Decision Report 201501847

Summary

Mrs C complained about the care and treatment given to her late husband (Mr A) at Ninewells Hospital where he was a patient from March to September 2014, when he died. She said that there was a delay in making his diagnosis and that information was given to him in an uncaring and uncompassionate way. She also complained that there was often confusion about her husband's medication and that his pain was not properly managed.

We took independent advice from consultants in oncology and radiology and also from a senior nurse practitioner. We found that while Mr A's care and treatment had been appropriate and reasonable, his pain had been very difficult to control (due to his complex condition) and communication had not been as good as it could have been. He was given upsetting information at a time when support was not available to him, and was given his diagnosis over the phone. There was also confusion about his medication and treatment. In particular, there was confusion about Metformin (a drug Mr A was taking for diabetes) and whether he needed to stop taking it before his imaging test. When Mrs C later complained about these circumstances, the board delayed in providing her with a response. In view of this, we upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• send an appropriate letter of apology;
• ensure that the clinicians involved in this case are made aware of our findings, and that they are considered as part of the clinicians' next formal appraisal;
• review their policy on withholding Metformin;
• ensure that all patients receive suitable information prior to undergoing scans;
• provide a formal apology for the delay in responding to the complaint; and
• remind staff of the importance of replying to complaints in a timely manner.