Health

Summary

Miss C complained about the care and treatment provided to her child (Child A) by the board. Child A was born by caesarean section. When Child A was older, they experienced a seizure and a scan showed right-sided ventricular enlargement (when the muscle on the right side of the heart becomes thickened and enlarged) and associated white matter loss, indicating brain damage or brain injury.

Miss C had concerns about how the brain damage occurred, when it occurred, and the delay in identifying this. She said that her view was that the board had caused the brain injury when Child A was born. She also complained that Child A had not received a brain scan earlier despite developmental difficulties.

We took independent advice from a paediatrician (doctor dealing with the medical care of infants, children and young people). We found that there was no indication in the medical records of any events which were likely to have caused brain injury in Child A during birth or during the neonatal period. We also found that Child A's early developmental course did not suggest the need for a scan and there did not appear to have been any delay in diagnosing the brain injury. We did not uphold Miss C's complaint.

However, we noted during our investigation that there were failings in the board's handling of Miss C's complaint in relation to updating Miss C, not responding to her questions, failing to refer to SPSO, and failing to acknowledge correspondence in a timely manner. Therefore, we made a recommendation to the board in light of this under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

In relation to complaints handling, we recommended:

• Complaints should be handled in line with Model Complaint Handling Procedures.

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

C underwent a polypectomy (a procedure used to remove polyps from the inside of the colon). C said that they informed staff prior to the procedure that they had a platelet disorder (platelets are the cells responsible for making blood clot. A platelet disorders mean that injured blood vessels bleed more than usual and heal more slowly), however, no precautions were taken prior to the polypectomy being carried out. C later experienced bleeding. C complained that the board unreasonably managed their care in relation to their history of a platelet disorder and failed to reasonably manage their care after they were admitted with bleeding.

We took independent medical advice. We found that clinicians undertook a pre-assessment with C. While C had a history of experiencing bleeding as a child, a more recent operation had not resulted in significant bleeding. We found that it was reasonable that no further tests were carried out prior to the procedure being undertaken, as there was full blood count and clotting information available to clinicians which would have highlighted any long standing problem with the number of platelets if there were any. We did not uphold this aspect of the complaint.

We found the board's management of C in the acute situation was adequate and carried out in a reasonable timescale. There was no indication a specific platelet or clotting factor transfusion was required. We did not uphold this aspect of C's complaint.

Summary

C complained that the board had unreasonably stopped their medication in prison. We took advice on the complaint from a medical adviser. The medication had been stopped after a check had been carried out and it had been found that some of C's medication was missing. We found that it had been reasonable to stop the medication and that the care provided to C had been reasonable. Medical staff had acknowledged C's mental health conditions and had directed them to engage with the mental health team. We did not uphold the complaint.

Summary

Ms C complained to us about the care and treatment provided to her father (Mr A) before his death from suicide. Mr A was admitted to Forth Valley Royal Hospital after expressing suicidal thoughts. He was discharged on the following day. Ms C complained that it was unreasonable to discharge Mr A at that time.

We took independent advice from a psychiatric adviser. We found that there was no evidence that Mr A had been adequately assessed and we upheld the complaint that he was discharged unreasonably.

Mr A returned to the hospital on the day he was discharged and asked to be readmitted. However, it was decided that he would not be readmitted. Ms C complained that this decision was unreasonable. We found that it was unreasonable that the nursing staff did not consult a doctor and carry out an assessment when Mr A returned to the hospital. We also upheld this complaint.

Ms C complained that Mr A's medical records were inadequate. We found that there were failings in relation to describing the assessment of risk, the clinical rationale for the management of Mr A, discharge planning, changes in his mental state and information available from his family. We upheld this complaint.

Finally, Ms C complained that the board had delayed in completing a significant adverse event review. The board had accepted that there were delays in this and had apologised for this. We upheld this complaint.

We were satisfied, however, that the board had taken reasonable and appropriate action to try to prevent all of these failings recurring. They had also apologised to the family for most of the failings, although we recommended that they issue a further apology for the delay in completing the significant adverse event review.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the delay in completing asignificant adverse event review. The apology should meet the standards set out in the SPSO guidelines onapology available at www.spso.org.uk/information-leaflets

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

C submitted a complaint on behalf of their child (A) about the treatment provided by the board in relation to A's eating disorder. C said that A had been diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID), however, in subsequent contact this term was not used by board staff.

We took independent advice from a consultant psychiatrist who had experience working with people with eating disorders. We found that the board had provided reasonable treatment to A. It was recognised that A would benefit from intensive input and the board offered an individualised approach to treatment. The board set out a clear rationale for the proposed treatment that was appropriate for A's identified needs. While there was inconsistency in using the term ARFID to describe A's diagnosis this did not impact on the treatment offered to A. Therefore, we did not uphold C's complaint.

While we did not uphold this complaint, we have made recommendations to the board for failing to explain the varying use of ARFID in the complaint response. We have made these recommendations under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for failing to provide a reasonable explanation regarding the varying use of the term ARFID when responding to their complaint. The apology should meet thestandards set out in the SPSO guidelines on apology available atwww.spso.org.uk/information-leaflets.

In relation to complaints handling, we recommended:

• The board's complaints responses should provide reasonable explanations of the actions taken/terms used as necessary to respond to a complaint.

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 about the treatment which he received at the Ear, Nose and Throat (ENT) Department at Queen Margaret Hospital. He had been referred by his GP for further investigation of hearing loss. Mr C said that he also had discharge from his ears. He said that the consultant had told him to leave his ears alone as they were fine and did not prescribe any drops or medication. Mr C then attended his GP later that day and a swab was taken and he was prescribed capsules and cream until the results were known. The swab result confirmed an infection and antibiotics were prescribed. Mr C felt that the consultant had dismissed his concerns about the discharge from his ears.

We took independent advice from an ENT consultant. We found that the consultant in the ENT Department had carried out an appropriate examination to establish the cause of Mr C's hearing loss. It was also not unreasonable that the consultant had determined Mr C had caused trauma to his ear canals by using cotton buds and gave advice to stop using them and to wait to see if the inflammation settled in due course. At that time it was not appropriate to issue antibiotics. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment she received from Victoria Hospital following a car injury. She attended A&E with injuries to her right hand. An x-ray identified a fracture at the joint of her right middle finger. Mrs C was advised to keep her hand elevated in a high arm sling but the injured finger was not strapped or splinted.

The following week, she was reviewed by an orthopaedic consultant (a specialist in the treatment of diseases and injuries of the musculoskeletal system) at a fracture clinic. Mrs C stated that, at that point, the tip of the injured finger was noticeably bent over. After assessing Mrs C's injury, the consultant did not consider any additional treatment to be required at that time and discharged Mrs C to the care of her GP. However, Mrs C's finger continued to be bent over and she was later assessed by a consultant hand surgeon who identified this as a mallet deformity.

Mrs C complained that she did not think the board had treated her injured finger appropriately. She queried why her finger was not strapped when she attended A&E and why it was left untreated following the consultation at the fracture clinic. In addition to this, Mrs C queried why she was not referred to a hand surgeon and was not provided with appropriate advice and information on how best to aid the recovery of her hand.

We took independent advice from an orthopaedic consultant. In respect of the care and treatment provided in the emergency department, we found that it would have been appropriate to apply a mallet splint at this point. Although a mallet injury may not have been visible at this point and it could not be known at the time whether splinting Mrs C's injury would have a beneficial outcome, we were satisfied that the evidence suggested it would have been reasonable to support splinting the finger on a 'just in case' basis. Therefore, we upheld this aspect of the complaint.

In respect of the care and treatment provided following Mrs C's discharge from A&E, we found that the possibility of a mallet deformity was underappreciated following Mrs C's discharge and, in particular, at the consultation at the fracture clinic. We considered there to be enough evidence to suggest that Mrs C's finger should have been splinted when she attended the fracture clinic. A referral to a consultant hand surgeon would not have been a required course of action given the nature of Mrs C's injury. In respect of physiotherapy, we felt this is unlikely to have prevented the mallet deformity from developing.

However, the more general hand injuries may have benefited from earlier physiotherapy or home exercise. We concluded that the board failed to provide appropriate care and treatment after Mrs C was discharged from the emergency department. Therefore, we upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failings identified. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Patients who present with hand injuries of this type should be provided with appropriate advice and information about physiotherapy or home exercise.
• Relevant staff should be aware of when it is appropriate to apply a splint to injuries of this type.

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

C complained about various aspects of the care and treatment that their parent (A) received from the board.

We took independent advice from a consultant geriatrician (a doctor specialising in medical care of the elderly) and from a nurse. We found that A was unreasonably discharged from Victoria Hospital when they had an infection, which may only have been partially treated, and that there may have been uncertainty about the effectiveness of the antibiotics A was receiving. We also found that A did not receive medical reviews when their delirium was active; that there should have been an earlier assessment of the possibility that A had a chest infection; that A was discharged from Queen Margaret Hospital to a care home without a prescription for stronger pain medication; and that no nursing transfer letter or discharge summary was provided to the care home when A was transferred from Queen Margaret Hospital.

We upheld C's complaint that the care and treatment provided to A was unreasonable.

C also complained about the board's communication. We found that there was a failure to discuss A's transfer arrangements, ongoing care (including palliative care) and medication with C prior to A's transfer to the care home. Therefore, we upheld this aspect of C's complain.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for: discharging A from Victoria Hospital, not carrying out a medical review of A, not carrying out an earlier assessment of the possibility that A had a chest infection, discharging A from Queen Margaret Hospital to the care home without a prescription for stronger pain medication, not providing a transfer letter or discharge summary to the care home when A was transferred, and for failing to discuss A's transfer arrangements, ongoing care (including palliative care) and medication prior to A's transfer to the care home. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets.

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

• Consideration should be given to the pain medication prescribed to patients who are approaching the end of their life and are being discharged from a hospital to a care home.
• Patients who are known to have delirium should receive regular medical reviews.
• Staff should discuss transfer arrangements, ongoing care (including palliative care) and medication with a patient's family when a patient is being transferred from hospital to a care home.
• Where a patient has been identified as potentially having a chest infection this should be assessed at the earliest opportunity.
• Where appropriate, the effectiveness of antibiotic treatment should be assessed prior to discharging a patient with an infection.

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

C complained about a failure on the part of the board to discuss their eye conditions and possible treatments before they were referred to another board for an operation.

We found that, whilst the referral to the other board was reasonable, the fact that C was not involved in a discussion, or advised about possible options for treatment prior to the referral, was unreasonable. Therefore, we upheld this aspect of the complaint.

C also complained about a failure on the part of the board to transfer all relevant medical information to the other board prior to the operation.

We found that it was reasonable practice for the board to state that the other board could contact them for relevant information if they considered it necessary to do so, given they had already met with C and had notes about their condition. We did not uphold this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to C for (1) failing to explain to them why the doctor considered it necessary to refer them on to the other health board and (2) failing to send them a copy of the letter to their GP stating why the referral was being made. The apology should meet the standards set out in the SPSO guidelines on apology available at www.spso.org.uk/information-leaflets

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

• To ensure patients receive information about why a referral has been made for them to see another clinician.

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 to the board on behalf of her son (Mr A), who had a diagnosis of autism. Mrs C was unhappy with aspects of the care and treatment provided to Mr A by the mental health service at Queen Margaret Hospital.

Mrs C firstly raised concern about the communication surrounding the prescription of a medication. The board upheld Mrs C's complaint and apologised that the information provided about the dose was not clear.We found that Mr A had taken a greater dose than intended; however, the dose taken was still within the safe limits of prescribing for this medication. We concluded that the board had taken reasonable action in light of the matter. We upheld the complaint but did not make recommendations.

Mrs C was also unhappy with the psychiatric care and treatment provided to Mr A more generally. We took independent advice from a consultant psychiatrist. We found that there was a reasonable level of assessment, treatment, and clinical management of Mr A during his consultations with the service. We did not uphold this complaint.

Finally, Mrs C raised concern about some of the language used in the board's complaint response. We considered that the use of one term or another was a matter of preference and we did not conclude that there were failings in the language used. However, we did consider that the time taken for the board to respond to Mrs C's complaint was excessive. On balance, we upheld this aspect of the complaint.

Recommendations

In relation to complaints handling, we recommended:

• In line with the NHS Scotland Complaints Handling Procedure, the person making the complaint should receive a full response to the complaint as soon as possible but not later than 20 working days, unless an extension is required. Delays in the investigation should be minimised.

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.