Health

Summary

Mr C was admitted to hospital as an emergency case in October 2009 with a perforated colon (hole in the bowel). The surgeon treated it conservatively (with medical treatment avoiding radical therapeutic measures or operative procedures) and explained to Mr C that further investigation was needed once this had settled down. Mr C was discharged several weeks later, then had a further episode of pain and inflammation which was also managed conservatively. Mr C had a scheduled colonoscopy (examination of the bowel with a camera on a flexible tube) in December 2009 and was diagnosed with complex diverticular disease (disease of the colon). Shortly after the colonoscopy, Mr C was admitted to hospital with abdominal pain and inflammation, again managed conservatively. He was admitted again in February 2010 with a diverticular bleed (a bleed in the colon). In March 2010, he agreed to a surgical resection (partial removal of the colon) and to lose weight as he had a high body mass index (a measure for estimating human body fat).

The surgeon reviewed Mr C in September 2010 and agreed to proceed with surgery when a consultant urologist (a clinician who treats disorders of the urinary tract) became available. Surgery was planned for October 2010 but this had to be cancelled. However, Mr C in fact underwent surgery a few days earlier than originally planned. The surgeon said that the procedure was extremely complex and that participation from other specialists was needed. Mr C believed that the procedure was complicated because the hospital failed to perform it within a reasonable time.

Mr C had further procedures including repeat dilatation (enlargement) of the anastomosis (the site of the bowel after resection). One of these procedures was performed on a date in February 2012, after another cancellation. Mr C said nobody contacted him from the hospital to tell him of that cancellation, and he only found out when he phoned the surgeon's secretary the day before. A reversal ileostomy (a surgical procedure carried out on the small intestine) was then planned, but in March 2012 surgeons told Mr C that a stent (mesh tube) should be inserted first. The reversal was performed in May 2012.

Mr C said that the board failed to notify him of cancelled appointments and contact him to rearrange them. Mr C also said that the board failed to give reasonable or consistent explanations about why the appointments had been cancelled. As a result of these failures, and the failure to provide appropriate treatment within a reasonable time, Mr C said that his life had been on hold and he had been unable to work.

Our investigation found that the board provided Mr C with appropriate treatment for his perforated colon and post-operative complications, within a reasonable time, so we did not uphold this complaint. We did, however, uphold his complaints about cancellations. It was not clear that he was told about the cancellations within a reasonable time, and the board acknowledged that there were shortcomings in communication. They apologised and addressed this with administration staff. We also found that, while the board's explanation when responding to Mr C's complaint was reasonable, that did not appear to be the case when he initially brought this to the attention of staff. The board accepted that there were further shortcomings when Mr C was seeking explanations from staff, and regretted his poor experience at the time of the cancellations.

Summary

Mr C complained to us about the treatment he received from his medical practice for problems with his neck. GPs at the practice saw Mr C five times during a five month period. He had reported a number of symptoms, including neck pain. Mr C reported that at one appointment he specifically raised concerns about cancer, but there was no record of this conversation in his medical file. He also reported being able to feel a lump, but none of the GPs who examined him during this period were able to find this until his final appointment. He was then referred for an urgent ultrasound scan (a special scanning technique that uses sound waves to produce internal images of the body), which found a lump that turned out to be cancerous. Mr C had a history of unexplained deep vein thrombosis (blood clots) dating back two to three years. He was concerned that this put him at increased risk of developing cancer, but that his GPs had not taken this into account.

In our investigation we examined Mr C's medical records and evidence from Mr C. We also took independent advice from one of our medical advisers. Our investigation found that, while there was conflicting information about one consultation, no evidence of a neck lump was found before the final consultation. While the GPs should have taken Mr C's history of unexplained deep vein thrombosis into consideration in making a diagnosis, without any evidence of a lump there was no evidence to act on. We also found that the practice had clearly set out the issues that were discussed at each consultation over the five month period, and had passed on an apology from one of the GPs involved.

Summary

Mr C's wife (Mrs C) was admitted to hospital for an operation to repair a hernia (a condition where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall).

After her operation Mrs C complained of pain. The surgeon examined her and found evidence of swelling. A CT scan (a special scan using a computer to produce an image of the body) was requested and the results suggested that Mrs C's bowel had been pierced. Mrs C was operated on and had the section of pierced bowel removed. She suffered pain and discomfort from this procedure and it took her eight weeks to recover from it. Mr C told us that he considered that the staff at the hospital had failed to provide appropriate treatment during the operation. He felt that this resulted in Mrs C's bowel being pierced.

We did not uphold Mr C's complaint. After taking independent advice from our medical adviser, we concluded that a pierced bowel was a recognised complication of this type of surgery. We found that Mrs C's treatment during the operation was reasonable, although we were critical of the board's consent policy. We felt that common and serious risks of surgery should be clearly explained to all patients and that these discussions should be recorded on the patients consent form or clinical records. This did not happen in Mrs C's case.

Recommendations

We recommended that the board:

• considers reviewing their consent policy to ensure that all common and serious risks are fully explained to patients when obtaining consent and that these are clearly recorded on the consent form or clinical records.

Summary

Miss C had been receiving a repeat prescription for tablets. However, on one occasion when she visited the pharmacy the pharmacist said the prescription could only be collected on certain dates, and that the next date had not yet arrived. Miss C had not been advised of this previously. The pharmacist gave Miss C five tablets to last until she could pick up her next prescription, although Miss C did not need that many tablets.

Miss C complained to us that the pharmacy applied rules about collection inconsistently and that although they had said there were dosage concerns, they then inconsistently issued more tablets than required. She was also unhappy with the way in which her complaint was handled.

We did not uphold Miss C's complaint about the inconsistent application of rules and issue of tablets. Our investigation found that the pharmacist was required to follow the advice of the prescribing doctor which in this case, was to provide a fortnight's supply of tablets every 14 days. The pattern of prescribing appears to have become slightly out of sync when the last prescription was written, leading to the change in dates. We did, however, make a recommendation to try to avoid this happening to someone else in future.

We upheld the complaint about complaints handling. Although the pharmacy acknowledged Miss C's complaint within their timescales, they did not respond to her until more than ten working days after receiving it, which was outside the recommended time limit. The pharmacy's head office, where the complaint was handled, is in England, and they failed to give Miss C information about the Scottish NHS complaints system and the Ombudsman.

Recommendations

We recommended that the pharmacy:

• provide staff with guidance that ensures that they clearly explain the prescribing regime to patients with repeat prescriptions, as well as indicating the dates on which patients can collect such prescriptions; and
• apologise to Miss C for failing to provide the correct information when responding to her complaint, and for the delay in responding.

Summary

Mrs C was assaulted, and was taken by ambulance to a hospital accident and emergency department (A&E) with two police officers in attendance. She complained that she was not fully examined and that no tests were done to assess whether or not she had a head injury, which meant that her concussion was undiagnosed. She said that this has caused her ongoing health problems.

Mrs C was discharged into the care of the police officers who took her to the police station to make her statement and then took her home. When she later applied for copies of her notes from the incident she took issue with the lack of detail in them. Mrs C complained to the board but was not satisfied with the response she received. She was unhappy that later statements made by the nurse and doctor who saw her on the night indicated that she had been uncooperative and possibly under the influence of alcohol.

Our investigation included taking independent advice from one of our medical advisers. We found that there was a disparity between the notes made at the time of the events and the later statements made by the staff who attended Mrs C. The A&E unit is a GP-led unit and on the night in question was staffed by a nurse practitioner (a specially qualified senior nurse) and an on-call GP. We found that the notes made at the time by the nurse and the GP did not record all the injuries Mrs C had suffered, as recorded by the Scottish Ambulance Service staff who took her to hospital. Nor did any of the notes taken at the time refer to Mrs C as being uncooperative or under the influence of alcohol. However, after Mrs C complained to the board, the nurse and GP were asked for statements and both then referred to her as being uncooperative, possibly due to alcohol intake. The GP said that it was because Mrs C was not cooperating that he was unable to conduct a full examination and assessment of her condition.

Our adviser found that the lack of information in the notes taken at the time did not give a full picture of Mrs C's condition on the night in question. However, he was of the view that with the information now known - that Mrs C had concussion - the management of her condition would have been the same even had the concussion been diagnosed at the time. Mrs C was discharged with a small amount of medication and with advice to return to A&E if her condition worsened. The adviser said that this would have been appropriate. He was also of the view that Mrs C's ongoing problems would probably have occurred even had the concussion been diagnosed at the time. We did, however, uphold Mrs C's complaint because no valid reason was recorded in the notes for the GP not having conducted a full assessment and examination at the time.

Recommendations

We recommended that the board:

• apologise for the failings identified during our investigation; and
• review a sample of notes to establish the quality of record-keeping of the staff involved.

Summary

Ms C complained that when she attended a physiotherapy appointment, the physiotherapist wrenched her shoulder and caused her great pain. She also complained that the home exercises that were suggested caused her more pain, and that she had not received proper instruction on how to use a pulley.

In investigating the complaint, we could not establish whether the physiotherapist actually wrenched Ms C's shoulder, but we found that it was appropriate for them to move it to assess the level of mobility. After taking independent advice from our medical adviser, we were satisfied that the physiotherapist provided appropriate treatment.

In this case, the board had also accepted that there were difficulties in communication about what a patient should report if home exercises led to an increase in pain, and they had reminded staff of their responsibilities in that regard.

Summary

Mr C's late wife (Mrs C) was diagnosed with cancer in June 2011. He complained that staff at the practice failed to take account of the seriousness of her condition and to take follow-up action. Mr C raised concerns about the way in which his wife's medication was given; a failure to document phone conversations; a failure to admit Mrs C to hospital when a provisional diagnosis of gastroenteritis (inflammation of the stomach and intestines) was made; and a failure to monitor her calcium levels. Mr C complained that, by the time Mrs C was admitted to hospital in October 2011, she was hallucinating. He believed that his wife had suffered more than she needed to as a consequence of the practice's failures or inaction.

In considering Mr C's complaint, we obtained independent advice from one of our medical advisers. Our investigation found that once Mrs C was diagnosed with cancer, her care was primarily the responsibility of the hospital and hospital staff. It was clear from hospital records that the practice was kept up to date with Mrs C's condition, and it was also clear that when requested, the practice took appropriate action. Our adviser confirmed that, in his experience, not all patients wanted to hear further from their GP, or to discuss matters with them, at what can be a busy and difficult time.

On the matter of administration of medication, we found that although Mr C was unhappy that his wife was given her medication in tablet rather than liquid form, the adviser said that there was no record on file confirming that this was required.

On the issue of Mrs C's non-admission to hospital when gastroenteritis was suspected, the adviser said that the records confirmed that this was discussed with Mr and Mrs C and it was noted that she was 'OK' to stay at home. Mr and Mrs C were given advice that if her condition worsened, they should phone NHS 24.

We found that Mrs C's calcium levels were not taken, and as she was vomiting, the adviser was of the view that when completing blood tests, this test should also have been carried out. He said that if her calcium levels were high, it might then have been possible to reduce them, and in turn this might have led to a reduction in Mrs C's sickness.

Recommendations

We recommended that the practice:

• apologise to Mr C for the failure to monitor Mrs C's calcium levels.

Summary

Mr C complained about the board on behalf of his daughter (Miss A) who had been referred to the board's Child and Adolescent Mental Health Service (CAMHS) when she was 15. Mr C and his wife attended some of the consultations with her. Miss A was prescribed with fluoxetine (a medicine used to treat a variety of mental health problems) and subsequently discharged from the service.

Four years later, Miss A was diagnosed with bipolar disorder (a condition affecting a person's moods). Mr C considered that CAMHS should have diagnosed this when Miss A saw them four years earlier. He complained to us that that the assessment and treatment package provided by CAMHS did not meet his daughter's needs and that that they did not listen to him and his wife.

Our investigation included taking independent advice from one of our medical advisers. We upheld part of Mr C's complaint, as we found that the treatment provided to Miss A by CAMHS was reasonable, but that there were a number of deficiencies in the records. In particular, there was no record of the action taken by the psychiatrist who briefly saw Miss A and no record of any formal mental state examination. Staff also failed to explicitly state the diagnosis, treatment plan and prognosis. However, the records made at the time indicated that the clinicians had listened to and reported the concerns of Miss A's parents while she was being seen by CAMHS. There was no indication that Miss A showed any symptoms or signs that were specific to the diagnosis of bipolar mood disorder at that time and there was no reason to diagnose this. The only diagnosis that appeared to be applicable during that period of assessment was of a depressive disorder. Given this, bipolar mood disorder would have been a risk for the future, but one amongst a number.

Recommendations

We recommended that the board:

• issue a written apology for the deficiencies in Miss C's records; and
• review the record-keeping in CAMHS to try to ensure that such failures are no longer occurring.

Summary

Miss C attended the dental practice complaining of pain in her lower left five tooth. She said that she specifically pointed this out to her dentist. The dentist recorded in the notes that the lower left seven tooth was mobile with a discharge of pus coming from the buccal aspect (cheek side of the tooth). The dentist then extracted the lower left seven tooth.

After around 20 minutes, Miss C returned to the practice and complained that the wrong tooth had been extracted. The dentist recorded that the lower left five tooth was mobile and then removed it. The dentist also recorded that she had apologised to Miss C and explained that the lower left seven tooth was not treatable by any means other than extraction.

In her complaint to us, Miss C understood that the dentist said she would not charge her for this extraction. Our investigation found that the notes completed at the time said that the lower left seven tooth was to be extracted, so we could not say for sure whether the wrong tooth was extracted. However, Miss C clearly thought that it was the lower left five tooth that was to be extracted. We found that the dentist did not obtain consent appropriately and did not communicate with Miss C effectively.

In responding to Miss C's complaint, the dental practice said that the dentist was aware of the crucial importance of securing valid consent prior to any treatment and would not have proceeded with the removal of the lower left seven tooth unless she believed that Miss C understood and agreed to this treatment. We concluded, however, that this was not the case and upheld Miss C's complaint that the practice had provided incorrect explanations as to why the tooth had been removed.

Recommendations

We recommended that the practice:

• issue a written apology for the failure to obtain consent appropriately for the extraction of the tooth and for failing to communicate effectively with Miss C; and
• make the dentist aware of our finding on this matter.

Summary

Mr C made a number of complaints about the care and treatment his son had received from the board. We were unable to reach agreement with Mr C on the issues to be investigated. Consequently, we were unable to take the case forward and it was closed.