Health

Summary
Ms C complained about the care and treatment she received after she registered with a new medical practice. She said that a GP did not carry out a general check of her health and that the action taken by the practice in relation to her symptoms of depression was inconsistent.

When Ms C had registered with the practice, they had checked her height, weight and blood pressure, in line with normal practice. They were not required to carry out a full physical examination. We found that the practice had initially treated Ms C for depression in light of the symptoms she displayed. When it became clearer that there were some doubts about whether she had depression, we found that the practice had acted reasonably in changing the way Ms C was treated.

Ms C also complained about the treatment she received for the abdominal symptoms she presented with. We found that the treatment provided was appropriate. The practice had performed a pregnancy test. When this proved negative, they made referred her for an ultrasound scan. They also examined her abdomen on a number of occasions and documented the findings. We also found that the practice had acted reasonably in relation to a gallstone identified by the ultrasound scan.
 

Summary
Mr C complained about the standard of care and treatment his late wife, Mrs C, received at Stirling Royal Infirmary. She died three weeks after being admitted to hospital.

Mr C had concerns about a number of aspects of his wife's care including a belief she had had an allergic reaction to antibiotics administered, that there were not sufficient efforts made to feed Mrs C out of bed and into a chair, that Mrs C could not refuse suctioning as had been explained by the hospital and that Mrs C was not moved to another ward at the family's request. Mr C felt that his wife had received substandard care because she was elderly. Mrs C had undergone a bronchoscopy procedure (used to view a patient's lung) to clear an obstruction in her lung and she did not recover from this. Mr C felt this operation should have been performed sooner to allow Mrs C a greater chance of survival.

Two of our advisers, a nursing adviser and a consultant geriatrician, considered Mrs C's medical files and the correspondence between Mr C and the hospital. They both found the care and treatment provided to Mrs C had been of a good standard. The clinical adviser found the hospital's explanation with regards to Mrs C's face and hand swelling had been rational - that she had suffered a seizure. He found no evidence of her having been given medication she was allergic to. He felt the ongoing and increasing difficulties with Mrs C's lungs had been monitored and treated to an acceptable standard. He noted radiological investigations were performed promptly. He noted the bronchoscopy, given it was a particularly invasive procedure, was performed at an appropriate stage of Mrs C's care.

The nursing adviser noted the communicative difficulties between Mr C, other family members and members of staff on the ward. The hospital had already apologised for any difficulties the family had experenced with the consultant responsible for Mrs C's care.

The adviser found the nursing care to have been of a good standard. She found the plan for the feeding of Mrs C to be appropriate in the circumstances and that frequent assessments were undertaken by a speech and language therapist to assess Mrs C's swallowing capabilities.

While recognising Mr C's concerns and his need for an independent review of his late wife's care, given the advice we received about the standard and quality of care, we did not uphold the complaints.
 

Summary
Mrs C's son, Mr A, was admitted to hospital in October 2010 with abdominal pain and vomiting. He was taken to theatre the following day where a laparotomy (a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity) was performed. He was discharged five days later but re-admitted the next day with clostridium difficile and diarrhoea.

Mrs C complained that therere had been a delay in carrying out the operation and that the decision to discharge Mr A on the day he was discharged was inappropriate. She also complained that staff had not taken reasonable action to prevent Mr A from contracting clostridium difficile. We sought advice from our clinical advisers and it was decided that there was no delay in taking Mr A to theatre; the discharge on the day in question was appropriate; and that there was no evidence that Mr A was suffering fron clostridium difficile on discharge from the hospital.
 

Summary
Mrs C complained about the care and treatment provided to her late husband, Mr C, and about the way in which the board handled her complaint.

Mrs C said that her husband was diagnosed as having prostate cancer in November 2006. She said that this was confirmed by a biopsy but that complications arose. She said that Mr C rang the hospital for advice about being unable to pass urine but he was wrongly referred back to his GP. As this was over the weekend, his GP was unavailable.

Generally, things appeared to settle by mid 2007, but, Mrs C said, from April 2007 her husband was complainaning of rectal bleeding, which continued until his death. Mrs C said this was raised at every meeting with clinical staff but the cause was suggested to be haemorrhoids.

In late 2008, Mr C was diagnosed with cancer of the liver and given hormone replacement therapy. Mrs C complained that by the end of 2009, he was suffering considerable pain and discomfort and that the quality of his life reduced significantly. She said that there was no coordinated plan for his treatment and that despite frequent requests for help there was no sense of urgency on the part of clinicians. She alleged that what action points there were, were not implemented. She complained that by 2010 there was a dramatic decline in her husband's condition and he was moved to Ninewells Hospital but again, she said that there was no coordinated plan and that Oncology and Urology failed to work together. She alleged that any treatment for Mr C was merely reactive.

After her husband died, Mrs C raised these matters as a formal complaint. She said that the time taken to deal with the complaint was too long and that the responses she recieved failed to answer her concerns. We fully upheld these complaints and also those about the care and treatment of her husband.

Recommendations
We recommended that the board:
• confirm to the Ombudsman the procedures for cover of absent consultant staff to ensure that continuity of care is maintained;
• remind oncology staff to involve urology staff in the management of catheterised patients; and
• highlight to the urology department that regular renal function measurement is required as part of the monitoring of patients with symptoms of prostatism and potential obstruction.
 

Summary
In early 2011, Mr C complained to the board about the length of time he was told he would have to wait on the waiting list for a psychological assessment. He had already been on the waiting list for over nine months and was told it would be another eight to ten months before he would be seen.

The board apologised to Mr C for the length of time that he would have to wait before treatment and told him that the problem was caused by the departure from post of one of the psychologists. They hoped to recruit a replacement as soon as possible and the manager had been working with the psychological department to reduce the waiting times as quickly as possible.

Mr C complained to us and we found that in 2008 the Scottish Government issued guidance to health boards so that they could take action to be best placed to meet new waiting time targets of 18 weeks from referral to treatment due to take effect from 2014. We found that the board failed to demonstrate to us that they had taken action in accordance with the guidance and that Mr C had waited too long for an appointment.

Recommendations
We recommended that the board:
• develop an action plan to deliver aspects of the 'Matrix' (the 2008 Scottish Government guide to delivering evidence-based psychological therapies) which are relevant to the situation in their area; and
• apologise to Mr C for the unreasonable delay he had on the psychological therapy waiting list.
 

Summary
Mr C lives next to a hospital. The local NHS board decided that an existing dental practice was not fit for purpose and decided to apply to the local authority for planning consent to develop a new dental teaching and treatment facility within the grounds of the hospital. Mr C complained that at meetings with residents in June and September 2009, board officers and their agents misled residents about their proposals and the changes they would incorporate prior to submitting an application for planning consent. He also complained that in implementing their planning consent, the board’s contractor deviated from approved plans to the detriment of residents and failed to incorporate assurances previously given to them.

Our investigation found no evidence of maladministration and we did not uphold the complaints.
 

Summary
Miss C suffered from abdominal pain and attended A&E on three occasions between July and August 2008. Appendicitis was suspected, but Miss C's symptoms settled and she was discharged after a short admission on the first two occasions. On the third admission, her symptoms did not settle and a laparoscopy was carried out to diagnose the cause of her pain. During the procedure, her appendix was removed and she was noted to have an inflamed uterus and fallopian tubes. Miss C continued to have recurrent abdominal pain following surgery.

Miss C complained that, at a routine doctor's appointment in 2010 she was told that she had been diagnosed with Pelvic Inflammatory Disease (PID) in August 2008. She had not been made aware of this diagnosis and complained that she had not been treated for it. She also questioned why her appendix had been removed.

We found that a provisional diagnosis of PID was made during the laparoscopy in August 2008. Miss C was treated empirically for PID with a course of antibiotics. We were satisfied that the removal of her appendix was in line with standard practice during laparoscopies. However, we found no evidence of Miss C being informed of her presumed diagnosis of PID or of another diagnosis that was also made at the time. Whilst treatment was clearly provided for her PID, we concluded that the combination of antibiotics used and the dosages prescribed were not in line with guidelines on the treatment of this condition. Furthermore, there was no evidence of any treatment being provided for Miss C's other condition.

Recommendations
We recommended that the board:
• review their procedure for obtaining patient consent to ensure that it is in line with the Scottish Government's Good Practice Guide for Health Professionals in NHS Scotland;
• provide the Ombudsman with details of any action they have taken, or propose to take, to ensure that patients are provided with information about the surgical team's findings;
• review their approach to treating patients with PID to ensure that the medication used is in line with the guidance in the Royal College of Obstetricians and Gynaecologists' document, Management of Acute Pelvic Inflammatory Disease;
• ensure that any future treatment that Miss C receives for PID is in line with the guidance in the above document; and
• apologise to Miss C for the issues highlighted in this decision letter.
 

Summary
Mrs C made a number of complaints to the board. Her husband, Mr C, was referred by his GP to hospital in March 2010 with swallowing difficulties. Initial investigations proved negative and further tests were planned. However, in May 2010 Mr C attended as an emergency and it was established that he had stomach cancer. Mr C died in June 2010 at home.

Mrs C complained about a delay in diagnosis and that there was a lack of communication from staff about Mr C's condition. The investigation revealed that although the diagnosis may have been established slightly sooner, it would not have affected the final outcome. However, it would have allowed Mr C and his family more time to come to terms with the situation. The investigation also upheld complaints that there were failings in communication and that the record-keeping was inadequate. We did not uphold a complaint that the board handled the complaint inadequately.

Recommendations
We recommended that the board:
• share this letter with staff to note our adviser's comments with specific reference to referring Mr C for an urgent endoscopy following the results of the barium swallow rather than discuss the result at a planned appointment;
• remind staff of their responsibilities to communicate in an effective manner with patients and their relatives and to accurately record what has been discussed; and
• remind staff to obtain informed consent from patients prior to carrying out medical procedures.
 

Summary
Mrs C complained on behalf of her husband, Mr C, who damaged his eye in a DIY accident. Mr C attended A&E at the Royal Alexandria Hospital in July 2010 and was examined by an ophthalmologist. His eye was x-rayed, cleaned and stitched and his sight was tested. An ultrasound was carried out three days later. Mr C's eye did not improve over the following weeks and his sight did not return. The following month a further ultrasound was arranged and he was found to have a detached retina.

Mrs C complained that the detached retina was not diagnosed at the time of Mr C's injury and that the second ultrasound was unreasonably delayed. She also complained that it took the input of a specialist to diagnose the detached retina after the second ultrasound and that the consultant radiologist who made the diagnosis failed to refer Mr C on to the eye clinic in good time.

We found that there was no evidence of retinal detachment at the time of Mr C's first ultrasound and that the diagnosis was, therefore, not missed. We considered that the second ultrasound could have been arranged sooner. However, we did not find that the waiting time was unreasonable in the circumstances, as there was no new evidence to suggest retinal detachment at that time. We were satisfied with the board's procedures for carrying out and reviewing ophthalmic ultrasounds and found that both ultrasounds were reviewed by appropriately trained staff. We felt that the consultant radiologist should have referred Mr C to the eye clinic following diagnosis of his detached retina. However, we did not consider his advice to wait until a forthcoming scheduled appointment would have had a detrimental impact on Mr C's prognosis or overall treatment.
 

Summary
Miss C's mother, Mrs A, was admitted to the hospital for bladder surgery. Shortly after discharge she experienced abdominal pain. She was re-admitted to the hospital the following day. It was suspected that she had experienced complications from the bladder procedure and investigations were carried out to establish whether this was the case. She was taken for exploratory surgery to establish the cause of her symptoms and given treatment including enemas. Mrs A was diagnosed with Acute Ischaemic Bowel disease (restricted blood supply to the bowel, causing tissue death). She had surgery to remove part of her colon.

Following surgery, Mrs A developed a chest infection and further complications and died nine days after the procedure. Mrs C complained about a lack of treatment for Mrs A during her first day in hospital and a subsequent delay to her diagnosis of Acute Ischemic Bowel disease. She also questioned the use of enemas and complained about staff's communication with the family.

We found that Mrs A's symptoms were, in fact, consistent with a diagnosis of Colonic Infarction. This is a more serious condition which causes a rapid collapse and loss of fluids. We were satisfied that there was no link to Mrs A's previous bladder surgery and that initial tests carried out by the board showed no indication of the condition. We, therefore, did not consider that further tests were required during her first day in hospital, or that there was any cause to carry out surgery any earlier. We did not support the use of enemas in Mrs A's case but concluded that these would not have been harmful to her. With regard to the communication with family members, we were unable to comment on the attitude or manner of individual staff members, but found evidence that appropriate information about Mrs A's condition and treatment was shared with the family as it became known to staff.