Decision Report 201204664

Summary

Ms C, a former prisoner, complained that while in prison her pain relief medication (pregabalin) was stopped suddenly. This was after a spot check of medicines found that she had removed powder from the capsules and not taken them as instructed. Ms C had been prescribed pregabalin for pain caused by nerve damage, and told the prison health centre that she had taken extra medication to help her cope with difficult family circumstances. She also said that she was unable to appropriately progress her complaint through the NHS complaints procedure.

We took independent advice on this complaint from one of our medical advisers. Although we found that the prison health centre doctor had noted that Ms C had not demonstrated objective neuropathy (nerve damage), it appeared from the records that the stopping of her medication was influenced by her interference with the capsules (Ms C had been given a warning two months earlier to be more careful with her medication). Our medical adviser said that pregabalin can also be used to treat anxiety, and explained that a patient's perception of pain and their mental health are closely linked, and that treating anxiety can improve the management of pain. We decided that the prison doctor did not give proper consideration either to whether pregabalin assisted Ms C in managing her anxiety, or to gradually reducing the dosage in line with best practice.

In terms of the complaints handling, we found that even after Ms C met with the clinical manager to discuss her concerns about a lack of response, she still did not get a reply. Her complaints were logged but not responded to, contrary to the NHS complaints handling guidance. It also appeared that some complaints information was inappropriately held in Ms C’s medical records.

We upheld both Ms C’s complaints.

Recommendations

We recommended that the board:

• draw to the doctor's attention the British National Formulary's guidance on avoiding abrupt withdrawal of pregabalin;
• put in place suitable guidance for prisoners in the prison about the consequences of misusing prescribed medication;
• apologise to Ms C for failing to handle her complaint in line with the NHS complaints procedure guidance; and
• ensure that health centre staff in the prison do not record complaints information in a patient's medical records, in line with the NHS complaints procedure guidance.