Not upheld, no recommendations

Summary

Ms C is an advocate for the sister of the late Mr A. Ms C complained that the care and treatment provided by the board to Mr A was unreasonable. Around 15 months after being diagnosed with cancer, Mr A was given the all-clear. However, within two months, his symptoms had returned. Initially, tests suggested that the original cancer had returned, but following a liver biopsy (where a sample of tissue is taken for examination in the laboratory), Mr A was found to have a second type of cancer, incurable small cell lung cancer, which had already spread to his liver. Mr A died some three weeks later.

Our investigation, which included taking independent advice from a medical adviser who is a consultant haematologist (a specialist in disorders of the blood), found that once Mr A had been referred to the board his care and treatment had been reasonable. Mr A had a rare form of cancer - Mantle Cell Lymphoma (MCL - cancer of the white cells that help the body fight infection). Mr A was treated for MCL by the board and by a specialist team in another NHS board area.

The adviser reviewed Mr A's treatment against guidelines issued by the British Committee for Standards in Haematology which were published in 2012. Although this guidance was provided after Mr A's treatment, the adviser said that his treatment complied with these standards and was, therefore, reasonable. The adviser considered that overall, the care and treatment provided to Mr A by the board was reasonable and timely.

Summary

Ms C's dentist referred her to the board's dental institute for treatment to remove the roots of a broken wisdom tooth. Ms C complained that there was unacceptable delay in providing an appointment at the institute; and that the lack of communication about the waiting time was unreasonable.

After investigating, we did not uphold Ms C's complaints. The dentist referred her to the dental institute as a routine referral, to have the roots of her tooth removed under sedation. Our investigation found that she was offered an appointment there ten weeks after the referral was received, and we were satisfied that this was within the national target timescales. We were also satisfied that the waiting time for an initial appointment was appropriately communicated to Ms C from the start, and that it was clearly explained to her why it was not possible to say before the initial consultation how long it would be before she received treatment.

Summary

Mr C complained that there was an unreasonable delay in diagnosing his wife (Mrs C)'s cancer. Mr C said that tests dating back to 2005 contained suspicious results that the hospital should have acted upon. He said that he had specifically asked if there was a possibility that his wife had cancer and had been told there was not. He also questioned why, after his wife had been assessed as unfit to have a biopsy, one was undertaken about five months later, when her health had deteriorated.

After taking independent advice from a medical adviser, we did not uphold Mr C's complaint. The adviser noted that his wife had other serious health conditions, including tuberculosis (a bacterial infection mainly affecting the lungs) and chronic obstructive pulmonary disease (a disease of the lungs in which the airways become narrowed). The adviser also noted that it was likely that the cause of the mass that Mr C thought was indicative of cancer in 2005 was likely to have been caused by Mrs C's tuberculosis. Our investigation, therefore, found that the actions of the hospital were, therefore, reasonable and appropriate. Although we did not uphold the complaint, we noted that the clinical team at the hospital did not seem to have been able to effectively communicate the seriousness of Mrs C's health problems to the couple.

Summary

Mr C's young daughter is in the care of his former partner. He complained to the board that a health visitor did not take appropriate action to protect his daughter when he raised concerns about her welfare.

Our investigation included taking independent advice from a medical adviser, who is a senior and experienced nurse and health visitor. The adviser was satisfied that the actions taken by the health visitor and her predecessor were appropriate, reasonable and proportionate. We reviewed the documentation from the board and other relevant agencies and were satisfied that the health visitor's actions were reasonable and complied with relevant national and local guidance.

Summary

Mr C, who is a prisoner, complained because he felt the prison doctor unreasonably refused to prescribe him the medication he wanted. Mr C felt the medication was not sufficiently controlling the symptoms of his mental health problem. Because of that, Mr C said he was having difficulty sleeping and he asked to be prescribed a sedative to help with this. Mr C also suffers from a bone condition, and as he felt his body had become used to his existing pain relief medication he asked to be prescribed something stronger.

In investigating Mr C's complaint, we reviewed the board's response to it and sought independent advice from our medical adviser. We noted that the prison doctor had tried to meet with Mr C to discuss his pain and consider introducing anti-inflammatory medication but, because Mr C became abusive, the meeting was ended. In addition, the board advised Mr C that the sedative he wanted was normally only prescribed for short term use and because of that, the doctor decided not to prescribe it. The board also confirmed that two different psychiatrists had not recommended that prescription for Mr C.

Our adviser provided an opinion on Mr C's complaint. She said it was likely the prison doctor would have prescribed anti-inflammatory medication in addition to Mr C's pain medication and doing that would have been reasonable. She did not consider that the pain medication Mr C wanted to be prescribed was appropriate for his circumstances. In addition, our adviser noted that some medication that Mr C was taking for his mental health condition had sedative qualities, and said it would not be reasonable to prescribe a regular as well as those medications. In light of this advice, our view was that the prison doctor's decision not to prescribe Mr C the pain medication and sedative that he wanted was reasonable and appropriate.

Summary

Mr C complained about the care and treatment of his wife (Mrs C) while she was in hospital over a two-month period. Mrs C had, amongst other things, a history of diverticular disease (a disease affecting the colon). During the period concerned she was admitted three times and three surgical procedures were carried out. After the third operation, Mrs C's condition declined and she died. Mr C believed that not enough was done for his wife; that on her first admission she should have been x-rayed, and that some of the treatment provided made her condition worse. Mr C also questioned the timing of his wife's second operation and said that she was discharged despite continuing symptoms and the fact that she had an infection. He believed that she should have been given a scan before discharge. During her third operation, he said that a stoma (a surgically created pouch on the outside of the body for body waste) should have been created.

In investigating the complaint, we took into account all the available information provided by Mr C and by the board, including all the complaints correspondence and Mrs C's relevant clinical notes. We also obtained independent advice from a medical adviser. We did not, however, uphold Mr C's complaint.

The adviser said that the care and treatment given to Mrs C on her first two admissions was completely reasonable. However, they also said that on the third admission the treatment was difficult to explain insofar as it relied upon the findings during surgery, and the clinical opinion and judgment of the surgeon at the time. The adviser went on to say that, with the benefit of hindsight, the surgeon concerned might well have made a different decision. However, the adviser was clear that the action ultimately taken was entirely reasonable in the circumstances at the time.

Summary

Mr C had suffered from abdominal and chest pain for several years. He complained that the board were unable to find out what was causing this. Mr C was under the care of a pain specialist at a hospital and was reviewed by surgeons, chest physicans, and gastroenterologists (specialists in the treatment of conditions affecting the liver, intestine and pancreas). He also complained that the pain specialist unreasonably refused him a specialised diagnostic scan and that he was not reviewed at regular intervals.

After taking independent advice from one of our medical advisers, our investigation found that thorough and appropriate assessments and investigations, including various specialised diagnostic scans, had been carried out. We also found that Mr C was reviewed at regular intervals and given appropriate pain relief in an attempt to address his pain.

Summary

Ms C is an advocate for the sister of the late Mr A. Ms C complained that the care and treatment provided by the board to Mr A was unreasonable. About 15 months after being diagnosed with cancer, Mr A was given the all-clear. However, within two months, his symptoms had returned. Tests at first suggested that the original cancer had come back, but following a liver biopsy (where a sample of tissue is taken for examination in the laboratory), he was told that he had a second type of cancer, incurable small cell lung cancer, which had already spread to his liver. Mr A died some three weeks later.

Our investigation, which included taking independent advice from two medical advisers, a consultant haematologist (a specialist in disorders of the blood) and a consultant oncologist (cancer specialist), found that once Mr A had been referred to the board, the investigation of his condition and his care and treatment were reasonable.

Mr A had a rare form of cancer - Mantle Cell Lymphoma (MCL - cancer of the white cells that help the body fight infection). Mr A was treated for MCL by both the board's specialist team and by another NHS board in his home area. The advisers reviewed Mr A's treatment against guidelines issued by the British Committee for Standards in Haematology which were published in 2012. Although this guidance was provided after Mr A's treatment, the advisers said that his treatment complied with these standards and was, therefore, reasonable. They also considered that overall the care and treatment provided by the board was reasonable and timely.

Summary

Mr C complained about the care and treatment of his late wife (Mrs C). Mrs C had developed a cough and, when it persisted, she visited her GP. She was given a range of medication over the next six weeks. When the cough did not clear up, the GP referred her for a chest x-ray, which was reported as normal, and she was referred to a respiratory consultant. While Mrs C awaited this appointment, her symptoms persisted and she developed a pain in her hip. She was given painkillers and referred for an x-ray of her pelvis. This was also reported as normal. When the pain continued and Mrs C also developed numbness in her shoulder, she was given an urgent referral to orthopaedic services. The hospital changed this to a normal referral. When this was identified, the GP changed the referral back to urgent. By this time, Mrs C had seen the respiratory consultant, who diagnosed her with a viral infection. When Mrs C had still not been seen by orthopaedic services a week later, her GP sent her to the hospital with an urgent referral. Mrs C was admitted, and was diagnosed with lung cancer.

Mr C complained that the medical practice failed to diagnose lung cancer for several months. Our investigation reviewed the NHS guidance on suspected cancer, and we took independent advice from one of our medical advisers. We did not, however, uphold Mr C's complaint. The advice we received was that the medical practice acted appropriately, based on the information they had. Mrs C was at low risk of lung cancer, and chest x-rays are the standard initial diagnostic tool. The lack of evidence of lung cancer was borne out by the chest physician's diagnosis of a viral infection. We also found that the medical practice referred Mrs C appropriately for x-rays and specialist opinion.

Summary

Mrs C visited her GP after having had a cough for three months, and was prescribed antibiotics. Mrs C returned a few weeks later. She said she told the GP that she was unable to climb 20 stairs and that the GP noted Mrs C's breathlessness when talking to her. Soon after that, Mrs C visited the medical practice again, saying her cough was no longer a problem but that she was still breathless even when exerting herself very little. At a further consultation about a month later, Mrs C said she told the GP she could no longer climb the stairs, was using the lift at work and her inhaler was not working. The GP then prescribed steroids, referred Mrs C for a blood test and discussed referring her to a chest physician.

About a week after that, Mrs C said she attended the practice for blood tests but asked to see a GP. Mrs C said that the steroids were not helping and she was unable to walk the few metres into the consulting room without stopping. The GP agreed to refer Mrs C to a private consultant to speed up diagnosis. Later that month, however, Mrs C was taken to a hospital accident and emergency department with an acute attack of breathlessness, where she was quickly diagnosed with a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs) that needed immediate treatment. Mrs C complained that her GP did not recognise the worsening symptoms or treat them with any sense of urgency, and did not adequately record the problem with breathlessness. She believed the delay in diagnosis caused a chronic (long-term) condition and that a potentially life-threatening situation could have been avoided.

As part of our investigation we took independent advice from a medical adviser, who studied Mrs C's medical records. The adviser said this was a complicated matter as, in his view, it involved two diagnoses, one related to the ongoing symptoms and the other to the acute symptoms. The adviser said that he considered that the early symptoms that Mrs C described were the result of pulmonary hypertension (raised blood pressure in the blood vessels that supply the lungs) and that later symptoms could have been caused by either this or the pulmonary embolism. He concluded that Mrs C had developed a progressive disease (pulmonary hypertension), but that the actions of the GPs had not changed the long term outlook. We did not uphold the complaint, noting that pulmonary embolism is difficult to diagnose and that the practice had throughout actively managed Mrs C's worsening symptoms and provided her with a reasonable standard of care and treatment.