Health

Summary

Mrs C complained about the treatment she received at the practice to have a leg wound dressed. Mrs C said that she attended on a number of occasions and told nursing staff that the wound was sore and infected but that they ignored her concerns. Subsequently, one of the nurses arranged for a swab to be taken and this identified that the wound had become infected. Mrs C felt that the nursing staff should have acted on her concerns earlier and that it would have saved her the additional pain and distress.

We took independent advice from a nurse. We found that the nurses involved provided appropriate wound care and that there were no recorded signs of infection. A swab was taken because of slight inflammation of the wound which subsequently identified an infection which was treated with antibiotics. We did not uphold the complaint.

Summary

C complained about the treatment provided to their child (A). A was admitted to hospital with a worsening lung infection, linked to their genetic disorder, and was found to be in acute kidney failure. As part of a number of tests, it was found that A's ferritin levels were very high, and when this was identified by the clinicians involved in A's care, A was diagnosed with an uncommon and serious problem with their immune system. A died from the condition. C complaind that the ferritin test results were not acted on in a reasonable timescale to provide appropriate treatment.

We took independent advice from a consultant nephrologist (doctor specialising in internal medicine that focuses on the treatment of diseases that affect the kidneys). We found that, overall, the treatment provided to A was reasonable. It was reasonable that the ferritin test was not actively sought out by A's clinicians as it was not considered to be crucial in treating A's acute illness. We found that there was nothing to indicate the very rare condition before the ferritin result, and that this was not an expected part of the management of an acute illness. We did not uphold C's complaint.

Summary

Mr and Mrs C complained on behalf of their daughter (Ms A) that the care and treatment Ms A received from practice was unreasonable. Mr and Mrs C said that the practice sought to reduce Ms A's prescriptions for morphine and diazepam when she joined as a new patient. Mr and Mrs C further complained that the doctor who saw Ms A did not give adequate reasons for why the medications were being reduced. We took independent advice from a GP. We found that it was reasonable for the practice to seek to reduce Ms A's medications. We also found that the doctor provided a clear explanation to Ms A, and Ms A's clinical records showed that she had received the same explanation on multiple occasions from other medical professionals involved in her care who had sought to reduce her medication doses. Therefore, we did not uphold this complaint.

Mr and Mrs C further complained that Ms A was unreasonably removed from the practice list. We found that it was reasonable for Ms A to be removed from the practice list as the doctor/patient relationship had broken down with all the partners in the practice, and while the relevant legislation states that a warning should be given within 12 months, that a warning does not need to be given if the GP does not feel that it is reasonable or practical to do so, which was the case here. Therefore, we did not uphold this complaint.

Mr and Mrs C also complained that the practice's handling of her complaint was unreasonable. We found that the practice's complaint responses did not adequately address the issues raised and the practice failed to signpost to this office. Therefore, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr & Mrs C for the complaint handling failures identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/informationleaflets.

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 on behalf of his wife (Mrs A) about a physiotherapy (the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery) assessment she underwent. The assessment found that Mrs A could safely use a three-wheeled walking aid outdoors under close supervision. Subsequently, Mrs A suffered a fall while using the three-wheeled walking aid on a downhill slope. Mr C raised concerns that the assessment did not include a slope; it did not assess Mrs A's ability to use the brakes; and that close supervision would not have prevented the accident.

We took independent advice from a physiotherapist. We found that Mrs A's assessment was unreasonable. We found that the record of the assessment lacked appropriate detail. We found it did not address Mrs A's ability to safely negotiate slopes or to use the brakes and that the advice given to Mrs A and Mr C during the assessment was unreasonable. We upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C and Mrs A for the failings identified in her physiotherapy assessment. 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' ability to safely use walking aids should be assessed appropriately; both physically and in light of any cognitive impairment they might have. The assessments should then be documented in sufficient detail.
• Patients and their carers should be given appropriate advice on the benefits/risks of using a particular walking aid and appropriate guidance on using it safely. This should then be appropriately documented.

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, an advocate, complained on behalf of her client (Ms A) that the board had decided, from an urology (the branch of medicine and physiology concerned with the function and disorders of the urinary track) perspective, there was no reason to refer Ms A for an immunology (the branch of medicine and biology concerned with immunity) opinion.

We took independent advice from a consultant urologist. We found that the care and treatment given to Ms A was reasonable, and that appropriate advice had been given in relation to her condition. We also found that Ms A had not completed the investigations necessary to diagnose her condition and that, in these circumstances and from an urology perspective, there was no reason to refer Ms A for an immunology opinion. Therefore, we did not uphold Miss C's complaint.

Summary

Mr C complained about the care and treatment provided by the practice in respect of his ongoing knee pain. He attended two consultations with knee pain and had requested to be referred to the orthopaedic (conditions involving the musculoskeletal system) clinic and for a multi-resonance imaging scan (MRI) to be carried out. However, at the first consultation, the practice prescribed anti-inflammatory medication and provided advice regarding exercise and knee care. At the second consultation, the practice arranged for x-rays to be carried out and advised Mr C to make a self-referral to physiotherapy.

Based on Mr C's presentation, the practice concluded that the source of the pain was likely to be osteoarthritis (the most common form of arthritis, usually occurring in older people, with chronic breakdown of cartilage in the joints leading to pain, stiffness, and swelling or the most common form of arthritis that affects the joints). The x-ray results confirmed this but the results were not relayed to Mr C. Years later, Mr C attended a further consultation and the practice made a referral to the orthopaedic clinic. At the time of making his complaint to the SPSO, Mr C was still on the waiting list to be seen at the orthopaedic clinic. This was partly due to the fact that the practice did not consider it appropriate to make an urgent referral. In Mr C's view, the practice unreasonably delayed in referring him to the orthopaedic clinic and for an MRI scan.

We took independent advice from a GP. We found that Mr C received appropriate care and treatment for his knee pain. This care and treatment was in line with the Scottish National Knee Pain and Management Pathway, produced by the Scottish Government. We recognised that Mr C was concerned that the practice did not contact him following his x-ray or physiotherapy appointment. However, we did not consider this to be unreasonable or out of line with the procedures of other practices. We did not uphold Mr C's complaint.

Summary

C complained that there was an unreasonable delay in being seen by neurological (relating to the anatomy, functions, and organic disorders of nerves and the nervous system) services after being referred with back and leg pain; and that when they were seen the care and treatment provided was unreasonable. C also complained that the communication from the board in relation to these matters was unreasonable.

We took independent advice from a neurologist. We found that the timescale for C's neurology appointment was unreasonable as it did not meet the NHS Scotland timescales. We upheld this aspect of C's complaint.

We considered that whilst the care provided to C at their appointment was of a good standard, and it was reasonable to conclude that no further neurological input was required, the timeframe between the appointment and the eventual decision was over ten weeks and we considered this to be unreasonable. We therefore upheld this aspect of C's complaint.

Finally, in relation to communication, whilst we fed back to the board that they may wish to reflect on how they communicate timescales for appointments, we noted that once the decision not to provide further treatment to C had been made this was communicated in a prompt manner. We therefore did not uphold this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for the unreasonable delay in providing C with an appointment following their referral to neurosurgical services, the unreasonable timeframe between the consultation and eventual decision, and that the Advanced Physiotherapy Practitioner did not have appropriate and timely access to a consultant opinion. 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:

• 95% of patients referred to neurosurgery should receive a first out-patient appointment within 12 weeks.
• Clinics being run by a non-consultant grade practitioner should have prompt access to a consultant or nominated deputy in order for decisions to treat or discharge to be made promptly.

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, a support and advocacy worker, complained on behalf of their client (B), regarding the care and treatment provided to B's late partner (A) when A was admitted to the Royal Alexandra Hospital with back pain. C complained that:

A was inappropriately prescribed Pabrinex (a vitamin infusion injection often given to patients with alcohol dependency);

the Abbreviated Mental Test 4 (AMT-4, a rapid test to detect cognitive impairment) and 4AT test (a slightly longer screening test for cognitive impairment and delirium) were not carried out appropriately;

there was a delay in carrying out an MRI; and

A was treated differently due to the incorrect assumption that they were experiencing symptoms due to alcohol access.

We took independent advice from a consultant in orthopaedics (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that:

the prescription of Pabrinex was unreasonable;

it was unreasonable that the AMT gave a score of zero, which would indicate severe cognitive impairment, but there was no documented action taken as a result of this outcome;

there was no indication that an MRI scan needed to be carried out earlier than it was; and

there was no indication that A was treated differently because of an incorrect assumption that they were suffering from alcohol excess.

We also found that in relation to the AMT score, the board gave inaccurate information to C and B in the complaint responses as they stated that a score of zero indicates no cognitive impairment. We upheld C's complaint about care and treatment.

C also complained that the minutes of the complaint meeting and follow-up actions were unreasonable. We considered that it was clear from the minutes of the meeting that there were several things that the board had committed to during the meeting that then do not appear to have been taken forward. We upheld this aspect of C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to B for the unreasonable prescription of Pabrinex, the failure to take appropriate action on the AMT score of zero; the inaccurate information in the complaint responses, and failing to take forward actions agreed during the complaint meeting or provide an explanation as to why this was not possible. 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:

• If the AMT gives a score of zero, which would indicate severe cognitive impairment, appropriate action should be taken as a result of this.
• Pabrinex should only be prescribed where clinically appropriate and the reasons for the prescription should be documented.

In relation to complaints handling, we recommended:

• Complaint responses should be accurate.
• During and after complaint meetings, care should be taken to ensure that all agreed actions are documented and either taken forward, or if it is not possible to take forward actions, an explanation is given to the complainant as to why this is.

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 during their admissions to Royal Alexandra Hospital and the board's communication with them during and after admission.

C considered that staff did not take into account their medical history or presenting symptoms and failed to offer appropriate treatment or consult relevant medical professionals. C also considered that the board failed to communicate reasonably with them in that staff were dismissive and patronising. C said that they were not given information as available and staff presented as reluctant to provide information. Furthermore, C considered that communication following discharge was unreasonable as C stated that they had been told that a member of staff from the board would contact them with follow-up but C received no further contact.

We took independent advice from advisers in the areas of emergency medicine and general surgery. We found that there had been no failures in the care and treatment provided to C. We found that C received reasonable care and treatment; in particular, their medical history and presenting symptoms were fully considered and appropriate treatment provided.

We found that there was no evidence to support C's assertion that the board's communication with them was below the standard that would have reasonably been expected.

Therefore, we did not uphold C's complaints.

Summary

C, a support and advocacy worker, complained on behalf of their client (A) regarding the care and treatment they received at the Queen Elizabeth University Hospital both before and after surgery to remove anal skin tags and banding of haemorrhoids. In particular, A was concerned that they were not properly consented for the surgical procedure; that the surgery and aftercare were not of a reasonable standard; and that information about a post-operative clinic consultation was shared with the operating surgeon.

The board investigated the complaint and apologised for the delay in A receiving pain relief after the operation; for the surgical wound area not being visually checked for signs of inflammation; and for the discharge letter having incorrectly advised A that they would be followed up post-surgery.

We took independent advice from a consultant in colorectal and general surgery. We found that informed consent had not been properly obtained from A prior to the surgical procedure being undertaken. We upheld this complaint.

We considered that there was no evidence to support that the surgery and aftercare were of an unreasonable standard. Therefore, we did not uphold this complaint.

We did not find evidence of failings regarding the sharing of information between surgical staff regarding a post-operative review appointment that took place relating to ongoing pain and bleeding that A was experiencing. Therefore, we did not uphold this complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to A for failing to adequately obtain their informed consent to surgery. 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:

• Surgeons should obtain a patient's consent for surgery in line with General Medical Council guidance.

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.