Health

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.
 

Summary
Mrs C complained to the board about aspects of care and communication when her late husband, Mr C, was a patient at Queen Margaret Hospital on three occasions. Mr C had speech difficulities and although he could understand what was being said to him, he had difficulty expressing himself and Mrs C had to assist him. She was concerned about the failure of staff to listen to her concerns that she believed Mr C had contracted clostridium difficile and that he was frequently moved between wards where staff did not know where he was.

We did not uphold the complaint about a delay in diagnosing that Mr C had contracted clostridium difficile, but we upheld a complaint that communication between the staff and Mrs C was inadequate. The board had already accepted there were communication issues and had undertaken to include its importance in staff training.
 

Summary
In August 2009, Ms C had a fall which resulted in an injury to her wrist and foot. She was referred by her GP to the hospital’s casualty department where wrist was x-rayed. Ms C was diagnosed with a fractured wrist and a cast was applied. The following day, she attended the hospital’s fracture clinic where her x-ray was reviewed by a registrar. The registrar questioned the diagnosis of a fracture and subsequently diagnosed a soft tissue injury. Her cast was removed and replaced with a temporary splint.

Over the next two months, Ms C experienced a great deal of pain and discomfort. She attended the casualty department of the hospital in October 2009 with pain. Her wrist was x-rayed a second time and a fracture was diagnosed. A few days later, Ms C attended the fracture clinic where her splint was replaced and a referral made for physiotherapy. Ms C attended the physiotherapy sessions but as her pain persisted over several months she was referred to a consultant hand surgeon who recommended corrective surgery.

Ms C complained that the failure to diagnose her broken wrist prolonged her suffering and led to a need for surgery. We did not uphold this complaint as we found that the diagnosis and subsequent treatment were reasonable.

Ms C also complained that the board delayed in taking action and that she had to wait too long for surgery. We did not uphold this complaint and found that the waiting time Ms C experienced was considered according to the nature of her injury and was within the NHS target for that type of operation.
 

Summary
Mrs C complained that she was removed from the practice list without warning or reasonable explanation. She also complained that the practice failed to give her advice about, or treat, a leg injury. In addition, Mrs C complained that the practice failed to refer her to appropriate specialists for treatment for ongoing health problems.

We did not uphold the complaint about referral to specialists. We found from looking at the practice's records and taking advice from one of our clinical advisers, that Mrs C was referred appropriately. We also found that, as Mrs C went to hospital for her leg injury, the practice were not responsible for treating it. The practice said they gave Mrs C appropriate advice about her leg injury. However, because they did not have a record of this, we upheld the complaint. We also upheld the complaint that Mrs C was removed from the list without warning, as we felt that the practice could have given one. However, we agreed that the practice had given Mrs C a reasonable explanation when they did remove her from the list.

Recommendations
We recommended that the practice:
• review their practice on making records of telephone conversations, with a view to making records where advice is given to a patient to attend a hospital department, or treatment advice is given; and
• review their policy on removal of patients from the list, to incorporate guidance on providing reasonable warning to patients who might be at risk of removal from the list.
 

Summary
Mr C complained about the treatment his adult daughter, Ms A, received at the Glasgow Southern General Hospital and a local Physical Disability Rehabilitation Unit following a diagnosis of thymus cancer. Mr C had numerous concerns in that Ms A was discharged from hospital in February 2010 with an inadequate care package and that in November 2010, Ms A was told she also had Neuromyelitis Optica (NMO) and her medication was altered. Mr C wondered how the NMO was missed in February 2010 and believed that this had resulted in a serious lapse in Ms A's condition.

We found that in general the treatment which Ms A received was of a reasonable standard and although there was a delay in the diagnosis of NMO this did not affect the treatment regime. While we upheld some of the complaint, we did not find that that board had failed to provide Ms A with suitable on-going care and that a comprehensive care package was in place.