Health

Summary
Mrs C complained that aspects of her mother (Mrs A)'s care and treatment in hospital before her death were of an unreasonable standard. On investigating the complaint, we found that much of the care and treatment that the board provided to Mrs A was reasonable and appropriate. We also found that the board had acted reasonably when they had discharged Mrs A after a previous admission to hospital. We found that there was no requirement for the board to discuss with the family or seek permission from them when they subsequently put a Do Not Attempt Resuscitation order in place, as Mrs A was able to make her own decisions at that time.

However, one of Mrs C's complaints was that the board had delayed in diagnosing a brain tumour. We received medical advice that a mini mental state examination (MMSE) should have been carried out when Mrs A was first admitted to hospital, as she was confused on admission. A brain scan should also have been considered if the MMSE results were abnormal. That said, an MMSE was carried out several months later and this was normal. Therefore, it was not possible to comment on what, if any, difference carrying out an MMSE on Mrs A when she was first admitted would have made to her prognosis. The board had written to Mrs C to apologise for the distress caused as a result of the delay in diagnosing her mother's condition.

We found that the board's communication did not meet the needs of Mrs A's family. The board had written to Mrs C stating that communication could have been improved. They said that a number of measures would be taken to improve communication between staff and to relatives. They also apologised that communication had been poor. We upheld the complaint because of these failings. However, in view of the board's response to Mrs C on these points, we had no recommendations to make.

Summary
Mr C attended the A&E department at Glasgow Royal Infirmary after a fall. He complained of severe back pain but a full skeletal x-ray was not carried out in A&E or on admission to an orthopaedic ward. Mr C was told a back x-ray was scheduled for two days' time and he could go home until then. Mr C's wife (Mrs C) reported her concerns about the proposed discharge to the consultant, who, after examining Mr C, said that an x-ray was not required and that Mr C could go home immediately.

Around two weeks later, Mr C attended the Glasgow Royal Infirmary Fracture Clinic and following an x-ray of his spine was admitted. He was examined the next day and it was decided to transfer Mr C to Spinal Injuries Intensive Care Unit at Glasgow Southern General Hospital where he was operated on for a broken back and complications with his right leg. Mrs C wished to know why the spinal injury was not picked up at Glasgow Royal Infirmary.
We found that on arrival at A&E, Mr C should have been placed flat on a spinal injury board and then examined by log-rolling to keep him immobilised but that this did not happen. We also found that staff failed to consider whether Mr C had sustained injuries elsewhere in his body and that there was a breakdown in communication between nursing and medical staff.

Although we upheld Mr C's complaint, we made no recommendations as the board had taken steps to prevent a similar situation occurring again and apologised for the failings which had been identified.
 

Summary
Mrs C complained about the treatment her mother (Mrs A) received at the Victoria Infirmary. Mrs A was admitted to hospital by emergency referral from her GP with a history of recurrent falls, drowsiness and reduced mobility. Mrs A was initially treated for a presumed infection based on abnormalities in her bloods and her presenting condition. However, no clear source of infection was identified. She was identified as being at risk of blood clots and was put on anticoagulant medication.

Nursing staff observed that Mrs A's right leg was swollen. A doctor reviewed the swelling and did not consider it to be significant. Mrs A's leg was found to be swollen again eight days later. A Doppler ultrasound (a type of ultrasound for monitoring blood flow) was carried out, which showed no signs of thrombosis. A CT scan showed that Mrs A had a mass in her pelvis. Biopsies were ordered, but because of the location of the mass and the quality of the material gathered, it took some time to obtain the eventual diagnosis of cancer of the B-cells. This diagnosis was made around a month later and three days after Mrs A's death. A post-mortem was carried out which concluded that Mrs A's death was the result of a pulmonary blood clot, caused by Deep Vein Thrombosis (DVT) in the right calf, due to a large tumour.

Mrs C complained that the board failed to take prompt or effective action to investigate the cause of her mother's swollen leg. She considered that this led to a failure to identify DVT. She also complained that delays to the biopsy results meant that there was no opportunity to treat her mother's cancer. Mrs C raised further concerns about delays to providing family members with test results and poor administration of medication.

Whilst we found that the board did not regularly assess Mrs A's risk of blood clots during her admission, we were satisfied that this would not have had a detrimental impact on her treatment. We considered that there were opportunities for further Doppler ultrasounds to be carried out, but were ultimately satisfied that it was reasonable for the board not to undertake these tests in the circumstances.

There was no evidence of DVT following the Doppler ultrasound and we found that Mrs A's mass (which was likely to cause leg swelling) and the fact that she was already receiving anticoagulant medication indicated that there were alternative causes for her swelling other than DVT. We did not find that the board unduly delayed providing family members with test results.

Similarly, the evidence presented to us showed that it was difficult to obtain biopsy samples from Mrs A's mass and, once obtained, the diagnosis of cancer of the B-cells was complex, requiring specialist opinion. We were satisfied that the biopsies were ordered, and their results reported, as quickly as possible. With regard to the provision of medication, we found that cough medicine prescribed for Mrs A was taken to a different patient in error. We also established that Mrs A was prescribed the wrong dose of anticoagulant medication and that doses may have been missed on more than one occasion. Whilst we were unable to confirm that doses were definitely missed, we considered that the lower dose provided would have increased Mrs A's risk of developing blood clots.

Recommendations
We recommended that the board:
• apologise to Mrs A's family for the failure to properly prescribe and record certain anticoagulant drugs;
• remind staff of the importance of recording and signing for all administered medication; and
• draw clinical staff's attention to the guidance in the Therapeutics Handbook for Thromboprophylaxis for Medical Patients (guidance on the administration of anticoagulant drugs to patients with an increased risk of blood clots).

Summary
Mr C complained about the care and treatment he received from his medical practice. Specifically, he said that he had been prescribed the wrong drugs for his illness. He maintained that he had resisted the prescriptions but that his GP had refused to change or stop his medication. He believed that his continuing mental health problems were as a consequence of receiving the wrong drugs.

The investigation found no evidence to suggest that the treatment given to Mr C was incorrect. We also did not find any evidence to suggest that Mr C had asked for his prescriptions to be changed or stopped or that his requests had been refused. We found that all the drugs prescribed to Mr C were appropriate for his presenting condition, and we did not uphold his complaint.

Summary
Mrs C complained on behalf of her family about their removal from a GP list. The family, a mother suffering from terminal cancer and two adult daughters, temporarily moved house and left the area after having been registered at the practice for a number of years. When the family returned to the town, but not to their former home, they applied to re-register at the practice.

Their application was refused because of a deteriorating relationship between Mrs C's daughters and the practice, which had been on-going for three to four years. Mrs C claimed that the family had been removed from the list without explanation and that when reasons were given they were inaccurate and inappropriate. She also complained that correspondence about the matter was not responded to.

Our investigation found that the family had been removed from the list when they removed themselves - albeit temporarily - from the geographical area covered by the practice. At this time, a collective decision was taken by the practice that should the family return to the area they would not be re-registered due to the breakdown of the relationship between the practice and Mrs C's daughters.

The family did move back into the area but not to their former home and there were other practices closer to their current address. Therefore, it was thought beneficial for the family to register with a GP closer to their home address due to Mrs C's cancer treatment. When Mrs C's daughters appealed to the practice for their mother alone to be re-registered this was refused, as it was not thought practicable.

Our investigation found that reasonable explanations had been provided to the family as to why they could not be re-registered and that the original removal for geographical reasons had been appropriate. It also found that correspondence on the matter had been responded to by the practice in a timely and reasonable manner. We, therefore, did not uphold the complaints.

Summary
Mrs C's late husband (Mr C) was a cancer sufferer. She complained that his practice failed to prescribe him antibiotics when blood test results suggested he had an infection and also that they failed to contact him when repeat blood tests were returned early and before he was scheduled to return to the practice. She also complained that the GP(s) failed to spot the seriousness of his condition.

Mrs C had to call an ambulance for her husband five days after his blood tests suggested an infection. He was taken to Ninewells Hospital where he died shortly afterwards of cardiac arrest and sepsis. Mrs C was told that her late husband's body had been overwhelmed by the infection and she felt that this caused or contributed to her husband's cardiac arrest.

We took advice from a medical adviser, who said that the actions of the GPs had been reasonable. He concluded that the GPs had taken full recognition of Mr C's condition and medical history. He also said that as the first blood test results were not conclusive, it had been appropriate to repeat them. The results from the second tests were also not conclusive and in some areas had actually improved. Our adviser took the view that it was, therefore, reasonable for the GPs to wait for the scheduled appointment to review Mr C. He also concluded that the infection which overwhelmed Mr C, although showing early but non-specific signs in the blood tests taken by the GPs, could not have been predicted from the results available to them at the time.

We did not uphold this complaint.

Summary
Miss C was diagnosed by hospital consultants as having fibromyalgia, neurological functional disorder and probable Crohn's disease. She complained that her GP did not accept these diagnoses and subsequently failed to provide treatment for them. In particular, she complained that her GP deleted a range of medications from her prescription list without good cause.

We found that Miss C's GP was not convinced by the diagnoses, but provided treatment in line with recommendations from various consultants. Medication was also withdrawn in line with specialist opinion. We did not consider it unreasonable for the GP to express his concern about the diagnoses to Miss C given that her treatment progressed appropriately.
 

Summary
Ms C complained about the care and treatment she received throughout her pregnancy and what she considered to be the mismanagement by the board of her labour and her baby's birth. She claimed that she had not been properly monitored; that matters were not properly explained to her and that she had not received appropriate treatment during her pregnancy and labour. She further complained that she was not properly monitored and cared for after the birth and she alleged that, as a consequence of this mismanagement, her daughter required medical treatment.

We investigated Mrs C's concerns, and obtained independent specialist advice. This established (and it was confirmed in the appropriate records) that the care and treatment Ms C received was satisfactory and that there were no issues of concern. In the circumstances, we made no recommendations in this case.

Summary
Mrs C complained to the board about the delay in diagnosing her son (Mr A) with asperger's syndrome when he was 41 years old. Mr A had been examined by various doctors since he was 8 years old and Mrs C wished to know why it had taken so long to reach a diagnosis.

We found that autism-spectrum disorders are a complex group of developmental disorders which are frequently associated with other psychiatric disorders which can colour their presentation and complicate their management. Asperger's syndrome was formally recognised by the World Health Organisation in 1992 and by the Diagnostic and Statistical Manual of Mental Disorders in 1994. Our medical adviser explained that due to system overlap, some people with asperger's syndrome can be wrongly diagnosed with other mental health disorders. However, it was possible that some of Mr A's previous diagnoses could have been legitimate mental health disorders in their own right. We found no evidence that there had been a delay in reaching Mr A's diagnosis of asperger's syndrome.
 

Summary
Mrs C visited her dentist to have a crown checked that had been causing her pain. After treatment, Mrs C complained that the dentist had extracted a perfectly healthy crown and had failed to give her any anaesthetic at the initial attempt to extract the crown. Mrs C said that after the dentist had pulled a couple of times at the crown, she shouted at him to stop as she felt sick and was shaking badly. The dentist then administered anaesthetic and both the crown and tooth were removed. Mrs C was dissatisfied that the dentist had not carried out an x-ray to see if the tooth was fractured or needed to come out.

In response to the complaint, the dentist said that Mrs C attended the practice complaining of a loose crown and when he attempted to remove it, she experienced quite a lot of pain and so local anaesthetic was given. The dentist documented that he suspected the crown may have fractured the root of the tooth and that extraction was probably required due to the resistance and mobility of the crown. The dentist also said that very little force was required indicating advanced gum disease and that this was supported by an x-ray taken in 2006 that had shown the root of the tooth to be particularly short with surrounding bone loss from periodontal disease.

Our dental adviser said that previous treatment had been carried out on the affected tooth which meant that the nerve and blood supply of the tooth had been removed. We found that it was, therefore, appropriate for the dentist to have attempted to remove the loose crown without giving any local anaesthetic as there was no longer any nerve supply to the tooth.
The adviser stated that the pain Mrs C had been experiencing in this tooth is often indicative of an underlying problem beneath the gum, such as an infection or a fractured root. He explained that the 2006 x-ray showed the presence of gum disease and a relatively short root indicating that a lesser amount of pressure would be required to remove the tooth.

He also said that, assuming the tooth was loose and given the x-ray, it is likely that the bone loss would have progressed in the intervening years and at some point the tooth would require extraction, although it was impossible to predict when this would happen. Therefore, we concluded that the treatment provided was appropriate.