Health

Summary

Mrs C's daughter (Miss A) damaged her teeth in an accident on a Sunday evening. Mrs C took her to hospital where Miss A was assessed, and they were advised to visit their dentist as soon as possible for emergency treatment. Mrs C told us that she tried to leave a phone message with the dental practice that evening to let them know this, but was unable to do so. After they went there the next morning, Mrs C was unhappy about a number of issues, including that the practice was closed for staff training, meaning that they had to wait outside in the cold for a time. She was unhappy with the attitude of the staff and said that the dentist seemed angry that they were there and shouted at them; and she also felt that her daughter was treated inappropriately, including the way she was spoken to and the fact that the dentist felt that her mouth was too swollen to treat at that time.

We based our investigation on the available documentary evidence, which meant that, in the absence of entirely independent witnesses, we could not reach a robust conclusion on what was said and by whom. We took independent advice from a dental adviser, who explained that, generally speaking, he would have expected a dentist, exercising professional experience and judgment, to display a sympathetic attitude to try to put Mrs C and her daughter at ease as much as possible. However, he said there were no definitive instructions that a dentist would be expected to follow when treating a child in these circumstances, and that the available evidence appeared to indicate that Miss A was reasonably treated. On balance, in light of the advice received, we did not uphold Mrs C's complaint. However, we made a recommendation as a result of Mrs C's experience.

Recommendations

We recommended that the dentist:

• confirm that they will ensure that patients are able to leave out-of-hours messages and that their voicemail message reflects days where the practice may open later (for example for staff training).

Summary

Ms C suffers from a blood condition - Factor V Leiden - which increases the risk of blood clots. Ms C complained that her medical practice had not taken sufficient account of this condition, in that they had not monitored her blood on an ongoing basis, they had given her an inappropriate contraceptive injection and when she went to them with a possible blood clot in her calf they had not referred her to hospital.

Ms C's concerns started when she attended the practice suspecting that she had a blood clot in her calf. Her GP referred her to hospital to see whether she had a DVT (deep vein thrombosis). The assessment showed some superficial clots, but no DVT. Ms C later had an contraceptive injection at the practice, which she continued to receive on a quarterly basis for the following year. A year after she first went to the practice with pain in her leg, Ms C went back for the same reason. The GP did not refer her to hospital this time, on the basis that no DVT was found on the previous occasion. However, the next morning Ms C woke with pains in her chest, and subsequent investigations found that Ms C was suffering from pulmonary embolisms (clots in the blood vessel that transports blood from the heart to the lungs).

We took independent advice on this complaint from one of our medical advisers, who is a GP. After considering Ms C's medical records, he explained that her blood condition did not require ongoing monitoring. He also said that her contraceptive injections were the most appropriate for her. Finally, he considered whether Ms C should have been referred to hospital when she presented with pain in her calf on the second occasion. He said that, although this was a finely balanced judgement, the GP had acted reasonably given the evidence he had available to him at the time.

Summary

Miss C complained about the dental treatment she received from the board following a referral from her dentist. She said the board did not provide her with reasonable care and treatment during her four appointments at the board's clinic and did not reasonably respond to her attempts to complain about the care and treatment they provided. Miss C explained that shortly after her treatment was completed, one of her teeth cracked, went black and eventually had to be removed.

We took independent advice on the case from our dental adviser, a general dental surgeon. The adviser said that the treatment Miss C received from the clinic appeared to have been carried out to a satisfactory standard and within the terms of the referral from Miss C's dentist. The adviser explained that following her root canal treatment, the clinic advised Miss C that the crown on one of her teeth could be replaced to improve aesthetics but noted that she declined this treatment. The evidence suggested that the clinic completed the treatment in the referral from Miss C's dentist as far as Miss C would allow them to go. However, based on the information in Miss C's records, we were not satisfied that the clinic advised Miss C that replacement of the crown could have improved the long term health of her tooth and were critical of the clinic in this regard.

The evidence showed that over a year after her treatment was completed, Miss C made multiple phone calls to her own dentist and phoned the clinic twice about her treatment. There was no documentary evidence that Miss C made contact with the clinic in the year after her treatment. The adviser explained that the clinic's response to Miss C's attempts to complain about her treatment was reasonable and that as Miss C was under the care of her own dentist at that time it would not have been reasonable for the clinic to see her again without her being referred there by her own dentist.

Although we did not uphold this complaint, we made two recommendations for improvement.

Recommendations

We recommended that the board:

• ensure that reasons for treatment provided to patients are fully explained and documented; and
• ensure that discussions of potential risks and benefits take place when a patient has not had sedative drugs administered so that the patient is fully capable of making an informed choice.

Summary

Mrs C complained that her medical practice had removed her from their list of patients. She had visited the practice to try to get an emergency appointment. She had a sore throat and had lost her voice so she used a pen and a scrap of paper to communicate with the receptionist. As a suitable appointment was not available she became frustrated and left the practice. The following day, the practice wrote to Mrs C saying that because of her behaviour, and after seeing relevant CCTV footage, they had no option but to immediately remove her from the practice list. Mrs C told us that she disputed the practice's interpretation of her behaviour. We explained that the practice were entitled to act on any concerns they had and that it was not our role to comment on the incident itself. We confirmed that our investigation would focus on the process the practice followed in removing her from their patient list.

We reviewed the relevant regulations and guidance, and discussed the case with one of our medical advisers. In order to remove a patient with immediate effect, the incident must have been reported to the police. Failing this, the practice should send the patient a warning letter. Only where a warning has been issued in the preceding 12 month period can they remove the patient without having involved the police. We upheld the complaint, as we found that in this case, the practice did not issue Mrs C with a warning, nor did they contact the police.

Recommendations

We recommended that the practice:

• review their removal policy to ensure it reflects the terms of the General Medical Services Contracts Regulations and associated guidance, particularly in respect of giving patients relevant prior warning if they are at risk of removal; and
• apologise to Mrs C for not following the proper procedure when removing her from their list of patients.

Summary

When Mrs C’s husband (Mr C) was taken to hospital by ambulance, the crew could not get the ambulance doors open, and there was a delay getting him to the hospital. Mr C passed away the following month and Mrs C then complained that the Scottish Ambulance Service (the service) had never apologised for the incident. When looking into the complaint, the service were unable to trace any details of the ambulance journey or crew involved. However, they formally apologised to Mrs C for the incident and assured her that steps had been taken to avoid a similar future problem.

Mrs C complained to us that the service had been unable to trace details of having transported her husband to hospital. The service told us what they had done to try and trace the journey. They said that no incident report was completed on the day in question and they received no reports of a vehicle with faulty doors. We were satisfied that they had fully investigated Mrs C’s complaint and gone to considerable effort in trying to trace the ambulance and crew involved. We also recognised that, despite not having traced the incident, they had apologised. However, we did not consider that they had taken appropriate action to try to avoid this happening again. We, therefore, made a recommendation.

Recommendations

We recommended that the service:

• issue an appropriate written reminder to staff of their obligations to formally report any incidents and also any related vehicle maintenance issues.

Summary

Mr C and his mother (Mrs A) received a visit from two community psychiatric nurses (CPNs) who assessed his and his mother's needs. At the end of the interview they mentioned that the results might be shared with colleagues in the social work department. Mr C was at that time involved in a dispute with that department about guardianship of his mother and was concerned that the information obtained might be used against him. He contacted the CPNs shortly after the assessment and said that he would not allow disclosure of the information without his permission. He complained to the board that the CPNs had not been open with him at the start of the assessment that information would be shared with the department to be considered as part of the application for guardianship.

We did not, however, uphold Mr C's complaint. Our investigation found that a consultant psychiatrist had asked the CPNs to carry out the assessment to establish if Mrs A had any health or social care needs, and not as part of the guardianship application.

Summary

Miss C and her mother complained about the care and treatment provided to Miss C's late father (Mr A) after he attended hospital for a day-case urology procedure (urology is a specialty in medicine that deals with problems of the urinary system and the male reproductive system). He had been unwell in the days leading up to the appointment. During the appointment, Mr A was found to have a fast heart rate and shortness of breath. The procedure was cancelled, and he was immediately admitted to the accident and emergency department, then transferred to a ward. Despite treatment, Mr A's condition deteriorated, and he was moved to the intensive care unit (ICU) where he was treated for six days. Although Mr A's condition was stabilised, his prognosis (the forecast of the likely outcome of his condition) was poor and he was transferred back to the ward to be more comfortable during the final days of his life. Mr A died two days later.

Miss C and her mother complained about the board's treatment of Mr A and said that they had failed to manage his pre-existing medical conditions. They also complained that staff in the ICU did not provide an adequate handover to ward staff when Mr A returned to the ward. As such, the ward staff did not know about his poor prognosis and did not ensure that end-of-life arrangements, such as extended visiting times and a single room, were in place.

As part of our investigation, we took independent advice from one of our medical advisers. We found that Mr A had a number of medical problems, including that his heart was failing and his kidney function had deteriorated significantly. Treating one condition led to a deterioration of the other and we acknowledged that managing Mr A's condition was a fine balancing act. Although staff gave Mr A a poor prognosis, we found that they agreed to his family's wishes that his kidney problems be treated in the ICU. This led to his condition being stabilised, although his prognosis remained poor and we were satisfied that this was explained clearly to the family. Our adviser said that the records showed that Mr A's underlying medical conditions were treated appropriately throughout his admission.

With regard to the handover between ICU and the ward, we acknowledged that the ICU had told family members that Mr A's prognosis was poor and that he did not have much time left. However, ward staff were also told that Mr A's condition was stable and were given no indication that a sudden decline in his condition was imminent. Under such circumstances, we found it appropriate that normal ward care was given, with normal visiting times in operation until such time as the patient entered the terminal phase of their illness. After Mr A's condition deteriorated significantly on the morning of his death, his family were given the opportunity to visit him outwith normal visiting times.

Summary

Ms C was a voluntary patient at the board's eating disorders unit. Some four months after she first attended there, the clinician responsible for her overall care told her that he intended to apply for a Compulsory Treatment Order (CTO - an order that allows professionals to treat a person's mental illness). A CTO can, however, only be implemented with the support of a Mental Health Officer (MHO), and they did not agree. A GP who knew Ms C agreed with the MHO and the application was dropped. Ms C was discharged from the unit and continued her treatment in the community.

Ms C complained that the period leading up to the application for the CTO was not managed responsibly, in that she was not provided with a proper explanation for the application. She said that she had been complying with her treatment programme and that there was no need for compulsory measures. Ms C also said that she was not provided with appropriate levels of support, that her family and other health professionals were not effectively communicated with and that her right to confidentiality was not respected.

Our investigation found that there was a failure to communicate effectively with staff as well as inappropriate wording in an anticipatory care plan, which meant that Ms C was effectively detained on the unit, despite being a voluntary patient, so we upheld that part of her complaint. We did not, however, find that Ms C was not provided with appropriate emotional or psychological support or that her confidentiality was breached.

Recommendations

We recommended that the board:

• issue Ms C with an apology for the failings identified in this investigation;
• develop a policy to reflect the Mental Welfare Commission’s guidance in relation to short term detention, for staff use and guidance and ensure this is distributed to all staff;
• remind medical staff of the need to ensure anticipatory care plans have sufficient flexibility to allow practitioners to exercise their clinical judgement; and
• ensure all staff are aware that communication with patients about a CTO application must comply with Mental Welfare Commission guidance.

Summary

Ms C's late mother (Mrs A) was treated in hospital as an in-patient for illnesses that included pneumonia and chronic heart failure. Ms C complained that during that time the hospital communicated inadequately with her and other family members about Mrs A's medical condition. In particular Ms C said that she and family members were not made aware of the severity of Mrs A's condition before she was discharged from hospital. Mrs A died around two weeks after being discharged.

We took independent advice from one of our medical advisers, who considered all aspects of the medical evidence. We took account of his advice alongside all the documentation supplied by Ms C and the board. Our adviser said that when Mrs A was admitted to hospital she was suffering from severe illnesses. When she was discharged, these had all been treated and were not significant ongoing issues. He noted that Mrs A had suffered from a severe degree of heart failure prior to admission. The adviser said that the records showed that staff had communicated appropriately with Ms C and other family members about Mrs A's true condition, in keeping with the General Medical Council's guidance on communication. Given this, we did not uphold this complaint.

Summary

Mrs C complained about the care and treatment the board provided to her late husband (Mr C) before his death. Mr C had been diagnosed with bladder cancer, and also had heart disease, diabetes, high blood pressure and arthritis. His bladder cancer was managed through intravesical BCG treatment (a vaccine for tuberculosis put directly into the bladder, which can help stop or delay bladder cancers), because he was not considered fit to undergo cystectomy (surgery to remove all or part of the bladder). This required weekly urethral catheterisation (insertion of a tube into the bladder).

Mr C developed a reaction to his intravesical BCG therapy, called BCG-osis (where the BCG organism has spread to cause an infection outwith the bladder), and was admitted to hospital. He was treated for this and then discharged. Mr C then developed a dramatic deterioration in his renal (kidney) function and was readmitted to hospital as an emergency with nausea, vomiting and anorexia. He was found to have developed acute kidney injury and pulmonary oedema (build-up of fluid in the lungs) and required kidney dialysis. Mr C died in the hospital from a presumed heart attack around ten days later.

Mrs C complained that the board failed to provide appropriate clinical treatment when her husband developed the reaction to his treatment. We took independent advice on this from one of our medical advisers, a specialist in treating bladder cancer, and found that it had been reasonable to manage Mr C's cancer by intravesical BCG treatment. We also found that the action taken to investigate, diagnose and treat his reaction to it was reasonable and appropriate. Mr C was appropriately discharged from hospital and our adviser did not consider that there were deficiencies in his care and treatment, nor alternatives that would have improved Mr C's prognosis. There was no evidence that the reaction that arose from the BCG therapy, or the treatment Mr C was given for this, contributed to the deterioration in his renal function. Our adviser said that it was likely that the deterioration resulted from the effects of gastroenteritis (inflammation of the stomach and intestines). We did not uphold Mrs C's complaint as we found that the medical care provided to Mr C was of a good standard.