Health

Summary
Mr C complained about the care and treatment that his 17-year-old nephew (Mr A) received from the board before his death from sudden unexpected death in epilepsy (SUDEP).

Mr A had had a suspected seizure and had seen a consultant at the board's 'first seizure clinic'. The consultant said that Mr A might have had a seizure, but needed more information. He provided Mr A with his contact details and suggested that Mr A contact him again after obtaining a phone number for a witness to the event, so that the consultant could speak to them about it. Mr C said that Mr A was not aware of the significance of not obtaining a phone number for this person. He complained that after Mr A's appointment there was no proactive follow-up by the first seizure clinic.

Our medical adviser said that it is not standard practice to provide follow-up appointments following a first seizure clinic, as in many cases it will be unnecessary. Treatment is not given if there is no immediate reason to believe that another event will happen. The patient should contact his or her GP if any subsequent suspicious event occurs. Follow-up and treatment will start if considered appropriate. In Mr A's case, the consultant tried to obtain a first-hand witness account to help him decide on this, but could not do so. We, therefore, found that the consultant's actions were reasonable.

Mr A was subsequently admitted to hospital after collapsing. Guidance from the Scottish Intercollegiate Guidelines Network (SIGN) on epilepsy (SIGN 70) says that the diagnosis of epilepsy should be made by a neurologist or other epilepsy specialist. Mr A was given a provisional diagnosis of epilepsy by a general physician at the hospital, referred to a neurologist, then discharged. Mr C complained that the board failed to involve Mr A's parents in discussions about his diagnosis, treatment and advice before he was discharged.

Our medical adviser said that once over the age of 12, the law assumes that a person can make their own decisions about their health care unless there is evidence to suggest they cannot. Health workers are not usually allowed to tell such a patient's parents anything unless the patient has agreed to this. Mr A was aged 17 at the time. Unless the board had evidence to suggest that he could not make his own decisions about his health care, they were not required to involve his parents in discussions about his diagnosis, treatment and advice. Mr C also complained that Mr A was discharged from hospital with no verbal or printed information about epilepsy. He said that no individual or personal assessment was undertaken of Mr A's circumstances and no information was provided about SUDEP.

In general, patients should be fully informed about the risk of any condition and its treatment. Although death from SUDEP is rare, most patients should be given information about it at some point soon after a diagnosis of epilepsy has been made. This will help patients to understand the issue and put it in perspective. However, detailed information about epilepsy and the risk of SUDEP should be provided as part of comprehensive counselling about risks and prevention. This should be provided by or arranged by neurologists after a definitive diagnosis of epilepsy has been made. Mr A had not seen a neurologist.

Mr C complained that the board had delayed in arranging an appointment for Mr A with a neurologist. The appointment arranged for Mr A was some 17 weeks after he was discharged from hospital. Mr A died before the appointment. Although we did not uphold Mr C's other complaints, we upheld this one as we found the delay unacceptable. Our medical adviser pointed out, however, that the risk of SUDEP cannot be eliminated and it is not possible to say that an earlier appointment at the neurology clinic would have prevented Mr A's death.

Recommendations
We recommended that the board:
• issue an apology to Mr A's parents for the delay in arranging an appointment for him with a neurological consultant; and
• take steps to ensure that patients who have been given a provisional diagnosis of epilepsy are seen by specialists as soon as possible so that a definitive diagnosis can be made and, where appropriate, detailed and specific information can be given.
 

Summary
Mrs C said that for eleven years she had been prescribed MST (morphine sulphate based medication) but had received a letter from her medical practice saying that the drug would no longer be prescribed. Mrs C complained that she had asked for the decision to be reconsidered but was told it was final. Mrs C said that because of the decision to stop her prescription she suffered very badly from withdrawal symptoms.

As part of our investigation, we discovered that the medical practice had received anonymous information alleging that Mrs C was selling her MST tablets. Because of this the practice requested a toxicology report on a urine sample. This did not show the presence of opiates and so the medical practice considered that it was reasonable to stop prescribing them. As it appeared that Mrs C was not taking the MST prescribed to her, the practice also considered it unlikely that she would have suffered withdrawal symptoms. We did not uphold the complaint but we made a recommendation to the practice.

Recommendation
We recommended that GPs at the practice:
• in future similar cases should seek patient consent before a toxicology screen is requested.

Summary
Mrs C’s two-year-old daughter was diagnosed with hip dysplasia. Mrs C felt that her GP should have diagnosed this sooner. She complained that the GP had not properly carried out developmental examinations of her daughter during the first year of her life. The board told Mrs C that the GP had reviewed her computer records and felt that they contained a reasonable level of detail for such an examination. No abnormality had been observed. They said that the GP’s usual practice would be to properly examine a baby at such an examination and that hip dysplasia can be difficult to detect in the early stages. The GP apologised for not having written in the parent-held medical records.

Mrs C, however, was dissatisfied that the board had not presented evidence that usual and proper procedures had been followed. She was concerned that the clinician had not noticed the extra skin crease and leg length discrepancy that she believed had always been present. She was also concerned that the board do not carry out further tests on older babies if hip dysplasia is difficult to detect in early stages. She recalled that her older daughter had had an examination at 8-9 months. The board said that records showed that Mrs C’s daughter’s hips were examined at birth and at six weeks, and that these examinations were properly recorded. They advised that the 8-9 month examination was discontinued in 2005, after the introduction of new guidelines. Mrs C was dissatisfied with this response and brought her concerns about the board’s complaint handling to us. We found that the board had not reasonably considered Mrs C's complaints, as they based them only on the GP's recollections. Given this, we upheld Mrs C's complaint.

Recommendation
We recommended that the board:
• apologise to Mrs C that their handling of her complaint was not reasonable.
 

Summary
Mrs C complained to us about aspects of her care and treatment by a hospital gynaecology department. We did not investigate the complaint as we decided it was out of our jurisdiction under Section 7 of the Scottish Public Services Ombudsman Act 2002.
 

Summary
Mr C complained on behalf of his daughter (Miss A) who attended her medical practice about a rash on her head. He said that she did not complain during her appointment of migraine or any kind of headache. At that time, Miss A was in the process of applying to join the Army and has since been told that she has been rejected on medical grounds due to her history of migraine.

Miss A said that the GP erroneously noted on her records that migraine was discussed at the consultation, and this caused the Army to reject her. The GP maintained that the note she made at the time was correct and that she completed a medical form she was sent by the Army properly, as she was required to do.

Our investigation showed that there was no evidence to suggest that the note recorded by the GP was incorrect. Further, the GP complied with the guidance she had been sent by filling out the form and making reference to a history of migraine. Our medical adviser confirmed that Miss C's medical records show that she did have a history of migraine, which the GP was bound to disclose.
 

Summary
Ms C was admitted to hospital after a colonoscopy to remove a polyp from her bowel. She was discharged and a further diagnostic appointment was made for some months later. A flexible sigmoidoscopy was to be carried out at that appointment to check for other polyps, and she was advised to take laxatives before attending, to reduce faecal matter. At the appointment, however, she was told that the procedure could not be fully completed due to 'faecal loading'. Ms C was told that she would have to wait 12 months for another appointment. She complained about the nursing care that she received during her stay in hospital and that there was confusion prior to her diagnostic appointment as to what procedure she had been booked for. She also complained that she was prescribed insufficient laxatives, that her procedure was unnecessarily delayed and that the board proposed insufficient follow-up action.

We found the nursing care during Ms C's initial hospital admission to be poor. Her fluid intake was not properly monitored and failed attempts were made to catheterise her, causing her discomfort, when there was no clinical need for this. Although Ms C was given incorrect verbal information about the further procedure, we found that the correct procedure had in fact been booked. The board confirmed that the procedure was delayed, but we were satisfied with their explanation that this was due to the urgent clinical needs of other patients.

We found the prescription of laxatives to be appropriate and, whilst faecal loading prevented a full inspection of the colon, our medical adviser confirmed that the consultant was able to see enough to confirm that no further sinister polyps were present. As such, further review in 12 months was considered appropriate, although the board did not explain this clearly to Ms C.

Recommendations
We recommended that the board:
• use this complaint to remind staff of the importance of accurate recording in records including recording of dignity issues; and
• apologise to Ms C for the failings identified regarding record-keeping, catheterisation, and the fact that their initial response to her complaint did not adequately address concerns about the outcome of her sigmoidoscopy.
 

Summary
Miss C complained about the care and treatment of her elderly mother (Mrs C) in hospital, as well as Mrs C’s treatment at the clinics she had been attending. Mrs C was admitted to hospital after collapsing. She had type II diabetes and kidney failure. She was assessed with low blood pressure and a reduced heart rate and spent several days in a high dependency unit before being transferred to a general ward. Miss C felt that her mother was moved to the general ward too quickly, and was not properly assessed.

We did not uphold Miss C's complaints. We found that clinical involvement in her mother’s care did not change at all when she was moved to the general ward, and that the transfer was reasonable. We noted that Miss C and her family could have been advised more fully about the difference in nurse to patient ratio once her mother was moved from the high dependency unit. Miss C was unhappy, too, with staff communication with her, her mother and her family. She told us that when her mother’s condition changed, staff did not contact her and she only found out when she telephoned the ward. Our investigation established that Mrs C’s condition began to deteriorate about an hour before Miss C’s call and that staff were engaged in treating her mother during that time. The board have, however, since raised with staff the issue of timely communication with family members.

Miss C complained about the discussions staff had with the family about Mrs C’s continued care after she had a heart attack. Miss C felt the clinical staff were allowing her mother to die rather than help her. We found that the clinical decisions taken were appropriate and that staff discussed decisions (such as the discontinuation of dialysis) with the family regularly and sensitively. Miss C also said that no-one helped her mother to eat or drink. We found, however, that staff assessed Mrs C’s requirements when she was admitted to the general ward, and decided that she did not need such assistance. The board also provided us with a detailed and reasonable explanation about Mrs C’s fluid requirements, which we passed on to Miss C in our decision letter.

Finally, Miss C complained about Mrs C’s treatment at the renal and diabetic clinic prior to her admission to hospital. Because Mrs C’s insulin dose was significantly reduced on admission, her daughter was concerned that the clinic had been overdosing her mother. We found, however, that Mrs C’s dosage prior to admission was appropriate. When she was admitted, Mrs C’s blood sugar levels were low because of a deterioration in her kidney function, which is why the dosage was changed.

Summary
Mr C is registered as having welfare power of attorney for his mother (Mrs C) who suffers from dementia. Mr C was concerned that a district nurse obtained his mother's signature on a 'Consent to Share Information Form'. This form, when completed, allows relevant public care and support agencies to share information regarding the care and support they provide to an individual.

Mr C complained to us that it was inappropriate for the district nurse to ask his mother to sign this form and that, when he complained about this to the board, they failed to respond appropriately to his complaint. We agreed with Mr C that the district nurse should not have asked an elderly lady with dementia to sign the consent form. As the board had already accepted that this should not have happened, discussed the issue at a team meeting and issued an apology to Mr C, we did not, however, make any recommendations. We did not agree that the board failed to deal with his complaint appropriately.
 

Summary
Ms C complained about the treatment her sister (Mrs A) received following a fall. Mrs A suffered from early onset Alzheimers disease and fell at home injuring her face and chest. She attended an Accident and Emergency unit (A&E) but was discharged without having had x-rays or a CT scan. Ms C complained about what she saw as inadequate investigation of her sister's injuries and a lack of timely pain relief or follow-up treatment. She also complained about the board's complaints handling and the fact that Mrs A was denied access to the Falls Team because she was under 60 years of age, which was apparently the minimum age to be able to access this service.

After taking advice from one of our professional medical advisers we upheld all of Ms C's complaints. Although our adviser confirmed that x-rays and a CT scan were not in fact necessary, we found the board's investigation of Mrs A's injuries inadequate, as they did not follow national Scottish Intercollegiate Guidelines Network (SIGN) guidance on the observation of head injuries. We also found that the board's policy was in fact to allow patients under the age of 60 to access the Falls Team if this was clinically indicated. The policy, however, was not followed on this occasion. We found that the discharge planning process was inadequate and that there were inaccuracies in the board's response to Ms C's complaint.

Recommendations
We recommended that the board:
• apologise to Mrs A's family for the delay in providing her with appropriate pain relief;
• remind staff in A&E of the need to both establish and adequately record the criteria for discharge following head injury contained in SIGN Guidance 110; and
• re-emphasise to complaints handling staff the importance of having an informed clinical review of complaints responses before they are issued.
 

Summary
Ms C complained about the treatment that her young daughter (Ms A) received from GPs at her local medical practice. In particular she felt the GPs delayed in taking action on Ms A's high cholesterol level and that at two appointments a GP failed to treat Ms A's symptoms of cough and explosive diarrhoea.

We found that at the time of the high cholesterol reading, Ms A was under the care of hospital clinicians, and as such they, rather than the GP, were responsible for monitoring this and deciding if treatment was appropriate. On the failure to take action in relation to Ms A's cough and explosive diarrhoea, after taking advice from one of our medical advisers, we found that clinically the actions of the GP were reasonable, although there were clearly communication difficulties between Ms C and the GP.

Our investigation also noted that there were concerns about the way the medical practice handled the complaint and, although we made no recommendations, we reminded them of their responsibilities under the NHS complaints procedure.