Health

Summary

Mr C complained that the board provided inadequate treatment to his adult daughter (Miss A) in a hospital accident and emergency department (A&E) after a fall. Miss A had been taken there after a neighbour found her with a head injury. The doctor who saw Miss A recorded that she was intoxicated with alcohol and had abdominal and chest pain. She noted that Miss A had drunk a bottle of wine, and was difficult to assess and quite uncooperative with questioning. Miss A was initially unwilling to say how she had hurt herself, but eventually said she had fallen in her flat and had gone to the foyer to get help. However, the doctor was not convinced by this.

The doctor noted that Miss A said that the abdominal/chest pain started before she fell and was due to an existing kidney disorder. Miss A refused to have the head injury stitched, so it was cleaned and glued. The doctor arranged for a chest x-ray and routine blood tests. She gave Miss A painkillers and re-examined her after two hours, by which time, the chest and abdominal pain had improved. The doctor recorded that she thought that Miss A had likely suffered a muscular chest injury, and discharged her. Miss A was advised to see her GP in two days to get her bloods rechecked, and to return to hospital if there were any problems. Miss A declined to contact her parents for help to get home.

Miss A returned to A&E later that day, and this time told staff that she had in fact fallen off a balcony. She was admitted and was in hospital for three weeks. A CT scan (a special scan using a computer to produce an image of the body) and x-rays showed that she had suffered a number of injuries.

We obtained independent medical advice on the complaint, and found that, in general, the care provided to Miss A was reasonable. The doctor assessed Miss A in the context of the description she gave of a minor fall, and Miss A had to take responsibility for not saying what had actually happened. If the examining doctor had been aware of how the injury happened, Miss A would have been immobilised and a CT scan would have been requested, which would have shown the extent of her injuries much earlier.

However, our adviser also said that there were a few lapses in the standard of care. There was inadequate questioning about the significance of the head injury, particularly in the context of there being a four centimetre laceration to the head. If the doctor had asked about loss of consciousness, persistent headache, vomiting or amnesia memory loss, then responses might have indicated a need for a CT scan. The adviser also said that it was unlikely that a more senior doctor would have discharged Miss A, and there were a few subtle clues missed. These included a mildly raised respiratory rate, the chest and abdominal pain and a raised white cell count.

Although we upheld the complaint this was a decision taken on balance, in view of the fact that the overall care provided to Miss A was reasonable and the doctor was clearly not assisted by the fact that she was given inaccurate information about how Miss A sustained her injury.

Recommendations

We recommended that the board:

• issue an apology to Miss A for the failings identified; and
• make the doctor aware of our findings.

Summary

Following a laparoscopic hysterectomy (keyhole surgery to remove the organs and surrounding tissue of the reproductive system), Miss C began experiencing pain in her back and left leg. She was kept in hospital for five weeks and diagnosed with sciatic nerve damage (damage to the nerves of the lower back area). She told us that she continues to suffer from these problems and has been told that it could take two years for her to regain normal function. She complained that, despite corresponding with the board and attending several appointments, she has not received an explanation as to what caused these problems.

Our investigation found that the board had carried out appropriate investigations to identify the problems Miss C was experiencing and that her pain was likely to be caused by sciatic nerve damage following her surgery. This was a rare complication and not something the board could take particular precautions to avoid. We found that, although the board were not clear about what was causing Miss C's pain and carried out a number of tests to establish this, there was a lack of evidence to show that they had explained why they were carrying out these tests, the conclusion reached, and the likely outcome. For this reason, we upheld this complaint.

Recommendations

We recommended that the board:

• give Miss C a copy of her consultant's letter to her GP; and
• arrange for Miss C to meet with neurology staff to discuss her condition and likely outcome, if she wishes to do so.

Summary

Ms C complained about what happened when she was assessed for a decision to detain her under the Mental Health Act. She said that the psychiatrist did not treat her with respect; breached confidentiality by discussing her condition in the presence of two police officers; and, after discharge and despite Ms C asking for no further contact with the psychiatrist, she was sent appointments to attend her clinic.

Our investigation, which included taking independent advice, found no evidence to show that Ms C had not been treated with respect during the assessment which took place in her flat. The notes taken by the psychiatrist and a social worker (who was present as Ms C's mental health officer (MHO)) were brief but professional. We explained to Ms C that while we did not doubt that she considered she had been treated disrespectfully, in situations where there is no independent corroborating evidence, we cannot determine which version of events is the correct one. Therefore, we were unable to uphold this aspect of her complaint.

On the matter of the discussion which took place in the presence of the police officers, our investigation found that this was reasonable. Concerns about Ms C's mental health had firstly been raised with the local mental health team by local police, who had been concerned about some aspects of Ms C's behaviour in the preceding weeks. The police officers who were present were, therefore, aware in general terms of Ms C's mental state. When the psychiatrist and the MHO needed to have a more detailed clinical discussion of Ms C's condition, they retired to Ms C's kitchen to discuss this in private. We, therefore, found no evidence of a breach of confidentiality.

In respect to the out-patient appointments sent to Ms C after her discharge, the board acknowledged and apologised for this oversight. The psychiatrist involved was the only one in the area that deals with out-patients, so the system automatically sent a follow-up appointment. This had gone out while the board were still considering Ms C's complaint as the system had not been updated. As the board had, however, already apologised for this, we made no recommendations.

Summary

Ms C complained that staff at a physiotherapy department failed to adequately manage her symptoms of severe back pain and limited mobility. Staff initially examined her and determined that she should be given conservative management (medical treatment avoiding radical therapeutic measures or operative procedures) of her pain with physiotherapy and acupuncture before she was referred for a magnetic resonance imaging scan (MRI - a scan used to diagnose health conditions that affect organs, tissue and bone). She then had a number of appointments with a physiotherapist and acupuncture was arranged. Ms C felt that her pain had continued to get worse. She then elected to have an MRI scan carried out privately. The scan showed that a surgical procedure was needed, and Ms C had this procedure privately.

Ms C complained that the physiotherapist did not refer her for an MRI scan. We took independent advice from one of our medical advisers who specialises in physiotherapy. She reviewed the board's policy for referral for an MRI scan and Ms C's clinical records. The adviser said that the treatment Ms C received was appropriate and that it was reasonable that she was not referred earlier for an MRI scan. She also confirmed that the physiotherapist followed the appropriate protocol for referring Ms C.

Summary

Mr C complained that he was unreasonably told that he had lung cancer, when in fact he had tuberculosis (a bacterial infection mainly affecting the lungs). Mr C explained that he was admitted to hospital for investigation of possible lung cancer. After a CT scan (a special scan using a computer to produce an image of the body) he was told that he had lung cancer and part of his lung would need to be removed. Mr C said the procedure was carried out, but when he received his patient discharge letter it showed his diagnosis as pulmonary tuberculosis.

Mr C's own account and the information in his medical records showed that at the time he was admitted to hospital he was aware that it was a possibility rather than a certainty that he had lung cancer. Having read Mr C's medical records, our independent medical adviser said that in later discussions Mr C was told of the likelihood rather than the certainty that the abnormality represented a lung cancer. The adviser said that, given that in his opinion the likelihood of Mr C having lung cancer at that point was at least 80 to 90 percent, it was not unreasonable to say that he might have lung cancer.

Our investigation did find a number of examples of the board failing to record information in Mr C's medical records, or entering incorrect information, so although we did not uphold the complaint, we made a recommendation about this.

Recommendations

We recommended that the board:

• feed back our findings on the board's record-keeping to the staff involved.

Summary

Miss C said that she experienced pain and difficulty eating after having her tooth filled. She was unhappy that, when she twice called the dental practice about the pain she was suffering, reception staff advised her to call the emergency dentist.

We did not uphold Miss C's complaint about her dental treatment. We could not find enough evidence to support what Miss C said about the phone calls she said she made to the dental practice after the treatment, or what was discussed with the reception staff. We noted that when Miss C visited a different dentist a few months later, the filling was removed and a small exposure of the pulp tissue was found (the pulp is the central soft core of the tooth, sometimes referred to as the nerve). Our dental adviser said that exposure of the pulp is relatively common when providing a deep filling and can often go undetected as it can be fractions of a millimetre in size. In Miss C's case, our adviser said that it was possible that a small exposure occurred following the tooth being filled but did not consider that the the treatment was inappropriate.

We did, however, uphold Miss C's complaint about complaints handling, as we found that the board had not provided a full and comprehensive response to her complaint. We noted that the board's feedback services are currently under review.

Recommendations

We recommended that the board:

• apologise to Ms C for not responding fully to her complaint; and
• update the Ombudsman when the Feedback Service review is completed.

Summary

Mr and Mrs C complained that the medical practice inappropriately prescribed their father (Mr A) anti-inflammatory medication on a long-term basis, without also prescribing gastric protection medication. Mr A had sciatica (lower back pain caused by pressure on a nerve) and osteoarthritis (the most common form of arthritis, affecting the joints) in his knees. He had been on a non-steroidal anti-inflammatory drug (NSAID) for a number of years when he attended hospital several times complaining of abdominal (stomach) pain. He was eventually admitted to hospital, where he was found to have a massive gastro-intestinal haemorrhage (severe bleeding in the stomach/intestine) because of a bleeding ulcer. Doctors were unable to control this, and although Mr A had emergency surgery, he did not survive.

Our investigation found that guidance in 2008 said that gastric protection medication should be prescribed with NSAIDs. We upheld the complaints, as we found that from 2008 onwards Mr A should not have been prescribed a NSAID without this protection. We noted that this was in fact picked up at a medication review that year, which noted that Mr A was over 65 and a smoker and was, therefore, at increased risk of stomach bleed. The review said that if the NSAID prescription was continued, gastric protection medication should be added. The NSAID was then removed from Mr A's repeat prescriptions. However, a year later, a NSAID was added to his repeat prescriptions without gastric protection medication. The practice apologised to Mr C for this after Mr A's death and carried out a significant event analysis.

Mr C also complained that the practice failed to diagnose and treat Mr A's ulcer. Mr A had attended the hospital with abdominal pain several times, and they had told the practice about this. We found that the practice were not required to follow this up unless the hospital specifically asked them to do so, and there was no evidence that Mr A attended the practice with abdominal problems until the day before his death. That said, we found that Mr A's abdominal pain, along with the fact that he was taking the NSAID without gastric protection, should have alerted the GP to the probability that the pain was being caused by an ulcer. We found that the GP should have prescribed gastric protection at that time, although it was unlikely that this would have prevented Mr A's death.

Recommendations

We recommended that the practice:

• make the GP who examined Mr A on the day before his death aware of our finding on this matter; and
• issue a written apology to Mr C for the failure to carry out a reasonable and appropriate consultation on that day.

Summary

Miss C complained that GPs failed to carry out appropriate investigations into the symptoms her late mother (Mrs A) was presenting with from November 2010. Mrs A was diagnosed with lung cancer in May 2011 and died in August 2011. Before she was diagnosed, Mrs A had been treated and monitored for breathlessness which was not resolving with the treatment provided. The family told us that they felt that the GPs were treating Mrs A as if her symptoms were psychological and that as a result there was a delay in diagnosing the cancer.

When Mrs A (who was a smoker) first complained of breathlessness, various tests were carried out. Her chest x-ray and blood tests were reported as being normal. Mrs A continued to suffer breathlessness, however, and was reviewed regularly in the practice by the nurse. She was also seen by GPs and the

out-of-hours service. In March 2011 Mrs A was diagnosed with a chest infection and prescribed antibiotics (drugs to treat bacterial infection). When the condition persisted, she was referred for a further chest x-ray. This x-ray was reported as abnormal and Mrs A was referred urgently for a CT scan (a special scan which uses a computer to produce an image of the body), after which she was diagnosed with lung cancer.

Our investigation, which included taking independent advice from a medical adviser, found that the care and treatment provided to Mrs A was reasonable, and in line with the national and local guidance on investigating, managing and treating lung cancer. Although Mrs A had been referred for counselling from the community psychiatric nurse, we found no evidence that the GPs considered Mrs A's symptoms were psychological. The adviser said that the GPs clearly took note of Mrs A's physical symptoms and investigated them in a reasonable and timely manner, and in line with national guidance.

Summary

Mr C complained about a wide range of issues concerning aspects of his mental health care by the board over a number of years. However, on investigation, we considered that the board had done all they could reasonably have been expected to do in respect of his mental health. For example, he had been seen by a number of appropriate clinicians, there had been very thorough assessments, and he had had appropriate treatment. We acknowledged that Mr C wanted more from the board but were satisfied that the board could not reasonably have been expected to have provided more.

Summary

Mrs C had an operation, after which packing material was left in her wound. She told us that when she complained to the board about this, their response was inadequate. The board had apologised to her for the failings and explained the actions they had taken to prevent this happening again.

Our investigation found that the board had taken the complaint seriously and had carried out a thorough investigation, including obtaining statements from the relevant staff so that this was not repeated. They had reminded staff of their responsibilities. The board had also sought information from the packing manufacturers, which led to them use an alternative form of wound packing. We were satisfied that the board's investigation was appropriate, and decided that further consideration of the complaint would be unlikely to achieve any more for Mrs C.