Not upheld, no recommendations

Summary

Mrs C complained that the care and treatment given to her young son (Master A) by his medical practice was inadequate. Master A had become increasingly unwell over the Christmas holiday period of 2011/12. He was eventually seen at hospital, but Mrs C complained that GPs in the medical practice had failed to diagnose her son properly and that it was largely due to luck that the second GP he saw referred him to hospital.

We investigated the complaint and took all the relevant documentation into account. We obtained independent advice from one of our medical advisers and reviewed Master A's clinical notes. We did not, however, uphold the complaint. The advice received was that the progression of Master A's illness had been slow and insidious. However, in the face of his presenting symptoms, his care and treatment had been satisfactory and appropriate.

Summary

Mrs C complained about the care and treatment given to her son (Master A) by out-of-hours GPs. Master A became increasingly unwell over the Christmas holiday period of 2011/12. He was twice seen by out-of-hours GPs in hospital but Mrs C said that he was not diagnosed properly or quickly enough, as a consequence of which he became severely ill. She also said that the board failed to properly deal with her complaint about this.

We investigated the complaint and took all the relevant documentation into account. We obtained independent advice from one of our medical advisers and reviewed Master A's clinical notes. We did not, however, uphold the complaint. Our adviser said that Master A's situation was a rare one and that most children with his symptoms would have recovered without hospital intervention. However, both out-of-hours doctors had responded appropriately and treated him satisfactorily.

Summary

Mr C complained that an optometrist used incorrect optical notes when undertaking his consultation and did not realise his mistake until Mr C pointed it out to him. The optometrist explained that he picks up the optical records for the next patient in the queue before entering the waiting room and calling their name. He said he followed the standard process on this occasion. He explained that it became clear during the consultation that Mr C's optical history and examination results did not correspond with the optical records he held. He then checked the name and established from Mr C that he was not the patient called. He explained that he called for a different patient in the waiting room but Mr C came forward.

Our investigation found that Mr C suffered no ill effects from this consultation. In addition, there were no witnesses to the consultation itself and we did not consider it proportionate to try and trace other patients who were in the waiting room and who may have witnessed the optometrist calling for the appointment. As we could not reasonably obtain sufficient evidence to allow us to reach a clear conclusion on what happened that day, we did not uphold Mr C's complaint.

Summary

A nurse working for the board's child and adolescent mental health services wrote to the local social work department about Ms C's teenage son, who lived in a children's home. Ms C considered the letter to be one-sided and unfair, and said that the nurse should not have written an assessment of her son without having met him.

Our investigation found that the nurse had been asked to assess Ms C's son. She had written the letter at the request of the social work department, and it was intended solely to represent the views that the nurse had obtained in discussion with the manager of the children's home. The discussion with the manager had been the starting point of the assessment that the nurse was asked to make, and he had also arranged to have two meetings with Ms C's son as part of his detailed assessment. We were satisfied that the letter was accurately based on the nurse's clinical record of his discussion with the manager, that it accurately explained the purpose of the letter and the context of the information in it and that it was appropriate for such a letter to be written.

Summary

Mr C’s wife (Mrs C) was diagnosed with breast cancer in June 2009. In early 2010, she developed problems going to the toilet. Mr C said this became an ongoing problem that caused his wife extreme pain and discomfort. Mrs C’s GP referred her to hospital for x-rays of her spine and pelvis which were carried out in July 2010 and showed no significant abnormality. In view of Mrs C’s history of breast cancer, the radiologist recommended a bone scan which was performed in August 2010. Although the bone scan findings noted ‘increased uptake’ (an abnormality) in both sacro-iliac joints (joints in the lower back next to the pelvic region), the opinion was that this could be due to mechanical reasons in the joints, as Mrs C had undergone hip operations 15 years previously.

Mrs C's GP then referred her to a different hospital for further investigation as she was having difficulty walking. An MRI scan (a diagnostic procedure used to provide three-dimensional images of internal body structures) was carried out in September 2010 which identified extensive cancer and Mrs C passed away in April 2011. Mr C complained to the board that he felt that something might have been missed on his wife’s x-ray and that she should have been diagnosed earlier, sparing her a lot of pain, and possibly prolonging her life.

After taking advice from two of our medical advisers, including a cancer specialist, we found that reasonable investigations were carried out after Mrs C's GP referred her for further investigation. There was no clear evidence of cancer from the earlier blood tests, x-rays and bone scans. We also found that the description given and findings reached on the x-rays and bone scan were accurate and that only two weeks had passed between the bone scan and the MRI scan being undertaken. We could not, therefore, conclude that there had been a delay in Mrs C being diagnosed.

Summary

Ms C complained that the treatment provided by an orthopaedic (dealing with conditions of the musculoskeletal system) department was not of an acceptable standard. Ms C was unhappy with the treatment she received in relation to her deformities in her feet as a result of bunions and thought that mistakes had been made.

After taking independent advice from one of our medical advisers, a consultant orthopaedic surgeon, we did not uphold her complaint. We recognised that this had been and continued to be, a difficult time for Ms C and that she had undergone three operations. However, we found no evidence that the treatment provided was not of a reasonable standard. The surgery initially carried out did have complications, and as a result of those complications there was a need for two more operations, however, this was not due to any fault in the treatment provided.

Summary

Ms C complained that her medical practice had not provided her with reasonable care and treatment. She said that they had stopped prescribing medication that she had been on long term, asked her to attend for reviews at the practice and had not supplied her with a neck collar to address the symptoms of her dystonia (a condition which causes shaking, in Ms C's case of the neck muscles). She further complained that they had not re-referred her to the dystonia clinic and declined to issue a certificate to excuse her from appearing in court.

Our investigation, which included taking independent advice from a medical adviser who is a GP, found that the actions of the practice had been reasonable, and we did not uphold Ms C's complaints. We found that Ms C had been taking a high dose of Hormone Replacement Therapy (HRT) since a hysterectomy (surgical removal of the uterus) a number of years ago. Medical opinion is that long-term use of HRT carries serious health risks and our adviser thought it was reasonable for the practice to encourage Ms C to reduce the HRT with a view to stopping eventually. When she declined to do so and also declined to attend the practice for health reviews, we considered it reasonable for them to refuse to continue to prescribe the HRT.

Ms C was also taking diazepam (a tranquiliser) to treat her dystonia. Diazepam is an addictive drug and the practice tried to encourage Ms C to attend for reviews of her long-term use of it. Again Ms C was reluctant to do so and at times the practice, therefore, prescribed a reduced amount of it until she was reviewed. This also happened when her son abused her supply. Again we considered the actions of the practice to be reasonable.

On the matter of the neck collar, our adviser said that current medical opinion is that neck collars cause the muscles to weaken and waste away which is the opposite to what is required in a patient with dystonia. Ms C had been seen twice at the dystonia clinic, where the only treatment they were able to offer her was botox injections, which she had declined. The practice invited Ms C to come in and discuss this but she declined to attend. We took the view that in the circumstances it was reasonable for the practice not to supply a collar or to re-refer Ms C to the clinic.

Ms C had not been seen in person at the practice for some six months when she asked one of the GPs by phone to write her a certificate to excuse her from attending court. The GP said that he could not do so without seeing her but Ms C said she did not want to visit the practice. We found that it was, therefore, reasonable for them not to provide the certificate.

Summary

Mrs C cancelled an appointment for a scale and polish (dental cleaning) and x-rays that her dentist had advised her to have. The dentist wrote to her explaining why he recommended the treatment. He said that she had excess tartar (dental plaque) accumulation and that x-rays of her back teeth would help determine if there were underlying problems. He also said that in most cases where patients suffer from sensitive teeth, he uses a local anaesthetic, which helps to decrease sensitivity during cleaning. He acknowledged that a patient can choose whether to continue with treatment but went on to say that if she did not have it, her teeth would require extensive scaling which might cost more. Without x-rays, he also could not guarantee that there were no undiagnosed areas of decay etc. When Mrs C attended an appointment with the dentist some eight months after the cancelled appointment, she asked for a standard clean and polish with no anaesthetic. She said that the dentist refused to treat her and when she asked to speak to the practice manager she was told to put her complaint in writing. She was removed from the dentist's practice list and not allowed to transfer to another dentist within the practice.

Mrs C was concerned about the insistence of using anaesthetic to proceed with the clean and polish and failure to provide an adequate explanation regarding why anaesthetic was required. Mrs C was also concerned about the dentist's attitude, saying he was condescending and unprofessional. She was unhappy at being removed from his list and not being allowed to transfer to another dentist within the practice. In relation to the complaints handling, Mrs C complained that she could not speak to the practice manager and that there was no attempt at informal resolution, that the dentist's response failed to answer some of her points and that the matter was investigated and responded to by the person she was complaining about. As a result, she said that she suffered anguish and upset and that she was left without NHS dental provision when she lost half a tooth which had previously been treated by the dentist.

We accepted the independent advice of one of our medical advisers that the use of anaesthetic in these circumstances is reasonable and that the dentist provided a reasonable explanation about this. We did not find evidence to support Mrs C's complaint about the dentist's attitude and we found that her removal from the list and not transferring her to another dentist in the practice to be reasonable. On complaints handling, we found that arrangements should have been made for Mrs C to talk to the practice manager but that on the whole the complaint was handled properly - Mrs C's complaint was fully considered and addressed, and she received a written response to her complaint from the dentist.

Summary

Ms C's medical practice referred her to a consultant surgeon at the hospital because she had rectal bleeding and loose stools. Tests were carried out and an inital diagnosis of proctitis (the mildest form of colitis, which is inflammation affecting the lining of the bowel causing diarrhoea and rectal bleeding).

As Ms C's symptoms did not improve with the medication that she was prescribed, she was referred to a consultant gastroenterologist (a medical professional specialising in the treatment of conditions affecting the liver, intestine and pancreas). Ms C attended several clinic appointments between March 2010 and June 2011 and had various investigative procedures carried out in response to her ongoing symptoms of fatigue and passing blood. Ms C's condition worsened in October 2011 and she was admitted to a different hospital where she underwent an emergency colectomy (an operation to remove the large bowel).

Ms C complained that the consultant gastroenterologist had failed to diagnose the severity of her condition. She felt that earlier diagnosis would have allowed alternative drug therapy to be tried which might have avoided the need for the colectomy and a stoma (a surgically made pouch on the outside of the body). Ms C was unhappy that the consultant gastroenterologist had not clearly told her that she had ulcerative colitis and that he had said at an appointment in June 2011 that there was nothing seriously wrong.

We did not uphold Ms C's complaint. After taking independent advice from one of our medical advisers, we found that Ms C was correctly referred to the consultant gastroenterologist and reviewed with a frequency appropriate to her condition and symptoms. In addition, Ms C was prescribed appropriate medication although it was identified that she had an intolerance to one of the drugs. Our adviser explained that flare-ups in ulcerative colitis can happen unpredictably and that Ms C's severe episode that led to the colectomy could not have been predicted or prevented. We found evidence that the consultant gastroenterologist clearly explained at an early stage the results of the investigative procedures and Ms C's diagnosis. However, we could not say exactly how much information they shared with Ms C about her condition, as there was a lack of documented information about this. Although we did not uphold Ms C's complaint, we drew the board's attention to the lack of information and to the relevant guidance about keeping records.

Summary

Mr C complained that the university failed to properly investigate his complaints about his tutor. He said that they did not consider all the evidence he submitted to them, and based their decision on matters not raised by him and on his tutor's previous performance. He also complained that university staff advised him that he had grounds to make an appeal, but that his appeal was then unreasonably rejected and he was not provided with adequate support in making his complaints.

Our investigation found that the decision made was based on all the evidence available, including the tutor's current performance. The university found that there had been a delay in providing feedback to Mr C on his independent study project and they apologised for this. They also wrote to the tutor to remind him or the requirement to give timely and professional feedback when requested by students. Following a further complaint from Mr C, the university also asked the tutor to write and apologise to Mr C, which he did.

Although Mr C was not satisfied with that letter of apology, we found that the tutor had done what was asked of him. We were also satisfied that the university had considered all the evidence that Mr C provided. On the matter of the advice given on the appeals process, we found that university staff had appropriately advised Mr C about the next stage of the complaints procedure. The fact that Mr C was given this information did not give, and should not have given, him an unrealistic expectation that any appeal he made would be upheld. In relation to the support provided to Mr C, we found that the university had, in compliance with their complaints procedure, given Mr C information about the support and assistance available and he had taken advantage of that support. Members of university staff and the students association had provided support and information to Mr C during the complaints process.