Health

Summary

C brought a complaint about the care and treatment that their late spouse (A) received during three admissions to Aberdeen Royal Infirmary. C was concerned that A did not receive appropriate treatment and was discharged on each occasion. A was initially admitted following a heart attack, and died a few months later due to heart failure.

We took independent advice from a consultant cardiologist (medical specialist dealing with disorders of the heart). We found that the care and treatment A received during two of these admissions was reasonable, including the decision to discharge A. However, during one admission the board acknowledged that there was a missed opportunity to provide cardiology input and seek an in-patient echocardiogram (a heart scan that uses sound waves to create images).

We found that it was unreasonable that no input was sought from the cardiology department during this particular admission and that an opportunity was lost to make the correct diagnosis and to optimise possible treatment options. We upheld the complaint but also noted that it was not possible to say definitively whether this would have changed A's survival prospects.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for not seeking input from the cardiology department during A's admission. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Input should be sought from the cardiology department where a patient has reduced cardiac function following a recent history of heart attack.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their child (A) about the service received from the practice and the way in which their complaint was handled.

A commenced a course of treatment with the practice because due to a dental overjet (when the upper teeth protrude outward and sit over the bottom teeth), they qualified for NHS funding. A and C agreed to proceed with a functional appliance to correct the overjet. A wore the appliance some of the time, but they did not comply with the treatment in full. A was warned of the necessity to comply and given several reminders. A also missed an appointment.

C was sent a 'wish to continue' letter in which they were advised that they should get in touch within four weeks or A would be discharged back to the dentist. C contacted the practice within this period of time to discuss other options for A. As C did not receive a response, they raised a complaint. During this period A was discharged back to the dentist.

We took independent advice from an orthodontist. We found that, although it is accepted that the clinical decision may not have been different, we considered there should have been a further clinical discussion before A was discharged. We upheld this aspect of C's complaint.

In relation to the complaint handling, we upheld this complaint on the basis that there was a delay in responding to C's concerns in full and C was not signposted to this office.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A and C for failing to have a clinical discussion with them, prior to discharging A, for a delay in responding to the complaint, for failing to provide a clinical explanation why A was discharged when C was trying to engage in discussions regarding A's future treatment and failing to signpost to this office. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• The practice should engage in clinical discussion before discharging the patient, when a patient or their representative asks to discuss clinical treatment within the timeframe set by the practice.

In relation to complaints handling, we recommended:

• To ensure a full explanation is provided to a complaint, with input from clinical staff, within a reasonable time, and that a complainant is signposted to this office.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained about the treatment which their partner (A) received when they attended their GP practice with confusion and could not walk unaided. A could not provide a urine sample and was given a prescription for antibiotics. A collapsed in the car park following the consultation and was taken to hospital. C believed that the GP should have arranged a hospital admission for A. The practice felt that appropriate clinical treatment had been offered.

We took independent clinical advice from a professional adviser. We found that the GP had carried out an appropriate assessment of A and had diagnosed A as having an infection and therefore prescribed alternative antibiotics with advice to seek further medical advice should their condition deteriorate. It could not have reasonably been foreseen that A would collapse shortly after leaving the GP practice. We did not uphold the complaint.

Summary

C was referred to the Ear, Nose and Throat (ENT) department of board by their GP after suffering extreme sore throats and infections. A diagnosis of recurrent tonsillitis (swelling of tonsils located at the back of the throat due to infection) and possible reflux (the flow of a fluid through a vessel or valve in the body in a direction opposite to normal) or allergy was offered. C was prescribed Gaviscon and recommended allergy tests, which later showed allergies to dust mites. C was seen again in clinic later where their symptoms were reported to have resolved and C was discharged.

Some years later a pre-cancerous lump was found on C's breast. The results of a biopsy confirmed oesophageal (organ which connects the throat to the stomach) cancer, for which C received chemotherapy and an operation.

C believed that they should have been referred to a specialist following their referral to ENT previously and that the prescription of Gaviscon had been unreasonable. C complained to the board. The board responded with the conclusion of their investigation that, in the circumstances, the prescription of Gaviscon was reasonable and no further referral from ENT was indicated. C was dissatisfied and raised their complaint with us.

We took independent advice from a consultant. We found that the board's actions were reasonable in the circumstances, that there was no indication at that time that further investigation or referral was required and that the board did not unreasonably fail to diagnose or treat any condition. We did not uphold the complaint.

Summary

C complained about the care and treatment their late parent (A) received from board. A was admitted to A&E at Victoria Hospital following a fall at home. A was found to have fractured their femur and was subsequently transferred to a ward. A died shortly after transferring to the ward. No post-mortem was required by the Procurator Fiscal and a heart attack was recorded as the likely cause of death.

C said that they were told by the board's staff that tests carried out in the A&E did not indicate any problems with A's heart. As such, no additional monitoring was required when A transferred to the ward.

C complained that the board's staff failed to note and act upon a number of “red flag” symptoms that should have highlighted that A was at increased risk of a heart attack. C noted that A had been given a high dose of morphine by the ambulance crew. C complained that the board's staff failed to adequately monitor A's general condition or their reaction to the morphine.

We found that A's general condition was reasonably assessed in the A&E. An echocardiogram (a heart scan that uses sound waves to create images) was carried out and did not raise any concerns about A's heart. Whilst A displayed a number of symptoms that could have been linked to a heart problem, the tests carried out by hospital staff were thorough and gave no indication that there was a need for any specific additional heart monitoring when A transferred to the ward.

A was given a high dosage of morphine by the ambulance crew. We accepted medical advice that the hospital staff should have been aware of this and that they should have monitored A's response to this medication. We found no record of the morphine dosage having been recorded upon A's admission to hospital, or of specific monitoring taking place to check for any adverse reactions to the medication. A displayed symptoms that could have been caused by morphine. It was not possible to determine whether A's death was caused by a problem with their heart, or a reaction to the morphine. However, we were critical of the board's failure to record the morphine dosage and monitor A's reaction to it throughout their admission. We upheld the complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and their family for the failures identified. The apology should meet the standards set out in the SPSO guidelines on apology available atwww.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• That the board confirms to this office whether they assess patient care against the Scottish Standards for the Care of Hip Fracture patients and provides details of any learning and improvements resulting from C's complaint.
• That the board share a copy of this decision with the departments involved in A's care with a view to preventing similar issues in the future.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained that the board failed to investigate, diagnose and treat gastrointestinal (relating to the stomach and intestines) problems and swallowing difficulties that they had experienced over a number of years. As a result of previous abuse, C required invasive procedures to be carried out under general anaesthetic. C complained that the board placed unreasonable emphasis on their trauma when making decisions about their treatment.

We took independent clinical advice from a consultant in gastroenterology (medicine of the digestive system and its disorders) and hepatology (liver disease). We considered C's initial treatment plan to be reasonable: a CT scan of C's colon followed by an upper GI endoscopy (a medical procedure where a tube-like instrumentis put into the body to look inside) as recommended by the private clinic that they attended, and a colonoscopy (examination of the bowel with a camera on aflexible tube) if indicated by the results of the CT scan. We found that the decision not to carry out a colonoscopy at this stage was reasonable, given the risks of performing this under general anaesthetic and the previous normal investigations.

We were critical of the board's failure to offer C a flexible sigmoidoscopy (an imaging test done to monitor the colon and rectum for the presence of ulcers, polyps or other abnormalities) after they developed rectal bleeding, but noted that this did not impact on C's overall treatment plan. C had gone on to have a colonoscopy under a different NHS board, which did not identify any significant pathology.

We did not consider the emphasis placed on C's childhood trauma to be excessive and we noted that reasonable investigations were carried out into C's swallowing difficulties.

Therefore, we did not uphold this complaint.

With regard to C's complaint that the board's complaint response contained inaccurate information, we found that generally their response was thorough and detailed. With the exception of an incorrect reference to C having anaemia, we found that the board's response to be factually accurate with clear explanations as to what investigations had been carried out and why. We did not uphold the complaint.

Summary

C complained about the care and treatment of their late parent (A) in the weeks prior to their death in Queen Margaret Hospital. C raised concerns that staff failed to notice and act upon A's deteriorating condition, and particularly a dramatic deterioration on the day that A died. C noted that the post mortem identified evidence of a chest infection, and they complained that A died of an easily treatable condition. C raised concerns about the stoppage of A's diuretic medication (drugs that enable the body to get rid of excess fluids), which they considered contributed to a fluid build-up in A's lungs.

We obtained independent medical advice from a consultant geriatrician (a doctor specialising in medical care for the elderly), who noted from the records that the expected level of observations took place. We found that sufficient attention was paid to A's fluid build-up, and that the decision to stop their diuretic medication was reasonable in the circumstances. However, we noted that A's vomiting and unstable observations in the days prior to their death were not acted upon. We noted that this should have prompted further clinical review. While we could not be certain that this would have identified a chest infection or how unwell A was, we considered that this should have received more attention from medical staff. We found no evidence to support that any dramatic deterioration in A's condition was overlooked on the day A died. On balance, we upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to act on A's vomiting and abnormal observations in the last few days of their life. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

What we said should change to put things right in future:

• Abnormal clinical observations (such as low blood pressure and high heart rate) and vomiting should prompt timely clinical review / further assessment of the patient.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their late child (A) who died of cancer. A received treatment from the dermatology department for a mole on their back. The mole was removed and, following testing, it was found to be cancerous.

A had further treatment from the plastic surgery department to excise (remove by cutting) more tissue from the area, which was tested and confirmed no cancer cells were present. After, A presented with abnormal lymph nodes, tests confirmed that they were cancerous. A underwent a procedure to remove the lymph nodes and some painful lumps on their body. After this procedure, A refused any further treatment.

C complained that the board did not do enough in the early stages to treat A's cancer. C felt that the procedure to remove the initial mole should have been more thorough, that A should have been monitored more closely for any spread of cancer, and that other treatments should have been considered at an earlier date. C said that they were unhappy with the board's communication with A and their family and that they were unhappy with the way in which the board handled their complaint, as they felt it was not consistent with their recollection of events.

We sought independent advice from clinical advisers with relevant experience. Both advisers reached the view that the care and treatment provided to A by the dermatology and plastic surgery departments were reasonable both in the early stages, and when the cancer later returned. It was also their view that the board's communication with A and their family members was reasonable.

In light of the evidence and the advice received, we found that the care and treatment provided to A and the communication from the board to A and their family was reasonable. We also found that the board's response to C's complaint was in line with what was recorded in the medical records. Our investigation did not identify any evidence that would cause us to doubt the board's position as detailed in their response. Therefore, we considered that the board handled and responded to C's complaint reasonably.

For the reasons set out above, we did not uphold C's complaints.

Summary

C complained on behalf of their parent (A). A had dementia, lived in their own home and took a number of medications. C raised concerns that A was not able to take their medication safely without supervision.

We took independent advice from a GP. We found that the primary responsibility of the practice was to prescribe appropriate medication for A's condition. They also had a role in assessing A's mental state and making appropriate referrals to other specialists. In terms of those responsibilities, we found that there was no evidence of failure on the practice's part.

There was a problem with one of A's prescriptions when they changed pharmacy. The practice addressed this problem quickly and an appropriate apology was given. As such, we did not uphold the complaint.