Health

Summary

Mrs C complained that a dentist did not give her enough information about the treatment options available, and the costs, which she said resulted in her being treated as a private patient rather than by the NHS.

After taking independent advice from our dental adviser, our investigation found that the medical records showed that Mrs C was informed of the options and received a written estimate for the cost of her treatment. Our adviser said that she had received the appropriate treatment and that from his examination of the records, he believed she had consented to the treatment being provided privately. The dentist had clearly and correctly explained the treatment options, and that the treatment she wanted could not be provided on the NHS without a six month delay. The adviser also said there was no guarantee that the dentist could have provided it in that way, as he would first have had to obtain NHS permission to do so.

Summary

Ms C complained that a doctor refused her request to be accompanied by a friend during a lumbar puncture procedure (a medical procedure where a needle is inserted into the lower part of the spine). She said she was aware of other patients who had been allowed this, and complained that the hospital were not treating patients consistently. The board said that it was the doctor's normal practice to only have herself and a nurse in the room with a patient, because of hygiene and infection control concerns. They also said that no one would be available to offer assistance if someone accompanying the patient became unwell. They apologised that this was not explained to Ms C at the time and confirmed that the doctor was happy for her to be accompanied during other parts of the consultation.

We asked the board whether this was board policy or the doctor's policy. The board said that they did not have a policy and the approach depended on the individual consultant and on the procedure. We took independent advice on this from one of our medical advisers. He said that a lumbar puncture was a fairly minor procedure, and that some doctors would have no objections to the patient being accompanied. He was not persuaded by the board's explanations, as he said hygiene and infection control could be reasonably managed, and considered it unlikely that an observer would become unwell during such a procedure. However, as there was no board policy, and although it meant approaches were likely to vary, it was reasonable for the decision about who was allowed to be in the room to be left to doctors. He noted that it would not be appropriate for patients to be accompanied during some more invasive procedures. Having reviewed the relevant clinical records, the adviser noted that Ms C consented to the procedure going ahead and that there was no record, in either the medical or nursing notes, that she raised any concerns at the time.

We acknowledged that Ms C was distressed at not being accompanied during the procedure, but we accepted that, in the absence of a board policy, it was reasonable for the doctor to decide who was allowed in the room. In the circumstances, and as Ms C consented to the procedure going ahead on these terms, we did not uphold the complaint. We noted that there was no evidence that she made the board aware in advance of her wish to be accompanied and equally no indication of the doctor having told Ms C of her position on this. Although we did not make any formal recommendations, we suggested that the board might wish to reflect on whether they could have communicated better with Ms C.

Summary

Mr and Ms C complained about the care and treatment given to their late mother (Mrs A) while she was a patient in hospital. Mrs A had been admitted with a history of diverticular disease (disease of the colon) and schizophrenia (a long-term mental health condition that causes a range of different psychological symptoms) but her immediate symptoms included a possible gastro-intestinal bleed. After admission, Mrs A experienced increasing confusion and showed signs of dehydration. Mr and Ms C said that staff failed to address these growing problems, together with the problem with which she had originally presented, to the extent that Mrs A became dangerously ill and died. Mr and Ms C were shocked at their mother's swift deterioration and death. They said that no proper intervention had been made until the day she died and they believed staff paid more attention to Mrs A's mental health than to the physical problems she was experiencing. They complained to the board, who said that they were satisfied that the care and treatment given to Mrs A was appropriate to her needs.

We obtained independent advice from a medical adviser and nursing adviser, and gave careful consideration to Mrs A's medical records and the complaints correspondence. We upheld the complaint, as our investigation found that although the board had tried to address Mr and Ms C's concerns by holding a number of meetings and by writing, their initial letter failed to mention that intravenous fluids were not started when they had been suggested or that a deteriorating renal function was a key part of Mrs A's condition.

Recommendations

We recommended that the board:

• consider the use of cognitive function screening and assessment tools as routine in similar circumstances;
• ensure that nursing care plans are in place for patients; and
• review their initial letter to Mr and Ms C and consider what steps could be taken to improve the quality of future responses.

Summary

An MP (Mr C) complained on behalf of Ms A's family about the treatment Ms A had received from her GP practice. In 2008, Ms A had a mole removed from her scalp. Due to its location, the mole could only be partially removed, but tests found no signs of cancer. In May 2009, she went back to the practice having found a lump behind her ear. Blood tests initially suggested inflammation and possible glandular fever, but when further lumps appeared and did not go away, the practice arranged for a referral to a haematologist (a specialist in blood-related disorders). Tests led to a diagnosis of skin cancer, linked to the scalp mole. Ms A had further surgery on the mole and to remove a number of lumps from her neck in February 2010 . Shortly after this, Ms A told the practice that she had a new lump in her back. She asked for a GP home visit but this was declined and instead a review was proposed after a week. She was unhappy with the lack of urgency shown by the practice and transferred to a different practice.

Ms A later developed a breast lump which became malignant. Despite treatment, she died in January 2012. Mr C complained that the first practice did not recognise the severity of Ms A's condition or treat her with the required level of urgency.

After taking independent advice from one of our medical advisers, we were satisfied that there was no evidence of cancer in 2008. There was no cause for the practice to arrange any further investigations at that point, and Ms A was appropriately advised to monitor the mole herself and contact the practice should she have any concerns. When the lumps appeared in her neck, blood tests were arranged and an appropriate referral was made to haematology for a biopsy (tissue sample) to be taken. With regard to the lump in her back, we found the practice's approach to have been reasonable, as Ms A was already under the care of cancer specialists, and had an appointment arranged. We accepted advice that the delay of one week was not significant and noted that this lump was ultimately found not to be cancerous. That said, we recognised that this was a very distressing time for Ms A and took the view that, given her recent medical history, a GP could have visited. Overall, however, we were satisfied that the practice acted in good time and arranged appropriate tests and referrals for Ms A.

Summary

Miss C complained that after her mother's death, a doctor influenced the family's decision not to have a post-mortem carried out, and misrepresented the family's views to the procurator fiscal (PF). In responding to the complaint, the board advised Miss C that the doctor should have immediately reported the death of Miss C's mother to the PF rather than discuss whether or not a hospital post-mortem should be carried out at this stage or a significant event review into events leading up to Miss C's death.

We found evidence indicating that the doctor had appropriately explained to the family what a hospital post-mortem would involve and that this appeared to be in order to help them decide whether or not they wanted one carried out, rather than trying to influence their decision either way. Although the doctor did not follow the correct procedure in reporting the death to the PF, we did not consider there was evidence that he was intentionally misleading the family because he had clearly documented in the medical records and disclosed his concerns about some aspects of the care to them. We noted that a different doctor informed the PF of the death but the PF did not consider that a fiscal post-mortem was required.

We were unable to clearly establish what the doctor said to the family immediately after Miss C's mother died, as there was no independent evidence of this. However, we noted that a record made by the doctor at the time documented that the family were not keen on a post-mortem being carried out and that the PF was told about this in an email. Although we did not uphold Miss C's complaints, we made recommendations to ensure that matters are more clearly understood and explained in future.

Recommendations

We recommended that the board:

• ensure that relevant staff are aware of the situations in which reporting death to the PF is necessary; and
• ensure that relevant staff clearly explain to families the process regarding post-mortems.

Summary

Mr C, who is a prisoner, complained because the prison health centre refused to give him the same pain medication that his doctor prescribed to him while he was in the community. Mr C said he was prescribed this for back pain.

Our investigation took into account Mr C's medical records and found that he was offered an alternative pain killer, which he had refused. We took independent advice from one of our medical advisers, who said that it was reasonable for Mr C's pain medication to be reviewed. She also said the person prescribing his medication was entitled to decide whether particular pain relief was appropriate or not. In the light of this information, we were satisfied the prison health centre acted reasonably.

Summary

Mr C, who is a prisoner, attended an out-patient appointment for a minor operation. He complained that afterwards the prison health centre did not prescribe him a pain killer at the dosage recommended by the hospital. In responding to his complaint, the board advised Mr C that there were risks when prescribing a high dosage of the pain killer alongside medication that he was taking for opiate addiction. However, when Mr C reduced the amount of that medication, the prison health centre agreed to increase the dosage of his pain medication. We did not uphold Mr C's complaint because after reviewing his medical records and seeking independent advice from one of our medical advisers, we were satisfied that the clinical care provided was reasonable and appropriate.

In addition, Mr C complained that the prison health centre would not prescribe him an alternative medication for his opiate addiction. The board told Mr C that his addictions nurse had agreed to speak with his community addictions worker to see whether they would be willing to set him up on the alternative medication after his release from prison. Our adviser said she felt it was reasonable for the prison health centre not to change Mr C's medication when he was being released from prison soon. In light of that, we were satisfied the prison health centre's position was reasonable.

Summary

Mr C, who is a prisoner, complained that the prison health centre unreasonably stopped his pain medication. When his need for the medication was reviewed, the prison doctor decided it was no longer necessary and offered an alternative.

We reviewed Mr C's clinical records and took independent advice from one of our medical advisers. She said that Mr C was being prescribed a strong pain killer, which was suitable for use at the time of an injury or flare-up of a condition. However, it was not suitable to continue to use it without a review to decide whether it was still appropriate. In Mr C's case, it had been reviewed and deemed no longer appropriate, and although Mr C was unhappy with this, we were satisfied that his clinical treatment was reasonable.

Summary

Mrs C complained that her mother (Mrs A) did not received adequate nursing care at a hospital. We noted that the Procurator Fiscal had been involved and so we obtained information from them about their investigation. We found that the Procurator Fiscal had investigated Mrs A's nursing care and reached conclusions about it. Because of this, we could not take any further action on Mrs C's complaint and we closed our file.

Summary

Mrs C complained that there were delays in providing dental treatment to her profoundly disabled daughter (Ms A). Mrs C said that after Ms A attended a dental appointment it was some seven months before she received treatment under general anaesthetic. Mrs C alleged that Ms A received a standard of care which was less than that given to the general population, because of her disability, and that the delay was unreasonable. Mrs C also complained that the board failed to deal with her complaint properly.

We took independent advice from our dental adviser on Ms A's care and treatment, and took all the complaints correspondence and relevant medical records into account. Our investigation found that Mrs C had questioned both the treatment and the approach recommended by Ms A's dentist. Because of this, the board were placed in the unusual position of having to have two dentists with Ms A during her treatment. The board also had to satisfy themselves that what was being agreed with Mrs C was in accordance with the policies with which they had to comply. The adviser confirmed that the complex discussions and additional arrangements that were necessary to provide Ms A's treatment created a delay which was understandable, and did not consider this unreasonable. However, an internal time line tracking events over a three month period between the date when an approach to treatment was agreed and the date the approach was confirmed to Mrs C was too long and showed no urgency. In the circumstances, we upheld the complaint of delay. We also found that the board showed a similar lack of urgency in responding to Mrs C's complaint.

Recommendations

We recommended that the board:

• make a formal apology to Mrs C and Ms A for the delays in providing treatment;
• confirm that a relevant protocol is in place;
• apologise to Mrs C for the delay in dealing with her complaint; and
• remind the appropriate staff of the importance of adhering to their stated complaints policy.