Health

Summary

Following a severe stroke a number of years ago, Mr C's wife (Mrs C) has had a number of ongoing health issues, including being unable to speak. Her shoulder (on the side affected by her stroke) has been dislocated several times. On one occasion, Mrs C attended the accident and emergency department of a hospital because her shoulder was painful. An x-ray was taken and an emergency doctor attempted to manipulate her shoulder back into position while she was sedated, fracturing one of the shoulder bones in the process. This was treated conservatively (with medical treatment that avoids radical therapeutic measures or operations) but Mrs C required hospital admission and her arm was immobilised.

Mr C complained that as a result of the fracture and bruising, Mrs C suffered a lot of pain. She also had to wear a sling and shoulder brace which made her life more difficult. Mr C said that the manipulation carried out was unreasonable and that Mrs C should not have had to cope with its consequences, particularly given the aftermath of the stroke.

During our investigation we took independent advice from one of our medical advisers, who examined Mrs C's medical records. Their advice, which we accepted, was that it was not reasonable to carry out the manipulation, because the shoulder was effectively not dislocated and there was a very high risk of a fracture occurring. These were significant failures. Furthermore, we were not satisfied from the medical records that Mrs C was fully informed of the risks of the procedure, or that the doctor properly obtained consent.

Recommendations

We recommended that the board:

• put in place a clear protocol for the treatment of chronic dislocation and subluxation (partial dislocation of a bone in a joint) of the shoulder particularly for patients with neurological abnormalities;
• ensure that written consent is obtained for invasive procedures, including the complications, which should be obtained prior to such procedures being undertaken and clearly recorded in the notes;
• ensure these issues are raised with the emergency department doctor as part of his annual appraisal; and
• apologise to Mr C for the failures identified in this investigation.

Summary

Ms C complained about the care and treatment provided to her son (Master A) after a circumcision operation. She said that hospital staff inappropriately discharged her son after the operation; failed to provide the family with information leaflets or advice about what aftercare was required and failed to provide appropriate follow-up treatment when it was evident that the wound was not healing.

After we took independent advice on this case from one of our medical advisers, a paediatric surgeon, we upheld all of Ms C's complaints. The adviser said that, given Master A’s level of discomfort and his difficulty in passing urine, he should not have been discharged from hospital when he was. The adviser also said that the board should have provided Ms C with a discharge summary, including plans for follow-up, when Master A was discharged. We found that the board failed to carry out an investigation into their discharge arrangements, information and documentation, as they had said they would, and to promptly convey the results to Ms C.

The adviser also said that a routine follow-up appointment should have been made for Master A, and that the board should have brought forward that appointment after his emergency reassessment, without any intervention from Ms C. Master A was later prepared for theatre without any explanation to his family, but a surgical registrar then decided not to operate and discharged him home. We found that the junior surgeon who initially saw Master A should have made Ms C aware that the final decision about surgery would be made by the surgical registrar.

Recommendations

We recommended that the board:

• ensure that this complaint is used as a learning tool for all staff responsible for the discharge arrangements for patients undergoing this type of procedure;
• ensure that patients undergoing this procedure are appropriately followed up, including ensuring any necessary follow-up appointments are made prior to discharge;
• ensure that a full review of their discharge policy is carried out for patients undergoing this type of procedure and provide the Ombudsman with evidence of the review; and
• provide both Ms C and Master A with a full apology for the failings identified.

Summary

Mrs C complained about the care and treatment of her late brother. During our consideration of the complaint, Mrs C advised that she had decided to pursue the matter by other means, as the outcome she sought was financial compensation. We decided, in the circumstances, and under the provisions of the Scottish Public Services Ombudsman Act 2002, that we would not consider the matter further.

Summary

Ms C, who is an advice worker, complained on behalf of Ms B about the care and treatment given to her late father (Mr A) by the practice in the year before his death. Ms B was unhappy with the attitude of staff there, saying that the practice had not taken sufficient account of her father's symptoms, that they dismissed certain issues, and would only address one issue at a time. She thought that this meant they had missed symptoms that would have led them to identify his final diagnosis of lung cancer earlier.

Mr A attended the practice on numerous occasions in the year or so before his death. He reported a range of symptoms, including chest infections, incontinence, possible dementia, mobility issues, a dry mouth and a cough. He was referred for chest x-rays early in the year and again towards the end of the year, which were reported as showing no signs of active disease. He was also referred to urology and for a geriatric medicine review. It was at this review, a month before he died, that specific concerns were first raised about a possible cancer diagnosis. Mr A was referred for a scan, which found lung cancer that had spread to other parts of his body. Mr A died three days after the diagnosis.

We noted that Ms B complained that the practice were dismissive of her father's symptoms and that their attitude indicated they did not take his concerns seriously. As, however, there was no objective evidence of this, our investigation focused on Mr A's medical records. We took independent advice from one of our medical advisers, who reviewed the practice's actions in respect of each of the issues Mr A had told them about. The adviser said that the practice referred Mr A for x-rays appropriately. While they could have done more to assist him with his reports of incontinence, what they did was fairly standard practice. In relation to Mr A's mobility, our adviser said that the practice assessed the situation appropriately. There had been some confusion around whether Mr A had a diagnosis of dementia, and our adviser indicated that the records showed that he did not. He said that there were references in correspondence which could have led to this confusion, and that Mr A may have been told that he had mild dementia. However, when Mr A raised his concerns with the practice, they had responded appropriately.

We found that the care and treatment given to Mr A was appropriate. He was referred for specialist opinion appropriately, and the practice took action to investigate concerning symptoms. Although they could have done more to assist him with the management of his continence issues, we noted that the adviser identified what they did as being standard practice.

Summary

Ms C, who is an advice worker, complained to us on behalf of Ms B about the care and treatment of her late father (Mr A) during an out-of-hours GP visit. This visit came shortly after Mr A had been diagnosed with lung cancer.

Ms B said that her father had become increasingly short of breath and was looking very unwell. The family called NHS 24 and requested a home visit. Mr A spoke to a nurse on the phone, and was assessed as needing a home visit within an hour. Ms B asked that the GP not mention the new cancer diagnosis to her father, as he was not fully aware of it. About half an hour after the call, a GP arrived. She assessed Mr A's condition, and listened to his chest. She noted his vital signs, and as not all her equipment was working fully, she judged his temperature by touch and found that he did not have a fever. Following discussion with the family, Mr A was not transferred to hospital, but was given medication for his cough and to reduce pain. Shortly after the GP left, Mr A collapsed and had to be resuscitated by his family until an ambulance came. He was taken to hospital, where he died the following afternoon.

We took independent advice from one of our medical advisers, who based their findings on the notes made by the GP at the time. We noted, however, that the accounts given by the GP and Ms B in relation to what happened during the visit were somewhat different. Our adviser said that during the consultation the GP took appropriate action in relation to her assessment of Mr A's condition. She had taken account of Mr A's medical history, and took the family's views into consideration in suggesting that he remain at home and be reviewed by his GP the following morning. However, the adviser was slightly critical of the level of detail in the GP's notes.

In coming to a decision on this complaint, we were not able to determine what exactly happened during the consultation, given the conflicting accounts. However, based on the clinical records made at the time, the advice we were given indicated that the GP assessed Mr A's condition appropriately, and appropriately considered the family's wishes when planning treatment.

Summary

Ms C complained that doctors at the practice did not recognise multiple chemical sensitivity (MCS) as a medical condition and had refused to supply her with a doctor’s note for a housing application she had made. Ms C said that the practice only provided consulting rooms which were heavily perfumed through the use of air fresheners, and that they had focused unreasonably on her illness being psychological.

During our investigation we took independent advice on Ms C's complaint from one of our medical advisers. We found that MCS is not a recognised medical condition, so the doctors were not able to certify Ms C as suffering from it. We found no evidence that the rooms at the practice were over-perfumed or that the use of air fresheners by the practice was targeted at Ms C. Given that MCS is not a recognised medical condition and in view of the symptoms she was displaying, we found that the doctors had acted responsibly in suggesting that Ms C might benefit from accessing mental health services.

Summary

Mr C was referred to the board's neurosurgical unit after an angiogram (a type of x-ray used to examine blood vessels) showed that he had two cerebral aneurysms (weak points in the walls of blood vessels supplying blood to the brain, causing them to bulge or balloon out). The referral was passed to a consultant neurosurgeon for consideration. Five days later, it was returned to the waiting list team, then passed to another consultant neurosurgeon the same day, for Mr C to be placed on a waiting list initiative list, so that he would be seen sooner.

Mr C, however, collapsed about a week later. He was admitted to hospital and a scan of his head was taken. This showed evidence of subarachnoid haemorrhage (bleeding in the area between the brain and the thin tissues that cover the brain). He was taken to theatre for emergency surgery, but this was abandoned due to the continuing bleeding and swelling in his brain. Mr C was then transferred to the intensive care unit, where he died later that day.

Mr C's wife complained about the care and treatment he received from the board before his death. After taking independent advice from one of our medical advisers, we found that it was reasonable for them to at that point put Mr C on the waiting list initiative list, which meant that he would have been seen sooner. The adviser explained that there was no indication from the medical records that Mr C had displayed any symptoms of subarachnoid haemorrhage at that time. We also found that Mr C had received reasonable care and treatment in hospital on the day he died.

Summary

Mrs C, who is an advice worker, complained to us on behalf of her client (Mrs A). Mrs A was referred to a gynaecology clinic, as she had been experiencing some loss of bladder control. It was agreed that Mrs A would have an operation to try to resolve this. However, after the operation Mrs A was left in pain, and with a feeling of great urgency to pass urine at times. Mrs C complained that Mrs A was not reasonably informed of the risks before the operation and that it had worsened her situation.

After considering Mrs A's clinical records and taking independent advice from one of our medical advisers, we found that Mrs A had been counselled appropriately about the risks and benefits of the operation. She signed a consent form that identified the risks and was given a patient information leaflet about the operation, which was clear and informative. This included information about the risk of long-term pain and the risk of developing irritable bladder symptoms.

Although it was clear that the operation had not been successful, we found that that it was reasonable for the board to carry out the procedure, which was performed appropriately and by surgeons with adequate training and expertise. We did not identify any failings by the board that led to the problems Mrs A experienced.

Mrs C also complained about the care provided to Mrs A after the operation. We found that her initial post-operative care was reasonable and appropriate. However, Mrs A had to wait too long for appointments and we found that the aftercare should have been provided in a more timely fashion. It was only when Mrs C complained on her behalf that an appointment with a consultant was brought forward, a complication was recognised and Mrs A was then referred to the pain clinic. Even then, the appointment with the pain clinic initially given to Mrs A was more than three months later.

Recommendations

We recommended that the board:

• issue a written apology to Mrs A for the delays in providing appointments once the complication had been recognised; and
• confirm to the Ombudsman that they have learned lessons from this case and will ensure that, in future, patients who suffer complications after having this type of surgery do not face similar delays in getting appointments.

Summary

Mrs C had her gall bladder removed by laparascopic (keyhole) surgery. She complained that although she felt ill and breathless the board had insisted on discharging her, as she had only been admitted for day surgery. Mrs C also complained that when she was then re-admitted as an emergency, this was under the care of the respiratory medicine department rather than the consultant who had carried out the operation. Mrs C continued to have medical issues, which she blamed on the surgery, and about which she spoke to the consultant the month after her operation. Although she felt he was rude and abrupt, she said he agreed to see her in his clinic. However, despite a letter from her GP, she did not receive a letter until three months later, for an appointment the following month. Mrs C also said that the board’s response to her complaint was inaccurate and did not answer all the points she had raised.

After taking independent advice on this case from three medical advisers, we upheld only one of Mrs C's complaints. After considering her medical records, the advice we received was that the decision to discharge Mrs C after surgery was appropriate, as was the decision to readmit her under the care of the respiratory medicine department. However, it was not reasonable that Mrs C was not seen for over three months by the operating consultant, given that she had discussed her problems with him personally. We found that although the complaint response was delayed and contained some typographical errors, it had appropriately addressed all the points Mrs C raised.

Recommendations

We recommended that the board:

• apologise for the failings identified in Mrs C's care; and
• review their procedures to ensure that following laparascopic surgery, patients are followed up appropriately.

Summary

Ms C, who is an advice worker, complained on behalf of her client (Mrs A) about a dentist. Ms C said the dentist failed to provide Mrs A with reasonable dental treatment when extracting three teeth. She said that he failed to remove a fragment of bone from Mrs A’s lower gum, resulting in infection, pain and discomfort, and that the follow-up treatment was not appropriate.

We obtained independent advice from our dental adviser. The adviser explained that fragments of bone can occur during the extraction process. They are quite often not seen until several days after the extraction and can come out themselves without any clinical intervention. The adviser said the fact that a fragment of bone remained after the extraction was not caused by inappropriate treatment, and that the dentist could not unreasonably fail to remove a fragment that was not evident to him at the time. The adviser said it seemed unlikely that the dentist would have identified a fragment of bone in Mrs A’s gum and then knowingly left it in place.

In terms of the follow-up treatment, the adviser said the records suggested that, on the whole, the treatment provided at two of the three follow-up appointments was reasonable. However, because of the dentist's poor record-keeping, it was not possible to say whether the treatment Mrs A received at the remaining appointment was reasonable. Because of this, although we did not uphold Ms C's complaint, we were critical of the dentist’s record-keeping.

Recommendations

We recommended that the dentist:

• reviews the Faculty of General Dental Practice clinical examination and record-keeping good practice guidelines and ensure that he follows these in future.