Health

Summary

Mrs C complained about the care and treatment provided to her father (Mr A) at Victoria Hospital. Mrs C was also concerned that the investigation of her complaint to the board had been inadequate.

Mr A had been admitted to hospital for treatment of a heart condition. Mrs C believed that his assessment had been inadequate and that he had been prescribed a drug which had caused a severe reaction when combined with the medication Mr A was already taking. Mr A had developed ulcers in his left eye and then contracted cellulitis (an infection of the deeper layers of skin), which had affected both eyes.

Mr A had required surgery to his left eye. Mrs C believed this experience had rapidly increased the onset of Mr A's dementia, leaving him incapable of managing by himself, where as he had previously had a significant degree of independence. Mrs C said that this could have been avoided, had his medication been checked properly before he was prescribed new drugs by the hospital, as ulceration was a known complication.

We took independent advice from an appropriately qualified adviser. We found that Mr A's care and treatment had fallen below a reasonable standard, because his medication had not been properly reconciled prior to the prescription of a new drug. We could not state for certain that Mr A's deterioration was solely attributable to this error, as the side effects he suffered could have been caused by the new drug by itself, rather than in combination with his existing medication. We upheld this aspect of the complaint.

We also found that the board's investigation of the complaint had been inadequate, as it had not identified the failure to reconcile Mr A's medication. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and Mr A for the inadequate standard of care provided by the board and the failure of the subsequent complaint investigation by the board to identify this. 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 need to comply with the board's procedures for medication reconciliation.

In relation to complaints handling, we recommended:

• Staff should be able to identify accurately the substantive issues contained within a complaint.

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 and treatment provided to their late spouse (A) by the practice. A had reported symptoms of excessive wind, bloating, nausea and loss of appetite. A was later diagnosed with metastatic melanoma (skin cancer that has spread). C complained that the practice delayed in carrying out an appropriate assessment of A's symptoms and that they failed to follow up on A's treatment and referrals. The practice considered that A was seen promptly following triage and that according to the Scottish Referral Guidelines, A did not warrant an urgent referral based on their symptoms at the time.

We took independent advice from a GP. We found that the assessment of A's symptoms was appropriate and the relevant guidelines for suspected cancer were followed appropriately by the practice. We also found that the referral for an urgent endoscopy (a procedure whereby a flexible tube with a camera is used to view the organs inside the body) was timely and appropriate. We did not uphold the complaint.

Summary

The board carried out a significant adverse event review (SAER) into the care provided to Mr C's family, following the death of their baby. The SAER identified various issues in the care provided to Mr C's family and it identified actions to address them. Mr C raised concerns with us that the board might not have carried out all of those actions appropriately and he wanted us to independently assess this.

We took independent advice from a midwife and from a consultant obstetrician (a doctor who specialises in pregnancy and childbirth). We found that the actions set out in the SAER were appropriate to address the issues in care and treatment that it identified. We also considered that the board had provided us with sufficient evidence that those actions were carried out appropriately. We did not uphold the complaint.

Summary

Mr C complained on behalf of his daughter (Ms A) in relation to charges for treatment provided to Ms A in Victoria Hospital. Ms A was visiting the UK from overseas and attended A&E with palpitations (noticeably rapid, strong or irregular heartbeat). Following assessment in A&E, Ms A was admitted to an acute medical ward before she was later discharged. Ms A reattended the hospital the following week for a check-up and at this time an interview to assess charges for overseas visitors was also performed. Ms A subsequently received an invoice for the admission. Ms A had extensive contact with the board's finance and patient feedback teams in relation to the invoice. She remained dissatisfied with the board's final response and Mr C brought the complaint to us.

Mr C firstly complained that the board failed to inform Ms A that she would be charged for treatment when she attended A&E. We found that, due to the timing of the attendance and discharge from the hospital, it was reasonable that Ms A was not informed she would be charged for treatment until the interview performed in the week following the admission. We did not uphold this complaint.

Mr C also complained that the board failed to charge and invoice Ms A appropriately for treatment provided. In response to Ms A's complaint, the board identified and apologised for issues with the invoicing process. We found that the board's documentation of the assessment of liability for charges was poor. We were unable to determine that the board had followed the correct process for establishing liability and fully established that no exemptions applied to Ms A's treatment. On this basis, we upheld the complaint.

Finally, we identified a number of failings in the board's handling of Ms A's complaint. We noted that there had been a delay in signposting Ms A to the complaints procedure; that the board's correspondence contained inaccurate information; and that the final response did not address all the points raised. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms A for the failings identified in assessment and complaint handling. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.
• Seek further information from Ms A (as needed) and reassess her liability for charges using overseas visitors' liability to pay charges for NHS care and services: a guide for healthcare providers in Scotland – CEL 09 (April 2010). Inform Ms A if she is deemed exempt or liable for charges, and provide a reason for this.

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

• Patients from overseas should be assessed for liability for charges in accordance with the board's internal procedure and the Scottish Government guide. An assessment of liability should be recorded in line with the board's procedure.

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the requirements of 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.

Summary

C attended an appointment at Victoria Hospital to have a stent (a splint placed temporarily inside a duct, canal, or blood vessel to aid healing or relieve an obstruction) removed. The procedure, scheduled for the morning, was not performed until the evening, and when C was transferred to a ward they had not eaten for over 24 hours or drunk for around 18 hours. The board accepted that C had been fasted of food and liquid for longer than guidelines recommended. The board apologised for this and committed to reviewing their fasting guidelines and discussing these with staff. C had also not received all of their regularly required medication during this time in the hospital. The board apologised for this and explained that a full medication history should have been obtained via discussion with C and took steps to improve medicines management. During the process of complaining about their experiences, C agreed with a patient relations officer that a meeting to discuss their complaints, as offered in the board's first response to them, would be arranged. C subsequently received a second response from the board but no further communication about the expected meeting.

We investigated C's complaints about these matters. We upheld C's complaint about being fasted for an unreasonable length of time and found the actions that the board had committed to had not been undertaken. We upheld C's complaint about the failure to provide their regularly prescribed medication, given these had not been provided and there was no evidence a medication history had been completed as per normal processes. The board explained that they had decided the second response was the appropriate way to provide the clarification that a meeting would have delivered. Given C had reached a similar conclusion and had not pursued the matter further with the board, we did not uphold their complaint about the board's failure to complete the arrangements.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide them with their regularly prescribed medication. 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 to complete a medication history for all patients as per normal processes.
• The board to fulfil their commitment to reviewing fasting guidelines and discussing these with all staff.

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

Miss C complained about the care and treatment provided to her late father (Mr A). Mr A had been diagnosed with advanced prostate cancer and was admitted to a community hospital for rehabilitation and intensive physiotherapy after he had undergone chemotherapy and radiotherapy. Mr A's care and treatment was provided by a team of medical professionals including a GP and nursing staff. Mr A's condition deteriorated and he died during his admission.

We took independent advice from a GP and a nurse.

Miss C was concerned that there was a failure to diagnose and treat Mr A's lower respiratory tract infection and pneumonia and questioned the administration of an antidepressant medication to Mr A. We found that the infection was identified appropriately and appropriate treatment was provided. In addition, it was reasonable to have prescribed the medication and that there was no connection between this and Mr A's deterioration and death.

Miss C also raised concerns about the physiotherapy and rehabilitation provided to Mr A and the input from the dietician service. We found that the records documented Mr C had received reasonable physiotherapy and dietary care.

In relation to Mr A's end of life care, we found that it was not required that a GP attend Mr A in the 24 hours before he died. We also found that appropriate nursing care was provided to Mr A.

For the reasons outlined above, we did not find evidence of unreasonable failings in the care and treatment provided to Mr A and, as such, we did not uphold this complaint.

Miss C further complained that there was a lack of reasonable communication with her and her family about Mr A's care and treatment. While we found there was evidence of appropriate communication about Mr A's care, including about Mr A's end of life care, we took account of the board's complaint response to Miss C which identified areas for improvement and learning and accepted that unintended distress was caused to Miss C and her family. Therefore, on balance, we upheld this complaint.

Miss C also considered that the board had failed to handle her complaint reasonably. We found that there was a reasonable and proportionate effort by the board to answer the issues raised by Miss C. We noted that the board offered to meet with Mr A's family. As such, we did not find that the board's handling of the complaint was unreasonable and, therefore, we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C and her family for the failings identified by the board's complaint investigation in communication, in particular, around the end of life care provided to Mr A. 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

Ms C returned to her GP after being discharged from the board's community psychiatric nursing (CPN) service as she was experiencing coping difficulties and anxiety. A further referral was submitted to the service but was refused. The local mental health team's view was that ongoing support for Ms C would not be appropriate or required because it was unlikely that she would derive any therapeutic gain.

In her complaint to the board, Ms C said she was unreasonably discharged from the service and that this had not been communicated to her clearly. She also complained about the decision to refuse the further referral to the service. The board said that Ms C's discharge from the service was well planned and discussed with her. It was also noted that Ms C had received extensive input from the service so it was felt she would not gain anything further and no plans were made to see her again after her GP referral. Ms C was unhappy with this response and brought her complaint to us.

We took independent advice from a mental health nurse. We found that Ms C's discharge was reasonably planned and phased and took place with her agreement and input. However, we were unable to identify a crisis plan within the records. A plan of this nature would have been helpful to all stakeholders in their efforts to support Ms C when her emotions fluctuate. It was unreasonable that no such plan appeared to be in place for Ms C. With that said, whilst it was clear from the GP's referral letter that Ms C was experiencing an increase in anxiety, there was no evidence to suggest that she was in crisis at that point. Given the evidence available, we concluded that Ms C's discharge from the CPN service was reasonable and that it was communicated to her appropriately. We also found that the local mental health team's response to her GP's referral was reasonable. Therefore, we did not uphold Ms C's complaints.

Ms C also complained that the board failed to handle her complaint reasonably. We found that there were delays in corresponding with Ms C and she was not kept up to date on the progress of her complaint. We also found that the board should have followed up with Ms C following a meeting were a number of action points were agreed. 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 handle her complaint reasonably. The apology should meet the standards set out in the SPSO guidelines on apology available at: www.spso.org.uk/information-leaflets.
• Write to Ms C to confirm the steps taken to progress the identified outcomes recorded following the meeting.

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

• Complaints should be handled in line with the Model Complaints Handling Procedure (MCHP). The MCHP and guidance can be found here: https://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 complained about the care and treatment provided to her by the board in relation to breast cancer screening. Ms C had attended the breast clinic where a mammogram (an x-ray test which can detect breast cancer) noted some microcalcifications (tiny abnormal deposit of calcium salts) in the left breast. These were compared with a previous screening and it was decided that no further investigation was needed. Some months later, Ms C had a further screening and on this occasion it was decided to biopsy the calcifications. The biopsy showed some abnormal features and Ms C was later found to have invasive disease (when germs invade parts of the body that are normally free from them). Ms C complained that pre-cancerous cells were not detected at her screening and there was no follow-up or further investigation at this time.

We took independent advice from a consultant in breast radiology (use of medical imaging techniques such as x-rays and other scans to diagnose and treat disease in the body). We found that based on the comparison of the mammogram images from a previous and the most recent scan, there was no indication to carry out a biopsy and it was appropriate not to take further action at this point. Therefore, we did not uphold the complaint.

Summary

Ms C was admitted to hospital due to increased suicidal ideation and an overdose. She remained there for a period of around three weeks where she underwent electroconvulsive therapy (ECT, a type of brain stimulation sometimes used to treat depression) as a treatment.

In her complaint to the board, Ms C was particularly concerned about whether she had capacity to consent to the ECT treatment given her presentation at her time of admission to hospital and during her stay. Ms C was also unhappy that the hospital did not involve her sister in decision-making. The board explained that whilst Ms C was experiencing moderately severe depressive illness at the time of her admission to hospital, she was assessed as having capacity to consent which was taken by the hospital in an appropriately informed manner. The board agreed that they could be more active in offering patients who are unwell the opportunity to include family members in discussions about significant treatment decisions and took steps to implement this. Ms C was unhappy with this response and brought her complaint to us.

We took independent advice from a mental health adviser. We noted that although Ms C experienced undesirable after-affects from the treatment, they were not uncommon or out of the ordinary. There was nothing to indicate a potential loss of capacity to make decisions regarding medical treatment in Ms C's case. We considered that Ms C was properly assessed as having capacity to make treatment decisions and she was provided with appropriate information in relation to the risks and benefits of the ECT treatment to enable her to make an informed decision. The evidence showed consent was re-checked prior to each of the treatments. When Ms C clearly withdrew consent, her treatment was stopped. We concluded that the issue of consent was handled appropriately by the board in Ms C's case. We did not uphold this complaint.

Summary

Ms C had a hysterectomy (surgical removal of the uterus) a number of years ago and recently accessed the records held by the hospital that performed it. She noted a report had been prepared post-surgery with advice to be followed in the event Ms C sought Hormone Replacement Therapy in the future. Ms C complained that this report was not sent to her former GP. We found that it was not possible to state the report was not sent to Ms C's former GP. Therefore, we did not uphold this complaint.

Ms C also complained about a failure to maintain an adequate record of when the hysterectomy report was sent to Ms C's former GP. We found that the procedure in place for the transfer and recording of information was standard practice at the time in question. We noted that since that time, the board's method of sending and recording this information had changed to an electronic method, and this removed the uncertainty around the transfer of information which had previously existed. Therefore, we did not uphold this complaint.

Ms C also complained about a failure to offer a follow-up appointment after her hysterectomy. We found that the decision not to arrange a follow-up appointment following surgery was standard practice at the board and that this was reasonable based on the surgery undertaken. We did not uphold this complaint.