Not upheld, no recommendations

Summary

Ms C, an advocate, complained on behalf of her client (Mr A) about the infection control procedures used by Raigmore Hospital when he had a total hip replacement.

When Mr A attended the pre-operative assessment when he was first scheduled for surgery, it was found that he had an in-growing toenail and surgery was delayed until this was treated. When the operation was re-scheduled, additional testing was undertaken to establish if Mr A had any on-going underlying infection and all the tests were negative. The operation took place and during the surgery samples of fluid and tissue were taken for laboratory analysis and Mr A was also given precautionary antibiotics (drugs used to fight bacterial infections). The samples taken were positive for infection which proved very difficult to eradicate, resulting in a long recovery period for Mr A, including that his hip replacement implant had to be removed while the infection was treated and then a new implant put in.

We took independent advice from one of our medical advisers who was satisfied that the board's infection control procedures were compliant with national guidance and that these procedures were followed appropriately. The adviser commented that no testing can fully eliminate the possibility of deep-seated infection and the adviser was of the view that the infection present in Mr A's hip during his operation had probably originated from his previous in-growing toenail. The adviser also considered that the fact that Mr A was a diabetic contributed to the lengthy recovery period as diabetics do not fight infections as quickly as non-diabetics.

Summary

Ms C had been referred to a hospital specialist by the practice as she had reported having blood in her sputum (spit). She was told that she had developed terminal cancer. Ms C complained to the practice that she had reported the same symptoms to them for a number of years and that they had only prescribed antibiotics for a burst blood vessel in her throat.

We took independent advice from a GP adviser and found that Ms C had a long history of chronic blood streaked throughout her sputum and that it had previously been investigated by specialists. The presumed diagnosis was inflammation of Ms C's pharynx (back of throat) aggravated by a chronic cough. The plan was that further investigations were not required unless there was a significant change in her symptoms or that new symptoms had developed. When a GP arranged a further x-ray for a possible diagnosis of lower respiratory infection, it was noted that Ms C had a lesion in her chest which was not present in a previous x-ray. This resulted in a further referral for specialist investigations and it was then discovered that Ms C had a lung tumour. There was no evidence to suggest that there had been a previous significant change in Ms C's symptoms which the practice had not taken action on and, when it became clear that the situation had altered, timely and appropriate action was taken in order to reach a definitive diagnosis. We did not uphold the complaint.

Summary

Mr C complained that his pain medication was stopped unreasonably following a medication spot check (a check carried out by prison staff to ensure a prisoner has the correct type and amount of medication prescribed to them). Mr C also complained he had not been provided with reasonable alternative medication.

We took independent advice from one of our GP advisers. The adviser was satisfied that as Mr C had failed the medication spot check it was reasonable to have removed and stopped the prescription of the medication. The adviser was also satisfied the alternative medication provided was appropriate. For these reasons, we did not uphold Mr C's complaints.

Summary

Mr C complained that the prison health centre's handling of his medication for nerve pain was unreasonable. He said he had been prescribed pain medication but when he was admitted to the prison, his prescription was stopped.

We obtained a copy of Mr C's medical records and we also sought independent advice from one of our GP advisers. Mr C's medical records confirmed that the prison health centre carried out an assessment prior to taking the decision to stop his medication. Our adviser said the assessment was appropriate and the decision to stop Mr C's medication had been taken in line with the relevant guidance issued by the General Medical Council.

In light of the evidence available, and given the view of our adviser which we accepted, we did not uphold Mr C's complaint.

Summary

Ms C complained on behalf of her mother (Mrs A), who lived in a nursing home. Ms C complained about a home visit by an out-of-hours GP, and that they were unwilling to provide a second home visit to give a second opinion on the GP's assessment.

Ms C was concerned that her mother had a chest and urine infection, and requested a GP home visit, via NHS 24. A GP assessed Mrs A and found no signs of infection. The following evening Ms C again requested a GP home visit, and another GP visited Mrs A at the nursing home. Following a full assessment and discussion with the nursing home staff and with Ms C, the GP confirmed that there were no signs of infection and no need for treatment. Later that evening Ms C phoned NHS 24 again, and requested a second opinion of her mother, as she had concerns that her mother was distressed. NHS 24 referred Ms C on to the out-of-hours service, where a GP explained that they would not be able to provide a second opinion as the GP had made a full assessment earlier that evening.

We took independent advice from one of our GP advisers who said that the second home visit (the focus of Ms C’s complaint) was thorough and reasonable. Our adviser said that the observations indicated that there was no sign of infection, and the GP's conclusions that there was no need for treatment or hospital admission were appropriate. Our adviser also confirmed that it was not the role of the out-of-hours service to provide a second opinion. On this basis, we did not uphold the complaint.

Summary

Ms C complained her medical practice had failed to properly diagnose her pelvic infection, resulting in a long stay in hospital and an inability to have children. Ms C said her symptoms had not been properly investigated by the practice and that she had not been properly referred when the practice was unable to identify the cause of her problems.

We took independent advice from one of our medical advisers. The adviser said that Ms C had presented with complex symptoms, from which a clear diagnosis could not be provided. The adviser said that the care and treatment Ms C had received had been appropriate and that the practice had responded reasonably to her reported symptoms, including referring her appropriately to specialists for examination.

Our investigation found Ms C had received a reasonable and appropriate standard of care and treatment from the practice.

Summary

Mr C complained that the board’s prison health centre doctor unreasonably stopped his pain medication for a long-term knee injury, on the basis of alleged intelligence that Mr C misused another pain relief medication he had previously been prescribed. Mr C was concerned that the doctors at the health centre would not give him painkillers because of someone else’s say so, with no concrete proof or evidence and that in the meantime he had been left without effective medication.

We obtained independent medical advice on Mr C’s complaint from a GP. We also sought advice from the office of the Chief Medical Officer (CMO) on disclosure of information/confidentiality.

Our adviser noted that Mr C’s records indicated that the decision to stop his co-dydramol and not replace it with co-codamol was made, at least in part due to reported information regarding past drug misuse. However, our adviser explained that the pain guideline followed by the board suggested that there was no evidence for the continued prescribing of opioid based drugs such as tramadol, co-codamol and co-dydramol in patients with unexplained or persistent pain. Our adviser said it was, therefore, not unreasonable for the board to reduce and then stop Mr C’s tramadol or to stop his co-dydramol and not prescribe co-codamol in its place. Our adviser noted that the doctor prescribed appropriate alternative pain relief treatment for Mr C. We were satisfied that Mr C’s pain relief was appropriately managed by the doctor and the medication prescribed was appropriate for Mr C’s condition.

In terms of the disclosure of the information about past drug misuse, the doctor confirmed he did not disclose the information to Mr C at the time he made the decision to stop his opioid based medication. Based on the advice received from the office of the CMO, we were not critical of the prison health centre’s actions in this regard.

Summary

Mr C complained about the care and treatment that his late mother (Mrs A) received from her GP. Mrs A had attended her GP with symptoms of breathlessness and the GP arranged an x-ray, took a blood sample and prescribed antibiotics. The x-ray result was reported as normal. Mrs A died four days after the consultation from a pulmonary embolus (a clot in the blood vessel that transports blood from the heart to the lungs) caused by deep vein thrombosis. Mr C felt that the GP had taken insufficient note of his mother's breathlessness and should have taken urgent action to establish a further diagnosis as the x-ray had been reported as clear.

We took independent advice from a GP adviser and found that Mrs A's GP had acted reasonably by conducting appropriate investigations in order to establish a diagnosis and that there were no signs that Mrs A would suffer a pulmonary embolus a few days after the consultation. We also found that there was no delay by her GP in their consideration of the x-ray result. We did, however, note that the GP's record-keeping was not as thorough as it could have been and that the GP should reflect on this.

We did not uphold the complaint.

Summary

Mrs C complained to the university that her son was not appropriately supported by them when he decided to withdraw from his masters course and complete a postgraduate diploma instead. She believed he was entitled to a refund of fees but the university refused his refund application. We considered the policies of the university and their investigation of her concerns. We found that the university had reasonably investigated and responded to the concerns, and had followed their policy in deciding not to make a refund.

Summary

Miss C, a solicitor, complained to us on behalf of her client (Mr A) about how the university had compensated him for disruption to his exams. Mr A had chronic exam anxiety. He had been assessed by the university's disability service and had been found to require a separate room for exams. He was also allowed an extra 15 minutes for each hour. The invigilator for one of Mr A's exams had been cancelled in error, which meant that the exam had started late. Mr A had been allowed the time for which the exam had been delayed plus an additional 15 minutes to compensate him for the disruption. We found that this had been reasonable and did not uphold Miss C's complaints about this.

In a subsequent exam, the invigilator had been ill and had collapsed. He subsequently apologised to Mr A for the incident and offered him some extra time, but did not specify how much, as Mr A said this was not necessary. Miss C complained that the university had failed to offer Mr A any further compensation for this. We did not consider that this was unreasonable and we did not uphold Miss C's complaint about this matter.

Finally, Miss C complained that the university did not follow procedure and refused to consider evidence of special circumstances outside of the current academic year when considering Mr A’s performance at his progress committee meeting. There was no evidence that the progress committee did not follow procedure in considering Mr A’s performance at the meeting and it was for them to decide what information they required. Mr A could have submitted an appeal if he considered that they had failed to take account of medical or other adverse personal circumstances. We did not uphold these aspects of Miss C's complaint.