Not upheld, no recommendations

Summary

Ccomplained that their late parent (A) called the practice and was given a prescription without being seen in person. C also complained that an appointment or home visit wasn’t arranged when C called three days later and reported that A's condition had worsened.

We obtained independent advice from a general practitioner adviser. We found that the actions taken by the practice at the time of the initial call were reasonable and considered it reasonable for A not to have been seen in person at that time. We also considered that reasonable action was taken when C called three days later, based on what was documented in the records. However, it was acknowledged that there were differing accounts of what had been discussed, and that the symptoms C said they communicated would reasonably have prompted A to be seen in person. Based on the evidence available and the advice obtained, which we accepted, we concluded that A received reasonable medical care and we did not uphold this complaint.

However, we noted that the level of documentation could have been improved. This includes recording when safety netting advice is given (when patients are advised to return if their symptoms don’t improve, advice which the practice said was given to A during the first call but was not documented); reasons why a patient is not spoken to directly (as was the case when C called); and reasons to see or not to see a patient in person, particularly for a repeat caller. We fed this back to the practice for their reflection and learning, along with feedback on their handling of the complaint.

Summary

C complained about the care and treatment provided to their parent (A) when they were a patient at Glasgow Royal Infirmary. C raised concerns that they had to alert staff to the fact that A had become unresponsive. C complained that A was stepped down from critical care to a medicine for the elderly ward when A was still unwell and suffering from delirium. C also complained about changes made to A's death certificate, which had been amended by a consultant, following the initial certificate prepared by a junior doctor. The death certificate was updated to fully reflect A's underlying condition, including the possibility of an underlying cancer diagnosis. However, it was subsequently amended again to remove the reference to cancer in light of C's upset over this.

We obtained independent medical advice from a consultant geriatrician (a specialist in medicine of the elderly). We found that A's condition was monitored appropriately and reasonable action was taken in a timely manner when it was noted they had deteriorated. We were satisfied that the board had already acknowledged and apologised for not keeping C updated while they dealt with A's care. Therefore, we did not uphold this complaint.

In relation to the second complaint, we considered action was appropriate as A was no longer in need of critical care, and confirmed delirium would not have been a reason to delay the transfer. We, therefore, did not uphold this complaint.

With regard to the complaint about changes to A's death certificate, we were satisfied that the board had provided an appropriate explanation and apology, and had demonstrated learning. We had no concerns about the accuracy of the death certificate. However, we noted that it would have been good practice to offer a post-mortem examination in light of the clinical uncertainty, and C's concerns, surrounding a possible underlying cancer. While we fed this back to the board, on balance, we did not uphold this complaint.

Summary

C's baby (A) was born with a rare genetic disorder and died four days after their birth. C complained about the board’'s failure to identify A's condition during prenatal scans. C complained that despite A's face not being visualised in two abnormality scans, a further scan was not arranged.

We took independent advice from a consultant obstetrician and gynaecologist (a specialist in pregnancy, childbirth and the female reproductive system). We found that the board had appropriately followed national and departmental guidance in relation to the scans. We found it reasonable that A's condition was not detected during C's pregnancy. Although imaging of A's face was not possible during the second scan, we found there was no requirement to carry out a further anomaly scan or take any further action in relation to this. We therefore did not uphold this complaint.

Summary

C complained about a delay in diagnosis of cancer due to insufficient investigations undertaken by a number of GP's at the practice. C was later diagnosed with stage 4 lung cancer. C said the signs of cancer were missed, which was likely due to seeing different GP's at each consultation. In addition to this, C had a history of kidney cancer and considered their history was not adequately taken into account. C attended the practice on several occasions, reporting a number of concerns. C said that considering their history of cancer, the early signs of lung cancer were evident. It was only following a CT scan for C's kidney cancer that the oncology team found evidence of stage 4 lung cancer.

The practice agreed that some of C's symptoms during this time could explain developing cancer. However, they also considered that the symptoms reported could be caused by a wide range of diagnoses. The practice evidenced that multiple x-rays were taken along with blood tests and vital sign checks, and there was nothing to indicate that cancer was developing. Due to these findings, the practice say that they had no medical reason to request a CT scan or refer C to a specialist team. We took independent advice from a GP adviser and reviewed the relevant medical records. We found that C did not present with any symptoms suggestive of lung cancer but a variety of unrelated problems, some of which were long standing. It was noted there was a lack of red flag symptoms of lung cancer, and as such, there was no requirement for a CT scan or to be referred to a specialist team during this period.

In light of this, we found that the overall care and treatment provided to C was reasonable. We therefore did not uphold this complaint.

Summary

C complained to the board about the treatment provided to their late relative (A) who died of a ruptured bowel. A had been in University Hospital Ayr two weeks previously with symptoms of severe pain. Staff had carried out tests and a scan, and discharged A home without follow-up. C believed that the board should have carried out more intensive investigations, which may have discovered A was still having bowel problems and provided additional treatment. The board believed that appropriate treatment had been provided.

We took independent advice from a consultant in acute medicine (a specialist in the immediate and early management of adult patients with a wide range of medical conditions who present in hospital as emergencies) and a consultant radiologist (a specialist in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans). We found that staff at the hospital provided a reasonable standard of treatment based on A's reported symptoms. We also found that it was not unreasonable to discharge A home with antibiotics based on the diagnosis of pyelonephritis (kidney infection) following a CT scan. Although a subsequent CT scan carried out on readmission showed evidence of infarct (a small localised area of dead tissue resulting from failure of blood supply) which might have been evident on the original scan, it was not unreasonable to have diagnosed pyelonephritis following the original scan. We therefore did not uphold the complaint.

Summary

C is an advocate who complains on behalf of A. A has a brain injury which impacts on their daily living tasks and functioning. C complained that A received poor treatment from their GP practice and that there were delays in making referrals for specialist input following a fall down stairs which made A’s existing health conditions worse.

We took independent advice from a GP adviser. We found that A's treatment had been reasonable. We noted that A had come to the practice with a number of previous unresolved problems. We considered that A's new GPs were right to be mindful that A's neurological symptoms had already been assessed as 'functional', meaning they had no known physical cause.

C also complained about repeated prescription of antibiotics. We found that this did not seem excessive given the poor general state of A's health and that referrals for specialist input had been appropriate. Therefore, we did not uphold C's complaints.

Summary

C has Asperger's Syndrome (a form of autism, in which people may find difficulty in social relationships and in communicating) / Autistic Spectrum Disorder and a diagnosis of chronic fatigue and Functional Neurological Symptom Disorder (symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder). They were referred by their GP to neurology (specialists in the nervous system) to explore a possible neurological basis for their pain symptoms. C raised a number of concerns about this consultation. C complained that no meaningful assessment took place, that the conclusions were unreasonable and that the consultant neurologist wrongly stated a psychiatric opinion by stating that they had a complex personality disorder. C also noted that there were inaccuracies in the board's response to their complaint.

The board responded to C's individual concerns and concluded that overall, they considered the assessment was reasonable.

We reviewed the relevant medical records, evidence provided by C and took independent advice from a consultant neurologist adviser. We found that there were not any significant failings and that the assessment was of a reasonable standard, consistent with General Medical Council guidelines and that the reasons for the referral were reasonably addressed. We did not uphold the complaint.

Summary

A was admitted to A&E at the Royal Hospital for Sick Children with symptoms including retching, a purple rash on their leg and feeling agitated. A had a diagnosis of quadriplegic cerebral palsy (form of cerebral palsy in which all four limbs are affected), was non-verbal and received PEG feeding (passing a thin tube through the skin to give food, fluids and medicines directly into the stomach). A was subsequently admitted to hospital after assessment.

A was observed in hospital and underwent a number of investigations. A gastrojejunal tube (when a thin, long tube is threaded into the jejunal portion of the small intestine) was inserted to address concerns about A's nutrition. A became increasingly distressed following the procedure and their condition deteriorated. A underwent emergency surgery where a caecal volvulus (obstruction of the bowel) was diagnosed.

C complained to the board that they had missed several opportunities to diagnose and treat the bowel obstruction which was causing A's symptoms. The board produced a report detailing the history of A's care and decision making during the period. The main finding was that there were no identified failings in the care provided to A and that there was no misdiagnosis of A's condition.

Dissatisfied with the board's response to the complaint, C brought their complaint to our office. We took independent advice from a paediatric gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas) and a paediatric radiologist (a specialist in the analysis of images of the body). We found that the investigations and treatment provided were appropriate. There was a delay in obtaining a CT scan, however the delay was relatively small in the context of the period of A's admission. As such, we found that the care and treatment provided to A was reasonable and we did not uphold the complaint.

There were some aspects of care which we identified as being suitable to feedback to the board for reflection and consideration.

Summary

C complained to the practice about a failure of their GP to offer them a face to face consultation when they reported being concerned about a breast lump. C was given a telephone consultation only. C was not seen for a further three months and when they attended the breast clinic, C was diagnosed with breast cancer.

We took independent advice from a GP. We found that the GP had acted reasonably in that the plan was to review C two weeks following the telephone consultation should the symptoms not have resolved. C did not contact the practice for a number of months and when they did, appropriate referrals were made to specialists for further consideration. We did not uphold the complaint.

Summary

C's parent (A) had been treated for kidney cancer and then developed cancer of the bladder. They were receiving dialysis three times a week. The GP practice in this case is managed by the board. A developed back pain and called out a GP, who prescribed dihydrocodeine (an opiate painkiller). They remained in pain the following day and called out another GP, who prescribed diazepam (a medicine used to treat anxiety) and told A to double the dose of dihydrocodeine. After increasing the dosage of dihydrocodeine A became drowsy and unresponsive. They were admitted to hospital and transferred to the Intensive Care Unit for dialysis but did not improve and died of multiple organ failure, and presumed ischaemic bowel disease (lack of blood flow to the intestine). Their death certificate also recorded end stage renal failure and a trial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate). C complained that A's GPs should not have prescribed these medications because of A's renal failure.

We took independent advice from a GP adviser. We found that each GP had assessed and treated A appropriately, taking into account their presenting symptoms and existing health concerns. We noted that A's treatment options were significantly limited by their renal failure. We found that it was appropriate to prescribe opiates, as pain control was the objective and A was due dialysis which would significantly reduce the risk of toxicity. We found that although the medications had a sedative effect, they did not cause A's subsequent death. We found some shortcomings in documentation but were satisfied that the board had addressed this matter. We found that the GP treatment provided to A was of a reasonable standard and therefore did not uphold this complaint.