SPSO Individual Decisions

Mrs C complained about the care and treatment she received from Ninewells Hospital regarding a delay in physiotherapy and the board's handling of her complaint concerning the matter. We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in childbirth and the female reproductive system). We found that the handling of Mrs C's referral to physiotherapy was unreasonable and caused a delay of around seven months in her receiving her first appointment. We acknowledged that the board had apologised to Mrs C for the failure to action the referral to physiotherapy and for problems both Mrs C and her GP had when trying to expedite the referral through the doctor's secretarial staff. We considered that there was an unreasonable failure to amend Mrs C's management plan (regarding the decision to refer her for physiotherapy) after she was reviewed post-operatively. We found that there was poor internal communication across two hospital sites and a missed opportunity for the problem with the referral to be addressed at an earlier stage when Mrs C and her GP contacted the doctor's support staff. We considered that the board had taken reasonable action to improve communication between hospital sites. We considered that the delay in receiving physiotherapy was unlikely to have affected the progression of Mrs C's condition. However, we upheld the complaint and made a further recommendation to ensure learning and improvement. In terms of the board's handling of Mrs C's complaint, we acknowledged that they had apologised to Mrs C about their delay in responding. We found that the board had delayed by three weeks in updating Mrs C when they were unable to meet the 20 working day timescale for responding to complaints. Were were also critical that the board had not responded to all of the concerns Mrs C had raised in her complaint correspondence. The board accepted that they should have responded to this aspect. We upheld Mrs C's

Mrs C complained that the dental treatment she received was unreasonable. Mrs  C had been a patient of the dentist for 20 years but received a second opinion from another dentist and was told that she had extensive gum disease. Mrs C was concerned that she was never informed of this and that the treatment she had received was inappropriate. Mrs C also complained that the dentist unreasonably communicated with her about the health of her mouth and that they provided an unreasonable response to her complaint. We took independent dental advice. We found that the patient notes recorded were very limited, with little information about the ongoing overall health of Mrs C's mouth or the investigations or treatments that occurred over the 20 year period. We also found no record of a Basic Periodontal Examination (BPE - a check on gum health that is required to take place at every six month exam). In relation to the dentist's communication with Mrs C, we found that there was little evidence in the dental records that the dentist adequately informed Mrs C about the health of her mouth over the 20 year period. We also found that the response to Mrs C's complaint included inaccuracies and comments that were not supported by the dental record and failed to signpost Mrs C to us at the end of the complaints process. We upheld all of Mrs C's complaints.

Mr C complained about a Do Not Attempt Cardiopulmonary Resuscitation decision (DNACPR - a decision taken that means a healthcare professional is not required to resuscitate the patient if their heart or breathing stops) taken when his mother (Mrs A) was a patient in Ninewells Hospital where she was being treated for heart failure. Mr C held Power of Attorney (POA, the authority to act for another person in specified or all legal or financial matters) in relation to his mother. He had been told of the decision in a public place, without being consulted. The doctor who spoke to him said he had spoken to Mrs A, who agreed with the decision. Mr C said his mother was very confused and unable to consent to this. Mr C complained that he had not had his views taken into account in relation to the DNACPR decision despite having POA and that the board unreasonably spoke to Mrs A and gained her consent despite her lacking capacity to give consent at the time. We took independent advice from a doctor with specialism in acute and general medicine. We found that it was inappropriate to have a discussion with Mr C about the decision in such a public setting, however, we found that the board had acknowledged and apologised for this. We noted that where a patient has granted a POA, the attorney should be involved in the decision wherever possible, with the patient as well if appropriate. However, if cardiopulmonary resuscitation (CPR - where the heart and/or breathing is re-started if it stops) is unlikely to be successful, healthcare staff are under no obligation to attempt CPR. The adviser considered that Mr C should have been involved in the discussions earlier, but ultimately it was the clinical team's decision to make. We did not uphold this aspect of Mr C's complaint. In relation to gaining Mrs A's consent, we found that the board acknowledged that a discussion had taken place and, given it was recorded that she was confused at this time, they noted it would have bee

Mrs C complained about the in-patient care she received at Ninewells Hospital. In particular, that there was a delay in diagnosing diverticulitis (where small pouches from the wall of the gut become inflamed or infected). She also complained that a consultant surgeon had not examined her when she attended an out-patient clinic appointment at Perth Royal Infirmary and that the care that she received from the out-of-hours service was unreasonable. We took independent advice from a consultant colorectal surgeon (a specialist in the medical and surgical treatment of conditions that affect the lower digestive tract) in relation to Mrs C's concerns about a delay in diagnosing diverticulitis. We found that a computer tomography (CT) scan should have been carried out rather than an magnetic resonance imaging (MRI) scan because it would have provided a more complete examination of Mrs C's abdomen and pelvis. In addition, we considered that a CT scan should have been performed within a few days after Mrs C's discharge from Ninewells Hospital. We were also critical of the length of time it took for staff at Ninewells Hospital to contact the consultant surgeon at Perth Royal Infirmary to inform them about the results of the MRI scan. We also found that the letter to the consultant surgeon had not referred to Mrs  C's earlier hospital admission. In terms of the clinic appointment at Perth Royal Infirmary, we considered that the consultant surgeon should have examined Mrs  C given there was no evidence of her symptoms having settled. We considered that the time taken to diagnose diverticulitis was unreasonable and upheld this aspect of Mrs C's complaint. In relation to Mrs C's out-of-hours appointment, we considered that the treatment she received was reasonable and appropriate. We did not uphold this aspect of Mrs C's complaint.

Ms C, who works for an advice and support agency, complained on behalf of Miss  A about the medical and nursing care and treatment Miss A received at Stracathro Hospital following hip replacement surgery. Ms C raised a number of concerns, including that Miss A suffered a stroke after surgery which was not picked up on by staff, despite her repeatedly reporting visual disturbance and blurred vision. We took independent advice from a consultant physician and cardiologist (a  doctor who specialises in disorders of the heart), a consultant orthopaedic surgeon (a surgeon who diagnoses and treats a wide range of conditions of the musculoskeletal system) and a nursing adviser. We found that there were no case note entries by the junior medical staff at any time in Miss A's post-operative notes (including in relation to the complaint of visual blurring) and that the board failed to assess Miss A's complaint of post-operative visual blurring in an appropriate manner. The failing was not that they did not diagnose a stroke as the cause of her visual blurring, but rather that they did not assess it at all. We also found that the medical staff failed to take Miss A's medical history or carry out a simple bedside assessment of her eyes. We noted that the board appropriately prescribed aspirin to Miss A on discharge. However, prescribing aspirin alone does not follow the board's protocol and there was no reason recorded in Miss A's notes to explain why this decision was taken. There was also no evidence of a 'venous thromboembolism (VTE - condition where a blood clot forms in a vein) risk assessment tool' being completed. We considered that the medical treatment provided to Ms A was unreasonable and upheld this aspect of Ms C's complaint. In terms of the nursing care and treatment, we found that the nurses acted reasonably by informing the medical staff about Miss A's complaints of visual blurring and ensuring Miss A was seen by a doctor. Therefore, we did not uphold thi

Mrs C complained about the care and treatment that her late husband (Mr A) received at Ninewells Hospital after he attended with painless jaundice (a  condition with yellowing of the skin or whites of the eyes). Mr A was later diagnosed with pancreatic cancer. Mrs C considered that the board had not taken appropriate action in terms of treating his symptoms as a red flag for cancer, carrying out appropriate investigations, diagnosing the primary source of cancer, acting on problems with a stent that had been inserted to drain a bile duct blockage, decision-making around surgical treatment and prescription of a medication to help digestion. We took independent advice from a consultant hepatologist and gastroenterologist (a specialist in the study of the esophagus, stomach, small and large intestines, pancreas, gallbladder, and liver). We found that the initial action taken to investigate Mr A was reasonable and that appropriate tests for his presentation had been carried out. We found that the primary source of cancer had been appropriately diagnosed within a reasonable timeframe and that the action taken in relation to Mr A's stent was appropriate. We found that surgical decision-making was also reasonable as, although it was initially thought that an operation could be carried out to remove the cancer, subsequent scans showed this treatment would have caused significant harm to Mr A with no benefit. However, we found failings in the prescription of Creon (a  medication that replaces pancreatic enzymes which help digest food) and also prescription of appropriate medication to treat itching caused by bile duct blockage. We noted that Creon could and should have been prescribed earlier and that the types of medication prescribed to treat Mr A's itching are known not to generally improve itching associated with bile duct blockages. We found that Mr A could have been made more comfortable with a different approach. Overall, we considered that the care and treatm

Mr C complained about a consultation which he had with a consultant surgeon following a referral from his GP. Mr C had a complex medical history, including abdominal pain, and he felt that the consultant was not interested in helping him. Mr C said that he was told by the consultant that his health problems could be in his mind and also that stress could be the cause of his problems, along with him being overweight. Mr C was not satisfied that the plan was for him to be reviewed in six months in the hope that he had managed to reduce his weight. He complained that he did not receive appropriate treatment. We took independent advice from a consultant in general medicine. We found that Mr C's care was complex and that previously he had seen a number of clinicians who had difficulty in reaching a diagnosis. We found that the consultant had spent a considerable amount of time with Mr C and that it was reasonable to arrange a review appointment in 6 months in the hope that any weight loss could improve Mr C's symptoms. It was also reasonable that, as the consultant had not reached a specific diagnosis, no additional medication was prescribed. We did not uphold the complaint. Related reading View Decision Report 201800927 as a PDF (11.15 KB) Updated: December 2, 2018

Ms C complained that the care and treatment she received from her medical practice was unreasonable. Ms C said that she called the practice for an emergency appointment because she was experiencing extreme pain, and that it was only after she called a number of times that she was given an appointment. She was diagnosed with a vaginal swelling, given antibiotics and advised what to do should her condition worsen. Ms C was seen again at the practice the next day, when it was decided that she should be admitted to hospital. Ms C complained that there had been a delay in offering her a GP appointment, and that she had been incorrectly treated with antibiotics rather than referred to hospital. We took independent advice from a GP adviser. We found that Ms C was given an appointment within a reasonable time. We also found that it was in accordance with General Medical Council good practice advice that she was given antibiotics and advice in the first instance. We did not uphold the complaint. Related reading View Decision Report 201708061 as a PDF (11.05 KB) Updated: December 2, 2018

Mrs C was referred by her GP to the orthopaedic department (the area of medicine which deals with the musculoskeletal system) at Ninewells Hospital for consideration of knee replacement surgery. However, there were problems with the communications from the board which resulted in her missing a scheduled out-patient clinic appointment. Mrs C questioned this with the board and she was told that arrangements had been made to reschedule the clinic appointment. However, she was then told that the rescheduled appointment had been cancelled and that the consultant had carried out a virtual assessment of the symptoms reported by the GP, and had subsequently discharged her. Mrs C complained that it was unreasonable that she had been discharged from the orthopaedic clinic without a face-to-face consultation. We took independent advice from an orthopaedic consultant. We found that, on occasions, it can be appropriate for clinicians to carry out virtual assessments based on the information provided from the GP referral and that, in Mrs C's case, it was reasonable to discharge her from the clinic without a face-to-face consultation. We did not uphold the complaint. However, we were critical of the letter sent to Mrs C by the consultant as it did not contain sufficient advice as to what alternative options could be considered, and we fed this back to the board for their consideration. Related reading View Decision Report 201708551 as a PDF (11.26 KB) Updated: December 2, 2018

Mrs C complained to us that the practice had failed to provide her with appropriate care and treatment. She had reported to her GP that she was feeling down since the death of a relative and that she had self harmed. She was also concerned about a mouth infection. Mrs C said that the GP showed no interest, telling her to attend a dentist for the mouth problem and that she should wait for contact from the mental health services, who were already in contact with Mrs C. The GP told Mrs C that it was her responsibility to chase up the mental health services. We took independent advice from a GP adviser. We found that it was appropriate for the GP to have referred Mrs C to her dentist as it would not be within a GP's remit to treat patients with dental problems. We also found that, when Mrs C attended the GP, there was no clinical indication for an immediate referral to the mental health services. The department within the mental health services which Mrs C was already attending operated a self-referral facility and there was no need for the GP to make a formal referral. We did not uphold the complaint. Related reading View Decision Report 201709126 as a PDF (11.12 KB) Updated: December 2, 2018

Mrs C complained about the care and treatment provided to her late grandfather (Mr A) at Ninewells Hospital. Mr A was admitted to hospital and treated for sepsis (a blood infection). It was initially thought that this was caused by a chest infection but investigation showed that the source was Mr A's gallbladder. Mrs C complained that staff had not listened to family concerns about the source of the infection and that this had affected his treatment. Mrs C was concerned that the placement of a drain or other treatment was unreasonably delayed and that an appropriate scan had not been done. Mrs C considered that a different approach could have prevented Mr A's death. We took independent advice from a consultant interventional radiologist (a clinician who would place a drain in the gallbladder) and a consultant physician (a senior doctor). We found that Mr A had received appropriate treatment and investigation of his symptoms. The adviser indicated that staff were aware that the gallbladder could be the source of infection and that there were no unreasonable delays in the particular circumstances of Mr A's case. We considered that earlier placement of a drain would not have resulted in a different outcome for Mr A. We did not uphold Mrs C's complaint. Related reading View Decision Report 201701763 as a PDF (11.19 KB) Updated: December 2, 2018

Mr C complained that his GP unreasonably stopped his diabetic medication, and that the practice later inapppropriately removed him from their patient list. Mr C subseuqently withdrew his complaint and no findings were reached. We closed our case. Related reading View Decision Report 201706941 as a PDF (10.72 KB) Updated: December 2, 2018

Miss C suffered ongoing complex urological problems (problems relating to the urinary tract, bladder or kidneys), and underwent a dilation and cystoscopy procedure (a procedure to look inside the bladder and stretch the urinary opening) at Ninewells Hospital. During the procedure biopsies (samples of tissue) were taken. Miss C complained about the medical and nursing care during this procedure, which she found very painful and distressing. Miss C also complained about her medical care following the procedure, and that it took several months for the board to refer on to a urological specialist in another board area after she requested this. Medical and nursing staff met with Miss C to discuss her concerns. The board apologised for some aspects of the nursing care, and said the day-of-surgery admission pathway had not been suitable for Miss C, as it could not provide much of the support she required. Miss C was not satisfied with this response, and she brought her complaint to us. We took independent advice from a consultant urologist and a nurse. We found that most of the medical care Miss C received was reasonable. However, the operation note was not sufficiently detailed to show why it was necessary to take biopsies, which caused Miss C post-operative pain. We upheld this aspect of Miss C's complaint. In relation to the nursing care, we noted that the board had acknowledged certain aspects of care were staff could have acted differently and had taken action to discuss Miss C's concerns with staff. We considered these actions to be reasonable and found that the nursing care Miss C received was appropriate. We did not uphold this aspect of Miss C's complaint. Finally, we found that there was a delay in referring Miss C to a specialist. We noted that some of the delay was due to her requiring urgent hospital admission in this period; however, part of the delay was due to a lack of cover arrangements during an unexpected staff absence. We upheld this aspect

Ms C complained about the care and treatment provided to her by the board in relation to her hearing. Ms C had surgery to fit a hearing implant and after this she felt that her hearing deteriorated. Ms C also developed tinnitus (a ringing or buzzing in the ears). Ms C further complained that the communication with her from clinicians with regards to her hearing was not reasonable. We took advice from an ear, nose, and throat consultant and an audiologist (a healthcare professional who specialises in hearing, balance and related disorders). We found that there was no suggestion that the reduction in Ms C's hearing was due to the surgery, and that clinicians involved in her care had provided a reasonable standard of care. We also found that the records showed a reasonable level of communication with Ms C. We did not uphold Ms C's complaints. Related reading View Decision Report 201705169 as a PDF (10.97 KB) Updated: December 2, 2018

Miss C complained about the medical treatment her late mother (Ms A) received at Ninewells Hospital before her death. Ms A had been admitted to hospital on three occasions with exacerbation of chronic obstructive pulmonary disease (COPD, a disease of the lungs in which the airways become narrowed). It was then diagnosed that she had heart failure and Ms A died a week after her final admission. Miss C considered that there had been a delay in making a diagnosis of heart failure, as staff wrongly assumed that Ms A had COPD and delayed in carrying out the tests that showed she had heart failure. We took independent advice from a consultant in acute medicine and from a consultant radiologist. We found that the investigations carried out in the hospital had been reasonable and appropriate and that it was reasonable that staff initially considered Ms A had COPD. We noted that it can be difficult to distinguish between heart and lung disease, especially when both are present together, and that there had not been an unreasonable delay in making a diagnosis. We did not uphold this aspect of Miss C's complaint. Miss C also complained that staff had failed to adequately communicate with her and Ms A. The board had accepted that there were failings in relation to communication and we upheld this aspect of Miss C's complaint. We found that the main impact of this was that Miss C was not prepared for Ms A's sudden death. However, we were satisfied that the board had apologised for and addressed these failings whilst they were dealing with Miss C's complaint and we did not make any recommendations in relation to this matter. Related reading View Decision Report 201701048 as a PDF (11.37 KB) Updated: December 2, 2018

Mrs C complained about the care and treatment provided to her late husband (Mr  A) at Ninewells Hospital. Mr A was resident in a care home and had Alzheimer's disease. He was referred to the emergency department by his GP as he was suffering from hip pain and could not bear weight. The GP asked that staff at the hospital rule out bony injury as a cause of Mr A's symptoms. X-rays were carried out and Mr A was discharged back to the care home after staff found no significant changes from previous x-rays. Four days later, an emergency referral was made for Mr A and he was admitted to hospital. Subsequent tests showed that Mr A had an abscess (a painful swelling caused by a build-up of pus) in his hip. It was determined that he was not suitable for surgery and Mr A was referred to the palliative (end of life) care team. Mr A died in hospital a few days later. Mrs C complained that Mr A's care in the emergency department was unreasonable and that there had been confusion over his palliative care referral. She also complained about how the board handled her complaint. We took independent advice from an acute care consultant and from an emergency medicine consultant. The advice highlighted that Mr A's pain and inability to straighten his leg should have prompted further action by the staff who saw him in the emergency department. However, there was no indication that earlier treatment would have changed the outcome for Mr A. We also found that national guidance from the Scottish Intercollegiate Guidelines Network (SIGN) in SIGN 111 recommended tests that could have identified Mr A's infection earlier and that the care he received fell short of what he required as a patient with dementia. Therefore, we found that the care and treatment Mr A received was unreasonable and upheld this aspect of Mrs C's complaint. In relation to communication around palliative care arrangements, we found that the board had identified failings and had apologised to Mrs C. Therefor

Mrs C complained that the board unreasonably discharged her from a community mental health team. She believed that she was discharged due to the absence of her usual community psychiatric nurse (CPN), who had been off work for a number of months at the time of discharge. Mrs C said that she had not been regularly seen or supported during this absence, only receiving two appointments, the focus of which were her discharge from services. While complaining to the board, she also became aware that her previous diagnosis of bipolar disorder (a mental health condition marked by alternating periods of elation and depression) had been changed to a possible diagnosis of borderline personality disorder (BPD, a disorder of mood and how a person interacts with others). Mrs C complained that she had never been informed of this change and that the board failed to communicate with her appropriately. We took independent advice from a CPN. We found no evidence to suggest that Mrs C's discharge was related to staffing issues. Prior to the CPN's absence, she had a clear care plan in place and was being seen around every two weeks. One of the aims of the plan was to explore a possible alternative diagnosis of BPD. There was also recorded agreement that any future discharge would be clearly planned in advance and communicated, to ensure that this happened in a supportive manner. We considered that the overall decison to discharge Mrs C was reasonable. However, the adviser explained that, under Scottish Government guidance, the board should have implemented an Integrated Care Pathway (ICP) which would define the care and support offered to people with personality disorders. We noted that it did not appear that the board had an ICP in place for BPD. We also found that there was a lack of continuity in the support provided to Mrs  C once her CPN was absent. Prior to discharge, Mrs C had been without support for around four months, despite her care plan stipulating that she woul

Mr C complained that the practice had failed to provide appropriate care and treatment to his daughter (Miss A). He said that the practice had failed to provide Miss A with an emergency appointment when a phone call was made to them one morning advising them that Miss A was showing symptoms of severe mental health issues, including self-harm and suicidal thoughts. The practice said that they were unable to see Miss A until later in the evening and gave advice that Miss A should attend the local accident and emergency department. Miss A was taken to the hospital and subsequently was transferred to another hospital for patients with mental health issues. Mr C believed that the practice should have made arrangements to see Miss A as an emergency that morning rather than her having to wait a number of hours at the hospital for an assessment. Mr C also complained about a previous consultation Miss A had with a GP at the practice where she was complaining about depression. Mr C said Miss A was not given any medication, but advised to make another appointment and to bring her mother with her and that a discussion would take place then about medication. Mr C felt that, as Miss C was of adult age, she did not require her mother to be there. We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. We found that the practice gave appropriate advice that Miss A should attend the nearest accident and emergency department as this way she was seen quicker than had she waited for the first available practice consultation slot later that day. We also concluded that a reasonable clinical assessment had been carried out at a previous GP consultation where the GP had taken an appropriate history and gave Miss A reasonable advice. Miss A had mentioned to the GP that her mother may not agree with the GP's proposed treatment plan and it was decided that she should make a review appointment af

Mr C complained on behalf of his late wife (Mrs A) who was diagnosed with cholangiocarcinoma (CCA, a very rare cancer of the bile duct) at Ninewells Hospital. Mr C was concerned that there had been a delay in providing the diagnosis and that, had appropriate tests and investigations been carried out sooner, Mrs A's death may have been avoided. Mr C was also concerned that after diagnosis, the board failed to make further more timely investigations about the spread of the disease (particularly to her bones) for which treatment may have been available. Mr C complained to the board who told him that Mrs A's illness had been life limiting but that throughout her illness, her treatment had been reasonable and appropriate. Mr C was unhappy with this response and brought his complaint to us. We took independent advice from a consultant oncologist (a doctor who specialises in cancer treatment). We found that Mrs A's illness was very rare and diagnosis was not obvious; it was often an unexpected finding on a scan. Mrs A had stomach problems a few years before her cancer diagnosis, for which she received appropriate tests and at that time there was no evidence that she had cancer. Mrs A had no further stomach problems for two years until she was sent to hospital for a scan and it was at this time that she was diagnosed with CCA. We found that there had been no delay in diagnosis. After her diagnosis, Mrs A was given palliative chemotherapy (cancer treatment that is not designed to cure the disease, but rather prolong life and minimise symptoms) and responded well. Her symptoms were managed as it was not possible to operate, however, Mrs A was later admitted to hospital as she had become jaundiced (where the skin and/or eyes become yellow in colour). Her disease had progressed and was later found in her bones but we did not find that there had been any missed opportunities for treatment that would have changed Mrs A's outcome. We found that her care and treatment h

Mr C complained on behalf of his late wife (Mrs A) about the care and treatment she received from her GP practice. Mrs A attended the practice with stomach pains but it was not until two years after her pain began that she was diagnosed with cholangiocarcinoma (CCA, a very rare cancer of the bileduct). Mr C complained that the practice had delayed in carrying out appropriate tests and investigations. The practice said that Mrs A had been treated and cared for reasonably. They explained the rarity of her illness and said that that her symptoms had not been specific for a diagnosis of CCA. Mr C was unhappy with this response and brought his complaint to us. We took independent advice from a GP. We found that, as well as Mrs A's illness being extremely rare, it was also very difficult to diagnose at an early stage and was often found incidentally. Mrs A initially attended the practice with abdominal pain for which she was appropriately treated. There was no indication at that time for further investigations and Mrs A noted an improvement. She did not return to the practice with abdominal pain until two years later. At this time, all her liver tests were normal; and showed no cause for concern. However, as her symptoms worsened, she was admitted to hospital and was diagnosed with CCA. We found that the care and treatment Mrs A received from the practice was reasonable and, therefore, we did not uphold this complaint. Related reading View Decision Report 201703356 as a PDF (11.29 KB) Updated: December 2, 2018

Miss C complained that the board unreasonably refused to perform liposuction (a  cosmetic procedure used to remove unwanted body fat) for her lipoedema (a  chronic fat tissue disorder in which fat cells build up, typically on the thighs, buttocks and lower legs, which causes tissue enlargement, swelling and pain. This tissue cannot be lost through weight loss). The board had criteria in place for providing this procedure and Miss C did not meet the criteria. Miss C complained that the criteria were unreasonable. We took independent advice from a plastic surgeon. We found that it was reasonable for the board to have criteria in place for providing liposuction for lipoedema, and that the criteria was appropriate in order to balance the benefits and potential risks of the procedure. We did not uphold Miss C's complaint. Related reading View Decision Report 201706572 as a PDF (10.96 KB) Updated: December 2, 2018

Mrs C complained about the care provided to her mother (Mrs A) by the practice. In particular, Mrs C complained that the practice unreasonably failed to re-start Mrs A's diuretic medication (medication that can help reduce fluid build-up in the body which occurs when the heart is not functioning properly) which had been stopped in hospital. Mrs C felt that this resulted in a deterioration of Mrs A's longstanding heart condition. Mrs C complained that the practice unreasonably failed to liaise with Mrs A's cardiologist in this regard. Mrs C also raised concerns about the decision to commence Mrs A on anti-depressant medication. Mrs A was subsequently reviewed by a consultant geriatrician (a doctor who specialises in the medicine of the elderly) who restarted the diuretic medication and stopped the anti-depressants. We took independent medical advice from a GP. We found that there was no evidence that Mrs A's diuretic medication should have been restarted earlier, or that the practice missed any significant signs of deteriorating heart failure. We also took independent advice from a consultant geriatrician on the timescale for restarting this medication. They explained that restarting diuretic medication is difficult to balance as restarting too soon can worsen dehydration, but leaving it too late can worsen the heart condition. The adviser considered that Mrs A's diuretic was restarted within a reasonable timeframe. We also found that an earlier cardiology review was not indicated, and that there was not a failure by the practice to liaise with Mrs A's cardiologist. As such, we did not uphold these aspects of Mrs C's complaint. In terms of the decision to prescribe anti-depressants, we found that Mrs A had indicated that she was feeling low and anxious and that, as such, the prescription was not unreasonable. We did not uphold this aspect of the complaint. However, the GP adviser said that the medical records kept by the practice were sparse in detail an

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mrs B) about the communication with Mrs B's husband (Mr A). Mr A suffered some stroke like symptoms and his GP referred him to the hospital for a scan to check if he had had a stroke or transient ischaemic attack (TIA or 'mini-stroke'). A doctor discussed the results of the scan with Mr A in an appointment at the TIA clinic, about two weeks after his initial symptoms. It was recorded that Mr A was at risk of a further stroke, and the doctor recommended that he take medication to reduce this. Mr A suffered a further stroke some months after this, and later died. Mrs B said that Mr A never told her about the results of the scan, and she queried whether he had fully understood this, given he was suffering from confusion. Mrs B felt it was unreasonable for the doctor to share this information with Mr A at an appointment he attended alone, and not with her. We took independent advice from a consultant in general medicine and medicine for the elderly. We found that Mr A's confusion was temporary and that there was nothing in the records to suggest he was not able to understand the information given or that he needed support during the appointment. We did not uphold Mrs C's complaint. We noted that the board had said that they had learned from the complaint and that they were changing the appointment letters for this clinic to suggest that patients may wish to bring someone with them. Related reading View Decision Report 201703145 as a PDF (11.32 KB) Updated: December 2, 2018

Ms C complained that the board unreasonably failed to identify her hip fracture. Following a referral to Ninewells hospital, Ms C was reviewed by a consultant orthopaedic and trauma surgeon who considered that she had strained a ligament in her knee. She was then referred for physiotherapy for mobilisation and rehabilitation. Ms C was reviewed over the following months and developed progressively worsening pain. A subsequent x-ray identified a hip fracture. We took independent advice from a consultant orthopaedic surgeon and a physiotherapist. Ms C noted that no x-ray was performed at the consultation with the surgeon. The board said that an appropriate examination was carried out, and that this examination gave no indication that an x-ray was required. The orthopaedic surgeon adviser said that the examination was not recorded in sufficient detail in Ms C's medical record, and that it provided inadequate evidence that a hip fracture was excluded. Ms C also raised concern about the subsequent physiotherapy appointments. The physiotherapist adviser considered that, throughout the physiotherapy sessions, there were indications that the initial diagnosis of ligament strain of the knee may have been incorrect. We found that there was a failure to re-evaluate the situation in light of Ms C's increasing pain and deteriorating mobility. We considered that this contributed to the delay in identifying the hip fracture. Finally, we found that there was failings in recording of assessments and pain scores during these appointments. However, we noted that the board had acknowledged this failing and had taken steps to address this. Overall, we found that the board unreasonably failed to identify Ms C's hip fracture and upheld the complaint.

Mr C complained about the care and treatment his late father (Mr A) received at Perth Royal Infirmary (hospital 1). Mr A was suffering from a chest infection and was also experiencing periods of delirium. Mr A was discharged from hospital 1 to a community hospital (hospital 2) in another health board area, but they refused to admit him due to his condition and he was transferred by ambulance to another hospital (hospital 3). Mr A was later admitted to hospital 2, where he died a short time later. Mr C complained that the decision to discharge Mr A from hospital 1 was unreasonable and that there was an unreasonable delay in replacing his hearing aids which were lost during his admission. Mr C raised concerns that hospital 1 had treated Mr A for a chest infection, and hospital 2 also identified a chest infection. Mr C therefore considered that Mr A was discharged from hospital 1 with an unresolved infection and he questioned whether this was appropriate. We took independent medical advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that Mr A's observations were stable leading up to his discharge from hospital 1. We did not consider that there was any evidence to suggest Mr A was not fit for discharge. We noted that Mr A quickly developed a further infection but we did not consider that this was identifiable, or could reasonably have been predicted, at the time of discharge. Therefore, we did not uphold this aspect of Mr C's complaint. However, the adviser noted that there was no evidence of medical staff having formally assessed Mr A's delirium using a recognised screening tool and we therefore, made a recommendation regarding this. In relation to the hearing aids, the board apologised to Mr C for the loss of these. In responding to our enquiries, they offered a fuller explanation of the steps followed in replacing them. We found that the timescale described for replacing the hearing aids was typical for