Health

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.

Summary

Mrs C complained about the care and treatment provided to her stepfather (Mr A) during his admissions to Gartnavel General Hospital and the Western Infirmary, Glasgow. She was unhappy about the standard of nursing care and the medical treatment Mr A received. Mrs C said there were delays in admitting Mr A and, once admitted, he was not properly cared for and nursing staff did not take his disabilities into consideration. Mr A was discharged from his first admission with a diagnosis of cancer, which proved to be incorrect, and there was a substantial delay in providing the correct diagnosis. The family said that this diagnosis came too late, as Mr A passed away some weeks later. Another of the board's departments then contacted them, offering assistance with Mr A's proposed discharge home, which added to their distress.

We took independent advice on this case from a nursing adviser and a medical adviser. We found the board had already acknowledged and apologised for a significant number of failings in Mr A's nursing care, and had provided evidence of what they had done to stop this happening again. Our nursing adviser said that Mr A's care was clearly substandard, but the board had demonstrated they had taken this seriously and had responded by taking proportionate and reasonable steps. Our medical adviser said that although Mr A's cancer diagnosis was not unreasonable, the delay in providing a conclusive diagnosis breached Scottish Government targets and that the board had not addressed this. We concluded that Mr A had experienced failings in nursing care, and in communication with the family, but that the board had taken reasonable steps to address these issues. They had not, however, identified that there was a failure to provide a follow-up appointment for Mr A following the cancer diagnosis.

Recommendations

We recommended that the board:

• provide evidence they have taken steps to identify the cause of the delay following Mr A's referral;
• provide evidence they have taken steps to ensure the delay experienced by Mr A when waiting for a follow-up appointment could not reoccur;
• provide evidence that they have taken action to ensure community-based staff are informed timeously of a patient's death; and
• apologise in a simple unqualified way for the failings our investigation identified, and the distress experienced by Mr A's family.

Summary

Mr C's wife (Mrs C) had an operation at Gartnavel General Hospital to treat a bunion on her foot, which involved inserting metalwork. Afterwards, she was in pain and could only mobilise with difficulty. The wound was slow to heal and six weeks after the operation she was admitted to a hospital in another board area with a severe infection, which was treated with intravenous antibiotics. At her next review, Mrs C's foot was still swollen and she had pain over her ankle and tenderness in her shin. The metalwork was removed the following month. However, at a subsequent review, she had pain in her heel and a magnetic resonance imaging scan (MRI: a scan used to diagnose health conditions that affect organs, tissue and bone) then showed that she had a tendon condition. Mrs C was reviewed again 14 weeks later, but decided not to have a further operation in light of the terminology the consultant used at that review.

Mr C complained about the care and treatment provided to his wife. He said that her tendon was damaged during the operation, causing pain in her ankle outside the site of injury and that she should not have been discharged so quickly. He also said that her infection was not treated reasonably and that the metalwork should have been removed sooner. Finally, Mr C complained that the injured tendon was not investigated appropriately or within a reasonable time and that there was an unreasonable delay between the scan and the subsequent consultation.

We took independent advice from one of our medical advisers, who said there was no evidence that Mrs C's tendon was injured during surgery. She had a wound that was slow to heal and was complicated by infection, but this was treated appropriately and effectively and the metalwork was removed within a reasonable time. In relation to Mrs C's final consultation, we were unable to reconcile the differing accounts about communication. However, we found that the advice given about the condition and treatment options was reasonable. Having said that, the delay between the MRI and subsequent consultation was unreasonable. Although this had no impact on the outcome for Mrs C, we found that the delay caused her additional uncertainty while she was dealing with a painful condition.

Recommendations

We recommended that the board:

• bring the failings in record-keeping to the attention of the relevant healthcare professional; and
• inform us of the steps taken to ensure there is no recurrence of the delay between the MRI scan and follow-up consultation.

Summary

Miss A was unhappy with the advice she had received on the management of her hypothyroidism (where the thyroid gland produces too little thyroid hormone) with regards to conception and pregnancy. Mrs C, who complained on behalf of Miss A, added that Miss A had complained that she was never offered a face-to-face appointment with a GP at the medical practice and that she had been added to the thyroid follow up register without her knowledge.

We took independent medical advice from our GP adviser. We found that the practice were reasonable in adding Miss A's name to the thyroid follow up register as this is a way to ensure that the patient has annual blood tests to manage the condition. In addition, the practice had responded by apologising and said that this was simply an administrative tool and they had not anticipated it causing any concern. Our adviser told us that there are no guidelines dictating any treatment prior to pregnancy with regards to hypothyroidism, only about actions that should be taken after the woman becomes pregnant. In addition, we found that, given the nature of the consultations, it was reasonable to offer phone appointments. We found that the practice had given a reasonable standard of care.

Summary

Mrs C experienced numerous troubling symptoms over a number of years including impaired vision and muscle wasting. She underwent a range of investigations with the board's neurology department to establish the cause of her symptoms. Mrs C then complained about the standard of her care and treatment. She felt that, although her symptoms were getting worse, staff did not take her case seriously, dismissed her as anxious and provided contradictory information. Mrs C told us that she decided to have an MRI scan (magnetic resonance imaging scan: a detailed scan of her brain) carried out privately, which identified a small focal lesion (an area of tumour or other tissue damage) on her brain. She complained that this had been missed in scans taken by the board some years previously.

We took independent medical advice from a consultant neurology adviser, and we found that the focal lesion had been present in the earlier scans, but was not easily identified. MRI scanning technology advanced in the intervening period and the lesion was more readily identifiable in the more modern scan. It was only with hindsight and knowledge of its location that radiology staff could identify it in the earlier scans. We did not find the board's actions to be unreasonable in this respect and were satisfied that a number of relevant and appropriate investigations were carried out to establish the cause of Mrs C's symptoms. Ultimately, we found that the treatment she received was in line with that which would have been provided had her lesion been identified from the outset.

That said, we were critical of the board's handling of Mrs C's complaint and their failure to provide an independent review of her MRI scans, as had been promised during their investigation of her complaint.

Recommendations

We recommended that the board:

• apologise to Mrs C for their inadequate communication about her complaint;
• contact Mrs C as a matter of urgency to discuss possible further actions to be taken to review her MRI scans outside of the board area, or provide us with evidence that this has been addressed; and
• review their handling of Mrs C's complaint to ensure that action points from meetings are properly recorded and followed-up and that the NHS complaints handling procedure is properly followed.

Summary

Mr C complained about the pain relief he was being prescribed by the prison health centre as he did not find it effective. He also complained about the way the board handled complaints and feedback he had submitted.

The board considered that Mr C was being prescribed appropriate medication to manage his pain. After taking independent advice from one of our GP advisers, we upheld this part of Mr C's complaint. The adviser did not consider that a thorough enough assessment of Mr C's pain had been recorded to determine if the pain relief he was prescribed was appropriate. In looking at the board's handling of Mr C's complaints, the evidence available confirmed that they did not respond to feedback that he had submitted in line with the relevant process and had failed to identify this during their investigation of his subsequent complaint. We also upheld this part of Mr C's complaint.

Recommendations

We recommended that the board:

• ensure that heath centre staff consider and reflect on how they assess a patient's pain;
• ensure that health centre staff consider the use of alternative treatments like local anaesthetic patches for the treatment of isolated areas of pain such as Mr C's;
• ensure that staff update their learning by reading the revised Scottish Intercollegiate Guidelines Network guideline 136;
• apologise to Mr C for failing to respond in line with the relevant process; and
• review their complaints handling procedure alongside the prisoner healthcare feedback, concerns and complaints form to ensure they provide a consistent approach.