Health

Summary

Mrs C complained about a number of matters related to her caesarean section (c-section - an operation to deliver a baby, which involves cutting the front of the abdomen and womb) and her subsequent care. Mrs C experienced a combination of complications including heavy bleeding and deep vein thrombosis (DVT) requiring hospitalisation.

After taking independent advice from a medical adviser, we found that most of Mrs C's medical and nursing care was reasonable. However, we upheld her complaint as we considered that the board did not take all possible precautions to reduce the likelihood of her developing DVT and heavy bleeding. We identified that Mrs C was given a combination of drugs that was likely to have caused her bleeding to worsen. We also considered that Mrs C should have been given compression stockings before and after the c-section until she regained full mobility. This did not happen in line with national guidelines on thrombosis and embolism in pregnancy. Mrs C also developed pressure sores following her c-section - the board acknowledged that she had not been properly assessed in this respect and agreed that this was unacceptable.

Recommendations

We recommended that the board:

• provide evidence to show that they have updated their policy on DVT to include the use of compression stockings;
• provide evidence to show that they have reminded relevant staff of the importance of assessing those mothers at risk of developing pressures sores following c-section;
• consider developing a template for documenting pressure sore risk assessments; and
• apologise to Mrs C for the failings we identified.

Summary

Mr C complained on behalf of his son (Mr A). Mr A had mental health problems but although he was twice on the waiting list for treatment for this, the board removed him from the list because he was either being investigated by the police or was awaiting trial. Mr C complained to the board, who confirmed that as there were outstanding charges against Mr A, his name had been removed. They said that this was in accordance with their usual protocol.

As part of our investigation we obtained independent advice from one of our medical advisers, a consultant forensic psychiatrist. Our adviser said that the board's protocol was contrary to the NHS policy of individualised care according to need. Mr A had been removed from the waiting list without due consideration for his needs and circumstances. We upheld the complaint as Mr A had received no treatment, and had significant psychological needs that went unmet.

Recommendations

We recommended that the board:

• formally apologise to both Mr C and Mr A for failings in this matter;
• look again at their protocol in terms of the Healthcare Quality Strategy for NHS Scotland 2010; and
• assure themselves that any outstanding mental health needs for Mr A are now addressed.

Summary

Mrs C complained that her GP had failed to diagnose her heart condition, and that as a result she had suffered a heart attack and had needed hospital treatment.

Our investigation found that Mrs C had gone to her GP with symptoms of postural hypertension (changes in blood pressure, caused by changes in position, such as moving from sitting to standing). After taking independent advice from one of our medical advisers, we did not uphold the complaint, as we found the treatment she received was appropriate for this condition. There was no evidence that the GP had failed to identify symptoms of an imminent heart attack.

Summary

Mr C complained that when he went to the practice for root canal treatment, the dentist fractured a crown and broke a portion of a front tooth. The dentist put in the existing crown, which lasted for two days. Mr C returned to the practice, but a further repair only lasted a day. Mr C obtained an emergency appointment with another dentist who inserted a temporary crown. On returning to the first dentist for further treatment Mr C explained he had been in a lot of pain and was unhappy that he had to pay for a new crown.

The practice said that Mr C had agreed to save the tooth and in order to carry out root treatment it was necessary to drill through the inner surface of the tooth/crown. At that point it was not possible to ascertain how much tooth structure was present below the crown. The practice said that the first dentist explained this to Mr C and that a fractured crown is a recognised problem which occurs fairly commonly after root treatments. The practice went on to say that it was also relatively common for temporary crowns to fall out, as normally they are only used for two weeks until permanent restoration can take place.

Mr C complained to us that the treatment options were not explained to him and he was not told the crown could be damaged. After taking independent advice from a dental adviser, we found that clinically the treatment which had been provided was appropriate. However, we upheld part of Mr C's complaint as we found no recorded evidence that the dentist had communicated the risks to him.

Recommendations

We recommended that the dentist:

• reflects on the importance of completing detailed records regarding communication with patients.

Summary

In 2007, Miss C was diagnosed with ulcerative colitis, a form of inflammatory bowel disease (IBD) causing ulcers or open sores to form on the colon. She suffered severe flare-ups in 2008 and 2010, and had to be admitted to hospital. Miss C explained that she was very aware of her own body and recognised the pattern of symptoms that would lead to flare-ups. She developed bleeding in 2011 and was referred to a gastroenterologist (a clinician specialising in the treatment of conditions affecting the liver, intestine and pancreas). Miss C complained that, although she was sure that she was heading towards another flare-up, the gastroenterologist did not take her concerns seriously and provided investigations and medications that did not help her. Ultimately, she developed a severe flare-up, and needed surgery.

We did not uphold most of Miss C's complaints. It was not possible to determine from the records what conversations had taken place between her and the gastroenterologist, or how seriously her concerns about her condition were taken. However, we found clear evidence that medication decisions were affected by what she had said. We also accepted independent medical advice that the treatment plan put in place for Miss C was appropriate for her symptoms and in line with national guidance. Our adviser said that Miss C's treatment did not deviate from the British Society of Gastroenterology’s Guidelines for the management of inflammatory bowel disease in adults (the BSG Guidelines).

Miss C also complained that the board did not obtain her medical records from another health board that had treated her previously. We were satisfied that procedures were in place to obtain records where necessary. However, on this occasion, the gastroenterologist had decided to conduct a fresh review of Miss C's symptoms, which we considered reasonable.

Although we found the treatment decisions to have been appropriate and made with reference to information from Miss C, we were critical of the standard of communication with her, and upheld her complaint about this. We found that staff could have done more to empathise with Miss C during her admission, and to explain the reasoning behind treatment decisions that she did not agree with.

Recommendations

We recommended that the board:

• provide details to the Ombudsman of the facilities they have in place to meet the BSG Guidelines' requirement to provide patients with access to an IBD helpline;
• consider asking their clinical team to review how they communicate with patients in terms of explaining decisions made about their treatment; and
• ask the clinical team to consider how they can ensure patients' comments, concerns and treatment options are discussed empathetically.

Summary

Mrs C complained about the care and treatment provided to her by an optometrist (a healthcare professional concerned with the health of the eyes). When Mrs C had problems with her right eye, she went to her GP, who prescribed eye drops and referred Mrs C to her local opticians. The opticians were members of the Grampian Eye Health Network, which provides assessments and treatment in the community for certain eye conditions. The network is supported by advice from a local hospital eye clinic via a phone helpline, which members can also use to make urgent referrals to hospital.

Mrs C was seen by the optometrist several times that month and was diagnosed with ulcers or marginal keratitis (inflammation of the outer layer of the eye). The optometrist advised her to continue with the drops prescribed by her GP, and added further treatments. They also took advice from the eye clinic via the helpline. Mrs C's condition seemed to improve, as the ulcers were reducing in size, but by the start of the next month she was still experiencing pain and inflammation. She phoned the optometrist saying that following research on the internet she had stopped all treatment and was requesting a referral to the hospital eye clinic. She was seen at the opticians the following day. The ulcers were found to have increased in size again and the optometrist made an urgent referral to hospital. Mrs C was seen in the eye clinic the next day, was admitted to hospital and received in-patient treatment for ten days.

After taking independent advice from one of our medical advisers we found that the care and treatment provided to Mrs C was reasonable, appropriate and timely. The adviser considered that the optometrist had prescribed reasonable treatment, which followed the advice and guidance of the network and also complied with that issued by the Royal College of Optometrists.

Summary

Ms C complained about the care and treatment that her father (Mr A) received from the medical practice during the weeks leading up to his admission to hospital with a chest infection and kidney failure. Mr A saw doctors from the practice several times in the four weeks before he was admitted. Ms C was concerned that an earlier diagnosis of chest infection could have improved his care at home, and reduced the need for hospital intervention. Mr A died three days after he was admitted to hospital.

Mr A had seen doctors from the practice five times - in relation to fluid on his lungs, an ongoing urine infection and unsteadiness with walking. In addition, he saw a physiotherapist twice, had a chest x-ray and a chest scan. The final consultation was during a home visit, when signs of a chest infection were apparent. At first, the GP had assessed that Mr A could stay at home, and take antibiotics. However, when blood tests showed that his kidney function was poor, she decided that he needed admission to hospital for closer monitoring.

We obtained independent advice on this complaint from one of our medical advisers, but did not uphold the complaint. The advice indicated that the chest infection was not apparent until the day Mr A was admitted to hospital, and was not evident on the chest scan. Our adviser considered that the care and treatment provided by the practice were of a good standard and that there was no delay in diagnosing the chest infection. We also found that the practice had acted promptly to secure Mr A's admission to hospital when the infection was identified.

Summary

Mr C, who was a prisoner, complained to us that the health board unreasonably stopped his medication. However, he was released from prison during our investigation and did not tell us his new address. As we were unable to contact Mr C, we closed the case.

Summary

Ms C was undergoing private treatment, including hormone therapy, as a transgender individual suffering from gender dysphoria (a condition in which a person feels that there is a mismatch between their biological sex and their gender identity). Her private medical provider was treating her with Zoladex (a hormonal therapy) but her NHS medical practice was not prepared to prescribe this for her, as it is only licensed in the UK for prostate cancer treatment. Ms C felt that she was being discriminated against.

After taking independent advice from one of our medical advisers, who is a GP, we did not uphold the complaint. We found that that the practice had acted appropriately and in line with General Medical Council guidelines in refusing to prescribe a drug they were not familiar with and that they did not feel competent to administer or monitor.

Summary

Mrs A, who was 91 years old, became ill and was admitted to hospital, where she deteriorated and died. Her son (Mr C) complained to the board that it was inappropriate for them to have placed his late mother on the Liverpool Care Pathway (LCP - a care planning system for dying patients). Mrs A was on the LCP for more than two weeks before she died, which Mr C felt was too long. He felt that staff should instead have provided her with treatment, for example an operation. He said that although it might have ended her life sooner, he felt that at least she would not have suffered for so long.

The board maintained that it was appropriate to have placed Mrs A on the LCP. Due to Mrs A's age and her other medical conditions, the board said the risks of surgery would have outweighed any potential benefit. They confirmed that communication was maintained with appropriate family members. Our investigation found that it was not unreasonable for staff to have placed Mrs A on the LCP, as it is used by health care staff to ensure high quality personal care is delivered in the last days of life. We also noted that the decision was discussed with family members who were the hospital's first point of contact.