Health

Summary

Mr C's wife (Mrs C) was referred to Wishaw General Hospital by her GP. She had been experiencing severe abdominal (stomach) pain and back pain. She was known to have an abdominal aortic aneurysm (a weak point in the blood vessels, causing them to bulge or balloon out) but when her GP examined her he felt another mass in her abdomen. Mrs C saw a consultant surgeon, who could not feel the mass and, after checking a recent scan, discharged Mrs C with pain medication. Mrs C continued to experience severe pain. Nine days later she was readmitted to the hospital as an emergency, and was found to have a bowel perforation (a hole in the bowel). As she was not fit for surgery, palliative care (care provided solely to prevent or relieve suffering) was put in place, and Mrs C died five days after being admitted. Mr C complained that, had the surgeon conducted a more thorough examination, the severity of his wife's condition might have been identified and she might have been treated.

We took independent advice on this case from one of our medical advisers, who is a consultant colorectal (bowel) surgeon. We found that the records taken by the surgeon who examined Mrs C were sparse and of poor quality. The surgeon had provided us with a separate written statement detailing the examination and findings, which our adviser found reasonable in the circumstances. However, the lack of contemporaneous notes cast doubt as to how much consideration the surgeon gave to Mrs C's underlying ongoing symptoms. Although we considered it reasonable for Mrs C to be discharged home after the initial examination, we were critical of the board for not arranging urgent follow-up tests to establish the source of her symptoms.

Recommendations

We recommended that the board:

• apologise to Mr C for the issues highlighted in our decision letter;
• discuss Mrs C's case with the consultant surgeon at their next appraisal; and
• remind the consultant surgeon and her team of the importance of maintaining detailed medical records.

Summary

Mrs C complained about the treatment she received from her dentist when she attended with a broken tooth. She complained that the dentist removed a remaining part of her tooth without her consent, that he used a local anaesthetic, which she had asked not be used, and that he performed root canal treatment and inserted a crown poorly. She also complained that her complaint about this was inadequately handled.

After taking independent advice from our dental adviser we found that the remaining part of Mrs C's tooth could not be saved and it was reasonable for the dentist to remove it. No formal written consent was required for this, but we noted that the dentist did not seek verbal consent, which would have been good practice. We were satisfied with the choice of local anaesthetics he used and found that an alternative was used because Mrs C said she had had an adverse reaction to the standard anaesthetic. However, we were critical that the dentist did not properly document his use of this, and of the work he carried out to prepare Mrs C's tooth for a crown. The root canal filling did not fill the entire root, leaving space for infection. Furthermore, the dentist perforated the filling material with the post that was inserted to hold the new crown. We upheld Mrs C's complaints about these aspects.

We also found that Mrs C's complaint was not handled in line with the complaints procedure in place in the dentist's practice at the time. However, that procedure was not fit for purpose and Mrs C's complaint was actually handled in line with the level of service that we would expect patients to receive. As such, we found the complaints handling to be reasonable.

Recommendations

We recommended that the dentist:

• apologise to Mrs C for the issues highlighted in our decision letter;
• reimburse Mrs C any charges for her dental treatment on the dates in question;
• take note of our adviser's comments about Mrs C's root canal treatment, post preparation, and the recording of the use of local anaesthetics with a view to identifying any points of learning for future treatment; and
• ensure that his current procedure for handling complaints is in line with NHS Scotland guidance.

Summary

Miss C and Mr C had twice taken their son (Master A) to a medical practice with hay fever symptoms. These persisted despite treatment with two different forms of antihistamines, and assessment by an ophthalmologist (a doctor who examines, diagnoses and treats diseases and injuries in and around the eye) that there was nothing apparently wrong with his eyes. Miss C and Mr C then took their son to a hospital out-of-hours service, where they were seen by the same GP they saw at their practice, as he was working as a locum. At this appointment, the doctor was concerned that Master A's symptoms were persisting despite treatment, and referred him to a paediatrician (a doctor dealing with the medical care of infants, children and young people).

Miss C and Mr C complained that, at the appointment, the GP made an inappropriate remark about them seeing him at the hospital as well as at his surgery. They were also concerned that the GP had not done enough to diagnose their son's condition and make a more urgent referral. We sought independent advice from one of our medical advisers, who is an experienced GP. The adviser said that the GP had clearly been concerned about Master A's condition, and that his referral was appropriate, given Master A's symptoms. He also said that if the doctor had made the comments suggested, this was unprofessional and inappropriate. However, we did not find evidence to uphold this concern. We found that Master A's care and treatment was appropriate.

Summary

Mrs C has a complex medical history. She told us that because she had been experiencing extreme pain in her feet (to the extent that she could not walk) she needed to contact her medical practice on a number of occasions. She complained about a lack of support from the GPs at the practice. In particular, she said that, despite telling a GP that tramadol (a drug used to treat moderate to moderately severe pain) did not work for her, he continued to prescribe it. Another GP refused her a dosette box (a pill organiser that helps people on multiple medications to take these at the right time) and prescribed an anti-inflammatory gel, which she said the pain clinic she had previously attended had told her not to use. Mrs C said that both GPs left her without support and in great pain.

We obtained independent advice from one of our medical advisers, who is a GP. After taking all the relevant information into account, including the complaints correspondence and Mrs C's medical records, we did not uphold Mrs C's complaints. We found that she was previously prescribed tramadol for chronic pain, and the new, acute pain she was experiencing had a different cause. Our adviser said that this pain might respond differently to tramadol, so the prescription was not unreasonable. Similarly, an anti-inflammatory gel could be used safely where anti-inflammatory tablets could not. Although Mrs C wanted a dosette box, we found that she did not qualify for this under the health board's criteria.

Summary

Mr C complained on behalf of his wife (Mrs C) that the board did not adequately demonstrate that they had taken remedial action in response to his complaint. Mrs C was taken to Glasgow Royal Infirmary because her GP thought she might have had a stroke. Mr C told us that his wife arrived there at approximately 20:00, and lay on a trolley with no attention until 04:00 when she was seen by a doctor. Mr C also told us that his wife was x-rayed and admitted to a ward at 07:00, eleven hours after she arrived at the hospital. Mr C said he was satisfied that the board had investigated his complaint but, given the seriousness of his wife's condition, he wanted an assurance that their procedures and attitudes had changed for the better.

We considered the information provided by Mr C and the board, and took independent advice from one of our medical advisers. We found that the board did take the remedial action to which they committed when they responded to Mr C's complaint. They had reviewed staffing levels, implemented a consultant evening shift in the relevant department and discussed the matter with hospital staff and reminded them of the need to transfer patients from trolleys to beds as soon as possible. We were satisfied that the information in the board's response was reasonable and that they had done what they said they would.

Summary

Mr C was admitted to the Western Infirmary with symptoms of nausea and vertigo. He was kept in overnight and discharged the following day, with a prescription for medication to take on an 'as required' basis to relieve his symptoms. As the hospital pharmacy was closed, he was given a small amount from the ward's supply until he could get his own prescription, but was given the wrong medication. In responding to Mr C's complaint, the board acknowledged that he had been given the wrong medication in error and apologised.

Mr C complained to us because the board had not fully addressed his concerns that a nurse had advised him to take the medication three times a day for three months, instead of on an 'as required' basis, and instructed him on the use of a spray he already used. He also said that the medication might have been intended for another patient, which could have had serious consequences for them. In responding to our enquiries, the board acknowledged that they should have provided Mr C with a fuller response. They explained that they had put an action plan in place to highlight to all staff the importance of ensuring safe medication practice.

We took independent advice on this complaint from one of our medical advisers. He did not think it likely that there was a mix-up with another patient, but rather that there had been a basic dispensing error. He noted that the frequency advice appeared to relate to the incorrect drug that was provided, and confirmed that there would have been no serious consequences had Mr C taken that drug. In relation to the advice on using the spray, the adviser noted that it was common for a hospital to prescribe medication that forms part of a patient's usual prescription, and that they may just have been making sure his medication supply was complete.

As Mr C was given the wrong medication and advice, we upheld his complaint. However, as we were satisfied that in this instance the drug error was not serious in nature, and that the board had acknowledged the error, apologised and taken steps to try to prevent this happening again, we did not need to make any recommendations.

Summary

Mrs C attended the practice for a routine check-up, and returned several days later for treatment to fill a small hole in her upper left molar. Mrs C assumed that the person who carried out the procedure was a dentist, although they were actually a dental therapist. That evening, the side of Mrs C's face became extremely swollen and next day she had a large area of bruising and was in pain. The following week, an x-ray showed that there was an infection in the tooth, and the practice prescribed a course of antibiotics. The pain settled four days later, and the bruising took another four days to disappear. Mrs C said that a dentist at the practice told her that it had been a very deep filling, which had possibly damaged the nerve, and he would have to remove the crown to treat it. Mrs C was concerned when she saw the extent of the planned work, and that it would cost over £400 to restore the appearance of her tooth.

We took independent advice on this complaint from one of our advisers, who is a dentist. The adviser said that it was reasonable not to carry out an x-ray before the procedure, but that there were communication failures. There was no evidence that Mrs C's consent was obtained in relation to the status of the healthcare professional carrying out the procedure, and during the procedure it appeared that Mrs C was not told about the degree of the decay and possible consequences of future treatment. However, the adviser also said that the treatment Mrs C received when she went back and the proposed course of treatment to address the problems were reasonable. Overall, we upheld Mrs C's complaint as although we were satisfied there was no evidence that the treatment was unreasonable, we found failures in care in relation to communication and consent.

Recommendations

We recommended that the practice:

• ensure the failures identified in relation to communication and consent issues are raised with relevant staff; and
• apologise to Mrs C for the failures identified.

Summary

Mr C's son (Master A) was unwell, and was taken to A&E at Yorkhill Hospital (also known as the Royal Hospital for Sick Children). The family were due to go on holiday two days later and Mr C said that he told hospital staff this. Master A was examined and discharged, and his parents were told to bring him back if his condition worsened or he was sick. This did not happen, and the family went on holiday. Two days later, Master A had to have emergency surgery abroad to remove his burst appendix. He was in hospital for five days being treated with antibiotics (drugs to fight bacterial infection), strong painkillers, and a drain to remove infected fluid from his abdomen. Mr C complained that staff at Yorkhill Hospital failed to diagnose that his son had appendicitis (inflammation of the appendix).

Our investigation, which included taking independent advice from one of our medical advisers, found that the care and treatment provided to Master A was reasonable and appropriate. Having studied Master A's medical records, the adviser said that the clinical signs and symptoms with which Master A presented gave insufficient evidence to make a definitive diagnosis of appendicitis. The likely cause of his illness was thought to be a viral infection. Appendicitis was not ruled out, but included as a differential (alternative) diagnosis. The adviser said that this was reasonable and that it was appropriate to discharge Master A with advice to come back to A&E if his condition worsened.

There had been some dispute over whether or not the staff who dealt with Master A were aware of the planned holiday. Mr C said that it was the first thing they told staff, but staff said that they could not recall being told this. However, the adviser said that, even if staff had this information, it should not have changed the management of Master A's condition and it was appropriate to discharge him with advice to seek further medical help if his condition deteriorated. Based on all the evidence and advice, we decided that Master A's care and treatment was reasonable.

Summary

As part of a research project, Mrs C had a knee replacement at Glasgow Royal Infirmary. The operation, which was robot-assisted, replaced only the part of her knee which was damaged. As this type of surgery is carried out on a smaller area than traditional knee replacement operations, recovery should be faster. However, after the surgery, Mrs C complained about the care and treatment she received. She questioned whether she had been fit for discharge and about the number of cancelled clinic appointments after the operation. She said that nerve endings were damaged during the operation, which had hindered her recovery. She also told us that she was in pain and had to give up her job.

During our investigation, we obtained independent advice from a medical adviser, who is a consultant in orthopaedic and trauma surgery. We also considered all the available documentation and Mrs C's relevant medical records. Having done so, we did not uphold Mrs C's complaint.

Our adviser said that the operation was carried out appropriately and the knee implant was well positioned. Before the operation, appropriate investigations were made, and appropriate information and consent were given. Later, Mrs C was properly assessed before she was discharged from hospital. The adviser said, however, that there is a known outcome of this operation for some patients, who will be left with worse pain than before. Mrs C fell into this category, and despite things going well, she was one of a small number of patients left with residual pain. While it was noted that two of Mrs C's follow-up appointments were cancelled, another was arranged and we found no evidence that this delay affected the outcome of her treatment.

Summary

Mr C complained that the medical practice did not provide his late wife (Mrs C) with appropriate diagnosis, care and treatment over a four-year period. Mrs C suffered from haemochromatosis (a condition where the body absorbs an excessive amount of iron which is then deposited in organs, mainly the liver) and had cirrhosis of the liver as a result. She also had diabetes and other health conditions. Mr C said that the practice demonstrated a lack of personal interest and care, and had not communicated with his wife. Mr C said that they were never told about the seriousness of her state of health, and that she had a life threatening condition. Mrs C died in 2012, and Mr C also said that no-one from the practice contacted him after her death.

We took independent advice on the complaint from one of our advisers, who is a GP. The adviser said that most of Mrs C's care and treatment was reasonable and appropriate. However, the adviser identified a number of failings in relation to her care and treatment in 2011. The practice had not recorded Mrs C's diabetes diagnosis on her medical summary and so she was not entered on their diabetic recall register to attend for an annual review. The adviser said, however, that this failure was unlikely to have resulted in Mrs C coming to any significant harm. The practice told us that they had reviewed this and put measures in place to stop it happening again. The adviser also said that, given Mrs C's medical conditions, the practice should have asked her to come in for review during 2011, and should have reviewed and monitored her medication, particularly in relation to the prescribing of spironolactone (a water pill that helps shift the fluid that gathers in cases of liver disease). The practice had continued to issue prescriptions for over a year, without having seen a safe set of blood results or having discussed the medication with Mrs C, and our adviser said that this was poor medical practice. We were unable to reach a conclusion about what the GPs had said to Mr and Mrs C about the state of her health.

The practice confirmed that they had not contacted Mr C after his wife died, although they said that they usually did try to get in touch with close family members after a bereavement. They apologised for this and said they have now changed their procedures to make sure that they proactively contact the family of a patient who has died.

Having considered the evidence carefully, and taken into account the advice we received, we upheld Mr C's complaint because of the failings our investigation identified.

Recommendations

We recommended that the practice:

• issue a written apology to Mr C for the failings identified in this complaint;
• provide us with evidence of their policy of checking patients' summaries as a routine part of a patient's first diabetic review; and
• provide us with evidence that there is a process in place to ensure that patients' repeat medications are reviewed annually.

When it was originally published in September 2014, this case was wrongly categorised as 'some upheld'.  The correct category is 'fully upheld'.