Not upheld, recommendations

Summary

Mr C complained that the dentist carrying out work on his teeth over a number of appointments acted unreasonably by treating what Mr C considered to be a healthy tooth.

We took independent advice from a dental surgeon. They noted that no unnecessary work had been carried out on Mr C's teeth and that his dental records confirmed that treatment had been carried out on teeth needing treatment.

Mr C does not speak English as a first language and during the course of our investigation we found that an interpreter was not present at every appointment. Mr C may not have understood fully the treatment that was being carried out. We therefore made a recommendation to address this.

Recommendations

We recommended that the dentist:

• take steps to ensure that an interpreter is present for appointments where a patient's understanding of English is not adequate to ensure informed consent for treatment is obtained.

Summary

Mrs C was referred for a colonoscopy for bowel cancer screening and was asked to contact the hospital to book this in. Mrs C contacted the board to raise concerns that there were no arrangements for her to see a consultant beforehand. She was also concerned to discover the procedure was booked with a nurse rather than a consultant. After further correspondence, the board arranged an appointment for Mrs C with a consultant to discuss the procedure. While Mrs C was dissatisfied that this delayed the procedure for three weeks, she attended the appointment and chose to go ahead with the procedure with the consultant. After the procedure Mrs C complained to the board about the attitude of the male nurse who prepared her for the procedure, the procedure itself, and the board's communication about this.

The board issued two written responses to Mrs C's complaint and met with her and her MSP to discuss the outstanding issues. The board apologised for some aspects of the procedure, including that the male nurse had touched Mrs C when demonstrating the procedure and that another member of staff had entered the room during the procedure to access a storeroom.

After taking independent medical and nursing advice we did not uphold Mrs C's complaints. The advice we received was that the board's care, treatment and communication were reasonable and they had apologised where appropriate. We were concerned that the steps taken by the board may not be sufficient to address the privacy issues raised and we made a further recommendation about this. While we considered some aspects of the board's complaints handling could have been improved, we found their response was reasonable and in line with Scottish Government guidance.

Recommendations

We recommended that the board:

• consider whether there is a recurring problem with staff entering the endoscopy suite to access the storeroom during procedures and take steps to address this.

Summary

Mr C complained about the clinical treatment and nursing care received by his mother (Mrs A) at University Hospital Crosshouse, in particular that the board had not prevented Mrs A from catching hospital acquired pneumonia (HAP). Mrs A died while in hospital.

During our investigation we took independent advice from two advisers, a consultant in respiratory medicine and a nursing adviser.

The consultant in respiratory medicine noted that the clinical care given to Mrs A was reasonable. They said that given the nature and severity of Mrs A's condition, she was vulnerable to catching HAP and that the medical team caring for her took all necessary measures to prevent infection.

The adviser also noted that although '1A Pneumonia' was recorded on Mrs A's death certificate, the certificate should have referred to HAP. We therefore made a recommendation to address this.

The nursing adviser noted that there was no evidence of failings and that the nursing care and treatment provided to Mrs A was reasonable. We therefore did not uphold Mr C's complaints.

In their response to Mr C's complaints to them, the board accepted that some of the communication with Mr C and his family had caused confusion and misunderstanding. They apologised for this and took action to address this. The board also apologised that they had failed to offer spiritual support to Mrs A. We therefore made recommendations to address these issues.

Recommendations

We recommended that the board:

• consider whether there are any training requirements for the staff involved in relation to communication with patients and family members and whether there need to be internal guidelines in relation to communication;
• bring detail recorded on the death certificate to the attention of relevant staff and report back on any action taken; and
• provide copies of their spiritual care policies/guidelines.

Summary

Mr C had previously paved his entire front garden to make a driveway and was given permission from the council to double the length of his dropped kerb to access this area. Mr C said he had difficulty accessing his drive and wished to further extend the dropped kerb. Mr C complained that the council unreasonably failed to appropriately assess his application to extend the drop kerb outside his home.

In considering Mr C's complaint, our role was to determine whether the council followed their normal process when dealing with Mr C's application. It was not our role to assess the site in question and determine whether or not Mr C's application should have been approved – that was the council's discretionary decision.

We saw no evidence that there was any visit made by a council officer to the site in question prior to giving his initial decision to refuse Mr C's application, although the council said a visit was made. When Mr C questioned the officer's decision it appeared that the council assessed Mr C's application in accordance with their normal process, with the council officer's manager assessing the site in question and setting out his professional opinion on why the application had been refused. On balance, we did not consider that the council unreasonably failed to appropriately assess Mr C's application.

However, the evidence showed that the council failed to keep adequate records on the case and deal with Mr C's concerns about their handling of his application and the actions of council staff appropriately. We made recommendations to address this.

Recommendations

We recommended that the council:

• feed back the failings identified in our decision to the staff involved;
• take steps to ensure that in future cases of this type, records of site visits and phone conversations regarding applications are kept and complainants are appropriately directed to their complaints procedure; and
• provide Mr C with a written apology for the failings identified.

Summary

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended an appointment with a dentist in the practice as the post and crown on a canine tooth had fallen out. The dentist had rinsed out the tooth using an antiseptic and re-cemented the post and crown, using a crown and bridge cement. The dentist had also advised Mrs C that a new post and crown should be constructed.

We took independent advice from a dental adviser who said that there was no evidence that the treatment provided by the dentist was inadequate and both the treatment and advice they had provided to Mrs C was reasonable. We accepted that advice and did not uphold Mrs C's complaint.

However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Recommendations

We recommended that the dentist:

• work with other dentists in the practice to give consideration to ensuring that, where a patient is seen and treated by more than one dentist, appropriate processes are in place so that the patient is given consistent messages and advice about their dental treatment.

Summary

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended two appointments with a dentist in the practice to re-cement a temporary crown and then to fit a new crown.

We took independent advice from a dental adviser who said that the dentist had noted that the crown did not fit well due to an overgrowth of the gum around the tooth, which the adviser explained was a common occurrence when a tooth has been without a crown or temporary crown for some time. The adviser said that the dentist had quite correctly, and in Mrs C's best interests, decided that this was not acceptable and took remedial action to deal with the problem by excising the excess gum tissue under local anaesthetic and taking impressions for the crown to be remade. The adviser said that the treatment provided by the dentist was reasonable. We accepted that advice and did not uphold Mrs C's complaint.

However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Recommendations

We recommended that the dentist:

• work with other dentists in the practice to give consideration to ensuring that, where a patient is seen and treated by more than one dentist, appropriate processes are in place so that the patient is given consistent messages and advice about their dental treatment.

Summary

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended four appointments with the dentist for the fitting of a new crown and as she was suffering discomfort from a bridge which had previously been fitted.

We took independent advice from a dental adviser who said that there was no evidence that the treatment provided by the dentist was of an unreasonable standard or that it was inadequate. The adviser also said that they did not find any failures in the clinical treatment provided by the dentist. We accepted that advice and did not uphold Mrs C's complaint.

However, the adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Recommendations

We recommended that the dentist:

• work with other dentists in the practice to give consideration to ensuring that, where a patient is seen and treated by more than one dentist, appropriate processes are in place so that the patient is given consistent messages and advice about their dental treatment.

When it was originally published on 28 September 2016, this case referred to a dentist in the Lothian NHS Board area. This was incorrect, and should have read a dentist in the Forth Valley NHS Board area. This means that the Parliamentary region was also incorrectly referred to as Lothian, and should have read Central Scotland. This was due to an administrative error which we have now corrected, and we apologise for any inconvenience that this has caused.

We have put measures in place to help avoid recurrence of this issue.

Summary

Mrs C complained about the treatment provided by her dentist. Mrs C said the treatment she received was unsatisfactory and as a result she had been left with problems with her teeth for which she held the practice responsible. Mrs C had attended two appointments with the dentist to undertake a crown preparation and the fitting of a temporary crown.

We took independent advice from a dental adviser who said there was no evidence to suggest the treatment which the dentist provided was of an unreasonable standard and the evidence was that the crown had been fitted satisfactorily. We accepted that advice and did not uphold Mrs C's complaint.

However, the adviser identified issues in relation to record-keeping concerning the dentist's discussions with Mrs C concerning her teeth and the suggested likely treatment options. There was no evidence in Mrs C's dental records of these discussions. The adviser said this was not in accordance with the standards contained in the General Dental Council's 'Standards for the Dental Team'.

The adviser also commented that because Mrs C saw the first dentist with an available appointment whenever she contacted the practice, she was seen and treated by six different dentists in the practice over several months. The adviser said this may have resulted in a failure in communication in that Mrs C was not provided with consistent messages and advice about her treatment, so we made a recommendation about this.

Recommendations

We recommended that the dentist:

• reflect on the comments of the adviser in relation to record-keeping; and
• work with other dentists in the practice to give consideration to ensuring that, where a patient is seen and treated by more than one dentist, appropriate processes are in place so that the patient is given consistent messages and advice about their dental treatment.

Summary

Mr C attended two consultations with the nurse at the medical practice. Mr C said that at the first consultation he was not prescribed antibiotics. At the second consultation, Mr C said he had taken antibiotics prescribed for his wife. The nurse prescribed antibiotics so that Mr C could complete the course. There was an error in the number of antibiotics prescribed and Mr C was required to be issued with another three-day course. Mr C complained to us about the treatment he received. He said that the nurse had been dismissive of his symptoms.

We obtained independent advice from a nursing adviser and a GP adviser. They noted that the actions of the practice nurse at the first consultation had been reasonable and that Mr C did not require antibiotics at that time. It appeared that the second consultation had been difficult for both Mr C and the practice nurse. We were advised that it had been reasonable for the practice nurse to have told Mr C that he should not have taken his wife's antibiotics. The prescribing error had been accepted by the practice and no harm had been caused to Mr C. We did not uphold Mr C's complaint.

Several months later, Mr C attended an appointment with a GP. Mr C complained to us about his treatment and the attitude of the GP. The GP adviser found that the treatment received by Mr C was appropriate. We therefore did not uphold this complaint. It was clear the consultation had been challenging and unsatisfactory for both Mr C and the GP, who recorded personal comments about Mr C in the clinical records. We were advised that it was at times helpful for the management of future consultations for a doctor to record an objective description of a challenging consultation. However, during our investigation we found that the comments about Mr C were subjective and unnecessarily personalised and so could have a negative effect on the doctor/patient relationship. We therefore made a recommendation to address this.

Recommendations

We recommended that the practice:

• reflect on the comments of the GP adviser in relation to the implications for the patient directly, and for the doctor/patient relationship, of recording subjective and/or personalised comments about the patient.

Summary

Mrs C, who works for an advice agency, complained to us on behalf of Miss A. Miss A had attended her medical practice after falling over on her ankle. Her appointment was made by her pharmacist, who thought Miss A might have a deep vein thrombosis (DVT, a blood clot in the vein). Miss A was examined by a doctor, who diagnosed a calf strain. She was advised to take pain relief.

However, Miss A's pain continued and she attended A&E on a number of occasions, where she was diagnosed with a fractured ankle. Miss A continued to report problems and was subsequently referred to a vascular surgeon (a surgeon who treats disorders of the circulatory system). A DVT was found and Miss A was required to have her leg amputated below the knee.

Mrs C complained to us that the practice failed to appropriately diagnose and treat Miss A and about the way they dealt with Miss A's subsequent complaint.

We took independent advice from a GP. They found that Miss A's diagnosis had not been unreasonable, that she had been appropriately examined and that her circulation was reasonably assessed. They also found that Miss A's complaint received a reasonable reply. We therefore did not uphold Mrs C's complaints. However, the adviser noted that Miss A's GP had not been alert to Miss A's early signs of PVD (peripheral vascular disease, or peripheral arterial disease (PAD)) which should have been followed up. We therefore made recommendations to address this.

Recommendations

We recommended that the practice:

• ensure that the GP familiarises themselves with the diagnosis and management of patients presenting with early PVD and discusses this at their next yearly appraisal; and
• takes steps to ensure that they are familiar with the presenting signs of PAD and its management.