Health

Summary

Ms C complained that a hospital appointment she attended was not carried out in a reasonable manner, including that a consultant did not have access to relevant medical records from her previous care and treatment. She also complained that the consultant did not adequately communicate with her GP.

In our investigation, we considered the information provided by Ms C, along with her medical records, as well as obtaining independent advice from one of our medical advisers. We recognised that Ms C was unhappy about aspects of the appointment, but found that there was a clear difference of opinion about what happened and the manner in which the appointment was conducted, which we could not resolve on the evidence available. We found from looking at the records, and taking account of our adviser's view, that there was no evidence that the appointment was not carried out in a reasonable manner. We also found that Ms C's medical history was noted at the time of the appointment, and that the consultant's letter to her GP was reasonable.

Summary

Mrs C complained that, after a day surgery gynaecological procedure, she developed a prolapsed bladder (when the bladder bulges or protrudes onto the front wall of the vagina). She was examined by a gynaecologist who said that the prolapse was mild. She later saw another gynaecologist privately, who said that the prolapse was more significant. Mrs C said that this was an unexpected complication and had happened because the surgeon used excessive force. As a result, she said that she is now more susceptible to infections. She also said that staff knew something had gone wrong during the procedure and that they had concerns about her general health. Mrs C explained that this has been a significant, life-changing event for her, and has had an adverse impact on her quality of life. Mrs C also complained about the board's complaints handling saying they trivialised her complaint and there were inaccuracies, and that the involvement of the gynaecologist in the complaints process was of concern.

As part of our investigation of Mrs C's complaint, we took independent advice from one of our medical advisers. Their advice, which we accepted, was that there was no evidence to link Mrs C's bladder prolapse with the procedure. We also accepted the medical adviser's comments that there was no evidence showing that the surgeon failed to carry out the procedure to a reasonable standard. Although we appreciated that Mrs C had been deeply affected by her experience, we found that post-operative interventions were reasonable and in line with standard practice, and we were satisfied that there was no evidence showing that staff expected Mrs C to experience more than the usual amount of pain from the procedure. Furthermore, we noted the adviser's comments that there was no evidence in Mrs C's records of any concern about her general health condition. In terms of the way the board dealt with the complaint, we were satisfied that they treated it seriously and that any discrepancies about the severity of the prolapse in their responses were not evidence of complaints mishandling. Nor was there any evidence the investigation was compromised by the gynaecologist's role.

Summary

Mr C complained that a GP provided him with inadequate care and treatment. Mr C visited the GP because he had pain on the left side of his head. He said the GP diagnosed shingles and prescribed inappropriate medication, an antidepressant.

We looked at Mr C's medical records and took independent advice from one of our medical advisers. In the absence of any independent evidence from the consultation, however, we could not reach a definitive finding on exactly what was said there. We found that the medical records showed that the GP had noted that there was no shingles rash present, and had treated Mr C for nerve pain. We also found that the medication prescribed was appropriate for this, as although it is an antidepressant, it is also frequently used to treat nerve pain. We concluded that the GP provided a reasonable level of care and treatment in the circumstances.

Summary

Mr C complained on behalf of his daughter (Ms A) about the care and treatment she received when twice admitted to hospital. Mr C questioned whether Ms A was properly assessed on both admissions and why, although he said she had suicidal thoughts, she was discharged on the second occasion with a large amount of drugs, before taking an overdose. He believed that this would not have happened if things had been handled differently, and that they should have dealt with her medical problems holistically.

The complaint was investigated and all the relevant information, including the complaints correspondence and the relevant medical records, was given careful consideration. We also obtained independent psychiatric advice from one of our medical advisers. As part of the investigation, the adviser reviewed Ms C's records with specific reference to the assessments made on her admissions and the circumstances of her discharge. He was satisfied with these and had no criticism to make about them. While Mr C believed his daughter had psychiatric problems which meant she should have stayed in hospital, our investigation found that on both admissions, she was a voluntary patient. She had been admitted primarily in relation to her excessive drinking and her admissions were based on an agreement that if she was found to possess or use alcohol she would be discharged. As Ms C had broken that agreement, she was discharged, and the records showed that reasonable outside support arrangements had been put in place for her. We did not uphold the complaint but as our adviser said that, though they would not have changed the outcome, there were some things that could have been done better, including the use of ICD10 (a classification of mental and behavioural disorders - clinical descriptions and diagnostic guidelines) we made some related recommendations.

Recommendations

We recommended that the board:

• consider using ICD 10 diagnoses;
• give attention to the dates on which letters are compiled and dispatched to satisfy themselves that they are issued in a timely manner;
• identify the responsibilities of agencies involved, and further, identify the lead; and
• review the procedure for passing information to carers and satisfy themselves that it is fit for purpose.

Summary

Miss C complained that out-of-hours hospital staff did not take account of her recent bowel surgery in providing diagnosis and treatment when she attended there because she had not opened her bowels for several days. Miss C said that as a result of this, she developed peritonitis (inflammation of the tissue lining the abdomen) and had to undergo further surgery, including having a colostomy bag.

After taking independent advice from one of our medical advisers, we found that the assessment carried out by the out-of-hours service was appropriate and there were no signs of peritonitis at this time. The records showed that the nurse who dealt with Miss C carried out appropriate examinations, and sought advice from medical staff when giving medication. We could not say for certain what the nurse said to Miss C, but there was evidence to suggest that Miss C was given the opportunity to be admitted to hospital (although we noted that she did not consider that she was in any position to make this decision at the time). We concluded after seeing the medical records that Miss C developed clear signs of peritonitis after she was admitted the following day to a different hospital, but that these symptoms had not been apparent when she attended the out-of-hours service.

Summary

Mrs C complained about the children's waiting arrangements in a hospital accident and emergency department (A&E). She said that when she had to go there with her grandson she was appalled that children waited together with adults and were, therefore, exposed to bad language and inappropriate behaviour. She said that despite complaining to the board's chief executive little action was taken and the board failed properly to deal with her complaint.

We carefully considered all the available information, including all the complaints correspondence, and the response to our formal enquiries to the board. Our investigation confirmed that at the time Mrs C made her complaint, the board were simply required to provide emergency care 'within a safe environment' which could have been provided in a variety of ways. Since then, new standards have been introduced which are more than mere recommendations. The board are currently exploring the feasibility of creating a children's waiting area in A&E and reviewing how this could be achieved. However, it would seem that progress is slow. Although we did not uphold this complaint, we made a recommendation in order to monitor this.

The investigation also showed that the board took too long to respond to Mrs C's complaint, so we upheld her complaint about this. We noted that the board have introduced new ways of working to avoid this in the future, and made relevant recommendations.

Recommendations

We recommended that the board:

• update the Ombudsman on the outcome of the feasibility study;
• formally apologise to Mrs C for their failure to deal with her complaint in a timely manner; and
• confirm to the Ombudsman that they are satisfied that their complaints process is robust and the resources to support it are sufficient to allow them to deal properly and efficiently with complaints made to them in accordance with the terms of the Patients Rights (Scotland) Act 2011.

Summary

Mr C, who is a prisoner, complained that his confidentiality was unreasonably breached, as he was given medication in the sight of other people. In their response to our enquiries, the board said that healthcare staff try as far as possible to issue medication in pharmacy bags. However, they said that prison officers are present when medication is given out, as they are needed to escort the prisoners to and from the dispensing hatch. They said that this is a security matter and that the prison officers are necessary as security for nursing and healthcare assistants whilst they dispense medication. The board said that there are other prisoners in the same area who are waiting for their names to be called and their movements are controlled by the prison officers. Our investigation found that there are clearly some practical issues about ensuring confidentiality in a prison setting. Staff in the prison health centre have to ensure that the correct medication is prescribed at the right time to a large number of prisoners whilst maintaining confidentiality. At the same time, prison officers have to ensure that security is maintained. In the circumstances, we considered that the board's response was reasonable.

Mr C also complained that his request for a review of his glasses was unreasonably refused. We found that the board had in fact arranged for him to see an optician but there was a delay, because the optician left without prior notice. The board then arranged for Mr C to see an optician from another prison. We found that this was reasonable.

Finally, Mr C complained that the board failed to provide chiropody treatment. There is no longer a chiropodist service in the prison. When Mr C asked to see a chiropodist, he was told that he could obtain nail clippers from officers to cut his nails. The board told us that when he complained about this, they asked a nurse to assess his feet. The nurse then ordered a pumice stone for Mr C, as he had hard skin on his feet. Again, we found that this was reasonable.

That said, we found that in their response to Mr C's complaint the board said that the first stage of the complaints process is to raise the matter directly with the healthcare team, who will do their best to resolve it. They also said that the second stage is to complete a feedback form, which the local healthcare team will respond to within seven days. The board said that only then should prisoners complete a complaint form. Although the board dealt with Mr C's letter as a complaint, they said that they would appreciate it if he would follow this process in the future. We have previously raised concerns that NHS boards are using their feedback system as an additional stage in the complaints process. There is no requirement to complete a feedback form, or to raise the issue with staff for that matter, before submitting a complaint to NHS boards. The Scottish Government have written to NHS boards to highlight our concerns about this, and in view of this, we made a recommendation.

Recommendations

We recommended that the board:

• ensure that the local process in place for the management of prison health care complaints is in line with the good practice outlined in the Scottish Government Guidance 'Can I help you?'

Summary

Mrs C had a long history of chronic obstructive pulmonary disease (a disease of the lungs in which the airways become narrowed) and as her condition worsened, she was admitted to hospital. After initial treatment, because of a shortage of appropriate bed spaces, she was transferred to a surgical rather than a respiratory ward through a process known as boarding. Mrs C complained that, once there, she began to react badly to the medication she was prescribed but staff on the surgical ward were unable to deal with her concerns. She maintained that she was given too high a dose and that she may have been suffering from side effects. She said no one explained this to her or addressed her concerns.

We took independent advice from one of our medical advisers, and carefully considered all the relevant information, including Mrs C's clinical records. We upheld Mrs C's complaints about the ward transfer and about staff not responding to her concerns. Our investigation found that although Mrs C was transferred to a surgical ward, throughout her stay there she was under the supervision of a specialist respiratory doctor; the nursing care she received was the same as that provided on any other ward with the exception of an intensive care ward; and her care had been reasonable. However, the board had not followed their own policy to facilitate such a change of ward. The investigation also showed that despite Mrs C's concerns that she was given an unusually high drug dosage, she had not, although she may have reacted badly to the dosage she received. However, we did find that staff failed to respond to Mrs C's concerns despite her long experience of taking this drug, nor did they address mental health concerns that had arisen.

Recommendations

We recommended that the board:

• review the decision to board Mrs C to a surgical ward in circumstances that were not in line with their own policy;
• assure Mrs C that she will not be boarded during future admissions unless this is in line with their policy, and her care needs, including potential side effects from treatment, can be met on the ward she is transferred to;
• formally apologise to Mrs C for their shortcomings in this matter; and
• review Mrs C's case notes and consider providing her with a letter so that if she is admitted as an emergency in future, clinicians are aware of the circumstances surrounding the prescription of salbutamol and her assessment of how the increased dose affected her.

Summary

Miss C complained about the care and treatment that her late mother (Mrs A) received in two hospitals. She said the board failed to appropriately manage her mother's intake of food and fluids; failed to adequately communicate with her mother and her family; handled her mother's transfer to the second hospital inappropriately; and unreasonably refused to discharge her mother from that hospital despite her wish to go home and her family's willingness to care for her.

We took independent advice from one of our medical advisers, a consultant geriatrician, and upheld most of Miss C's complaints. The adviser explained that in many respects the board managed Mrs A's intake of food and fluids appropriately. However, he was critical of the first hospital's failure to assess Mrs A's nutritional needs using a malnutrition universal screening tool, a universally recognised nursing standard used to identify adults who are at risk of malnutrition.

The adviser said that overall the level of communication by staff in this case was relatively good. However, he was critical of the board's timing of a 'do not resuscitate' decision (a decision that a doctor is not required to resuscitate the patient if their heart stops) and their failure to speak to Miss C face-to-face about that decision, once it had been made, or to discuss the issue of Mrs A not returning home. We also noted that the tone of one of the consultant's comments was rather insensitive.

Our investigation found significant failings by the board in their handling of Mrs A's transfer to the second hospital. These included the assessment for transfer, the transfer decision, the documentation transferred, speech and language therapy assessments before and after transfer, and engagement with Mrs A's family. We were also critical of the board for failing to advise Miss C, in their response to her complaint, about failings in her mother's transfer that were identified in the internal correspondence between the consultants at the time of the transfer.

We did not uphold the complaint about Mrs A's discharge from the second hospital, as we took the view that the board's actions were reasonable in the circumstances.

Recommendations

We recommended that the board:

• apologise to Miss C for each of the failings identified;
• feed back our decisions on these complaints to the staff involved to try to ensure that similar situations do not happen again; and
• review their transfer arrangements, including assessment for transfer, to try to ensure that such failings do not occur in future.

Summary

Miss C complained that the care and treatment provided to her late mother (Mrs A) was inappropriate after she suffered a third heart attack. Mrs A also had a history of lung cancer and breathing problems. She was admitted to hospital on the Wednesday before a bank holiday weekend and told she would be transferred to another hospital for further investigations and treatment. However, as services were not available over the holiday weekend, Miss C was also told that Mrs A would not be transferred until the following week. Mrs A was treated with blood thinning medication and her condition was monitored. She complained of dizziness and was diagnosed with postural hypotension (where the blood pressure drops on standing) and some of her medication was stopped. On the Monday she developed severe pain in her head and neck which was not relieved by painkillers. When she was examined by a doctor and had a CT scan (a special type of computerised x-ray), it was found that she was bleeding from the brain. Her doctors consulted with a neurosurgeon (brain specialist) who advised that nothing could be done. Mrs A died later that day.

Miss C complained that, given her past medical history, her mother should have been treated as an emergency case for transfer. Miss C also complained that record-keeping was not to an acceptable standard and that while her mother was in hospital she was not properly cared for, including that her pain was not monitored and managed appropriately.

Our investigation, which included taking independent advice from a medical adviser and a nursing adviser, found that the care and treatment provided to Mrs A was reasonable, appropriate and in line with current NHS guidance. The observations and test results in the clinical records showed that Mrs A's condition was clinically stable and there was no indication to treat her as requiring emergency transfer. Mrs A suffered a recognised risk factor of the treatment she was undergoing, but the medical adviser was of the view that the treatment was reasonable, appropriate and timely. There was evidence that Mrs A's condition, including her pain level, was being regularly monitored and addressed. Neither adviser found any deficiency in the medical or nursing records.