Health

Summary
Ms C complained about the board's treatment of her wrist injury. She complained that the investigation of her injury and treatment had not been reasonable, and that the treatment had not been undertaken within a reasonable timescale. We upheld both complaints.

We found that a failure to assess Ms C's symptoms from the outset and to treat them with a high level of suspicion had led to failings in her care. We were critical of a number of aspects of the care, including the decision to treat her with a splint initially rather than a cast (whilst acknowledging this may not have impacted upon the healing of Ms C's fracture, we found more consistent immobilisation would have assisted in easing Ms C's pain and discomfort, as throughout the course of her treatment she had splints and casts fitted and removed on several occasions). We also criticised the board's failure to send Ms C for specific wrist x-rays and the decision to discharge her on three occasions without appropriate follow-up care.

In relation to treatment being undertaken within a reasonable timescale, we found that Ms C should have been referred for physiotherapy at around the time she was diagnosed with the fracture. Instead, Ms C did not begin to receive physiotherapy until around six months later after she self-referred. We found this delay may have impacted upon her long term recovery.

Recommendations
We recommended that the board:
• provide a full apology to Ms C for the failures in identified in her treatment;
• review their Minor Injury Wrist and Forearm protocol to ensure that a patient presenting with symptoms potentially indicative of a scaphoid (wrist) fracture are appropriately investigated and managed; and
• ensure staff involved in Ms C's case are made aware of the need to arrange follow-up appointments when necessary, to give consideration toa physiotherapy referral for patients if appropriate, and that the board take these issues into account when reviewing their Minor Injury Wrist and Forearm protocol.
 

Summary
In 2011, Miss C viewed her maternity records relating to the death of her son in 1993. She submitted a list of clinical questions and asked to meet with someone to discuss these. However, there was a delay in this request being processed, which Miss C complained about to the board. She later also complained about the way in which her complaint was handled.

Miss C's questions and meeting request were submitted in early September 2011 and were not passed to clinical staff to address until mid-December 2011. We agreed that this was an unreasonable delay and upheld Miss C's complaint. However, as the board assured us reasonable steps had been taken to avoid a similar future occurrence, and as they had already apologised to Miss C, we did not make any recommendations.

Miss C submitted her complaint about the delay in late November 2011 but it appears to have then been confused with her original clinical request which had yet to be addressed. This resulted in further delays and ambiguity and we, therefore, considered that the board had not responded to Miss C's complaint in an accurate and timely manner. We, therefore, upheld this complaint. However, we were satisfied that this was an isolated incident and that appropriate remedial action had been taken by the board and we did not make any recommendations.

Summary
Mr C attended the practice for an appointment with his GP. During the consultation, he said that the GP told him off for failing to attend or cancel a hospital appointment that he had been referred to. Mr C did not like the GP's tone and walked out of the consultation. He complained to the practice manager and a further appointment was made for later the same day with another GP. Mr C explained to the second GP that he had been suffering from low mood over a period of days and had thought of taking his life. As Mr C was not diagnosed as being biologically depressed, it was not considered appropriate to give him medication. Counselling was offered, but declined by Mr C as he was already attending counselling sessions and did not find these to be beneficial. The practice were unable to offer him any alternative treatment and he was eventually asked to leave the premises.

Mr C complained about the practice's failure to address his feelings of low mood on the day of his appointments. We found that it was not appropriate for Mr C to be offered medication and that counselling was the correct course of action. Mr C had commented that he had thought about suicide. We were satisfied that he was appropriately assessed as being a low risk of suicide and that it was, therefore, reasonable for the consultation to end without any further treatment or referrals being proposed. We did not uphold his complaints.
 

Summary
Ms C fell and slipped on ice. Some days later, she began to feel pain and her GP diagnosed a fractured tailbone. Approximately two weeks after the fall, she was rushed to hospital where she was diagnosed with an abscess. As a result of the abscess, she had to have surgery and it was some time before she made a full recovery.

Ms C complained to the practice about the misdiagnosis and also about the attitude of the GP during the visit. We sought advice from our independent medical adviser who confirmed that, from a clinical standpoint, the initial consultation had failed to achieve the correct diagnosis. However, the practice's response to the complaint provided a full explanation, apologies where necessary and also the offer to meet with Ms C to discuss the matter. Although we upheld this aspect of this complaint, we did not consider that there was anything more that we could reasonably expect the practice to do as a result of the complaint and so did not make any recommendations.

In relation to Ms C's complaint about the attitude of the GP, we noted that the practice acknowledged that there was an initial difficult telephone conversation and the GP apologised for this and for the way in which they came across to Ms C. On balance, in the absence of evidence to confirm exactly what was said and, as importantly, the way in which it was said, we were unable to uphold this aspect of Ms C’s complaint.

Summary
Ms C complained that obstacles were put in her way when she attempted to register with a GP. Ms C complained that the systems in place at three medical practices to which she applied were obstructive and were not properly applied. She claimed that as a result she was prevented from registering with a GP.

Our investigation established that the systems in place at all three practices reflected national standards and were, therefore, found to be reasonable. In addition, in trying to resolve Ms C's complaint the board offered firstly to register Ms C at a practice of her choice. Ms C declined this offer as she felt it would negate her purpose in complaining.

Subsequently, when Ms C was dissatisfied with the responses from the individual practices, the board offered four months later to facilitate a new patient appointment at one of the practices. Again Ms C declined the offer on the basis that it would negate her complaint.

We found that the offers made by the board were a reasonable attempt to resolve not only Ms C's complaint but the difficulties she had found in registering with a GP. We expect complainants to co-operate with bodies in trying to resolve complaints and that where a reasonable offer to do so is made, we consider it appropriate for the complainant to accept such an offer. The board have confirmed that the offer to register Ms C at a practice of her choice is still open to her. We have encouraged Ms C to contact the board to discuss this.

Summary
Ms C complained that the board failed to take adequate care of her jewellery when she was taken to theatre at Monklands Hospital. Ms C explained that she was prepared for surgery in the ward before being taken to theatre and a nurse taped a ring on her finger. She said that just outside theatre, nursing staff noticed that she was still wearing a necklace and medal and removed them as they were not allowed in theatre. Ms C said she never saw the items again.

During our investigation of the complaint, we reviewed copies of Ms C's medical records and her complaint file, including notes of the board's investigation of her complaint and interviews with the nursing staff involved. We also reviewed the board's internal procedure for dealing with enquiries/claims and their procedures on the handling of, or checks for, jewellery. In addition, we obtained a copy of the disclaimer notice displayed in the hospital wards and a copy of the in-patient booklet which contains advice on bringing valuables into hospital.

The documentary evidence showed that the board followed their normal procedure in this case. The documentation completed at the three separate stages for Ms C's admission to theatre clearly stated that she was only wearing her wedding ring. It was, therefore, not possible to prove that Ms C was wearing the additional jewellery at the time she went to theatre and that the board failed to take adequate care of her jewellery. We did not uphold the complaint.

Summary
At around six weeks old, Miss C's baby (Baby A) developed laboured breathing and was not sleeping or feeding well. She was referred to hospital by her GP who noted that was symptomatic of an upper respiratory tract infection (URTI). Baby A was triaged and seen by a junior doctor at Wishaw General Hospital. She was noted as having a four-week history of worsening wheezing, cough and intermittent fever. It was also noted that Miss C described Baby A as making a 'squeaking noise' when breathing.

The junior doctor diagnosed a URTI and this diagnosis was supported upon review by a paediatric registrar. Baby A was discharged home with arrangements put in place for follow-up review at home. Baby A was reviewed three days later. She was found to have a stridor (high-pitched breathing sound, normally associated with a blockage in the throat). Further examination by a consultant, and a chest x-ray, resulted in Baby A being transferred to Yorkhill Hospital, where she was diagnosed with a hemangioma (a benign tumour partially blocking her airway). Miss C complained that Baby A's condition had not changed during the time she was at the first hospital and that, therefore, the stridor had been missed and the hemangioma diagnosis delayed. She also complained about the attitude and actions of the junior doctor and the board's complaint handling.

Our investigation did not find that the hemangioma could have been diagnosed earlier. We found that the stridor would have been an indicator for the condition, but that none of the four medical staff who originally examined Baby A recorded this symptom, which is relatively simple to identify. We were satisfied that Baby A's symptoms were indicative of a URTI and established that the symptoms associated with hemangioma can be exacerbated by URTIs, indicating that her condition likely developed and worsened. We were unable to comment in specific detail on the actions of the junior doctor, but did not find any evidence that issues complained about had any impact on Baby A's treatment. We were also generally satisfied with the board's complaint handling.
 

Summary
Mrs C's infant son (Master A) had a history of throat problems, reflux and allergies. Mrs C was concerned that he was having problems while sleeping, and she was not happy with the investigations and treatment provided by the board. The specific complaints we investigated were that there was an avoidable delay in fully investigating and diagnosing Master A's condition, and there was an error in a letter from the board regarding the date when Master A's 'failure to thrive' was diagnosed. Mrs C was also unhappy that the board had not explained to her why a flexiscope examination (a specialist examination of the throat using a camera device) was not carried out on Master A more recently.

We found from looking at the evidence, and taking advice from two of our medical advisers, that there was no reason to have repeated a flexiscope in Master A's case. In terms of referrals, investigations and treatment within the board, there was no evidence of avoidable delay. There was a delay in Master A having a polysomnography (sleep study), as he remained on a waiting list in another health board area. However, the board had limited, if any, influence over how quickly a referral to another health board would be actioned as it was not within their direct control, and there was evidence that they had pursued the referral with the other health board. As the referral had not taken place, the board acted correctly in referring Master A to a third health board area, where he was seen. Therefore, we found no evidence of avoidable delay by the board, and did not uphold this complaint.

In their letter to Mrs C, the board stated a date when 'failure to thrive' was first identified. The clinical records showed that a suggestion of 'failure to thrive' was first noted about a year previously. On that basis, we found that the board's letter to Mrs C should have accurately reflected this and, therefore, we upheld this complaint. Our decision notice drew this error to the board's attention and, therefore, we did not make any recommendations.

Summary
In late 2005, tests revealed that Mr C had elevated liver function tests and he was advised to reduce his alcohol consumption. Mr C's liver function tests became significantly elevated in 2007 and his GP believed that these were consistent with his alcohol history, a view supported by hospital specialists. In 2010, following tests, a hospital specialist diagnosed hepatitis C.

Mr C complained that his GP did not look beyond alcohol misuse as the cause of the abnormal results and that he should have been screened for hepatitis C much earlier. He said that as a result of the failure to do so, he began treatment at an advanced stage of the disease which had impacted adversely on his chances of surviving.

We found that the GP failed to fully investigate Mr C's liver functions abnormalities, particularly in 2007. Although it was impossible to say definitively whether Mr C would have tested positive for hepatitis C earlier than 2010, we found that it was possible he might have and, therefore, an opportunity to make an earlier diagnosis was missed and treatment was potentially delayed.

Recommendations
We recommended that the practice:
• review its management of liver function abnormalities including information provided in referrals; and
• apologise to Mr C for the failures identified.

Summary
Mr C complained about cosmetic dental treatment he received at a dental hospital between 2007 and 2010. Mr C initially underwent oral hygiene treatment, and then had surgical crown lengthening treatment to improve the appearance of his upper front teeth and his gum line. He had temporary crowns fitted at this time with a view to having permanent crowns fitted once the gum line had fully healed.

Mr C was dissatisfied with the outcome of the surgery, and the consultant responsible for his treatment agreed to carry out the procedure a second time. Mr C remained dissatisfied with the aesthetic outcome, and had a number of complaints about several aspects of his treatment.

He complained that his care and treatment was inadequate; that some information about his treatment was incorrect; and that his complaint was not properly responded to.
We did not uphold any of Mr C's complaints about his treatment. We found that Mr C's treatment plan was consistent throughout; that Mr C's oral hygiene had improved as a result of his treatment; that there was no evidence to show Mr C had received inadequate care and treatment. We found that there appeared to have been an element of miscommunication in relation to some of the issues which arose during Mr C's treatment.

We did uphold Mr C's complaint that the board had failed to advise him of the SPSO, as our contact details were not included within their final letter to Mr C. We will bring this failing to the attention of the board to prevent recurrence.