Health

Summary
Mrs C complained that doctors were insensitive in the way that they told her husband (Mr C) that he had terminal cancer.

We acknowledged that it must have been extremely distressing for Mr C to receive the news that he had terminal cancer, particularly as this was the only hospital appointment that he attended alone. However, our medical adviser said that it was appropriate to be frank and open in such circumstances. We found no objective evidence that doctors were insensitive in the way that they communicated Mr C's prognosis to him.

Summary
Mr C first visited his GP in September 2009 with pain and swelling in his testicles and was referred to the urology team at the Western General Hospital. He was placed on a waiting list for treatment. He was seen in January 2010 by two specialists who could not agree a diagnosis and referred for a scan which was done in February. In March he was seen by another urologist and told that his problem was not a urology one. Mr C was referred back to the general surgical department and in April 2010 he received a letter telling him that he was on the waiting list to see a consultant.

Mr C telephoned the department to complain about this further delay but was told that nothing could be done. Mr C was seen in July 2010 in the colorectal department and referred for an MRI scan. He was seen again there in September 2010 and a hernia was diagnosed. Mr C was told that due to his other complex health difficulties, the remedial surgery he required would have to be done at another hospital by a specific surgeon. Mr C was seen there in November 2010 and had his surgery in January 2011. Mr C was dissatisfied with the wait for surgery which totalled some 64 weeks and the resultant increase in pain and discomfort he had to endure.

We upheld Mr C's complaint. We found that his wait for surgery had been excessive. There were a number of things that could have been done differently which would have reduced his waiting time. A CT scan was first considered in March 2010, but was not performed until August 2010. Mr C was reviewed by two registrars, who could have discussed his case with a consultant, given there were clear diagnostic difficulties. It was not until November 2010, over a year after Mr C had first been referred, that a consultant took responsibility for the management of his care. We also found the board's responses to Mr C's letters of complaint to be insufficient.

Recommendation
We recommended that the board provide a full apology to Mr C for the delay he experienced when waiting to undergo his operation.

Summary
Mr C complained about the treatment he received from the board for two hernias. He said that a surgeon failed to correctly interpret his scan results, as he failed to identify one of the hernias. However, we found that the surgeon had interpreted the scan correctly and had identified the second hernia. Mr C also complained that the surgeon said that he would be contacted in a week's time about another appointment, but there was then a ten-week delay in providing him with an appointment.

There was no evidence that the surgeon told Mr C he would be contacted in a week. The surgeon had recorded that he would discuss the scan with radiologists and one of his colleagues who specialised in abdominal wall repair. He also said that Mr C should continue to try to lose weight to improve the chances of repairing the hernias. In view of this, we found that the ten-week gap between his appointments was reasonable.

Mr C then cancelled the appointment due to work commitments. He complained about the board's delay in arranging a further appointment. We found that four and half months was too long for him to wait for another appointment and upheld his complaint about this delay.
 

Summary
Mr C complained to the practice that his late partner (Ms C) had attended there on numerous occasions between November 2010 and March 2011 with respiratory problems. The practice referred Ms C to hospital for x-ray and to the spirometry clinic (where tests for lung conditions are carried out). Ms C was admitted to hospital in early March 2011 where cancer was diagnosed and she died later that month. Mr C's complaint was that there had been a delay in his partner's diagnosis.

Our investigation found that doctors from the practice had taken Ms C's symptoms seriously and arranged appropriate investigations and hospital referrals in an effort to establish a diagnosis. Independent medical advice that we took concluded that the early differential diagnosis of Chronic Obstructive Pulmonary Disease was reasonable and that there was no evidence of any 'red flag' symptoms which would have pointed to cancer as a likely diagnosis.

Our clinical adviser also examined the x-ray image which was taken in January 2011 and found that it was appropriately reported as normal. We, therefore, were satisfied that the care and treatment provided to Ms C by the doctors was reasonable.
 

Summary
Mr C complained to the board about the treatment provided to his late partner (Ms C) at a hospital in the board area. Ms C was admitted in early March 2011 and died later that month. Shortly after admission the family were told that Ms C's condition was serious. They were concerned that although in the last year of her life Mrs C had numerous tests and x-rays nobody had noticed that she had two tumours growing in her body. In particular, Mr C wanted to know why an x-ray taken in January 2011 did not ring alarm bells.

Our investigation established, however, that Ms C received appropriate investigations in hospital and that there was no evidence of any delay in her treatment. Our clinical adviser examined the x-ray image which was taken in January 2011 and found that it was appropriately reported as normal.
 

Summary
Mrs C attended her GP in January 2010 complaining of abdominal pain. She complained that from then until November 2010 when she was diagnosed as having intra-abdominal cancer, her GP practice failed to either act upon her symptoms or treat them appropriately.

Our clinical adviser found that Mrs C had significant, persistent symptoms which appeared to become worse despite a number of medications related to the gastrointestinal tract. In the adviser's view, this should have prompted a review of the diagnosis especially in the presence of a normal upper abdominal ultrasound and normal endoscopy and sigmoidoscopy (a procedure used to see inside the sigmoid colon and rectum). The adviser added that Mrs C's communications with the practice were clear and concise and that her requests for assistance were specific. Accordingly, the adviser concluded that the management of Mrs C was deficient and we upheld the complaint.

Recommendations
We recommended that the practice:
• formally apologise to Mrs C for their oversights in her management and perform a Significant Event Audit; and
• ensure that the GP discusses this case at their next appraisal.
 

Summary
Mrs C complained on behalf of her husband (Mr C) about the care and treatment he received from his medical practice in relation to abdominal pain. Mr C had been suffering from constipation for several months. A GP visited Mr C at home as he was unable to attend the practice because of the pain. Mrs C called the practice several times shortly after the home visit, telling two GPs that Mr C's condition was not improving despite intervention from the district nurse and treatment for constipation. The practice did not, however, arrange a further home visit during the telephone calls.

Mrs C telephoned NHS 24 and an out-of-hours GP examined Mr C and arranged an emergency admission to hospital. Mr C had an operation on the day of his admission given the seriousness of his condition. He had peritonitis and a large inflammatory mass related to the large bowel. His recovery was traumatic and he continues to experience significant health problems and chronic pain. Mrs C said that if the practice had properly followed up their initial home visit, Mr C would have been admitted to hospital earlier and might not have been so severely ill. She felt that his continuing significant health problems and chronic pain could also have been avoided.

We found that the information available to the GPs from the telephone calls and the district nurse should have prompted them to reassess Mr C in person and examine him. Having said that, our medical adviser said that it was not certain that the deterioration in Mr C's condition would have been picked up by clinical examination or whether it would have made any difference to the outcome. A home visit could, however, have improved the chances of a better outcome for Mr C. The practice have already recognised that there were failings and have taken some action to address these.

Recommendations
We recommended that the practice:
• review their processes around telephone consultations and report to the Ombudsman on the outcome of the review and the related training (that they have already planned); and
• review their management of diverticular disease.
 

Summary
Ms C, an advice worker, complained on behalf of Mrs A, whose husband (Mr A) was admitted to hospital in November 2009 due to depression and suicidal feelings. While he was in hospital, Mrs A and her husband found the staff's attitude to be poor. They also felt that there was a lack of support around the time of his discharge home. Some ten months later, Mr A was diagnosed with a rectal tumour. Ms C complained that staff at the hospital did not carry out investigations when Mr A advised them of rectal bleeding and changed bowel habits during his admission.

We found that there was insufficient evidence to confirm whether Mr A raised these concerns with staff during his stay. We were concerned, however, with the arrangements for his discharge and follow-up treatment and found that additional support to carry out day-to-day tasks could have been provided during his stay.

Recommendation
We recommended that the board:
• review their handling of Mr A's discharge and take steps to ensure future compliance with the guidance in the Scottish Government's Best Practice Template - 'Admission, Transfer and Discharge Protocol for hospital patients in Scotland.'
 

Summary
Mrs C's husband (Mr C) was admitted to the emergency department of a hospital suffering from severe, sudden headaches and vomiting. He was seen by a doctor about four hours later. He lay in the bed for a further few hours before being taken for an x-ray and admitted to the acute medical unit. The following day, Mrs C called the acute medical unit and was told that her husband had pneumonia, which was incorrect. A scan, also undertaken that day, showed that Mr C had a sub-arachnoid haemorrhage. As soon as the results of the scan were known, he was taken to the neurosurgical unit where further tests were carried out.

Mrs C complained on behalf of Mr C about the delay in providing appropriate care and treatment to Mr C following his admission and that the acute medical unit gave her incorrect information about Mr C's condition when she contacted them.

The board had already acknowledged, in responding to Mrs C's complaint, that there was an unacceptable delay in providing Mr C with appropriate care and treatment and that incorrect information had been given to Mrs C about her husband's condition. The board's local protocol on the management of sudden onset headache also made clear that it was important that scans were undertaken as soon as possible when a sub-arachnoid haemorrhage is suspected.

The board had already taken action following Mrs C's complaint. In particular, they had apologised unreservedly for the delay Mr C experienced and that Mrs C had been given incorrect information when she called. The board also provided their action plan following Mrs C's complaint, which included a summary of learning and improvements. The learning points identified included both a specific and general reminder to staff to organise investigations promptly and the importance of giving accurate and correct information to relatives about a patient's condition. The complaint had also been discussed with the doctor concerned. We commended the board for the action they had already taken following Mrs C's complaint and had no recommendations to make.
 

Summary
Mrs C complained to the board about the treatment her late father (Mr A) received at Inverclyde Royal Hospital from the end of January 2011 until his death in early March.

The complaints included that Mr A had received a lack of continuity of care and treatment; poor communication between staff and the family; a general staff failure to recognise and address Mr A's pain; and poor record-keeping. Our clinical adviser examined Mr A's cardiac history and found that the care and treatment that had been provided was appropriate. The investigation also estabished that communication with the family was appropriate, Mr A's pain was recognised and addressed and we found no evidence that the standard of record-keeping was inadequate.