Health

Summary
Mr C complained that his mother, Mrs A, had received inadequate care and treatment during two accident and emergency admissions and discharges to a hospital that served a rural area. Mr C was also dissatisfied with the facilities in the wards, staff communication and attitude. Mr C also stated that an out-of-hours doctor wrongly diagnosed Mrs A's medical condition.

Our investigations concluded that Mrs A received proper care and treatment from clinical staff at the hospital. We also concluded that the out-of-hours doctor had not wrongly diagnosed Mrs A's condition. We also found that the board had responded reasonably to Mr C’s complaints.

We did not uphold any of the complaints. However, we did make two recommendations, one about about Mr C's participating in a significant events analysis and one about record-keeping. We noted that before Mr C brought this complaint to us the board had apologised to Mr C for the issues he had raised with them on his mother's behalf.

Recommendations
We recommended that the board:
• ensure that the GP reflects on his procedure regarding the assessment of elderly patients and arranges a Significant Events Analysis (SEA) for this issue; and
• ensure that the GP's written records comply with NHS record-keeping guidelines.
 

Summary
Mr C, an advocate, complained that the board failed to provide reasonable care and treatment to Mr A from March until June 2009 and, as a result, Mr A became increasingly vulnerable and was forced to move to another health board for alternative treatment. Mr A accessed mental health services for treatment when he became mentally unwell in March 2009. Mr C said that the board had failed to diagnose Mr A's psychotic depression and provide appropriate treatment. He also complained about the board's decisions to discharge Mr A on four occasions and that the communication between the board and Mr A and his wife was inadequate. Finally, he complained about a psychiatrist's assessment of Mr A as fit to plead in court and the follow-up arrangements following his final discharge in June 2009. Mr A said that he had moved to another health board who diagnosed psychotic depression and treated him with electroconvulsive therapy. Mr A said the treatment was successful.

We did not uphold the complaint because we found that all the board's actions in managing Mr A's mental illness were reasonable.
 

Summary
Ms C suffers from Graves or Thyroid Eye Disease which is a complex and devastating condition. She complained that after 2007 her care and treatment was poor and likened it to a ‘production line’. She alleged that she had been examined and discharged without comment from either medical or nursing staff and that her condition has never been discussed with her. She maintained that there was no proper appreciation of her condition and its consequences and that little information has ever been made available to her. She also complained that she was incorrectly diagnosed with dry age related macular degeneration but this since turned out to be incorrect. She did not receive an apology. She also complained that when she submitted a complaint to the board, they failed to adhere to her request to keep some information confidential and delayed in responding.

While we did not uphold most of Ms C's complaints, we did find that she was misdiagnosed with age related macular degeneration and she was not adequately supported in relation to this. We made one recommendation to redress this failing.

Recommendation
We recommended that the board:
• apologise to the complainant for the confusion surrounding her diagnosis of dry age related macular degeneration.
 

Summary
Mr C's father, Mr A, was admitted to the Victoria and Queen Margaret Hospitals for treatment of cancer of the oesophagus. The board assessed Mr A as being unfit for surgery. As a result, Mr C arranged for his father to travel abroad for a second opinion and he subsequently underwent successful surgery.

As Mr C complained to both the General Medical Council and Nursing and Midwifery Council regarding his father's treatment, this office did not duplicate their efforts and reconsider any clinical aspects. Our role was focussed on the board's handling of Mr C's complaint.

Mr C complained that the board failed to take promised follow-up action to consider implementing a policy for assessing patients' fitness for surgery. We asked the board to clarify what action had been taken following Mr C's complaint. They confirmed that the matter had been referred to their Managed Clinical Network and subsequently discussed at their annual meeting. The board concluded that the current systems in place were reasonable and that a formal policy was not required. As it appeared that the matter was duly considered by the board, we did not uphold the complaint.

Mr C also complained that the board had delayed in responding to his complaint. The board acknowledged that their investigation was delayed and they offered their apologies to Mr C. They also accepted that they delayed in issuing a holding letter to Mr C and that the holding letter should have provided fuller information. They advised us that they had taken steps to raise these matters with the relevant staff. In the circumstances, we upheld this complaint. However, as the board had already taken what we considered to be reasonable remedial action, we did not make any recommendations.

Summary
Ms C complained about the treatment provided to her late father, Mr A. Mr had a history of heart attacks and strokes, and he also suffered from dementia. His wife had a poor memory. Mr A was prescribed warfarin following a heart attack and when a blood clot had developed on the inner wall of his heart. However, on many occasions, he failed to take the appropriate dosage and did not attend the appointments made to monitor his blood. In August 2010, a decision was taken to stop his warfarin prescription. One month later Mr A suffered a stroke and died.

Ms C believed that the GP concerned did not do enough to ensure that her father took his warfarin, or that he attended all his appointments. She said that more information should have been to her family so that they could have taken appropriate action.

Our investigation determined that by summer 2009, the family were aware of Mr A's erratic ingestion of warfarin and his non attendance at appointments. We also found that the medical practice had reminded him on many occasions to attend and demonstrated that they did everything they could. Confidentiality prevented them from discussing matters directly with the family.

Ms C also believed that some warfarin was better than none and that her father should have been weaned from his prescription. She also said that the GP had not referred her father to a consultant cardiologist as he should. We did not uphold either of these complaints.
 

Summary
Miss C complained that the board had deliberately, and inaccurately, diagnosed her with cancer and were pretending to give her medicine (so-called placebo injections and pills). Her medical records showed much evidence of testing and decision-making by a number of different healthcare professionals in order to reach a diagnosis of cancer. Likewise, the records indicated that actual medication was being administered. There was no evidence to support Miss C's views and we, therefore, did not uphold the complaint.
 

Summary
Mr C, who had a history of surgery for colon cancer and treatment for depression and anxiety, had a heart attack. He was admitted to hospital for treatment, and transferred to another hospital for surgery. After surgery, Mr C was transferred back to the first hospital before being discharged around two weeks later. Mr C then had a number of consultations with staff from cardiology, and was seen on a regular basis by a heart failure nurse. Mr C developed a form of anaemia and a condition called myelodysplasia (an abnormality of the bone marrow, resulting in a lack of healthy blood cells). Hospital staff also investigated Mr C for a possible lung tumour, but scans did not confirm this. Mr C had eight admissions to hospital in nearly two years, until his general condition deteriorated and he died.

Mr C's wife, Mrs C, complained about: the follow-up care for Mr C's heart attack; the care Mr C received for his anaemia and myelodysplasia; coordination between different hospital departments in treating Mr C's various medical conditions; how hospital staff explained things to her and her husband; and how the board handled her complaint. We looked at Mr C's clinical records and took advice from three of our professional clinical advisers. We found that the care and treatment Mr C received was appropriate, that staff had explained things to Mr C, and the board had dealt properly with Mrs C's complaint.
 

Summary
Mr C raised a number of complaints, some about a pharmacy and one about the board's handling of his correspondence. In the circumstances of his complaint, we decided that we did not have the authority to investigate his complaints about the pharmacy. We upheld his complaint against the board because they did not acknowledge or respond to a letter he sent. We made no recommendations, because the board had already identified that the letter had not been responded to, provided an explanation for this, apologised to Mr C and provided him with a response. We did suggest to the board that they reflect on whether they could have managed Mr C's large volume of correspondence better by perhaps nominating a single point of contact.

When this report was first published on 21 September 2011, it was incorrectly categorised as being about Grampian NHS Board. This was due to an administrative error which we discovered on 22 September 2011, and for which we apologise.

Summary
In August 2009 Mrs C attended her GP complaining of a lump in her left breast. She was examined and asked to return for a follow up appointment a week later. She was seen by a different GP at the review appointment and was advised that the lump was most likely a cyst. She was told to monitor the lump over the course of a few menstrual cycles. No follow-up appointment was made. Mrs C said that the lump increased in size and she returned to her GP practice in August 2010. She was seen by a third GP, who was concerned by the lump and referred her to a breast clinic for further investigation. The lump was found to be cancerous. Each of the three GPs described the lump as being in a different location and the Practice concluded that different lumps had been examined.

Mrs C maintained that she had had the same lump since August 2009 and that it had increased in size. She complained that the first GP incorrectly noted the lump as being in her right breast, and that she should have been referred to the breast clinic by the second GP. Although it was not possible for us to confirm whether there had been three different lumps, or if the same lump had been described differently, we upheld both of Mrs C's complaints, as we found the first GP's record-keeping to be poor and possibly inaccurate. We found that the treatment plan proposed by the second GP was not in line with good practice guidance and that Mrs C could have been referred to the breast clinic significantly earlier, or had it confirmed whether her lump was just a cyst.

Recommendations
We recommend that the practice:
• add a note to Mrs C's records clarifying that she attended her examination on 14 August 2009 complaining of a lump in her left breast;
• draw their staff's attention to the guidance in SIGN 84 and the Scottish Primary Care Cancer Group's publication: Scottish referral guidelines for suspected cancer; and
• apologise to Mrs C for the failings identified by our investigation.

 When this report was first published on 21 September 2011, it was incorrectly categorised as being about Greater and Glasgow and Clyde NHS Board. This was due to an administrative error which we discovered on 22 September 2011, and for which we apologise.

Summary
Mrs C complained to the board about the delays encountered when she took her mother, Mrs A, to the Plastic Surgery Clinic at Wishaw General Hospital. Mrs C said that at recent appointments her mother had to wait over an hour from her scheduled appointment time to be seen and although the clinic ran until 13.00, patients did not arrive for appointments after about 11.00. Mrs C felt that the scheduled appointment times could be spread about more and this would cut down on the waiting times. The investigation revealed the board had taken action to keep the appointment times under review, but we found that there was also a problem with the consultant arriving at the hospital for the scheduled start time and this contributed to the delays.

Recommendation
We recommend that Lanarkshire NHS Board:
• take action to ensure that the consultant is able to attend the plastic surgery clinic at the scheduled start time.