Health

Summary
Ms C complained on behalf of her mother (Mrs A) about the care and treatment Mrs A received from a hospital both as an in-patient and an out-patient. Ms C complained that the hospital delayed in providing Mrs A with surgery, and that there had been different views among hospital clinicians about how the surgery would be carried out.

After taking advice from two of our professional medical advisers, we did not uphold either of Ms C’s complaints. Although surgery was delayed, we found that there were medical reasons for this; that the hospital had correctly followed procedures and that Mrs A was on an appropriate clinical pathway, given the health issues she presented during the period in question.
 

Summary
Mrs C complained that her GP practice removed her and her husband from their list of patients without an appropriate explanation. Mrs C also complained that the practice failed to make sufficient adjustments for her disability in dealing with her complaints. In particular, she said that the practice declined to deal with the matter verbally.

The practice had asked Mr and Mrs C to register with another practice, and later removed them from the practice list. They told Mr and Mrs C that this was because of a breakdown in the doctor/patient relationship, but did not give a more specific reason. We found that in asking them to register elsewhere, the practice had, in effect, already taken the decision to remove Mr and Mrs C from the list, and did not leave any room for negotiation. They should have first warned Mr and Mrs C that they were at risk of removal, and explained the reasons for this. The practice did not keep a written record of the reason why they did not give a warning. Neither did they keep a written record of the grounds for a more specific reason not being appropriate. We concluded that the practice removed Mr and Mrs C from their list without providing them with an appropriate explanation, so we upheld this complaint.

Mrs C also asked the practice to deal with her complaints verbally, due to her disability. We found from looking at the practice's records that they did speak to her by telephone. However, Mrs C was not willing to discuss her complaints in any detail on the telephone. The practice were willing to meet with Mrs C, but before they or Mrs C could take this further, they decided to remove her from their list. After this, understandably, Mrs C did not pursue her complaints with the practice. We took advice from our professional medical adviser, whose view was that the practice acted reasonably in relation to Mrs C's disability while they were dealing with her complaints. We concluded that, from an administrative point of view, the practice did try to make sufficient adjustments for Mrs C's disability, and did not decline to deal with the matter verbally. Therefore, we did not uphold this complaint.

Recommendations
We recommended that the practice:
• apologise to Mr and Mrs C for failing to deal with their removal from the practice list in line with the NHS Regulations; and
• review their procedure for removing patients from the list, to ensure that future actions are consistent with their obligations as set out in the NHS Regulations.
 

Summary
Mr C complained that the board failed to reimburse his travel expenses in respect of two appointments at a hospital in England in June and October 2010. Our investigation found that the board had in fact arranged and paid for Mr C's travel in June, but that he had chosen to make alternative and unnecessary arrangements for another date. We considered that it was reasonable for the board not to reimburse Mr C's expenses in those circumstances. With regard to the October appointment we found that the board had told Mr C before he travelled that they did not support this treatment and would not refund his expenses. As travelling expenses require the approval of the board we did not uphold this complaint.
 

Summary
Mr C had requested a home visit early in 2010 which was refused. In December 2010 he contacted the practice by email to ask why the visit had been refused and to ask for a copy of the practice policy on home visits.

The practice manager responded five days later by email explaining the policy on home visits. The final paragraph of the emailed letter stated that Mr C's previous email had 'sullied' the patient / doctor relationship and Mr C was to be removed from the list. Mr C complained that the decision to remove him from the GP list without prior warning was unreasonable. We found that it was not appropriate for the practice to have taken the action they did without first giving Mr C a warning and we, therefore, upheld his complaint.

Recommendations
We recommended that the practice:
• apologise to Mr C for the failings identified in this report.

Summary
Mrs C complained that a nurse had inappropriately discussed social work matters in front of her and her son, Master A, during a 1-2-1 meeting that resulted in Master A becoming upset and distressed. Mrs C also complained about the board's handling of her complaint about the discussion and that her complaint against the nurse had not been addressed. The board had investigated Mrs C’s complaint and met with her, however, this had not resolved matters and Mrs C brought her complaint to the SPSO.

We did not uphold the complaint against the nurse as there was no evidence to substantiate the allegations. We did not uphold the complaint that the board’s handling of the investigation into the alleged discussion that took place at the 1-2-1 was inadequate. We noted that before Mrs C brought the complaint to us the board had apologised for a delay in their final response being sent to her.

Summary
Mr C's son was an in-patient at a clinic. Mr C raised concerns about staff accusations that he and his partner made inappropriate and/or racial comments about or to nursing staff. Mr C claimed that when he challenged the accusations, staff refused to detail what comments had caused offence or who had reported them. The accusations resulted in visits to Mr C's son being restricted and supervised.

As this complaint centred on matters of communciation it was difficult for our investigation to establish exactly what had been said. Mr C denied that any of his remarks were offensive or racist. However, some of the staff had found them to be so. Without commenting on whether or not Mr C had made racist or offensive remarks, our investigation found that the action taken by the board was reasonable. This is because they have a responsibility to protect staff, patients and other visitors from behaviours that some may find offensive. It was emphasised to Mr C that in such cases the definition of whether or not a comment is offensive rests with the perception of the recipient rather than the intention of the speaker.

Our investigation also looked at whether or not it was reasonable for the board to decline to tell Mr C who had reported his comments. Our view was that the board had a duty to protect the confidentiality of those making the complaints and it was, therefore, reasonable of the board not to give this information to Mr C. We also looked at whether the board's investigation of the matter was appropriate and found that they had taken reasonable, appropriate and timely action to investigate the complaints and inform Mr C of their findings.

Summary
Mrs C raised a number of concerns about the conduct of a nurse at the medical practice she attended during an appointment with her son for the prescription of booster vaccines. She also complained about the practice's handling of her complaint about the nurse.

In our investigation on this complaint, we reviewed all the documentation provided by Mrs C. We also reviewed all the documentation the practice held on the complaint, including a full copy of the complaints file and related correspondence, a copy of the internal complaint handling procedure, policies or procedures covering the conduct of nursing staff at the practice and any relevant medical records relating to the specific complaint.

From the evidence available, it was not possible to conclude whether or not the nurse failed to introduce herself; did not listen to Mrs C or her son during the consultation; or prevented Mrs C from producing her son’s vaccination certificate. Although Mrs C stated that the nurse did not provide her with her name, the practice confirmed and Mrs C acknowledged that the nurse was wearing a name badge throughout the consultation.

However, it was clear from both Mrs C's and the practice's reporting of events, and from the nurse’s note of the consultation, that the nurse did comment on Mrs C accompanying her son to medical appointments. It was clear that Mrs C personally found this comment unacceptable and unprofessional, whether it was intended to be or not. Given the practice's confirmation that patients have a right to be accompanied, and that it was normal practice to clarify who the accompanying adult was at the start of any consultation, this comment appeared to be contrary to normal practice. We, therefore, upheld this complaint.

The evidence showed that the practice responded to Mrs C's complaint in good time and offered apologies to her on three different occasions. For this reason, we did not uphold this complaint. However, the wording of the practice's apologies could have been more meaningful. By saying that they apologised if Mrs C 'felt' they had done something wrong, they did not fully acknowledge the wrongdoing.

In addition, the practice’s complaints handling policy stated that in line with the NHS procedures they would deal with all complaints within 20 working days. For GP practices, the specified timescale in the NHS procedure is ten working days.

Recommendations
We recommended that the practice:
• remind all staff of the need to clarify at the start of any accompanied consultation who the accompanying adult is and that the patient is content for them to participate; and
• review their complaints handling policy to ensure it meets the timescales set out under the NHS complaints handling procedures and includes guidance on how to offer a meaningful apology.

Summary
Ms C complained that her dentist failed to provide appropriate treatment over a two year period. She had raised repeated concerns about pain and sensitivity in her teeth and asked the dentist to take x-rays. The dentist said that this was not required as x-rays had been taken two years previously. She put Ms C's sensitivity down to gingivitis and gum recession.

Ms C sought a second opinion from another dentist. X-rays were taken and showed that she had an abscess and tooth decay. She complained that her own dentist should have diagnosed this.

We found that there was a difference of opinion between Ms C and the dentist as to what information she had provided about her symptoms. The dentist's examination was suitable for a complaint of sensitivity, but not for a complaint of severe pain as described by Ms C. We were compelled, however, by the fact that Ms C sought a second opinion straight after one of her appointments and was found to have a well-developed abscess. We concluded that, on the balance of probabilities, Ms C provided details of her symptoms and the dentist should have taken diagnostic x-rays.

Summary
Ms C was given treatment for toothache by a dentist. Ms C complained that the filling was too close to the nerve and resulted in ongoing pain. In addition, she complained that she called the dental practice a few weeks later but no follow-up treatment was provided by the dentist and she had to seek further treatment from a different dentist.

Our investigation found that the first dentist had carried out a comprehensive clinical examination and that it was likely the toothache was caused by damage already done to the nerve as a result of a deep cavity. Furthermore, we did not find any evidence to support Ms C's position that she had contacted the dentist after the initial treatment. We did, however, make a recommendation to the first dentist about record-keeping.

Recommendations
We recommended that the practice:
• ensures that more detailed information is noted in the patient's clinical records in relation to presenting symptoms and treatment given.

Summary
Ms C, an advice worker, complained to us on behalf of Mrs A, about the board. She said that they had failed to respond appropriately to Mrs A's sudden drop in blood pressure following an operation on her eye under general anaesthetic.

During the post-operative period of the eye operation, Mrs A was unable to breathe and her blood pressure fell dramatically. The board said that she had suffered a primary cardiac event and developed pulmonary oedema (excessive fluid in the lung airspaces). She had to be transferred to the intensive care unit and was put on a life support machine. Mrs A was eventually discharged two weeks later, but now has permanent double vision and vocal problems.

Our investigation found that Mrs A had suffered an obstructive pulmonary oedema whilst awaking from general anaesthetic. This can happen when a breathing tube is removed after an operation. It is not primarily caused by heart failure, however, the resulting fall in oxygen levels had secondary effects on Mrs A’s heart. At the time, the condition could not have been specifically identified as either a primary breathing or primary heart event. However, we found that the management of it and the resulting heart problems was appropriate and timely. This complaint was, therefore, not upheld.

However, we did uphold Ms C’s complaint that the board failed to provide a consistent explanation of what happened to Mrs A. The board had accepted that Mrs A had received conflicting statements from clinical staff about what happened during and following her eye procedure. They had apologised for this and had told Ms C that staff would be reminded of the importance of providing accurate patient information at all times.