Not upheld, no recommendations

Summary

Mrs C complained to the board about the care and treatment provided to her mother (Mrs A) by her GP practice. In particular, Mrs C felt that the practice failed to arrange appropriate investigations in view of the symptoms Mrs A presented with.

Mrs A attended the practice on a number of occasions over a two year period, and presented with symptoms including abdominal pain, vomiting and weight loss. After Mrs A's condition did not improve following an out-of-hours GP assessment, she was admitted to hospital. Several tests were performed during this admission and further tests were carried out in the months following discharge. Following these investigations, Mrs A was diagnosed with gastric cancer and she died a number of months following this diagnosis.

In response to our enquiries, the board provided a copy of a review that they had undertaken. Within the review, the board noted that Mrs A had complained of a number of symptoms, yet on each occasion Mrs A's symptoms could have been explained by non-cancer related causes. The board also noted that Mrs A's weight was relatively stable and various blood tests did not suggest anything sinister, with no evidence of anaemia or other worrying findings. The board concluded that the recorded symptoms did not suggest that a referral for gastroenterology investigation was indicated in accordance with local protocols.

We took independent advice on the case from a GP adviser. Having reviewed the records, the adviser did not consider that the practice had failed to take appropriate action in view of Mrs A's symptoms, and did not find that Mrs A's symptoms should have alerted the practice to a likely diagnosis of gastric cancer. The adviser concluded that the practice provided Mrs A with reasonable care. We accepted the adviser's comments, and for this reason we did not uphold this complaint.

Summary

Mr C complained about delays and communication in relation to his wife (Mrs A)'s hip-replacement surgery at Ninewells Hospital.

After taking independent advice from a consultant orthopaedic surgeon, we did not uphold Mr C's complaints. The advice we received was that while Mrs A's patient journey had been a long one, there were no unreasonable delays in her orthopaedic treatment. After reviewing all the available evidence, no issues were found with the standard of communication.

Summary

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his son (Mr A). He said that a GP had prescribed oxycodone (opiate medication) over the phone to Mr A on the morning that he died from a medication overdose. Mr C was also concerned that there had been an entry in Mr A's clinical records from his previous GP surgery noting that Mr A was not to be prescribed opiates.

The practice said that practitioners are aware of the need to balance the potential benefits of a drug against any possible harm. The practice were aware of the previous GP surgery concerns that Mr A used illicit drugs and that care should be taken about the strength of any opiates prescribed. Mr A had recently undergone significant surgery and he reported that his pain control was ineffective. It was also noted that Mr A was attending orthopaedics and the pain clinic.

We took independent medical advice from a GP who noted that Mr A had been referred to orthopaedics and the pain clinic and that he was regularly reviewed in either face-to-face consultations or phone contact. When required, his pain relief was increased and this was considered reasonable care. The adviser had no concerns about the actions of the GP who prescribed the oxycodone, as they had taken note of the previous GP practice's concerns about drug misuse and made a reasonable clinical judgement based on the recorded evidence available. We did not uphold the complaint.

While we did not uphold the complaint, we noted that the practice and the previous GP practice operated different electronic record recording systems and that there was a failure of the first practice to transfer all relevant information over when Mr A joined the new practice. We made a suggestion to both practices which may have allowed more clarity, although it may not have altered the GP's decision to prescribe the oxycodone.

Summary

Mr C complained about the board's decision not to offer him surgical treatment for his condition. The board said that the decision to proceed with surgery was subject to the Adult Exceptional Aesthetic Referral Protocol, which details the limited criteria in which surgery can be provided for a range of conditions. The board said that because Mr C did not meet criteria within this protocol, he did not qualify for surgery for his condition.

We found that Mr C was assessed by a plastic surgery registrar and a clinical psychologist before a multi-disciplinary team made a decision on whether Mr C met the criteria. We took independent advice from a consultant plastic and reconstructive surgeon and a consultant psychiatrist. Based on the advice we received, we concluded that the assessments carried out prior to the decision-making were reasonable. Although we found that the board had not undertaken the assessments in the order specified within the protocol, the advisers did not consider that this would have prejudiced the subsequent decision of the multi-disciplinary team. We concluded that the board's decision not to offer Mr C surgery was reasonable, and for this reason we did not uphold this complaint.

Summary

Mr C complained about the orthopaedic treatment he had received from the board. In particular, he complained that he had undergone a number of operations on his shoulder and had contracted an infection.

We took independent advice from a consultant orthopaedic surgeon. The advice we received was that the orthopaedic treatment Mr C received was reasonable and that, while his care pathway had resulted in a poor outcome for him, there was nothing the board could have done differently to achieve a better outcome for him. The advice we also received was that there was no way of knowing when the persistent infection Mr C contracted had developed. In the circumstances we did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to him at the diabetes clinic at the New Victoria Hospital. Mr C complained that when he was experiencing severe problems with his diabetes there were delays in him being given appointments, and that he was often given phone reviews instead of face-to-face appointments.

During our investigation we took independent advice from a diabetes nurse specialist. We found that Mr C had been reasonably assessed and offered appointments or phone reviews as appropriate. We found that over a period of six weeks he had eight phone reviews and two face-to-face appointments and we found that the advice and treatment given at each of these was reasonable. Therefore, we did not uphold these aspects of Mr C's complaint.

Mr C also complained about the phone service at the diabetes clinic. He said that often when he called he could not reach anybody to speak to and instead reached an answering service. We found that it was reasonable for the diabetes clinic to have an answering service as it was often the case that the nurses were unable to answer incoming calls as they were reviewing other patients. We did not uphold this aspect of Mr C's complaint.

Summary

Mr C complained that his wife (Mrs A) underwent a number of surgical procedures for an anal fistula (an abnormal opening in the anus). He said that the procedures may have been unnecessary had staff at Inverclyde Royal Hospital identified that her high dose of Nicorandil (a medication used to treat angina) may have been the likely cause.

In responding to the complaint, the board acknowledged the possibility of a link between the Nicorandil and anal fistula, but said the only way to check was by stopping the medication to see if there were any improvements.

We took independent medical advice from a consultant colorectal surgeon. We found that although Nicorandil is known to cause mouth and rectal ulcerations when prescribed in higher doses, its association with anal fistula is much less clear. Therefore, given Mrs A did not present with ulceration, we considered it was reasonable that the surgeons involved in her care did not make the association between the anal fistula and Nicorandil. We concluded it was only with hindsight that the Nicorandil should have been stopped sooner.

Summary

Ms C complained about the care and treatment that her father-in-law (Mr A) received when he attended at the board's out-of-hours service at the Royal Alexandra Hospital. Mr A had been suffering from worsening symptoms of a cough and cold. He was examined and diagnosed with a viral illness, considered likely to be flu. Mr A was given advice on what to do if his condition worsened. Later that day, he was admitted to hospital. Mr A died the following day as a result of multiple organ failure due to sepsis (blood infection). Ms C complained about the out-of-hours examination as she felt that Mr A was clearly very ill and further action should have been taken at that time.

After taking independent medical advice, we did not uphold Ms C's complaint. The advice we received was that the examination was reasonable with appropriate advice and treatment being provided on the basis of the findings. The adviser explained that Mr A had not shown any signs of sepsis at the time of the examination and that his condition was significantly different when he was later admitted to hospital. The adviser highlighted that sepsis is a condition that can develop and deteriorate rapidly.

Summary

Mr C made regular visits to his medical practice. He was concerned about symptoms of facial flushing and rash (for which he was seeing a dermatologist at a hospital). After six months, a blood test confirmed that Mr C had diabetes. Mr C complained that the practice failed unreasonably to recognise or suspect that he had diabetes given his symptoms.

We took independent medical advice. We found that had the GPs been made aware that Mr C had symptoms including constant thirst and urination, they should have checked the levels of his blood sugar earlier. However, these symptoms were not noted in Mr C's clinical records. The evidence from the clinical records indicated that the GPs had been made aware of symptoms in relation to Mr C's facial flushing and rash and that it was reasonable they did not consider that diabetes could have been the underlying cause of this. We were therefore satisfied the standard of care and treatment provided was reasonable and did not uphold Mr C's complaint.

Summary

Ms C complained about care and treatment her mother (Mrs A) received from her medical practice. Ms C was concerned that the practice missed opportunities to enable an earlier diagnosis of lung cancer. She felt that an earlier diagnosis could have helped prevent Mrs A's death. Ms C also raised concern about the way in which a GP handled a conversation about possible future resuscitation.

We took independent medical advice from a GP. We found that the practice had provided a reasonable standard of care in response to the various symptoms Mrs A had presented with in the year leading up to her cancer diagnosis. We did not identify any clear evidence to show that the conversation about resuscitation was handled inappropriately, and considered that it was reasonable to have this conversation with Ms C and Mrs A. The practice reflected on Ms C's concerns in any case and took steps to improve the way in which their staff deal with such conversations with patients and their families. We did not uphold Ms C's complaints.