Not upheld, no recommendations

Summary

Mr C is 76 years old and has a disability. He complained about the board's toenail cutting service. He said he needed his nails cut every eight to ten weeks, but the board only provided the service every 12 to 14 weeks. Mr C also said that because they recently told him that it would be 16 weeks until his next appointment, he had to pay for private treatment in between times. He felt that the service he received was inadequate.

When we investigated, the board explained that their view of Mr C's requirements was based on an assessment that they make of each patient to decide how often appointments were needed. This assessed Mr C as requiring appointments every 12 weeks. They said that they had obtained a detailed second opinion from a senior specialist at another of their clinics, which supported this view. The board also said that they try to meet the required timescale for the next appointment but there were times when this was not possible, for example when there were staff absences. At such times, patients such as Mr C who need only routine attention may find that their appointment is after the end of the recommended return period.

As part of our investigation, we obtained advice from our nursing adviser. She said that the board's assessments appeared to have been carried out appropriately. There was no clinical evidence to suggest that Mr C needed appointments more often than every 12 weeks. Our adviser noted that although Mr C would like to have his nails cut more often, the board had to make difficult decisions about managing resources. We found that they had managed Mr C's case appropriately and provided an adequate service.

Summary

Mr C said that an NHS 24 nurse practitioner failed to respond appropriately to a call made to NHS 24 when his mother fell ill. The nurse practitioner explained during the call that she would arrange for an out-of-hours GP to attend within two hours. Following the GP's visit, Mr C's mother was admitted to hospital where she later died. Mr C complained that the nurse practitioner failed to take into account his mother's recent admission to hospital, following the fracture of her hip, and failed to give the case sufficient priority.

Our nursing adviser considered the evidence, including a recording of the call, and reached the conclusion that the nurse practitioner's actions were reasonable. She noted that the nurse practitioner had in fact upgraded the response time from 'two hours' to an 'urgent' response after the telephone call but that, unfortunately, the family were not informed of this. As the nurse practitioner's actions were, however, reasonable in terms of the priority given to the call, we did not uphold the complaint.

Summary

Mr C attends hospital regularly for treatment. On one of those occasions a member of staff handed him an envelope containing letters that Mr C had given another member of staff to read. The envelope was addressed to Mr C but it was open. Mr C was concerned because the letters contained personal information about him. He complained to the board but was dissatisfied with their response and complained to us.

When we investigated, the board said they had asked staff about this after Mr C complained but no-one could remember anything about the envelope and there was nothing documented in his file. There was no further information or evidence available, and in the absence of such evidence we could not uphold the complaint as we could not say for certain whether or not the envelope was open when it was left for Mr C.

Summary

Mr C complained that he endured more than 18 years of illness due to inadequate care and treatment by the doctors at his medical practice. Mr C said this was demonstrated by the doctors’ inability to provide appropriate care and treatment for his stomach problems or tell him about his post-prandial condition (which involved symptoms arising after he ate). Mr C said that he had lost trust with the practice doctors.

We did not uphold Mr C's complaints. Having taken advice from our medical adviser, who considered Mr C's clinical records, we decided that the practice had appropriately treated and cared for Mr C over the period in question. Our adviser said that the term 'post-prandial fatigue' is not a diagnosis as such, but is a medical term used to describe symptoms. We noted that doctors had referred Mr C to hospital at his insistence - our adviser said this sometimes happens when a doctor cannot reassure a patient about their symptoms. We also noted that tests taken at the hospital proved negative.

Summary

When Miss C was admitted to a ward for a mental health assessment, she was unhappy with the attitude and conduct of a nurse. She complained that the nurse had shouted at her and that she had to ask other staff to intervene. The board responded to the complaint, saying that staff recollections differed from Miss C's recollections, but that all staff members involved agreed that she had been distressed and a situation had developed. Miss C was dissatisfied with the board's investigation into her complaint.

We explained to Miss C that we would not consider her complaint about the nurse's conduct as this was open to differing interpretations of those involved and there was an absence of independent witnesses. We did consider whether the board's investigation was adequate, and found that there was evidence that the relevant staff had been interviewed and provided statements.

Summary

Mr C had chronic pain in his back and leg which had previously been relieved by epidural injections (injections into the spine to relieve pain or inflammation). In May 2011, he was referred for a further injection. He said that during the procedure the consultant anaesthetist hit bone and a nerve in his back, and had attempted to place the injection several times before placing it 'anywhere he could'. Mr C said that the pain in his back had been intense, and that he now had a permanent numb leg with loss of muscle tone, caused by the inadequate administration of the injection. He felt the procedure had caused him irreparable nerve damage, and he had gone on to have a second opinion and investigatory tests in relation to this from another board area.

After taking advice from our medical adviser, we decided that we could not definitively conclude that Mr C's symptoms were a result of the procedure being performed inadequately. We found that in this type of procedure it was not unusual for several attempts to be made to site a needle, and that bones in the spine could in fact be used as a landmark to help place the injection accurately. We also found that nerve damage was a rare but recognised complication. We did not uphold the complaint but noted that the consent documentation did not record that nerve damage was discussed with Mr C as a potential complication. Although Mr C had not raised this as a specific complaint, we drew it to the board's attention.

Summary

Mrs C complained to the board about the contents of a report that a consultant orthopaedic surgeon prepared after she attended his clinic. Mrs C felt that the report understated her true clinical condition at the time, as she had to attend hospital again some five months later with a swollen leg. She was dissatisfied with the board's response to her complaint.

After taking advice from our medical adviser, we found that the consultant's recording of the appointment was reasonable. He set out his findings, as well as his future plans should Mrs C's condition deteriorate. We noted that Mrs C had to attend hospital some five months after the clinic appointment, but did not find that this indicated that the consultant's report was inaccurate.

Summary

Mrs C had a method of contraception, an intrauterine device (IUD), fitted by a doctor in March 2010. She subsequently developed symptoms including abdominal pain, bleeding and difficulty with bowel movements. Mrs C attended the practice three days later and was prescribed antibiotics for a possible infection following the fitting. In June 2010, Mrs C found out that she was pregnant. After her baby was born, she had surgery to have the IUD removed. It was found to have caused internal damage and to have moved.

Mrs C complained that the doctor had not taken reasonable care when fitting the IUD and did not properly investigate her symptoms. Although we were unable to assess the procedure, we found that Mrs C’s medical notes were comprehensive and detailed, and that the doctor had undergone suitable update training and fitted an appropriate number of IUDs per year. We also noted that Mrs C had undergone IUD counselling before having the device fitted, where she had been told about the risks, including the risk of internal damage. Although this was a rare complication, the fact it had occurred did not mean the doctor had not carried out the procedure with reasonable care, so we did not uphold this complaint.

We also found that the practice carried out reasonable investigations of Mrs C’s symptoms. They examined her at three appointments and located the threads of the device. Guidance states if these threads can be seen and felt then it can be assumed the IUD is in the correct place. When Mrs C attended a second appointment after the fitting, she said that the symptoms had resolved so we found it was reasonable that the practice did not undertake further investigations. We also found that the practice would not have been expected to arrange an ultrasound scan to confirm the positioning of the IUD, as this is not recommended by guidelines.

Summary

Mr C had a history of mental health problems. In 2011 he started to become increasingly anxious with strong violent urges. He was able to control the urges but found it difficult and was concerned that he might harm friends or family members if he did not receive effective treatment. Mr C complained that his medical practice did not do enough to progress his treatment. He was unhappy with how they managed his condition, saying that they adopted a 'wait and see' approach.

The medical records showed that therapists and the practice had made a number of referrals. We were satisfied that there was a pattern of reasonable care, and that the referrals made were detailed and appropriate and responsive to Mr C's circumstances. Mr C had also asked the medical practice to prescribe medication to help with his unwanted thoughts, but this was refused. Our medical adviser considered Mr C's case and said that medication should not be used to treat personality disorders. We, therefore, found that the decision not to prescribe medication was appropriate, as Mr C had been diagnosed with a personality disorder rather than a psychiatric disorder. Mr C is receiving ongoing treatment from a psychologist and we considered this to be the appropriate treatment for his condition.

Summary

Mr C asked us to take forward a complaint after the death of his mother (Mrs A). Mrs A initially complained to us about a shortfall in care she said she had received from her medical practice from 2003 onwards. She told us that the matter only came to light in 2011.

Mrs A said that, despite repeatedly attending the practice from 2003 to December 2010, she was not checked or referred by the practice to see if she had a more serious underlying condition. Mrs A was diagnosed with lung cancer in or around June 2011 and died in November 2011. Both she and her son considered that there had been a failure to diagnose or pick up on her symptoms from 2003 onwards.

Our investigation, which involved taking advice from our medical adviser, found that while it was clear that Mrs A attended the practice for a variety of medical concerns from 2003 to 2010, she received appropriate care and treatment for the symptoms she presented with during this period. We found no evidence that the practice failed to pick up or diagnose cancer symptoms. Our adviser also said that from reading the progression of Mrs A's symptoms in her medical records, it was unlikely that the outcome would have been altered by an earlier diagnosis.