Health

Summary
Mr C had been experiencing abdominal pain since around 05:00 on a day in June 2010. He became unwell and his pain increased in severity around 22:00. He telephoned the Scottish Ambulance Service (SAS). They did not consider his case to be an emergency and transferred his call to NHS 24. Mr C’s conversation with NHS 24 lasted around 40 minutes, during which time he repeatedly asked for an ambulance to be dispatched to his home. The NHS 24 call handler sought details of his symptoms and ultimately decided to arrange for a duty doctor to call him back within one hour. Mr C was not satisfied with this outcome and arranged for a neighbour to assist him to phone the SAS again. Following this call, a paramedic was dispatched and, following an examination, an ambulance was called. Mr C was found to have a burst appendix.

Mr C complained that NHS 24 should have dispatched an ambulance given the nature of his symptoms. He felt that the number and nature of the questions put to him by the call handler was repetitive, unreasonable and inappropriate. He also complained that it was inappropriate and unreasonable for NHS 24 to suggest that a doctor phone him ‘within an hour’ for further assessment when he was clearly in considerable pain and distress.

We were satisfied with the nature of the questions asked by NHS 24 and found that, whilst there was some duplication, this was kept to a minimum. The evidence that we were presented with showed that there were some communication issues between Mr C and the call-handler and we considered that these contributed to the length of the call more than the NHS 24 call procedure. Our professional medical adviser shared an opinion expressed by NHS 24 that Mr C’s symptoms indicated a need for a physical examination. Mr C had advised the call-handler that he was unable to make his own way to hospital, so we considered it unreasonable for the physical examination to be delayed further by arranging for a doctor to telephone him. We considered that NHS 24 should have made arrangements for a physical examination and, given the symptoms described by Mr C, we found that the most appropriate outcome would have been for an ambulance to be dispatched.

Recommendations
We recommended that NHS 24:
• reflect on their handling of Category C calls and the assessment criteria for transferring cases back to the Scottish Ambulance Service; and
• consider reviewing their criteria for assessing cases of acute abdominal pain to ensure that where rapid escalation of symptoms occurs, this is given due emphasis.
 

Summary
Ms C had a planned operation to remove cysts, uterus, tubes and ovaries. The operation was performed under a general anaesthetic. During surgery, the cysts were not situated as had been thought from the scans and the surgeon decided not to remove these. After the operation Ms C were given morphine for pain relief but she had an adverse reaction to this and further drugs were administered to reverse the effects of the morphine. Following the operation, further scans were arranged to assess the exact position of cysts and a second operation to remove the cysts was carried out five weeks later. This operation was carried out under epidural anaesthetic.

Ms C complained about the timing of her operations and the after care she received in relation to the pain relief prescribed. She also complained that staff failed to remove the clamp from her catheter within a reasonable time causing pain. She also complained that they failed to record medication given which meant that staff attempted to give her analgesia twice.

We found that the timing of the operations were reasonable, as was the anaesthetic provided. However, we found that the board's failures to remove the clamp from Mrs C's catheter within a reasonable time and to record medication given were potentially very serious failures. We did not make any recommendations in light of the action the board had already taken to address the complaint.
 

Summary
Mr C complained that a medical practice acted unreasonably in sending him a letter warning him of unacceptable/intimidating behaviour following a visit to the practice. Mr C disputed that, during the incident in question, his behaviour had been unacceptable/intimidating. In the absence of objective evidence to support Mr C's version of events, we were unable to uphold the complaint. However, we did suggest to the practice that, as a matter of good practice and so that additional evidence is available if they are challenged, they should consider keeping a contemporaneous record of such incidents in future.
 

Summary
Mr C attended his GP with regard to a lesion below his right eye. His GP referred him to a clinic at the hospital for further examination of the lesion. He was reviewed by a registrar initially in November 2010, and attended for the procedure around one month later. When Mr C left the clinic, he found the lesion he was concerned about remained on his face, and a lesion on his nose had been removed instead. Mr C complained to the board.

We found that the notes for the initial clinical appointment contained inaccurate details, and that the lesion for which Mr C’s GP had referred him was not the lesion subsequently identified by the registrar for removal. On this basis, we upheld Mr C’s complaint that the board failed to remove the lesion which he had been concerned about. Mr C had several lesions on his face, and it may also have been helpful if the original GP referral had included details of the other lesions to prevent this confusion arising.

However, we did not uphold Mr C’s second complaint that it was inappropriate to remove the lesion from the side of his nose. Examination of this lesion established that it was a benign tumour and, therefore, it was of clinical concern and certainly the most high risk lesion on Mr C’s face. We also found Mr C had signed a consent form prior to the procedure which stated he consented to any additional procedure which was in his best interests and justifiable for medical reasons.

We did not uphold Mr C’s third complaint that he had been provided with conflicting information regarding the necessity of removing the lesion he had been concerned about. The board had referred Mr C on to a dermatology specialist who had established this lesion was a mole which could be treated satisfactorily with cryotherapy. We did not find this to be conflicting, but in fact appropriate medical advice on the best way in which to proceed.

Recommendation
We recommended that the board:
• apologise Mr C for removing a different lesion on his face to the one he and his GP were concerned about.
 

Summary
Mr C attended an Accident and Emergency department in October 2009 complaining of pain, weakness and pins and needles in his left wrist. An initial diagnosis of carpal tunnel syndrome, secondary to an underlying arthritis, was made. He was referred for review by an orthopaedic consultant and subsequently to a rheumatologist. It was not until he was seen by a locum rheumatologist in August the following year that he was given steroid injections, which relieved his pain.

Mr C was referred back to the orthopaedic consultant and underwent carpal tunnel decompression surgery in March 2011. He complained about delays to the progression of his treatment, the lack of steroid injections during earlier appointments and the unnecessary pain he had to endure as a result. He also complained that the board took an unacceptable length of time to diagnose a particular infection in his wrist.

We found that Mr C's case was particularly unusual. Separate investigations into a bad cough proved positive for an organism that can cause tuberculosis. As Mr C did not have active tuberculosis at the time, we found the board's decision not to provide treatment to be reasonable. The orthopaedic consultant was concerned that Mr C did not have a straightforward case of carpal tunnel syndrome and carried out exploratory surgery which showed he had inflammation of the lining of the tendons of his wrist which can be associated with tuberculosis. Once this was identified, he referred Mr C back to the chest physician who had investigated his cough. We were satisfied that appropriate diagnostic tests were subsequently carried out. We did not find that the treatment of Mr C's wrist or the diagnosis of his infection were unduly delayed and we did not uphold the complaint.

Summary
Mr C's daughter (Ms A) was admitted to hospital suffering from abdominal pain. A few days later, a scan revealed a large cyst on Ms A's left ovary. The registrar telephoned the on-call duty consultant. They decided to discharge Ms A and to arrange elective surgery at a later date as her condition stabilised and Ms A was told to return to hospital if the severe pain returned. Several days after her discharge, Ms A saw a private consultant who operated and removed a cyst from her left ovary.

Mr C complained that the staffing levels were unreasonable during his daughter’s admission to hospital which meant that she was not reviewed personally by a consultant and that the discharge plan and arrangements were also unreasonable. He said that the failures by the board had put Ms A's life and health at risk.

We found that the staffing levels were reasonable and that the care and treatment Ms A received, including the discharge plan and arrangements, was also reasonable. We found no evidence that Ms A required emergency surgery on her discharge from hospital or that her health or life was at risk at any time.

Summary
Mrs C complained that when she was admitted to a ward at the hospital she initially made progress. However, she became unwell and stated that a nurse’s attitude towards her then became unacceptable. Mrs C stated that the nurse’s attitude was aggressive and frightening in her manner towards her and in how she spoke to her. She also said the nurse treated her cheekily and roughly, pushed her and struck her twice.

Mrs C also stated there were failures in her care at the hospital. This centred round the use, prescription; and monitoring of anticoagulant therapy (warfarin). Mrs C said errors were made that could have had fatal consequences.

After investigating Mrs C’s complaint, we did not uphold that there was any error or omission in Mrs C’s clinical care and we found that the management of the warfarin was entirely reasonable. We also did not uphold any aspect of Mrs C’s complaints about the nurse’s behaviour towards Mrs C as there was no evidence to support her allegations.
 

Summary
Ms C had been on Depo-Provera contraceptive injections for a number of years, from 1994-2002, then from around 2005-2010. In May 2010 she developed back pain and other symptoms which she reported to the GPs at her local surgery. She was given various possible causes but after referral to a dermatologist, rheumatologist and an MRI scan she was eventually diagnosed in February 2011 with a probable chronic syndrome.

Ms C considers that had her contraceptive medication been appropriately monitored she would not have developed the condition ‘SAPHO syndrome’. She also considers that the GPs failed to diagnose her syndrome.

Our medical adviser considered the case and found that the monitoring of Ms C's contraceptive use, particularly in the earlier years had lacked detail. He found that blood pressure monitoring had been sporadic and there was no evidence of systematic review of the method of contraception. The adviser noted guidelines regarding review periods had not been issued until 2004, and that the notes had improved significantly from 2010 onwards – nonetheless the complaint regarding monitoring was upheld.

In relation to investigation and diagnosis, the adviser found the GPs’ actions to be a demonstration of good practice, in that appropriate and detailed referrals to specialist departments were made timeously. The adviser also found the probable syndrome was extremely rare and would not have expected a GP to diagnose it. Finally, no causative link between the contraceptive and SAPHO syndrome has been established. We did not uphold this complaint.

Recommendation
We recommended that the practice:
• apologise to Ms C for failing to monitor her appropriately whilst she was on Depo-Provera.
 

Summary
Mr C, an advice worker, made several complaints on behalf of Mr A. He complained about a delay to remedial hip surgery; that Mr A’s proposed surgery by hospital 1 was blocked by the board; and that misleading and/or inaccurate information about tests resulted in an unnecessary referral to London.

Mr A underwent hip replacement surgery in January 2009 at hospital 1. He later developed a fracture of the neck of the femur and underwent revision surgery at hospital 2. This was known as a ‘metal on metal’ (MOM) hip replacement procedure. Mr A then developed pain in the hip and following a national alert in April 2010 concerning MOM hip replacements, his consultant surgeon referred Mr A to hospital 3 in London for tests to be carried out.

When Mr A was next reviewed by his consultant and informed he required surgery he requested a second opinion. Mr A was then referred to hospital 4 where the board have a service level agreement to provide a number of routine procedures and to assist with waiting times. Hospital 4 was prepared to carry out the necessary surgery. However, the board informed Mr A that due to the nature of the MOM hip replacement procedure his care should, for clinical reasons, remain within their system because hospital 4 is only used for routine procedures and this procedure did not fall into this category. Mr A eventually had further remedial surgery at hospital 2 in April 2011.

We obtained advice from our medical adviser which was that, from a clinical perspective, the timescale within which the surgery was carried out would not have had any clinical bearings on the outcome of the surgery. Therefore, there was no undue delay in Mr A undergoing revision surgery. Therefore, we did not uphold the first complaint.

We upheld the second complaint because our medical adviser considered that Mr A’s surgery was blocked from going ahead at hospital 4 on financial and administrative grounds. Although this was reasonable, the advice we received was that there was no clinical reason for the surgery to have been carried out by one of the board’s hospitals rather than hospital 4.

We also upheld complaint 3 because while we did not doubt that Mr A’s consultant acted with the best of intentions in referring Mr A to a centre of excellence in London, there was no evidence that he was given the alternative option of having his case dealt with in Glasgow, which would have avoided him having to travel to London. We recommended that the board apologise to Mr A for this.

Recommendation
We recommended that the board:
• issue Mr A with an apology for the failure to inform him of an alternative option of having the necessary investigations carried out in Glasgow.
 

Summary
Ms C made several complaints about her dental practice. She complained that her dentist failed to deliver the appropriate treatment and service when she asked him to check on her bridge. She also complained that either the dentist or the dental practice failed to ensure that the dental hospital received her x-rays within a reasonable time, and that the failure to do so led to a delay in her being seen at the dental hospital and so exacerbated the decay in the teeth supporting the bridge.

On investigation we found that the actions of the dentist did not result in the loss of the bridge. The bridge had failed due to Ms C having extensive decay in both supporting teeth. The dentist had provided Ms C with appropriate advice, which was to have a new bridge fitted or otherwise for him to refer her to the dental hospital. Therefore, we did not uphold this part of Ms C’s complaint.

Ms C asked to be referred to the dental hospital. Following the referral, x-rays were required by the dental hospital. However, due to a lack of record-keeping by the dental practice, our investigation was unable to establish what had occurred regarding the taking of the x-rays and when they were sent to and received by the dental hospital. We, therefore, found that the dentist or the dental practice failed to ensure that the dental hospital received the x-rays within a reasonable time and upheld this part of Ms C’s complaint.

We accepted that, as a result, Ms C had to wait a number of months before being seen and given a diagnosis at the dental hospital. While we considered that part of this delay was caused by the dental hospital not having Ms C’s x-rays we also considered that part of the delay was also due to Ms C’s personal circumstances. Furthermore, while the delay caused by the lack of x-rays was unfortunate we considered that it would not have had any effect on the outcome in Ms C’s case and we, therefore, did not uphold this part of the complaint.

Recommendations
We recommended that the practice:
• review their record-keeping so that telephone calls received and made in relation to a patient’s treatment are recorded; and
• review their practices and procedures so as to ensure that a patient’s
x-rays, where appropriate, are sent to and received by the dental hospital.