Not upheld, no recommendations

Summary

Ms C attended a dermatology clinic and a podiatry clinic before she was diagnosed with Hodgkin lymphoma (an uncommon cancer that develops in the network of vessels and glands spread throughout the body). Ms C considered that she had displayed symptoms that should have brought about an earlier diagnosis and complained that the board had delayed in making a diagnosis.

We took independent medical advice. We found that Ms C's medical records did not suggest that dermatologists had missed symptoms of lymphoma. We also found that a podiatrist would not be expected to recognise these symptoms. In view of this, we did not uphold Ms C's complaint.

Summary

Mrs C complained that when she phoned the medical practice for an appointment, she was given neither an appointment nor a phone consultation.

We looked at the practice's records and took independent advice from a GP adviser. As there was no audio recording of the phone calls, we could not determine what was said. There was no evidence that Mrs C was not taken seriously when she was unwell, and we found that she saw a GP the day after she phoned the practice. We did not find that practice staff failed to respond to Mrs C's request for a medical consultation in a reasonable manner and therefore we did not uphold Mrs C's complaint.

Summary

Mr C complained about the treatment he received from his GP practice after a fall in which he sustained a head and neck injury. He thought the practice should have referred him to A&E.

We found the treatment Mr C received was reasonable. He attended the practice without an appointment and was seen by a triage nurse who assessed his injury. He was advised to take pain relief. Mr C later called the out-of-hours service and was given a pain-relieving injection and on-going pain relief. When the medication ran out he went back to the practice, was assessed, and was given more medication.

Mr C returned to the practice and told them he wanted to go to A&E. He attended A&E the same day and had an x-ray, which was clear. He was given advice about lying flat and exercise.

We found the treatment the practice provided was reasonable in the circumstances, given Mr C's presenting symptoms. Mr C's injury was assessed in the normal way by a triage nurse. No serious injury was evident. Mr C was, appropriately, advised to seek further advice should his condition deteriorate. When Mr C was assessed in A&E, no significant injury was found. We therefore did not uphold Mr C's complaint.

Summary

Mr C complained about the care and treatment provided to him by the prison health centre. He said that he was not being provided with appropriate pain relief for a number of complex medical problems and his complaints about these issues had not been properly investigated. Mr C said that the GP he saw in prison changed his prescription from that provided to him in the community. Mr C said his mobility and balance had been severely affected.

We took independent medical advice on Mr C's prescriptions. The adviser said that Mr C was properly reviewed and the changes to his prescriptions were in line with national guidance on the management of chronic pain and the prescribing of pain relief within a prison setting. Mr C had been reviewed and his medication discussed with him. The adviser did not find evidence that Mr C had been significantly affected in the ways he described by the changes to his medication.

Our investigation found that Mr C's complaints were responded to promptly and addressed the issues he raised. There was no evidence that complaint procedures were not properly followed.

Summary

Mrs C complained that GPs at the medical practice failed to diagnose cholesteatoma (an uncommon abnormal collection of skin cells inside the ear). Mrs C felt the practice had failed to do this over a number of years.

We took independent advice from a GP adviser. We found there was no evidence that Mrs C's consultations with GPs several years ago were linked to her recent consultations in terms of cholesteatoma diagnosis. We also found that the practice's management of Mrs C's case was reasonable during all consultations, and when they noted that her symptoms were not settling they arranged an urgent review with a hospital specialist. There was no evidence of a delay in the referral and we concluded that the care provided to Mrs C was to a reasonable standard given the circumstances at the time. Therefore we did not uphold Mrs C's complaint.

Summary

Mrs C's father (Mr A) was treated with radiotherapy for cancer of the tongue. In the 18 months following his treatment, Mr A received ongoing support from community dieticians and speech and language therapy (SALT), and regular reviews at a joint cancer clinic. During this period, Mr A had increasing difficulty swallowing and suffered from recurrent mouth ulcers and pain. He also had several short hospital admissions with bleeding from the mouth. In June 2014 Mr A was referred back to hospital with weight loss, decreased ability to swallow and stridor (noisy breathing caused by a narrowed or obstructed airway). He underwent endo-tracheal intubation (insertion of a tube to maintain an open airway to the lungs) and was transferred to a different hospital. Mr A passed away about ten days later.

Mrs C complained about the care provided by the practice during this period. She said Mr A's family constantly raised concerns about his weight loss, increasing pain and frailty, but these were not listened to. She said the practice often phoned Mr A (instead of arranging face-to-face appointments) and did not adequately monitor his weight loss and malnutrition. Mrs C was also concerned that the practice did not provide adequate care for Mr A's emotional wellbeing or diagnose him with depression. In addition, Mrs C said the practice refused to refer Mr A back to hospital in late May 2014, and the admission was only arranged when her sister called the specialist nurse directly a few days later.

After taking independent advice from a GP, we did not uphold Mrs C's complaints. We found that the practice provided reasonable care during this period, including responding to Mr A's symptoms (and the adviser noted that many of Mr A's symptoms related to his recent cancer treatment, for which he was receiving specialist care). In relation to emotional support, the adviser said the records did not show any symptoms that should have prompted a diagnosis of clinical depression, and they explained that information on support for cancer patients is normally provided by the hospital (so this is not a specific role for the GP). In relation to Mr A's final hospital admission, we found the practice had arranged appropriate assessments for Mr A and had already begun making arrangements for admission before his daughter called the specialist nurse about this.

When it was originally published on 15 February 2017, this case referred to a dentist in the Ayrshire and Arran NHS Board area. This was incorrect, and should have read a dentist in the Greater Glasgow and Clyde NHS Board area. This was due to an administrative error which we have now corrected, and we apologise for any inconvenience that this has caused.

Summary

Ms C complained about the dental care and treatment she received during a course of treatment for a root canal. She complained that at one appointment, the local anaesthetic injection had resulted in her lower lip becoming tingly for several months, and that it then went completely numb. She also complained that she had not been told of the potential risks of local anaesthetic injections.

During our investigation, we took independent advice from a dental practitioner. We found that whilst altered sensation is a rare complication of a local anaesthetic injection, it does not suggest any failing on the part of the dentist. We also found that there is no requirement for dental practitioners to discuss potential risks of local anaesthetic injections with patients. Therefore, we did not uphold Ms C's complaints.

Summary

Mr C complained to us that his GP had not provided him with appropriate medication in view of his symptoms and medical history. Mr C had on-going high blood pressure and this was complicated by low sodium levels. He felt that the medications his GP had prescribed him were the cause of him being hospitalised due to low sodium and dehydration.

We took independent medical advice and found that whilst it had been difficult to balance Mr C's blood pressure and sodium levels, his GP had prescribed him appropriate mediation. We found that when he was hospitalised, he was suffering from a very rare side effect of one of his medications. The adviser said that they would not have expected Mr C's GP to have been alert to the possibility of this side effect. We found that there was one occasion on which Mr C's GP could have given Mr C a blood test and failed to. However, we noted that the practice had already apologised for this. Therefore, we did not uphold Mr C's complaint.

Summary

Mr C complained that the opening balance for his account when he transferred his custom to Cobalt Water Ltd for the provision of water services was incorrect. He said that the bill based on this balance was also incorrect and it was unreasonable that he was being pursued for payment. Cobalt Water Ltd maintained that the transfer reading was in line with Mr C's usage with his previous provider and that his bill was correct. While Mr C's meter subsequently recorded large amounts of water being used, no water leak had been discovered although it was noted that some of Mr C's taps and sanitaryware could allow water to continue to run unnecessarily.

We investigated the complaint and we found evidence to show that Mr C's transfer reading was in line with his previous usage. Photographic evidence was also available of his subsequent usage and his water usage had continued to climb. It was unclear whether Mr C had taken action to investigate his own equipment. We did not uphold the complaint.

Summary

Mr C complained that Business Stream had given an incorrect closing balance when he transferred to another water provider and were unreasonably pursuing him for the bill calculated. However, Business Stream said that his closing bill had been calculated appropriately and had been based on his final reading.

The complaint was investigated and we found that, in accordance with Business Stream's policy, they were required to be provided with a transfer reading by the customer's new licensed provider. This was to prevent the customer being charged twice for the same period, and Mr C's new provider had provided the reading. No evidence was provided to suggest that this figure was incorrect and it was found to be in line with a previous year's meter reading. While Mr C also complained about what he described as a four-month spike in water usage, he was by then no longer a Business Stream customer. Accordingly, we did not uphold Mr C's complaint.