Health

Summary

Ms C complained to the board about a possible breach of confidentiality caused by automated messages which had been left on the family's landline phone. Ms C heard no more until the board sent her a formal response to her complaint some six months later. The response explained that the automated service had been suspended until new procedures could be installed to prevent possible breaches of confidentiality.

Our investigation found that the board had treated Ms C's complaint as a return complaint rather than a new one, and that the delayed response was compounded by a period of high numbers of staff absences. We upheld the complaint but made no recommendations as the board had recently formally apologised to Ms C and provided detailed explanation of the action taken to prevent a repeat occurrence.

Summary

Mr C was admitted to a hospital accident and emergency (A&E) department after falling down stairs. On arrival his neck was immobilised in a collar, and it was noted that he had movement in his arms and legs with sensation in all his limbs. However, it was also noted that there were problems with his cooperation during this examination. A scan showed no acute fracture or bleeding and Mr C's neck collar was removed. The next morning, Mr C was found to have lost the power in his legs and he was transferred urgently to another hospital for treatment. His wife (Mrs C) complained that, given his accident, Mr C should have been kept immobile and given a full spinal scan. She also believed that proper tests were not carried out to determine the extent of his injuries and that he should have been transferred immediately to a specialist unit.

To investigate the complaint, we carefully considered all the relevant information, including all the complaints correspondence and Mr C's medical records. We also obtained independent advice from a consultant in emergency medicine and took this into account. Our investigation found that although Mr C was immediately immobilised on his admission to A&E, his neck collar was removed despite recorded difficulties in completing an assessment. Relevant advanced trauma life support (ATLS) guidelines suggested that Mr C should have remained in the collar until he was determined to be neurologically normal and could have been properly assessed. We upheld the complaint that Mr C should have been kept immobile, but did not uphold the others as our investigation found that all appropriate tests were carried out to establish the extent of his injuries and that the proper protocol was followed in transferring him to another hospital, rather than to a specialist unit.

Recommendations

We recommended that the board:

• apologise to Mr C for removing the hard collar before he was confirmed to be neurologically normal; and
• take appropriate steps to satisfy themselves that, with regard to evaluation, ATLS guidelines are fully complied with.

Summary

Ms C complained that the board had failed to take action to prevent her father (Mr A) from falling while he was in hospital. The hospital had completed a nursing assessment when Mr A was admitted. It was recorded that he was able to walk independently with a stick, but that he needed bed rails. Mr A got up to go to the toilet during the night. The nightshift staff in the hospital found him standing next to the toilet, holding onto the handrail. The next day, staff found that Mr A's mobility had deteriorated. He told them that he had fallen in the toilet during the night. Staff arranged an x-ray and it was found that Mr A had fractured his pelvis.

After taking independent advice from one of our medical advisers, we found that it was appropriate to promote Mr A's independence and that it was reasonable that he was able to go to the toilet alone. Although it was decided that Mr A needed bed rails, the board's guideline for falls management stated that bed rails would not prevent a patient leaving their bed and falling elsewhere, and should not be used for this purpose. Ms C said that her father had told her that the bed rails were not up when he went to the toilet. However, the member of staff who had assisted Mr A when she found him in the toilet recorded that the bed rails were up when she took him back to the bed. Although we recognised that the fall had a significant impact on both Mr A and Ms C, we found that there was no evidence to suggest that it could have been prevented.

Ms C also complained about the board's handling of her complaint. We found that they had delayed in responding, although they had apologised to Ms C for this. They had also failed to provide a full and detailed response to the complaint. We found that they should have tried to address the points Ms C made about whether or not the bed rails were up when Mr A got out of bed. In addition, the response had incorrectly referred to her late mother instead of her father. In view of all of this, we upheld this aspect of her complaint.

Recommendations

We recommended that the board:

• issue a written apology to Ms C for incorrectly referring to her mother instead of her father in their response to her complaint and for failing to provide a full and detailed response to the complaint.

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?'