Health

Summary

Mr C complained to the medical practice about the level of treatment he had received there over a period of a few years. They responded, acknowledging that there had been communication difficulties with Mr C, and that actions of and comments from the GPs had been made with the best of intentions.

It was their view that Mr C had misinterpreted these. However, as a result of the complaint, the practice said that they had learned that they should be more sensitive and vigilant towards any patient who is dissatisfied or unhappy with any member of staff.

Our investigation found that the medical records confirmed the information in the practice's response to Mr C, and that they had carried out a thorough investigation into his complaint.

Summary

Mrs C complained about the care and treatment her husband (Mr C) received in hospital during two separate admissions. Mrs C was dissatisfied that her husband was discharged from the hospital despite being advised that he would be undergoing further tests at a second hospital while an inpatient. She was also dissatisfied with the care Mr C received during a second admission because she said there were communication problems between two doctors about arrangements for Mr C to have a coronary artery bypass graft (CABG - a surgical procedure to treat coronary heart disease) at the second hospital. Mrs C said that in response to the complaint, the board acknowledged her frustration at the length of time Mr C waited for the CABG but advised that they did not consider there had been any mismanagement by the first doctor.

Our investigation found that there was evidence to support that the first doctor provided appropriate care during Mr C's first admission and made reasonable attempts during the second admission to transfer Mr C to the second hospital with a view to having a CABG carried out. We also established that the second doctor had to ensure that Mr C was fit to undertake major cardiac surgery, because of a number of underlying health conditions. Although we did not uphold the complaint, we made a recommendation to address the issue of joined-up care between hospitals.

Recommendations

We recommended that the board:

• review how they share information about a patient's management plan between hospitals to ensure timely care and treatment.

Summary

Mr and Mrs C complained about care that the board provided to their son (Mr A). Mr A was placed in foster care in an area away from the family home. The doctor who had been treating Mr A at home referred him to the new area's child and adolescent mental health services team (CAMHS). Mrs C complained that she and Mr C were not involved in the subsequent process.

We upheld this complaint. Our investigation found that there was no opportunity for Mr and Mrs C to express their views to the team despite the fact they maintained parental rights. We also found that CAMHS did not communicate with Mr and Mrs C until a third party prompted them to do so. We also upheld a complaint that mental health care arrangements for Mr A were not reasonable. We found that, although the board had attempted initial unsuccessful engagement with Mr A, his views had not been clearly sought at any stage. We noted that, during a meeting, those involved considered that Mr A was 'reluctant' to engage with CAMHS, but did not initiate a follow-up plan (which should have included obtaining Mr A's views clearly). Five months passed before Mr A was contacted again with the offer of an appointment, which he accepted.

We did not uphold a complaint that staff unreasonably failed to contact Mr and Mrs C when Mr A was admitted to hospital, as we found that they had acted reasonably by accepting that Mr A's foster parents, who had attended hospital with him, were acting as the responsible adults. Mrs C said that Mr A had been asking for her and Mr C, but we found no evidence that staff at the hospital were aware of this, as this information came from Mr A's foster carers rather than the medical records.

Recommendations

We recommended that the board:

• apologise to Mr and Mrs C for not involving them in Mr A's transfer to CAMHS;
• review the procedures within CAMHS following referrals, to ensure parents have the opportunity to exercise their parental rights, where appropriate, and that parents are advised of outcomes and communicated with appropriately;
• ensure all the staff concerned, and the CAMHS team as a whole, are reminded of the need to maintain detailed minutes during professionals' meetings and to ensure the terms of a referral are considered fully; and
• review CAMHS processes to ensure that the views of the child or young person concerned are taken into account in a timely way.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr C), who had heart problems, during three admissions to hospital. Mr C was to have an operation to improve the blood flow to his heart. Mrs C said that, over the three admissions, her husband's transfer to a second hospital for the procedure was cancelled five times. He was eventually transferred, but died late the following evening. Mrs C also complained that it was unreasonable that she was referred to the second hospital for information about the cancellations, and that the board's response to her complaint glossed over the reasons for one of Mr C's discharges from hospital and was not consistent with the response from the second 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 his clinical condition at the time. They also said that the procedure he was to undergo was designed to relieve chest pain. However, because of his other serious medical conditions, even if the procedure had been carried out during Mr C's 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.

On the matter of Mrs C being referred to the second hospital for further information on the cancellations, we found this was not unreasonable. Cancellation decisions were made jointly on the basis of her husband's clinical condition and the second hospital had the final say in whether or not he was fit to undergo the procedure. It was, therefore, reasonable that Mrs C should be referred to them for further information. Our investigation also found that the reasons for her husband'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 has dementia. His wife (Mrs C) complained that the care and treatment provided to her husband by two hospitals was below a reasonable standard. She also said that when Mr C was reviewed by two doctors from an out-of-hours GP service they ignored her concerns that Mr C had a deep venous thrombosis (DVT – a blood clot in a vein). Mrs C also complained about a lack of communication from staff about Mr C's condition.

Mr C normally lived at home but in April 2011 he was in respite care when he became ill. His confusion increased and his mobility was affected. He was admitted to hospital but discharged three days later. Just over a week after he was discharged, Mrs C reported that Mr C was feeling terrible and had swollen legs and feet. He was seen on two consecutive days by GPs from the out-of-hours service. No definitive diagnosis was reached at either of these visits and Mrs C was given advice on managing Mr C's condition and to contact them again if his condition worsened. Mr C was, however, admitted to hospital again two days later, where DVT was diagnosed. He was transferred to another hospital, where he remained for three months before he was discharged.

We did not uphold Mrs C's complaints. Our investigation, which included taking independent medical and nursing advice, found no failings in the care and treatment provided to Mr C. Mrs C had been particularly concerned about two drugs given to her husband, an antipsychotic and a tranquiliser. Although more commonly used to treat mental illness, these drugs have been found to be useful, in low doses, for short periods under careful monitoring for those displaying the anxiety and agitation that can be a part of dementia. Our advisers were satisfied that the dosages were appropriate and that careful monitoring, dosage reduction and eventual withdrawal followed.

Our investigation found evidence of regular communication from staff to the family, in face to face or phone conversations. Mrs C complained that the family had had to seek out information and take the first steps in communicating with staff, but we found that it would be impractical and unreasonable to expect staff to always be proactive in communicating with patients' relatives. We found no evidence that the family were refused, or had any difficulty in obtaining, information about Mr C's condition.

Our investigation also found that the records showed that the out-of-hours GPs made appropriate and thorough examinations of Mr C. They considered DVT as a possible diagnosis but could make no definitive diagnosis at the time of the visits. Our medical adviser found no evidence of failure on the part of either GP.

Summary

Mrs C attended the board's dental service, as her dentures were loose and uncomfortable. She had a new lower denture fitted and her top denture relined. However, she found the new dentures uncomfortable from the outset and returned to the service. The dentist made her a new lower denture based on her original dentures. Mrs C was unable to eat with these dentures and they caused her pain. She went back to the dental service again and was referred to the dental hospital. She was told to wear her old dentures in the meantime, as they fitted better.

Mrs C saw a consultant at the hospital. He suggested replicating her old dentures, and adding a permanent soft lining material. He placed her on the waiting list for treatment by postgraduates at the hospital. However, at that time, they were reaching the end of their placements and were unable to offer treatment to new patients. Mrs C told us that due to the delay, she decided to get private treatment. She said that the dentist she saw privately was able to make her dentures without any difficulty.

Our investigation found that the board had failed to let Mrs C know that there would be a delay in her treatment because the postgraduates were unable to offer treatment to new patients at that time. Due to the delay that occurred as a result of this, the board failed to meet the 18 weeks referral to treatment target. Although the board's view was that the dentures made by the dental service were not defective, we found that they had accepted that the dentures were not fit for purpose by agreeing to make new ones.

Recommendations

We recommended that the board:

• consider how they can prevent delays for patients referred to postgraduates at the dental hospital for treatment; and
• refund the money Mrs C paid for dentures that she was unable to wear.

Summary

Mrs C's GP referred her to hospital because she suddenly lost the vision in her left eye. She was diagnosed with a blockage of the main artery supplying the retina (the inside lining of the eye), and her loss of vision was severe and permanent. Mrs C attended the hospital again a few days later with similar symptoms affecting her right eye. She was then given a high dose of steroids, as it was suspected she had giant cell arteritis (GCA - inflammation of the blood vessels, usually in the head, which can cause blindness).

Mrs C's husband (Mr C) complained to the board that Mrs C was not closely monitored after being prescribed such a large dose of steroids, but we did not uphold his complaints. After taking independent advice from one of our medical advisers, we found that the relevant consultant kept Mrs C under appropriate review, and there was a clear plan for the management of her steroids. We concluded that although Mrs C did suffer side effects, which were very distressing for her, these were properly assessed against the risk of her losing her eyesight permanently and having a stroke.

Summary

Mrs C said that her husband (Mr C) experienced a seizure while driving his taxi, and an ambulance was called. After Mr C was assisted out of the taxi and into the ambulance, Mrs C alleged that the ambulance staff used unreasonable restraint, which resulted in a compression fracture (when the bones of the spine become compressed due to trauma). She said that her husband could no longer work or enjoy the quality of life he had enjoyed previously. When Mrs C complained about what had happened, the paramedics involved denied that any unreasonable restraint had been used and the Scottish Ambulance Service said that his back injury was likely to have occurred as a result of his seizure. They said that this was not unusual.

As part of our investigation of the complaint, we took independent advice from one of our medical advisers. We took all the available information into account, including complaints correspondence, staff statements and patient report forms. Our investigation found that Mr C had had a tonic-clonic seizure (a seizure which affects all of the brain) and, as such, the adviser said that Mr C was likely to have been confused and disorientated. They said that a person suffering such events was not likely to remember what happened. This was confirmed by Mr C, who said that his recollection of events, in part, was unclear. The adviser also said that Mr C had suffered a compression fracture but that this was not, in his view, consistent with pressure exerted in a downward direction when a patient was lying on his back. The adviser confirmed that it was most unlikely that Mr C's injury had been caused in the way Mrs C alleged, and that it had likely occurred during his seizure.

Summary

Miss C submitted a repeat prescription request to the medical practice on behalf of her mother. When she went to the pharmacy to collect the prescription over the next few days, it was not available. It was not until several weeks later, when she called about another matter, that she found out the prescription had been lying at the practice awaiting collection. Miss C complained that the practice did not tell her that the prescription was waiting to be picked up, and felt they should have been responsible for dropping it off at the pharmacy.

During our investigation we took independent advice from one of our medical advisers. The adviser said that responsibility for collecting prescriptions and taking them to a pharmacy lies with the patient or their carer. He noted that pharmacists often collect prescriptions from GP surgeries, but that this is a goodwill service and they are not obliged to do so. We considered that it would have been reasonable for Miss C to have asked what had happened to the prescription. We also noted that when the complaint reached us, the prescription had still not been collected, although Miss C had been aware for some time that it was waiting to be picked up. In the circumstances, we did not uphold the complaint.

Summary

Mrs C complained that she experienced an unreasonable delay in receiving appointment notification letters from the board. After she was referred to a respiratory clinic by her GP, the board wrote inviting her to an appointment at the clinic. Mrs C did not receive this letter until after the time of the appointment on the day it was due to be held. The letter was dated seven days earlier. It had been sent via a private delivery firm and had not been stamped with the date it had been posted. Mrs C went to her medical practice and a receptionist phoned the hospital to rearrange the appointment.

The board wrote to Mrs C the next day to confirm the rearranged appointment time and date. Mrs C received the letter two days later. The envelope was marked first class and had two Royal Mail first class stamps on it. She attended the appointment four days later, but returned home to find another letter inviting her to the appointment. The letter had been dated six days earlier. It had been sent via the private firm and had not been stamped with the date it had been posted. The letter said that if she failed to keep the appointment without notifying them in advance, she would not necessarily be given another one.

Mrs C did not receive the two appointment letters posted via the private firm until after the appointments were due to be held. In view of this, we upheld the complaint. In addition, we found that Mrs C had told the board that she was deaf. However, in their response to her complaint, they said that she should phone them if she had any questions.

Recommendations

We recommended that the board:

• carry out a further audit of the time taken for letters posted via the private delivery firm to arrive and take appropriate action on the results of this audit;
• provide clarification to staff on when first class Royal Mail/private delivery postage should be used; and
• issue a written apology for stating that Mrs C should contact the complaints team on the phone number provided if she had any questions, despite the fact she had told them she was deaf.