Not upheld, no recommendations

Summary

Mrs C complained on behalf of her husband (Mr C) who had suffered from rheumatoid arthritis for many years. In 1996 he began taking a low dose of methotrexate (MTX - a disease modifying drug.) In 2003, Mr C had a biopsy (tissue sample) taken, which showed fatty changes to his liver. Mrs C felt that at this stage the MTX should have been stopped. However, Mr C went on to take the drug for a further two years before he was told to stop it. The board said this was because the benefits of a low dose of MTX in terms of treating Mr C's rheumatoid arthritis outweighed any potential detrimental effects on his liver. Mr C was later diagnosed with cirrhosis of the liver (scarring of the liver as a result of continuous, long-term damage). Mrs C complained that this was because of the MTX.

To investigate the complaint, we took all the relevant information, including the complaints correspondence and Mr C's clinical records, into account. We also obtained independent advice from one of our medical advisers. Our adviser said that in 2003 it was reasonable for Mr C to continue with MTX as the risks associated with it, although serious, were rare and the decision was taken in the full knowledge of all the factors involved. The adviser also said that at the same time Mr C was strongly advised about weight reduction, glucose control and close monitoring of his blood pressure. In 2005, Mr C's liver function tests showed a mild disturbance and, taking into account the existing fatty liver disease, his increasing weight and diabetes, it was decided then to stop the MTX. While Mr C had taken a low dose of MTX for a number of years, our adviser confirmed that it was not the length of time for which someone was exposed to the drug but rather the overall exposure that was likely to increase the risk. In light of this, we did not uphold the complaint.

Summary

Mr A had been suffering from a number of serious medical conditions including lupus (an autoimmune condition that affects the body's defences against illnesses and infections). Mr A was discharged from hospital into the care of his medical practice. He was readmitted several days later, after a visit from an out-of-hours doctor, and died the day after readmission. Mr A's son (Mr C) complained that after Mr A was discharged from hospital there was a lack of reasonable care by the practice. Mr C was concerned that no doctor from the practice visited his father at home, despite both Mr A and Mr C speaking to different doctors there.

In response to the complaint, the practice said that they would not routinely visit a patient after they were discharged from a hospital unless there were special circumstances. They took the view that there were no urgent concerns about Mr A at that time. They had received Mr A's discharge summary from the hospital after he had already been at home for several days. Doctors in the practice had spoken with both Mr C and Mr A by phone, and with the district nurse who had been visiting Mr A at home, and the practice had arranged for a doctor to visit Mr A at home in the coming days for review.

We took independent advice about the complaint from one of our medical advisers. The adviser was of the view that the practice had not failed in their care of Mr A, and that the hospital discharge letter, received several days after Mr A's discharge, did not indicate any issue that needed a doctor to visit. In addition, the adviser said that the information that Mr A, Mr C and the district nurse gave the practice did not highlight anything suggesting that Mr A needed to be reviewed sooner than planned. We accepted the adviser's view that, from the information presented to the practice at the time, the care and treatment they gave Mr A after he was discharged from hospital was reasonable and appropriate.

Summary

Mrs C, who is an advice worker, complained on behalf of her client (Mrs A) about care and treatment provided by a dentist. Mrs A said that when she visited the dentist, he x-rayed her jaw and told her there was a gap in it, but it was nothing to worry about. However, Mrs A later found out she had a cancerous tumour which caused a break in her jaw bone, for which she needed treatment.

We looked at Mrs A's clinical records, and took independent advice from our dental adviser. We found that, based on the records, the dentist had provided adequate care and treatment in the circumstances. The dentist had told Mrs A that she had some bone loss in her jaw, and about the possible causes of mouth ulcers. He advised Mrs A to return after two weeks to check if her symptoms had improved. He had said that if the symptoms had not improved at the review appointment in two weeks' time, he would refer her to hospital for further investigations, which could include investigation for an oral tumour. However, even though the dental practice contacted Mrs A to arrange a review appointment, she did not return.

Summary

Mrs C complained about the care and treatment that her late mother (Mrs A) received in Belford Hospital. Mrs A had been admitted to hospital after collapsing. She was discharged home some fifteen days later with a package of care, and was later moved to respite care. Her condition, however, deteriorated and she died about a month after being discharged home. Mrs C said that hospital staff did not encourage Mrs A to eat or drink; did not tell her if Mrs A had a urine infection while she was in hospital; did not go through the discharge medication with her, and discharged Mrs A before she was ready.

We took independent advice on this complaint from our nursing adviser, who said that hospital staff had taken reasonable steps to encourage Mrs A to eat and drink, and there was no evidence that she had a urine infection. We also found that, taking into account the detailed notes and the fact that Mrs A was medically fit for discharge, it had been appropriate to discharge her home with a package of care in place. We found that, on balance, the level of communication with Mrs C had been reasonable. Although there was no record that the discharge medication was explained to Mrs C, this would not always be recorded. In view of all of this, we did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that a community nurse's actions in respect of Mrs A's catheter (a thin tube used to drain and collect urine from the bladder) were unreasonable. Mrs A had a long-term catheter and this meant that there was a high risk of urinary infection. Good hygiene and prevention were, therefore, important. Mrs C said that the community nurses failed to change the catheter when it was reported to be badly blocked with sediment.

We found that a catheter care plan had been completed, which was good practice, and a good record of the care required. Our nursing adviser also said that community nurses had provided good care in relation to the catheter and had followed the guidance in the care plan. Changing the catheter when it was initially noted to have a lot of sedimentation might have caused further trauma, distress and a higher risk of infection. We considered that the care and treatment by the community nursing team in relation to the catheter had been reasonable.

Summary

Mrs C complained on behalf of her husband (Mr C) about a home visit by a GP from their local health centre. Mrs C felt the GP did not provide her husband with adequate care and treatment. She said that the GP was in her house for less than five minutes, did not carry out medical checks properly, and did not arrange for Mr C to go to hospital. Instead, the GP arranged for a rehabilitation team and social work to visit Mr C later that day. In response to the complaint, the GP said that Mr C declined the offer of admission to hospital, which was why she arranged the visit from the rehabilitation team and social work. The rehabilitation team contacted the GP and said Mr C now agreed with being admitted to hospital, and so the GP arranged this. Mrs C felt, however, that the delay was because of the GP's actions and complained to us.

We looked at the information Mrs C sent us, as well as information from the GP, including Mr C's medical records. We also took independent advice from our GP adviser. We could not reconcile the different recollections of exactly what was said and done during the visit. Our adviser looked at Mr C's medical records, however, and found that they showed that the GP provided reasonable care and treatment during it, and had acted correctly after the rehabilitation team contacted her. Our adviser also said there was no clinical indication that Mr C should have been admitted to hospital more quickly than he was.

Summary

Mr C complained that when he attended two dermatology appointments, the consultant reported that she had concerns about two moles on his back. Mr C pointed out that there was a further mole which was causing him concern and he felt the consultant was being dismissive about this. The consultant agreed to investigate the three moles and it turned out that the first two were benign but the third was cancerous. Mr C was concerned that the consultant had not taken his fears seriously, and said that had he not pursued the matter it could have had serious consequences for him.

As part of our investigation we took independent advice from one of our medical advisers. They said that clinicians have to use their clinical judgement in a reasonable manner. In this case, the consultant thought that only two moles required further consideration but in view of the concerns raised at the appointments, she agreed to also look at the third mole. The adviser said that it can be difficult for clinicians to determine whether a mole looks problematic, and whether there is a need for further investigations. Although the consultant did not have any immediate concerns about the third mole, she did agree to further investigation when it was pointed out to her, and the result confirmed Mr C's concerns. We found that the consultant acted appropriately on his concerns, and found no evidence that she failed to exercise her clinical judgement in a reasonable manner.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she went to an out-of-hours GP service. Mrs C said that the doctor there did not properly assess Mrs A's new symptoms and consider them in the context of her recent medical history. Two days later, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that the doctor had made reasonable records of her examination of Mrs A, and had recognised the important details of Mrs A's recent medical history. She had made logical and reasonable decisions, which were in line with current guidance. Although we recognised that Mrs A's death was sudden and unexpected and caused great distress to Mrs C and her family, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she attended an emergency appointment at a GP practice. She said that the doctor concerned did not take proper account of Mrs A's recent medical history, nor did she examine her legs but merely accepted Mrs A's home GP's diagnosis of phlebitis (inflammation of the vein). Mrs C said that this was a missed opportunity to consider a diagnosis of deep vein thrombosis (a blood clot in a vein). Shortly afterwards, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that Mrs A had been appropriately examined and that the symptoms and examination had led to the GP making a reasonable diagnosis of phlebitis. All of this was clearly noted in Mrs A's records. We noted that the practice had since carried out a significant event analysis and looked again at their protocol for assessing leg pain.

Summary

Ms C said that when she attended for her six-monthly check up at the dental practice, she reported a problem with a tooth where she had previously had root canal treatment. The dentist said that she had a slight infection and that she needed more work on the tooth. Ms C then complained that the treatment was not carried out in a reasonable way, and that the dentist had not had a proper x-ray done before starting the work. When Ms C raised these matters with the dentist, she said he behaved inappropriately and removed her from his list.

After obtaining independent advice from one of our dental advisers, we did not uphold Ms C's complaints. The adviser said that the records showed that an x-ray was taken to establish the working length of the tooth and the length of the filling required. This x-ray did not need to be ready on the day it was taken, but on the day the filling was to be done, and was the x-ray that Ms C (incorrectly) thought had not worked. Ms C also got an infection in the tooth, which was not uncommon, and the dentist had treated it appropriately with antibiotics. Ms C had disputed her care with the dentist and did not accept his explanations about it. The dentist then decided that in his view, as the trust between them had broken down, it would be more appropriate for Ms C to change dentist. Our investigation confirmed that, given the circumstances, he was entitled to do this.

Summary

Mrs C complained that she saw a nurse at her medical practice twice to report a lump on her breast but nothing was done. In between these appointments, she attended a mobile breast screening clinic for a mammogram (an x-ray of the breast) and, after being recalled for further investigations, she was diagnosed with breast cancer. When she raised concerns with the practice about not being referred, they said there was no trace of the first appointment having taken place. They also said that at the second appointment the nurse did not consider that any action was necessary, as Mrs C's mammogram was already being followed up by the breast clinic.

We took independent advice from our GP adviser who, having reviewed the records, confirmed that there was no evidence of the first appointment taking place. He could see no apparent discrepancies in the records and noted that the practice appeared to have conducted a thorough search. With regards to the second appointment, he advised that there would have been no merit in the practice taking further action as Mrs C was already in the screening system and was awaiting follow-up. In the circumstances, we did not uphold the complaint.