Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment her child (Child A) received from a practice managed by the health board. Child A had initially attended the practice for treatment of tonsillitis. However, they continued to be unwell and Mrs C took them back to the practice a number of times over the subsequent months.

Mrs C complained that, despite raising concerns about Child A's symptoms with the GPs, her suspicion that Child A may have glandular fever was not properly investigated. Based on Child A's presentation, the practice concluded that they were suffering from post-viral symptoms. However, Mrs C stated that this was never communicated to her. Mrs C complained that the practice did not provide reasonable care and treatment to Child A in respect of their presenting symptoms.

We took independent advice from a GP. We found that the clinical decision-making and management in respect of Child A's presenting symptoms was reasonable. From the review of the consultation notes, it was likely that post-viral symptoms were discussed with Mrs C. However, we concluded that it was not possible to categorically confirm this from the medical records kept by the practice. While we did not consider this to mean that the practice failed to provide reasonable care and treatment to Child A, we did provide feedback about the fact that Mrs C was not left with a clear understanding of the diagnosis that had been made. However, on the basis of reasonable care and treatment being provided to Child A, we did not uphold this complaint.

Summary

Mr C complained about the treatment which he had received at A&E of Caithness General Hospital. He had initially contacted NHS 24 and arrangements were made for him to be taken to hospital. Caithness Hospital does not have an ear, nose and throat (ENT) department and Mr C said that he expected to be transferred to another hospital to see the specialists there, but instead he was discharged home. Mr C's GP made a subsequent referral to ENT at Raigmore Hospital. Mr C felt it had inappropriately been downgraded and that he was not provided with appropriate treatment for his reported symptoms.

We took independent advice from an A&E consultant and from an ENT consultant. We found that Mr C had been appropriately assessed and treated at A&E on his initial attendance, and when he was subsequently referred to the ENT department, his symptoms were appropriately assessed and reasonable investigations were carried out in an effort to reach a diagnosis. We did not uphold the complaint.

Summary

C complained about their detention under an emergency detention order under the Mental Health (Care and Treatment) (Scotland) Act 2003. C stated that the detention was unnecessary and that the board failed to inform them about it. C also complained that there was a failure to offer support and signposting to advocacy services.

We took independent advice from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness). We found that the detention was appropriate from both a clinical and legal perspective under the Mental Health (Care and Treatment) (Scotland) Act 2003. We found that it was considered to be in C's best interests to detain them because of legitimate concerns about their mental health. The documentation was signed by a medical practitioner with full General Medical Council (GMC) registration and with the consent of a mental health officer, in accordance with the requirements of the act. We did not uphold this aspect of C's complaint.

We also found that C was informed of their detention within a reasonable period of time. We noted that prioritisation was given to addressing C's mental and physical health. The clinical team sought the views of C's relatives to inform their ongoing clinical management of C. Under the circumstances, this was an appropriate and reasonable action which then resulted in C's detention being revoked early. We did not uphold this aspect of the complaints.

Summary

C underwent a left total hip replacement for progressive osteoarthritis (chronic breakdown of cartilage in the joints leading to pain, stiffness and swelling). Following the surgery, it was identified C suffered nerve damage which resulted in a foot drop/sciatic nerve palsy (loss of movement and or lack of sensation) and a limp. C complained that the board failed to provide the appropriate aftercare to address these issues.

The board confirmed they provided the appropriate aftercare in the form of an ankle foot orthosis (a brace) and physiotherapy. The board noted C's initial problems had resolved and there were other factors that contributed to C's ongoing issues.

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 C's foot drop was managed appropriately by the provision of the orthosis and several physiotherapy sessions. We also concluded that the board's opinion that there were other factors which were the cause of C's ongoing problems was reasonable. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late sister (Ms A) by practice. Ms A had attended the practice on a number of occasions over many months. She had symptoms of low energy and mood, fatigue, and lack of motivation. The practice diagnosed a depressive illness and prescribed antidepressant medication. Ms A continued to deteriorate and was admitted to hospital where it was found that she had had a tumour at the base of her skull and she later died. Mrs C said that the practice should have considered alternative diagnoses rather than depression.

We took independent advice from a GP. We found that it was reasonable for the practice to continue along the route of a depressive illness in view of Ms A's reported symptoms, and it was only when red flag symptoms were reported that it was appropriate to refer Ms A to hospital. Therefore, we did not uphold the complaint.

Summary

Mrs C, an advocate, complained on behalf of her client (Mrs B) about the decision to discharge Mrs B's late husband (Mr A) from Royal Alexandra Hospital. Mr A had been diagnosed with a chest infection and bowel obstruction. When Mr A arrived home following discharge, he collapsed and had to be readmitted. The board confirmed that all appropriate assessments had been carried out prior to Mr A's discharge and his observations from the morning of his discharge were found to be in the normal range.

We took independent advice from a consultant surgeon. We noted that Mr A underwent regular observations and that he was assessed as ready for discharge by a consultant, physiotherapist and occupational therapist. There was no evidence to suggest a significant deterioration in Mr A's condition in the run up to his discharge. We did not uphold the complaint.

Summary

Mr C complained to us about the care and treatment he received when he attended the out-of-hours service at Stobhill Hospital. Mr C had undergone a shoulder operation at the hospital on the previous day and was discharged that afternoon. He returned to the hospital on the following day, as he was in pain. He said that he had also been unable to urinate. He saw a doctor but complained that they did not examine him or take a sample and he was told to go home and make an appointment to see his GP if he did not feel better within two days. Mr C said that he was in pain for the next two days and vomited blood. When he saw his GP, he was rushed to hospital and a catheter was fitted, which drained two litres of fluid.

We took independent advice from a GP. We found that the examinations and the assessments carried out when Mr C attended the out-of-hours service had been reasonable. Urinary retention can develop over time and there was no evidence that Mr C had urinary retention when he presented at the out-of-hours service. We considered that the care and treatment provided to Mr C had been reasonable and we did not uphold the complaint.

Summary

C, an advocate, complained on behalf of their client (A). A's appendix was removed after they suffered from acute appendicitis. After the operation A continued to experience pain and had multiple admissions to the Queen Elizabeth University Hospital over a period of several months. A was unhappy with the treatment provided by the board in response to their symptoms.

We took independent advice from a general anaesthetist experienced in acute pain services and from a general and colorectal consultant (a surgeon who specialises in conditions in the colon, rectum or anus). We found that the board provided reasonable treatment to A. There were elements of the management of A's symptoms of pain which could have been better, with chronic pain considered earlier once A's infection had resolved. However overall, the board's response to A's symptoms of pain and rectal bleeding were reasonable with reasonable investigations and treatment carried out. Therefore, we did not uphold this complaint.

Summary

When C became a patient of the practice their 'as required' medication was reduced and stopped. Within a couple of years C moved to another GP practice. They complained to the practice that the decision to reduce and stop their medication had been unreasonable, that they had not been reasonably monitored following the ending of these prescriptions and that the practice had failed to provide their notes to the new practice within a reasonable timescale. The practice responded that they felt the decision to stop medication had been reasonable and that C had received good and safe clinical care. They also stated that, while one specific summary part of C's notes had not been provided to the new practice initially, this had been corrected as soon as they had been made aware of it, and they had apologised for it.

We took independent advice from a GP adviser. We found that the decision to stop the medication was reasonable in principle given C's circumstances and the possible long-term effects of their use; that the withdrawal was carried out in line with applicable guidance; that a reasonable level of follow-up was provided; and that the practice's explanation that the failure to provide part of C's medical record to the new practice had been reasonable. We did not uphold C's complaints.

Summary

C attended the practice with a growth on their face. When after initially being prescribed antibiotics the growth remained, the practice referred C to the local NHS board's plastic surgery department as a routine referral. C contacted the practice some months later as the growth had enlarged and C was experiencing other symptoms. The referral was upgraded to urgent and C was seen by the plastic surgery department shortly after. C was subsequently diagnosed with a malignant tumour and underwent further treatment by the board after the diagnosis.

C complained to the practice about the treatment that they received. C said that if the malignant tumour had been diagnosed sooner, then the treatment to remove the tumour would have been less invasive and impactful on their appearance. The practice responded via the local NHS board. Dissatisfied with the response, C brought the complaint to our office.

We took independent advice from a GP. We found that the practice's working diagnosis of a sebaceous cyst (a common non-cancerous cyst of the skin) was reasonable, with appropriate treatment provided, initially with antibiotics and, when the cyst remained, with a referral to the local NHS board's plastic surgery department. We considered that the skin cancer had presented atypically, and it was therefore reasonable that the practice initially considered the lesion to be a benign lesion, rather than an atypically presenting cancerous lesion. When it was reported that the lesion had grown and C was experiencing other symptoms, the practice reasonably escalated C's referral to urgent. We did not uphold the complaint.