Health

Summary
Mr C complained on behalf of his wife (Mrs C) about delay in getting a hospital appointment, treatment at the pain clinic, and poor complaints handling. Mrs C had had pain in her back and leg for ten months and pain in her neck and arm for eight months, and Mr C thought she should have been seen at the hospital more urgently. Her GP referred her to the neurosurgery department in July 2011, and followed this up with a further referral two months later, including a request that she should have a scan on her neck before attending her scheduled appointment. No scan was taken, however, even though Mr C also wrote to the board. Mrs C was seen in neurosurgery as scheduled in November and was referred to the pain clinic, where she was eventually seen in December. Mr C complained that although the GP made an urgent request for Mrs C to be seen at the pain clinic, because the referral from the department of neurosurgery was classed as routine she was not prioritised.

We did not uphold the complaints about delay and treatment. Our investigation, which included taking advice from our medical adviser, found that it was reasonable for the GP to refer Mrs C on a routine basis as she had no 'red flag' symptoms that would have triggered an urgent referral. Mrs C was seen by a specialist within 17 weeks. This was just within the national target of 18 weeks and there was no evidence of avoidable delay. The reclassification of the referral to the pain clinic was also reasonable. Our adviser said that although Mrs C had been in pain for some time, she was not displaying the sort of symptoms that would have needed an urgent referral. It is also the responsibility of hospital specialists to fully assess and categorise referrals. In Mrs C's case, this was done appropriately by the on-call pain consultant.

We found, however, that there were unreasonable delays in providing a response to Mr C's complaint. The board did not respond for two months and provided no acknowledgement, explanation or apology for this. We found that the delay was partly due to the board calculating response times wrongly - not from the original date Mr C complained, but from the date of a later email that he had sent. We upheld the complaint and made a recommendation about this.

Recommendations
We recommended that the board:

• apologise to Mr C for the complaints handling failings we identified.

Summary

Mr C had a history of alcohol dependency. He stopped drinking in May 2010. His medical practice prescribed medication, including Thiamine B (a specific type of vitamin B). In 2008, Mr C had experienced ice-cold feet, severe pain and loss of sensation in his legs. In 2009, he was diagnosed with peripheral neuropathy (damage to the nerves that connect the central nervous system to the limbs) and in May 2010 he began to have seizures and tremors.

Mr C stopped taking the prescribed Thiamine B in August 2011 and found that his pain, muscular problems and seizures stopped. He complained to the practice about the use of Thiamine B and the fact that this was not reviewed following his deterioration in 2008. They told him that there are no side effects associated with this medication. However, Mr C conducted his own research and found that an allergic reaction to the medication could cause the symptoms he experienced. He also believed that his other medication had a detrimental impact on his health. He complained to us that the practice failed to reassess his medication when his symptoms developed and failed to identify that Thiamine B was causing his neurological problems. He also complained that the practice failed to refer him for a specialist opinion.

We took advice from one of our medical advisers and found that all the medication complained about was appropriate for a patient with Mr C's symptoms and history of alcohol dependency. Thiamine B in particular has a protective role in limiting damage to the nervous system should the patient continue to consume alcohol. We accepted that patients may react in unpredictable ways to any medication and recognised the symptoms that can be caused by a reaction to Thiamine B. However, we found no link between this medication and neurological problems as described by Mr C. We were satisfied that the practice held regular discussions with Mr C about his medication during a number of consultations. We were also satisfied that the practice arranged suitable tests and made appropriate referrals for investigation into the cause of Mr C's symptoms by specialist consultants.

Summary
Mrs C had surgery in hospital to remove a soft tissue lump from her right thigh. She said that a few days later the wound had become red and infected. She contacted NHS 24 who referred her to an out-of-hours (OOH) GP service where a nurse prescribed antibiotics. Mrs C returned home, but her condition worsened and later that day NHS 24 arranged for an ambulance to transfer her to hospital where she was diagnosed with a skin infection and an infection of the thigh wound. Mrs C had a further surgical excision and drainage, and the wound was left open to heal from the inside. She received antibiotics intravenously (directly into a vein) and was discharged on oral antibiotics.

Mrs C complained that the hospital failed to prescribe her with antibiotics after the initial surgery, which she believed might have prevented the infection she later contracted. She also said that the OOH service failed to take her seriously and recognise the seriousness of her condition. Mrs C said that as a result of the failure to provide antibiotics and the failures in the care and treatment she received from the OOH service, she has struggled to recover from her operation and continues to have difficulty in walking.

After taking advice from our medical adviser, we found that the hospital's decision not to prescribe Mrs C antibiotics after her initial surgery was reasonable. However, we also found that the OOH nurse failed to recognise the significance of Mrs C's symptoms and admit her to hospital, although our medical adviser said that this would not have affected the outcome.

Recommendations
We recommended that the board:

• have the relevant staff review the management of this case in light of the findings; and
• apologise to Mrs C. 

Summary
Mr C complained that a GP failed to provide him with appropriate treatment for his throat condition during a home visit. He said that he went to see another GP the next day, who referred him to hospital, where he received treatment for an abscess on his tonsil.

We took advice from our medical adviser. He commented that this type of abscess can develop quickly. He said that, given the GP's account that the appearance of Mr C's throat had changed, the management of Mr C's sore throat had been reasonable.

Mr C also complained that the GPs had misdiagnosed his rhinitis (inflammation of the lining of the nose) as sinusitis (inflammation of the sinuses) for a number of years. We found that Mr C had been diagnosed with sinusitis at a hospital. Our medical adviser considered that the actions of the GPs in relation to this matter were reasonable. He said that sinusitis and rhinitis can coexist and can be treated in the same way. He also noted that there had been little change in Mr C's management after the diagnosis of rhinitis.

Mr C also complained about the actions of a receptionist and the practice manager when he visited the medical practice. We found that the actions of the members of staff had been reasonable.

Summary
Ms C complained that she had to wait an unreasonably long time for appointments for problems with her hip, and that after that she had to wait an unreasonably long time for surgery. She complained that this breached the government's 'referral to treatment' target. She also complained that the board failed to provide a response to her complaints.

After taking advice from our medical adviser, we did not uphold Ms C's complaints about waiting time. We found that, overall, her clinical treatment was reasonable. She was first seen by an orthopaedic consultant after a referral from her GP, and was then referred to and seen by a physiotherapist, all within the governmental target. We accepted the board's position that this was when Ms C's treatment started. We found that the decision to refer Ms C for physiotherapy was appropriate, and that she needed to go through this programme before surgery could be considered. Therefore, we did not consider that her wait for surgery was unreasonable. When it was established that physiotherapy had not been successful, the orthopaedic consultant referred Ms C for a scan. The results of the scan indicated that hip surgery was appropriate. At that time, the board had withdrawn funding for this procedure, so Ms C was referred to another board area. She subsequently underwent surgery privately.

Although we acknowledged Ms C's frustration, both about waiting time and the withdrawal of funding, we found that her treatment was appropriate. We did find there was an unreasonable delay in Ms C receiving a full response to her complaint, and were critical of the board about this.

Summary

Mr C told us that when his wife (Mrs C) became very unwell, he rang NHS 24. He explained her symptoms and told the operator that Mrs C had just completed in vitro fertilisation (IVF) treatment. He said that an hour passed and there was no return call from NHS 24, so he rang again and was told someone would call soon. Another hour passed and Mr C phoned again. He said he was again told someone would call soon. Another 30 minutes passed and having still had no contact from NHS 24 Mr C phoned again, but again they did not offer help.

Mr C said he then took his wife to a hospital accident and emergency unit. He said that they received a call-back from NHS 24, but this was three hours after his original telephone call. Mr and Mrs C were upset that it took so long for NHS 24 to return his calls for assistance.

Before we could look into Mr C's complaint, we needed more information from him. As we did not receive the requested complaints information, we were unable to reach a decision on his complaint.

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.