Health

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The guidelines that were in place in 2005 for dealing with patients with cardiac problems have been updated and replaced by new guidelines that include preventative action to reduce the consequence of further cardiac problems for such patients.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

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.