Not upheld, no recommendations

Summary

Mrs C complained to us about aspects of treatment provided to her mother (Mrs A) by GPs at her medical practice. She was concerned that at a home visit a GP did not admit Mrs A to hospital, although later she had to go there. When Mrs A was discharged from hospital there was a problem with her medication.

Our investigation found that although the GP's records were not as thorough as they should have been, which we pointed out to the practice, she had carried out a reasonable assessment of Mrs A at the home visit and that at that time there was no clinical reason for a hospital admission. We took independent advice from one of our medical advisers, who said the GP had used her clinical judgement in a reasonable manner and had provided appropriate advice about what the family should do if Mrs A's health deteriorated over the weekend. We also found that the practice acted reasonably when told that Mrs A needed additional medication, and that her care was not compromised by a slight delay in obtaining the medication when it was not in stock at the local pharmacy.

Summary

Mr C, who is a prisoner, complained that the board stopped his pain medication after he was sent to prison. The medication (gabapentin) had been prescribed by his GP. However, Mr C was also on methadone (a drug used medically as a heroin substitute). Doctors in the prison told him that it was recommended that methadone and gabapentin were not prescribed together, and prescribed a different medication for his pain.

After taking independent advice from one of our medical advisers, we found that there was potential for harm if the doctors in the prison had continued to prescribe gabapentin while Mr C was still on high doses of methadone. The prison doctors had also offered reasonable pain killing alternatives when the gabapentin was stopped. In view of this, we did not uphold Mr C's complaint.

Summary

Miss C was unhappy with the care and treatment that her late mother (Mrs A) received from district nurses in the weeks prior to her death, and in particular in relation to pressure ulcers (bed sores).

As part of our investigation, we took took independent advice from our nursing adviser, and carefully considered all the complaints correspondence and Mrs A's clinical records. We recognised how distressing this had been for Miss C and her family, but our investigation did not find that there had been any failings in the care or treatment provided to her mother. Our adviser said that that this had been of a good standard and was in keeping with current standards and guidance.

Summary

Ms C complained that the care and treatment she received from her dentist on two occasions was unreasonable, both when a temporary filling was inserted into a tooth in her lower jaw, and when she attended a week later for a permanent filling. Ms C said that from the time the temporary filling was applied she felt sick and had a bad taste in her mouth. She also said that part of it broke off, and she swallowed it, after which she also experienced stomach problems. When she went for the permanent filling, she said the dentist injected a local anaesthetic but then did not wait long enough before starting to work on her tooth. When she complained of pain, the dentist injected her again, leaving her face temporarily paralysed on one side, so that she could not close her eye.

Our investigation included taking independent advice from one of our dental advisers, who said that the material (Cavit G) was widely used for temporary fillings, and was approved by the relevant regulatory authorities as being safe for use. The adviser said that it was reasonable and appropriate for the dentist to use this in Ms C's case, but that, very rarely, a few patients report similar side effects to those Ms C experienced. The adviser was unable to say whether Cavit G was the direct cause of these in Ms C's case, and noted that the dentist had provided Ms C with a list of its ingredients to take to her GP if the symptoms continued.

In terms of what happened with the permanent filling, the adviser explained that local anaesthetic in the lower jaw has to be placed close to the facial nerve and usually takes between two and four minutes to work. However, as the dentist cannot see the facial nerve, and each patient's physiology is different, the placing of the injection can only be an educated guess. This can sometimes mean that a second injection is needed in a slightly different place, which can have the effect of temporarily paralysing the facial nerve. The adviser found no evidence that the dentist's treatment had been unreasonable, and noted that they had offered Ms C an eye patch that day to cover her eye, and had phoned the next day to ensure she had recovered. The notes said that Ms C had told them she was fine, and that the paralysis had worn off by the time she arrived home on the day of the appointment.

Summary

Mr C, who is a prisoner, complained about the management of his sleep disorder by the prison health centre team. He was unhappy that his zopiclone (a drug used to treat sleeping problems) prescription was reduced and stopped. In addition, Mr C said that an alternative drug he was given did not agree with him as he was also on methadone (a drug substitute for heroin).

After taking independent advice from one of our medical advisers, we found that the health centre team acted reasonably in reducing Mr C's zopiclone, as it is a drug that is licensed for short term use of insomnia. Mr C was aware of this at the time it was first prescribed. There was also evidence to show that Mr C was reviewed appropriately and told of the need to reduce the zopiclone prescription on more than three occasions.

Summary

Mrs C had undergone knee replacement surgery at Woodend Hospital. She was not offered immediate physiotherapy treatment on discharge. At an orthopaedic (involving the musculoskeletal system) out-patient clinic appointment six weeks later, a consultant arranged for out-patient physiotherapy and a further clinic review in six weeks. Mrs C felt that she should have been offered physiotherapy appointments immediately on discharge from hospital, rather than continuing with exercises arranged by the in-patient physiotherapist. The board explained that their standard procedure is that in-patient physiotherapy advice is provided before discharge, and the patient should continue with these exercises until the six week clinic review.

We took independent advice from one of our medical advisers, who said that it is expected that patients would normally follow the exercises set by the in-patient physiotherapist for a period of rehabilitation and then discuss their condition at the orthopaedic out-patient clinic. We found that the practice of not arranging out-patient physiotherapy appointments until after a patient has attended the six week clinic review was accepted practice throughout the NHS and did not uphold Mrs C's complaint.

Summary

Mrs C's mother (Mrs A) died from complications following surgery for an abdominal aortic aneurysm (bulging of part of the aorta, the body's largest artery). Mrs C complained that there was a delay in diagnosing the aneurysm (a weak point in the blood vessels, which causes them to bulge or balloon out). She said that her mother had been visiting the practice for two years and had been diagnosed with sciatica (back and leg pain, caused by irritation of or pressure on the sciatic nerve). However, she felt that her mother should have been referred to hospital earlier for further tests. She also complained about the follow-up care after her mother had surgery, in particular a delay in identifying post-operative complications.

To investigate the complaint, we considered all the relevant documentation, including the complaints correspondence and Mrs A's medical records. We also obtained independent advice from one of our medical advisers.

Our investigation found that the practice had acted reasonably, and that there was no evidence of an unreasonable delay in referring Mrs A to hospital for tests. Our adviser said that there was no evidence of specific symptoms that would have alerted the practice to an aortic aneurysm, and that it was in fact picked up by chance during an x-ray to investigate back pain. She also said that as there are usually no symptoms, such aneurysms are often not discovered until they leak or burst. Once the aneurysm was identified, appropriate action was taken to investigate it further and to resolve it. We also found no evidence that the practice had failed to assess Mrs A after her operation or that there was a delay in diagnosing the post-operative complications. The operation was clearly a risky one, as Mrs A had other health conditions. The medical records show that the procedure was complicated, and we noted that doctors had discussed the risks with Mr and Mrs A (Mrs C's parents) before the operation was carried out.

Summary

Mr C complained that he had been inappropriately treated by his dentist. He was unhappy with the insertion of two crowns on teeth in his upper jaw and the removal of a crown from a tooth from his lower jaw. Mr C said that the upper crowns had not been fitted properly, and had left unsightly gaps between his teeth, which had never been there before. Mr C said that the dentist had then referred him to a dental hospital, because the dentist found him too difficult to deal with. Mr C also complained that when attempting to remove the crown from his lower jaw, the dentist had removed almost the entire tooth. He said he had not been warned that this was a possibility and, had he known this, he would not have agreed to the removal of the crown.

We took independent advice on Mr C's complaint from our dental adviser. He said the decision to replace the two upper crowns was appropriate, and was supported by the x-rays of the teeth, and that the same applied to the removal of the crown from the lower tooth. He said that gaps between the teeth would have appeared as inflammation of the gums (caused by previous poorly fitting crowns) receded. It was appropriate for the dentist to have referred Mr C to the dental hospital, in line with General Dental Council guidelines, once it became clear he was still unhappy with the treatment he had received. The adviser said that the dental records for the removal of the crown from the lower tooth showed that the treatment options were explained to Mr C. He also pointed out that, had the tooth been left in place, it would have fractured. We did not uphold Mr C's complaints as our investigation found no evidence to support his claims of inadequate and unnecessary treatment.

Summary

Mrs C complained on behalf of her partner (Mr A) about a procedure to remove his gallbladder at Borders General Hospital. Mrs C said they had originally been told that the procedure would be performed by keyhole surgery but that, if complications arose, it would be performed as open surgery, and Mr A would need to be kept in hospital for several days. Mrs C said that when she phoned the hospital on the day of the operation, she was told complications had arisen. When she visited Mr A after his surgery, he was in great pain, which she did not believe was being managed properly. When Mrs C visited the next day, she found Mr A being prepared for a scan. Mrs C said she had repeatedly asked nurses and medical staff about Mr A's wound and the frequency of his dressing changes. She believed that it was only as a result of her questioning that Mr A's wound was examined, leading to Mr A's transfer to a specialist unit.

We took independent advice from one of our medical advisers, a specialist in gallbladder surgery. He explained that Mr A's procedure had not been converted into open surgery, due to the complications that the surgeon had identified, and that this was an appropriate course of action. The notes of the operation showed that there were significant difficulties in performing the operation, due to existing damage to the gallbladder. The adviser said that the notes also showed that the care plan for Mr A was to perform a scan to identify the complications from the operation, and to consult with a specialist unit. The adviser said that the surgeon had acted appropriately and in Mr A's best interests when complications occurred. We found no evidence that Mr A had not been appropriately treated, and did not uphold Mrs C's complaint, as we found no evidence to support her claim that Mr A was only transferred due to her intervention.

Summary

Mr C said that during an incident in the university he was assaulted and prevented from leaving by university staff, who called the police. The police then detained and searched him and a fellow student. When he complained to the university about the treatment he had received, his complaint was not upheld and he complained to us that his view of events was not taken into account, and so the university did not deal with his complaint in a balanced manner.

Our investigation found that the university had interviewed all those involved and had taken account of the various views of events. In the light of the evidence they obtained, they decided not to uphold his complaint, as they were entitled to do.