Health

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.

Summary

Mrs C, an advocacy worker, complained on behalf of Mrs A. Mrs A had given birth to her third child twelve days after the date on which the baby was expected. The board said that before the birth, Mrs A had only minor problems and so she was on a low risk pathway. The plan was for the baby to be born with the use of an epidural (spinal pain relief) but as labour progressed, the baby began to show significant distress and so was delivered by caesarean section under general anaesthetic. Within a few minutes, Mrs A began to suffer heavy bleeding, and needed a hysterectomy (surgery to remove the womb) to control this. Unfortunately, during this procedure Mrs A suffered damage to her urinary system, which needed further surgery. She had a slow recovery and was not discharged home for several weeks. Mrs C said that Mrs A suffered psychologically because of these events and that not enough was done to prevent them from happening.

Our investigation took into account all the available information, including the complaints correspondence and the relevant clinical and nursing records. We obtained independent advice from relevant consultants in all the areas relating to Mrs A's concerns, and from a senior matron in a maternity unit.

The board had sympathised with the difficult time Mrs A experienced and had apologised that aspects of her care had caused her concern. They acknowledged that the events of the delivery and what had happened after it had been difficult for Mrs A, but said they were of the view that everything that had been done had been in the best interests of her and her baby.

We did not uphold Mrs A's complaints about her care and treatment before and during the birth. We found that the clinicians involved in Mrs A's case had done nothing that contributed to her serious and life threatening condition. Our advisers said that all the procedures carried out were reasonable and had been appropriately administered. Although Mrs A felt that her husband had not been properly updated about her condition we concluded that this was reasonable, as the clinician's first responsibility had been to save Mrs A's life.

Overall, we found that Mrs A's care was generally reasonable. However, one of our advisers said that, once Mrs A was returned to a ward, it would have been appropriate to reassess her situation with regard to transferring her to a single room, particularly in view of her prolonged stay in hospital. The adviser also noted that an error was made with an injection and that Mrs A had been discussed publicly. These things should not have happened. We, therefore, upheld her complaint about the care she later received in the maternity ward and made recommendations to address this.

Recommendations

We recommended that the board:

• apologise to Mrs A for their shortcomings in this matter;
• emphasise to staff the importance of ensuring that discussions between professionals about an individual's care needs are kept private; and
• remind nursing staff to take account of individual patients' needs when allocating single rooms.

Summary

Mr C fractured his leg in several places. He was admitted to hospital and had an operation. The consultant reviewed Mr C the next day. Mr C had a change of plaster cast and was advised not to put weight on his leg. Mr C's medical records noted the following day that he was not complying with the non-weight bearing instructions. He was discharged several days later.

Mr C's first out-patient appointment early the next month was cancelled and he was seen towards the end of that month. An x-ray taken at that appointment showed that the tibia (large bone in the leg) was misaligned. The board told Mr C that the consultant's opinion was that the misalignment was likely to have been the result of Mr C bearing weight on his leg contrary to advice. Mr C told us that this unreasonably blamed him for problems with his leg. Mr C sought an acknowledgement that things went wrong during his operation and an apology from the board. He said that as a result of the board’s failures, he will suffer pain permanently.

Our investigation included taking independent advice from one of our medical advisers. We found that the operation was performed to a reasonable standard and that it was likely that a number of factors, including the severity of the fracture, led to the misalignment. Mr C was concerned about the misalignment, but the advice we received and accepted is that it was within reasonable limits. We also found evidence in Mr C's medical records that he was not complying with the advice to put weight on his leg, and we were satisfied that the board's response reflected what was in these records. We appreciated why Mr C was unhappy with the way in which the board's first response was worded, but found that they had later assured him that they were not accusing him of wrongdoing but, rather, had recognised that he could not comply fully.

Summary

Mr C raised a complaint about how a dental practice had handled his representations about treatment that he had received by a dentist at the practice. Although it was difficult to establish the exact sequence of events after Mr C complained, our investigation found that the practice had not handled his complaint in line with their complaints procedure and we upheld his complaint.

Recommendations

We recommended that the practice:

• review their procedures to ensure they deal with complaints in accordance with the NHS complaints procedure; and
• apologise to Mr C for their handling of this complaint.

Summary

Mrs C complained on behalf of her brother (Mr A) that his hip replacement operation was unreasonably delayed. Mr A's consultant put him on the waiting list for surgery. Mr A waited 13 weeks before receiving a phone call offering him an appointment for surgery in the Greater Glasgow and Clyde health board area. As Mr A had not discussed this option with his consultant, and as he had significant difficulty in mobilising, he said he would prefer to wait for a local appointment. Mr A and Mrs C then wrote to the board asking for all further communication about Mr A's care to be via Mrs C. Unfortunately, the board did not receive this before they called Mr A again and offered him an appointment in the Tayside health board area. Again, Mr A refused this and said he would rather wait for a local appointment.

Mrs C complained that Mr A's treatment was unreasonably delayed. We upheld her complaint, as there was no evidence that Mr A was told or had any discussion with his consultant about the possibility of having to travel for treatment. On this basis, we took the view that it was unreasonable to offer him treatment outside his local health board area. He was, therefore, not provided with any reasonable offers of treatment within the 18 week target time. Mr A's surgery was eventually carried out 26 weeks after he went on the waiting list, and we did not consider this to be reasonable.

Since Mr A's treatment, there have been several changes in local and national policy and practice, including the implementation of new legislation relating to waiting times. As these changes have addressed many of the shortcomings that led to this complaint, we did not make any recommendations.

Summary

Mr C complained about a range of issues related to his late wife’s (Mrs C) medical and nursing care and treatment while she was in hospital. Mrs C became terminally ill and died shortly afterwards, having been admitted to another hospital for palliative care.

Our investigation established that it would not be possible to prove the facts in relation to a number of Mr C's complaints because he and the board disputed what had happened, or what had been said, and Mrs C's clinical records did not cast any light on this. In cases where it is very unlikely that we would be able to establish enough facts to reach a robust conclusion, it is not our practice to look further into a complaint.

In respect of other parts of Mr C's complaint, we considered that the board's responses (which were given in two letters, at two meetings and through a number of phone conversations and emails) showed that their investigation had been reasonable and they had made significant efforts to give him a large volume of detailed information. They had taken his complaints seriously and took action to improve various areas of their practice, even where they had been unable to prove his allegations. Overall, however, we could not reach a finding on Mr C's complaint because of a lack of evidence.