Not upheld, no recommendations

Summary

Mr C, who is a prisoner, complained that the prison health centre stopped his prescribed medication without any warning or gradual reduction. Mr C had been prescribed zopiclone (a drug used to treat sleeping problems) and gabapentin (a drug for pain relief). The board told Mr C that his medication was stopped as he had failed to take it in the manner in which it had been prescribed. In addition, they said that Mr C would have been aware of the consequences of his medication being stopped if any discrepancies were found.

We found that the records showed that Mr C had tried to conceal the zopiclone rather than swallow it in front of staff. This led to him being reviewed by the mental health team, and the zopiclone prescription being discontinued. In addition, health centre staff carried out a spot check of his medication around a month later and he was found to have more gabapentin tablets than he should have had. The staff did not know, therefore, how much of the prescribed medication Mr C had been taking and he had admitted to buying non-prescribed drugs in prison.

We took independent advice on this from one of our medical advisers. The adviser said that although some patients can be affected if gabapentin is stopped abruptly, the health centre did not act unreasonably in discontinuing Mr C's medication immediately, given the difficulties in planning a gradual reduction.

Summary

Ms C, who is a solicitor, complained on behalf of her client (Mr A), who is a prisoner, that the board had refused to prescribe him suboxone (a prescription medication used to treat opiate addiction). Mr A had been prescribed methadone, but said that it was causing him constipation and sickness. He had told the board that he wanted to switch to suboxone instead. However, he was told that suboxone was not available for maintenance treatment (the prescribing of a substitute drug to prevent the use of illicit substances) at that time.

In their response to our enquiries, the board said that all patients within the addictions service are regularly assessed using both national and local guidance. They said that some patients may not be offered the drug of their choice and that Mr A was receiving the most appropriate treatment for his clinical needs.

Mr A required maintenance treatment for his opiate addiction and the board's view was that suboxone was not to be used for this. After taking independent advice from one of our medical advisers, we found that the board's decision had been reasonable and we did not uphold the complaint. The board had produced new guidance for prescribing suboxone in the prison after Ms C complained, and we found that the decision was also in line with this.

Summary

Mr C complained about an operation at Monklands Hospital, and about the medical and nursing care provided there. He believed an experimental procedure had been performed on his nose, and said that he was now embarassed by its appearance. Mr C also complained that he was not given enough information to give informed consent to the operation, and that photographs were taken without his consent. He also complained that there was a poor standard of cleanliness at the hospital.

We took advice from our medical adviser, a specialist in cosmetic and reconstructive facial surgery. He said there had been three previous operations on Mr C's nose, and that each made the next procedure more difficult, due to the scarring caused. The adviser said that the operation was a complex but standard procedure and had been carried out successfully. He noted that Mr C had been provided with the mobile phone number of the consultant surgeon who carried out his operation, which was unusual and in his view, showed a high standard of personal care and attention to Mr C.

Our investigation found there was no evidence Mr C had objected at the time to the amount of information he was given before giving his consent to the operation. We also found no evidence that the hospital had failed to meet an acceptable standard of cleanliness, or that Mr C had not been provided with an appropriate level of care and treatment. There was no evidence that photographs were taken during the operation and retained by the board.

Summary

Mr C complained about his care and treatment after a road traffic accident. He complained that the physiotherapy service had not diagnosed his injuries correctly and were overly focused on possible legal action that he was pursuing. Mr C believed that this meant they did not believe his description of his injuries, or the amount of pain he was in. He also felt this influenced the pain clinic he was referred to, where he said staff were also dismissive of symptoms that he maintained were caused by spinal injury. Mr C later paid for a private scan of his spine, which revealed some damage to a spinal disc, which he believed proved the pain he was experiencing had a physical source.

Mr C also said that the board did not investigate his complaint properly. His first letter of complaint was lost, even though it was signed for on delivery. He said that they did not then investigate his complaints about the physiotherapy treatment, concentrating instead on his treatment at the pain clinic.

We took independent advice on Mr C's complaint from two of our medical advisers. The advice we received was that Mr C had received a comprehensive assessment, and that treatment for whiplash associated disorder had initially improved his symptoms. He returned to the physiotherapy service when his symptoms became worse. As he did not then respond to treatment, he was referred appropriately to the pain management clinic. We found no evidence that Mr C's symptoms were treated differently or inappropriately due to a focus on legal action. The private scan showed changes that were normal for a man of Mr C's age and they were not in keeping with the symptoms Mr C described. The treatment Mr C received was appropriate, and in keeping with guidelines and best practice on treating whiplash injuries. Both advisers said that the evidence showed that Mr C's care and treatment was reasonable.

Our investigation found that the board acknowledged that Mr C's initial complaint letter was misplaced, but also that it did not contain enough information to support an investigation. When they became aware that Mr C wanted to complain, they repeatedly tried to establish what he was complaining about, but Mr C did not provide information to the board until we told him he should do so. The information he then provided was limited, and the board were unable to investigate the complaint about the physiotherapy service. They did investigate his complaint about the pain clinic. We did not uphold Mr C's complaints.

Summary

After Ms C's son (Master A) was born, he had problems taking milk and keeping it down and it often flowed from his nose when feeding. He also had a blocked nose and colic and did not sleep well. He was late to start talking, his pronunciation was poor and his speech was quite nasal. He developed behavioural problems, stemming from his frustrations about his speech. In 2011, Master A was referred to an ear nose and throat (ENT) specialist and was diagnosed with a cleft palate. Ms C then complained that her son had displayed classic signs of this condition, but multiple health professionals had failed to make a diagnosis.

Master A had a submucous cleft palate (where the muscles of the soft palate were not joined as they should be). We took independent advice from one of our medical advisers about the complaint, and accepted their advice that this type of cleft palate is invisible and would not be identified through routine mouth examinations. The adviser said that this is normally diagnosed when the child starts to speak, and speech problems are identified. We found that Master A's symptoms were investigated appropriately when Ms C raised them and in November 2011 he was appropriately referred to an ENT specialist. Due to a misunderstanding, however, this appointment was missed and there was a seven-month delay before another appointment was secured and a diagnosis made. We were satisfied, however, that the board were not responsible for the delays and that staff could not have diagnosed and treated Master A's condition any sooner.

Summary

Mrs C complained that the board unreasonably failed to diagnose the cause of her pain. Mrs C told us that she had experienced pain in her rib cage area since 2009 and had provisionally been diagnosed with gallstones. However, despite several hospital admissions, various tests and treatment, including the removal of her gall bladder, she remained in pain with no cause being identified. Mrs C said that the doctors treating her appeared to be accepting that her pain was unexplained and taking steps to help her cope with it, rather than seeking to diagnose the problem.

After taking independent advice from an adviser who is a specialist in pain management, we found that all the different specialists who had seen Mrs C had taken her concerns seriously and had carried out many appropriate investigations, including surgery, to determine the cause of her pain. When, however, a conclusive diagnosis for the root cause of it could not be made it was appropriate to shift the emphasis of treatment onto pain management and to refer her to a hospital pain clinic. Although Mrs C did not consider that the treatment she had received there addressed her pain, we considered it to be appropriate and in line with current medical practice. A decision to then refer Mrs C to a clinical psychologist had also been appropriate. Our medical adviser told us that there were no other investigations that the board should have reasonably considered to try to establish the cause of Mrs C's pain.

Summary

Ms C, who is an advice worker, complained on behalf of her client (Miss A) that the medical practice unreasonably failed to investigate Miss A's reported symptoms and make timely and appropriate referrals. Ms C also complained that when a referral was made, it was marked as routine, rather than urgent.

Miss A had suffered for a number of years with a condition causing discomfort and pain in her joints, for which she had received various treatments and referrals, including physiotherapy. Since January 2012, however, she had also been reporting a lump and pain in her right groin and felt that physiotherapy was making matters worse. Her GP then referred her to a specialist physiotherapist who in turn referred her to an orthopaedic surgeon (dealing with conditions of the musculoskeletal system). After tests and examinations, the orthopaedic surgeon referred Miss A to a bone cancer specialist. Miss A was then diagnosed with chondrosarcoma (cancer of the cartilage) with an overlying osteochondroma (a benign (not progressive or destructive) bone tumour). Miss A has since had successful treatment.

Our investigation, which included taking independent advice from one of our medical advisers, found that the GPs had acted reasonably in referring Miss A for physiotherapy for her pre-existing condition. We also found that when she reported the lump in her groin that she thought was increasing in size, appropriate and timely referral was made. The adviser said that the osteochondroma was masking the more aggressive and serious chondrosarcoma so that it was not unreasonable for the GP to have made a routine, rather than urgent referral. The adviser said that overall the care and treatment provided to Miss A was reasonable, and we did not uphold this complaint.

Summary

Mr C said that he had suffered from repeated bouts of sinusitis (inflammation of the lining of the sinuses, causing facial pain) since he was a teenager. He said that he had tried a variety of different treatments, but the only one that had consistently worked for him was a short course of antibiotics.

Mr C complained that when he contacted his medical practice suffering from sinusitis, he was not initially given an appointment but told to contact his pharmacist. He then called NHS 24 and was referred back to the practice, where he was given an appointment that day. Mr C was unhappy that when he went there he was seen by the practice nurse, rather than a doctor. The nurse did not accept that Mr C needed antibiotics, and refused to prescribe them. Mr C said that he was forced to return to his previous medical practice to get them. He said that the practice nurse refused to allow him to see a doctor and inaccurately recorded his symptoms to support her diagnosis.

We took independent advice on this complaint from one of our medical advisers, a specialist in general practice medicine. He said that Mr C had symptoms that corresponded with acute sinusitis, but that current guidance was not to prescribe antibiotics for this condition, as research suggested they were ineffective. He also said that it was standard practice in busy surgeries for patients to be seen initially by a practice nurse. He found no evidence of the notes being altered, or of Mr C having asked to see a doctor. Having taken this advice into account, we did not uphold Mr C's complaint.

Summary

Mr C had a long-term history of ulcerative colitis (an inflammatory condition of the intestines). He complained that there was a delay in his medical practice appropriately investigating his symptoms when he suffered a flare-up of his condition. Mr C also complained that the handling of his complaint about this was unreasonable.

Mr C had previously taken a particular drug to relieve his symptoms but was not taking it at the time of the complaint, as his condition had been under control. When he began to suffer symptoms that he thought were indicative of a flare-up, he went to his GP and asked to be prescribed the drug. The GPs Mr C saw undertook various investigations, including blood tests, which were inconclusive. Because of this they felt unable to prescribe the requested drug. Mr C was referred to a specialist for further investigations, including a colonoscopy (where a camera is inserted into the intestines). The investigations eventually confirmed Mr C's view that he was experiencing a flare-up of his condition and the specialist prescribed him the drug he had requested.

Our investigation included taking independent advice from one of our medical advisers, who is an experienced GP. The adviser said that it was reasonable, and in line with the guidance issued by the General Medical Council (the regulatory body for doctors in the UK), for the GPs not to prescribe the drug Mr C was requesting. The guidance says that doctors should only prescribe medication when they are confident they have sufficient knowledge of the patient's condition and that the medication in question is in their best interests. The adviser said that, in Mr C's case, the initial tests were inconclusive and there are other conditions with similar symptoms, which could have been made worse had he taken the drugs he was requesting. We took the view that the actions of the GPs were reasonable. There were some delays in Mr C receiving the colonoscopy but the GPs had no control over this, and there was evidence that they had taken action to try to speed it up.

On the complaints handling, Mr C had addressed his complaint to the practice manager, but the response came from one of the GPs. Mr C felt that this meant that the practice manager had washed her hands of the complaint. We found, however, that because much of Mr C's complaint was about his clinical care and treatment, it was reasonable for a GP to respond, and we were satisfied that all the issues he raised were addressed in that response. Although we did not uphold the complaint, we found that the medical practice's complaints procedure said that the final stage of the process was to refer the matter to the local NHS board. As this is no longer the case, and the final stage is referral to the SPSO, we brought this to the attention of the practice.

Summary

Mr C complained that when his appeal was rejected faculty tutors were asked for their opinions as part of the process, which he thought was unfair. He claimed that the university should not have allowed him to sit assessments because of his low attendance rate, that they had not followed their own procedures in dealing with his appeal and that they were negligent in handling his situation. When he submitted his senate appeal saying that he had new information, the university found that he had not in fact produced any new evidence and closed their consideration of his case.

Our investigation found that the university had followed all procedures properly, and had taken into account Mr C's circumstances in allowing him four attempts at the assessment. Mr C had not produced any substantial new information in relation to the appeal, as the procedure required.