Health

Summary

Mr and Mrs C complained to us on behalf of their teenage son (Mr A), following his stay in an adult psychiatric unit. They complained that he had been held in the adult unit for an unreasonable length of time, that he had been given medication without their consent, that he had been denied the company of his mother on his transfer to another unit, and that their complaints had been inappropriately handled.

We began our investigations, including discussions with the Mental Welfare Commission who had also looked into Mr A's care and treatment. However, during the course of our investigations, Mr A moved away from home, and was not in contact with his parents. Therefore, we took the decision to close the complaint in line with our procedures, as we had no way of contacting him, and considered that we no longer had his consent to share his personal information with his parents.

Summary

Mr C, who is an advocate, complained on behalf of his client (Mrs A) about the care and treatment provided to Mrs A's late husband (Mr A) by his medical practice. Mr A had a history of chronic obstructive pulmonary disease (COPD, a disease of the lungs in which the airways become narrowed). Mr A called the practice and during the phone consultation reported having strained a muscle. The practice advised Mr A to take painkillers and prescribed him co-codamol (a painkiller formed of a mixture of paracetamol and codeine). They told him to contact them again if the condition got worse. Three days later Mr A attended the practice. The GP examined him and considered the possibility of a lung infection, however, decided it was more likely to be muscle strain and prescribed a stronger pain killer. Later that day Mr A was taken into hospital and died three days later from pneumonia (a serious lung infection).

Mr C complained that Mr A's condition was not assessed properly by the GP. Mrs A also raised specific concerns that at Mr A's COPD review the practice did not have a pulse oximeter (an instrument used to measure oxygen levels in the blood). Mrs A also raised concerns that Mr A was prescribed co-codamol and that this medication is not recommended for patients with COPD. When Mr C complained to the practice the GP who had examined Mr A responded to the complaint and Mrs A and Mr C said this was not impartial.

During our investigation we sought independent advice from one of our GP advisers. The adviser was satisfied that when Mr A attended the practice his symptoms were indicative of muscle strain and that the GP's actions were reasonable. The adviser was also satisfied that co-codamol is an appropriate painkiller to prescribe to patients with COPD as long as the prescriber is aware of the patient's COPD condition, as they were in this case.

The practice told us that they are a small practice of only one GP. As the complaint related to clinical matters, the complaint needed to be responded to by a doctor. We found this to be a reasonable position and for the reasons above did not uphold the complaints.

However, our adviser did say the practice should have had access to a pulse oximeter. The practice told us that they had already purchased one and we recommended that they ensure it is used appropriately.

Recommendations

We recommended that the practice:

• provide us with evidence of the steps taken to ensure the pulse oximeter is utilised as required.

Summary

Ms C had been referred to a hospital specialist by the practice as she had reported having blood in her sputum (spit). She was told that she had developed terminal cancer. Ms C complained to the practice that she had reported the same symptoms to them for a number of years and that they had only prescribed antibiotics for a burst blood vessel in her throat.

We took independent advice from a GP adviser and found that Ms C had a long history of chronic blood streaked throughout her sputum and that it had previously been investigated by specialists. The presumed diagnosis was inflammation of Ms C's pharynx (back of throat) aggravated by a chronic cough. The plan was that further investigations were not required unless there was a significant change in her symptoms or that new symptoms had developed. When a GP arranged a further x-ray for a possible diagnosis of lower respiratory infection, it was noted that Ms C had a lesion in her chest which was not present in a previous x-ray. This resulted in a further referral for specialist investigations and it was then discovered that Ms C had a lung tumour. There was no evidence to suggest that there had been a previous significant change in Ms C's symptoms which the practice had not taken action on and, when it became clear that the situation had altered, timely and appropriate action was taken in order to reach a definitive diagnosis. We did not uphold the complaint.

Summary

Mr C complained that his pain medication was stopped unreasonably following a medication spot check (a check carried out by prison staff to ensure a prisoner has the correct type and amount of medication prescribed to them). Mr C also complained he had not been provided with reasonable alternative medication.

We took independent advice from one of our GP advisers. The adviser was satisfied that as Mr C had failed the medication spot check it was reasonable to have removed and stopped the prescription of the medication. The adviser was also satisfied the alternative medication provided was appropriate. For these reasons, we did not uphold Mr C's complaints.

Summary

Mr C complained that the prison health centre's handling of his medication for nerve pain was unreasonable. He said he had been prescribed pain medication but when he was admitted to the prison, his prescription was stopped.

We obtained a copy of Mr C's medical records and we also sought independent advice from one of our GP advisers. Mr C's medical records confirmed that the prison health centre carried out an assessment prior to taking the decision to stop his medication. Our adviser said the assessment was appropriate and the decision to stop Mr C's medication had been taken in line with the relevant guidance issued by the General Medical Council.

In light of the evidence available, and given the view of our adviser which we accepted, we did not uphold Mr C's complaint.

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.