Not upheld, no recommendations

Summary

Mr C complained about the way he was treated by an ambulance crew who attended his home following a fall. He felt that the crew had handled him badly, and said that they did not fit a neck brace or transport him to the ambulance using a stretcher. On arrival at hospital it was established that Mr C had suffered a fracture of the second vertebra. The board explained that the crew had carried out a thorough assessment and could not detect any tenderness to the vertebrae of Mr C's neck or back, and there were no signs of nervous system damage. There was some mild tenderness on the left side of the neck but this was over the soft tissue area. Current UK guidelines say immobilisation is not required if there is no central spinal tenderness. The crew decided there was no requirement for a neck brace based on the symptoms reported, and no detectable signs of spinal injury at the time.

We sought independent advice from a medical adviser with experience in the training of paramedics. The adviser had no concerns about the actions of the ambulance crew, and was satisfied that they had acted in accordance with the guidelines concerning the treatment of patients with neck and back injuries.

Summary

Ms C complained that her GP practice had failed to diagnose her or refer her appropriately, despite consistent reports of stomach pain. This pain persisted until she was diagnosed with Helicobacter infection (Helicobacter pylori is a germ that can live in the stomach), and it was successfully treated. Ms C said she felt she had been ignored and treated with a lack of respect. Ms C added that, even once Helicobacter infection had been diagnosed, she felt the practice had not treated her within a reasonable time-frame.

We took independent advice from one of our GP advisers. The advice received was that the practice had followed national guidelines in its attempts to diagnose and treat Ms C for the pain she was experiencing. The practice performed the appropriate tests on Ms C and it was noted that, on occasion, she had declined medical advice and declined appropriate referrals, which would have speeded up her diagnosis.

On the basis of the advice received, we found that the practice had acted reasonably and that they had not delayed in referring Ms C for specialist opinion.

Summary

Mrs C complained about the care her late daughter (Miss C) received from her former GP practice between January and August 2011 after Miss C was diagnosed with a brain tumour in July 2012. Mrs C was concerned that Miss C was misdiagnosed with depression and, given that her symptoms (headaches, dizziness, tiredness and dilating pupils) were getting progressively worse, she should have been referred for a brain scan. Mrs C also provided evidence to show that Miss C had been unwell at college and had attended another medical facility.

We took independent advice from one of our medical advisers who is a GP. Based on their advice, we found that the initial diagnosis of vertigo was reasonable based on the symptoms of dizziness and abnormal eye movements. It was also noted that Miss C had described symptoms of anxiety which were explored by the practice, and the reasons for this were plausible. We did not find evidence in any of the records made of the eleven GP consultations, the records made by the college, or medical facility, that Miss C had reported suffering from headaches or that her condition was getting progressively worse. We found that Miss C's symptoms were not consistent with the symptoms of brain tumour set out in the relevant Scottish guidelines for referring patients for urgent assessment (such as for a brain scan). We concluded that this was a tragic case where Miss C's symptoms were not clearly typical of a brain tumour.

Summary

Mrs C complained about the pregnancy care she received from Raigmore Hospital. She said that the hospital failed to perform basic medical tests and that there was an inappropriate evaluation of her health which resulted in her pregnancy loss. Mrs C had a past history of thyroid problems and she complained that the management of this problem had been unreasonable. Mrs C also complained that no examination was carried out after her pregnancy loss to make sure everything was all right.

We took independent advice from a consultant obstetrician and gynaecologist. Our investigation found that overall the care and treatment given to Mrs C was reasonable, including the care and treatment Mrs C received when she attended the hospital with bleeding. The advice we received was that the hospital had also reasonably managed Mrs C's thyroid levels and there was no evidence that the loss of her pregnancy was caused by her thyroid condition or its treatment. We were also satisfied that, as Mrs C's pregnancy loss had occurred abroad, the hospital had not been aware of the situation until they contacted Mrs C when she missed a number of appointments. When responding to Mrs C's complaint, the board offered a further appointment to discuss what further investigations were appropriate at that time. In light of our findings, we did not uphold Mrs C’s complaint.

Summary

Mrs C had a hysterectomy (surgery to remove the womb) for a fibroid uterus at the Royal Alexandra Hospital. She said she then suffered an infection, was in severe pain, and had bladder problems. Mrs C was discharged home and later visited her GP who gave antibiotics for a urine infection. The following month, Mrs C attended a follow-up appointment at the hospital and was diagnosed with a vesico-vaginal fistula (an abnormal opening connecting the vagina to the urinary tract). She had to have further surgery to repair it. She was dissatisfied with her treatment and that a fistula had occurred, which had a very detrimental effect on many aspects of her life. Mrs C complained that the fact that she had suffered a vesico-vaginal fistula should have been discovered while she was an in-patient, and she should not have been discharged given her condition.

We took independent advice from a medical adviser. We found that the post-operative care and treatment provided was reasonable, as was the decision to discharge Mrs C, and that it was also reasonable to assume that the fistula developed as a later complication.

Summary

Mr C complained that the board failed to prescribe him specific medication for his drug addiction, and that his drug worker did not listen to his concerns.

We looked at Mr C’s medical records, and we took independent advice from one of our medical advisers. We found that the prison health centre kept detailed records of consultations with Mr C, and that they took his state of health into account when deciding not to prescribe him the specific medication he wanted. The records confirmed that assessments carried out by Mr C’s drug worker were appropriate. We concluded that the prison health centre’s actions were reasonable in the circumstances, and that the care provided by them was of a reasonable standard. We did not uphold Mr C’s complaint.

Summary

Miss C complained to the medical practice because she said the doctor had inappropriately told her mother (Mrs A) at a consultation that she had been diagnosed with dementia. Miss C said the doctor repeated the diagnosis of dementia to both herself and her father in further phone calls. However, it was confirmed that Mrs A did not have dementia. The doctor denied telling Mrs A and her family that she had been diagnosed with dementia. Instead, the doctor said she advised that there was a possible diagnosis.

Having reviewed the related medical information, the evidence available suggested dementia was being explored as a possible diagnosis and at no point was it confirmed as having been diagnosed. We did not see any evidence to suggest that the doctor, or any of the other clinicians involved in Mrs A's case, had confirmed a diagnosis of dementia. Therefore, we did not uphold the complaint.

Summary

Mrs C had been receiving medication prescribed by her medical practice for around ten years. However, the practice reviewed her medication and decided to stop it. Mrs C complained to us about the decision to stop her medication and the practice’s response to her complaint.

We looked at the practice’s complaints file and Mrs C’s medical records, as well as taking independent advice from one of our GP advisers. Relevant guidance stated that medical practices should review medication periodically. We found that the practice had done so, while also taking advice from appropriate specialists. In addition, the practice had offered Mrs C an alternative, which was to receive her medication on a private prescription.

Although the practice’s response to Mrs C’s complaint could have provided some additional information, it dealt with the key point of why they would no longer prescribe the medication to her, which we decided was reasonable in the circumstances. We did not uphold Mrs C’s complaints.

Summary

Ms C complained about the care she received when she attended A&E at Crosshouse Hospital. She also complained about the care she received from the out-of-hours service at Ayrshire Central Hospital. Ms C presented with abdominal pains and was diagnosed with a viral infection. She was prescribed painkillers and anti-sickness medication, and was then discharged. She was later diagnosed with acute appendicitis (inflammation of the appendix) and underwent surgery to have her appendix removed.

We sought independent advice from one of our advisers who specialises in emergency medicine, and one of our GP advisers. They both noted that appendicitis is difficult to diagnose as the symptoms it often presents with are similar to many other, more common, conditions. The views of the advisers were that, on both occasions, Ms C was examined thoroughly and given the correct advice and medication based on her symptoms at the time. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the standard of treatment her father (Mr A) received from the practice in the final months of his life. Mr A had been diagnosed with bladder cancer in 2012 and had received radiotherapy treatment for this. He remained under the care of a urologist (doctor who specialises in disorders of the urinary tract) and his cancer remained under control until January 2013. At that point, Mr A’s condition deteriorated, and he experienced weight loss and significant pain. At a follow-up urology appointment in August 2013, he was found to have developed untreatable cancer that had spread to his bones and spine. He was admitted to a hospice for palliative care (care provided solely to prevent or relieve suffering) shortly afterwards.

Mrs C complained that her father’s blood sugar levels were not adequately monitored, and that his pain was not managed effectively by the GPs at the practice between early 2013 and September 2013.

We obtained independent advice from one of our medical advisers. We accepted their view that the practice had managed Mr A’s pain in line with national guidance for the control of pain in adults with cancer. We acknowledged that Mr A had experienced significant pain which would have been distressing for him and his family. However, we recognised that pain management in cancer patients can be complex, and it is not always possible to achieve immediate or complete pain relief.

We were also satisfied that Mr A was referred for appropriate specialist investigation and that the practice referred him to the hospice appropriately.