Health

Summary

Mr C complained that his medical practice inappropriately asked the local health board to remove him from their list of patients. He said that the practice did not give him an adequate reason for this, and simply told him to contact the board for further information. He was also unhappy about the practice's handling of his complaints.

We upheld most of Mr C's complaints. The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004 outline the procedure to be followed when a practice wishes to remove a patient from their list of patients. The British Medical Association and the General Medical Council have also provided guidance on this. The practice told us that their relationship with Mr C had broken down. However, we found that they did not issue him with a warning as outlined in the regulations. The practice also failed to explain his removal from their list. It was not appropriate that they told him to contact the board about this - it was up to the practice to explain why he was removed.

Our investigation also found that the practice's complaints procedure was out of date when Mr C complained, and that they had made inappropriate comments in their response. We did not, however, uphold Mr C’s complaint that the practice took too long to deal with the matter. They issued a response as soon as they received a copy of his letter from the board.

We noted that, before Mr C complained to us, the board had arranged a meeting between him and the practice. At the meeting, the practice apologised for their failings and outlined the steps they had taken to prevent similar complaints.

Recommendations

We recommended that the practice: issue a written apology to Mr C for their failures in relation to him being removed from their list; the fact that their complaints procedure was out of date; and the inappropriate comments about other patients being placed at unnecessary risk in their response to his complaint. 

Summary

Mrs C complained that her late father (Mr A) received inadequate care and treatment while he was a hospital in-patient. Mrs C said that a nurse refused to help Mr A (who had limited mobility due to a stroke) to the toilet and then provided him with a used urinal bottle, which was also difficult for Mr A to manage. Mrs C also said that alert buzzers were inaccessible. She complained that the board had not robustly investigated her complaint to minimise the risk of this happening again, and that the remedial action they took was inadequate.

We took advice from our nursing adviser, who reviewed the records and Mrs C’s complaint. We noted that the complaint had not followed the board’s formal complaints procedure, which is normally a requirement before we can consider a complaint. However, in this case, we decided to accept the complaint and waive that requirement, as we are entitled to where we consider the circumstances make it appropriate to do so.

As part of our investigation we obtained additional information from the board about the level of service Mr A received at the hospital. We also carefully considered all the documents and advice related to Mrs C’s concerns. We found no direct evidence to support Mrs C’s concerns. We were also satisfied that the board investigated Mrs C’s complaint thoroughly and in good time and arrived at an evidence based conclusion. We noted that the local management team had implemented changes over the past year and considered these appropriate in relation to the concerns Mrs C raised.

Summary

Mrs C complained to the board about the contents of a report that a consultant orthopaedic surgeon prepared after she attended his clinic. Mrs C felt that the report understated her true clinical condition at the time, as she had to attend hospital again some five months later with a swollen leg. She was dissatisfied with the board's response to her complaint.

After taking advice from our medical adviser, we found that the consultant's recording of the appointment was reasonable. He set out his findings, as well as his future plans should Mrs C's condition deteriorate. We noted that Mrs C had to attend hospital some five months after the clinic appointment, but did not find that this indicated that the consultant's report was inaccurate.

Summary

Mr C had an overactive bladder muscle and, supported by his consultant, requested treatment with Botulinum Toxin A (Botox A) to help control his condition. The board refused Mr C’s request, and he complained to us that the refusal was unreasonable as he was aware of the treatment being made available to female patients.

Mr C also complained that the board gave him an unreasonable explanation that such drugs should only be used for patients who have extremely severe symptoms and who have accepted the associated risks. Mr C said that the board failed to take into account the severity of his symptoms and acknowledge his acceptance of the risks as he had twice previously paid to have the procedure carried out privately.

Our investigation found that the board did not deal with Mr C’s request in line with their own policies. In addition, the board acknowledged that different sets of practice had developed within urology and gynaecology, which required further review. For these reasons, we decided it was unreasonable of the board to refuse Mr C’s request and so we upheld this complaint.

We thought the board’s explanation that Botox A should only be used for patients who have extremely severe symptoms who have accepted the associated risks was not, in itself, unreasonable. It was a matter of clinical interpretation whether Mr C’s symptoms were extremely severe, and we understood the board’s explanation that it was not possible for Mr C to have accepted the risks, as the risks were unknown. However, the urology staff who had treated Mr C for several years considered him to be an ideal candidate for Botox A, and supported his attempts to get the treatment. Also, Mr C had received successful Botox A treatment twice in a private hospital. In addition, the explanation provided in the board’s response to Mr C’s consultant’s request for treatment was not consistent with their unlicensed medicines policy. Taking all of this into account, we upheld this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for the failings identified in our investigation;
• consider Mr C's and his consultant's request for Botox treatment in line with the current version of the unlicensed medicines policy; and
• remind management and clinicians of the unlicensed medicines policy, and ensure that the policy is referred to and followed in relevant cases.

Summary

Mrs C was diagnosed with breast cancer and agreed after discussion with medical staff that she would have chemotherapy followed by breast conserving surgery. Mrs C completed her chemotherapy treatment, but shortly before her planned surgery (some six months after her diagnosis) she found out the full extent of the disease and decided to have the breast surgically removed. Mrs C complained that healthcare professionals did not communicate the full extent of the disease to her or report it fully within a reasonable time. She said that as a result, her treatment plan was initially based on the incorrect belief that breast conservation was possible. Mrs C also raised a number of concerns about the board's complaints handling.

We took advice from our relevant medical advisers and found that there were failures in the board's management of Mrs C's breast cancer, and that the process to ensure that healthcare professionals communicated effectively with each other and with Mrs C was not followed. Although we considered that the board's failures made no difference to the treatment and outcome for Mrs C, they did cause her additional stress at a very difficult time. We also found some aspects of the board's complaints handling was inadequate in that there were delays and the board failed to keep Mrs C informed.

Recommendations

We recommended that the board:

• review their practice on management of patients with breast cancer to ensure it meets Scottish Intercollegiate Guidelines Network guidelines, particularly in relation to the multidisciplinary team process;
• review their complaints process to ensure it meets the requirements of the NHS complaints procedure; and
• apologise to Mrs C for the failures identified.

Summary

Mrs C had a method of contraception, an intrauterine device (IUD), fitted by a doctor in March 2010. She subsequently developed symptoms including abdominal pain, bleeding and difficulty with bowel movements. Mrs C attended the practice three days later and was prescribed antibiotics for a possible infection following the fitting. In June 2010, Mrs C found out that she was pregnant. After her baby was born, she had surgery to have the IUD removed. It was found to have caused internal damage and to have moved.

Mrs C complained that the doctor had not taken reasonable care when fitting the IUD and did not properly investigate her symptoms. Although we were unable to assess the procedure, we found that Mrs C’s medical notes were comprehensive and detailed, and that the doctor had undergone suitable update training and fitted an appropriate number of IUDs per year. We also noted that Mrs C had undergone IUD counselling before having the device fitted, where she had been told about the risks, including the risk of internal damage. Although this was a rare complication, the fact it had occurred did not mean the doctor had not carried out the procedure with reasonable care, so we did not uphold this complaint.

We also found that the practice carried out reasonable investigations of Mrs C’s symptoms. They examined her at three appointments and located the threads of the device. Guidance states if these threads can be seen and felt then it can be assumed the IUD is in the correct place. When Mrs C attended a second appointment after the fitting, she said that the symptoms had resolved so we found it was reasonable that the practice did not undertake further investigations. We also found that the practice would not have been expected to arrange an ultrasound scan to confirm the positioning of the IUD, as this is not recommended by guidelines.

Summary

Mr C complained about the board's decision to relocate the pain management clinic at a hospital. He said that the previous location for the clinic was more accessible for him and because of the relocation he now faced a journey time of over eight hours for a 15 minute appointment. In response to Mr C’s complaint, the board suggested alternative means by which he could attend the clinic but he did not feel they were appropriate. He felt the board had not taken into account his health needs when making the decision to relocate the clinic and complained to us.

We explained that health boards have the authority to take decisions about where to site services within their area. We found that in an effort to address Mr C's concerns, the board had offered Mr C reasonable solutions in order that he could access the clinic where his condition could be assessed. This included information about public transport links and the availability of patient transport services. In addition, the board also offered to pay for a taxi fare for his next appointment but said that the matter would be kept under review. The board also suggested that to avoid the need for travelling, Mr C could have a telephone consultation. We concluded that the board had taken appropriate action to assist Mr C and did not uphold the complaint.

Summary

Mr C had a history of mental health problems. In 2011 he started to become increasingly anxious with strong violent urges. He was able to control the urges but found it difficult and was concerned that he might harm friends or family members if he did not receive effective treatment. Mr C complained that his medical practice did not do enough to progress his treatment. He was unhappy with how they managed his condition, saying that they adopted a 'wait and see' approach.

The medical records showed that therapists and the practice had made a number of referrals. We were satisfied that there was a pattern of reasonable care, and that the referrals made were detailed and appropriate and responsive to Mr C's circumstances. Mr C had also asked the medical practice to prescribe medication to help with his unwanted thoughts, but this was refused. Our medical adviser considered Mr C's case and said that medication should not be used to treat personality disorders. We, therefore, found that the decision not to prescribe medication was appropriate, as Mr C had been diagnosed with a personality disorder rather than a psychiatric disorder. Mr C is receiving ongoing treatment from a psychologist and we considered this to be the appropriate treatment for his condition.

Summary

Mrs C was unhappy with the quality of the food she received while in hospital. The board said that as she had not reported it to them when she was a patient they were unable to look into her concerns. They said that they had very few complaints about food standards and reported very good results from patient satisfaction surveys.

Mrs C then complained to us about poor food quality and that there was a lack of investigation into her complaint. It is not our role to monitor food quality in hospitals. However, we looked to see whether the food quality was effectively monitored and reviewed by the board. We also looked at the food quality results from patient surveys. In both cases we found that the board achieved high patient satisfaction results. We also noted a number of actions the board was taking in response to issues that had been identified. As the board appeared to achieve good quality food standards, and responded to problems when they arose, we did not uphold this complaint.

We did, however, uphold the complaint about the lack of investigation into Mrs C's concerns, but we did not make recommendations. We felt that the board could have examined whether there were any specific reasons why food quality might have been affected during the period of Mrs C's stay, and that they had missed the opportunity to tell her about the active steps they were taking to improve food quality.

Summary

Mr C asked us to take forward a complaint after the death of his mother (Mrs A). Mrs A initially complained to us about a shortfall in care she said she had received from her medical practice from 2003 onwards. She told us that the matter only came to light in 2011.

Mrs A said that, despite repeatedly attending the practice from 2003 to December 2010, she was not checked or referred by the practice to see if she had a more serious underlying condition. Mrs A was diagnosed with lung cancer in or around June 2011 and died in November 2011. Both she and her son considered that there had been a failure to diagnose or pick up on her symptoms from 2003 onwards.

Our investigation, which involved taking advice from our medical adviser, found that while it was clear that Mrs A attended the practice for a variety of medical concerns from 2003 to 2010, she received appropriate care and treatment for the symptoms she presented with during this period. We found no evidence that the practice failed to pick up or diagnose cancer symptoms. Our adviser also said that from reading the progression of Mrs A's symptoms in her medical records, it was unlikely that the outcome would have been altered by an earlier diagnosis.