Health

Summary

Mrs C complained on behalf of her husband (Mr C) about a home visit by a GP from their local health centre. Mrs C felt the GP did not provide her husband with adequate care and treatment. She said that the GP was in her house for less than five minutes, did not carry out medical checks properly, and did not arrange for Mr C to go to hospital. Instead, the GP arranged for a rehabilitation team and social work to visit Mr C later that day. In response to the complaint, the GP said that Mr C declined the offer of admission to hospital, which was why she arranged the visit from the rehabilitation team and social work. The rehabilitation team contacted the GP and said Mr C now agreed with being admitted to hospital, and so the GP arranged this. Mrs C felt, however, that the delay was because of the GP's actions and complained to us.

We looked at the information Mrs C sent us, as well as information from the GP, including Mr C's medical records. We also took independent advice from our GP adviser. We could not reconcile the different recollections of exactly what was said and done during the visit. Our adviser looked at Mr C's medical records, however, and found that they showed that the GP provided reasonable care and treatment during it, and had acted correctly after the rehabilitation team contacted her. Our adviser also said there was no clinical indication that Mr C should have been admitted to hospital more quickly than he was.

Summary

Mr C complained that when he attended two dermatology appointments, the consultant reported that she had concerns about two moles on his back. Mr C pointed out that there was a further mole which was causing him concern and he felt the consultant was being dismissive about this. The consultant agreed to investigate the three moles and it turned out that the first two were benign but the third was cancerous. Mr C was concerned that the consultant had not taken his fears seriously, and said that had he not pursued the matter it could have had serious consequences for him.

As part of our investigation we took independent advice from one of our medical advisers. They said that clinicians have to use their clinical judgement in a reasonable manner. In this case, the consultant thought that only two moles required further consideration but in view of the concerns raised at the appointments, she agreed to also look at the third mole. The adviser said that it can be difficult for clinicians to determine whether a mole looks problematic, and whether there is a need for further investigations. Although the consultant did not have any immediate concerns about the third mole, she did agree to further investigation when it was pointed out to her, and the result confirmed Mr C's concerns. We found that the consultant acted appropriately on his concerns, and found no evidence that she failed to exercise her clinical judgement in a reasonable manner.

Summary

Miss C complained that her dental practice had decided to remove her from their patient list without providing her with treatment for a three month period in accordance with national guidance. She also told us that she made a complaint to the practice in 2012 and that she had not been told the outcome.

We found that, although the practice had the right to give notice of removal from the list, they also had a statutory duty to provide dental treatment for a three month period after their decision. Their final letter to Miss C did not mention this, and so gave the impression that termination would take effect immediately. We also found that the practice did not deal with the previous complaint appropriately and should have told Miss C of the outcome of their investigation into that complaint.

Recommendations

We recommended that the practice:

• remind staff of their obligation to provide dental treatment for a period of three months after their intention to withdraw from a continuing care arrangement and to communicate this to the patient;
• apologise to Miss C for the failure to explain that dental treatment would continue for a period of three months or until she registered at another dental practice;
• remind staff of their obligations under the NHS complaints procedure; and
• apologise to Miss C for the failure to respond to her complaint in an appropriate manner.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she went to an out-of-hours GP service. Mrs C said that the doctor there did not properly assess Mrs A's new symptoms and consider them in the context of her recent medical history. Two days later, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that the doctor had made reasonable records of her examination of Mrs A, and had recognised the important details of Mrs A's recent medical history. She had made logical and reasonable decisions, which were in line with current guidance. Although we recognised that Mrs A's death was sudden and unexpected and caused great distress to Mrs C and her family, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment given to her late mother (Mrs A) when she attended an emergency appointment at a GP practice. She said that the doctor concerned did not take proper account of Mrs A's recent medical history, nor did she examine her legs but merely accepted Mrs A's home GP's diagnosis of phlebitis (inflammation of the vein). Mrs C said that this was a missed opportunity to consider a diagnosis of deep vein thrombosis (a blood clot in a vein). Shortly afterwards, Mrs A died of a bilateral pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs).

The complaint was investigated and all the relevant information was taken into account including the complaints correspondence and Mrs A's relevant clinical records. We also took independent advice from our GP adviser on Mrs A's care and treatment. We found that Mrs A had been appropriately examined and that the symptoms and examination had led to the GP making a reasonable diagnosis of phlebitis. All of this was clearly noted in Mrs A's records. We noted that the practice had since carried out a significant event analysis and looked again at their protocol for assessing leg pain.

Summary

Mr C, a member of the Scottish Parliament, complained on behalf of one of his constituents (Ms A) about the care and treatment she received following an operation at Gartnavel General Hospital. He said that the plans for Ms A's discharge home were inadequate and that there was a failure to ensure that she was technically able to deal with the catheter (a thin tube used to drain and collect urine from the bladder) that was a consequence of the operation. He also complained that there was a failure to review her in a timely manner, that arrangements for reviews were confused, that Ms A's concerns about her operation were dismissed and that the operation had not greatly improved her condition.

The complaint was investigated and carefully considered all the relevant documentation (including all the complaints correspondence and Ms A's clinical records). We also obtained independent advice on Ms A's care and treatment from one of our medical advisers, a consultant urological surgeon (dealing with issues of the urinary tract).

Our investigation showed that the clinical aspects of Ms A's care and treatment were reasonable, as were her discharge plans. We found no evidence to suggest that her concerns about her operation had been dismissed. However, plans to review her were frustrated by confused administration and poor communication between departments which no doubt caused Ms A unnecessary stress and inconvenience at what must have been a difficult time. This was unacceptable and amounted to a service failure, and we upheld the complaint.

Recommendations

We recommended that the board:

• make a formal apology to Ms A for the added stress she experienced;
• confirm to the Ombudsman that procedures for making x-ray appointments are now effective and robust, and advise of the actions taken to ensure this; and
• advise the Ombudsman that they are satisfied that the communications problems affecting Ms A's appointments have now been addressed.

Summary

Ms C said that when she attended for her six-monthly check up at the dental practice, she reported a problem with a tooth where she had previously had root canal treatment. The dentist said that she had a slight infection and that she needed more work on the tooth. Ms C then complained that the treatment was not carried out in a reasonable way, and that the dentist had not had a proper x-ray done before starting the work. When Ms C raised these matters with the dentist, she said he behaved inappropriately and removed her from his list.

After obtaining independent advice from one of our dental advisers, we did not uphold Ms C's complaints. The adviser said that the records showed that an x-ray was taken to establish the working length of the tooth and the length of the filling required. This x-ray did not need to be ready on the day it was taken, but on the day the filling was to be done, and was the x-ray that Ms C (incorrectly) thought had not worked. Ms C also got an infection in the tooth, which was not uncommon, and the dentist had treated it appropriately with antibiotics. Ms C had disputed her care with the dentist and did not accept his explanations about it. The dentist then decided that in his view, as the trust between them had broken down, it would be more appropriate for Ms C to change dentist. Our investigation confirmed that, given the circumstances, he was entitled to do this.

Summary

Ms C, who is an advocacy worker, complained on behalf of her client, Mrs A. Mrs A went to her dentist with toothache. She was examined, but decided not to have treatment because of the complexity of the problems. Early the next month, the dentist referred Mrs A to the dental hospital. They referred her there again about two weeks later for an emergency appointment, and made a further referral some four days after that. The assessment consultation for this last referral was not until two months after the date of referral. Mrs A said that despite then going to the dental hospital a number of times, she did not receive appropriate treatment until some eight months after she first went to her dentist with toothache. Throughout this period, she made a number of calls to NHS 24 because she was in considerable pain.

Mrs A complained about the delay in treatment, and said her dentist provided all relevant information to allow treatment to proceed at the time of the third referral. She said that the delay was particularly unreasonable because she was pregnant and in pain.

We took independent advice on this case from one of our dental advisers. They said that while the board failed to meet the national 18-week target in relation to the third referral, they did tell Mrs A of the likely delays, and provided advice about what she could do to be treated more quickly. The adviser also said that Mrs A's pregnancy did not necessarily mean that she was a priority patient, and that it was the responsibility of her dentist to manage her pain while waiting for treatment. In light of the board's failure to meet the target, we upheld the complaint but we did not make any recommendations as the board have introduced a new system for appointments, with the aim of ensuring that target times are met in future.

Summary

Mrs C complained that she saw a nurse at her medical practice twice to report a lump on her breast but nothing was done. In between these appointments, she attended a mobile breast screening clinic for a mammogram (an x-ray of the breast) and, after being recalled for further investigations, she was diagnosed with breast cancer. When she raised concerns with the practice about not being referred, they said there was no trace of the first appointment having taken place. They also said that at the second appointment the nurse did not consider that any action was necessary, as Mrs C's mammogram was already being followed up by the breast clinic.

We took independent advice from our GP adviser who, having reviewed the records, confirmed that there was no evidence of the first appointment taking place. He could see no apparent discrepancies in the records and noted that the practice appeared to have conducted a thorough search. With regards to the second appointment, he advised that there would have been no merit in the practice taking further action as Mrs C was already in the screening system and was awaiting follow-up. In the circumstances, we did not uphold the complaint.

Summary

Ms C complained that after reconstructive breast surgery, there was an avoidable delay by staff at the Royal Alexandria Hospital in diagnosing that she was suffering from a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue). She said that she complained several times to staff at the hospital that there was a large protrusion on her waist on the side of the reconstruction and that she was in pain, but that this was not addressed appropriately. Ms C also said there was an unreasonable delay of five months between an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body) that showed there was a problem, and a CT scan (a scan that uses a computer to produce an image of the body) that confirmed she had a hernia.

We obtained advice on this case from one of our medical advisers, a general surgeon with a specialist interest in breast surgery. The adviser said that in the 12 months following surgery, the board acted in an appropriate and reasonably timely manner in dealing with Ms C's symptoms, as the likelihood was that the underlying cause of the pain and swelling was commonly recognised complications of her surgery. The adviser said it would not have been acceptable to carry out surgery based on the results of the ultrasound, without a CT scan to help identify the problem.

The adviser confirmed, however, that there was an unacceptable delay between the ultrasound report 12 months after surgery and the CT scan report that confirmed the hernia more than five months later. Ms C suffered a prolonged period of pain and discomfort from her hernia as a result. The adviser noted that Ms C's hernia was recorded by the board as having increased in size during the three months following the ultrasound report. However, he explained that such hernias were generally slow growing, wide necked and very rarely life threatening and that the delay did not change the final outcome in Ms C's case.

Recommendations

We recommended that the board:

• feed back our decision on this case to the staff involved to ensure that a similar situation does not occur in future; and
• provide Ms C with a written apology for the failures identified in our report.