Health

Summary

Mrs C complained that the practice cancelled an important appointment with the practice nurse without giving her notice. Mrs C moved to a different practice, and she complained there was delay in sending her medical records to the new practice.

We found that the practice could have told Mrs C sooner that the appointment had been cancelled, and there was no record that they had tried to contact her before she arrived for the appointment. We also found that the practice should have tried to re-arrange the appointment for Mrs C, or arrange an alternative appointment nearby. In addition, we found that there was an unexplained delay of several weeks in the practice sending Mrs C's medical records to her new practice. We upheld Mrs C's complaints.

Shortly after Mrs C complained to the practice, it changed management from GPs to the local health board, as the GPs had left the area. Given these specific circumstances, we did not make recommendations to the health board, as they were not responsible for running the practice at the time of the events complained about. However, we asked the board to confirm whether any relevant staff currently working at the practice were there at the time of the events complained about and, if so, to share our findings with them so they could learn lessons from what happened, to try to ensure that similar problems do not arise again.

Summary

Mr and Mrs C complained to us that the board had failed to inform Mrs C of a diagnosis of diverticulitis (a common disease of the digestive system) that was reached when she had a colonoscopy (examination of the bowel with a camera on a flexible tube) under the Scottish bowel screening programme. Mrs C had undergone the colonoscopy following the detection of blood in samples she submitted under the bowel screening programme. During the colonoscopy, a minor non-cancerous growth had been removed and it was assumed that this had been the cause of the blood. The unit who carried out the colonoscopy wrote to Mrs C's GP practice to inform them of this. However, in the cover letter sent to the GP practice, they did not refer to a diagnosis of diverticulitis that had also been made during the colonoscopy. They also failed to inform Mrs C that she had also been diagnosed with diverticulitis at that time.

We took independent advice on Mrs C's complaint from a medical adviser who is a GP and from another medical adviser who is a consultant physician. Mrs C clearly should have been informed of the diagnosis of diverticulitis and we found that the unit who had carried out the colonoscopy should have made her aware of this. We considered that this problem originated from the lack of clarity in the board's procedures in relation to the Scottish bowel screening programme regarding sharing information with patients. We upheld the complaint, although we found that the board had already apologised to Mrs C for this.

Mr and Mrs C also complained that the board had failed to provide Mrs C with treatment for diverticulitis within a reasonable timescale. We found that it was unlikely that she required any treatment for this, although she should have been told to increase the fibre in her diet. We did not uphold this aspect of the complaint.

Recommendations

We recommended that the board:

• consider adding further guidance about sharing information with the patient when they review their procedures in relation to the Scottish bowel screening programme.

Summary

Mr C complained to us about how the board had handled his enquiries about NHS continuing health care. His mother had been assessed as needing continuing care, but was in hospital in another health board's area. Mr C had written to the board to ask for further information about this. The board did not respond and he had to contact them again. Despite this, he still did not receive a response and in view of this, we upheld this aspect of Mr C's complaint.

Mr C also complained that the board had failed to handle his complaint about this matter in accordance with their complaints procedure. We found that the board had adequately responded to the points Mr C had raised in his complaint. We also found that it had been reasonable for the board to contact his mother's power of attorney to obtain consent to share the details of the investigation with him. However, we found that there had been a delay in responding to Mr C's complaint and we also upheld this aspect of his complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the delay in responding to his complaint; and
• make relevant staff aware of our findings on his complaints.

Summary

Mr C complained about the medical and nursing care and treatment he received in Raigmore, Broadford and Ross Memorial hospitals between June and December 2012. Mr C had a complex medical history and began to experience chronic back pain at the end of June 2012. This proved to be a lumbar disc infection and he was treated conservatively. Mr C complained about various aspects of his care and treatment during his various admissions to the hospitals including the frequency and standard of consultant review, treatment decisions, diagnosis, pain management, communication and the decisions to discharge him home or to other hospitals.

We took independent advice from a nursing adviser and two medical advisers, one in emergency medicine and the other in orthopaedics (conditions involving the musculoskeletal system). We found that the standard of medical care and treatment provided by Raigmore Hospital was reasonable and that the nursing treatment was also reasonable with the exception of the use of a commode for showering purposes. We made a recommendation to address this.

We also found that the standard of medical and nursing care and treatment provided by Broadford Hospital was reasonable. However, in relation to the standard of medical care and treatment at Ross Memorial Hospital, while we found no failings in relation to nursing care, we found that there was a missed opportunity to potentially manage Mr C's pain more effectively and that a planned discharge home was unreasonable. We made a number of recommendations to address these failings.

Recommendations

We recommended that the board:

• bring the shortcoming in nursing care to the attention of relevant staff;
• bring the failings to the attention of relevant staff;
• clarify referral procedures to the chronic pain team and ensure staff are aware of the procedure; and
• apologise for the failures we identified.

Summary

Mr C complained about how his new dentist communicated with him after taking over his care. He was also concerned that the dentist had failed to provide appropriate dental treatment to him over a number of appointments. The new dentist took over Mr C's care after his dental practice was sold to a new owner. Mr C advised he had not been told about the changes and felt uncomfortable.

After taking independent advice on this case from a dental adviser, we upheld Mr C's complaint regarding communication. The adviser explained that in order to obtain valid consent, patients must be given all options including the risks and benefits of each. We found that there was insufficient evidence that this had been done, particularly with regard to the option of extracting the tooth in question. The adviser also considered that there was a lack of evidence that the changes to staff providing Mr C's care had been properly explained to him, particularly after his treatment became problematic and required referral to a more experienced dentist at the practice. We made two recommendations to address the issues highlighted during the investigation. The adviser found no issues with the actual treatment that had been provided to Mr C by the dentist and so we did not uphold this element of his complaint.

Recommendations

We recommended that the dentist:

• review the process followed for obtaining patient consent and ensure this is in line with the General Dental Council Standards; and
• issue an apology for the standard of communication with Mr C.

Summary

Mr C complained about treatment that was proposed at an appointment with the dentist. He was also concerned that there was a failure to properly communicate with him about his ongoing treatment. Mr C was advised by the dentist that his tooth was in poor condition and might require further treatment at another appointment, referral to a specialist or extraction. Mr C was unhappy with the information provided by the dentist and did not proceed with any treatment.

After taking independent advice on this case from a dental adviser, we did not uphold either of Mr C's complaints. The adviser considered that the dentist's assessment of the tooth in question was reasonable and highlighted no concerns about communication with Mr C regarding his treatment.

Summary

Mr C complained about the treatment he received from his dentist at an examination. He was also concerned that the dentist had not advised him that the practice was about to be sold and that a different dentist would be continuing his treatment at a subsequent appointment.

After taking independent advice on this case from a dental adviser, we did not uphold Mr C's complaint about treatment. The adviser considered that the examination was appropriate and that while further investigations could potentially have been carried out at the same time, overall, the care and treatment provided at the appointment in question was reasonable. We did, however, uphold Mr C's complaint regarding communication about the change of dentist. We found a lack of evidence that Mr C had been advised of the changes at the practice and received advice that General Dental Council Standards state that patients should be told who will be involved in their care.

Summary

Mr C complained about his dentist's charging policy. However, the complaint was resolved when the dental practice offered to change it. There were therefore no grounds for investigation and we closed the case.

Summary

Mrs C complained to us that her daughter (Ms A) had attended the board's out-of-hours GP service with symptoms of a numb tongue, swollen face and a burning sensation down the left side. Mrs C said that the GP who saw her daughter failed to carry out an appropriate examination, dismissed Ms A's concerns and told her to contact her own GP if the symptoms persisted. The following day, Ms A attended hospital and was diagnosed with Bell's palsy (a condition that causes temporary weakness or paralysis of the muscles in one side of the face). Mrs C was dissatisfied with the out-of-hours GP's actions.

We took independent advice from an adviser in general practice medicine and concluded that the out-of-hours GP had carried out an appropriate assessment based on the presenting symptoms and taking note of Ms A's previous medical history. At the time of the examination, there were no signs which indicated the presence of Bell's palsy. Bell's palsy commonly develops suddenly and as such the adviser did not consider that the GP had missed the diagnosis but rather that the symptoms were not present at the time Ms A was examined to allow a diagnosis to be made. We did not uphold the complaint.

Summary

Mr C entered into a patient contract with the NHS about the prescription of substitute medication used to help patients to stop the use of heroin. A nurse gave Mr C a dose of the medication, but it was suspected that he had diverted the medication. The nurse checked his mouth and found no sign of it. Mr C said he had broken the medication so it could be taken quicker. However, the board decided to withdraw the medication. Mr C told us that taking the medication was the only option for him to lead a normal life and that the decision to stop it has affected adversely his mental health and confidence.

We took independent advice from a medical adviser who said the board's decision was reasonable. We found that the patient contract was very specific about the way in which the medication should be taken and that the medication could be withdrawn on the basis of suspicion of misuse.