Health

Summary

Ms C complained about the care and treatment provided to her by the board for a number of symptoms over a period of several months. We took independent advice from a GP, from a consultant in acute medicine, from a gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) and from a neurologist (a doctor who specialises in the brain and nervous system). We found that whilst much of the care and treatment provided to Ms C was reasonable, the possibility of Ms C's symptoms being caused by other disorders should have been discussed with her. Therefore, on balance, we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to recognise and discuss the possibility of her symptoms being caused by a functional disorder or chronic fatigue syndrome. The apology should meet the standard set out in the SPSO guidelines on apology available at: www.spso.org.uk/leaflets-and-guidance .
• Consider carrying out a further review of Ms C's symptoms (should she still wish to have this done) if she is referred to the board via her GP in light of the findings of this investigation.

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

• Staff should be aware of how to recognise and manage functional disorders, including chronic fatigue syndrome.

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 provided to his late father (Mr A). Mr A had complained about poor memory and poor balance over a number of weeks. The board carried out a number of investigations, however, due to the wait for follow-up appointments, Mr A decided to seek private treatment and he was subsequently diagnosed with Creutzfeldt-Jakob Disease (CJD - a rare degenerative brain disorder). Mr C complained that the board failed to carry out the appropriate investigations, and that the board inappropriately discharged Mr A when his condition was getting progressively worse.

The board confirmed they were satisfied that the appropriate investigations were undertaken. They acknowledged that they could not offer Mr A an earlier appointment and explained that this was due to the service being understaffed.

We took independent advice from a consultant neurologist (a doctor who specialises in the brain and nervous system). We found that the appropriate investigations were carried out. Due to the nature of Mr A's condition, a number of conditions had to be ruled out first and there is no single test that can be performed in order to reach a diagnosis. The board subsequently informed us that the staffing issues have since been resolved. We also considered that it was appropriate to discharge Mr A as the risks of complications was much lower at home than in hospital. We did not uphold Mr C's complaints, however, feedback was provided regarding the board's communication with the patient and his family and the manner in which Mr A was prioritised.

Summary

Ms C complained about the care and treatment provided to her by the practice for a number of symptoms over period of several months. We took independent advice from a GP. We found that the assessments, investigations, referrals and treatment provided to Ms C were reasonable. We did not uphold the complaint.

Summary

Mr C was admitted to A&E following a road traffic accident. He was concerned that inadequate investigations were carried out to determine the extent of his injuries. Following an MRI scan, it was found that Mr C had a neck injury which required surgery. Mr C also felt his complaints of pain were minimised and often ignored by staff.

We took independent advice from an emergency medicine consultant. We found that proper assessments and investigations were carried out in light of the injuries Mr C presented with. We had no concerns about the way staff managed Mr C's reports of pain and that he was given appropriate pain relief. We found that there was no indication that an MRI of Mr C's neck should have been carried out sooner. MRI scans are required to identify injuries to the soft tissues in the neck or the spinal cord and are normally only carried out when patients have symptoms consistent with spinal cord injury or when, in the presence of a normal CT scan, there is a significant suspicion of a ligamentous injury. In Mr C's case, it was noted that when he displayed a foot drop and weakness in his hand, the decision was taken to obtain an MRI scan.

We found that the board provided reasonable care and treatment for Mr C's neck injury and, therefore, we did not uphold the complaint.

Summary

Mrs C complained that the care and treatment provided to her late mother (Mrs A) at Royal Alexandra Hospital was unreasonable. Mrs C also complained that the board's communication with Mrs A's family was unreasonable.

Mrs C said that staff had acted unprofessionally when asked for help changing Mrs A's position. Mrs C also told us she had frequently observed nursing staff inaccurately recording information on Mrs A's care plan, food and fluid charts. During our investigation we found that Mrs C had made amendments on the nursing records where she perceived them to be wrong. It was unclear though where Mrs C had made amendments so we were unable to assess the quality of the records. It also meant we were unable to clearly identify failings in the board's care and treatment of Mrs A. We therefore discontinued our investigation of this aspect of the complaint.

Mrs C told us the board's communication with Mrs A's family was unreasonable because staff did not provide them with updates about Mrs A's condition. She also said that on a couple of occasions staff told Mrs A that she would be going home and a care package would be organised, only for her later to be told the care package had been cancelled due to lack of carers. We found that although the medical records demonstrated that staff spoke to Mrs A's family about her condition throughout her stay in hospital, it was clear that Mrs A's family did not feel they knew enough about what was happening and, in particular, when Mrs A could be discharged. In response to Mrs C's complaint to them, the board apologised for their communication with Mrs A's family and the distress caused by the uncertainty about Mrs A's discharge date. They agreed this should have been communicated more effectively. We upheld this aspect of the complaint but made no recommendations as the board had already taken appropriate action.

Summary

Ms C complained that the care and treatment she received from the practice was unreasonable. Ms C attended the practice on a number of occasions complaining of a sore lump. She was referred to the treatment room (the treatment room is staffed by nurses who are trained and specialise in wound care) for assessment and management of a post-operative wound she had. Ms C also attended the hospital and was informed she had cellulitis (an infection of the deeper layers of skin).

We took independent advice from a GP. We found that the practice had assessed Ms C's wound, arranged an appropriate referral to the treatment room and arranged appropriate treatment. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received from a number of different clinical areas provided by the board. In particular, Mr C raised concerns about the care and treatment he received while he was a patient of the Physical Disability Rehabilitation Unit, the treatment he received from occupational therapy and the treatment of his urine infections and acid reflux symptoms.

We took independent advice from a physiotherapist, an occupational therapist, a consultant urological surgeon and a neurologist regarding Mr C's concerns. We did not find any failings regarding the care and treatment Mr C received.

We did not uphold Mr C's complaint.

Summary

Miss C complained that the board had unreasonably delayed in diagnosing and treating her brother (Mr A)'s prostate cancer. We took independent advice from a consultant urological surgeon (a doctor who specialises in the male and female urinary tract, and the male reproductive organs).

We found that communication about Mr A's diagnosis and prognosis had been reasonable. However, we found that there had been an avoidable delay in diagnosing his prostate cancer, and as a result there had been a possible delay of six to eight weeks in staring his treatment. We upheld the complaint. However, we noted that the delay had no significant clinical impact on the disease progression or prognosis.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C and the family for the delays identified in this case. 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 presenting with signs or symptoms of prostate cancer should be referred to the local multidisciplinary team meeting as soon the diagnosis is suspected.

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 that medical staff failed to diagnose her husband (Mr A) with urethral obstruction (a blockage that inhibits the flow of urine through it's normal path). Mr A presented to Royal Alexandria Hospital on a number of occasions with urology (the branch of medicine and physiology concerned with the function and disorders of the urinary system) problems, including difficulty urinating and passing blood. An X-ray was carried out which showed no kidney stones and tests confirmed no infection. He was discharged but attended several days later to the emergency department, unable to pass urine. He was examined, catheterised and discharged home with medication to relax the bladder neck. No follow-up appointment was arranged. Nine days later Mr A was admitted to hospital as he was unable to pass urine. Following further tests, and subsequent attendances at hospital with issues regarding his catheter, including treatment with antibiotics for infection, Mr A underwent a cystoscopy (bladder examination using a narrow tube-like telescopic camera) where a intra-urethral stone was extracted from the penis. Mrs C said that doctors did not take account of the symptoms Mr A had presented with and they failed to carry out basic checks. It was not until they sought private opinion that appropriate tests were carried our and the stone causing the obstruction was discovered.

We took independent medical advice from a consultant urologist. We found that on the initial presentations to hospital, physical examinations of the abdomen and genitals were not carried out, despite repeat presentation and reported symptoms indicating this should have occurred. Appropriate examinations, particularly of the penis when indicated, would likely have identified the presence of the stone. Medical and nursing staff did not adequately document and act on difficulties which were encountered in passing the catheter. We, therefore, upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for the failure to carry out appropriate physical examination, escalate difficulties in catheterising, and to arrange for further assessment with flexible cystoscopy. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance .

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

• Emergency staff, when presented with blood in urine in the absence of infection, should recognise this requires urgent investigation.
• Relevant medical and nursing staff should be aware of the need to take a good history and perform appropriate genital examinations. Nursing staff should be aware of potential causes for difficulties in catheterisation and empowered to ask for support or abandon catheterisation if difficulties are encountered.

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 she received at Princess Royal Maternity Unit and Queen Elizabeth University Hospital following the birth of her baby. Ms C complained about the appropriateness of a speculum (a metal instrument that is used to dilate an orifice or canal in the body to allow inspection) examination and had concerns whether an ultrasound had been carried out and reported properly. Ms C also complained that it took around three weeks for it to be identified that she needed surgical treatment for ongoing bleeding and retained products of conception, and about the lack of breast pump available and support given regarding expressing milk.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in pregnancy, childbirth and the female reproductive system) qualified in ultrasound, a consultant obstetrician and gynaecologist, and a midwife. We found that it was appropriate to perform the speculum examination and that the ultrasound had likely been interpreted accurately. Therefore, we did not uphold this aspect of Ms C's complaint.

We also found that subsequent investigations did not identify significant products of conception that required earlier surgical intervention. We further considered that there was reasonable evidence to reflect that advice had been offered regarding breast care and that it was not unreasonable that a breast pump was not available at the time of discharge. However, we noted that the board reflected on Ms C's concerns and acknowledged the benefit of improving their supply of breast pumps. We did not uphold this aspect of Ms C's complaint.