Health

Summary
Miss C was diagnosed by hospital consultants as having fibromyalgia, neurological functional disorder and probable Crohn's disease. She complained that her GP did not accept these diagnoses and subsequently failed to provide treatment for them. In particular, she complained that her GP deleted a range of medications from her prescription list without good cause.

We found that Miss C's GP was not convinced by the diagnoses, but provided treatment in line with recommendations from various consultants. Medication was also withdrawn in line with specialist opinion. We did not consider it unreasonable for the GP to express his concern about the diagnoses to Miss C given that her treatment progressed appropriately.
 

Summary
Ms C complained about the care and treatment she received throughout her pregnancy and what she considered to be the mismanagement by the board of her labour and her baby's birth. She claimed that she had not been properly monitored; that matters were not properly explained to her and that she had not received appropriate treatment during her pregnancy and labour. She further complained that she was not properly monitored and cared for after the birth and she alleged that, as a consequence of this mismanagement, her daughter required medical treatment.

We investigated Mrs C's concerns, and obtained independent specialist advice. This established (and it was confirmed in the appropriate records) that the care and treatment Ms C received was satisfactory and that there were no issues of concern. In the circumstances, we made no recommendations in this case.

Summary
Mrs C complained to the board about the delay in diagnosing her son (Mr A) with asperger's syndrome when he was 41 years old. Mr A had been examined by various doctors since he was 8 years old and Mrs C wished to know why it had taken so long to reach a diagnosis.

We found that autism-spectrum disorders are a complex group of developmental disorders which are frequently associated with other psychiatric disorders which can colour their presentation and complicate their management. Asperger's syndrome was formally recognised by the World Health Organisation in 1992 and by the Diagnostic and Statistical Manual of Mental Disorders in 1994. Our medical adviser explained that due to system overlap, some people with asperger's syndrome can be wrongly diagnosed with other mental health disorders. However, it was possible that some of Mr A's previous diagnoses could have been legitimate mental health disorders in their own right. We found no evidence that there had been a delay in reaching Mr A's diagnosis of asperger's syndrome.
 

Summary
Mrs C visited her dentist to have a crown checked that had been causing her pain. After treatment, Mrs C complained that the dentist had extracted a perfectly healthy crown and had failed to give her any anaesthetic at the initial attempt to extract the crown. Mrs C said that after the dentist had pulled a couple of times at the crown, she shouted at him to stop as she felt sick and was shaking badly. The dentist then administered anaesthetic and both the crown and tooth were removed. Mrs C was dissatisfied that the dentist had not carried out an x-ray to see if the tooth was fractured or needed to come out.

In response to the complaint, the dentist said that Mrs C attended the practice complaining of a loose crown and when he attempted to remove it, she experienced quite a lot of pain and so local anaesthetic was given. The dentist documented that he suspected the crown may have fractured the root of the tooth and that extraction was probably required due to the resistance and mobility of the crown. The dentist also said that very little force was required indicating advanced gum disease and that this was supported by an x-ray taken in 2006 that had shown the root of the tooth to be particularly short with surrounding bone loss from periodontal disease.

Our dental adviser said that previous treatment had been carried out on the affected tooth which meant that the nerve and blood supply of the tooth had been removed. We found that it was, therefore, appropriate for the dentist to have attempted to remove the loose crown without giving any local anaesthetic as there was no longer any nerve supply to the tooth.
The adviser stated that the pain Mrs C had been experiencing in this tooth is often indicative of an underlying problem beneath the gum, such as an infection or a fractured root. He explained that the 2006 x-ray showed the presence of gum disease and a relatively short root indicating that a lesser amount of pressure would be required to remove the tooth.

He also said that, assuming the tooth was loose and given the x-ray, it is likely that the bone loss would have progressed in the intervening years and at some point the tooth would require extraction, although it was impossible to predict when this would happen. Therefore, we concluded that the treatment provided was appropriate.

Summary
Mrs C was a patient of a consultant gynaecologist for about five years, during
which time she had gynaecological surgery, including a hysterectomy. At the
time of this surgery, the consultant noted signs of endometriosis (a condition in
which cells from the lining of the uterus appear outside the uterus). Five years
after the surgery, Mrs C was suffering intermittent pelvic pain and her GP
referred her to the board's gynaecology department.

Mrs C was unhappy with the care and treatment she received after the referral.
In particular, she was unhappy with the information that was provided to her
before surgery to remove her ovary. She felt that information was an
insufficient basis for her to give fully informed consent before surgery. She was
also unhappy about the removal of a stent, and complained that her ureter was
damaged during the ovary surgery. She also said that, due to failures in care
and treatment, she developed preventable infections, including MRSA.

We could not say with certainty what was said to Mrs C in advance of the two
procedures. From looking at the evidence, we found that Mrs C signed consent
forms for each procedure. Both forms stated that the nature and purpose of the
procedures had been explained to her, and that she consented to further
alternative operative measures that might be found necessary during the course
of the operation. In addition, the consent form for the ovary surgery had been
annotated and showed that the potential for bowel and bladder damage were
discussed. We were satisfied from the evidence that consent was properly
obtained and Mrs C was provided with sufficient information, and therefore, we
did not uphold this complaint.

We took advice from three of our medical advisers. One adviser said it was not
possible to say exactly how, or at what stage of, the ovary surgery Mrs C's left
ureter was damaged. The adviser was critical of the sparse record of the
operation and was also of the view, based on the available information, that the
damage to Mrs C's ureter could have been avoided. Given the deficiency in
record-keeping, and taking into account the views of the adviser, we upheld this
complaint.

In terms of Mrs C's treatment in hospital, two of our advisers found no evidence
of failures in care and treatment leading to Mrs C developing preventable
infections. However, based on the medical notes provided by the board, one
adviser was of the view that Mrs C should have been seen by a consultant
gynaecologist more urgently in another hospital, especially when she was still
unwell on the two days following her readmission after ovary surgery. In
addition, the adviser was critical of the wait for a CT urogram (a scan of the
urinary tract) before her move to another hospital. Given these failings in care
and treatment, we upheld this complaint.

Recommendations
We recommended that the board:
• apologise to Mrs C for the damage to her ureter during surgery;
• ensure operation notes include appropriate details, taking account of
Royal College of Obstetrics and Gynaecology guidelines and the
comments made in our decision; and
• draw the failings in care and treatment to the attention of medical staff in
the gynaecology department.

Summary
Mr C's 86-year-old mother (Mrs A) was admitted to The Golden Jubilee National Hospital for hip surgery. Following surgery, she was returned to the ward for bed rest and was noted to be a little confused. The hospital said that they explained to Mrs A that she should not mobilise and to use her call bell if she needed assistance. They said that she seemed to understand this advice.

During the night, Mrs A fell out of bed and dislocated her hip which then required further surgery. Within half an hour, she fell out of bed again and was then placed in an alarmed bed. Since her falls and surgeries, Mrs A’s recovery has been protracted and her long term prognosis is poor.

Mr C complained that his mother was not properly monitored following her surgery. Our investigation confirmed that although Mrs A's first fall could not have been anticipated, the hospital did not take appropriate action after a second fall. We found that the hospital also failed to send Mr C a copy of the appropriate incident report after he requested it.

Recommendation
We recommended that the hospital:
• apologise for failing to send Mr C a copy of the appropriate incident report and that they provide one.
 

Summary
Mr C complained that his practice failed to provide a reasonable standard of medical care on a number of occasions. He went to his practice complaining of pain and was prescribed a drug that he said led to his collapse later in the evening. Later, he went to his practice complaining about severe indigestion and nausea which he believed was a reaction to the medication he was prescribed and was eventually prescribed a different medication. Following an operation, Mr C sought treatment from the practice when he had discomfort and his wound began to leak. He did not receive treatment and went to hospital where he said he was diagnosed with internal bleeding.

We found that on the whole the care and treatment Mr C received from the practice was reasonable. Mr C was prescribed a drug that should have been used with caution, but that there were no contraindications to its use and it was discontinued the following day. We found no evidence that the practice failed to provide a reasonable standard of care to Mr C on the other occasions.

Summary
Mr C's mother (Mrs A) required ankle replacement surgery. Around one week after her surgery, Mrs A was discharged home. Mr C complained that his mother was not properly cared for by the district nursing service to the extent that her ankle became severely infected, and she was disorientated and malnourished. Mr C said that when Mrs A was admitted to Ninewells Hospital around three weeks later, her condition was life-threatening.

Mr C said that the infection in his mother's ankle had also spread to her spine but that despite her pain and the concerns expressed by her family, it took a month to determine and treat the extent of the problem.

We investigated Mr C’s complaint and obtained advice from our medical adviser. The adviser found that the care and treatment given to Mr C's mother was satisfactory and that hospital staff had correctly concentrated on the severity of Mrs A's infection before addressing the pain in her back.

Although Mr C's complaints about his mother's care and treatment were not upheld, we did uphold his complaint about the board's complaints handling. We found that the board took too long to handle and investigate Mr C’s complaint and that they did not comply with their own stated timescales.

Recommendation
We recommended that the board:
• remind all staff involved in this complaint (particularly those who have been asked to respond to the complaints department) of their responsibility to support the NHS complaints procedure by replying in a timely way.

Summary
Mrs C was treated for a vaginal prolapse. She underwent surgery to correct the condition but had complications following the procedure which left her with bladder dysfunction. As a result of this, she required a permanent catheter.

Mrs C was initially taught to intermittently self-catheterise. She was uncomfortable with this procedure and found that it had a detrimental impact on her life. She raised her concerns with the board but it was some time before an alternative form of catheterisation was provided. Mrs C complained that avoidable surgical failures resulted in her losing bladder sensation and that the board failed to warn her in advance that her surgery could permanently damage her bladder. She also felt that the board took too long to investigate alternatives to self-catheterisation.

We found that the board did not warn Mrs C of the possibility of permanent bladder damage prior to her surgery. Whilst we were satisfied that the surgery was carried out correctly and the subsequent complications were unavoidable, we considered that there was an unreasonable delay to providing Mrs C with an alternative to self-catheterisation.

Recommendations
We recommended that the board:
• include information about the potential for permanent bladder problems, and any other significant detrimental outcomes, in their pre-operative counselling for vaginal repair surgery;
• draw their staff's attention to the NICE guidance on surgical repair of vaginal wall prolapse using mesh to ensure that patients are provided with full information regarding the risks and benefits of this procedure prior to giving consent; and
• apologise to Mrs C for the issues highlighted.
 

Summary
An MSP complained on behalf of Mrs A about the Scottish Ambulance Service (SAS). Mrs C's husband (Mr A) suffered a heart attack and the SAS were asked to dispatch an ambulance. The ambulance crew gave Mr A aspirin and carried out an ECG (electrocardiograph). It is normal practice for ECG results to be transmitted to the Golden Jubilee Hospital, which provides specialist emergency treatment for heart attack patients. However, on this occasion, the ambulance crew were unable to transmit the results. The paramedic who attended Mr A phoned the Golden Jubilee for advice, as per the protocol for such situations. He was advised that he could take Mr A to the Golden Jubilee if he was having a heart attack, otherwise he should be redirected to a local Accident and Emergency unit.

The paramedic understood that the correct procedure at that time was to take patients to the Vale of Leven Hospital for initial assessment. He did this, but, upon confirmation that Mr A was having a heart attack, staff at the Vale of Leven redirected him to the Golden Jubilee. By the time Mr A arrived at the Golden Jubilee, another patient had arrived and was treated before him. Mr A did not recover from his heart attack and died three weeks later.

We found that the equipment provided in the ambulance was not properly configured and prevented the ambulance crew from transmitting Mr A's ECG results to the Golden Jubilee. The protocol in place at the time of this incident required ambulance crews to take patients showing signs of a heart attack to the Golden Jubilee in the first instance. We found that the paramedic was not aware of the correct protocol and incorrectly decided to take Mr A to the Vale of Leven, delaying his treatment.

Recommendations
We recommended that the Scottish Ambulance Service:
• apologise to Mrs A and her family for the issues highlighted in this decision notice; and
• consider establishing a standard form of words with PCI (Percutaneous Coronary Intervention) centres to avoid any confusion as to what action ambulance crews are being advised to take.