Health

Summary

Mrs C complained that the practice had failed to properly investigate a series of complaints she had made about entries in her and her children's medical records. Mrs C believed the practice's conclusions were unreasonable given the available evidence. Mrs C also complained that the practice failed to communicate appropriately with her.

We took independent advice from an adviser on general practice medicine. We found that the practice had reasonably and appropriately investigated the complaints brought to it by Mrs C and had communicated reasonably with her. Some of the medical record entries that Mrs C objected to were the opinions of the GP following their encounter with her. We considered that it was reasonable for medical records to contain subjective opinion and it was not possible to amend or delete the entries Mrs C was concerned about. In addition, the practice had offered Mrs C the opportunity to place notes in her medical records, indicating that she disagreed with the content or tone of the entries. Mrs C had not responded to these offers. We did not uphold any of Mrs C's complaints.

Summary

C complained about the care and treatment provided to them by Scottish Ambulance Service (SAS) when they called for an ambulance after they had bleeding following the removal of a lesion earlier that day.

We took independent advice from an appropriately qualified adviser. We found that the care and treatment provided to C by SAS was of a reasonable standard. C was given appropriate advice from the call handler, the ambulance was dispatched and arrived with C in a timely manner. We also found that the ambulance crew's assessment of C's wound was reasonable. Therefore, we did not uphold C's complaint.

Summary

C complained about the care and treatment their late relative (A) received at the practice. A sought advice from the practice after returning home from a holiday abroad where they had become unwell. C's complaint related to a number of issues; including communication, medication, and scans.

We took independent advice from a GP. We found that there were no failings by the medical practice in terms of communication with the family or the time taken to perform scans. In relation to the management of A's medication, we found that the responsibility of stopping and restarting medication lay with the hospital clinicians. We also found that there were many reasons for A's balance and mobility issues, thus, a head scan was not indicated. We concluded that the care and treatment provided by the medical practice was of a reasonable standard. Therefore, we did not uphold this complaint.

C also complained about the practice's handling of their complaint. We found that the medical practice had provided their response to C's complaint to the health board within three weeks of them receiving the complaint and in line with the agreement to issue a coordinated response. However, there was a delay in the health board issuing the response to C for which they apologised for. We concluded that there was no fault by the medical practice and, therefore, we did not uphold the complaint.

Summary

C complained about the care and treatment their late relative (A) received. A became unwell whilst abroad and was treated in hospital, at which time their blood thinning medication was stopped. Upon A's return home, they sought advice from their medical practice and arrangements were subsequently made for A to be admitted to hospital. After a period of six days, A was discharged from hospital. Their blood thinning medication was not restarted pending investigations. A then suffered two strokes and later died.

C complained about a number of issues related to: communication; failure to manage blood thinning medication; no head scan being performed prior to A's first stroke; the time taken to perform scans; matters related to an echocardiogram (a scan used to look at the heart and nearby blood vessels); management of the first stroke; and that a post mortem was not performed. C also complained that the board failed to respond to additional complaint correspondence they had sent.

The board's investigation identified areas of care that were of an unacceptable standard and they made a number of recommendations to address the failings.

During our investigation, we took independent advice from a consultant geriatrician (a specialist in medicine of the elderly). We did not identify evidence of unreasonable practice in the board's care in relation to a head scan not being performed prior to A's first stroke, nor did we identify any failings related to the management of A's first stroke. Nevertheless, we found that there were unreasonable failings related to communication; management of A's blood thinning medication; the echocardiogram and the post mortem. We, therefore, upheld this complaint.

We also investigated C's concerns about the board's handling of their complaint. We found that there were issues raised in C's additional letter that were not fully addressed by the board. We considered that a clear written response should have been provided to C. We concluded that it was unreasonable that the board did not provide a written response to the points laid out in C's additional correspondence. We, therefore, upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and the family for the unreasonable failings in A's care and treatment and for the inaccurate reference in the Significant Adverse Event Review report that it was the GP's recommendation that A did not go on holiday. 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:

• Appropriate consideration should be given to the restarting of blood thinning medication following clinical procedures, such as biopsy.
• Comments made by families during the Significant Adverse Event Review process should be reasonably responded to.

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 that the board failed to carry out further tests when they became aware of the fact that their partner (A) had polyhydramnios (excess amniotic fluid) during pregnancy before giving birth to their baby (B). B was diagnosed with Noonan Syndrome (a genetic disorder that causes a wide range of features, such as heart abnormalities and unusual facial features) after birth. C considered that, if the board had carried out further tests, this may have led to the detection of Noonan Syndrome prior to the birth of B.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth). We found that the board's staff followed recognised practices when carrying out ultrasound scans and assessing the unborn child. During the 30th week of A's pregnancy, polyhydramnios was first raised as an issue. At that time it was a mild case and no abnormalities were identified with the foetus. By the 36th week of A's pregnancy, polyhydramnios had increased to a moderate case. We found that, whilst polyhydramnios is a feature of Noonan Syndrome, it can be caused by a number of other factors, and no other features of Noonan Syndrome were present. We found that there was no indication for an amniocentesis (a test offered during pregnancy to check if the baby has a genetic or chromosomal condition) to be carried out. If an amniocentesis had been offered, Noonan Syndrome would not have been identified, unless a specific test for this had been carried out. We did not uphold this complaint.

Summary

Mrs C complained that the board failed to deal with her complaint in a reasonable way. Mrs C made a complaint and received an acknowledgement but did not hear anything back for seven months. Mrs C asked for an explanation about the delay in keeping her informed and when the health board expected to be in a position to respond to the complaint. In all emails, Mrs C asked to be contacted by email. The health board responded the following month by letter saying that the matters raised were not new (as Mrs C had made several complaints previously) and they were handling the complaint under their unacceptable actions procedure.

In reaching our decision, we did not reach a judgement on whether the issues raised were new, but considered whether the health board handled the complaint in a reasonable way and whether their actions were in line with their unacceptable actions procedure.

During our investigation, the health board acknowledged their response to Mrs C was insufficiently clear about why they had determined that no further response to the complaint was required and that there was an unacceptable delay in responding to her complaint. Moreover, whilst we appreciated the health board did not email because of concerns about security, we considered that as long as complainants are made aware of any data protection concerns when receiving confidential information by email, then staff should respect a complainant's preferred method of contact. In addition, we found that staff should have signposted Mrs C to this office in their response in line with the NHS Model Complaints Handling Procedure (MCHP). Furthermore, there was no evidence that the health board complied with their unacceptable actions procedure in a number of respects. Overall, we found that the health board did not deal with Mrs C or her complaint in line with their procedure and we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to deal with her complaint in a reasonable way. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/information-leaflets.

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

• Complaints should be dealt with in line with the MCHP and, where appropriate, the board's unacceptable actions procedure. The MCHP 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

C complained on behalf of their partner (A) following A's admission to University Hospital Hairmyres with drowsiness. There was an indication that A may have taken too much of their prescribed medication at home. C raised concerns that a period of deterioration during A's admission was due to poor care.

We took independent advice from an appropriately qualified adviser. We considered that A's deterioration was related to infection, and were unable to identify anything to suggest that their deterioration was due to poor care. We did not uphold this aspect of the complaint.

C complained that their concerns about A's deterioration were ignored, and that when they asked to speak to medical staff, this was not arranged. The board noted that C had been given the telephone number of the consultant's secretary, and that two doctors were on the ward during the day on weekdays and were available to speak to patients and relatives. We considered that nursing staff should have arranged for the ward doctors to speak to C, rather than providing a number to make an appointment with the consultant. We considered that this would have been simpler, quicker and more effective. We upheld this aspect of the complaint.

C also expressed concern about the arrangements in place for A's medication on discharge, including that they were not given a dosette box to assist them in managing the medication at home. We noted that there was concern that A's medication may have caused the symptoms which led to their admission, and as such they considered that the discharge medication should have received more care and attention. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and A for not giving more care and attention to A's discharge 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:

• Care and attention should be given to arrangements for discharge medication, especially where there is evidence of a patient having had previous problems taking (or relatives having had problems administering) the correct medication.

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 that there was an unreasonable delay in providing their parent (A) with a diagnosis of pancreatic cancer.

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 gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We found that radiology unreasonably failed to detect and report pancreatic cancer from a scan taken five months prior to diagnosis and that there was an unreasonable failure to hold a multi-disciplinary team meeting between radiology and gastroenterology with imaging. We also found that there was an unreasonable delay in investigating the cause of A's pancreatic insufficiency as it would have triggered further imaging. We considered that earlier detection may have improved A's quality of life because they would have had a management plan for palliative care sooner. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C and their family for the delay in diagnosing A's pancreatic cancer at the three points detailed in the decision. 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:

• Regular multidisciplinary meetings should be arranged where difficult cases are discussed with imaging and clinical information available.
• The board should encourage the use of multiplanar reformatting facility (involves the process of converting data from an imaging modality acquired in a certain plane, usually axial, into another plane).
• The board should ensure all organs are assessed for CT reporting.
• To ensure radiological errors are reviewed with all reporting radiologists and radiographers to facilitate shared learning.
• To view this case as a learning opportunity that a lower threshold for suspicion of pancreatic cancer should be adopted by clinicians.

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 provided to her child (Child A). Mrs C felt that Child A was denied access to NHS doctors with experience in paediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS - a neurological and psychiatric condition in which symptoms are brought on or worsened by infection). She also felt that the board had unreasonably refused to treat Child A with antibiotics and had instead suggested mental health treatment as an alternative. Mrs C had requested that Child A be referred to specialist clinicians in England and felt that the board had unreasonably denied this request.

We took independent advice from a paediatrician. We found that there was evidence that the board were engaged with the medical literature on PANDAS and used this to inform their decision not to offer antibiotic treatment. We considered this to be a reasonable position and concluded that the board provided appropriate care and treatment in this respect. We also considered that the board's approach to obtaining second opinions and referring Child A to alternative clinicians was reasonable. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the board's communication with her. We found that there was evidence in the records of timely and appropriate communication, and there was no evidence of unfair treatment. We did not uphold this aspect of Mrs C's complaint. However, we did identify that there were issues with the board's handling of Mrs C's complaint, as there was a delay in issuing a response and the response did not address all the issues Mrs C had raised. Therefore we made a recommendation under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the delay in issuing the formal response to her complaint, and for the failure to address the issues she had raised in the formal response to her 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:

• Complaint responses should be full and timely.

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 treatment the board provided to him following his surgery for Dupuytren's Contracture (a condition in which one or more fingers become permanently bent in a flexed position). Mr C complained that he had suffered an infection post-operatively which was not appropriately treated.

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 board had provided a reasonable standard of treatment to Mr C. He was seen regularly after the operation and no concerns were recorded by clinical staff that Mr C was suffering from a post-operative infection that was clinically significant (required treatment). Therefore, we did not uphold Mr C's complaint.