Not upheld, no recommendations

Summary

Mr C complained that he was not warned about the possible specific side effect of developing cataracts (a clouding of the lens of the eye leading to a reduction in vision) when taking steroid drugs via an inhaler.

Mr C had been treated by his GPs and specialists for a number of years for respiratory conditions. He was prescribed inhalers and nasal drops, some of which were steroids. Mr C was diagnosed with cataracts on both eyes while on holiday overseas and had surgery there to remove the cataract from one eye. He was told by his surgeon that the cataracts had been caused by his steroid inhaler.

We took independent medical advice and found that although recognised as a possible side effect, cataracts were such a rare occurrence that it was reasonable that this would not have been specifically discussed with Mr C. Information was available about this in the patient information leaflet supplied with each new batch of the drug. Our view, therefore, was that the actions of the practice were reasonable and in line with relevant General Medical Council guidance to GPs.

Summary

Ms C was admitted to the Royal Edinburgh Hospital. She complained that her care and treatment during her two-day admission was not reasonable. She also complained about record-keeping.

Ms C said that during her admission, an earlier misdiagnosis of personality disorder was relied upon and a more recent diagnosis of post partum psychosis (the onset of psychotic symptoms following childbirth) was ignored. Ms C also said that her medical records did not reasonably portray where she wished to go after her discharge.

During our investigation we took independent advice from a consultant psychiatrist. We found no evidence that the board had relied upon the diagnosis of personality disorder that had been previously made, nor that they had ignored the more recent diagnosis of post partum psychosis. We also found that the care and treatment provided to Ms C during her admission was reasonable. Finally, we found that medical records relating to where Ms C wished to go after her discharge were reasonable. We therefore did not uphold Ms C's complaints.

Summary

Miss C complained about the dental care and treatment received by her son (Mr A). Mr A had a tooth extracted by the board's dental service and several days later was experiencing severe pain from a hard swelling on the floor of his mouth. Mr A was admitted into hospital for emergency surgery to drain what was found to be an infected oral haematoma (a solid swelling of clotted blood). Miss C complained that the extraction of Mr A's tooth had resulted in him having to undergo emergency surgery.

During this investigation, we took independent advice from a dental practitioner. We found that a haematoma is a rare but known complication of extraction, and is not due to anything being done incorrectly. We therefore did not uphold this complaint.

Miss C also complained that the board's response to her complaint contained several inaccuracies. We found that the board's response had been based on the dental records which were available to them, and therefore we did not find their complaints response to be unreasonable.

Summary

Mrs C complained about the care and treatment given to her late husband (Mr A) by his medical practice. She said that despite his serious symptoms, the practice failed to ensure that appropriate tests were carried out. In particular, he was not referred for a scan. She maintained that he was misdiagnosed and not properly treated as a consequence.

We took independent medical advice which confirmed that the practice had provided a reasonable standard of care. We found that doctors in general practice were unable to request scans and that once a referral had been made to hospital (as happened in Mr A's case), his treatment was determined by clinicians there. We did not uphold Mrs C's complaint.

Summary

Mrs C complained about the care and treatment provided by the board to her husband (Mr A). In particular, she said that there was an unreasonable delay in diagnosing him with non-Hodgkin lymphoma (a cancer that develops in the lymphatic system) and that a procedure involving a drain to his lungs was not carried out to a reasonable standard.

We took independent advice from consultants in nephrology (the study of the kidney) and haematology (the study of the blood) and we found that on his admission to hospital, Mr A was seriously ill and suffering from numerous illnesses including heart and lung disease and diabetes. He was admitted to investigate anaemia (a deficiency of red cells in the blood) but on examination was found to have a liver dysfunction and an enlarged liver and spleen. Appropriate tests were made at Monklands Hospital and Mr A was treated for his presenting symptoms. However, his condition continued to worsen and a scan followed with various biopsies being undertaken. These confirmed that Mr A had lymphoma. While Mr A's diagnosis was delayed, this was not unreasonable as priority had been given to his presenting symptoms and existing illnesses. Tests were difficult because of these.

Mr A's treatment options were limited because of his many illnesses and his cancer did not respond to chemotherapy. His declining condition led to further complications including a collapsed lung and Mr A later died. We found that Mr A's symptoms had been treated reasonably and therefore we did not uphold Mrs C's complaint.

Summary

Mr C complained about the time taken to diagnose the cause of his ongoing pain following a bone marrow biopsy at Hairmyres Hospital. About 12 months after the biopsy, Mr C was referred to orthopaedics at a different hospital and it was found that the pain was likely caused by damage to his sacroiliac joint (a joint in the pelvis). Mr C queried why he was not referred to orthopaedics or given an MRI scan sooner, and why he was not warned about the risk of ongoing pain before the biopsy.

The board considered staff took appropriate action to investigate Mr C's pain. They explained that they do not routinely warn patients of the risk of persistent pain from bone marrow biopsies as this is extremely rare, but they proposed to update their patient information leaflet in light of Mr C's experience.

After taking independent haematology (study of the blood) and radiology advice, we did not uphold Mr C's complaints. We found staff had taken reasonable action following the biopsy to investigate the cause for Mr C's pain, including a scan and treatment for signs of infection. When the pain persisted, staff treated this appropriately with medication and a referral to the pain clinic. While we acknowledged that an earlier scan would have been helpful to diagnose the cause of Mr C's pain, given that Mr C was undergoing chemotherapy and radiotherapy during this time which could have contributed to the pain, we considered it was reasonable for staff to wait until Mr C's cancer treatment was finished before referring him for further investigations.

We also found that, while persistent pain has been recognised as a complication from bone marrow biopsy, this is extremely rare. In view of this, we did not consider it unreasonable that staff did not warn Mr C about this risk.

Summary

Mrs C sustained a broken hip following an accident at work and underwent hip replacement surgery at Wishaw General Hospital the next day. She complained that she had been left in pain and walking with a limp since her surgery. In particular, she raised concern over the surgeon's indication that her ongoing symptoms were due to the type of prosthetic joint that he was required to use, due to non-availability of his preferred joint type.

We took independent advice from a consultant orthopaedic surgeon who advised that the type of prosthetic joint used in Mrs C's surgery was in keeping with relevant guidelines and best practice. They reviewed Mrs C's post-operative x-rays and considered that her surgery was carried out appropriately. On balance, they did not consider that her surgery was the cause of her ongoing symptoms and they were of the view that the use of an alternative joint would not have given a better outcome. They considered that there were alternative causes that were more likely explanations for the type of symptoms Mrs C experienced, including referred pain from the lower spine and/or inflammation of the soft tissues overlying the hip. As we found no evidence to suggest that Mrs C's surgery was not carried out appropriately, we did not uphold this complaint.

Mrs C also complained that appropriate follow-up action was not taken to address her ongoing symptoms. However, the adviser considered that she was appropriately followed up, including a second orthopaedic opinion having been sought. In addition, they did not consider that there was an unreasonable delay in referring Mrs C for pain management. We therefore did not uphold this aspect of Mrs C's complaint.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Mrs C said that staff had failed to diagnose that Ms A had suffered a fracture to her right tibia and broken bones in her right knee when she attended A&E at Raigmore Hospital. Ms A was given painkillers and discharged home. She continued to suffer pain and two weeks later an x-ray revealed the fracture and broken bones. Ms A felt the staff should have arranged an x-ray when she attended A&E.

The board said that Ms A was appropriately assessed by nursing and clinical staff who diagnosed a soft tissue injury and that an x-ray was not required.

We took independent medical advice from a consultant in emergency medicine and found that the staff had carried out an appropriate assessment based on the presenting symptoms and reached a reasonable diagnosis of soft tissue injury. There was no requirement to have arranged an x-ray at that time, although it was subsequently established that the fracture had occurred. We did not feel that the actions of the staff were unreasonable and therefore we did not uphold Mrs C's complaint.

Summary

Mrs C had attended a series of physiotherapy appointments at the Victoria Integrated Care Centre. However, her symptoms related to a degenerative disc disease in her spine were unresponsive and she was referred back to her GP for further management. She was provided with a home exercise programme and advised of the symptoms of cauda equina syndrome (a spine disorder affecting the nerves).

Mrs C's pain continued and her GP referred her to Queen Elizabeth University Hospital where she had an MRI scan. The scan showed that she had a bulging disc in her lower back which was pressing on the nerves of her leg. Before Mrs C could attend a further specialist consultation which had been arranged, her situation deteriorated. She attended A&E at the Royal Alexandra Hospital with symptoms of cauda equina syndrome and was admitted. The next day Mrs C underwent surgery.

Mrs C complained that the physiotherapist she attended failed to treat her appropriately and that she should have been referred for an MRI scan.

We investigated the complaint and took independent physiotherapy advice. We found that although Mrs C's symptoms were noted to be developing, she was reviewed and her treatment amended accordingly. However, her symptoms did not meet the criteria that would have required her to have an MRI scan and she was given appropriate advice and treatment and referred back to her GP. We therefore did not uphold Mrs C's complaint.

Summary

Mrs C complained about the standard of clinical and nursing care provided to her mother (Mrs A) at Inverclyde Royal Hospital and the Royal Alexandra Hospital. Mrs C said Mrs A was suffering from non-Hodgkin lymphoma and had been unreasonably denied chemotherapy treatment at the Royal Alexandra Hospital, against her clearly stated wishes. Mrs C believed her mother had not been provided with the appropriate antibiotic therapy and that she had been allowed to lie in a position in bed which exacerbated the pneumonia she acquired at Inverclyde Royal Hospital. Overall, Mrs C believed the treatment her mother had received had increased the speed of her decline, causing her unnecessary suffering and denying her family time with her.

We took independent advice from a consultant geriatrician and a nurse. The advice we received was that the clinical and nursing treatment provided to Mrs A was of a reasonable standard overall. It had been a reasonable decision not to proceed with chemotherapy as Mrs A was suffering from repeated and serious infections and was becoming increasingly frail. The advice found that this was explained appropriately as soon as practically possible after the decision had been made.

We noted that while Mrs A had been in hospital, the board had failed to provide her with adequate fluids over a weekend. This had already been recognised by the board during their own investigation and we were advised that the steps the board had taken were adequate to address the issue. The advice noted that overall Mrs A had been in hospital for 44 days and, with the exception of the weekend period, they considered her treatment reasonable.

We found that on balance the overall standard of clinical and nursing care was reasonable and therefore we did not uphold Mrs C's complaint.