Health

Summary

Mrs C complained that the practice failed to provide appropriate medical care to her husband (Mr A).

Mr A suffered from ischaemia (inadequate blood supply), which had previously resulted in the amputation of his right leg below the knee. He was admitted to hospital with ischaemia of his left foot and an ulcer. There was no surgical option available to address this issue and the plan was to delay amputation as long as possible. Mr A was being seen twice a week by district nurses following discharge from hospital.

Some months after discharge, the practice was contacted by the board's district nurse who had identified deterioration in Mr A's foot. A GP at the practice did not consider a visit was necessary at that time, and instead prescribed antibiotics for Mr A. On the fourth day after the visit, Mrs C further contacted the practice when she received no subsequent visit from the board's district nurses. A second GP from the practice attended Mr A at home. The GP did not examine the wound, but prescribed further antibiotics. Two days later, the practice was further contacted as a district nurse had attended and discovered a maggot infestation in Mr A's wound. A GP attended and Mr A was taken to hospital. Mr A subsequently received an above-knee amputation of his left leg.

Mrs C complained about the actions of the two GPs. She also complained about the practice's communication with the board. The practice acknowledged communication failings had occurred, and apologised to Mrs C.

After receiving independent advice from a GP, we upheld Mrs C's complaint. While we found the first GP acted appropriately in prescribing antibiotics, we found the second GP should have examined the wound given Mr A had previously received antibiotics and his symptoms were worsening. We also found that the practice's communication with the board fell below a reasonable standard.

Recommendations

We recommended that the practice:

• ensure the relevant GP is made aware of the findings of the investigation for reflection and learning;
• issue an apology for the identified failings in care.

Summary

Ms C complained about the care and treatment provided by her dentist. She said an extraction had been incompetently performed and she had not been given adequate treatment following the extraction. This had caused her needless pain and suffering.

It became apparent during the investigation that the General Dental Council (GDC) were conducting a fitness to practise investigation. On the basis that this would consider the care and treatment provided to Ms C and had wider reaching powers, the decision was taken to close the complaint. Ms C was informed she could make a further complaint if the GDC investigation did not address her concerns fully.

Summary

Miss C complained about care provided by her GP practice. She attended the practice a number of times over a period of six months with various symptoms which were ascribed to depression and treated as such.

When Miss C began displaying slurred speech, her GP urgently referred her to hospital where she was diagnosed with a brain tumour.

We sought independent advice from a medical adviser. Their view was that Miss C's symptoms were reasonably ascribed to other causes and it was not until the symptom of slurred speech occurred that it became clear there might be another cause for Miss C's condition. The adviser said the GP then took appropriate action by urgently referring Miss C. For this reason we did not uphold this complaint.

We did however uphold the complaint about post-operative care as the practice had acknowledged that their normal practice is to contact patients once they have been discharged from hospital and this did not happen in this case. The practice said they intended to carry out an Enhanced Significant Adverse Event (ESAE), and we made a recommendation in relation to this.

Recommendations

We recommended that the practice:

• apologise to Miss C for the failings they identified; and
• share with Miss C any learning from the ESAE.

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 has a diagnosed personality disorder and post-traumatic stress disorder (PTSD). He complained that the practice had refused to come to his home for a house call in relation to physical symptoms he was experiencing including a cough. When the practice initially declined the house call request, Mr C said that his PTSD had rendered him housebound. He later asked for a mental health referral. The practice advised that they needed to see him at a consultation at the surgery before this could be made and Mr C also complained about this decision. In addition, Mr C complained that his complaint to the practice had not been handled properly.

After taking independent advice from a GP, we did not uphold either of Mr C's complaints about his care. We found that Mr C had been seen recently at the practice and that it was reasonable to ask him to attend for an assessment of his physical symptoms. The GP adviser also considered that it was reasonable to require a face-to-face consultation before making a mental health referral. We also took independent advice from a mental health adviser. The mental health adviser said that the practice's approach was reasonable but highlighted the fluctuating symptoms of PTSD and considered that their approach may need to change in future. These comments were drawn to the practice's attention.

However, we found no evidence that Mr C had been provided with information about the Patient Advice and Support Service and the final response to Mr C's complaint did not include information on how to progress his concerns if he remained dissatisfied. We upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the practice:

• review their complaints handling procedure to ensure that it reflects the requirements of the Scottish Government's 'Can I help you?' guidance.

Summary

Mr C complained that following surgery for a hernia repair at Stracathro Hospital, he suffered severe and continuing pain. Mr C complained to the board about the surgery and the reasons for his continuing pain, which he said had an adverse effect on his daily life. Mr C was dissatisfied with the response he received from the board.

We took independent advice from a consultant surgeon experienced in performing hernia repairs and related complications. They advised that the treatment Mr C received was appropriate. The adviser did not identify failings in either the surgical procedure or in Mr C's post-operative care. The adviser said that Mr C was one of the small percentage of patients who develop pain following this procedure. The steps taken by the board to address Mr C's ongoing pain had been appropriate and reasonable. We accepted this advice and did not uphold Mr C's complaint.

Mr C also complained that the board had failed to respond appropriately to his complaint. The board had accepted they had not dealt with Mr C's complaint in a timely and reasonable manner and that the delay in responding to the complaint was unacceptable. The board had apologised and mentioned action taken to improve their complaints handling.

It was clear to us that the board had failed to deal with Mr C's complaint in a timely manner and in accordance with their complaints procedure. We also considered in particular that their communication with Mr C about the reasons for the delay was poor. We therefore upheld this complaint.

Recommendations

We recommended that the board:

• issue Mr C with a formal apology for their failure to handle his complaint in a timely manner and in their communication with him; and
• provide evidence of the action taken to review and improve their complaints handling.

Summary

Mrs C complained about the practice's failure to make reasonable adjustments to her medication regime regarding repeat prescriptions required following her consultation with a consultant ophthalmologist. Mrs C felt that there had been delays in the provision of eye drops and ointments.

We took independent advice from a GP adviser who said that the practice had provided details of their repeat prescription policy which was reasonable. They said the practice had acted reasonably in regard to the issue of ophthalmic prescriptions, and where they were unable to provide a prescription when requested this was due to either there being a need to clarify the prescription or due to medication supply issues. We did not uphold the complaint.

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 for a review appointment, where she complained of tenderness above an incisor tooth when she pressed on the gum. No treatment was provided by the dentist and Mrs C was advised to book a further review appointment at a later date.

We took independent advice from a dental adviser who said Mrs C's symptoms were suggestive of an infection. The adviser said the dentist should have carried out some form of investigation, as a minimum an x-ray, in order to determine the cause and confirm a diagnosis. There was no evidence that they did so.

The adviser said that remedial treatment may then have been appropriate or arranging a further review appointment if it was considered that the problem would resolve without further treatment. The adviser considered that the dentist had not provided Mrs C with appropriate treatment. We accepted that advice and upheld Mrs C's complaint.

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:

• issue Mrs C with an apology for failing to undertake treatment when they saw her;
• reflect on the comments of the adviser in relation to ensuring that they can confirm any clinical findings with an accurate diagnosis before providing advice to a patient; 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

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.