Not upheld, no recommendations

Summary

Mr C attended the hospital's minor injuries unit, having injured his knee while playing football. He complained that the nurse practitioner (a specially qualified senior nurse) whom he saw did not assess the injury adequately. We took independent advice from our medical adviser, who considered that the nurse practitioner had acted appropriately. For example, her diagnosis of a sprain of his lateral collateral ligament (one of the four main ligaments in the knee) was appropriate based on her findings; she arranged follow-up with a physiotherapist for the following week; and she gave appropriate advice about the use of pain relief, ice and crutches in the meantime. Mr C considered he should have been x-rayed, but the adviser explained that there were no grounds for x-ray, and that x-ray would not have shown damage to his ligaments or cartilage.

Summary

Miss C complained about three consultations with three of the GPs at her medical practice as she did not feel the questions asked by the GPs had been appropriate. We took independent advice from one of our GP advisers, who considered that the questions and actions of Miss C's GPs had been thorough and appropriate. For example, when Miss C reported an episode of self-harm, the GP appropriately asked, amongst other things, about her support network at home.

Summary

Ms C complained that her mother (Mrs A) had not been provided with a reasonable standard of treatment by her medical practice. She felt the practice had unreasonably handled much of Mrs A's contact over the phone and, following hospital investigations and tests, that the practice had failed to take the appropriate steps.

We considered whether Mrs A's treatment was reasonable in the circumstances at the time. We took independent advice from one of our medical adviers, who explained that managing contact over the phone is common practice, and that there was nothing to indicate it had been done unreasonably in this case. Our adviser also said that it was the hospital doctor's responsibility to explain hospital test results and, in any event, the practice had not misinterpreted hospital correspondence as Ms C felt they had.

Although we took Ms C's concerns into account and recognised her strength of feeling, the medical advice we received was that the records did not indicate that Mrs A's treatment had been unreasonable. We did not consider the evidence indicated that Mrs A's practice had failed to provide her with a reasonable standard of medical treatment, and so we did not uphold this complaint.

Summary

Mr C complained that the operation on his foot performed by the board at St John's Hospital to help his dropped foot (a muscular weakness or paralysis that makes it difficult to lift the front part of the foot and toes) was not carried out to a reasonable standard. Mr C said that, prior to the operation, he had restricted up-and-down movement in his foot but full side-to-side movement, and he tripped and fell regularly because of his foot. Mr C said that after the operation, he had no movement either way in his foot, and he tripped and fell on almost a daily basis. Mr C also complained that there was an unreasonable delay in him receiving physiotherapy treatment.

We obtained independent medical advice on Mr C's complaint from a consultant orthopaedic and trauma surgeon, with special interest in foot and ankle surgery. Our adviser said that the procedure failed in Mr C's case, but the documentary evidence suggested that Mr C was advised that this could happen. Our adviser explained that a standard technique was used during Mr C's operation, and the treatment provided did not seem unreasonable.

The evidence showed that Mr C was referred for physiotherapy treatment six weeks after surgery. Our adviser said there was no significant avoidable delay in Mr C's physiotherapy treatment and that, given the failure in his surgery, the apparent delay in physiotherapy would not have made a significant difference to the outcome in his case.

Summary

Mrs C complained that her husband (Mr C), who suffered from multiple sclerosis, had received inadequate care and treatment from the District Nursing Team. He had developed a pressure ulcer on his back, and Mrs C said she believed that had she not insisted her husband phone his GP, then the pressure ulcers would have continued to deteriorate. Mrs C said that when he examined the pressure ulcer, the GP had been surprised at how bad it was, and her husband had been admitted for hospital treatment. Mr C had spent an extended period in hospital with a serious infection, which she attributed to the poor care he had received at home.

The board said that the nurses treating Mr C had made a number of suggestions to him that would have helped to treat his pressure ulcer, but he had refused them. The board said that successful treatment of pressure ulcers was dependent on the patient following the advice of staff, and that treatment would be limited if this did not happen. Nurses had attempted to obtain a medical opinion prior to Mrs C's contact with the GP, but Mr C had refused this.

We took independent advice from our nursing adviser, who said that the nursing record was appropriately completed and showed that a good standard of wound care had been provided. The adviser said that the wound had improved at times and then deteriorated, and it was reasonable for the nurses to persist with home treatment. Our investigation found that on the basis of the advice received, Mr C had been provided with a reasonable standard of care and treatment.

Summary

Mr C complained to us about the apparent lack of assessment of his late mother (Ms A) for NHS Continuing Care funding. Ms A was admitted to hospital from a care home with a broken ankle. However, she was not able to fully rehabilitate, and was subsequently transferred to a nursing home for ongoing care. Mr C complained that the board did not fully assess whether Ms A was eligible for NHS Continuing Care funding when she was discharged from hospital, or during her time at the nursing home.

We took independent advice from a consultant geriatrician (a doctor specialising in medical care for the elderly) on the assessment of Ms A's care needs when she was discharged from hospital, and on the evidence of her care needs while she was in the nursing home. Our adviser said that Ms A's care needs had been appropriately assessed before her discharge, and she had been given appropriate opportunities to rehabilitate prior to discharge. He said that her care needs clearly did not meet the criteria for NHS Continuing Care, and that this was so obvious that it had not been documented. Given subsequent events, he noted that it would have been helpful if it had been documented, but he considered this to be a minor issue. He also noted that, from the evidence available, Ms A was not eligible for NHS Continuing Care at any time during her stay in the nursing home.

In our decision we noted that the board had provided information which showed that they had made a similar assessment to our adviser. However, this information had not been provided to Mr C. We were critical of this, though overall we were satisfied that the board had appropriately assessed Ms A's care needs, and that it had been reasonable not to document a full NHS Continuing Care assessment.

Summary

Mrs C complained about the care and treatment provided when she underwent surgery at Wishaw General Hospital to remove several adhesions (where organs are stuck to each other and/or the pelvic wall).

Mrs C had surgery. The following day she became unwell and a CT (computerised tomography - a special type of x-ray using computerised images) scan was done to eliminate the possibility that her urinary tract had been damaged during surgery. No evidence of this was seen. When her condition continued to deteriorate and bilious fluid (from the digestive system) was seen in her surgical drain, she underwent further surgery three days after the first operation. A perforation of the bowel was discovered and repaired. Mrs C's condition continued to deteriorate and she was operated on again three days later. A second perforation was found, and Mrs C's appendix and part of her bowel were removed. Mrs C was admitted to the adult critical care unit following the third operation and spent two months in hospital in total. She then had a six-month recovery at home.

Our investigation included taking independent advice from three of our medical advisers: a gynaecologist (specialist in disorders of the female reproductive system); a general surgeon; and a radiologist (specialist in imaging). No evidence of any failures was found in the original surgery, or the post-operative care. Although the CT scan did not reveal the perforations, the radiologist stated that this was reasonable in the circumstances. Similarly, the general surgeon considered that it was appropriate to have repaired only the visible perforation at the second operation. Inspecting the whole length of the bowel would have needed more invasive surgery and risked creating more adhesions. The fact that Mrs C required a third operation was not, in the view of the advisers, due to any failings in Mrs C's care and treatment.

Summary

Ms C complained that the board had not managed her Individual Patient Treatment Request (IPTR) panel appropriately. She had been obliged to make an IPTR in order to obtain a drug which helped control the symptoms of her multiple sclerosis (MS) as the drug was not licensed for prescription in Scotland. Ms C had been prescribed a free trial of the drug and said her neurologist supported the prescription of it once the trial had finished.

She said there had been undue delay in arranging her hearings and that the board had not provided her with information about the panel's decisions appropriately. Ms C also complained that the panel had failed to consider the evidence she had presented appropriately. Ms C said this had caused her considerable distress and worsened her MS.

We took independent advice from one of our medical advisers who said he believed the panel had been conducted appropriately. He noted there were delays in the submission of the original IPTR request, and further delays caused by the departure from the board of Ms C's original neurologist. The board had acted to mitigate these delays, but were not responsible for them.

Our investigation found the board had arranged the IPTR process appropriately. Although Ms C had been successful on appeal, this was due to a change in Scottish Government guidance, rather than a reassessment or reinterpretation of the evidence by the IPTR Panel. The substantial delays in the IPTR process were due to the actions of Ms C's neurologists and the delays in submitting documents. We did not find the board failed to provide Ms C with information about the panel's decisions.

Summary

Mrs C complained about the delay in diagnosing her late husband (Mr C)'s cancer. Mr C suffered intermittent left-sided pain after a fall and attended the practice on numerous occasions over the next two years. Although Mr C had a number of tests and investigations, he was not diagnosed with cancer until a scan over two years after the fall.

The practice apologised that it took so long to diagnose Mr C's cancer, but explained that his case was a challenging one and diagnosis was difficult. They said Mr C did not have symptoms suggesting a serious underlying problem until about two years after his fall, and also did not start losing weight until after this. While they immediately referred Mr C to the colorectal service (specialising in the colon and rectum), it took three specialist referrals (two to the colorectal service and one to the gastroenterology clinic (specialising in the digestive system) before Mr C's cancer was diagnosed about five months later.

After taking independent medical advice, we did not uphold Mrs C's complaint. We found that Mr C's symptoms did not suggest a serious underlying problem until about two years after his fall. We found the practice then acted appropriately and timeously in referring Mr C to specialists for investigations. Our adviser explained that Mr C's symptoms first suggested an underlying colorectal problem, and it was appropriate to refer Mr C for colorectal investigations and a colorectal clinic review. However, when nothing was found but Mr C's problems persisted and he experienced ongoing weight loss, the practice acted appropriately in referring him to the gastroenterology clinic.

Summary

Mr C complained that the board had not been able to evidence or explain the decision to regard his mother-in-law as not suitable for continuing care. There had been protracted correspondence between Mr C and the board, however, he remained of the view that the board could not document their decision.

Our investigation, which included taking independent advice from one of our medical advisers, found that Mr C had been provided with all the available medical records relating to his mother-in-law. These medical records showed that Mr C had been invited to participate in the meetings between medical and social work staff at which they decided to transfer his mother-in-law to social care. Mr C had declined to participate in these and declined to pursue legal guardianship for his mother-in-law. The guidance in force at the time did not require the board to provide Mr C with a written decision or reasons for their decision. We found the evidence showed the family were aware that Mr C's mother-in-law would be transferred to social care and that they understood the decision. There was no evidence they had objected to it at the time.