Health

Summary

Ms C complained on behalf of her mother (Mrs A), who lived in a nursing home. Ms C complained about a home visit by an out-of-hours GP, and that they were unwilling to provide a second home visit to give a second opinion on the GP's assessment.

Ms C was concerned that her mother had a chest and urine infection, and requested a GP home visit, via NHS 24. A GP assessed Mrs A and found no signs of infection. The following evening Ms C again requested a GP home visit, and another GP visited Mrs A at the nursing home. Following a full assessment and discussion with the nursing home staff and with Ms C, the GP confirmed that there were no signs of infection and no need for treatment. Later that evening Ms C phoned NHS 24 again, and requested a second opinion of her mother, as she had concerns that her mother was distressed. NHS 24 referred Ms C on to the out-of-hours service, where a GP explained that they would not be able to provide a second opinion as the GP had made a full assessment earlier that evening.

We took independent advice from one of our GP advisers who said that the second home visit (the focus of Ms C’s complaint) was thorough and reasonable. Our adviser said that the observations indicated that there was no sign of infection, and the GP's conclusions that there was no need for treatment or hospital admission were appropriate. Our adviser also confirmed that it was not the role of the out-of-hours service to provide a second opinion. On this basis, we did not uphold the complaint.

Summary

Ms C complained her medical practice had failed to properly diagnose her pelvic infection, resulting in a long stay in hospital and an inability to have children. Ms C said her symptoms had not been properly investigated by the practice and that she had not been properly referred when the practice was unable to identify the cause of her problems.

We took independent advice from one of our medical advisers. The adviser said that Ms C had presented with complex symptoms, from which a clear diagnosis could not be provided. The adviser said that the care and treatment Ms C had received had been appropriate and that the practice had responded reasonably to her reported symptoms, including referring her appropriately to specialists for examination.

Our investigation found Ms C had received a reasonable and appropriate standard of care and treatment from the practice.

Summary

Mrs C was unable to eat or drink without being sick in the early weeks of her pregnancy, and she complained that a midwife should have taken a urine sample for testing to look into this problem. Mrs C also felt unwell in the weeks following her return home after giving birth. Mrs C said the midwife incorrectly told her that a urine test result for infection was negative, when she was later told by a doctor that the result was not ready on the day the midwife spoke to her, and it turned out to be positive for infection. In addition, Mrs C complained about the board’s handling of her complaint.

We looked at Mrs C’s records and took independent advice from one of our nursing advisers. We found that the records made by the midwife were minimal and not accurate, and we noted the board’s acknowledgement that this was not a standard of care they would expect to see. We upheld this part of Mrs C’s complaint.

In their written response to Mrs C, the board acknowledged that the experiences with the midwife had caused Mrs C distress, and that there had been miscommunication and failures in record-keeping, for which they apologised. While we had some criticisms, which we made recommendations to address, we decided on balance that the board’s handling of Mrs C’s complaint was adequate and we did not uphold this part of Mrs C’s complaint.

Recommendations

We recommended that the board:

• provide us with evidence of the feedback given to the midwife involved and community midwives in general, and of how the issues around communication, planning and documentation have been addressed;
• ensure that references to the content of clinical records in written complaint responses accurately reflect the records; and
• ensure that discussions with relevant staff as part of complaints investigations are documented and included in the complaint file.

Summary

Mr C complained that the prison health centre failed to provide appropriate treatment for the injury to his knee. After injuring his knee, Mr C attended the health centre and was prescribed pain medication. Mr C saw the doctor again a few days later because of the pain in his knee and also because the pain medication had given him a rash. The doctor prescribed a different pain medication and referred Mr C for physiotherapy and an x-ray. Mr C said his pain medication was not working but was advised that the doctor would review his medication after the x-ray results were received. The result confirmed Mr C had fluid and a loose fragment in his knee and the health centre referred him to an orthopaedic consultant.

NHS Scotland’s national guidelines for the management of knee pain indicates that if a patient presents with a significant knee injury then they should be referred to A&E, a minor injuries unit or to an orthopaedic specialist which would allow for imaging of the knee to be carried out by x-ray or MRI scan. We took independent advice from one of our GP advisers about the treatment Mr C received and they confirmed that the correct referral protocol – as outlined in the guidelines – was not followed by the health centre when Mr C presented with his knee injury.

In light of the evidence available, and given our adviser’s view which we accepted, we concluded that the health centre failed to provide appropriate treatment for the injury to Mr C’s knee because they did not refer him to A&E for further assessment when he first presented with the injury. Therefore, we upheld Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for the failures we found with the treatment he received;
• ensure relevant health centre staff familiarise themselves with the NHS Scotland guidelines; and
• reflect on Mr C's case and feed back any learning to us.

Summary

Mr C complained that the board required him to post a complaint to their patient relations team, rather than allowing him to submit a complaint to his prison health centre. Mr C felt this was unfair as he only had access to one second class stamp each week.

The board explained that in order to meet the national 20 working day target for dealing with complaints, they had asked prisoners to post their complaints directly to the patient relations team. In the board's view, this helped to remove any unnecessary delays in complaints being passed from the prison health centre to the patient relations team. The board also felt this approach was in line with the national complaints guidance 'Can I Help You' (CIHY).

We decided that the board's approach was not in line with CIHY, as the guidance does not specify to whom complaints should be made, only that the board must accept written or verbal complaints. This means complaints can be made to any member of board staff, including prison health centre staff. It is for the board to resolve any internal problems that might delay complaints being passed from the prison health centre to the patient relations team, and we would expect the board to deal with this without requiring prisoners to post a written complaint to the patient relations team. We upheld Mr C's complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for requiring him to post his complaint;
• reimburse Mr C for the cost of a second class stamp;
• revise their process so that prisoners can submit complaints to their prison health centre; and
• put in place internal arrangements to expedite the transfer of complaints from prison health centres to the patient relations team.

Summary

Mr C complained that the board’s prison health centre doctor unreasonably stopped his pain medication for a long-term knee injury, on the basis of alleged intelligence that Mr C misused another pain relief medication he had previously been prescribed. Mr C was concerned that the doctors at the health centre would not give him painkillers because of someone else’s say so, with no concrete proof or evidence and that in the meantime he had been left without effective medication.

We obtained independent medical advice on Mr C’s complaint from a GP. We also sought advice from the office of the Chief Medical Officer (CMO) on disclosure of information/confidentiality.

Our adviser noted that Mr C’s records indicated that the decision to stop his co-dydramol and not replace it with co-codamol was made, at least in part due to reported information regarding past drug misuse. However, our adviser explained that the pain guideline followed by the board suggested that there was no evidence for the continued prescribing of opioid based drugs such as tramadol, co-codamol and co-dydramol in patients with unexplained or persistent pain. Our adviser said it was, therefore, not unreasonable for the board to reduce and then stop Mr C’s tramadol or to stop his co-dydramol and not prescribe co-codamol in its place. Our adviser noted that the doctor prescribed appropriate alternative pain relief treatment for Mr C. We were satisfied that Mr C’s pain relief was appropriately managed by the doctor and the medication prescribed was appropriate for Mr C’s condition.

In terms of the disclosure of the information about past drug misuse, the doctor confirmed he did not disclose the information to Mr C at the time he made the decision to stop his opioid based medication. Based on the advice received from the office of the CMO, we were not critical of the prison health centre’s actions in this regard.

Summary

Mr C complained about the medication he was prescribed at Dumfries and Galloway Royal Infirmary. He said the side effects were not explained to him properly and that his medication had caused him to suffer problems with his lungs.

As part of our investigation, we took independent medical advice from one of our advisers. He explained that not discussing the medication’s side effects would have been unreasonable and that such discussions should ideally be noted in the medical records. Our adviser was unable to determine the extent of any such discussions from Mr C’s medical records and, although he accepted it was possible that it may have caused Mr C’s subsequent health problems, he said it was a low probability. However, he said the actual decision to have prescribed the medication was not, of itself, unreasonable.

In light of the advice we received, we could not absolutely say Mr C’s medication caused his health problems or the decision to have prescribed it was unreasonable and so we did not uphold his complaint. We did, however, have reservations about the extent of the discussions about its possible side effects and the extent of the assessment that was done for Mr C and so we made three recommendations.

Recommendations

We recommended that the board:

• remind clinical staff of the importance of accurate note keeping;
• remind staff to carry out and follow up on appropriate physical examinations for lung disease (particularly where symptoms such as lung crackles have been identified); and
• remind clinical staff of this medication’s side effects and the need to explain them to patients, particularly in light of patients’ presenting symptoms.

Summary

Mr C, a patient with long standing heart problems, complained that he was not provided with a cardiology service at Borders General Hospital for a period of nearly 18 months. We found that Mr C was not recalled for his routine six-monthly cardiology review appointment. The board said this was because, after Mr C declined surgery for an unrelated medical condition, surgeons did not let the cardiology department know that the surgery did not go ahead. We found that even after Mr C’s GP referred him again it took too long, and considerable effort on his part, to get another cardiology appointment. We asked the board to review the process by which patients are discharged from one service to another and back again. We asked them to build in safeguards to ensure the system was robust and, following review, that the process was shared and understood across specialist areas as well as within administration teams.

Mr C told us there was an unreasonable delay when a letter from the board took 49 days to reach him. The board acknowledged that there were problems with workload within the administration team and apologised for their failing. They acknowledged the delay was unacceptable. They also took steps to monitor workflow within the administration team. We found that these were reasonable actions.

We found some shortcomings in the handling of Mr C’s complaint. The initial response to Mr C’s complaint made no reference to key points he had raised. Nor did it refer to the difficulties he experienced when he contacted the board by phone. We found the board had apologised for the fact that a room used for the meeting caused Mr C distress in that it was very small and full of people when he arrived. The board acknowledged the agenda could have been better arranged. We found that the cumulative effect of these errors made Mr C feel that his complaints were not being taken seriously.

Recommendations

We recommended that the board:

• review the process by which patients are discharged from one service to another and back again and ensure, following this review, that the process is shared and understood across specialist areas as well as within administration teams.

Summary

Mr C complained about the care and treatment that his late mother (Mrs A) received from her GP. Mrs A had attended her GP with symptoms of breathlessness and the GP arranged an x-ray, took a blood sample and prescribed antibiotics. The x-ray result was reported as normal. Mrs A died four days after the consultation from a pulmonary embolus (a clot in the blood vessel that transports blood from the heart to the lungs) caused by deep vein thrombosis. Mr C felt that the GP had taken insufficient note of his mother's breathlessness and should have taken urgent action to establish a further diagnosis as the x-ray had been reported as clear.

We took independent advice from a GP adviser and found that Mrs A's GP had acted reasonably by conducting appropriate investigations in order to establish a diagnosis and that there were no signs that Mrs A would suffer a pulmonary embolus a few days after the consultation. We also found that there was no delay by her GP in their consideration of the x-ray result. We did, however, note that the GP's record-keeping was not as thorough as it could have been and that the GP should reflect on this.

We did not uphold the complaint.

Summary

Ms C, who is an advice worker, complained that the care and treatment provided by the prison health centre to her client (Mr A) for pain in his arm was unreasonable. In particular, Mr A had been unhappy because a nurse had questioned why he was being prescribed a certain type of pain killer. Mr A felt the nurse did not have the authority to do that.

We reviewed Mr A's medical records which confirmed the nurse had concerns about Mr A receiving the pain killer whilst also being prescribed methadone. His medical record also confirmed the doctor was unsure what kind of pain Mr A was feeling and felt further investigation was needed. The doctor prescribed the pain killer for a two week period and also referred Mr A's case to neurology. We took independent medical advice from a GP adviser who confirmed that there was no issue with a clinician - either a doctor or nurse - clarifying why a patient was being prescribed certain medication. Our adviser also confirmed that Mr A's case was reviewed regularly by the doctor and proper steps were taken to explore the type of pain he was experiencing. In addition, our adviser said Mr A was prescribed an appropriate alternative pain killer. Because of this, we did not uphold the complaint.

Ms C also complained that the board's handling of Mr A's complaint was inappropriate. In particular, Mr A said that after he submitted his complaint form, he was called to a meeting with the doctor. He said that when he arrived in the doctor's room, the nurse who he had raised concerns about was there and she was holding his complaint form. Mr A said he understood his form would go to the board's complaints and feedback team. We reviewed the relevant Scottish Government guidance, Can I help you?, which outlines how health service providers should deal with complaints. In particular, it says that if a complaint is reasonably straight forward and non-complex it may be managed without the requirement for a detailed investigation. In Mr A's case, the prison health centre forwarded his complaint to the board's complaints and feedback team the day after the meeting took place and a written response was issued to him in line with the complaints procedure. We were satisfied that the handling of Mr A's complaint was appropriate and we did not uphold his complaint.