Not upheld, no recommendations

Summary

Mrs C raised a number of issues about the care and treatment her late husband (Mr C) received during admissions to Ninewells Hospital and Royal Victoria Hospital.

During our investigation, we took independent advice from a consultant geriatrician and a nursing adviser. We found no evidence that the clinical and nursing care was unreasonable. In particular, the consultant geriatrician noted that Mr C had been suffering from several conditions and had required significant medication to try and control his symptoms, and we found that there had been a number of discussions with Mrs C about her husband's condition. The consultant geriatrician was satisfied that the medication given to Mr C was always appropriately considered, prescribed and administered. While some of the medication caused side effects, the consultant geriatrician was satisfied that the board tried to avoid this medication as much as possible and that the side effects were unavoidable.

The nursing adviser was satisfied that Mr C had been regularly assessed and care was planned for his mobility problems. We were satisfied that the care planning and assessment charts and nursing notes confirmed that Mr C's needs were fully assessed and managed. We did not uphold Mrs C's complaints.

Summary

Mr C complained about the care and treatment provided by a physiotherapist during his recovery from surgery performed on his hand. Mr C complained that the physiotherapist provided inadequate exercise advice at an appointment, in particular by encouraging him to perform intensive exercise on the hand, which led his wound to open. Mr C considered this advice led to ongoing pain in his hand and its reduced function.

The board said there was no evidence that advice had been given to perform intensive exercise. The board said advice was provided to perform gentle exercise, which was appropriate, and there was no link between the physiotherapy care and treatment provided and the subsequent problems Mr C experienced in his hand.

After receiving independent advice from a consultant physiotherapist, we did not uphold Mr C's complaint. We found there was no evidence that the board provided inappropriate advice, rather the records indicated the physiotherapy advice was reasonable given Mr C's circumstances.

Summary

Mr C complained to us that the medical practice failed to provide him with appropriate clinical treatment when he turned up for a consultation and was in need of medical attention. He was also told that he had been removed from the practice list of patients and he complained that they did not provide an explanation for this.

The practice explained that when Mr C attended the practice there was no indication that he required medical treatment and that he did not mention this to the staff who saw him. They also explained that the reasons he had been removed from the practice patient list were that he had previously intimated he was leaving the country and they had received a medication enquiry from another medical practice outwith Scotland. Further, they explained that contact was made to Mr C's registered address and staff were informed he was no longer resident there, and that he had failed to attend a pre-arranged consultation.

We took independent advice from an adviser in general practice medicine and concluded that if there was no indication that a patient required immediate medical attention then there was no requirement for a GP to see a patient immediately. In addition, as the practice had confirmed that Mr C was no longer at the address stated then it would be reasonable for them to remove him from the practice patient list. The clinical records substantiated the explanations provide by the practice. We did not uphold the complaints.

Summary

Mr C's father (Mr A) was diagnosed with stomach cancer and died five months later. Mr C complained that the medical practice should have investigated his father's symptoms sooner as an earlier scan may have allowed some level of preventative treatment. We took independent advice from a medical adviser who is a GP. We found that until he was under the care of hospital specialists, Mr A had not reported or exhibited symptoms of more serious underlying disease which would have suggested urgent referral in accordance with national guidelines for the investigation of cancer. The adviser therefore considered that there was no evidence from Mr A's medical records that the practice failed to identify or act on any concerning symptoms, so we did not uphold Mr C's complaint.

Summary

Mrs C contacted the practice about appointments for her sons. She was unhappy with the way in which the practice handled her contact. She felt that the practice manager had breached confidentiality by referring to a previous conversation she had had with a GP at the practice about one son when she was calling about her other son. She also felt that the practice had not acted correctly in relation to allegations that she was abusive and that she was told to go elsewhere. She was also unhappy that they had noted on her medical records that she was more interested in her sons' rights than taking them to review appointments.

Following consideration of Mrs C's complaint to the practice and to us, the practice's response to her complaints as well as the information the practice provided to us following our enquiry (which included records of the conversations Mrs C had had with the practice), we did not uphold Mrs C's complaints. We felt it was reasonable for the practice manager to refer to previous conversations between Mrs C and the practice in so far as it related to her own actions and behaviour, rather than the specific medical conditions of her sons. The notes of the conversations did not indicate that Mrs C was abusive, rather that she was upset and excessively angry. Given the circumstances, we considered that the practice's handling of Mrs C's contact, which was to put a note on her record that any future issues are fed back to the practice manager, was a reasonable way to proactively manage internally any potential issues with future contact. There was no record in the practice's notes of the conversation that Mrs C was told to go elsewhere and the practice and Mrs C had differing recollections of what was said. It was not possible, therefore, for us to determine exactly what was said. Although we understood that Mrs C was unhappy about what was written in the record about not taking her sons to review appointments, we considered that the practice's explanation that this was an accurate reflection of the discussion and beneficial to have recorded for any future contact, was reasonable.

Summary

Mr C brought this complaint to us on behalf of his late wife (Mrs C), following a rapid deterioration in her health. He raised concerns that GPs should have identified her deteriorating condition over the course of three consultations she had with them prior to her admission to hospital. She was admitted to hospital suffering from shock within 24 hours of her last GP visit. The hospital doctors were unable to save her, as she did not respond to the treatment she was given, and she died a week after admission.

We took independent advice from a GP adviser. The adviser reviewed the consultations that Mrs C had with GPs, and was satisfied that the assessments had been reasonable and the treatments were appropriate. She noted that the main issue discussed had been back pain. There had been no mention of diarrhoea, though Mr C said that his wife had been suffering from this for several weeks. He reported that he mentioned it to the GP at the final consultation. However, it was not noted in the medical records, and the adviser was satisfied that the GPs had made reasonable decisions based on the information they were given. The adviser also noted that the GPs may have made different decisions if they had been told of Mrs C's persistent diarrhoea.

We noted the sequence of events that led to Mrs C's death, but concluded that GPs could not have predicted this, based on the information she gave them. We were satisfied that the GPs had assessed and treated Mrs C reasonably for the back problems she presented with, and noted that they were also reasonable not to ask about diarrhoea when she had not raised this as an issue. We were satisfied that the practice provided Mrs C with appropriate clinical treatment in view of the symptoms which she presented with.

Summary

Mr C complained that a consultant nephrologist (a doctor who specialises in kidney care) provided inadequate medical care to him during a kidney biopsy. We looked at the board's complaint file and Mr C's medical records. We also took independent advice from a medical adviser. We found there were no failings in how the biopsy was explained to Mr C or in how it was carried out and the post-biopsy monitoring was appropriate. We also found that a rare but recognised complication was noticed in reasonable time and appropriate steps were taken to deal with the complication in reasonable time once it became apparent. We did not uphold Mr C's complaint.

Summary

Mr C complained about treatment that was proposed at an appointment with the dentist. He was also concerned that there was a failure to properly communicate with him about his ongoing treatment. Mr C was advised by the dentist that his tooth was in poor condition and might require further treatment at another appointment, referral to a specialist or extraction. Mr C was unhappy with the information provided by the dentist and did not proceed with any treatment.

After taking independent advice on this case from a dental adviser, we did not uphold either of Mr C's complaints. The adviser considered that the dentist's assessment of the tooth in question was reasonable and highlighted no concerns about communication with Mr C regarding his treatment.

Summary

Mrs C complained to us that her daughter (Ms A) had attended the board's out-of-hours GP service with symptoms of a numb tongue, swollen face and a burning sensation down the left side. Mrs C said that the GP who saw her daughter failed to carry out an appropriate examination, dismissed Ms A's concerns and told her to contact her own GP if the symptoms persisted. The following day, Ms A attended hospital and was diagnosed with Bell's palsy (a condition that causes temporary weakness or paralysis of the muscles in one side of the face). Mrs C was dissatisfied with the out-of-hours GP's actions.

We took independent advice from an adviser in general practice medicine and concluded that the out-of-hours GP had carried out an appropriate assessment based on the presenting symptoms and taking note of Ms A's previous medical history. At the time of the examination, there were no signs which indicated the presence of Bell's palsy. Bell's palsy commonly develops suddenly and as such the adviser did not consider that the GP had missed the diagnosis but rather that the symptoms were not present at the time Ms A was examined to allow a diagnosis to be made. We did not uphold the complaint.

Summary

Mr C entered into a patient contract with the NHS about the prescription of substitute medication used to help patients to stop the use of heroin. A nurse gave Mr C a dose of the medication, but it was suspected that he had diverted the medication. The nurse checked his mouth and found no sign of it. Mr C said he had broken the medication so it could be taken quicker. However, the board decided to withdraw the medication. Mr C told us that taking the medication was the only option for him to lead a normal life and that the decision to stop it has affected adversely his mental health and confidence.

We took independent advice from a medical adviser who said the board's decision was reasonable. We found that the patient contract was very specific about the way in which the medication should be taken and that the medication could be withdrawn on the basis of suspicion of misuse.