Health

Summary
Mr C made several complaints about the care and treatment he received in hospital, most of which we did not uphold. He said that a communication failure meant that staff were not expecting him when he arrived. However, we found that the staff nurse had been told that he was coming in and that, although there was a delay in providing him with a bed, this was not unreasonable in the circumstances. Mr C also said that he asked for a doctor when he felt that he was developing a urinary tract infection, but no doctor attended. We found that nursing staff had contacted the night team, which included medical staff, and the team had said that the staff should wait for the results of tests on a urine sample that had been taken. We found that staff acted reasonably in response to Mr C's requests and noted that a consultant saw him the next day. Mr C asked to see a doctor again the next evening. Nursing staff again contacted the night team, who said that they would see him after they had seen some other patients. However, Mr C then decided to discharge himself and was ready to leave when the team arrived.

Mr C also told us that some nursing staff displayed hostility towards him. We found no evidence of this, but noted that Mr C felt very frustrated by what he saw as staff failure to respond to his requests and wishes. We took the view that staff might have been able to prevent the situation escalating if they had more expertise in listening and responding to feedback. We noted that Mr C's complaint resulted in the board deciding that staff should have additional training in relevant techniques.

We did uphold Mr C's complaint that the board delayed in responding when he complained to them. We found the response itself to be satisfactory, although we thought the board could have provided Mr C with more information about the training they had arranged for staff in response to his complaint.

Recommendation
We recommended that the board:
• provide us with further information about the training in de-escalation techniques that was provided to staff in response to this complaint.

Summary
Ms C was pregnant. She went to hospital, where it was found that her waters had broken and she was booked in to be admitted the next morning for an induced labour. Ms C complained to us that on the day she was admitted she did not receive antibiotics until the evening. This was contrary to the board's own policy that if an expectant mother's waters had broken she should receive antibiotics immediately on admittance to hospital to reduce the risk of infection. We upheld Ms C's complaint that there had been a delay in administering antibiotics in her case. However we did not make any recommendations as we noted the board had taken steps to address this.

Ms C underwent a long labour, and had a epidural (an anaesthetic administered by a fine tube inserted into the spine, the effects of which come on gradually and continuously) which she told us became displaced and leaked. As Ms C's labour was not progressing, staff decided that she should go into theatre for either a forceps delivery or caesarean section. To prepare her for this, she was given a spinal block (a single shot spinal injection) for more rapid and profound analgesia. The anaesthetist had difficulty placing the block, and after several attempts called a consultant anaesthetist for assistance. The consultant also had difficulty placing the block although they eventually managed to do so. Having taken advice from one of our medical advisers who is a consultant anaesthetist, we did not uphold Ms C's complaint that an unreasonable number of attempts were made to insert the block. We found that the anaesthetist had acted correctly and called the consultant within a reasonable amount of time. We also found that given that both the anaesthetist and the consultant had had difficulties in placing the block, there were no training issues identified.

The block then worked very quickly, and Ms C developed numbness in her arms and chest and had breathing difficulties. After her daughter was born, Ms C had to be placed under general anaesthetic and on a ventilator until she was able to breathe unassisted again. Although we recognised how traumatic and frightening this had been for Ms C, we did not uphold her complaint about this, as we found that it was a rare but recognised complication of a spinal block. We also found that medical staff had acted appropriately, and had met Ms C later and tried to explain to her what had happened. As general medical understanding about this complication is limited, we found that they had explained it to the best of their abilities.

Finally, Ms C complained the board had not responded to her complaints adequately, especially her concerns about the future. We did not uphold this complaint. We found that the board had made efforts to discuss Ms C's continuing concerns about future pregnancies or procedures. We considered that their position that further tests would not add anything to their knowledge of Ms C was reasonable.

Summary
Mr C complained that his 14-year-old son (Master A) had six baby teeth extracted by his dentist. At the time the family were told that this was necessary to allow room for his adult teeth to come through. Master A also had an adult molar removed, again to allow space for the rest of his adult teeth to come through. Mr C has now learned that his son has a congenital problem (a condition present at birth) that means he has no further adult teeth to come through. Mr C said that the dentist was wrong to have extracted the teeth when there was no clinical need to do so.

We upheld Mr C's complaints. We found that overall there was a lack of documentation to show what the dentist discussed with him. Although there was no evidence about whether it was clinically appropriate to have extracted Master A's baby teeth, we found that the dentist should have sought specialist orthodontic advice before carrying out the procedure. We found that the adult tooth which was extracted had been heavily filled. However, while it may have been appropriate for the dentist to have extracted it, there was no evidence that a treatment plan had been carried out or that informed consent had been obtained.

Recommendations
We recommended that the practice:
• apologise for the failure to obtain an orthodontic opinion prior to the extraction of Master A's baby teeth and for failing to explain his reasons for doing so; and
• apologise for the failure to produce a treatment plan for the extraction and for not obtaining informed consent for the extraction.

Summary
Mrs C had root canal treatment from her dentist. She complained that the dentist did not tell her that there was a risk that, if the root canal treatment failed, Mrs C could lose the tooth and ultimately need a crown. Mrs C did lose her tooth and felt that the treatment was unnecessary and that the tooth could have been saved had another form of treatment been given. She also complained that other possible treatment options were not discussed with her and the response to her complaint was unreasonably delayed and contained inaccurate information.

Dentists have a duty to explain any commonly encountered or serious risks and any risks of particular concern to the patient. We found that there was no evidence to show that the dentist had done so in Mrs C's case. Nor was it clear whether the dentist discussed other treatment options (in this case, extraction of the tooth) with Mrs C. We upheld this complaint.

We did not uphold the complaint that root canal treatment was inappropriate. Although the results of such treatment can be uncertain, our dental adviser said that it was the only long term treatment with any possibility of success for the symptoms Mrs C was experiencing.

Finally, we upheld the complaint about the dentist's complaints handling. We found that ten weeks was an unreasonable length of time for Mrs C to wait for a response to her complaint, that she had not been proactively updated on its progress by the dentist and that the letter contained inaccuracies.

Recommendations
We recommended that the practice:
• apologise for unreasonably failing to explain the risks associated with root canal treatment or to discuss other options available with her;
• apologise for the unreasonable time it took to respond to her complaint; and
• ensure complainants are updated on the progress of their complaint in a timely manner and advised of the date by which they can expect a response.

Summary
Mrs C complained about treatment she received from a dental practice. She had had a replacement bridge fitted which caused her difficulties. The practice and Mrs C had different views about what had happened. Mrs C said her dentist had advised her to have the bridge replaced, but the practice said that Mrs C had expressed dissatisfaction with her original bridge and had made several requests for it to be replaced. When we looked at the written records, these did not show that Mrs C had been fully informed of the risks of having her bridgework replaced. On this basis we upheld the complaint as we found that Mrs C had not been able to give fully informed consent to the procedure.

Mrs C also complained that the bridge was inadequate. It fractured, fell out on several occasions and Mrs C developed abscesses. We found that the practice had replaced the old single-unit bridge with a bridge in two parts, which was not in the original approved treatment plan. After taking advice from our dental adviser, we found some aspects of the work unsatisfactory, in particular that Mrs C's bite was not properly assessed at the fitting stage, the bridge had to be re-fixed a number of times and the porcelain had fractured. We also upheld this complaint.

Finally, although we recognised that the practice had refunded Mrs C the cost of the bridge and referred her for specialist treatment, we found that they had failed to correct the work, as Mrs C has continued to experience numerous difficulties.

Recommendations
We recommended that the practice:
• provide evidence to the Ombudsman that they take steps to ensure patients give fully informed consent by advising them of potential risks with
• undertake and meet the cost of any further treatment as laid out within the suggested treatment plan in the specialist's letter.

Summary
Mr C told us he had a history of chest tightness, chest pain and severe heartburn. He said he twice raised concerns about these symptoms with his GP. Shortly afterwards, while working overseas, Mr C suffered a heart attack and had a coronary artery bypass graft (a surgical procedure to improve blood supply). When he came back to the UK, he asked his GP to refer him to a cardiologist (heart specialist) for review. His GP felt that this was unnecessary as Mr C had already received the best treatment for his condition and appeared to be recovering well. As Mr C needed a fitness to work certificate, he was ultimately referred to a cardiologist, but this was done privately.

Mr C complained that the practice failed to appropriately assess the symptoms that he had reported before he had the heart attack. He also complained that it was unreasonable of them not to refer him to a cardiologist after he returned to the UK.

We found no evidence in Mr C's clinical records that he had told the practice about his chest tightness and heartburn. Whilst recognising that he may have provided this information without it being recorded, we were unable to say conclusively that the records were deficient or that the practice failed to act on information that Mr C provided about these symptoms. We did not uphold this complaint.

We did, however, uphold his complaint about referral. Mr C was ultimately referred to a cardiologist and we did not find it unreasonable that this was done privately, given his desire to return to work. However, we found that it would have been good practice for a referral to have been made when he returned to the UK, as a cardiologist was able to perform specific tests that would highlight the extent of residual damage to the heart. The cardiologist ultimately found that Mr C had a blood clot which necessitated a change in treatment plan. We felt that this highlighted the benefit of referral to cardiology but also considered that there was a strong argument for referral in the circumstances of Mr C's case, particularly as his surgery was performed overseas where practices may be different.

Recommendations
We recommended that the practice:
• apologise for their failure to refer him to cardiology; and
• share our adviser's comments with their GPs with a view to identifying any points of learning that can be taken from this case.

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.