Health

Summary

Mr C had a hernia operation, but was admitted to hospital a week later with severe pain in his testicles. It was discovered that the blood supply to one of his testicles had been cut off and it had to be removed. The surgeon said that the obstruction in the blood supply had been caused by a combination of the hernia operation and a vasectomy that Mr C had previously had. Mr C complained to us about the standard of the hernia repair surgery.

We found that the hernia operation Mr C had was the standard procedure. Our medical adviser said that the operation note was a well-completed document that complied with good surgical practice. We also found that it was appropriate that the operation was carried out by a suitably experienced junior doctor under the direct supervision of a surgeon. Damage to the blood supply to a testicle is a recognised, but rare, complication of hernia surgery. If a testicle does not have any blood supply, it has to be removed. However, our adviser said that there was no evidence that Mr C's earlier vasectomy had been a factor in the complication he suffered and we told the board this.

Mr C also complained that the board failed to adequately communicate with him before and after his surgery. We found that the consent forms for the operations had been completed appropriately. The surgeons also recorded that they met Mr C before and after the operations to discuss the procedures. Mr C disputed this and his version of events clearly conflicted with the surgeons. However, there was no clear and objective evidence to support his complaint about this matter.

Summary

Mr C complained about the care and treatment provided by his dentist in 2010. He said that a denture and replacement filling were not completed properly, and that an existing cavity (area of decay) was not discovered and/or treated.

We upheld Mr C's complaint, as our investigation found that the treatment was not of a reasonable standard. We took independent advice from our dental adviser, who commented that there was no record in Mr C's dental notes of the purpose of his first appointment with the dentist. Although the next three appointments followed what would be considered best practice, the adviser said that there appeared to be problems with the denture from the start. She also noted that subsequent adjustments appeared only to make matters worse. There was a lack of detail in the notes about a treatment plan or discussion of treatment options relating to the filling. The adviser was concerned that the filling was done after the construction and fitting of the new denture and said that normal practice would have been to do the filling first.

On the matter of the undetected cavity, the adviser said that this was likely to have been present during the treatment but might not have been visible in the mouth. It should, however, have been detectable on an x-ray. She noted that the later removal of this tooth by Mr C's new dentist caused further problems with the denture. X-rays were taken in May 2010 but the records do not make it clear what type they were; on which teeth they were taken or the reason for taking them. The adviser said that Mr C had had considerable work done on his teeth since these x-rays and further x-rays should have been taken before making the denture, as these might have revealed the cavity.

Overall, the dental adviser was concerned that the standard of the records did not conform to that expected by the General Dental Council or the Faculty of General Dental Practice (UK).

As the practice waived the cost of treatment after Mr C complained to them, we made no recommendation about this, although we did make recommendations to address the other failures our investigation found.

Recommendations

We recommended that the dentist:

• reviews her practice in relation to this complaint - this to be discussed at her next annual appraisal;
• reviews the standard of her record-keeping with particular regards to the level of detail of the treatments undertaken and discussions on treatment options and consent - this to be discussed at her next annual appraisal; and
• issues a written apology for the failings identified.

Summary

Mr C complained about the care and treatment received from his dentist, including that: a root canal treatment was not completed properly; despite requesting a white filling the filling provided was grey; the dentist allowed bleach from a syringe to spill on to Mr C's suit and allowed the syringe to fall on to Mr C's thigh.

We upheld Mr C's complaint. Our investigation, which included taking independent dental advice, found that the root canal treatment (a deep filling of the root of a tooth) was not completed properly. Our adviser said that the dentist should have used a rubber dam, which would have protected Mr C's gums from the hypochlorite (bleach) used during the treatment. The adviser was also of the opinion that, although the end result could be deemed acceptable, the root filling was slightly short of the tip of the root canal. She was also concerned at the lack of detail in the dental notes, including a failure to document the working lengths of the canals or what substance was used to wash them out.

On the matter of the type of filling used, the adviser stated that it would be normal practice within the NHS to use an amalgam (grey or silver) filling. She said that white fillings can be provided but that this would be on a private basis. The adviser also commented that it is considered best practice to restore a root filled tooth with a crown (a metal and/or porcelain restoration made in a laboratory which covers the tooth) and that all the various options should have been discussed with Mr C. However, we found no evidence that this was done. Overall, the dental adviser was concerned that the standard of the records did not conform to that expected by the General Dental Council or the Faculty of General Dental Practice (UK).

On the matter of the incident with the syringe, the dentist acknowledged that this had happened but he could not at the time of the investigation, some two years after the incident, recall exactly what had happened. He acknowledged that the bleach had damaged Mr C's trousers, and that Mr C had complained about it. The dentist said that he apologised to Mr C at the time and offered a compensatory payment, which Mr C accepted. In the circumstances, we took no further action on this element of the complaint.

Recommendations

We recommended that the dentist:

• reviews his practice in carrying out root canal treatments with particular regard to the use of rubber dams - this to be discussed at his next annual appraisal;
• reviews the standard of his record-keeping with particular regard to the level of detail of the treatments undertaken and discussions on treatment options and consent - this to be discussed at his next annual appraisal; and
• issues a written apology for the failings identified.

Summary

Miss C had her tonsils removed. After the procedure, she was in a great deal of pain and unable to eat and drink. Five days after the procedure, she went to see her GP about these symptoms. Miss C said that her GP just looked at the back of her throat and did not take her temperature or carry out any other tests. Miss C also said that her GP suggested she should go to the ear nose and throat (ENT) ward if she had any further problems, although her understanding was that she could not do this. The GP diagnosed post-operative pain and muscle spasm and prescribed strong analgesia (pain relief) and anti-inflammatory gargles (solutions used to treat throat conditions).

We upheld Miss C's complaint and made two recommendations. Our investigation found that, while the GP's diagnosis and the medication prescribed were reasonable, his advice to attend ENT was not helpful.

Recommendations

We recommended that the practice:

• review their actions in light of the findings; and
• apologise to Miss C for the failings identified.

Summary

Mrs C, who is an advocacy worker, complained on behalf of her client (Mr A) that the board did not make information about NHS continuing healthcare publicly available. Mr A had disputed the grounds on which his late father was considered liable for care home fees, as he felt that his father's placement related to health needs rather than social care needs. At the time of the placement, Mr A was not told that the NHS could fund care costs in care homes. Our investigation found that Mr A's father had been placed temporarily in the home for respite care, and he did not require an emergency hospital admission. The decision was then taken to make the care home placement permanent and health board staff were not asked to contribute to any assessments. The board accepted that at the time of the placement they had not made information about NHS continuing healthcare publicly available. They had since done this, and had apologised to Mr A.

Summary

Mrs C, an advocacy worker, complained on behalf of Miss A, who had hurt her leg by tearing her anterior cruciate ligament (ACL) in a skiing accident in March 2010. Miss A was referred to the hospital where she was seen by a consultant orthopaedic surgeon, who arranged for her to undergo ACL reconstruction surgery about seven months after the accident. Screws were used to reattach tendons between her knee and thighbone.

Two months after the operation, Miss A fell and hurt her knee again. She went to an accident and emergency (A&E) unit and was referred back to the consultant. X-rays taken at A&E showed that the screw in Miss A's thighbone had become dislodged. However, due to the amount of pain she was in, and the level of swelling, the consultant was unable to carry out a full examination. He noted that Miss A had a good range of movement and concluded that the screw was likely in the soft tissue, holding the ACL reconstruction in place. A few days later, Miss A's pain increased and her knee began to lock. She returned to A&E where further x-rays found that the screw was inside her knee joint. Surgery was arranged to remove it and to re-do the ACL reconstruction.

After taking independent advice from our medical adviser, we upheld this complaint. We found that there was very little detail recorded at the time about what procedure the consultant initially performed. However, from the x-ray evidence we were able to establish that the ACL reconstruction had been placed in a less than satisfactory position. We also found that the advice given to Miss A by the consultant after her second fall was inappropriate. Although the x-ray evidence was not conclusive, it was most likely that the screw had migrated into the knee joint, and in any case, it was known that the screw was not in the thighbone. As such, the ACL graft was not performing its intended task and we took the view that revision surgery should have been arranged at that time.

Recommendations

We recommended that the hospital:

• apologise for the issues highlighted in this case; and
• draw our adviser's comments to the consultant's attention.

Summary

Miss C's medical practice were concerned about her compliance with her medication. They had, therefore, previously decided, with Miss C's agreement, to dispense her medication on a daily basis. However, Miss C requested that this be returned to weekly or monthly prescriptions, and she complained when this request was refused. The practice told us that, as they continued to have safety concerns about Miss C's compliance with her medication, they had decided that daily prescribing would remain in place. Having taken independent advice from our medical adviser, we considered this to be a reasonable decision in the circumstances.

Miss C also complained that her medication was no longer being prescribed to her in tablet form. She was receiving a liquid alternative and did not feel it was working as well for her. Although the practice had advised her that the tablet form was no longer available in this country, Miss C identified a drug company who could still supply this. However, the practice noted that this was imported and unlicensed and, therefore, did not agree to prescribe it. Our medical adviser took the view that this was reasonable and said that doctors are discouraged from prescribing unlicensed medication when licensed alternatives are available. In addition, he noted that the medication was very expensive and he did not consider that it would be prudent for the practice to prescribe overly expensive drugs that were not clinically necessary.

Summary

Mrs C was on medication for serious mental health problems. She registered with a new medical practice in 2011, having been stable for a number of years on an existing medication regime. However, the new practice did not obtain her medical records nor make contact with the psychiatrist who had been treating her previously.

In March 2012, Mrs C attended the practice about a non-related medical issue and saw a doctor. During the appointment, the doctor questioned the medication regime and said that Mrs C should undergo a review, as the types of medication she was on could have serious cumulative side effects if taken long term. Mrs C was upset and anxious that the doctor proposed reviewing her medication, given that she had been stable on the regime for a number of years and had had serious difficulties in achieving this stability. She was also upset by the doctor's tone and a number of comments he made during the consultation which she felt were inappropriate when dealing with a patient with mental health problems.

We found that the aims of the consultation were valid and constituted good practice. We were, however, critical that the practice failed to obtain Mrs C's medical records or to contact her psychiatrist, as she had registered with them nearly a year before. We noted that the doctor had written details of his comments in the consultation notes, and that he himself had since accepted that these may have added to her concerns. We were critical of this, and for the fact that he did not conduct an assessment of Mrs C's health at that time, although we recognised this could have been difficult given the nature of the consultation overall. On balance, however, we did not uphold the complaint as we found the aims of the consultation about which Mrs C had complained were reasonable and should have been undertaken earlier. We did, however, make recommendations to address the shortcomings we identified that took place before the consultation.

Recommendations

We recommended that the practice:

• conduct a significant event analysis in relation to Mrs C's treatment; and
• implement a procedure to ensure that all previous medical history and treatment is obtained when registering new patients.

Summary

Mr C complained on behalf of a constituent (Mr A). He complained about the board's decision to refuse funding for Mr A's weight-loss surgery to be carried out by another health board.

Mr A had serious concerns about the care and treatment he received from the board, when he was admitted to hospital previously. As a result, during the past few years, his GP had referred him for treatment, including weight-loss surgery, to a hospital in another health board area. The hospital offered Mr A weight-loss surgery but said that it would have to be funded by his local health board. The local board decided not to approve Mr A's application for funding and instead offered him the weight-loss surgery service that they provided. Mr A, however, believed it would be in his best medical interests for the surgery to be performed outwith his local health board area.

Our investigation found that the board's decision to refuse the funding of Mr A's treatment at another health board was a discretionary decision that they were entitled to take. We cannot look at such a decision unless we find evidence that something went wrong in the way it was taken. We did not uphold Mr C's complaint, as we found that the board followed their procedures and took all relevant factors into account in reaching their decision.

Summary

Ms C complained about the care and treatment she received from a hospital. She outlined eight specific areas of concern, including communication, standard of care, waiting times, lack of after care and competence of staff. She said that she initially went to the hospital with symptoms of bowel disease, but her worsening symptoms suggested a gynaecological problem. She said that after that she experienced other health issues. She underwent an operation and was referred for treatment to another health board. Ms C’s complaint to us also included other issues of concern including misdiagnosis, inappropriate administration of medication and poor complaints handling.

Our medical adviser considered all aspects of Ms C’s complaints and said that she displayed complex symptoms and had had a thorough investigation of her gastro-intestinal tract. She had an ovarian cyst (a sac filled with fluid that forms on or inside an ovary) removed promptly and an area of endometriosis (small pieces of womb lining found outside of the womb) destroyed. We found that medication was appropriately used, communication was effective and Ms C received timely inpatient attention and after care. Having taken account of all the evidence and the advice received, we considered that the board appropriately addressed and responded to all Ms C’s complaints. Although we did not uphold her complaints, we found some delay in advising Ms C's GP of a test result.

Recommendations

We recommended that the board:

• apologise for the delay in sending the results of the echocardiogram test to the GP; and
• take steps to ensure such a delay does not recurr.