Not upheld, no recommendations

Summary

Mrs C complained that when she had a colonoscopy (examination of the bowel, using a camera on a flexible tube) at Monklands Hospital some years ago, it was not carried out properly. She explained that she was in severe pain throughout the procedure, but the doctor disregarded her requests to stop. She had, more recently, experienced problems with her bowel, which she thought were a result of the procedure.

Mrs C said that there was a nurse present during the procedure, whom she felt would be able to recall what happened. We asked the board to obtain a statement from the nurse, but neither he nor the doctor who carried it out could recall specific details. We also took independent advice on this complaint from one of our medical advisers, who is a hospital consultant. He said it was understandable that staff could not recall the specific procedure, given the time that had passed since the procedure. He said, however, that the records showed no evidence of Mrs C having asked for the procedure to be stopped, and she did not appear to have raised any concerns immediately afterwards, when her pain was noted to have settled.

As we found no evidence that the procedure was not properly carried out and the adviser thought it unlikely that Mrs C's more recent bowel problems were connected to the earlier procedure, we did not uphold the complaint.

Summary

Mrs C had a caesarean section (an operation to deliver a baby, which involves cutting the front of the abdomen and womb) in Wishaw General Hospital when her baby was born. The wound subsequently became infected, and Mrs C complained about the way it had been closed. She said that her health visitor told her that the hospital had used double the amount of staples that should have been used, and that they were put in too tightly. After taking independent advice from one of our medical advisers, we found that the procedure was carried out by someone with appropriate skills and experience. The number of staples used was within the range of acceptable practice and the advice we were given is that it is not within the surgeon's control to apply the staples more or less tightly. However, they can become tighter if, as in Mrs C's case, the wound becomes infected. We found that the way the wound was closed was reasonable.

Mrs C also complained that the wound was not reasonably treated during her time in hospital. Although it had become infected, this is a common complication of caesarean section and we found that appropriate measures had been taken to reduce the risk of infection. The wound care provided was reasonable and appropriate and was in line with the hospital's guidance.

Summary

Ms C's aunt (Ms A) had multiple health issues and lived in a nursing home. Ms C complained that on one occasion when Ms A became distressed, a GP who was in the nursing home at the time decided not to examine her, despite the symptoms that were reported. Ms C thought it inappropriate that the GP decided there were no grounds to examine Ms A, without having seen her.

The medical practice said that the GP was there to see a number of patients for whom consultations had been pre-arranged. He had told staff to contact the practice so that another GP could make an arranged home visit to Ms A. The practice told us that when staff told the GP of the specific circumstances, he decided that there was no requirement for a consultation at that time as there were no medical issues that needed to be addressed. Having taken independent advice from one of our medical advisers, we found that the GP had made a reasonable decision that there was no need for an immediate medical assessment. Although it was clear that Ms A had been distressed, this appeared to have been triggered by an environmental, rather than a medical, issue.

Summary

Mr A was admitted to Monklands Hospital with abdominal pain and vomiting. He had a hernia operation, then suffered a heart attack a week later. Despite a range of treatment, he died due to the severity of the blockages in his arteries. Ms C, who is an independent advocate, then complained on behalf of Mr A's wife (Mrs A) that the board did not investigate Mr A's underlying heart condition during his many hospital admissions over the previous 18 months. Mrs A was concerned that her husband was at high risk of developing heart disease, but only had one appointment with a cardiologist.

In their response to the complaint, the board said that Mr A had been receiving treatment to control his risk factors, including advice about smoking, and medication prescribed to reduce the likelihood of a blood clot developing, and to lower his blood pressure and cholesterol. They said that during his previous admissions to hospital there was no indication that Mr A had a specific problem with his heart. His shortness of breath was thought to be related to his underlying lung disease, and his indigestion to a history of stomach ulcers.

We took independent advice on this case from one of our medical advisers, who is a cardiologist (a heart specialist). The adviser said that Mr A had a severe respiratory (breathing) disorder and that tests carried out on his heart did not show any problems that required him to be kept under regular review by a cardiologist. During the admissions to hospital, his heart was examined but no significant abnormalities were identified other than a fast heart rate which could reasonably be attributed to his respiratory problems. We did not uphold the complaint.

Summary

Mr C complained that an out-of-hours (OOH) dentist had failed to provide him with appropriate treatment when extracting one of his teeth. He said that the dentist was unable to administer the anaesthetic competently, causing him unnecessary pain and discomfort. Mr C said that the extraction was also incompetent, causing the fracture of the tooth and damage to the adjacent tooth.

Mr C raised his concerns with the board, and they investigated his treatment. They found that the records of his appointment were too brief for the treatment to be assessed. They asked the dentist in question to voluntarily remove himself from the OOH rota until he had received training on his record-keeping. The board apologised to Mr C for his dissatisfaction with the treatment he had received and arranged for him to be reviewed by a senior member of the OOH dental service.

We took independent advice on the case from a dental adviser, who said that the standard of record-keeping was inadequate. Because of this, it was not possible to comment on Mr C's description of his treatment. The adviser said that the extraction was appropriate, given Mr C's symptoms and that in difficult extractions, damage could occur to surrounding teeth. There was no evidence from later treatment, however, that the extraction had caused damage. Our investigation found that although the record-keeping was inadequate, the board had taken action to address this before Mr C made his formal complaint. The lack of records did not allow us to comment on how Mr C's treatment was carried out, but we found that extraction was the appropriate treatment in the circumstances.

Summary

Mrs C told us that during a consultation on another matter she had mentioned to her GP that she had a lump on her thigh. She said the GP dismissed the lump as being of no consequence. She mentioned the lump again during a consultation three years later, after it began to grow. She was referred to hospital and was later diagnosed with a malignant tumour. Mrs C said she thought the GP was unreasonably dismissive of the concerns she had raised at the earlier consultation.

We found that there was no written record of the earlier discussion between Mrs C and her GP. The GP had no recollection of the consultation, but the practice had accepted Mrs C's account of the discussion. They said that the lump would not have been referred unless it was bigger than five centimetres, was deep or was increasing in size. They said that Mrs C's own account of the lump was that it was very small and had not changed during the three year period between consultations.

We concluded that the original decision not to refer Mrs C was reasonable and consistent with the guidance relating to the referral of lumps, and did not uphold Mrs C's complaint. Although it would have been best practice for the GP to record that discussion, in the circumstances we did not consider it unreasonable that they did not.

Summary

Mr C, who is a prisoner, was being prescribed medication to treat nerve pain. However, after an incident in which a nurse suspected Mr C was trying to conceal his medication, the decision was taken to change it to an alternative. Mr C complained about this and that there was an unreasonable delay in him being seen by a doctor.

We took independent advice on Mr C's case from our GP medical adviser. The adviser explained that because the nurse thought that Mr C had tried to conceal his medication, it was important for the prison health centre to act. The adviser confirmed that if there is evidence that a patient is not complying with their treatment regime, for example by concealing medication, then it is reasonable for medical staff to review this. In Mr C's case, our adviser said the prison health centre appeared to have properly assessed the situation. Our adviser said that because Mr C was previously on the alternative medication, with good benefit, and given there was no evidence of misuse of that medication, the prison doctor's decision was clinically correct. Our adviser said the decision was supported by Mr C's pain specialist's advice to rotate his type of medication. In light of the information available, and our adviser's advice, we did not uphold Mr C's complaint.

Mr C said that after the alleged incident, he was left without pain medication for nearly three weeks. The board told us that following the decision to withdraw the medication, Mr C asked to see a doctor. This was classed as a routine appointment and he was listed for the first available appointment after a public holiday period. On the day Mr C was to see the doctor, he did not attend. The board explained that the Scottish Prison Service were responsible for escorting prisoners from the main prison to the health centre. Sometimes, due to operational issues within the prison, prisoners did not attend scheduled appointments. The board said Mr C was then given a new appointment, which he attended. The board also confirmed that the prison health centre aimed to see prisoners with non-urgent referrals within seven to ten days. In Mr C's case, his appointment to see the doctor was classed as routine and he was seen eleven days after first asking to see a doctor. Because the time Mr C waited overlapped with public holidays, we did not think this was unreasonable and we did not uphold his complaint.

Summary

Mr C, who is a prisoner, asked to be prescribed an alternative medication, and night sedation, to help him with his opioid addiction. The prison health centre refused because they were satisfied that Mr C's current prescription, and the additional support available to him, were appropriate. Mr C complained to us their decision was unreasonable.

We reviewed national guidance which deals with the provision of medications for the management of opioid dependence. We also sought independent advice from one of our medical advisers. In light of this, we were satisfied the prison health centre's decision to refuse Mr C's request was reasonable.

Summary

Mr C, who is an advice worker, complained on behalf of his client (Ms A) after the birth of her baby. He said that when Ms A was admitted to Glasgow Royal Infirmary to have the birth of her baby induced, staff did not fully consider her previous medical history, did not provide her with enough pain relief, and failed to adequately repair three tears that she sustained during the birth.

Our investigation, which included taking independent advice from one of our medical advisers, found that Ms A's previous history had been fully recorded. We also found that she was provided with appropriate medication to induce the birth of her child, taking into consideration her previous medical history, and that when she started having painful contractions, Ms A was provided with appropriate pain relief. However, her labour progressed very quickly and when she needed more pain relief, there was not enough time to assess her and provide an epidural (local anaesthetic injected into the spine). It was not safe to her unborn child to provide her with opiates (very strong pain killing drugs). While it was clear from the records that Ms A suffered a painful labour, our adviser said that the care and treatment provided was reasonable, appropriate and timely.

The tears Ms A sustained were repaired by a senior specialist trainee doctor, using local anaesthetic and inserting one or two stitches in each wound. The local anaesthetic had begun to wear off by the time the doctor was repairing the third tear, and Ms A was given the option to continue, or to have more local anaesthetic inserted. This in itself can be painful, and Ms A decided to go ahead without further anaesthetic. She later continued to have problems with pain and what she considered to be an unsightly result of the repair. Two months after the birth she went to an A&E department, where she was examined and referred for reconstructive surgery. Our medical adviser reviewed all the clinical notes from the birth and the reconstructive surgery and found no evidence that the problems Ms A suffered had been caused by poor technique during the original repair. The adviser explained that such tears are fairly common and often require reconstructive surgery some time after a birth. The adviser said that the doctor had used appropriate materials and technique, and there was no evidence of an inadequate repair.

Summary

Mr C's house is behind, and next to, his business premises. He pays for domestic water usage through his council tax. Although he does not have a water connection to his business, Business Stream told him that he had to pay a water charge. Mr C complained that Business Stream were acting unreasonably, and that they did not respond reasonably to his representations.

We considered all the relevant information, including the complaints correspondence, a statement of Mr C's account, Business Stream's computerised records and their policy on dual use. We also made enquiries of Business Stream.

Our investigation found that both Mr C's business and domestic premises are separately rated and were publicly recorded as such. We also noted that commercial premises require access to water for health and safety purposes. Business Stream's policy is that where a property has both a rateable value notice and a separate council tax banding notice it is classed as 'dual-use premises'. Council tax charges should exist for the property, but charges are still applied by Business Stream on the full rateable value. Although Mr C considered this unfair and did not accept this explanation, we confirmed that he was being treated in accordance with Business Stream's policy and did not uphold his complaint.