Health

Summary

Ms C complained about treatment received after she fractured her wrist. She said that nurses within the hospital's plaster room had incorrectly applied a cast on two dates in January 2011.

She complained in particular that on one visit, the treatment was inappropriate and resulted in permanent damage to her hand and wrist. However, we found no evidence that the treatment was unreasonable – reviews of the positioning of the casts during the board's investigation had established they had been positioned appropriately, and after taking advice from our medical adviser, we accepted this. There was also no evidence Ms C had sustained permanent damage because of the positioning or fitting of the casts. We did not uphold any of her complaints.

Ms C also complained that following her review appointment she had received inappropriate advice from a registrar that she had suffered permanent damage to her wrist, had lost the use of three fingers, and would require obtaining the services of a carer. We found no evidence that this advice had been given, and the written records reflected that she had been given different information.

We also found that the board's investigation into Ms C's complaints was thorough and reasonable, with all issues raised addressed. We noted Ms C had been in frequent communication with the board via letter, email and telephone, and the board had acknowledged all correspondence. We found that the board had generally addressed follow-up queries well, although Ms C had frequently requested two particular members of staff be removed from the investigation, and the board had not addressed this concern. Although we found it was reasonable for the board to maintain those staff members' involvement in the investigation, we found the board could have clearly told Ms C about this decision, and drew this to their attention.

Summary

When Ms C attended for a psychiatric assessment, the board had concerns about her mental heath and the risks she presented to herself and others. They notified the police about an aspect of this. Ms C complained that the board failed to tell her about the action taken. We reviewed the records, and found that it was clearly documented that the police contact had been discussed with Ms C in advance. Although Ms C did not agree with this, in the absence of any specific evidence to the contrary we did not uphold the complaint.

Summary

Ms C's late father (Mr A) was admitted to hospital with circulation problems in his legs. He was diagnosed as having compressed arteries causing reduced blood supply, and emergency surgery was arranged for that afternoon. This was carried out but there was no improvement and his condition deteriorated. Two days later, medical staff concluded that the outlook for Mr A was poor and agreed with his family to provide only palliative care (care to prevent or relieve suffering). Mr A passed away later that day.

Ms C said that the day after Mr A's operation her mother (Mrs A) tried unsuccessfully to discuss his condition with a doctor. Ms C also told staff that she was going on holiday the next day, but said that nobody told her how serious her father's condition was. The next day, Mrs A went to hospital expecting an update and so did not bring any family members with her. Staff there told her that Mr A’s condition was terminal. Ms C was informed of this when she arrived at her holiday destination but could not get a flight back until the following day and so did not see her father before he died.

We took advice from one of our medical advisers, and found that while Mr A was critically ill, he was stable on the day after his operation. We found no evidence that his death so soon afterwards could have been predicted, as his condition did not deteriorate significantly until shortly before his death. We also found that staff acted reasonably when they asked Mrs A to come into the hospital quickly and told her of her husband's terminal condition, as at that point Mr A was deteriorating rapidly.

Summary

Mr C is 76 years old and has a disability. He complained about the board's toenail cutting service. He said he needed his nails cut every eight to ten weeks, but the board only provided the service every 12 to 14 weeks. Mr C also said that because they recently told him that it would be 16 weeks until his next appointment, he had to pay for private treatment in between times. He felt that the service he received was inadequate.

When we investigated, the board explained that their view of Mr C's requirements was based on an assessment that they make of each patient to decide how often appointments were needed. This assessed Mr C as requiring appointments every 12 weeks. They said that they had obtained a detailed second opinion from a senior specialist at another of their clinics, which supported this view. The board also said that they try to meet the required timescale for the next appointment but there were times when this was not possible, for example when there were staff absences. At such times, patients such as Mr C who need only routine attention may find that their appointment is after the end of the recommended return period.

As part of our investigation, we obtained advice from our nursing adviser. She said that the board's assessments appeared to have been carried out appropriately. There was no clinical evidence to suggest that Mr C needed appointments more often than every 12 weeks. Our adviser noted that although Mr C would like to have his nails cut more often, the board had to make difficult decisions about managing resources. We found that they had managed Mr C's case appropriately and provided an adequate service.

Summary

Mr C said that an NHS 24 nurse practitioner failed to respond appropriately to a call made to NHS 24 when his mother fell ill. The nurse practitioner explained during the call that she would arrange for an out-of-hours GP to attend within two hours. Following the GP's visit, Mr C's mother was admitted to hospital where she later died. Mr C complained that the nurse practitioner failed to take into account his mother's recent admission to hospital, following the fracture of her hip, and failed to give the case sufficient priority.

Our nursing adviser considered the evidence, including a recording of the call, and reached the conclusion that the nurse practitioner's actions were reasonable. She noted that the nurse practitioner had in fact upgraded the response time from 'two hours' to an 'urgent' response after the telephone call but that, unfortunately, the family were not informed of this. As the nurse practitioner's actions were, however, reasonable in terms of the priority given to the call, we did not uphold the complaint.

Summary

Mrs C complained about the orthodontic treatment that her son (Mr A) received. (Orthodontics is the branch of dentistry dealing with the prevention and correction of irregular teeth.) Mr A attended an appointment with the orthodontist and Mrs C completed an NHS form so he could be considered for NHS treatment. The orthodontist found that Mr A's teeth were not misaligned enough to qualify for NHS funding but carried out work privately on his front teeth. Mrs C complained that she was not told that Mr A would be treated privately. She said that she did not agree to this and that she only became aware of the decision when she relocated to England and found that the orthodontist had withheld Mr A's clinical records because the bills were unpaid.

We found that Mr A should not have been considered eligible for NHS treatment. However, the orthodontist should in that case have obtained written consent from Mrs C for private treatment to be carried out. The decision to provide the treatment was confirmed in writing to Mr A's dentist, and the orthodontist said that it was discussed with Mrs C during the appointment, along with the associated costs. However, we found no evidence in the records to show that this was discussed with Mrs C. Neither did we find evidence that consent was obtained, or that any payment was taken once treatment commenced. We also found that it was inappropriate for the orthodontist to withhold Mr A's clinical records. We made recommendations to address thse failings.

Recommendations

We recommended that the dentist:

• arrange for copies of Mr A's clinical records to be provided to his new dentist and/or orthodontist on request;
• waive any outstanding fees associated with Mr A's treatment; and
• apologise to Mrs C for the issues highlighted by our investigation.

Summary

Mr C attends hospital regularly for treatment. On one of those occasions a member of staff handed him an envelope containing letters that Mr C had given another member of staff to read. The envelope was addressed to Mr C but it was open. Mr C was concerned because the letters contained personal information about him. He complained to the board but was dissatisfied with their response and complained to us.

When we investigated, the board said they had asked staff about this after Mr C complained but no-one could remember anything about the envelope and there was nothing documented in his file. There was no further information or evidence available, and in the absence of such evidence we could not uphold the complaint as we could not say for certain whether or not the envelope was open when it was left for Mr C.

Summary

Ms C fell while away from home and fractured her wrist. At the time she was 70 years old with a history of osteoarthritis (a common form of arthritis causing chronic breakdown of cartilage in the joints). She had a cast applied to her wrist. On returning home, she was seen at a hospital. As the bones had not lined up properly, she had an operation to correct this using a fixator (a device to fix the position of fractured bones). Ms C was unhappy when the fixator was removed, as she was told that the bones were still out of alignment and she would not regain the full function of her wrist and fingers. She questioned whether the bones had been correctly aligned before the fixator was fitted. She further complained that the anaesthesia (pain relief) given to her failed to work and that she experienced a great deal of pain. She said that the operation had not been properly explained to her and that the board had taken too long to deal with her complaint.

We investigated the complaint taking into account all the relevant information, including the complaints correspondence, relevant clinical notes and x-rays. We also obtained advice from our medical adviser, who reviewed Ms C's notes and the care and treatment she received. He said that her treatment was entirely appropriate and satisfactory. He said that sometimes anaesthesia could be imperfect, but that this did not necessarily indicate any failure by the doctors. He said that her pain was managed in accordance with accepted practice. The adviser also took the view that the board's explanations to Ms C about her operation were appropriate and reasonable.

Taking all these factors into account, we did not uphold Ms C's complaints about her care and treatment. However, there was evidence to suggest that the board took too long to deal with her complaints on these matters.

Recommendations

We recommended that the board:

• apologise to Ms C for the delay in responding to her complaint; and
• remind their staff of the importance of adhering to their stated complaints handling timescales and process.

Summary

Mr C complained that there were several errors in a letter that a doctor sent to his GP after he attended a clinic about his stomach problems. He said that this showed the doctor had not paid attention to him during the consultation. We obtained the doctor’s notes of the consultation and asked for his comments on the matter. The doctor said that he believed that the notes he took and the letter he dictated following the consultation with Mr C were accurate. Our investigation did not find any evidence to support Mr C’s complaint that there were errors in the letter.

Mr C also said that the doctor sent the letter to the wrong medical practice. Our investigation found that the letter had been sent to the correct practice and did not uphold this part of Mr C’s complaint. However, we found that when Mr C complained to the doctor about the letter, the doctor sent the complaint to Mr C’s practice, but did not respond to it.

Recommendations

We recommended that the board:

• write to Mr C to apologise for the doctor's failure to respond to his complaint.

Summary

Mr C complained that he endured more than 18 years of illness due to inadequate care and treatment by the doctors at his medical practice. Mr C said this was demonstrated by the doctors’ inability to provide appropriate care and treatment for his stomach problems or tell him about his post-prandial condition (which involved symptoms arising after he ate). Mr C said that he had lost trust with the practice doctors.

We did not uphold Mr C's complaints. Having taken advice from our medical adviser, who considered Mr C's clinical records, we decided that the practice had appropriately treated and cared for Mr C over the period in question. Our adviser said that the term 'post-prandial fatigue' is not a diagnosis as such, but is a medical term used to describe symptoms. We noted that doctors had referred Mr C to hospital at his insistence - our adviser said this sometimes happens when a doctor cannot reassure a patient about their symptoms. We also noted that tests taken at the hospital proved negative.