Not upheld, no recommendations

Summary

Mr C complained about a consultation he had at the fracture clinic at Perth Royal Infirmary and the following care and treatment he received. Mr C was referred to the clinic after he fell and injured his hip. Prior to attending the consultation, an x-ray of Mr C's hip had been arranged by his GP, whilst an MRI scan had been carried out privately. Mr C brought the written MRI report to the consultation, but did not bring the imaging CD. After examination, the surgeon decided that conservative treatment (medical treatment avoiding radical therapy or an operation) was appropriate and they arranged to review Mr C in three months' time. Mr C obtained a different opinion on the treatment of his injury from a surgeon at a different NHS board. Mr C then agreed to have surgery on his hip at this same NHS board and said that this improved his condition.

Mr C raised concern that the surgeon at Perth Royal Infirmary failed to carry out an appropriate assessment of his condition. Mr C felt that the surgeon should have reviewed the MRI images and spoken to the radiologist who carried out the MRI privately. We received independent advice from a consultant orthopaedic surgeon. They said that Mr C was responsible for providing the MRI images, if he wished for them to be considered. The adviser considered that the assessment carried out was reasonable, and we did not uphold the complaint.

Mr C also complained that the board had failed to provide him with the same care that he subsequently received from another health board. In response to our enquiries, the board said that, based on the information available to them, they could see no reason for surgery and were satisfied that conservative treatment was appropriate. The adviser was satisfied that the surgeon's diagnosis was reasonable and consistent with Mr C's symptoms and the radiological findings. The adviser said that it was appropriate for the surgeon to arrange to review Mr C again, but suggested that an earlier review might have been more reassuring for Mr C. The adviser did not consider the different treatment by another NHS board to reflect failure in care on the part of the board, and they were satisfied that the care and treatment provided by them was reasonable. We did not uphold this complaint.

Finally, Mr C raised concern about the quality of the board's complaint investigation. We found that the board's complaint response did provide an explanation about the surgeon's findings and a reason for the treatment they suggested. We noted that an independent clinician had reviewed the surgeon's findings and the medical records, which informed the board's response to the complaint. We were satisfied that the approach taken to investigating the complaint was reasonable, and we did not uphold this complaint.

Summary

Mr C complained on behalf of his wife (Mrs A). Mr C complained that, when his wife attended the accident and emergency department at Gilbert Bain Hospital following a fall, she was not given appropriate care and treatment. Mr C also complained that the GPs at Mrs A's GP practice did not provide her with appropriate care and treatment for problems that she had with her legs, and that staff attitudes towards Mrs A at the practice were unreasonable.

We took independent advice from a consultant in emergency medicine and from a GP adviser. We found that, when Mrs A attended the accident and emergency department following her fall, a full and thorough history and assessment were carried out. We considered that the care and treatment provided to her were reasonable. We also found that the care given to Mrs A for the problems with her legs by the GP practice was reasonable, and that there was no evidence that the attitude of practice staff towards Mrs A was unreasonable. We did not uphold Mr C's complaints.

Summary

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her father (Mr A) who had fallen whilst coming out of the shower. Mr A was seen by three GPs from the practice over a two week period, who treated him for a knee injury. Mr A then called an out-of-hours service and was seen by a different GP. It was found he had a fractured hip and he was taken to hospital where a rod and pins were inserted into his leg. Mrs C felt the GPs at the practice had failed to diagnose the hip fracture.

We took independent advice from an adviser in general practice medicine and concluded that at no time during the three GP consultations did Mr A complain of hip pain or hip injury and that there were no symptoms which indicated that his hip was fractured. There was also no report that he was unable to walk or bear weight which would have been an indication of a hip problem. We found that the GPs involved reasonably concluded from Mr A's reported symptoms that he had injured his knee and they provided appropriate treatment. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late mother (Mrs A) by the practice. Mrs C complained that the practice failed to appropriately monitor and treat Mrs A's symptoms after she was diagnosed with a heart condition. Mrs A was referred to cardiology by the practice a number of years ago and was diagnosed with a heart condition known as mitral regurgitation (when blood back flows through a valve in the heart called the mitral valve). She was prescribed diuretic medication (also known as water tablets - tablets which can help reduce the fluid build up that can occur when the heart is not working normally). When Mrs A was reviewed by cardiology again two years later, the condition was noted to have resolved and the cardiology clinic advised that the diuretic medication could be reduced and stopped. In line with Mrs A's wishes, she continued to take the medication for a further three years before it was stopped when she was found to have low sodium levels. In the interim, Mrs A had also been given a steroid inhaler for suspected asthma. Mrs A suffered a heart attack and died less than two months after stopping the diuretic medication.

Mrs C complained that stopping the diuretic medication contibuted to her mother's death. She raised concerns that closer monitoring of Mrs A's known heart condition did not occur. She also raised concerns that the steriod inhaler prescribed for breathlessness may have masked the underlying problems with Mrs A's heart. In particular, Mrs C did not consider that Mrs A received the appropriate attention required to properly identify the cause of the symptoms she presented with in the final months of her life.

We took independent advice from a GP adviser. We found that the management of Mrs A's symptoms was reasonable. The adviser noted that the cause of the mitral regurgitation was never established and that, when it appeared to have resolved, no ongoing cardiology follow-up was arranged. Had heart valve disease, which is one of the possible causes of mitral regurgitation, been identified, the adviser confirmed that this would have been followed up by the cardiology clinic, and not by the practice. In light of the cardiology clinic's advice that the diuretic medication could be stopped, alongside the low sodium level later found in Mrs A, we were advised that it was reasonable for the practice to have stopped this medication. We were also assured by the advice we recieved that the prescription of inhalers was reasonable and that there was nothing to indicate that this masked an underlying heart condition. The adviser did not consider that Mrs A's death could reasonably have been forseen by the GPs at the practice, and they concluded that the care provided to her by the practice was reasonable. We accepted this advice and we did not uphold Mrs C's complaint.

Summary

Mrs C underwent dental work. After she submitted the invoice to her dental insurer, they refused to cover most of the costs as the work had been charged on a private treatment basis and the insurance policy only covered NHS costs. Mrs C complained that her dentist had never discussed this with her. She said that if she had known that the work was going to be charged at private costs she would not have agreed to it.

Mrs C's dental records included entries documenting discussion about the work being charged on a private basis, and an entry stating that she was given a written estimate. A copy of the written estimate was provided to us, showing itemised NHS and private treatment costs. We concluded that the fact that the work would be charged on a private treatment basis had been discussed with Mrs C. As such, we did not uphold her complaint.

Summary

Ms C's mother (Mrs A) had a number of health concerns and she required numerous hospital admissions over the course of two years. Ms C complained about the removal of diazepam (a medication used to treat anxiety) from her mother's medication regime during one of her admissions. Mrs A had been taking diazepam regularly for over forty years, and Ms C believed that its sudden withdrawal had caused delirium, which led to a worsening of Mrs A's dementia and her eventually having to go into a care home.

The board did not consider that Mrs A's increased confusion was necessarily caused by the withdrawal of diazepam. They noted that there were a number of other possible causes, including several long-term conditions and other issues, including acute infections. They accepted, however, that there had been some shortcomings when recording medicines on admission and on discharge and they identified this as a learning point.

We took independent advice from a consultant in acute medicine. We found that there are often multiple potential causes for delirium, and the adviser thought it unlikely that Mrs A's decline was attributable to diazepam withdrawal. We noted that there appeared to be admissions during which Mrs A was not administered any diazepam and showed no signs of withdrawal. Given that Mrs A was on a relatively low dose, the adviser did not think the withdrawal had caused Mrs A's delirium and decline. We therefore did not uphold this complaint.

Ms C also complained that the board failed to ensure that her mother was receiving reasonable medication therapy following the decision to stop her diazepam medication. The board had found during review that an alternative was prescribed and administered, albeit inconsistently. We found that Mrs A was on other medications which may have alleviated the need for a substitute and we noted that Mrs A had managed for several days during one admission without diazepam and without any signs of withdrawal. The adviser therefore thought it reasonable to have stopped this medication, assuming that withdrawal would not occur. We found that, at a later date, a susbtitute was introduced to Mrs A's medication regime, and the adviser did not consider that this was needed before this point. Therefore, we did not uphold this complaint.

Summary

Mr C complained about the prison healthcare team's decision to withdraw his suboxone medication (medication used to treat opiate addictions). He also complained that it took an unreasonable amount of time for him to be reviewed by a GP when his prescription was discontinued.

We took independent advice from a medical adviser. Mr C was found to be concealing his medication and so it was stopped. The advice we received was that this decision was reasonable as it was in line with the medication contract that Mr C had signed. We did not uphold this aspect of Mr C's complaint.

Regarding the time taken for Mr C to be reviewed by a GP, we found that Mr C's records were reviewed by a GP within three days and that he subsequently received an appointment. The advice we received was that this wait was not unreasonable. We did not uphold this part of Mr C's complaint.

Summary

Mr C, who is an advocacy and support worker, complained on behalf of his client (Ms B) about the clinical treatment provided to Ms B's son (Mr A). Mr A had been attending the practice over a number of months with recurrent symptoms, and Ms B felt that further investigations should have been carried out to determine the cause of Mr A's symptoms.

We took independent advice from a general practitioner. We found that Mr A had been appropriately assessed, examined and investigated by the practice. We also found that appropriate referrals were made for further investigations in light of Ms B's concerns. We found that the care and treatment provided was in line with the General Medical Council Good Medical Practice guidance. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the practice had unreasonably refused to provide Mr A with a medical appointment. We found that there had been no indication for an urgent appointment when Ms B had contacted the practice and that appropriate and adequate advice had been provided by the practice to Ms B based on Mr A's past clinical record, past attendances and persistently normal investigations. We did not uphold this aspect of Mr C's complaint.

Summary

Mrs C complained to us about the care and treatment she received at her GP practice. She considered that the practice delayed in diagnosing the severity of circulation problems in her leg and she questioned the treatment she had received. Mrs C felt that she should have been referred to the hospital's vascular department sooner. She believed that if she had been provided with appropriate clinical treatment and referred to vascular surgeons earlier then she may not have had to have her lower leg amputated.

We took independent advice from a GP adviser. We found that the assessment and treatment provided to Mrs C by the practice doctors was reasonable and appropriate and was in accordance with national guidelines. We found that there was no unreasonable delay by the practice in making the referral to the vascular department and that the referral did not require to be urgent because, at the time Mrs C was assessed, there was nothing to suggest critical ischaemia (an advanced state of peripheral artery disease and a threat to a limb). In addition, the referral had appropriately requested further investigation and clearly stated that Mrs C's doctor suspected vascular disease and asked that a doppler scan (a non-invasive test that can be used to estimate the patient's blood flow through blood vessels by bouncing high-frequency sound waves off of circulating red blood cells) be arranged. We also considered that there was no evidence to support the view that an earlier referral by the practice could have avoided the loss of Mrs C's lower leg.

Taking account of the evidence available, and the advice we received, we did not uphold Mrs C's complaints.

Summary

Mr C, who was diagnosed with gastric lymphoma (a cancer originating in the stomach), complained that there had been an unreasonable delay by the practice in referring him for a specialist opinion. We took independent advice from a general practitioner. We found that there was no undue delay in referring Mr C for a specialist opinion given the information the practice had on which to base their decision. We also found that the practice had been diligent in their review of Mr C's case and that the action taken by the practice was reasonable. We did not uphold Mr C's complaint.