Health

Summary

Mrs C had a fall in her home and sustained a fracture of her upper arm. She complained about the way a body bandage had been fitted at Monklands Hospital the following day and about the aftercare advice she was given. A nurse had fitted the bandage over her clothing, with advice that the bandage should be removed each night. Mrs C said that when she returned to the fracture clinic three days later, a nurse told her the bandage had been incorrectly fitted, and re-fitted it underneath her clothing.

Mrs C's fracture had not healed properly, leaving her in pain and requiring surgery. She believed that the way the injury was bandaged when she initially attended Monklands Hospital, and the aftercare advice about removing it at night, had caused her ongoing problems.

We took independent advice from a consultant orthopaedic surgeon. The adviser explained that the purpose of the body bandage for fractures of this type is to provide some support and comfort to the patient, not to provide fracture stability. They advised that the way it was fitted was not material to the outcome in terms of Mrs C's recovery. They noted, however, that removing it would have caused her more pain. The only failing the adviser noted was the lack of consistency of advice regarding the way the bandage was fitted, but they noted that the board appeared to have addressed this by coming up with a standard protocol for these fractures.

In relation to the advice to remove the bandage at night, the adviser reiterated that the purpose of the bandage was not to provide fracture stability, and accordingly its removal would not have affected recovery. Because the focus of our investigation was on whether Mrs C's recovery was affected by the fitting of the body bandage and the aftercare advice, we did not uphold the complaints.

Summary

Mrs C complained on behalf of her husband (Mr A) regarding treatment he received at Wishaw General Hospital after collapsing whilst he was out running. Mr A has a history of heart problems so, on admission to hospital, the symptoms he was experiencing, including ongoing headaches and worsening balance, were initially attributed to a suspected heart issue. However, as these symptoms continued to worsen in the following couple of days, a scan was arranged and a bleed to his brain was identified. Mrs C complained that, as a result of the delay in identifying the bleed, the board had failed to provide appropriate treatment for Mr A's head injury.

We took independent advice from a consultant in emergency medicine. The advice we received was that the treatment provided to Mr A was reasonable. The adviser considered that, based on Mr A's presenting symptoms, medical history and the information provided by the ambulance service, it was reasonable for the board to conclude that this was a cardiac event and that they had then offered appropriate treatment for this diagnosis. For this reason, we did not uphold Mrs C's complaint.

Summary

Miss C, who is an advocacy and support worker, complained on behalf of her client (Miss A) about the clinical treatment Miss A received for her urinary problems. In particular, Miss C complained about the board's decision to withdraw support from community nursing services. Miss C also complained about a delay in actioning Miss A's request for a second opinion from the urology service.

We took independent advice from a consultant urologist. We found that a number of clinicians involved in Miss A's care had taken the decision to withdraw the support from community nursing services as the care being provided was no longer clinically appropriate. We found that there was no evidence of failings in the urology care provided to Miss A. We were also satisfied that Miss A's needs had been taken into account in arriving at the decision. As such, we did not uphold this aspect of Miss C's complaint.

We found that there had been a delay in actioning Miss A's request for a second opinion from urology services. We considered this to be unreasonable and we upheld this part of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss A for the delay in actioning the request for a second opinion.

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

• Requests for second opinions should be actioned timeously.

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 palliative care and treatment provided to her late husband (Mr A) at Cowal Community Hospital. Mrs C highlighted concerns about the prescription of pain relief, arrangements for a blood transfusion and communication with the family. Mrs C particularly felt that meetings with staff had been misrepresented in his medical records. She also complained that the board had failed to handle her complaints reasonably.

As the doctors who cared for Mr A at the hospital were general practitioners, we took independent advice from a GP adviser. The advice we received was that Mr A's pain relief had been appropriately reviewed and adjusted, and that there had been no indication that a blood transfusion was necessary. We did not uphold these aspects of Mrs C's complaint.

We did not uphold Mrs C’s complaints about communication or meetings. We found evidence that there had been regular and appropriate communication with Mr A's family, although we acknowledged that Mrs C's recollection differed from that recorded in the medical notes and other records. The advice we received was that the actions taken by the board were reasonable, on the basis of what was recorded in the relevant records.

We upheld Mrs C's complaint about the way that the board had handled her complaint. We found that there was an inaccuracy in the final response around the timeframe of Mr A dying and the complaint being raised. We also found that an issue Mrs C had raised had not been fully addressed when the board responded to her concerns. We made two recommendations to address these issues, including one regarding the new model complaints handling procedure introduced in April 2017.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the complaints handling issues identified. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• In keeping with the new complaints handling procedure, complaint responses should be accurate and address the points made by the complainant.

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 the medical practice failed to provide appropriate care and treatment to her late husband (Mr A), who died in hospital of double pneumonia a few days after last seeing a GP. She said that her husband had seen a GP on two occasions before the hospital admission and that the GP had not carried out appropriate assessments to diagnose the pneumonia or to have referred her husband to hospital for a specialist opinion.

We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The records showed that the GP had carried out appropriate assessments and that, based on the symptoms which Mr A had reported, it was reasonable for the GP to have diagnosed a viral illness. The GP had advised Mr A to rest, take fluids and paracetamol. It was clear that, following the last GP appointment, Mr A's symptoms had changed and that he had deteriorated and at that time a hospital referral was appropriate. We did not uphold the complaint.

Summary

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her son (Mr A) who had attended an appointment with one of the GPs with symptoms of sore lungs and a cough. Ms C said that the GP had failed to listen to Mr A's lungs or chest and did not prescribe an antibiotic for him to take. Mr A was still unwell the following week and was taken to hospital, where he was diagnosed with pneumonia.

We took independent advice from an adviser in general practice medicine and concluded that the GP had provided a reasonable level of care. We found that the GP had examined Mr A's lungs and had found no signs of an infection. We also found that an adequate medical history was recorded and that it was not unreasonable for the GP to have diagnosed a viral infection. As such, it was not unreasonable that the GP did not prescribe antibiotics. We did not uphold the complaint.

Summary

Ms C complained on behalf of her late brother (Mr A) about the treatment he received from the practice in the four months prior to his diagnosis of lung cancer. She complained that the standard of care and treatment provided to her brother was unreasonable.

We took independent advice from a GP adviser who said that the initial symptoms Mr A presented with had led doctors to believe that he had a problem with his hormones, and that doctors had referred him appropriately at that time. When Mr A complained of different symptoms, which could have indicated cancer, his GP then asked him to complete a form to arrange an x-ray. The practice were unable to reach Mr A by phone and Mr A either did not receive the letter sent to him, or did not respond to it. When Mr A re-attended the practice it was noted that the x-ray request had not been returned and he was referred urgently to hospital that day. The adviser said that this was reasonable.

We accepted the advice we received and we did not uphold the complaint.

Summary

Mrs C, who has a background of lupus (an autoimmune condition that affects the body's defences against illnesses and infections) had a tumour detected during a scan. Her case was discussed by the multi-disciplinary team (MDT) and she was given an appointment with an oncologist to discuss chemotherapy (a treatment where medicine is used to kill cancerous cells) and radiotherapy (a treatment using high-energy radiation). The oncologist was concerned that, due to her background of lupus, Mrs C could suffer significant side effects from this treatment. The oncologist asked for further discussion of the case at a second MDT, where the possibility of surgery was also discussed.

Following this, the oncologist outlined the options of surgery or oncology treatment (chemotherapy and radiotherapy) to Mrs C and Mrs C agreed to have surgery. The surgery was carried out, but did not remove enough of the tumour to give a good chance of a cure. Mrs C was then offered oncology treatment as well.

Mrs C complained to the board that she was not told before the surgery that there was a high risk that she would also need oncology treatment. She said that she would not have chosen to have major surgery if she had known that she might still need the full oncology treatment. The board took several months to respond to Mrs C's complaints, because the surgeon and oncologist disagreed about some parts of the response. Eventually, the response was sent without the surgeon's agreement. Mrs C remained dissatisfied and brought her complaints to us.

Mrs C complained that the communication with her about her condition and treatment options was unreasonable. She also complained that the care and treatment provided was unreasonable. We took independent oncology and surgical advice. We found that, whilst the oncology treatment carried a high risk of significant side effects, the surgery also carried a high risk of being unsuccessful, and Mrs C would then need the oncology treatment as well. We found that there was insufficient evidence that these two options had been fully explained to Mrs C. We also found that consent for the surgery had only been sought on the day of the operation, and there was no evidence that the risks of the surgery had been discussed with Mrs C before this point. We also found that there was an occasion where Mrs C could have been given an update on her pathology results more quickly. We upheld these two aspects of Mrs C's complaint.

Mrs C also complained that there were unreasonable delays in her treatment. We found that the timeframes were reasonable and that quicker treatment would not neccesarily have impacted on Mrs C's outcome. We did not uphold this aspect of Mrs C's complaint.

Mrs C also raised concerns about the board's handling of her complaint, and particularly raised concern that she was unable to contact the complaints team by phone at certain points. We found that the board's complaint response was delayed for several months, that they had misunderstood part of her complaint and that Mrs C was not kept updated in this time. We upheld this part of Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings in communication, care and treatment and complaints handling. 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 should be given full information about all their options before deciding on a treatment.
• Consent should not be sought on the day of surgery, unless there is an emergency situation.
• Consultants should be mindful of the need to communicate clearly and avoid misunderstandings.
• Patients should be fully informed and kept up to date on information relevant to their illness. Information should not be withheld unless they specifically request this, or if there is a potential risk of harm.
• In a similar situation, surgery should not be offered as a first line treatment without a full discussion of the multi-disciplinary team's views (both for and against) and options with the patient.

In relation to complaints handling, we recommended:

• The board should have a clear process for escalating disagreements about complaints responses, with senior management involvement, to ensure a whole-of-board response to the complaint.
• The board should contact the complainant to confirm the issues complained about as the first step in their investigation, in line with the Model Complaints Handling Procedure.
• The complaints team should be contactable by phone, with the facility to leave a message if there are no staff available.

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 provided to her mother (Mrs A) at Queen Elizabeth University Hospital. Mrs A was admitted to hospital with an infection in her knee. During the admission, Mrs A sustained an injury to her calf area whilst nursing staff were moving her to sit on the side of the bed. The day following the injury, a doctor inaccurately informed one of Mrs A's daughters that the injury was the result of a fall. Over the following days, Mrs A's condition deteriorated and she died.

Mrs C raised concern that nursing staff did not take appropriate steps to prevent her mother from sustaining an injury. We found that the board had completed an incident report for the injury which noted that Mrs A's skin was very fragile and concluded that nursing staff had provided appropriate care such that the injury was unavoidable. We took independent advice from a nursing adviser. We were satisfied that appropriate falls risk assessments had been carried out during the admission and we considered that the actions of nursing staff were reasonable and in keeping with the board's moving and handling policy. The nursing adviser agreed with the conclusion of the board's incident report, and we were unable to conclude that nursing staff failed to take appropriate steps to prevent the injury. We did not uphold this aspect of Mrs C's complaint.

Mrs C also raised concern about the way staff communicated with the family about the injury and the level of information provided about Mrs A's condition over the following days prior to her death. We took independent advice from the nursing adviser, as well as an adviser in general medicine. We found that the family were not told about the injury until the following day. The board said that this was because Mrs A wished to tell her family of the injury herself, yet we did not find evidence that Mrs A had stated this. When one of Mrs A's daughters was contacted, we found that a doctor provided inaccurate information about what had happened to Mrs A. We found that this should not have happened given that the injury was documented accurately in the nursing notes.

We also considered that there was evidence of a delay in recognising and responding to a deterioration in Mrs A's condition. The medical adviser was unable to conclude that Mrs A would have survived her illness if she received better care, however they did consider that the care was unreasonable. The medical adviser noted that the family did not seem prepared for Mrs A's death. The medical adviser was satisfied that the consultant did try to communicate that Mrs A might deteriorate further and that death was a possibility, but found that they may not have been quite explicit or clear enough when doing so. On balance, we upheld Mrs C's complaint about communication.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C and her family for failing to immediately inform the family that Mrs A had sustained an injury and for the delay in recognising and responding to a deterioration in Mrs A's 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:

• In a similar situation staff should promptly contact family members or significant others (as appropriate), in line with the protocol for informing next of kin when a serious incident occurs. If a patient states that they wish to inform their family of an incident themselves, this should be documented in the records.
• Medical staff should be aware of information documented in the nursing records when providing patients and their families with information about their condition.
• Staff should ensure that deteriorations are recognised promptly and should be aware of how to respond.

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, who is an advocacy and support worker, complained on behalf of her client (Mr A) who underwent knee replacement surgery at Royal Alexandra Hospital. Following the operation, Mr A experienced a number of complications and continued to feel pain and discomfort.

Ms C complained that Mr A was not informed about the risks and complications of the procedure, including the possible outcomes. The board said that there were four interactions with Mr A prior to the surgery and that these interactions focussed on the need for, undertaking of and preparation for surgery. The board considered that this would have afforded the space and time to offer information and to answer any concerns that Mr A had. We took independent advice from a consultant orthopaedic surgeon. Whilst we noted that a consent form for surgery had been signed by Mr A, the adviser did not find evidence that the benefits and risks of surgery had been explained to Mr A. We were unable to conclude that Mr A was given the information he needed to understand the procedure and its risks in order to make an informed decision to consent to the treatment offered. We upheld this complaint and recommended that the board apologise for this failing. However, we noted that the board had since updated their consent form and consent procedure and we were satisfied that appropriate steps had been taken to try and prevent the same failing from happening again. Therefore, we did not make any further recommendations in connection to this.

Ms C also complained that the surgery provided to Mr A was not reasonable. The adviser explained that the complications Mr A experienced following the surgery were recognised complications of the procedure. The adviser did not find evidence of failings in the surgery performed on Mr A and we did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A for failing to obtain informed consent for the procedure. 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.