Health

Summary

Mrs C complained about the care and treatment given to her late husband (Mr A) by his medical practice. She said that despite his serious symptoms, the practice failed to ensure that appropriate tests were carried out. In particular, he was not referred for a scan. She maintained that he was misdiagnosed and not properly treated as a consequence.

We took independent medical advice which confirmed that the practice had provided a reasonable standard of care. We found that doctors in general practice were unable to request scans and that once a referral had been made to hospital (as happened in Mr A's case), his treatment was determined by clinicians there. We did not uphold Mrs C's complaint.

Summary

Mrs C complained about the care and treatment provided by the board to her husband (Mr A). In particular, she said that there was an unreasonable delay in diagnosing him with non-Hodgkin lymphoma (a cancer that develops in the lymphatic system) and that a procedure involving a drain to his lungs was not carried out to a reasonable standard.

We took independent advice from consultants in nephrology (the study of the kidney) and haematology (the study of the blood) and we found that on his admission to hospital, Mr A was seriously ill and suffering from numerous illnesses including heart and lung disease and diabetes. He was admitted to investigate anaemia (a deficiency of red cells in the blood) but on examination was found to have a liver dysfunction and an enlarged liver and spleen. Appropriate tests were made at Monklands Hospital and Mr A was treated for his presenting symptoms. However, his condition continued to worsen and a scan followed with various biopsies being undertaken. These confirmed that Mr A had lymphoma. While Mr A's diagnosis was delayed, this was not unreasonable as priority had been given to his presenting symptoms and existing illnesses. Tests were difficult because of these.

Mr A's treatment options were limited because of his many illnesses and his cancer did not respond to chemotherapy. His declining condition led to further complications including a collapsed lung and Mr A later died. We found that Mr A's symptoms had been treated reasonably and therefore we did not uphold Mrs C's complaint.

Summary

Mr C complained about the time taken to diagnose the cause of his ongoing pain following a bone marrow biopsy at Hairmyres Hospital. About 12 months after the biopsy, Mr C was referred to orthopaedics at a different hospital and it was found that the pain was likely caused by damage to his sacroiliac joint (a joint in the pelvis). Mr C queried why he was not referred to orthopaedics or given an MRI scan sooner, and why he was not warned about the risk of ongoing pain before the biopsy.

The board considered staff took appropriate action to investigate Mr C's pain. They explained that they do not routinely warn patients of the risk of persistent pain from bone marrow biopsies as this is extremely rare, but they proposed to update their patient information leaflet in light of Mr C's experience.

After taking independent haematology (study of the blood) and radiology advice, we did not uphold Mr C's complaints. We found staff had taken reasonable action following the biopsy to investigate the cause for Mr C's pain, including a scan and treatment for signs of infection. When the pain persisted, staff treated this appropriately with medication and a referral to the pain clinic. While we acknowledged that an earlier scan would have been helpful to diagnose the cause of Mr C's pain, given that Mr C was undergoing chemotherapy and radiotherapy during this time which could have contributed to the pain, we considered it was reasonable for staff to wait until Mr C's cancer treatment was finished before referring him for further investigations.

We also found that, while persistent pain has been recognised as a complication from bone marrow biopsy, this is extremely rare. In view of this, we did not consider it unreasonable that staff did not warn Mr C about this risk.

Summary

Mrs C sustained a broken hip following an accident at work and underwent hip replacement surgery at Wishaw General Hospital the next day. She complained that she had been left in pain and walking with a limp since her surgery. In particular, she raised concern over the surgeon's indication that her ongoing symptoms were due to the type of prosthetic joint that he was required to use, due to non-availability of his preferred joint type.

We took independent advice from a consultant orthopaedic surgeon who advised that the type of prosthetic joint used in Mrs C's surgery was in keeping with relevant guidelines and best practice. They reviewed Mrs C's post-operative x-rays and considered that her surgery was carried out appropriately. On balance, they did not consider that her surgery was the cause of her ongoing symptoms and they were of the view that the use of an alternative joint would not have given a better outcome. They considered that there were alternative causes that were more likely explanations for the type of symptoms Mrs C experienced, including referred pain from the lower spine and/or inflammation of the soft tissues overlying the hip. As we found no evidence to suggest that Mrs C's surgery was not carried out appropriately, we did not uphold this complaint.

Mrs C also complained that appropriate follow-up action was not taken to address her ongoing symptoms. However, the adviser considered that she was appropriately followed up, including a second orthopaedic opinion having been sought. In addition, they did not consider that there was an unreasonable delay in referring Mrs C for pain management. We therefore did not uphold this aspect of Mrs C's complaint.

Summary

Mr C complained to us about the care and treatment he had received from an opticians practice he attended with a problem in his left eye. He was examined by two optometrists at the practice. When he then phoned the practice again about the matter, they referred him to hospital, where a retinal detachment was diagnosed and surgery performed. Retinal detachment occurs when the thin lining at the back of the eye called the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients. Without prompt treatment, it will lead to blindness in the affected eye. Mr C said that the sight loss he suffered in his left eye would not have been as severe had the optometrists referred him to hospital earlier.

We took independent optometry advice. We were unable to say for certain whether the retinal detachment was present on the two occasions Mr C attended the opticians. However, we found that the initial examination carried out when he attended the opticians was reasonable and appropriate according to the relevant guidelines. This would have offered a reasonable chance to detect whether retinal detachment was present at that time. When Mr C attended the opticians on the second occasion, his pupils were not dilated and the full set of relevant tests was not carried out. However, we found that this was reasonable as there was no evidence of increasing symptoms.

We did not uphold Mr C's complaint, as there was no clear evidence that he should have been referred to hospital earlier. However, there was no evidence that he was given an information leaflet about retinal detachment in line with both local and national guidance and we made a recommendation to the opticians in relation to this.

Recommendations

We recommended that the opticians:

• take steps to ensure that in appropriate cases, patients are provided with a retinal detachment warning leaflet.

When it was originally published on 25 January 2017, this case referred to a pharmacy in the Lanarkshire NHS Board area. This was incorrect, and should have read a pharmacy in the Greater Glasgow and Clyde NHS Board area. This was due to an administrative error which we have now corrected, and we apologise for any inconvenience that this has caused.

Summary

Mrs C contacted a pharmacy by phone for an emergency supply of her prescribed medication. She told us the pharmacist refused her request a number of times and that she was treated rudely and asked unreasonable and irrelevant questions. Mrs C complained to us that the pharmacy had not responded reasonably to her complaint. We were satisfied that the pharmacy had investigated her complaint in a reasonable manner. Their response was made within a reasonable timescale and contained a reasonable level of detail. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained about the lack of a suitable response to the issues she raised during the complaints process. We upheld this complaint because the pharmacy did not signpost Mrs C to this office at the end of their complaints process. They also caused confusion in setting out Mrs C's options for escalating the complaint and continued to correspond with her after they said their complaint process was at an end.

Recommendations

We recommended that the pharmacy:

• review their complaints process demonstrating compliance with the requirements which apply to NHS complaints in Scotland, and which will ensure the correct escalation advice is given to complainants, and provide us with a copy of the written process and evidence of its circulation to relevant staff.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Mrs C said that staff had failed to diagnose that Ms A had suffered a fracture to her right tibia and broken bones in her right knee when she attended A&E at Raigmore Hospital. Ms A was given painkillers and discharged home. She continued to suffer pain and two weeks later an x-ray revealed the fracture and broken bones. Ms A felt the staff should have arranged an x-ray when she attended A&E.

The board said that Ms A was appropriately assessed by nursing and clinical staff who diagnosed a soft tissue injury and that an x-ray was not required.

We took independent medical advice from a consultant in emergency medicine and found that the staff had carried out an appropriate assessment based on the presenting symptoms and reached a reasonable diagnosis of soft tissue injury. There was no requirement to have arranged an x-ray at that time, although it was subsequently established that the fracture had occurred. We did not feel that the actions of the staff were unreasonable and therefore we did not uphold Mrs C's complaint.

Summary

Mrs C had attended a series of physiotherapy appointments at the Victoria Integrated Care Centre. However, her symptoms related to a degenerative disc disease in her spine were unresponsive and she was referred back to her GP for further management. She was provided with a home exercise programme and advised of the symptoms of cauda equina syndrome (a spine disorder affecting the nerves).

Mrs C's pain continued and her GP referred her to Queen Elizabeth University Hospital where she had an MRI scan. The scan showed that she had a bulging disc in her lower back which was pressing on the nerves of her leg. Before Mrs C could attend a further specialist consultation which had been arranged, her situation deteriorated. She attended A&E at the Royal Alexandra Hospital with symptoms of cauda equina syndrome and was admitted. The next day Mrs C underwent surgery.

Mrs C complained that the physiotherapist she attended failed to treat her appropriately and that she should have been referred for an MRI scan.

We investigated the complaint and took independent physiotherapy advice. We found that although Mrs C's symptoms were noted to be developing, she was reviewed and her treatment amended accordingly. However, her symptoms did not meet the criteria that would have required her to have an MRI scan and she was given appropriate advice and treatment and referred back to her GP. We therefore did not uphold Mrs C's complaint.

Summary

Miss C complained to us that the practice had failed to provide her with appropriate care and treatment when she developed problems following back surgery. In particular, she felt that her GP should have taken a urine sample as she was having difficulty urinating and that as she was suffering from pain and swelling at the surgery wound site, a referral should have been made to a specialist consultant. Miss C continued to be in pain for a number of days before contacting the out-of-hours service where she was admitted to hospital for further surgery.

The practice said that it was not appropriate to take a urine sample as the urinary symptoms which Miss C reported were consistent with a diagnosis of a urine infection and that appropriate antibiotics were prescribed. In regards to the wound site, it was felt that the problem was a build-up of fluid which would resolve naturally over time.

We took independent advice from a GP and concluded that there was no requirement for her GP to take a urine sample as the diagnosis of a urine infection was reasonable. However, we found that the GP should have referred Miss C for an urgent specialist orthopaedic opinion as she had developed an acute complication following the surgery. Miss C's symptoms of swelling and pain at the wound site had only been present for three days but it had been three weeks since Miss C's original back surgery. We therefore upheld this complaint.

Recommendations

We recommended that the practice:

• apologise to Miss C for not referring her for a specialist opinion for her spinal condition.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her clients (Mr and Ms B) about care their daughter (Miss A) received from her medical practice. They also complained about the response to their complaint.

Miss A attended her medical practice on three occasions over two months. On the third attendance she was seen by a locum doctor who urgently referred her to hospital where she was diagnosed with a brain tumour. Miss A died later that month.

We sought independent medical advice. The adviser's view was that no symptoms were recorded at Miss A's earlier appointments that would have indicated a serious neurological problem and that the treatment given was reasonable. The adviser said the only significant symptom appeared in the last consultation, where Miss A was appropriately referred to hospital. For these reasons, we did not uphold this complaint.

However, we did uphold Ms C's complaint about the practice's response to the complaint as there were unreasonable delays in responding and third-party information was included in the response when it should not have been.

Recommendations

We recommended that the practice:

• provide us with a copy of their complaints handling procedure demonstrating compliance with the Patient Rights Act and government guidance 'Can I Help You?';
• reassure us that they have a robust system for recording and storing complaints documentation; and
• ensure that the GP concerned undergoes relevant appraisal with regard to complaints handling.