Health

Summary

Mr C complained that the board failed to provide him with adequate care and treatment following his admission to A&E at Raigmore Hospital with stroke symptoms. Mr C said that he was not given a thrombolysis injection ('clot buster' therapy which may reverse neurological deficit) and raised concerns about CT scans (scans that use a computer to produce an image of the body) and the prescription of perindopril (a blood pressure lowering agent).

We obtained independent medical advice from a consultant in emergency medicine (adviser 1) and a consultant in general and elderly medicine with a special interest in stroke medicine (adviser 2). Adviser 2 said that thrombolysis was not indicated at any point in Mr C's treatment and would not have been likely to result in Mr C having a better recovery. Had it been indicated, however, it was clear that by the time this was determined it would have been too late to safely administer it. Adviser 1 identified unreasonable delays in A&E and said it was not clear that the nurse who assessed Mr C recognised that his symptoms might be due to a stroke. The advisers found no evidence that the appropriate assessment tool was used when triaging Mr C (deciding where he should be treated based on his condition), and there was also an error in completing a checklist for stroke thrombolysis.

Delays in treatment resulted in an unreasonable delay in a CT scan being carried out. However, our advisers said there was no requirement for the board to carry out a second scan after what Mr C believed was a second stroke after he arrived at hospital. Adviser 2 said that a blood pressure lowering agent such as perindopril should have been prescribed for Mr C on discharge. The board acknowledged their failing in this area and took appropriate remedial action.

Recommendations

We recommended that the board:

• feed back our decision on Mr C's complaint to the staff involved;
• review their care pathway for identification of patients with a suspected stroke and escalation of care in A&E at Raigmore Hospital to ensure patients with a suspected stroke are appropriately triaged and assessed in line with Scottish Intercollegiate Guidelines Network guidance; and
• provide Mr C with a written apology for the failings identified.

Summary

Ms C had complained to us, through her solicitors, about the treatment she had received from the board. However, we learned that Ms C was taking legal action against the board in relation to the events of the complaint. Under the Scottish Public Services Ombudsman Act 2002, it would not be our practice to investigate a complaint where legal action was being taken. The complaint was, therefore, closed without further investigation.

Summary

Mrs C contacted her medical practice to get the flu vaccine for her young son. The practice provided an appointment three weeks away, but Mrs C asked if an earlier appointment would be available as her son had some outstanding health conditions. The practice said there was no urgency for the appointment so an earlier appointment was not offered.

Mrs C complained that the practice had not considered her son's individual health conditions, as they should have. She also complained that they had unreasonably told her she could leave the practice and did not respond to her complaint reasonably.

We took independent advice from one of our medical advisers. The adviser was satisfied that Mrs C's son did not exhibit any of the conditions which would qualify him as a priority patient to get the flu vaccine. For this reason, we did not uphold this complaint.

We also could not establish from the evidence available, the context in which the option to leave the practice was brought up and did not uphold this complaint. While we decided the practice had, on balance, reasonably responded to the complaint we did note areas for improvement and made a recommendation to address this.

Recommendations

We recommended that the practice:

• include, in final complaint replies, information about how a patient can progress their complaint if they remain unhappy.

Summary

Mr C complained that a nurse in a prison health centre did not deal with his referral form appropriately. Mr C asked to see the mental health team and he outlined his reasons for his request. A nurse discussed his referral with him and asked questions that Mr C felt were inappropriate.

We reviewed the board's response to Mr C's complaint in which they explained that the nurse was trying to find out what had led to the symptoms he described in his referral form. They also commented that the symptoms described would prompt most healthcare professionals to ask questions around the causes. The board also noted Mr C's view that the nurse had not read his referral and because of that, had questioned him unnecessarily. They assured him that was not the nurse's intention and offered an apology if that was his impression.

We took independent medical advice on this from our GP adviser, who told us that the nurse's actions in Mr C's case were reasonable and appropriate. In light of that, and having reviewed the board's response, we were satisfied that the nurse handled Mr C's referral appropriately, and we did not uphold his complaint.

Summary

Ms C complained to the board about the lack of clinical supervision which was provided to her late daughter (Miss A) by clinicians at Yorkhill Hospital. Miss A had a number of complex medical conditions and had had repeated hospital admissions over the years. When Miss A showed signs of deterioration during the latest admission, Ms C felt that staff showed a lack of urgency and that there appeared to be a lack of senior clinician involvement in her care. The board said that Miss A was appropriately supervised by senior clinicians although they apologised that communication with Miss A's family about her chances of survival could have been improved. We took independent medical advice from a specialist in paediatric intensive care who reviewed Miss A's medical records and was satisfied that the standard of senior clinician input into Miss A's medical treatment was of an appropriate standard. We did not uphold the complaint.

Summary

Ms C complained that, although she had multiple fractures in her foot, she was not treated appropriately and that this led to her condition deteriorating. She said that there were delays in tests on her symptoms and in telling her of the results, and that she should have had a bone scan earlier . Ms C believed that as a result, she had constant pain with reducing mobility.

Ms C complained to the board, who said that they had done their best to deal with her problems and associated pain, but that stress fractures in feet and heels could be difficult to determine and often no specific intervention was required.

We took independent advice from a consultant in rheumatology and osteoporosis (a condition that affects the bones, causing them to become fragile and more likely to break), after which we upheld MS C’s complaints about delay. We found that while the investigations into Ms C's foot problems were reasonable, there were delays in completing these and in providing Ms C with the outcome of x-rays and scans. This was unreasonable, given that there was a suspicion of a fracture. The delays also led to a delay in making a diagnosis, although the treatment then provided was all reasonable. Ms C also complained about the way her complaint was dealt with, but the evidence showed that the board had followed their usual processes and replied within their timescales.

Recommendations

We recommended that the board:

• formally apologise;
• review their procedures (including in radiology) to ensure that a similar situation would not occur. They should confirm to us that they have done so; and
• apologise for the delay in providing a diagnosis.

Summary

Ms C was a new patient at a dental practice, and had seen a dentist there who started her treatment. However, Ms C complained that when she attended another dentist (the dentist) in the practice as an emergency, she was not cared for or treated properly. She said that the dentist was reluctant to treat her and that when she did, she gave Ms C an injection that caused bruising and facial swelling. Ms C also said that the dentist drilled her tooth too deeply and then left her without finishing the treatment, saying that she did not have the necessary equipment. Ms C believed that her treatment was not carried out properly, and said that it caused her extreme pain and discomfort.

We took independent dental advice and found that after examining Ms C's mouth, the dentist gave Ms C appropriate advice and treatment, but did not take an x-ray to review the existing fillings to ensure that she was fully informed. We found that the dentist should also have continued Ms C's treatment, as it was possible to do so without the equipment to which she referred. Alternatively, if she felt she was unable to do this, she should have referred Ms C to a more experienced practitioner. Because of these failings, on balance we upheld the complaint. Our adviser noted, however, that although Ms C suffered discomfort and bruising because of an injection, this was a well-recognised complication and not a reflection on the ability of the dentist.

Recommendations

We recommended that the dentist:

• apologise to Ms C; and
• reflect on what happened and address the concerns raised by the adviser as part of her continuing professional development. She should confirm to us that she has done so.

Summary

Ms C said that when she changed her medical practice she had to see the practice nurse before she could be seen by a doctor. She said that this registration procedure created delays in her seeing a doctor. She also said that there were obstacles to accessing the medication she needed, and that other medications she was given put her at significant harm because they were contraindicated (should not be given) with drugs she was already taking for her complex health problems. Ms C was also unhappy because she said she had been blamed for an act of vandalism to the practice's premises and information about this had been added to her medical records. She complained about the way in which the practice dealt with her complaints about these matters.

We took independent medical advice from one of our medical advisers, who confirmed that it was not a requirement of the General Medical Council contract for a patient to have a medical with a practice nurse before seeing a doctor, as this could lead to delay in prescribing or seeing a doctor. This was what happened in Ms C's case. When Ms C did see a doctor her initial prescription requests were dealt with appropriately but subsequently there was evidence that she was over-prescribed medication without being properly assessed or reviewed. Finally, the investigation showed that non-medical information had been added to Ms C's records inappropriately and that the practice had not handled her complaint in accordance with required timescales. We upheld all of Ms C’s complaints, except that about the medicines she was prescribed, as we found no evidence that any of these was contraindicated.

Recommendations

We recommended that the practice:

• make a formal apology for the difficulties encountered in obtaining GP appointments;
• review their acute prescription request system in terms of how they respond to patient requests for antibiotics. They should confirm to us that they have done so;
• make a sincere apology for the inappropriate entry in the medical records;
• seek to ensure that an appropriate amendment is made (in accordance with relevant guidance) to the complainant's medical records;
• apologise for the way in which the complaint was dealt with; and
• emphasise to all those staff involved the importance of making full and timely replies to complaints in accordance with stated procedures.

Summary

Mrs C complained about delays in diagnosing and treating her late daughter (Ms A)'s secondary cancer. She also complained that the board failed to appropriately communicate with her daughter and that they had found it difficult to contact someone from the breast cancer team.

We took independent medical advice from a consultant clinical oncologist (cancer specialist) and found that, while there were some short delays, these did not impact on Ms A's clinical outcome. Our adviser said that the secondary cancer Ms A developed was extremely rare and behaved very aggressively. We did not uphold this complaint, as we were satisfied that the team responsible for Ms A's care had responded compassionately, accurately and with due speed.

We upheld Mrs C's complaint about the board's communication, and we pointed out the importance of patients being clear about how to contact the breast cancer team. The board had apologised that their contact process was not fully explained to Mrs C and her family, and had taken action to review their communication channels and processes with a view to identifying how they could improve contact for patients.

Recommendations

We recommended that the board:

• report back to us on the outcome of the review being carried out into communication channels and processes, with particular reference to information that is available about where other sources of support can be found.

Summary

Mrs C visited the Western Infirmary, Glasgow as she was feeling unwell. She complained about the attitude of a doctor who spoke to her, and the care and treatment they provided. Mrs C also complained about the board’s response to her complaint.

Mrs C’s account of her conversation with the doctor was different from that of the doctor, and of a nurse who was also present. Where there are differing accounts of what was said or what happened in a particular situation, it can be difficult to prove what actually happened without independent evidence. In such cases, we normally base our findings on written records. In this case, the records noted it was a difficult conversation, and also noted a version of events contrary to what Mrs C told us had happened. We could not resolve this aspect of Mrs C’s complaint given the differing accounts, although we pointed out that this does not mean that we believed one account over another.

We looked at the board’s file on Mrs C’s complaint and at her medical records, and took independent advice from one of our medical advisers. Our adviser’s view, which we accepted, was that the care and treatment provided by the doctor was adequate in the circumstances, and consistent with usual practice and relevant guidelines.

In dealing with Mrs C’s complaint, the board looked at her medical records and obtained statements from the doctor and the nurse, and their response was consistent with this information. The board’s response acknowledged Mrs C's reported experience and apologised if problems with communication had made an already distressing situation worse. We were satisfied that, in the circumstances, the board’s response to Mrs C’s complaint was adequate. We did not uphold Mrs C’s complaints.