Health

Summary

C complained that the practice failed to appropriately investigate their urinary symptoms over a two-month period; in particular, that they failed to take blood tests and arrange a prostate check. C was later admitted to hospital with an acute kidney injury and urinary retention.

We took independent medical advice from a GP, who considered that the practice had unreasonably failed to examine C's prostate in light of their persistent urinary symptoms and repeated negative results for infection. Therefore, we concluded that there was a failure to reasonably investigate C's urinary symptoms and we upheld this complaint. However, the practice provided us with evidence that reflection and learning had already taken place through a Significant Event Analysis and we were satisfied that appropriate learning had been demonstrated. We recommended that the practice should apologise to C for the identified failings but made no further recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to examine their prostate in light of their persistent urinary symptoms and repeated negative results for infection. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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, an advocate, brought a complaint on behalf of their client (B) about B's child (A). B was unhappy that A was discharged by the Child and Adolescent Mental Health Services (CAMHS) after A was diagnosed with autism (a developmental disability that affects how a person communicates with, and relates to, other people). B felt that the discharge was premature as A was suffering with both behavioural and mental health issues.

We took independent advice from an appropriately qualified adviser. We found that A's discharge from CAMHS was reasonable and that their mental health needs were reasonably responded to. It was determined that A did not present with a moderate or severe mental ill health comorbidity alongside their diagnosis of autism and it was reasonable for the board to discharge A, knowing that social work was supporting them and their family. As such, we did not uphold this aspect of C's complaint.

C also complained that the board unreasonably refused referrals for A to CAMHS, submitted by A&E after discharge. We found that CAMHS and A&E staff assessed A and concluded that, while A was upset and distressed, there was no evidence of moderate or severe mental ill health that would make intervention from CAMHS appropriate. As such, we did not uphold this aspect of C's complaint.

Summary

C complained on behalf of B in relation to B's child (A). A was taken to A&E at Wishaw General Hospital and was diagnosed with a broken arm. Staff at the hospital did not consider that the explanation given by A's parents of how the injury happened fit with the injury found. Emergency department staff referred the case to a consultant paediatrician (doctor dealing with the medical care of infants, children and young people) for a forensic medical examination. It was determined that the type of injury sustained by A was highly indicative of a non-accidental injury (NAI). The board followed their child protection procedures, reporting the incident to the appropriate health and social care partnership and provided a forensic medical examination report as part of the child protection investigation. C complained that the diagnosis of NAI was unreasonable.

We took independent advice from a medical adviser. We found that the board's assessment and management of A was in keeping with local and national guidance, and that the diagnosis of NAI was reasonable. Therefore, we did not uphold the complaint.

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.