Not upheld, no recommendations

Summary

Mr C had a history of alcohol dependency. He stopped drinking in May 2010. His medical practice prescribed medication, including Thiamine B (a specific type of vitamin B). In 2008, Mr C had experienced ice-cold feet, severe pain and loss of sensation in his legs. In 2009, he was diagnosed with peripheral neuropathy (damage to the nerves that connect the central nervous system to the limbs) and in May 2010 he began to have seizures and tremors.

Mr C stopped taking the prescribed Thiamine B in August 2011 and found that his pain, muscular problems and seizures stopped. He complained to the practice about the use of Thiamine B and the fact that this was not reviewed following his deterioration in 2008. They told him that there are no side effects associated with this medication. However, Mr C conducted his own research and found that an allergic reaction to the medication could cause the symptoms he experienced. He also believed that his other medication had a detrimental impact on his health. He complained to us that the practice failed to reassess his medication when his symptoms developed and failed to identify that Thiamine B was causing his neurological problems. He also complained that the practice failed to refer him for a specialist opinion.

We took advice from one of our medical advisers and found that all the medication complained about was appropriate for a patient with Mr C's symptoms and history of alcohol dependency. Thiamine B in particular has a protective role in limiting damage to the nervous system should the patient continue to consume alcohol. We accepted that patients may react in unpredictable ways to any medication and recognised the symptoms that can be caused by a reaction to Thiamine B. However, we found no link between this medication and neurological problems as described by Mr C. We were satisfied that the practice held regular discussions with Mr C about his medication during a number of consultations. We were also satisfied that the practice arranged suitable tests and made appropriate referrals for investigation into the cause of Mr C's symptoms by specialist consultants.

Summary
Mr C complained that a GP failed to provide him with appropriate treatment for his throat condition during a home visit. He said that he went to see another GP the next day, who referred him to hospital, where he received treatment for an abscess on his tonsil.

We took advice from our medical adviser. He commented that this type of abscess can develop quickly. He said that, given the GP's account that the appearance of Mr C's throat had changed, the management of Mr C's sore throat had been reasonable.

Mr C also complained that the GPs had misdiagnosed his rhinitis (inflammation of the lining of the nose) as sinusitis (inflammation of the sinuses) for a number of years. We found that Mr C had been diagnosed with sinusitis at a hospital. Our medical adviser considered that the actions of the GPs in relation to this matter were reasonable. He said that sinusitis and rhinitis can coexist and can be treated in the same way. He also noted that there had been little change in Mr C's management after the diagnosis of rhinitis.

Mr C also complained about the actions of a receptionist and the practice manager when he visited the medical practice. We found that the actions of the members of staff had been reasonable.

Summary

Mr C attended his medical practice and requested a prostate examination. He said that the GP refused to carry out this procedure and was rude and aggressive towards him. The GP asked Mr C to complete a symptom score sheet and discussed the possible negative side effects of checking for prostate cancer. Mr C considered that these were steps that the GP need not have taken.

He raised a complaint about the matter but the practice maintained that the GP had acted reasonably, and within guidance. Mr C then told the practice that he would no longer see the GP, even in an emergency. The practice replied explaining that they considered his behaviour towards the GP to have been unacceptable. They said they would be unable to continue to provide services if he was unable to accept treatment from the GP in an emergency. As Mr C did not wish to comply with the practice's request, they wrote telling him that they intended to remove him from their list of patients.

We took advice from our medical adviser, and found that the steps that the GP had taken during the consultation were in accordance with best practice. We were unable to establish Mr C's allegations of rudeness and aggressiveness without some independent evidence. We found that the evidence of the communications between Mr C and the practice indicated that the doctor/patient relationship had broken down. This gave the practice reasonable grounds to issue a warning, and eventually ask Mr C to leave the practice.

Summary

Mr and Mrs C complained that, before starting in vitro fertilisation (IVF) treatment, a hospital gave them inaccurate statistical information about relevant IVF success rates applicable to Mrs C.

The couple said that they followed medical advice and undertook IVF treatment in the knowledge that they had been told that due to Mrs C's age, achieving fertilisation might be more challenging. They said that a clinician had advised that as there were no underlying health issues preventing conception, there remained around a 15 percent chance of success.

Mr and Mrs C said that the IVF treatment resulted in one successful embryo transfer. However, the next day Mrs C became unwell, and the transfer failed. The couple complained that the care and treatment Mrs C received was inadequate. They said that staff failed them; that care procedures were lacking; and that staff misled prospective parents.

We took advice from our medical adviser, who considered all the facts and relevant information and guidance. After careful consideration, we decided that there was no evidence that clinical staff had provided inaccurate information to Mr and Mrs C before IVF treatment began. We also considered that the actions of the ward's out-of-hours service staff were appropriate and adequate.

We also looked at how the board handled Mr and Mrs C's complaint and found that they had appropriately addressed all the issues raised.

Summary

Mrs C complained that her dentist had not ensured the fit of a crown before cementing it in place, and that he would not refund her the full cost of fitting the crown to allow her to receive further treatment at a different dental practice.

We found that the dentist had taken all reasonable steps to ensure the fit of the crown was suitable prior to the cementing, including having the crown remade at an earlier appointment, giving Mrs C the opportunity to check the appearance and position of the crown with a mirror and obtaining her consent before undertaking the cementing.

We noted that Mrs C had already received a refund of the cost of the crown from the dentist as a goodwill gesture, and that other fees she had paid had been for different treatment. We found that if Mrs C was to seek further treatment elsewhere, she would be required to pay the cost of the crown again. As this cost had already been refunded, we did not find that Mrs C was entitled to any further refund.

Summary

Mrs C complained about the care and treatment her dentist provided in relation to root canal treatment that resulted in the loss of her tooth. Mrs C was also unhappy that the dentist had not explained the associated risks with this treatment and that her complaint was not properly handled.

In response to the complaint, the practice manager advised Mrs C that the dentist had explained the treatment and this had been documented in her clinical records.

When we looked at the clinical records, we found that the dentist had carried out an x-ray several months before root canal treatment was attempted, and had told Mrs C that she needed this treatment or that the tooth would eventually need extraction. We also took into account that the dentist had documented that Mrs C had been told at other appointments that she still needed to have this treatment carried out.

After taking advice from our dental adviser, we considered that it was good practice for the dentist to have treated the tooth by either root canal treatment or extraction as the x-ray had indicated an area of either inflammation or infection around the tooth. We also considered the dentist's explanation to why the root canal treatment failed to be reasonable. They had said that the root of the tooth was perforated (contained holes) and the continuation of the root canal could not be found, so extraction of the tooth was the best option to ensure that the inflammation did not spread.

We also found that the practice manager had responded appropriately to the issues Mrs C had raised in her complaint. Although the letter contained medical terms that could have been better worded, we did not consider that this significantly affected the overall understanding of the response.

Summary

Mrs C complained about her diagnosis and treatment when a suspected pre-cancerous duct was found in her breast after a routine screening. She said that she was offered only radiotherapy after her operation, although she believed alternative treatments were available. Mrs C undertook her own internet research and went to a private doctor for a second opinion. Mrs C said that she was, however, being advised by her clinicians, her GP and even her family to undergo radiotherapy so she eventually signed the consent form and agreed to treatment.

Our investigation showed that several clinicians spoke to Mrs C about her condition and radiotherapy treatment. We took advice from our medical adviser, who said that the only alternative to radiotherapy was no treatment at all. This was because the type of condition that Mrs C had cannot be treated with more usual treatments for breast cancer.

Mrs C was also unhappy with the diagnosis of her condition. She had a mammogram (breast x-ray) and two needle biopsies (where a small amount of tissue is removed for examination). She was also seen by a consultant surgeon. Our medical adviser said that this diagnostic process complied with SIGN (Scottish Intercollegiate Guidelines Network) guidance. He did not consider that the process was overly invasive or radical. In line with the SIGN guidance, the matter was discussed at a multi-disciplinary team meeting and the options discussed with Mrs C and passed on to her GP.

Summary

Mrs C complained that a hospital gynaecology department provided her with inadequate care and treatment for ovarian cancer. She said there were inadequacies with her diagnosis and treatment and specifically a failure to properly diagnose her condition. She also said she experienced delays by the board in the way they progressed her treatment. Mrs C went to France for a second opinion from a clinically trained friend. She said she experienced problems in getting the board to provide or release relevant medical records and test results to her doctor in France. Mrs C told us that as a result, she had to undergo emergency surgery in France without this information being provided. She said that the board showed no inclination to appropriately respond to her complaint about this.

We took advice from one of our medical advisers who reviewed Mrs C's medical records. He noted that Mrs C presented with an abdominal mass and from the scan that was taken, he said it was appropriate to consider ovarian malignancy as the likely diagnosis. He said that a definitive diagnosis could only be reached by the microscopic examination of tissue obtained during surgery to remove the mass. He also said that the provisional diagnosis was not incorrect or hasty and was appropriately based on the evidence available.

Following the clinic appointment at which the abdominal mass was found, arrangements were made for Mrs C's case to be discussed by a multi-disciplinary team. This is in line with guidance, the intention of which is to ensure that patients with suspected cancer get the best possible treatment by the most appropriate team. The adviser noted that Mrs C's gynaecologist communicated the outcome of the team meeting to her, about a week after she attended the clinic, and it was arranged that Mrs C would see a gynaecological surgeon for a pre-operative assessment about three weeks after that. The adviser said that this time-frame was reasonable.

We found that it was appropriate that the consultant considered the need for patient consent before releasing medical information to a third party - in this case to Mrs C's doctor in France. There was evidence that Mrs C had received appropriate and timely communication from the board and received a follow up appointment in good time. Finally, we found that it was reasonable that the board (in the time-frame available) were not able to advise Mrs C about reimbursement of her medical costs in France and that they adequately investigated and addressed her complaint.

Summary

Mr C told us that his eye was injured in a road traffic accident some time ago. He had undergone ten or eleven operations on his eye, but complained to us specifically about his last two procedures.

Mr C told us that he had ingrown eye lashes and a hospital doctor decided to turn the eyelid out. Mr C said he was unhappy with the result, as his eye was drooping and he still had pain from the eyelashes. He said that he had laser treatment from another doctor at the hospital and this helped by getting rid of the ingrown eyelashes. However, Mr C was also eventually dissatisfied with this treatment. He also complained that he was incorrectly discharged from the hospital, that the board either did not have, or had inadequate, access to his medical records, and that they had not dealt with his complaint correctly.

Our medical adviser reviewed Mr C's medical history and treatment from 2001 when Mr C had first presented with trichiasis (eyelashes misdirecting towards the surface of his eye). The adviser said that there was no evidence to support Mr C's view that he had not received appropriate treatment. We found no evidence to suggest that Mr C was incorrectly discharged from the hospital or that the board did not have appropriate access to his medical records.

Mr C was dissatisfied with the board's complaint responses. However, we considered that the board appropriately investigated and answered the issues he raised.

Summary

Mrs C complained about the treatment that her late son (Mr A) received at a cancer centre where he had been admitted for a course of chemotherapy. She complained that when it was noticed that he was suffering from side effects of anti-sickness drugs, the consultant who prescribed the medication delayed in stopping it. She also said that the consultant failed to consult with other clinicians about the appropriateness of the prescribed drugs and failed to take Mr A's complex medical conditions into account.

Mrs C also complained that the consultant failed to explain the possible side effects of the medication, and that when she formally complained to the board she was not treated sympathetically and they took a long time to respond to her complaint.

We did not uphold Mrs C's complaints. Our investigation found that the clinicians involved were fully aware of Mr A's medical history, took his concerns seriously and treated him appropriately. We also found that they investigated his symptoms properly to determine the underlying cause. The medical notes showed that communication between clinicians had been excellent, and that staff took time to discuss Mr A's condition and medication with him and his family.

Finally, we found that the board's complaints handling was good. We found that they had provided responses that were thorough, detailed and empathetic. However, we found that the board failed to provide updates for a period of time before sending their final response. We drew this to their attention, but made no recommendation.