Health

Summary

C, an advice and support worker, complained on behalf of their client (A) who had concerns about the treatment which A had received at Raigmore Hospital. A had a kidney stone and was operated on, which resulted in a ureteric stent (a thin tube structure allowing urine to drain into the bladder) being inserted. The stone remained in place and Levofloxacin (an antibiotic) was prescribed and A was discharged from hospital. A then began to suffer from leg pains, attended their GP and was readmitted to hospital after a few days with tendon issues. The stent and the kidney stones were removed and the antibiotic was stopped. A felt that the kidney stone should have been removed at the initial surgery and that Levofloxacin should not have been prescribed as this would have prevented their tendon issues which were as a result of a reaction to the Levofloxacin.

We took independent advice from a consultant urologist (a doctor specialising in the diagnoses and treatment of disorders of the kidneys, ureters, bladder, prostate and male reproductive organs). We found that A received an appropriate standard of care and treatment, but suffered a rare but recognised complication of antibiotic medication. We did not uphold the complaint although we highlighted as feedback that the board may wish to review their antimicrobial guidelines.

Summary

C was referred to the ear, nose and throat (ENT) service by their GP practice because they had been suffering from worsening headaches, balance problems and nausea. C was reviewed several times by the ENT service.

C later returned to the practice because their symptoms were not improving. A referral was made to a private healthcare provider for C to see a neurologist. An MRI scan was arranged and following that, C was diagnosed with a brain tumour.

C complained to the board. They felt that the ENT service had failed to adequately investigate their symptoms and, because of that, they failed to diagnose C's brain tumour. In response, the board confirmed it was felt that C was experiencing vestibular migraine (a nervous system problem that causes repeated dizziness), based on the symptoms. It was noted that a neurological examination was not performed at the initial examination, but was carried out at a subsequent review. The board accepted it would have been preferable to perform the neurological examination at the initial appointment, although in C's case it was unlikely to have led to an earlier diagnosis.

We took independent advice from a clinical adviser who is an ENT consultant. We found that the tumour was a rare find in what was a common presentation of vertigo and headaches. It was difficult to know whether or not there would have been any earlier cues to instigate the MRI scan. We noted information from C's first encounter with the ENT service was limited but, overall, the evidence available suggested that the initial diagnosis and treatment were reasonable.

We did not uphold the complaint.

Summary

C complained on behalf of their parent (A) about the care and treatment A received at Raigmore Hospital. C was concerned that A was told by the hospital, following a CT scan, that they had a brain tumour (and likely metastases due to their lung cancer) when it later became apparent after an MRI scan that A had a stroke rather than a brain tumour.

We took independent advice from a consultant 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) and a consultant in acute medicine. We found many aspects of A's care and treatment to be reasonable. However, the CT scan report stated there was uncertainty over a diagnosis of metastases and that an MRI scan should be carried out. Over a 24-hour period, a diagnostic momentum increased. This meant whilst there was uncertainty around this diagnosis it was not picked up by successive clinicians and the working diagnosis became more certain despite a confirmatory MRI having yet to be carried out. A and their family were led to believe by successive clinicians over a 7-day period that A had a brain tumour when this was not certain. Therefore, we upheld C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure of successive clinicians to pick up on the fact the CT brain scan was uncertain around the diagnosis of a metastasis which led them to convey to A and their relatives that it was definitive. 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:

• The board should ensure CT scans commenting on diagnostic uncertainty should not be taken as definitive in their diagnostic conclusion.

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

Mr C complained that the board failed to follow relevant procedures for moving his mother-in-law (Mrs A) from a hospital in Scotland to a residential care home in England. We took independent advice from a social worker. We found that there are three contractual routes available and that the board entered into a Route 2 contract without giving Mr C a choice about the contractual route he wished to take. This was contrary to the guidance that was in place at the time of events and we upheld this aspect of Mr C's complaint.

Mr C also complained that the board failed to communicate reasonably with him about the process of moving Mrs A to a residential care home in England. We found that there was no clear communication with Mr C about the process for a cross-border placement, the contractual requirements, or transport arrangements. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to clearly communicate the process for a cross border placement, the contractual requirements, and transport arrangements and for entering into a Route 2 contract without giving him a choice about the contractual route he wished to take. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.
• Consider whether it would be possible to offer Mr C other contractual options, including the Route 3 option.

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

• Individuals should be given relevant information about the different contractual arrangements, which they can fully understand and then act upon in accordance with the Guidance on Charging for Residential Accommodation (CCD2/2019).
• There should be clear communication with family members at the earliest opportunity about the process for a cross-border placement, the contractual requirements, and transport arrangements.

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

Mrs C complained about the care and treatment she received during childbirth from the board. Mrs C's baby was born by low cavity forceps delivery which required her to have her legs in supports. She found the process painful and traumatic and complained that staff failed to explore or act upon her pain. She also said that the orthopaedic (specialists in the musculoskeletal system) care she received after the birth was unreasonable and that she was not satisfied with the way the board investigated her complaint. The board said that as a result of her complaint they had learned not to make assumptions when a woman was very vocal during labour but that she had had anaesthetic to deal with pain. They also apologised for the lack of support she had received and for poor communication.

We took independent advice from a midwife and consultants in orthopaedics, and obstetrics (the medical specialism for pregnancy and childbirth) and gynaecology (medicine of the female genital tract and its disorders). We found that it had been reasonable to undertake a forceps delivery as Mrs C had been pushing for an hour without her baby being delivered. To assist this, Mrs C's legs had been placed in lithotomy (leg restraints). This was associated with symphysis pubic diastasis (the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture) in up to 25% of cases and Mrs C suffered this. While Mrs C said that she was crying out in pain as a consequence, the clinical records did not support this, therefore, we could not conclude that she was ignored. However, we noted that there was no mention of a pudendal block (local anaesthesia commonly used to relieve pain during the delivery of a baby by forceps) in Mrs C's records. On this basis, we considered that the board failed to explore or act upon the causes of Mrs C's pain and upheld this aspect of her complaint.

We found that Mrs C's orthopaedic care and management after the birth had been reasonable and did not uphold this aspect of her complaint. However, the board did not investigate Mrs C's complaint well and she experienced several months delay before receiving the boards response. This was too long and, accordingly, we upheld this aspect of her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the delay in responding to her complaint and for the lack of detail in her clinical records, in particular that there was no mention of a pudendal block. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• All relevant documentation should be completed appropriately and as required. In line with Nursing and Midwifery Council/General Medical Council guidelines.

In relation to complaints handling, we recommended:

• Complaints should be dealt with in accordance with the board's formal complaints procedure.

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 treatment they received at the Queen Elizabeth University Hospital. They were treated for sigmoid diverticulitis (colon disease) and were prescribed antibiotics and discharged home. C continued to suffer from abdominal pains and saw their GP, who referred them back to the hospital. C then underwent surgery to resolve their symptoms.

C felt that the surgery should have been performed on the initial admittance and that it was unreasonable to discharge them home on antibiotics.

We took independent advice from an appropriately qualified adviser. We found that in the initial admission it was appropriate to treat C with antibiotics rather than proceed to surgery, which could have left C with a permanent stoma (large intestine diverted through opening on abdomen to collect waste in bag or pouch). Additionally, when C was readmitted, it was also appropriate to administer antibiotics in the first instance and it was only when C's condition deteriorated that it was appropriate to proceed to surgery. We did not uphold the complaint.

Summary

C complained about the treatment they received from the practice. C had a pre-existing diagnosis of Chronic Fatigue Syndrome (CFS). C attended the practice about back pain they were experiencing. They were referred to neurology (specialists concerned with the diagnosis and treatment of disorders of the nervous system), urology (specialists in the male and female urinary tract, and the male reproductive organs), rheumatology (specialists that deals with rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments) and orthopaedics (specialists in the treatment of diseases and injuries of the musculoskeletal system) on a routine basis. The neurological service performed two MRI scans which identified a lesion (a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour). C was advised by specialists to come back in six months for a review. At around this time, C was advised that, despite referrals to orthopaedics, they would not be offered an appointment as they had passed the referral to the pain clinic. The practice followed this up with the service, requesting further MRI scans.

On several occasions, C consulted with the practice regarding severe pain and worsening symptoms. C was later seen by neurosurgeons, who confirmed that the lesion was the cause of the pain and C underwent surgery. The lesion was cancerous, and C underwent therapy to treat it.

C said that the practice showed a lack of understanding of the pain and symptoms that they presented with and failed to prioritise investigations which would have resulted in a timelier diagnosis. C considered that there was an assumption that the pain had an underlying psychological element.

We took independent advice from an appropriately qualified adviser. We found that GPs were responsive to C's requests for further investigations and appropriate referrals were made. There was no significant delay in any referrals being sent. The practice had appropriate discussions with C regarding pain relief, the addictive qualities of medication and sought advice from specialists about managing pain. We found that the care and treatment provided by the practice was reasonable. We did not uphold the complaint.

Summary

C complained that when the Driver & Vehicle Licensing Agency (DVLA) contacted the practice about C's fitness to drive, the practice incorrectly advised the DVLA that they had attended detoxification for alcohol in the past 12 months.

We took independent advice from a GP. We found that the treatment C had received from the practice was not to treat alcohol withdrawal and would not be classed as a detoxification programme. We found that there was no evidence that C had attended a detoxification programme in the past 12 months. Therefore, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failing identified. 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:

• The practice should ensure their knowledge of detoxification programmes is up to date - who delivers them and what a programme entails. Also the practice should ensure the information held by the DVLA in relation to this issue provides details of the treatment given to C.

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 partner (A). A had been suffering from debilitating shoulder problems over an extended period. A had been referred from their own NHS Board to Greater Glasgow and Clyde NHS Board for specialist surgery. Although surgery was carried out, it did not relieve A's symptoms. A underwent further surgery and received a second opinion from Greater Glasgow and Clyde NHS Board, as well as undergoing neurological tests and assessment at the pain clinic. During this period A moved house, which meant a different NHS Board became responsible for A's care.

C felt that Greater Glasgow and Clyde NHS Board had failed to properly consider A's symptoms and that they were unwilling or reluctant to investigate or perform further surgery on A. C had a lengthy correspondence with the board, during which they made several formal complaints.

Whilst this correspondence was ongoing, the board suggested that A should be referred to a specialist in England. C and A were told this referral was to be made, but they were not told what the process would be. A referral of this nature required A's own health board's agreement, but this was not provided. C made a number of attempts to contact Greater Glasgow and Clyde NHS Board to discover whether the referral was going ahead. When they did not receive a response, C took A to have further surgery on A's shoulder privately.

C said they had been forced to do this by the board's failure to provide A with adequate care and treatment and their decision to block the referral to England. C said the board should reimburse them for the expenses they had incurred and provide guarantees A would receive the treatment they would need in future. The board had declined to pay for the cost of private medical treatment, because their view was that A had chosen to take this course of action independently.

We received independent medical advice. We found that the board had provided A with reasonable care and treatment. The investigations that had been carried out were appropriate for the symptoms reported and these investigations, and the provision of a second opinion, had been carried out within a reasonable timescale. We did not uphold this aspect of C's complaint.

In relation to the referral to England, we found that the board had not made the decision to cancel A's referral to England. This decision had been made by A's own health board. Therefore, we did not uphold this aspect of C's complaint.

The board had, however, failed to acknowledge or respond to C's questions about the referral, or to respond to questions from their MSP. They had also unreasonably prevented C from accessing the complaints process. The board had told C they would be able to liaise with a named contact about A's treatment. Despite it being clear that the named contact was not responding to C and that C was not receiving answers to their questions, the board failed to take action to address this but also failed to allow C to raise a new complaint. We considered the boards communication with C to be unreasonable and upheld this aspect of their complaint. However, we noted that this did not justify reimbursing C for the cost of private treatment in England.

Recommendations

What we asked the organisation to do in this case:

• Clarify for C and A which board had responsibility for the decision not to proceed with the out of board referral, explain what the process followed was and clarify who remained responsible for A's ongoing care and treatment.

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

• The board should ensure they have a clear procedure for staff to follow, when out of board referrals are made, including communicating the outcome to the patient.

In relation to complaints handling, we recommended:

• The board should review their procedures to ensure that when communication with a patient or their representative breaks down, complaints staff are able to escalate the matter appropriately.

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 complained that the care she received from the board when she attended A&E at Queen Elizabeth University Hospital and a surgical hot clinic (the hot clinic provides assessment and management of patients referred by A&E that need further investigations and assessment but that do not require to be admitted) the following day was unreasonable. We took independent advice from a consultant in emergency medicine. We found that while the majority of the care and treatment Ms C received in A&E was reasonable, the wait for triage and the wait for pain relief was unreasonable and there was no evidence of pain scores being recorded in Ms C's notes. With regard to Ms C's attendance at the hot clinic, there was an issue with her appointment, and the way the hot clinic operated did not appear to have been communicated to Ms C in advance to manage her expectations. As a result, we upheld this aspect of Ms C's complaint.

Ms C further complained that there was an undue delay in the board providing her with an endoscopy (a medical procedure where a tube-like instrument is put into the body to look inside). We found that Ms C had to wait 15 weeks for an endoscopy which was outwith the 6 week national standard waiting time and as a result, we upheld this aspect of the complaint.

Ms C also complained that the board's handling of her complaint was unreasonable. We found that the board's handling of Ms C's complaint was not in line with the NHS Complaints Handling Procedure and as a result, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the unreasonable care and treatment, the unreasonable delay in receiving her endoscopy and the unreasonable handling of her complaint. 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:

• Patients should be triaged timeously, in line with relevant guidelines. Pain scores should be recorded regularly and acted upon timeously in line with relevant guidelines.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the NHS Scotland Model Complaints Handling Procedure.

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.