Not upheld, no recommendations

Summary

Mr C complained about a consultation which he had with a consultant surgeon following a referral from his GP. Mr C had a complex medical history, including abdominal pain, and he felt that the consultant was not interested in helping him. Mr C said that he was told by the consultant that his health problems could be in his mind and also that stress could be the cause of his problems, along with him being overweight. Mr C was not satisfied that the plan was for him to be reviewed in six months in the hope that he had managed to reduce his weight. He complained that he did not receive appropriate treatment.

We took independent advice from a consultant in general medicine. We found that Mr C's care was complex and that previously he had seen a number of clinicians who had difficulty in reaching a diagnosis. We found that the consultant had spent a considerable amount of time with Mr C and that it was reasonable to arrange a review appointment in 6 months in the hope that any weight loss could improve Mr C's symptoms. It was also reasonable that, as the consultant had not reached a specific diagnosis, no additional medication was prescribed. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided by the practice to his late child (Baby A). Baby A was taken to the practice with a blocked nose and congestion. The doctor considered that Baby A was suffering from a respiratory tract infection, but that there was no evidence of a more serious infection requiring any treatment or hospital admission at that time. The following day, Baby A suffered cardiac arrest at home and was taken by ambulance to hospital. They did not regain consciousness and died a number of weeks later.

Mr C complained that the practice failed to carry out an adequate assessment and failed to make a hospital referral for further investigation, despite Baby A's history of bronchiolitis (a lower respiratory tract infection that affects babies). Prior to Baby A's death, they were found to have been positive for Respiratory Syncytial Virus (RSV - a virus which causes respiratory tract infections, and the most common cause of bronchiolitis). Mr C complained that the practice failed to detect RSV.

We took independent advice from a GP adviser. We found that the doctor's assessment was reasonable and in line with relevant guidelines, which did not indicate that a hospital admission was required, based on the clinical findings. We found that hospital admission with bronchiolitis is normally only required when there are difficulties breathing or feeding, and the GP assessment did not identify any difficulties in Baby A in either regard. We found that the hospital consultant did not consider that RSV and bronchiolitis was the definitive cause of Baby A's death. We found no evidence that the practice overlooked any relevant factors in their assessment of Baby A and we did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received at St John's Hospital following breast surgery. In particular, that the board failed to listen to her when she asked for medication for the pain she was experiencing, failed to provide appropriate medication to address her pain and failed to appropriately recognise and act on seeing her red wristband for known allergies to certain painkillers.

We took independent advice from a consultant in general medicine and a senior nurse. We found that Ms C's records suggested medical and nursing staff had listened to her regarding her post-operative symptoms, made appropriate changes to her pain medication and provided a reasonable level of care. We also found that staff were aware of Ms C's allergies and acted appropriately. We considered that Ms C's care was reasonable and did not uphold her complaint.

Summary

Mr C complained to the practice about the lack of care provided to his late partner (Ms A). Ms A had attended the practice on numerous occasions over a four  month period reporting continuing neck pain. The practice had diagnosed that Ms A was suffering from Polymyalgia Rheumatica (inflammation of the muscles in the neck, shoulder or hip) and prescribed painkillers. Ms A subsequently attended hospital due to the pain and a x-ray revealed she had neck fractures caused by lung cancer spreading through her body. Mr C felt there had been a delay in carrying out investigations which would have identified the cancer at an earlier time.

We took independent advice from a GP adviser. We found that, based on Ms A's presenting symptoms, it was not unreasonable that the practice followed a working diagnosis of Polymyalgia Rheumatica. They prescribed appropriate medication which was changed to an alternative when it did not alleviate the symptoms. There were no red flag signs which would have indicated the possibility of cancer or symptoms which warranted either a hospital admission or an urgent hospital referral for a specialist opinion from a respiratory clinician. We found that Ms A's cancer presented in an unusual manner and that the cancer could not have reasonably been diagnosed earlier. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment provided to him at one of the board's addiction clinics. In particular, he felt that he did not receive appropriate support in order to help him withdraw from his diazepam medication (medication to help anxiety or withdrawal symptoms) in a safe and controlled manner. He said that he had been discharged back to the community mental health team without any assistance to reduce his medication.

We took independent advice from a psychiatrist. We found that Mr C's consultant psychiatrist had referred him to the addiction unit for advice and support to assist in his withdrawal from diazepam. The referral to the addiction team was on a time limited basis, with further care and treatment to be provided by the community mental health team. The addiction team made appropriate slight amendments to the dosage of Mr C's medication. We also found that Mr C received appropriate advice on psychological support services which were available in the community. We found that it was also appropriate that a long term treatment plan to enable Mr C to reduce his diazepam dosage was managed by the community mental health team as Mr C had a number of other health issues which would have been outwith the scope of the addiction unit. We did not uphold the complaint.

Summary

Mrs C complained about the treatment she received from a podiatrist (a medical professional who specialises in the feet and ankles) when she attended a consultation to remove some hardened skin around her toe. Mrs C believed that the podiatrist had removed too much skin as her toe became painful and she was subsequently diagnosed with an infection.

We took independent advice from a podiatrist. We found no evidence from the clinical records that there was a problem for the podiatrist when treating Mrs C's toe. We noted that they gave Mrs C appropriate advice on changing the type of footwear she wore as this would have contributed to her foot problems. We also found that Mrs C had other health conditions which may have contributed to her being susceptible to skin infections. We did not uphold the complaint.

Summary

Mrs C complained about the treatment which her late husband (Mr A) received during attendances at the out-of-hours service at the Vale of Leven Hospital. Mr  A had attended on three occasions over a period of 15 months with chest pains and numbness, where staff repeatedly told him he had a trapped nerve and prescribed painkillers. Mr A subsequently died of a heart attack a month following the last hospital attendance. Mrs C felt that the board had not carried out sufficient examinations to have ruled out the possibility of Mr A having heart disease.

We took independent advice from a GP adviser. We found that the GPs who saw Mr A had carried out appropriate assessments and obtained a reasonable history based on his reported symptoms. It was reasonable that the GPs had each arrived at a working diagnosis of musculoskeletal symptoms as a result of a trapped nerve. There also was no clinical evidence that Mr A required to be referred to a hospital specialism, such as cardiology (the area of medicine which deals with the heart and circulatory system). We did not uphold the complaint.

Summary

Mr C complained about the treatment he received from an emergency nurse practitioner (ENP) when he attended Stobhill Hospital. Mr C had injured his hand a number of weeks previously and other health professionals had said he had suffered some soft tissue damage. Mr C told the ENP that he thought he had perhaps broken a bone in his hand. He said that they did not listen to him and as a result arranged for him to have a standard x-ray which was not appropriate for identifying a fracture in the specific bone he thought was broken (the hamate bone - located on the outside of the wrist).

We took independent advice from an ENP. We found that hamate fractures are rare and difficult to diagnose. There was some disagreement between the ENP and Mr C about what was actually discussed during the assessment. There were aspects of the ENP's record-keeping which were not to an appropriate standard in that they lacked detail about the exact physical examination which had taken place. However, they had taken a reasonable history from Mr C and we felt that, due to the low suspicion of a bone fracture, it was appropriate to direct Mr C to his GP should the problem persist. Emergency departments would not have access to the specialist x-ray which would have identified a hamate fracture and this would come under the remit of specialist hand or orthopaedic surgeons (surgeons who specialise in the musculoskeletal system). We did not uphold the complaint.

Summary

Mrs C complained to us about the failure of staff at A&E at the Queen Elizabeth University Hospital to arrange a x-ray when she reported that she had hurt her back. Mrs C was given painkillers and encouraged to mobilise before being discharged home. Mrs C asked whether she should have an x-ray, but was advised that it would be unlikely to show anything and that she had probably torn muscles in her stomach and back. Mrs C was subsequently referred to physiotherapy by her GP and, after a few months, the physiotherapist sent her for a x-ray which revealed that she had suffered a fracture of her back. Mrs C felt that an x-ray should have been arranged at the initial hospital presentation and that, if this had happened, she may have avoided months of pain.

We took independent advice from a consultant in emergency medicine. We found that Mrs C had had a thorough examination on attendance at A&E and that it was appropriate to have prescribed her painkilling medication for suspected torn muscles in her stomach and back. Mrs C was encouraged to mobilise and given advice to contact her GP if the symptoms persisted or deteriorated. It is a matter of clinical judgement whether an x-ray should have been taken, but we considered that it was not unreasonable for the staff not to have arranged an x- ray in the circumstances, given Mrs C's presenting symptoms. It was also noted that, had an x-ray been arranged on initial presentation, then the treatment plan would not have altered. We did not uphold the complaint.

Summary

Miss C complained to us that the practice had failed to provide appropriate care and treatment to her mother (Mrs A). She said that her mother had reported symptoms of severe pain in her back and shoulders to GPs over a two month period, and they increased her painkilling medication and made a referral to the Elderly Care Clinic. Mrs A was subsequently diagnosed with bone and lung cancer. Miss C felt the GPs should have taken additional action to investigate the cause of her mother's pain.

We took independent advice from a GP adviser. We found that the practice had provided a reasonable level of care. The GPs had taken a thorough medical history from Mrs A and examined her appropriately, including taking blood samples and making a referral for a hospital opinion. Mrs A's back pain had been present for two months and the shoulder pain for three weeks which was not a long presentation. It was appropriate for the GPs to have altered Mrs A's painkilling medication while waiting for the hospital referral and to chase up the referral when Mrs A had not heard from the hospital. The blood test results did not show significant abnormalities or signs suggestive of cancer. We did not uphold the complaint.