Health

Summary
Mrs C had concerns about the treatment which her late mother (Mrs A) received at the Royal Alexandra Hospital in March 2010. Mrs A had been admitted for an elective kidney removal and suffered a stroke following the surgery. Mrs A remained in hospital until her death later that month. Her daughter had concerns that the staff should have transferred Mrs A to a specialist stroke unit for treatment and that the level of communication from the staff was inadequate.

We obtained clinical advice in this case and made the conclusion that Mrs A’s stroke could not have been predicted after surgery and that the treatment provided during the operation and the subsequent management plan following the stroke was appropriate.

In regards to communication issues, there was evidence of frequent communication between the staff and the relatives. We also found that the board had already apologised if some of the explanations which were provided to the relatives were not fully understood. We did not uphold the complaints.

Summary
Ms C has been undergoing psychiatric treatment for a number of years and had been diagnosed with 'Bi-Polar Type II Rapid Cycling Mood Disorder'. In May 2010 she attended a consultation and was told that her diagnosis had been changed to 'Complex Personality Disorder'. Despite advice that the team would gradually reduce her medication, Ms C stopped taking her medication right away. She reported that this has made her feel considerably worse. She was also concerned that the board told her she needed a chaperone when attending any consultation where there would be discussion of her condition and treatment. Finally, she also complained that some of the copy clinical notes she was provided with were hand-written and illegible.

The complaint was investigated and independent psychiatric advice was obtained. At this point the difficulties of psychiatric advice were explained (that it was rarely that objective investigations, like blood tests, could be relied upon) and that changes in diagnosis were perhaps more probable in this area of medicine. It was confirmed that as an initial diagnosis had taken four years it was likely that Ms C's presentation was atypical and it was, therefore, reasonable to review her diagnosis and medication.

The investigation also showed that after an alleged incident involving Ms C, there had been significant concern expressed by a senior member of staff about his personal safety. A collective decision had later been taken by board staff that a chaperone should be present with Ms C and any practitioner when her clinical care and treatment were being discussed with her. This satisfied the board's own responsibilities to their staff while not prejudicing Ms C's clinical care.

After consideration, Ms C’s complaints were not upheld. However, the investigation confirmed evidence that the clinical notes given to Ms C after she requested them were, in part, difficult to read. In the circumstances, while upholding this complaint, it was recommended that the board should provide Ms C with a written transcript.

Recommendation
We recommended that the board:
• provide Ms C with a written transcript of the relevant notes.
 

Summary
Mrs C complained about the care and treatment that her husband (Mr C) received from the board before his death from cancer. She said that they had delayed in removing a lump from Mr C’s groin. We found that it was unreasonable for Mr C to have to wait for nearly six weeks for the surgery after the decision was made to remove the lump. We also found that the surgeon should have contacted an oncologist to discuss Mr C instead of waiting to discuss the case at a multidisciplinary meeting.

The surgeon had acknowledged that he would have preferred to operate sooner, but carried out the operation as soon as was possible. The board also told us that they had reorganised services within the department to increase the amount of theatre time available to cancer surgeons. They also said that they had reviewed their outpatient clinics so that greater time could be spent with these patients. In view of this, we did not make any recommendations.

Mrs C also complained that the board discharged Mr C from hospital inappropriately. We received medical advice that Mr C appeared to be fit for discharge, although the records in relation to this could have been clearer. We also found that the surgeon had communicated with Mr C and his medical practice in a satisfactory manner. These aspects of the complaint were not upheld.

Summary
Mrs C complained on behalf of her son (Mr A) about the care and treatment he received from his dentist. The dentist had extracted four of Mr A's adult teeth that were different from those requested by the orthodontist. When the dentist found out that he had extracted the wrong teeth, he apologised to Mrs C. He explained that there was an error in the orthodontist's letter.

We upheld the complaint as we found that the responsibility clearly lay with the dentist. He should have realised that there was a typing error and clarified matters with the orthodontist before carrying out extractions. However, our medical adviser noted that Mr A's orthodontist should still be able to produce an orthodontic result comparable to that which was initially planned. The dentist has, however, changed his processes and procedures as a result of the complaint to ensure that he does not make the same mistake again.

When this report was first published on 18 January 2012, it was incorrectly
categorised as being about Lothian NHS Board. This was due to an
administrative error which we discovered on 18 January 2012, and for which we
apologise.

Summary
Mr C complained that his dental practice had given him inaccurate information in telling him that work he needed done (template and crown work in preparation for implants) could not be provided on the NHS. Our dental adviser confirmed that the required work would not have been covered by the NHS and so would have to have been done on a private basis. We, therefore, concluded that the practice's response was reasonable.
 

Summary
Mrs C complained to the board about the treatment her late husband (Mr C) received at Ninewells Hospital in January and February 2011. Mr C had been attending his GP surgery since November 2010 with breathlessness, cough and weight loss. Mr C attended the hospital's A&E department in late January 2011 and after seeing a nurse and a doctor he was sent home and told to wait until the GP referred him to hospital. No medical assistance was given.

Mr C attended the respiratory clinic ten days later where he was x-rayed, weighed and had bloods taken. He was told he did not have cancer. Eight days later, the GP arranged for Mr C to be admitted to hospital that day and a CT scan was carried out two days later. The scan showed evidence of widespread infiltration of the lung, suggestive of malignant disease or infection. As the scan was inconclusive a biopsy of the lung was carried out the following day. The result indicated that Mr C had lung cancer which was rapidly progressing and which was unusual for a non-smoker. It was decided that Mr C should be transferred to a community hospital, where he died two weeks later.

We upheld Mrs C's complaint that her husband was unreasonably turned away from the A&E department when she brought him there when she was concerned at his condition and the lack of urgency shown by his GPs. We also upheld the complaint that when Mr C attended an outpatient appointment he was incorrectly told he 'definitely did not have cancer'.

Recommendations
We recommended that the board:
• remind nursing and clinical staff in A&E of the need to complete nursing and clinical records in accordance with the Nursing and Midwifery Council and General Medical Council guidance; and
• apologise to Mrs C for the failings identified in our investigation.
 

Summary
Mr C was HIV-positive and was prescribed an anti-retroviral drug, efavirenz, by healthcare professionals at the board. Mr C was told that the potential side-effects of the drugs included dizziness, light-headedness, skin rash and vivid dreams or nightmares. After taking the initial dose, Mr C experienced very distressing mental changes including depression, paranoia, suicidal thoughts and violent thoughts. Mr C complained that he should not have been prescribed the drug in light of his history of mental ill health and that he had not been warned that he might suffer from serious mental change.

After taking advice from one of our medical advisers, we found that Mr C's history of mental ill health was not a reason to avoid the drug, which was a first choice of drug by practitioners in the treatment of HIV because of its effectiveness. We also found that, although healthcare professionals had discussed the main side effects with Mr C, he was not told that he might suffer from serious mental change but we considered this to be reasonable because it was such a rare side-effect. However, we considered that the information provided to patients about the side-effects could be better.

Recommendation
We recommended that the board:
• review the information provided to patients about the potential side-effects of efavirenz.
 

Summary
Mr C complained to us about the board's care and treatment of his late brother (Mr A) prior to his death. Mr A, who was elderly, was due to be admitted to hospital for an endoscopic examination. In anticipation of this, he was given medication the day before, but became very ill and was instead admitted to hospital on the day of the planned procedure, as an emergency. The next day, a Tuesday, Mr A had a colonoscopy and he was then considered ready for discharge in a few days. It was proposed he would be discharged on Friday or Monday, subject to the availability of an ambulance. However, he was returned to his care home by ambulance on the Saturday. Unfortunately, he was returned back to the hospital later that day in a very poor state, and died the next day. Mr C was of the view that his brother was unreasonably discharged from hospital. He also complained that the board's communication with his family was inadequate.

We fully upheld Mr C's complaints. Our investigation showed that there was little information in Mr A's clinical notes and our medical adviser pointed out that nothing at all was noted about his condition on the day that he was discharged. Accordingly, Mr A may well have not been ready and fit for discharge. Similarly, there was very little record of any discussion with Mr A and his family about his care and treatment.

Recommendations
We recommended that the board:
• apologise for the distress caused to Mr C and his brother at the time of Mr A's discharge from hospital;
• formally apologise to Mr C for their failures in communication;
• stress to their staff the importance of effective communication; and
• further review the quality of the content of their clinical notes as they were not held in accordance with relevant guidelines. They should report back to the Ombudsman about the action they take in this regard.
 

Summary
Mrs C complained that when her late husband (Mr C) was being transferred from Ninewells Hospital to his local community hospital his clinical records were not passed on and staff could not administer medication until they received them which was later in the day.

We established that Mr C's records were left in the ambulance and that responsibility for the safekeeping of the records rested with the ambulance service. Our report stated that medical records are important documents and have to be available should clinicians need to review them to obtain details of a patients medical history, medication etc. We were satisfied that in this case the delay was caused by human error. It was discovered shortly after Mr C's arrival that the records were missing and contact was made with the service. They located the records immediately and made arrangements for them to be picked up later in the day and delivered to the hospital. The hospital was content with this arrangement and stated that Mr C was not disadvantaged by the missing records and that he did not require his prescribed medication until after the records had arrived. They also explained that should Mr C have required assistance in the interim period then he would have been assessed by a clinician who would have prescribed appropriate medication if required.

Recommendations
We recommended that the service:
• review their procedures and consider whether measures such as a simple checklist could be completed by staff to ensure that medical records have been collected and delivered when a patient is transferred; and
• apologise to Mrs C for the delay in delivering Mr C's records.
 

Summary
Mr C complained that his GP failed to diagnose rotator cuff syndrome (damage or dysfunction to one of the rotator cuff muscles which are located in the shoulder area) following a number of visits to the practice. This condition was diagnosed after he changed GP practices. He also complained that he was not provided with appropriate advice and care in relation to his shoulder pain, particularly as he felt that his GP had failed to provide him with information about the availability of an NHS physiotherapy drop-in centre and offer him a steroid injection.

However, following advice obtained from our clinical adviser who had access to Mr C's clinical records and information provided by Mr C's GP, we were of the view that the care and treatment options provided to Mr C were appropriate for his condition. Whilst steroid injections and a surgical referral would have been a further option, the decision to suggest physiotherapy initially was reasonable. Had Mr C stayed with this practice it is likely that these further options would have been considered had Mr C's condition not improved. We, therefore, found that the care and treatment provided were appropriate.