Health

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.

Summary

Mrs C complained to the board about the treatment she received from a hospital doctor. Mrs C's GP had referred her there because Mrs C was suffering from urinary incontinence. The hospital doctor had conducted tests then referred her to neurology and a bladder specialist. Mrs C said the doctor failed to ask about her vaginal discharge and failed to carry out a pelvic ultrasound scan. Mrs C was subsequently diagnosed with a tumour in her womb. She believed that, had this been found sooner, then the cancer would not have spread to other organs.

We took advice from our medical adviser who noted that he saw no indication that a pelvic ultrasound scan was required given Mrs C's presented symptoms. Mrs C was assessed by three different clinicians with expertise in different areas. All the correspondence and medical notes suggest that Mrs C's symptoms were of incontinence rather than of vaginal discharge. When the symptoms did not ease, Mrs C was appropriately referred for further investigation. We noted that there was a delay in the process for arranging a hysteroscopy (a procedure that allows a surgeon to look inside the womb using a narrow tube-like telescopic camera) and the board apologised to Mrs C and explained the action that they had been taken to prevent a repeat occurrence before she complained to us. Although, therefore, we understood why Mrs C was concerned that a chance to diagnose the cancer may have been missed, we took the view that the care she received was appropriate in the circumstances.

Summary

Mrs C, an advocacy worker, complained on behalf of Miss A, who had injured her knee in a skiing accident. Miss A was referred by the board to a hospital outwith their area. However, the board for her own area also provided some treatment and investigated and responded to Mrs C's formal complaint. Mrs C complained that the board provided inadequate explanations in response to her complaints and that the board's handling of the complaint was poor.

We were satisfied that, whilst the board's investigation of the complaint was delayed, updates were sent in line with their complaints procedure. That said, we found that the board's initial response to the complaint contained a number of inaccuracies, particularly in relation to some of the dates of events and their description of the operation that Miss A underwent. We noted, however, that the board had accepted this and apologised to Mrs C and Miss A so we made no recommendations.

Summary

Mrs C complained on behalf of her mother (Mrs A) about the care and treatment Mrs A received from her dentist. Mrs A attended the dentist in pain after a filling fell out. The dentist took an x-ray and removed a nerve. He made an appointment for a couple of weeks later to extract some teeth. Unfortunately, the pain did not get any better and Mrs A had to go back a further three times for treatment. However, before the date on which the extractions were scheduled, she was admitted to hospital, where it was found that her windpipe was obstructed by a large abscess. Mrs A had emergency surgery, and needed a tracheotomy (an operation to insert a tube into the windpipe) to assist with her breathing.

Mrs C complained that the dentist did not treat her mother appropriately and that had he done so she would not have deteriorated to such an extent. After taking advice from two of our dental advisers, however, our investigation found that the dentist's decisions about prescribing antibiotics to Mrs A were reasonable, as was the care and treatment provided.

Summary

Mrs C had a complex medical history including pelvic, back and shoulder pain, arthritis, kidney problems, ovarian cysts, endometriosis, hypertension, depression and gastric problems. Over the course of 2009 to 2012 she attended her medical practice for pain management and treatment of these and other illnesses. GPs referred her to a number of specialists for treatment and exploratory tests, including consultants in neurology, neurosurgery, pain management and gynaecology. GPs also prescribed Mrs C with various drugs to treat her pain symptoms, including a number of different types of opioid analgesics (pain relief that acts on the central nervous system), but with limited success.

In July 2011, Mrs C became very unwell with dizziness and weakness and was confined to bed. A GP diagnosed severe postural hypotension (a drop in blood pressure than can cause dizziness), which they considered was likely to be drug-induced with inactivity contributing to it. They advised Mrs C to reduce her intake of opioid medications. During a hospital admission, specialists noted that Mrs C had a decreased level of a particular hormone and carried out extensive tests. These established that she was suffering from drug induced suppression of another hormone. Mrs C complained to us that between 2010 and 2012 the practice did not provide her with appropriate care and treatment.

As part of our investigation, we obtained independent advice from our medical adviser, who said that this is a recognised, but rare side-effect of long-term opioid analgesic use. However, he advised that the treatment that the practice prescribed for Mrs C was appropriate, and was taken with the appropriate secondary care advice, and that the referrals made were reasonable. We, therefore, did not uphold this complaint.

Summary

Mr C, who is a prisoner, complained to the board about the medication decisions taken by his prison health centre. Mr C was not satisfied with their reply, which he felt had not addressed his concerns, and so he sent them a follow-up letter. However, the board sent it back to the health centre, unanswered, and the health centre gave it to him, with a note that advised him to follow the correct complaints process.

Mr C contacted us for help in getting a reply to his follow-up letter as he thought he had been following the process and did not know what to do.

Although initial complaints to health boards should go through the health centre, it is our view that follow-up letters may go direct to a board. If a board wish to ensure that the health centre knows what is happening, the board may tell the health centre about it themselves. But we take the view that it is not for a complainant to have to try to navigate a complaints system this way. We, therefore, sent Mr C's follow-up letter back to the board and asked them to reply to Mr C.

We told Mr C that we had closed his complaint while he and the board were dealing with it but that he could come back to this office after that if he thought the complaint should be investigated further.