Health

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.
 

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.