Health

Summary
Miss C complained to the board about aspects of the care and treatment that her late father, Mr A, received in hospital. Mr A, who had irreversible chronic obstructive airways disease (COAD), suffered a cardiac arrest at home. He was resuscitated by paramedics and taken to the hospital's intensive care unit. Initially he was on a ventilator to help him breathe, but this was discontinued the day after he was admitted. The same day, Miss C spoke to a doctor who told her that she had spoken to Mr A and that he had said he did not want to be put on a ventilator. The doctor also told Miss C that Mr A's health was too poor for him to benefit from ventilation and that he would not survive. Although initially Mr A had improved, his condition later deteriorated and he died a week after being admitted to hospital. In her complaint, Miss C said the family contested the fact that Mr A's health was too poor for him to have benefitted from ventilation.

We took advice from one of our medical advisers, who said that as an emergency admission, it was appropriate to initially place Mr C an a ventilator until his condition stabilised. He was taken off the ventilator once his condition improved. However, when his condition deteriorated staff had to take into account Mr A's irreversible COAD. We found that the records show that staff took steps to explain the situation to Mr A and decided that further ventilation would not be of benefit to him. We found that the decision not to place Mr A on ventilation was appropriate in view of the poor prognosis, that staff had fully consulted with Mr A in the process and that he was in full agreement.

Summary
Miss C complained that her dentist had removed her from the dental practice's list of patients. However, dentists can do this, as long as they give three months' notice to the patient (unless the patient has shown violence). As the dentist had given adequate notice, there were no grounds for us to uphold the complaint.

Summary
Mrs A had been receiving treatment for high blood pressure for a number of years. She had three strokes within six months. Mrs A's husband, Mr C, complained that their GP practice failed to provide appropriate advice to him when he contacted them about the first and second strokes. Mr C also complained that the practice failed to respond within a reasonable timescale when Mrs A's stroke nurse reported high blood pressure results shortly before the third stroke.

In looking at the records, we could not determine exactly what was said when Mr C spoke to the practice on the day Mrs A had her first stroke, as there was no direct objective evidence. However, the records did show that the practice's advice to bring Mrs A to the evening surgery on the day of her first stroke was reasonable. While we acknowledged this, there was no record of advice given to Mr C about what to do if Mrs A's symptoms worsened. In addition, one of our medical advisers was of the view that Mrs A should have been taken to hospital that evening by emergency ambulance. In relation to the day of Mrs A's second stroke, the practice advised Mr C to bring her in for a consultation the following morning. In our view, she should have been seen and assessed on the same day, given her history and unresolved symptoms. Taking all of this into account, and noting the views of our adviser, on balance we upheld this complaint.

In relation to Mr C's second complaint, the records showed that the practice discussed Mrs A's high blood pressure results with the stroke nurse, and arranged for further review and a home visit. Our adviser's view was that the practice acted appropriately in the circumstances. Taking this into account, we concluded that the practice did respond within a reasonable timescale and, therefore, we did not uphold this complaint.

Recommendation
We recommended that the practice:
• review their protocol for the management of hypertension, in terms of the threshold for referring patients to a hospital consultant. This would include urgent referral and emergency ambulance transfer to hospital of patients suspected of stroke if symptoms persist on assessment.

Summary
Ms C was admitted to hospital on two occasions. She said that before each admission she had lodged an advance decision with the board to cover the care and treatment she was prepared to accept. She was unhappy with the care and treatment she received. She said it did not agree with her advance decision; that the advance decision was not recorded in her notes until after the first admission; she waited around six hours before receiving treatment; she was incorrectly told to take her own medication; staff took offence at her; her advance decision was not respected and it was inappropriate for staff to ask about her mental health problems.

Our investigation took account of all the available information, including Ms C's medical records. We obtained medical advice from two medical advisers.

A medical adviser said that advance decisions are drawn up to indicate how an individual would wish to be treated, should they be unable to make that decision at the time. There was no indication in the medical records that Ms C was in that position at the times concerned. However, we found that the advance decision was not inserted in her records at the right time and that on admission, she waited too long before receiving treatment and we upheld her complaints about these matters. We also found that staff told her, incorrectly, to continue taking her own medication once she was admitted to a ward and that in view of this a member of the medical team (correctly) refused to continue to give her strong apin relief. There was, however, no evidence to show that a member of staff took any offence at Ms C or her requests. We also found that it was appropriate for staff to discuss Ms C's mental health with her even though it had no apparent bearing on her physical presentation at the time.

Recommendations
We recommended that the board:
• apologise for the delay in 2010 in attaching the advance decision to the relevant notes;
• audit their current process to lodge records information and act on any recommendations subsequently made; and
• review the means, in Crosshouse Hospital, by which they ensure that acute admissions are promptly assessed by medical and surgical staff in their acute wards and that actions taken to ensure attainment of the four hour target do not compromise patient care. An audit of time from presentation at Accident and Emergency to review by medical staff would support such an aim.

Summary
Mr C complained about the way the board handled his request for funding of a course of six episodes of prolotherapy treatment (a treatment involving injections into the affected area, which is believed to stimulate healing). Mr C felt that the treatment would have relieved his back pain. The board refused the request and Mr C appealed against the decision. The appeal panel refused his appeal on the basis that research had shown there was no credible evidence that prolotherapy alone has a role to play in back pain. Mr C complained that the research literature that the panel considered was flawed, and that he had not had the opportunity to make additional presentations to the panel after they considered evidence from a member of board staff.

We found that the board dealt with Mr C's request in an appropriate manner and that the panel gave his request careful consideration in accordance with the guidance. We found no evidence that the decision-making process was flawed.

Summary
Mrs C attended a hospital accident and emergency unit in 2005 with a suspected deep vein thrombosis (DVT). DVT was not, however, diagnosed and Mrs C was sent home.

In 2011, Mrs C's health deteriorated and an electrocardiogram (a test that measures the electrical activity of the heart) showed that she had a heart abnormality called a left bundle branch block (LBBB).

On reviewing her past medical records Mrs C saw that this was actually diagnosed in 2005 but that no action had been taken. Mrs C is now on numerous medications for angina, heart failure and increased blood pressure. Mrs C complained because she felt that treatment should have been provided in 2005, and that she should have been seen by a heart specialist and had a thorough review of her heart condition.

We found that the finding of LBBB in 2005 was picked up by chance and was unrelated to the matter which was being investigated (which related to pain in Mrs C's leg). Also, at that time, Mrs C was not exhibiting any sign of heart problems.

The guidelines that were in place in 2005 for dealing with patients with cardiac problems have been updated and replaced by new guidelines that include preventative action to reduce the consequence of further cardiac problems for such patients.

We found that the care and treatment provided to Mrs C in 2005 was, therfore, appropriate at the time.

Summary
Mr C's wife (Mrs C) was admitted as an emergency case to hospital, but passed away the next day. Mr C was unhappy that the board did not contact him to tell him that his wife had died, and that he only found this out when he called to ask how she was. Mrs C had also wished for her body be donated for the benefit of medical science, and Mr C complained that the board unreasonably failed to contact a local university to arrange for her body to be taken there for this.

Our investigation found that when admitted to hospital, Mrs C had said she had no next of kin and had asked that her GP be told about any changes in her condition. We, therefore, did not uphold this complaint. We also found, however, that Mr C had been in touch with the hospital enquiring about her condition, but no note had been made about this, nor had the board given him a full explanation of their findings. We, therefore, made recommendations to address this.

We upheld the complaint about what happened to Mrs C's body as we found that the board were aware of Mrs C's wishes but that after she died they failed to contact the university to explore the possibility of donation. We also found during our investigation that the board's initial decision not to refer Mrs C's death to the procurator fiscal was incorrect and that they did not properly investigate Mr C's complaint or make him fully aware of what they had found out.

Recommendations
We recommended that the board:
• apologise for not having provided a full explanation of their findings when responding initially;
• apologise to Mr C for their failure to act upon his wife's wish to have her body donated to medical science; for initially failing to make the correct decision on referral to the procurator fiscal; for failing to thoroughly investigate his complaint and for failing to report the findings of their investigation to him;
• feed back the Ombudsman's views on this complaint to the staff involved to try to ensure that such failings do not happen again; and
• write to the Ombudsman to explain what action they have taken to implement the remedies suggested as a result of their investigation and provide evidence regarding their implementation.

Summary
Mr C complained that the Scottish Ambulance Service (the Service) transported his wife from their shower room to their bedroom by dragging her there on a blanket. Mr C said this was an unreasonable way to have moved her. Mr C also said that the lifting equipment which the Service brought with them was faulty.

Our investigation took into account all relevant documentation and we also sought advice from one of our medical advisers. The Service told us that the ambulance crew initially planned to use lifting equipment to move Mr C's wife, who was acutely ill. Given the restricted access in the shower room, however, they decided in consultation with the attending doctor that it would not be appropriate to use the equipment. With the help of the doctor and his driver, the crew, therefore, used a blanket to move Mr C's wife from the shower room to the bedroom. They explained that it was felt that this would be a quicker way of getting Mr C's wife into a more comfortable position before taking her to hospital. Taking account of all the information provided, we took the view that this decision appeared to have been reasonable based on the situation at the time and taking into account the best interests of Mr C's wife.

The Service were clear in their view that the lifting equipment was not faulty, but it was not possible for us to prove this one way or the other. We could not, therefore, say whether there had been a failing by the Service in this respect.

Summary
Mr C had problems with his hip and used a walking aid. He fell while walking with a friend in the city centre. The police, who attended to Mr C first, called an ambulance. Mr C complained that the ambulance crew did not provide adequate care and treatment to him. Specifically Mr C said that the ambulance crew did not give him pain relief despite his requests; did not properly assess the injury to his leg; and did not take him to hospital despite his requests. Four days after falling in the city centre, Mr C fell at home and was taken to hospital, where he was diagnosed with a broken leg. Mr C felt that the break happened when he fell in the city centre.

We found from looking at the records, and taking advice from one of our professional medical advisers, that there was anecdotal evidence that Mr C did ask for pain relief. However, our adviser said it would not have been appropriate to administer it in the specific circumstances. We also found that the ambulance crew's record of the assessment of Mr C was inadequate and, given subsequent events, appeared to have been deficient. There was anecdotal evidence that Mr C did ask to be taken to hospital. We found the decision not to take Mr C to hospital was correct, based on the assessment carried out by the ambulance crew. However, given that the assessment was deficient, that decision could be questioned. Therefore, given the failings identified, we concluded that the ambulance crew did not provide adequate care and treatment to Mr C, and we upheld his complaint.

Recommendations
We recommended that the service:
• apologise to Mr C for the failure of the ambulance crew to provide him with adequate care and treatment; and
• ensure the ambulance crew refresh their knowledge of the relevant sections of the UK Ambulance Service Clinical Practice Guidelines relating to limb injury and pain management.

Summary
Ms C complained that NHS 24 refused to send an emergency ambulance to take her to hospital but instead referred her to the local out-of-hours service. She said that this was despite her step-daughter and her requesting an emergency ambulance.

Having obtained the recordings of the telephone calls during our investigation, however, it was clear that Ms C and her step-daughter did not request an ambulance nor did they raise objections to being advised to visit the local health centre.

We did not uphold this complaint.