Health

Summary

Ms C complained about the medical care and treatment provided to her father (Mr A) when he was an in-patient at the Royal Infirmary of Edinburgh. Ms C had concerns about the medical reviews, the decision to withdraw treatment/fluids, the monitoring of Mr A's condition, whether Mr A had an infection, the decision to reinstate active treatment, and communication with Mr A's family.

We took independent advice from a consultant in geriatrics (a doctor who specialises in medicine of the elderly) and general medicine. We found that the care and treatment provided to Mr A was reasonable and decisions were made sensitively to balance the wishes of Mr A's family and to reduce distress for Mr A. We did not uphold this complaint.

Summary

Mrs C complained about the care and treatment her late brother (Mr A) received from the practice. Mr A attended two consultations at the practice as he had experienced shortness of breath on exertion for the previous few weeks. The GP arranged for a chest x-ray and blood tests to be carried out. These tests did not highlight any concerns but Mr A confirmed that his breathing difficulties were ongoing. The GP felt his breathing difficulties could have been caused by angina (chest pain caused by reduced blood flow to the heart muscles) and increased his medication for this with the intention to refer Mr A for more specialist assessment if his symptoms persisted. Mr A died suddenly one week after his second consultation. Following a post-mortem, it was confirmed that the primary cause of death was a pulmonary embolism (a blockage in one of the pulmonary arteries in the lungs, caused by a blood clot). Mrs C complained to the practice and queried why the GP did not look at Mr A's medical history, as this included details of a previous blood clot. In addition to this, Mrs C queried why no further investigation was carried out after the second consultation when Mr A's x-ray results were confirmed as clear. In their response to Mrs C's complaint, the practice concluded that the GP's clinical assessment and decision-making, based on the information at the time, was considered and reasonable. Mrs C was unhappy with this response and brought her complaint to us.

We took independent advice from a GP. We found that the care and treatment the practice provided to Mr A was reasonable. We were satisfied that appropriate consideration was given to Mr A's medical history in respect of blood clots when assessing his breathing difficulties. We also concluded that the practice's actions, after Mr A's x-ray results were known, were reasonable and appropriate. We were satisfied that the records indicated the practice had a firm treatment plan in place for Mr A and had clearly detailed the reasons for this approach. Therefore, we did not uphold Mrs C's complaints.

Summary

Ms C complained about the care and treatment she received at the Royal Infirmary of Edinburgh. Ms C complained that she was unreasonably prescribed a drug, uniphyllin, in order to treat her asthma.

We took independent advice from a consultant in respiratory and general internal medicine. We found that it was reasonable to prescribe uniphyllin for Ms C's asthma and long-term breathing difficulties. Therefore, we did not uphold this aspect of the complaint.

Ms C experienced a tonic-clonic seizure (type of seizure that involves both stiffening and twitching or jerking of a person's muscles) whilst taking the drug and said that she was not advised that this was a possible side effect. We considered that it would have been reasonable for Ms C to have been provided with information so that she could be involved in decisions made about her care and the possible side effects of medication. We upheld this aspect of Ms C's complaint.

Ms C also complained that she was given an increased dose of the drug without the effect of this being monitored. We found that the symptoms Ms C was experiencing were not necessarily a sign that the dose she was given was too high. An increase was also reasonable for maximum therapeutic effect. We did not uphold this aspect of Ms C's complaint.

Finally, Ms C complained that there was an unreasonable delay in advising her to stop taking the drug after she had a seizure. We considered that it would have been reasonable for Ms C to have been advised in A&E to stop taking the drug when she was admitted after her seizure. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to advise her of the possible side effects of the drug and for failing to advise her when she attended A&E with a seizure that she should stop taking the drug because she was at risk of further seizures. 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:

• To ensure General Medical Council good practice is followed when considering treatments to ensure patients are aware of significant side effects.

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 underwent specialist reconstructive surgery. After the surgery, C experienced urinary incontinence. C said that they had believed the surgery would be of a routine nature and complained that they had not been not provided with adequate information about it; in particular, that a possible side effect was incontinence.

We took independent advice from a urology adviser (a doctor who specialises in the male and female urinary tract, and the male reproductive organs). We found that the board failed to provide adequate information to C about the planned procedure prior to obtaining their consent and, therefore, we upheld this complaint.

C also complained about the delay in the surgery being carried out. The board accepted that there was a delay in C accessing treatment and explained that the delay reflected the waiting list issues the department had at the time. We found that there was an unreasonable delay in C's planned procedure being carried out. We upheld this complaint.

C complained that the board failed to provide them with reasonable care and treatment. C had concerns about how the board managed their place on the waiting list for the planned procedure and about the aftercare provided. The board acknowledged that there was a breakdown in communication which resulted in C having to arrange aftercare themselves. However, they said that their waiting list was managed appropriately. We found that there was nothing to suggest that C's place on the board's waiting list was managed inappropriately. However, we upheld the complaint on the basis of the breakdown in communication which resulted in C arranging aftercare treatment themselves.

Finally, C complained that the board failed to handle their complaint reasonably. The board acknowledged that there had been a delay in responding to C's complaint and that they had not communicated about the delay with C. We found that the board did not respond to C's complaint within expected timescales or communicate with C about that delay. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the identified failures. 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 consent process should follow national guidelines. Consent should be taken, where possible, prior to the day of surgery. As part of the consent process, there should be a clear discussion of the risks and benefits (of having the surgery and not having the surgery) and of any alternative treatment options; and those discussions should be clearly documented.
• Patients should get appropriate follow-up appointments.

In relation to complaints handling, we recommended:

• Staff should handle complaints in line with the Model Complaints Handling Procedure, which includes responding to complaints within timescales and where this is not possible, advising complainants of this and providing revised timescales.

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 about the dental assessment she received from a consultant in restorative dentistry at the board and the consultant's report of their findings. Ms C said that the consultant failed to consider her health/dental health issues and the views of her own dentist appropriately. She complained that the consultant unreasonably concluded that she did not qualify for specialist treatment at the board. Ms C felt that the consultant should have agreed for her to have dental implants.

We took independent advice from a dentist. We found that Ms C's dentist felt that her natural dentition should be removed to make way for dentures and that they referred Ms C to the board for a second opinion. We found that dental implants were not available on the NHS, other than in exceptional circumstances, which Ms C did not meet those criteria. We noted that the two alternative treatment options identified for Ms C by the board consultant would most appropriately be carried out by her own dentist rather than a specialist at the board. We also found that Ms C's health and dental phobia issues would usually be managed by a patient's dentist and would not be the remit of a restorative consultant. However, we noted that if these proved to be too complex, then a patient should be referred to the Public Dental Service, where dentists are better versed in treating patients with medical, behavioural or phobia issues

We concluded that the board provided Ms C with appropriate care and treatment and, therefore, did not uphold the complaint.

Summary

Mr C has autistic spectrum disorder (a developmental disability that affects how a person communicates with, and relates to, other people). After attending an advice clinic, Mr C was assessed by a psychologist. He was then referred to a community mental health service to see if they could help him with social skills and managing anxiety. The community mental health service did not consider they could meet Mr C's specific needs; and they explained that he might be able to access support from a charity instead.

Mr C complained that after his psychology assessment, he was not referred for care and treatment suitable to his needs. We took independent advice from a psychologist. We found that Mr C was appropriately assessed and referred for help with social skills. We found that the community mental health service gave the referral careful consideration. We also found it was reasonable that they refused it, as the charity was better equipped to meet Mr C's needs. We did not uphold this aspect of the complaint.

Mr C also complained that the board failed to handle his complaint in a reasonable manner. We found that the board did not communicate clearly with Mr C about his complaint, in particular in relation to the scope of their investigation. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to handle his complaint in a reasonable manner. 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:

• The board should communicate with complainants in a way that is clear and easy to understand.

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 had not made reasonable decisions around whether to provide plasma exchanges (a procedure which separates your blood into its different parts: red cells, white cells, platelets and plasma. The plasma is removed from the blood and replaced by a plasma substitute) to his wife (Mrs A) and whether to further explore the possibility of thrombectomy (procedure of removing a blood clot from a blood vessel), or reasonably monitor her levels of consciousness during an admission to hospital following a stroke. We found that the board's decisions around plasma exchanges and the possibility of thrombectomy had been reasonable, but that the board had not reasonably monitored Mrs A's levels of consciousness for a period. This meant that there was a delay to the board providing her with specific treatment. Although this treatment had only a small chance of success, we decided that the board's actions had been unreasonable. Therefore, we upheld this aspect of Mr C's complaint.

Mr C also complained about how the board had responded to his complaint. We found that the board's responses had been reasonable and did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs A's family for their unreasonable failure to monitor Mrs A's consciousness levels hourly, which caused a delay in providing reasonable treatment to her. 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 reasonably monitor patients' consciousness levels.

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, complained on behalf of their client (A) about the care and treatment A received at St John's Hospital when they attended after becoming unwell with vomiting. A had also been suffering from migraines over the previous few days. C complained that there was inaccurate reporting of the CT angiogram (a specialised scan using x-rays to look at the heart) which resulted in a delay in diagnosing a stroke; there was a delay in performing a lumbar puncture; and there had been a lack of consistent communication with the family. C also complained that A was not treated fairly due to comments made by staff about their previous medical history and that they did not receive assistance with personal care.

The board accepted that there was a failing in relation to the provisional report of the CT scan and this would have initiated treatment for A's stroke at that time. The board apologised and said that they would highlight the case at their local learning meeting. The board accepted that there was no documented evidence to support that A was receiving help with personal care, for which they apologised. However, they noted that there were regular attempts to keep A and their family updated on care.

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), from a consultant in general medicine and from a registered nurse. We found that, while many aspects of the medical care provided were reasonable (including the timing of the lumbar puncture), there was an unreasonable error regarding the provisional CT scan. This meant that there was a delay between the scan being performed and it being correctly reported. We upheld this aspect of the complaint.

We considered that A would have received medication, such as aspirin, to thin their blood earlier, but the effect of this is to prevent future strokes rather than improve the one that has currently occurred. While this would have added to the distress of A's family, we were of the opinion that the impact on A's clinical outcome would not likely have been significant.

We found evidence of reasonable communication and did not consider that inappropriate comments were made about A's previous medical history. However, we were unable to establish that A received a reasonable level of assistance with personal care because the nursing documentation fell below the record-keeping standards set out in the Nursing and Midwifery Code. Therefore, we upheld this aspect of the complaint.

Recommendations

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

• Patients should receive personal nursing care where appropriate; and this should be clearly and accurately recorded in accordance with the Nursing and Midwifery Code.
• The board should minimise the contribution of any system deficiencies to radiological errors.

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 about the way the practice removed his Duloxetine medication when he reported that it was not giving him adequate pain relief. When the medication was removed Mr C suffered from withdrawal symptoms and had to be admitted to hospital.

We took independent advice from a GP. We found that the practice had reduced Mr C's medication in line with accepted medical practice, while at the same time introducing an alternative painkilling medication. Unfortunately, Mr C then developed some signs of withdrawal, but this was not as a result of inappropriate medical treatment. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received at University Hospital Monklands in relation to hip pain. In particular, Mr C was concerned that the board mismanaged his condition and did not identify that he required a hip replacement following scans and x-rays.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the care and treatment provided to Mr C was reasonable. We noted that, based on the findings of the x-rays and the scan, there was no indication that Mr C should have been offered surgery at that time. We did not uphold Mr C's complaint.