Upheld, recommendations

Summary

Mrs C complained to us that the practice had failed to appropriately monitor her for any side effects of taking nitrofurantoin medication (antibiotic to treat urinary tract infections) for a number of years. She subsequently went on to develop pulmonary fibrosis (lung disease) and liver disease and she felt that these conditions were a direct result of the practice's failure to monitor her medication.

We took independent advice from a GP adviser and concluded that the practice had failed to appropriately monitor Mrs C's liver function and respiratory status over a number of years. The British National Formulary, which is the gold standard reference and guidance regarding medicines, has over the years highlighted advice and more recently issued safety alerts that patients on long term nitrofurantoin medication should be regularly monitored for liver function and respiratory function, although it does not state the frequency. In addition, Mrs C was exhibiting symptoms which are recognised complications of nitrofurantoin medication. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the failure to monitor her medication.The apology should comply with the SPSO guidelines on making an apology, available at: www.spso.org.uk/leaflets-and-guidance.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Miss C complained on behalf of her mother (Mrs B) about the care and treatment provided to her late father (Mr A) following his admission to Victoria Hospital with a painful hip. Mr A, who had prostate cancer, underwent a hip replacement. The oncology (cancer) consultant who had been caring for Mr A went on leave for a number of weeks. During this period a scan found that Mr A's cancer had spread and he was later admitted to a hospice where he died a short time later. Miss C complained about the care and treatment Mr A received following his admission to hospital. In particular, that Mr A had not been informed that his cancer had spread significantly and that his life expectancy was much shorter than he had previously thought.

We took independent advice from an oncology consultant. We found that, during the period Mr A's oncology consultant was on leave, there was no record of him being informed that his cancer had progressed significantly and that his life expectancy was reduced. We also found that the delay in referring Mr A to the oncology team and informing him of the progression of his cancer appeared to have been caused by a lack of senior oncology cover when Mr A's oncology consultant was on leave. However, we noted that had the oncology medical team been contacted earlier it would not have changed Mr A's management as there had been no further treatment available to him. We also found that, in terms of palliative care, there had been no impact on his management as he had continued with his medication. We upheld Miss C's complaint. Whilst we noted that the board had already accepted that there had been a delay in informing Mr A of his cancer progression and had apologised for this failing, we made a further recommendation.

Recommendations

What we said should change to put things right in future:

• If a consultant goes on leave there should be adequate supportive cover.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD - a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness) by a private specialist, and she reported a very positive response to the medication prescribed. She had previously been seen by a consultant psychiatrist at Queen Margaret Hospital, who noted longstanding symptoms of anxiety.

Mrs C saw the psychiatrist again following receipt of the private opinion but the psychiatrist did not agree with the ADHD diagnosis and was not willing to support the recommended medication prescription. As Mrs C's GP practice would not agree to prescribing this medication without the support of her NHS psychiatrist, she was required to pay for it privately.

The board offered Mrs C a second opinion from another consultant psychiatrist, who confirmed her ADHD diagnosis and supported the prescribing of the recommended medication. Mrs C complained that the initial psychiatrist unreasonably failed to diagnose her ADHD and did not follow relevant ADHD protocols.

We took independent medical advice from a consultant psychiatrist, who considered that it was reasonable for the first psychiatrist not to have followed specific ADHD diagnostic protocols at Mrs C's initial out-patient appointment. We found that the psychiatrist's management plan following this consultation was appropriate and that it allowed for review of Mrs C's diagnosis, and specific diagnostic protocols to be considered, at future appointments.

However, the board were unable to provide any written record of Mrs C's follow-up consultation with the psychiatrist. We found that the psychiatrist appeared to only have phoned Mrs C's GP to recommend referral for a second opinion. They did not document the call and no clinic letter was produced. Therefore, we considered that there was an absence of adequate medical documentation to support the psychiatrist's diagnosis and, in particular, their rationale for disagreeing with the medical opinion of the private specialist. We upheld Mrs C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mrs C for the psychiatrist's failure to appropriately document details of their consultation with her, including their rationale for disagreeing with a specialist opinion.The apology should meet the standards set out in the SPSO guidelines on apology available at: https://www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• Clinicians should ensure that they adhere to General Medical Council Good Medical Practice guidelines on record keeping and, in particular, they should clearly document their clinical rationale where there is a difference of opinion.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C transferred to the practice from another practice and, on first attendance at the new practice, was prescribed Sertraline (an anti-depressant medication used to treat anxiety). However, he suffered side effects as a result of this prescription. He was of the opinion that this would have been immediately obvious to the doctor he saw, had they checked with his previous GP, as Mr C had previously been prescribed this medication and had suffered side effects. He was also unhappy with the manner and tone adopted by the doctor. He complained about these matters to the practice and was further concerned by the tone and content of the response he received, which he considered to be confrontational and unprofessional.

Mr C brought his complaints to us. He complained that the practice unreasonably failed to consider his medical history before prescribing Sertraline and that the prescription of Sertraline was inappropriate due to the potential side effects. We took independent advice from a GP. We found that, in order to justify immediately prescribing Sertraline, rather than first trying therapies that did not require medication, the doctor should have documented a pressing clinical need or sought further evidence from Mr C's previous practice to ensure that this was appropriate. However, we found no evidence that this took place. Therefore, we upheld these two aspects of Mr C's complaint.

We also considered that the tone and content of both the clinical records and the practice's complaints responses, both to Mr C and to us, was inappropriate. We upheld this aspect of Mr C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for failing to sufficiently evidence the decision to prescribe him Sertraline and for failing to communicate appropriately with him. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• Records should fully evidence any clinical decisions.
• Records and communication should be factual, neutral, and professional in tone and content.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C raised a complaint about the care and treatment he had received from his dentist when he had two teeth removed and two new teeth added to his existing denture. Mr C later found his denture to be too loose fitting and returned to his dentist. Mr C had clips fitted to make his denture more secure, however, he still felt that it was too loose and was advised by his dentist that a new denture was the only other option. Mr C was unhappy with his treatment and brought his complaint to us.

We took independent advice from a dentist. We found that the dental treatment Mr C received was reasonable and in accordance with usual practice. However, we found issues with patient communication and record-keeping. Mr C was not given a full explanation of his treatment at the outset or advised of the all the possible options and outcomes. We also found that dental records did not mention the advice that the dentist had given to Mr C. On balance, we found Mr C's treatment to be unreasonable and upheld his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for not outlining all his options to him at the start of treatment. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.
• Refund Mr C the money he paid for the clips to be fitted.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mrs C complained on behalf of her husband (Mr A) about the care and treatment he received at Dumfries and Galloway Royal Infirmary. Mr A became unwell and was admitted to hospital. A heart scan identified that he had a gathering of fluid around his heart. Staff inserted a chest drain (a tube to remove fluid) but the next day staff discovered that the drain had become blocked. They made multiple unsuccessful attempts to insert another chest drain which resulted in significant bleeding. A decision was made to transfer Mr A to a hospital out with the board, which took place late in the evening.

Mrs C complained that the board failed to provide Mr A with appropriate medical care and treatment. She raised particular concerns about the actions of the staff in inserting chest drains and about the time taken to transfer Mr A to the other hospital. Mrs C also complained that the board failed to communicate appropriately regarding Mr A's condition.

We took independent advice from a consultant cardiologist. We found that bleeding is a recognised complication of the chest drain procedure and that it appeared reasonable. However, we found that records showed evidence of poor communication between staff and concerns about skills in relation to some members of staff. Regarding the transfer of hospitals, we found that the time taken to transfer Mr A to the hospital outside the board was unreasonable. We also found that the discharge arrangements were inadequate, given the complicated nature of Mr A's admission. Therefore, we upheld this aspect of Mrs C's complaint.

In relation to communication with Mrs C, we found that there was evidence of poor and limited communication with both her and Mr A, particularly surrounding the procedure to insert the chest drain and the transfer of hospitals. We upheld this aspect of Mrs C's complaint. However, we noted that the board had taken action to address a number of these problems.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr A and his family for the failings in care, discharge arrangements and communication. The apology should meet the standards set out in the SPSO guidelines on apology available at: https://www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• In similar cases, consideration should be given to ensuring appropriate out-patient follow-up on discharge.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained on behalf of his partner (Ms A) about the care and treatment Ms A received following an operation to her knee at Borders General Hospital. Ms A had been admitted for a planned day surgery but was kept in overnight for observation. In particular, Mr C complained that the board had failed to exercise proper care and attention to Ms A immediately after her operation, as no doctor or consultant saw her prior to discharge despite Ms A having been admitted overnight. He was also concerned that Ms A was advised to fully weight-bear following the operation.

We took independent advice from a consultant orthopaedic surgeon and a nursing adviser. The consultant orthopaedic surgeon indicated that, while there are a number of published protocols recommending non weight-bearing initially, the surgeon performing the operation was best placed to judge this, and that in this case the surgeon's recommendation to weight-bear was reasonable.

We were concerned about the lack of communication with Ms A during her overnight stay in the hospital, which the board had accepted and had apologised for. The advice we received from the consultant orthopaedic surgeon was that the delay in communicating Ms A's surgery details would not have an adverse impact of her prognosis. However, we considered that it would have been in line with established practice for Ms A to have been seen on a post-operative ward round during her hospital stay.

We also found that a hand-written operation note was inadequate in that it lacked detail, but we noted that Ms A had been managed in line with the post-operative instructions contained in the hand written note. Both the consultant orthopaedic surgeon and the nursing adviser were of the view that the overall the care and treatment Ms A had received had been reasonable. However, given our concerns about the lack of a post-operative ward round, the lack of detail in the hand written operation note and the lack of communication with Ms A, we upheld Mr C's complaint.

Recommendations

What we said should change to put things right in future:

• A post-operative ward round should be part of routine surgical care.
• Post-operation instructions should contain adequate detail to allow the transfer of information.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C complained to us that the practice had failed to provide appropriate care and treatment to her late mother (Mrs A). She said that her mother had attended the practice on a number of occasions and was given a diagnosis of a chest infection, whereas she was in the final stages of lung cancer. Ms C was concerned that the practice had concentrated on a chest infection being the cause of her mother's symptoms. In addition, a chest x-ray which was taken showed signs of a cavity in her lung which was not followed up or mentioned to Mrs A or her family.

We took independent advice from a GP adviser and concluded that there were some failings in the level of care provided. During the initial consultations it was appropriate for the GP to arrive at a potential diagnosis of a chest infection and we found that appropriate investigations including an x-ray and blood tests were performed. However, we considered that once the chest x-ray result had been received which showed a cavity on the lung, then further action should have been taken. This would either have been to repeat the chest x-ray within a defined time frame with a view to onward referral to a chest specialist, or to make a direct referral at that time to a chest specialist. Further action should also have been taken as Mrs A's blood results revealed that she was anaemic. We also concluded that, although the final outcome would not have altered, the diagnosis would have been reached sooner and this would have allowed Mrs A and her family to make decisions regarding future care and support which would be required. We upheld the complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for the failure to follow upon the blood results and x-ray result.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Ms C failed her exams and was advised by the university that she could not resit them. Ms C appealed this decision and went through three stages of the appeal process. Ms C complained that the university failed to deal with all stages of the appeals process within a reasonable period of time.

We found that in relation to the second stage of her appeal, which was to the senate office, Ms C had to prompt the university to advise her that there was a delay. The university did not tell her the reason for the delay, and the decision was not issued within the timescale set out in the university's code of procedure for appeals to the senate office. Therefore, we upheld Ms C's complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Ms C for failing to deal with the appeals process within a reasonable period of time. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

What we said should change to put things right in future:

• Where an appeal is being considered, the university should ensure that the applicant is advised of any delay and the reason for that delay.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.

Summary

Mr C complained that the council had unreasonably refused to progress his complaint about social work matters to a complaints review committee (CRC). The council said that a CRC was not the appropriate route for the issues raised by Mr C and did not fall within the remit of the committee. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a social worker. We found that Mr C's complaint was eligible to be progressed to a CRC and, therefore, we upheld his complaint.

Recommendations

What we asked the organisation to do in this case:

• Apologise to Mr C for not holding a CRC. The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance.

In relation to complaints handling, we recommended:

• The council should now progress Mr C's complaint to a CRC.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.