Health

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.

Summary
Mr A was referred by his GP to a hospital urology department for review of his mixed urological symptoms at that time. He subsequently had a CT scan of his urinary tract which showed appearances of retro peritoneal fibrosis (RPF). Following a consultation with a consultant urologist, he was admitted to hospital for further investigation which showed that his right kidney was providing 90 percent of his renal function and his left kidney only accounted for 10 percent of this function.

After this investigation, a senior registrar in urology wrote to Mr A informing him of the possibility that his left kidney may have to be removed. This was the first time that Mr A had been made aware this was a possibility and that his left kidney was non functioning. Mr A was also referred to a vascular surgeon as he was diagnosed with aortitis. Mr A considered there was an unacceptable delay with this referral.

Mr A requested to be reviewed by another urology consultant for a second opinion. At this appointment it was discovered that the consultant did not have his case notes and had been given the case notes for another patient.

Mr A complaiend to us. He said that he felt that he had not been dealt with in an 'appropriate, timely or professional manner'. He said that there was both delay and failure to treat his condition and also a failure to communicate with him about his condition.

We obtained Mr A's medical records and took professional advice from our independent medical adviser. The adviser explained that RPF is a rare kidney condition which in the case of Mr A presented in an unusual manner. The adviser found that the initial investigation and management of Mr A's condition was conducted in a timely manner and there was no delay in diagnosis of the condition.

However, the adviser stated that following a failure to pass a ureteric stent there was no evidence in Mr A’s medical notes that there were discussions about possible other treatment for Mr A’s condition. For this reason we concluded that there was a failure to treat Mr A’s condition and we, therefore, upheld this element of the complaint.

In relation to the diagnosis and treatment of Mr A’s vascular condition, the advice received was that there was a delay in Mr A’s treatment and for this reason we also upheld this element of Mr A’s complaint. However, the adviser also stated that this did not impact on the treatment that Mr A received and that the treatment in this regard was appropriate for his condition.

We found that there was a failure to communicate with Mr A about his condition and we, therefore, upheld this part of his complaint.

We did not uphold Mr A’s complaint that there was a failure to transfer his medical notes to his consultant for an appointment. This was because while it was accepted by the board that the consultant did not physically have in his possession Mr A’s medical notes when he saw him, we accepted that the consultant was able to appropriately access all information pertinent to his case through the clinical portal.

Recommendations
We recommended that the board:
• review their procedures so that a robust system is put in place to ensure that the results of investigations are communicated quickly to clinical teams, particularly if they are abnormal;
• review their procedures so that all clinical letters to patients are typed promptly after dictation and any outcomes from these are actioned quickly;
• review their procedures so that discussions by multi-disciplinary teams are recorded and communicated to patients particularly if there is a delay before the patient can be seen in an outpatient clinic;
• apologise to Mr A for their failure to communicate with him effectively about his condition and outcomes; and
• review their systems so as to ensure a patient’s medical records, as appropriate, are available when they attend an appointment with a clinician.

Summary
Mrs C complained on behalf of her son, Mr A, about the way the board managed his condition. Mr A suffered from pilondial sinus (an infected tract under the skin between the buttocks). He received treatment from a surgeon over a twenty month period, and then the surgeon referred him to a plastic surgeon for alternative treatment. The plastic surgeon performed a multiple flat procedure, which was successful. Mrs C said that the surgeon should have referred Mr A to a plastic surgeon much earlier than he did, and when it became clear that the treatment he was providing was unsuccessful. She said that the delay in referring to a plastic surgeon meant that Mr A suffered from pain and repeated infections which had adversely affected his quality of life. We found that there was more than one way to treat Mr A, and that while an earlier referral to plastic surgery could have been made, the care and treatment Mr A received was reasonable and in line with standard practice.

Summary
Ms C, an advice worker, complained on behalf of Mr A that, as a result of a hip replacement operation being performed inadequately, his muscle was damaged.

Mr A underwent a hip replacement operation in July 2009. He subsequently attended a number of follow-up appointments with the consultant surgeon who had performed the operation. Mr A complained of continuing pain in his hip and that he had developed a pronounced limp. The consultant initially stated he could not identify what was causing the problems. However, following the consultation in June 2010, he stated that the problem was likely to be due to underdevelopment of the abductor muscles and advised Mr A to carry out appropriate exercise to build up the muscles.

Mr A continued to suffer pain and discomfort and attended his GP in July 2010. He asked for a second opinion. He was referred to another consultant surgeon who order an ultrasound scan which identified a rent in Mr A's abductor muscle. Mr A was informed this could not be operated on to be healed; the consultant also could not identify whether the rent was due to an incision in the muscle failing to heal, or whether it had been reopened following a subsequent aggravation (Mr A had suffered a bad fall the night of his discharge from hospital).

Mr A complained that the original consultant had never informed him that this was the cause of the pain, and, as a result, he queried whether the operation had in fact been performed adequately.

One of our advisers, a consultant orthopaedic surgeon, provided advice in this case. He said the operation had been performed to an acceptable standard. He commented that the tear was not an accident, but that the muscle initially required to be incised (and then reattached to the bone) as part of this type of procedure. He too stated it was impossible to tell whether the rent was because the muscle had failed to heal (a risk of this type of surgery) or whether a subsequent aggravation had re-opened it. Our adviser commented that the original surgeon could have provided Mr A with more detail in the consultations to save him requiring a second opinion, but that essentially the original surgeon had identifed the same problem as the second one. The complaint was, therefore, not upheld and no recommendations were made.

Summary
Mrs C complained that her GP practice's actions in in relation to her daughter, Ms A, were unreasonable.

As Ms A had had severe stomach pain for a couple of hours, Mrs C telephoned the practice. The receptionist told her that the triage GP was unavailable to decide what priority she should have and that there was no point bringing her daughter in as the other GPs were with patients. The receptionist said someone would call her back very soon and sought the advice of one of the GPs. On the GP's advice, the receptionist told Mrs C that, in the absence of the triage GP, it would be better if she brought her daughter in, so that any necessary treatment could then be considered without any further delay. The receptionist could not promise that a GP would be available to see Ms A straight away. Mrs C brought her daughter in, and they were seen 15 minutes later.

Our investigation found that the receptionist had acted appropriately in seeking GP advice in the absence of the triage GP, in calling Mrs C back promptly and in resisting pressure to make promises that she was not in a position to make. We also considered that, in the circumstances at the time, it was reasonable that no GP was immediately available and, therefore, we did not uphold the complaint.