Not upheld, no recommendations

Summary

Mr C complained about care and treatment provided to his daughter (Miss A) at Perth Royal Infirmary when she attended the eye clinic there. Mr C believed that her condition was misdiagnosed, and that the treatment prescribed may have aggravated her condition and led to her sudden death.

Mr C told us that Miss A was being treated by her GP for acute conjunctivitis. The common treatment is with antibiotic (drugs to fight infection) drops or ointment and in some cases also steroid (drugs to fight inflammation) drops or ointment. The GP prescribed an antibiotic only. When her condition worsened, Miss A went back to the GP and was referred urgently to the eye clinic. Miss A attended the clinic the following day and a specialist doctor there diagnosed marginal keratitis (MK - an eye condition), with a possible allergic reaction to the antibiotic prescribed by the GP. The specialist changed the antibiotic, added a steroid and arranged a follow-up appointment for a week later. Three days later, however, Miss A died suddenly. Mr C told us that he disagreed with the stated cause of her death. He was of the view that she had in fact been suffering from a more serious infective eye condition and that the treatment provided was not only wrong, but contributed to her death by increasing pressure and inflammation in the brain.

Our investigation included taking independent advice from one of our medical advisers, who was of the view that appropriate examinations and investigations were carried out and that Miss A had been correctly diagnosed with, and treated for, MK. The adviser said that although the two conditions have similar symptoms, sufferers of the more serious condition also experience other symptoms, which Miss A did not have. The adviser was, therefore, of the view that Miss A's diagnosis, care and treatment were reasonable, appropriate and timely and there was no evidence that these contributed to her sudden death.

Amendment to summary text

When it was originally published on 20 May 2015, the first sentence of the second paragraph read: Miss A was being treated by her GP for marginal keratitis (MK- an eye condition).

This has been amended to read: Mr C told us that Miss A was being treated by her GP for acute conjunctivitis.

The reference to ‘MK’ in the fifth line of the second paragraph has been amended to read marginal keratitis (MK – an eye condition).

4 June 2015

Summary

Mr C complained that the prison health centre had failed to change the dressing on his wound appropriately. In particular, he said his dressing should have been changed every day. In addition, Mr C was unhappy because the doctor did not assess his wound at an appointment and he said that was unreasonable.

We reviewed Mr C's medical record which confirmed that his dressing was changed frequently and his wound was assessed on a regular basis. We also took independent advice from one of our GP advisers, who advised that the decision on how to manage a patient's wound was determined by on-going clinical assessment and Mr C's wound was assessed as regular intervals. Our adviser also explained that nursing staff were responsible for the care and management of wounds. They said a doctor would be asked to prescribe an antibiotic if nursing staff felt the wound had become infected. In Mr C's case, his medical record confirmed a nurse had noted that his wound had become malodourous (offensive smelling) with increased swelling and because of that, Mr C was referred to the doctor who prescribed an antibiotic.

In light of the information available, and our adviser's view which we accepted, we were satisfied the prison health centre changed Mr C's dressing regularly which was appropriate. We were also satisfied that the doctor did not have to assess Mr C's wound at the appointment given a nurse had already done so. Therefore, we did not uphold the complaints.

Summary

Mrs C complained to us about the care and treatment her husband (Mr C) had received from the Royal Edinburgh Hospital before his death. She said that staff had failed to take symptoms Mr C had been experiencing over a number of years into account and this had led to a delay in diagnosing cerebral atrophy (shrinkage of the brain). Mr C had been receiving treatment from the hospital for a number of years for depression and obsessive compulsive disorder and had been admitted there on a number of occasions. His physical condition then deteriorated significantly and he was admitted to another hospital for treatment. He died there six weeks later. The cause of death recorded on his death certificate was acute delirium with cerebrovascular disease (disease of the blood vessels in the brain).

We took independent advice from one of our medical advisers, who is an experienced psychiatrist. They said they did not consider that cerebral atrophy had been the major cause of Mr C's relatively rapid physical decline and subsequent death. Although a CT scan (a scan that uses a computer to produce an image of the body) taken a number of years before Mr C's death had shown cerebral atrophy, this was of normal appearance for a man of Mr C's age. There had been no reason to provide treatment or to take further scans to monitor this.

Our adviser said that the care provided to Mr C by the hospital had been well documented and had been delivered in an appropriate multi-disciplinary manner. We also found that the relevant treatment plans were clear and logical and that Mr C and his family had been involved in the care he received. The diagnoses were discussed with the family and their views were taken into account. We did not, therefore, uphold the complaint.

Summary

Ms C complained about a delay in diagnosing and treating an ovarian cyst (a fluid-filled sac on part of the reproductive system) between 2008 and 2013.

Ms C complained of abdominal symptoms in 2008 and various investigations, including an ultrasound scan (a special x-ray using sound waves) were undertaken. In January 2009 she saw a physician at Roodlands Hospital who told her that nothing had been seen on the scan. She continued to experience abdominal symptoms and further investigations took place until 2010. In April 2013 Ms C experienced severe abdominal pain and was referred urgently by her GP to the A&E department of another hospital, where she had emergency surgery to remove the cyst.

We took independent advice from one of our medical advisers who was satisfied that the care and treatment provided to Ms C was reasonable and timely. We found that the cyst had shown up on the scan taken in 2009 but that following consultation with the gynaecology (disorders of the female reproductive system) department it was thought that the cyst was not the cause of Ms C's symptoms. The board acknowledged that this was not discussed with Ms C as further investigation of the cyst had been delegated to her GP. The GP told the physician that they had discussed the matter again with the gynaecologists who advised that no action was required. Our adviser was of the view that it was reasonable to delegate the further investigation to the GP, and also commented that the sudden onset of symptoms from the cyst after a long period of having no direct symptoms was a known and common complication of ovarian cysts.

Summary

Mr C, who is an advocate, complained to us on behalf of his client (Ms A) that the board had failed to provide her daughter (Miss B) with appropriate clinical treatment when she was admitted to the Royal Infirmary of Edinburgh with chest pain and other symptoms. We took independent advice on this complaint from one of our medical advisers. Although the board had been unable to provide an explanation for Miss B's symptoms, we found that they had appropriately assessed her chest pain and that she had been appropriately investigated. The medical records also indicated that there had been a reasonable and appropriate attempt to provide her with pain relief. No abnormal cardiac rhythms were found when tests were carried out and there was no evidence that a treadmill test that she had was not carried out or recorded properly. Staff also appropriately involved the relevant specialists in relation to Miss B's earache and hearing problems. We found that the care and treatment provided was reasonable in view of the symptoms that she presented with and we did not uphold the complaint.

Mr C also complained that staff had failed to provide Miss B with an adequate level of occupational and physiotherapy treatment. We found, however, that the assessment and ongoing physiotherapy treatment provided was reasonable and in line with her care plan. We did not uphold this aspect of the complaint.

Finally, Mr C complained that staff failed to communicate adequately with Ms A about her daughter's condition and treatment. We did not uphold this complaint, as we found that they had communicated adequately with Ms A.

Summary

Ms C complained that a GP inappropriately gave her father (Mr A) a cortisone steroid injection without taking account of his existing medication and health condition, and without advising Mr A about possible side effects. Ms C was also unhappy with how the GP dealt with her complaint.

We looked at Mr A's medical records and took independent advice from one of our medical advisers. We found that there was no record that the GP had discussed side effects with Mr A, although the GP said they did this. Although we made no formal recommendations, we asked the GP to reflect on their record-keeping. There was no indication from Mr A's existing medication and health condition that he could not be given the injection. We also found that the GP was aware of Mr A's history and, therefore, put themselves in the position of being able to make a reasoned decision that the injection was appropriate. In addition, we found that the GP's response to Ms C's complaint was reasonable in the circumstances. We did not uphold Ms C's complaints.

Summary

Miss C attended an emergency dental appointment, as she was concerned about a large lump in her mouth that had become extremely painful and caused her face to swell. The swelling had been developing for a week, and had worsened despite receiving antibiotics and starting root canal treatment with her regular dentist.

The dentist at the emergency appointment immediately referred Miss C to hospital, and gave her a letter of referral to take with her. Miss C asked where exactly she should go, and the dentist told her to go to A&E, as they would transfer her to the right unit. However, when she got to A&E, staff told Miss C she was given the wrong advice and the dentist should have phoned the maxillofacial unit (a unit specialising in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) and sent her there directly. At the unit, Miss C had an infected tooth removed and the abscess in her mouth was drained. While she was there, hospital staff called the practice to advise them of the correct referral process for that unit.

Miss C complained about the care and treatment she had received. In particular, Miss C was concerned that the dentist had not taken an x-ray, or tried to drain the abscess or remove the tooth themselves. She said that staff at the hospital told her this was a simple procedure, and the dentist could have phoned the hospital and received advice over the phone about this. The dentist explained that in Miss C's condition he thought it was appropriate to refer her for hospital treatment immediately. He apologised for not knowing the correct referral process for the unit, and explained that dentists at the practice had now been made aware of this. Miss C was not satisfied with the dentist's response, and brought her complaint to our office.

After taking independent dental advice, we did not uphold Miss C's complaint. We found that the dentist had acted correctly in referring her immediately to hospital, and it would not have been appropriate for the dentist to take an x-ray or attempt treatment himself (even with advice from the hospital). Although the dentist should ideally have referred Miss C directly to the specialist unit, we found that the important thing was for her to be transferred to hospital as soon as possible, so it was not unreasonable to tell her to go to A&E.

Summary

Ms C, who is an advice worker, complained on behalf of her client (Miss A) that the board failed to carry out her hysterectomy at Glasgow Royal Infirmary to an appropriate standard. She said this caused significant and irreparable damage to Miss A's bladder and ureter. Ms C said the surgeon who performed the operation unreasonably failed to identify the damage and remedy this during the operation. She said that as a result, repairs which might have prevented exacerbation of the damage were not carried out.

We obtained independent medical advice from a consultant in obstetrics and gynaecology. Our adviser explained that Miss A experienced an uncommon but recognised complication of hysterectomy. She said that injuries to the bladder and ureter could occur during surgery or it was possible for injuries as a result of surgery to be delayed. Our adviser said it was unlikely that the damage in Miss A's case occurred due to cutting or tearing during surgery and it was more likely to have been caused by compromised blood supply resulting in tissue/cells dying and a fistula (an abnormal passageway between two organs) forming after the surgery was complete. As such, the surgeon could not have reasonably been expected to rectify damage which was not immediately visible at the end of surgery and would only have become apparent some days later.

There was evidence that Miss A was made aware that damage to the bladder and ureter were recognised complications of the surgery she consented to receive. Our adviser said the records showed that the surgeon demonstrated a reasonable level of care during the surgery to avoid these complications and there was no evidence that Miss A's hysterectomy was performed unreasonably.

Summary

Mr C said the board unreasonably failed to provide the correct care and treatment on two occasions when he attended Stobhill Hospital with an ankle injury. He said that a piece of bone below his ankle bone should have been recognised and he should have been referred to a consultant orthopaedic surgeon much sooner. Mr C also said that during his first attendance, the board failed to tell him that he had a piece of bone below his ankle bone.

We obtained independent advice on the complaint from an emergency medicine consultant. The adviser said that the examination and investigation Mr C received at the hospital, leading to the conclusion of a soft tissue injury, was reasonable on both occasions. He said there were no failings by the board in Mr C's management, as on both occasions his x-rays were reported as normal by the radiology department, this was reported back to Mr C's GP and he did not need to be recalled. The adviser said that if Mr C had ongoing problems with his ankle the appropriate action would have been review by his GP and referral to the orthopaedic service.

Mr C's medical records did not indicate that the emergency nurse practitioner who saw him on his first attendance advised him about the piece of bone. However, the adviser said there were no failings by the board in the management of Mr C's case and the conclusion that he had a soft tissue injury was reasonable. Therefore, on balance, we did not find it unreasonable that the board did not tell Mr C about the piece of bone.

Summary

Mr C complained about the treatment he had received from the board for problems he had with his nose and breathing. Mr C had two operations on his nose, but this did not resolve the problems. We took independent advice from one of our medical advisers, who is an experienced ear, nose and throat surgeon. We found that it had been reasonable to carry out the operations on Mr C's nose. He had also been given appropriate information about the procedures before they were carried out. The operations had been carried out appropriately, but the symptoms Mr C complained of were rarely completely resolved by the surgery. It was also reasonable that the board had decided that that no further surgical options were possible. We found that the board had provided a reasonable standard of medical treatment to Mr C and we did not uphold his complaint.