Health

Summary

Mr C told us that his eye was injured in a road traffic accident some time ago. He had undergone ten or eleven operations on his eye, but complained to us specifically about his last two procedures.

Mr C told us that he had ingrown eye lashes and a hospital doctor decided to turn the eyelid out. Mr C said he was unhappy with the result, as his eye was drooping and he still had pain from the eyelashes. He said that he had laser treatment from another doctor at the hospital and this helped by getting rid of the ingrown eyelashes. However, Mr C was also eventually dissatisfied with this treatment. He also complained that he was incorrectly discharged from the hospital, that the board either did not have, or had inadequate, access to his medical records, and that they had not dealt with his complaint correctly.

Our medical adviser reviewed Mr C's medical history and treatment from 2001 when Mr C had first presented with trichiasis (eyelashes misdirecting towards the surface of his eye). The adviser said that there was no evidence to support Mr C's view that he had not received appropriate treatment. We found no evidence to suggest that Mr C was incorrectly discharged from the hospital or that the board did not have appropriate access to his medical records.

Mr C was dissatisfied with the board's complaint responses. However, we considered that the board appropriately investigated and answered the issues he raised.

Summary

Ms C (an advice worker) complained about the care and treatment provided to her client (Mrs A) by her medical practice.

Mrs A has a history of early osteoporosis (abnormal loss of bone tissue causing fragile bones), and a family history of osteoporosis. In 2010, her GP prescribed her with a long-term course of steroids for another condition. The GP planned a scan to measure her bone density in May 2010, but the hospital did not receive a request form. For the next five months, Mrs A attended the practice complaining of severe back pain. She said that she raised the possibility of osteoporosis with her doctors. She also went to her local accident and emergency department three times because the pain was so bad. The practice treated her symptoms as mechanical back pain. They referred her to a physiotherapist, ordered x-rays and blood tests, and prescribed painkillers. In November 2010, another doctor referred Mrs A for a scan. This showed that she had severe osteoporosis and fractures to four vertebrae.

Ms C complained that her client was not told about the potential side effects of the steroids and was not given medication to counteract the side effects. She said that the scan should have been carried out earlier and that the practice did not reasonably monitor Mrs A. She also raised concerns about the level of steroids prescribed. Mrs A now has severe osteoporosis and daily pain, curvature of the spine and has lost three inches in height. She said that the failures by the practice had a significant adverse impact on her quality of life.

Our investigation found that Mrs A was at high risk of developing osteoporosis and we identified failures in treatment, monitoring, communication and record-keeping. Mrs A should have been given treatment to counteract the effects of the steroids and the practice should have ensured a scan was performed earlier. However, we found that the dose, duration and adjustment of the steroids was reasonable in relation to the symptoms she was displaying. It was not certain whether earlier treatment would have made a difference to the outcome, but it was clear that specialist intervention was delayed which caused Mrs A distress.

Recommendations

We recommended that the practice:

• review its record-keeping, particularly relating to advice on medication with significant side effects; and
• confirm they have implemented the recommendations in their significant event analysis and report back to us on progress.

Summary

Mrs C complained that the board had not explained bruising on her son's chest and neck after he came out of the operating theatre following a procedure. She said that her son (who has a blood disorder) had undergone the procedure regularly over the past eight years but had never sustained bruising. She was also concerned that the board's response to her complaint was contradictory.

The board told Mrs C that the likely cause of the bruising was a combination of force used to remove heart monitor stickers and her son's blood disorder. The board explained that the blood disorder was likely to have been a contributory factor to the bruising on the neck area as no stickers had been placed in this area and it appeared Mrs C's son had been lying on the heart monitor lead during the procedure.

We took advice from our medical adviser, a specialist in working with children with blood disorders. He advised that the most likely cause of the bruising on the chest area was the normal amount of force needed to remove the heart monitor stickers, which was made worse by Mrs C's son's blood disorder. He also considered that the bruising on the neck was likely to have occurred as a result of her son's lying position on the wires during the procedure.

We accepted this advice and did not uphold the complaint, but we made a recommendation to ensure that in future parents are aware of the possibility of such bruising.

Recommendations

We recommended that the board:

• ensure that parents and carers of children with low platelet counts are warned, either at general counselling stage or when seeking consent for an operative procedure, about the possibility that mild to reasonable force could cause unnaturally severe bruising.

Summary

Mrs C complained about the treatment that her late son (Mr A) received at a cancer centre where he had been admitted for a course of chemotherapy. She complained that when it was noticed that he was suffering from side effects of anti-sickness drugs, the consultant who prescribed the medication delayed in stopping it. She also said that the consultant failed to consult with other clinicians about the appropriateness of the prescribed drugs and failed to take Mr A's complex medical conditions into account.

Mrs C also complained that the consultant failed to explain the possible side effects of the medication, and that when she formally complained to the board she was not treated sympathetically and they took a long time to respond to her complaint.

We did not uphold Mrs C's complaints. Our investigation found that the clinicians involved were fully aware of Mr A's medical history, took his concerns seriously and treated him appropriately. We also found that they investigated his symptoms properly to determine the underlying cause. The medical notes showed that communication between clinicians had been excellent, and that staff took time to discuss Mr A's condition and medication with him and his family.

Finally, we found that the board's complaints handling was good. We found that they had provided responses that were thorough, detailed and empathetic. However, we found that the board failed to provide updates for a period of time before sending their final response. We drew this to their attention, but made no recommendation.

Summary

Mr C was unhappy about the suspension of his psychological therapy. He complained that the suspension took place on the basis of a tentative change of diagnosis which was later discounted. The advice from our medical adviser suggested that the suspension of treatment was premature, and we upheld the complaint.

Mr C also complained of a delay in his referral for alternative psychological therapy. He was referred in 2010 despite his psychiatrist having first considered a referral in 2009. We acknowledged the psychiatrist's concerns that Mr C may not have been ready for the treatment, but noted that a referral would only have been to assess whether he was a suitable candidate. We, therefore, concluded that the delay was unreasonable and upheld the complaint.

Mr C was prescribed anti-depressant medication, which had potentially serious side effects when mixed with alcohol. His psychiatrist informed him of the risks and referred him to a pharmacist for specialist advice. The pharmacist also provided Mr C with guidance from the drug manufacturer which said that alcohol presented a moderate risk. Mr C complained that this advice was inconsistent with the other advice offered. He felt that it had not been made sufficiently clear that alcohol should be avoided. We were satisfied that Mr C was appropriately told about the risks, so we did not uphold this complaint. However, we found that the pharmacist had not recorded details of her contact with Mr C or the advice given, and we made a recommendation to address this.

Finally, Mr C complained about the board's handling of his complaint. He felt that his complaint had a negative impact on his treatment but we found no evidence to support this. However, we found an unexplained delay in responding to his initial complaint and also that his last letter of complaint did not receive a response at all. In addition, complaints handling staff tasked Mr C's psychiatrist with gathering information on his complaint during a clinical appointment, which we considered to be inappropriate use of a therapeutic consultation. In these circumstances, we upheld this complaint.

Recommendations

We recommended that the board:

• apologise to Mr C for prematurely suspending his treatment;
• remind clinicians to ensure that, when writing to a patient's GP, they copy in other relevant professionals involved in the patient's care, especially when the content of the letter suggests a change of diagnosis and/or treatment direction;
• remind clinicians that, where there is a clear diagnosis, patients need to know what that is, and where there is uncertainty, they need to know why;
• apologise to Mr C for the delay in referring him for an assessment for further psychological therapy;
• remind pharmacists who have therapeutic contact with patients of the importance of recording their interactions and, in particular, any medication advice provided;
• ensure that, where they are unable to respond to complaints within their target timeframe, they explain the reason for this to complainants and advise of when they expect to be able to respond;
• ensure that they respond to all correspondence from complainants and provide clear guidance on what steps they should take if they remain unhappy;
• highlight to complaints handling staff that it is not appropriate to use therapeutic consultations for complaint information gathering purposes; and
• apologise to Mr C for the inappropriate handling of his complaint, as identified in our investigation.

Summary

Mrs C complained that a doctor in a hospital's accident and emergency department did not order an x-ray despite her prior history of osteopenia (a condition affecting bone density). Mrs C said that the doctor had examined her and advised that nothing was broken but that there was some bruising to her ribs that was likely to last two months or so. She also said that the doctor had told her to take 500 milligrams of paracetamol four times a day for pain relief. Mrs C said that the doctor planned to do a rectal examination but she left before it was carried out. This was because of the time it was taking to arrange a chaperone, and because she was unable to get into the required position due to the level of pain she experienced.

As the pain had not improved, Mrs C visited her GP some two weeks later. An x-ray was arranged and showed a fracture to her spine. In their response to the complaint, the board advised Mrs C that it was not possible to make a judgement on whether it would have been appropriate for the doctor to have requested an x-ray, as she had left the department before the clinical assessment could be completed.

Following advice from our medical adviser, we concluded that, although Mrs C had left the department before the rectal examination was done, the doctor should have considered an x-ray based on the risk factors Mrs C presented with and her previous medical history. We also noted that most protocols suggest that, in women over fifty years of age, back pain caused by trauma requires

x-ray investigation.

We also identified that the doctor had not documented the partial examination he had carried out on Mrs C, nor had he noted the plan to carry out a rectal examination. The doctor has said that he will learn from the incident and ensure that relevant information is recorded if a similar situation were to arise in future.

Recommendations

We recommended that the board:

• apologise to Mrs C for the failures identified; and
• review their accident and emergency guidelines for the management of patients presenting with thoracic back pain caused by trauma and non-trauma, to ensure appropriate x-ray investigation and pain management where relevant.

Summary

Mrs A, who was elderly and disabled, was admitted to hospital. While in hospital she fell. Mrs A was seen by a doctor, who did not suspect any broken bones. Later, it was determined that she had broken her hip. Her solicitor (Mr C) complained that although her mobility problems were recorded, she was not given enough assistance. He said that as the fracture was not diagnosed at the time, Mrs A was caused additional pain.

We carefully considered all the available information provided by Mr C, Mrs A's son and the board. Our investigation found that the board failed to carry out an adequate mobility assessment when Mrs A was admitted to hospital. However, we found no evidence that she was not offered appropriate assistance. We also found that the board's care and treatment of Mrs A was satisfactory.

We upheld Mr C's complaint that the board unreasonably failed to respond when he questioned the outcome of their investigation.

Recommendations

We recommended that the board:

• offer a sincere apology for the failing identified; and
• emphasise to staff concerned the importance of following and acting upon guidance available to them concerning the prevention of falls.

Summary

Mrs C attended a NHS dentist for treatment. While there, she asked for some minor remedial work to a denture that was made at a private practice. Mrs C complained that the dentist had removed extensive material from the denture making it sharp, uneven, and unwearable. Mrs C also complained that the dentist failed to properly handle her complaint.

We did not find anything lacking in the dentist's handling of Mrs C's complaint. The evidence showed that the dentist responded to the correspondence within a reasonable timescale, offered an appointment to discuss the complaint in more detail, fully explained her position, offered to discuss the matter with Mrs C's private dentist, and offered to arrange for another dentist in the practice to reline her denture.

Summary

Mr C, who is a prisoner, complained about his health care treatment in prison. He was unhappy that the doctor would not prescribe him with sleeping medication.

In Mr C's case, the medical records showed that he had been prescribed a three night course of sleeping medication, offered non medication alternatives including smoking cessation advice and sleep hygiene advice and had his case referred to a consultant psychiatrist for review.

In light of this, and on the advice of our medical adviser, we were satisfied that the treatment provided to Mr C was reasonable and we did not uphold his complaint.

Summary

Mrs A was admitted to hospital on numerous occasions in the two years before her death. She had a complex medical history and tested positive for a bacterial infection, Methicillin-resistant Staphylococcus aureus (MRSA), on six occasions during that time. Mrs A's daughter (Mrs C) complained that the board failed to investigate the cause of her mother's MRSA and to successfully treat it.

Our investigation found that the cause of Mrs A's MRSA was appropriately investigated and successfully treated on each occasion she tested positive and we did not uphold the complaints. We noted that the board acknowledged there was poor communication with Mrs C and other members of Mrs A's family about MRSA and how it was being treated. The board apologised to Mrs C for this, and addressed the issue with staff on relevant wards in the hospital.

Although we did not uphold the complaints, we were concerned about problems in the record-keeping and made a recommendation to address this.

Recommendations

We recommended that the board:

• share our adviser's comments with staff involved in Mrs A's case, and ensure that records are kept in line with Royal College of Physicians and Nursing and Midwifery Council guidance.