Health

Summary
Mr C went to his GP about problems he was having with his knee. His GP referred him to a knee clinic, from where Mr C was sent for physiotherapy sessions. Mr C felt that he was not properly examined or treated at the clinic and that treatment was delayed.  He felt that they should have referred him for a scan. He had had a scan on his knee (outside the UK) and was told then that the problem might require surgery. However, after seeing Mr C’s medical records and taking advice from one of the Ombudsman’s professional medical advisers we did not uphold his complaint. Our adviser took the view that diagnosis and treatment with physiotherapy was correct, although he pointed out that no clinical review was carried out after the physiotherapy, which would have been desirable. Despite this, he said that Mr C’s overall care and treatment was reasonable. We pointed out the issue of the clinical review to the health board, although we did not make any recommendations on the complaint.

Summary
Ms A injured her back in 2007 and went to the Accident and Emergency Department at Raigmore Hospital. They diagnosed a soft tissue injury in her lower back. They told her GP that she was able to move about and they had allowed her home with some advice about how to deal with the injury. In 2010, Ms A had an x-ray and a scan that showed she had three fractures in her back. This caused her concern that she might have been mis-diagnosed in 2007. An MSP complained on Ms A’s behalf that the hospital failed to carry out a comprehensive and appropriate assessment of her injury.

After taking and accepting advice from one of the Ombudsman’s professional medical advisers we found that that the hospital’s assessment of Ms A had in fact been entirely reasonable, and of a good standard. Our adviser said that medical records showed that the doctor made a good assessment of the possible presence of neurological damage. The symptoms recorded at the time would not normally support a diagnosis of a fracture, but would support a muscular or arthritic cause for the pain. He said that there was a possibility that a fracture first occurred then but, given the assessment that was made, it was unlikely that it had. As the hospital had diagnosed a muscular injury, it was reasonable and in accordance with relevant guidelines for them not to have
x-rayed Ms A’s spine. He pointed out that the guidelines generally advise against
x-rays in such circumstances. The board had also pointed out that x-rays of the lumbar region involve large doses of radiation.

Our adviser also said that the fractures seen on the x-ray in 2010 could have happened before or after Ms A attended the hospital in 2007, and that the x-ray could not be used to establish when they occurred. He had reviewed the films with an experienced consultant radiologist who agreed with this conclusion. Ms A also now had other underlying medical conditions that may have had a bearing on the discovery of the fractures in 2010.

We recognised that Ms A had experienced considerable health difficulties over the last few years, but found that the care and treatment she received in 2007 was entirely reasonable in the circumstances at the time.

Summary
Mr and Mrs C complained that the board unreasonably delayed in performing a sperm retrieval operation to find out if in vitro fertilisation was likely to be a successful route for them to have a child. Mr C said that in August 2010 he was told that he would receive an appointment for this soon. In October of that year, however, he discovered that his consultant had moved to another hospital that did not have the specialist equipment or insurance for transporting the sample for testing. When investigating the complaint, we asked the board for the medical records and their comments and they told us that they had already acted to resolve the complaint. There has been a meeting between the departments concerned and the board have ordered equipment to enable transportation of sperm samples to testing facilities. They are also considering how they can reduce waiting times for this procedure for other patients. Mr C has a revised date for his operation and can come back to us if this does not happen when expected.

Summary
Ms C made a GP appointment for her daughter, who was unwell. When, however, her daughter became more unwell Ms C phoned to request a GP home visit on an earlier date. She did not specifically cancel the booked appointment. As their records showed that she had not kept an appointment on an earlier occasion, the practice wrote to her saying that if she continued to miss appointments, they would remove her from their register. She complained that it was unreasonable for them to have done this, and said that she was also unhappy with the practice's attitude when she phoned them about the letter.  We explained that although we could look at the first part of her complaint, we would be unable to prove what happened during the phone call.  Although she was disappointed that we would not be looking at this, she withdrew her complaint.

Summary
Mrs C complained that her medical practice removed her and her baby from the
practice list without prior discussion, warning or reasonable explanation. In the course of the investigation, we found that the practice removed Mrs C because they believed that she had missed an appointment. This was in line with the practice’s protocol for new patients missing appointments. We found, however, that their protocol did not adhere to the General Medical Council Regulations on this issue (Section 20 of Schedule 5, Part 2, of The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004).

Recommendations
We recommended that the practice:
• apologise for removing Mrs C and her baby from the practice list without any prior warning, discussion or reasonable explanation;
• provide us with a copy of the revised protocol for removing both new and existing
patients from the practice list in situations where appointments are not kept and
adequate cancellation notice is not given; and
• review their systems for documenting when appointments have been made, in
particular when they are made at the patient's request, to ensure they are robust
and accurate.

Summary
Mr C complained about the care and treatment of his son, Mr A, who has multiple
sclerosis and diabetes and suffers severe spasticity (involuntary and continuous
contraction of muscles) due to his condition. Mr C felt that treating Mr A’s spasticity with phenol injections was unsuitable, inadequately explained and caused further problems. He said that Mr A’s condition had greatly deteriorated after the injections.  Mr A had become significantly less able to move, and this caused bowel and bladder management problems. Mr A has since had his right leg amputated above the knee.

Mr C felt that his son should not have been offered this treatment because of his
already limited mobility. Mr C has power of attorney for Mr A, and felt that he should have been involved in this decision before Mr A took it. He normally discusses options with Mr A before decisions are taken, but in this case Mr A had consented to treatment without Mr C being involved. Mr C was concerned that Mr A, who has memory difficulties, couldn’t make a proper decision without having everything, including any negative aspects, explained in a way that he could fully understand. Mr A’s quality of life significantly deteriorated after treatment and he now requires much more care than before. Mr C also believed that pressure sores and other skin infections contributed to the need for amputation. This further impacted on Mr A’s quality of life and added to the distress of his family.

When Mr C came to us, we obtained his son’s medical and nursing records, took
advice from our independent medical adviser and made enquiries of the Board. The NHS guidance on consent says that a patient must have information that they can understand about any proposed treatment. Because the doctor was aware of Mr A’s memory difficulties, our medical adviser was of the view that it would have been reasonable to include Mr C in these discussions. I am satisfied that there were discussions with Mr A and that he consented to the treatment. I am not, however, able to say whether the information was presented in sufficient detail or in a way that he was able to understand in light of his memory problems. We noted that the Board had already apologised to Mr C for this, and we upheld this complaint.

We did not, however uphold the complaint about phenol treatment. Our medical
adviser explained that there is a range of escalating treatments for Mr A’s condition.  He said that it was reasonable to treat Mr A with these injections, although they probably did cause bladder and bowel function to deteriorate. However, the medical team knew about and expected the possible side effects of the treatment. They said they were able to manage these during Mr A’s hospital stays but were unable to establish a routine that he could maintain at home. Our adviser also noted that the medical records show that the injections seemed to have an immediate positive effect on Mr A’s spasticity. Finally, on the complaint about care, our medical adviser said that diabetics have increased skin sensitivity and a reduced healing capacity. In his view it was this, combined with leg weakness and spasticity, that was the likely main cause of the skin problems that developed and that resulted in the need for an amputation. He said that the injections played, at most, a minor part in Mr A’s skin problems and that Mr A’s care plan was appropriate for the acknowledged side-effects of these injections.
Because of this we did not uphold this complaint.

We acknowledge that Mr A, Mr C and the rest of the family have suffered a great deal of distress from the side-effects of Mr A’s treatment.

Recommendations
We recommended that the Board:
• apologise to Mr C and Mr A for their failure to ensure NHS Scotland guidance on
obtaining consent was properly followed; and
• consider, as a matter of good practice, providing supplementary, written information to patients about the use and possible side effects of such phenol injections.

Summary
Mrs C, who has several medical conditions, complained about the care and treatment she received from the Board and about the attitude of Board staff. She said that a consultant behaved aggressively towards her and wrongly said she was unlikely to be lactose-intolerant, and that a nurse was unfriendly and uncooperative when she attended for an injection. She also said that the consultant told her that an appointment had been made for her to have radio iodine treatment at a cancer treatment centre in Glasgow, when this was not the case.

Mrs C said that the medicines she had tried for her thyroid condition made her ill. She said they contained lactose and that there was a possibility that she might be lactose intolerant.  Mrs C visited the consultant with her son. She explained this and said that she could not tolerate the medication. She said that the consultant was aggressive and verbally abusive throughout the consultation. He told her she was not likely to be lactose intolerant. She left the consultation early because of this. The consultant, on the other hand, said that Mrs C was angry from the start of the consultation. He said he explained that he did not think there would be a problem with the medication, and why, but when he did so she became angrier and left the room.

We did not uphold Mrs C’s complaints about staff attitude, as there was no
independent evidence to substantiate either account of events. Neither did we uphold the complaint that the consultant told Mrs C that she was not lactose intolerant - again there was no independent evidence of what was said. We took advice from one of the Ombudsman’s medical advisers who, after seeing Mrs C’s medical records, said that the board conducted reasonable clinical investigations into the side effects she reported. They also appropriately discussed normal treatment options with her. He said that there are many different thyroid preparations and it was unlikely that Mrs C would be intolerant to all of them. Therefore, we did not uphold the aspect of Mrs C's complaint that the Board did not adequately consider her lactose intolerance.  However, we did note the Adviser's comment that it was possible the consultant might not have explained this to her in detail.

On the subject of the appointment, Mrs C said that nurses told her son that there was no appointment for her in the cancer centre's system. We asked the Board about this.  They provided a record sheet showing that an appointment had indeed been requested. Radio iodine appointments were at set times each week and so cancer centre staff were simply given Mrs C’s name to allocate to a particular slot during one of these times. As the appointment was made in this way it did not show up in the general appointment system.

Summary
Mrs C complained that the board lost and then disposed of a gold chain necklace that she left in an x-ray department. She said that the board failed to properly investigate her claim and subsequent complaint, and refused to compensate her for her loss.  When we contacted the board about this complaint, they said that they would be happy to make a payment to Mrs C in respect of her lost chain. They also offered to apologise for losing it and explained that they were carrying out a review of the way they deal with lost property to try and prevent similar circumstances arising in the future.

As these were the outcomes that the complainant wanted to achieve, we closed the complaint.

Summary
Ms A started to feel unwell while working abroad. She attended a hospital there for scans before returning to Scotland. Ms A went to her GP and explained the problems she was experiencing. She gave him the scans and medical reports, but as these were not in English, he was unable to read them. A friend suggested that she ask her GP to send the scans to hospital for a consultant radiologist to interpret them. The GP did this, but the consultant was not willing to look at them. Ms A went back to her GP, and was referred for private treatment. She was found to have cancer and underwent major surgery, including a hysterectomy, removal of a bowel tumour and the fitting of a stoma. Mr and Mrs C felt that it took too long for their daughter’s concerns to be taken seriously. They complained on her behalf that diagnosis and treatment were delayed because the consultant did not report on the scans when asked to do. Mr and Mrs C were also unhappy with the stoma aftercare advice and support provided.

Having taken advice from our medical advisers, we did not uphold Mr and Mrs C’s complaints. On the first complaint, our adviser said that sending the scans to a radiologist in this way was unusual and it was unlikely that they would give a professional opinion based on such scans and reports. He particularly noted that the radiologist was not given these along with or supported by relevant medical information. It was therefore reasonable that the radiologist did not try to interpret them, but it would have been a courtesy for them to let the GP know how to progress matters. On the aftercare provided, we found that there was evidence that Ms A received a reasonable level of treatment from the District Nursing Service and the Stoma Care Nursing Service. The number of contacts with the services was reasonable and staff had recorded and taken into account the fact that Ms A had sight difficulties (one of Mr and Mrs C’s concerns). Staff were satisfied that with assistance Ms A could manage her stoma but pointed out that if problems arose then she had their contact details.

Summary
Ms A started to feel unwell while working abroad. She attended a hospital there for scans before returning to Scotland. Ms A attended her GP and explained the problems she was experiencing. She gave him the scans and medical reports, but as these were not in English, he was unable to read them. He agreed to send the scans to a hospital for interpretation, but the radiologist there did not look at them. Ms A attended the surgery again and asked for a private referral, which the GP made. She was also to be referred for an ultrasound scan but the GP did not send the form and assumed his secretary had done so. It was six weeks before the referral took place and Ms A was eventually diagnosed with ovarian cancer. She underwent major surgery, including a hysterectomy, removal of a bowel tumour and the fitting of a stoma. Ms A’s parents, Mr and Mrs C, felt that it took too long for their daughter’s concerns to be taken seriously, and complained on her behalf that treatment was delayed. They said this was because there was delay in diagnosing Ms A’s condition, including a failure to translate the test results into English. Mr and Mrs C were also unhappy with the aftercare provided in the community and felt it was inadequate.

We did not uphold the complaint about aftercare. We found from looking at the medical records and taking advice from one of the Ombudsman’s professional medical advisers that the aftercare provided was appropriate. We found that various healthcare professionals in appropriate disciplines saw Ms A. Her medical records show that she received appropriate levels of advice, care and support. We did not uphold the complaint about the delay in diagnosis either. Our adviser said that it would not have been appropriate for the GP to have attempted to interpret the scan, as he was not qualified to do so. This was an issue appropriate for a radiologist and as requested by Ms A the GP sent the scans to a hospital radiologist for interpretation, although ultimately the radiologist did not do this. The GP also arranged appropriate tests. However, he failed to request an appointment for an ultrasound scan despite intending to do so. He did not realise this until some six weeks later when Ms A said that she had not yet received an appointment. Ms A had attended a private consultation during that time and her symptoms were under review. If the ultrasound scan had been ordered earlier, however, the results would have been available more quickly and could have led to an earlier diagnosis.

Recommendations
We recommended that the medical practice formally apologise to Ms A for the failure to order an ultrasound scan.