Not upheld, no recommendations

Summary

Mr C complained that he was not appropriately assessed and treated during two separate attendances at the A&E department of the Royal Infirmary of Edinburgh. He also complained that he was inappropriately discharged on both occasions.

Mr C attended the A&E department having sustained a head injury and was assessed and admitted for a period of observation before being discharged. He presented again two days later reporting ongoing symptoms including vomiting and a worsening headache. He received a brain scan and spinal x-ray, both of which were normal. He was discharged with head injury and pain management advice.

We took independent advice from a consultant in emergency medicine who considered that the care Mr C received on both attendances was of a high standard and was consistent with national guidance on the early management of patients with a head injury. He considered that it was reasonable for Mr C to have been discharged on both occasions, noting that the tests had excluded the possibility of a significant injury to his brain. We did not uphold the complaint.

Summary

Ms C complained on behalf of Miss A who said she suffered from Jarisch Herxheimer's reaction (a severe but treatable reaction to antibiotics). Miss A said doctors at Raigmore Hospital had failed to treat her properly by refusing to accept that she suffered from this condition and refusing to admit her to hospital for a week-long course of supervised antibiotics that would have demonstrated that her condition was genuine.

We took advice from a consultant in infectious disease medicine. The advice said the condition was normally found in patients being treated with antibiotics for a specific type of bacterial infection, such as syphilis or Lyme disease. Miss A had been tested for these and been found to be clear of infection. She had also been tested for latent tuberculosis. The advice said Miss A's doctors had eliminated any possible infections that might cause the condition when treated with antibiotics. It would not be appropriate to provide antibiotic treatment to a patient without an identified infection. This could lead to an increase in antibiotic resistance both in Miss A and the general population, reducing the effectiveness of future treatments. It would also put Miss A at risk of side effects including possible significant bowel disease.

We found that Miss A had been provided with a reasonable standard of care and treatment. While it was acknowledged that Miss A had suffered a very distressing experience, there was no medical evidence to show she suffered from Jarisch Herxheimer's reaction and we did not uphold the complaint.

Summary

Mrs C said that she attended Gartnavel General Hospital in 2012 because of a persistent chronic cough. She was told that there were a number of potential causes for this but that a high resolution computerised tomography (HRCT) scan and other tests had been ordered to exclude any structural lung disease, in particular bronchiectasis (a chronic lung condition). The required tests were carried out and reported at clinic in January 2013. At this stage, it appeared that there was no evidence of bronchiectasis.

Mrs C said that she remained unwell and a repeat HRCT was ordered. Following this, she was told in September 2014 that she had bronchiectasis. Mrs C complained to the board that they had failed to diagnose her in early 2013 and that as a consequence she did not receive the required treatment. The board, however, maintained that she had been treated appropriately and that changes occurred in the period after her first HRCT.

We took independent advice from a consultant in respiratory medicine and we found that HRCT scanning was the 'gold standard' to determine whether or not bronchiectasis was present. On the first such scan there was no such evidence of this but this was found to be the case in 2014. While the impact of the diagnosis for Mrs C has been great, we found no evidence to suggest that this was as a consequence of any shortcoming on the part of the board.

Summary

Ms C said that a nurse injured her child's arm while removing a plaster cast. She complained to the board who made their own investigations but concluded that the cast had been removed in an appropriate way, and that neither the nurse or the doctor concerned had noted any injury.

We took independent nursing advice and we found that the records did not show any evidence of the child being distressed or injured. There was no evidence to show that the plaster cast had been removed in an inappropriate way. The complaint was not upheld.

Summary

Following eye surgery, Mrs A was referred to an optometry practice by her consultant ophthalmologist to be fitted with a corneoscleral lens (a large diameter rigid contact lens) on her right eye to assist with eye moisture retention. Mrs A attended an appointment to be provided with instruction on the use and care of the lens which involved the use of a lens cleaning and disinfecting solution. At the end of the consultation Mrs A purchased the solution from the practice's reception.

Mrs A later used the solution, which is peroxide based, in its unneutralised state and suffered pain, inflammation and damage to the eye and the surrounding skin. Mr C complained on behalf of Mrs A (his wife) that the optometry practice had failed to ensure Mrs A was provided with an appropriate lens care regime and instructions on how to use the lens safely.

We obtained independent advice from an optometrist. The adviser said that what had happened in Mrs A's case been brought about by her misunderstanding of the correct contact lens cleaning regime which had led to her erroneously applying the solution to the lens in the pre-neutralised state just prior to insertion into the eye. The adviser found no evidence that what occurred had been due to failings in the advice and treatment Mrs A received from the optometry practice. The adviser said the advice and treatment they provided had been appropriate. We accepted this advice and did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late grandson (Mr A) during an admission to Royal Cornhill Hospital. Mr A had a history of mild learning disability, drug and alcohol misuse and self-harm. He had a previous admission a couple of months earlier following attempted hanging and also attempted to hang himself while an in-patient when his discharge was planned. Mr A was discharged with support in the community but was readmitted following a further attempted hanging several weeks later. Mr A remained on the ward for two weeks and was then discharged again. Mr A completed suicide by hanging that evening. Mrs C complained that staff had not adequately assessed Mr A and that the discharge decision was unreasonable.

Following Mr A's death the board conducted an adverse event review. The board did not consider Mr A suffered from a major mental illness and although he was at risk of harming himself, staff did not consider an ongoing hospital admission would be in his best interests.

After taking independent psychiatric advice, we did not uphold Mrs C's complaints. We found that staff had appropriately assessed Mr A and reasonably concluded he did not have a major mental illness and would not benefit from ongoing hospitalisation. The adviser also explained that hospitalisation does not necessarily prevent attempts to self-harm (and noted that one of Mr A's previous attempts at suicide occurred in the in-patient setting). In view of Mr A's participation in the discharge planning and his previous pattern of behaviour, the adviser considered there was no indication that Mr A planned to harm himself that evening and it was reasonable for staff to predict that, although Mr A may attempt self-harm in future, he would likely warn someone before doing so. Overall, we considered that Mr A's suicide was an event that could not have been predicted by staff at the time of discharge.

Summary

Mrs C complained that her husband (Mr C) did not receive a reasonable standard of care from the practice. Mr C suffered from a number of health conditions, including asthma, and passed away from sudden cardiac arrest whilst he was a patient at the practice. Mrs C felt that the practice did not investigate Mr C's condition urgently enough, and said that there had been a sequence of failed attempts to diagnose and treat Mr C.

We took independent advice from a GP adviser. The adviser noted that the practice had investigated Mr C's condition within a reasonable timeframe and with the appropriate level of urgency. The adviser said that appropriate investigative tests had been arranged and concluded that the care Mr C received was reasonable. We accepted the adviser's comments and we did not uphold Mrs C's complaint.

Summary

Mr C, who works for an advice and support agency, complained about the care and treatment of his clients' late daughter (Miss A). Miss A attended the practice on a number of occasions from May 2014 with symptoms including a persistent cough, sore joints, fatigue and weight loss. A number of possible diagnoses were considered and investigated but Miss A's symptoms persisted. In October 2014 following an out-of-hours attendance, Miss A was admitted to hospital and diagnosed with endocarditis (a rare and potentially fatal infection of the inner lining of the heart). Miss A passed away in hospital a few weeks later. Her parents raised concern that a window of opportunity had been missed to diagnose Miss A. They felt that there was a delay in the practice arranging appropriate investigations and referrals.

The practice met with Miss A's parents and carried out a significant event analysis. The practice considered the care provided was reasonable, although they identified some learning points for improvement including improving continuity of care and having a lower threshold for investigatory blood tests in young people with persistent symptoms.

After taking independent medical advice we did not uphold Mr C's complaint. We found the practice had arranged appropriate investigations in view of Miss A's symptoms, including seeking advice from Miss A's former specialist to check for any connection between her symptoms and another ongoing condition and making referrals to hospital specialists. The adviser explained that Miss A's symptoms varied over this time and appeared more in keeping with a respiratory problem (which the GPs appropriately investigated). The adviser considered symptoms indicating a possible problem with the heart were first documented at the out-of-hours admission in October 2014, so it was not a failing that the practice did not investigate this possibility earlier.

Summary

Mr C complained about the way in which his pain relief medication was handled by the prison health centre and that the doctor refused to see him in private.

Mr C had been prescribed pain relief for pain in his leg. This was later stopped and an alternative medication prescribed. However, due to concerns that Mr C was failing to take the medication in the way it was prescribed, this medication was also stopped and further alternatives, including anti-depressants, were suggested.

We took independent advice from a GP adviser. We found that, when reviewing Mr C's medication, the health centre had acted in line with Scottish national guidelines on the management of chronic pain and on prescribing. We considered the health centre's actions to be reasonable given the assessments carried out for Mr C.

The board told us that there were no records of Mr C asking to see health centre staff in private. We considered that in a secure environment, it would not be unreasonable for Mr C to be accompanied at health centre appointments. We saw evidence of only one occasion on which Mr C had been accompanied and that this was reasonable. We therefore did not uphold Mr C's complaints.

Summary

Mr C complained that a GP practice did not properly maintain the medical records of his wife (Mrs A) and as a consequence, when she was admitted to hospital she was given medication which led to serious side effects. He further complained that a member of staff spoke to him inappropriately and told him that by stopping his wife's medication he could cause Mrs A's death.

We took independent general practice advice and noted that while Mrs A's medical records showed that a conversation with Mr C had taken place where he said that he was stopping her medication due to his belief that it caused side effects, they did not record a change to her medication. This was because Mrs A had the capacity to make decisions about her treatment and any changes could only be made after discussion with her. Whilst the records noted a terse conversation with Mr C about his wife's medication, there was no evidence that he had been spoken to inappropriately. It was clear that the repercussions of Mrs A stopping taking her medication had been clearly explained to Mr C. We did not uphold the complaint.