Health

Summary
Mrs C complained about aspects of the care and treatment provided to her late mother (Mrs A) in hospital after she fell at home in a sheltered housing complex.

Mrs C said that there was difficulty in receiving accurate information from staff about her mother's condition and whether she was going to be taken to theatre. In addition, Mrs A had gone eight days without food; and the family could not understand how Mrs A could die of pneumonia in hospital two weeks after a simple fall with no injuries.

We took advice from two medical advisers who established that Mrs A was an elderly lady in poor health. On looking at the board's care and treatment of Mrs A, we found that she had a number of pre-existing medical conditions, which meant that she did not have the physical reserves to cope with the complications that followed her fall.

Our advisers confirmed that Mrs A received appropriate care and treatment while in hospital and that it was necessary for her to be fasted in order to manage her condition, and, therefore, we did not uphold this complaint.

We did, however, find that there were failings in the way in which medical staff communicated with the family, and delays in the handling of Mrs C's complaint.

Recommendations
We recommended that the board:
• remind staff of the importance of communication with relatives about a patient's care and treatment;
• remind staff to respond to complaints in accordance with the guidance contained in the NHS complaints procedure; and
• apologise to Mrs C for the delay in responding to her complaint.

Summary
Mr C is the carer for his son who has a severe and enduring mental illness. Following a reorganisation of the board's mental health services, the consultant psychiatrists became either in-patient or community focused. This led to a change in consultant for many patients, including Mr C's son. The board consulted a number of representative groups about the changes.

Mr C complained that the board failed to consult with patients and carers and that consultation with the groups was not a substitute for this. He said that the board failed to comply with the Mental Health (Care and Treatment) (Scotland) Act 2003, Scottish Government guidance and the board's strategy on consulting and involving people. He also complained about the board's complaints handling.

We found that the board did not fail in their duties under the relevant legislation when they reorganised mental health consultant services and so we did not uphold Mr C's complaint about that. We also found that when the board consulted with the representative groups, they complied with the guidance.

However, we upheld Mr C's remaining three complaints as we found that the board failed to adhere to their strategy and that it would have been reasonable and proportionate if they had sought to discuss the planned changes directly with patients and carers. We also found failures in the board's complaints handling. We made no recommendations as the board had already taken action to address the failings identified.

Summary
Miss C raised a number of concerns about the treatment her late father (Mr A) received in hospital.

Mr A had become unwell after surgery, complaining of abdominal pain. He was found to have several bleeding ulcers. Mr A received treatment for these, but his condition deteriorated and he died a few days after the surgery took place. Miss C felt that there had been a delay in transferring Mr A to theatre and then for surgery, and that his pain relief was inadequate. She felt that a proton pump inhibitor (PPI) (a drug that reduces acid in the stomach) should have been prescribed earlier.

Having looked at the case, our medical adviser found that Mr A had received reasonable treatment and that there were no unreasonable delays. We found that Mr A was taken to theatre for surgery when it was clinically appropriate to do so.

We did, however, find that Mr A's pain management was inadequate for a period during the admission. While recognising that Mr A's pain was difficult to manage, our adviser was concerned that someone with a history of chronic duodenal (lower intestine) ulcers did not have PPI protection throughout his recovery. We took the view that Mr A's abdominal pain should have been identified and addressed earlier and made a recommendation to the board about this.

Recommendation
We recommended that the board:
• apologise to Miss C for the failure to fully address Mr A's pain issues.

Summary
Miss C complained that, over a number of years, the board's staff had failed to listen to her or obtain her previous medical records. She said that these would have shown that she had suffered from epileptic seizures and that she should have been diagnosed with post-ictal psychosis (a rare complication that can occur after a series of seizures). As a result Miss C felt she had been unreasonably detained under the Mental Health Act.

We took detailed advice from two of our medical advisers on Miss C's complaint. We found that Miss C had complex symptoms, some of which were considered to be caused by epileptic seizures and others by non-epileptic seizures. We found that, over the years, clinicians had carried out appropriate examinations in an effort to reach a definitive diagnosis, and that sight of Miss C's previous medical records would be unlikely to have altered their thinking. Although it did take time to reach a diagnosis, we were satisfied that the clinicians involved had clearly taken account of what Miss C had told them, and in the circumstances had arrived at reasonable diagnoses.

Summary
Mrs C hurt her leg after a fall at home and went to a hospital's accident and emergency unit. Mrs C said she was told her leg was in shock and was given pain killers. She was also told to keep an eye on the swelling and to go to her doctor's surgery if it got worse.

The pain continued to get worse so she went to the surgery. She said that her doctor telephoned the hospital and was told to complete a letter of referral. Nine days passed and as Mrs C did not receive an appointment and was in considerable pain, she went directly to another hospital, where she was x-rayed.

The x-ray revealed that Mrs C had a fractured foot, which was set in plaster for four weeks. As a result Mrs C said she was left in significant pain for months and was unable to work. She complained to us about the care and treatment she received in the first hospital, and was unhappy that her foot was not x-rayed on the day of the accident.

Our medical adviser looked at this complaint. The adviser said that many such injuries result in sprains or soft tissue injuries. A few patients have fractures. However, many fractures are minor and do not require much treatment other than pain relief, support and gentle mobilisation as a patient's injury heals. Others may need a plaster cast for pain relief.

The adviser said that overall, according to NHS guidance and what was in Mrs C's medical records, x-rays were not indicated when Mrs C attended the first hospital. We took the view that clinical staff carried out adequate, appropriate investigations and treatment of Mrs C's injury, according to NHS guidelines, and that she was given appropriate follow-up advice.

Summary
Mr C complained about the treatment his wife (Mrs C) received in two hospitals. Mrs C was admitted to the first hospital complaining of groin pain. She also showed signs of infection. Urologists found that Mrs C had a kidney stone preventing her right kidney from draining properly. A nephrostomy (insertion of a small tube to release the urine from the kidney) was attempted but this was unsuccessful.

Staff at the second hospital failed to insert a stent (tube) to drain the kidney the following day but were, with difficulty, able to complete the nephrostomy three days after her admission. Mrs C subsequently developed internal bleeding and was too unwell to undergo surgery. She died seven days after her admission to the first hospital.

Mr C complained that insufficient time was allowed before the first nephrostomy for antibiotics to take effect and resolve Mrs C's infection. He also felt that urology staff spent too much time attempting the first procedure, which he had been told would be quick. It took several hours and, as a result, Mr C believed his wife had been left overnight with internal bleeding. He felt that this delay left insufficient time for staff at the second hospital to treat her.

Mr C raised further complaints about the communication with his wife's relatives; a lack of involvement in decisions about her treatment; and the accuracy of comments made in response to his complaints.

After taking advice from our medical adviser, we found that the nephrostomy was required urgently as failure to provide treatment could have led to Mrs C developing an abscess and blood poisoning. The antibiotics that she was prescribed were also to help prevent blood poisoning. We found that some bleeding was caused by the first procedure but that this was stemmed appropriately. There was insufficient evidence available to determine the cause of her subsequent internal bleeding, but our adviser said that Mrs C had a number of additional medical problems, some of which could have caused this separate to her kidney treatment.

As Mrs C did not have any mental deficiencies that the board were made aware of, we found that it was appropriate for staff to discuss treatment directly with her. The discussions were documented and Mrs C signed consent for each of the procedures carried out. Although the family were not updated until several days after her admission, there was no evidence to suggest that they were denied the opportunity to discuss Mrs C's treatment with staff.

We were satisfied that the board's responses to Mr C's complaints were accurate.
 

Summary
Mr C complained about his treatment in hospital after a knee replacement operation. He said that he developed an infection and had to attend hospital for some time after his surgery. He felt that if the consultant who operated on him had investigated the infection sooner, then it might have been contained or eradicated. He said that the board failed to adequately treat his ongoing problems of pain or to adequately investigate his complaint.

The evidence in the clinical records showed that Mr C’s follow-up reviews and treatments were held in good time. We took independent advice from one of our medical advisers, who said that infections in prosthetic knee replacements can be difficult to diagnose, and that the clinical judgements made were reasonable. Our investigation found no evidence to support Mr C’s view that the board failed to adequately treat his pain. There was also no evidence that the follow-up care was inadequate or fell short of the clinical standards expected.

We found that the board responded appropriately to Mr C’s complaint. They addressed and answered his questions, demonstrated empathy with his situation, and kept him updated about how their investigation was progressing. Although Mr C was unhappy with the investigation we also took the view that, to answer his questions and concerns, it was appropriate for the board to refer these to the consultant for comment. This is common and acceptable practice when responding to a complaint. We recognise that Mr C is still dissatisfied with the responses he received, but dissatisfaction with the outcome of a complaint does not mean that the board did anything wrong.
 

Summary
Miss C complained that when a heart murmur (an extra or unusual sound heard during a heartbeat) was detected on the morning of pre-planned surgery she was asked to 'have a chat' with a cardiologist (heart specialist).

When she saw the cardiologist he did some tests. Miss C felt that she was misled about this. She also said that she has never been provided with the results of the tests.
We did not uphold Miss C's complaint as our investigation found that referral to the cardiologist was appropriate in the circumstances. The board also confirmed that, as is normal practice, the test results were sent to Miss C's GP. They were apparently also discussed with Miss C on the day.

Miss C was concerned that she had not yet had access to her clinical notes. At the time of our investigation, the board were in the process of arranging this. As Miss C raised the issue of accessing her records with us before she had raised it with the board, we could not take it forward.

We informed Miss C of this position and gave advice on complaining to the board. We advised her that she could advised her that she could bring her complaint to us if she was still unhappy after the board had finished looking at it.

Miss C also raised concerns about information that she felt had been withheld or was incorrect. We could not look at this issue as she could not specify what information this was.

Summary
Miss C was unhappy about communications with NHS staff when using mainstream services for her physical ailments. She raised various concerns about interactions she had had recently with NHS staff.

Miss C said that she felt that staff were not listening to her wishes or concerns and were not taking notice of an Advance Decision Letter (ADL) which set out her wishes as to what treatments she would and would not consent to. She attributed this to her mental health issues which were known to the staff who were dealing with her physical problems.
She was also concerned that a letter from the head of administration, who had been involved in her complaint, had been placed in her clinical case file. The NHS guidelines for dealing with complaints state that correspondence about complaints should not be held on a patient's clinical records.

On investigation we found, however, that this letter was in fact about the ADL, explaining its background and context. As such, although it was from one of the board's staff who had been heavily involved in her complaint, it was not complaints correspondence. We also considered that it was appropriate that an explanatory letter was placed in Miss C's file as ADLs are usually only used in the case of patients with terminal, life limiting, or life threatening conditions. This was not the case for Miss C.

Having considered all of Ms C's concerns, we did not uphold a number of her complaints and were unable to take others forward as they were either out of time; out of jurisdiction; or were already being considered under another complaint reference within SPSO.

Summary
Mr C complained that the treatment he received in hospital for his broken arm failed to take full account of an existing arthritic condition in his shoulder. He felt that this was the reason that the bone did not heal. He also complained that the board did not provide information about whether a support group existed for sufferers of his condition.

We investigated the complaint and took specialist medical advice. We found that Mr C's medical notes showed that each time he was seen, clinicians were fully aware of his existing condition and made their recommendations for his treatment in this knowledge.

Our adviser confirmed that Mr C's treatment was entirely appropriate for the symptoms with which he presented. We also found that, regardless of his suspicion, a longer period of immobilisation would not have been beneficial. On the issue of locating a support group, our adviser confirmed that it would be for Mr C's GP, not the hospital, to recommend such a group, should one exist.