Not upheld, no recommendations

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.

Summary

Ms C complained about the treatment which her mother (Mrs A) received from district nursing staff while she was in a care home. Mrs A had entered the care home for respite for one week but ended up in the care system for more than five months. Mrs A had developed pressure ulcers in her heels and although care was provided by the district nursing team, Ms C felt the care was inadequate and that it resulted in Mrs A's ulcers becoming infected, which affected her mobility.

We took independent advice from an adviser in district nursing. We found that the district nurses had provided appropriate care to Mrs A in that her pressure ulcers were treated and dressed, and that appropriate pressure relieving aids such as a special mattress and boots were in use. There was also an appropriate referral to podiatry to provide the ongoing management of Mrs A's foot care. We did not uphold the complaint but did provide feedback to the staff about a lack of record-keeping which would have highlighted which risk assessments had been carried out in order to substantiate the need for the treatment options which were put in place.

Summary

Miss C complained to us that the medical practice had failed to provide her with appropriate care and treatment. She had attended the practice for a medical certificate following her recent attendance at A&E where she was diagnosed with a fractured finger and had her fingers strapped. Miss C said that the practice failed to manage her care appropriately in liaising with hospital staff and delayed making a referral to the hand clinic.

Summary

Mrs C complained about the treatment she received from the practice for an infection in her leg. Mrs C attended an out-of-hours surgery over the weekend prior to attending her local practice on the Monday. The practice adjusted Mrs C's medications and arranged a follow-up appointment with a nurse for wound dressing. Mrs C's leg grew worse and a GP was called to her home. The GP arranged for Mrs C's admission and further assessment at a hospital.

We took independent medical advice from a GP. We found that Mrs C's treatment by the practice was reasonable and found no failings in the treatment offered. Therefore, we did not uphold Mrs C's complaint.

Summary

Mr C complained that the board had not provided him with appropriate care and treatment for pain in his knee and thigh.

We took independant advice from a GP. We found that appropriate investigations had been carried out into both issues, appropriate referrals to other services had been made, and pain had been managed in line with guidance. We did not uphold Mr C's complaint.

Summary

Ms C complained about the care and treatment she received following a total abdominal hysterectomy (surgery to remove the womb). The day after the surgery, Ms C began to feel unwell and experienced severe pain in the lower right-hand side of her abdomen. Ms C requested help from a nurse and was advised that her symptoms could have been wind. Based on this, the nurse gave her some peppermint water. After the pain persisted, Ms C asked to be seen by a doctor. Ms C was given pain relief and monitored throughout the night. The following day, Ms C's haemoglobin level dropped and she required surgery to treat a rectus sheath haematoma (internal bleeding). Ms C felt that the hospital should have identified earlier that she was bleeding internally. She also complained about the nursing care she received while in hospital, especially in relation to one particular nurse who Ms C felt displayed inappropriate attitude and behaviour.

We took independent advice from a consultant gynaecologist and a nurse. We found that it was not unreasonable for the rectus sheath haematoma not to be identified or addressed earlier. We considered that the board's actions, including their post-operative treatment plans for Ms C's care, were reasonable. Therefore, we did not uphold this complaint.

In relation to nursing care, we found that it was not unreasonable for nursing staff to have suggested Ms C's pain was caused by wind and there was nothing in the medical records to suggest nursing staff unreasonably delayed contacting a doctor. We noted that the medical records indicate that there was some conflict or difficulty in the communication between Ms C and nursing staff. However, we did not consider what was recorded in the records to be unreasonable or a cause for concern. We acknowledged that Ms C's account differed from what was recorded in the medical records and that we had no reason to doubt what she had told us. However, we concluded that we would not be able to reach a conclusive view on the interactions between Ms C and the nursing staff, as there was no evidence that the nursing care provided was inappropriate or unreasonable. We did not uphold this complaint.