Health

Summary

Mr C complained about the admisitration processes for outpatient appointments and complaint handling.

The SPSO investigation found that there had been a delay in Mr C being allocated his original outpatient appointment and the board acknowledged this. However, our investigation did not find that the system was 'chaotic' as Mr C claimed. To the extent identified, that is the delayed initial appointment, this complaint was upheld.

On the matter of a verbal complaint made when Mr C attended for an appointment on the wrong day due to a failure to confirm a re-arranged appointment in writing, The investigation could not establish why he was told that a person whom the board have been unable to identify would come to speak to him. No one came to speak to Mr C within 10 minutes at which point Mr C began to suffer chest pains and was taken to the accident and emergency. He was then admitted to a ward for observation for 24 hours. He asked the ward staff to pass a message to Mr A to ask him to come to speak to Mr C on the ward. This did not happen before Mr C was discharged.

Our investigation could not establish who Mr A was. The board told us that there were no male members of the complaints team in the hospital that Mr C had attended. The board tried to establish who Mr A was but no one of that name could be found on the staff lists at the time of the incident.

On the matter of the complaints handling, our investigation found that although some of Mr C's complaints had been responded to in a comprehensive and timely manner there had been some matters that were not addressed. Mr C had also asked to be reassured that the issues he had raIsed had been brought to the attention of senior managers and/or the chief executive of the board. Our investigation established that although the complaints were brought to the attention of the chief executive, Mr C was not informed of this fact. Therefore, to the extent of the failings identified, this complaint was upheld.

Recommendations

We recommended that the board:

• apolgise for the delay in providing the inital outpatient appointment; and
• apologise for the failings identified in the complaints handling.

Summary

Mrs C had a history of tiredness and told us that she had a number of medical conditions. She complained that a medical practice, and one GP in particular, provided her with inadequate care and treatment over a seven year period. Specifically, Mrs C said that the GP; refused to investigate her symptoms; claimed to make referrals which turned out not to be the case which, in her view, prevented other doctors from investigating and treating her symptoms; inappropriately offered her cognitive behavioural therapy (CBT); and inappropriately prescribed and failed to monitor the use of a beta blocker for her symptoms, which Mrs C said almost led to her death.

Mrs C's letters and the medical records showed that the experiences she described were clearly very difficult and distressing for her. However, the GPs and hospital doctors she was referred to had not been able to medically explain her symptoms or find any abnormalities from their investigations. We did not uphold Mrs C's complaint. Our investigation found that the practice explained to Mrs C how they had treated her. Also, our medical adviser did not find any evidence that Mrs C's GP acted unreasonably when investigating her symptoms, making referrals, offering CBT or prescribing the beta blocker.

Summary

Mr C, who is a prisoner, complained that the board unreasonably delayed in providing dental treatment. Although Mr C was waiting to see a dentist before the board took over responsibility for prison healthcare in November 2011, he did not bring the matter to their attention until May 2012. He was seen the following month and the board explained the steps they had taken to reduce waiting times for dental treatment. We considered this reasonable and did not uphold the complaint.

Summary

Mrs A was an elderly woman with cognitive impairment (a condition that affects the ability to think, concentrate, formulate ideas, reason and remember). She was admitted to hospital in April 2011 after falling at home and had an operation to repair a fractured hip. Mrs A developed an abnormally large volume of fluid in her feet and ankles and a leg infection. In July 2011, she was transferred to another hospital for treatment but was considered too frail for an operation and returned to the first hospital several days later. Mrs A was transferred to a third hospital at the end of August and died several months later. Mrs A's daughter (Ms C) complained about numerous aspects of her mother's care and treatment, including wound management and treatment, falls prevention, loss of hearing aids and teeth, the suitability of the ward and failure to carry out a Doppler test to assess her blood flow.

Our investigation found that the care and treatment in relation to wound management and treatment, the suitability of the ward, and failure to carry out the Doppler test was reasonable. There was no evidence to suggest that a Doppler test should have been carried out earlier, and the tissue viability nurse visited Mrs A at frequent intervals, documented their assessments and plans and took into account the overall requirements of Mrs A’s health and wellbeing. On the loss of hearing aids and teeth, we recognised the impact of this on Mrs A, but we were unable to establish how these were lost. It can be very difficult to prevent the loss of such items and we found staff took reasonable action to find and replace them. However, in relation to falls prevention, we found that the hospital failed to adequately risk assess, keep the assessment under review or have a cohesive falls prevention plan as part of the overall care plan.

Recommendations

We recommended that the board:

• take steps to ensure that ward staff comply with guidance on falls prevention; and
• apologise to Ms C for the failures identified.

Summary

Mrs C complained that her late husband Mr A (who had terminal cancer), had suffered during his illness up to his death. Mrs C stated that in her view, she could not believe so many things had gone wrong with the care and treatment Mr A had received from the practice over 17 months. These issues were a failure to follow up Mr A’s admission to a hospital in the board’s area after the hospital had discharged him; that a practice GP had provided incorrect information about Mr A during a home visit and that the practice failed to follow the appropriate processes and procedures when completing the Do Not Resuscitate Form (the DNR).

Our adviser considered all aspects of Mrs C’s complaint and said that Mr A had lung cancer and that it was the responsibility of the hospital clinician that arranged Mr A’s investigation to follow up and act on the results, not the practice.

Our adviser stated that a practice doctor had provided incorrect information during a home visit; however, the practice doctor had speedily corrected this and apologised.

The adviser stated that the DNR Form (as part of end-of-life care), assists with the management of terminally ill people and compliments the expertise of those using it. We took account of the adviser’s advice and considered that the practice had followed the correct DNR procedures. Mrs C’s complaint was partially upheld.

Recommendations

We recommended that the practice:

• re-examine along with the District Nursing Team as a whole, their role in this case within the Liverpool Care Pathway continuous Quality Improvement Programme (to include the completion of the DNR form), to see (and reinforce) if there are lessons to be learned and how they can be applied to prevent such a scenario arising in the future (reference to both complaints 3 and 4).

Summary

Mr C complained about the care and treatment that his late wife (Mrs A) received from her medical practice from early 2010 when she went there complaining of irregular bleeding. He said that it was not until mid-2011 that a diagnosis of endometrial cancer (cancer in the lining of the womb) was confirmed. He said that his late wife's care and treatment had been inadequate and that the relevant guidelines were not followed.

In investigating Mr C's complaint we carefully considered all the relevant information, including the practice’s complaint’s file and Mrs A’s clinical notes. We also obtained independent advice from our medical adviser. The adviser said that this type of illness usually presented after the menopause and was usually benign (not cancerous). However, Mrs A’s case was unusual as it did not fit this pattern and the symptoms of irregular bleeding with which Mrs A presented appeared to indicate that she was starting the menopause. The adviser said that in the circumstances this was not an unreasonable view to take, and that throughout 2010 and early 2011, investigations appeared to bear this out. It was not until after Mrs A had reported that her symptoms were ongoing and was referred to a gynaecologist, that tests confirmed, in June 2011, that Mrs A had endometrial cancer. Her condition deteriorated rapidly and she died in October 2011.

Having taken this advice, we found that Mrs A’s care and treatment had been good, and well within the limits of acceptability. We also found that there had been no delays on the part of the practice and they had followed all relevant national guidance.

Summary

Mrs C attended the medical practice with her son (Master A), who was complaining of a high temperature, sore throat and sore ear. A GP diagnosed a virus, however, his condition worsened over the next few days and they returned to the practice.

During this visit, another GP diagnosed Master A with an ear infection and prescribed antibiotics. The following week, Mrs C and her son returned to the practice and were referred to a hospital for treatment. A doctor at the hospital diagnosed Master A with an abscess and carried out an ear procedure.

The following week, Mrs C returned Master A to the practice as he had pain behind his ear. The GP prescribed more antibiotics, but several days later Mrs C took her son returned as the area behind his ear had worsened. The GP cut the lump to drain it. Mrs C said this was done without any anaesthetic and was painful. Master A's condition failed to improve and when they returned to the practice 11 days later, a GP diagnosed an infection of one of the bones in the ear and advised them to return to the hospital to see another specialist. However, Mrs C took her son to another country for treatment. She said that he was then diagnosed with inflammation of the lymph node and received appropriate care there, and that the condition cleared within two weeks.

Mrs C complained that the practice failed to diagnose the problem accurately. She also said that the ear infection would not have become so severe if the GP at the first consultation had prescribed antibiotics, and that they had failed to take her concerns seriously or to document the consultation.

We did not, however, uphold Mrs C's complaints. After taking independent advice from our medical adviser, we found that the practice's treatment, decisions and management were reasonable, including that the GP did not use a local anaesthetic when cutting the abscess. This is because an anaesthetic can spread the infection to surrounding tissue. We also found no evidence that the GP failed to properly examine Master A or take her concerns seriously at the first consultation, which was clearly documented.

Summary

Mr C complained that a medical practice would not issue prescriptions that he considered were appropriate to accommodate his individual circumstances. Mr C wished, as standard, to receive 56 day prescriptions (not the 28 day prescriptions the practice issued to him), for a long standing medical condition. Mr C had only recently moved to the practice. He also complained that the practice did not deal with his complaint appropriately.

We took independent advice from our medical adviser. After careful consideration of the advice and taking into account that the practice had made Mr C a reasonable offer to try to suit his personal circumstances, we did not uphold the complaint. We also considered that the practice had appropriately addressed Mr C’s complaint in good time. They had not, however, advised him of his right to bring his complaint to us if he wished to do so, which they are required to do. We upheld this aspect of his complaint.

Recommendations

We recommended that the practice:

• ensure that, in any complaint response, SPSO details are included to provide a complainant with the opportunity to contact us if they wish to do so.

Summary

Mr C complained that the board had unfairly invoked their 'Unreasonable, Demanding and Persistent Complaints Procedure' (the procedure) against him as he had made numerous contacts with them over a period of time. Mr C raised concerns that the board were not actioning his requests for information from his clinical records and other matters. Mr C also felt that by having to channel all requests through a named member of staff that this would affect his access to NHS services.

Our investigation found that the board were entitled to invoke the procedure due to the disproportionate amount of contacts which Mr C had made with numerous staff from varying departments. The board previously told Mr C that they would invoke the policy should his behaviour continue and when it did they invoked it. We found no evidence that invoking the policy would affect Mr C's access to NHS services and did not uphold the complaint.

Summary

Mr C complained about the treatment he received from his dentist in 2009. He had problems with a crown on one of his teeth. He said that the dentist told him that it could no longer support a crown, it had to be removed and a bridge structure from a neighbouring tooth would be a remedy. The tooth was removed with difficulty (it took twenty minutes) and a temporary denture was fitted. Particles of bone later broke through the surface of the gum. Nine months later Mr C returned to the practice and saw another dentist as his had left. The new dentist said that the suggestion of a crown and bridge structure was not practicable and that it would cost several thousand pounds to rectify the problem privately. Mr C was shocked at the cost as he had expected that treatment costs would be in the region of several hundred pounds. He complained that the dentist failed to provide him with a reasonable standard of dental treatment and a treatment plan, or to explain the likely costs prior to carrying out the dental treatment.

After taking independent advice from our dental adviser, we found that that the dentist's decision to extract the tooth and the extraction itself were reasonable. We also found evidence that Mr C was provided with a treatment plan of the extraction and replacement denture, and about costs. Although we found no treatment plan for any potential bridgework discussed between Mr C and the dentist, we considered that this was also reasonable. This is because any further work that might be required would normally be discussed later with the patient when they returned for the treatment. We did not uphold Mr C's complaints, but we made recommendations about two related points that we noted during our investigation.

Recommendations

We recommended that the dentist:

• consider taking preoperative x-rays of teeth that are going to be extracted; and
• ensure all treatment plans are signed by the patient and scanned into the dental records.