Health

Summary
Mr A was referred by his GP to a hospital urology department for review of his mixed urological symptoms at that time. He subsequently had a CT scan of his urinary tract which showed appearances of retro peritoneal fibrosis (RPF). Following a consultation with a consultant urologist, he was admitted to hospital for further investigation which showed that his right kidney was providing 90 percent of his renal function and his left kidney only accounted for 10 percent of this function.

After this investigation, a senior registrar in urology wrote to Mr A informing him of the possibility that his left kidney may have to be removed. This was the first time that Mr A had been made aware this was a possibility and that his left kidney was non functioning. Mr A was also referred to a vascular surgeon as he was diagnosed with aortitis. Mr A considered there was an unacceptable delay with this referral.

Mr A requested to be reviewed by another urology consultant for a second opinion. At this appointment it was discovered that the consultant did not have his case notes and had been given the case notes for another patient.

Mr A complaiend to us. He said that he felt that he had not been dealt with in an 'appropriate, timely or professional manner'. He said that there was both delay and failure to treat his condition and also a failure to communicate with him about his condition.

We obtained Mr A's medical records and took professional advice from our independent medical adviser. The adviser explained that RPF is a rare kidney condition which in the case of Mr A presented in an unusual manner. The adviser found that the initial investigation and management of Mr A's condition was conducted in a timely manner and there was no delay in diagnosis of the condition.

However, the adviser stated that following a failure to pass a ureteric stent there was no evidence in Mr A’s medical notes that there were discussions about possible other treatment for Mr A’s condition. For this reason we concluded that there was a failure to treat Mr A’s condition and we, therefore, upheld this element of the complaint.

In relation to the diagnosis and treatment of Mr A’s vascular condition, the advice received was that there was a delay in Mr A’s treatment and for this reason we also upheld this element of Mr A’s complaint. However, the adviser also stated that this did not impact on the treatment that Mr A received and that the treatment in this regard was appropriate for his condition.

We found that there was a failure to communicate with Mr A about his condition and we, therefore, upheld this part of his complaint.

We did not uphold Mr A’s complaint that there was a failure to transfer his medical notes to his consultant for an appointment. This was because while it was accepted by the board that the consultant did not physically have in his possession Mr A’s medical notes when he saw him, we accepted that the consultant was able to appropriately access all information pertinent to his case through the clinical portal.

Recommendations
We recommended that the board:
• review their procedures so that a robust system is put in place to ensure that the results of investigations are communicated quickly to clinical teams, particularly if they are abnormal;
• review their procedures so that all clinical letters to patients are typed promptly after dictation and any outcomes from these are actioned quickly;
• review their procedures so that discussions by multi-disciplinary teams are recorded and communicated to patients particularly if there is a delay before the patient can be seen in an outpatient clinic;
• apologise to Mr A for their failure to communicate with him effectively about his condition and outcomes; and
• review their systems so as to ensure a patient’s medical records, as appropriate, are available when they attend an appointment with a clinician.

Summary
Mrs C complained on behalf of her son, Mr A, about the way the board managed his condition. Mr A suffered from pilondial sinus (an infected tract under the skin between the buttocks). He received treatment from a surgeon over a twenty month period, and then the surgeon referred him to a plastic surgeon for alternative treatment. The plastic surgeon performed a multiple flat procedure, which was successful. Mrs C said that the surgeon should have referred Mr A to a plastic surgeon much earlier than he did, and when it became clear that the treatment he was providing was unsuccessful. She said that the delay in referring to a plastic surgeon meant that Mr A suffered from pain and repeated infections which had adversely affected his quality of life. We found that there was more than one way to treat Mr A, and that while an earlier referral to plastic surgery could have been made, the care and treatment Mr A received was reasonable and in line with standard practice.

Summary
Ms C, an advice worker, complained on behalf of Mr A that, as a result of a hip replacement operation being performed inadequately, his muscle was damaged.

Mr A underwent a hip replacement operation in July 2009. He subsequently attended a number of follow-up appointments with the consultant surgeon who had performed the operation. Mr A complained of continuing pain in his hip and that he had developed a pronounced limp. The consultant initially stated he could not identify what was causing the problems. However, following the consultation in June 2010, he stated that the problem was likely to be due to underdevelopment of the abductor muscles and advised Mr A to carry out appropriate exercise to build up the muscles.

Mr A continued to suffer pain and discomfort and attended his GP in July 2010. He asked for a second opinion. He was referred to another consultant surgeon who order an ultrasound scan which identified a rent in Mr A's abductor muscle. Mr A was informed this could not be operated on to be healed; the consultant also could not identify whether the rent was due to an incision in the muscle failing to heal, or whether it had been reopened following a subsequent aggravation (Mr A had suffered a bad fall the night of his discharge from hospital).

Mr A complained that the original consultant had never informed him that this was the cause of the pain, and, as a result, he queried whether the operation had in fact been performed adequately.

One of our advisers, a consultant orthopaedic surgeon, provided advice in this case. He said the operation had been performed to an acceptable standard. He commented that the tear was not an accident, but that the muscle initially required to be incised (and then reattached to the bone) as part of this type of procedure. He too stated it was impossible to tell whether the rent was because the muscle had failed to heal (a risk of this type of surgery) or whether a subsequent aggravation had re-opened it. Our adviser commented that the original surgeon could have provided Mr A with more detail in the consultations to save him requiring a second opinion, but that essentially the original surgeon had identifed the same problem as the second one. The complaint was, therefore, not upheld and no recommendations were made.

Summary
Mrs C complained that her GP practice's actions in in relation to her daughter, Ms A, were unreasonable.

As Ms A had had severe stomach pain for a couple of hours, Mrs C telephoned the practice. The receptionist told her that the triage GP was unavailable to decide what priority she should have and that there was no point bringing her daughter in as the other GPs were with patients. The receptionist said someone would call her back very soon and sought the advice of one of the GPs. On the GP's advice, the receptionist told Mrs C that, in the absence of the triage GP, it would be better if she brought her daughter in, so that any necessary treatment could then be considered without any further delay. The receptionist could not promise that a GP would be available to see Ms A straight away. Mrs C brought her daughter in, and they were seen 15 minutes later.

Our investigation found that the receptionist had acted appropriately in seeking GP advice in the absence of the triage GP, in calling Mrs C back promptly and in resisting pressure to make promises that she was not in a position to make. We also considered that, in the circumstances at the time, it was reasonable that no GP was immediately available and, therefore, we did not uphold the complaint.

Summary
Mrs C complained about the treatment her late husband, Mr C, received in hospital. Mr C had been diagnosed with oesophageal cancer in December 2008. He took ill in June 2010 and died shortly after admission to hospital. Mrs C complained about her husband’s treatment for cancer, that the consultant would not consider alternative treatment; delayed in obtaining a second opinion and failed to ensure that Mr C's pain was managed adequately. Mrs C also complained that when her husband attended the Accident and Emergency Department in June 2010 the junior doctors were not supervised; Mr C's records were not available; and that Mrs C was asked to leave her husband's bedside while tests were being carried out.

Our investigation concluded that Mr C received appropriate care and treatment for his cancer in that the clinicians arranged appropriate investigations and that he was kept under regular review. We also found that Mr C received appropriate care and treatment in the Accident and Emergency Department and that Mr C was moved in order that he could be observed more closely. We also explained that it would be normal practice to ask a relative to leave while the doctors carried out tests to establish the patient's response to painful stimuli as this can cause further distress to both patient and relative. We also established that although Mr C's records were not to hand because he had attended a clinic that day, it would not have affected his clinical treatment. The board have informed us that records are now available electronically and, therefore, such a situation should not arise again.

Summary
Mrs C complained on behalf of her son, Mr A, about his GP's refusal to refer him for a particular type of hospital test, an Exercise Tolerance Test (ETT), at her request. She was concerned that her son might have a heart condition, which an ETT would help to diagnose. However, it was clear from Mr A's medical records that he was not showing any relevant symptoms that would make a referral appropriate. We found that the GP had acted within NHS guidelines about ETT testing and we did not uphold the complaint.

Summary
Mr C was referred to the board's mental health team by his GP. Mr C was initially seen by mental health staff over a period of months. He was not satisfied with their response to his needs and so he complained to the board. Mr C was not happy with the board's response to his complaint, and complained to us. He complained that the board failed to provide him with appropriate care and treatment following the referral from his GP. He also complained that the board failed to provide him with adequate information on his assessment and treatment.

We did not uphold the complaint about appropriate care and treatment. We found from looking at the medical records, and taking advice from one of our professional medical advisers, that the mental health team's response to Mr C's clinical presentation was adequate, reasonable and based on assessed need and that, overall, the care and treatment provided to him following the referral from his GP was appropriate.

We did uphold the complaint about adequate information. We found that the board did not provide Mr C with sufficient detailed information about his care and treatment, in the form of a written and agreed care plan.

Recommendations
We recommended that the board:
• apologise to Mr C for failing to provide him with adequate information on his assessment and treatment, in particular failing to provide him with a written and agreed care plan; and
• review the Primary Care Mental Health Team's practice on written care plans, to ensure that all relevant information is included, and that patients are aware of the care plan and can countersign their agreement to it. This should be in line with the Mental Welfare Commission for Scotland's best practice guidance on Mental Health Act care plans, and NHS Quality Improvement Scotland's Standards for integrated care pathways for mental health.

Summary
Mrs C contacted her medical practice to request an ambulance to take her to an out-patient appointment at hospital. She said the practice refused to tell her who decided that she could not have an ambulance. She wanted to know who had made this decision and to receive an apology from them.

We found that at the time of Mrs C request, it was noted in the surgery's duty doctor book, then discussed by the receptionist and the duty doctor who then discussed the request with a second GP who was more familiar with Mrs C. The second GP told our office that he advised the duty doctor that he was trying to get Mrs C 'out and about' to improve her mobility and that he thought it perfectly reasonable for her to make her own way to the hospital. The duty doctor was responsible for making the final decision and decided, on the basis of what the other GP had said, that Mrs C did not require transport.

It was clear that it was the duty doctor who refused the request. As there was evidence that the surgery and the duty doctor had already told Mrs C who had made the decision and had already apologised both in correspondence and in person for any distress caused, we did not uphold the complaint.
 

Summary
Mr C complained that he had an appointment which was canceled by his dental practice, without the practice informing Mr C. When he complained to the practice, Mr C claimed that the practice neither acknowledged or responded to his complaint.

The investigation established that Mr C had treatment in October 2010 with which he was not satisfied. He complained to the practice in December 2010. The practice manager acknowledged Mr C's complaint and arranged an appointment for him to see one of the dentists to review the tooth and carry out any remedial work on a date in January 2011. A week before the appointment, the practice was contacted by another dentist and told that Mr C was now registered with that other practice and he was requesting Mr C's dental records. The records were sent to the new practice and the appointment was cancelled.

We found that the practice's actions were reasonable and, therefore, we did not uphold the complaint. On the complaints handling issue, the practice provided information that showed that they had responded to Mr C's complaint. Mr C stated that he then wrote again to the practice in February 2011, hand-delivering a letter and following up with emails in April.

The practice manager told us that the reception area is always very busy but that if a letter was hand-delivered she would expect it to be either given to her directly or put in her pigeon-hole. This did not happen in this case and in view of the intervening time the practice manager was unable to explain why. It was established that the emails had been sent to an obsolete address and were never received by the practice. In view of the lack of evidence, no decision was reached on this particular complaint.

Summary
Mr C complained about care and treatment provided to his wife, Mrs C. Mrs C was admittted to Accident and Emergency at Ayr Hospital in December 2010 after a fall at her home. She had a suspected fracture. After being assessed, it was confirmed that she had a fractured pelvis. She spent the night in an observation ward.

The next day, because she was unable to mobilise and was in a lot of pain, Mrs C was sent for a period of rehabilitation to Biggar Hospital. While there, her condition appeared to deteriorate and late the following day Mrs C was moved back to Ayr Hospital. Shortly afterwards, Mrs C died.

Mr C complained that his wife was not given proper care and treatment and our investigation found that there were unreasonable failings in aspects of her treatment at both hospitals.

Recommendations
We recommended that the board:
• apologise to Mr C for their failings with regard to his late wife's treatment; and
• remind staff involved of the nature of acute medical conditions in terms of the fast tract protocol, with particular reference to the exploration of unresolved issues prior to transfer.