Not upheld, no recommendations

Summary

Mr C complained about the care and treatment that his late wife (Mrs A) received from her medical practice from early 2010 when she went there complaining of irregular bleeding. He said that it was not until mid-2011 that a diagnosis of endometrial cancer (cancer in the lining of the womb) was confirmed. He said that his late wife's care and treatment had been inadequate and that the relevant guidelines were not followed.

In investigating Mr C's complaint we carefully considered all the relevant information, including the practice’s complaint’s file and Mrs A’s clinical notes. We also obtained independent advice from our medical adviser. The adviser said that this type of illness usually presented after the menopause and was usually benign (not cancerous). However, Mrs A’s case was unusual as it did not fit this pattern and the symptoms of irregular bleeding with which Mrs A presented appeared to indicate that she was starting the menopause. The adviser said that in the circumstances this was not an unreasonable view to take, and that throughout 2010 and early 2011, investigations appeared to bear this out. It was not until after Mrs A had reported that her symptoms were ongoing and was referred to a gynaecologist, that tests confirmed, in June 2011, that Mrs A had endometrial cancer. Her condition deteriorated rapidly and she died in October 2011.

Having taken this advice, we found that Mrs A’s care and treatment had been good, and well within the limits of acceptability. We also found that there had been no delays on the part of the practice and they had followed all relevant national guidance.

Summary

Mrs C attended the medical practice with her son (Master A), who was complaining of a high temperature, sore throat and sore ear. A GP diagnosed a virus, however, his condition worsened over the next few days and they returned to the practice.

During this visit, another GP diagnosed Master A with an ear infection and prescribed antibiotics. The following week, Mrs C and her son returned to the practice and were referred to a hospital for treatment. A doctor at the hospital diagnosed Master A with an abscess and carried out an ear procedure.

The following week, Mrs C returned Master A to the practice as he had pain behind his ear. The GP prescribed more antibiotics, but several days later Mrs C took her son returned as the area behind his ear had worsened. The GP cut the lump to drain it. Mrs C said this was done without any anaesthetic and was painful. Master A's condition failed to improve and when they returned to the practice 11 days later, a GP diagnosed an infection of one of the bones in the ear and advised them to return to the hospital to see another specialist. However, Mrs C took her son to another country for treatment. She said that he was then diagnosed with inflammation of the lymph node and received appropriate care there, and that the condition cleared within two weeks.

Mrs C complained that the practice failed to diagnose the problem accurately. She also said that the ear infection would not have become so severe if the GP at the first consultation had prescribed antibiotics, and that they had failed to take her concerns seriously or to document the consultation.

We did not, however, uphold Mrs C's complaints. After taking independent advice from our medical adviser, we found that the practice's treatment, decisions and management were reasonable, including that the GP did not use a local anaesthetic when cutting the abscess. This is because an anaesthetic can spread the infection to surrounding tissue. We also found no evidence that the GP failed to properly examine Master A or take her concerns seriously at the first consultation, which was clearly documented.

Summary

Mr C complained that the board had unfairly invoked their 'Unreasonable, Demanding and Persistent Complaints Procedure' (the procedure) against him as he had made numerous contacts with them over a period of time. Mr C raised concerns that the board were not actioning his requests for information from his clinical records and other matters. Mr C also felt that by having to channel all requests through a named member of staff that this would affect his access to NHS services.

Our investigation found that the board were entitled to invoke the procedure due to the disproportionate amount of contacts which Mr C had made with numerous staff from varying departments. The board previously told Mr C that they would invoke the policy should his behaviour continue and when it did they invoked it. We found no evidence that invoking the policy would affect Mr C's access to NHS services and did not uphold the complaint.

Summary

Mrs C complained to the board about the treatment she received from a hospital doctor. Mrs C's GP had referred her there because Mrs C was suffering from urinary incontinence. The hospital doctor had conducted tests then referred her to neurology and a bladder specialist. Mrs C said the doctor failed to ask about her vaginal discharge and failed to carry out a pelvic ultrasound scan. Mrs C was subsequently diagnosed with a tumour in her womb. She believed that, had this been found sooner, then the cancer would not have spread to other organs.

We took advice from our medical adviser who noted that he saw no indication that a pelvic ultrasound scan was required given Mrs C's presented symptoms. Mrs C was assessed by three different clinicians with expertise in different areas. All the correspondence and medical notes suggest that Mrs C's symptoms were of incontinence rather than of vaginal discharge. When the symptoms did not ease, Mrs C was appropriately referred for further investigation. We noted that there was a delay in the process for arranging a hysteroscopy (a procedure that allows a surgeon to look inside the womb using a narrow tube-like telescopic camera) and the board apologised to Mrs C and explained the action that they had been taken to prevent a repeat occurrence before she complained to us. Although, therefore, we understood why Mrs C was concerned that a chance to diagnose the cancer may have been missed, we took the view that the care she received was appropriate in the circumstances.

Summary

Mrs C complained on behalf of her mother (Mrs A) about the care and treatment Mrs A received from her dentist. Mrs A attended the dentist in pain after a filling fell out. The dentist took an x-ray and removed a nerve. He made an appointment for a couple of weeks later to extract some teeth. Unfortunately, the pain did not get any better and Mrs A had to go back a further three times for treatment. However, before the date on which the extractions were scheduled, she was admitted to hospital, where it was found that her windpipe was obstructed by a large abscess. Mrs A had emergency surgery, and needed a tracheotomy (an operation to insert a tube into the windpipe) to assist with her breathing.

Mrs C complained that the dentist did not treat her mother appropriately and that had he done so she would not have deteriorated to such an extent. After taking advice from two of our dental advisers, however, our investigation found that the dentist's decisions about prescribing antibiotics to Mrs A were reasonable, as was the care and treatment provided.

Summary

Mrs C had a complex medical history including pelvic, back and shoulder pain, arthritis, kidney problems, ovarian cysts, endometriosis, hypertension, depression and gastric problems. Over the course of 2009 to 2012 she attended her medical practice for pain management and treatment of these and other illnesses. GPs referred her to a number of specialists for treatment and exploratory tests, including consultants in neurology, neurosurgery, pain management and gynaecology. GPs also prescribed Mrs C with various drugs to treat her pain symptoms, including a number of different types of opioid analgesics (pain relief that acts on the central nervous system), but with limited success.

In July 2011, Mrs C became very unwell with dizziness and weakness and was confined to bed. A GP diagnosed severe postural hypotension (a drop in blood pressure than can cause dizziness), which they considered was likely to be drug-induced with inactivity contributing to it. They advised Mrs C to reduce her intake of opioid medications. During a hospital admission, specialists noted that Mrs C had a decreased level of a particular hormone and carried out extensive tests. These established that she was suffering from drug induced suppression of another hormone. Mrs C complained to us that between 2010 and 2012 the practice did not provide her with appropriate care and treatment.

As part of our investigation, we obtained independent advice from our medical adviser, who said that this is a recognised, but rare side-effect of long-term opioid analgesic use. However, he advised that the treatment that the practice prescribed for Mrs C was appropriate, and was taken with the appropriate secondary care advice, and that the referrals made were reasonable. We, therefore, did not uphold this complaint.

Summary

Mrs C, complained to us about the care and treatment of her late mother (Mrs A) who had a complex medical history, including bowel cancer. After falling, Mrs A was admitted to a hospital high dependency unit. She was given a blood transfusion and antibiotics for a urinary tract infection. As doctors thought Mrs A had suffered a stroke she was moved to the stroke ward at 03:30.

Shortly after admission to the stroke ward, Mrs A stopped eating, experienced constipation and complained to her daughter of knee pain. Six days after she was moved there, her condition deteriorated rapidly and Mrs C’s husband telephoned Mrs C saying that the hospital had called to say that Mrs A had taken a bad turn and Mrs C should go to the hospital. Mrs A passed away shortly afterwards. The death certificate noted Mrs A’s cause of death as toxins and a perforated bowel.

Mrs C complained about these events, saying that staff should have dealt with Mrs A’s problems sooner and that her mother was transferred from one ward to another at an inappropriate time. She also said that she suspected that the suppositories or other medical interventions might have caused her mother’s deterioration and death, and was unhappy about the attitude of nursing staff. She said that they showed unprofessional attitudes to her and her mother and failed to properly contact her on the morning of Mrs A’s death.

The board’s reply to Mrs C’s complaint recognised that there were some problems with communication between nurses and Mrs A’s family. They also recognised that the early morning transfer between the high dependency unit and the stroke ward was inappropriate as there was no clinical need for it to be done at this time. They agreed that staff should have known to contact Mrs C directly on the morning of her mother’s death. They apologised and ensured that the relevant managers were made aware of the issues.

We did not uphold Mrs C's complaints. After reviewing the board’s file and Mrs A's medical records, and taking independent advice from our medical and nursing advisers, we found that the general quality of care provided was reasonable. We also considered that the board had taken reasonable steps to resolve the issues about communication, transfer and contact. We considered that the medication provided to Mrs A during her stay was appropriate and could not reasonably be linked to Mrs A’s death. We found no evidence of unprofessional behaviour by nursing staff towards Mrs C or her family.

Summary

Mr C complained that the medical practice had acted unreasonably in refusing him a repeat prescription for an inhaler. He had made a repeat prescription request, but this was refused and he was told to attend an asthma review clinic two weeks later. He was unhappy that he had not been given his medication at the time he needed it, which he felt was a risk to his health.

The practice's response to Mr C indicated that before he made the prescription request he had been sent four letters inviting him to attend the asthma clinic but he had not gone. The prescription record also showed that Mr C was not using his inhaler regularly. They had, therefore, felt unable to issue the prescription until he had complied with their requests for an asthma review. They said they had a clinical, ethical and legal responsibility to review his medication and clinical condition before issuing a prescription. They offered him the opportunity to have the review undertaken in a manner and at a time which suited him, and to refer him to a respiratory specialist.

We took advice from our medical adviser, who considered Mr C's medical records. He said that treatment cannot be given without reasonable and correct supervision, and that the practice had given Mr C various opportunities to attend for the review. Given the pattern of inhaler use, he also considered that such a review would be good clinical practice. We concluded that the practice did not act unreasonably, and did not uphold the complaint.

Summary

Ms C's mother (Mrs A) was admitted to hospital with community-acquired pneumonia. During her stay, Mrs A also complained of constipation, nausea and vomiting. On the final day of her admission, Mrs A’s condition worsened considerably. She was transferred to the hospital’s medical high care area and, within hours, to the highest level of care within the intensive care unit, where she died.

Ms C considered that the care provided to her mother was inadequate. In particular, she felt that staff failed to properly address Mrs A’s constipation and that nursing staff acted rudely and unprofessionally towards Ms C and her family. Ms C also considered that medical staff failed to act quickly enough to transfer Mrs A to medical high care and felt that, if Mrs A had been transferred earlier, she might not have died.

We did not uphold Ms C's complaints. After obtaining independent advice from our nursing adviser, we decided that the nursing care provided to Mrs A was reasonable, that nursing staff acted appropriately to the reports of constipation and that recorded communication with Ms C and her family was reasonable. As there was no corroboration of events, we were unable to come to an accurate conclusion about the manners of particular nursing staff. We also obtained independent advice from our medical adviser, and found that medical staff took appropriate action to monitor Mrs A’s condition and investigated and addressed her medical problems reasonably. We found that the timing of Mrs A’s transfer to medical high care was reasonable and saw no evidence to suggest that staff should have taken the decision to transfer her earlier.

Summary

Ms C complained about long-term flooding in her area and that Scottish Water had failed to resolve the matter. Our investigation revealed that Scottish Water were not at fault. Although their water pipes did not have sufficient capacity, their funding regime does not provide for the circumstances in question, where a major upgrade of the local pipe network is needed. We explained the situation in detail to Ms C and also passed on information from Scottish Water that they were working with other organisations, in the hope that some form of joint project, with funding coming from elsewhere, might be possible in a few years' time. We acknowledged that Ms C would be likely to find this disappointing but concluded that, as there had been no failings by Scottish Water, there were no grounds to uphold her complaint.