Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment provided to her late daughter (Ms A). Ms A had a history of breast cancer and she had been complaining of severe leg pain. She attended A&E to request an emergency MRI scan, however, she was advised by hospital staff that she did not meet the criteria for an emergency scan. An out-patient referral was made instead. Ms A was later diagnosed with cancer and underwent surgery to repair a cancer related fracture of her hip. Following the surgery, it was identified that Ms A had a neck fracture.

Mrs C complained that the hospital staff unreasonably refused to perform the MRI scan when Ms A attended A&E and that the board failed to provide a reasonable explanation for the cause of Ms A's neck fractures.

We took independent medical advice from an orthopaedic (conditions involving the musculoskeletal system) surgeon. We found that an emergency MRI scan can only be performed if the patient is suffering from a neurological deficit, therefore it was correct that Ms A was advised she did not meet the criteria. We also found that there was no evidence to suggest that Ms A's neck fracture occurred during surgery, and it was reasonable to conclude that the fracture developed due to the progression of the cancer into her bones. We did not uphold the complaints.

Summary

Mrs C complained about the treatment which her son (Mr A) received at Hairmyres Hospital. Mr A was admitted with severe stomach pains, vomiting of blood and blood in his stools. The diagnosis was a bleed within his intestinal tract. Initially the plans were that an endoscopy (a medical procedure where a tube-like instrument is put into the body to look inside) would be carried out while Mr A was a patient. Mr A was then discharged home after a few days and arrangements were made for him have an endoscopy as an out-patient within four to six weeks. A letter was issued to Mr A asking him to make contact for a date for the endoscopy, but he did not respond. He was then admitted to another hospital as an emergency where he underwent surgery for a perforated gastric ulcer (condition in which an untreated ulcer can burn through the wall of the stomach or other areas of the gastrointestinal tract). Mrs C felt that had Mr A received the endoscopy while an in-patient, it may have prevented the ulcer perforation.

We took independent advice from a surgeon. We found that while Mr A was in hospital the staff carried out appropriate investigations in order to arrive at a diagnosis. There is guidance that Mr A should have received an endoscopy while an in-patient. However, this would have been for the purposes of establishing whether Mr A was continuing to lose blood; but as Mr A showed signs of improvement, this was not the case. It was appropriate to discharge Mr A from hospital as he appeared to be stable, and the revised plan for an out-patient endoscopy was then reasonable in the circumstances. We did not uphold the complaint.

Although we did not uphold the complaint we highlighted issues of concern regarding record-keeping, risk assessment and communication with primary care as feedback to the board in an effort to improve learning.

Summary

Mr C complained that the practice had over-prescribed Diazepam and Nitrazepam (both belonging to a class of sedative medication called benzodiazepines) for a period of ten years. He believed that this had caused long-term damage to his mental health including aggression and anger. He said that the practice had failed in their care by not managing a controlled withdrawal.

We took independent advice from a GP. We found that Diazepam was being prescribed along with antipsychotic medication, as instructed and monitored by psychiatry. We noted that the practice closely monitored Mr C, made efforts to refer him to addiction services for Diazepam detoxification and, when he defaulted from the services, they monitored and gradually reduced his Diazepam within the practice. We found that the practice's management of his prescription was reasonable, and we did not uphold this complaint.

Mr C also complained that the practice unreasonably removed him from their practice list. The practice said he had been removed from their list due to aggressive behaviour, and that this was not the first instance of such. Mr C felt that this was unreasonable as he considered he had been displaying the symptoms of over-prescription of Diazepam and Nitrazepam.

We noted that the records showed Mr C was 'repeatedly harassing the reception staff' and had received previous warnings for inappropriate and aggressive behaviour. We confirmed that benzodiazepines are noted to have a rare side effect of aggression, but having reviewed Mr C's records going back 16 years, we found that suggesting his medication was the cause of his aggression was the least likely explanation. We noted from the records that there had been an irrevocable breakdown in the relationship between Mr C and the practice and we considered it reasonable to remove him from the list. We did not uphold this complaint.

Summary

Mrs C, an advice worker, complained on behalf of her client (Mrs A) who had concerns about the treatment which she received from a consultant rheumatologist (specialism of the medical treatment of the musculoskeletal and its disorders) at Raigmore Hospital. Mrs A had a leg ulcer and was being considered for treatment for her arthritis (a disease causing painful inflammation and stiffness of the joints). She requested that the board provide her with a certain medication that she had identified when researching the internet. However, the board refused as the requested medication could not be used as first line treatment until alternative medication had been considered in the first instance.

We took independent advice from a consultant rheumatologist. We found that the decision not to provide the requested medication until alternative first line medication had been attempted was reasonable and in line with accepted medical practice. We did not uphold the complaint.

Summary

Mr C complained about the treatment he received at Queen Elizabeth University Hospital when he attended for a kidney biopsy. Mr C said that the doctor performing the procedure was unsuccessful in obtaining the tissue sample and that a consultant had to complete the procedure. Mr C subsequently went on to suffer a bleed from the site of the biopsy and required a blood transfusion. Mr C felt that the procedure may have been carried out incorrectly.

We took independent advice from a consultant nephrologist (doctor specialising in medical treatment of the kidneys). We found that Mr C had suffered from a recognised complication of the kidney biopsy procedure. Initially the procedure was carried out by a trainee under consultant supervision but when difficulties were encountered, it was appropriate for the consultant to complete the procedure which was successful. While minor bleeding can occur at the site of the biopsy needle, on occasions more significant bleeding can happen. This was the case with Mr C, and it was not an indication that the procedure had been carried out incorrectly. We also found that the risks of the procedure were explained to Mr C and appropriate consent was obtained. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late daughter (Ms A) by the practice. Ms A attended the practice complaining of severe leg pain and was diagnosed some time later with cancer. Mrs C complained that the practice failed to carry out the appropriate investigations in response to Ms A's symptoms and previous history of breast cancer.

We took independent advice from a GP. We found that Ms A's symptoms, which she discussed with the GP on the first two appointments, were not indicative that cancer was a likely diagnosis and the appropriate treatment was provided.

When Ms A began to complain of back pain, and it was noted that she had weight loss, we found that the practice acted appropriately by making an urgent referral for imaging and arranging for blood tests to be carried out. We concluded that the treatment provided was in line with national guidelines and we did not uphold the complaint.

Summary

Ms C complained that the care and treatment provided to her late mother (Mrs A) was inadequate. Mrs A died following a short admission to hospital, following emergency surgery. Ms C was specifically concerned that Mrs A had been diagnosed correctly early in her admission to hospital, but that this had not been properly acted upon. Ms C also suggested that surgery should have been performed earlier and that this had contributed to Mrs A's death. Ms C said that the subsequent morbidity and mortality meetings investigating Mrs A's death had not been appropriately carried out, as they had not identified the reason for her admission correctly.

We took independent medical advice from a consultant gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). We found that Mrs A had been suffering from a condition which was difficult to diagnose and which shared symptoms with a number of conditions. Mrs A had been given a differential diagnosis, and although this included the condition she was suffering from, it was not accurate to say that she had been conclusively diagnosed early in her admission. We concluded that the process of diagnosis had followed the correct procedures, and that the test result which could most reliably diagnose her condition was inconclusive. Mrs A had undergone surgery within a reasonable timeframe. The morbidity and mortality meetings had reflected on the condition Mrs A had been suffering from, rather the reason her GP had referred her to hospital. We concluded that Mrs A's care and treatment had been reasonable and, therefore, did not uphold the complaint.

Summary

Mrs C complained to us about the care provided to her late husband (Mr A) by the practice prior to him suffering a fatal heart attack. In particular, Mr A had reported chest pains three times over a three month period to his GP. The GP had felt the problems were related to a stomach problem, prescribed Gaviscon (medication for heartburn or indigestion) to Mr A and said they had ruled out a cardiac cause for the chest pain.

We took independent advice from a GP. We found that at the initial consultation it was reasonable that the GP had considered that Mr A's long standing stomach problem was responsible for his reported chest pain, and it was appropriate to prescribe medication. There was a question as to whether Mr A was taking the prescribed medication, which may have resolved the stomach problem, and that it was reasonable to pursue that line of enquiry in an effort to resolve the situation. We found that the GP had carried out an appropriate examination and did not uphold the complaint. We also noted that there was no evidence to suggest that had an earlier diagnosis been made, it would have prevented Mr A's sudden death.

Summary

Mr C complained that the care and treatment given to his late wife (Mrs A) by the board was unreasonable. Mrs A had a history of rheumatoid arthritis (an inflammatory disorder that mainly affects flexible joints) and was later investigated for possible heart disease. The investigations proved negative. However, a year later she was admitted to hospital again and found to have severe problems with the functioning of her heart valves. Heart surgery was considered, but Mrs A developed sepsis and multiple organ failure which increased the risks associated with surgery. However, it was considered that Mrs A would not survive without an operation, which went ahead. After Mrs A was discharged home, she picked up a serious infection and suffered a stoke. She died a few months later.

We took independent advice from a cardiologist (a doctor who specialises in the heart and blood vessels). We found that it was extremely unusual for a patient's heart condition to deteriorate so rapidly and that this could not have been foreseen; there had been no delay in treating Mrs A's symptoms or in diagnosing her heart problems. Mrs A's health was such that surgery was always going to be risky for her, but there had been no delay undertaking it. Afterwards, the serious infection from which Mrs A suffered had a significant associated mortality rate and her health continued to deteriorate despite her treatment. Therefore, we did not uphold the complaint.

Summary

Mrs C complained about the treatment provided to her father (Mr A) while he was a patient at the Golden Jubilee National Hospital. Mr A had been admitted for planned surgery and subsequently his health deteriorated. Mrs C said that Mr A reported problems with his leg/foot and that these were ignored by staff. Mrs C felt that Mr A should have been sent to the high dependency ward after the surgery so that he would have been better observed by staff and that his outcome would have improved. Mr A was then housebound, had limited mobility, and a poorer quality of life.

We took independent advice from a cardiothoracic consultant (doctor specialising in operations of the heart, lungs and other chest organs). We found that the planned surgery was carried out without complications and that it was appropriate to transfer Mr A back to a ward rather than a high dependency ward as there were no concerns noted. When Mr A did deteriorate, he developed respiratory failure (a condition in which the blood does not have enough oxygen or has too much carbon dioxide) which was identified by staff and he was then taken to the high dependency ward. Mr A also had other long-standing medical conditions, which were more likely to have contributed to Mr A's deterioration rather than as a result of the surgery he underwent. We did not uphold the complaint.