Not upheld, no recommendations

Summary

Ms C received treatment at a dental service run by the partnership and was unhappy that, for one instance of specific dental treatment, the partnership referred her treatment to the Practitioner Services Division (PSD) for approval. Ms C said that if she had been a patient at a high street dentist, she would not have needed the treatment referred.

We took independent advice from a dental adviser. We found that both high street dentists and the partnership's dental service were regulated in exactly the same way, including carrying out treatments in line with the Statement of Dental Remuneration (SDR). The SDR sets out the rules defining the types of filling, denture or other restoration, and what type of material can be used. It also defines the timing of treatment types and the costs of those treatments. Some types of material, or restoration, are not included in the SDR, and so require prior approval from PSD.

The treatment Ms C wanted was not included in the SDR and, therefore, the partnership had to apply to PSD for approval. This was not a policy of the parternship's making, but applies across Scotland. We concluded that the partnership acted reasonably in referring Ms C's treatment to PSD for approval, and we did not uphold her complaint.

Summary

Mr C complained about the way NHS 24 had handled a phone call from him when he reported that he had been experiencing headaches for over three weeks and was told that he was suffering from migraines. Mr C subsequently went on to develop vertebral artery dissection (a tear to the inner lining of an artery in the neck which supplies blood to the brain and can cause a blood clot) three weeks later. Mr C believed that the call to NHS 24 was not managed appropriately and that he was unreasonably only advised to rest and increase his fluid intake.

We took independent advice from a practitioner experienced in out-of-hours services. We found that NHS 24 had treated Mr C's concerns seriously and they had conducted a clinical investigation report. Mr C had contacted NHS 24 during the hours when GP surgeries are open and, during such periods, the remit of NHS 24 is to provide advice and to direct patients to contact their GP. We were satisfied that, in view of Mr C's reported symptoms at that time, there was no requirement for him to attend hospital or arrange an emergency ambulance and that it was appropriate to direct him to his GP surgery. We did not uphold the complaint.

Summary

Mrs C complained that, following a foot operation at the Golden Jubilee National Hospital, she continued to suffer pain and discomfort. During the surgery a bone fractured and had to be fixed by a wire. Mrs C reported continuing problems and was reviewed at both the Golden Jubilee National Hospital and the orthopaedic department of her local hospital, where it was established that she had also suffered a further complication of the surgery where there was a non-union of the bone. Mrs C believed that the original surgery had not been performed properly and that she had not been told of the risks of surgery prior to her operation.

We took independent advice from a consultant orthopaedic surgeon. We found that both the bone fracture during the surgery and the subsequent non-union of the bone were recognised, but rare complications, of the surgery. We found that there was no indication that the original surgery was not performed to a satisfactory standard. The fracture was caused when inserting a screw in order to fix a bone into place and we found that it was appropriate to change the fixation method to wire when the bone fractured. The two complications of the surgery which affected Mrs C were not specifically mentioned in the operation consent form as they were rare; however, it was found that the actual risks mentioned on the form were adequate as they had identified the most common types of complications. We did not uphold the complaints.

Summary

Mr C complained that the practice had failed to provide appropriate care and treatment to his daughter (Miss A). He said that the practice had failed to provide Miss A with an emergency appointment when a phone call was made to them one morning advising them that Miss A was showing symptoms of severe mental health issues, including self-harm and suicidal thoughts. The practice said that they were unable to see Miss A until later in the evening and gave advice that Miss A should attend the local accident and emergency department. Miss A was taken to the hospital and subsequently was transferred to another hospital for patients with mental health issues. Mr C believed that the practice should have made arrangements to see Miss A as an emergency that morning rather than her having to wait a number of hours at the hospital for an assessment. Mr C also complained about a previous consultation Miss A had with a GP at the practice where she was complaining about depression. Mr C said Miss A was not given any medication, but advised to make another appointment and to bring her mother with her and that a discussion would take place then about medication. Mr C felt that, as Miss C was of adult age, she did not require her mother to be there.

We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. We found that the practice gave appropriate advice that Miss A should attend the nearest accident and emergency department as this way she was seen quicker than had she waited for the first available practice consultation slot later that day. We also concluded that a reasonable clinical assessment had been carried out at a previous GP consultation where the GP had taken an appropriate history and gave Miss A reasonable advice. Miss A had mentioned to the GP that her mother may not agree with the GP's proposed treatment plan and it was decided that she should make a review appointment after discussing the situation with her mother. The records did not indicate that Miss A's mother had to be present at the review appointment. We did not uphold the complaints.

Summary

Miss C complained that the board unreasonably refused to perform liposuction (a  cosmetic procedure used to remove unwanted body fat) for her lipoedema (a  chronic fat tissue disorder in which fat cells build up, typically on the thighs, buttocks and lower legs, which causes tissue enlargement, swelling and pain. This tissue cannot be lost through weight loss). The board had criteria in place for providing this procedure and Miss C did not meet the criteria. Miss C complained that the criteria were unreasonable.

We took independent advice from a plastic surgeon. We found that it was reasonable for the board to have criteria in place for providing liposuction for lipoedema, and that the criteria was appropriate in order to balance the benefits and potential risks of the procedure. We did not uphold Miss C's complaint.

Summary

Ms C complained about the care and treatment provided to her by the board in relation to her hearing. Ms C had surgery to fit a hearing implant and after this she felt that her hearing deteriorated. Ms C also developed tinnitus (a ringing or buzzing in the ears). Ms C further complained that the communication with her from clinicians with regards to her hearing was not reasonable.

We took advice from an ear, nose, and throat consultant and an audiologist (a healthcare professional who specialises in hearing, balance and related disorders). We found that there was no suggestion that the reduction in Ms C's hearing was due to the surgery, and that clinicians involved in her care had provided a reasonable standard of care. We also found that the records showed a reasonable level of communication with Ms C. We did not uphold Ms C's complaints.

Summary

Mr C complained on behalf of his late wife (Mrs A) about the care and treatment she received from her GP practice. Mrs A attended the practice with stomach pains but it was not until two years after her pain began that she was diagnosed with cholangiocarcinoma (CCA, a very rare cancer of the bileduct). Mr C complained that the practice had delayed in carrying out appropriate tests and investigations. The practice said that Mrs A had been treated and cared for reasonably. They explained the rarity of her illness and said that that her symptoms had not been specific for a diagnosis of CCA. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a GP. We found that, as well as Mrs A's illness being extremely rare, it was also very difficult to diagnose at an early stage and was often found incidentally. Mrs A initially attended the practice with abdominal pain for which she was appropriately treated. There was no indication at that time for further investigations and Mrs A noted an improvement. She did not return to the practice with abdominal pain until two years later. At this time, all her liver tests were normal; and showed no cause for concern. However, as her symptoms worsened, she was admitted to hospital and was diagnosed with CCA. We found that the care and treatment Mrs A received from the practice was reasonable and, therefore, we did not uphold this complaint.

Summary

Mr C complained on behalf of his late wife (Mrs A) who was diagnosed with cholangiocarcinoma (CCA, a very rare cancer of the bile duct) at Ninewells Hospital. Mr C was concerned that there had been a delay in providing the diagnosis and that, had appropriate tests and investigations been carried out sooner, Mrs A's death may have been avoided. Mr C was also concerned that after diagnosis, the board failed to make further more timely investigations about the spread of the disease (particularly to her bones) for which treatment may have been available. Mr C complained to the board who told him that Mrs A's illness had been life limiting but that throughout her illness, her treatment had been reasonable and appropriate. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a consultant oncologist (a doctor who specialises in cancer treatment). We found that Mrs A's illness was very rare and diagnosis was not obvious; it was often an unexpected finding on a scan. Mrs A had stomach problems a few years before her cancer diagnosis, for which she received appropriate tests and at that time there was no evidence that she had cancer. Mrs A had no further stomach problems for two years until she was sent to hospital for a scan and it was at this time that she was diagnosed with CCA. We found that there had been no delay in diagnosis. After her diagnosis, Mrs A was given palliative chemotherapy (cancer treatment that is not designed to cure the disease, but rather prolong life and minimise symptoms) and responded well. Her symptoms were managed as it was not possible to operate, however, Mrs A was later admitted to hospital as she had become jaundiced (where the skin and/or eyes become yellow in colour). Her disease had progressed and was later found in her bones but we did not find that there had been any missed opportunities for treatment that would have changed Mrs A's outcome. We found that her care and treatment had been reasonable. Therefore, we did not uphold Mr C's complaint.

Summary

Ms C arranged an emergency appointment at the out-of-hours dental service as she was suffering from toothache. The dentist performed the first stage of a root canal treatment, however they experienced difficulty in accessing all the root canals. Ms C's tooth pain worsened and she had to return to the out-of-hours dental service the following day and she opted to have the tooth extracted. Ms  C complained that the dentist failed to properly explain the treatment options to enable her to give informed consent. She also complained the dentist failed to provide the appropriate treatment and that, had the dentist informed her of the difficulty they would have performing the treatment, she would have opted to have the tooth extracted.

The board explained that the dentist had difficulty accessing all the root canals and this would explain why Ms C had significant post-operative pain, however, they did not consider that the dentist failed to provide the appropriate treatment or that they failed to appropriately explain the treatment options.

We took independent advice from a dentist. We found that it was not possible to identify from scans taken of Ms C's mouth that the root canal treatment would be so difficult to perform, therefore the appropriate treatment was provided. We also found that the information provided to Ms C in terms of treatment options was reasonable in the context of an emergency service setting. We did not uphold Ms C's complaints.

Summary

Mrs C complained about the respiratory care (care of the lungs and other organs) and treatment provided to her by the board. She said that she did not feel she was given appropriate follow-up care and that this resulted in her respiratory problems becoming worse.

We took independent advice from a consultant in respiratory medicine. We found that Mrs C was appropriately investigated and that no follow-up was necessary. We also found that there was no evidence that her respiratory problems had been caused by, or became worse as a result of, lack of follow-up. We did not uphold Mrs C's complaint.