Health

Summary
Mr C attended an Accident and Emergency department in October 2009 complaining of pain, weakness and pins and needles in his left wrist. An initial diagnosis of carpal tunnel syndrome, secondary to an underlying arthritis, was made. He was referred for review by an orthopaedic consultant and subsequently to a rheumatologist. It was not until he was seen by a locum rheumatologist in August the following year that he was given steroid injections, which relieved his pain.

Mr C was referred back to the orthopaedic consultant and underwent carpal tunnel decompression surgery in March 2011. He complained about delays to the progression of his treatment, the lack of steroid injections during earlier appointments and the unnecessary pain he had to endure as a result. He also complained that the board took an unacceptable length of time to diagnose a particular infection in his wrist.

We found that Mr C's case was particularly unusual. Separate investigations into a bad cough proved positive for an organism that can cause tuberculosis. As Mr C did not have active tuberculosis at the time, we found the board's decision not to provide treatment to be reasonable. The orthopaedic consultant was concerned that Mr C did not have a straightforward case of carpal tunnel syndrome and carried out exploratory surgery which showed he had inflammation of the lining of the tendons of his wrist which can be associated with tuberculosis. Once this was identified, he referred Mr C back to the chest physician who had investigated his cough. We were satisfied that appropriate diagnostic tests were subsequently carried out. We did not find that the treatment of Mr C's wrist or the diagnosis of his infection were unduly delayed and we did not uphold the complaint.

Summary
Mr C's daughter (Ms A) was admitted to hospital suffering from abdominal pain. A few days later, a scan revealed a large cyst on Ms A's left ovary. The registrar telephoned the on-call duty consultant. They decided to discharge Ms A and to arrange elective surgery at a later date as her condition stabilised and Ms A was told to return to hospital if the severe pain returned. Several days after her discharge, Ms A saw a private consultant who operated and removed a cyst from her left ovary.

Mr C complained that the staffing levels were unreasonable during his daughter’s admission to hospital which meant that she was not reviewed personally by a consultant and that the discharge plan and arrangements were also unreasonable. He said that the failures by the board had put Ms A's life and health at risk.

We found that the staffing levels were reasonable and that the care and treatment Ms A received, including the discharge plan and arrangements, was also reasonable. We found no evidence that Ms A required emergency surgery on her discharge from hospital or that her health or life was at risk at any time.

Summary
Mrs C complained that when she was admitted to a ward at the hospital she initially made progress. However, she became unwell and stated that a nurse’s attitude towards her then became unacceptable. Mrs C stated that the nurse’s attitude was aggressive and frightening in her manner towards her and in how she spoke to her. She also said the nurse treated her cheekily and roughly, pushed her and struck her twice.

Mrs C also stated there were failures in her care at the hospital. This centred round the use, prescription; and monitoring of anticoagulant therapy (warfarin). Mrs C said errors were made that could have had fatal consequences.

After investigating Mrs C’s complaint, we did not uphold that there was any error or omission in Mrs C’s clinical care and we found that the management of the warfarin was entirely reasonable. We also did not uphold any aspect of Mrs C’s complaints about the nurse’s behaviour towards Mrs C as there was no evidence to support her allegations.
 

Summary
Ms C had been on Depo-Provera contraceptive injections for a number of years, from 1994-2002, then from around 2005-2010. In May 2010 she developed back pain and other symptoms which she reported to the GPs at her local surgery. She was given various possible causes but after referral to a dermatologist, rheumatologist and an MRI scan she was eventually diagnosed in February 2011 with a probable chronic syndrome.

Ms C considers that had her contraceptive medication been appropriately monitored she would not have developed the condition ‘SAPHO syndrome’. She also considers that the GPs failed to diagnose her syndrome.

Our medical adviser considered the case and found that the monitoring of Ms C's contraceptive use, particularly in the earlier years had lacked detail. He found that blood pressure monitoring had been sporadic and there was no evidence of systematic review of the method of contraception. The adviser noted guidelines regarding review periods had not been issued until 2004, and that the notes had improved significantly from 2010 onwards – nonetheless the complaint regarding monitoring was upheld.

In relation to investigation and diagnosis, the adviser found the GPs’ actions to be a demonstration of good practice, in that appropriate and detailed referrals to specialist departments were made timeously. The adviser also found the probable syndrome was extremely rare and would not have expected a GP to diagnose it. Finally, no causative link between the contraceptive and SAPHO syndrome has been established. We did not uphold this complaint.

Recommendation
We recommended that the practice:
• apologise to Ms C for failing to monitor her appropriately whilst she was on Depo-Provera.
 

Summary
Mr C, an advice worker, made several complaints on behalf of Mr A. He complained about a delay to remedial hip surgery; that Mr A’s proposed surgery by hospital 1 was blocked by the board; and that misleading and/or inaccurate information about tests resulted in an unnecessary referral to London.

Mr A underwent hip replacement surgery in January 2009 at hospital 1. He later developed a fracture of the neck of the femur and underwent revision surgery at hospital 2. This was known as a ‘metal on metal’ (MOM) hip replacement procedure. Mr A then developed pain in the hip and following a national alert in April 2010 concerning MOM hip replacements, his consultant surgeon referred Mr A to hospital 3 in London for tests to be carried out.

When Mr A was next reviewed by his consultant and informed he required surgery he requested a second opinion. Mr A was then referred to hospital 4 where the board have a service level agreement to provide a number of routine procedures and to assist with waiting times. Hospital 4 was prepared to carry out the necessary surgery. However, the board informed Mr A that due to the nature of the MOM hip replacement procedure his care should, for clinical reasons, remain within their system because hospital 4 is only used for routine procedures and this procedure did not fall into this category. Mr A eventually had further remedial surgery at hospital 2 in April 2011.

We obtained advice from our medical adviser which was that, from a clinical perspective, the timescale within which the surgery was carried out would not have had any clinical bearings on the outcome of the surgery. Therefore, there was no undue delay in Mr A undergoing revision surgery. Therefore, we did not uphold the first complaint.

We upheld the second complaint because our medical adviser considered that Mr A’s surgery was blocked from going ahead at hospital 4 on financial and administrative grounds. Although this was reasonable, the advice we received was that there was no clinical reason for the surgery to have been carried out by one of the board’s hospitals rather than hospital 4.

We also upheld complaint 3 because while we did not doubt that Mr A’s consultant acted with the best of intentions in referring Mr A to a centre of excellence in London, there was no evidence that he was given the alternative option of having his case dealt with in Glasgow, which would have avoided him having to travel to London. We recommended that the board apologise to Mr A for this.

Recommendation
We recommended that the board:
• issue Mr A with an apology for the failure to inform him of an alternative option of having the necessary investigations carried out in Glasgow.
 

Summary
Ms C made several complaints about her dental practice. She complained that her dentist failed to deliver the appropriate treatment and service when she asked him to check on her bridge. She also complained that either the dentist or the dental practice failed to ensure that the dental hospital received her x-rays within a reasonable time, and that the failure to do so led to a delay in her being seen at the dental hospital and so exacerbated the decay in the teeth supporting the bridge.

On investigation we found that the actions of the dentist did not result in the loss of the bridge. The bridge had failed due to Ms C having extensive decay in both supporting teeth. The dentist had provided Ms C with appropriate advice, which was to have a new bridge fitted or otherwise for him to refer her to the dental hospital. Therefore, we did not uphold this part of Ms C’s complaint.

Ms C asked to be referred to the dental hospital. Following the referral, x-rays were required by the dental hospital. However, due to a lack of record-keeping by the dental practice, our investigation was unable to establish what had occurred regarding the taking of the x-rays and when they were sent to and received by the dental hospital. We, therefore, found that the dentist or the dental practice failed to ensure that the dental hospital received the x-rays within a reasonable time and upheld this part of Ms C’s complaint.

We accepted that, as a result, Ms C had to wait a number of months before being seen and given a diagnosis at the dental hospital. While we considered that part of this delay was caused by the dental hospital not having Ms C’s x-rays we also considered that part of the delay was also due to Ms C’s personal circumstances. Furthermore, while the delay caused by the lack of x-rays was unfortunate we considered that it would not have had any effect on the outcome in Ms C’s case and we, therefore, did not uphold this part of the complaint.

Recommendations
We recommended that the practice:
• review their record-keeping so that telephone calls received and made in relation to a patient’s treatment are recorded; and
• review their practices and procedures so as to ensure that a patient’s
x-rays, where appropriate, are sent to and received by the dental hospital.

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.