Not upheld, no recommendations

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.

Summary

Mrs C, an advice worker, complained on behalf of her client (Ms A) about the treatment which Ms A received following admission to Aberdeen Royal Infirmary with symptoms of right upper quadrant pain and inflammation. Investigations led to a diagnosis of chronic cholecystitis (inflamed gallbladder). Treatment options were considered and it was decided to insert a drain, rather than perform surgery at that time, with a referral to a hepatobiliary surgeon (surgeon specialising in the treatment of the liver, bile duct and pancreas) for ongoing treatment. Ms A was discharged home but was readmitted to hospital as an emergency due to further right upper quadrant pain and required surgery. By the time of readmission, Ms A had not received any correspondence from the surgeon. Ms A said that surgery should have been performed during the initial admission and that the delay in treatment caused her additional health problems.

We took independent advice from a consultant in general surgery. We found that Ms A had multiple medical problems and that upon admission to attempt keyhole surgery would be impossible and open surgery would be challenging. It was appropriate to discharge Ms A with a drain in situation for follow-up by specialists at a later date. Although there were gaps in communication with Ms A, this did not impact on her clinical treatment. We did not uphold the complaint.

Summary

Mr C complained on behalf of his daughter (Ms A). Ms A was suspected to have gallstones (small stones that form in the gallbladder) and was referred for laparoscopic (keyhole) surgery. During the surgery Ms A's gallbladder could not be located and following further investigations, it was confirmed that Ms A had gallbladder agenesis (absent from birth). Mr C complained that Ms A's surgery could have been avoided had further investigations been performed when it was observed during the ultrasound that the gallbladder could not be definitively seen. Mr C also complained about the board's handling of his complaint. The board said that they considered the appropriate investigations were carried out and that further scans prior to surgery were not clinically indicated.

We took independent advice from a consultant surgeon. We found that the conclusion of Ms A's scan, which stated it was “suggestive of a contracted bladder” was reasonable on the basis that gallbladder agenesis is sufficiently rare. Further scans were not warranted in this case as Ms A did not meet the criteria. We also concluded that, while the board's final response to the complaint was somewhat delayed, the delay was reasonable in the circumstances. We did not uphold Mr C's complaints.

Summary

Mrs C complained about the care and treatment provided to her late sister (Miss A). Miss A attended the practice and was prescribed medication for suspected vertigo (a sensation of whirling and loss of balance). The following day she collapsed at home and was admitted to hospital. It was found that she had hypercalcaemia (excessive calcium levels), acute pancreatitis (inflammation of the pancreas) and severe dehydration. Miss A's condition continued to deteriorate and she died. Mrs C raised concerns about the level of medication Miss A was prescribed and queried whether they played a role in her death. Mrs C complained that the practice failed to monitor Miss A's medication regime appropriately, to ensure that she received appropriate follow-up for specialist care and that they failed to carry out an appropriate assessment of her condition the day before she collapsed.

We took independent advice from a GP. We found that the practice correctly followed the prescribing instruction received by Miss A's specialist and that the list of medications prescribed were reasonable given her symptoms. We concluded it was not the practice's responsibility to chase up the hospital with regards to follow-up appointments. We also found that an appropriate and thorough examination was carried out and there was no evidence to suggest that Miss A was suffering from pancreatitis the day before she collapsed. We did not uphold Mrs C's complaints.

Summary

Miss C complained about the antenatal (before a baby's birth) care and treatment she received when she attended Forth Valley Royal Hospital where her child was stillborn at full term.

Miss C raised concerns that, despite attending triage on a number of occasions, in relation to concerns about her blood pressure and possible pre-eclampsia (a pregnancy-related condition involving a combination of raised blood pressure and protein in the urine), she was not adequately supported. Miss C said that she felt that her concerns were not taken seriously, that she received poor continuity of care and that these failings meant that there were missed opportunities to save her baby.

The board said that Miss C was provided with reasonable care and treatment. The board found that staff provided appropriate care and treatment and there was nothing that could have been done to prevent the stillbirth of Miss C's baby. The board also requested an external review to be carried out in relation to Miss C's care.

We took independent advice from two advisers – a midwife and an obstetrician (a doctor who specialises in pregnancy and childbirth).

We found that the midwifery care and treatment given to Miss C was appropriate and in line with relevant guidance. We also found that the obstetric care and treatment given to Miss C was reasonable and in accordance with national guidelines. We found no evidence of missed opportunities which could have affected the outcome in this case and concluded that Miss C's antenatal care was of a high standard. As such, we did not uphold this complaint.

Summary

C attended the practice a number of times over several years with recurring urinary tract infections (UTIs). C said that in that period, the practice had failed to undertake a test for a prostate specific antigen (PSA test) despite C's repeated requests. When the practice did agree to undertake a PSA test the result for this was high and caused the practice to urgently refer C to the local NHS board's urology department for further investigation. Subsequently, C was informed that they had prostate cancer. C complained that the treatment provided by the practice was unreasonable.

We took independent advice from a GP. We found that the practice provided reasonable treatment to C. We considered that C's condition of recurrent UTIs had been identified by the practice, who appropriately noted that this should be managed by the urology department. The referral to this department was in line with General Medical Council's Good Medical Practice as the ongoing symptom management of the patient lay outwith the practice's professional expertise. We concluded that the care provided by the practice was reasonable. We did not uphold this complaint.

Summary

C complained about the care and treatment provided to their late spouse (A) by the practice. A had reported symptoms of excessive wind, bloating, nausea and loss of appetite. A was later diagnosed with metastatic melanoma (skin cancer that has spread). C complained that the practice delayed in carrying out an appropriate assessment of A's symptoms and that they failed to follow up on A's treatment and referrals. The practice considered that A was seen promptly following triage and that according to the Scottish Referral Guidelines, A did not warrant an urgent referral based on their symptoms at the time.

We took independent advice from a GP. We found that the assessment of A's symptoms was appropriate and the relevant guidelines for suspected cancer were followed appropriately by the practice. We also found that the referral for an urgent endoscopy (a procedure whereby a flexible tube with a camera is used to view the organs inside the body) was timely and appropriate. We did not uphold the complaint.