Not upheld, no recommendations

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.

Summary

Mrs C complained to us about the nursing care that her father (Mr A) received at the Royal Alexandra Hospital. We took independent advice on this complaint from a nursing adviser. We found that there had been some problems on the ward in relation to communication and drug administration. However, we found that the nursing care provided to Mr A had been reasonable overall, as were the arrangements made for his discharge. We did not uphold this aspect of the complaint.

Mrs C also complained that the board had not appropriately assessed her father for NHS continuing care (a package of care provided and solely funded by the NHS) when he had been discharged from hospital. She also considered that they had not dealt appropriately with her request for a review of the decision that her father was not entitled to NHS continuing care. We took independent advice on this aspect of the complaint from a medical adviser who is a consultant in acute medicine for older people and general medicine. We found that the initial assessment of Mr A for NHS continuing care and the subsequent reviews were all appropriate. Although some incorrect dates were used in the board's correspondence, and some of the documentation was not fully completed, we also found that the communication with the family had been reasonable overall. In view of this, we did not uphold this aspect of the complaint.

Summary

Mr C complained about the physiotherapy and orthopaedic care he received from Forth Valley Royal Hospital after dislocating his knee-cap. He said that staff ignored his on-going symptoms and that he should have had a scan of his knee to identify what was causing him persistent pain. He was concerned that a locum orthopaedic specialist had wrongly diagnosed a meniscal tear (damage to cartilage in the knee) rather than a loose fragment under the knee-cap.

We took independent advice on this case from two of our advisers, one of whom is a physiotherapist and the other a consultant orthopaedic surgeon. We found that the physiotherapy management of Mr C's injury was in accordance with guidance on managing patients who have dislocated their knee-cap for the first time.

Whilst the board said that it would have been appropriate for Mr C to have had a scan prior to surgery, we did not consider that the diagnosis of a meniscal tear was unreasonable given that loose fragment can have similar symptoms. Furthermore, both meniscal tears and loose fragments can be treated by the surgery that Mr C underwent. We also considered that it was reasonable to proceed to surgery without a scan given that Mr C's symptoms were not resolving and were affecting his ability to work.