Health

Summary

Mrs C complained about the medical and nursing care and treatment provided to her late husband (Mr C) under the Liverpool Care Pathway (LCP - a care planning system for dying patients) when he was in Raigmore Hospital. Mr C had suffered a spontaneous intracranial haemorrhage (bleeding within the skull), the effects of which had possibly been magnified by warfarin (a type of medicine that is given to stop clots forming in the blood) that he had, appropriately, been taking.

We took independent advice from one of our medical advisers who explained, after examining Mr C's medical records, that the prospects of any sort of meaningful recovery from such a severe brain injury were non-existent. The records showed that the doctor's conclusion had been that Mr C's condition had deteriorated, and the family had accepted this and that the implementation of the LCP would be appropriate. The adviser said that the principal aims of the LCP were to ensure that patients who were dying were not subjected to unnecessary investigations such as blood tests that would not alter the outcome, but that they would receive all care necessary to maintain their comfort and relieve any distress. In view of this, we found that it had been reasonable to place Mr C on the LCP and then to keep him on it. We also found that the LCP had been implemented appropriately.

In addition, we found that the medical and nursing care records indicated that Mr C received good and entirely appropriate care while he was in hospital. There were also detailed records of discussions with Mrs C and her family. In view of all of this, we did not uphold Mrs C's complaint.

Summary

Mr C, who is a prisoner, complained that the prison health centre would not prescribe the pain relief medication that he was receiving before he went to prison, and that the medication they did prescribe was inadequate.

We explained to Mr C that medication decisions by prison health centres will not automatically be the same as such decisions in the past. For example, some medications are not considered appropriate for use in prison because of their particular potential for abuse in a prison setting. It is for the prison health centre to carry out their own assessment of the individual and decide what, if any, medication or other treatment would be appropriate.

In Mr C's case, we looked at the board's policy on prescribing pain relief in prisons, and at Mr C's medical records. We found that he had had an appropriate assessment. We also took independent advice from one of our medical advisers, who said that the decision about what action to take had been medically appropriate, including the reasons for the medication that was prescribed for Mr C. We did not, therefore, uphold his complaint.

Summary

Mrs C complained to us about aspects of treatment provided to her mother (Mrs A) by GPs at her medical practice. She was concerned that at a home visit a GP did not admit Mrs A to hospital, although later she had to go there. When Mrs A was discharged from hospital there was a problem with her medication.

Our investigation found that although the GP's records were not as thorough as they should have been, which we pointed out to the practice, she had carried out a reasonable assessment of Mrs A at the home visit and that at that time there was no clinical reason for a hospital admission. We took independent advice from one of our medical advisers, who said the GP had used her clinical judgement in a reasonable manner and had provided appropriate advice about what the family should do if Mrs A's health deteriorated over the weekend. We also found that the practice acted reasonably when told that Mrs A needed additional medication, and that her care was not compromised by a slight delay in obtaining the medication when it was not in stock at the local pharmacy.

Summary

Ms C, who is an advocacy worker, complained to us on behalf of her client (Mr A). Mr A said that he had complained to the board some time ago about care and treatment he received. Having received no reply, he asked Ms C to complain on his behalf. For a period of around 15 months the advocacy service tried to make Mr A's complaints or receive updates on them. Having received no response they then complained to us.

After making enquiries of the board, we found evidence that they received most of the letters and emails sent by the advocacy worker between September 2012 and November 2013, but that of 15 contacts, only four were directly responded to. Having considered the circumstances and the content of the letters and emails, we considered this unreasonable and we upheld the complaint. The board had, however, taken action before we became involved to try to ensure that a similar situation would not recur, so our recommendations related only to apologies for the failure.

Recommendations

We recommended that the board:

• apologise to Mr A that they did not respond reasonably to complaints and subsequent correspondence raised on his behalf; and
• apologise to Ms C that they did not respond reasonably to complaints and subsequent correspondence raised on Mr A's behalf.

Summary

Mr C sustained an injury during spinal surgery and after further surgery his consultant neurosurgeon phoned the spinal injuries unit in the Southern General Hospital and discussed the possibility of Mr C being admitted. When a written referral was made, however, Mr C was refused admission. His MP corresponded with the board about this asking for an explanation and, in responding, the board said that the director of the spinal injuries unit had investigated the complaint.

Mr C then complained to us that the unit had unreasonably altered their decision to accept his referral and that its director had inappropriately been appointed to investigate his complaint. Our investigation found that, although there had clearly been a discussion about Mr C's condition, there was no specific evidence that the unit had agreed to accept the referral during the phone call, and we concluded that there was no evidence that a decision had been altered. Although we did not uphold Mr C’s complaints, we found that the initial use of the term 'investigated' in relation to the director's role was misleading, although his actual role (in providing a summary, comments and feedback) was appropriate. We made a recommendation about this.

Recommendations

We recommended that the board:

• alter their standing response wording to ensure that staff involved in providing information and comments as part of the complaints handling process are not referred to as having 'investigated' the complaint.

Summary

Mr C, who is a prisoner, complained that the board stopped his pain medication after he was sent to prison. The medication (gabapentin) had been prescribed by his GP. However, Mr C was also on methadone (a drug used medically as a heroin substitute). Doctors in the prison told him that it was recommended that methadone and gabapentin were not prescribed together, and prescribed a different medication for his pain.

After taking independent advice from one of our medical advisers, we found that there was potential for harm if the doctors in the prison had continued to prescribe gabapentin while Mr C was still on high doses of methadone. The prison doctors had also offered reasonable pain killing alternatives when the gabapentin was stopped. In view of this, we did not uphold Mr C's complaint.

Summary

Mr C suffers from excessive sweating over most of his body, and was referred to a dermatologist (a specialist in diseases of the skin, hair and nails). At the dermatology appointment at Inverclyde Royal Hospital, a consultant dermatologist examined Mr C but said there was no treatment they could offer him. He was unhappy about this and complained to the board.

We took independent advice from one of our medical advisers, also a consultant dermatologist, who reviewed the board's response to Mr C's complaint as well as the relevant medical records. He explained that to say there was no treatment that could be offered was incorrect. He said that, in Mr C's circumstances, he would have expected the consultant to have considered an anticholinergic drug (a drug that blocks the action of a particular neurotransmitter in the brain). We upheld Mr C's complaint. Although we were aware that the appointment had been a difficult one, there was no evidence that an anticholinergic drug was considered or discussed with Mr C there, and the information he was given was incorrect.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified; and
• share this letter with the consultant concerned and ask them to reflect on their actions.

Summary

Miss C was unhappy with the care and treatment that her late mother (Mrs A) received from district nurses in the weeks prior to her death, and in particular in relation to pressure ulcers (bed sores).

As part of our investigation, we took took independent advice from our nursing adviser, and carefully considered all the complaints correspondence and Mrs A's clinical records. We recognised how distressing this had been for Miss C and her family, but our investigation did not find that there had been any failings in the care or treatment provided to her mother. Our adviser said that that this had been of a good standard and was in keeping with current standards and guidance.

Summary

Ms C complained that the care and treatment she received from her dentist on two occasions was unreasonable, both when a temporary filling was inserted into a tooth in her lower jaw, and when she attended a week later for a permanent filling. Ms C said that from the time the temporary filling was applied she felt sick and had a bad taste in her mouth. She also said that part of it broke off, and she swallowed it, after which she also experienced stomach problems. When she went for the permanent filling, she said the dentist injected a local anaesthetic but then did not wait long enough before starting to work on her tooth. When she complained of pain, the dentist injected her again, leaving her face temporarily paralysed on one side, so that she could not close her eye.

Our investigation included taking independent advice from one of our dental advisers, who said that the material (Cavit G) was widely used for temporary fillings, and was approved by the relevant regulatory authorities as being safe for use. The adviser said that it was reasonable and appropriate for the dentist to use this in Ms C's case, but that, very rarely, a few patients report similar side effects to those Ms C experienced. The adviser was unable to say whether Cavit G was the direct cause of these in Ms C's case, and noted that the dentist had provided Ms C with a list of its ingredients to take to her GP if the symptoms continued.

In terms of what happened with the permanent filling, the adviser explained that local anaesthetic in the lower jaw has to be placed close to the facial nerve and usually takes between two and four minutes to work. However, as the dentist cannot see the facial nerve, and each patient's physiology is different, the placing of the injection can only be an educated guess. This can sometimes mean that a second injection is needed in a slightly different place, which can have the effect of temporarily paralysing the facial nerve. The adviser found no evidence that the dentist's treatment had been unreasonable, and noted that they had offered Ms C an eye patch that day to cover her eye, and had phoned the next day to ensure she had recovered. The notes said that Ms C had told them she was fine, and that the paralysis had worn off by the time she arrived home on the day of the appointment.

Summary

Mr C, who is a prisoner, complained about the management of his sleep disorder by the prison health centre team. He was unhappy that his zopiclone (a drug used to treat sleeping problems) prescription was reduced and stopped. In addition, Mr C said that an alternative drug he was given did not agree with him as he was also on methadone (a drug substitute for heroin).

After taking independent advice from one of our medical advisers, we found that the health centre team acted reasonably in reducing Mr C's zopiclone, as it is a drug that is licensed for short term use of insomnia. Mr C was aware of this at the time it was first prescribed. There was also evidence to show that Mr C was reviewed appropriately and told of the need to reduce the zopiclone prescription on more than three occasions.