Not upheld, no recommendations

Summary

Mr C, who is a doctor, complained on behalf of his friend (Mr A). Mr A had phoned Mr C because he had pain in his chest and arm. Mr C was concerned that his friend was having a heart attack, so he phoned for an ambulance. The crew assessed Mr A, including carrying out an electrocardiograph (ECG - a test that records the electrical activity of the heart). They found no indicators of a heart attack, and Mr A decided not to go to hospital. When Mr C heard this, he was very concerned and phoned for another ambulance. At this point his call was transferred to NHS 24, who went on to speak to Mr A before sending another ambulance. Mr A was taken to hospital and was found to have had a heart attack. Mr C then complained that the first crew did not assess Mr A properly and take him to hospital.

The Scottish Ambulance Service said that Mr A had not been taken to hospital in the first ambulance at his own request. However, they also noted that the crew did not make sufficiently thorough records of the tests they carried out and their visit.

We sought independent advice from a paramedic, who said that the first call was taken and prioritised appropriately, and that the service appropriately sent an emergency ambulance. He also considered that, given the finding of the tests when they assessed Mr A, it was reasonable for the crew's assessment to override Mr C's phone assessment. Mr C's second phone call was also appropriately handled, given the evidence available. We did not uphold the complaint, as although we found that the first crew were not told that a doctor had assessed Mr A by phone, and did not keep sufficient records of their interaction with Mr A, we were satisfied that they appropriately assessed his condition. We also noted that the service had reminded ambulance crews that they should make sure they evidence all of their clinical actions, particularly where a patient is not being taken to hospital.

Summary

Ms C was the carer for her late employer (Ms A). When Ms A became unwell late at night with nausea, diarrhoea and abdominal (stomach) pains, Ms C requested an ambulance. She was referred to NHS 24 and a nurse called back and arranged for an out-of-hours (OOH) GP visit. About an hour and a half later, Ms C called NHS 24 again as Ms A's pain was worsening, at which point the OOH doctors arrived. They examined Ms A, provided medication and advised Ms C and Ms A to call back should Ms A's condition worsen. When Ms C's colleague took over caring for Ms A in the morning, she contacted NHS 24 and was told to call Ms A's medical practice. Ms A's GP visited, after which Ms A was admitted to hospital, where she later died.

Ms C complained about the care and treatment that Ms A received from both the OOH GP service and NHS 24. Ms C was of the view that if Ms A had been taken to hospital sooner, the outcome might have been better. She also thought that the OOH doctors provided inadequate pain relief, and was unhappy that she had to contact NHS 24 again (rather than being able to contact the doctor directly).

Our role was to consider whether – on the basis of the available evidence - the care provided to Ms A was reasonable. We took independent advice on the case from one of our medical advisers, who is a GP. The adviser reviewed the evidence, and explained that NHS 24 had not acted unreasonably in arranging for the OOH GPs to attend. He said that the records showed that the doctors examined Ms A and appeared to have discussed a possible hospital admission with her. The adviser was also satisfied that the OOH doctor gave appropriate advice by advising Ms A to call back should her condition worsen. His overall view was that the care provided was of a reasonable standard. Although we recognised how difficult and distressing this had been for Ms C, in the light of the advice we received we did not uphold her complaints.

Summary

Ms C was the carer for her late employer (Ms A). When Ms A became unwell late at night with nausea, diarrhoea and abdominal (stomach) pains, Ms C requested an ambulance. She was referred to NHS 24 and a nurse called back and arranged for an out-of-hours (OOH) GP visit. About an hour and a half later, Ms C called NHS 24 again as Ms A's pain was worsening, at which point the OOH doctors arrived. They examined Ms A, provided medication and advised Ms C and Ms A to call back should Ms A's condition worsen. When Ms C's colleague took over caring for Ms A in the morning, she contacted NHS 24 and was told to call Ms A's medical practice. Ms A's GP visited, after which Ms A was admitted to hospital, where she later died.

Ms C complained about the care and treatment that Ms A received from both the OOH GP service and NHS 24. Ms C was of the view that if Ms A had been taken to hospital sooner, the outcome might have been better. She also thought that the OOH doctors provided inadequate pain relief, and was unhappy that she had to contact NHS 24 again (rather than being able to contact the doctor directly).

Our role was to consider whether – on the basis of the available evidence - the care provided to Ms A was reasonable. We took independent advice on the case from one of our medical advisers, who is a GP. The adviser reviewed the evidence, and explained that NHS 24 had not acted unreasonably in arranging for the OOH doctors to attend. He said that the records showed that the doctors examined Ms A and appeared to have discussed a possible hospital admission with her. The adviser was also satisfied that the OOH doctor gave appropriate advice by advising Ms A to call back should her condition worsen. His overall view was that the care provided was of a reasonable standard. Although we recognised how difficult and distressing this had been for Ms C, in the light of the advice we received we did not uphold her complaints.

Summary

Miss C and Mr C had twice taken their son (Master A) to a medical practice with hay fever symptoms. These persisted despite treatment with two different forms of antihistamines, and assessment by an ophthalmologist (a doctor who examines, diagnoses and treats diseases and injuries in and around the eye) that there was nothing apparently wrong with his eyes. Miss C and Mr C then took their son to a hospital out-of-hours service, where they were seen by the same GP they saw at their practice, as he was working as a locum. At this appointment, the doctor was concerned that Master A's symptoms were persisting despite treatment, and referred him to a paediatrician (a doctor dealing with the medical care of infants, children and young people).

Miss C and Mr C complained that, at the appointment, the GP made an inappropriate remark about them seeing him at the hospital as well as at his surgery. They were also concerned that the GP had not done enough to diagnose their son's condition and make a more urgent referral. We sought independent advice from one of our medical advisers, who is an experienced GP. The adviser said that the GP had clearly been concerned about Master A's condition, and that his referral was appropriate, given Master A's symptoms. He also said that if the doctor had made the comments suggested, this was unprofessional and inappropriate. However, we did not find evidence to uphold this concern. We found that Master A's care and treatment was appropriate.

Summary

Mrs C has a complex medical history. She told us that because she had been experiencing extreme pain in her feet (to the extent that she could not walk) she needed to contact her medical practice on a number of occasions. She complained about a lack of support from the GPs at the practice. In particular, she said that, despite telling a GP that tramadol (a drug used to treat moderate to moderately severe pain) did not work for her, he continued to prescribe it. Another GP refused her a dosette box (a pill organiser that helps people on multiple medications to take these at the right time) and prescribed an anti-inflammatory gel, which she said the pain clinic she had previously attended had told her not to use. Mrs C said that both GPs left her without support and in great pain.

We obtained independent advice from one of our medical advisers, who is a GP. After taking all the relevant information into account, including the complaints correspondence and Mrs C's medical records, we did not uphold Mrs C's complaints. We found that she was previously prescribed tramadol for chronic pain, and the new, acute pain she was experiencing had a different cause. Our adviser said that this pain might respond differently to tramadol, so the prescription was not unreasonable. Similarly, an anti-inflammatory gel could be used safely where anti-inflammatory tablets could not. Although Mrs C wanted a dosette box, we found that she did not qualify for this under the health board's criteria.

Summary

Mr C's son (Master A) was unwell, and was taken to A&E at Yorkhill Hospital (also known as the Royal Hospital for Sick Children). The family were due to go on holiday two days later and Mr C said that he told hospital staff this. Master A was examined and discharged, and his parents were told to bring him back if his condition worsened or he was sick. This did not happen, and the family went on holiday. Two days later, Master A had to have emergency surgery abroad to remove his burst appendix. He was in hospital for five days being treated with antibiotics (drugs to fight bacterial infection), strong painkillers, and a drain to remove infected fluid from his abdomen. Mr C complained that staff at Yorkhill Hospital failed to diagnose that his son had appendicitis (inflammation of the appendix).

Our investigation, which included taking independent advice from one of our medical advisers, found that the care and treatment provided to Master A was reasonable and appropriate. Having studied Master A's medical records, the adviser said that the clinical signs and symptoms with which Master A presented gave insufficient evidence to make a definitive diagnosis of appendicitis. The likely cause of his illness was thought to be a viral infection. Appendicitis was not ruled out, but included as a differential (alternative) diagnosis. The adviser said that this was reasonable and that it was appropriate to discharge Master A with advice to come back to A&E if his condition worsened.

There had been some dispute over whether or not the staff who dealt with Master A were aware of the planned holiday. Mr C said that it was the first thing they told staff, but staff said that they could not recall being told this. However, the adviser said that, even if staff had this information, it should not have changed the management of Master A's condition and it was appropriate to discharge him with advice to seek further medical help if his condition deteriorated. Based on all the evidence and advice, we decided that Master A's care and treatment was reasonable.

Summary

As part of a research project, Mrs C had a knee replacement at Glasgow Royal Infirmary. The operation, which was robot-assisted, replaced only the part of her knee which was damaged. As this type of surgery is carried out on a smaller area than traditional knee replacement operations, recovery should be faster. However, after the surgery, Mrs C complained about the care and treatment she received. She questioned whether she had been fit for discharge and about the number of cancelled clinic appointments after the operation. She said that nerve endings were damaged during the operation, which had hindered her recovery. She also told us that she was in pain and had to give up her job.

During our investigation, we obtained independent advice from a medical adviser, who is a consultant in orthopaedic and trauma surgery. We also considered all the available documentation and Mrs C's relevant medical records. Having done so, we did not uphold Mrs C's complaint.

Our adviser said that the operation was carried out appropriately and the knee implant was well positioned. Before the operation, appropriate investigations were made, and appropriate information and consent were given. Later, Mrs C was properly assessed before she was discharged from hospital. The adviser said, however, that there is a known outcome of this operation for some patients, who will be left with worse pain than before. Mrs C fell into this category, and despite things going well, she was one of a small number of patients left with residual pain. While it was noted that two of Mrs C's follow-up appointments were cancelled, another was arranged and we found no evidence that this delay affected the outcome of her treatment.

Summary

Mrs C complained on behalf of her sister-in-law (Mrs A) that the board cancelled Mrs A's facial reconstruction surgery at Aberdeen Royal Infirmary, and did not provide a reasonable explanation for this. From what Mrs C described, this was clearly an upsetting experience for Mrs A.

We looked at information from Mrs C and the board, and took independent advice from one of our medical advisers. We found that the board cancelled the operation because at the time there were not enough nurses to staff the intensive care bed that Mrs A needed afterwards, because of emergency admissions. The board said that this was not what they would have wanted for Mrs A, but that they had to put her safety first. They also explained to us what they had done to deal with demand for post-operative intensive care beds in future. Although we understood why Mrs A had found this distressing, we did not uphold Mrs C's complaints, as we found that the cancellation was not unreasonable in the circumstances, and that the board had provided a reasonable explanation of why it happened.

Summary

Mr C was unhappy with the care and treatment he received when he attended A&E at Aberdeen Royal Infirmary. He said that NHS 24 had told him to attend a primary care service next to A&E, and an appointment had been made for him to be seen just under two hours later. He cancelled this, however, and instead called an ambulance to take him to A&E. He said the care and treatment he received was unreasonable, that a senior charge nurse had assessed him as only being 'in some discomfort' and he was escorted from A&E to the primary care department.

We obtained Mr C's medical records and after taking independent advice from one of our medical advisers, who is a hospital doctor, we did not uphold the complaint. We found that staff had accurately assessed Mr C's pain and discomfort, had correctly followed their triage policy (triage is the process of deciding which patients should be treated first, based on how sick or seriously injured they are) and referred him appropriately to the primary care department.

Summary

Mr C, who is a prisoner, told us that he suffered from severe pain that restricted his ability to leave his cell. He said that gabapentin (pain-killing medication) had been effective in controlling this and complained that the prison health centre had stopped his prescription for it and prescribed various alternative medications. He said these had not helped with his pain and had in fact made him more unwell. He acknowledged that there were security implications about having gabapentin in the prison environment but said that he was prepared to take it under supervision.

We took independent advice on this complaint from one of our medical advisers, who is a GP. After reading Mr C's medical records, he said that there was evidence, from these and by Mr C's own admission, of him misusing medication and sourcing drugs from other prisoners. The adviser explained that, as well as the security implications, this dramatically increased the risk of drug interactions which could, in some cases, be fatal. He noted that it was important for there to be trust between the patient and doctor before a drug with dangerous side effects and the potential for abuse could reasonably be prescribed. In addition, he said Mr C was potentially suffering from the recognised side effects of gabapentin and that he was participating in a methadone programme, on which it was important to allow doctors to remove any medications they felt he should not continue. In the circumstances, we found that it was reasonable that the doctors discontinued the prescription.