Health

Summary

Mr C is a patient in a mental health facility. He complained that in documentation the board stated as fact information which had not been investigated or confirmed. He also said they had not sent reasonable responses to his letters of complaint.

Our investigation found that information had been incorrectly presented as fact, although it had not been clearly established what happened. A police investigation into the matter could not be progressed as a key witness refused to cooperate. We upheld this complaint and made a recommendation to address this.

Mr C was also unhappy with the response that the board gave to his complaint. However, we found that it was clear that the responses had fully explained the reasoning and the fact that the police investigation had stalled. We did not uphold this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for their actions in this matter and update, correctly, the information held on their care plan.

Summary

Mr C attended his medical practice and requested a prostate examination. He said that the GP refused to carry out this procedure and was rude and aggressive towards him. The GP asked Mr C to complete a symptom score sheet and discussed the possible negative side effects of checking for prostate cancer. Mr C considered that these were steps that the GP need not have taken.

He raised a complaint about the matter but the practice maintained that the GP had acted reasonably, and within guidance. Mr C then told the practice that he would no longer see the GP, even in an emergency. The practice replied explaining that they considered his behaviour towards the GP to have been unacceptable. They said they would be unable to continue to provide services if he was unable to accept treatment from the GP in an emergency. As Mr C did not wish to comply with the practice's request, they wrote telling him that they intended to remove him from their list of patients.

We took advice from our medical adviser, and found that the steps that the GP had taken during the consultation were in accordance with best practice. We were unable to establish Mr C's allegations of rudeness and aggressiveness without some independent evidence. We found that the evidence of the communications between Mr C and the practice indicated that the doctor/patient relationship had broken down. This gave the practice reasonable grounds to issue a warning, and eventually ask Mr C to leave the practice.

Summary

Mr and Mrs C complained that, before starting in vitro fertilisation (IVF) treatment, a hospital gave them inaccurate statistical information about relevant IVF success rates applicable to Mrs C.

The couple said that they followed medical advice and undertook IVF treatment in the knowledge that they had been told that due to Mrs C's age, achieving fertilisation might be more challenging. They said that a clinician had advised that as there were no underlying health issues preventing conception, there remained around a 15 percent chance of success.

Mr and Mrs C said that the IVF treatment resulted in one successful embryo transfer. However, the next day Mrs C became unwell, and the transfer failed. The couple complained that the care and treatment Mrs C received was inadequate. They said that staff failed them; that care procedures were lacking; and that staff misled prospective parents.

We took advice from our medical adviser, who considered all the facts and relevant information and guidance. After careful consideration, we decided that there was no evidence that clinical staff had provided inaccurate information to Mr and Mrs C before IVF treatment began. We also considered that the actions of the ward's out-of-hours service staff were appropriate and adequate.

We also looked at how the board handled Mr and Mrs C's complaint and found that they had appropriately addressed all the issues raised.

Summary

Mrs C complained that her dentist had not ensured the fit of a crown before cementing it in place, and that he would not refund her the full cost of fitting the crown to allow her to receive further treatment at a different dental practice.

We found that the dentist had taken all reasonable steps to ensure the fit of the crown was suitable prior to the cementing, including having the crown remade at an earlier appointment, giving Mrs C the opportunity to check the appearance and position of the crown with a mirror and obtaining her consent before undertaking the cementing.

We noted that Mrs C had already received a refund of the cost of the crown from the dentist as a goodwill gesture, and that other fees she had paid had been for different treatment. We found that if Mrs C was to seek further treatment elsewhere, she would be required to pay the cost of the crown again. As this cost had already been refunded, we did not find that Mrs C was entitled to any further refund.

Summary

Mr A was an elderly man with a history of health problems and restricted mobility. He had been nursed at home for several years.

Mr A was admitted to hospital with confusion, infection and back pain. Nine days after admission, he developed pressure ulcers. Mr A remained in the hospital for around seven weeks until he was transferred to a second hospital, where he remained until his death around three weeks later.

Mr A's son (Mr C) said that his father was at known risk of developing pressure ulcers. He said that the family alerted staff to their concerns about the the need to change Mr A's position. He complained that, despite this, staff at the first hospital unreasonably failed to monitor his father appropriately and change his position frequently enough to prevent pressure ulcers developing.

Mr C also complained that there was an unreasonable delay of nine days in obtaining specialist equipment such as a special mattress. He said that when Mr A was transferred to the second hospital there was a further unreasonable delay of two days in transferring the special mattress between the two hospitals. In addition, Mr C complained that the board's response to the family's complaint about Mr A's care was inadequate.

We upheld Mr C's complaint about the two day delay in the transfer of a special mattress between the hospitals. The board acknowledged there was a delay, and our adviser's view was that such a delay was unacceptable. As a result of this failing, the board introduced a standard operating procedure to avoid future delays. We, therefore, did not find it necessary to make any recommendations about this.

We did not uphold Mr C's other complaints. We understood the family's reasons for concern about Mr A's care and treatment. However, our investigation found that Mr A's pressure areas were monitored and cared for appropriately for the first nine days in hospital. When pressure ulcers developed, they were properly cared for, in line with relevant NHS guidance. From admission to the first hospital, Mr A was on an appropriate mattress based on his pressure ulcer risk assessment score. When the score increased, a special mattress was ordered. This was in line with both the board's guidance and general NHS guidance.

We found that the board's investigation of the family's complaint and their response to it addressed the points made in the family's complaint letter, and was a reasonable reflection of Mr A's condition and the care provided to him.

Summary

Mrs C's husband (Mr C) was ill and she called NHS 24. However, she complained that the board failed to respond to her call and that the out-of-hours (OOH) doctor who came did not treat her husband appropriately. She also doubted that the doctor properly recalled the visit.

We considered all the relevant information and obtained advice from our medical adviser. We found the information about the telephone calls inconclusive. Mrs C said that the board had not called, however, the board's records said that attempts to call Mrs C were made, but were unsuccessful. We did not see any records of these specific calls, and in the absence of evidence, could not uphold this complaint.

We agreed that the OOH doctor had not properly treated Mr C in accordance with his symptoms and had kept poor records of the visit. This meant that the information that the board gave Mrs C when she complained was confusing. We made recommendations to address the failures identified.

Recommendations

We recommended that the board:

• apologise to Mr and Mrs C for their oversights in this matter; and
• emphasise to the OOH doctor the importance of taking a full record and, if it has not already occurred, the OOH doctor should prepare a significant event audit on this case and discuss it at their next appraisal.

Summary

Mrs C complained about the care and treatment her dentist provided in relation to root canal treatment that resulted in the loss of her tooth. Mrs C was also unhappy that the dentist had not explained the associated risks with this treatment and that her complaint was not properly handled.

In response to the complaint, the practice manager advised Mrs C that the dentist had explained the treatment and this had been documented in her clinical records.

When we looked at the clinical records, we found that the dentist had carried out an x-ray several months before root canal treatment was attempted, and had told Mrs C that she needed this treatment or that the tooth would eventually need extraction. We also took into account that the dentist had documented that Mrs C had been told at other appointments that she still needed to have this treatment carried out.

After taking advice from our dental adviser, we considered that it was good practice for the dentist to have treated the tooth by either root canal treatment or extraction as the x-ray had indicated an area of either inflammation or infection around the tooth. We also considered the dentist's explanation to why the root canal treatment failed to be reasonable. They had said that the root of the tooth was perforated (contained holes) and the continuation of the root canal could not be found, so extraction of the tooth was the best option to ensure that the inflammation did not spread.

We also found that the practice manager had responded appropriately to the issues Mrs C had raised in her complaint. Although the letter contained medical terms that could have been better worded, we did not consider that this significantly affected the overall understanding of the response.

Summary

Mrs C complained about her diagnosis and treatment when a suspected pre-cancerous duct was found in her breast after a routine screening. She said that she was offered only radiotherapy after her operation, although she believed alternative treatments were available. Mrs C undertook her own internet research and went to a private doctor for a second opinion. Mrs C said that she was, however, being advised by her clinicians, her GP and even her family to undergo radiotherapy so she eventually signed the consent form and agreed to treatment.

Our investigation showed that several clinicians spoke to Mrs C about her condition and radiotherapy treatment. We took advice from our medical adviser, who said that the only alternative to radiotherapy was no treatment at all. This was because the type of condition that Mrs C had cannot be treated with more usual treatments for breast cancer.

Mrs C was also unhappy with the diagnosis of her condition. She had a mammogram (breast x-ray) and two needle biopsies (where a small amount of tissue is removed for examination). She was also seen by a consultant surgeon. Our medical adviser said that this diagnostic process complied with SIGN (Scottish Intercollegiate Guidelines Network) guidance. He did not consider that the process was overly invasive or radical. In line with the SIGN guidance, the matter was discussed at a multi-disciplinary team meeting and the options discussed with Mrs C and passed on to her GP.

Summary

Mr C and Mrs D complained about the care and treatment provided to their late mother (Mrs A) by her medical practice. Mrs A attended the practice in May 2011 complaining of pain over the previous four months. Her GP arranged a number of tests including a pelvic ultrasound scan, which was inconclusive.

In June and July, Mrs A continued to attend the practice complaining of pain. Her GP prescribed antidepressants, and medication for her spasms and pain. After further visits, the GP referred Mrs A for a routine surgical out-patient consultation in August. This referral was upgraded to an urgent priority following another GP consultation in September. Before she could attend her out-patient appointment, she was admitted to hospital by emergency services. She was diagnosed with pancreatic cancer after a scan, and died at the end of October.

Mr C and Mrs D complained that no follow-up action was taken following the inconclusive results of the pelvic scan and they believed that, given the severity of their mother's pain and the number of times she attended the practice, she should have been referred urgently to hospital for further investigation. They also said that the practice failed to prescribe pain relief within a reasonable time and they raised concerns that their mother was diagnosed with anxiety and depression. They said that anybody suffering pain of this severity would understandably be anxious and depressed and felt that this distracted the practice from properly investigating the causes of her pain.

We found that although the practice could have been more proactive in searching for the cause for Mrs A's pain, the time taken to refer her was, on balance, reasonable particularly as there was no evidence of abnormalities available to the GP in August. We also found that although there may have been an over-emphasis on the psychological aspects of Mrs A's condition, the suggestion that she was suffering from anxiety and depression was not in itself inappropriate. We did not uphold either of these complaints. However, we found that while the practice attempted to manage Mrs A's pain, pain relief was prescribed relatively late and we upheld the complaint about this.

Recommendations

We recommended that the practice:

• review the management of this case in light of our findings; and
• apologise to Mrs A's family.

Summary

Mrs C complained that a hospital gynaecology department provided her with inadequate care and treatment for ovarian cancer. She said there were inadequacies with her diagnosis and treatment and specifically a failure to properly diagnose her condition. She also said she experienced delays by the board in the way they progressed her treatment. Mrs C went to France for a second opinion from a clinically trained friend. She said she experienced problems in getting the board to provide or release relevant medical records and test results to her doctor in France. Mrs C told us that as a result, she had to undergo emergency surgery in France without this information being provided. She said that the board showed no inclination to appropriately respond to her complaint about this.

We took advice from one of our medical advisers who reviewed Mrs C's medical records. He noted that Mrs C presented with an abdominal mass and from the scan that was taken, he said it was appropriate to consider ovarian malignancy as the likely diagnosis. He said that a definitive diagnosis could only be reached by the microscopic examination of tissue obtained during surgery to remove the mass. He also said that the provisional diagnosis was not incorrect or hasty and was appropriately based on the evidence available.

Following the clinic appointment at which the abdominal mass was found, arrangements were made for Mrs C's case to be discussed by a multi-disciplinary team. This is in line with guidance, the intention of which is to ensure that patients with suspected cancer get the best possible treatment by the most appropriate team. The adviser noted that Mrs C's gynaecologist communicated the outcome of the team meeting to her, about a week after she attended the clinic, and it was arranged that Mrs C would see a gynaecological surgeon for a pre-operative assessment about three weeks after that. The adviser said that this time-frame was reasonable.

We found that it was appropriate that the consultant considered the need for patient consent before releasing medical information to a third party - in this case to Mrs C's doctor in France. There was evidence that Mrs C had received appropriate and timely communication from the board and received a follow up appointment in good time. Finally, we found that it was reasonable that the board (in the time-frame available) were not able to advise Mrs C about reimbursement of her medical costs in France and that they adequately investigated and addressed her complaint.