Health

Summary

Ms C complained about the care and treatment of her late mother (Mrs A). In 2009, Mrs A received treatment for leg ulcers and various symptoms relating to her underlying vascular condition (condition of the blood vessels). She was admitted to hospital in July 2009 for emergency treatment, including an operation, and discharged in September. After-care services were provided by the board's rapid response team for 11 days after discharge. Mrs A continued to receive treatment in the community for her condition. She was readmitted to hospital that November where she remained until her death in January 2010.

Ms C said that the initial discharge arrangements were inadequate because the after-care services had not been planned in advance. She said that after-care services were essential given the nature of her mother's condition and the length of stay in hospital. She said that the board only arranged services from the rapid response team because she asked about this when she collected Mrs A from hospital. Ms C also complained that the after-care services were inadequate, saying that Mrs A did not receive assistance with personal care, cooking, feeding, medication, getting to the bathroom or physiotherapy.

We found, given the importance in involving family in the process, that the planning and implementation of Mrs A's discharge was deficient because Ms C had not been involved. In all other respects, it was reasonable. We concluded that overall, the board's planning was unreasonable due to the lack of involvement of Mrs A's daughter. However, we found that the records showed that the after-care was comprehensive, individualised and reasonable.

Recommendations

We recommended that the board:

• bring our letter to the attention of relevant staff to ensure lessons are learned; and
• apologise to Ms C for the failures identified.

Summary
Mr C complained to a medical practice about the care and treatment that his mother had received. The practice responded but did not address the matters he had raised. Mr C was dissatisfied with this and his wife raised the matter with us. During our consideration the practice wrote again to Mr C.

We decided that the practice did not reasonably provide him with all the information suggested by their complaints procedure, provided inaccurate information to him, requested unnecessary information from him, and did not advise him of the reasons for their delay in providing a full response. When read together, all the responses from the practice did reasonably address the matters he complained of, but as those responses did not reflect the practice's complaints procedure we upheld the complaint.

Recommendations
We recommended that the practice:
• apologise to Mr C that they did not respond reasonably to his complaint; and
• take steps to ensure that their implementation of their complaints handling procedure and their responses to complaints are in line with that procedure.

Summary
Miss C complained about the care and treatment provided to her late uncle (Mr A) by his medical practice. Her mother (who is Mr A's sister) had initially made the complaint, but Miss C eventually took it forward on her mother's behalf. Mr A had cancer and was undergoing chemotherapy in hospital.

Several days after he was discharged from hospital, he telephoned the practice asking for a prescription for antibiotics and a telephone consultation with his doctor. His doctor returned the call and issued a prescription for antibiotics.

A few days later, Mr A's sister became increasingly concerned about his condition and telephoned the practice requesting a home visit from a doctor. The practice advised her to contact emergency services. She was dissatisfied with the advice and phoned NHS 24, who arranged with the practice to send a doctor to visit him at home. The doctor arranged for an emergency ambulance to admit Mr A to hospital. Mr A died several weeks later.

Miss C complained that Mr A should have been seen by a doctor after her mother called the practice, and that the practice's response to the request for a home visit was unreasonable.

We upheld Miss C's complaints. We found that, given the seriousness of Mr A's illness, he should have had a face-to-face assessment rather than a telephone consultation. We could not establish what was said between Mr A's sister and the practice during the telephone call. However, we found that the problems of communication were compounded by a lack of specific instructions about the advice from the practice to contact emergency services. As a result, there was a delay in admitting Mr A to hospital and, while this may not have affected the outcome, it was clearly distressing to him and his family. We made recommendations in respect of both the doctor concerned and the practice.

Recommendations
We recommended that the practice:
• reflect on its management of this case particularly in light of the complications of chemotherapy;
• review its record-keeping for telephone consultations;
• apologise to Miss C for the failures identified; and
• review its procedures for house calls in light of this case.

Summary
Mr C was dissatisfied with the physiotherapy treatment he received from the board and complained to us about it. We did not, however, reach a decision on the issues involved in Mr C's case as he decided to withdraw his complaint.

Summary
Ms C complained about the Scottish Ambulance Service’s (the service) investigation into the circumstances where her late partner's wallet went missing when an ambulance attended to him following a serious accident.

We found that initially it was reasonable for the service to wait for the result of a police investigation into the missing wallet (which concluded that it had most likely been disposed of as clinical waste). However, after receiving the police report it was 40 days before the service wrote to Ms C with this information. This was despite Ms C telephoning during that period asking for updates. We, therefore, upheld her complaint and made recommendations to address these failures. The service also told us that they did not at that time have a lost property procedure but would develop one, so we made no recommendation in respect of this.

Recommendations
We recommended that the service:
• remind staff of their responsibilities to respond to complaints in a timely manner; and
• apologise to Mrs C for the delay in responding to her complaint.

Summary
Mrs C complained about the way an ambulance crew treated her mother (Mrs A) who had fainted and had been slipping in and out of consciousness. Mrs C said that the crew had shouted at her mother, handled her roughly and treated her as if she was drunk. Mrs C also complained about the time the Scottish Ambulance Service (the service) took to respond to her complaint.

We did not consider the specific complaint about the crew's manner as this was subject to the differing interpretations of those involved. Having taken advice from one of our medical advisers, we found that the crew carried out an appropriate assessment of Mrs A's clinical condition and that it was correct for them to decide to take her to hospital. We also found, however, that the board took too long to formally respond to the complaint.

Recommendations
We recommended that the service:
• remind staff who have a responsibility to investigate complaints about the timescales in the NHS complaints procedure; and
• apologise for the overall time taken to investigate the complaint.

Summary
Ms C complained about the treatment she received from a GP employed by the board. She visited the medical practice complaining of neck pain, muscle weakness and fatigue. Blood tests were taken and Ms C was told that she was fine. However, she was found to have low levels of vitamin D and was prescribed a calcium supplement. Ms C subsequently developed indigestion, heart palpitations, eyesight deterioration and shortness of temper. She complained to us that the GP was dismissive of her symptoms.

About six weeks after the first consultation, Ms C's condition deteriorated to the extent that she found it difficult to walk. She began taking medication that she sourced on the internet and adjusted her diet. This resulted in some improvement to her energy levels, but she deteriorated again. She went back to the GP, and it was discovered that her original blood tests had shown a vitamin B12 deficiency. Specialist investigations confirmed that this was the cause of her symptoms.

After taking advice from one of our medical advisers, we upheld most of Ms C’s complaints. We found that the board had used a number of locum (temporary) doctors throughout the period in question, which had led to a lack of continuity of care. We found that the medical practice's clinical records were unsystematic and lacked any clear management plan for Ms C. As such, an important diagnosis was missed by incoming staff. Although Ms C's B12 deficiency was overlooked we were, however, satisfied with the efforts that the GP then made to minimise the potential impact of this oversight and we did not make any recommendations about this.

Ms C had also complained about the system the medical practice had in place for requesting, tracking and reporting blood tests. While we concluded that the system in place at the time was not fit for purpose, we found that they have since introduced a procedure which is in line with good working practice. On her complaint about the board’s complaints handling, we found that many of the points Ms C raised went unanswered and we made recommendations to address this.

Recommendations
We recommended that the board:
• remind complaint handling staff of the importance of answering all points raised by the complainant; and
• take steps to ensure their complaint handling staff work in accordance with the NHS Scotland complaints procedure.

Summary
Ms C, an advice worker, complained about the care and treatment provided to Ms A. Ms A had a very complex medical and surgical history. This included a pancreatic and renal (pancreas and kidney) transplant in 2002, during which surgeons also removed Ms A's appendix. The operation note contained details of the procedures relating to the transplants, but did not refer to the removal of the appendix.

In July 2010, Ms A was admitted to hospital with abdominal pain. Following clinical examination, blood tests and a scan, clinicians provisionally diagnosed appendicitis. They operated on Ms A to remove her appendix, but surgeons could not find it. They were not aware that the appendix had been removed in 2002, and Ms A said that she had not been told about it at that time. Ms C complained that the board’s failure to tell Ms A about this or to properly record it in her medical records led to an unnecessary operation.

In August 2010, Ms A was transferred to another hospital and underwent further procedures. Shortly after one procedure, Ms A requested help from two nurses to go to the toilet. Only one nurse helped. Ms A was unable to manoeuvre and fell to the floor. She suffered a haematoma (an accumulation of blood) in her leg, which burst causing loss of blood. Ms A said this would not have happened if two nurses helped her as she requested. As a result of her fall, Ms A said that she had to undergo further surgery and suffered significant physical and mental distress.

We found that the board’s failure to record the removal of Ms A’s appendix in 2002 was unreasonable. This was compounded by the failure to tell Ms A or her GP that her appendix had been removed. Had the surgeons in 2010 known that Ms A’s appendix had been removed and thus ruled out acute appendicitis as a diagnosis, the intended appendix operation would have been prevented.

We also found that the board failed to explain the record-keeping omission when responding to Ms C's complaint.

On the issue of Ms A’s request for help from two nurses, we found that the board’s failure to listen to Ms A and provide more assistance was not reasonable and that her resulting fall had significant consequences for her. As, however, the board had already acknowledged that the nurse should have listened to Ms A, and apologised for this, we made no recommendation in respect of this complaint.

Recommendations
We recommended that the board:
• amend the transplant protocol to ensure it meets guidelines relating to communication with the patient and the patient’s GP; and
• ensure they investigate complaints fully and provide a comprehensive response to complainants.

Summary
Mr C underwent a hernia repair and had a testicle removed in January 2011. He later developed a painful swollen lump where his testicle had been. He attended a post-operative review with the consultant surgeon about six weeks after surgery and was advised this was a haematoma (an accumulation of blood) that would decrease over time. However, the lump became bigger and Mr C went to the hospital's accident and emergency unit a few weeks later, where the lump was drained.

In May 2011 Mr C’s GP made an urgent referral for him to be seen again at the hospital. The referral was considered, and re-graded as routine, and Mr C was given a general surgery appointment for August 2011. His GP, however, wrote to the hospital again, and a consultant identified that Mr C should be seen by the surgeon who had operated. He was given an appointment at that clinic for July 2011. Mr C said he would like further surgery to remove the haematoma, and was monitored in relation to this until he was given a date for surgery.

He complained that there was a delay in treating his ongoing difficulties. We found that, although Mr C was initially treated appropriately in his post-operative review, a failure to record full clinical findings after the haematoma was drained meant that a possible opportunity to refer him for a further clinic review had been missed. Although we accepted the board’s general position about the re-grading of referrals, we could not find evidence of why Mr C's initial referral was re-graded as routine. We also found that the board did not appear to operate a mechanism for identifying patients like Mr C who needed to be referred back to their operating surgeon. The board also acknowledged that there had been a delay from the point of referral until the offer of an appointment. In the circumstances we found this to be unreasonable, and upheld Mr C’s complaint.

Recommendations
We recommended that the board:
• review the referral system to ensure when referrals are re-graded the reasons for doing so are clearly documented and communicated; and re-referred patients are routed back to the appropriate consultant; and
• provide a full apology to Mr C for the failings identified.

Summary
Ms C complained that her medical practice had kept information from her about her hospital test results. She also said that when she wrote a formal letter of complaint to the practice they had failed to address the issues she raised.

Our investigation found, however, that the practice had correctly reported the outcome of the hospital tests to Ms C and that their response letter to the complaint was appropriate.