Health

Summary

C attended the practice to collect prescriptions and had a brief discussion with a member of staff. Subsequently, C received a letter from the practice informing them their registration with the practice had been terminated due to inappropriate behaviour. C considered the practice’s actions to be unreasonable.

We found that the practice failed to follow the relevant process prior to removing C’s registration. The practice did not give a prior warning or keep reasonable records of the actions they took. We also found that the practice did not provide an accurate response to C’s complaint. As such, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to investigate C’s complaint appropriately, failing to issue an accurate response letter and for unreasonably removing C from the list of patients. The apologies 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 attended A&E at Wishaw General Hospital complaining of chest tightness, sweating, nausea and palpitations (a noticeably rapid, strong, or irregular heartbeat due to agitation, exertion, or illness). C felt that their concerns were not fully listened to and concerns about side effects of medication were not taken into account.

We took independent advice from a consultant in emergency medicine. We found that the assessment C received was of a reasonable standard for a patient presenting with chest pain and appropriate investigations were carried out. We did not uphold this aspect of the complaint.

C also complained about the response they received to their complaints. We found that while some of the board's actions were reasonable (a resolution was sought; C spoke with the consultant about their concerns; C was offered to add their account to the medical record), overall the board's complaint handling was unreasonable. We found that the board had not responded to all of the points that C raised as complaints, and the board acknowledged this failing in a later complaint response. We also found that the board should have been clearer when advising C of which stage of the complaints process they were at and should have managed C's expectations about the next steps if a resolution could not be reached. Therefore, we upheld this aspect of the complaint.

C also complained about the board's application of their Unacceptable Actions Policy (UAP). We found that the board had acted in line with process. While they had warned C that they had a UAP and why they considered C's actions were unreasonable, they did not formally restrict C's contact with them through the UAP. We did not uphold this complaint.

Recommendations

In relation to complaints handling, we recommended:

• The board should ensure that complaints communications are clear.

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 about the care they received from their GP practice when they presented with problems with their sight and a headache. Whilst in the waiting room, C became more unwell. Following an examination, an emergency ambulance was called and C was taken to hospital where they were later diagnosed with a stroke. C complained that more immediate action should have been taken when they initially contacted and then attended the practice. The practice did not identify significant failings during their complaint investigation, but noted that some aspects could have been handled better.

We took independent advice from a GP. We found that the practice’s initial handling of C’s call to the practice was reasonable, and it was appropriate that C was signposted to contact an optician. Furthermore, we found that, once C attended the practice, the care provided was reasonable and consistent with clinical guidance on assessment, history taking and examination. We did not uphold C’s complaint.

Summary

C complained about the care and treatment provided to their parent (A). A was diagnosed with cancer and was admitted to hospital. As the hospital team struggled to control A’s pain, A was transferred to hospice care, where they later died. C complained about the care and treatment offered to A at the hospice and asserted that it was not reasonable. C’s position was that as a result of that unreasonable care and treatment, A experienced chronic pain and died prematurely. C stated that they believed that staff involved in A’s care failed to act in line with guidelines and ignored medical guidance.

The board found no evidence to support C’s assertions that A was not provided with reasonable care and treatment. The board said that a multi-disciplinary, patient-centred approach was taken to A’s care and many clinicians contributed to A’s pain management strategy.

We took independent advice from a medical adviser. We did not find any failings in A’s care and treatment and did not consider that it was unreasonable. Therefore, we did not uphold this complaint.

Summary

C complained about the care and treatment provided to them by the board when they presented with abdominal pain. C complained that they were repeatedly unnecessarily catheterised, their symptoms and clinical context were ignored, and they were misdiagnosed as having a bladder tumour instead of an ovarian tumour.

We took independent advice from a nurse, a radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans), a urologist (a doctor who specialises in the male and female urinary tract, and the male reproductive organs), and a sonographer (a healthcare professional who performs diagnostic medical sonography, or diagnostic ultrasound). We found that both nursing and urology care and treatment provided to C was reasonable. However, we found that an ultrasound scan incorrectly interpreted a mass as being a bladder tumour, when in fact the mass represented a large ovarian tumour. Though this was a misinterpretation of the scan, we found that given the clinical information available at the time, this misinterpretation was not unreasonable. We did not uphold this aspect of C’s complaint.

C also complained about the board's handling of their complaint. We found that there were significant complaint handling failings, including failure to advise C in a timely manner which aspect of the complaint they would investigate; failure to update C in a timely manner throughout the investigation; incorrect information being contained in the complaint response and no apology being given for this. We therefore upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the unreasonable handling of their complaint. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• Staff should be aware of the scope of a complaints investigation and the relevant standards and processes that apply. Staff should be able to appropriately obtain and evaluate the evidence obtained and use this to give reasons for decisions reached; and complaints should be handled in line with the model complaint handling procedure. SPSO have issued a guidance tool to support investigations staff. This can be accessed here: www.spso.org.uk/how-we-offer-support-and-guidance. The model complaints handling procedure and guidance can be found here: www.spso.org.uk/the-model-complaints-handling-procedures.

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

Ms C, who works for an advocacy and support agency, complained on behalf of a family about the care and treatment that their relative (Mr A) received from the board. Mr A was admitted to Raigmore Hospital with endocarditis (an infection of the inner lining of the heart). He was discharged home for out-patient parenteral antibiotic therapy (where antibiotics are given to a patient in their own home). Mr A's condition worsened and he died a few weeks later. Ms C complained about Mr A's medical care and treatment, and that he was not medically fit to be discharged home.

We took independent advice from a cardiologist (specialists in the heart and blood vessels) and from a nurse. We found that Mr A's condition was diagnosed in a timely manner and he was given appropriate treatment. We also found that it was reasonable that Mr A was discharged home, as there was an appropriate plan to continue his treatment at home.

Ms C complained about the communication with Mr A's family. We found that the medical and nursing records showed evidence of appropriate communication with Mr A's family.

Ms C further complained that Mr A was discharged home without appropriate care planning and an appropriate care package. We found that there was appropriate multi-disciplinary care planning for Mr A's discharge home.

Ms C also complained about the board's complaints handling; in particular, that there was a delay in their response and its tone lacked empathy. We considered that as it was a complex complaint, it was reasonable that the investigation took longer than usual and regular updates were provided. We did not consider the tone was inappropriate.

We did not uphold Ms C’s complaints.

Summary

C complained about the board's communications with them regarding the treatment of their children. C’s children have a congenital condition which requires steroid replacement treatment and regular monitoring. C was dissatisfied with the treatment provided by the board and initiated the process to have the children transferred to another provider for treatment. The board gave inconsistent messages about the referral process and C was left unclear about the steps being taken to transfer the children’s treatment. Some months elapsed during which the children did not receive treatment.

During our investigation, we found that the board’s position regarding the referral had been inconsistent and confusing. Had they been clearer with C about the referral process, C's children could have accessed treatment much sooner. Given their need for regular monitoring, this was a significant failing. We found that the board’s communication had been unreasonable and, therefore, upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings in communication, with a recognition of the impact this had on their family.The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Staff should communicate clearly about who is responsible for doing what in this type of situation. In particular they must ensure the relevant information is clearly conveyed to the patient.

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 was diagnosed with a meningioma (a tumour that forms on membranes that cover the brain and spinal cord just inside the skull), which required surgical removal. C complained about the failure of the practice to appropriately assess their symptoms in the years preceding diagnosis. C said their records showed that they presented at the practice with red flag symptoms on a number of occasions dating back years. C also said that the practice failed to make appropriate referrals for investigation.

We took independent advice from a GP. We considered that C had been assessed appropriately by the practice. We found that C’s care was reasonable and in line with General Medical Council Good Medical Practice. We did not consider that there had been any missed opportunities to refer to secondary care in respect of C’s meningioma, taking into account their presenting symptoms. We did not uphold either aspect of C's complaints.

Summary

C complained on behalf of their client (B) in relation to the care and treatment provided to B’s spouse (A) whilst A was a patient within the board. A had a complex medical history and was referred to Queen Elizabeth University Hospital, receiving care and treatment over two days. B’s specific concerns related to a procedure A underwent on the second day. On that day, CT scan findings showed the presence of a large liver abscess which was possibly the result of a perforated gallbladder. Treatment options were reviewed and the best option was considered to be draining the abscess percutaneously (by accessing the abscess through the skin rather than operating and opening the abdomen). A passed away that day.

C told us that B believed that the procedure was not the best clinical option for A and that A would not have died had the procedure not been undertaken. B felt that A’s judgement was impaired because of medication which they had been prescribed, and as such was not competent at the time of making the decision to have the procedure, so could not agree to it.

We took independent advice from a surgical adviser. We found that the care A received during their admission was reasonable and followed accepted management pathways. We noted that the board assessed and provided the best clinical option of treatment. We found no evidence to suggest that A was impaired by the medication prescribed to them and as such was competent to consent to the procedure. We did not uphold C's complaint.

Summary

C complained on behalf of their child (A), who was admitted to the Royal Hospital for Children with multiple bruises. Medical staff initiated child protection procedures to investigate if A's bruising had been caused by physical abuse. C raised various concerns about A's care and treatment. In particular, that the decision to initiate child protections was disproportionate; that unnecessary and distressing medical investigations were carried out on A; and there was a lack of communication with C.

We took independent advice from a consultant paediatrician. We found that it was reasonable child protection procedures were initiated and that no unnecessary medical investigations were carried out. However, we found that there was a failure to communicate clearly with C about what was happening at the outset so we upheld their complaint.

C also raised concerns about how the child protection process was concluded. We found that there was an unreasonable delay in the board concluding their part of the child protection process. We also found that the outcome should have been recorded in A's medical records. We upheld their complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failings identified in the communication with them and in relation to how the child protection process was concluded. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• As it could be relevant to future care and treatment, A's medical record should contain information about the final outcome of the child protection process.

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

• Families should be given prompt and clear information about the child protection process. It should then be documented in sufficient detail.
• When child protection concerns have been raised, medical reports should be provided within a reasonable timeframe, taking into account relevant clinical guidance.
• When child protection concerns have been raised, the child's x-rays should be reported in a timely manner, taking into account relevant clinical guidance.
• When child protection procedures are initiated in hospital, the child's medical record should contain information about the final outcome so it is available to hospital based medical staff if the child is readmitted.

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.