Health

Summary

C underwent a left total hip replacement for progressive osteoarthritis (chronic breakdown of cartilage in the joints leading to pain, stiffness and swelling). Following the surgery, it was identified C suffered nerve damage which resulted in a foot drop/sciatic nerve palsy (loss of movement and or lack of sensation) and a limp. C complained that the board failed to provide the appropriate aftercare to address these issues.

The board confirmed they provided the appropriate aftercare in the form of an ankle foot orthosis (a brace) and physiotherapy. The board noted C's initial problems had resolved and there were other factors that contributed to C's ongoing issues.

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 C's foot drop was managed appropriately by the provision of the orthosis and several physiotherapy sessions. We also concluded that the board's opinion that there were other factors which were the cause of C's ongoing problems was reasonable. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late sister (Ms A) by practice. Ms A had attended the practice on a number of occasions over many months. She had symptoms of low energy and mood, fatigue, and lack of motivation. The practice diagnosed a depressive illness and prescribed antidepressant medication. Ms A continued to deteriorate and was admitted to hospital where it was found that she had had a tumour at the base of her skull and she later died. Mrs C said that the practice should have considered alternative diagnoses rather than depression.

We took independent advice from a GP. We found that it was reasonable for the practice to continue along the route of a depressive illness in view of Ms A's reported symptoms, and it was only when red flag symptoms were reported that it was appropriate to refer Ms A to hospital. Therefore, we did not uphold the complaint.

Summary

Mrs C, an advocate, complained on behalf of her client (Mrs B) about the decision to discharge Mrs B's late husband (Mr A) from Royal Alexandra Hospital. Mr A had been diagnosed with a chest infection and bowel obstruction. When Mr A arrived home following discharge, he collapsed and had to be readmitted. The board confirmed that all appropriate assessments had been carried out prior to Mr A's discharge and his observations from the morning of his discharge were found to be in the normal range.

We took independent advice from a consultant surgeon. We noted that Mr A underwent regular observations and that he was assessed as ready for discharge by a consultant, physiotherapist and occupational therapist. There was no evidence to suggest a significant deterioration in Mr A's condition in the run up to his discharge. We did not uphold the complaint.

Summary

C complained about a globe perforation (small hole in the eyeball) which occurred during retrobulbar injection (an anaesthetic injection given into the eye) for a left trabeculectomy (a surgical operation to lower pressure inside the eye). C reported the injection being extremely painful and felt that this should have alerted the doctor to the perforation.

We took independent advice from an ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye). We found that there is a debate as to whether retrobulbar injections have been outmoded by alternative methods of local anaesthetic. Though we did not consider it a failing that the board used this method of anaesthetic, we suggested that they may wish to reflect upon whether the methods of local anaesthesia should be reviewed in light of the outcome of this case.

We also found that the globe perforation that C experienced should have been suspected at an earlier point. We found that whilst the pain C experienced did not indicate a definite perforation, this should have raised suspicion of perforation. We also considered that had the perforation not been suspected/identified at the time of the injection, it should have been the following day when C experienced a leakage of blood in the eye. We upheld C's complaint on this basis.

The board had already discussed the case with doctors involved in C's care, presented the case at a teaching session, and discussed the case at a clinical governance meeting. However, we made further recommendations on the basis that the board had not identified that the perforation could have been suspected at an earlier point.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that they did not suspect/identify the globe perforation at an earlier point. 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:

• Where a patient experiences marked pain at the time of retrobulbar injection; or vitreous haemorrhage following retrobulbar injection, clinicians should be alert to the possibility of a globe perforation.

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 to us about the care and treatment he received when he attended the out-of-hours service at Stobhill Hospital. Mr C had undergone a shoulder operation at the hospital on the previous day and was discharged that afternoon. He returned to the hospital on the following day, as he was in pain. He said that he had also been unable to urinate. He saw a doctor but complained that they did not examine him or take a sample and he was told to go home and make an appointment to see his GP if he did not feel better within two days. Mr C said that he was in pain for the next two days and vomited blood. When he saw his GP, he was rushed to hospital and a catheter was fitted, which drained two litres of fluid.

We took independent advice from a GP. We found that the examinations and the assessments carried out when Mr C attended the out-of-hours service had been reasonable. Urinary retention can develop over time and there was no evidence that Mr C had urinary retention when he presented at the out-of-hours service. We considered that the care and treatment provided to Mr C had been reasonable and we did not uphold the complaint.

Summary

C, an advocate, complained on behalf of their client (A). A's appendix was removed after they suffered from acute appendicitis. After the operation A continued to experience pain and had multiple admissions to the Queen Elizabeth University Hospital over a period of several months. A was unhappy with the treatment provided by the board in response to their symptoms.

We took independent advice from a general anaesthetist experienced in acute pain services and from a general and colorectal consultant (a surgeon who specialises in conditions in the colon, rectum or anus). We found that the board provided reasonable treatment to A. There were elements of the management of A's symptoms of pain which could have been better, with chronic pain considered earlier once A's infection had resolved. However overall, the board's response to A's symptoms of pain and rectal bleeding were reasonable with reasonable investigations and treatment carried out. Therefore, we did not uphold this complaint.

Summary

C complained on behalf of their spouse (A). A had a history of metastatic cancer (cancer which has spread to another part of the body). A attended their GP with a sudden on-set headache and was advised to attend the Glasgow Royal Infirmary (GRI). A arrived at GRI as an emergency attendance and was admitted for investigation. Scans were carried out which revealed that A had an intracranial metastasis (a malignant growth that had spread to the brain from a tumour in another organ). C complained that there was an unreasonable delay in the scans being carried out. C also complained that A had unreasonably been advised that surgery was not an option.

We took independent advice from a consultant in acute medicine and from a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques). We found that there had been an unreasonable delay in the first scan being carried out given A's history, current medications and symptoms. All relevant information was not provided to the radiologist to determine the priority of the scan and, when the scan was not carried out as planned, the board failed to query this with the radiology department when it had not occurred as scheduled. We upheld this aspect of C's complaint.

In relation to the second complaint there was little information available to confirm exactly what was said between the board, C and A regarding the discussion that surgery was not an option for A. We found, based on the information available, that the board had reasonably informed A that curative surgery was not an option in relation to their intracranial metastasis. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for failing to carry out A's scans in a reasonable timescale. 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:

• All relevant information should be provided to the radiology department when requesting a CT scan.
• Patients presenting with a headache and taking anticoagulant medication should receive appropriate investigations to identify whether an urgent scan is needed.
• The board should carry out scans in the timeframe agreed.

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 was referred by her GP to the board's Assisted Conception Service (ACS). At her appointment with ACS months later, she was told that it was too late to proceed with screening/referral to the Assisted Reproductive (ART) Clinic tertiary centre, as the waiting time for an appointment at the ART is five to six months, by which time she would be over the age limit (the upper limit to be eligible for in vitro fertilisation (IVF, a process of fertilisation where an egg is combined with sperm outside the body) treatment on the NHS). Ms C complained that, according to the information on the board's website, she should have been eligible for NHS fertility treatment.

We took independent advice from a consultant gynaecologist (a doctor who specialises in the female reproductive system) and from a GP. We found that the information on the board's website regarding timescales for referral for fertility treatment had originally been incorrect, as it stated that a patient need only be referred prior to their 42nd birthday, as opposed to needing to be screened before their 42nd birthday. However, we found that the board had amended this information in order to ensure it was accurate. Whilst we welcomed this, we were concerned that the incorrect information was not noted by the board until drawn to their attention by our office.

We considered that, whilst changes had been made, the information on the website was still unclear as it did not explain the steps involved in screening, and the waiting times involved in these steps. We also found that the board's position regarding how they communicate this information to GPs is not in line with current primary care practice. We upheld this aspect of Ms C's complaint.

With regard to Ms C's complaint that she was unreasonably denied fertility treatment, we found that Ms C did not meet the criteria, and therefore it was reasonable to deny her fertility treatment. Therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C that the information on their website regarding timescales for referral for IVF is unclear. 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 information available to patients and GPs should make clear the referral pathway, screening process, and timescales involved in these steps, are explained clearly; including how long before the patients 42nd birthday they may need to be referred to complete the screening process in time.

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 care and treatment provided to her husband (Mr A) at the Royal Alexandra Hospital when he attended A&E with a headache, nausea, resolved left sided weakness and a facial droop. Mr A underwent medical review and scanning and was admitted into hospital. The following morning Mr A's condition appeared to deteriorate and following a further scan he was found to have had a type of stroke.

We took advice from a consultant in acute medicine, and a consultant radiologist (a specialist in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans). We found that the care and treatment provided to Mr A had been reasonable, with timely assessments and investigations. We did not uphold this aspect of Ms C's complaint.

Ms C also complained about the communication with Mr A's family, particularly when he deteriorated. The board had reviewed Mr A's care and acknowledged that there were failings in communication. Whilst the board had already shared the findings of their investigation widely, we made a further recommendation on this point. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A and Mrs C for the failure to communicate reasonably with Mr A's 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:

• Communication with families/next of kin should be part of the response to a deteriorating 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

Ms C, an advocacy worker, complained to us on behalf her client (Mr A) about the care and treatment Mr A received at a consultation when he disclosed details of his mental ill health. Ms C said that the GP did not make eye contact with Mr A and rushed through the consultation. Ms C also complained that Mr A was subsequently removed from the practice list after they submitted a complaint.

We took independent advice from a GP. We were unable to comment on the amount of eye contact made during the consultation as there was no evidence in relation to this. We noted, however, that the GP had stated that they would try to learn from this. The practice had also stated that the consultation took longer than the ten minutes allocated. We found that the practice had a lot of history available for Mr A and the decision to decline referral to psychiatric services was based on their knowledge of Mr A and his medical history. We considered that the care and treatment provided to Mr A at the consultation was reasonable and we did not uphold this aspect of the complaint.

In relation to the complaint that the practice unreasonably removed Mr A from their list, we found that the practice should have issued a warning letter to Mr A before removing him from their list. We upheld this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failure to issue a warning before removing him from their practice list. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Consider any application to re-register on the practice list received from Mr A.

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

• A breakdown in a doctor/patient relationship should be managed in line with the General Medical Council's guidance and the relevant regulations.

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.