Not upheld, no recommendations

Summary

Mr C complained that his prison health centre revealed information about his health to Scottish Prison Service (SPS) staff. Mr C also complained about the board's response to his complaint.

We looked at the board's investigation, and at an SPS investigation that was carried out in partnership with the board. The investigations concluded that no member of board staff was involved in revealing information about Mr C and, in the absence of any evidence to the contrary, it was not possible to dispute this. We found that the board's investigation of, and response to, Mr C's complaint were reasonable in the circumstances. We did not uphold Mr C's complaints.

Summary

Ms C complained about the care and treatment provided by her former dental practice in relation to the fitting of a bridge (a device to replace a missing tooth or teeth).

Ms C complained that the bridge had not been fitted properly and was loose from the start; that it did not match the colour of her other teeth; that she was not told that an existing crown would have to be removed to accommodate the bridge; and that the whole process had not been adequately explained to her.

Our investigation included taking independent advice from one of our dental advisers and a review of Ms C's dental records from her former and current dental practices. Our adviser was of the view that the care and treatment provided to Ms C was reasonable and appropriate. Ms C had attended the practice for a number of years and had difficulty with the teeth in question since 2004. The adviser was of the opinion that all treatment options had been discussed with Ms C and sufficient information had been provided to her to enable her to make fully informed decisions about her treatment.

Summary

Miss C complained that when she attended the out-of-hours service at the Royal Alexandra Hospital with chest pains the doctor diagnosed that she was suffering from flu-like symptoms. The following day the chest pains remained and she was admitted to hospital having suffered a heart attack. Miss C said that she had reported a family history of heart trouble and that she had had ECGs (electrocardiographs - tests to record the electrical activity of the heart) taken previously at the hospital. She felt the doctor should have taken note of this and conducted further tests.

We took independent advice from one of our GP advisers and determined that the doctor who saw Miss C when she attended the out-of-hours service had carried out an appropriate assessment based on the symptoms which were recorded. There was no indication from the medical records that Miss C had reported the previous ECGs or family history of heart problems. The symptoms which Miss C presented with were not indicative of a patient suffering a heart attack. We did not uphold the complaint.

Summary

Mr C complained that the board failed to monitor the steroid treatment he was receiving for his chest condition and its consequences. He said the lack of monitoring systems in place resulted in him developing cataracts; his adrenal glands (two small hormone secreting glands, one located above each kidney) no longer functioning; and in him developing osteoporosis (a condition that affects the bones, causing them to become fragile and more likely to break). Mr C also complained that when he emailed the board three questions about the side effects of steroids, the points he raised were never answered.

We obtained independent advice on the case from our medical adviser, a consultant in respiratory and general medicine. Our adviser said the information available suggested that the steroid treatment Mr C received was in line with both formal guidelines and established clinical practice throughout the UK. He explained that there was no universal agreement as to whether, or how, to monitor patients who were receiving steroids for bone loss and said the guidelines indicated that it was only when courses of treatment lasted three months or more that any form of osteoporosis screening or treatment needed to be considered. In Mr C's case, it appeared that his steroid was prescribed in short courses, suggesting that monitoring was not required.

Our adviser said he was not aware of any guidelines which suggested that monitoring for adrenal suppression (where the adrenal glands do not produce adequate amounts of steroid hormones) or cataracts was a necessary component of steroid therapy for adults. He also said it was not usual practice to screen patients with Mr C's chest condition needing short course steroid treatment for cataracts.

In terms of Mr C's three questions to the board, they acknowledged that osteoporosis, cataracts and adrenal suppression were known side effects of steroid therapy. They explained their policy on screening/monitoring for osteoporosis and adrenal suppression. While we feel the board could have commented on screening/monitoring for cataracts, on balance, we considered their response covered the main points in Mr C's email.

Summary

Ms C complained about the care and treatment she had received from the board. She felt she was discharged too promptly following minor surgery at Glasgow Royal Infirmary and, when she was readmitted to the Western Infirmary, that she was given inadequate medication. Ms C was also unhappy about her follow up care following her second discharge.

Our role was to assess whether Ms C's treatment was reasonable in the circumstances. We took independent medical advice which said that clinical staff had, on each occasion, followed the relevant guidance. Our adviser did not think additional steps should reasonably have been taken either time or that Ms C's medical outcome would have been different had she remained in hospital longer. He also had no concerns about Ms C's medication.

Although the adviser noted that many surgeons would have discharged Ms C to her GP practice without planned follow-up, the fact was that follow-up care had been planned for Ms C after she was discharged from the Western Infirmary. We took account her difficulties contacting staff to obtain this care (there had been an administrative error booking her appointments), but recognised that Ms C was ultimately seen at a follow-up appointment. The board also confirmed the steps they had taken as a result of Ms C's complaint and so, although we took this shortcoming into account, we did not consider that Ms C's care as a whole had been unreasonable. We did not uphold her complaint.

Summary

Mrs C complained on behalf of her client (Mrs B) whose late partner (Mr A) was treated in Dr Gray's Hospital and the Fleming Hospital. Mr A was admitted to Dr Gray's hospital after wandering from his home in a confused state. He was subsequently transferred to the Fleming hospital where he reported severe abdominal pain to Mrs B. Although Mrs B reported this to nursing staff, she conceded that she did not think they had heard her. Mrs C complained that Mr A's pain was not investigated by staff until the following day. She also complained that there was a delay in treating Mr A.

Mr A had previously been diagnosed with a duodenal ulcer (an ulcer in the first part of the small intestine). A doctor at the Fleming hospital considered that this may have perforated and arranged for Mr A to be transferred back to Dr Gray's hospital. A chest x-ray was carried out to check for free air in the abdomen which would indicate a perforated ulcer. No free air was identified and Mr A was diagnosed as having a chest infection. His condition was too severe for any invasive treatment so he was treated with antibiotics and fluids until his death the following morning.

We found no evidence of abdominal pain on the day that Mrs B raised this with the nursing staff. Whilst there was no record of her report to the staff, there was evidence of regular reviews of Mr A and his condition was reasonably stable. Once his abdominal pain was identified the following day, along with a marked deterioration of his condition, we were satisfied that staff took appropriate and timely action. We took independent advice from one of our medical advisers, who told us that the chest x-ray did show free air in Mr A's abdomen, however, we found that his treatment was not affected by this oversight, so we did not uphold the complaint.

Summary

Mr C complained to us that the board had unreasonably refused to give him braces when he entered prison. The prison dentist originally told Mr C that he could not have braces because his oral hygiene was poor. He gave Mr C advice about improving this. When Mr C's oral hygiene had sufficiently improved, the dentist took impressions of Mr C's teeth for study models in order that the models could be scored for the Index of Orthodontic Treatment Need (IOTN). However, both the dentist and an orthodontist considered that Mr C did not achieve the minimum score for orthodontic treatment on the IOTN and that he did not meet the criteria for NHS orthodontic treatment.

We took independent advice on the complaint from a dental adviser with experience in orthodontics. We found that if Mr C's oral hygiene had remained poor during orthodontic treatment, there would have been a risk of the development of decay and further damage to his teeth around the brace. Mr C was also given reasonable advice and the opportunity to improve his oral hygiene. Mr C's oral hygiene had subsequently improved, however, the impressions that were taken showed that he did not meet the criteria for NHS orthodontic treatment, as he did not achieve the minimum score for orthodontic treatment on the IOTN. Consequently, we found that it had been reasonable for the board not to give Mr C braces and we did not uphold his complaint.

Summary

Mr C complained because he said an addictions caseworker inappropriately shared information about him at an integrated case management (ICM) meeting. The board told Mr C that he had consented to information about him to be shared because he had signed a consent form. Mr C disputed that he had given consent.

We obtained a copy of the information sharing protocol (ISP) agreement drawn up between the Scottish Prison Service and the NHS. That document was prepared to support the regular sharing of personal information for patients who are in prison with a view to supporting their care and case management in prisons and their transition in and out of prison. The ISP confirms that the information being shared will be used to facilitate operational prison management, including ICM, and the ongoing management and review of a prisoner's health and social care. It confirms the information that can be shared includes clinical information and also states that, for the purposes of the protocol and the processes described in it, no consent will be required from service users. We also obtained a copy of the consent form Mr C signed which confirmed that he consented to participating in the ICM process and understood what the process involved and how the information gathered would be used and stored.

In light of the information available, we concluded that the caseworker shared information about Mr C in line with the ISP. In addition, Mr C signed a consent form. Therefore, we did not uphold the complaint.

Summary

Ms C complained that her dentist had failed to fit temporary crowns properly. As a result they had become detached shortly after fitting. Ms C said when she returned to the dental practice, she was made to wait for an hour, before being told to go home and come in later that day. When she attended again, she felt the dentist was unprofessional and unreasonable as she asked Ms C to leave the surgery and refused to provide her with the impressions that had been taken of her teeth.

We took independent advice from one of our dental advisers on the treatment provided to Ms C. We found that the treatment provided was well documented and complied with the appropriate national guidance. Our investigation found there was no evidence that Ms C had received inappropriate or unreasonable dental care.

Summary

Mrs C suffered a fall when she was on holiday and attended Arran War Memorial Hospital on two occasions over a four day period. The doctors who examined Mrs C on both occasions thought that she had suffered a musculoskeletal injury to her chest and that she had possibly broken a couple of ribs. They prescribed painkillers which did not resolve the pain. Mrs C then returned to her home area where it was found that she had suffered a punctured lung. Mrs C believed that the punctured lung should have been identified by staff at the hospital prior to her having to travel back home. We took independent medical advice which showed that the doctors who treated Mrs C at the hospital provided her with appropriate treatment (painkillers and advised to rest). There was no indication at that time that Mrs C had suffered a punctured lung and there was no requirement to carry out an x-ray. We did not uphold the complaint.