Health

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.
 

Summary
Ms C was injured when there was an accident involving the stair lift on which she was being transported by a member of the Scottish Ambulance Service (the Service) to a hospital appointment. She complained that, following the accident, she reported the matter to the receptionist at the clinic and was told that someone (apparently the lead nurse of the clinic) would come to see her. This did not happen before Ms C was collected again by the Service for transport home.

Ms C also complained that despite being in pain from her injuries no hospital staff came to check her over. She also said that when the board responded to her complaints the letters contained inaccurate information, including referring to her injuries being caused when she was 'putting her aunt onto the stair lift' and that she had been 'walking with the consultant' within the clinic. Ms C was in fact in a wheelchair the whole time she was in the clinic on this day.

We upheld all of Ms C's complaints and made relevant recommendations. The board acknowledged that the incident had occurred (while Ms C was in the care of the Service) and that Ms C had made hospital staff aware that it had happened. Although a member of staff checked with the Service that they knew about the matter, no action was taken to report it within the hospital's own policy on accidents. The board had not referred in their response to the failure of the lead nurse to come to speak to Ms C while she was in the clinic.

On the matter of Ms C not being checked over, the board said that the consultant that Ms C was there to see recalled Ms C mentioning that she had had an accident but not that she had been injured and/or was in pain. They also said that none of the other staff had any recollection either of Ms C saying she was in pain or that she seemed to be in pain. Although there was no conclusive evidence to support either version of events, we found that although aware that there had been an accident, there was little evidence to suggest that staff had taken steps to find out how Ms C was after it happened. On balance, therefore, we took the view that little or no effort had been made by staff to establish the extent of Ms C's injuries and/or pain.

On the issue of their complaint response, the board acknowledged that there were errors in two letters. In particular, the chief executive said that the comment about Ms C walking within the clinic was based on the recollections of staff from a previous visit to the clinic by Ms C. The chief executive accepted that on the day in question Ms C was in a wheelchair the whole time she was in the clinic.

Recommendations
We recommended that the board:
• apologise to Ms C for the failures identified; and
• review the policy and procedures for reporting accidents and ensure that all staff are aware of the policy and their responsibilities within it.

Summary
Mr C complained on behalf of his mother about a cancer diagnosis that was delayed due to 'human error' by a radiologist (a medical specialist that uses imaging to diagnose and treat disease) in interpreting a scan.

He also complained about the board's complaints handling and what he regarded as confusing and/or contradictory information.

We upheld Mr C's complaint about the misinterpreted scan. We found that the board had already acknowledged this and apologised to him.

When looking at the complaint, we took account of the action already taken by the board. We also looked at the remedial action they took to minimise the likelihood of a recurrence and took advice from our medical adviser, who compared the board's action to national standards set by the Royal College of Radiographers. We found that the remedial action either matched or exceeded the national standards and we were satisfied that appropriate and timely action had been taken to address the failings identified. We, therefore, did not make any recommendations.

On the issue of the complaints handling, we found that the information provided to Mr C was clear and was not contradictory.
 

Summary
Mrs C complained to the board about aspects of the care and treatment provided to her late husband (Mr C) both in hospital and by the Out of Hours Service (OOHS). Mr C had been suffering from cancer. When he became unwell with abdominal pain and diarrhoea, Mrs C contacted the OOHS and Mr C was taken to hospital.

Mrs C complained that Mr C should have been taken to a different hospital, and that he was given inadequate clinical treatment and pain relief. She also complained about delays in diagnosis and treatment; poor communication and unhelpful attitudes from staff; the time taken for an OOHS doctor to arrive at the house and that the doctor was uncaring.

We did not uphold the majority of Mrs C's complaints. We established that, as an emergency ambulance was called, it was appropriate for Mr C to be taken to the hospital where he was treated. After taking advice from one of our medical advisers, we also found that while Mr C was in hospital he received appropriate clinical treatment, staff carried out appropriate investigations, and the general level of communication was adequate.

We upheld two of Mrs C's complaints as we found that for a period Mr C's pain was not managed appropriately; and that there had been a fifteen minute delay by the OOHS doctor in arriving for the home visit.

We did not make recommendations on this complaint as the board have already taken action to remedy what went wrong. The board have apologised for a breakdown in communication by the nurses in regards to pain relief and staff at the OOHS have apologised for the delay in their doctor making a house call.

Summary
Mr C attended his GP, complaining of blurred vision. Two days later, he attended again with the same symptoms. The GP telephoned the hospital to ask for an appointment to be provided more quickly and was told Mr C would be seen as soon as possible.

Just over a month later, Mr C saw a consultant ophthalmologist who could not find anything wrong. Mr C questioned this and was told that the consultant could send him for a scan. Mr C attended for a scan three weeks later. The following week, the consultant telephoned and said that the results of the scan showed Mr C had suffered a stroke and urgently needed to attend the stroke clinic. Mr C was dissatisfied with the consultant's attitude and was unhappy that it took over nine weeks to diagnose that he had suffered a stroke.

After taking advice from one of our medical advisers, we found that Mr C's symptoms were not typical of a stroke and that the consultant had carried out an appropriate assessment. We did, however, uphold his complaint that there was a delay in the board providing him with an ophthalmology appointment after the GP asked for Mr C to be seen more urgently.
 

Recommendation
We recommended that the board:
• apologise to Mr C for the failure to act on the second GP referral.