Health

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.

Summary

Ms C complained about the care and treatment of her late mother (Mrs A). In 2009, Mrs A received treatment for leg ulcers and various symptoms relating to her underlying vascular condition (condition of the blood vessels). She was admitted to hospital in July 2009 for emergency treatment, including an operation, and discharged in September. After-care services were provided by the board's rapid response team for 11 days after discharge. Mrs A continued to receive treatment in the community for her condition. She was readmitted to hospital that November where she remained until her death in January 2010.

Ms C said that the initial discharge arrangements were inadequate because the after-care services had not been planned in advance. She said that after-care services were essential given the nature of her mother's condition and the length of stay in hospital. She said that the board only arranged services from the rapid response team because she asked about this when she collected Mrs A from hospital. Ms C also complained that the after-care services were inadequate, saying that Mrs A did not receive assistance with personal care, cooking, feeding, medication, getting to the bathroom or physiotherapy.

We found, given the importance in involving family in the process, that the planning and implementation of Mrs A's discharge was deficient because Ms C had not been involved. In all other respects, it was reasonable. We concluded that overall, the board's planning was unreasonable due to the lack of involvement of Mrs A's daughter. However, we found that the records showed that the after-care was comprehensive, individualised and reasonable.

Recommendations

We recommended that the board:

• bring our letter to the attention of relevant staff to ensure lessons are learned; and
• apologise to Ms C for the failures identified.

Summary
Mr C complained to a medical practice about the care and treatment that his mother had received. The practice responded but did not address the matters he had raised. Mr C was dissatisfied with this and his wife raised the matter with us. During our consideration the practice wrote again to Mr C.

We decided that the practice did not reasonably provide him with all the information suggested by their complaints procedure, provided inaccurate information to him, requested unnecessary information from him, and did not advise him of the reasons for their delay in providing a full response. When read together, all the responses from the practice did reasonably address the matters he complained of, but as those responses did not reflect the practice's complaints procedure we upheld the complaint.

Recommendations
We recommended that the practice:
• apologise to Mr C that they did not respond reasonably to his complaint; and
• take steps to ensure that their implementation of their complaints handling procedure and their responses to complaints are in line with that procedure.

Summary
Miss C complained about the care and treatment provided to her late uncle (Mr A) by his medical practice. Her mother (who is Mr A's sister) had initially made the complaint, but Miss C eventually took it forward on her mother's behalf. Mr A had cancer and was undergoing chemotherapy in hospital.

Several days after he was discharged from hospital, he telephoned the practice asking for a prescription for antibiotics and a telephone consultation with his doctor. His doctor returned the call and issued a prescription for antibiotics.

A few days later, Mr A's sister became increasingly concerned about his condition and telephoned the practice requesting a home visit from a doctor. The practice advised her to contact emergency services. She was dissatisfied with the advice and phoned NHS 24, who arranged with the practice to send a doctor to visit him at home. The doctor arranged for an emergency ambulance to admit Mr A to hospital. Mr A died several weeks later.

Miss C complained that Mr A should have been seen by a doctor after her mother called the practice, and that the practice's response to the request for a home visit was unreasonable.

We upheld Miss C's complaints. We found that, given the seriousness of Mr A's illness, he should have had a face-to-face assessment rather than a telephone consultation. We could not establish what was said between Mr A's sister and the practice during the telephone call. However, we found that the problems of communication were compounded by a lack of specific instructions about the advice from the practice to contact emergency services. As a result, there was a delay in admitting Mr A to hospital and, while this may not have affected the outcome, it was clearly distressing to him and his family. We made recommendations in respect of both the doctor concerned and the practice.

Recommendations
We recommended that the practice:
• reflect on its management of this case particularly in light of the complications of chemotherapy;
• review its record-keeping for telephone consultations;
• apologise to Miss C for the failures identified; and
• review its procedures for house calls in light of this case.

Summary
Mr C was dissatisfied with the physiotherapy treatment he received from the board and complained to us about it. We did not, however, reach a decision on the issues involved in Mr C's case as he decided to withdraw his complaint.