SPSO Individual Decisions

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file. Related reading View Decision Report 201204718 as a PDF (10.78 KB) Updated: March 13, 2018

Mr C complained about the care and treatment provided to him by the medical practice. We started our investigation, but Mr C died before it was completed. As we had no contact details for Mr C's next of kin or executor/executrix, we were unable to take this complaint further, and closed our file. Related reading View Decision Report 201204712 as a PDF (10.78 KB) Updated: March 13, 2018

Ms C complained that doctors at the practice failed to manage her medication regime appropriately. Ms C was suffering from bi-polar disorder (a condition that affects a person's mood). She was prescribed medication, including lithium (a medicine used to treat mood disorders) and quetiapine (a drug used to treat bi-polar disorder). Her lithium levels were monitored every three months at a special clinic as lithium may interact with other drugs and can cause toxicity (a poisonous effect on the body). She was also monitored by a community psychiatric nurse (CPN) and a consultant psychiatrist every four to six weeks. On one occasion Ms C went to the practice as she felt she was suffering from toxicity. She saw a locum GP (a doctor in a temporary position at the practice), who did not think that she was but asked her to speak to her CPN to organise a blood test. The CPN told her to go back to the practice, and another doctor did the blood test. The results showed that she was not suffering from toxicity. After investigating, we did not uphold Ms C's complaint. We took advice from as independent medical adviser, who said that the evidence in the clinical notes showed that it was unlikely Ms C was suffering from toxicity when she saw the locum GP. Although the adviser was concerned that the locum GP asked Ms C to arrange her own blood tests, she considered this to be a misunderstanding about the resources available. In light of this, although we did not uphold Ms C's complaints, we drew to the practice's attention that the adviser had suggested they might wish to consider placing an alert on the notes of patients prescribed lithium, with information on how to obtain urgent blood tests where there is a suspicion of possible lithium toxicity. Ms C also complained that the practice would not prescribe her extra quetiapine. She was under the impression that her psychiatrist had increased the dose. Having looked at Ms C's clinical notes and the communication between

Miss C's medical practice were concerned about her compliance with her medication. They had, therefore, previously decided, with Miss C's agreement, to dispense her medication on a daily basis. However, Miss C requested that this be returned to weekly or monthly prescriptions, and she complained when this request was refused. The practice told us that, as they continued to have safety concerns about Miss C's compliance with her medication, they had decided that daily prescribing would remain in place. Having taken independent advice from our medical adviser, we considered this to be a reasonable decision in the circumstances. Miss C also complained that her medication was no longer being prescribed to her in tablet form. She was receiving a liquid alternative and did not feel it was working as well for her. Although the practice had advised her that the tablet form was no longer available in this country, Miss C identified a drug company who could still supply this. However, the practice noted that this was imported and unlicensed and, therefore, did not agree to prescribe it. Our medical adviser took the view that this was reasonable and said that doctors are discouraged from prescribing unlicensed medication when licensed alternatives are available. In addition, he noted that the medication was very expensive and he did not consider that it would be prudent for the practice to prescribe overly expensive drugs that were not clinically necessary. Related reading View Decision Report 201200850 as a PDF (11.34 KB) Updated: March 13, 2018

Mrs C was on medication for serious mental health problems. She registered with a new medical practice in 2011, having been stable for a number of years on an existing medication regime. However, the new practice did not obtain her medical records nor make contact with the psychiatrist who had been treating her previously. In March 2012, Mrs C attended the practice about a non-related medical issue and saw a doctor. During the appointment, the doctor questioned the medication regime and said that Mrs C should undergo a review, as the types of medication she was on could have serious cumulative side effects if taken long term. Mrs C was upset and anxious that the doctor proposed reviewing her medication, given that she had been stable on the regime for a number of years and had had serious difficulties in achieving this stability. She was also upset by the doctor's tone and a number of comments he made during the consultation which she felt were inappropriate when dealing with a patient with mental health problems. We found that the aims of the consultation were valid and constituted good practice. We were, however, critical that the practice failed to obtain Mrs C's medical records or to contact her psychiatrist, as she had registered with them nearly a year before. We noted that the doctor had written details of his comments in the consultation notes, and that he himself had since accepted that these may have added to her concerns. We were critical of this, and for the fact that he did not conduct an assessment of Mrs C's health at that time, although we recognised this could have been difficult given the nature of the consultation overall. On balance, however, we did not uphold the complaint as we found the aims of the consultation about which Mrs C had complained were reasonable and should have been undertaken earlier. We did, however, make recommendations to address the shortcomings we identified that took place before the consultation.

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 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

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

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

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