SPSO Individual Decisions

When Ms C attended for a psychiatric assessment, the board had concerns about her mental heath and the risks she presented to herself and others. They notified the police about an aspect of this. Ms C complained that the board failed to tell her about the action taken. We reviewed the records, and found that it was clearly documented that the police contact had been discussed with Ms C in advance. Although Ms C did not agree with this, in the absence of any specific evidence to the contrary we did not uphold the complaint. Related reading View Decision Report 201200365 as a PDF (10.96 KB) Updated: March 13, 2018

Mr C is 76 years old and has a disability. He complained about the board's toenail cutting service. He said he needed his nails cut every eight to ten weeks, but the board only provided the service every 12 to 14 weeks. Mr C also said that because they recently told him that it would be 16 weeks until his next appointment, he had to pay for private treatment in between times. He felt that the service he received was inadequate. When we investigated, the board explained that their view of Mr C's requirements was based on an assessment that they make of each patient to decide how often appointments were needed. This assessed Mr C as requiring appointments every 12 weeks. They said that they had obtained a detailed second opinion from a senior specialist at another of their clinics, which supported this view. The board also said that they try to meet the required timescale for the next appointment but there were times when this was not possible, for example when there were staff absences. At such times, patients such as Mr C who need only routine attention may find that their appointment is after the end of the recommended return period. As part of our investigation, we obtained advice from our nursing adviser. She said that the board's assessments appeared to have been carried out appropriately. There was no clinical evidence to suggest that Mr C needed appointments more often than every 12 weeks. Our adviser noted that although Mr C would like to have his nails cut more often, the board had to make difficult decisions about managing resources. We found that they had managed Mr C's case appropriately and provided an adequate service. Related reading View Decision Report 201102523 as a PDF (11.54 KB) Updated: March 13, 2018

Ms C complained that she had to wait an unreasonably long time for appointments for problems with her hip, and that after that she had to wait an unreasonably long time for surgery. She complained that this breached the government's 'referral to treatment' target. She also complained that the board failed to provide a response to her complaints. After taking advice from our medical adviser, we did not uphold Ms C's complaints about waiting time. We found that, overall, her clinical treatment was reasonable. She was first seen by an orthopaedic consultant after a referral from her GP, and was then referred to and seen by a physiotherapist, all within the governmental target. We accepted the board's position that this was when Ms C's treatment started. We found that the decision to refer Ms C for physiotherapy was appropriate, and that she needed to go through this programme before surgery could be considered. Therefore, we did not consider that her wait for surgery was unreasonable. When it was established that physiotherapy had not been successful, the orthopaedic consultant referred Ms C for a scan. The results of the scan indicated that hip surgery was appropriate. At that time, the board had withdrawn funding for this procedure, so Ms C was referred to another board area. She subsequently underwent surgery privately. Although we acknowledged Ms C's frustration, both about waiting time and the withdrawal of funding, we found that her treatment was appropriate. We did find there was an unreasonable delay in Ms C receiving a full response to her complaint, and were critical of the board about this. Related reading View Decision Report 201102615 as a PDF () Updated: March 13, 2018

Mr C complained that a GP failed to provide him with appropriate treatment for his throat condition during a home visit. He said that he went to see another GP the next day, who referred him to hospital, where he received treatment for an abscess on his tonsil. We took advice from our medical adviser. He commented that this type of abscess can develop quickly. He said that, given the GP's account that the appearance of Mr C's throat had changed, the management of Mr C's sore throat had been reasonable. Mr C also complained that the GPs had misdiagnosed his rhinitis (inflammation of the lining of the nose) as sinusitis (inflammation of the sinuses) for a number of years. We found that Mr C had been diagnosed with sinusitis at a hospital. Our medical adviser considered that the actions of the GPs in relation to this matter were reasonable. He said that sinusitis and rhinitis can coexist and can be treated in the same way. He also noted that there had been little change in Mr C's management after the diagnosis of rhinitis. Mr C also complained about the actions of a receptionist and the practice manager when he visited the medical practice. We found that the actions of the members of staff had been reasonable. Related reading View Decision Report 201103091 as a PDF (17.02 KB) Updated: March 13, 2018

Mr C went to a hospital accident and emergency unit after falling from height. He complained that the care and treatment he received there was inadequate. He said that there was a failure to x-ray and diagnose a fracture that caused him severe pain in the weeks after. Mr C said he was eventually x-rayed about two weeks after the fall and told about the fracture five days after that. He wanted to know why he was not x-rayed when he first went to hospital, considering the accident he had and the pain he was in. He also said that when he complained to the hospital about his care and treatment, they delayed in responding to his concerns. We did not uphold Mr C's complaints. We took advice from our medical adviser, who said that the need for an x-ray was a matter of clinical judgement. He said that the assessing clinician should (and did) take into account Mr C's age and gender, how the injury happened, look for various external evidence of injury, as well as evidence of nerve or spinal damage, and assess Mr C's mobility. He commented that a spinal fracture from low impact injury is unusual in men of Mr C's age, and that an x-ray was not mandatory in his situation. He said that the judgement of the assessing clinician that an x-ray was not necessary was not unreasonable, even with the benefit of hindsight. We also found that there were valid reasons for the delays in the board responding to Mr C's complaint. This included that a consultant whom Mr C wished to meet to discuss his concerns was abroad for several months. When the board told Mr C about this, he said he wished to wait for the consultant to return. We also noted that the board kept Mr C regularly updated about his complaint during this period and gave him the opportunity to contact us if he so wished. Related reading View Decision Report 201103439 as a PDF (17.35 KB) Updated: March 13, 2018

Mr C complained on behalf of his brother (Mr A), an adult with a mental health condition. Mr A had permission to leave the mental health unit where he lived to visit his own home for a few days. However, at the end of that time, no one came to collect and return him to the unit. As he did not return, the unit told his family and the police. The police found Mr A at his home and damaged his door to gain entry. They removed him from his home and took him back to the unit. Mr C complained about the trauma that the whole incident would have caused his brother. When Mr C complained to the board, they acknowledged immediately that there had been a communication breakdown regarding the arrangements for collecting Mr A at the end of his home visit. They described the steps they were taking to help prevent the same thing from happening again. Mr C remained dissatisfied and complained to us. As the board had acknowledged a shortcoming, we upheld the complaint. We considered that the action the board had taken in response to the event was good but did not go quite far enough as it would not necessarily prevent a recurrence.

Mr C complained on behalf of his wife (Mrs C) about delay in getting a hospital appointment, treatment at the pain clinic, and poor complaints handling. Mrs C had had pain in her back and leg for ten months and pain in her neck and arm for eight months, and Mr C thought she should have been seen at the hospital more urgently. Her GP referred her to the neurosurgery department in July 2011, and followed this up with a further referral two months later, including a request that she should have a scan on her neck before attending her scheduled appointment. No scan was taken, however, even though Mr C also wrote to the board. Mrs C was seen in neurosurgery as scheduled in November and was referred to the pain clinic, where she was eventually seen in December. Mr C complained that although the GP made an urgent request for Mrs C to be seen at the pain clinic, because the referral from the department of neurosurgery was classed as routine she was not prioritised. We did not uphold the complaints about delay and treatment. Our investigation, which included taking advice from our medical adviser, found that it was reasonable for the GP to refer Mrs C on a routine basis as she had no 'red flag' symptoms that would have triggered an urgent referral. Mrs C was seen by a specialist within 17 weeks. This was just within the national target of 18 weeks and there was no evidence of avoidable delay. The reclassification of the referral to the pain clinic was also reasonable. Our adviser said that although Mrs C had been in pain for some time, she was not displaying the sort of symptoms that would have needed an urgent referral. It is also the responsibility of hospital specialists to fully assess and categorise referrals. In Mrs C's case, this was done appropriately by the on-call pain consultant. We found, however, that there were unreasonable delays in providing a response to Mr C's complaint. The board did not respond for two months and provided no acknowledgement, explanation o

Mr C had a history of alcohol dependency. He stopped drinking in May 2010. His medical practice prescribed medication, including Thiamine B (a specific type of vitamin B). In 2008, Mr C had experienced ice-cold feet, severe pain and loss of sensation in his legs. In 2009, he was diagnosed with peripheral neuropathy (damage to the nerves that connect the central nervous system to the limbs) and in May 2010 he began to have seizures and tremors. Mr C stopped taking the prescribed Thiamine B in August 2011 and found that his pain, muscular problems and seizures stopped. He complained to the practice about the use of Thiamine B and the fact that this was not reviewed following his deterioration in 2008. They told him that there are no side effects associated with this medication. However, Mr C conducted his own research and found that an allergic reaction to the medication could cause the symptoms he experienced. He also believed that his other medication had a detrimental impact on his health. He complained to us that the practice failed to reassess his medication when his symptoms developed and failed to identify that Thiamine B was causing his neurological problems. He also complained that the practice failed to refer him for a specialist opinion. We took advice from one of our medical advisers and found that all the medication complained about was appropriate for a patient with Mr C's symptoms and history of alcohol dependency. Thiamine B in particular has a protective role in limiting damage to the nervous system should the patient continue to consume alcohol. We accepted that patients may react in unpredictable ways to any medication and recognised the symptoms that can be caused by a reaction to Thiamine B. However, we found no link between this medication and neurological problems as described by Mr C. We were satisfied that the practice held regular discussions with Mr C about his medication during a number of consultations. We were also satisfied that the prac

Mrs C had surgery in hospital to remove a soft tissue lump from her right thigh. She said that a few days later the wound had become red and infected. She contacted NHS 24 who referred her to an out-of-hours (OOH) GP service where a nurse prescribed antibiotics. Mrs C returned home, but her condition worsened and later that day NHS 24 arranged for an ambulance to transfer her to hospital where she was diagnosed with a skin infection and an infection of the thigh wound. Mrs C had a further surgical excision and drainage, and the wound was left open to heal from the inside. She received antibiotics intravenously (directly into a vein) and was discharged on oral antibiotics. Mrs C complained that the hospital failed to prescribe her with antibiotics after the initial surgery, which she believed might have prevented the infection she later contracted. She also said that the OOH service failed to take her seriously and recognise the seriousness of her condition. Mrs C said that as a result of the failure to provide antibiotics and the failures in the care and treatment she received from the OOH service, she has struggled to recover from her operation and continues to have difficulty in walking. After taking advice from our medical adviser, we found that the hospital's decision not to prescribe Mrs C antibiotics after her initial surgery was reasonable. However, we also found that the OOH nurse failed to recognise the significance of Mrs C's symptoms and admit her to hospital, although our medical adviser said that this would not have affected the outcome.

Ms C complained that her medical practice had kept information from her about her hospital test results. She also said that when she wrote a formal letter of complaint to the practice they had failed to address the issues she raised. Our investigation found, however, that the practice had correctly reported the outcome of the hospital tests to Ms C and that their response letter to the complaint was appropriate. Related reading View Decision Report 201200021 as a PDF (16.21 KB) Updated: March 13, 2018

Ms C complained that her GP had withdrawn prescription milk for two of her three children who have allergy-related eczema (skin inflammation). We found that, following advice from the health board, the practice reviewed their prescribing policy for milk powder. At this time one of Ms C's children was being prescribed the powder. The practice told us that they did not withdraw the prescription, but did change it from an automatic repeat prescription to one that has to be approved by a GP each time. They were concerned that if they did not do that the automatic repeat prescription system might mean that the milk powder was over-prescribed and the child's condition might not be regularly monitored. Our investigation found that prescriptions for milk powder were never stopped and no prescription request was ever refused. The prescribing was reviewed and then monitored and our view was that, in the circumstances and on the evidence available to us, this was appropriate. Related reading View Decision Report 201103622 as a PDF (16.62 KB) Updated: March 13, 2018

Mr C complained that the board did not provide pelvic support girdles, which he considered his partner needed because of pelvic pain in pregnancy. We explained to him that our role in such complaints is limited because it is not for us to tell the NHS how to use their financial resources. Our role was solely to consider if the board's decision making had been flawed. The board had taken a decision six years earlier not to provide these support belts because there was not enough likelihood of benefit. Our investigation found that the board had consulted various studies and European guidelines since then to ensure that the decision remained up-to-date. We concluded that this was appropriate decision making. Mr C had also been concerned that the decision seemed to be based on cost, rather than clinical need. However, health boards have to manage their resources carefully and are expected to reach decisions by considering factors such as a balance of cost and likely benefit. We considered it entirely reasonable for the board to take account of cost. Related reading View Decision Report 201103809 as a PDF (16.66 KB) Updated: March 13, 2018

Mrs C complained that the board's handling of her complaint was inadequate. The board dealt with her initial complaint by arranging a meeting between her and a service manager. However, this did not take place until nearly two months after she complained. Mrs C later made further complaints to the board. The board told her that they had already issued a response to her complaint. Mrs C then wrote to us. However, it was clear that the board had not responded to many of the points she had raised and we referred the complaint back to them for a response. The board took a further three months to issue a response, and their letter failed to explain the reasons for this delay. Mrs C continued to write to the board, and the chief executive issued a further response to her, in offering a meeting with two of the board's directors. Mrs C accepted the offer and met the directors. However, at the meeting, the directors both said that they did not consider that the chief executive's letter had addressed her concerns. They said that they wished to revoke this and send her a revised letter. The chief executive then issued a full response to Mrs C. He said that it was evident that the board's response to her complaints could have been significantly improved. We upheld Mrs C's complaint, as our investigation found that the board clearly delayed in responding, and failed to explain the reasons for these delays to her. Their earlier responses also did not address her complaints adequately or take on board all of the problems she raised. However, we considered that the board's final letter to Mrs C was a detailed response to the complaints she had made. It was issued after the board had carried out a thorough investigation. We were pleased to see that the board identified that their earlier responses to Mrs C's complaints were not satisfactory and undertook a further investigation into the matter. The board also apologised for the length of time it had taken to complete the investigati

Ms C complained to the Ombudsman about the length of time that her late mother (Mrs A) had been prescribed medication (Mogadon/Nitrazepam). Ms C had read literature which mentioned that Nitrazepam should not be prescribed for more than nine months. She wondered whether the medication could have been the cause of Mrs A's obsessional episodes and led on to her suffering from dementia and Alzheimer's disease. Our investigation found that medical opinion had changed over the years and that currently it would not be best practice to prescribe Nitrazepam for a prolonged period. However, withdrawal of the medication is quite complex and requires the risks to be balanced against the benefits. In Mrs A's case our medical adviser said that long term prescription of the medication was appropriate. Related reading View Decision Report 201102328 as a PDF (16.66 KB) Updated: March 13, 2018

Mrs C was referred for orthodontic treatment by her dentist in 2008. She was first seen by a restorative dentistry consultant in February 2009 for hygiene therapy as she had severe gum disease. She was then referred to orthodontics, and was seen in December 2009. She was referred to see a specialist about orthognathic (jaw) surgery as she wanted to undergo this form of treatment, but was not seen until January 2011. Following this assessment, Mrs C was placed on the waiting list for surgery, and seen again in September 2011, when she was advised that her gum disease and level of oral hygiene were not sufficiently stable for surgery at that time. A treatment plan was put in place to continue to treat Mrs C's gum disease. Mrs C had also been advised previously to give up smoking, as this would affect her oral health and hygiene. Mrs C complained to us that the board failed to provide her with treatment for her dental problems within a reasonable time. We upheld her complaint as our investigation found that her wait to see a orthognathic specialist was unreasonable. We noted that the board had implemented evening clinics to tackle the long waiting lists, and that they had experienced a shortage of qualified staff. We found, however, that the board could make further efforts to reduce waiting times within the orthodontic/orthognathic department, and we made a recommendation about this. We did not, however, find that the delay itself had adversely affected the state of Mrs C's teeth, as her oral heath and hygiene needed to be addressed before surgical treatment could begin. Recommendation We recommended that the board: • implement an action plan to reduce the current waiting lists for treatment within the orthodontic/ orthognathic department. Related reading View Decision Report 201102608 as a PDF (22.44 KB) Updated: March 13, 2018

Mr C was unhappy with his GP practice. He told us that he left his medication on a bus by mistake. The next day he telephoned the practice, arranged for another prescription and went to collect it. Mr C told us that the prescription was wrong as it was for a medicine that he had not requested. He said that he returned to the reception to ask for the prescription to be looked at again and to complain about what had happened. Mr C said he was treated inappropriately by the GP at that point. He complained to the practice and as he remained dissatisfied with their response, he brought his complaint to us. Mr C decided to withdraw his complaint before we completed our investigation. Related reading View Decision Report 201103157 as a PDF (16.5 KB) Updated: March 13, 2018

Mr C's wife (Mrs C) was admitted as an emergency case to hospital, but passed away the next day. Mr C was unhappy that the board did not contact him to tell him that his wife had died, and that he only found this out when he called to ask how she was. Mrs C had also wished for her body be donated for the benefit of medical science, and Mr C complained that the board unreasonably failed to contact a local university to arrange for her body to be taken there for this. Our investigation found that when admitted to hospital, Mrs C had said she had no next of kin and had asked that her GP be told about any changes in her condition. We, therefore, did not uphold this complaint. We also found, however, that Mr C had been in touch with the hospital enquiring about her condition, but no note had been made about this, nor had the board given him a full explanation of their findings. We, therefore, made recommendations to address this. We upheld the complaint about what happened to Mrs C's body as we found that the board were aware of Mrs C's wishes but that after she died they failed to contact the university to explore the possibility of donation. We also found during our investigation that the board's initial decision not to refer Mrs C's death to the procurator fiscal was incorrect and that they did not properly investigate Mr C's complaint or make him fully aware of what they had found out.

Mr C made a number of complaints about the care and treatment he received in Ninewells Hospital. He had been admitted following a hernia operation at another hospital. At Ninewells, he was found to have a haematoma (bruise) and there was also some evidence of infection. We found that Mr C had been monitored appropriately following his admission to the hospital. The SEWS (the Scottish Early Warning Score) charts had been completed regularly and appropriately throughout his admission. There was no evidence to suggest that the monitoring, assessment and management of his pain was not reasonable. Although Mr C complained that he was not provided with his regular prescribed medication until the day after he was admitted, the drug administration record showed that he had self-administered some of his medication on the day of his admission. We found that staff clearly failed to provide him with other medication that he needed, but had not taken to the hospital. We upheld Mr C's complaint about this. However, we did not make any recommendations, as the board had already apologised to Mr C and were taking action to reduce the likelihood of similar problems recurring. Mr C also complained that the board did not provide him with oral antibiotics for 26 hours after he was taken off an intravenous antibiotic drip, despite his repeated requests and complaints. We upheld this complaint, as the records were not clear on the matter. It was not possible for us to say categorically whether there was a delay in providing him with oral antibiotics or whether the original intention was that the antibiotics should be stopped. We did not consider that Mr C was asked inappropriate questions in A&E or that the questions were unnecessarily duplicated when he was transferred to a ward. Mr C also complained that the records of his stay in the hospital had been fabricated. We found no evidence of this. In addition, we found that the board's handling of his complaint was satisfactory. Recommendat

Ms C complained about the board's treatment of her wrist injury. She complained that the investigation of her injury and treatment had not been reasonable, and that the treatment had not been undertaken within a reasonable timescale. We upheld both complaints. We found that a failure to assess Ms C's symptoms from the outset and to treat them with a high level of suspicion had led to failings in her care. We were critical of a number of aspects of the care, including the decision to treat her with a splint initially rather than a cast (whilst acknowledging this may not have impacted upon the healing of Ms C's fracture, we found more consistent immobilisation would have assisted in easing Ms C's pain and discomfort, as throughout the course of her treatment she had splints and casts fitted and removed on several occasions). We also criticised the board's failure to send Ms C for specific wrist x-rays and the decision to discharge her on three occasions without appropriate follow-up care. In relation to treatment being undertaken within a reasonable timescale, we found that Ms C should have been referred for physiotherapy at around the time she was diagnosed with the fracture. Instead, Ms C did not begin to receive physiotherapy until around six months later after she self-referred. We found this delay may have impacted upon her long term recovery.

Mrs C's mother (Mrs A) fell at home and was taken to A&E at Ninewells Hospital. X-rays confirmed that Mrs A had broken her femur and she was transferred to a ward a few hours later. The plan was for Mrs A to have surgery the next morning so she was given no food. When Mrs C called the ward the following morning she was told that there had been an emergency and Mrs A had not yet gone to theatre. Mrs A went to theatre for her operation that evening. Mrs C telephoned the ward the next morning and was told that her mother had had a satisfactory night and was fine apart from being 'a bit chesty'. When Mrs C and her daughter arrived that afternoon they were told that Mrs A's condition had deteriorated and a team were attempting to resuscitate her. The attempt was unsuccessful and Mrs A died. When her family saw her, they believed that she had been dead for some time given her pallor and temperature. Mrs C also complained that Mrs A was not given something to eat when she was transferred to the ward and that there had been an unreasonable delay in getting her to theatre. Furthermore, Mrs C believed that no appropriate action had been taken to address her mother's condition following surgery and that it was inappropriate that the family were not alerted when her condition deteriorated. Finally, Mrs C complained about the delay by the board in responding to her complaint. The board accepted that Mrs A should have been given something to eat when she was transferred to the ward and apologised for their failure to do so. They also acknowledged that there was an unreasonable delay in responding to the complaint and apologised. In regards to the timing of the operation, we found that this was reasonable as Mrs A's operation began just over 24 hours after admission. We also found that Mrs A's deterioration was rapid and that the care and treatment she received following her operation was reasonable and timely and that the board's failure to alert the family was reasonable in the

Mr C made a number of complaints about the care and treatment he received in Ninewells Hospital. He had been admitted following a hernia operation at another hospital. At Ninewells, he was found to have a haematoma (bruise) and there was also some evidence of infection. We found that Mr C had been monitored appropriately following his admission to the hospital. The SEWS (the Scottish Early Warning Score) charts had been completed regularly and appropriately throughout his admission. There was no evidence to suggest that the monitoring, assessment and management of his pain was not reasonable. Although Mr C complained that he was not provided with his regular prescribed medication until the day after he was admitted, the drug administration record showed that he had self-administered some of his medication on the day of his admission. We found that staff clearly failed to provide him with other medication that he needed, but had not taken to the hospital. We upheld Mr C's complaint about this. However, we did not make any recommendations, as the board had already apologised to Mr C and were taking action to reduce the likelihood of similar problems recurring. Mr C also complained that the board did not provide him with oral antibiotics for 26 hours after he was taken off an intravenous antibiotic drip, despite his repeated requests and complaints. We upheld this complaint, as the records were not clear on the matter. It was not possible for us to say categorically whether there was a delay in providing him with oral antibiotics or whether the original intention was that the antibiotics should be stopped. We did not consider that Mr C was asked inappropriate questions in A&E or that the questions were unnecessarily duplicated when he was transferred to a ward. Mr C also complained that the records of his stay in the hospital had been fabricated. We found no evidence of this. In addition, we found that the board's handling of his complaint was satisfactory. Recommendat

Mr C's mother (Mrs A) required ankle replacement surgery. Around one week after her surgery, Mrs A was discharged home. Mr C complained that his mother was not properly cared for by the district nursing service to the extent that her ankle became severely infected, and she was disorientated and malnourished. Mr C said that when Mrs A was admitted to Ninewells Hospital around three weeks later, her condition was life-threatening. Mr C said that the infection in his mother's ankle had also spread to her spine but that despite her pain and the concerns expressed by her family, it took a month to determine and treat the extent of the problem. We investigated Mr C’s complaint and obtained advice from our medical adviser. The adviser found that the care and treatment given to Mr C's mother was satisfactory and that hospital staff had correctly concentrated on the severity of Mrs A's infection before addressing the pain in her back. Although Mr C's complaints about his mother's care and treatment were not upheld, we did uphold his complaint about the board's complaints handling. We found that the board took too long to handle and investigate Mr C’s complaint and that they did not comply with their own stated timescales. Recommendation We recommended that the board: • remind all staff involved in this complaint (particularly those who have been asked to respond to the complaints department) of their responsibility to support the NHS complaints procedure by replying in a timely way. Related reading View Decision Report 201100825 as a PDF (13.82 KB) Updated: March 13, 2018

Mrs C was treated for a vaginal prolapse. She underwent surgery to correct the condition but had complications following the procedure which left her with bladder dysfunction. As a result of this, she required a permanent catheter. Mrs C was initially taught to intermittently self-catheterise. She was uncomfortable with this procedure and found that it had a detrimental impact on her life. She raised her concerns with the board but it was some time before an alternative form of catheterisation was provided. Mrs C complained that avoidable surgical failures resulted in her losing bladder sensation and that the board failed to warn her in advance that her surgery could permanently damage her bladder. She also felt that the board took too long to investigate alternatives to self-catheterisation. We found that the board did not warn Mrs C of the possibility of permanent bladder damage prior to her surgery. Whilst we were satisfied that the surgery was carried out correctly and the subsequent complications were unavoidable, we considered that there was an unreasonable delay to providing Mrs C with an alternative to self-catheterisation.

Mr C complained that his practice failed to provide a reasonable standard of medical care on a number of occasions. He went to his practice complaining of pain and was prescribed a drug that he said led to his collapse later in the evening. Later, he went to his practice complaining about severe indigestion and nausea which he believed was a reaction to the medication he was prescribed and was eventually prescribed a different medication. Following an operation, Mr C sought treatment from the practice when he had discomfort and his wound began to leak. He did not receive treatment and went to hospital where he said he was diagnosed with internal bleeding. We found that on the whole the care and treatment Mr C received from the practice was reasonable. Mr C was prescribed a drug that should have been used with caution, but that there were no contraindications to its use and it was discontinued the following day. We found no evidence that the practice failed to provide a reasonable standard of care to Mr C on the other occasions. Related reading View Decision Report 201101060 as a PDF (19 KB) Updated: March 13, 2018

Mr C was HIV-positive and was prescribed an anti-retroviral drug, efavirenz, by healthcare professionals at the board. Mr C was told that the potential side-effects of the drugs included dizziness, light-headedness, skin rash and vivid dreams or nightmares. After taking the initial dose, Mr C experienced very distressing mental changes including depression, paranoia, suicidal thoughts and violent thoughts. Mr C complained that he should not have been prescribed the drug in light of his history of mental ill health and that he had not been warned that he might suffer from serious mental change. After taking advice from one of our medical advisers, we found that Mr C's history of mental ill health was not a reason to avoid the drug, which was a first choice of drug by practitioners in the treatment of HIV because of its effectiveness. We also found that, although healthcare professionals had discussed the main side effects with Mr C, he was not told that he might suffer from serious mental change but we considered this to be reasonable because it was such a rare side-effect. However, we considered that the information provided to patients about the side-effects could be better. Recommendation We recommended that the board: • review the information provided to patients about the potential side-effects of efavirenz. Related reading View Decision Report 201005378 as a PDF (18.75 KB) Updated: March 13, 2018