Not upheld, no recommendations

Summary

Mrs C complained that she had a day procedure in Royal Infirmary of Edinburgh to treat abnormal bleeding of the womb. She said that this had left her with pain, discomfort and nerve damage, to the extent that she has been unable to work for several months. Mrs C also said that when she signed the original consent form, nerve damage was not mentioned as a possible complication.

We took independent advice on this case from one of our medical advisers, and did not uphold Mrs C's complaint. The adviser said that the operation appeared to have been straightforward, and that nerve damage was an extremely unusual complication of the surgery and was not an issue that he would expect to be discussed when obtaining consent before the operation. We concluded that the operation was carried out according to guidelines and procedures and that Mrs C was a suitable patient for the procedure. Mrs C also complained that the board did not respond to two emails she sent. As we found that these had been incorrectly addressed, we did not uphold this.

Summary

Mrs C's late father (Mr A) had moved house just as he had been given a diagnosis of terminal lung cancer. Because of this, he had de-registered from his previous medical practice, and registered as a new patient at the medical practice about which the complaint was made. The GP there noted the cancer diagnosis, and compiled a full summary of Mr A's medical history. The GP also referred him to hospital that day as he was acutely unwell. After his discharge, he was seen twice by GPs at the practice, and in the following month he was again admitted to hospital. He was discharged shortly after to the care of his GP and district nurses. The next month, Mr A was admitted again, by emergency ambulance. This time, when he was discharged his consultant advised the practice that any future admission should be to a hospice. Shortly after this, a GP visited him at home and noted how Mr A and his family were struggling and that the situation was difficult and stressful. The GP arranged a hospice bed for the following day and noted in the records that Mr A's wife (Mrs A) and family were happy with this plan. A specialist nurse also visited and, with the GP, provided specialised pain relief equipment. Mr A was admitted to the hospice the next day, and passed away during the early hours of the following morning.

Mrs C complained about the end of life care provided to Mr A and that GPs showed a lack of care and empathy. She was unhappy that, after hospice care had been arranged, Mr A could not be admitted until the next day. She also told us that Mrs A was very distressed that during the time with the practice she had to explain her husband's medical history to a number of GPs. Mrs A had said that several of them appeared to have failed to read his clinical notes before visiting.

We took independent advice on this case from one of our medical advisers. The adviser said that the practice provided a reasonable standard of care to Mr A in relation to pain relief and support. We noted that events on the day before he was admitted to the hospice appeared to have been extremely distressing for all involved, and in particular for Mr A and his family. However, the adviser said that the GP took all reasonable measures to secure a bed for him, and we were satisfied that there was nothing more that she could have done.

In relation to Mrs C's complaint that Mrs A had to tell visiting GPs about her husband's medical history, the practice said it was standard practice to question patients. Our adviser said that, in this respect, they provided a reasonable standard of care to Mr A. Given this, we did not uphold the complaint. However, clearly Mrs C and her family were extremely distressed by their experience and we drew the adviser's comments about the practice giving consideration to changing the way they provide palliative care to the practice's attention.

Summary

Mrs C complained about orthodontic treatment (dentistry dealing with the prevention and correction of irregular teeth) provided to her son (Mr A). Mrs C was of the view that the treatment left Mr A with an underbite (a condition in which the lower teeth and jaw protrude in front of the upper teeth) and no continuity between his top and bottom teeth.

We took advice from our orthodontic adviser. He advised that the treatment provided had focused solely on Mr A's upper jaw. This was reasonable as the rate of growth in the lower jaw was unpredictable. The orthodontist who treated Mr A was entitled to take a view on whether treatment to Mr A's lower jaw was appropriate. Our investigation found that the care and treatment provided to Mr A was reasonable and that the growth of his lower jaw could not have been affected by orthodontic treatment, making it impossible for the development of his underbite to be prevented.

Summary

Mr C complained about the care and treatment that district nurses provided to his late mother (Mrs A) before her death. He said that they had not taken reasonable steps to assess and monitor Mrs A's pain when changes were made to her medication. He also said that they unreasonably put Mrs A on the Liverpool Care Pathway (a framework used by healthcare professionals in the last hours or days of life when a death is expected).

We took independent advice on Mr C's complaints from a nursing adviser and a medical adviser. After doing so, we did not uphold the complaints. Our advisers said that the district nurses had assessed Mrs A's pain appropriately and in line with guidance. We found that Mrs A's level of pain had been assessed at every visit, the family had information on what to do if they had concerns about her, and that it had been reasonable that the nurses had not used a pain assessment tool. The decision to put Mrs A on the Liverpool Care Pathway was predominantly made by a GP and a palliative care nurse, although it did involve discussion with family members and the district nurses. We found that, on balance, the decision to start the Liverpool Care Pathway had been reasonable and we did not identify any failings by the district nurses in relation to this decision. We found that it had been completed and implemented appropriately and that communication with Mrs A's family had been reasonable.

Summary

Mrs C complained about the care and treatment provided to her late brother (Mr A), who had a number of medical conditions. She said that when he was admitted to hospital, despite his complex medical history he was denied admission to intensive care. He was instead admitted to the acute medical unit, where he died some nine days later. Mrs C said that the care and treatment her brother received was less than he deserved and meant that he was denied the chance to live. She also complained that the board did not communicate well with the family, and that the family were unaware of Mr A's 'not for resuscitation' status (a decision taken that means a doctor is not required to resuscitate the patient if their heart stops).

In investigating the complaint we carefully considered all the relevant documentation, including Mr A's medical records and the complaints correspondence, and obtained independent medical advice from one of our advisers, a consultant in acute internal medicine.

Our investigation found that when Mr A was admitted to hospital, he was comatose (unconscious) and in a very serious condition. Because he had a complex and difficult medical history, he was reviewed and doctors decided that Mr A should not go to intensive care, but to the acute medical unit. Our adviser said that this decision was based on what was best for Mr A and was in accordance with the board's policy and national clinical guidance. The adviser recognised the gravity of the decision, but said that to do otherwise would have been futile and unethical, as more invasive treatment would have meant that Mr A's final days would have been needlessly uncomfortable and painful. While this was contrary to what the family wished, good practice was to put the interests of the patient first and to make Mr A as comfortable as possible. Mr A was extremely unwell, and in the circumstances we found all his care and treatment to have been reasonable.

We found that the decision not to treat Mr A should his heart or breathing stop was documented, and that Mrs C was told about it. Although Mrs C said that she was not told what was happening to Mr A or about the decision not to resuscitate him, the records detailed a number of conversations with her and other family members.

Summary

Mrs C complained that the care and treatment provided to her husband (Mr C) were inappropriate. She also complained that it was unreasonable for staff to communicate directly with her husband, who is profoundly deaf and cannot speak, when he had asked staff to communicate through Mrs C.

Mr C had heart problems for which he was taking warfarin (a blood-thinning medication). When he developed blood in his urine, he was initially treated as an out-patient but was then scheduled for surgery as an in-patient at Gartnavel Royal Hospital. Following surgery Mr C was catheterised (a tube was inserted into the bladder to drain urine). It took some time for the blood in Mr C's urine to resolve and he had to receive blood transfusions and antibiotics (drugs to fight bacterial infections) when he developed an infection. Mrs C complained that something must have gone wrong with the operation and said that she suspected that there had been a problem with the instruments used. She also complained that, unusually, Mr C suffered pain from the catheter used after his operation.

Our investigation, which included taking independent medical and nursing advice from two of our advisers, found no evidence that anything had gone wrong with either the instruments or the actual operation. Our medical adviser said that the records of the operation were very clear and documented a straightforward and uneventful procedure. There was no evidence of a problem with the instruments. The medical adviser said that when Mr C went into hospital his warfarin medication was changed to heparin (an anti-coagulant) which was reasonable. Patients taking long-term warfarin or heparin are prone to increased bleeding and that this was the reason for Mr C's extended blood-loss, which was treated appropriately. Both advisers were of the view that the type of catheter used, although larger than the type that Mr C was used to, was appropriate for his condition at the time. This was a 'three-way' catheter that allowed nursing staff to irrigate Mr C's bladder with sterile water which the advisers considered was appropriate.

On communication with Mr C, both advisers were of the view that it was reasonable for staff to use hand-written notes to communicate directly with him, and noted that he engaged in this without objection. Healthcare staff have to tread a fine line between respecting the wishes of the patient and their family and doing what is necessary to provide care safely and with the informed consent of the patient. Mrs C could not be with her husband at all times and it was important that staff were able to communicate with him to provide care. The nursing adviser also commented that, even when Mrs C was present, there would be times when staff would have to ensure they had Mr C's consent before providing care.

Summary

Mr C, who is a prisoner, complained that the prison health centre unreasonably refused to issue him with a medical marker excusing him from work. He said that he had suffered a stroke the month before arriving in prison and had been signed off work in the community on medical grounds. When the board responded to his complaint they said that, based on his recent test results, they found no grounds upon which to excuse him from work in prison.

We took independent advice from one of our medical advisers, who reviewed Mr C's records and noted that he had had a number of tests relevant to his fitness to work. As none of these revealed any cause for concern, the adviser said that the prison health centre's decision not to excuse Mr C from work was appropriate. In light of this advice, we concluded that Mr C's fitness to work had been appropriately assessed and we did not uphold the complaint.

Summary

Mrs C's mother (Mrs A) is 92 years old. Mrs C complained about the length of time that her mother had to wait for a flu vaccination. Mrs A had requested a home visit for the vaccination and initially the medical practice had refused, saying that their policy was that only housebound patients were entitled to this. However, they then changed their mind and passed the request to district nursing staff to arrange. After a few days, Mrs A had received no contact from either the practice or the district nurses. She contacted the practice and was given a surgery appointment, where the vaccination was administered.

The practice confirmed to us that their policy was that only housebound patients were given a home visit for this, but that they had made an exception in Mrs A's case. District nurses had to prioritise flu vaccinations, and gave clinical priority to housebound patients and those in residential homes or sheltered housing complexes. The practice explained that Mrs A would have received the flu vaccination at home by the end of the month in which she got it, in line with their guidelines. We took independent advice on this from one of our medical advisers, who confirmed that the practice's actions were appropriate. He had no concerns that the home visit was not carried out earlier or that the priority afforded to the request was unreasonable, and we found no evidence of any avoidable delays in dealing with Mrs A's request.

Summary

Ms C suffers from a blood condition - Factor V Leiden - which increases the risk of blood clots. Ms C complained that her medical practice had not taken sufficient account of this condition, in that they had not monitored her blood on an ongoing basis, they had given her an inappropriate contraceptive injection and when she went to them with a possible blood clot in her calf they had not referred her to hospital.

Ms C's concerns started when she attended the practice suspecting that she had a blood clot in her calf. Her GP referred her to hospital to see whether she had a DVT (deep vein thrombosis). The assessment showed some superficial clots, but no DVT. Ms C later had an contraceptive injection at the practice, which she continued to receive on a quarterly basis for the following year. A year after she first went to the practice with pain in her leg, Ms C went back for the same reason. The GP did not refer her to hospital this time, on the basis that no DVT was found on the previous occasion. However, the next morning Ms C woke with pains in her chest, and subsequent investigations found that Ms C was suffering from pulmonary embolisms (clots in the blood vessel that transports blood from the heart to the lungs).

We took independent advice on this complaint from one of our medical advisers, who is a GP. After considering Ms C's medical records, he explained that her blood condition did not require ongoing monitoring. He also said that her contraceptive injections were the most appropriate for her. Finally, he considered whether Ms C should have been referred to hospital when she presented with pain in her calf on the second occasion. He said that, although this was a finely balanced judgement, the GP had acted reasonably given the evidence he had available to him at the time.

Summary

Mr C complained to us on behalf of his son (Mr A). Mr A had submitted an academic appeal to the university because he felt that his work had not been considered fairly. He said that he had not received adequate support, and that he lacked confidence in the mark assigned because he felt staff were not impartial. The university found that there were no grounds to uphold his academic appeal. Mr C then complained to us that they had not reasonably investigated and considered Mr A's appeal.

Although we cannot investigate matters of academic judgement, we can look at whether the appropriate processes were followed in reaching a decision on an academic appeal. Our investigation found that the university had thoroughly investigated the circumstances of Mr A's appeal, and had ensured that adequate and appropriate support was provided and that reasonable steps had been taken to ensure impartiality and verify the marks awarded.