Health

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.

Summary

Mr C had surgery at Inverclyde Royal Hospital in July 2011 to fix a finger flexion (where one or more fingers start to bend into the palm of the hand) of the right little finger. Afterwards, Mr C was given a splint for his finger, and started physiotherapy. In early August, the surgeon noted that the wound had healed. Mr C was discharged from physiotherapy later that month. The discharge report was, however, dated early October. It outlined the physiotherapy treatment provided, said that the range of movement had worsened and noted that Mr C was happy to continue with exercises at home. In September, the surgeon saw Mr C and noted that his little finger had stiffened up dramatically, and had no movement at the middle joint. His ring finger joint had also stiffened. The surgeon also noted that Mr C had returned to work and had stopped wearing a splint at night. Mr C was referred to a hand therapist and for further splinting, which did not take place, and he then sought a second opinion.

Mr C complained to us that he cannot use the finger, and another finger is now bent over. He said that within weeks of starting physiotherapy, the physiotherapist advised him that nothing more could be done and discharged him to the care of the surgeon. Mr C said he is now in constant pain and may have to have further surgery. He said that he believed the operation was not successful.

We took independent advice on Mr C's complaint from one of our medical advisers. The adviser said that from the evidence available it appeared that the operation was carried out to a reasonable standard, noting that the surgeon believed that the operation was successful, but that Mr C's post-operative rehabilitation was poor. The adviser outlined a number of factors that might explain this, including pre-existing arthritis at the middle joint of the finger; a complication of the operation; a lack of physiotherapy from the end of August, and failure to wear a splint for the recommended period. We noted that Mr C said that he wore the splints as instructed and that the physiotherapist discharged him saying she could not do anything further. The board said that he declined further physiotherapy, but were unable to substantiate this. Moreover, we found that it was some six weeks before the physiotherapist told the surgeon that Mr C's range of movement had worsened, and that physiotherapy had stopped. Our adviser was concerned about this, given its importance to a positive outcome. We recognised that the operation itself appeared to have been carried out appropriately, and that there were a number of factors that could explain the poor outcome Mr C experienced. However, we upheld his complaint because there was no evidence to support the board's view that it was Mr C's decision to stop physiotherapy, and because of the shortcomings in communication between the physiotherapist and the surgeon.

Recommendations

We recommended that the board:

• review their practice relating to the storage of patients' medical records to ensure it accords with the Scottish Government Records Management: NHS Code of Practice (Scotland); and
• ensure the failures identified are raised with relevant staff.

Summary

Mrs C had undergone knee replacement surgery at Woodend Hospital. She was not offered immediate physiotherapy treatment on discharge. At an orthopaedic (involving the musculoskeletal system) out-patient clinic appointment six weeks later, a consultant arranged for out-patient physiotherapy and a further clinic review in six weeks. Mrs C felt that she should have been offered physiotherapy appointments immediately on discharge from hospital, rather than continuing with exercises arranged by the in-patient physiotherapist. The board explained that their standard procedure is that in-patient physiotherapy advice is provided before discharge, and the patient should continue with these exercises until the six week clinic review.

We took independent advice from one of our medical advisers, who said that it is expected that patients would normally follow the exercises set by the in-patient physiotherapist for a period of rehabilitation and then discuss their condition at the orthopaedic out-patient clinic. We found that the practice of not arranging out-patient physiotherapy appointments until after a patient has attended the six week clinic review was accepted practice throughout the NHS and did not uphold Mrs C's complaint.