Not upheld, no recommendations

Summary

Mr A's dentist gave him a filling in autumn 2011. This was a very large restoration and Mr A was treated for minor pain over the next few weeks. In early 2012 he returned to the practice with further pain associated with the tooth. The practice told him that the dentist who treated him had left, and had in fact practiced there under his own NHS contract. They offered treatment but told Mr A that they would charge for this. Mr A recalled that his previous dentist had told him that any follow-up treatment required on the tooth would be free of charge, and declined the offer of paid treatment. He returned to the practice the next month and again said that he would only consent to treatment if it was provided free of charge. He refused to sign forms consenting to paid treatment or a medical history form.

Mr A complained about this to the practice, who explained their position and advised that they had taken steps to remove him from their treatment list on the basis that Mr A had lost confidence in them.

Ms C, who is an advice worker, wrote to the local health board on Mr A's behalf and this was passed to the practice for a response. The practice repeated the information they had given Mr A about his treatment and his removal from their practice list. They also offered him the cost of the treatment he had experienced problems with, but noted this was not the full amount he had paid at that time, as that had included treatment for another matter.

Mr A remained dissatisfied and Ms C complained to us on his behalf. We did not, however, uphold the complaint as we decided that there was no evidence of service failure. This was because the practice were correct in saying that the responsibility for treatment lay with the dentist who provided it and not themselves, now that he had left the practice.

Summary

Ms C's mother (Mrs A) was admitted to a hospital accident and emergency department (A&E). In the resuscitation room three gold necklaces were removed from Mrs A, along with other jewellery which was handed to her family immediately. Mrs A was then transferred to another ward, where she passed away. On collecting Mrs A's personal belongings, her family discovered that the necklaces were missing. The A&E department was searched, with the family present, and other departments were contacted but the necklaces were not found.

Mrs A's family complained to the hospital about the loss of the necklaces. In their response, the board accepted that the necklaces had been lost there and noted that the usual procedure of sealing belongings in a bag and giving them to the patient or next of kin had not happened on this occasion, advised that the importance of documenting and caring for patients' belongings had been reiterated to staff and that new labels and a belongings register had been provided in the A&E department. The board expressed their regret at the distress that had been caused and offered their sincere apologies to the family.

Ms C was dissatisfied with this response and complained to us. We decided that the board's response had been reasonable, and did not uphold that complaint. She had made other complaints relating to the loss of the necklaces and the board's investigation, but we could not consider these as they had not yet completed the board's complaints procedures.

Summary

Mrs C complained that the board's rheumatology service (which deals with conditions affecting the musculoskeletal system, including joints, bones and muscles) unreasonably failed to offer an appointment to her mother (Mrs A). Mrs A had slipped at home the previous week, was unable to put weight on her leg, and was in pain and discomfort. Mrs A's GP had diagnosed a 'flare-up' of arthritis. Mrs C phoned the rheumatology service, where her mother had been a long-standing patient, in the hope that they would see her at the regular weekly clinic. Mrs C said that her request was unreasonably refused and that she was told that this was because the service was short staffed and clinics had been cancelled in the unexpected absence of two key members of staff.

The board said that this was not why the request was refused. They said that the specialist rheumatology nurse who spoke to Mrs C refused the request because she did not think that Mrs A's symptoms were consistent with a 'flare-up' of arthritis. The nurse advised Mrs C to take her mother to the accident and emergency department (A&E), or revisit her GP. The board said that, in spite of the lower than usual staffing levels, had Mrs A required a review because of her arthritis, then she would have been offered an appointment at a nurse-led clinic. Five days later Mrs A was admitted to A&E and was discovered to have a fracture.

Although we understood Mrs C's concerns about this, we did not uphold the complaint. This was because it was not possible during our investigation to reconcile the two very different accounts of the same phone call. There was no supportable evidence to suggest that the rheumatology service had unreasonably refused to see Mrs A on the basis of capacity alone, and there were in fact sound clinical reasons for Mrs A to be referred to A&E either directly, or via her GP.

Summary

Mrs C complained about the treatment that her late husband (Mr C) received after he was admitted to hospital with an infected ulcer on his toe. Mrs C also complained that staff did not adequately monitor how much pain her husband was experiencing and did not make adequate arrangements when he was discharged from hospital on three separate occasions, including arranging transport home.

Mr C developed ulcers and ischemia (insufficient blood flow) to his foot and underwent surgery to improve the blood flow through the artery below his knee. He was discharged shortly afterwards but a few weeks later his toe became necrotic (the tissue in the toe died because of a lack of blood and oxygen). Mr C was admitted to hospital again and the decision was taken to observe and wait for auto amputation (for the toe to fall off spontaneously). When the condition of his toe worsened, Mr C had emergency surgery, resulting in some toes being amputated. However, he died a few weeks later. Mrs C said there was an unreasonable delay in fully investigating and treating her husband's toe, which meant he had to have more radical surgery. Mrs C believed that her husband would still be alive if an operation been carried out sooner and had he not been discharged several times.

After taking independent advice from one of our medical advisers, we did not uphold Mrs C's complaints. We found that Mr C received appropriate treatment from a podiatrist (a clinician who diagnoses and treats abnormalities of the lower limb) and that there was no undue delay in referring him to a vascular specialist (a clinician who treats disorders of the circulatory system). The treatment provided by vascular surgeons was also timely and appropriate.

Whilst we identified that on one occasion there was an error with Mr C's pain relief medication, our adviser said that overall his pain was monitored adequately and appropriate pain relief prescribed. Finally, we found that the hospital acted reasonably in not providing Mr C with transport home after he was discharged, as he did not meet the relevant criteria.

Summary

Mr C was discharged from hospital after having major surgery to remove tumours from his stomach area. When the district nurse attended she noted that the wound, which was substantial, had reopened. She called the medical practice to request an ambulance. The GP was visiting patients at the time and could not be located. Mr C's wife said that if the GP could not be located within five minutes she would call the ambulance, which she did. By this time the GP was on his way to Mr C's house but, when he was advised that an ambulance had been called, he returned to the surgery. Mr C complained that the practice did not immediately call for an ambulance.

We took independent advice from one of our medical advisers, who explained that it was reasonable for the GP to wish to assess Mr C before deciding whether an ambulance was necessary. He commented that in this case it was probably necessary, but that it might not have been necessary to call an emergency ambulance. He also pointed out that the district nurse would know that she could call an ambulance directly by phoning 999 if this was required.

As our investigation found that the practice acted reasonably, and as we noted that the ambulance would not have arrived any more quickly had the GP reviewed Mr C first, we did not uphold this complaint.

Summary

Mrs C's late mother (Mrs A) was diagnosed with cancer in 2011. Mrs C complained that when blood test results were found to be abnormal, a GP from her mother's medical practice (GP 1) failed to tell Mrs A about these when he was the on-call doctor. Mrs C was unhappy that her mother did not find out the results until nine days later when she attended the local community hospital's accident and emergency department (A&E) and GP 1 (who was the on-call GP in the hospital at the time) accessed the results.

The background to this is that another GP at the practice (GP 2) had arranged for Mrs A to attend the surgery in late December 2010 to have non-urgent blood samples taken. These were sent to the laboratory the following day where they were immediately identified as abnormal. At the time, the laboratory's procedures set out that they must communicate abnormal test results to medical staff quickly, and make a computer entry showing when the call took place and to whom. The procedure also included an out-of-hours number for laboratory staff to call if it concerned an out-of-hours GP.

In their response to Mrs C's complaint, the board apologised for a failure in the timely reporting of the abnormal blood results. However, the board advised us that it was unclear to them whether the laboratory had failed to follow procedure. When we investigated, we found that it was difficult for us to be certain whether the laboratory had telephoned and told the practice the results. There was an entry on the computer system suggesting that a call had been made to GP 2. However, the surgery had closed an hour before the laboratory had apparently made the call. In addition, GP 2 saw his last patient in the surgery at 12:45 and was not the on-call doctor that particular day. There was also no entry in Mrs A's medical records to indicate that the surgery had received a call from the laboratory. There was, therefore, no conclusive evidence that confirmed that the practice were aware of the test results.

The medical records showed that GP 1 accessed the results in early January 2011 when Mrs C's mother attended A&E. We did not uphold the complaint, as we considered that GP1 had taken appropriate action to have Mrs A further assessed at that time, and there was no evidence to support that he was aware of the blood test results before he accessed them in January 2011.

Summary

Mr and Mrs C underwent in vitro fertilisation (IVF) treatment (fertility treatment) in 2010 and had a child. They understood that they were not entitled to further treatment from the health board and had been saving for private treatment. They made an appointment for a private consultation. However, Mrs C said she received a telephone call from the board in April 2011 saying she was entitled to a further cycle of treatment. On that basis, Mr and Mrs C cancelled their private treatment, and made appointments at the board's assisted conception unit. Around three months later, Mrs C contacted the board to confirm the dates of her appointment with the assisted conception unit and was told that there had been an error, and she was in fact no longer entitled to further NHS treatment.

The board conducted an investigation including tracing their call logs, but could find no record of the call to Mrs C in April 2011. There was also no record of appointments having been made for her with the assisted conception unit in 2011. The board considered Mr and Mrs C's case again, but reached the decision that they would not deviate from their normal policy on IVF to offer a second cycle of treatment. We considered the board's investigation and obtained further information. We found that there was no independent evidence to support Mrs C's position about the telephone call, although we did not disbelieve her position. We also found the board's position of following their policy to be reasonable. Although we did find that there was a delay in Mr and Mrs C obtaining IVF treatment as a result of their experiences, on balance we did not uphold the complaint.

Summary

Ms C complained about the treatment her mother (Mrs A) received from a GP at her medical practice. Mrs A had attended an appointment with the GP in relation to rectal pain and bleeding. The GP performed an examination, diagnosed piles, prescribed a treatment, and advised Mrs A to return within seven to ten days if her symptoms did not improve. Mrs A returned some five weeks later, by which time her symptoms had worsened and she had blood in her stools. Another GP referred Mrs A to hospital for tests, and she was given a clinic appointment for just over two months later. In the meantime, Mrs A attended the practice on two further occasions, when she was seen again by the first GP. On one of these occasions, the GP physically examined Mrs A again.

Mrs A was diagnosed with colorectal (bowel) cancer after the hospital appointment. She underwent chemotherapy and radiotherapy. Due to other medical conditions, it was considered that surgery was not a suitable option and Mrs A died just under a year and a half after being diagnosed. Ms C said that if the GP had properly recognised her mother's symptoms at the start, she might have had a better life expectancy and an improved quality of life. Ms C was also concerned that, given the subsequent cancer diagnosis, the GP had said that there was 'nothing untoward' on the occasions that she examined Mrs A.

Having taken independent advice from one of our medical advisers, we found that the GP's care of Mrs A had been appropriate. We found that it was reasonable for the GP to prescribe medication for piles at the first appointment, and to advise Mrs A to attend seven to ten days later if her symptoms had not improved. We accepted that the referral was appropriate, and that there was no requirement for the GP to try to speed that up after Mrs A's later appointments. We noted that, as a hospital appointment had already been made and was due shortly, this would have had no practical impact upon Mrs A's prognosis and treatment time. We also found that the GP's statement that there had been 'nothing untoward' was made in the context of the physical examinations. It was reasonable that further tests at the hospital were needed in order to discover a cancer diagnosis.

We did draw to the practice's attention that it might have given Ms C some reassurance if they had told her that they had carried out a Significant Event Analysis (a detailed investigation into what happened) as a direct result of her complaint, and had put in place the learning outcomes that it identified.

Summary

Mr C complained about the board's actions in relation to his elderly father (Mr A). He said that his father had been admitted to hospital late in the evening. After being examined and declared fit, he was sent home in the early hours of the morning by car, with a relative. Mr C said the relative was not entirely happy with this but, nevertheless, complied. When Mr A reached home, a neighbour had to be recruited to help him get into the house. Mr C said that his father should not have been discharged, particularly because he was elderly, disabled and had memory problems.

We investigated the complaint taking all the relevant information, including all the complaints correspondence, the relevant clinical records and the board's discharge policy, into account. We also obtained independent advice from one of our advisers, who is a nurse.

In responding to the complaint, the board had confirmed that Mr A was considered fit for discharge and was keen to go home. There was, therefore, in their view, no clinical reason to keep him in hospital. They pointed out that the Scottish Ambulance Service did not provide out-of-hours transport and, as there was a relative available and willing to take Mr A home, they had asked him to do so. They said that if this had not been the case, they would have had to consider whether a taxi was appropriate.

Our nursing adviser reviewed the files and confirmed that the information in them indicated that Mr A was fit to go home. She also confirmed that Mr A was not in fact admitted to hospital, and so the board's discharge policy would not apply in his case. She said that in all the circumstances, it was not unreasonable for Mr A to return home with a relative, given that an emergency department was not an ideal place for an elderly and frail person.

Taking all the information into account, we did not uphold the complaint as we found that, while not ideal, in all the circumstances it was not unreasonable for the board to discharge Mr A home.

Summary

Mr C had a hernia operation, but was admitted to hospital a week later with severe pain in his testicles. It was discovered that the blood supply to one of his testicles had been cut off and it had to be removed. The surgeon said that the obstruction in the blood supply had been caused by a combination of the hernia operation and a vasectomy that Mr C had previously had. Mr C complained to us about the standard of the hernia repair surgery.

We found that the hernia operation Mr C had was the standard procedure. Our medical adviser said that the operation note was a well-completed document that complied with good surgical practice. We also found that it was appropriate that the operation was carried out by a suitably experienced junior doctor under the direct supervision of a surgeon. Damage to the blood supply to a testicle is a recognised, but rare, complication of hernia surgery. If a testicle does not have any blood supply, it has to be removed. However, our adviser said that there was no evidence that Mr C's earlier vasectomy had been a factor in the complication he suffered and we told the board this.

Mr C also complained that the board failed to adequately communicate with him before and after his surgery. We found that the consent forms for the operations had been completed appropriately. The surgeons also recorded that they met Mr C before and after the operations to discuss the procedures. Mr C disputed this and his version of events clearly conflicted with the surgeons. However, there was no clear and objective evidence to support his complaint about this matter.