Health

Summary

Mrs C complained that the treatment the board provided to her son (Mr A) was not of a reasonable standard. The board carried out investigations about the role of their staff in the complaint. They found that Mrs C had not advised the board's staff of concerns about her son's health, and had only notified Mr A's social worker. Mrs C subsequently accepted that there was no complaint to pursue against NHS staff, and the investigation with our office was not taken any further.

Summary

Mrs C complained about the cardiology care and treatment given to her late husband (Mr A) when he was a patient at Aberdeen Royal Infirmary. Mr A was admitted to hospital and reported having chest pains and shortage of breath. During his admission, Mr A was also seen by the diabetic team and urology advice was taken.

The next month, he attended the cardiology clinic and he was noted to have continuing and increasing breathing difficulties. It was recommended that he be admitted for tests. However, in order to first rule out an infection, he was referred to the Acute Medical Initial Assessment Unit (AMIA). A few months later, Mr A was admitted to the AMIA for the second time as he was reporting chest pains and breathlessness. The cardiology team were contacted and it was decided only to manage his medical conditions, and not for him to have a clinical review at that time. He was later discharged.

Mr A died the following month and Mrs C believed that this was as a result of the pills he had been taking and she said that she felt he had not been treated properly. She also said that communication had been poor and that Mr A's unexpected death came as an enormous shock. She complained to the board and they considered that Mr A had been treated appropriately. Mrs C then brought her complaints to us.

We took independent advice from a consultant cardiologist and we found that Mr A's cardiology care had not been of a reasonable standard. We found that Mr A and Mrs C had not been given the opportunity of cardiac rehabilitation education. We found that a diuretic (a drug that enables the body to get rid of excess fluids) was recommended to Mr A during his treatment, but that he declined this. The adviser was concerned that this was not discussed further with Mr A during subsequent admissions to hospital. We found that after his second admission to the AMIA, it may have been preferable for Mr A to have been reviewed by the cardiology team. We also found that during Mr A's final admission to hospital, his follow-up should have been more timely. For these reasons, we upheld Mrs C's complaints.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings in Mr A's care and treatment, and for the failings in communication. 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 receive appropriate medical management including where appropriate, diuretic treatment. Contact between the acute medical and cardiology units should be improved.
• Information and education should be available to long-term cardiac patients.
• To avoid breakdowns in communication, staff should listen to patients and/or their carers and consider any concerns they express.

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, an advocacy and support worker, raised a complaint on behalf of her client (Mr A) about the care and treatment he received for a bunion from Golden Jubilee National Hospital. Specifically, she complained that appropriate surgery was not carried out, that the cause of infection following surgery was not properly investigated and that Mr A had not been advised of the problems which could occur with the surgery.

We took independent advice from a consultant orthopaedic trauma surgeon and found that there was evidence to support that discussion had taken place with Mr A about the recognised complications associated with the bunion surgery. Some of these included the possible risk of non-healing and a need for further surgery. We considered that the surgery was appropriate and that, whilst there was no clear evidence of infection post-surgery, it was appropriate to consider the possibility of infection when Mr A experienced problems following his surgery. We noted that the board had apologised to Mr A regarding the lack of communication about this. We concluded that there was no evidence of unreasonable treatment and that delayed healing had been the likely reason for Mr A's protracted recovery. We did not uphold the complaint.

Summary

Mr C attended his GP practice because he was concerned that he may have Lyme disease (an infection transmitted by ticks). He said that the practice failed to follow reasonable process in diagnosing him with Lyme disease. He was prescribed antibiotics on two occasions, some months apart. Mr C said that a GP had failed to note in his medical records that he had a reaction eight days into the second course of antibiotics, which Mr C said was crucial evidence that he had the disease. As a result of the practice's failure to recognise Mr C had Lyme disease, he said that he was concerned for his future health. Mr C also complained that the practice had failed to provide reasonable explanations in their response to his complaint.

We took independent advice from a GP adviser. We found that the treatment decisions and investigations carried out by the practice were reasonable in light of the symptoms Mr C presented with. We found that it was reasonable that the practice referred Mr C to several specialists, who did not confirm that Mr C had Lyme disease. We were satisfied that the standard of medical care and treatment was reasonable and we did not uphold the complaint.

In relation to complaints handling, we found that the practice properly explained the rationale behind the decision-making on treatment and managing Mr C's symptoms, and that the responses were fair and appropriate. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to his late wife (Mrs A). Mrs A had amyloidosis (a condition caused by abnormal deposits of a protein called amyloid around tissues and organs in the body) and Mr C felt that the diagnostic process for this was slow. Mr C had concerns that biopsies undertaken by the board were found to be negative for amyloidosis, but were later found to be positive when tested at the UK's National Amyloidosis Centre. We took independent advice from a consultant physician, a cardiologist, and a pathologist. We did not find that there were any unreasonable delays in determining that Mrs A had amyloidosis. The advice we received was that it was reasonable that the National Amyloidosis Centre was able to make a diagnosis when the board did not, as the National Amyloidosis Centre is more experienced in the techniques for testing. We did not uphold this complaint.

Mr C also complained about failures in communication and failures in providing adequate support to Mrs A and her family during Mrs A's illness. We took independent advice from a consultant physician and found that the board's communication with the family throughout Mrs A's illness, and the support provided to Mrs A, was unreasonable and insufficient. We considered that a protocol for earlier involvement of specialist nurses, and consideration of how to access information from the National Amyloidosis Centre, would have minimised this issue. We made recommendations regarding this.

Finally, Mr C complained about the board's handling of his complaint. We found that the board had failed to meet deadlines and had failed to provide clear explanations to Mr C. We upheld this complaint. However, we found that the board had implemented a new complaints handling procedure since Mr C's complaints and so we did not make any recommendations around this issue.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to communicate with the family properly during Mrs A's illness, for failing to provide Mrs A with adequate support and for failing to handle Mr C's complaints about Mrs A's treatment reasonably.

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

• There should be a protocol for how to involve specialist nurses in the care of patients with very rare conditions, and where to get specialised information and support.
• The board should consider how they could access information and support from the National Amyloidosis Centre to provide to patients.

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 her father (Mr A) received at University Hospital Crosshouse. Mr A had cancer and was suffering from jaundice, requiring him to have bile drained from his body. Mr A had an Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure (a procedure that examines the pancreatic and bile ducts) to try and drain the bile. After this he developed sepsis (a blood infection) and died in the hospital several days later.

We took independent medical advice from a consultant in gastroenterology and an intensive care consultant. We found that an ERCP procedure was the recommended and appropriate treatment to attempt to drain the bile and relieve Mr A's jaundice. Whilst we found that it was reasonable for staff to have carried out this treatment, we found that the procedure was unsuccessful as a result of the invasion of the cancer. The resulting undrained bile had led to Mr A developing sepsis, which is a recognised complication of this procedure. We also found that, although there were some delays in carrying out investigations, including the ERCP procedure, these delays were not unreasonable and did not affect Mr A's outcome. We noted that the surgical team could have recognised the deterioration in Mr A's condition more quickly, however, we found that this did not affect his outcome and found his overall medical management was acceptable. Taking account of the evidence and the independent advice we received from both advisers, we considered that, on the whole, the care and treatment Mr A received was reasonable and we did not uphold this complaint.

Ms C also complained that hospital staff had failed to communicate adequately with her and her family about the seriousness of Mr A's clinical condition and prognosis. We found that there should have been better communication with Mr A's family regarding the risks of an ERCP procedure and also regarding the severity of his illness and prognosis, in particular, when Mr A's condition deteriorated after the ERCP procedure. The board acknowledged that there were shortcomings in their communication with Mr A's family, for which they had apologised. They said that they had taken action to address these failings and we asked the board to provide us with evidence of this. We upheld this aspect of Ms C's complaint but, in light of the action the board had said they had taken, we did not make any further recommendations on this issue.

The gastroenterology consultant who we took advice from on this case commented that there were shortcomings in the level of detail and clarity of documented discussions with Mr A about his diagnosis and its management. We made a recommendation for action in relation to this.

Recommendations

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

• Discussions with a patient should be clearly documented with the relevant amount of clarity and detail.

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 support her child (child A) received from the Child and Adolescent Mental Health Service (CAMHS). During a period of absence of child A's regular therapist, child A was transferred to a new therapist who was not trained in the approach that the first therapist had used. The second therapist then left the service, and Ms C was told that, if child A wished to wait for the first therapist to return, they would need to be discharged in the meantime. Ms C also complained that CAMHS did not provide support to child A in response to a recent traumatic event, or in relation to a decision about child A's future schooling.

In response to Ms C's complaint, senior members of staff met with her, and it was agreed that child A would remain a patient with CAMHS, but that support would be provided by phone to Ms C until the first therapist returned. The board sent a written response to Ms C's complaint five months after this meeting, which confirmed these arrangements and apologised for the tone of a phone call with the CAMHS team leader. Ms C was not satisfied with the response, or the board's handling of her complaint, and she brought her complaint to us.

We took independent advice from a psychologist. In relation to the proposal to discharge child A while waiting for the first therapist to return, we found that staff acted reasonably, and so we did not uphold this complaint. However, we noted that it would have been helpful for them to have discussed Ms C's concerns and explored alternative options to discharge at an earlier stage, as we found that this was only done in response to her complaint.

We found that, whilst it was appropriate for the therapist not to raise the subject of a traumatic event with child A, they should have raised this with Ms C separately in order to explore the issues and offer indirect support. We also found that, although CAMHS was not responsible for the schooling decision, they had agreed to provide an assessment to support this decision and that there was an unreasonable delay in providing this. We upheld these aspects of Ms C's complaint.

Whilst the board had already apologised for the delayed complaint response, we were critical that Ms C was not kept updated during this delay, and that the board's response did not address key points of her complaint. 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:
• not providing support in response to the recent traumatic event
• not completing the agreed assessment in time
• failing to update her regularly during their complaint investigation
• not responding to all of her points of 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:

• Where a recent traumatic event is reported in relation to a child currently under the care of CAMHS, the therapist should seek to provide support, for example by raising the issue separately with the parent/carer.
• Agreed assessments should be carried out timeously.

In relation to complaints handling, we recommended:

• Where a complaint response takes longer than 20 days, the complainant should be kept updated on progress.
• Complaints should be responded to in full.

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 works for an advocacy and support agency, complained on behalf of her client (Mrs A). Mrs A was referred by her GP to hospital as she had an umbilical hernia. She had tests involving her chest, abdomen and pelvis which led to a suspicion of cancer, and a letter was sent to her GP advising that at the same time as her hernia was repaired, a biopsy would be taken. After these procedures, Mrs A was advised that it was likely that she had cancer. She was reviewed at a subsequent appointment where it was confirmed that she had advanced malignant disease.

Ms C complained about the way in which Mrs A had been told about her diagnosis and that she had not been given full information about the surgical procedures she was to undergo. She also said that the board had delayed in reaching a diagnosis and delayed in responding after Ms C made these complaints to them.

We found that Mrs A had been alone when her diagnosis was given to her and that no effort had been made to try to contact her husband before she was given bad news. We found little evidence that the procedures and the risks had been fully explained to Mrs A, despite the fact that she had signed the consent form as having understood. We upheld these aspects of the complaint. Although Mrs A felt that there had been a delay in diagnosing her, we found no evidence of this. She was seen within a month of referral, and tests were carried out in a timely way. We did not uphold this aspect of the complaint. However, we did find that when the board came to consider Ms C's complaints, they took too long, so we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• The board should send Mrs A a formal letter apologising for failing to attempt to involve her husband or another supporter when she was given bad news.
• The board should send Mrs A a formal letter apologising for failing to discuss the risks of surgery with her.
• The board should send Mrs A a formal letter apologising for the delays in responding to her complaint.

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

• The board should ensure as far as possible that when patients are receiving bad news, they are personally supported by a friend or family member.
• The board should ensure that prior to elective surgery, a full explanation is given to the patient including information about the risks entailed. This conversation should be documented.

In relation to complaints handling, we recommended:

• The board should complaints should be responded to within the stated timeframes. Where this is not possible, the complainant should be updated.

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 by her medical practice for her back pain. She said that she was not appropriately investigated or diagnosed, and that there was a delay in her being referred for a scan.

We took independent advice from a GP. We found that when Mrs C presented with back pain, she was appropriately assessed and examined, and that appropriate action was taken as a result of these assessments. We also found that she was referred for a scan within two and a half weeks of presentation. We found that the care and treatment provided by the practice was reasonable and we did not uphold Mrs C's complaint.

Summary

Mrs C complained about her medical practice, specifically that they failed to recognise or suspect she had whooping cough given her symptoms until a blood test confirmed the condition. Mrs C told us that as a result of the failings, her health needs were not met and she posed an unnecessary risk to her family and other members of the public. Mrs C also raised concerns about the way the board handled her complaint in that a complaints manager had been involved in both supporting her and investigating her complaint.

We took independent advice from a medical adviser. We found that the standard of medical care and treatment provided was reasonable. We also found that, given the review of the investigation and report was undertaken by the head of services and not the complaints manager, the complaints handling was reasonable.