The Practice incorrectly referred Miss O to gastroenterology when she should have been referred to gynaecology
23. The law says a person needs to make their complaint to us within a year of becoming aware of the problem. We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do so. We have discussed this with Miss O to understand why she could not make her complaint earlier. We have also considered the time the organisation has taken to respond to Miss O.
24. Miss O told us the Practice incorrectly referred her to the Trust’s gastroenterology department on 14 August 2018. She told us this wasted time when she should have been referred to gynaecology.
25. Miss O says she had pelvic pain and should not have been sent to gastroenterology. She told us she should have been sent straight to gynaecology as the pain she was experiencing was the same which led to her gynaecology referral years previously.
26. The Practice says Miss O’s stool test results showed abnormalities which warranted a referral to gastroenterology for further investigation.
Local resolution
• On 15 September 2020, Miss O complained to the Practice.
• On 19 March 2021, Miss O returned her outstanding concerns to the Practice.
• On 28 April 2021, the Practice sent a response.
• On 10 May 2021, Miss O returned to the Practice.
• On 7 June 2021, the Practice sent its final response and signposted Miss O to us.
27. Miss O told us the point at which she knew she could make a complaint (her point of knowledge) about this aspect was 25 March 2020.
28. We assess Miss O’s point of knowledge to be sooner, at the point of referral to gastroenterology on or shortly after 14 August 2018.
29. We can see from the evidence provided by the Practice that Miss O was aware the referral was incorrect in December 2018, when she wrote a letter to the Practice to request a different GP at the Practice, as she knew she had been referred to the incorrect department following a clear colonoscopy (an imaging test of the colon for detection of abnormalities) on 21 December 2018. Miss O confirmed this in a letter to the Practice.
30. Miss O says after the clear colonoscopy, she ‘went to a different GP at the Practice as she felt the referral to gastroenterology was unneeded and she should have been referred to gynaecology, which is what the consultant had advised in June 2016 if the pain was ever when I was not ovulating’.
31. We can see Miss O was aware she needed to be referred to gynaecology as she says she had been advised by a previous consultant in 2016 that she should be referred to gynaecology if she experienced pain when she was not ovulating. Therefore, she would have been aware that the GP’s decision to refer her to gastroenterology was incorrect.
32. Miss O complained to the Practice on 15 September 2020, one year and nine months after her point of knowledge.
33. Miss O complained to our office on 16 September 2021.
34. In total, the Trust’s complaint handling took nine months. This means Miss O had until December 2019 to bring her complaint to us for it to be within our time limit.
35. This complaint is one year and nine months out of time.
36. We discussed with Miss O the reasons why she did not complain to us until 16 September 2021. Miss O told us she did not have a reason for why she did not complain earlier, but she did tell us she understood why this part of the complaint could potentially be out of time.
37. In certain circumstances, we have the discretion to put our time limit aside. We cannot see a suitable reason for Miss O not to have complained to us sooner.
38. Miss O knew she had a reason to complain in December 2018 but did not submit her complaint to us until 16 September 2021. For that reason, we will take no further action.
The Practice did not investigate a subclinical pelvic infection when she presented with pelvic pain following her coil insertion
39. Miss O told us a doctor at the Practice did not diagnose a subclinical pelvic infection between November 2016 and March 2020.
40. The Practice says pelvic inflammatory disease (PID) (an infection of the female reproductive system, including the womb, fallopian tubes and ovaries) was ruled out after Miss O’s coil insertion in November 2016, as she did not have a temperature or tenderness on pelvic examination.
41. Miss O told the Practice in her complaint that her point of knowledge for this part of the complaint was at an appointment in March 2020, when she was told she had a blocked left fallopian tube and was informed the problem with her left tube would not have been apparent on ultrasound. She says she was told the tube may have been blocked due to a growing fibroid or due to previous infection or damage.
42. Miss O says her right fallopian tube also has adhesions which could have been due to a previous subclinical infection at the time of coil insertion on 16 November 2016.
43. We assess Miss O’s point of knowledge to be before March 2020. Miss O was aware shortly after her coil insertion in November 2016 that she was suffering pain and she had been given no clear diagnosis for the pain she was suffering. She told us she attended the Practice for the pain and was incorrectly referred to gastroenterology in 2018.
44. While Miss O may not have been aware her pain may have been due to PID, she was aware that, following her coil insertion, something was not right, which is why she attended the Practice, gastroenterology and then the gynaecology department at the Trust.
45. The Practice received a complaint from Miss O on 19 March 2021.
46. We assess Miss O’s point of knowledge to be 14 August 2018, as this is the date she was referred for further tests.
47. Miss O had until 14 August 2019 to bring her complaint to our office.
48. She complained to us in September 2021, two years and one month out of our time limit. We discussed with Miss O the reasons why she did not complain earlier.
49. We can see from the timeline of events that Miss O returned numerous times to the Practice in 2018 as she was in pain, but she did not raise a complaint with the Practice until 15 September 2020.
50. Miss O told us she did not have a reason for why she did not complain earlier, but she did tell us she understood why this part of the complaint could potentially be out of time.
51. We cannot see a suitable reason to set aside the time limit. Miss O knew she had a reason to complain earlier but did not do so until a later date. Therefore, this complaint is out of time and we will take no further action.
A secretary at the Trust did not follow her or her consultant's instructions to book a laparoscopy
52. Miss O told us she had an appointment with a doctor in the gynaecology department at the Trust on 29 August 2019 following a referral from her GP after suffering pain.
53. Miss O told us that at the appointment the doctor told her she could decide whether she wanted a laparoscopy.
54. Miss O told us she booked a follow-up appointment with the doctor for 9 January 2020 on the way out of the appointment.
55. Miss O says the doctor told her to ring the secretary after the appointment and arrange a laparoscopy if she wanted to go ahead with the procedure.
56. Miss O says she phoned the secretary at the Trust in the first two to three weeks of September 2019 - she is unsure of the exact date - but was unable to speak to the secretary as there was no answer. She told us she left three voicemails, but her calls were never returned. Miss O told us this was definitely before 24 September 2019.
57. Miss O told us she knows this because she phoned an alternative secretary on the 24 September 2019, as instructed by a voicemail message which was subsequently recorded on the doctor’s secretary’s voicemail stating they were absent.
58. Miss O told us she explained the situation to the member of staff who answered, and they understood and were very helpful but said they could not book the laparoscopy as it needed to be booked by the doctor’s personal secretary.
59. Miss O told us she got through to the doctor’s personal secretary on 30 October 2019. She explained she was worried as the pain was getting worse and it was now on the other side, which it had not been previously. She told the secretary the delay in the laparoscopy could be causing more problems. The secretary told her a prebooked appointment on 9 January 2020 was the earliest she could be seen, even though she explained the doctor said she could go straight for a laparoscopy if she chose to.
60. Miss O says the secretary did not carry out her request to book the laparoscopy, causing a delay between 30 October 2019 and January 2020.
61. As a result of being unable to book her laparoscopy earlier, Miss O says her fibroid grew larger.
62. Miss O told us if her laparoscopy had been booked when she first tried to book it in September 2019, the delay would have been shorter.
63. Miss O says she has experienced infertility. She says she suffers from stress, anxiety and low mood.
64. The Trust confirms in its response the secretary did not carry out the request to book a laparoscopy and has apologised. It says a note was added to Miss O’s medical record to say: ‘She [Miss O] will decide and ring my secretary about further management.’
65. The Trust says it has communicated this to the secretary. It says the issues raised in Miss O’s complaint will be discussed within the Trust-wide Gynaecology Governance process in August 2020 to promote learning and understanding of this incident.
66. Miss O told us she was able to speak to the secretary on 30 October 2019. She told us this was to book her appointment for laparoscopy, however, the secretary would not.
67. We assess 30 October 2019 to be Miss O’s point of knowledge.
Local resolution
• On 20 July 2020, Miss O made a complaint to the Trust.
• On 8 October 2020, the Trust issued a response.
• On 9 June 2021, Miss O returned her concerns to the Trust.
• On 9 July 2021, the Trust issued a further response.
• On 16 September 2021, Miss O complained to our office.
• We can see from the records that the Trust’s complaint handling took 14 months.
68. Miss O told us her date of knowledge is 30 March 2020. We assess Miss O was aware her laparoscopy was not booked on 30 October 2019; therefore, this is her point of knowledge. This means she had until 30 October 2020 to bring her complaint to our office to be within our time limit.
69. Miss O complained to our office on 16 September 2021, so her complaint is eleven months out of time.
70. We can see Miss O had delays in getting an advocate to help her with her complaint due to the COVID-19 pandemic following her first response from the Trust on 8 October 2020.
71. Miss O told us, following the Trust’s first response on 8 October 2020, she was in regular contact with a member of the Patient Advice and Liaison Service (PALS). She told us she was advised by a member of staff at PALS in February 2021 to wait for an advocate to be assigned before it took the complaint any further.
72. We can see from a letter sent by Miss O to the surgery on 26 February 2021 that an advocate was quickly put in place, as Miss O copied the advocate’s email address into the letter. We can see Miss O did not return to the Trust until 9 June 2021, which is a delay of 3 months and 11 days.
73. Miss O did not give any further explanation for this delay.
74. Miss O returned her complaint to the Trust on 9 June 2021. We assess Miss O could have returned her complaint to the Trust earlier, as we can see from documentation that an advocate was in place in February.
75. We can see a further delay of two months from Miss O’s final response from the Trust on 9 July 2021 and bringing her complaint to us on 16 September 2021.
76. Miss O told us that during this time she sought advice from a solicitor as she knew she could not do this once she had submitted her complaint to us, so she wanted to make sure she had covered all her options before submitting to us.
77. She told us she was ‘growing stressed and tiresome of the complaints process and did not really want to have to drag through everything yet again when she was already anxious about her current situation’. We understand how difficult this must have been for Miss O.
78. Miss O also told us on 15 September 2021 she had a referral appointment at a different hospital, where she would get the results, and she wanted to do this before taking the matter further, so she could have confirmation the problem was caused by not being treated for pelvic infection when she had the coil fitted.
79. We understand Miss O chose to take legal advice and get a second opinion. However, Miss O could have sought advice on whether she could complain to us from her advocate. This delay accounts for 3 months of the 11-month delay in bringing her complaint to us.
80. This is not enough reason to set aside the time limit, as Miss O knew she had a reason to complain and did not.
81. Having considered all the evidence available to us, we have not seen enough justification to put our time limit aside, so we have decided this complaint is out of time and we will take no further action.