Not upheld, no recommendations

Summary

Ms C complained on behalf of her father (Mr A) about a delay in transferring him home from hospital. Ms C complained that the ambulance service had not taken reasonable steps to ensure they could transfer Mr A home.

The transfer was booked by staff on the hospital ward. They advised the ambulance service that, if there were any steps at Mr A's home, they believed Mr A would be able to move from a stretcher to a wheelchair. When the crew arrived, they found that Mr A would not be able to do this and they cancelled the transfer.

We found this was a reasonable decision to have made, ensuring the safety of both the patient and the crew. Therefore, we did not uphold the complaint.

Summary

Mr C complained about the care and treatment of his late wife (Mrs C) during an ambulance visit and, in particular, the decision not to take Mrs C to hospital. Mrs C had been recently admitted to hospital. Two days after discharge, Mr C became concerned about Mrs C’s symptoms and called 999. An ambulance crew attended and gave Mrs C oxygen treatment and advice about fluid intake. However, the paramedic decided not to take Mrs C to hospital immediately.

Mr C said the decision to leave Mrs C at home was made because the paramedic could not get through to the duty doctor for permission to bring her to hospital. He said Mrs C’s hospital admission later that day was arranged by a community nurse who visited shortly afterwards and raised concerns about Mrs C’s condition with the duty doctor. The ambulance service disagreed with this account. They said the paramedic spoke to the duty doctor and agreed that it would be appropriate to leave Mrs C at home to allow time for Mrs C’s recent insulin injection, and the advice about fluid intake, to take effect. The ambulance service said the paramedic arranged for an unscheduled care nurse to visit in four hours to check whether Mrs C had improved, and this was what prompted Mrs C’s admission later that day.

After taking independent advice from a paramedic adviser, we did not uphold Mr C’s complaint. There was evidence that the paramedic did call the duty doctor to discuss Mrs C’s condition and to arrange review. The adviser considered that, in these circumstances, the decision to leave Mrs C at home was reasonable.

Summary

Miss C complained about the care and treatment her baby son received from the GPs at the practice. Miss C said she attended the practice a dozen times over a three-month period as her son was continually crying and was in great distress. Miss C raised a number of issues about her son’s care. She said that the GPs at the practice unreasonably failed to listen to her concerns about her son’s health. She said that they failed to ask relevant questions which might have helped get to the bottom of her son’s problems sooner. She also said that they did not recognise when they were out of their depth and needed to refer her son to more specialist medical staff. Miss C said that eventually a referral was made to the Royal Hospital for Sick Children, where severe reflux and colic was diagnosed as the cause of her son’s symptoms.

We obtained independent medical advice on the complaint from a GP adviser. The adviser said that the GPs at the practice listened to Miss C’s concerns and tried reasonable medication options. The adviser said that, when there was no evidence of consistent improvement, they arranged specialist referral to a dietician and a paediatrician (a doctor dealing with the medical care of infants, children and young people). The adviser said that the practice’s response was reasonable, referral occurred early on in the consultation history and there was no evidence of delay in referral.

The adviser found no evidence that the GPs failed to ask relevant questions which might have helped diagnose Miss C’s son’s medical problems sooner, or that the GPs treated him beyond their competencies. The adviser also indicated that the GPs acted in accordance with relevant national guidelines and Lothian NHS board’s policy.

Summary

Mr C complained to us about his care and treatment during an assessment for psychological therapy. He was seen by a junior clinical psychologist at St John's Hospital to identify what form of treatment he might be suitable for. However, the psychologist was concerned about some of the issues he raised, and referred Mr C for a psychiatric review. Mr C was seen by a junior psychiatrist later that day, and had a home visit the following day from two psychiatric nurses. He was also seen the next day by a consultant psychiatrist. The consultant was satisfied that, while Mr C had disturbing thoughts, he did not have any plans to act on them, and was fully in control of his behaviour. The consultant therefore discharged him from psychiatric services, but noted his referral for psychological treatment. Mr C said that this succession of different assessments by various professionals had been distressing, and had not been necessary.

We took independent advice from a medical adviser who is a psychiatrist. The adviser was satisfied that, given the issues raised by Mr C during his initial consultation, it was reasonable for the psychologist to refer him for psychiatric review. The adviser said that the initial psychiatric consultation had covered some of the same issues as the psychologist had, but in greater detail. Overall, they considered that this consultation was reasonable. They noted the need for some assessments to be carried out over a number of days to assess fluctuations in symptoms. They considered the visit by psychiatric nurses to have been reasonable. They were satisfied that the consultation with the consultant psychiatrist had been reasonable, and had appropriately considered the stability of Mr C’s mental health.

We noted the distress that this assessment process had caused Mr C. However, given the assurances of the adviser, we were satisfied that this process was reasonable, and did not uphold the complaint.

Summary

Mr C, who is an advice worker, complained on behalf of Mr A about the care and treatment he received at the Royal Infirmary of Edinburgh's A&E department, when he injured his shoulder. In particular, Mr A maintained that the hospital failed to carry out a proper assessment of his injury, and that they delayed in offering follow-up appointments.

During our investigation, we took independent advice from a consultant in orthopaedic and trauma surgery. We found that the treatment given to Mr A was reasonable and appropriate. The advice we received was that there was no evidence the hospital had failed to carry out a reasonable medical assessment of Mr A's injury. We found that the injury was diagnosed by A&E in a reasonable manner and he was appropriately referred for further specialist assessment and management. We also found no evidence that there was any delay in the follow-up appointments for his injury.

Summary

Mr C was diagnosed with attention deficit hyperactivity disorder. To help with his symptoms, he was started on a drug regime which was changed twice after his condition had been reviewed. However, Mr C said that he had not found any of the treatment he had been given particularly helpful, and he had continuing problems sleeping and concentrating. He questioned whether the care and treatment he received had been appropriate. He also complained that, since his diagnosis, the board had not taken reasonable steps to keep him informed. However, in responding to his complaint, the board said that he had been treated reasonably. While they acknowledged Mr C's concerns about communication, they said that his doctor always allowed 30 minutes for consultations to allow patients to raise questions.

We took independent advice from a consultant psychiatrist. We found that Mr C's care and treatment was all reasonable and in accordance with national guidance, as he was regularly reviewed and his medication was changed after reporting that his symptoms were not being helped. He had had the support of community psychiatric nurses and occupational therapists. Although Mr C considered that he had not been kept informed, there was evidence to show that his condition and drug therapy had been discussed with him. On this basis, his complaints were not upheld.

Summary

Miss C said that she had attended the Early Pregnancy Clinic at Raigmore Hospital as she was considering having a medical termination of her pregnancy. She had experienced bleeding and was concerned that she was going to miscarry. She was unhappy that the consultant had told her to take the contraceptive pill, and that she had to return the following day for a medical termination of her pregnancy. Miss C continued to suffer from pain. She attended her GP, who told her not to take the contraceptive pill and that she would probably miscarry without medical intervention. Miss C did not return to the clinic but subsequently attended her GP. The GP arranged for a pregnancy test which proved to be negative. Miss C felt that it was inappropriate for the consultant to have ordered her to take the contraceptive pill.

We took independent advice from a nursing adviser. The adviser said that the medical record of Miss C's attendance at the clinic was detailed. It contained information regarding the plans for a medical termination of her pregnancy, and confirmed that Miss C was advised to seek medical advice if she should have additional bleeding or pain. The adviser felt that in such situations it would also be appropriate for a consultant to discuss family planning matters such as contraception. We did not uphold the complaint.

Summary

Mrs C said that she had moved to a new GP surgery, where her symptoms had been quickly diagnosed as due to hyperthyroidism (excess thyroid hormone). Mrs C then complained to her former GP practice that she had reported the same symptoms to them for the past two years but they had failed to reach the true diagnosis. She complained that she may have been prescribed inappropriate medication.

The practice maintained that they had provided appropriate treatment based on the symptoms reported at the time. They apologised for the failure to order a set of blood tests on one occasion and said this was caused by an administrative failure. They said that it was not possible to say that hyperthyroidism was present at that time.

We sought independent advice from a GP adviser. The adviser considered that, other than the failure to carry out specific blood tests on one occasion, the practice had performed appropriate investigations in an effort to reach a diagnosis. The symptoms which Mrs C had shown during the period were not classically suggestive of hyperthyroidism. The adviser did not think it was a failure that the GPs at the practice were not alerted to a possible alternative diagnosis. We did not uphold the complaint.

Summary

Mr C complained that the treatment provided to him for his shoulder injury was unreasonable. In particular, he said the health centre had only prescribed him pain relief, and had not arranged for him to have a scan or referred him for physiotherapy.

We found that Mr C had been assessed by a doctor several times due to his shoulder pain, and that medication for his pain had been prescribed. We took independent advice from a GP adviser on whether the treatment provided to Mr C was reasonable. The adviser noted that Mr C had indicated he had muscle pain but there were no concerns about swelling, bruising or restricted movement. The adviser explained that symptoms like these would have indicated trauma or a fracture. As Mr C did not have those symptoms, the adviser considered it was reasonable for the doctor to treat Mr C's shoulder pain with painkillers. The adviser also said that referral to a physiotherapist was not necessary because Mr C had a full range of movement in his shoulder joint. The adviser also said a scan was not necessary because Mr C did not have symptoms to suggest he had a fracture.

In light of the evidence available, we did not uphold Mr C's complaint.

Summary

Mrs C complained on behalf of her sister (Miss A) about care received from her GP practice on two occasions. Mrs C complained that the practice did not thoroughly investigate Miss A's symptoms and did not provide reasonable treatment.

We took independent advice from a medical adviser. The adviser said that, based on the consultation notes, the care Miss A received was of a reasonable standard, and we did not uphold the complaint.