Not upheld, no recommendations

Summary

Miss C's late father (Mr A) had been admitted to Hairmyres Hospital with a suspected mini-stroke and it was decided that he required vascular surgery. However, the vascular surgery was not carried out during that admission of four days, and arrangements were made for him to return to hospital two weeks later. The re-admission date was extended by a further week due to a medical emergency concerning another patient. Mr A suffered a major stroke the day before the planned re-admission date and died before the vascular surgery could be performed. Miss C complained that there was an unreasonable delay in arranging vascular surgery for her father.

We took independent advice from an adviser in vascular surgery. We found that during the initial admission Mr A was not fit for surgery, due to his other health conditions, and that it was appropriate to postpone the vascular surgery for two weeks. When the planned surgery had to be postponed for a further week for another patient who had clinical priority, we found it was appropriate at that time to postpone it. We did not find any evidence of avoidable delays in scheduling Mr A's surgery, and as such we did not uphold the complaint.

Summary

Mr and Mrs C complained about the care and treatment the practice provided to their late son (Mr A).

Mr A had a background of autism and other additional needs. He attended the practice with problems including diarrhoea, sickness and weight loss. The practice initially considered Mr A’s bowel upset was caused by antibiotics. After approximately three months, the practice referred Mr A to gastroenterology for investigations. However, his background health problems made these investigations difficult. Mr A’s condition continued to deteriorate and he was taken into hospital approximately four months later. Mr A was diagnosed with Crohn’s disease (a long-term condition that causes inflammation of the lining of the digestive system), and died despite surgical management.

Mr and Mrs C complained that the practice failed to provide Mr A with appropriate clinical treatment. They said his condition deteriorated considerably, and that his family and carers specifically raised concerns that he was suffering from Crohn’s disease. They also raised concerns that the practice did not appropriately take into account Mr A’s additional needs. Mr and Mrs C also complained that the practice unreasonably delayed in referring Mr A for a gastroenterology opinion.

Summary

Mrs C complained about the practice after she required a CT scan to be diagnosed with pneumonia. She told us that she felt an earlier diagnosis should have been possible, based on her medical history and presenting symptoms.

We took independent advice from a GP adviser. We found that the practice did not fail to identify any signs or symptoms that would have led a GP to reach a diagnosis of pneumonia. The adviser considered that the practice carried out reasonable examinations and, when these failed to provide a diagnosis, took prompt and reasonable steps to arrange appropriate tests to investigate further. This involved arranging for an x-ray and then a CT scan, which provided the eventual diagnosis. For these reasons, we did not uphold the complaint.

Summary

Miss C complained to us that the medical practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that she had alcohol issues. She said that she had to surrender her driving licence for a period and that she had suffered financially as a result. The practice explained that they had acted in accordance with their policy about advising patients to inform DVLA about alcohol problems and the circumstances where the practice could contact DVLA themselves.

We took independent advice from an a GP adviser and concluded that the practice policy in force was reasonable and that the practice were entitled to notify DVLA in this instance. We did not uphold the complaint.

Summary

Mrs C complained that her late mother (Mrs A)'s medical practice did not take urgent action and advise Mrs A to attend hospital after she reported symptoms related to deep vein thrombosis (DVT, a blood clot). Mrs A collapsed at the entrance of the main health centre at the practice and was taken to hospital. She died shortly after of a pulmonary embolus (a blockage of an artery in the lungs), which is a side effect of DVT. Mrs C was also unhappy that the medical practice had not told her about the incident.

We took independent medical advice and found that the practice acted reasonably in advising Mrs A to attend the practice for assessment rather than going immediately to her local emergency department. We considered that the practice provided a timely appointment for Mrs A to be reviewed. In addition, we considered it was reasonable that practice staff had not contacted Mrs C regarding the incident because Mrs A had collapsed outwith the premises of the medical practice and staff there were unaware of what had happened. In view of these findings, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late father (Mr A) by his medical practice. Mr A suffered from advanced dementia and was cared for at home by his daughters. Mrs C was concerned that a GP from the practice prescribed Mr A pain relief without consulting his welfare power of attorney (Mrs C’s sister), even though they had agreed to consult her on any medication decisions. Mrs C also felt the medication prescribed resulted in Mr A being over-sedated and contributed to his deterioration in health.

The practice acknowledged that the GP had prescribed some medication without consulting the welfare power of attorney. The GP apologised for this and the practice said that the GP had reflected on the case and had undertaken reading on the Adult with Incapacity (Scotland) Act. The practice said the GP understood that the role of the welfare power of attorney is to act in the best interests of the patient and that they can consent to or decline any treatment, and must be involved in decisions. However, the practice considered the medication prescribed was appropriate.

After taking independent medical advice, we did not uphold Mrs C’s complaints. We found that the medications prescribed by the GP were reasonable and the effects of the medication were appropriately monitored with regular visits and feedback from carers and district nurses. In relation to the GP’s failure to consult the welfare power of attorney, we noted that the GP had apologised for this and had taken appropriate steps to improve.

Summary

Mrs C complained that, at an emergency dental appointment, the dentist did not communicate adequately with her. Mrs C said that the dentist told her that previous treatment carried out had not been done correctly and that corrective work would be required. Mrs C said that no explanation was given to her of the work required or costs.

We took independent dental advice. The adviser said that the dental records showed that the dentist was unhappy with the previous work carried out on Mrs C's teeth, but that it was not clear whether these concerns were communicated to Mrs C. We found that the records showed that the dentist communicated to Mrs C that the appointment in question was only to deal with the pain she was suffering from at that point and not to decide on future treatment. Whilst we considered the dental records could have been clearer in showing what was communicated to Mrs C, we were satisfied that the dentist adequately explained that the emergency appointment was only to treat the tooth that was causing pain, and not to create a treatment plan for the future. We did not uphold Mrs C's complaint.

Summary

Mrs C was diagnosed with jak2+VE primary polycythaemia (a cancer where the bone marrow makes an excess of red blood cells). Mrs C complained that staff at Beatson Cancer Centre failed to take appropriate action to establish the cause of abnormal blood tests, and that if they had taken action, a diagnosis could have been made earlier.

We obtained independent advice from a clinical adviser who noted that, in the year prior to Mrs C's diagnosis, a doctor at the oncology clinic at Beatson Cancer Centre had ordered a full blood count inadvertently, which was not part of the usual practice from an oncology perspective. The full blood result revealed a high haemoglobin level and, according to the relevant guidance, further action should have been considered to determine the cause of the high haemoglobin level. However, as the oncology doctor was unaware that a full blood count had been ordered, there was no reason for the doctor to establish the result of the full blood test. It was noted that Mrs C already had a long previous medical history of high haemoglobin levels, which the clinicians were aware of, and she was not displaying symptoms of polycythaemia when she attended for clinical review in the year prior to her diagnosis. We found that Mrs C's high haemoglobin level at that time was of minimal clinical significance and Mrs C did not appear to have suffered any complications as a result.

We also reviewed the process where, in addition to the electronic reporting of the abnormal result, the laboratory would phone the clinician to highlight the abnormal result. We found that the criteria was not met in Mrs C's case, and that, according to the standard operating procedure, a phone call to alert the clinician was not required in this case. As such, we found that there had not been a failure in the reporting process. We did not uphold the complaint.

Summary

Mr C complained that his GP practice failed to provide him with a GP appointment and a medical certificate for sickness absence. Mr C said he could not get a same day appointment when he phoned the practice in the mornings. We found there were other means of getting an appointment, such as booking online or booking an appointment for later in the same week. An audit of the practice’s appointment records showed there were appointments available in the week Mr C phoned the practice. We took independent advice from a GP adviser, and in their view the practice’s appointment system was reasonable.

Mr C said because he could not get an appointment he could not get a medical certificate and, when he spoke to a GP by phone, the GP refused to issue a certificate. We found that the GP asked Mr C to make an appointment for review, given that his circumstances had changed. In the adviser’s view, the GP acted in line with the General Medical Council's guidance, and the care provided to Mr C was of a reasonable standard. We did not uphold Mr C’s complaints.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A). Mr A had experienced symptoms of pain and numbness in his left foot. After he attended a number of consultations in the board's podiatry and orthopaedic services, he underwent surgery at Gartnavel General Hospital to fuse one of the joints in a toe. Following the operation, Mr A continued to experience pain and numbness and he attended a number of review appointments in the orthopaedic department before being discharged approximately a year after the procedure.

Ms C complained that the board did not perform appropriate orthopaedic surgery on Mr A, and said that Mr A was not informed of the possible side effects of surgery.

We took independent advice from an orthopaedic surgeon. The adviser was satisfied that Mr A was appropriately informed of the potential side effects of the procedure and that consent was obtained appropriately and in accordance with the board's consent policy. Furthermore, the adviser considered that the records indicated that the operation was carried out to a reasonable standard. In view of this advice, we did not uphold this aspect of Ms C's complaint.

Ms C also raised concern that Mr A did not receive appropriate treatment following surgery when he reported further concerns to the surgeon. We found that Mr A had attended three review appointments in the orthopaedic department following the surgery and that by the point of discharge the surgeon was satisfied that the toe joint had healed well. The adviser did not find evidence of failings in the aftercare provided to Mr A. We did not uphold this aspect of Ms C's complaint.