Health

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.

Summary

Miss C complained about care her late mother (Mrs A) received from the medical practice. Mrs A had experienced chest pains and called an ambulance. Paramedics came to Mrs A's home and carried out an echocardiogram (a way of monitoring the heart). The paramedics did not believe Mrs A was suffering angina (chest pain caused by a problem in the blood supply to the heart) or a heart attack. They offered to take her to hospital. Mrs A, however, declined and said she would attend her GP the next morning.

Mrs A attended the practice the following morning, where she was seen by a GP. She was diagnosed with acid reflux and was prescribed medication for this. Mrs A passed away at home later that day.

We took independent advice from one our medical advisers who is a GP. They considered the evidence and found that the GP who treated Mrs A had made a reasonable diagnosis based on the symptoms at the time, and the previous advice of the paramedics. Therefore, we did not uphold the complaint.

Summary

Mr C complained that his uncle (Mr A) who suffered from dementia was not reasonably cared for after he was admitted to hospital and when a catheter was fitted. He said that Mr A was not discharged appropriately and that as his uncle's next of kin he was not always kept informed about what was happening about his care and about arrangements being made.

We took independent advice from a consultant urologist and from a senior nurse. We found that Mr A's clinical and nursing care were well within a standard that could be reasonably expected. However, there were occasions when Mr C was not kept informed and when he was given confusing information about out-patient appointments. He was also sent an appointment for Mr A which was for a location 50 miles away from his home. For these reasons, Mr C's complaints about poor communication were upheld.

Recommendations

We recommended that the board:

• make a formal apology for the communications shortcomings identified; and
• remind staff involved in this case of their professional responsibility to communicate with relatives, particularly next of kin, in a clear and timely manner.

Summary

Ms C complained about a delay in arranging surgery for her child (Miss A), who suffered from malocclusion (a misalignment of the teeth and jaws) and chronic facial pain. A treatment plan was agreed for Miss A's malocclusion, including a period of braces followed by maxillofacial surgery (surgery affecting the mouth, jaws, face or neck). After 18 months of braces, it was decided that Miss A was ready for surgery and she was placed on the waiting list of a surgeon at the Southern General Hospital. However, no surgery date was offered for about 16 months.

Ms C complained to the board about the delay during this time. They were unable to offer a date for surgery due to demand, and emphasised that the surgery was unlikely to help Miss A's pain. They suggested that Ms C discuss the possibility of an out-of-area referral with the surgeon. Ms C said she asked about this and was told to contact other hospitals herself. Although Ms C found a hospital willing to conduct the surgery, the time-frame for this was similar to the estimate given by the Southern General Hospital at that time, so Ms C decided not to take it. However, Ms C said the Southern General's estimate then shifted several months. Miss A ultimately received her surgery about 17 months after she was placed on the waiting list.

In response to our enquiries, the board said the national treatment time guarantee of 18 weeks referral to treatment did not apply to Miss A, as she was a returning patient. They said they had now engaged another consultant to improve their waiting times.

After taking independent medical advice, we upheld Ms C's complaint. Although we agreed that the national treatment time guarantee did not apply to Miss A, and it was unlikely that the surgery would improve Miss A's pain, we found that 17 months was an unreasonable delay for this kind of surgery. We were also critical of the board's communication, and we said they should have been more proactive about arranging an out-of-area referral for Miss A.

Recommendations

We recommended that the board:

• apologise to Ms C and Miss A for the delay and poor communication in relation to her surgery;
• review how they monitor waiting times for 'follow on' maxillofacial surgery, to ensure that any significant pressures are identified and addressed proactively; and
• review what processes they have in place to support patients with arrangements for out-of-area referrals (where this is due to the board's waiting times).

Summary

Mrs C's mother (Mrs A) received regular dialysis (a form of treatment that replicates many of the kidney's functions) at the Inverclyde Royal Hospital Renal Unit. During one session, Mrs A experienced some pain and bleeding and, shortly after this, nurses noticed a red scabbed area near the dialysis access. Two weeks later, Mrs A experienced a significant bleed from her dialysis access and required emergency surgery. Sadly, Mrs A suffered a heart attack shortly after the surgery and died.

Mrs C complained about the treatment provided by the dialysis unit, and in particular the decision not to refer Mrs A for medical review when the scab was noticed. The doctor Mrs C spoke to handled this as a concern, and arranged a meeting with relevant staff, with a written summary provided. Mrs C then wrote to the board to complain, and they investigated the issues. The board said the nurses did not consider Mrs A required medical review, and they were capable of making this decision. However, the board acknowledged that their documentation was poor and said they were making improvements to this. Mrs C was dissatisfied with this response, and complained to us about Mrs A's care and the board's handling of her complaint.

After taking independent advice from a specialist renal nurse, we upheld Mrs C's complaint. We found that nursing staff should have taken further action in response to Mrs A's condition, including monitoring the scabbed area and documenting this, and referring Mrs A for access review. However, during our investigation the board gave us information on additional action they had taken to improve their dialysis service after Mrs A's experience and a similar incident, and we considered that the board had now taken appropriate steps to address the failings in care. We also found Mrs C's complaint should have been investigated as a complaint as soon as she had raised it, rather than being handled as a concern.

Recommendations

We recommended that the board:

• feed back our findings to the staff involved for reflection;
• feed back our findings on complaints handling to the doctor involved for reflection; and
• apologise to Mrs A's family for the failures identified.