Not upheld, no recommendations

Summary

A GP was called to Mrs A's home when she was experiencing breathing difficulties. The GP examined Mrs A and prescribed medication. Two days later Mrs A was admitted to hospital with respiratory failure. Mrs A subsequently complained to the practice about the care and treatment she received at the home visit. The practice explained the reasons why the GP had made his decisions and indicated that they considered that these had been reasonable. Mrs A remained dissatisfied and Mrs C, who works for an advice agency, complained to us on behalf of Mrs A. Specifically, Mrs A wanted to see if there was a preventable delay in her care.

We took independent advice from a GP adviser. The adviser reviewed the medical records for the home visit and considered that the symptoms and signs recorded were consistent with the diagnosis made, which was an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The adviser told us that the GP had identified this appropriately and treated Mrs A in line with the National Institute for Health and Care Excellence (NICE) guidance relevant to COPD in Scotland.

Overall, the adviser was satisfied that the practice's care and treatment of Mrs A was reasonable. We agreed with this advice, and did not uphold the complaint.

Summary

Mrs C's husband (Mr C) was admitted to Perth Royal Infirmary and treated for pneumonia. His condition did not improve whilst in hospital and he died seven days after being admitted.

Mrs C raised a number of specific complaints about the medical and nursing treatment her husband received at the hospital. In particular, she felt that his medication was not managed appropriately and that she was left to take care of many of his basic personal care needs.

We took independent advice from two advisers, one a consultant geriatrician and the other a nurse. Whilst we were critical of the board for failing to ensure Mr C's teeth were cleaned regularly and for initially denying Mrs C access to the ward outside of normal visiting times, we were generally satisfied that the medical and nursing care was of a good standard.

Summary

Mrs C complained after her mother (Mrs A) suffered a fall in Hairmyres Hospital. Mrs A suffered from dementia and was unsteady on her feet. Mrs C said the board had not done enough to prevent her mother's fall.

We took independent advice from a nursing adviser. The adviser found that the board had carried out appropriate assessments and were monitoring Mrs A's mobility. The adviser explained that staff had to balance trying to encourage Mrs A to be independent (with a view to getting her home) with the need to ensure her safety. The adviser was satisfied that the board had done all they reasonably could to mitigate the risk of Mrs A having a fall, recognising that they cannot eliminate the possibility altogether. For this reason, we did not uphold the complaint.

Summary

Mr C was admitted to Hairmyres Hospital with symptoms suggestive of vasculitis (inflammation of a blood vessel or vessels). He was prescribed steroids and discharged. He was seen again at a clinic, at which point it was understood that he would be reviewed by a respiratory team three weeks later. A plan was put in place to reduce his steroid dose over this three-week period.

An appointment was also made for a follow-up appointment with his consultant two months later, by which time it was assumed he would have been seen by the respiratory team. However, when he attended he had still not been seen by them, and had remained on steroids. Mr C was re-referred urgently, and an appointment was made. Following this appointment it was advised that the steroids would be cut down, with a view to stopping them altogether.

Mr C subsequently contracted avascular necrosis (AVN - death of bone tissue due to a lack of blood supply) in both hips, which meant he required a total replacement of his right hip. He believed this was caused by his prolonged steroid use.

We took independent advice from a medical adviser who told us that Mr C's steroids were prescribed appropriately and were used for a relatively short period. There was no evidence to suggest that the steroids would have contributed to his AVN and we were satisfied that his dosage was gradually reduced appropriately. Therefore, we did not uphold Mr C's complaint.

Summary

Miss C's father (Mr A) attended the medical practice on two occasions over a four week period with chest and abdominal problems and breathlessness. He also had a phone consultation with the practice about his condition. Whilst waiting for x-ray results, Mr A died suddenly. His post mortem gave his cause of death as cardiac enlargement (an enlarged heart which may not pump blood effectively, resulting in congestive heart failure).

Miss C complained that the practice failed to provide appropriate care and treatment to her father. She raised a number of concerns including that a nurse practitioner and a GP at the practice failed to carry out appropriate assessments and examinations of her father and provide appropriate treatment.

We obtained independent medical advice on Miss C's complaint from a nursing adviser and a GP adviser. The nursing adviser explained that the nurse practitioner's assessment and examinations of Mr A were reasonable and Mr A was provided with appropriate treatment. The GP adviser said that the GP's assessment, care and management of Mr A were reasonable and in accordance with relevant guidelines. The GP adviser said the details recorded in the consultation together with the examination of Mr A were not significantly suggestive of a heart condition as the primary underlying cause of Mr A's condition. They explained that chest infection was a reasonable diagnosis for the GP to have made based on the symptoms and signs presented to them. Therefore, we did not conclude that the practice failed to provide appropriate care and treatment to Mr A.

Summary

Mr C, who works for an advocacy agency, complained on behalf of Mr A about the care and treatment provided to him by his psychiatrist. Mr A's community care package initially included him receiving night visits from care staff but these were discontinued due to his non-compliant behaviour. He was subsequently detained in hospital for a period. Mr C complained that Mr A's psychiatrist had not provided him with sufficient support in the community and that this had led to his hospital detention. In particular, he complained that the psychiatrist did not take adequate steps to try to have Mr A's overnight support reinstated. He also complained about the care Mr A received while in hospital and raised concerns that there was not an appropriate care plan in place throughout his admission.

We took independent advice from a psychiatrist who considered that the actions taken by Mr A's psychiatrist were reasonable in the circumstances. The adviser noted that there was disagreement among the wider team regarding how best to manage Mr A's care and that, even if the psychiatrist had done more, there was no guarantee that this would have helped prevent Mr A's hospitalisation. We therefore could not conclude that the psychiatrist unreasonably contributed to Mr A's hospital admission. We were also advised that that there was an adequate care plan in place during Mr A's hospital admission, although it was noted that this was not always successful in engaging him. We did not uphold either aspect of the complaint.

Summary

Ms C, who works for an advice agency, complained on behalf of Ms A about treatment she had received from the medical practice. Ms A has chronic psoriasis (a long-term, recurring skin disease, which causes sore or itchy patches of skin) on her hands and feet. She sought treatment for this at her practice but continued to suffer symptoms. Following a visit from a district nurse, Ms A was referred to a podiatrist (a clinician who diagnoses and treats abnormalities in the lower limbs). Ms C complained about the delay in Ms A being referred to a podiatrist.

We took independent advice from a GP adviser. The adviser said that the practice had made appropriate investigations into Ms A's condition and recommended reasonable treatments. As the psoriasis affected Ms A's hands as well as her feet, they did not believe a referral to a podiatrist was appropriate at that time. For this reason, we did not uphold the complaint.

Summary

Miss C was examined by her current GP and had a contraceptive coil removed. However, at that time, Miss C had thought that all coils had already been removed; therefore, she thought her previous GP had failed to remove a coil.

We looked at the file on Miss C's complaint, at her medical records from her current and previous GPs, and we took independent advice from a GP adviser. We noted the adviser's comments that patients should be aware if they have a coil in place and if it needs to be removed, and that it is a patient's responsibility to tell their GP if they wish to have an existing coil removed. We found that the care provided by Miss C's previous GP in relation to fitting and removing coils was reasonable in the circumstances at the time. Therefore, we did not uphold Miss C's complaint.

Summary

Mr C, who works for an advice agency, complained to the medical practice on behalf of his client (Mr A) who suffered from lower back and leg pain. Mr A said that there had been a delay by the practice in referring him for a MRI scan (magnetic resonance imaging - a scan used to diagnose health conditions that affect organs, tissue and bone) and it did not appear that they had followed the correct referral process and that had contributed to the delay. It was only after an appointment with a private physiotherapist that a MRI scan was arranged.

We took independent advice from a GP adviser and concluded that the practice had made appropriate referrals for specialist opinions from physiotherapy and orthopaedics and that initially there were no indications that, from a clinical perspective, a MRI scan was appropriate. By the time Mr A had seen the private physiotherapist, the clinical situation had deteriorated and at that time it was then appropriate to make a referral for an MRI scan. We did not uphold the complaint.

Summary

Mrs C, who works for an advice agency, complained on behalf of the family of Mr A. She said they believed Mr A's nasogastric tube had been incorrectly inserted, which had caused a collapsed lung by puncturing the inside of his lung. They said that, following this, he had deteriorated and this had contributed to his death. Mr A's family believed that Mr A had been being prepared for discharge at the time of the insertion.

The board said that they did not believe it was possible that the nasogastric tube had led to Mr A's death. The tube had been inserted by an experienced nurse, and checked by x-ray. When it was found to be in the wrong place, it had been immediately removed. The board said that there had been no discharge plan in place for Mr A.

We received independent medical and nursing advice. The medical advice stated it was not medically possible for a nasogastric tube to puncture a lung. Mr A had suffered from serious lung disease and it was more likely that this had caused his collapsed lung. The nursing advice said the insertion of a nasogastric tube was routine, but that even if inserted correctly, it could subsequently move within a patient. It was appropriate for the board to have confirmed the position by x-ray and this was an example of good practice.

We found there was no evidence that Mr A had not received an appropriate level of care and treatment and did not uphold the complaint.