Health

Summary

Mrs C complained to the board about the treatment she received from a hospital doctor. Mrs C's GP had referred her there because Mrs C was suffering from urinary incontinence. The hospital doctor had conducted tests then referred her to neurology and a bladder specialist. Mrs C said the doctor failed to ask about her vaginal discharge and failed to carry out a pelvic ultrasound scan. Mrs C was subsequently diagnosed with a tumour in her womb. She believed that, had this been found sooner, then the cancer would not have spread to other organs.

We took advice from our medical adviser who noted that he saw no indication that a pelvic ultrasound scan was required given Mrs C's presented symptoms. Mrs C was assessed by three different clinicians with expertise in different areas. All the correspondence and medical notes suggest that Mrs C's symptoms were of incontinence rather than of vaginal discharge. When the symptoms did not ease, Mrs C was appropriately referred for further investigation. We noted that there was a delay in the process for arranging a hysteroscopy (a procedure that allows a surgeon to look inside the womb using a narrow tube-like telescopic camera) and the board apologised to Mrs C and explained the action that they had been taken to prevent a repeat occurrence before she complained to us. Although, therefore, we understood why Mrs C was concerned that a chance to diagnose the cancer may have been missed, we took the view that the care she received was appropriate in the circumstances.

Summary

Mrs C, an advocacy worker, complained on behalf of Miss A, who had injured her knee in a skiing accident. Miss A was referred by the board to a hospital outwith their area. However, the board for her own area also provided some treatment and investigated and responded to Mrs C's formal complaint. Mrs C complained that the board provided inadequate explanations in response to her complaints and that the board's handling of the complaint was poor.

We were satisfied that, whilst the board's investigation of the complaint was delayed, updates were sent in line with their complaints procedure. That said, we found that the board's initial response to the complaint contained a number of inaccuracies, particularly in relation to some of the dates of events and their description of the operation that Miss A underwent. We noted, however, that the board had accepted this and apologised to Mrs C and Miss A so we made no recommendations.

Summary

Mrs C complained on behalf of her mother (Mrs A) about the care and treatment Mrs A received from her dentist. Mrs A attended the dentist in pain after a filling fell out. The dentist took an x-ray and removed a nerve. He made an appointment for a couple of weeks later to extract some teeth. Unfortunately, the pain did not get any better and Mrs A had to go back a further three times for treatment. However, before the date on which the extractions were scheduled, she was admitted to hospital, where it was found that her windpipe was obstructed by a large abscess. Mrs A had emergency surgery, and needed a tracheotomy (an operation to insert a tube into the windpipe) to assist with her breathing.

Mrs C complained that the dentist did not treat her mother appropriately and that had he done so she would not have deteriorated to such an extent. After taking advice from two of our dental advisers, however, our investigation found that the dentist's decisions about prescribing antibiotics to Mrs A were reasonable, as was the care and treatment provided.

Summary

Mrs C had a complex medical history including pelvic, back and shoulder pain, arthritis, kidney problems, ovarian cysts, endometriosis, hypertension, depression and gastric problems. Over the course of 2009 to 2012 she attended her medical practice for pain management and treatment of these and other illnesses. GPs referred her to a number of specialists for treatment and exploratory tests, including consultants in neurology, neurosurgery, pain management and gynaecology. GPs also prescribed Mrs C with various drugs to treat her pain symptoms, including a number of different types of opioid analgesics (pain relief that acts on the central nervous system), but with limited success.

In July 2011, Mrs C became very unwell with dizziness and weakness and was confined to bed. A GP diagnosed severe postural hypotension (a drop in blood pressure than can cause dizziness), which they considered was likely to be drug-induced with inactivity contributing to it. They advised Mrs C to reduce her intake of opioid medications. During a hospital admission, specialists noted that Mrs C had a decreased level of a particular hormone and carried out extensive tests. These established that she was suffering from drug induced suppression of another hormone. Mrs C complained to us that between 2010 and 2012 the practice did not provide her with appropriate care and treatment.

As part of our investigation, we obtained independent advice from our medical adviser, who said that this is a recognised, but rare side-effect of long-term opioid analgesic use. However, he advised that the treatment that the practice prescribed for Mrs C was appropriate, and was taken with the appropriate secondary care advice, and that the referrals made were reasonable. We, therefore, did not uphold this complaint.

Summary

Mr C, who is a prisoner, complained to the board about the medication decisions taken by his prison health centre. Mr C was not satisfied with their reply, which he felt had not addressed his concerns, and so he sent them a follow-up letter. However, the board sent it back to the health centre, unanswered, and the health centre gave it to him, with a note that advised him to follow the correct complaints process.

Mr C contacted us for help in getting a reply to his follow-up letter as he thought he had been following the process and did not know what to do.

Although initial complaints to health boards should go through the health centre, it is our view that follow-up letters may go direct to a board. If a board wish to ensure that the health centre knows what is happening, the board may tell the health centre about it themselves. But we take the view that it is not for a complainant to have to try to navigate a complaints system this way. We, therefore, sent Mr C's follow-up letter back to the board and asked them to reply to Mr C.

We told Mr C that we had closed his complaint while he and the board were dealing with it but that he could come back to this office after that if he thought the complaint should be investigated further.

Summary

Mrs C, complained to us about the care and treatment of her late mother (Mrs A) who had a complex medical history, including bowel cancer. After falling, Mrs A was admitted to a hospital high dependency unit. She was given a blood transfusion and antibiotics for a urinary tract infection. As doctors thought Mrs A had suffered a stroke she was moved to the stroke ward at 03:30.

Shortly after admission to the stroke ward, Mrs A stopped eating, experienced constipation and complained to her daughter of knee pain. Six days after she was moved there, her condition deteriorated rapidly and Mrs C’s husband telephoned Mrs C saying that the hospital had called to say that Mrs A had taken a bad turn and Mrs C should go to the hospital. Mrs A passed away shortly afterwards. The death certificate noted Mrs A’s cause of death as toxins and a perforated bowel.

Mrs C complained about these events, saying that staff should have dealt with Mrs A’s problems sooner and that her mother was transferred from one ward to another at an inappropriate time. She also said that she suspected that the suppositories or other medical interventions might have caused her mother’s deterioration and death, and was unhappy about the attitude of nursing staff. She said that they showed unprofessional attitudes to her and her mother and failed to properly contact her on the morning of Mrs A’s death.

The board’s reply to Mrs C’s complaint recognised that there were some problems with communication between nurses and Mrs A’s family. They also recognised that the early morning transfer between the high dependency unit and the stroke ward was inappropriate as there was no clinical need for it to be done at this time. They agreed that staff should have known to contact Mrs C directly on the morning of her mother’s death. They apologised and ensured that the relevant managers were made aware of the issues.

We did not uphold Mrs C's complaints. After reviewing the board’s file and Mrs A's medical records, and taking independent advice from our medical and nursing advisers, we found that the general quality of care provided was reasonable. We also considered that the board had taken reasonable steps to resolve the issues about communication, transfer and contact. We considered that the medication provided to Mrs A during her stay was appropriate and could not reasonably be linked to Mrs A’s death. We found no evidence of unprofessional behaviour by nursing staff towards Mrs C or her family.

Summary

Mr C complained that the board failed to provide him with reasonable care and treatment for his mental health problems. He detailed a number of areas about which he was concerned, and he was also unhappy about the way in which the board handled his complaint. He said that the consultant concerned had lied in his response.

During our investigation, we took independent advice from our medical adviser who is a consultant psychiatrist. We found that that the frequency of the board’s contact with Mr C was reasonable. We also found that the frequent use of hospital admissions and the fact that a large team were involved in his assessment and treatment were examples of good clinical practice. Although some of the clinics that Mr C was to attend were cancelled, we did not consider that this was excessive. We also found that it was reasonable to arrange clinics in locations that would benefit the greatest number of patients. However, we found that Mr C had been prescribed with large doses of medication that were not appropriate for the disorder he had been diagnosed with. This led to him being over-sedated. For this reason, we upheld his complaint about care and treatment, although we noted that the board had since carried out a review of his medication. We did not uphold the complaint about complaints handling, as we found that the board’s response was reasonable and we did not consider that the consultant had lied.

Recommendations

We recommended that the board:

• issue a written apology for their failings in relation to prescribing medication, which led to Mr C's over-sedation.

Summary

Mr C complained that the medical practice had acted unreasonably in refusing him a repeat prescription for an inhaler. He had made a repeat prescription request, but this was refused and he was told to attend an asthma review clinic two weeks later. He was unhappy that he had not been given his medication at the time he needed it, which he felt was a risk to his health.

The practice's response to Mr C indicated that before he made the prescription request he had been sent four letters inviting him to attend the asthma clinic but he had not gone. The prescription record also showed that Mr C was not using his inhaler regularly. They had, therefore, felt unable to issue the prescription until he had complied with their requests for an asthma review. They said they had a clinical, ethical and legal responsibility to review his medication and clinical condition before issuing a prescription. They offered him the opportunity to have the review undertaken in a manner and at a time which suited him, and to refer him to a respiratory specialist.

We took advice from our medical adviser, who considered Mr C's medical records. He said that treatment cannot be given without reasonable and correct supervision, and that the practice had given Mr C various opportunities to attend for the review. Given the pattern of inhaler use, he also considered that such a review would be good clinical practice. We concluded that the practice did not act unreasonably, and did not uphold the complaint.

Summary

Ms C's mother (Mrs A) was admitted to hospital with community-acquired pneumonia. During her stay, Mrs A also complained of constipation, nausea and vomiting. On the final day of her admission, Mrs A’s condition worsened considerably. She was transferred to the hospital’s medical high care area and, within hours, to the highest level of care within the intensive care unit, where she died.

Ms C considered that the care provided to her mother was inadequate. In particular, she felt that staff failed to properly address Mrs A’s constipation and that nursing staff acted rudely and unprofessionally towards Ms C and her family. Ms C also considered that medical staff failed to act quickly enough to transfer Mrs A to medical high care and felt that, if Mrs A had been transferred earlier, she might not have died.

We did not uphold Ms C's complaints. After obtaining independent advice from our nursing adviser, we decided that the nursing care provided to Mrs A was reasonable, that nursing staff acted appropriately to the reports of constipation and that recorded communication with Ms C and her family was reasonable. As there was no corroboration of events, we were unable to come to an accurate conclusion about the manners of particular nursing staff. We also obtained independent advice from our medical adviser, and found that medical staff took appropriate action to monitor Mrs A’s condition and investigated and addressed her medical problems reasonably. We found that the timing of Mrs A’s transfer to medical high care was reasonable and saw no evidence to suggest that staff should have taken the decision to transfer her earlier.

Summary

The hospital introduced a new clinical model in September 2011, setting up new hub and cluster units. Each of the four hubs supports a cluster of three

12-bedded wards, with various therapeutic, physical, creative and social activities taking place in the hub. There is also a central unit where more formal therapies and educational activies are held.

Mr C, who is a patient in the hospital, complained that when the new model was introduced he was unreasonably pressurised to attend activities in the hub area even though he did not like it there. He described it as little more than a corridor, and found it cold and uncomfortable. The board acknowledged that there were teething problems in the early days of the new model while both staff and patients got used to the new regime. This sometimes meant that wards were closed, or patients relocated to other wards, to allow staff to be suitably deployed while ensuring patient and staff safety.

Our investigation found that since Mr C made his original complaint to the board - which they upheld - matters had improved. The board had addressed staff recruitment and training issues and reviewed some policies to allow a more flexible use of resources. This had allowed them to keep more wards open while still staffing the hubs, and they confirmed that in the last few months Mr C's ward had not been relocated. Mr C said that he considered that this had only happened because he had complained. However, we explained that the purpose of the complaints system is for issues to be raised and addressed and for solutions to be found.

We did not uphold Mr C's complaint. Although work is still on-going to fully implement the new clinical model, the independent advice received from our adviser was that good and positive progress had been made. We found no evidence that Mr C had been forced or unreasonably pressurised to attend the hub. Our adviser said that staff often have to find a balance between encouraging patients to engage with therapies and activities and making them feel pressurised. However, our adviser said that staff would be failing in their duty of care if they did not try to encourage patients to engage with treatment programmes.