Health

Summary

C complained that they were provided with inadequate pain relief following surgery. C has chronic pain and as such required more careful management of pain relief due to their high tolerance of opioids. The board considered that they had appropriately assessed and managed C's pain.

We took independent advice from a consultant anaesthetist. We found that while the postoperative pain relief provided was appropriate, there was a lack of true multi-modal analgesia (pain management which combines various groups of medications for pain relief) intra-operatively (during surgery) which increased the chances of immediate pain control problems. We upheld the complaint and made recommendations for learning and improvement.

Recommendations

What we said should change to put things right in future:

• The board should reflect and specifically consider our suggestion for further learning and advise this office of what further improvements they intend making.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

C complained on behalf of their parent (A) about the care and treatment A received from their GP practice; in particular, that there was a delay in referring A for further investigations which led to a delay in A being diagnosed with colon cancer.

We took independent advice from a GP. We found that all appropriate investigative tests were carried out at A's first attendance at the practice. On their second attendance, we found that the care and treatment A received was reasonable and that tests were undertaken with appropriate follow-up to a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) who A chose to see at a private hospital. Following receipt of the consultant gastroenterologist's report, we considered that there was no unreasonable delay by the practice in making an urgent referral to the gastroenterology out-patient clinic at an NHS hospital. We considered that a rectal examination should have been performed when A attended the practice, however, this was a minor criticism and had not impacted on A's future treatment. We noted that this had been addressed in the Significant Event Analysis (SEA) carried out by the practice.

On balance, we considered that the practice provided A with reasonable care and treatment. Therefore, we did not uphold the complaint.

Summary

C's parent (A) developed breathing difficulties and underwent investigations and treatment, including hospital admission, for bilateral pneumonia (inflammation of both lungs). As they had ongoing symptoms, the possibility of a cardiac (heart) cause was raised by A's GP. A CT scan of the chest was undertaken and confirmed pneumonia. An electrocardiogram (a test that records the electrical activity of the heart) identified an abnormality with A's heart so an echocardiogram (a heart scan that uses sound waves to create images) was requested. Shortly after this, A attended their GP with ankle swelling and was prescribed diuretic tablets. They also had a follow-up appointment with respiratory. Communication sent to the GP following this appointment referred to A's echocardiogram report as showing 'impaired left ventricle' and that cardiology opinion was awaited. A died suddenly before being seen in the cardiology out-patient clinic.

C complained that the practice failed to provide appropriate treatment for A's heart condition, that they failed to communicate properly to A about their heart condition, and that they failed to ensure relevant information about A's family history was shared with hospital consultants.

Summary

C complained about the care and treatment provided by the board to their parent in law (A) at Raigmore Hospital. C complained that the board missed a diagnosis of urosepsis (a condition where sepsis impacts structures of the urinary tract) and to put in place appropriate falls prevention measures. The board said that A was at the end stage of their conditions and that A was treated in accordance with national and international guidance. The board recognised that A suffered several falls and said that they have since made improvements to their falls prevention practices.

In investigating C's concerns, we took independent advice from a consultant geriatrician (a specialist in medicine of the elderly) and a registered nurse. We found that while there was an unreasonable delay in performing a urine test, any treatment would have been unlikely to improve A's health or alter the outcome and that overall, the medical care and treatment was reasonable. We also found that appropriate falls assessments were carried out and A was appropriately recognised as a high falls risk. We did not uphold the complaints, however we have asked that the board reflect on the timing of the urine test.

Summary

C, a support and advocacy worker, complained on behalf of their client (B) about the care and treatment provided to B's spouse (A). A received a diagnosis of lung cancer that had spread to their brain and neck. A was discharged home with anticoagulant injections (medicine to prevent blood clots) that B agreed to administer whilst further treatment and care was awaited. A subsequently underwent a course of radiotherapy and physiotherapy before being admitted to hospital where they died the following day.

C complained about the treatment A received. We took independent advice from a consultant physician and a nurse. We found that it was reasonable for A to have had a consultation that B thought was unnecessary and that, while a definitive decision could not be reached on whether relevant staff had failed to recognise deterioration in A, no opportunities had been missed in A's treatment. We did not uphold this aspect of the complaint.

C complained about the care A received. We found that reasonable follow-up support was either provided or offered to A and B. We did not uphold this aspect of the complaint.

C complained about specific communication between the board and B and A. We found no evidence indicating unreasonable communication on the board's part. We did not uphold this aspect of the complaint.

Finally, C complained about the board's response to the complaint submitted on B's behalf. We found that the response had been reasonable and, therefore, did not uphold this aspect of the complaint.

Summary

C complained that the practice failed to provide their parent (A) with appropriate medical treatment. A had health problems affecting their heart and lungs and was under the care of hospital specialists. A reported symptoms of back pain and weight loss and had a number of telephone consultations at the practice and was given painkillers. A deteriorated and was referred immediately to hospital where they were diagnosed with cancer. C felt that A should have been referred to hospital earlier in view of their rapid weight loss and pain symptoms.

We took independent advice from an appropriately qualified adviser. We found that A was under the care of hospital specialists for their longstanding health problems and although A had reported some symptoms to GPs at the practice, there were no red flag signs to indicate that A was suffering from cancer. We considered that the treatment provided by the practice was of a reasonable standard. Therefore, we did not uphold the complaint.

Summary

C complained about the care and treatment that they received from the Beatson West of Scotland Cancer Centre. We took independent advice from an oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that the symptoms C described were not 'red flags' and could have been explained by recovery from the chest infection C had experienced. The response to C's symptoms (including the length of time to request and perform a CT scan) was reasonable in the circumstances. We also found that the communication with C about the results of the CT scan was reasonable

C was also concerned that bleeding at their Dalteparin (anticoagulant that helps prevent the formation of blood clots) injection sites was not appropriately escalated or responded to. The board did not provide us with a contemporaneous record of the advice that was given to C regarding bruising and bleeding at their Daltaparin injection site. We found that it would be good practice for all contact with clinicians to be recorded and we included this as feedback for the board. However, we noted that there was no dispute between the board and C that the advice given on this occasion was for C to contact their GP. We found that the advice given to C was reasonable in the circumstances.

We did not uphold C's complaint.

Summary

C complained that the board failed to carry out an endoscopic retrograde cholangiopancreatography (ERCP, an imaging test involving a combination of endoscopy and X-rays for examination of the bile ducts and pancreas) procedure reasonably which resulted in a retroperitoneal perforation (a tear in the lining of the abdomen) and post-ERCP pancreatitis (inflammation of the pancreas).

We took independent advice from a consultant gastroenterologist and hepatologist (a physician who specialises in the diagnosis and treatment of disorders of the gastrointestinal tract, liver, pancreas and gall bladder). We found that the ERCP was a necessary procedure in C's case, that the perforation and post-ERCP pancreatitis are recognised complications and that appropriate measures were taken to reduce the risk of post-ERCP pancreatitis by administering diclofenac (a non-steroidal anti-inflammatory or NSAID). We did not identify any unreasonable failings regarding C's care and we did not uphold this complaint.

C also complained that they were not informed of the risks of the ERCP (including pancreatitis or duodenal perforation) and that following the ERCP, the tear was not mentioned to C by the consultants and that they were given different stories by them. We took independent advice from a consultant general surgeon. We found that the communication with C regarding the findings of the CT scan (a tear in the lining of the abdomen) was reasonable. We also found that an information booklet was attached to the consent form when it was signed, and that C was appropriately made aware of the risks and complications associated with the procedure. However, we noted that it would be good practice to keep a copy of the information booklet in the medical records and we included this in our feedback for the board. We did not uphold C's complaint regarding the board's communication.

Summary

C sustained severe and multiple injuries to their wrist and pelvis following a road accident. C underwent numerous surgical procedures on their wrist and complained that the care and treatment they received was unreasonable. C felt that due to the placement, the screws that were used caused greater damage. C also said that the board chose not to undertake any further surgery to treat the ongoing pain and limited range of movement that C experienced.

We took independent advice from an appropriately qualified medical adviser. We found that the board provided reasonable emergency care to C immediately after their accident. The surgery carried out was reasonable, with the screws and plates appropriately placed, given the type of injury that C had. We also found that it was reasonable for the board to decide to end the first operation (due to operation length) and undertake further surgery to complete their treatment of C's wrist, and that C's discharge was appropriate. We did not uphold this complaint. However, we noted that earlier counselling around the significance of an injury like this and making sure that C did not have unrealistic expectations, may have been helpful in this case. We provided feedback to the board on this point.

Summary

C complained on behalf of their parent (A) that the care and treatment they received from the board was unreasonable and led to a delay in A being diagnosed with colon cancer. A was urgently referred to the board from their GP with a suspicion of inflammatory bowel disease. An initial appointment for the gastroenterology (medicine of the digestive system and itsdisorders) outpatient clinic was scheduled for six weeks from the date of receipt of the referral but this was cancelled and delayed for a further six weeks. However, A did not require to wait this period of time due to an emergency admission to Inverclyde Royal Hospital (IRH). A was later discharged with a view to them returning for a colonoscopy (examination of the bowel with a camera on a flexible tube) in four weeks. Before the colonoscopy was carried out, A was readmitted to IRH with deterioration of their symptoms which required emergency surgery and A's cancer diagnosis was made.

We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We found that, as the referral was not for suspected cancer but for inflammatory bowel disease, the initial six week wait was reasonable. However, a wait of nearly three months would have been unreasonable in view of the severity of A's symptoms and the urgency of the referral. The board have acknowledged this delay. We were unable to conclude if A's outcome would have been different had they been seen at an outpatient gastroenterology clinic as initially arranged.

In relation to A's admission to IRH, we found that the care was reasonable and in line with accepted practice. We also found that it was reasonable to discharge A without performing a colonoscopy at that time, so as to allow inflammation to settle and reduce the risks of complications related to performing such a procedure. We concluded that A's case was an unusual presentation of colon cancer.

On balance, we considered that there was an unreasonable failure in A's care and treatment but only in relation to the delay in the gastroenterology referral. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for the unreasonable delay in the time they waited for a gastroenterology outpatient appointment. The apology should meet the standards set out in the SPSO guidelines on apology available at HYPERLINK "http://www.spso.org.uk/information-leaflets" www.spso.org.uk/information-leaflets .

What we said should change to put things right in future:

• Where a referral appointment is to be delayed, there should be a process of reviewing the referral to assess the appropriateness of such delay.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.