Health

Summary
Mr C contacted his dental practice to bring forward an appointment for treatment. He was told by the practice manager that no earlier appointments were available. He asked to speak to a dentist but was told that none were available. The conversation became heated and the manager terminated the call.

Mr C and his wife visited the practice and were met by the practice manager who they claimed was rude and aggressive. They raised a complaint with a dentist but did not feel that he listened to their concerns. During their exchanges with the dentist and the practice manager, their relationship with the practice broke down to the extent that Mr C asked to be removed from the patient register.

Mr C complained about the practice's handling of his request for an earlier appointment and his subsequent complaint. He also complained that the practice manager was rude and aggressive during telephone calls with him. We did not find that the practice failed to deal appropriately with his appointment request or his complaint. Whilst there was corroborating evidence of the comments made by the practice manager, we were unable to conclude that she acted aggressively or rudely toward Mr C or his wife.
 

Summary
Mrs C told us that she accompanied her daughter to the medical centre to see a doctor, as her daughter had suffered an allergic reaction to silicone. An incident occurred within the premises. Mrs C's daughter was subsequently removed from the practice list for inappropriate violence and abuse towards staff.

Differing accounts of what happened have been given by Mrs C and her daughter compared with those of the practice nurse and practice manager. Mrs C wrote to one of the doctors saying that her daughter had not been abusive towards staff and asked that she be allowed to re-register. After the medical centre cancelled a meeting to discuss Mrs C's concerns, she made a formal complaint to the board as she was concerned that the medical centre were not interested in resolving the issues she had raised. The board explained to Mrs C the complaints process for family health services and acted as an intermediary between her and the medical centre.

The complaint we investigated was about the way that staff treated Mrs C's daughter on the day she attended the practice, and the way in which the medical centre handled the complaint. We found that there was insufficient evidence to support the complaint that staff had mistreated her daughter. However, we established that the medical centre did not respond to the complaint in full in good time, and we concluded that there was evidence of poor complaints handling.

Recommendations
We recommended that the practice remind staff dealing with complaints to:
• respond to all the issues raised and ensure that the letter is clearly addressed, dated and contains relevant information on who has carried out the investigation and issued the letter; and
• respond within the time frame set out in the guidance document 'Making a Complaint about the NHS'.
 

Summary
Mrs C complained about the care and treatment that her late husband (Mr C) received from the board's out-of-hours service and in hospital. Mrs C said the response from the out-of-hours service was inappropriate, as the attendant arrived without batteries and sterile gloves and asked her to provide these. Mrs C also said she was refused an ambulance, and so took Mr C to hospital in her car. As there were no independent witnesses to the out-of-hours service's visit to Mrs C's home, we could not prove what took place. Therefore, in the absence of any direct objective evidence, we did not uphold this complaint.

Mrs C said the board failed to diagnose and treat her husband. We found from looking at the clinical records and after taking advice from one of our medical advisers that, although there were issues with a delayed gastroscopy and poor recording and communication about Mr C's' mobility, we could not conclude that the board failed to diagnose and treat him. We did not, therefore, uphold this complaint, although we made a recommendation related to it.

Mrs C said the board failed to record and/or pass on Mr C's wishes about resuscitation, and that Mr C was later resuscitated after a collapse. The board appeared to accept Mrs C's account that she was not given an indication that Mr C was ill enough for her to advise hospital staff of his wishes about resuscitation. However, when she felt his condition had deteriorated, she told a nurse, although the nurse did not record this or pass the information to medical staff. The board said there would be a review and confirmed to our office that nursing staff had been spoken to. As Mrs C's evidence was not disputed, we concluded that the board failed to record and/or pass on her husband's wishes about resuscitation and upheld this complaint.

Mrs C said the board provided poor general care. We found from looking at the clinical records and taking advice from one of our medical advisers that, while it was clear that the events of Mr C's final days were deeply upsetting for Mrs C and her family, we could not conclude that the board provided poor general care to Mr C. We did not uphold this complaint.

Mrs C said there was poor communication from staff to her and her husband. We found there had been failings in communication and we upheld this complaint.

Finally, Mrs C said the board failed to order a post mortem to confirm the cause of death. We found from looking at the evidence, and taking advice from one of our advisers, that medical staff were confident of Mr C's final diagnosis and, therefore, there was no need for a post mortem. Our adviser agreed with this, in terms of Crown Office and Procurator Fiscal Service guidance and the clinical records. However, our adviser's view was that it was inappropriate for medical staff to presume what Mr C's wishes regarding a post mortem might have been, and that it would have been reasonable for them to have offered Mrs C the option of a hospital post mortem. However, as there was no requirement for the board to order a post mortem to confirm the cause of death in this case, we did not uphold the complaint.

Recommendations
We recommended that the board:
• ensure that clinical records document a patient's mobility, and that such information is communicated to relatives/carers on discharge;
• review their threshold for initiating discussions with patients/carers about resuscitation, given the record of a 'guarded' prognosis in this case; and
• review their practice on when a hospital post mortem should be offered to relatives/carers.
 

Summary
Mrs C was admitted to hospital for removal of her ovaries. Complications arose which resulted in an extended stay in hospital. Mrs C complained that the board failed to provide appropriate care and treatment during the first five months of her stay in hospital, which included an injury to her bowel leading to a colostomy, as well as septicaemia, pneumonia, kidney failure and becoming infected with clostridium difficile. Mrs C also complained that for over a year the board failed to disclose to her that an ovary had adhered to her bowel.

Although there is no question that Mrs C suffered serious consequences as a result of the injury to her bowel, resulting in an extended stay in hospital and the need for ongoing care and treatment, we did not uphold the complaint about care and treatment. We found from looking at the medical records, and taking advice from two of our medical advisers, that it was not possible to say definitively how the bowel injury was caused, but it was a recognised complication of abdominal surgery.

Both advisers said it was unlikely that the injury, as the cause of Mrs C's symptoms, could have been identified sooner, and they were satisfied that the board provided reasonable care and treatment. We did, however, conclude that medical records could have been clearer. There was no documentation in the medical records to confirm that Mrs C was given an explanation of the procedure used during, and the findings and outcomes of, the surgery to remove her ovaries. There was no evidence that this information had been deliberately withheld, but the lack of records was not in keeping with the General Medical Council's Good Medical Practice guidance. Given this, we could not conclude that Mrs C was provided a clear and consistent explanation of events and, therefore, we upheld this complaint.

Recommendations
We recommended that the board:
• apologise to Mrs C for their failure to provide a clear and consistent explanation of events;
• remind medical staff in the hospital of the need to maintain clear and thorough medical notes, in line with Royal College of Physicians' guidelines on standards for medical record-keeping; and
• remind medical staff of the importance of recording details of explanations given to patients, in line with the General Medical Council's Good Medical Practice guidance.
 

Summary
Mr A was an elderly man with a history of hypertension, aortic aneurism, and chronic kidney disease. Mr A fell while crossing the road and was taken by ambulance to hospital, where he stayed for several days. He was discharged but remained unwell and was admitted again a few days later. He was discharged after several days. Mr A remained unwell and was admitted to another hospital about three weeks later, where he died after three days. His daughter (Mrs C) complained that the care and treatment her father received during and between his second and third admissions was inadequate, that her concerns and information she provided were not recorded or reasonably acted upon during his second and third admissions, and that the board's complaint handling was poor.

Having looked at the clinical records and taken advice from two of our medical advisers we found that Mr A's care and treatment appeared, overall, to have been reasonable. However, we upheld Mrs C's complaints. We identified a number of failings in relation to obtaining Mr A's first admission records, prescribing antihypertensive medication, communication about drug treatment and discharge planning. We also found that the board had acknowledged that information provided by Mrs C was not always recorded.

In addition, our advisers found only limited evidence of communication being recorded, which was below a standard that could reasonably be expected. We also found that, although it was reasonable for the board to have asked different clinicians for their views of Mr A's treatment, more could have been done to integrate their views into a coherent response to Mrs C's complaints. The board should have explained in advance of a meeting with Mrs C why staff responsible for the administration of records were not included, despite Mrs C having asked for them to be present. The note of the meeting should have been checked more carefully to ensure that the correct names were used, as Mr A's name was wrong in two places. In the board's response to Mrs C's final complaint, they should have provided more information about what was done to address the issues raised about Mr A's third admission, and they should have openly acknowledged their failings in handling Mrs C's complaint.

Recommendations
We recommended that the board:
• review their procedure for urgently obtaining clinical notes of patients re-admitted, to reduce the opportunities for the procedure to fail;
• review this case to improve practice on prescribing antihypertensive medication in such circumstances;
• review this case to improve practice on communicating between community and hospital care about drug treatment, and recording such communication in the clinical record;
• review their discharge policy, to ensure it complies with national guidance and that staff act in line with it;
• apologise to Mrs C for staff failing to communicate with her to a reasonable standard about Mr A and for failing to deal with her complaint appropriately; and
• review how they draft responses to complaints, to ensure these are coherent and transparent.
 

Summary
Ms C complained on behalf of her late mother (Mrs A) about the care and treatment that she received from her GP practice. Mrs A attended the surgery for a period of two years with repeated complaints of breathlessness, pain in the back and rib cage, and a cough. She made the practice aware of a family history of lung disease and lung cancer. She was treated for numerous chest infections but received little or no relief from her symptons. Mrs A's condition deteriorated and she was admitted to hospital and diagnosed with terminal cancer of the lung, liver and upper chest. Mrs A died shortly after. Ms C complained that the practice failed to properly investigate Mrs A's symptoms within a reasonable time and that they failed to suspect her condition and refer her to hospital within a reasonable time.

We found that the practice carried out reasonable investigations, but that they should have had a high index of suspicion of lung cancer given Mrs A's strong family history and that she was previously a heavy smoker. Our medical adviser said that the practice should have considered referring Mrs A to a respiratory specialist when her respiratory symptoms had persisted for more than six weeks and were unexplained. However, we also found that even if the diagnosis had been made sooner, this was unlikely to have affected the outcome because Mrs A probably had a non-curable disease at presentation. Having said that, an earlier diagnosis might have improved her quality of life because it would have allowed treatments to be explored that might have alleviated some of her symptoms.

Recommendations
We recommended that the practice:
• undertake a significant event audit and review their practice on management of respiratory symptoms to ensure that they refer for specialist advice within a reasonable time; and
• apologise for the failures identified.
 

Summary
Mrs C complained to the practice about the treatment that they provided to her late husband (Mr C). Mr C had attended various GPs at the practice between November 2010 and February 2011 with a persistent cough, breathlessness, loss of appetite and severe weight loss. Mrs C also spoke to the GPs and expressed her fears that Mr C was dying of lung cancer as she had experience of nursing both her mother and mother-in-law through the disease. The GPs told Mr C that he 'definitely did not have cancer'. Mr C was eventually referred to Ninewells Hospital where following various investigations he was diagnosed with lung cancer. He was transferred to a local community hospital where he died two weeks later.

Mrs C complained that the practice's failure to investigate fully her husband's symptoms led to a delayed diagnosis of lung cancer. Our clinical adviser, however, found that the doctors at the practice had carried out appropriate tests in an effort to reach a diagnosis and made appropriate specialist referrals where required. Our adviser found that the initial working diagnosis of lower respiratory tract infection was reasonable and that when the symptoms did not improve specialist hospital referral was instigated which initially indicated that a diagnosis of malignancy was less unlikely. The adviser explained that lymphagitis carcinomatosis is a relatively uncommon presentation of lung cancer and more so in the case of Mr C who was a non-smoker.

Mrs C also complained that the practice failed to take into account her concerns about the seriousness of her husband's condition. However, our investigation found evidence that the doctors had taken on board Mr C's reported symptoms and had noted Mrs C's concerns and did not dismiss them.
 

Summary
Mrs C made a number of complaints about the care and treatment that her late husband (Mr C) received from his medical practice before his death from cancer. She complained that the practice failed to diagnose her husband's illness and order appropriate tests within a reasonable time, or to chase up the result of the tests. We took advice from our medical adviser, and found that it was in fact appropriate for the practice to refer Mr C to a specialist in order that the specialist could carry out further tests. The practice made an urgent referral, which was sent the day after Mr C attended the practice. In addition, there was no evidence that the practice were subsequently asked to chase up the results.

Mrs C also complained that the practice failed to refer her husband to hospital when he was severely dehydrated. We found that the practice had failed to carry out a reasonable clinical assessment. They had also failed to assess Mr C for hydration. We upheld the complaint as, based on the inadequate assessment, it was not possible to say whether Mr C was dehydrated or whether he should have been admitted to hospital.

In addition, we found that the practice should not have told Mrs C that she would be able to accompany her husband in the transport that they booked for him to attend hospital to get his results. The practice could not guarantee this, as space is limited when patients are being transported. We upheld the complaint, as the practice should have told Mrs C this, although we noted that they had already apologised to her for their failure to make her aware of this.

Mrs C also complained that the practice failed to provide palliative care to her husband or to offer any information about palliative care nursing. We found that the deterioration in Mr C's condition was extremely rapid, and that it would have been difficult to foresee this. We were satisfied that the practice's attempts to provide palliative care and to offer information during the short period from confirmation of his terminal diagnosis to his admission to hospital were reasonable. We also noted that the practice had taken steps to improve their delivery of palliative care.

Finally, Mrs C complained that the practice failed to show an appropriate degree of compassion throughout Mr C's illness by making inappropriate and insensitive comments. In response to her complaint about this, the practice said that part of their role in such situations is to be open, honest and realistic. Although we understood why Mr and Mrs C might have found the comments distressing, we did not find them inappropriate.

Recommendations
We recommended that the practice:
• make relevant staff aware of the need to undertake proper clinical assessment where appropriate; and
• draft a protocol for patient transport.
 

Summary
Mrs C, an advice worker, complained on behalf of Mr A about the care and treatment that his late wife (Mrs A) received in hospital. Mrs A was admitted in late October and discharged two days later with a diagnosis of oesophageal cancer. She was readmitted in November but died six days later. Mr A had concerns that his wife was discharged prematurely and that her hydration had not been maintained. He also felt staff had not been aware that she had a bowel blockage; did not take into account the possibility of sepsis; were not aware that she had been taking thyroxine; and that inappropriate arrangements had been made for her discharge.

We did not uphold the complaints as, after taking advice from our medical adviser, we found that the care and treatment that was provided to Mrs A during both admissions was appropriate. However, we noted that as a result of the complaint the board enhanced the role of the senior charge nurse endoscopy service to provide support for patients diagnosed with upper gastrointestinal cancer and introduced a checklist to improve record-keeping.
 

Summary
Mrs C complained that the clinicians at Ayr Hospital provided inadequate treatment to her late sister (Mrs A) who required cardiac surgery, and that Mrs A should have been transferred to The Golden Jubilee National Hospital for urgent surgery at an earlier date. She also raised issues about poor communication with the family and the way in which the board handled the complaint. After taking advice from one of our medical advisers, we established that Mrs A received appropriate treatment. We also found that the level of communication and complaints handling was adequate.