Not upheld, no recommendations

Summary

Miss C complained that out-of-hours hospital staff did not take account of her recent bowel surgery in providing diagnosis and treatment when she attended there because she had not opened her bowels for several days. Miss C said that as a result of this, she developed peritonitis (inflammation of the tissue lining the abdomen) and had to undergo further surgery, including having a colostomy bag.

After taking independent advice from one of our medical advisers, we found that the assessment carried out by the out-of-hours service was appropriate and there were no signs of peritonitis at this time. The records showed that the nurse who dealt with Miss C carried out appropriate examinations, and sought advice from medical staff when giving medication. We could not say for certain what the nurse said to Miss C, but there was evidence to suggest that Miss C was given the opportunity to be admitted to hospital (although we noted that she did not consider that she was in any position to make this decision at the time). We concluded after seeing the medical records that Miss C developed clear signs of peritonitis after she was admitted the following day to a different hospital, but that these symptoms had not been apparent when she attended the out-of-hours service.

Summary

Miss C complained that the care and treatment provided to her late mother (Mrs A) was inappropriate after she suffered a third heart attack. Mrs A also had a history of lung cancer and breathing problems. She was admitted to hospital on the Wednesday before a bank holiday weekend and told she would be transferred to another hospital for further investigations and treatment. However, as services were not available over the holiday weekend, Miss C was also told that Mrs A would not be transferred until the following week. Mrs A was treated with blood thinning medication and her condition was monitored. She complained of dizziness and was diagnosed with postural hypotension (where the blood pressure drops on standing) and some of her medication was stopped. On the Monday she developed severe pain in her head and neck which was not relieved by painkillers. When she was examined by a doctor and had a CT scan (a special type of computerised x-ray), it was found that she was bleeding from the brain. Her doctors consulted with a neurosurgeon (brain specialist) who advised that nothing could be done. Mrs A died later that day.

Miss C complained that, given her past medical history, her mother should have been treated as an emergency case for transfer. Miss C also complained that record-keeping was not to an acceptable standard and that while her mother was in hospital she was not properly cared for, including that her pain was not monitored and managed appropriately.

Our investigation, which included taking independent advice from a medical adviser and a nursing adviser, found that the care and treatment provided to Mrs A was reasonable, appropriate and in line with current NHS guidance. The observations and test results in the clinical records showed that Mrs A's condition was clinically stable and there was no indication to treat her as requiring emergency transfer. Mrs A suffered a recognised risk factor of the treatment she was undergoing, but the medical adviser was of the view that the treatment was reasonable, appropriate and timely. There was evidence that Mrs A's condition, including her pain level, was being regularly monitored and addressed. Neither adviser found any deficiency in the medical or nursing records.

Summary

Ms C, who was acting on behalf of Mr and Mrs A, complained about the care and treatment that their son (Master A) received after he fell from a tree and hurt his arm. He went to the accident and emergency department of a hospital, and was discharged after the wound was cleaned and glued. He later visited his GP and was referred to hospital where he had surgical treatment for the wound. However, this did not identify that two pieces of bark were lodged in it, which were only removed during a later private surgical procedure. Master A's parents felt that by not identifying the bark in the wound, the board had failed to reach the correct diagnosis.

We took independent advice from one of our medical advisers, an experienced orthopaedic surgeon. He reviewed the board's notes and all of the associated correspondence and said that, based on the evidence available at the time, the treatment was reasonable. He said that while it may seem to a member of the public that a foreign object should be identified within a wound, such objects can easily move within the body. By the time the private procedure was carried out, it was highly likely that Master C's body had been trying to expel the bark and so it may have been more evident at that point. We agreed that, without the benefit of hindsight, the board's treatment was reasonable. We also noted that the board had explained to the family that they had identified learning points from their complaint. We checked on these and, in light of this confirmation and the advice received, we were satisfied that the board had acted reasonably and that we did not need to make any recommendations.

Summary

Mrs A, who lived in a care home, became ill in the early hours of the morning. The care home contacted the out-of-hours service, and one of their doctors came and examined Mrs A. He recorded that there were signs on her teeth that she had vomited blood and that her abdomen was soft and non-tender. He diagnosed gastritis (inflammation of the stomach lining) and said that the care home should observe Mrs A, and if she vomited blood again or complained of pain in her abdomen, they should call 999. He also said she should see a GP from her own practice. One of the practice doctors visited later that day, and considered that she had an upper gastrointestinal tract bleed. She was then examined by the practice on a number of occasions and was eventually admitted to hospital three weeks after the out-of-hours doctor first examined her. Mrs A died in hospital of a small bowel obstruction nine days later.

Mrs A's son (Mr C) complained about the care and treatment provided by the out-of-hours doctor. He was of the view that the doctor had failed to diagnose that Mrs A had a small bowel obstruction and felt that he should have referred her to hospital. After taking independent advice from one of our medical advisers, however, we did not uphold his complaints. We found that the doctor's investigation, diagnosis, care and treatment of Mrs A were of a reasonable standard. Her presentation was not consistent with the symptoms or signs of bowel obstruction and we did not consider that the doctor failed to identify this. The only option the out-of-hours doctor had for referring Mrs A to hospital was as an emergency admission, and it would have been for her own GP to refer her for an out-patient assessment. We found that the medical records showed that Mrs A did not warrant emergency admission and so the doctor had arranged for her GP to see her. We also found that the doctor's clinical records were adequate and that his instructions to the care home staff were comprehensive.

Mr C was welfare power of attorney for his mother (ie he was able to take decisions about her care and welfare), and he also complained that the out-of-hours doctor failed to consult him about the treatment provided to Mrs A and about her future care plans. We found, however, that there would have been no reason for that doctor to contact Mr C in the early hours of the morning, as he made no treatment decisions when he visited Mrs A. He simply verified that she did not need to be admitted as an emergency, and referred her to her own GP the same day. There was also no requirement for him to tell Mr C that he had visited Mrs A, which we considered was the responsibility of care home staff, during normal working hours.

Summary

Mrs C complained that a dentist did not give her enough information about the treatment options available, and the costs, which she said resulted in her being treated as a private patient rather than by the NHS.

After taking independent advice from our dental adviser, our investigation found that the medical records showed that Mrs C was informed of the options and received a written estimate for the cost of her treatment. Our adviser said that she had received the appropriate treatment and that from his examination of the records, he believed she had consented to the treatment being provided privately. The dentist had clearly and correctly explained the treatment options, and that the treatment she wanted could not be provided on the NHS without a six month delay. The adviser also said there was no guarantee that the dentist could have provided it in that way, as he would first have had to obtain NHS permission to do so.

Summary

Ms C complained that a doctor refused her request to be accompanied by a friend during a lumbar puncture procedure (a medical procedure where a needle is inserted into the lower part of the spine). She said she was aware of other patients who had been allowed this, and complained that the hospital were not treating patients consistently. The board said that it was the doctor's normal practice to only have herself and a nurse in the room with a patient, because of hygiene and infection control concerns. They also said that no one would be available to offer assistance if someone accompanying the patient became unwell. They apologised that this was not explained to Ms C at the time and confirmed that the doctor was happy for her to be accompanied during other parts of the consultation.

We asked the board whether this was board policy or the doctor's policy. The board said that they did not have a policy and the approach depended on the individual consultant and on the procedure. We took independent advice on this from one of our medical advisers. He said that a lumbar puncture was a fairly minor procedure, and that some doctors would have no objections to the patient being accompanied. He was not persuaded by the board's explanations, as he said hygiene and infection control could be reasonably managed, and considered it unlikely that an observer would become unwell during such a procedure. However, as there was no board policy, and although it meant approaches were likely to vary, it was reasonable for the decision about who was allowed to be in the room to be left to doctors. He noted that it would not be appropriate for patients to be accompanied during some more invasive procedures. Having reviewed the relevant clinical records, the adviser noted that Ms C consented to the procedure going ahead and that there was no record, in either the medical or nursing notes, that she raised any concerns at the time.

We acknowledged that Ms C was distressed at not being accompanied during the procedure, but we accepted that, in the absence of a board policy, it was reasonable for the doctor to decide who was allowed in the room. In the circumstances, and as Ms C consented to the procedure going ahead on these terms, we did not uphold the complaint. We noted that there was no evidence that she made the board aware in advance of her wish to be accompanied and equally no indication of the doctor having told Ms C of her position on this. Although we did not make any formal recommendations, we suggested that the board might wish to reflect on whether they could have communicated better with Ms C.

Summary

An MP (Mr C) complained on behalf of Ms A's family about the treatment Ms A had received from her GP practice. In 2008, Ms A had a mole removed from her scalp. Due to its location, the mole could only be partially removed, but tests found no signs of cancer. In May 2009, she went back to the practice having found a lump behind her ear. Blood tests initially suggested inflammation and possible glandular fever, but when further lumps appeared and did not go away, the practice arranged for a referral to a haematologist (a specialist in blood-related disorders). Tests led to a diagnosis of skin cancer, linked to the scalp mole. Ms A had further surgery on the mole and to remove a number of lumps from her neck in February 2010 . Shortly after this, Ms A told the practice that she had a new lump in her back. She asked for a GP home visit but this was declined and instead a review was proposed after a week. She was unhappy with the lack of urgency shown by the practice and transferred to a different practice.

Ms A later developed a breast lump which became malignant. Despite treatment, she died in January 2012. Mr C complained that the first practice did not recognise the severity of Ms A's condition or treat her with the required level of urgency.

After taking independent advice from one of our medical advisers, we were satisfied that there was no evidence of cancer in 2008. There was no cause for the practice to arrange any further investigations at that point, and Ms A was appropriately advised to monitor the mole herself and contact the practice should she have any concerns. When the lumps appeared in her neck, blood tests were arranged and an appropriate referral was made to haematology for a biopsy (tissue sample) to be taken. With regard to the lump in her back, we found the practice's approach to have been reasonable, as Ms A was already under the care of cancer specialists, and had an appointment arranged. We accepted advice that the delay of one week was not significant and noted that this lump was ultimately found not to be cancerous. That said, we recognised that this was a very distressing time for Ms A and took the view that, given her recent medical history, a GP could have visited. Overall, however, we were satisfied that the practice acted in good time and arranged appropriate tests and referrals for Ms A.

Summary

Mr C, who is a prisoner, complained because the prison health centre refused to give him the same pain medication that his doctor prescribed to him while he was in the community. Mr C said he was prescribed this for back pain.

Our investigation took into account Mr C's medical records and found that he was offered an alternative pain killer, which he had refused. We took independent advice from one of our medical advisers, who said that it was reasonable for Mr C's pain medication to be reviewed. She also said the person prescribing his medication was entitled to decide whether particular pain relief was appropriate or not. In the light of this information, we were satisfied the prison health centre acted reasonably.

Summary

Mr C, who is a prisoner, attended an out-patient appointment for a minor operation. He complained that afterwards the prison health centre did not prescribe him a pain killer at the dosage recommended by the hospital. In responding to his complaint, the board advised Mr C that there were risks when prescribing a high dosage of the pain killer alongside medication that he was taking for opiate addiction. However, when Mr C reduced the amount of that medication, the prison health centre agreed to increase the dosage of his pain medication. We did not uphold Mr C's complaint because after reviewing his medical records and seeking independent advice from one of our medical advisers, we were satisfied that the clinical care provided was reasonable and appropriate.

In addition, Mr C complained that the prison health centre would not prescribe him an alternative medication for his opiate addiction. The board told Mr C that his addictions nurse had agreed to speak with his community addictions worker to see whether they would be willing to set him up on the alternative medication after his release from prison. Our adviser said she felt it was reasonable for the prison health centre not to change Mr C's medication when he was being released from prison soon. In light of that, we were satisfied the prison health centre's position was reasonable.

Summary

Mr C, who is a prisoner, complained that the prison health centre unreasonably stopped his pain medication. When his need for the medication was reviewed, the prison doctor decided it was no longer necessary and offered an alternative.

We reviewed Mr C's clinical records and took independent advice from one of our medical advisers. She said that Mr C was being prescribed a strong pain killer, which was suitable for use at the time of an injury or flare-up of a condition. However, it was not suitable to continue to use it without a review to decide whether it was still appropriate. In Mr C's case, it had been reviewed and deemed no longer appropriate, and although Mr C was unhappy with this, we were satisfied that his clinical treatment was reasonable.