Not upheld, no recommendations

Summary

Mrs C complained that the practice had failed to properly investigate a series of complaints she had made about entries in her and her children's medical records. Mrs C believed the practice's conclusions were unreasonable given the available evidence. Mrs C also complained that the practice failed to communicate appropriately with her.

We took independent advice from an adviser on general practice medicine. We found that the practice had reasonably and appropriately investigated the complaints brought to it by Mrs C and had communicated reasonably with her. Some of the medical record entries that Mrs C objected to were the opinions of the GP following their encounter with her. We considered that it was reasonable for medical records to contain subjective opinion and it was not possible to amend or delete the entries Mrs C was concerned about. In addition, the practice had offered Mrs C the opportunity to place notes in her medical records, indicating that she disagreed with the content or tone of the entries. Mrs C had not responded to these offers. We did not uphold any of Mrs C's complaints.

Summary

C complained about the care and treatment provided to them by Scottish Ambulance Service (SAS) when they called for an ambulance after they had bleeding following the removal of a lesion earlier that day.

We took independent advice from an appropriately qualified adviser. We found that the care and treatment provided to C by SAS was of a reasonable standard. C was given appropriate advice from the call handler, the ambulance was dispatched and arrived with C in a timely manner. We also found that the ambulance crew's assessment of C's wound was reasonable. Therefore, we did not uphold C's complaint.

Summary

C complained about the care and treatment their late relative (A) received at the practice. A sought advice from the practice after returning home from a holiday abroad where they had become unwell. C's complaint related to a number of issues; including communication, medication, and scans.

We took independent advice from a GP. We found that there were no failings by the medical practice in terms of communication with the family or the time taken to perform scans. In relation to the management of A's medication, we found that the responsibility of stopping and restarting medication lay with the hospital clinicians. We also found that there were many reasons for A's balance and mobility issues, thus, a head scan was not indicated. We concluded that the care and treatment provided by the medical practice was of a reasonable standard. Therefore, we did not uphold this complaint.

C also complained about the practice's handling of their complaint. We found that the medical practice had provided their response to C's complaint to the health board within three weeks of them receiving the complaint and in line with the agreement to issue a coordinated response. However, there was a delay in the health board issuing the response to C for which they apologised for. We concluded that there was no fault by the medical practice and, therefore, we did not uphold the complaint.

Summary

C complained that the board failed to carry out further tests when they became aware of the fact that their partner (A) had polyhydramnios (excess amniotic fluid) during pregnancy before giving birth to their baby (B). B was diagnosed with Noonan Syndrome (a genetic disorder that causes a wide range of features, such as heart abnormalities and unusual facial features) after birth. C considered that, if the board had carried out further tests, this may have led to the detection of Noonan Syndrome prior to the birth of B.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth). We found that the board's staff followed recognised practices when carrying out ultrasound scans and assessing the unborn child. During the 30th week of A's pregnancy, polyhydramnios was first raised as an issue. At that time it was a mild case and no abnormalities were identified with the foetus. By the 36th week of A's pregnancy, polyhydramnios had increased to a moderate case. We found that, whilst polyhydramnios is a feature of Noonan Syndrome, it can be caused by a number of other factors, and no other features of Noonan Syndrome were present. We found that there was no indication for an amniocentesis (a test offered during pregnancy to check if the baby has a genetic or chromosomal condition) to be carried out. If an amniocentesis had been offered, Noonan Syndrome would not have been identified, unless a specific test for this had been carried out. We did not uphold this complaint.

Summary

Mr C complained about the treatment the board provided to him following his surgery for Dupuytren's Contracture (a condition in which one or more fingers become permanently bent in a flexed position). Mr C complained that he had suffered an infection post-operatively which was not appropriately treated.

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 the board had provided a reasonable standard of treatment to Mr C. He was seen regularly after the operation and no concerns were recorded by clinical staff that Mr C was suffering from a post-operative infection that was clinically significant (required treatment). Therefore, we did not uphold Mr C's complaint.

Summary

C complained on behalf of their client (A) who was admitted to the Royal Alexandra Hospital after fainting at home. A CT scan showed that A had suffered a fractured bone in their neck. A was initially fitted with a collar but C complained that this did not fit well and caused A severe pain and discomfort, to the extent that A's neck injury became worse. Due to A's ongoing pain, a further CT scan was carried out which confirmed that the fracture had displaced (not lined up) slightly. A was referred to the spinal unit at another hospital and was fitted with an alternative form of brace. C complained that A should have been referred to the spinal unit from the outset.

We took independent advice from an orthopaedic consultant (a doctor specialising in the treatment of diseases and injuries of the musculoskeletal system). We considered that the initial investigations and treatment were reasonable. We found evidence that the fitting of the collar was checked by staff. We also considered that the subsequent change to an alternative brace was reasonable, and there was no indication for an earlier referral to the spinal unit. However, we were critical of a delay in reporting the second CT scan. This was an urgent scan which should have been reported within days, but it was not reported for three weeks. This delay did not cause A harm, but it did prolong their pain and discomfort. The treatment of A's injury was otherwise of a good standard and, on balance, we did not uphold this complaint.

Summary

C underwent surgery at Victoria Hospital to repair a fracture in their left wrist. Following the surgery, infections developed and this led to several further procedures being required to clean the wound and address damage caused by the infections. C complained that the board failed to provide them with appropriate care and treatment. Their concerns included that the board did not detect and effectively treat the infections, and that blood tests were not carried out to check for infection after C was discharged from hospital.

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 recognised complications (including infection) were discussed with C as part of the consent process and that there did not appear to have been undue delay in identifying C's first infection. We also found that blood tests to check for infection were carried out with reasonable frequency. However, the board should have ensured that blood test results were monitored and acted on timeously. Though we noted that there was a delay in responding to a blood test result, which suggested infection was present, this could not itself be said to have negatively affected the overall outcome for C.

We concluded that the overall care and treatment provided to C was reasonable. It was noted that the board had acknowledged the blood test result failing and taken appropriate remedial action. As such, we did not uphold the complaint.

Summary

Ms C complained about the care and treatment her mother (Mrs A) had received in Dumfries and Galloway Royal Infirmary and Castle Douglas Hospital. She was transferred to these hospitals after having surgery on her brain, which left her with quadriplegia (paralysis of all four limbs).

We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nursing adviser. In relation to Ms C's complaint about the care provided to Mrs A, we did not uphold the complaint, as we found that:

staff had assessed Mrs A in detail after her transfer and there was no evidence of a negative or palliative approach to her care;

a detailed physiotherapy assessment was carried out promptly the day after her transfer and this was followed by regular sessions with physiotherapists;

Mrs A's care in relation to alerting staff and consuming meals had been reasonable;

it was reasonable that Mrs A did not receive counselling, as there was no clear indication for this in the observations of staff, or requests from Mrs A or her family; and

the level of care provided to Mrs A in relation to massage, physiotherapy and bodily movement was reasonable.

Ms C also complained that the board did not provide reasonable treatment to Mrs A following her admission. We found that there was evidence of a comprehensive assessment of Mrs A's needs and specific attempts to provide care and rehabilitation for her in both hospitals. The prescription of medication, based on the assessments carried out, was reasonable even if it did cause some sedation as a side-effect. We did not uphold this aspect of the complaint.

Finally, Ms C complained that the board unreasonably instructed staff not to talk to her. We found that it had been reasonable for staff to propose a contact time for Ms C every day. This meant that rather than deal with a number of calls from Ms C, staff could give a focussed update. We did not uphold this complaint.

Summary

C complained about the treatment the board provided to their spouse (A). After falling unwell, C had contacted NHS 24 on A's behalf as they were concerned that A's symptoms may have been due to a cardiac (heart and its blood vessels) issue. A then spoke to a medical professional from NHS 24 who signposted them towards Borders Emergency Care Service (BECS), an out-of-hours service, which they attended.

When A attended BECS, they were examined by a trainee advance nurse practitioner (ANP). After examining A and taking a history from them, the trainee ANP's view was that A's symptoms were due to a muscular strain rather than being cardiac in nature. A was discharged on this basis but died four days later as a result of coronary artery atheroma (fatty deposits that build up on the walls of arteries around the heart). C complained that A's death was preventable and that they were not examined appropriately when they attended BECS.

We took independent advice from a nurse. We found that the examination of A, and the trainee ANP's decision-making, were reasonable given the information provided to them. In addition to this, it was appropriate for a trainee ANP to examine A and reach conclusions on their treatment. We concluded that A received appropriate treatment when they attended BECS. Therefore, we did not uphold this complaint.

Summary

C complained on behalf of their parent (A) about the care they received by the practice. A had been unwell and required a home visit from the practice. C believed that A had not been adequately examined during this visit, which had placed A's life at risk. C said that within days of the home visit, another GP had reviewed A, which resulted in A's admission to hospital. During this admission a significant amount of fluid was removed from A's legs and A was found to have a damaged heart valve. C felt that the practice had failed to honestly admit their failings or to offer a sincere apology.

We took independent advice from a GP. We found that A had been reviewed thoroughly and appropriately. There was no evidence that clear symptoms of heart failure had been overlooked. There was also no evidence that A had an acute condition at the time of the home visit, and the symptoms reported and recorded were consistent with A's pre-existing medical conditions.

We found that the care provided to A was of a reasonable standard and did not uphold the complaint