Health

Summary

Mrs C complained that the care her child (Child A) received from the board during their admission for bacterial meningitis (an infection of the protective membranes that surround the brain and spinal cord) was unreasonable. Mrs C said that Child A was not given the full dose of antibiotics and that the day after discharge they had to be re-admitted as the infection had not been cleared. Mrs C also complained that Child A was given an MRI scan using the feed and wrap technique (use of feeding and swaddling to induce natural sleep in infants), which did not work, rather than performing the test under general anaesthetic.

We took independent advice from a consultant paediatrician (a medical practitioner specialising in children and their diseases). We found that, on review of the medical notes, Child A received the stated course of antibiotics, there were no concerns over the timing of the doses, and it was reasonable for Child A to have been discharged initially. We also found that it was reasonable for Child A to have their MRI using the feed and wrap technique in the first instance. As a result, we did not uphold this aspect of the complaint.

Mrs C also complained that the handling of her complaint was unreasonable. We were satisfied that the board had followed the NHS Complaints Handling Procedure and as a result, did not uphold this aspect of the complaint.

Summary

C complained about the care and treatment provided to their late partner (A). C said that there was an unreasonable delay in diagnosing that A was suffering from cancer. We took independent advice from a consultant in acute medicine (a doctor who specialises in the immediate and early management of adult patients with a wide range of medical conditions who present in hospital as emergencies) and a consultant in respiratory medicine (a doctor who specialises in treating and managing patients with conditions affecting their lungs). We found that the care and treatment A received was reasonable and that there was no delay in diagnosing that they had cancer. As such, we did not uphold the complaint.

C also complained that the medical care and treatment provided to A after diagnosis was unreasonable. We took independent advice from a consultant in respiratory medicine. We found that the care and treatment given to A was reasonable; that all appropriate investigations and tests were carried out and that these were performed rapidly. We also noted that A's main consultant was actively involved and spoke at length to the family, as did the clinical nurse specialist. Finally, we found that there were frequent discussions where A and the family were updated on their condition. Therefore, we did not uphold the complaint.

In addition, C complained that the nursing care and treatment provided to A after the diagnosis of cancer was unreasonable. We took independent advice from a nursing adviser. We found that, while the majority of the nursing care and treatment given to A was reasonable and in line with the Nursing Midwifery Council Code, the board had accepted that the condition that C had found A in when they had attended the ward on one occasion was unreasonable and that they had taken action as a result. On balance, we upheld the complaint but made no recommendations.

Finally, C complained that A was unreasonably discharged from Forth Valley Royal Hospital. We took independent advice from a consultant in respiratory medicine and from a nursing adviser. We found no evidence that A had been unreasonably discharged and as such we did not uphold the complaint.

Summary

C complained on behalf of the child (A) about the care and treatment received by the board. A was referred to neurology (the branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system) after reporting that they were experiencing upper body jerks and involuntary twitching. A review was undertaken by a private healthcare provider on behalf of the board as part of a neurology waiting list initiative. The neurologist agreed that an MRI scan and an EEG (electroencephalogram - a test used to evaluate the electrical activity in the brain) would be carried out. Some years later, A was admitted to hospital after a seizure. It was noted that the earlier EEG referral was not progressed. Another EEG was arranged and following that, A was diagnosed with epilepsy (a condition that affects the brain and causes frequent seizures).

C said that they considered the failure to carry out the EEG meant there was a delay in diagnosing A's epilepsy. The board said it was the neurologist's intention to have the scan carried out. An apology was given for the lack of follow-up in A's case.

The evidence available confirmed that the neurologist appropriately considered the possibility that A was suffering from myoclonic epilepsy (brief shock-like jerks of a muscle or group of muscles), and intended to order appropriate investigations. However, there was no evidence available to confirm that the request for the EEG was actioned or followed up. The relevant paperwork was not available to reflect back on what may have happened.

We took independent advice from an appropriately qualified adviser. We found that an EEG should have been carried out in A's case. The relevant guidance indicates the significance of arranging an EEG in cases of suspected myoclonic epilepsy.

We upheld the complaint but did not recommend any further action because the board had already apologised for not actioning the EEG. In addition, the board also told us they no longer used the services of the provider.

Summary

C complained about the care and treatment provided to their child (A). A was treated with intravenous immunoglobin (antibodies) because it was suspected they had an immune-related movement disorder. The focus of C's complaint was about the decision to stop this treatment as they considered it was of benefit to A.

During our investigation we noted that the decision to start and stop this treatment was made by a doctor under a different health board. The treatment plan was commenced at the other board and moved to Fife NHS board because it was more convenient for A and their family to attend. We were therefore unable to comment on whether or not it was reasonable to stop this treatment, as the decision was not made by the board subject to the complaint. In relation to the treatment carried out at Fife NHS board, we found that the infusions of immunoglobin were administered by the board in accordance with the plan that was put in place by clinicians under the other board. We did not uphold this complaint.

We provided feedback to the board in relation to their complaints handling. As this complaint focussed on the decisions made about treatment, it would have been helpful to C and this office if this had been clarified at an early stage so that the correct focus of the investigation (a different board) could have been identified earlier.

Summary

Mr C complained about the treatment which he received at the A&E of Borders General Hospital. Mr C said the doctor failed to diagnose that he had suffered a fracture and dislocation of a finger and that the injury was only picked up a few weeks later following further x-rays being taken.

We took independent advice from an A&E consultant. We found that the doctor who saw Mr C at A&E carried out an appropriate assessment. The doctor could not identify a fracture from the x-ray which was taken and arranged a review at a Virtual Fracture Clinic. The injury was also not identified at the clinic. It was only when further x-rays were taken after a couple of weeks that the fracture and dislocation were identified. Mr C had suffered a rare injury and although the correct diagnosis was not reached at A&E, this did not mean that the treatment was not to an appropriate standard. We did not uphold the complaint.

Summary

C complained about the Child and Adolescent Mental Health Service (CAMHS) care and treatment provided to their child (A). A had an assessment with CAMHS, and following this, the board felt that further CAMHS input was not necessary as they considered the information suggested attachment related difficulties as opposed to a neuro-developmental disorder. C complained that the board had not carried out an in-depth assessment or obtained relevant information from A's school.

We took independent advice from a CAMHS mental health nurse. We found that the assessment of A carried out by CAMHS was reasonable and gathered the appropriate information in order to make a decision that no further input or support from CAMHS was required. We did not uphold this aspect of C's complaint.

C also complained that following A's appointment, the board's communication was unreasonable as they were not told of follow-up appointments in a timely manner and had not fully discussed A's case with C. We found that in all but one case, appointment letters were sent to C in a timely manner. However, we found that the board had failed to explain to C that the school assessments were no longer required and the reasons for this. On this basis, we upheld this aspect of C's complaint.

We also identified that the board had failed to follow up on an action agreed in their complaint response and made a recommendation in relation to this.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to explain that school assessments were no longer required and the reasons for this; and for failing to follow up the referral. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets
• The board should consider whether it would still be appropriate to follow up the referral to the area inclusion team at this point. They may wish to contact C to discuss whether this is something A would still benefit from.

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

• If decisions are made not to proceed with assessments, this should be explained to the patient/their family.

In relation to complaints handling, we recommended:

• Actions agreed in complaint responses should be followed up and there should be evidence of the actions being taken.

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 they received from the board. C’s local NHS board referred them to a consultant bariatric (branch of medicine that deals with the causes, prevention, and treatment of obesity) surgeon at Tayside NHS Board. C complained that, although they had made lifestyle and health changes as requested by the multidisciplinary specialist weight management team, they were not put forward for surgery on a number of occasions. C complained that a consultant bariatric surgeon acted inappropriately during consultations with them and that information C provided upon request was ignored when considering their suitability for surgery. C considered the delays to their surgery to have been unreasonable and raised further complaints about the board’s handling of their concerns.

We found that the consultant bariatric surgeon inappropriately required C to bring their test results to a consultation and inappropriately referred to them having made a complaint during a consultation. We found that the decision to postpone the surgery until such time as C’s diabetes was being better managed was reasonable. However, in relation to the decision to postpone surgery, we found that the board’s poor administration of C’s case and poor communication with them led to C not being suitable for surgery. We found, therefore, that this had led to C’s request for later surgery being denied and that the board had contributed to this situation. We found that the board had taken reasonable action in response to C’s complaint but that they had unreasonably failed to advise C of the outcome of a multidisciplinary team meeting. We, therefore, upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C that the consultant inappropriately raised their formal complaint about them during a consultation. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets
• That the board invite C to an multidisciplinary team review of their case with a view to forming a clear plan for them with specific targets and timescales for progression to surgery should that remain the best option for them.

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

• That the board take steps to ensure specialist weight management team's from other health boards receive clear communication as to what criteria each patient needs to meet to progress to surgery.
• The board’s procedures should ensure bariatric patients are given a clear plan with scheduled review points as to their progression through Tiers 3 and 4, and onto surgery, and the criteria they must meet.
• All board staff should be aware of the importance of allowing the complaints procedure to operate independently of clinical discussions. Patients must be able to raise concerns about services or individuals without fear of confrontation or of their criticisms affecting decisions regarding their ongoing treatment.

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 her late mother (Mrs A) received at Gilbert Bain Hospital. Mrs A had widespread bladder cancer and she was admitted to the hospital because she was experiencing pain and discomfort. Medical staff decided it would be appropriate to try to insert a urinary catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag). Ms C raised concerns that the decision to try to insert a urinary catheter was unreasonable; and that medical staff should have stopped the attempts sooner, as Mrs A was in pain and shouting for them to stop.

We took independent advice from a general surgeon. We found it was reasonable that medical staff tried to insert a urinary catheter. However, we found that the repeated and distressing attempts to do so were unreasonable. We considered that the first attempt to insert a urinary catheter should have been carried out by a more senior member of medical staff. We considered that Mrs A should have been given better pain relief/sedation before any further attempts were made. We also considered that medical staff had failed to recognise Mrs A's distress and to respond to her clear withdrawal of consent. We upheld this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failings 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:

• Patients, at the end of their life, should only undergo invasive procedures and interventions if they will ease their distress or pain. When such procedures are carried out, it should be by medical staff with an appropriate level of expertise; with appropriate consent from the patient; and only after adequate pain relief has been administered.

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 they received from A&E of St John's Hospital. C has a history of painful skin conditions requiring hospitalisation. C presented at A&E and was triaged by a nurse. The nurse carried out an assessment of C’s condition and discussed it with the a doctor. C was referred to the out-of-hours GP service. C said that they should have been examined by a doctor in light of their symptoms and previous history.

We took independent advice from a senior emergency nurse practitioner. We found that C’s medical history was considered and observations of their temperature, heart rate and blood oxygen were recorded. The notes did not contain details of the physical examination nor the discussion with the doctor. The out-of-hours GP that C was referred to did not refer them back to the doctor, as they could have done, if they thought the referral was not appropriate. We concluded that C had received a reasonable standard of care and treatment and did not uphold the complaint.

Summary

Following open surgery, Miss C’s abdomen was closed. Miss C was unhappy with the stitching of her abdomen as it had a ‘dog eared’ appearance at one end. Miss C considered that the stitching was inadequate and she should have been given corrective surgery. As the board did not consider that this was necessary at the time, Miss C proceeded to have private surgery to change the appearance of the scar.

We took independent advice form a plastic surgeon. We found that the closure of the surgical wound was achieved by an acceptable technique using appropriate materials. We found the stitching was of a reasonable standard. After several months, there was a small ‘dog ear’ at the end of the scar. We found that the scar was immature at this stage and that it was reasonable to state that it should be allowed to heal, rather than performing corrective surgery at that time. We did not uphold the complaint.