Health

Summary

Mr C complained about the care and treatment his late wife (Mrs A) received during admissions to St John's Hospital, the Royal Infirmary of Edinburgh and the Western General Hospital. In particular, Mr C complained about an unreasonable delay in diagnosing Mrs A's lymphoma (a type of cancer) during those admissions.

We took independent advice from a consultant upper-gastrointestinal surgeon and from a consultant physician. We found that appropriate investigations were carried out into Mrs A's condition. However, we found lymphoma is very difficult to diagnose and that it had presented in Mrs A in a very unusual way. We did find that Mrs A was unreasonably diagnosed with an autoimmune condition at St John's Hospital, based on blood test results that actually suggested inflammation. We found that an opinion from other relevant specialists may have avoided this misdiagnosis. We found that this error may have delayed her diagnosis of lymphoma by one month and we upheld Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for misdiagnosing Mrs A with an autoimmune condition. 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:

• Blood test results should be carefully reviewed, with the input of other medical specialists when appropriate.

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, an advocacy and support worker, complained on behalf of her client (Mr B) who had concerns about the way the medical practice had managed his mother (Mrs A)'s oxazepam medication (for anxiety and to be taken for short periods only). He said that Mrs A had been taking the medication for a number of years and that the practice had recently reduced the medication and, as a result, Mrs A suffered a stroke. She was taken to hospital and died of a further stroke a number of days later. Mr B felt that the stress of the medication reduction caused Mrs A to suffer a stroke.

We took independent advice from an adviser in general practice medicine and found that the practice had managed Mrs A's medication regime in an appropriate manner. Care has to be taken with oxazepam medication as it can cause both psychological and physical addiction. Practices have a responsibility to keep medication under review to ensure that it is still required and if it is not, they must reduce it or stop the medication completely. We found that there was evidence from the records that Mrs A was initially not requesting the medication on a regular basis but recently had made increased requests. This made it necessary to review and reduce the medication to an appropriate level. There was also no evidence that the reduction in medication led to Mrs A suffering a stroke. Therefore, we did not uphold the complaint.

Summary

Mr C complained to us that the practice had failed to provide appropriate treatment to his late wife (Mrs A). Mrs A had been attending a hospital out-patient department for a separate matter and had been advised to make an emergency GP appointment as she was showing symptoms of a cough and breathlessness. Mrs A developed deep vein thrombosis (DVT, blood clot in a large vein) four days after the consultation and later died. Mr C believed that the practice should have referred his wife to hospital at the time of the appointment.

The practice responded that Mrs A was given an emergency appointment following her attendance at the out-patient clinic. However, the reason for the appointment was for anxiety problems and Mrs A only reported symptoms of low mood and that her heart was racing. Mrs A did not report symptoms of having a cough, chest pain, shortness of breath, or pain or swelling in her leg. The practice prescribed anti-depressant medication and diagnosed anxiety problems.

We took independent advice from an adviser in general practice medicine and concluded that, from the entries in Mrs A's medical records, the practice had provided a reasonable level of care. There was no indication that Mrs A had reported symptoms suggestive of DVT and the medication prescribed by the practice was appropriate for symptoms of anxiety and low mood. There was also no indication that a hospital referral was required at that time. We did not uphold the complaint.

Summary

Ms C complained on behalf of her late father (Mr A) about the care and treatment he received from the practice prior to his diagnosis of cancer. Mr A presented at the practice with a swollen jaw and neck and was advised to visit his dentist immediately. Mr A later attended the out-of-hours GP service. The practice received the out-of-hours report that stated Mr A had an upcoming appointment at hospital and that he had been referred to an ear, nose and throat specialist. Ms C later contacted the practice as Mr A had become more unwell and an admission to hospital was agreed. Mr A was diagnosed with cancer and died not long after his diagnosis. Ms C complained that more could have been done by the practice to speed up the diagnosis.

We took independent advice from a medical adviser. They reviewed the records and were satisfied that the practice had provided reasonable care at each point of contact. Mr A had been seen by his dentist and out-of-hours services and was soon under the care of a consultant. Therefore, we did not uphold the complaint.

Summary

Mrs C, who is an advocacy and support worker, complained on behalf of her client (Mrs A). Mrs A was unhappy about delays in getting confirmation of an appointment with a consultant ophthalmologist (a doctor who deals with injuries and conditions in and around the eye). Mrs A was also unhappy with ophthalmology advice and treatment provided to her by the board.

The board acknowledged that Mrs A's clinic appointments were cancelled on a number of occasions and they apologised to Mrs A for the inconvenience this had caused. We found that, at the time, the board did not know that Mrs A's appointments had been cancelled so many times until Mrs C complained on her behalf. We found that the board had unreasonably delayed in confirming an appointment for Mrs A with a consultant ophthalmologist, and we upheld this aspect of Mrs C's complaint. The board provided reassurance that they were taking administrative steps and had recruited staff to stop such delays happening again. Given these steps taken by the board, we made no further recommendations in relation to this.

Mrs A was given different ophthalmology advice at her most recent clinic appointment from advice she had been given before. Mrs A felt she should have been given the new advice previously. We were satisfied with the board's explanation that the latest advice given to Mrs A was not a new type of treatment, but was a variation of the standard advice given for her eye condition. We did not uphold this aspect of Mrs C's complaint.

Summary

Ms C complained about the care and treatment that her late mother (Mrs A) received at Monklands Hospital. Mrs A was admitted to A&E and was diagnosed with a urine infection. Hospital staff expressed concern over her condition and offered admission to the hospital but Mrs A declined as she thought she only had a urine infection. A week later, as Mrs A's symptoms did not improve, she was seen at home by a doctor. A large mass was identified in her pelvis and there was concern that she may have had a stroke. Mrs A was subsequently admitted to hospital where her stroke diagnosis was confirmed with a scan. Mrs A fell out of bed twice while in the hospital, the second time fracturing her hip which required surgery. After recovering from surgery, she was transferred to another hospital which catered for elderly patients. Mrs A was later discharged and died a few months later.

Ms C complained that Mrs A had not been properly assessed when she was first admitted to A&E and that Mrs A was not given proper rehabilitation support or physiotherapy following her stroke. Ms C was also concerned that the care Mrs A received after her hip fracture was unreasonable. Finally, Ms C complained that communication between the hospital and Mrs A's family was poor.

We took independent advice from a consultant geriatrician, a chartered physiotherapist and a registered nurse. We found that Mrs A's initial assessment had been thorough, and a reasonable diagnosis had been made. We also found that her rehabilitation and physiotherapy had been reasonable but that it had been limited by Mrs A's inability to participate due to her condition. Similarly, her care after she fractured her hip had been appropriate and we found that, although efforts had been made to prevent her fall, it had not been possible to do so. While communication with Mrs A had not always met her and her family's needs, we found that it had been clear and reasonable. For these reasons, we did not uphold Ms C's complaints.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Ms C complained that Mr A did not receive a reasonable standard of surgical care and treatment when he was admitted to Raigmore Hospital for an operation. During the operation, Mr A suffered an ureteric injury (an injury or cut to the ureter - a tube that carries urine from the kidneys to the urinary bladder). Ms C said that Mr A was not warned of the risk of ureteric injury when he consented to the procedure and that the injury itself was an unreasonable surgical error. Ms C also said that the injury was not identified and treated within a reasonable time. As a result of the failings, Mr A has endured poor health and the quality of his life has significantly deteriorated. It was also likely that Mr A would require further surgical procedures.

We took independent advice from a colorectal surgeon. We found no evidence that the specific risk of ureteric injury was discussed with Mr A during the consent process, which was unreasonable and contrary to the relevant guidance. We also found that the ureteric injury was a surgical error which had an adverse outcome and that it was, to an extent, avoidable. We also found that there was an unreasonable lack of detail in the operation note which may have helped clinicians to be more alert to post-operative complications, although we found that the standard of post-operative care and treatment provided was reasonable. We upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to follow the relevant guidance on consent and ensure sufficient care was taken during the procedure and in completing the operation note. 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:

• The consent process and related documentation should be reviewed so that clinicians properly obtain and document consent for procedures. The surgeon involved should reflect on this case in their annual appraisal.

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 about the care and treatment her father (Mr A) received from the board at Caithness General Hospital. Mrs C complained that the board unreasonably failed to take into account her father's dementia, unreasonably failed to establish that Mrs C held a welfare power of attorney in respect of her father and unreasonably failed to obtain appropriate consent for a gastroscopy procedure (an examination of the inside of the gullet, stomach and the first part of the small intestine).

We took independent advice from a nurse and from a consultant in acute medicine. Based on the information in Mr A's records and the advice we received, we considered that the board did not unreasonably fail to take into account Mr A's dementia while he was in hospital and we did not uphold this part of the complaint. However, we were concerned that some documents relating to this were not completed by hospital staff and so we made a recommendation regarding this.

On the issue of welfare power of attorney, we found that attempts should have been made to establish if Mr A had a welfare power of attorney within 24 hours of admission. We found that this had taken the board three days and that this was an unreasonably long time for this to take. We upheld this aspect of the complaint.

Mr A had more than one gastroscopy and Mrs C's complaint was that the board had not obtained appropriate consent for the first gastroscopy. We found that it was reasonable for staff to conclude that Mr A had sufficient capacity to give his consent for his first gastroscopy procedure and that appropriate consent was obtained. We, therefore, did not uphold this part of Mrs C's complaint. However, we were concerned about the consent process for Mr A's second gastroscopy and we found that an adult with incapacity form (completed for patients deemed not to have capacity to consent) should have been completed and that the procedure should have been discussed with Mrs C. We also found that the board's response to Mrs C's complaint was inadequate. We, therefore, made recommendations on these matters.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C, Mr A and their family for the failings in establishing if Mr A had welfare power of attorney, the failings in record-keeping and the complaints handling failures. 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:

• Patients' Admission/Care Records and Treatment Escalation Plans should be completed fully and accurately.
• In cases such as this, staff should establish if patients have a welfare power of attorney in a timely manner.
• In cases such as this, staff should obtain appropriate consent for patients' surgical procedures.

In relation to complaints handling, we recommended:

• Information in internal investigations of complaints should be accurately reflected in complaint responses and full explanations of decisions should be provided.

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 that the medical practice wrongly provided her with the flu vaccination a number of years ago and that, as a result, she suffered from numerous medical conditions. These included brain damage, multiple sclerosis, uveitis (inflammation in the eye), reactive arthritis and facial disfigurement. Ms C was concerned that she had not been advised of the risks or potential side effects of the vaccination.

We took independent advice from a GP and found that it was appropriate for the practice to have offered Ms C the vaccination as she suffered from asthma. There was nothing in Ms C's medical records that showed she was suffering from any medical conditions which would have prevented her from receiving the flu vaccination. We also noted that Ms C had signed the consent form for the vaccination at the time. In addition, Ms C's later health issues were not recognised as being attributed side effects from the vaccination. Therefore, we did not uphold the complaint.

Summary

Mr C, who works for an advice and support agency, complained to us on behalf of his client (Mrs A) that her GP practice failed to provide her with appropriate medical treatment for a painful shoulder. Mrs A asked the practice to give her a steroid injection as her frozen shoulder was causing her pain and distress but was referred to physiotherapy who would decide whether or not to provide the injection. Mrs A was unhappy as she had been given the steroid injection by the practice the year before.

We took independent advice from a GP and found that the practice had provided a reasonable level of care. Although some practices can administer steroid injections to patients if they have additional training, there is no requirement for them to do so. We found that the practice had acted reasonably by asking Mrs A to attend physiotherapy and that they would determine if it was appropriate to administer a steroid injection. We also found that the practice had acted reasonably by prescribing painkilling medication to Mrs A in order to address her symptoms. Therefore, we did not uphold Mr C's complaint.