Health

Summary

Mr C complained about the care and treatment his partner (Mr A) received from the board. Mr A was diagnosed with Functional Neurological Disorder (FND, a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts) and depression. Mr A was seen by a consultant neurologist (a specialist in the diagnosis and treatment of disorders of the nervous system) at a neurology clinic. Mr C complained about the length of time it took to arrange appointments for the joint Functional Neurological Clinic (the joint clinic); the communications surrounding these appointments; the changes in medication and the lack of subsequent review. Mr C also complained about the length of time it took the board to respond to the complaint.

We took independent advice from a consultant psychiatric adviser. We found that, whilst the clinic appointment waiting time was not ideal, there was no unreasonable delay in the circumstances. We also did not identify any unreasonable delays in Mr A's follow-up appointments being arranged. Whilst there was some communication shortcomings, we did not consider that these amounted to unreasonable failings. However, given there was no record of a discussion with Mr A about the potential adverse effects of increasing his medication, on balance, we upheld this complaint.

We also found that the board had accepted that the delay in responding to the complaint was excessive and that they had apologised accordingly. We upheld this aspect of the complaint but made no further recommendations.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to demonstrate that discussion took place with him regarding the potential risks of adverse effects when increasing his medication dosage. 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 expected benefits as well as the potential burdens and risks of any proposed investigation or treatment should be explained to patients in line with General Medical Council guidance on consent.

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 arrived at Ninewells Hospital's emergency department by ambulance. After an initial assessment C was transferred to a mental health unit. C complained about the treatment provided at both locations. We took independent psychiatric advice.

We found that the treatment provided at Ninewells Hospital was reasonable, C was appropriately assessed and managed, with an appropriate referral to psychiatric services and appropriate steps taken to maintain C's safety. We did not uphold this aspect of the complaint.

We found the treatment provided at the mental health unit was also reasonable. A thorough examination of C was undertaken and during C's admission adequate monitoring and care of C was provided. We did not uphold this complaint.

Summary

Mr C, who had a previous history of repeated sinus infections, attended the day surgery unit at St John's Hospital for planned septoplasty surgery (corrective nose surgery). He was prepared for surgery by a nurse but Mr C was then reviewed by a doctor who decided that surgery was not required at that time and that Mr C could be discharged home with nasal capsules and would be reviewed at a later date. Mr C said that it was unreasonable that the doctor had overruled a previous consultant, who deemed that surgery was required, and that he was prescribed capsules which had not been effective in the past.

We took independent advice from an ear, nose and throat surgeon. We found that it is not unusual for planned surgery to be cancelled on the day of surgery. Clinicians who may have not seen the patient previously routinely review the symptoms reported and may determine that the surgery is cancelled or that alternative surgery should proceed instead. We did not uphold Mr C's complaint.

Summary

Miss C attended the Royal Infirmary of Edinburgh A&E having cut her lower right leg. The wound was treated with wound closure strips and a dry dressing. Miss C complained that it was not appropriate to treat her wound with strips and that they should have been sutured as she developed an infection and required further treatment. The board explained that wounds on the lower leg take longer to heal, are more prone to infection and it is unlikely suturing would have resulted in a different outcome.

We took independent advice from a medical adviser. We found that the use of wound closure strips can be as effective as sutures in cuts. There was no evidence to suggest that the treatment provided was unreasonable and it would not be possible to determine whether the wound would not have become infected if it had been stitched. Therefore, we did not uphold the complaint.

Summary

Mrs C complained that the reporting of x-rays taken of her knees was unreasonable. Mrs C was referred by her GP for an x-ray as she had been suffering from pain in her knees for over a year and her GP thought that she might be experiencing the onset of arthritis (a disease causing painful inflammation and stiffness of the joints) . Knee x-rays were carried out and Mrs C's GP later advised her that the x-rays showed no signs of arthritis. However, Mrs C subsequently attended a private hospital and was advised that x-rays did show early onset arthritis and swelling in both knees. Mrs C stated that the x-rays from the board had not been looked at properly.

We took independent advice from 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 no evidence that the reporting of Mrs C's knee x-rays had not been reasonable but the images taken allowed for different interpretations and did not give a clear enough picture to result in a definite arthritis diagnosis. Therefore, we did not uphold the complaint.

Summary

C complained about the care and treatment they received from the practice. C had a history of back pain and attended a consultation at the practice. During the consultation, the GP discussed a number of pain relief medications with C and a prescription was made.

Approximately three weeks later, C presented to a hospital and received emergency treatment for cauda equina syndrome (a rare and serious neurological condition that affects the bundle of nerves (cauda equina) at the base of the spine). C raised concern that the practice missed signs of cauda equina syndrome when they attended the practice a number of weeks earlier. They were also unhappy with the treatment provided at the time.

We received independent advice from an appropriately qualified adviser. We found that an appropriate assessment was performed during the GP consultation. Having considered the accounts of C and the practice, we concluded that the practice did not miss red flags for cauda equina syndrome. We also considered that the discussion regarding medication and prescription were reasonable. We did not uphold C's complaint.

Summary

C complained on behalf of their late parent (A) regarding nursing and medical care and treatment provided to A during an admission to the Western General Hospital.

We took independent advice from a nurse and from a consultant in general medicine and care of the elderly.

With regard to the concerns about nursing care, we found that there were failures in relation to:

risk assessment completion and accuracy

personal care

pressure sore prevention and management

wound care

continence management

encouraging mobilisation

person-centred care planning

We upheld this aspect of C's complaint.

With regard to medical treatment, we found that there was an unreasonable delay in providing antibiotics for A's urinary tract infection. However, we noted that the board had acknowledged and apologised for this failing previously. We also found that A was kept on the medical assessment unit for the entire admission of over a week, despite this unit being for maximum stays of 48 hours. Given these failings, we upheld this aspect of C's complaint.

C further complained that A had a dental appointment at another hospital in the area whilst they were an in-patient, and no arrangements were made to assist A to attend this or to arrange for them to be seen by their dentist at the Western General Hospital. The board had previously acknowledged that they should have arranged for transport and for a member of staff to attend the appointment with A, apologised, and offered to compensate C for the cost of transport. We upheld this aspect of C's complaint.

Finally, C complained that the board failed to identify that they were making a formal complaint. We found that C's complaints were not appropriately identified and responded to in line with the Model Complaint Handling Procedure and the board had accepted this. We therefore upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the failure to provide reasonable nursing care and medical treatment to A, and for the failure to handle C's 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.

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

• Appropriate care rounding should be carried out in a patient at risk of pressure damage.
• Every patient should have a person-centred care plan, and this should include consideration of how to manage any continence issues and mobility issues.
• Patients should be encouraged to get out of bed and get dressed appropriate to their condition.
• Patients should be transferred from the medical assessment unit to a ward, or be discharged, within a reasonable timescale. If a patient is on the medical assessment unit for more than the board's maximum period of stay (48 hours), the reasons for this, and any attempts to find a more suitable ward or a single room should be documented.
• Pressure sore prevention and management should be carried out in line with Healthcare Improvement Scotland Pressure Ulcer Prevention Standards.
• The Waterlow Pressure Area Risk Assessment Chart should be accurately completed on admission.
• Where appropriate, antibiotics should be provided in a timely manner when lab results become available.
• Wounds should be assessed and managed in line with Healthcare Improvement Scotland Scottish Wound Assessment and Action Guide, and relevant wound formularies.

In relation to complaints handling, we recommended:

• Complaints should be accurately identified and logged. If it is not clear whether the issues are a complaint or a concern, this should be clarified.

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 sibling (A) who is a Type 1 diabetic. A was admitted to hospital twice following hypoglycaemic (low blood sugar) episodes. The second admission took place via A&E. The discharge letter for A's second admission described A as being 'anorexic' (an eating disorder where individuals feel a need to keep their weight as low as possible) and having 'learning difficulties'. A, and A's family, complained about the decisions taken to discharge A, about the treatment A received at A&E, that the board did not perform tests or investigate A's condition during A's second admission and about the descriptions of A included in the discharge letter.

We took independent advice from an appropriately qualified adviser. We found that that the decisions to discharge A had been reasonable, that A had been provided reasonable treatment within A&E, that A's management during the second admission had been reasonable and that the board's inclusion of the descriptions A took issue with in the second discharge letter were reasonable. We did not uphold the complaints.

Summary

Ms C complained that the total knee replacement surgery she had undergone had not been carried out appropriately. We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). The board were unable to locate the operation note for the surgery. However, we found that the evidence that was available indicated that it was likely there had been a technical error in the operation in that too much bone was resected (removed). However, without the operation note, it was not possible to state this categorically.

We also found that Ms C had been poorly consented for the operation. There was little evidence that she had been informed of the risks of surgery. The risks of ongoing pain, dissatisfaction and the fact that revision might be necessary were not specifically recorded. It was also unreasonable that the operation note was not available. Given this, we upheld this aspect of Ms C's complaint.

Ms C also complained that the board's response to her complaint was unreasonable. We found that the board's response had been inaccurate about who carried out the operation. There was also a delay in responding to the complaint and no evidence that the board agreed revised time limits with Ms C for responding. Therefore, we also upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings we have 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:

• Important documents such as operation notes should be securely retained by the board.
• Patients who are being offered total knee replacements should be given adequate information about the risks and possible complications.

In relation to complaints handling, we recommended:

• Where an investigation takes longer than 20 working days, the board should inform the complainant; agree revised time limits; and keep them updated on progress.
• Responses to complaints should be accurate.

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 she received at A&E at Royal Infirmary of Edinburgh (RIE) and when she attended for an MRI scan. She also complained about the clinical and nursing care and treatment provided during a number of admissions to the RIE.

We took independent advice from a consultant in emergency medicine in relation to Miss C's attendance at A&E. We found that the care and treatment was reasonable, in particular, that Miss C was seen by an emergency medicine doctor who obtained a thorough history and conducted a comprehensive examination; that the possibility of a pituitary (a small gland in the brain that makes hormones) tumour was considered and the most appropriate radiological imaging plan was discussed with a radiologist; that arrangements were made for an emergency out-patient MRI scan which was carried out within the timeframe for an urgent MRI scan.

We took independent advice from a consultant radiologist in relation to the care and treatment given to Miss C when she attended for an MRI scan. We found no evidence that the care and treatment was unreasonable and, therefore, we did not uphold the complaint.

In relation to the clinical care and treatment given to Miss C when she was admitted to the RIE on three occasions, we took independent advice from a consultant surgeon. We found that the clinical care and treatment given to Miss C during these admissions was reasonable and we did not uphold these complaints.

Finally, we took independent advice from a nursing adviser in relation to the nursing aspects of the care given to Miss C during two of her admissions to the RIE. We found failings in relation to Miss C's discharge medication on one occasion and we upheld this aspect of her complaint. The board accepted these failings and had taken action which we considered was reasonable.

Therefore, we made no further recommendations. We found no failings in relation to the nursing care and treatment given to Miss C during the second admission to the RIE and we did not uphold this complaint.