A hospital which claimed a man with terminal cancer who could not speak phoned them to cancel an examination and a locum GP who withdrew continuous pain relief from a dying man have been criticised by an ombudsman.
Two women who faced unacceptable delays in receiving cancer diagnoses, including one whose operable cancer grew inoperable in the delay, have also had their complaints upheld by the Scottish Public Services Ombudsman (SPSO).
A man was having bowel problems and his GP referred him urgently to Hairmyres Hospital, in East Kilbride, South Lanarkshire.
When, four months later, he had not received an appointment, the GP referred him again.
He had a bowel examination some seven weeks after the second referral, and a further examination a month after that identified advanced bowel cancer. He died six months later.
The SPSO said: "The board at first told (his wife) that the reason her husband was not seen sooner was because he made an appointment but phoned them and cancelled it. They said they had then removed him from the waiting list as he did not ask for another date.
"She told them, however, that he had never received a letter and could not have called as he had had a stroke and would not have been able to speak to them by phone.
"My investigation found that the board could not provide any evidence to show what had happened, and they acknowledged that they had got this wrong. They also failed to tell his GP that he had been removed from the waiting list.
"Although my medical adviser said that the delay was unlikely to have affected the outcome for (the man), I upheld this complaint."
Another man with terminal mesothelioma, cancer affecting the lining of the lung, was prescribed a syringe driver, a device that continuously supplies pain relief, by an out of hours GP.
However, the following morning a locum GP from their practice in Greater Glasgow overturned this decision and said he must continue with his existing pain relief.
The SPSO said: "I took independent advice on this complaint from my GP adviser, who said that the actions taken by the out of hours doctor to relieve (the man's) symptoms were excellent, and in keeping with the wishes of (the man and his wife).
"In contrast, the locum decided to put (the man) back on his original pain relief medication without ever seeing him. My adviser took the view that this decision was taken with insufficient information.
He added: "My adviser said that the locum showed a lack of empathy for (the man) and his family."
A woman diagnosed with liver cancer was referred to NHS Lothian for surgery, waited two weeks for a consultation, a further month for analysis of scan results, was referred to an anaesthetist nine days later and waited another week to see the anaesthetist, who scheduled surgery five weeks later.
The SPSO said: "A further scan immediately before surgery, however, showed that the cancer had developed and surgery was no longer possible.
"(The woman) complained about this to the board and then to me, but died before I completed my investigation."
He added: "While it is not possible to say whether the outcome would have been different, I found that there were unacceptable delays that caused (the woman) and her family significant distress."
A woman who had had cancer twice and found lumps in her groin had to wait four months for a biopsy to confirm it was cancer again.
The SPSO said: "(The woman) saw at least six doctors during the period concerned, and my adviser said that there was effectively a lack of ownership of her care and that doctors failed to recognise the severity and urgency of her situation.
"He did, however, also say that although (the woman) waited too long for a biopsy, he did not think that
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