Not upheld, no recommendations

Summary

Mrs C complained about care she received from the medical practice when she attended with an injury to her toe. Mrs C has diabetes which makes foot complications more common and harder to treat. Mrs C had been prescribed an antibiotic to treat the infection but she had returned to the practice around a month later as she was still in pain, at which point she was referred to hospital. She had to have emergency surgery, resulting in the amputation of her big toe. Mrs C said that she had attended the practice three times before being referred to hospital and that the amputation could have been avoided if the practice had provided appropriate care and treatment when she had first attended.

The practice said that they had conducted an audit and could not find any evidence that she had attended on the first occasion. We took independent advice from a GP adviser. The adviser considered the records available and found the treatment Mrs C was given was appropriate, and that Mrs C's GP could not have foreseen that Mrs C's condition deteriorated or recurred between the point at which she was prescribed antibiotics and being referred to hospital. We also found no evidence of the initial appointment that Mrs C referred to. We did not uphold Mrs C's complaint.

Summary

Ms C, a voluntary agency worker, complained on behalf of Mr A that the dental care and treatment he had received had been inadequate. We took dental advice which stated that the care and treatment had been appropriate. It noted Mr A had not attended regular dental reviews, which had contributed to the damage to his teeth.

We found that the dentist had acted reasonably and that the care they had provided was appropriate, and we therefore did not uphold this complaint.

Summary

Ms C, who works for a voluntary agency, complained on behalf of Mr A that the care and treatment he received was inadequate and that his subsequent complaint had been poorly handled. Mr A had suffered repeated problems with dental bridgework failing. Ms C said he had been seen by a number of different dentists, causing problems with continuity of care. Mr A also believed that a tooth had been prepared for a crown inappropriately and that he had had an unnecessary extraction, and that he had unreasonably been refused bridgework treatment.

We took independent dental advice, which stated that Mr A had received a comprehensive examination. It was not practical to fit a bridge because of decay in the teeth it would have to be attached to. It would also not have been appropriate to attempt any other restorative work until Mr A's gum disease issues were dealt with. The advice noted that Mr A had been insistent that a bridge be fitted, but the dentist had correctly refused on the basis that this would be inappropriate and would worsen the condition of his teeth.

We found that Mr A's care and treatment was reasonable in the circumstances. His complaint had been thoroughly investigated and a response provided within a reasonable timescale.

Summary

Ms C, an advice agency worker, complained on behalf of the family of Mrs A. Two GPs at the practice had visited Mrs A's home on request and diagnosed that she had a urinary tract infection, for which they prescribed medication. After the GPs left, the family tried to move Mrs A upstairs to her bedroom, but in the process she suffered a leg injury. An ambulance was called and she was admitted to hospital for that injury.

The family complained that Mrs A was not very mobile and that the GPs should have admitted her to hospital, rather than simply leave them on their own to manage an elderly, immobile patient in a home with steep stairs.

We took independent advice on this case from a GP. Our investigation established that the GPs had acted in line with guidance on hospitalisation in the SIGN guideline, 'The Management of Urinary Tract Infection in Adults'. (SIGN is the Scottish Intercollegiate Guidelines Network, which is an organisation that develops clinical guidelines for the NHS in Scotland.) In other words, they had appropriately identified that, in her case, Mrs A should be treated at home but that hospitalisation might become appropriate. The GPs had also appropriately arranged urgent referral to a multi-disciplinary team, who would be able to help Mrs A with self-care and mobilisation.

The GPs considered that they had advised the family that Mrs A might need to remain downstairs initially. In the absence of independent evidence, the facts around this could not be established either way. The lead GP felt on reflection that he could have checked more whether the family had understood his advice and information, and said he would check this more in future cases.

Summary

Mr C complained about the involvement of a senior charge nurse in relation to a dispute on the ward between him (Mr C) and a relative of his, both of whom happened to be visiting Mr C's mother (Mrs A) at the same time. Mrs A was a patient on the ward at Aberdeen Royal Infirmary. The relationship between Mr C and his relative had been strained for a long time, and difficulties arose because they both wished to visit Mrs A before she died.

We took independent advice from a nurse. They considered the various actions of nursing staff, particularly those of the senior charge nurse. They were satisfied that staff had appropriately tried to act in Mrs A's best interests by trying to give both relatives separate time with Mrs A and that it had not been their responsibility to check that one relative had left the premises before the other arrived.

Mr C also expressed concerns about the board's handling of his complaint. We saw no evidence to support such concerns.

Summary

Mr C complained about the care and treatment provided to his late father (Mr A) when he was admitted to Aberdeen Royal Infirmary early in 2015. Clinicians said Mr A had an inflammatory mass in keeping with complicated appendicitis (inflammation of the appendix) and was treated with antibiotics and discharged. Mr A was readmitted to hospital the following month when his abdominal pain worsened and he was diagnosed with an aggressive form of cancer that had spread. Mr C complained that despite Mr A presenting with symptoms indicating a serious condition, clinicians failed to consider the possibility of bowel cancer and carry out appropriate tests, investigations and referrals.

We took independent advice from our medical adviser. We found that the care and treatment provided by the board was reasonable including that referrals and investigations were arranged within a reasonable time during both of Mr A's admissions to hospital. We were also satisfied there was no evidence suggesting that hospital clinicians missed symptoms suggesting bowel cancer.

Summary

Mr C said that his late father (Mr A) attended the GP practice on a number of occasions with symptoms indicating a serious condition. He said that the practice unreasonably failed to consider the possibility of bowel cancer and carry out appropriate tests, investigations and referrals. Mr A died a few months after several admissions to hospital where he was diagnosed with bowel cancer.

We took independent advice from a GP adviser. We found that the care and treatment provided by the practice was reasonable including that referrals and investigations were arranged within a reasonable time before Mr A's first admission to hospital. We also found no evidence suggesting that the practice failed to monitor Mr A appropriately when he was discharged from hospital.

Summary

Mr C, an advice worker, complained about the treatment which his client (Mr A) received when he attended a consultation. Mr A had a previous medical history of facial and arm weakness and was thought to have long-standing hydrocephalus (build-up of fluid on the brain). He saw a GP as he wanted to have further investigations in order to reach a diagnosis. Mr A felt the GP had dismissed his symptoms. Mr A was admitted to hospital two days later with worsening neck and back pain, increasing confusion, poor mobility, right upper limb weakness and urinary incontinence. Over the next six months Mr A was found to have stable chronic hydrocephalus along with possible abscesses (painful swellings caused by a build-up of puss) of his neck and the area between the spine and spinal cord. It was subsequently discovered he had chronic discitis (infection of the vertebral disc space). Mr A believed that the GP had dismissed his symptoms and that his condition had deteriorated because of the delays which he had encountered.

We took independent medical advice from a GP and concluded that the GP had provided a reasonable level of care. When Mr A had attended the consultation the GP was aware of Mr A's medical history, including that he had attended hospital the previous day. He carried out an appropriate examination given the symptoms which were presented. There was no indication at that time for a hospital admission. It was clear from the records that Mr A's condition deteriorated two days after the GP consultation and it was only then that a hospital admission was appropriate. We did not uphold the complaint.

Summary

Miss C complained about the care and treatment received by her late father (Mr A). Mr A had an MRI (magnetic resonance imaging) scan at Forth Valley Royal Hospital to investigate leg weakness. The scan revealed an incidental finding of a six centimetre abdominal aortic aneurysm (AAA - a bulging of the aorta, one of the largest blood vessels in the body, which runs from the heart to the legs). This had not yet been shared with Mr A when he took unwell a few days later and, while being transported to hospital in an ambulance, he went into cardiac arrest and died. Miss C complained about the time taken to share and act upon the findings of the MRI scan.

The board informed Miss C that, in line with normal practice, the MRI was flagged for urgent reporting within two to three days. They explained that immediate intervention would only be arranged where there was evidence that the AAA had ruptured, which there was not in Mr A's case. They noted that the MRI was reported three days later and an urgent referral was made to the vascular team two days after that. This was the day of Mr A's death. The board noted that further tests would have been required and the national target for elective treatment of aneurysms is 42 days. They therefore considered that even if Mr A had been referred to the vascular team on the same day as the MRI scan, it would have been a few weeks before he received treatment.

We took independent medical advice from a consultant physician. They noted that, while they could not be certain of the cause of death, the risk of the AAA rupturing was low and that the board attributed Mr A's death to a heart attack. They noted that Mr A did not have any symptoms suggestive of a rupture at the time of his scan and they considered that the scan was reported and acted on within an appropriate timeframe. We accepted this advice and concluded that the outcome could not reasonably have been prevented.

Summary

Mr C complained that the board had failed to carry out the hernia surgery at Forth Valley Royal Hospital that he had consented to and that they had failed to provide him with appropriate treatment following the surgery. Mr C said as consequence he suffered from regular and severe pain, which impacted on his quality of life and ability to work.

We found Mr C underwent surgery in the summer of 2012 without incident, although he did then attend the A&E department at the hospital complaining of pain at the wound site. He was examined and discharged as no cause for alarm could be identified. Mr C was reviewed in late 2012 and early 2013, and although a further review appointment was made, Mr C did not attend. In the absence of contact from Mr C, no further appointments were offered.

Mr C was re-referred by his GP and seen in 2015. He was reviewed in clinic by the surgeon who had performed the operation and provided with a scan of the area, which confirmed that the hernia had not reoccurred. Mr C was unhappy with the outcome of this review and a second opinion was arranged.

We took independent advice from a consultant colorectal surgeon, who said that the treatment Mr C had received was appropriate. The relevant consent documents had been filled in and signed and the operation had been performed in accordance with normal surgical procedure. There was no evidence that the operation performed was not the one Mr C consented to. The adviser also said the reviews of Mr C had been carried out appropriately post-surgery and it was reasonable to have referred him for a second opinion when the relationship with medical staff broke down.

We found there was no evidence Mr C had not consented to the operation performed on him, or that he had received inadequate care following the second surgery and did not uphold the complaint.