Health

Summary

Ms C complained that a member of staff at her GP practice had divulged confidential medical information about her to a mutual acquaintance and the practice did not thoroughly and appropriately investigate her complaint to them about this.

Our investigation found that the practice had taken reasonable and appropriate action to investigate the matter, including taking statements from Ms C's friend (who had overheard a conversation between the staff member and the mutual acquaintance), the mutual acquaintance and the staff member. Despite this, it was not possible to determine exactly what had been said. In these circumstances, we were unable to uphold the complaint.

Summary

Mrs C was removed from the treatment list of her GP practice following a difficult visit to the practice. Her husband (Mr C) complained about this and Mr and Mrs C were invited to a meeting to discuss the investigation. At the meeting they felt that no investigation had been undertaken and subsequently complained to us. The reasons the practice gave us for removing Mrs C from their treatment list did not meet the relevant criteria in legislation, policy or guidance for the immediate removal of a patient from a treatment list and we could see no other evidence that immediate removal was warranted. We saw no evidence that Mr C's complaints were dealt with in line with the NHS Scotland complaints procedure. As a result, we upheld both complaints.

Recommendations

We recommended that the practice:

• apologise to Mrs C for unreasonably removing her from their treatment list;
• review their policy for removal of patients to ensure it reflects the relevant regulations and General Medical Council guidance;
• ensure all staff are aware of the revised policy and are trained in managing difficult and challenging behaviour and in particular de-escalation techniques;
• apologise to Mrs and Mr C for not responding to the letter of complaint in line with the NHS Scotland complaints procedure; and
• ensure that staff with responsibility for responding to complaints are aware of the detail of the NHS Scotland complaints policy and related guidance.

Summary

Mrs C complained that the practice failed to take her late husband (Mr C)'s symptoms seriously between January and March 2014, in particular his weight loss. She also said that they were given inaccurate information about the length of time Mr C would be admitted to a hospice.

We took independent advice from a general practitioner and we found that Mr C had a history of back pain and diabetes, and in 2013 had been given advice about his diet. He lost weight as a consequence and, when he went to the GP a few months later suffering from leg pain, it was noted that he was still losing weight but this was considered to be because of his healthier diet. Nevertheless, Mr C's pain was investigated: blood tests were taken, he was referred for physiotherapy and an MRI (magnetic resonance imaging) scan of his back was carried out. Mr C's blood tests showed an abnormality, and he was, therefore, referred to hospital where he was later diagnosed with cancer. Mr C's pain was very difficult to control and he was admitted to a hospice on two occasions. On the second occasion, Mrs C felt that she had been misled as it was indicated his stay would only be short. However, because of the complexity of his needs, it took a considerable time to provide a solution to his pain.

We acknowledged that Mrs C had coped with a very stressful situation but we did not uphold her complaint. However, as we found that Mr C's referral to hospital should have been an urgent one (because of the presence of weight loss), we made a recommendation for the practice to familiarise themselves with appropriate guidance.

Recommendations

We recommended that the practice:

• ensure that GPs in the practice familiarise themselves with the appropriate guidance and discuss this as a learning point.

Summary

Mrs C complained about the care and treatment given to her late husband (Mr A) at Ninewells Hospital where he was a patient from March to September 2014, when he died. She said that there was a delay in making his diagnosis and that information was given to him in an uncaring and uncompassionate way. She also complained that there was often confusion about her husband's medication and that his pain was not properly managed.

We took independent advice from consultants in oncology and radiology and also from a senior nurse practitioner. We found that while Mr A's care and treatment had been appropriate and reasonable, his pain had been very difficult to control (due to his complex condition) and communication had not been as good as it could have been. He was given upsetting information at a time when support was not available to him, and was given his diagnosis over the phone. There was also confusion about his medication and treatment. In particular, there was confusion about Metformin (a drug Mr A was taking for diabetes) and whether he needed to stop taking it before his imaging test. When Mrs C later complained about these circumstances, the board delayed in providing her with a response. In view of this, we upheld Mrs C's complaint.

Recommendations

We recommended that the board:

• send an appropriate letter of apology;
• ensure that the clinicians involved in this case are made aware of our findings, and that they are considered as part of the clinicians' next formal appraisal;
• review their policy on withholding Metformin;
• ensure that all patients receive suitable information prior to undergoing scans;
• provide a formal apology for the delay in responding to the complaint; and
• remind staff of the importance of replying to complaints in a timely manner.

Summary

Mr C saw a podiatrist because of the deteriorating condition of his foot due to an ulcer. He then had several admissions to Ninewells Hospital as well as being seen as an out-patient. He underwent an artery bypass (a procedure to improve blood flow) from just below the knee to the foot with amputation of several toes and a skin graft. The bypass and the skin graft failed and Mr C may need further surgery in the future.

We took independent advice from a podiatrist and a vascular surgeon. In relation to the podiatry treatment provided, we found that there were clear indications that Mr C had progressive foot disease when he saw the podiatrist on three occasions which the podiatrist failed to act on including referring Mr C to secondary care within a reasonable time. Clinical notes of Mr C's assessments were also inadequate. We found that the relevant guidelines (Scottish Intercollegiate Guidelines Network, SIGN) were not followed. We upheld this aspect of Mr C's complaint. With regard to the surgical care that Mr C received during his two admissions to hospital, we found that on the whole the board provided a reasonable standard of care and treatment but that there was an unreasonable delay in treating the foot initially when clinicians became aware that it was infected. We upheld this aspect of Mr C's complaint. In relation to Mr C's out-patient appointments following discharge from hospital, we were satisfied that there was evidence showing that assessment for each out-patient appointment was reasonable as was communication in relation to the management plan. We did not uphold this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• review the podiatry service to ensure complex foot problems are appropriately managed in the community in line with relevant SIGN guidelines including access to multi-disciplinary teams;
• bring our decision including the medical advisers' comments to the attention of the podiatrist and ensure it is reflected upon and addressed at their annual appraisal;
• address the shortcomings in record-keeping with the podiatrist;
• bring our decision including the medical advisers' comments to the attention of the relevant vascular healthcare professionals and ensure it is reflected upon and addressed at their annual appraisal; and
• apologise for the failings identified.

Summary

Mrs C was referred to Perth Royal Infirmary due to a missing intrauterine system (IUS - a contraceptive device). A scan showed the IUS could be in her abdomen, but she was then found to be pregnant, so no x-ray could be done to confirm the exact location. The pregnancy was not viable and a medical miscarriage was performed. Mrs C was discharged after this without an x-ray to locate the missing IUS. Her GP arranged an x-ray, which showed the IUS was in her abdomen, and she was referred to gynaecology for surgery to locate and remove it. Mrs C raised concerns about the failure to x-ray her after the medical miscarriage, and about her surgery (which was more complex than expected). Mrs C said she was told an x-ray would be taken before the surgery to confirm the exact location of the IUS, and she queried why this did not happen. Mrs C also complained about delays in her gynaecology appointment and in the board's response to her complaint.

The board agreed Mrs C should have been x-rayed after her medical miscarriage and they apologised for this. They said the delay in gynaecology appointments was due to increased demand, and they were taking action to improve this. However, they considered the surgery was carried out appropriately.

After taking independent medical advice, we upheld Mrs C's complaints. We agreed the board should have x-rayed Mrs C earlier, and we found unreasonable delays in arranging the gynaecology appointment. However, we found that the surgery was carried out reasonably. The adviser explained that x-rays are not normally used to confirm the location of an IUS before surgery, as an x-ray cannot show the exact location (in three dimensions) and the position of the IUS can also change during the surgery as the patient is moved. We found the delay in responding to Mrs C's complaint was unreasonable, as the bulk of the delay (over five weeks) was caused by a delay in the draft response being signed off, rather than the investigation itself.

Recommendations

We recommended that the board:

• demonstrate to us the steps being taken to ensure the national standards for waiting times for gynaecology can be met;
• apologise to Mrs C for the failings we found; and
• review their processes for clearing draft complaint letters, to ensure this does not cause undue delay.

Summary

Mrs C raised a number of issues about the care and treatment her late husband (Mr C) received during admissions to Ninewells Hospital and Royal Victoria Hospital.

During our investigation, we took independent advice from a consultant geriatrician and a nursing adviser. We found no evidence that the clinical and nursing care was unreasonable. In particular, the consultant geriatrician noted that Mr C had been suffering from several conditions and had required significant medication to try and control his symptoms, and we found that there had been a number of discussions with Mrs C about her husband's condition. The consultant geriatrician was satisfied that the medication given to Mr C was always appropriately considered, prescribed and administered. While some of the medication caused side effects, the consultant geriatrician was satisfied that the board tried to avoid this medication as much as possible and that the side effects were unavoidable.

The nursing adviser was satisfied that Mr C had been regularly assessed and care was planned for his mobility problems. We were satisfied that the care planning and assessment charts and nursing notes confirmed that Mr C's needs were fully assessed and managed. We did not uphold Mrs C's complaints.

Summary

Mr C complained about the care and treatment provided by a physiotherapist during his recovery from surgery performed on his hand. Mr C complained that the physiotherapist provided inadequate exercise advice at an appointment, in particular by encouraging him to perform intensive exercise on the hand, which led his wound to open. Mr C considered this advice led to ongoing pain in his hand and its reduced function.

The board said there was no evidence that advice had been given to perform intensive exercise. The board said advice was provided to perform gentle exercise, which was appropriate, and there was no link between the physiotherapy care and treatment provided and the subsequent problems Mr C experienced in his hand.

After receiving independent advice from a consultant physiotherapist, we did not uphold Mr C's complaint. We found there was no evidence that the board provided inappropriate advice, rather the records indicated the physiotherapy advice was reasonable given Mr C's circumstances.

Summary

Mr C complained to us that the medical practice failed to provide him with appropriate clinical treatment when he turned up for a consultation and was in need of medical attention. He was also told that he had been removed from the practice list of patients and he complained that they did not provide an explanation for this.

The practice explained that when Mr C attended the practice there was no indication that he required medical treatment and that he did not mention this to the staff who saw him. They also explained that the reasons he had been removed from the practice patient list were that he had previously intimated he was leaving the country and they had received a medication enquiry from another medical practice outwith Scotland. Further, they explained that contact was made to Mr C's registered address and staff were informed he was no longer resident there, and that he had failed to attend a pre-arranged consultation.

We took independent advice from an adviser in general practice medicine and concluded that if there was no indication that a patient required immediate medical attention then there was no requirement for a GP to see a patient immediately. In addition, as the practice had confirmed that Mr C was no longer at the address stated then it would be reasonable for them to remove him from the practice patient list. The clinical records substantiated the explanations provide by the practice. We did not uphold the complaints.

Summary

Mr C complained that his prison's medical health centre unreasonably stopped his medication. However, before we could reach a decision on his complaint, he was released from prison and gave us no forwarding address. We therefore closed his complaint without making a decision.