Not upheld, no recommendations

Summary

Mr C was on holiday when he was taken ill while on a moored boat. He called 999 but was told that as his condition was not life-threatening he should call NHS 24. When he did so, they said they would ask an out-of-hours doctor at a local hospital to call Mr C within an hour. Mr C complained that the out-of-hours doctor would not arrange an ambulance to take him to hospital, and instead gave him the number of local GP surgeries he could contact. Mr C said that he was in great pain and could not walk, but with assistance managed to get back to his holiday home. When he got there, an ambulance was called and Mr C was taken to hospital. Mr C felt the out-of-hours doctor should have arranged an ambulance to take him to hospital in the first instance.

Our investigation found that there was a difference of opinion between the out-of-hours doctor and Mr C about his ability to get off the boat, but the information in the records did not help us resolve this. We took independent advice from one of our medical advisers, who said that there was no evidence to suggest an emergency ambulance was required, and that the out-of-hours doctor had provided appropriate advice. This was that, should Mr C's condition worsen, he should contact the emergency service again. It was also appropriate for the out-of-hours doctor to suggest that Mr C should contact a general practitioner who might have been willing to visit him on the boat.

Summary

Mr C hurt his foot while gardening. He complained that the board did not diagnose that it was fractured despite two visits to a hospital accident and emergency department (A&E). When he first attended A&E, Mr C was recorded as limping but able to bear weight on his injured foot. The records showed that his foot was sore but with a good range of movement. A bad sprain was diagnosed and Mr C was given advice on how to care for his foot.

Mr C then went on holiday for two weeks. His foot had not improved so on the way home he went to another A&E. Again the foot was recorded as having a good range of movement and Mr C was able to put weight on it. A rash was also recorded but was put down to a sweat rash, and it was noted that Mr C told staff that he had done a lot of walking on his holiday. Again a bad sprain was diagnosed. Mr C's foot was not x-rayed during either visit to hospital.

Mr C then went to see his GP as he was still having trouble with his foot and now felt it was mis-shapen. The GP arranged an x-ray which revealed that Mr C's foot was fractured. He was referred to an orthopaedic specialist (a specialist in medicine of the musculoskeletal system) who diagnosed that four of the five bones in Mr C's foot had been displaced. Mr C now has to wear orthotic footwear (special footwear available on NHS prescription) to accommodate his mis-shapen foot. Mr C was also unhappy that the board would only provide two pairs of footwear and would not provide specialist footwear such as Wellington boots; gardening boots; or sandals.

Our investigation, which included taking advice from an independent adviser specialising in emergency medicine, concluded that it was reasonable that

x-rays were not taken and that the fracture went un-diagnosed. The adviser pointed out that there should always be clear clinical indications of the need for examination by x-ray. In Mr C's case no such clear indications were present - he was able to bear weight and although his foot was painful and swollen, it had a good range of movement. The adviser commented that this type of dislocation is a relatively rare injury and so, in the circumstances, it was not unreasonable that it was not diagnosed at the time. On the matter of the orthotic footwear, we found that the board’s guidance reflects national guidance issued by the NHS in Scotland, and that it was reasonable for them not to provide more than two pairs.

Summary

Ms C said she was discharged from hospital and issued with medication. She complained that she had visited her GP nine days later to ask for a further prescription but he had told her that the hospital discharge form said she had been issued with sufficient medication on discharge. To check this, the practice called the hospital and a nurse confirmed that Ms C had been issued with the quantities of tablets stated on the discharge form. The GP, therefore, refused to issue her with a prescription.

Ms C phoned the ward and spoke to a nurse who told her that the amount of tablets she had received on discharge had been wrongly recorded and that the nurse would phone the GP to explain the mistake and ask him to issue her with a prescription. We did not uphold the complaint about the practice, as we found that the health board had accepted full responsibility for the error on the discharge form and that the GP had acted reasonably and appropriately.

Summary

Mr C fractured his leg in several places. He was admitted to hospital and had an operation. The consultant reviewed Mr C the next day. Mr C had a change of plaster cast and was advised not to put weight on his leg. Mr C's medical records noted the following day that he was not complying with the non-weight bearing instructions. He was discharged several days later.

Mr C's first out-patient appointment early the next month was cancelled and he was seen towards the end of that month. An x-ray taken at that appointment showed that the tibia (large bone in the leg) was misaligned. The board told Mr C that the consultant's opinion was that the misalignment was likely to have been the result of Mr C bearing weight on his leg contrary to advice. Mr C told us that this unreasonably blamed him for problems with his leg. Mr C sought an acknowledgement that things went wrong during his operation and an apology from the board. He said that as a result of the board’s failures, he will suffer pain permanently.

Our investigation included taking independent advice from one of our medical advisers. We found that the operation was performed to a reasonable standard and that it was likely that a number of factors, including the severity of the fracture, led to the misalignment. Mr C was concerned about the misalignment, but the advice we received and accepted is that it was within reasonable limits. We also found evidence in Mr C's medical records that he was not complying with the advice to put weight on his leg, and we were satisfied that the board's response reflected what was in these records. We appreciated why Mr C was unhappy with the way in which the board's first response was worded, but found that they had later assured him that they were not accusing him of wrongdoing but, rather, had recognised that he could not comply fully.

Summary

When Mrs C 's mother (Mrs A) became unwell, Mrs A's carer contacted Mrs C, who went to her mother's house, and a doctor from NHS 24 (the out-of-hours service) visited. He examined Mrs A and wanted to admit her to hospital but his notes recorded that she strongly refused. He prescribed an antibiotic (a drug used to treat bacterial infection) after asking Mrs C if she knew if her mother had any drug allergies. He also advised Mrs C to get in touch again if her mother's condition deteriorated. He later discovered that she was allergic to the drug he had prescribed, and contacted Mrs C to arrange an alternative. Mrs A, however, died during the night. Mrs C disagreed that her mother had refused hospital admission and felt that the doctor should have known of Mrs A's previous experience of the drug.

Our investigation found that the doctor could not have known of Mrs A's allergy as he did not have access to her emergency care summary. This consists of basic information about a patient (including allergic reactions) and is available in the out-of-hours centre but not in the out-of-hours doctors' vehicles. The doctor was in his vehicle when asked to attend Mrs A. It was clear he took prompt and appropriate action to check her summary when he reached the out-of-hours centre, and to then arrange alternative medication. We took independent medical advice from one of our advisers, who said that the doctor's other actions, such as his examination of Mrs A, were also appropriate. We could not say for sure whether Mrs A had refused to go to hospital, as the accounts were so different. However, we did not uphold the complaint, as we found no grounds to suggest that the doctor's care and treatment (including his decision not to admit Mrs A to hospital) were unreasonable.

Summary

Mr C, who is a prisoner, suffers from irritable bowel syndrome (IBS) - a condition that can cause stomach cramps, bloating, diarrhoea and constipation. He told us that he spent a short period of time in one prison, where he received a gluten free diet to help his symptoms. However, when he transferred to the prison where he was to spend the majority of his sentence, he only received a gluten free diet for around three weeks. It was then stopped while the board awaited the results of blood tests. When the results came back, they showed that Mr C was not gluten intolerant, and he was told he would not receive a gluten free diet in future.

We did not uphold Mr C's complaint as we found that the decision not to provide him with a gluten free diet was clinically appropriate. However, we were critical of the board for the apparent inconsistency in approach, as Mr C apparently initially received a gluten free diet, which raised his expectations about what he should receive. We drew this to the board's attention.

Summary

Miss C complained that during treatment a dentist handled her five-year-old daughter (Miss A) with excessive force, and shouted at her. While the dentist was attempting to fill one of Miss A's teeth, she became distressed and moved in the chair. In trying to adjust Miss A's position in the chair, Miss C complained that the dentist handled Miss A roughly, causing bruising to her arm.

The dentist indicated that, as Miss A had slid down the chair, he lifted her under the arms to put her back in the correct position. He said he did not use any force and he could not understand the bruising allegation. He also said that he was required to raise his voice to give instructions to his nurse and be heard over Miss A's crying. He said he did not shout at Miss A. In investigating the complaint, we obtained a statement from the nurse which supported the dentist's position. In the absence of any evidence to support Miss C's version of events, we did not uphold the complaint.

Summary

Mr A had several consultations at the practice over four months, complaining of ongoing and increasing pain in his hip and knee. Mr A was then admitted to hospital and was diagnosed with lung cancer that had spread to his liver and bones. Mr A died a month after being admitted.

Mr A's wife (Mrs C) complained that if her husband been diagnosed sooner, he could have lived longer and had better pain relief.

As part of our investigation, we took independent advice from a medical adviser. The adviser said that the practice had carried out and arranged for appropriate investigations in an attempt to establish the reasons for Mr A's pain. They arranged chest and hip x-rays at an early stage, but these did not show any signs of cancer. The practice had prescribed stronger pain relief and referred Mr A to an orthopaedic specialist when the pain continued. Although the practice did not re-check a slightly abnormal blood test result within the specified period of a week, the adviser did not consider that the actual delay of ten days was unreasonable. The practice acted promptly when this was identified and we did not consider that the ten day delay would have affected what happened to Mr A. In addition, we could not say whether re-checking this sooner would have resulted in Mr A receiving more adequate pain relief or being admitted to hospital more quickly.

Summary

Mr C complained that by investigating an allegation of gross misconduct against him, the organisation breached their regulations, codes of procedure and general rules, by creating rights beyond their statutory and common law obligations.

We explained to Mr C that our investigation of his complaint could only look at whether policies and procedures were followed and if appropriate advice was taken. We found that the organisation had taken legal advice. We could not compel them to provide this to us, and only a court could determine whether the legal advice was reasonably acted upon. We could not, therefore, determine whether they breached the regulations by investigating allegations against Mr C, and could not uphold his complaint.

Summary

Mr C had worked from home on a part-time basis for a number of years, using a room in his house as a surgery. He complained that Business Stream had written to him saying that an audit had shown that he was occupying a property thought to be vacant and, to continue to receive water and waste services there, he needed to set up an account. As the default provider, they billed Mr C for usage. Mr C complained to us that Business Stream was unreasonably charging him for services to his property, even though they did not provide this. He also said that Business Stream were acting against advice on a government website which said that if a person works from home, any water used would be included in the domestic bill.

Our investigation found that Business Stream had explained to Mr C that they had received information from Scottish Water and the Scottish Assessors' Association that there had been no charge for services since he entered the property, and that the surgery was commercially rated. Acting in line with their dual use property policy and duty under the legislation, and in the absence of any other service provider, they had asked for payment for provision of services. As it was clear that Business Stream was acting in line with their policy, and we could only question this if it had not been applied properly, we found that they acted reasonably in charging for these services. Although we appreciated that Mr C had seen differing website advice about how the water usage would be charged, we did not find that Business Stream could be held responsible for information on another website. They had, however, said that they would take action to ask for this to be corrected, which we found appropriate.