Health

Summary

Mrs C had concerns that in 2011 the board had sent us a complaints file which was incomplete and contained inaccurate information about previous complaints that she had raised. We had asked for this file when looking at a previous complaint from Mrs C. (We had decided that complaint was too old for us to look at, so the information from the complaint file did not, therefore, affect that decision.) Mrs C formally complained to the board about the file and, when she received their response, she felt her concerns had not been addressed.

Our investigation found that the board had taken Mrs C's concerns seriously and had conducted a thorough investigation. They provided a comprehensive response about the contacts that Mrs C had made with their complaints team as far back as 2007. They also explained the difference between enquiries, informal complaints and formal complaints, and how they deal with these. We, therefore, did not uphold Mrs C's complaint. However, we found that Mrs C had raised a couple of concerns that would have benefitted from a more detailed response and made a recommendation about this.

Recommendations

We recommended that the board:

• address specific issues raised by Mrs C in her formal complaint.

Summary

Ms C complained that doctors at the practice failed to manage her medication regime appropriately. Ms C was suffering from bi-polar disorder (a condition that affects a person's mood). She was prescribed medication, including lithium (a medicine used to treat mood disorders) and quetiapine (a drug used to treat bi-polar disorder). Her lithium levels were monitored every three months at a special clinic as lithium may interact with other drugs and can cause toxicity (a poisonous effect on the body). She was also monitored by a community psychiatric nurse (CPN) and a consultant psychiatrist every four to six weeks.

On one occasion Ms C went to the practice as she felt she was suffering from toxicity. She saw a locum GP (a doctor in a temporary position at the practice), who did not think that she was but asked her to speak to her CPN to organise a blood test. The CPN told her to go back to the practice, and another doctor did the blood test. The results showed that she was not suffering from toxicity.

After investigating, we did not uphold Ms C's complaint. We took advice from as independent medical adviser, who said that the evidence in the clinical notes showed that it was unlikely Ms C was suffering from toxicity when she saw the locum GP. Although the adviser was concerned that the locum GP asked Ms C to arrange her own blood tests, she considered this to be a misunderstanding about the resources available. In light of this, although we did not uphold Ms C's complaints, we drew to the practice's attention that the adviser had suggested they might wish to consider placing an alert on the notes of patients prescribed lithium, with information on how to obtain urgent blood tests where there is a suspicion of possible lithium toxicity.

Ms C also complained that the practice would not prescribe her extra quetiapine. She was under the impression that her psychiatrist had increased the dose. Having looked at Ms C's clinical notes and the communication between the psychiatrist and practice, the adviser confirmed that the psychiatrist had not further increased the dosage. Ms C also had helicobacter pylori (h-pylori - a bacterium found in the stomach) and complained that the practice had not adequately treated it. The adviser confirmed that the dose and duration of treatment for h-pylori was appropriate.

Summary

Miss C raised a concern about the treatment she received from a hospital dermatology department (a department dealing with skin conditions and problems). In particular, she said that there was an unreasonable delay in diagnosing her condition and in progressing treatment.

After taking independent advice from one of our medical advisers, a senior consultant dermatologist, we did not uphold her complaint about diagnosis. We recognised that this was a difficult and stressful time for Miss C, but we found no evidence that the treatment was not of a reasonable standard in the face of what had been an unusual problem. We did, however, uphold her complaint that there was a delay in progressing treatment. Before we investigated, the board had accepted that Miss C's referral to the plastic surgery team had, in error, not been marked as urgent. As a result, it had been treated as a routine referral and this had resulted in a delay before Miss C was seen by the team. As, however, the board had already recognised this and apologised to Miss C, we did not make a recommendation about this.

Summary

Mrs C's husband collapsed at home and an emergency ambulance was called. Although Mrs C lives near an ambulance station and a hospital, the ambulance sent was not the nearest one at the time, and there was a delay before it arrived. Mrs C's husband later died from a heart attack. The service explained to her that the nearest ambulance was already involved with a patient, and so the next available vehicle was despatched. Mrs C complained to us that the service had not conducted a thorough investigation into what had happened, and that, after she complained to them, it was five months before she received a final response.

Our investigation found that the service had completed a thorough investigation, so we did not uphold that complaint. We did, however, uphold her complaint about the complaints handling, as the board had not sent her regular updates on the progress of the investigation or told her that she could contact us, when the response to her complaint was delayed. We also established that they incorrectly told Mrs C that the investigation was nearing completion, when in fact it had been concluded.

Recommendations

We recommended that the service:

• conduct a review into the time taken to respond to formal complaints; and
• apologise to Mrs C for the time taken to respond to her complaint.

Summary

Mrs C complained about the treatment that the Scottish Ambulance Service gave to her mother (Mrs A). Mrs A, who suffers from rheumatoid arthritis (an inflammatory disorder that mainly affects the joints), had hurt her leg and was unable to put weight on it. She had been in pain for a number of days and Mrs C phoned 999 for an ambulance. However, the person who took the call assessed it as a non-emergency situation, and decided not to send an emergency ambulance.

Our investigation found that this was reasonable in the circumstances, and that it followed the protocol of the medical priority dispatch system. We did note that the call taker had not told Mrs C that there was another route she could use - she could call NHS 24 to see if her mother could be referred to hospital that way. However, as the service had already recognised this omission when investigating Mrs C's complaint, and had taken steps to address it, we made no recommendation about this.

Summary

Mr C complained about various aspects of his treatment by reception staff and the practice manager when he attended the practice on two occasions.

Our investigation found that there had been shortcomings in a number of areas and because of this we upheld the complaint. However, we also noted that the practice had already reviewed what had happened and had identified a number of areas where they could have handled things better. They had taken adequate action to put things right and help prevent these problems from happening again. We did not, therefore, find it necessary to make any recommendations.

Summary

Ms C's daughter (Ms A) suffers from chronic back pain following an accident some years ago. Ms C complained on behalf of her daughter that the medical practice failed to do enough to provide her with appropriate treatment.

As part of our investigation, we took independent advice from a medical adviser. He considered Ms A's medical records, her medical history and the care and treatment provided by the practice. He said that the practice had provided an appropriate level of care and treatment, including tests and treatment options. Although Ms A's pain has not been resolved, the adviser took the view that the practice have taken appropriate steps to try and identify the underlying problem and to provide on-going treatment in order to minimise the pain Ms A is suffering.

Summary

Mr C had been prescribed nitrofurantoin (an antibiotic drug used to treat bacterial infection) for a number of years for a recurring infection. He was then diagnosed with pulmonary fibrosis (a rare condition causing scarring of the lungs), which is a known side effect of nitrofurantoin and the drug was stopped. He complained that his medical practice failed to review his long-term prescriptions of nitrofurantoin appropriately.

The British National Formulary (BNF) provides national guidance for healthcare professionals about the prescribing of medicines. The BNF entry for nitrofurantoin says that lung and liver function should be monitored where someone had been prescribed this long-term. In addition, the General Medical Council (GMC) provide prescribing guidance, which says doctors should ensure that they are familiar with the BNF guidance for medicines they prescribe.

Our investigation found that during medication reviews the practice should have consulted the BNF to look up the long-term effects of the drug that they were prescribing. They should also have asked Mr C if he was having any problems with his breathing and recorded his response to this in the medical records. There was no evidence in Mr C's medical records that they had done so. Mr C also complained that the practice failed to consider the possible implications when he presented several times with breathing or chest problems. We obtained independent medical advice on this and found that the practice had acted reasonably in response to the symptoms Mr C presented with. However, in view of the fact that the practice had failed to consult the BNF about nitrofurantoin, they were not aware of the possible implications of taking the drug on a long-term basis. We, therefore, upheld both complaints.

Recommendations

We recommended that the practice:

• apologise Mr C for the failure to consult the BNF during medication reviews or at any other time to look up the long-term effects of nitrofurantoin.

Summary

Mr C had been prescribed nitrofurantoin (an antibiotic drug used to treat bacterial infection) for a number of years for a recurring infection. He was then diagnosed with pulmonary fibrosis (a rare condition causing scarring of the lungs), which is a known side effect of nitrofurantoin and the drug was stopped. He complained that his former medical practice failed to review his long-term prescriptions of nitrofurantoin appropriately.

The British National Formulary (BNF) provides national guidance for healthcare professionals about the prescribing of medicines. The BNF entry for nitrofurantoin says that lung and liver function should be monitored where someone had been prescribed this long-term. In addition, the General Medical Council (GMC) provide prescribing guidance, which says doctors should ensure that they are familiar with the BNF guidance for medicines they prescribe.

We considered that the practice should have asked Mr C if he was having any problems with his breathing when they were reviewing his medication and that they should have recorded his response to this in the medical records. As there was no evidence in Mr C's medical records that they had done so, we upheld his complaint.

Recommendations

We recommended that the practice:

• apologise to Mr C for failing to record whether they had asked if he was having any problems with his breathing when they reviewed his medication.

Summary

Mrs C complained that the board failed to provide her with appropriate care and treatment when she attended a hospital accident and emergency department (A&E). Mrs C said she had gone to hospital a number of weeks after injuring her ankle. She said she was told that she had a bad sprain, but that she did not need an x-ray as the pain would ease itself. A week later Mrs C went back to hospital in severe pain. A number of x-rays were taken and she was told that her foot was fractured. Mrs C complained that the staff nurse who dealt with her on her first visit to hospital did not check on her while she was waiting and treated her with contempt, as if she should not have been there.

During our investigation, we took independent advice from a medical adviser. He explained that the treatment Mrs C received when she first went to A&E was appropriate, and in accordance with internationally validated and recognised clinical guidelines. He said it was clearly recorded that there was no evidence of bone pain and that Mrs C was able to put weight on her foot. He explained that the absence of bone pain suggested that an x-ray was not required. We did not, therefore, uphold Mrs C's complaint about her care and treatment.

On the matter of the nurse’s conduct, although the board said they had discussed this with her during their investigation of the complaint, they had not recorded what was said, and had taken no statement from her. In response to our enquiries, they obtained an account from the nurse in which they said she accepted that her conduct towards Mrs C had been inappropriate. Although it would have been more appropriate for a statement to have been taken at the time rather than eleven months later, we upheld this element of Mrs C's complaint, as the evidence supported her view that the nurse did not deal with her appropriately.

Recommendations

We recommended that the board:

• apologise to Mrs C for the staff nurse’s conduct towards her; and
• provide the Ombudsman with a copy of the change to their procedure for investigation of complaints.