Health

Summary

Mrs C complained about the care and treatment provided to her brother (Mr A) while he was both an out-patient and an in-patient in hospital. Mrs C also complained about the arrangements for discharging her brother from hospital, and of a lack of communication and/or consultation with Mr A's family.

Mr A had severe learning difficulties, significant health problems, and had developed dementia, but lived in his own home with the assistance of carers. In early 2011 he developed a number of further health problems and was admitted to hospital. After Mr A had been in hospital for some time, Mrs C was told that he was dying and it was recommended that he be transferred to another hospital for end of life care. Mr A's family took steps to surrender the tenancy of his home and to dispose of some of his belongings. However, Mr A's condition improved and about three months later he was deemed fit enough to be discharged. Mrs C complained that because of what she had been told earlier, Mr A was now homeless and had to be discharged to a nursing home. Mr A became unwell again two months later and was readmitted to hospital. He was discharged again but died a few hours later at his nursing home. Mrs C was particularly concerned that, during his transfer to the nursing home on a very cold and snowy day, Mr A was not dressed in the warm clothing she had ensured was available.

Our investigation, which included taking independent advice from two of our medical advisers, found that the care and treatment provided to Mr A had been reasonable overall. There was no evidence to suggest that he had not been adequately assessed or that his nutrition was inadequate, as Mrs C had feared. However, the advisers raised some concerns over a lack of clarity on issues of Mr A's lack of capacity; the waiting times for out-patient investigations; and information for relatives on NHS continuing care provision. Although we did not uphold Mrs C's complaint, we made recommendations to address these points.

Recommendations

We recommended that the board:

• consider implementing guidelines or targets on timescales for the provision of out-patient investigations such as echocardiograph;
• consider reviewing relevant patient documentation to clarify, where a patient lacks capacity, whether a legally appointed Attorney or Guardian is in place; and
• consider reviewing their policy on informing relatives in relevant situations about the option of NHS continuing care, the assessment process and the appeal process.

Summary

Mr C went to the practice because he had lower back and left leg pain, together with numbness. After his second visit, he was referred for physiotherapy, and then to hospital for a consultant opinion and an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone). The hospital, however, returned the referral to the practice on the basis that there were no 'red flag' symptoms (symptoms indicating a possible serious condition).

Three days after being referred, Mr C went to a hospital accident and emergency department with increasing pain and numbness. He was ultimately given a scan that confirmed a central prolapsed disc (where the centre of a disc in the spine pushes out into the spinal column) which required emergency surgery. Mr C questioned the treatment he had been given by the practice, as he believed they should have done more. He claimed that as a consequence, his outcome was poorer than it would have been.

To investigate this complaint we considered all the available documentation and relevant clinical records. We also obtained independent advice from one of our medical advisers. We did not, however, uphold Mr C's complaint. Our adviser said that, overall, Mr C's care and treatment had been entirely appropriate and reasonable. The adviser also said that the practice had correctly identified red flag symptoms and made an appropriate, immediate referral, which the hospital had declined to accept.

Summary

Mr C visited a hospital accident and emergency department (A&E) with lower back and left leg pain and increasing periods of numbness. He was discharged with an appointment to see a consultant twelve days later. Within a short time of being discharged, however, Mr C returned to hospital as he was experiencing increasing pain and numbness. Examination showed that there had been some loss of sensation and Mr C was admitted. An MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone) was carried out the next day, and showed a central prolapsed disc (when the centre of a disc in the spine pushes out into the spinal column) and Mr C was urgently transferred to a neurological unit at another hospital. The following day, a laminectomy (a surgical procedure to remove a portion of the vertebral bone called the lamina) and a discectomy (surgical removal of disc material that presses on a nerve root or spinal cord) were carried out.

Mr C complained that he should not have been sent home after he first attended A&E. He believed that if he had been kept in hospital the first time, his post-operative problems would have been reduced. We investigated the complaint and all the relevant documentation and clinical records were carefully considered. We obtained independent advice from a clinical adviser, which we also took into account. The adviser said that Mr C's first examination showed a decreased sensation in the area surrounding the anus and genitals and, so the diagnosis of partial or incomplete cauda equine syndrome (a very large disc prolapse that may cause pressure on the nerves supplying the bowel and bladder, leading to incontinence) should have been considered. Unless this is dealt with very quickly, within hours, the chances of recovery are low, and it was not considered. We upheld the complaint, noting that Mr C should have had an immediate MRI scan.

Recommendations

We recommended that the board:

• formally apologise to Mr C for their failure in this matter; and
• review their management pathway for suspected cauda equina syndrome and define the indications for an emergency MRI scan.

Summary

Mr A was in hospital for four months, and his daughter (Ms C) was unhappy about aspects of his nursing care during that time. Mr A was prescribed a low dose of madopar (a drug used to treat Parkinson's disease), which was increased two weeks later. The medical records show that his behaviour became increasingly problematic, and Ms C said that Mr A became very aggressive while taking the drug.

About two months later, Mr A was transferred to another ward contrary to the wishes of Ms C. Ms C said that nursing staff sat at a table during visiting time and failed to attend to her father's needs or communicate with the family. Mr A had three falls and Ms C said staff failed to explain why this happened or how he had a cut on his head, and that there was an unreasonable delay in swabbing the cut. Ms C was also concerned about the management of Mr A's skin condition.

After taking independent advice from our nursing adviser, we found that aspects of the nursing care provided to Mr A fell below a reasonable standard, and we upheld Ms C's complaint. However, the board had acknowledged the shortcomings in relation to communication and nursing staff availability during visiting time and had taken action on this. The adviser reviewed evidence from the board's audits and quality improvement plan and was of the view that they took sufficient action to address these shortcomings. We, therefore, did not find it necessary to make any recommendations.

In relation to Mr A’s transfer from one ward to another, the adviser said that the decision was reasonable. The ward staff took the family's views into account, but there was a clear rationale for moving Mr A to a more appropriate setting. In relation to medication, we found that the prescription of madopar was reasonable.

Summary

Mr C was admitted to a mental health ward in hospital after taking an overdose. A few days after his admission, he was transferred to another mental health ward. Several days later, Mr C was assaulted by another patient. He was examined by medical staff who concluded that he had not suffered a significant head injury but noted that he was upset and distressed by what happened. Mr C suffered from a headache on several occasions in the weeks following the assault and was again examined. Medical staff again concluded that he did not have a significant head injury. A CT scan (a special scan using a computer to produce an image of the body) was carried out shortly after Mr C's discharge and showed nothing abnormal. Mr C said he expressed his concerns about his safety when he was transferred, and received assurances from staff that he would be safe. He complained that he was inappropriately placed in a ward where he was vulnerable to an unprovoked attack and that the after-care provided to him following the assault was inadequate.

Our investigation found that, while there were failures to update Mr C's risk assessment at certain points, there was nothing to suggest that the assessment would have changed or that Mr C was at particular risk of assault from others whilst in hospital. The independent advice from our medical adviser was that it would, however, be helpful if the board's guidelines were more specific in relation to key times when risk assessments should be completed. We found that the transfer was reasonable as was Mr C's care and treatment after the assault. We did not uphold Mr C's complaints, but made recommendations because we had identified failures in relation to record-keeping and risk assessment.

Recommendations

We recommended that the board:

• review its guidelines on risk assessment in light of our adviser's comments; and
• bring the failures in record-keeping to the attention of relevant staff.

Summary

Mrs C's late mother (Mrs A) was admitted to hospital following a stroke. She was transferred to another ward a few days later. The day after her transfer to the ward, Mrs C told a nurse that her mother had a headache and needed pain relief. Mrs C said that the nurse was very defensive and extremely rude when she tried to discuss her concerns about her mother's pain relief. A scan was carried out, which did not show any physical cause for Mrs A's headache, and a psychiatrist later diagnosed a chronic tension headache.

Mrs C complained about the nurse's attitude and that Mrs A's pain relief was not reasonably managed after her stroke. After taking independent advice from one of our medical advisers, we found that Mrs A was given appropriate pain relief within a reasonable time, as only certain types of pain relief are normally provided after a stroke, to avoid affecting the patient's brain function. We found no evidence that the nurse had behaved inappropriately or in an unreasonable manner towards Mrs C.

Summary

Mr C complained that the board failed to take reasonable steps to fund travel and accommodation costs for his mother (Mrs A) following his father's emergency transfer to a hospital on the mainland. Mrs A wished to accompany her husband but there was no room in the ambulance, and so she made arrangements to travel to the mainland herself. Mrs A's GP had signed a post-dated escort authorisation form for her. Because of this she submitted an expenses claim, expecting the board to pay her costs, but they refused to do so.

Our investigation found that the board's policy says that they will only fund costs when someone is required to escort a patient who needs their support when travelling. This does not apply where the patient has travelled by ambulance, nor where family members to travel to be with someone who had been taken to hospital, and so the GP had incorrectly signed the form. Because of this, we did not uphold Mr C's complaint. In responding to our enquiries, the board also explained that they intended to highlight the requirements of the patient travel policy to all GPs in their area to ensure that the correct information is provided to families in future.

Recommendations

We recommended that the board:

• provide the Ombudsman with evidence that they have reminded GPs in their area about correct use of the patient travel policy.

Summary

Mr C, who had heart problems, was to undergo elective (non-urgent) surgery in the hospital to improve the blood flow to his heart to relieve the symptoms of angina (chest pain) he was suffering. His wife (Mrs C) complained that his planned transfer from another hospital for this procedure was cancelled five times. Mr C was eventually transferred, but died late the following evening. Mrs C also complained that the hospital's response to her complaint glossed over the reasons for one of her husband's discharges from hospital and was not consistent with the response from the other hospital.

Our investigation, which included taking independent advice from a medical adviser who is a consultant cardiologist (heart specialist), found that the reasons for the multiple cancellations of Mr C's transfer were all medically based. The adviser was of the view that each of the cancellations was reasonable, based on Mr C's clinical condition at the time. The adviser said that the procedure was designed to relieve chest pain. However, because of Mr C's other serious medical conditions, even if the procedure been carried out during his first admission to hospital it would have been unlikely to have changed the eventual outcome or to have prolonged his life. This is because Mr C's eventual condition would not have been cured, altered or improved by the procedure.

Our investigation also found that the reasons for Mr C's discharge were clear and had been made clear at the time. He was discharged so that another medical condition could be addressed to try to ensure that he was fit enough to undergo the surgical procedure, and we took the view that this was reasonable. Similarly, we found that there was no contradiction in the information provided in the complaint responses. Although we appreciated that this had been a very difficult time for Mrs C and her husband, we were satisfied that the overall care and treatment provided was reasonable.

Summary

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file.

Summary

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file.