Health

Summary
Ms C complained that her GP had withdrawn prescription milk for two of her three children who have allergy-related eczema (skin inflammation).

We found that, following advice from the health board, the practice reviewed their prescribing policy for milk powder. At this time one of Ms C's children was being prescribed the powder. The practice told us that they did not withdraw the prescription, but did change it from an automatic repeat prescription to one that has to be approved by a GP each time. They were concerned that if they did not do that the automatic repeat prescription system might mean that the milk powder was over-prescribed and the child's condition might not be regularly monitored.

Our investigation found that prescriptions for milk powder were never stopped and no prescription request was ever refused. The prescribing was reviewed and then monitored and our view was that, in the circumstances and on the evidence available to us, this was appropriate.

Summary
Mrs C visited a hospital accident and emergency department, where she was diagnosed as having suffered an allergic reaction. Medical staff advised her to visit her GP the next day. When she did so, she was dissatisfied with the care and treatment she received and the attitude displayed towards her.

She made a number of complaints about the GP, including that he questioned the diagnosis she had received (because the doctor who had seen her was a junior doctor); refused to look at the rash on her neck or to prescribe the anti-histamines that she said she had been advised to ask for; pulled her prescription away when she tried to take it from him and laughed at her, and referred to headaches she had been suffering as ‘supposed headaches.’

The GP whom Mrs C had complained about responded to her. He apologised that she had been caused upset and distress by the consultation. He explained that he had referred to ‘the headaches the neurologist is calling chronic migraine’. He also said that he understood Mrs C had been given advice by a junior doctor, but that he was not bound to agree with that advice. He apologised if his communication of this had caused upset. Mrs C was not satisfied with this response and raised her complaints with us.

The accounts of what happened at the consultation differ considerably and there were no independent witnesses to what happened. We found no evidence that could help us reach a conclusion on Mrs C's complaint about the care and treatment she had received, so we did not uphold that complaint. We did, however, uphold her complaint about the response she received from the practice, as we found evidence that they had considered matters that Mrs C had complained about but had not addressed these in their response to her.

Recommendations
We recommended that the practice:
• apologise to Mrs C that they did not reasonably respond to all the issues she raised in her complaint to them; and
• take steps to ensure that all issues raised in complaints are reasonably addressed in their written responses to complaints.

Summary
When Mr C's mother died in hospital, he made arrangements with a funeral home to have her body collected and prepared for cremation.

Mr C complained that his mother's body was not released by the hospital until late afternoon two days later. He was particularly upset because he had been told that all the necessary paperwork was completed on the afternoon of the day she died. Our investigation confirmed that, although there was a slight delay in the paperwork reaching mortuary staff, this was due to the internal set up of the hospital and could not be avoided. We also found evidence, confirmed by the funeral home, that Mr C's mother's body was actually released the day after she died. Although we appreciated that this was a distressing time for Mr C and his family, we found that there was no unreasonable delay, and did not uphold the complaint.

Mr C also complained that mortuary staff failed to co-operate with the funeral home and that one of them was abusive to a trainee funeral director. The board denied that anyone was abusive or that staff had failed to co-operate, although they confirmed that there was an initial misunderstanding about whether the relevant paperwork was complete. We contacted the funeral home, who confirmed that they did not consider that mortuary staff been abusive or obstructive. They agreed that there was a delay in arranging to collect Mr C's mother's body, but that this was because of the slight delay in the paperwork reaching mortuary staff.

Finally, Mr C complained that he and his family were not given a reasonable and clear explanation as to why there had been delay in releasing his mother's body. The board provided us with copies of the correspondence they had sent to Mr C and details of their investigation into his complaint. The evidence confirmed that Mr C's initial complaint was about a delay in providing the death certificate and other matters concerning his mother's final stay in hospital.

These were all addressed by the board in their relevant response to Mr C. After receiving this letter, Mr C then raised the issue of the delay in releasing his mother's body and the allegations of abusive attitude. The board produced evidence to show that they had also responded to this. We were satisfied that the board provided Mr C with reasonable and clear explanations of all of these concerns.

Summary
Mr C complained that the board unreasonably failed to consult him when they decided to put a 'do not resuscitate' order in place for his late mother. Mr C was unhappy about how the board had implemented the national policy on decisions regarding resuscitation.

We took advice from our medical adviser about Mr C's concerns. The adviser said that the policy is intended to prevent inappropriate or futile attempts at resuscitation, which may cause distress to the patient and their families. The policy also outlines the circumstances in which healthcare professionals are not required to discuss the order with a relative or carer. This is when the patient's doctor believes that resuscitation would be unsuccessful and, therefore, should not be attempted.

On looking at this case, we found that the board implemented the policy properly because one of the doctors caring for Mr C's mother had decided that resuscitation would be inappropriate because of her medical condition and frailty at the time.

Summary
Mr C had a history of skin cancer and suffered from a back condition. He complained that the board failed to: make a full and accurate diagnosis of his back condition, provide him with appropriate treatments including alternative therapies, and explain the prognosis. Mr C also complained that the board failed to provide him with a report containing this information to allow him to claim appropriate benefits. In addition, Mr C complained that the board failed to ensure that there was adequate communication between different departments in the board and medical professionals from other boards on the diagnosis and treatment of his condition.

We did not uphold Mr C's complaints. After looking at the clinical records and taking advice from one of our medical advisers, we found that hospital staff did diagnose Mr C appropriately. They also made recommendations for treatment and made him aware of what his condition was and the outlook for it. Mr C had told us that he asked specific staff for a report for benefit purposes at consultations. The board said Mr C did not ask staff for such reports, and we found no mention of this in the clinical records. In addition, the board said that staff were only required to complete reports sent to them by the relevant benefits agency.

We also found evidence in Mr C's clinical records that hospital staff did communicate adequately and in reasonable time, both within the board and with relevant staff from other health boards, about the diagnosis and treatment of Mr C's condition.

Summary
Mrs C was referred for orthodontic treatment by her dentist in 2008. She was first seen by a restorative dentistry consultant in February 2009 for hygiene therapy as she had severe gum disease. She was then referred to orthodontics, and was seen in December 2009. She was referred to see a specialist about orthognathic (jaw) surgery as she wanted to undergo this form of treatment, but was not seen until January 2011.

Following this assessment, Mrs C was placed on the waiting list for surgery, and seen again in September 2011, when she was advised that her gum disease and level of oral hygiene were not sufficiently stable for surgery at that time. A treatment plan was put in place to continue to treat Mrs C's gum disease. Mrs C had also been advised previously to give up smoking, as this would affect her oral health and hygiene.

Mrs C complained to us that the board failed to provide her with treatment for her dental problems within a reasonable time. We upheld her complaint as our investigation found that her wait to see a orthognathic specialist was unreasonable. We noted that the board had implemented evening clinics to tackle the long waiting lists, and that they had experienced a shortage of qualified staff. We found, however, that the board could make further efforts to reduce waiting times within the orthodontic/orthognathic department, and we made a recommendation about this. We did not, however, find that the delay itself had adversely affected the state of Mrs C's teeth, as her oral heath and hygiene needed to be addressed before surgical treatment could begin.

Recommendation
We recommended that the board:
• implement an action plan to reduce the current waiting lists for treatment within the orthodontic/ orthognathic department.

Summary
Mrs C complained that the board's handling of her complaint was inadequate. The board dealt with her initial complaint by arranging a meeting between her and a service manager. However, this did not take place until nearly two months after she complained. Mrs C later made further complaints to the board. The board told her that they had already issued a response to her complaint. Mrs C then wrote to us. However, it was clear that the board had not responded to many of the points she had raised and we referred the complaint back to them for a response. The board took a further three months to issue a response, and their letter failed to explain the reasons for this delay.

Mrs C continued to write to the board, and the chief executive issued a further response to her, in offering a meeting with two of the board's directors. Mrs C accepted the offer and met the directors. However, at the meeting, the directors both said that they did not consider that the chief executive's letter had addressed her concerns. They said that they wished to revoke this and send her a revised letter. The chief executive then issued a full response to Mrs C. He said that it was evident that the board's response to her complaints could have been significantly improved.

We upheld Mrs C's complaint, as our investigation found that the board clearly delayed in responding, and failed to explain the reasons for these delays to her. Their earlier responses also did not address her complaints adequately or take on board all of the problems she raised.

However, we considered that the board's final letter to Mrs C was a detailed response to the complaints she had made. It was issued after the board had carried out a thorough investigation. We were pleased to see that the board identified that their earlier responses to Mrs C's complaints were not satisfactory and undertook a further investigation into the matter. The board also apologised for the length of time it had taken to complete the investigation and the distress this had caused. They also said that they were reviewing their complaints procedures to ensure that significant improvement was achieved. In view of all of this, we had no recommendations to make.

Summary
Mrs C complained that her GP practice failed to diagnose that her daughter (Miss A) had hip dysplasia (HD) as a baby. She thought that the GP who had carried out Miss A's hip examination at 6/8 weeks had not done so correctly. Mrs C said that there was a lack of detailed notes as to the precise procedures that the GP said she carried out during this examination, and that the records were not complete.

Mrs C felt that her daughter's condition should have been noticed sooner. She acknowledged that even when checks are carried out properly, the condition can be missed. However, she was also concerned that no further checks were routinely offered. (Miss A's older sister had had a further developmental check when aged between 6/9 months.) Mrs C said that because of this, Miss A had to undergo extensive surgery and rehabilitation when she was two years and nine months old. In her view Miss A's suffering could have been significantly reduced if her HD had been diagnosed earlier.

After taking advice from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser noted that there were two different accounts of what may have happened at Miss A's assessment and said that the entries in the records were of a normal standard for GP records in Scotland. He also said that the diagnosis of HD can be missed, even when the tests are performed correctly by experienced doctors. The adviser also noted that the timing of developmental assessment checks has changed from when Miss A's sister was assessed.

Based on the evidence found during our investigation, we could not support Mrs C’s view that the practice did not reasonably carry out the six to eight week examination on Miss A or make an appropriate record of that examination.

Summary
Mr C was unhappy with his former GP practice. He complained about his GP's failure to promptly given him hospital scan results, and a failure to refer him to a hospital specialist. He also complained that the practice inappropriately asked him to register with another practice, and that the practice manager failed to investigate his concerns or answer his complaints fully.

We did not uphold any of Mr C's complaints. We looked at the medical records and took advice from one of our medical advisers. Given the circumstances of this case and given that the scan took place because of a referral within the hospital and not from the practice, we did not find it unreasonable that Mr C had to ask the GP about his scan results. After Mr C did so, the GP appropriately gave advice and prepared a prescription. We also found that there was no reason for the GP to refer Mr C to the hospital, as the scan report did not indicate this (which it normally would if required).

Shortly after the consultation, the practice wrote to Mr C asking him to register with another practice nearer to his home, as he no longer lived in the practice's catchment area. Our investigation found that the practice initially appeared to have taken account of Mr C's personal circumstances and allowed him to remain on their list, despite that fact that he was living in temporary accommodation outside their established catchment area. As Mr C remained in temporary accommodation for some time, however, the practice decided that it would be more appropriate for him to register with a practice nearer to his home. We found that, in doing so, the practice acted in line with their guidance.

Finally, we found no evidence that the practice failed to investigate Mr C's concerns or answer his complaints fully. The records showed that they acted in line with their complaints procedure, and based their response on their guidelines, policies, and records of Mr C's consultations.

Summary
Ms C complained about an accident she had while being transported by the Scottish Ambulance Service (the service) to a clinic appointment. Ms C said that the driver had taken his finger from the remote-control button operating a stair-lift while Ms C was sitting on it in a wheelchair. The lift stopped suddenly and the driver fell against Ms C, who was thrown forward and to the right. She was injured by a bar at the front of the stair-lift.

Ms C said that the driver was speaking to someone else, lost concentration and took his finger off the button. The driver, however, said that he had slipped on the stairs. There was no doubt that the driver's finger came off the button but as there was no objective evidence to explain exactly how this happened, we could not uphold this complaint.

Ms C also complained that the driver then left her at the clinic reception and did not report the incident. She had to report it herself. The evidence confirmed that although the driver reported the incident to his own management, he did not report it to the clinic staff or any other hospital staff member. He apologised to Ms C and asked how she was, but did not take any action to ensure that someone attended to her. We upheld this complaint. We noted, however, that the service had provided evidence that the driver's line manager had addressed this and reminded him of his responsibilities in dealing with such incidents in the future. We, therefore, made no recommendations.

Ms C's final complaint was that the response she received from the service was inaccurate as it referred to the driver slipping on the stair and also that he had reported the incident to the clinic reception. There was no conclusive evidence to establish whether or not the driver slipped, but the service acknowledged that the driver had not reported the incident to hospital staff. We, therefore, upheld this complaint and made a recommendation.

Recommendation
We recommended that the service:
• apologise to Ms C for the failings identified.