Health

Summary

Mr C complained that NHS National Services Scotland’s practitioner services division (PSD) had changed his Community Heath Index (CHI – a ten digit number that identifies a patient in the NHS in Scotland) number without his permission. PSD had given Mr C a new CHI number in order that his results from a national screening programme could be recorded on the relevant database. Mr C was unhappy with this and complained that he did not want to be part of the national screening programme. He asked that the new CHI number was deleted. PSD agreed to do this.

We found that, ideally, PSD should have discussed the matter with Mr C before they changed his CHI number. We also found that PSD had apologised to Mr C for any distress or upset that had been caused. However, Mr C’s complaint was that PSD unreasonably made changes to his CHI number without his permission. We found that PSD were not required to seek Mr C’s permission to make changes to the CHI number. Therefore, we did not uphold this complaint.

Mr C also complained that PSD had failed to ensure that correct information was applied to the new CHI number. He said that PSD had entered a previous GP practice on his record. However, the evidence that PSD sent us showed that the correct details had been recorded for Mr C. There was no evidence that incorrect information had been recorded and we did not uphold this aspect of his complaint.

Finally, Mr C complained that PSD’s response to his complaint had been inaccurate. We found that part of the response had been inaccurate and we upheld this aspect of his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C that the response to his complaint included inaccurate information. The apology should meet the standards set out in the SPSO guidelines on apology available at https://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 was referred by her GP to the orthopaedic department (the area of medicine which deals with the musculoskeletal system) at Ninewells Hospital for consideration of knee replacement surgery. However, there were problems with the communications from the board which resulted in her missing a scheduled out-patient clinic appointment. Mrs C questioned this with the board and she was told that arrangements had been made to reschedule the clinic appointment. However, she was then told that the rescheduled appointment had been cancelled and that the consultant had carried out a virtual assessment of the symptoms reported by the GP, and had subsequently discharged her. Mrs C complained that it was unreasonable that she had been discharged from the orthopaedic clinic without a face-to-face consultation.

We took independent advice from an orthopaedic consultant. We found that, on occasions, it can be appropriate for clinicians to carry out virtual assessments based on the information provided from the GP referral and that, in Mrs C's case, it was reasonable to discharge her from the clinic without a face-to-face consultation. We did not uphold the complaint. However, we were critical of the letter sent to Mrs C by the consultant as it did not contain sufficient advice as to what alternative options could be considered, and we fed this back to the board for their consideration.

Summary

Ms C complained that the care and treatment she received from her medical practice was unreasonable. Ms C said that she called the practice for an emergency appointment because she was experiencing extreme pain, and that it was only after she called a number of times that she was given an appointment. She was diagnosed with a vaginal swelling, given antibiotics and advised what to do should her condition worsen. Ms C was seen again at the practice the next day, when it was decided that she should be admitted to hospital. Ms C complained that there had been a delay in offering her a GP appointment, and that she had been incorrectly treated with antibiotics rather than referred to hospital.

We took independent advice from a GP adviser. We found that Ms C was given an appointment within a reasonable time. We also found that it was in accordance with General Medical Council good practice advice that she was given antibiotics and advice in the first instance. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment which she received during her pregnancy at the Royal Infirmary of Edinburgh. She had attended for a check-up where her baby's heartbeat was checked and blood tests were taken. Mrs C said that a nurse said that she might have an infection, but sent her home without medication. Mrs C then developed acute back pain and returned to hospital where she was admitted. Mrs C's condition deteriorated and she developed abdominal pain and was placed on a monitor. There were signs of fetal distress and it was decided to proceed to caesarean section (an operation to deliver a baby involving cutting the front of the abdomen and womb) where her baby was born. Mrs C then suffered a massive bleed and a hysterectomy (a surgery to remove the womb) had to be performed. Mrs C complained that there had been a delay in deciding to proceed to caesarean section and that antibiotics should have been prescribed earlier which would also have stopped her suffering from sepsis (a blood infection).

We took independent advice from a consultant obstetrician (a doctor who specialises in pregnancy, childbirth and a woman's reproductive system) and we found that Mrs C had received a reasonable standard of care and treatment. We found that staff adopted a conservative approach initially to establish if Mrs C would be able to deliver naturally and they kept her under observation. When it became clear that there were signs of fetal distress then it was appropriate to move to a caesarean section. There was no evidence of any delay and the caesarean section was carried out to an acceptable timescale. There was also no evidence that antibiotics should have been administered to Mrs C at an earlier stage and they were provided when she showed symptoms of infection. We also found that, when it was realised that Mrs C had suffered a bleed, staff acted appropriately in accordance with the national guidance that in such cases staff should resort to hysterectomy sooner rather than later. While we noted that the decision to proceed to hysterectomy appeared to be taken by a single consultant, it would have been normal practice to have a discussion with a senior colleague if appropriate. That said, the decision to proceed to hysterectomy was appropriate and completed in a timely manner. We did not uphold the complaints.

Summary

Miss C complained about the care and treatment provided to her by the board. She complained that the board did not identify that she had an anal fissure (cut or tear in the tissue inside the anus) during an examination under anaesthetic. She also complained about the length of time she had to wait for that examination.

We took independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that it was reasonable that the board did not identify an anal fissure because it was in remission at the time of Miss C's examination under anaesthetic. However, we found that there was a delay in Miss C receiving the examination and that this exceeded the national waiting time standards. We considered that this was unreasonable given the amount of pain she was experiencing. We upheld Miss C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for the amount of time she had to wait to receive an examination under anaesthetic. 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 with a suspected anal fissure should be treated within national wait time standards and the board should consider mechanisms to allow patients with severe anal pain to be seen as soon as possible. The board should consider advising patients in a timely manner that they may not be seen within waiting time targets.

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 that the board had unreasonably failed to reimburse the costs of his Clomiphene medication (medication to increase levels of the hormone testosterone) which had previously been prescribed outwith the UK. Mr C also complained that the board had refused to reimburse his costs for attending an endocrinilogist (a medical professional who specialises in hormones) outwith the UK. Mr C maintained that the medication and service provided by the endocrinologist improved his health.

We took independent advice on Mr C's complaint from a consultant endocrinologist. We found that, although Clomiphene is effective in raising testosterone levels, it has not yet replaced the currently used testosterone supplements in the management of hormone deficiency in men. The treatment is unlicensed in the UK and, whilst a clinician could prescribe it, it would be a discretionary matter to do so, and they would have to make a specific request. We found that the board's decision not to fund the medication or the consultation costs on the basis that it was not licensed, alternative appropriate medication was available, and the condition is commonly managed in the UK, was reasonable. We did not uphold the complaints.

Summary

Mr C complained on behalf of his wife (Mrs A) who has multiple sclerosis (MS - a condition which can affect the brain and/or spinal cord). Mrs A began to experience leg and back pain and a scan showed she had a ruptured disc. She was referred to see a consultant neurosurgeon (a doctor who specialises in conditions of the nervous system, including the brain, the spine, the spinal cord and nerves). Mr C complained that, despite a number of consultations and opinions, Mrs A was not given a proper diagnosis for the cause of her leg and back pain, nor was she offered surgery or a referral out-with the board's area.

We took independent advice from a consultant neurosurgeon and that we found that Mrs A's case was complicated by her MS. We found that the care provided to Mrs A was in accordance with national guidelines and that clinicians involved made a well reasoned decision not to undertake surgery or refer her elsewhere. We were satisfied that Mrs A had been given reasonable care and treatment. We did not uphold the complaint.

Summary

Mr C complained on behalf of his late wife (Mrs A). Mrs A attended the Emergency Department (ED) at the Royal Infirmary of Edinburgh. When she attended she was unable to walk and required a wheelchair. Mr C said that Mrs A waited for nearly four hours before she was seen by a doctor, during which time her requests for pain relief were ignored. He complained that the care and treatment given to Mrs A in the ED was unreasonable. He also complained that the board gave incorrect or inaccurate information when they responded to his complaint about this.

We took independent advice from a consultant in emergency medicine. We found that in the ED Mrs A had been appropriately examined, that many aspects of her care were reasonable and that she was appropriately discharged. However, we found that she was not assessed, and reassessed, for her pain as she should have been. We found that she was given two paracetamol three hours after arriving, and then oral morphine an hour and a half later. However, we found that this delay was unreasonable and contrary to the Royal College of Emergency Medicine guidelines. We upheld this part of Mr C's complaint.

We found no evidence that the board had provided Mr C with incorrect or inaccurate information, and so we did not uphold this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C that Mrs A's pain was not promptly assessed/reassessed and for the delay in providing pain relief.

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

• The Royal College of Emergency Medicine guidelines (management of pain in adults 2014) should be implemented.

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 was admitted to the Royal Infirmary of Edinburgh with severe sudden onset headache. A lumbar puncture procedure (a medical procedure where a needle is inserted into the lower part of the spine to test for diseases in the brain, spinal cord or central nervous system) was carried out but the results were negative and she was discharged the following day. However, she subsequently suffered ongoing headaches and low back pain. She complained that she had not been advised long term pain was a possible risk of the lumbar puncture. She also complained about how the procedure was carried out, expressing unhappiness that it was carried out by a junior doctor and questioning what had gone wrong to cause her so much pain. She also asked what her long term prognosis was.

We took independent medical advice from a consultant physician. We found that an initial headache and back pain are recognised complications of lumbar puncture procedures, but that the pain usually settles within a few days and severe ongoing pain is rare. As such, we found that it would not be expected practice for clinicians to advise patients of a risk of long term pain. We did not uphold this aspect of the complaint.

In terms of Miss C’s long term prognosis, the adviser suggested it might be helpful for her to have her symptoms reviewed by a specialist and we suggested the board might consider offering a neurology appointment.

We found no evidence to indicate that there were any failings in the way the procedure was carried out that might reasonably explain Miss C’s ongoing pain. We also found that it is appropriate for junior doctors to carry out such procedures, under supervision, when they are at the stage of their training that the doctor who carried out Miss C's procedure was at that time. We did not uphold this aspect of the complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care and treatment Ms A received at the Royal Infirmary of Edinburgh. Ms A had painful and uncomfortable symptoms in her throat and neck, which affected her breathing and swallowing. After investigations were carried out, Ms A was told that no physical cause was found to explain these symptoms. Ms A was referred to psychiatry and she was diagnosed with somatoform disorder (a syndrome where someone has recurring physical symptoms thought to be caused by psychological or emotional factors). Ms A complained that following this diagnosis, she was not given treatment for her physical symptoms.

We took independent advice from a consultant psychiatrist. We found that Ms A's psychiatry assessment was comprehensive and she was diagnosed with somatoform disorder with the appropriate input of various medical specialists. We also found that a reasonable decision was made not to investigate Ms A's physical symptoms any further, as that can be harmful for someone with somatoform disorder. We did not uphold Ms C's complaint.