Health

Summary
Mr C complained on behalf of his daughter (Miss A) who attended her medical practice about a rash on her head. He said that she did not complain during her appointment of migraine or any kind of headache. At that time, Miss A was in the process of applying to join the Army and has since been told that she has been rejected on medical grounds due to her history of migraine.

Miss A said that the GP erroneously noted on her records that migraine was discussed at the consultation, and this caused the Army to reject her. The GP maintained that the note she made at the time was correct and that she completed a medical form she was sent by the Army properly, as she was required to do.

Our investigation showed that there was no evidence to suggest that the note recorded by the GP was incorrect. Further, the GP complied with the guidance she had been sent by filling out the form and making reference to a history of migraine. Our medical adviser confirmed that Miss C's medical records show that she did have a history of migraine, which the GP was bound to disclose.
 

Summary
Ms C was admitted to hospital after a colonoscopy to remove a polyp from her bowel. She was discharged and a further diagnostic appointment was made for some months later. A flexible sigmoidoscopy was to be carried out at that appointment to check for other polyps, and she was advised to take laxatives before attending, to reduce faecal matter. At the appointment, however, she was told that the procedure could not be fully completed due to 'faecal loading'. Ms C was told that she would have to wait 12 months for another appointment. She complained about the nursing care that she received during her stay in hospital and that there was confusion prior to her diagnostic appointment as to what procedure she had been booked for. She also complained that she was prescribed insufficient laxatives, that her procedure was unnecessarily delayed and that the board proposed insufficient follow-up action.

We found the nursing care during Ms C's initial hospital admission to be poor. Her fluid intake was not properly monitored and failed attempts were made to catheterise her, causing her discomfort, when there was no clinical need for this. Although Ms C was given incorrect verbal information about the further procedure, we found that the correct procedure had in fact been booked. The board confirmed that the procedure was delayed, but we were satisfied with their explanation that this was due to the urgent clinical needs of other patients.

We found the prescription of laxatives to be appropriate and, whilst faecal loading prevented a full inspection of the colon, our medical adviser confirmed that the consultant was able to see enough to confirm that no further sinister polyps were present. As such, further review in 12 months was considered appropriate, although the board did not explain this clearly to Ms C.

Recommendations
We recommended that the board:
• use this complaint to remind staff of the importance of accurate recording in records including recording of dignity issues; and
• apologise to Ms C for the failings identified regarding record-keeping, catheterisation, and the fact that their initial response to her complaint did not adequately address concerns about the outcome of her sigmoidoscopy.
 

Summary
Miss C complained about the care and treatment of her elderly mother (Mrs C) in hospital, as well as Mrs C’s treatment at the clinics she had been attending. Mrs C was admitted to hospital after collapsing. She had type II diabetes and kidney failure. She was assessed with low blood pressure and a reduced heart rate and spent several days in a high dependency unit before being transferred to a general ward. Miss C felt that her mother was moved to the general ward too quickly, and was not properly assessed.

We did not uphold Miss C's complaints. We found that clinical involvement in her mother’s care did not change at all when she was moved to the general ward, and that the transfer was reasonable. We noted that Miss C and her family could have been advised more fully about the difference in nurse to patient ratio once her mother was moved from the high dependency unit. Miss C was unhappy, too, with staff communication with her, her mother and her family. She told us that when her mother’s condition changed, staff did not contact her and she only found out when she telephoned the ward. Our investigation established that Mrs C’s condition began to deteriorate about an hour before Miss C’s call and that staff were engaged in treating her mother during that time. The board have, however, since raised with staff the issue of timely communication with family members.

Miss C complained about the discussions staff had with the family about Mrs C’s continued care after she had a heart attack. Miss C felt the clinical staff were allowing her mother to die rather than help her. We found that the clinical decisions taken were appropriate and that staff discussed decisions (such as the discontinuation of dialysis) with the family regularly and sensitively. Miss C also said that no-one helped her mother to eat or drink. We found, however, that staff assessed Mrs C’s requirements when she was admitted to the general ward, and decided that she did not need such assistance. The board also provided us with a detailed and reasonable explanation about Mrs C’s fluid requirements, which we passed on to Miss C in our decision letter.

Finally, Miss C complained about Mrs C’s treatment at the renal and diabetic clinic prior to her admission to hospital. Because Mrs C’s insulin dose was significantly reduced on admission, her daughter was concerned that the clinic had been overdosing her mother. We found, however, that Mrs C’s dosage prior to admission was appropriate. When she was admitted, Mrs C’s blood sugar levels were low because of a deterioration in her kidney function, which is why the dosage was changed.

Summary
Mr C is registered as having welfare power of attorney for his mother (Mrs C) who suffers from dementia. Mr C was concerned that a district nurse obtained his mother's signature on a 'Consent to Share Information Form'. This form, when completed, allows relevant public care and support agencies to share information regarding the care and support they provide to an individual.

Mr C complained to us that it was inappropriate for the district nurse to ask his mother to sign this form and that, when he complained about this to the board, they failed to respond appropriately to his complaint. We agreed with Mr C that the district nurse should not have asked an elderly lady with dementia to sign the consent form. As the board had already accepted that this should not have happened, discussed the issue at a team meeting and issued an apology to Mr C, we did not, however, make any recommendations. We did not agree that the board failed to deal with his complaint appropriately.
 

Summary
Ms C complained about the treatment her sister (Mrs A) received following a fall. Mrs A suffered from early onset Alzheimers disease and fell at home injuring her face and chest. She attended an Accident and Emergency unit (A&E) but was discharged without having had x-rays or a CT scan. Ms C complained about what she saw as inadequate investigation of her sister's injuries and a lack of timely pain relief or follow-up treatment. She also complained about the board's complaints handling and the fact that Mrs A was denied access to the Falls Team because she was under 60 years of age, which was apparently the minimum age to be able to access this service.

After taking advice from one of our professional medical advisers we upheld all of Ms C's complaints. Although our adviser confirmed that x-rays and a CT scan were not in fact necessary, we found the board's investigation of Mrs A's injuries inadequate, as they did not follow national Scottish Intercollegiate Guidelines Network (SIGN) guidance on the observation of head injuries. We also found that the board's policy was in fact to allow patients under the age of 60 to access the Falls Team if this was clinically indicated. The policy, however, was not followed on this occasion. We found that the discharge planning process was inadequate and that there were inaccuracies in the board's response to Ms C's complaint.

Recommendations
We recommended that the board:
• apologise to Mrs A's family for the delay in providing her with appropriate pain relief;
• remind staff in A&E of the need to both establish and adequately record the criteria for discharge following head injury contained in SIGN Guidance 110; and
• re-emphasise to complaints handling staff the importance of having an informed clinical review of complaints responses before they are issued.
 

Summary
Ms C complained about the treatment that her young daughter (Ms A) received from GPs at her local medical practice. In particular she felt the GPs delayed in taking action on Ms A's high cholesterol level and that at two appointments a GP failed to treat Ms A's symptoms of cough and explosive diarrhoea.

We found that at the time of the high cholesterol reading, Ms A was under the care of hospital clinicians, and as such they, rather than the GP, were responsible for monitoring this and deciding if treatment was appropriate. On the failure to take action in relation to Ms A's cough and explosive diarrhoea, after taking advice from one of our medical advisers, we found that clinically the actions of the GP were reasonable, although there were clearly communication difficulties between Ms C and the GP.

Our investigation also noted that there were concerns about the way the medical practice handled the complaint and, although we made no recommendations, we reminded them of their responsibilities under the NHS complaints procedure.
 

Summary
Mrs C complained that her late father (Mr A) received inadequate care and treatment in hospital. She said that Mr A had been admitted three times and that his condition worsened during the period of approximately three months he was in hospital care. Mrs C also said that several wrong diagnoses were made and Mr A suffered considerable weight loss while in hospital. Furthermore, he was terminally ill and no one told her that he was dying or what his diagnosis was.

Having taken advice from two of our medical advisers, we did not uphold Mrs C's complaints. On the allegation of poor care and treatment we considered that, given Mr A’s case was complex and unusual, he was appropriately diagnosed and treated by the hospital. Our advisers explained that Mr A was suffering from a rare combination of conditions and complications that did not respond to reasonable medical treatment. We did not find evidence of inadequate communication of Mr A’s condition to his family, although we acknowledged that his illness presented considerable challenges to all concerned.

Summary
Following advice from NHS 24, Ms C attended a hospital out-of-hours (OOH) service complaining of a two-day history of nausea, pain, itching and an area of what she thought to be shingles on her torso. She also had a small 'protrusion' in the area of discolouration. Ms C asked the OOH doctor if this could be a tick. The doctor removed the object and told Ms C that she thought it was merely a scab. After noting all Ms C's symptoms and her past history of shingles attacks, the doctor made a provisional diagnosis of shingles. Ms C was prescribed anti-viral drugs and advised to 'seek further medical assistance' if her symptoms continued. Ms C's symptoms did continue, and worsened, and she attended her GP five times during the following weeks before being diagnosed with Lyme Disease and given antibiotics. Her recovery is slow and on-going.

Ms C complained that the OOH doctor should have examined the object removed from her skin either with a magnifying glass or under a microscope to establish whether or not it was a tick. She also complained that the doctor failed to diagnose Lyme Disease. Our professional adviser said that Lyme Disease is very difficult to diagnose and that the examination and provisional diagnosis made by the OOH doctor was reasonable. They said that it was also reasonable to tell Ms C to seek further advice if her symptoms continued and noted that she had done so, but that she had gone to her own GP, and not the OOH service. It was, therefore, not reasonable to lay the delayed diagnosis at the door of the OOH service. The adviser also said that further examination of the object removed from Ms C's skin would not have helped achieve an earlier diagnosis of Lyme Disease. This is because although ticks can carry and transmit this, a bite from a tick would not automatically mean that the disease had been contracted.
 

Summary
Mrs C's son (Mr A) was removed from his dental practice’s list of patients. When he attended a new dentist, he was told that he needed at least nine fillings. Mrs C complained that the original dentist had provided inadequate dental treatment to her son resulting in the need for several fillings.

The original dentist maintained that Mr A had poor oral health and said that he only attended for emergency appointments. The dentist said that at such appointments it would not be usual practice to undertake a full check-up, and on the day of attendance they would concentrate on the cause of pain.

We were not able to establish whether the dental decay developed before or after the initial visit to the new practice. We upheld the complaint, however, as we noted that the original practice did not follow Scottish Intercollegiate Guidelines Network (SIGN) guidelines in that they did not take recommended (bitewing) x-rays or carry out a full assessment of Mr A.

Recommendation
We recommended:
• that the dentist takes into account the contents of SIGN 47 for future reference.
 

Summary
Mrs C complained about the actions of a GP who attended her father (Mr A) at home. She was unhappy that the GP did not arrange for Mr A to be admitted to hospital, despite having low blood pressure; not eating or drinking; and not thinking straight. Mr A had told the GP he did not want to go to hospital.

Mr A was seen at home the following day by an out-of-hours doctor who arranged for him to be admitted. Mr A died in hospital less than two weeks later. Mrs C felt that the GP who first attended should have ignored Mr A’s wishes, and arranged for him to be admitted. She felt that the delay had contributed to her father’s death.

Our investigation established that the GP had recommended that Mr A should go to hospital, but he had refused this, and was competent to do so. We also found that the GP had carried out an appropriate examination and that although she spent some time with Mr A, she could not persuade him to agree to admission.