Health

Summary

Mr C complained on behalf of Mr A about the care and treatment he received at a hospital. Mr A had attended the hospital's accident and emergency department (A&E), complaining of dehydration, frequent urination, vomiting and lack of energy. Mr A had also said that his eyesight was blurry and he had a dry mouth. After tests, Mr A was diagnosed with a virus and a low salt count, and discharged. Two days later, Mr A became ill during a journey and was taken to hospital where he was immediately diagnosed as having type 1 diabetes. He was in hospital for about a week. Mr C complained that Mr A was not properly diagnosed during his initial hospital visit.

Our investigation took account of all the available information, including the complaints correspondence and Mr A's medical records. We also obtained independent medical advice. We found that not all the tests that should have been carried out were carried out. This meant that Mr A's condition was not properly diagnosed and he was discharged from A&E too early. Our investigations also showed that the board had not addressed all the complaints Mr C put to them on behalf of Mr A.

Recommendations

We recommended that the board:

• apologise to Mr A for their failure to carry out appropriate diagnostic testing;
• apologise for failing to correctly diagnose Mr A and for discharging him prematurely;
• confirm that the GP specialist trainee raised this case as a significant event at her appraisal;
• confirm to the Ombudsman that they are satisfied that the systems failure that allowed a patient to be discharged from A&E before test results were reviewed has been remedied;
• apologise to Mr C and Mr A for failing to admit when responding to the complaint that there had been faults with regard to Mr A's care and treatment; and
• apologise for their failure to respond to the complaint about the way in which Mr A was spoken to.

Summary

When Mr and Ms C's young daughter became ill, they took her to their medical practice. She was examined by a GP, who said that she was suffering from a yeast infection and nappy rash. Later that day Mr and Ms C's daughter’s condition deteriorated and she was taken to hospital, where she was diagnosed with scarlet fever. Mr and Ms C complained to the practice that the GP did not diagnose their daughter correctly. The practice responded but Mr and Ms C felt that the response was inaccurate and did not deal with the complaint.

As part of our investigation, we took independent advice from a medical adviser. He explained that the diagnosis of scarlet fever is rare, and that there was evidence that the GP had taken appropriate steps to diagnose Mr and Mrs C's daughter's condition. Taking this into account we did not uphold the complaint.

When investigating the complaint about the practice's complaints handling, we looked at the practice's complaints procedure and response. We found that the practice had not followed their complaints process. We also found that the GP had not written detailed medical notes which meant that the practice's response was incomplete. We, therefore, upheld this complaint and made recommendations to address these failings.

Recommendations

We recommended that the practice:

• ensure that all relevant members of staff reacquaint themselves with the practice complaints procedure and ensure that they follow it; and
• ensure that the GP concerned is aware of the General Medical Council guidance on record-keeping.

Summary

Mr C was on holiday when he was taken ill while on a moored boat. He called 999 but was told that as his condition was not life-threatening he should call NHS 24. When he did so, they said they would ask an out-of-hours doctor at a local hospital to call Mr C within an hour. Mr C complained that the out-of-hours doctor would not arrange an ambulance to take him to hospital, and instead gave him the number of local GP surgeries he could contact. Mr C said that he was in great pain and could not walk, but with assistance managed to get back to his holiday home. When he got there, an ambulance was called and Mr C was taken to hospital. Mr C felt the out-of-hours doctor should have arranged an ambulance to take him to hospital in the first instance.

Our investigation found that there was a difference of opinion between the out-of-hours doctor and Mr C about his ability to get off the boat, but the information in the records did not help us resolve this. We took independent advice from one of our medical advisers, who said that there was no evidence to suggest an emergency ambulance was required, and that the out-of-hours doctor had provided appropriate advice. This was that, should Mr C's condition worsen, he should contact the emergency service again. It was also appropriate for the out-of-hours doctor to suggest that Mr C should contact a general practitioner who might have been willing to visit him on the boat.

Summary

Mr C hurt his foot while gardening. He complained that the board did not diagnose that it was fractured despite two visits to a hospital accident and emergency department (A&E). When he first attended A&E, Mr C was recorded as limping but able to bear weight on his injured foot. The records showed that his foot was sore but with a good range of movement. A bad sprain was diagnosed and Mr C was given advice on how to care for his foot.

Mr C then went on holiday for two weeks. His foot had not improved so on the way home he went to another A&E. Again the foot was recorded as having a good range of movement and Mr C was able to put weight on it. A rash was also recorded but was put down to a sweat rash, and it was noted that Mr C told staff that he had done a lot of walking on his holiday. Again a bad sprain was diagnosed. Mr C's foot was not x-rayed during either visit to hospital.

Mr C then went to see his GP as he was still having trouble with his foot and now felt it was mis-shapen. The GP arranged an x-ray which revealed that Mr C's foot was fractured. He was referred to an orthopaedic specialist (a specialist in medicine of the musculoskeletal system) who diagnosed that four of the five bones in Mr C's foot had been displaced. Mr C now has to wear orthotic footwear (special footwear available on NHS prescription) to accommodate his mis-shapen foot. Mr C was also unhappy that the board would only provide two pairs of footwear and would not provide specialist footwear such as Wellington boots; gardening boots; or sandals.

Our investigation, which included taking advice from an independent adviser specialising in emergency medicine, concluded that it was reasonable that

x-rays were not taken and that the fracture went un-diagnosed. The adviser pointed out that there should always be clear clinical indications of the need for examination by x-ray. In Mr C's case no such clear indications were present - he was able to bear weight and although his foot was painful and swollen, it had a good range of movement. The adviser commented that this type of dislocation is a relatively rare injury and so, in the circumstances, it was not unreasonable that it was not diagnosed at the time. On the matter of the orthotic footwear, we found that the board’s guidance reflects national guidance issued by the NHS in Scotland, and that it was reasonable for them not to provide more than two pairs.

Summary

Mr and Mrs C's son was admitted to hospital for surgery to correct a squint. He was discharged the same day but had to be re-admitted three days later as his eye had become infected. Mr and Mrs C were unhappy that their son has since had to endure the pain and trauma of five further operations, and that despite these, the prognosis for his eye remains poor.

Mr and Mrs C were critical of the care and treatment given to their son both during and after the operation. They said that his eye should have been patched immediately afterwards, which would have prevented infection. They also maintained that as the infection was so rare, medical staff involved were uncertain about treatment and had been unable to predict any degree of success for any of the procedures undertaken.

Our investigation took into account all the relevant information, including complaints correspondence and the relevant clinical records. We also took independent advice from a medical specialist in paediatric ophthalmology (the anatomy, physiology and diseases of the eye in children).

Our adviser said that the decision to operate was correct, that all the procedures undertaken were reasonable and appropriate, and that the care and treatment provided were satisfactory. He did not consider that the lack of an eye patch had had any effect. However, he said that Mr and Mrs C could have been given a more detailed explanation about how the infection had occurred. He said it was unclear from the records what had or had not been discussed with them, and that the consent forms used did not provide space to record the aims or possible risks or complications of an operation. We did not, therefore, uphold Mr and Mrs C's concerns about their son's treatment, although we did uphold their complaint that the explanation given was not reasonable.

Recommendations

We recommended that the board:

• apologise to Mr and Mrs C for failing to provide a full explanation; and
• satisfy themselves that their consent forms are adequately formatted to allow the recording of information about the aims and risks of surgery.

Summary

Mr C complained he had been removed unreasonably from his medical practice's list of patients.

Our investigation found that he had not been removed in line with the legislation about this, as he had not been given a warning about possible removal. We, therefore, upheld the complaint but made no recommendations because the practice had already taken action that we considered appropriate. They had apologised, acknowledged that he should have received a warning, explained that they had taken action to ensure such an omission would not recur, and told him that, although he had now registered elsewhere, he could return to the practice if he wished.

Summary

Ms C said she was discharged from hospital and issued with medication. She complained that she had visited her GP nine days later to ask for a further prescription but he had told her that the hospital discharge form said she had been issued with sufficient medication on discharge. To check this, the practice called the hospital and a nurse confirmed that Ms C had been issued with the quantities of tablets stated on the discharge form. The GP, therefore, refused to issue her with a prescription.

Ms C phoned the ward and spoke to a nurse who told her that the amount of tablets she had received on discharge had been wrongly recorded and that the nurse would phone the GP to explain the mistake and ask him to issue her with a prescription. We did not uphold the complaint about the practice, as we found that the health board had accepted full responsibility for the error on the discharge form and that the GP had acted reasonably and appropriately.

Summary

Mrs C complained that the board took an unreasonable length of time to offer her a hospital appointment to have her contraceptive coil (a device used to prevent pregnancy) replaced. The board accepted that an administrative error meant that a clinic did not send the referral letter to the hospital, which caused a delay of over three months.

We upheld the complaint, but noted that the board had apologised to Mrs C. Following the complaint, they also changed the administrative support arrangements at the clinic and are in the process of implementing an electronic system for the transfer of information. We, therefore, did not find it necessary to make any recommendations.

Summary

A company acting on behalf of Ms A complained about the management of her throat condition in hospital. They said that, during a tonsillectomy (surgery to remove the tonsils), the uvula (the tissue suspended from the soft palate) at the back of her throat had been removed. Ms A said that the quality of her voice had since changed and that she had difficulty swallowing. In response to the complaint, the board said that they had not removed the uvula but that atrophy (wasting away) of the uvula, while unusual, was a recognised complication of this operation.

Our investigation took account of all the available information, including all the complaints papers and Ms A's relevant medical notes. We also obtained independent advice from a consultant ENT (ear, nose and throat) surgeon, who considered the notes about Ms A's operation. The adviser was satisfied that both the operation and the aftercare given to Ms A were satisfactory. He said that in his view the uvula had not been removed but that rather Ms A's tonsillectomy had led to some scarring of her soft palate. He said that it was likely that this caused the soft palate to tighten, and led to Ms A's concern that her uvula had been removed and to the changes in her voice.

Recommendations

We recommended that the board:

• contact Ms A further in relation to addressing any continuing symptoms.

Summary

Mrs C, an advocacy worker, complained on behalf of Ms A about the care and treatment she received at the dental practice when her upper right second molar was extracted. After the extraction, Ms A experienced extreme pain. Her face started to swell and she felt physically sick. She contacted NHS 24 and attended the dental hospital for treatment. Ms A said that the dentist had failed to explain the risk associated with the removal of the tooth and made an error when extracting the tooth. She also felt the dentist had not provided an adequate response to her complaint.

We upheld two of Ms C's three complaints. Our investigation found that the dentist had failed to explain the risks involved, and we noted that x-rays were not taken, after difficulties with the extraction were recognised. We also found that there was not enough detail in the dental records and that, while the dentist provided accurate information in responding to Ms A, the response was incomplete because of the inadequate level of detail. However, we found no evidence that an error was made when extracting the tooth, and noted that the complications that occurred were a well recognised complication of the extraction of upper molars.

Recommendations

We recommended that the dentist:

• apologises to Ms A for the issues highlighted in our investigation;
• reviews her clinical dental practice in relation to this complaint, taking into account our adviser's comments, and provides the Ombudsman with confirmation that she has done so; and
• ensures that dental records are in accordance with General Dental Council standards including obtaining informed consent.