Health

Summary

Mrs C complained about the care and treatment given to her father (Mr A) on four occasions he attended A&E at Wishaw General Hospital. She further complained that the board failed to deal with her subsequent complaint in a reasonable and timely way. The board took the view that Mr A had been treated appropriately and that they had dealt quickly and reasonably with the complaint.

We took independent advice from a nurse and from a consultant in emergency medicine. Mr A first attended A&E on three occasions over the course of a month. We found that Mr A had largely been treated appropriately but that when he unexpectedly attended on the second occasion, his case should have been discussed with a consultant and he should have undergone a scan.

On his fourth attendance around a month later, we found that while there were delays in treating Mr A, these were unavoidable as the A&E department was at full capacity. However, we found shortcomings in his triage and that he was not reviewed by the intensive care team. We found this to have been unreasonable as Mr A's diagnosis was unclear and he was seriously deteriorating. Mr A died the day after this admission. We upheld these aspects of Mrs C's complaint.

Although Mrs C also complained about the way her complaint to the board was dealt with, we found that it had been considered in a timely and appropriate way. Staff also met with her family on four occasions. We therefore did not uphold this aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• make a formal apology for the shortcomings identified;
• ensure that staff are made aware of the findings of this investigation so that they may consider these further with a view to preventing similar occurences;
• make a formal apology referencing the identified failures in dealing with Mr A's care and treatment;
• advise us of the action taken and confirm that this would prevent a similar occurrence; and
• carry out an internal review of this case which should be presented and discussed at a morbidity and mortality meeting with peer review.

Summary

Mrs C, who works for an advice agency, complained on behalf of her client (Miss A), who said she was suffering from Jarisch Herxheimer's reaction (a physical reaction to the death of microorganisms within the body during antibiotic treatment). Mrs C said Miss A believed that she had not received the appropriate care and treatment from her medical practice. Miss A believed that she had not been prescribed antibiotics appropriately and that the practice had inappropriately interfered with her consultations with hospital specialists.

We took independent medical advice from a GP adviser. The adviser said, and we agreed, that Miss A had been treated appropriately. Jarisch Herxheimer's reaction was an unusual condition and would require diagnosis by a hospital specialist. Miss A had received the appropriate referrals, but the specialists in question had confirmed that Miss A did not have this condition. We found that there was no evidence that the practice had acted inappropriately or that they had attributed Miss A's problems to her mental health.

We found that the care and treatment provided was of a reasonable standard and we did not uphold the complaint.

Summary

Mrs C attended Raigmore Hospital with an injury to her ankle. She complained about the care and treatment provided, in particular that there was an unreasonable delay in providing her with orthopaedic treatment.

During our investigation we took independent advice from a consultant radiologist and a consultant trauma and orthopaedic surgeon.

The consultant radiologist considered that an abnormality on Mrs C's first x-ray was missed, and as a result there was a delay in being referred to an orthopaedic surgeon and in a diagnosis being made. In addition, the consultant radiologist considered that the abnormality was also missed on an x-ray taken 15 months later and that had this been noticed, Mrs C may have been referred for imaging earlier than she was.

We found that there were no long-term orthopaedic consequences for Mrs C's ankle as a result of the delays. However, we were concerned that the delays added to Mrs C's distress and that she had continued to suffer pain and discomfort when this could possibly have been avoided.

We considered that a delay between Mrs C being placed on the waiting list for an orthopaedic appointment and being advised four months later that she would not be offered an appointment within the target timescale was unreasonable.

We also found that the delay between Mrs C attending hospital for her injury and being seen in an orthopaedic clinic was unreasonable. However, we noted that action was being taken by the board to address the delays. We upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• apologise for the failure to report and act on the abnormality shown in
• x-rays of Mrs C's ankle and for the prolonged waiting time between being referred to orthopaedic services and receiving an orthopaedic appointment;
• consider the adviser's comments on the failure to observe the radiological abnormalities in this case and identify any action which could be taken to minimise the occurrence of such errors;
• ensure patients are advised in a timely manner that they may not be seen within waiting-time targets; and
• provide us with evidence that the action taken to reduce waiting times is having the desired effect.

Summary

Mr C was receiving his medication and an officer observing suspected that Mr C had attempted to conceal his medication. After consultation with the prison doctor, Mr C's medication was discontinued and he was offered an alternative medication.

Mr C complained about the decision to discontinue his medication. He said he had not attempted to conceal the medication and felt his recent dental surgery had affected his ability to take the medication appropriately. We found that the prison health centre had acted appropriately, in line with their protocol, and offered Mr C a reasonable alternative. We did not uphold Mr C's complaint.

Summary

Ms C, an advocacy and support worker, complained to the board on behalf of her client (Mrs A) who was admitted to Glasgow Royal Infirmary with a urinary tract infection and was prescribed an antibiotic to take at home. Mrs A was readmitted to hospital some months later with a kidney injury, as a result of sepsis and dehydration. On her initial admission to the hospital, Mrs A was already on medication for high blood pressure and she felt the antibiotic should not have been prescribed.

We took independent medical advice. We found that it was not unreasonable to have prescribed the antibiotic in view of Mrs A's previous medical history. We also found that clinical staff had given advice that Mrs A should seek a further clinical opinion should her symptoms worsen. We therefore did not uphold Ms C's complaint.

Summary

Mr C complained about a lack of treatment during an admission to the Royal Alexandra Hospital. He had been admitted following fracture of his hip and femur. Mr C said that he vomited throughout one night and now suffers from throat discomfort. He said that although staff changed his basin on occasions he now feels that the lack of treatment for his vomiting caused this.

We took independent medical advice. We found that nursing staff reported the vomiting. The adviser noted that Mr C was stable and that anti-sickness medication was prescribed and that an appropriate treatment plan was put in place. We therefore did not uphold Mr C's complaint.

Summary

Miss C complained that her medical practice unreasonably removed her from the practice patient list because of comments which had been made on her social media site. The practice said that they would not tolerate such comments and that there had been a breakdown in the doctor/patient relationship which meant that it was not possible for them to treat Miss C. They considered the tone of the comments to be both threatening and bereft of any respect for the practice.

We took independent advice from an adviser in general practice and concluded that the comments which were made could be reasonably interpreted as threatening to the practice and as such it was not unreasonable that Miss C was removed without a preceding warning. We found the practice had adhered to their contractual specifications in this regard and their actions were reasonable. We did not uphold Miss C's complaint.

Summary

Mr C asked the prison health centre to prescribe him a medicine used in the treatment of opiate addiction. The prison health centre refused and explained to Mr C that he did not meet the relevant criteria.

We took independent medical advice. We found that the decision to refuse to prescribe Mr C the medicine he requested was taken following a thorough clinical assessment and that the care and treatment given to him was reasonable. We therefore did not uphold Mr C's complaint.

Summary

Mr C complained that the prison health centre unreasonably reduced his medication for nerve pain. He said the decision had affected his wellbeing and he wanted to have the dose increased.

The information available confirmed Mr C was reviewed and assessed by a number of clinicians and they did not feel there was any clinical need to increase his medication. We took independent medical advice. The adviser found that the health centre's decision appeared to be reasonable and in line with appropriate guidance. We therefore did not uphold Mr C's complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mr A) that there had been an unreasonable delay in the GP practice referring Mr A for further assessment and advice when he attended with on-going abdominal pain and diarrhoea. Mr A had undergone a colonoscopy (an examination of the bowel with a camera on a flexible tube) in hospital several months earlier and had been diagnosed with diverticulosis (small pouches that stick out from the wall of the gut). He had then had a bowel screening test, which showed blood in his bowel motion and his health board had written to him to say that they would arrange another colonoscopy.

Mr A then attended the practice with abdominal pains and diarrhoea. He was prescribed medication and it was recorded that he was hoping to have a repeat colonoscopy from the board. He attended the practice again four weeks later and they sent a routine referral to the board asking for advice about whether he needed further investigation. Mr A was subsequently diagnosed with bowel cancer, which had spread to his liver and lungs.

We took independent advice from a GP. We found that the practice had provided a reasonable standard of care to Mr A when he attended with abdominal pains and diarrhoea. The on-going investigation by the board into Mr A's bowel problems fell outwith the practice's remit. It was also reasonable for the practice to send a routine referral to the board asking for advice. We did not uphold Ms C's complaint.