Health

Summary

Mrs C complained to the board about the care and treatment that her late husband (Mr A) received in hospital when he attended the emergency department. Mr A was discharged home but around two months later he was admitted to the hospital again where it was identified that he had terminal lung cancer that had spread to his liver and bones. Mrs C said that her husband had been suffering agonising pain in his leg over a few months and had been frequently attending his medical practice.

After taking independent advice from one of our medical advisers, we did not uphold Mrs C's complaint. Her husband had presented at the emergency department with pleuritic chest pain (pain associated with the lungs). Our investigation found that the hospital carried out appropriate assessments and investigations at this time. In addition, a chest x-ray and blood tests had given no indication of pneumonia or malignancy.

Summary

Mr A was an elderly man who was admitted by ambulance to a hospital accident and emergency department after complaining of chest pains. His son (Mr C) complained that the board failed to carry out appropriate investigation, diagnosis and management of Mr A's condition before deciding to discharge him from the hospital, and unreasonably failed to place Mr A in isolation. Mr C also complained that the board failed to provide an appropriate response to his complaint.

We did not uphold Mr C's complaints. After looking at Mr A's hospital records and taking independent advice from our medical and nursing advisers, our investigation found that the decision to discharge Mr A was reasonable and was taken after appropriate investigation, diagnosis and management were carried out. Mr A's chest pain was investigated through observation, an electrocardiogram (a test that records the electrical activity of the heart) and a blood test. Mr A had taken aspirin before going to hospital, and so we found it was reasonable that other medicines were not administered. We also found that Mr A did not meet the criteria for isolation, in that he was not considered to have a diagnosis of infectious diarrhoea or diarrhoea associated with recent antibiotic use, or both. Nor was there any need to place Mr A in a single room and the decision not to initially place Mr A in one was reasonable. The board's response to Mr C's complaint was reasonable in light of the medical and nursing care provided and Mr A's hospital records, and we concluded that it addressed all the issues Mr C raised.

Summary

Mr C attended the hospital's accident and emergency department (A&E) during the night, as he was concerned that he might be experiencing a repeat of a chest condition he had had some years previously. After discussion with a nurse, he was shown to a phone and advised to speak to the person at the other end, who turned out to be from the out-of-hours GP service, NHS 24. NHS 24 advised him to return home, and that they would phone him within an hour to assess his condition. Mr C felt that his situation had not been taken seriously and he left. NHS 24 phoned him three times at home, but Mr C felt too distressed to answer their calls. In the morning, he saw his GP, who diagnosed a chest infection.

We explained to Mr C that it is NHS policy that someone should only attend A&E if they have an emergency and that, if they need to see a GP outside their practice's opening hours, they should phone NHS 24. NHS 24 then assess, by phone, whether the patient needs to see a GP and, if so, whether they should travel to the out-of-hours GP, or whether the out-of-hours GP should visit them at home. The papers we received from the board showed that, when Mr C arrived at A&E, the nurse considered whether he did need emergency care and spoke to a doctor, who decided that this was a matter for NHS 24, rather than A&E.

We did not uphold the complaint because the hospital appropriately established that Mr C needed to contact NHS 24, rather than themselves, then helped him contact them. We also noted that the board said that, because of Mr C's complaint, if someone arrived at A&E but needed to contact NHS 24, staff now made the phone call themselves, giving NHS 24 the relevant details. NHS 24 would then phone the patient back. They believed this would improve their service for patients, and we welcomed the board's use of a complaint as an opportunity for learning and improvement.

Summary

Mr C complained that there was an inadequate number of toilet facilities on his ward.

Our investigation found that patients spend only a limited time on the ward. In essence, the ward is used for little more than eating meals and making phone calls. Patients spend most of their waking time in other areas, which have ample toilet facilities. Sleeping areas are separate, and have en-suite toilet facilities. We also established that Mr C was able to move between areas to a reasonable extent. We considered this reasonable and we did not uphold the complaint.

Summary

Mrs C complained that when her husband (Mr C) was airlifted to hospital after a heart attack, there was unreasonable delay in transferring him from the air transport into the hospital and in assessing his condition.

We upheld both Mrs C's complaints. Our investigation found that there was no ambulance available to transfer Mr C into the hospital. The health board and Scottish Ambulance Service were in the process of finalising a protocol under which patients could be transferred on a trolley in such circumstances. However, when Mr C was taken ill the protocol had not been finally agreed or adopted although the equipment required - such as a trolley and protective clothing and equipment - was available.

Our investigation identified that responsibility for a patient remains with the service until the patient is received in hospital. The ambulance staff involved in transporting Mr C were paramedics and provided evidence that they had offered to take clinical responsibility for transferring Mr C on a trolley. However, this offer was declined by a nurse from the hospital who was also there. It was about 40 minutes before an ambulance was available to transfer Mr C. In view of the offer made by the paramedics, we considered that it was unreasonable for Mr C to have had to wait this long.

With regard to the assessment of Mr C's condition, our independent adviser noted that she would not necessarily expect to find notes of an assessment made while a patient was the responsibility of another body. However, although we noted that responsibility remained with the service until Mr C was received at the hospital, the board had in fact indicated in their response that the nurse had assessed Mr C's condition. We found no evidence, however, that any such assessment was made.

Recommendations

We recommended that the hospital:

• apologise for the distress caused by the failings identifed; and
• ensure that all staff are aware of the amended policy for manual transfer of patients when ambulances are not available, in order to expedite transfer, assessment and treatment of patients.

Summary

Mr C is unable to cut his own toenails, and complained that the board failed to provide him with an appropriate regular service for this. He explained that delays in having his toenails cut impacted on his mobility and caused him discomfort.

Our independent medical adviser noted that it was reasonable that times between appointments may be affected by staff resource and demand. As Mr C’s complaint was very similar to one that he had made before and the board had already explained the appointment system to him at that time, we did not uphold his complaint.

Summary

Mr C complained that, when he attended a hospital clinic appointment, the doctor carried out a procedure without Mr C's consent. He said that he told the doctor that he could look at the problem only, but not take any action. He said that the doctor ignored his wishes.

When we investigated this, the board explained that the doctor and the health care assistant who were present were of the opinion that Mr C had agreed to the procedure. We found, however, that the doctor had not strictly adhered to the board's informed consent policy and had not explained what the procedure entailed, or recorded that Mr C had agreed to the procedure. We upheld Mr C's complaint and made a recommendation about this.

Recommendations

We recommended that the board:

• apologise to Mr C for the failure to obtain his informed consent.

Summary

Mrs C had concerns that in 2011 the board had sent us a complaints file which was incomplete and contained inaccurate information about previous complaints that she had raised. We had asked for this file when looking at a previous complaint from Mrs C. (We had decided that complaint was too old for us to look at, so the information from the complaint file did not, therefore, affect that decision.) Mrs C formally complained to the board about the file and, when she received their response, she felt her concerns had not been addressed.

Our investigation found that the board had taken Mrs C's concerns seriously and had conducted a thorough investigation. They provided a comprehensive response about the contacts that Mrs C had made with their complaints team as far back as 2007. They also explained the difference between enquiries, informal complaints and formal complaints, and how they deal with these. We, therefore, did not uphold Mrs C's complaint. However, we found that Mrs C had raised a couple of concerns that would have benefitted from a more detailed response and made a recommendation about this.

Recommendations

We recommended that the board:

• address specific issues raised by Mrs C in her formal complaint.

Summary

Ms C complained that doctors at the practice failed to manage her medication regime appropriately. Ms C was suffering from bi-polar disorder (a condition that affects a person's mood). She was prescribed medication, including lithium (a medicine used to treat mood disorders) and quetiapine (a drug used to treat bi-polar disorder). Her lithium levels were monitored every three months at a special clinic as lithium may interact with other drugs and can cause toxicity (a poisonous effect on the body). She was also monitored by a community psychiatric nurse (CPN) and a consultant psychiatrist every four to six weeks.

On one occasion Ms C went to the practice as she felt she was suffering from toxicity. She saw a locum GP (a doctor in a temporary position at the practice), who did not think that she was but asked her to speak to her CPN to organise a blood test. The CPN told her to go back to the practice, and another doctor did the blood test. The results showed that she was not suffering from toxicity.

After investigating, we did not uphold Ms C's complaint. We took advice from as independent medical adviser, who said that the evidence in the clinical notes showed that it was unlikely Ms C was suffering from toxicity when she saw the locum GP. Although the adviser was concerned that the locum GP asked Ms C to arrange her own blood tests, she considered this to be a misunderstanding about the resources available. In light of this, although we did not uphold Ms C's complaints, we drew to the practice's attention that the adviser had suggested they might wish to consider placing an alert on the notes of patients prescribed lithium, with information on how to obtain urgent blood tests where there is a suspicion of possible lithium toxicity.

Ms C also complained that the practice would not prescribe her extra quetiapine. She was under the impression that her psychiatrist had increased the dose. Having looked at Ms C's clinical notes and the communication between the psychiatrist and practice, the adviser confirmed that the psychiatrist had not further increased the dosage. Ms C also had helicobacter pylori (h-pylori - a bacterium found in the stomach) and complained that the practice had not adequately treated it. The adviser confirmed that the dose and duration of treatment for h-pylori was appropriate.

Summary

Miss C raised a concern about the treatment she received from a hospital dermatology department (a department dealing with skin conditions and problems). In particular, she said that there was an unreasonable delay in diagnosing her condition and in progressing treatment.

After taking independent advice from one of our medical advisers, a senior consultant dermatologist, we did not uphold her complaint about diagnosis. We recognised that this was a difficult and stressful time for Miss C, but we found no evidence that the treatment was not of a reasonable standard in the face of what had been an unusual problem. We did, however, uphold her complaint that there was a delay in progressing treatment. Before we investigated, the board had accepted that Miss C's referral to the plastic surgery team had, in error, not been marked as urgent. As a result, it had been treated as a routine referral and this had resulted in a delay before Miss C was seen by the team. As, however, the board had already recognised this and apologised to Miss C, we did not make a recommendation about this.