Health

Summary

Ms C contacted us on behalf of her client (Mr A) who was unhappy with treatment he received during a hospital consultation. She said that Mr A was not provided with the correct treatment and procedures were not properly explained to him beforehand.

After taking independent advice from one of our medical advisers, we did not uphold the complaint about treatment as we found that it was reasonable given the symptoms he reported. We did, however, uphold the complaint about the explanations provided. The board told us that patients are fully informed verbally before the consultation, that they are sent a leaflet in advance by post and that Mr A had given verbal consent to the procedure. Mr A disagrees, and there was insufficient evidence for us to reach a decision on whether reasonable verbal information was in fact provided beforehand. We found that the board had no written record or evidence that the procedure was explained to Mr A, or whether he had been sent a leaflet or given verbal consent. Because of the lack of clear evidence that the board had adequately explained this to him, we upheld the complaint.

Recommendations

We recommended that the board:

• carry out a review of the patient's pathway when attending the relevant clinic, with a view to improving documentation and record-keeping to incorporate a record of all advice given, acknowledgement that the patient understands the advice and that consent had been given; and
• consider revising the appointment letter to either incorporate the information leaflet or clarify that a leaflet is enclosed.

Summary

Ms C complained on behalf of her brother (Mr A). In April 2012, Mr A was admitted to hospital as an emergency suffering from an arteriovenous malformation (AVM - an abnormal collection of blood vessels in the brain where bleeds can occur, and which can be life-threatening). There are three approaches to treat an AVM, two of which the hospital considered, but thought unsuitable. Mr A was then discharged and told that he would be referred to a hospital in England for the third type of treatment. Ms C complained that there was an avoidable delay in providing this.

As part of our investigation, we took independent advice from one of our medical advisers, who is a consultant neurosurgeon. Evidence obtained during the investigation showed that on admission, Mr A's treatment was appropriate and reasonable as were the attempts to address the AVM. We found that the three types of treatment were options (not requirements) and that Mr A's case had been appropriately referred to the English hospital for consideration, although after a long delay. Ultimately, that treatment was also found to be unsuitable, as in the clinicians' view, it could cause more harm than good. (This had not been Ms C's understanding, as she had thought the treatment was essential.)

After careful consideration, although no treatment was ultimately available to Mr A, we upheld the complaint because of the avoidable delays in referring his case on for consideration.

Recommendations

We recommended that the board:

• formally apologise to Ms C and her brother for the delay and confusion over his referral;
• review referrals within the department of neurosurgery and satisfy themselves that these are made in a timely manner and that communication is clear; and
• review the situation in the department of neurosurgery with regard to discharge letters and satisfy themselves that they are typed and issued within appropriate time limits.

Summary

Miss C complained about the care and treatment provided by her former dentist, together with the way in which her complaint was handled. During the course of our enquiries, the dentist acknowledged that there were failings in Miss C's follow-up treatment and the handling of her complaint. In order to address these issues, the dentist agreed to apologise to Miss C and reimburse her for the cost of her treatment. Miss C was satisfied with the proposed action and so we considered her complaints resolved.

Summary

After she was diagnosed with osteoarthritis (the most common form of arthritis), Mrs C had hip replacement surgery. She went back to see the surgeon because she had pain in her hip. He thought that her symptoms suggested trochanteric bursitis (a condition that causes pain over the outside of the upper thigh, usually due to inflammation or injury to some of the tissues that lie over the top of the thighbone). He injected the tender area with a local anaesthetic and steroid on a number of occasions and arranged for her to attend physiotherapy.

When the problems persisted, Mrs C was referred to another surgeon. He said that the pre-operative x-ray showed minimal osteoarthritic change, and thought that the diagnosis of trochanteric bursitis was improbable. He said that the pain might be related to infection or mechanical loosening and organised a bone scan and then an MRI scan, although these did not show any abnormality. The surgeon decided that there were some problems with the hip replacement and that there was enough evidence to support replacing it with a different type. He then carried out this operation.

Mrs C complained to us that the board had failed to carry out appropriate hip replacement surgery in the first operation. After taking independent advice from one of our medical advisers, however, our investigation found that it was reasonable and appropriate to carry out a total hip replacement and that the surgery was carried out to a reasonable standard. Although the first operation failed to achieve the aim of the surgery, which was pain relief, the operation note was clear and did not indicate any problems. A small number of patients have significant pain following hip replacement and we were unable to say what had caused Mrs C's pain. There were no identifiable technical errors and we found that the initial surgery was carried out to an acceptable standard.

Summary

Mr C had been diagnosed with a retroperitoneal liposarcoma (a malignant soft-tissue tumour) which was removed. Two years later, a CT scan (a special scan using a computer to produce an image of the body) showed that the tumour had grown back, and it was decided that scans should be carried out to monitor its growth. The scans showed that the affected area had grown and so it was decided to surgically remove the tumour. When the operation was carried out, it was not possible to remove the tumour completely. The right ureter (the tube that carries urine from the kidney to the bladder) was also involved in the tumour and it was divided and closed off.

Mr C complained that the surgeon failed to obtain an up to date CT scan of the affected area before he carried out the operation. After taking independent advice from one of our medical advisers, we found that such a scan was not needed as it would not have changed the need for or prevented the surgery on Mr C's ureter. We also found that all the required investigations were performed and documented before Mr C had the operation.

We did, however, uphold his other complaints. Mr C complained that the surgeon had failed to obtain informed consent from him for the operation. He said that he thought that only the tumour would be removed and had never been told that surgery on other tissue or organs might be required. The board's consent policy clearly says that it is essential for health professionals to clearly document both a patient's agreement to treatment and the discussions that led to that agreement. The policy says that this will be done either using a consent form that the patient signs, or by documenting in the patient's case record that they have given verbal consent. We found that the clinical decisions and surgical treatment were correct and in line with the accepted standard of practice for this operation. However, there was no documented evidence that Mr C was given sufficient information before the surgery about possible loss of kidney function. Consequently, we found that that there was no evidence that the board had communicated with Mr C effectively during the consent process.

Several weeks after Mr C was discharged from hospital, he was admitted to another hospital with hydronephrosis in his right kidney (a condition where one or both kidneys become stretched and swollen because of a build-up of urine). Mr C said that he and the staff in the other hospital were initially unaware that his right ureter had been intentionally closed off. Because of this he was initially diagnosed with a possible kidney stone, before it was identified that the problem was related to the surgery on his ureter.

We found that it was not possible to say whether Mr C was given sufficient information after the operation, as there was no written documentation of the discussions on ward rounds. The board said that he was told what had been done. However, it was clear that after the operation Mr C was not fully aware of the extent of the surgery he had. We could not say whether this was because he was told, but did not retain the information, or because this information was not given to him. However, important information shared with the patient on ward rounds should be clearly documented in writing in the clinical notes and there was no evidence in Mr C's notes that staff had effectively communicated details of the operation to him.

Recommendations

We recommended that the board:

• consider if their consent form should be reviewed in order that there is a section to record possible risks and complications; and
• remind the relevant staff involved in Mr C's care and treatment that important information shared with the patient on ward rounds should be clearly documented in writing in the clinical notes.

Summary

Mr C, who has type 1 diabetes, complained that he was not offered a meal over a period of several hours while waiting to leave hospital. He did say that a nurse had offered him something, which he had declined. The board said that the staff nurse recalled a nurse offering food three times, although Mr C said this was not true. Our investigation found that Mr C had been in hospital overnight in relation to a condition other than his diabetes, and nursing staff were satisfied he knew how to manage the diabetes himself. He was administering his insulin himself while in the hospital. This meant that his food intake did not need to be recorded, which also meant we were unable to establish whether he was offered something to eat at a suitable time. There were, therefore, no grounds to uphold this part of Mr C's complaint.

Mr C also complained that the patient discharge sheet referred to him as female. When he complained to the board, they apologised, explained that this had been human error and told him what action they were taking to help prevent a recurrence. We also noted that the writer of the discharge sheet had referred to Mr C as 'Mr' on the following line, which was an indication that the gender error had been a human error, rather than a deliberate attempt to humiliate Mr C. We also considered the board's explanations and actions were reasonable.

Mr C was also unhappy with the board's complaints handling, which he said took too long and did not address the issues. We found that the board had taken the complaint seriously, investigated the various issues robustly and tried hard to respond to the key issues raised and many of Mr C's other points. There were delays, but we also noted that the NHS complaints procedure only gives timescale guidelines in respect of the first complaint reply, not in respect of follow-up correspondence, such as Mr C's follow-up letter. We took the view that the board should have kept in contact with Mr C about the delays but did not consider it would be proportionate to make any recommendation for action by the board as, on balance, their complaints handling was generally good.

Summary

Mr C complained about the time the board took to provide him with tests, referrals and a diagnosis. He was concerned that every time he was referred for tests or treatment he was placed back on the waiting list. He was of the view that the board failed to meet their obligations in terms of the required waiting times.

We found that the board's initial referral exceeded, by a few days, the 18 week NHS 'treatment to referral time' standard. A subsequent referral for an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) also exceeded this timescale, so we upheld the complaint. As the board had, however, already apologised to Mr C for the delay and taken steps to try and avoid similar future failures, we did not make any recommendations.

Summary

Mrs C complained about her late husband (Mr C)'s care and treatment by the board. She said there was an avoidable delay in the diagnosis of Mr C's cancer and that following chemotherapy in March 2012, it was unreasonable to have scheduled a follow-up CT scan (a special scan using a computer to produce an image of the body) for six months later – Mrs C thought it should have been sooner.

We obtained independent advice on this case from one of our medical advisers, a consultant clinical oncologist (a specialist in treating patients who have cancer). The adviser explained that Mr C had a rare aggressive duodenal (in the first part of the small intestine) cancer which the board promptly diagnosed and treated by surgery and chemotherapy. He said the clinical care and treatment Mr C received was both appropriate and to a high standard.

The adviser said there was no evidence in Mr C’s medical notes that the board told Mr and Mrs C when the next CT scan would be carried out. A letter from the board to Mr C’s GP said only that Mr C had a further appointment for three months’ time. According to the board, they planned to carry out a further scan in September 2012, six months after the completion of chemotherapy. Therefore, while it appeared that the board planned to carry out a further scan at a future date, we were unable, due to the conflicting evidence, to reach a definite conclusion on what the board told Mr and Mrs C about the time frame. However, our adviser explained that CT scans are usually only carried out if a patient has symptoms that suggest the cancer may have come back, and this was not the situation when Mr C was seen in March 2012. Therefore, the board’s apparent plan to carry out a further CT scan was, according to the adviser, above standard care and would not, irrespective of the timescale, be deemed unreasonable. We accepted the adviser’s view, and did not uphold Mrs C's complaints.

Summary

Mr C complained to the medical practice about the treatment that his late wife (Mrs C) received for gout. A GP had prescribed tranquilisers instead of painkillers. After two weeks Mrs C started losing skin on her hands and the GP reduced the medication. Mrs C was later admitted to hospital, where she died, with the cause of death stated as kidney failure and diabetes. Mr C said that his wife should have been admitted to hospital sooner, as she was passing blood.

Although we noted that this was a complex medical case, we upheld Mr C's complaint. After taking independent advice from one of our medical advisers, our investigation found that there was a lack of documentation in the GP records about Mrs C's deterioration in the weeks before she was admitted to hospital. There was also a failure to check her kidney function in view of medication that had been prescribed, and the practice should have referred Mrs C for a specialist opinion or hospital admission sooner.

Recommendations

We recommended that :

• conduct a significant event audit to see if lessons can be learned from this complaint;
• apologise to Mr C for the failings identified in our report; and
• ensure that the GP concerned revises the presentation of acute renal failure and management of hypertension and discusses the case at his next appraisal.

Summary

Mr C complained about the prison healthcare team making changes to medication he had been prescribed for chronic leg pain and migraines. He also complained about not being given medication for high blood pressure.

Mr C, however, withdrew his complaint before our investigation was completed.