Health

Summary

Mrs C complained about the failure of the practice to refer her late father (Mr A) to hospital skin specialists for investigation of a lesion on his forehead. By the time a referral was made, it was too late to attempt surgery and palliative care was instigated. Mr A had a previous history of skin cancer and Mrs C felt that an early and urgent referral to the skin specialists should have been made. We took independent medical advice from a GP. We found that it was not unreasonable for the practice to have thought that Mr A had a cyst and that it was appropriate to transfer his care to district nursing staff in order that they could dress the wound. When the district nurses requested antibiotics the practice made out an appropriate prescription. It appeared that there was a change in the appearance of the lesion after Mr C had been seen by the practice. We did not uphold the complaint.

Summary

Mr C complained about the treatment he received at St John's Hospital. He said that his GP had been treating him for a suspected urinary tract infection and referred him to hospital. Initially staff felt that he had a viral infection, but subsequent investigations found that he had a prostatic abscess (accumulation of pus within the prostate gland) and had also developed staphylococcus aureus bacteraemia (a bacterial infection). Mr C felt that there had been an undue delay in reaching an accurate diagnosis.

We took independent professional advice from a consultant physician. We found that staff had performed a number of investigations to establish the cause of Mr C's symptoms and that it was not initially unreasonable to have diagnosed him as suffering from a viral illness. His temperature fluctuated and appropriate antibiotics were administered at an early stage. The staff also arranged further appropriate investigations in case there was a danger of Mr C losing his sight or requiring heart surgery. We did not uphold the complaint.

Summary

Mr C complained about the change in the way his medication was administered at the Royal Infirmary of Edinburgh. In the past, Mr C received IV morphine (injection into a vein) but had now been changed to subcutaneous morphine (injection under the skin). Mr C believed that the change meant he was in pain for a longer period of time and that it was not as effective. He believed that the decision to change the method of administration of the morphine was unreasonable.

We took independent medical advice from a clinician and found that the board had implemented a new Recurring Pain Pathway which included guidance in appropriate cases that morphine should be given subcutaneously (under the skin). This would have the effect of a slower absorption with fewer side effects. We also found that the board staff had explained the rationale for the change to Mr C in a sensitive manner taking into account his other health issues. We did not uphold the complaint.

Summary

Miss C complained about the care and treatment she received following elective abdominal surgery. When Miss C awoke following the surgery, she had considerable pain in her leg. She was given pain medication but her leg became significantly worse the next day. Compartment syndrome (when pressure rises in a compartment bordered by a facial covering because of a reduction in the blood flow to the muscle) was suspected and later diagnosed. Miss C underwent surgery but suffered outer muscle loss on her left leg. Miss C complained that there had been a delay in diagnosing compartment syndrome in light of her symptoms. She also complained that the board failed to provide proper treatment because of this delay. Finally, Miss C complained about how the board handled her complaint.

We took independent advice from a surgeon. We found that there had been an unreasonable delay in diagnosing compartment syndrome. Specifically, the signs and symptoms Miss C experienced should have led to an earlier orthopaedic consultant (specialist in the treatment of diseases and injuries of the musculoskeletal system) review and diagnosis of compartment syndrome. In light of this, we upheld this aspect of the complaint.

In respect of Miss C's second complaint, we considered that her symptoms were well-monitored and recorded. We considered the failing to be in the interpretation of the clinical observations. Outside of this failure, we considered Miss C's management to be good and as expected following significant surgery. Once compartment syndrome was diagnosed, we found the care and treatment to be reasonable. We concluded that the failing had been the unreasonable delay in diagnosing compartment syndrome and not in the treatment provided. Therefore, we did not uphold this aspect of the complaint.

Finally, we concluded that it took an unreasonable length of time for the board to carry out their stage 2 complaint investigation and that Miss C was not appropriately updated about this delay. Furthermore, we did not consider the board's response to clearly reflect the findings of an Adverse Event Review that was carried out. Finally, the board's internal records indicated that Miss C's complaint was upheld but this was not apparent in their stage 2 response. As a result of this, we upheld this aspect of the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Miss C for failing to diagnose compartment syndrome promptly and for failing to keep her adequately informed about delays in the investigation of her complaint and the progress and outcome of the Adverse Event Review. The apology should meet the standards set out in the SPSO guidelines on apology 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

Mrs C complained about the care and treatment provided to her late husband (Mr A) who had a rare and aggressive form of bladder cancer. Mr A received care and treatment at the Royal Infirmary of Edinburgh and the Western General Hospital.

We took independent advice from urology (specialism that deals with the male and female urinary tract, and the male reproductive organs), oncology (cancer) and general surgery advisers. We found that the time taken to investigate and begin treatment for Mr A's bladder cancer was reasonable and in accordance with the Scottish Government's cancer waiting time targets. We also found that chemotherapy treatment commenced within a reasonable timescale. The level of information about treatment options, including their risks and benefits, provided to Mr A was also reasonable. This included sufficient information about the specific risk of pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs), a complication Mr A subsequently experienced.

In the context of Mr A's rapid deterioration, the level of planning for end of life care was reasonable. When Mr A subsequently experienced bowel obstruction, it was reasonable that he was treated on a surgical ward. While Mr A's pain was difficult to manage, the attempts by the clinical team were reasonable, as was the aim to discharge Mr A home. When Mr A's condition deteriorated, he was transferred to a hospice without unreasonable delay.

We did not uphold Mrs C's complaints.

Summary

Mr C complained to us that his GP practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that he had alcohol issues. We found that the practice had previously discussed this matter with Mr C and that it had been reasonable for them to contact the DVLA regarding their concerns about Mr C's health and alcohol intake. We did not uphold Mr C's complaint.

Summary

Ms C complained to us that a dentist had failed to provide reasonable care and treatment to her. She said that the dentist inappropriately removed an inlay despite the fact that this had not caused her any problems.

We took independent advice from a dental adviser. We found that it had been reasonable for the dentist to remove the inlay, as there was evidence of decay, and to carry out drilling on the tooth to do so. We also found that it was reasonable for the dentist to refer Ms C to a specialist for root canal treatment. There were no failings by the dentist that led Ms C to develop an infection. The presence of decay meant that there was a risk of infection for Ms C, with or without treatment, and this risk would increase through time, given that the decay would most likely spread further. However, we found that there was insufficient evidence that the dentist gave Ms C adequate information about the likelihood of infection. Therefore, we upheld the complaint for this specific reason.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for this failing. 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:

• Dentists should ensure that, where appropriate, patients are given adequate information about the likelihood of infection and that this is documented.

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 nursing care she received at St John's Hospital during two separate admissions. Ms C had a complex medical history and was assessed by a range of clinical professionals during each admission. Ms C was unhappy with the way nurses behaved towards her and communicated with her.

We took independent advice from a registered nurse. We considered Ms C's account, staff statements and the clinical records available. Based on the evidence available, we were unable to establish that there had been failings in the way nursing staff behaved towards or communicated with Ms C. We did not find that the care provided was unreasonable and we did not uphold Ms C's complaints about care.

We also considered whether the board investigated and responded to Ms C's complaints appropriately. We did not identify failings in the level of investigation performed or the accuracy of the complaint response. However, we found that the board did not meet the timescales for issuing a response set out in the procedure. For this reason, we upheld this complaint. We were satisfied that the board had taken appropriate action to address this issue since the time of the complaint and we did not make any recommendations.

Summary

Ms C saw her dentist about a number of issues and agreed to undertake a course of dental treatment which included denture fittings over a number of months. However, Ms C told us that once treatment had been completed the dentures were ill-fitting and the cost of the planned treatment had not been made clear to her.

We took independent advice from a dental adviser. We found that the evidence from Ms C's dental records showed the standard of treatment provided at each appointment during this period was reasonable and that treatment decisions were in line with options under the NHS. We also found that the evidence showed the planned treatment costs were discussed with Ms C and adjustments were made to meet Ms C's communication needs. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received when she was admitted to A&E at the Royal Infirmary of Edinburgh. In particular, that she had been catheterised without her consent and against her will. She also complained that unnecessary restraint had been used.

We took independent advice from a consultant in emergency medicine. We found that the care and treatment given to Ms A was reasonable, and that the history, examination and investigations had been appropriate and reasonable. In particular, we found that this had been a potentially life threatening emergency and the decision to insert a catheter had been reasonable. We considered that it was extremely unlikely that Ms C would, at that time, have had the capacity to consent to medical treatment. As such, an adult with incapacity assessment had been completed before the decision to insert the catheter had been made. We also found there was no evidence in the medical records that unnecessary constraint had been used. We did not uphold Ms C's complaint.