valley Royal Hospital after taking an overdose of a mixture of medications, including venlafaxine (an anti-depressant) and propanolol (a beta blocker, used to treat conditions such as heart problems, blood pressure and anxiety), which are absorbed into the system slowly. She had called an ambulance herself and was taken to the emergency department, where she was seen immediately by a staff nurse. She was assessed before being seen by a trainee doctor. Ms A was groggy and her blood pressure was low. She was treated with intravenous fluids (fluids put directly into a vein). Blood tests and an electrocardiograph (a test that records the electrical activity of the heart) were also arranged. Over the following hours, Ms A's blood pressure remained low. Around seven hours after being admitted she began to have seizures and breathing difficulties. Her condition deteriorated further and the intensive care unit was asked to review her. Shortly afterwards, Ms A's heart stopped. Attempts were made to resuscitate her and she was treated with glucagon (medication used to increase blood sugar levels, which can be used in the treatment of propanolol overdose). This failed to improve her condition, however, and she died.

Mrs C complained that staff did not provide glucagon until it was too late. She considered that, had this medication been provided earlier, Ms A might have survived. She also complained about the board's record-keeping. The board said in response to her complaint that glucagon is not the first line of treatment for propanolol overdose and, as Ms A had been responding to intravenous fluids, it was not considered a necessary treatment for her at the time.

After taking advice on this complaint from one of our medical advisers, who is a consultant in emergency medicine, we upheld both of Mrs C's complaints. The adviser reviewed Ms A's medical records, and said that she had not been responding adequately to the intravenous fluids and that glucagon should have been considered far sooner. Although we found evidence that clinical staff consulted TOXBASE (the national poisons information database) we were critical that there was a delay in doing so. We found that Ms A's overdose would have been treated differently had the guidance been consulted and followed earlier in her admission. We were also critical of the board's record-keeping. Important information about medication had been lost from Ms A's records and there was no documented record there of staff having consulted TOXBASE.

Recommendations

We recommended that the board:

• provide a copy of our decision letter to the doctor to ensure that he is fully aware of the outcome of our investigation and discuss any learning points with him at his next appraisal;
• apologise for the lack of appropriate record-keeping in this case; and
• remind all nursing and medical staff of the importance of maintaining accurate contemporaneous records.

Summary

Mrs C complained that when her medical practice increased the dosage of her medication, it had side effects on both her heart rate and blood pressure. The practice said that they had acted in line with the appropriate guidelines when doing so. Mrs C remained unhappy and brought her complaint to us.

As part of our investigation we took independent advice from one of our medical advisers, who is a GP. He considered Mrs C's medical records and confirmed that the practice had decided to increase the dosage because of blood test results, and that the increased dosage was in keeping with standard practice in most GP surgeries. He also said that the internal systems the practice had in place to review Mrs C's medication in future were in line with good practice. As such, although we recognised that the change in dosage had affected Mrs C, we found no evidence to suggest that the practice acted unreasonably in prescribing this.

Summary

Mrs C complained that a nurse delayed in making a referral for a claim for benefit for her late husband (Mr C) when he was diagnosed with a terminal illness. The nurse specialised in palliative case (care to prevent or relieve suffering only). Mrs C said that the nurse visited her husband at home and, during a discussion with him, said that she would make a referral to another agency, who would take his benefit claim forward. There was a delay of several weeks before the claim was processed, and Mrs C said that her husband lost a month's benefit because of this. She believed that the reason for the delay was that the nurse delayed in making the referral.

In response to our enquiries about the complaint, the board told us that community specialist palliative care nurses are not responsible for submitting benefit claims for patients. However, they can help by signposting patients, or contacting the agency who will then take the claim forward on their behalf. The nurse had completed a statement saying that she contacted the agency a week after discussing the matter with Mr and Mrs C. There was a note in her diary that suggested she had contacted them then, but it was not conclusive evidence. The agency who dealt with the claim said that they did not receive the referral until a month after the nurse discussed the matter with Mr C. They then took the claim forward and, in line with the relevant legislation, awarded benefit from the date they said they received the referral from the nurse.

On balance, we found that there was insufficient evidence to decide that it was definitely the nurse who delayed in making the referral. The evidence was conflicting, in that the nurse said that she made the referral on a specific date, but the agency said they had not received it until a number of weeks later. Having carefully considered the matter, we did not uphold the complaint.

However, we recognised that Mr C had lost over three weeks' benefit because of the delay, through no fault of his own, and that this had caused him some distress before his death. The other agency involved does not fall within our jurisdiction, so we could not look at what they did. As it had not been possible to prove which organisation was responsible for the delay, we made recommendations to address this.

Recommendations

We recommended that the board:

• award Mrs C a payment for 50 percent of the benefit that she and her late husband lost out on due to the delay in his claim being actioned; and
• provide the Ombudsman with an update on the action they are taking to prevent this problem recurring.

Summary

Miss C, who is an independent advocate, complained to us on behalf of her client (Miss A). Miss A had previously had input from the board's speech and language therapy (SaLT) and learning disabilities teams, and was looking for further input from them. The board, however, did not provide this. They said that the SaLT team could not identify a clinical risk to Miss A that would benefit from further intervention, and that the learning disabilities team had identified behavioural family therapy as being appropriate, which was begun. Miss C complained about these decisions.

The board investigated the complaints but remained of the view that their decisions had been reasonable. Miss C then raised her complaints with us.

We obtained independent advice from one of our medical advisers, who is an experienced mental health professional. He read Miss A's relevant records and considered the situation carefully. He explained that the use of both services has a particular purpose, and that the board had to take this into account. He agreed that the way the decisions were taken was correct, and that the board's decision not to offer further direct engagement was reasonable. We accepted his advice and did not uphold Miss C's complaints.

Summary

Mr C, who is a prisoner, wanted his prescription increased due to extreme pain in his knee, and lower back pain. After the consultation, he complained about the medical treatment he received, and was unhappy with the way he had been treated and spoken to by the GP.

We took all the available information into account, including Mr C's relevant clinical records and the complaints correspondence. We also obtained independent advice on Mr C's care and treatment from one of our medical advisers.

We did not uphold the complaint, as our investigation found no specific shortcomings in the way that the GP dealt with Mr C. We were also satisfied that, based on his medical records, Mr C had access to different GPs and was referred for further investigation as well as for a specialist physiotherapy review. Our adviser said that the examination and medication dosage were reasonable, and that the GP had taken Mr C's individual needs into account. However, we were concerned that there was no evidence that the GP spoke to Mr C to exclude any potentially serious cause for his back pain, and we made a recommendation about this.

Recommendations

We recommended that the board:

• draw to the attention of the GP involved our adviser's comments on excluding potentially serious causes for back pain.