Health

Summary
Mr C complained that his dental practice had given him inaccurate information in telling him that work he needed done (template and crown work in preparation for implants) could not be provided on the NHS. Our dental adviser confirmed that the required work would not have been covered by the NHS and so would have to have been done on a private basis. We, therefore, concluded that the practice's response was reasonable.
 

Summary
Mrs C complained to the board about the treatment her late husband (Mr C) received at Ninewells Hospital in January and February 2011. Mr C had been attending his GP surgery since November 2010 with breathlessness, cough and weight loss. Mr C attended the hospital's A&E department in late January 2011 and after seeing a nurse and a doctor he was sent home and told to wait until the GP referred him to hospital. No medical assistance was given.

Mr C attended the respiratory clinic ten days later where he was x-rayed, weighed and had bloods taken. He was told he did not have cancer. Eight days later, the GP arranged for Mr C to be admitted to hospital that day and a CT scan was carried out two days later. The scan showed evidence of widespread infiltration of the lung, suggestive of malignant disease or infection. As the scan was inconclusive a biopsy of the lung was carried out the following day. The result indicated that Mr C had lung cancer which was rapidly progressing and which was unusual for a non-smoker. It was decided that Mr C should be transferred to a community hospital, where he died two weeks later.

We upheld Mrs C's complaint that her husband was unreasonably turned away from the A&E department when she brought him there when she was concerned at his condition and the lack of urgency shown by his GPs. We also upheld the complaint that when Mr C attended an outpatient appointment he was incorrectly told he 'definitely did not have cancer'.

Recommendations
We recommended that the board:
• remind nursing and clinical staff in A&E of the need to complete nursing and clinical records in accordance with the Nursing and Midwifery Council and General Medical Council guidance; and
• apologise to Mrs C for the failings identified in our investigation.
 

Summary
Mr C was HIV-positive and was prescribed an anti-retroviral drug, efavirenz, by healthcare professionals at the board. Mr C was told that the potential side-effects of the drugs included dizziness, light-headedness, skin rash and vivid dreams or nightmares. After taking the initial dose, Mr C experienced very distressing mental changes including depression, paranoia, suicidal thoughts and violent thoughts. Mr C complained that he should not have been prescribed the drug in light of his history of mental ill health and that he had not been warned that he might suffer from serious mental change.

After taking advice from one of our medical advisers, we found that Mr C's history of mental ill health was not a reason to avoid the drug, which was a first choice of drug by practitioners in the treatment of HIV because of its effectiveness. We also found that, although healthcare professionals had discussed the main side effects with Mr C, he was not told that he might suffer from serious mental change but we considered this to be reasonable because it was such a rare side-effect. However, we considered that the information provided to patients about the side-effects could be better.

Recommendation
We recommended that the board:
• review the information provided to patients about the potential side-effects of efavirenz.
 

Summary
Mr C complained to us about the board's care and treatment of his late brother (Mr A) prior to his death. Mr A, who was elderly, was due to be admitted to hospital for an endoscopic examination. In anticipation of this, he was given medication the day before, but became very ill and was instead admitted to hospital on the day of the planned procedure, as an emergency. The next day, a Tuesday, Mr A had a colonoscopy and he was then considered ready for discharge in a few days. It was proposed he would be discharged on Friday or Monday, subject to the availability of an ambulance. However, he was returned to his care home by ambulance on the Saturday. Unfortunately, he was returned back to the hospital later that day in a very poor state, and died the next day. Mr C was of the view that his brother was unreasonably discharged from hospital. He also complained that the board's communication with his family was inadequate.

We fully upheld Mr C's complaints. Our investigation showed that there was little information in Mr A's clinical notes and our medical adviser pointed out that nothing at all was noted about his condition on the day that he was discharged. Accordingly, Mr A may well have not been ready and fit for discharge. Similarly, there was very little record of any discussion with Mr A and his family about his care and treatment.

Recommendations
We recommended that the board:
• apologise for the distress caused to Mr C and his brother at the time of Mr A's discharge from hospital;
• formally apologise to Mr C for their failures in communication;
• stress to their staff the importance of effective communication; and
• further review the quality of the content of their clinical notes as they were not held in accordance with relevant guidelines. They should report back to the Ombudsman about the action they take in this regard.
 

Summary
Mrs C complained that when her late husband (Mr C) was being transferred from Ninewells Hospital to his local community hospital his clinical records were not passed on and staff could not administer medication until they received them which was later in the day.

We established that Mr C's records were left in the ambulance and that responsibility for the safekeeping of the records rested with the ambulance service. Our report stated that medical records are important documents and have to be available should clinicians need to review them to obtain details of a patients medical history, medication etc. We were satisfied that in this case the delay was caused by human error. It was discovered shortly after Mr C's arrival that the records were missing and contact was made with the service. They located the records immediately and made arrangements for them to be picked up later in the day and delivered to the hospital. The hospital was content with this arrangement and stated that Mr C was not disadvantaged by the missing records and that he did not require his prescribed medication until after the records had arrived. They also explained that should Mr C have required assistance in the interim period then he would have been assessed by a clinician who would have prescribed appropriate medication if required.

Recommendations
We recommended that the service:
• review their procedures and consider whether measures such as a simple checklist could be completed by staff to ensure that medical records have been collected and delivered when a patient is transferred; and
• apologise to Mrs C for the delay in delivering Mr C's records.
 

Summary
Mr C complained that his GP failed to diagnose rotator cuff syndrome (damage or dysfunction to one of the rotator cuff muscles which are located in the shoulder area) following a number of visits to the practice. This condition was diagnosed after he changed GP practices. He also complained that he was not provided with appropriate advice and care in relation to his shoulder pain, particularly as he felt that his GP had failed to provide him with information about the availability of an NHS physiotherapy drop-in centre and offer him a steroid injection.

However, following advice obtained from our clinical adviser who had access to Mr C's clinical records and information provided by Mr C's GP, we were of the view that the care and treatment options provided to Mr C were appropriate for his condition. Whilst steroid injections and a surgical referral would have been a further option, the decision to suggest physiotherapy initially was reasonable. Had Mr C stayed with this practice it is likely that these further options would have been considered had Mr C's condition not improved. We, therefore, found that the care and treatment provided were appropriate.
 

Summary
Mrs C complained that doctors were insensitive in the way that they told her husband (Mr C) that he had terminal cancer.

We acknowledged that it must have been extremely distressing for Mr C to receive the news that he had terminal cancer, particularly as this was the only hospital appointment that he attended alone. However, our medical adviser said that it was appropriate to be frank and open in such circumstances. We found no objective evidence that doctors were insensitive in the way that they communicated Mr C's prognosis to him.

Summary
Mr C first visited his GP in September 2009 with pain and swelling in his testicles and was referred to the urology team at the Western General Hospital. He was placed on a waiting list for treatment. He was seen in January 2010 by two specialists who could not agree a diagnosis and referred for a scan which was done in February. In March he was seen by another urologist and told that his problem was not a urology one. Mr C was referred back to the general surgical department and in April 2010 he received a letter telling him that he was on the waiting list to see a consultant.

Mr C telephoned the department to complain about this further delay but was told that nothing could be done. Mr C was seen in July 2010 in the colorectal department and referred for an MRI scan. He was seen again there in September 2010 and a hernia was diagnosed. Mr C was told that due to his other complex health difficulties, the remedial surgery he required would have to be done at another hospital by a specific surgeon. Mr C was seen there in November 2010 and had his surgery in January 2011. Mr C was dissatisfied with the wait for surgery which totalled some 64 weeks and the resultant increase in pain and discomfort he had to endure.

We upheld Mr C's complaint. We found that his wait for surgery had been excessive. There were a number of things that could have been done differently which would have reduced his waiting time. A CT scan was first considered in March 2010, but was not performed until August 2010. Mr C was reviewed by two registrars, who could have discussed his case with a consultant, given there were clear diagnostic difficulties. It was not until November 2010, over a year after Mr C had first been referred, that a consultant took responsibility for the management of his care. We also found the board's responses to Mr C's letters of complaint to be insufficient.

Recommendation
We recommended that the board provide a full apology to Mr C for the delay he experienced when waiting to undergo his operation.

Summary
Mr C complained about the treatment he received from the board for two hernias. He said that a surgeon failed to correctly interpret his scan results, as he failed to identify one of the hernias. However, we found that the surgeon had interpreted the scan correctly and had identified the second hernia. Mr C also complained that the surgeon said that he would be contacted in a week's time about another appointment, but there was then a ten-week delay in providing him with an appointment.

There was no evidence that the surgeon told Mr C he would be contacted in a week. The surgeon had recorded that he would discuss the scan with radiologists and one of his colleagues who specialised in abdominal wall repair. He also said that Mr C should continue to try to lose weight to improve the chances of repairing the hernias. In view of this, we found that the ten-week gap between his appointments was reasonable.

Mr C then cancelled the appointment due to work commitments. He complained about the board's delay in arranging a further appointment. We found that four and half months was too long for him to wait for another appointment and upheld his complaint about this delay.
 

Summary
Mr C complained to the practice that his late partner (Ms C) had attended there on numerous occasions between November 2010 and March 2011 with respiratory problems. The practice referred Ms C to hospital for x-ray and to the spirometry clinic (where tests for lung conditions are carried out). Ms C was admitted to hospital in early March 2011 where cancer was diagnosed and she died later that month. Mr C's complaint was that there had been a delay in his partner's diagnosis.

Our investigation found that doctors from the practice had taken Ms C's symptoms seriously and arranged appropriate investigations and hospital referrals in an effort to establish a diagnosis. Independent medical advice that we took concluded that the early differential diagnosis of Chronic Obstructive Pulmonary Disease was reasonable and that there was no evidence of any 'red flag' symptoms which would have pointed to cancer as a likely diagnosis.

Our clinical adviser also examined the x-ray image which was taken in January 2011 and found that it was appropriately reported as normal. We, therefore, were satisfied that the care and treatment provided to Ms C by the doctors was reasonable.