Health

Summary

Mr C complained that the care and treatment given to his late wife (Mrs A) by her GP practice were unreasonable.

Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects the flexible joints). Her health began to deteriorate further, but Mr C said that it took time to establish that Mrs A had heart problems for which she needed an operation. After surgery Mrs A was discharged home, but months later she required to be admitted to hospital again. Mrs A had developed a serious infection in her heart and died shortly afterwards. Mr C complained that it took too long to diagnose his wife's infection.

We took independent advice from a GP. We found that in the early stages of her illness, Mrs A had been investigated and treated appropriately and it had been very unusual for a patient to have developed such severe heart disease in a short space of time. After her operation and return home, Mrs A became increasingly unwell and was regularly seen by members of the GP practice who treated her for a urinary tract infection. However, we found that the severe heart infection (endocarditis) had not been considered as a possible diagnosis, as it should have been, particularly as it was known that Mrs A had an artificial heart valve and persistent signs of infection. Her pre-existing heart condition could have predisposed Mrs A to developing endocarditis, and it was unreasonable not to consider this. This led to a delay in diagnosis and a delay in admitting Mrs A to hospital. Therefore, we upheld the complaint.

During the course of our investigation, we also found the complaint handling to be unreasonable.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the failure to properly consider Mrs A's presenting symptoms and for failing to consider and discount the possibility that she had endocarditis. As a consequence there was a delay in admitting her to hospital.
• Apologise to Mr C for the failure to deal with their complaint as required by NHS Scotland's Model Complaints Handling Procedure.

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

• Patients' symptoms should be considered holistically.
• Clinicians should be aware of National Institute for Health and Care Excellence (NICE) guidance (s64) in relation to the symptoms that may indicate infective endocarditis.

In relation to complaints handling, we recommended:

• Complaints should be addressed and responded to in terms of the NHS Scotland's Model Complaints Handling Procedure.

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 on behalf of her late son (Mr A) about the care and treatment he received from his GP practice. Mr A phoned the practice as he was coughing and felt unwell. Mr A was considered to have symptoms of a cold and he was prescribed a cough suppressant. Around a week later, Mr A died from pneumonia (an infection of the lungs).

Mrs C complained that the practice unreasonably diagnosed Mr A over the phone, even though he had asthma and learning difficulties. We took independent advice from a GP. We found that as Mr A was noted to have symptoms of a cold, it was reasonable that he was diagnosed over the phone, even though he was a vulnerable adult. We did not uphold this aspect of the complaint.

Mrs C also complained that when she was admitted to hospital shortly afterwards, the practice did not contact her son to check on his condition. We found that the practice had not been informed of Mrs C's hospital admission or advised of any concerns about Mr A. Therefore, we found that the practice had no cause to check on Mr A's condition. We did not uphold this aspect of the complaint.

Lastly, Mrs C complained about the practice's handling of her complaint. We found that there were failings in their complaints handling, which the practice had already acknowledged and apologised for. We noted that Mrs C's complaint was not acknowledged within the relevant timescale and her request for a phone call was not followed up. Therefore, we upheld this aspect of the complaint.

Recommendations

In relation to complaints handling, we recommended:

• Complaints should be handled in line with the NHS Scotland Model Complaints Handling Procedure. The model complaints handling procedure and guidance can be found here: www.valuingcomplaints.org.uk/handling-complaints/complaints-procedures/nhs

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 from Victoria Hospital. She said that there were delays in receiving appointments and treatment; that she was not properly consented for surgery; that a stent was removed without anaesthetic; and that after surgery she was left with a bulge/hernia that did not receive timely treatment. In responding to the complaint, the board acknowledged that Ms C had incorrectly been sent a letter saying that she was no longer on the waiting list for surgery and incorrectly advising that she would require another GP referral. The board also found that the bulge she was concerned about had not been examined as it should have been; that there were some communication failures; and that an appointment had to be rescheduled twice. The board apologised for these errors.

We took independent advice from a consultant urological surgeon (a specialist in diseases of the urinary organs in females and the urinary tract and sex organs in males). We found a number of failings in terms of it being unclear about; what treatment options had been discussed with Ms C; the implications and risks of the change in surgery; poor record-keeping; the removal of the stent was not clearly explained; and no written advice leaflet provided. Therefore, we concluded that Ms C's care and treatment was of an unreasonable standard and upheld her complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failures 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:

• The consent process (and evidence of it) should start earlier than the day of surgery and General Medical Council guidance should be followed.
• Clinicians should keep clear, accurate, and legible records which report the relevant clinical findings, the decisions made, the information given to patients, any drugs or other treatment prescribed and who is making the record and when.
• When available, explanatory leaflets should be used to assist patients in their understanding and decision-making.

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, a solicitor, complained on behalf of his client (Mr B) about the care and treatment Mr B's mother (Mrs A) received at Stratheden Hospital after she broke her hip. Mr C complained that Mrs A did not get appropriate treatment for her physical health issues; in particular, that her condition was not appropriately monitored, which led to her becoming dehydrated. Mr C also complained about the nursing care, particularly that Mrs A did not receive appropriate nutritional care and that there was a lack of action in response to her weight loss. Additionally, Mr C raised concerns about the board's complaints handling.

We took independent advice from a consultant psychiatrist and from a mental health nurse. We found that Mrs A's treatment plan was reasonable and that she received appropriate treatment for her physical health issues, which led to an improvement in her condition. However, we found that her fluid balance was not recorded appropriately during that time, as the board had acknowledged. We found that after Mrs A's condition improved, the board decided to take a more limited approach to her treatment. We considered that the reasons for that decision were not properly recorded, and Mrs A's condition was not monitored appropriately afterwards. Therefore, we upheld this aspect of Mr C's complaint.

In relation to the nursing care provided to Mrs A, we found that insufficient action was taken in relation to her nutrition and weight loss. The board identified these failings and apologised to Mr B. We upheld this aspect of Mr C's complaint.

Finally, we found that the board did not clearly respond to all aspects of Mr B's complaint. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for the failures to appropriately monitor Mrs A's condition, to record relevant information about her care and treatment, and for not providing a clear response to aspects of his complaint. 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:

• In similar cases, fluid balance sheets should be completed appropriately and in accordance with the board's procedure.
• If a decision is made to change the treatment plan for a complex patient, the clinical reasons should be clearly recorded, along with the parameters of what that means for managing their condition.
• Nutritional screening should be carried out promptly and patients should receive effective nutritional care, which is in line with the relevant national nutritional guidance.

In relation to complaints handling, we recommended:

• Complaint responses should be clear to avoid any misunderstandings and the issues should be thoroughly investigated.

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 psychiatric treatment she received for anxiety. She complained that there were unnecessary delays and a lack of communication regarding her treatment which added to her anxiety. Ms C complained that her psychiatrist did not assess her properly and proceeded with options for therapy without first carrying out an appropriate assessment.

We took independent advice from a consultant psychiatrist. We found that Ms C's assessment had been appropriate and reasonable, and that medical staff tried to work constructively with Ms C and to tailor treatment to her specific needs and wishes for treatment. We considered that the board had taken Ms C's social anxiety into consideration when arranging appointments. Therefore, we did not uphold this aspect of the complaint.

Ms C also complained about the board's complaints handling. We considered that the board could have clarified aspects of the complaint at the outset, with a view to agreeing a reduced number of complaints. This may have provided for a more manageable complaint from the point of view of investigation. We noted there had been significant delay in providing complaint responses, which had added to Ms C's stress. We considered that the delays were unreasonable and we therefore upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in providing a response to her complaints. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-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.

Summary

Mrs C complained that there was an unreasonable delay in diagnosing her with a breast abscess. Following the birth of her child, Mrs C's GP referred her to Borders General Hospital with a suspected breast abscess after she had been suffering from mastitis (when a woman's breast tissue becomes painful and inflamed). On admission, a surgeon said that there was no evidence of an abscess and Mrs C was discharged. Mrs C was due to return for an ultrasound scan the following day, however, the hospital changed her appointment to a later date. In the interim period, Mrs C experienced a deterioration in her condition and was referred back to the hospital. An ultrasound scan was carried out which confirmed that she had a breast abscess, requiring surgery. Mrs C said the length of time that it took for a scan to be arranged meant that there was an unreasonable delay in diagnosing her with a breast abscess and, as a result, she endured significant distress and her baby did not gain weight appropriately due to difficulties with breastfeeding.

We took independent advice from a medical adviser who specialises in breast surgery. We found that an ultrasound scan should have been carried out to investigate the possibility of a breast abscess during Mrs C's first admission, and that the subsequent delay in arranging the scan was unreasonable. We determined that these failings meant that there was an unreasonable delay in diagnosing Mrs C with a breast abscess. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for failing to arrange an ultrasound scan within a reasonable time and the associated delay in receiving treatment. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Ensure that ultrasound scans are carried out within a reasonable timeframe in line with the relevant 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.

Summary

Mr C complained about the care and treatment he received at Ayr Hospital. Mr C attended the orthopaedic department (specialising in the treatment of disease and injury of the musculoskeletal system) in relation to knee pain. He had surgery but despite that he continued to experience pain. Mr C was unhappy because he was discharged by the consultant without his pain being fully investigated.

We took independent advice from an orthopaedic consultant. We found that the standard of care that Mr C received for his knee was reasonable and that post-operative follow-up was appropriate. Therefore, we did not uphold this aspect of the complaint.

In addition, Mr C became aware of comments written in his clinical record by the consultant which Mr C described as slanderous. We found that the language used was unreasonable, inappropriate and unfair. However, we noted that the consultant had apologised to Mr C and had reflected on the fact that the language used was open to misinterpretation. We upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for the inappropriate comment written by the consultant in the clinical letter. The apology should meet the standards set out inthe SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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 provided to her by Crosshouse Hospital both during and after her pregnancy. She felt that she was not monitored appropriately during pregnancy and that her concerns had not been taken seriously. She also raised concern that she had requested a caesarean section but this had been denied, and that planning for delivery had not been reasonable.

We took independent advice from a midwife and an obstetrician (a doctor specialising in pregnancy and childbirth). We noted that there was an inappropriate remark recorded in Ms C's records by a midwife and we made a recommendation to the board about this. We found that, whilst many aspects of the care and treatment provided to Ms C were reasonable, there was a failure to take appropriate and timely action when Ms C presented with polyhydramnios (increased fluid) and accelerated foetal growth. Therefore, we upheld this aspect of Ms C's complaint.

In relation to Ms C's concerns about post-pregnancy care, we found that this was appropriate and in line with standard practice. Therefore, we did not uphold this aspect of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the inappropriate description in her medical records, and the failure to investigate the cause of polyhydramnios and accelerated fetal growth in a timely 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:

• Notes made in medical records should be appropriate and in line with relevant nursing and midwifery standards.
• Polyhydramnios and accelerated fetal growth should be investigated in a timely manner.

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 clinical and nursing care and treatment given to her late father (Mr A).

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and from a nursing adviser.

In relation to the clinical care and treatment, we found that the clinical records evidenced that an appropriate assessment of Mr A was carried out and that reasonable efforts were made by clinical staff to treat Mr A's condition. We found that, overall, the clinical care and treatment given to Mr A was reasonable and we did not uphold this aspect of the complaint.

In relation to the nursing care and treatment given to Mr A, we found that the nursing records were of a reasonable standard and that they demonstrated that there had been a risk-based assessment of Mr A. There was also evidence of care planning related to the level of risk and ongoing documentation around delivery of daily care for Mr A. However, we found that the documentation around the injury to Mr A's foot could have been better and we drew this to the board's attention. On balance, we found that the nursing care and treatment was reasonable and did not uphold this aspect of the complaint.

Lastly, Miss C complained about the communication from the hospital with her and her family. We found that the clinical records demonstrated an appropriate level of communication and we did not uphold the complaint.

Summary

Mr C complained about the time taken for the board to refer him to specialist care for pain in his hip following a hip replacement.

We found that for several years the board's actions were reasonable. However, at one point, the board recognised the possibility of infection but chose not to aspirate (drain fluid from) Mr C's hip. We considered this to be unreasonable and that Mr C should have been refererred for specialist care. We upheld this aspect of the complaint.

Mr C also complained about the boards handling of his complaint. We found that the board complaint handling was reasonable and, therefore, we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to provide reasonable treatment in relation to pain in his hip. The apology should meet thestandards 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 board should develop a written policy for the investigation of painful hip replacements that takes into consideration the content of the European Consensus Document on Periprosthetic Infection (https://www.efort.org/wp-content/uploads/2013/10/philadelphia_consensus.pdf).

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.