Not upheld, no recommendations

Summary

Ms C had an ad-hoc consultation with a podiatrist (a clinician who diagnoses and treats abnormalities of the lower limb). The podiatrist asked a diabetic consultant if they would review Ms C on the same day. Ms C was concerned that the diabetic consultant did not see her.

Summary

Mr C complained that the practice wrongly focused their assessment and treatment on the wrong condition, which caused a delay in him being diagnosed with pancreatic cancer.

We took independent GP advice and found that the care provided, and investigations carried out, were in line with the Scottish Cancer Referral Guidelines. When Mr C's symptoms changed, the appropriate referrals were made. We did not uphold the complaint.

Summary

Mr C complained about the treatment he received from the board, when he was referred for the provision of a specialist prosthetic (artificial substitute or replacement of a part of the body). Mr C had to travel a long distance and attend a number of consultations because he had problems with the prosthetic which had been provided and it failed to fit his limb properly, and was out of alignment.

We took independent advice from an adviser. We found that the staff had listened to Mr C's concerns and made a number of attempts to provide him with a satisfactory fit for the prosthetic but they were unable to meet his needs. We did not uphold the complaint.

Summary

Mr C complained that his wife (Ms A) contracted methicillin-resistant staphylococcus aureus (MRSA - a bacterial infection that is resistant to a number of widely used antibiotics) due to medical negligence in the Princes Royal Maternity Unit (PRMU), and of a subsequent delay in identifying and appropriately treating the infection. Mr C considered that Ms A contracted MRSA as a result of negligence following the birth of their child. He considered that there was a delay in medical staff diagnosing the infection and thereafter providing proper treatment. Ms A returned home, continuing to have difficulties, and had to receive treatment despite having been discharged from the PRMU.

We requested the relevant medical files and asked an independent medical adviser to consider the care and treatment provided to Ms A. The medical records evidenced that the treatment in hospital had been appropriate, with Ms A's observations being monitored appropriately and decisions taken to discharge her were reasonable in the circumstances. However, on re-admission it was apparent Ms A was suffering from an infection. We found that appropriate investigations were undertaken in a timely manner to identify the cause of Ms A's infection when her symptoms became apparent. The antibiotic treatment was revised when tests concluded the cause of the infection was MRSA. There was no evidence of medical negligence that resulted in the infection. We concluded that the diagnosis and treatment provided to Ms A was reasonable, and therefore did not uphold the complaint.

Summary

Mrs C complained about the care and treatment she received from the board for her bunions (painful swellings on the first joint of the big toes). Mrs C complained that the board failed to advise her prior to her bunion surgery that permanent nerve damage or bone fracture were potential complications of the surgery. Mrs C said that if she had been advised of these potential outcomes, she would not have gone ahead with the operation.

We took independent medical advice on the case from a consultant orthopaedic and trauma surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that nerve damage and bone fracture were recognised complications of the surgery Mrs C had. We also found that the appropriate consenting process was carried out and the correct consent form was signed by Mrs C and the doctor who was to carry out her surgery. The consent form listed the complications of the procedure, including nerve damage and fracture. Therefore, we did not uphold this complaint.

Summary

Mr C complained about the treatment he received at his dental practice. His dentist had said that he required a filling and the filling was performed by a dental therapist. Following the filling, Mr C experienced pain from the tooth and was told that a nerve had been damaged and that he would require either extraction or root canal treatment and then that he would require a crown. Mr C felt that the dental therapist had not carried out the filling in an appropriate manner. Mr C was also dissatisfied that when he made a formal complaint to the practice that he received responses from the dental therapist, head of practice and the dentist.

Summary

Mrs C complained about the care and treatment provided to her daughter (Miss A) when she was admitted to Aberdeen Royal Infirmary for abdominal pain, vomiting, and a high temperature. Mrs C felt that there was a delay in diagnosing Miss A with pelvic inflammatory disease (infection of the organs of the reproductive system).

We took independent advice from a general surgeon, a radiologist, and a gynaecologist (a doctor who specialises in the treatment of women's diseases, especially those of the reproductive organs). We found that the care and treatment provided to Miss A was reasonable and that it would not have been possible to diagnose her with pelvic inflammatory disease any earlier. We did not uphold this complaint.

Summary

Mr C complained to us about the care and treatment provided to his son (Mr A) by the board in the community. Mr A had been diagnosed with paranoid schizophrenia (a serious mental health condition that causes disordered ideas, beliefs and experience), complicated by drug misuse. The conditions of Mr A's treatment were set out in a compulsory treatment order. We took independent advice from a mental health nurse.

Mr C complained that Mr A received an inadequate level of support and that restrictive measures should have been put in place when Mr A failed to comply with his treatment plan. We found that Mr A's care plan was reasonable. We found that the board demonstrated good practice by encouraging Mr A to comply with his treatment plan rather than immediately resorting to more restrictive measures. We found that the board did admit Mr A to hospital when it was the only practical way to stabilise his condition. We did not uphold this aspect of the complaint.

Mr C complained that there was a failure to take the circumstances of Mr A's family into account and to ease the strain they were experiencing. He also complained there was a failure to communicate effectively with the family. We found that the board acted appropriately by referring Mr C to social work for a carer's assessment. We found there was no obligation for the board to carry out their own assessment of the family's needs as carers. We also found that the board's communication with the family was reasonable. Therefore, we did not uphold these aspects of the complaint.

Summary

Mr C complained about the nursing care provided to his late mother (Mrs A) while she was a patient at Borders General Hospital. Mr C said Mrs A had told him that a nurse had pulled out her nephrostomy tube (a thin plastic tube passed from the back, through the skin and then into the kidney) and that it had not been reinserted properly. As a result of the failure to properly reinsert the tube, Mr C felt Mrs A's condition deteriorated until her death.

We took independent advice from an adviser and found that, had the tube been displaced, it would have to be reinserted in a sterile environment such as a theatre which would not normally be a procedure carried out by nursing staff. In addition, there was no entry in the nursing records which indicated that there was a problem with the tube and when Mrs A was subsequently transferred to another hospital the tube was seen to be working appropriately. We did not uphold the complaint.

Summary

Ms C complained on behalf of her child (Child A). After being assessed at a gender identity clinic, Child A was diagnosed with transsexualism and it was recommended that they be prescribed Sustanon (a hormone injection). The gender identity clinic wrote to Child A's GP to ask for arrangements to be made for Sustanon to be prescribed and administered. However, the practice advised that they would not prescribe or administer the medication for an initial period. Instead, they considered it appropriate for the gender identity clinic to prescribe the medication and make arrangements for it to be administered until Child A was stabilised, at which point the practice would take over. The practice stated that this decision was due to a lack of professional knowledge in this area and concerns about the GP's indemnity cover as Sustanon is classed as an unlicensed medication for this purpose. Ms C complained that the practice unreasonably declined to prescribe the medication and that they failed to communicate reasonably. Ms C stated that no GPs had been in contact to discuss the situation and there had been a lack of clarity about the practice's decision-making.

We took independent advice from an adviser with a background in general practice. We found that General Medical Council guidance supported the practice's position that they should not prescribe medication or initiate treatment if they do not consider themselves professionally competent to do so. We considered it appropriate, and in line with relevant guidance, for the practice to refer the matter back to the gender identity clinic for them to arrange treatment. In addition to this, we were satisfied that the reasons provided by the practice to Ms C were valid considerations for the practice to take into account. Therefore, we did not uphold this aspect of Ms C's complaint.

In relation to communication, we considered that it would have been helpful if a GP from the practice contacted Ms C or Child A to discuss their concerns. However, we noted that the practice's position was accurately conveyed by the practice manager. On balance, we considered the practice's communication to be reasonable. Therefore, we did not uphold this aspect of Ms C's complaint.