Health

Summary

Mr C complained that the decision to stop his prescription for co-codamol was unreasonable. He said he had been prescribed the medication for around two years for arthritis but the doctor stopped it without explaining why.

We reviewed Mr C's medical records and we took independent advice from a medical adviser who is a GP. We found that the prison health centre doctor took the decision to stop Mr C's prescription for co-codamol because there was no medical evidence available to indicate that he had arthritis. The adviser told us that the doctor's decision was reasonable. They also confirmed that the doctor prescribed another suitable medication for Mr C's muscular and bone pain.

In light of this information, we did not uphold Mr C's complaint.

Summary

Mrs C complained on behalf of her son (Mr A) who had been admitted to Forth Valley Royal Hospital with chronic liver disease. Mrs C said she believed the care and treatment provided to her son had been inadequate, highlighting poor dietary input as a particular concern. Mrs C also said the decision to discharge him had been inappropriate, as he had refused all treatment at home and died a few days later.

We took independent medical advice on Mr A's treatment and discharge. The adviser said that Mr A had been provided with all treatments short of a liver transplant. The advice noted that Mr A had been adamant that he wished to be discharged and that he was prepared to refuse to eat or drink in order to achieve this. Although it was arguable Mr A should have been made to discharge himself, he had been provided with follow-up care as an out-patient. Mr A had refused to engage with this treatment.

We found Mr A's care and treatment had been reasonable and that the decision to discharge him was also, on balance, reasonable.

Summary

Mr C complained to us about the care and treatment he had received from the board at a prison health centre in relation to his stomach pains. We took independent advice from a medical adviser. We found that the care provided to Mr C in relation to his stomach pains had been of a reasonable standard and we did not uphold the complaint.

Mr C also complained that the board failed to provide a reasonable response to his complaints about this. We were satisfied that the board had acted in line with their complaints procedure and that they had issued a reasonable response to Mr C's concerns. In view of this, we did not uphold this aspect of Mr C's complaint.

Summary

Mr C complained to us that staff at Forth Valley Royal Hospital had removed a cannula (a small tube inserted into the body that can be used to drain fluid or to give medication) against his will when he was being discharged from hospital. We took independent advice on the complaint from a medical adviser. We found that it had been reasonable for staff to remove the cannula, as there was a risk of infection. We did not uphold this aspect of Mr C's complaint.

Mr C also complained that the board failed to deal with his complaints about this appropriately. He had complained to a prison health centre and they sent the complaint to the board's complaints handling team to respond. However, the complaints handling team did not receive the complaint and, as a result, Mr C did not receive an acknowledgement or a response to his complaint at that time. He had to write to the board again and faced a significant delay before receiving a response to the complaint. Some of the information in the board's response was also factually inaccurate. In view of this, we upheld this aspect of Mr C's complaint.

Recommendations

We recommended that the board:

• issue a written apology to Mr C for the failings identified;
• provide evidence that they have taken steps to ensure that all complaints referred by prison health centres to their Patient Relations and Complaints Service are received and responded to; and
• remind complaints handling staff that responses to complaints must be factually accurate.

Summary

Over a period of time, Ms C began to experience constant bloating, was unable to lose weight and was concerned about other symptoms. She attended her GP, who examined her stomach and said there was excess fluid but he was not concerned. The GP's note of this consultation said that Ms C was doing well with her diet, had lost three stone, but felt she was putting weight on despite not changing anything. He arranged routine blood tests which came back normal. Ms C's symptoms got worse. A few weeks later she attended a different GP. The GP found what she thought was a cyst on Ms C's left ovary and a scan confirmed this. Surgery removed a very large (30 centimetres by 24 centimetres) cyst. Ms C complained that the care and treatment she received from the first GP was inadequate.

We sought independent advice from a GP adviser. The adviser considered the relevant General Medical Council (GMC), Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Health and Care Excellence (NICE) guidance. They concluded that the note of the appointment was not of a reasonable standard as it was sparse in detail, showed evidence of only a very limited recorded history, and no evidence of a medical examination. The adviser explained that Ms C's symptoms required examination and follow-up, neither of which was recorded. They also considered that the note did not show evidence of good communication or working in partnership with patients so it was not of a reasonable standard. The adviser explained that, in line with SIGN and NICE guidance on the investigations needed to exclude ovarian cancer, Ms C should have had a particular blood test and a scan. Therefore, we found that reasonable investigations were not carried out.

We upheld Ms C's complaint and made several recommendations.

Recommendations

We recommended that the practice:

• ensure the GP apologises to Ms C for the specific failings identified by our investigation;
• ensure the GP familiarises himself with the SIGN and NICE guidelines in relation to the presenting features of possible ovarian cancer, and identifies this as a learning need for his yearly appraisal;
• ensure the GP reviews his medical record-keeping and provides evidence of improvement;
• ensure the GP reviews and reflects on his communication with patients; and
• ensure they make certain their complaints handling procedure is fully compliant with the Patient Rights (Scotland) Act 2011 and the Scottish Government 'Can I help you?' guidance.

Summary

Miss C complained about the board after using their Ayrshire Doctors on Call (ADOC) out-of-hours service twice. She was unhappy with the treatment she received as, on the first occasion, her gallstones were misdiagnosed as muscular pain. The second time she received the correct diagnosis, but was sent home with painkillers and asked to attend her GP the next morning.

We took independent advice from a medical adviser who is a GP. The adviser said that the treatment Miss C received on her second presentation was reasonable. She was given the correct diagnosis and her symptoms did not justify an emergency hospital submission. Therefore, the correct course of action was to direct her to her GP to arrange an ultrasound scan. However, based on the symptoms Miss C presented with on the first occasion, the adviser considered the diagnosis of muscular pain she received from a nurse practitioner was not reasonable. The adviser felt that further investigation or a referral to the GP should have been made. As such, we upheld the complaint.

Recommendations

We recommended that the board:

• apologise to Miss C for the failings identified;
• share the outcome of this complaint with relevant ADOC staff; and
• discuss the issues identified with the nurse practitioner to assess whether any additional learning is required in the assessment and diagnosis of acute abdominal pain.

Summary

Mr C was concerned about the care and treatment given to his son (Mr A) by the University Hospital Crosshouse immediately before his death. Mr A had recently been diagnosed with terminal and inoperable cancer. He was told that his time was short. He was admitted to the hospital as an emergency with increasing pain and sickness but he died a few days later. Mr C complained to us that he had not been told how advanced his son's illness was; that his son had no treatment plan; that his son was treated without dignity or privacy; staff were inflexible about visiting times; and that communication was poor.

We took independent advice from a consultant clinical oncologist and from a nurse practitioner. We found that while Mr A's medical care and treatment had been reasonable, there had been poor communication by staff. Mr C should have been informed that Mr A was extremely ill and had very little time. We also found that while arrangements were confirmed with Mr C that he and his wife were able to visit on a more flexible basis, this instruction was not passed to all staff involved. In light of this, we upheld two of Mr C's complaints.

Recommendations

We recommended that the board:

• make a formal apology for their communication shortcomings;
• remind the medical team involved in Mr A's care and treatment of their obligations to keep families and carers informed particularly at the end of life; and
• confirm to us that they are satisfied that such an occurrence would not occur again.

Summary

Mrs C was concerned at the care and treatment given to her late mother (Mrs A) while she was a patient at University Hospital Ayr.

Mrs A had a history of heart problems and breathing difficulties and had not been eating. She had been vomiting for three weeks. She was admitted to hospital but her condition quickly deteriorated and she died a few days later. Mrs C believed that without her knowledge, her mother been placed on the Liverpool Care Pathway (LCP - an end of life care planning system for dying patients); that she was given too much fluid and that although diuretic treatment (medication to promote water loss from the body via the kidneys) was prescribed, it was not given. Despite complaining at the time, Mrs C said that action was not taken and as a consequence, Mrs A died. Mrs C also said that after she complained, she was told that her mother had been very seriously ill on arrival, however, she complained that she had not been given this information at the time.

We took independent advice from a consultant geriatrician and from a nurse practitioner. We established that Mrs A had not been placed on the LCP but we found a number of shortcomings with Mrs A's care and treatment: her medical and nursing records were not as complete as they should have been; there were failures in communication and staff did not properly engage with Mrs A and her family; medication was not administered and staff did not appear to have been alert to Mrs A's deteriorating condition. For all these reasons, we upheld the complaint.

Recommendations

We recommended that the board:

• make a formal apology for the clinical shortcomings identified;
• remind clinical staff involved in this case of their professional obligation to complete proper and detailed clinical notes;
• remind clinical staff involved in this case to communicate appropriately and in a timely manner with the patient and their family;
• ensure Mrs A's consultant considers this case as part of his next annual appraisal;
• make a formal apology for the nursing shortcomings identified;
• remind nursing staff of their professional obligation in so far as maintaining correct records in concerned;
• remind nursing staff of their professional obligation to communicate with family members; and
• reflect on the way the complaint was handled, particularly given its serious and significant nature, to prevent similar situations arising in the future.

Summary

Mr C complained that the GP who examined his late father (Mr A) at a consultation had not provided a reasonable standard of care and treatment.  When Mr C visited Mr A later the same day, he was distressed by his father’s condition and called an ambulance.  When Mr A was admitted to hospital he was found to be dehydrated, with a chest infection.  He died four days later from aspiration pneumonia (caused by a poor swallowing mechanism whereby foreign matter enters the lungs).  Mr C also complained that his father’s medication had been unreasonably increased, despite previous knowledge that an increased dose previously reduced Mr A's appetite and he would therefore lose weight.

We took independent advice from a GP adviser.  They found the increase in the medication dosage to have been reasonable.  However, they noted that there was not a documented consultation for the day Mr A was admitted to hospital.  The adviser said this was not in line with General Medical Council (GMC) guidance.

On balance, we upheld the complaint as the practice were unable to demonstrate they had provided a reasonable standard of care and treatment.  We also noted they had failed to refer Mr C to us at the end of their complaints investigation.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings identified in our investigation;
• remind relevant staff of the importance of completing accurate documentation in line with the GMC guidance;
• ensure future complainants are referred to us at the end of the complaint response letter; and
• confirm the GP concerned will discuss this case at their next appraisal.

Summary

Mr C complained about a GP during a home visit deciding not to refer his wife (Mrs C) to hospital. Mr C was particularly concerned that Mrs C had been treated with steroids during a recent hospital admission for a chest infection, and this was likely to affect her diabetes.

The GP said that, during the home visit, they considered Mrs C was suffering from diabetes and a flare-up of her chronic obstructive pulmonary disease (COPD - a disease of the lungs in which the airways become narrowed). However, they said there was no evidence of a chest infection. The GP said the steroid treatment was important for Mrs C’s COPD (although it had a negative impact on her diabetes control) and they encouraged Mr C to continue this treatment. The GP considered their actions were appropriate.

After taking independent medical advice from a GP adviser, we upheld Mr C’s complaint. In relation to Mr C’s concerns about the steroid treatment, we found that the GP acted appropriately by advising Mr C to continue this (as the benefit to Mrs C’s COPD outweighed the impact on her diabetes). However, the adviser explained that Mrs C had lower oxygen saturation levels than when tested 11 days earlier, and the GP should have arranged further investigation of this (which would usually be done in a hospital setting).

Recommendations

We recommended that the practice:

• apologise to Mr C for the failings our investigation found;
• ensure that the GP familiarises themself with the National Institute for Health and Care Excellence (NICE) guideline on COPD, in particular in relation to the assessment of oxygen saturation; and
• ensure that the GP reflects on the findings of our investigation at their next annual appraisal.