Not upheld, no recommendations

Summary

Miss C had major surgery on her bowel, and complained to us about the treatment she received after the surgery, which she thought was inadequate, and about the handling of her out-patient appointments.

During our investigation, we took independent advice from a consultant general and colorectal surgeon, following which we did not uphold Miss C's complaint. The adviser said that, although Miss C had not been seen personally by the doctor who carried out the surgery, she was seen in his clinic by his representative. The adviser was satisfied that the action taken was consistent with good practice. He also said that Miss C's medical records confirmed that the doctor offered reasonable treatment following the surgery and discussed the treatment options open to Miss C, including further surgery. It was unfortunate that some of Miss C's out-patient appointments were rescheduled and that this added to her concern about the level of aftercare she was receiving, but we noted that the board had already apologised to her for this.

Summary

Ms C, who is an advice worker, complained on behalf of her client (Ms A) about her care and treatment. Ms A's GP referred her to Raigmore Hospital because she had been experiencing backache, painful urination and pain in her thighs, and she was admitted as an emergency. She was treated for a urinary tract infection and, as she also had back pain, arrangements were made for her to have an x-ray after she was discharged. Less than a month later, Ms A was seen in hospital again but when she was examined, no pulse could be found in either of her legs below her knee. She was started immediately on aspirin and a statin (a drug to reduce cholesterol in the blood) and an MR angiogram (magnetic resonance angiogram, a type of imaging) was carried out. Subsequently, Ms A was admitted to hospital where she underwent a femoral distal bypass (an operation to bypass the blocked part of an artery, carried out when a patient is threatened with amputation). This was re-done on two further occasions and the possibility of amputation of one of Ms A's legs was discussed.

Ms C complained about the care and treatment Ms A received on her first admission to hospital and said that she had not been properly examined and appropriate tests had not been carried out. She also said that an inaccurate diagnosis was made and Ms A was discharged without appropriate follow-up arrangements. Ms A thought that if she had been kept in hospital for tests, the outcome might have been different.

We took independent medical advice from a consultant surgeon as part of our investigation. We found that when Ms A was first admitted to hospital she showed no signs of peripheral vascular disease (a common condition, in which a build-up of fatty deposits in the arteries restricts blood supply to leg muscles) and she did not report any pain in her legs or discolouration in her feet. Accordingly, her treatment had been appropriate. Similarly, before she was sent home, she had been assessed as fit for discharge. It was quite appropriate for further tests, including an x-ray, to be arranged for her as an out-patient. It was only later, after it was found that there were no pulses in her lower legs and further tests were done that the extent of Ms A's problem was revealed.

Summary

Mrs C complained on behalf of her mother (Mrs A) that the care and treatment of her grandmother (Mrs B), had been unreasonable. Mrs C and Mrs A felt that it was not appropriate to put the Liverpool Care Pathway (LCP - an end of life care planning system) in place in view of the state of Mrs B's health, and said that the family were not told that it was in force.

We investigated the complaint and took independent advice from an experienced registered nurse. The investigation showed that when Mrs B arrived in hospital with her son (Mr B) who was her next of kin, she had an ischaemic leg (where the blood supply to the leg is poor, causing the tissue to die). Her condition was so poor that amputation was discussed. Mrs B, who had capacity to make her own decisions, said that she did not wish an amputation even though she was aware that her decision would lead to her death. She said that she wanted to be kept comfortable and out of pain. Immediate steps were taken to do this and the LCP was initiated.

We found that the board had acted in accordance with Mrs B's wishes, which was appropriate. Mr B, as next of kin, was involved in the discussions and, although Mrs A believed that matters should have been put on hold until she arrived and they could be discussed with her, this was not reasonable or appropriate in the circumstances.

Summary

Mr C's father (Mr A) suffered from Parkinson's disease and was admitted to a care home, where he lived for the last few years of his life. A few years after Mr A's death, Mr C applied to the board for a retrospective award of funding for Mr A's care. In response to Mr C's application, the multi-disciplinary team involved in Mr A's care retrospectively undertook an assessment of his needs, and the board declined Mr C's application. Mr C appealed this decision. The appeal was considered first by the clinical director, who recommended granting the application. However, the appeal was decided by the medical director, who personally reviewed Mr A's records and chose not to accept the clinical director's recommendation, instead declining Mr C's application.

Mr C complained that the board's assessment of his application was unreasonable. He raised concerns that the multi-disciplinary team's assessment was unreasonable, that the board did not refer to relevant medical records, and that they did not take account of the fact that the decision not to transfer Mr A to a hospital was made on social, rather than medical, grounds. Mr C also said that the medical director gave no reasons for not accepting the clinical director's recommendation.

After taking independent advice on this complaint from one of our medical advisers, we did not uphold Mr C's complaint. The medical adviser said that the multi-disciplinary team's retrospective assessment of Mr A's needs was reasonable in the circumstances. There was no evidence that the medical records that Mr C thought had been overlooked existed, so we found that the board had not overlooked evidence in this regard. We also found that the medical director had taken account of the argument that the decision not to transfer Mr A to a hospital was based on social, not medical, grounds but had nevertheless decided not to uphold the appeal. Finally, we found that the medical director's decision not to accept the clinical director's recommendation was reasonable and that the reasons for this were set out in the decision letter. Although Mr C did not agree with the board's conclusions, we were satisfied that the assessment was conducted reasonably and in line with relevant guidance.

Summary

Mrs C, an advocacy worker, complained on behalf of her client (Mr A). She said that Mr A's medical practice had not passed on information to him that the hospital had given to them about a change in his treatment plan. We sought independent advice on this from one of our medical advisers, who said that it was the hospital's responsibility to pass this on, unless the hospital or patient asked the practice for information. We also noted from Mr A's medical records that a particular letter from the hospital to the practice would have led the practice to believe that the hospital had made Mr A aware of the change.

The practice had also written in Mr A's medical records that they were having difficulties dealing with his family, and that they were trying to resolve the situation but so far this had not been successful. In the meantime, a locum doctor would normally see Mr A and his family at the practice or at the hospital, although the GPs at the practice would see them if there was an emergency. Mrs C complained that the practice had not told the family that they considered there were difficulties and that, if the family had known earlier, they would have changed to another medical practice. The evidence in Mr A's medical records, however, showed that the practice were proactively and constructively trying to address and repair the relationship problem, and our adviser saw no reason why they should have passed on the information in the records. We also noted that, although it would have been open to the practice to warn the family that if the situation did not improve they would be removed from the list of patients, the practice did not do this but were appropriately trying to resolve matters, which was good practice.

Mrs C also complained about a point in relation to the practice's handling of her complaint, but we could not establish the facts about this. We did not uphold any of Mrs C's complaints.

Summary

Mr C, who is an advocate, complained on behalf of his client (Mr A). Mr A had raised concerns about changes to his anti-depressant medication. He said that one doctor told him the medication he was taking was illegal and switched him to another medication. He complained that he experienced adverse side effects from the medication he was switched to and he did not believe it to be suitable for someone of his age. He noted that, when he later brought his concerns to the attention of another doctor, he was switched back to his original medication and told that the drug was not illegal.

The medical practice said that Mr A was not told his original medication was illegal. They explained that the dose had previously been reduced following a licence change, which set a lower maximum dose for elderly patients. We took independent advice on this complaint from one of our GP advisers, who confirmed that the changes to Mr A's medication were reasonable and in line with acceptable clinical practice. We were advised that the decision to restart Mr A on his original medication was appropriate in light of his symptoms at the time, and was not an indication that the initial switch was unreasonable.

Mr C also complained that the records of Mr A's consultations with the practice did not accurately reflect what was discussed. As we were not party to the consultations, we could not say exactly what was discussed. The adviser reviewed the records and considered them to be clear and of a reasonable standard.

In the circumstances, we did not uphold either complaint.

Summary

Mrs C wrote to the board on a number of occasions seeking clarification and information about a wide range of issues arising from her medical records. Mrs C said that the board failed to carry out a full investigation of her records and, as a result, she had become very anxious about any future care she may need.

After taking independent advice from one of our medical advisers, we found that the board's explanations were reasonable. There was no evidence of Mrs C having a significant diagnosis or condition that the board failed to disclose, or that they failed to address a significant medical issue. We found that they had carried out a full investigation into her complaint.

Summary

Mrs C said that when she was a patient at the practice, the acronym DNR appeared in her medical records. She said she was told by a medical professional this meant 'do not resuscitate'. She was extremely upset about this and wrote to the practice asking for an explanation. The practice said that the acronym referred to 'diabetic nurse review' and that they used the abbreviation DNAR for 'do not attempt resuscitation', rather than DNR. Mrs C complained that this explanation did not make sense in the context of her medical records.

After taking independent advice from one of our medical advisers, we found that the practice's explanation was accurate and that they had responded to Mrs C's complaint in a reasonable way.

Summary

Mrs C wrote to the practice to complain about her medical records. She thought there were a number of inconsistencies between the two copies of the records she had, which she said showed that her notes appeared to have been rewritten or that information had been re-entered by the practice at some point. Mrs C also referred to the coded acronym 'DNR' which she believed related to not resuscitating her and meant that she had at some point been identified for palliative care (care provided solely to prevent or relieve suffering). The practice responded explaining that Mrs C's medical notes had not been altered and a resuscitation-related code had never been entered into her records.

Mrs C complained to us that the practice unreasonably failed to respond to her complaint about information held in her medical notes, particularly the use of the abbreviation DNR. After taking independent advice from one of our medical advisers on the clinical aspects of Mrs C's complaint, we found that the practice's explanations were reasonable. We also found no evidence that Mrs C's medical notes were purposely altered, and we did not uphold Mrs C's complaint.

Summary

Mr C complained that a dentist had failed to provide him with an acceptable level of treatment, including root canal treatment, which meant he had to have a significant amount of additional treatment.

In considering Mr C's complaint, we took independent advice from one of our advisers, who is a dentist. Although a drill had broken whilst inside Mr C's tooth during root canal treatment, our adviser said that this is a well-recognised complication of the treatment and is a fairly common occurrence. Mr C was concerned that part of the drill remained in his tooth, but there was no evidence of this in an x-ray taken after the treatment. Mr C had also been sprayed with water during the treatment, but the practice had already written to him to apologise for this. We found that it was reasonable for the dentist to try to repair a fractured filling rather than removing and replacing the whole filling, and that it was reasonable to prescribe Mr C with an antibiotic. In addition, we found that there was no requirement for the practice to offer Mr C an emergency appointment when a temporary filling fell out. Overall, we found that that the dental treatment provided to Mr C was reasonable.