Health

Summary

Mr C pursued a complaint on behalf of his late mother (Mrs A), who passed away from terminal cancer soon after bringing her complaint to us. Mrs A’s complaint letter to the board said that they had not provided her with regular checks when she had heart problems diagnosed. She said that in her view, this contributed to her cancer remaining undiagnosed until it became terminal.

We took advice on the complaint from one of our medical advisers, a consultant in acute medicine, with specialist experience in heart disease in older people. Our investigation found no evidence of any failure to carry out appropriate or regular checks for Mrs A’s heart problems relative to the recorded symptoms she displayed at any given time.

Summary

After Mrs A had a knee replacement operation she was discharged home into the care of the district nursing service (district nurses visit and treat patients at home). Her daughter (Mrs C) complained about the care Mrs A then received - in particular, that two clips were not removed. Mrs C said that this caused her mother to suffer an infection, and that this was not properly treated in that on one occasion, dressings were not available. She also said that Mrs A was not provided with antibiotics quickly enough. Mrs C considered that her mother suffered unnecessarily because of this, and lost mobility and independence.

We investigated the complaint and took advice from our nursing adviser. We found that, contrary to what Mrs C thought, wound clips are not normally counted as they are put in and taken out, and are generally obvious. Although two clips were left in Mrs A's knee for a short time, the adviser could not conclude that this led to the infection. However, the adviser also said that the notes taken at visits were not of good quality and that not all actions taken were noted. Nevertheless, the records suggested that there was no delay in giving Mrs A appropriate antibiotics. Although it was regrettable that Mrs A contacted an infection, we could not determine with certainty that this was as a result of a lack of care. We did, however, uphold Mrs C's complaint that on one occasion the wound was not dressed.

Recommendations

We recommended that the board:

• emphasise to all district nursing staff the importance of adhering to the Nursing and Midwifery Council 2009 Guidelines 'Record keeping

Summary

Mr C complained on behalf of his brother (Mr A), an adult with a mental health condition. Mr A had permission to leave the mental health unit where he lived to visit his own home for a few days. However, at the end of that time, no one came to collect and return him to the unit. As he did not return, the unit told his family and the police. The police found Mr A at his home and damaged his door to gain entry. They removed him from his home and took him back to the unit. Mr C complained about the trauma that the whole incident would have caused his brother.

When Mr C complained to the board, they acknowledged immediately that there had been a communication breakdown regarding the arrangements for collecting Mr A at the end of his home visit. They described the steps they were taking to help prevent the same thing from happening again.

Mr C remained dissatisfied and complained to us. As the board had acknowledged a shortcoming, we upheld the complaint. We considered that the action the board had taken in response to the event was good but did not go quite far enough as it would not necessarily prevent a recurrence.

Recommendations

We recommended that the board:

• put in place a written policy or guideline for staff, in relation to patients who are using a pass, for example for a home visit.

Summary
Mr C went to a hospital accident and emergency unit after falling from height. He complained that the care and treatment he received there was inadequate. He said that there was a failure to x-ray and diagnose a fracture that caused him severe pain in the weeks after. Mr C said he was eventually x-rayed about two weeks after the fall and told about the fracture five days after that. He wanted to know why he was not x-rayed when he first went to hospital, considering the accident he had and the pain he was in. He also said that when he complained to the hospital about his care and treatment, they delayed in responding to his concerns.

We did not uphold Mr C's complaints. We took advice from our medical adviser, who said that the need for an x-ray was a matter of clinical judgement. He said that the assessing clinician should (and did) take into account Mr C's age and gender, how the injury happened, look for various external evidence of injury, as well as evidence of nerve or spinal damage, and assess Mr C's mobility. He commented that a spinal fracture from low impact injury is unusual in men of Mr C's age, and that an x-ray was not mandatory in his situation. He said that the judgement of the assessing clinician that an x-ray was not necessary was not unreasonable, even with the benefit of hindsight.

We also found that there were valid reasons for the delays in the board responding to Mr C's complaint. This included that a consultant whom Mr C wished to meet to discuss his concerns was abroad for several months. When the board told Mr C about this, he said he wished to wait for the consultant to return. We also noted that the board kept Mr C regularly updated about his complaint during this period and gave him the opportunity to contact us if he so wished.

Summary
Mr C complained on behalf of his wife (Mrs C) about delay in getting a hospital appointment, treatment at the pain clinic, and poor complaints handling. Mrs C had had pain in her back and leg for ten months and pain in her neck and arm for eight months, and Mr C thought she should have been seen at the hospital more urgently. Her GP referred her to the neurosurgery department in July 2011, and followed this up with a further referral two months later, including a request that she should have a scan on her neck before attending her scheduled appointment. No scan was taken, however, even though Mr C also wrote to the board. Mrs C was seen in neurosurgery as scheduled in November and was referred to the pain clinic, where she was eventually seen in December. Mr C complained that although the GP made an urgent request for Mrs C to be seen at the pain clinic, because the referral from the department of neurosurgery was classed as routine she was not prioritised.

We did not uphold the complaints about delay and treatment. Our investigation, which included taking advice from our medical adviser, found that it was reasonable for the GP to refer Mrs C on a routine basis as she had no 'red flag' symptoms that would have triggered an urgent referral. Mrs C was seen by a specialist within 17 weeks. This was just within the national target of 18 weeks and there was no evidence of avoidable delay. The reclassification of the referral to the pain clinic was also reasonable. Our adviser said that although Mrs C had been in pain for some time, she was not displaying the sort of symptoms that would have needed an urgent referral. It is also the responsibility of hospital specialists to fully assess and categorise referrals. In Mrs C's case, this was done appropriately by the on-call pain consultant.

We found, however, that there were unreasonable delays in providing a response to Mr C's complaint. The board did not respond for two months and provided no acknowledgement, explanation or apology for this. We found that the delay was partly due to the board calculating response times wrongly - not from the original date Mr C complained, but from the date of a later email that he had sent. We upheld the complaint and made a recommendation about this.

Recommendations
We recommended that the board:

• apologise to Mr C for the complaints handling failings we identified.

Summary

Mr C had a history of alcohol dependency. He stopped drinking in May 2010. His medical practice prescribed medication, including Thiamine B (a specific type of vitamin B). In 2008, Mr C had experienced ice-cold feet, severe pain and loss of sensation in his legs. In 2009, he was diagnosed with peripheral neuropathy (damage to the nerves that connect the central nervous system to the limbs) and in May 2010 he began to have seizures and tremors.

Mr C stopped taking the prescribed Thiamine B in August 2011 and found that his pain, muscular problems and seizures stopped. He complained to the practice about the use of Thiamine B and the fact that this was not reviewed following his deterioration in 2008. They told him that there are no side effects associated with this medication. However, Mr C conducted his own research and found that an allergic reaction to the medication could cause the symptoms he experienced. He also believed that his other medication had a detrimental impact on his health. He complained to us that the practice failed to reassess his medication when his symptoms developed and failed to identify that Thiamine B was causing his neurological problems. He also complained that the practice failed to refer him for a specialist opinion.

We took advice from one of our medical advisers and found that all the medication complained about was appropriate for a patient with Mr C's symptoms and history of alcohol dependency. Thiamine B in particular has a protective role in limiting damage to the nervous system should the patient continue to consume alcohol. We accepted that patients may react in unpredictable ways to any medication and recognised the symptoms that can be caused by a reaction to Thiamine B. However, we found no link between this medication and neurological problems as described by Mr C. We were satisfied that the practice held regular discussions with Mr C about his medication during a number of consultations. We were also satisfied that the practice arranged suitable tests and made appropriate referrals for investigation into the cause of Mr C's symptoms by specialist consultants.

Summary
Mrs C had surgery in hospital to remove a soft tissue lump from her right thigh. She said that a few days later the wound had become red and infected. She contacted NHS 24 who referred her to an out-of-hours (OOH) GP service where a nurse prescribed antibiotics. Mrs C returned home, but her condition worsened and later that day NHS 24 arranged for an ambulance to transfer her to hospital where she was diagnosed with a skin infection and an infection of the thigh wound. Mrs C had a further surgical excision and drainage, and the wound was left open to heal from the inside. She received antibiotics intravenously (directly into a vein) and was discharged on oral antibiotics.

Mrs C complained that the hospital failed to prescribe her with antibiotics after the initial surgery, which she believed might have prevented the infection she later contracted. She also said that the OOH service failed to take her seriously and recognise the seriousness of her condition. Mrs C said that as a result of the failure to provide antibiotics and the failures in the care and treatment she received from the OOH service, she has struggled to recover from her operation and continues to have difficulty in walking.

After taking advice from our medical adviser, we found that the hospital's decision not to prescribe Mrs C antibiotics after her initial surgery was reasonable. However, we also found that the OOH nurse failed to recognise the significance of Mrs C's symptoms and admit her to hospital, although our medical adviser said that this would not have affected the outcome.

Recommendations
We recommended that the board:

• have the relevant staff review the management of this case in light of the findings; and
• apologise to Mrs C. 

Summary
Mr C complained that a GP failed to provide him with appropriate treatment for his throat condition during a home visit. He said that he went to see another GP the next day, who referred him to hospital, where he received treatment for an abscess on his tonsil.

We took advice from our medical adviser. He commented that this type of abscess can develop quickly. He said that, given the GP's account that the appearance of Mr C's throat had changed, the management of Mr C's sore throat had been reasonable.

Mr C also complained that the GPs had misdiagnosed his rhinitis (inflammation of the lining of the nose) as sinusitis (inflammation of the sinuses) for a number of years. We found that Mr C had been diagnosed with sinusitis at a hospital. Our medical adviser considered that the actions of the GPs in relation to this matter were reasonable. He said that sinusitis and rhinitis can coexist and can be treated in the same way. He also noted that there had been little change in Mr C's management after the diagnosis of rhinitis.

Mr C also complained about the actions of a receptionist and the practice manager when he visited the medical practice. We found that the actions of the members of staff had been reasonable.

Summary
Ms C complained that she had to wait an unreasonably long time for appointments for problems with her hip, and that after that she had to wait an unreasonably long time for surgery. She complained that this breached the government's 'referral to treatment' target. She also complained that the board failed to provide a response to her complaints.

After taking advice from our medical adviser, we did not uphold Ms C's complaints about waiting time. We found that, overall, her clinical treatment was reasonable. She was first seen by an orthopaedic consultant after a referral from her GP, and was then referred to and seen by a physiotherapist, all within the governmental target. We accepted the board's position that this was when Ms C's treatment started. We found that the decision to refer Ms C for physiotherapy was appropriate, and that she needed to go through this programme before surgery could be considered. Therefore, we did not consider that her wait for surgery was unreasonable. When it was established that physiotherapy had not been successful, the orthopaedic consultant referred Ms C for a scan. The results of the scan indicated that hip surgery was appropriate. At that time, the board had withdrawn funding for this procedure, so Ms C was referred to another board area. She subsequently underwent surgery privately.

Although we acknowledged Ms C's frustration, both about waiting time and the withdrawal of funding, we found that her treatment was appropriate. We did find there was an unreasonable delay in Ms C receiving a full response to her complaint, and were critical of the board about this.

Summary

Mr C told us that when his wife (Mrs C) became very unwell, he rang NHS 24. He explained her symptoms and told the operator that Mrs C had just completed in vitro fertilisation (IVF) treatment. He said that an hour passed and there was no return call from NHS 24, so he rang again and was told someone would call soon. Another hour passed and Mr C phoned again. He said he was again told someone would call soon. Another 30 minutes passed and having still had no contact from NHS 24 Mr C phoned again, but again they did not offer help.

Mr C said he then took his wife to a hospital accident and emergency unit. He said that they received a call-back from NHS 24, but this was three hours after his original telephone call. Mr and Mrs C were upset that it took so long for NHS 24 to return his calls for assistance.

Before we could look into Mr C's complaint, we needed more information from him. As we did not receive the requested complaints information, we were unable to reach a decision on his complaint.