Not upheld, no recommendations

Summary

C underwent knee surgery, following which the hospital provided them with a sick note. At the end of that sickness period, they were told that they required two more weeks of recovery before they could return to work. When C approached the practice, they were told they should be given a sick note by the hospital. C then went back and forth between the practice and the board. C said they were told by the board’s complaints team that it was the practice’s responsibility and that if the practice refused to provide a sick note, they would be in breach of their NHS contract.

C said the process was very stressful and at one point they were without a sick note. While they were issued with one by the hospital, it was reiterated to C that this should have been the practice’s responsibility.

The practice told us they had taken advice on whether it was their responsibility to provide a sick note for C. They said that the Lanarkshire Local Medical Committee (LLMC) had told them it was the responsibility of the hospital who had operated on C. They said that the LLMC was taking the matter up with the board more generally. The practice said that they would have provided C with a sick note, but by that time, the hospital had done this.

We took independent advice from an appropriately qualified adviser. We found that records stated that C was the responsibility of the hospital until they were fully discharged. This meant that whilst C still had out-patient appointments to attend, the practice were correct to state that they were not responsible. We did not uphold C's complaint.

Summary

C complained about the care they received from their GP practice when they presented with problems with their sight and a headache. Whilst in the waiting room, C became more unwell. Following an examination, an emergency ambulance was called and C was taken to hospital where they were later diagnosed with a stroke. C complained that more immediate action should have been taken when they initially contacted and then attended the practice. The practice did not identify significant failings during their complaint investigation, but noted that some aspects could have been handled better.

We took independent advice from a GP. We found that the practice’s initial handling of C’s call to the practice was reasonable, and it was appropriate that C was signposted to contact an optician. Furthermore, we found that, once C attended the practice, the care provided was reasonable and consistent with clinical guidance on assessment, history taking and examination. We did not uphold C’s complaint.

Summary

C complained about the care and treatment provided to their parent (A). A was diagnosed with cancer and was admitted to hospital. As the hospital team struggled to control A’s pain, A was transferred to hospice care, where they later died. C complained about the care and treatment offered to A at the hospice and asserted that it was not reasonable. C’s position was that as a result of that unreasonable care and treatment, A experienced chronic pain and died prematurely. C stated that they believed that staff involved in A’s care failed to act in line with guidelines and ignored medical guidance.

The board found no evidence to support C’s assertions that A was not provided with reasonable care and treatment. The board said that a multi-disciplinary, patient-centred approach was taken to A’s care and many clinicians contributed to A’s pain management strategy.

We took independent advice from a medical adviser. We did not find any failings in A’s care and treatment and did not consider that it was unreasonable. Therefore, we did not uphold this complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of a family about the care and treatment that their relative (Mr A) received from the board. Mr A was admitted to Raigmore Hospital with endocarditis (an infection of the inner lining of the heart). He was discharged home for out-patient parenteral antibiotic therapy (where antibiotics are given to a patient in their own home). Mr A's condition worsened and he died a few weeks later. Ms C complained about Mr A's medical care and treatment, and that he was not medically fit to be discharged home.

We took independent advice from a cardiologist (specialists in the heart and blood vessels) and from a nurse. We found that Mr A's condition was diagnosed in a timely manner and he was given appropriate treatment. We also found that it was reasonable that Mr A was discharged home, as there was an appropriate plan to continue his treatment at home.

Ms C complained about the communication with Mr A's family. We found that the medical and nursing records showed evidence of appropriate communication with Mr A's family.

Ms C further complained that Mr A was discharged home without appropriate care planning and an appropriate care package. We found that there was appropriate multi-disciplinary care planning for Mr A's discharge home.

Ms C also complained about the board's complaints handling; in particular, that there was a delay in their response and its tone lacked empathy. We considered that as it was a complex complaint, it was reasonable that the investigation took longer than usual and regular updates were provided. We did not consider the tone was inappropriate.

We did not uphold Ms C’s complaints.

Summary

C was diagnosed with a meningioma (a tumour that forms on membranes that cover the brain and spinal cord just inside the skull), which required surgical removal. C complained about the failure of the practice to appropriately assess their symptoms in the years preceding diagnosis. C said their records showed that they presented at the practice with red flag symptoms on a number of occasions dating back years. C also said that the practice failed to make appropriate referrals for investigation.

We took independent advice from a GP. We considered that C had been assessed appropriately by the practice. We found that C’s care was reasonable and in line with General Medical Council Good Medical Practice. We did not consider that there had been any missed opportunities to refer to secondary care in respect of C’s meningioma, taking into account their presenting symptoms. We did not uphold either aspect of C's complaints.

Summary

C complained on behalf of their client (B) in relation to the care and treatment provided to B’s spouse (A) whilst A was a patient within the board. A had a complex medical history and was referred to Queen Elizabeth University Hospital, receiving care and treatment over two days. B’s specific concerns related to a procedure A underwent on the second day. On that day, CT scan findings showed the presence of a large liver abscess which was possibly the result of a perforated gallbladder. Treatment options were reviewed and the best option was considered to be draining the abscess percutaneously (by accessing the abscess through the skin rather than operating and opening the abdomen). A passed away that day.

C told us that B believed that the procedure was not the best clinical option for A and that A would not have died had the procedure not been undertaken. B felt that A’s judgement was impaired because of medication which they had been prescribed, and as such was not competent at the time of making the decision to have the procedure, so could not agree to it.

We took independent advice from a surgical adviser. We found that the care A received during their admission was reasonable and followed accepted management pathways. We noted that the board assessed and provided the best clinical option of treatment. We found no evidence to suggest that A was impaired by the medication prescribed to them and as such was competent to consent to the procedure. We did not uphold C's complaint.

Summary

C complained that the board failed properly to investigate the causes of their neck and shoulder pain. As a result, they said that they experienced up to 20 migraines a month and spent a large part of time in bed. C said that they regularly asked for an x-ray but were told that it would not be appropriate and were prescribed a number of medications and botox, none of which had effect. Because they were struggling with their quality of life, C attended a private chiropractor (a person who treats diseases by pressing a person's joints, especially those in the back) who took x-rays which revealed that the vertebrae at the top of their spine were out of alignment. The chiropractor then carried out a procedure to address this, as a consequence of which, C said, their migraines largely disappeared.

C believed that the board ignored their concerns about neck and shoulder pain and said that had they been addressed when requested, they would have had a better quality of life.

The board’s view was that, throughout, C had been treated appropriately and in line with clinical guidance; x-rays were not normally recommended in migraine diagnosis and management and were not standard practice. They also said that clinicians were not trained in alternative procedures and were unable to recommend them.

We took independent clinical advice. We found that x-rays were not part of the normal practice in the diagnosis and management of migraine and that neck and shoulder pain can occur in 90% of patients with migraine. We also found that the alternative procedure given to C was not an approach offered by the NHS and that C had been treated in line with clinical best practice. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A). Mr A was admitted to hospital after he attended A&E complaining of abdominal pain with a background of hiatus hernia (where part of the stomach pushes up into the lower chest). Mr A had a nasogastric tube (where a tube is placed through the nose into the stomach) inserted to decompress the hiatus hernia, however on one occasion it fell out and a number attempts had to be made before it was reinserted. During this procedure, Mr A suffered a cardiac arrest and died.

Mrs C complained that the board inappropriately handled the insertion of his nasogastric tube and raised concerns that it may have caused Mr A's cardiac arrest. Mrs C also complained that insufficient attempts were made to resuscitate Mr A when he suffered cardiac arrest.

The board explained that nursing staff escalated the procedure for passing the nasogastric tube appropriately and that Mr A arrested before any further escalation could happen. The board also explained that Mr A’s cardiac rhythm was asystole (unshockable) therefore attempts to prolong resuscitation would be ineffective.

We took independent advice from a consultant general surgeon and from a consultant in acute medicine. We found that reasonable action was taken by the nursing staff in escalating the reinsertion of the nasogastric tube and there was no evidence that the procedure was inappropriately handled. We also found that the decision to stop resuscitation was made in consultation with the clinical staff present and the decision was reasonable in light of his additional conditions and the fact that his heart rhythm was asystole. Therefore, we did not uphold Mrs C's complaints.

Summary

C complained about the treatment which they received at the Golden Jubilee National Hospital. C had undergone a total right hip joint replacement but post operatively reported problems with right foot drop and loss of sensation in the right foot and leg. C was put on medication and referred to physiotherapy but still remained in pain with loss of sensation. C felt that something must have gone wrong during the surgery.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that there was no indication from the clinical records that complications had been encountered during C’s surgery in that the surgery was completed within normal timescales and that blood loss was within expected levels. It was possible that the sciatic nerve (nerve in the lower back area) could have been inadvertently damaged during the surgical procedure but there was no documentation to support such a view.

While we did not uphold the complaint, we noted concerns about the standard of the record-keeping regarding the brevity of the actual operation notes and whether sufficient discussions about C’s high body mass index (BMI, a measure for estimating human body fat) level, which would increase risks of any surgery, were discussed with them prior to surgery. The concerns were highlighted as feedback to the hospital who have already amended their procedures in an effort to improve learning.

Summary

C’s sibling (A) attended the practice with constipation and blood in their urine. C was referred to the local health board’s urology department (specialists in the male and female urinary tract, and the male reproductive organs) where they were diagnosed with pedunculated fibroids (benign (non-cancerous) growths in the uterus). This diagnosis was later found to be inaccurate and the growths were found to be cancerous. C complained that the practice failed to provide reasonable treatment to A when they attended the practice in response to their symptoms.

We took independent advice from a GP. We considered that the actions and investigations carried out by the practice were reasonable at each appointment, based on the information available at the time. A was referred to appropriate specialities and prescribed reasonable medication in response to their symptoms and the diagnosis made by urology. We did not uphold the complaint.