Health

Summary

Mr C complained about the treatment he received from an emergency nurse practitioner (ENP) when he attended Stobhill Hospital. Mr C had injured his hand a number of weeks previously and other health professionals had said he had suffered some soft tissue damage. Mr C told the ENP that he thought he had perhaps broken a bone in his hand. He said that they did not listen to him and as a result arranged for him to have a standard x-ray which was not appropriate for identifying a fracture in the specific bone he thought was broken (the hamate bone - located on the outside of the wrist).

We took independent advice from an ENP. We found that hamate fractures are rare and difficult to diagnose. There was some disagreement between the ENP and Mr C about what was actually discussed during the assessment. There were aspects of the ENP's record-keeping which were not to an appropriate standard in that they lacked detail about the exact physical examination which had taken place. However, they had taken a reasonable history from Mr C and we felt that, due to the low suspicion of a bone fracture, it was appropriate to direct Mr C to his GP should the problem persist. Emergency departments would not have access to the specialist x-ray which would have identified a hamate fracture and this would come under the remit of specialist hand or orthopaedic surgeons (surgeons who specialise in the musculoskeletal system). We did not uphold the complaint.

Summary

Mrs C complained to us about the failure of staff at A&E at the Queen Elizabeth University Hospital to arrange a x-ray when she reported that she had hurt her back. Mrs C was given painkillers and encouraged to mobilise before being discharged home. Mrs C asked whether she should have an x-ray, but was advised that it would be unlikely to show anything and that she had probably torn muscles in her stomach and back. Mrs C was subsequently referred to physiotherapy by her GP and, after a few months, the physiotherapist sent her for a x-ray which revealed that she had suffered a fracture of her back. Mrs C felt that an x-ray should have been arranged at the initial hospital presentation and that, if this had happened, she may have avoided months of pain.

We took independent advice from a consultant in emergency medicine. We found that Mrs C had had a thorough examination on attendance at A&E and that it was appropriate to have prescribed her painkilling medication for suspected torn muscles in her stomach and back. Mrs C was encouraged to mobilise and given advice to contact her GP if the symptoms persisted or deteriorated. It is a matter of clinical judgement whether an x-ray should have been taken, but we considered that it was not unreasonable for the staff not to have arranged an x- ray in the circumstances, given Mrs C's presenting symptoms. It was also noted that, had an x-ray been arranged on initial presentation, then the treatment plan would not have altered. We did not uphold the complaint.

Summary

Miss C complained to us that the practice had failed to provide appropriate care and treatment to her mother (Mrs A). She said that her mother had reported symptoms of severe pain in her back and shoulders to GPs over a two month period, and they increased her painkilling medication and made a referral to the Elderly Care Clinic. Mrs A was subsequently diagnosed with bone and lung cancer. Miss C felt the GPs should have taken additional action to investigate the cause of her mother's pain.

We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. The GPs had taken a thorough medical history from Mrs A and examined her appropriately, including taking blood samples and making a referral for a hospital opinion. Mrs A's back pain had been present for two months and the shoulder pain for three weeks which was not a long presentation. It was appropriate for the GPs to have altered Mrs A's painkilling medication while waiting for the hospital referral and to chase up the referral when Mrs A had not heard from the hospital. The blood test results did not show significant abnormalities or signs suggestive of cancer. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received at Royal Alexandra Hospital following the birth of her daughter. Ms C felt that staff did not provide her with advice on breastfeeding techniques. She also raised concern that staff denied her a medical review, despite the fact that she felt she had suffered a lot of blood loss. As a result of her dissatisfaction with the care provided, Ms C discharged herself from hospital against medical advice and put her care in the hands of the community midwife team instead.

We took independent advice from a midwife. We found that, although there was evidence that Ms C had received some advice and support regarding breastfeeding, it was not to the standard expected in the board's breastfeeding policy. There was also a lack of entries in the records regarding communication in the immediate post-natal period. From a clinical perspective, there were no concerns about the amount of blood which Ms C had lost, and we found that she was kept under appropriate medical review. On balance, given the failings in record-keeping and communication, we considered that there was a failing in care and we upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to provide her with breastfeeding advice and support in line with the board's policy. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

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

• Staff should be aware of the board's breastfeeding policy in order that appropriate advice and support is provided to new mothers.

Summary

Ms C complained about the care and treatment provided to her late mother (Mrs  A) by the practice. Mrs A reported hip and back pain to her GP, and was later found to have breast cancer which had spread to her stomach and bones. Ms C complained that the practice failed to identify that Mrs A's back and hip pain was due to cancer in her bones.

We took independent advice from a GP adviser. We found that, when Mrs A presented with back pain she was directed to physiotherapy, which was reasonable, and that there were no signs or symptoms of cancer at this point. We found that the practice provided reasonable care and treatment to Mrs A for her back and hip pain, and we did not uphold the complaint.

Ms C also complained about the way the practice handled her complaint. We found that the practice had not handled her complaint in line with the model complaints handling procedure and, therefore, we upheld this part of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to respond to her complaint in a reasonable manner.The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

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

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr B) about the care and treatment provided to Mr B's late wife (Mrs  A) when she was an in-patient at Queen Elizabeth University Hospital.

We took independent advice from a consultant physician. We found that, on one occasion, Mrs A was not given her dose of insulin, and that the reasons for this were not clear. We found that this resulted in Mrs A developing diabetic ketoacidosis (DKA – a potentially life threatening complication of diabetes, which happens when the body starts running out of insulin), and that there was a delay in the DKA protocol being commenced. We also found that there was a failure in communication between medical and nursing staff around the plan to measure Mrs A's blood pressure. There were also inconsistencies in recording Mrs A's intolerance to certain medication. We found that Mrs A was prescribed a medication which she had an intolerance to without the rationale for this decision being recorded.

We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr B for failing to provide reasonable care and treatment to Mrs A with regards to administration of insulin, the delay in DKA protocol being commenced and the poor management of medication. 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:

• Staff should be aware of the importance of insulin in patients with Type 1 diabetes. Diabetes medication should be given when required, and reasons for not doing this should be clearly documented.
• The DKA protocol should be commenced within the appropriate timeframe wherever possible.
• There should be one clear way for communicating tasks and results between staff groups. This should include a way for medical staff to remember what investigations and instructions they are awaiting the results of.
• Allergy/intolerance information should be recorded consistently.
• If medication is to be prescribed despite a recorded allergy/intolerance, the reasons for this should be documented.

Summary

Mr C, who is an MSP, complained on behalf of his constituent (Mr B). Mr C complained that the board failed to take reasonable care of Mr B's wife (Mrs A)'s clothing when she was a patient at Royal Alexandra Hospital, and that this resulted in Mrs A's clothing going missing. Mr C also complained that the board did not handle Mr B's claim to be reimbursed for the loss of Mrs A's clothing in line with their own policy.

We took independent advice from a nursing adviser. We found that nursing staff were not responsible for washing patients' clothing. We also found that ward staff were not responsible for marking patients' clothing, and we did not find any evidence that staff said that they would mark Mrs A's clothing as hers. Therefore, we did not find evidence that the board had failed to take reasonable care of Mrs  A's clothing, and we did not uphold this aspect of the complaint.

Regarding Mr B's claim for reimbursement, we found that the claim was handled in line with the board's policy and guidance.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care Ms A received at the Vale of Leven Hospital.

Ms A was injured at work and afterwards her knee was painful and giving way. She was referred for an arthroscopy (keyhole joint surgery). Ms A was told that she had torn her anterior cruciate ligament (a band of connective tissue that holds the knee bones together and helps stabilise the joint). She was referred for physiotherapy but she continued to have problems with her knee. She was then offered surgery to reconstruct her anterior cruciate ligament, which she declined. Several years later, Ms A had a further knee arthroscopy. She was told that her anterior cruciate ligament was present, intact and functional. Ms C complained that following her first arthroscopy, Ms A was misdiagnosed with a torn anterior cruciate ligament.

We took independent advice from a consultant orthopaedic surgeon with a special interest in knee surgery. We found that Ms A had suffered a partial tear to her anterior cruciate ligament and as a result of this injury, her anterior cruciate ligament was not stabilising her knee so it required treatment. We found that Ms  A was correctly referred for physiotherapy and as this was not successful, surgery was appropriately discussed with her. We noted that the findings of her second arthroscopy were broadly similar to the first arthroscopy, as it also found evidence she had experienced a partial tear to her anterior cruciate ligament. We found that although Ms A no longer appeared to have instability in her knee joint, this may have been because of the osteoarthritis (chronic breakdown of cartilage in the joints leading to stiffness) in her knee joint. We found no evidence that Ms  A's injury had originally been misdiagnosed and, therefore, we did not uphold Ms C's complaint. However, we noted that Ms A should have been referred to a specialist to assess if anterior cruciate ligament surgery was appropriate for her and made a recommendation in light of this finding.

Recommendations

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

• Patients with anterior cruciate ligament injuries should be appropriately referred to a specialist surgeon.

Summary

Ms C complained about the care and treatment she received at Queen Elizabeth University Hospital. Ms C attended a follow-up orthopaedic (the branch of medicine involving the musculoskeletal system) clinic at the hospital after hip surgery and explained she was experiencing discomfort in her ankle. She was found to have deep vein thrombosis (DVT, a blood clot in a vein) in her calf. However, other tests also showed that she may have secondary liver cancer. It was later found that she had primary breast cancer which had spread to her liver. Ms C complained about the way she was told about her diagnosis and that she was given inconsistent information about her illness. She also complained that her care was not appropriately personalised for her.

We took independent advice from consultants in acute medicine and clinical oncology (cancer treatment). We found that the doctor who told Ms C about her diagnosis had made a conscious decision to wait overnight before giving her the details because they wanted the opportunity to discuss the matter first with the breast cancer team. While we considered that this was a reasonable approach, when Ms C was told the following day, she was alone. This does not follow Scottish Cancer guidelines and Ms C appeared not to have been appropriately supported. Therefore, we upheld this aspect of Ms C's complaint. However, we did not find that Ms C had been given inconsistent information and we found that staff had adapted her care, as far as possible, to suit her needs. Therefore, we did not uphold these aspects of Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to support her properly when giving her bad news. 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:

• Patients should be adequately supported when being given bad news and discussions with patients/relatives should be fully documented in medical records.

Summary

Mr C complained about the care and treatment he received at New Victoria Hospital. Mr C had been experiencing ongoing and worsening pain in his hip region and considered that there was an unreasonable delay in treating the cause of this pain.

We took independent medical advice from a consultant orthopaedic surgeon (a  surgeon who diagnoses and treats a wide range of conditions of the musculoskeletal system).

We found that appropriate investigations were carried out to find the cause of Mr  C's hip pain but the cause of his hip pain was still unclear following these. Mr  C was referred for physiotherapy to see if that improved his condition. However, there was an unreasonable delay in offering Mr C a physiotherapy appointment. This was due to an error in the referral process, as the referral was not received by physiotherapy. We considered this delay to be unreasonable and upheld Mr C's complaint. However, we noted that the board had acknowledged and apologised for this delay.

Recommendations

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

• There should be an appropriate process in place between orthopaedics and physiotherapy to ensure that referrals are received.