SPSO Individual Decisions

Miss C raised a number a number of concerns about the care and treatment her daughter (child A) received when she attended Raigmore Hospital. In particular, she complained that staff failed to listen to her and this had an adverse effect on her daughter. Miss C also complained that there was an unreasonable delay in obtaining a jejunal feeding tube (a small tube that is passed through the nose or mouth and into the small intestine). We took independent advice from a consultant general paediatrician. The advice we received and accepted was that, overall, the care and treatment child A received was reasonable. However, we were concerned about the delay in obtaining the jejunal feeding tube. The adviser also said that there was no evidence in the medical records of an overarching plan for child A's care and that, overall, the communication with Miss C was not adequate for her needs. We upheld Miss C's complaint. During our investigation the board met with Miss C and agreed to discuss ways in which they could improve communication with her around medical issues whilst her daughter was in hospital.

Mrs C raised a number of concerns about the care and treatment provided to her late mother (Mrs A). She said that the board had failed to appropriately investigate her mother's symptoms and that this led to a delayed diagnosis of a brain tumour. Mrs A was admitted to Raigmore Hospital following a seizure. She was evaluated by the Stroke Team and various procedures were carried out including a CT scan (a scan that uses a computer to produce an image of the body) and an electroencephalogram (EEG - a test that measures and records the electrical activity of the brain). The results were reported as normal and Mrs A was discharged a few days later. Around five months later, Mrs A was readmitted to Raigmore after suffering a further seizure. She was admitted to Nairn Hospital soon after this with a history of a loss of consciousness and episodes of twitching and seizures. There were further episodes in hospital. It was thought that these were likely epileptic seizures and an antiepileptic drug was prescribed. Mrs A was again discharged. Around seven months later, Mrs A attended a follow-up appointment at Raigmore Hospital, and the following day was admitted to A&E at Perth Royal Infirmary where Mrs C was advised that Mrs A had a brain tumour. During our investigation, we took independent advice from a consultant neurologist. We found that, while some aspects of Mrs A's care and treatment were reasonable, there was an unreasonable delay in performing an MRI (magnetic resonance imaging - a scan used to diagnose health conditions that affect organs, tissue and bone) of her brain. This should have been arranged within four weeks of Mrs A's admission after the loss of consciousness and seizures. We found that it was appropriate that the board started Mrs A on antiepileptic medication but that the subsequent monitoring of the medication and her condition were not reasonable. We found that there was a delay in Mrs A receiving a follow-up appointment at the neurology c

Miss C complained that doctors at her GP practice had failed to refer her for appropriate tests in order to diagnose a tumour in her bowel. After taking independent advice on this case from a GP adviser, we did not uphold Miss C's complaint. The advice we received was that the appropriate guidance had been followed and that there had been no delay in referring Miss C for further investigations. Related reading View Decision Report 201508029 as a PDF (10.78 KB) Updated: March 13, 2018

Mrs C complained about care she received from the medical practice when she attended with an injury to her toe. Mrs C has diabetes which makes foot complications more common and harder to treat. Mrs C had been prescribed an antibiotic to treat the infection but she had returned to the practice around a month later as she was still in pain, at which point she was referred to hospital. She had to have emergency surgery, resulting in the amputation of her big toe. Mrs C said that she had attended the practice three times before being referred to hospital and that the amputation could have been avoided if the practice had provided appropriate care and treatment when she had first attended. The practice said that they had conducted an audit and could not find any evidence that she had attended on the first occasion. We took independent advice from a GP adviser. The adviser considered the records available and found the treatment Mrs C was given was appropriate, and that Mrs C's GP could not have foreseen that Mrs C's condition deteriorated or recurred between the point at which she was prescribed antibiotics and being referred to hospital. We also found no evidence of the initial appointment that Mrs C referred to. We did not uphold Mrs C's complaint. Related reading View Decision Report 201507543 as a PDF (11.18 KB) Updated: March 13, 2018

Mr C complained about the time he had to wait for a gastroscopy procedure (a procedure where a thin, flexible telescope called an endoscope is used to look inside the gullet and stomach) at Raigmore Hospital. Mr C was referred for the procedure by his GP after he complained of symptoms of indigestion. Mr C was offered an appointment 16 weeks after referral, but when he attended the appointment the procedure could not go ahead as the endoscopy department did not have the required equipment available. Mr C complained to the board about the delay and expressed concern that the anticoagulation medication he was taking (treatment with drugs that reduce the body's ability to form clots in the blood) could have posed a risk to his health in the period while he waited for the procedure. The board apologised to Mr C and noted that the equipment was not available at the previous appointment because of a delay in the return of endoscopes following decontamination. We took independent medical advice from a consultant physician who was critical that the time between referral and the procedure exceeded the target waiting time set by the Scottish Government. The adviser also noted that the appointment booking process should not have required two interventions from Mr C's GP. The adviser concluded that because of the delay in the procedure, Mr C suffered from his symptoms longer than was necessary, which was unreasonable. In view of this, we upheld this complaint and made two recommendations. Mr C also complained that the board did not fully address the concerns he raised in his complaint and had exceeded their complaint response time target. The board acknowledged that a letter explaining the delay was not sent in this instance, and stated that staff have since been reminded about the requirement to send holding letters when appropriate. We were critical that, once they had received Mr C's complaint, the board failed to quickly offer Mr C an appointment, and therefore an

Mr C was experiencing pain in his left knee and was referred to Raigmore Hospital by his GP. Mr C was seen by specialists at a number of appointments over the following two years as his symptoms worsened and began to affect other areas including his back. Mr C complained that the staff caring for him at the board had failed to pick up on his spinal problems or investigate appropriately. After taking independent advice on this case from a consultant orthopaedic surgeon, we did not uphold Mr C's complaint. The advice we received was that Mr C had appropriate treatment for his symptoms and that thorough clinical investigations had been carried out. However, we found that after one of his appointments, no clinic letter had been issued (a letter that would be sent from a hospital specialist to the patient's GP). The adviser did not consider that this had any impact on the care provided in Mr C's case, but as this could potentially be significant in other cases, we did make a recommendation to the board about this.

Mrs C complained about the care and treatment provided following an injury to her shoulder. Mrs C complained that A & E staff at Raigmore Hospital failed to promptly diagnose that she had multiple fractures to her arm. Mrs C also raised concerns that on her subsequent attendance at the fracture clinic, staff failed to carry out a CT scan (a scan which uses x-rays and a computer to create detailed images of the inside of the body) as a matter of urgency. Mrs C complained that the board failed to ensure that she received surgery for her shoulder within a reasonable timescale. Mrs C linked these concerns with subsequent complications in her shoulder, which led to further surgery. Mrs C complained that the board failed to provide reasonable care and treatment at the further operation she received approximately nine months after her shoulder injury. Mrs C also raised concerns about whether the board appropriately investigated her complaints. The board said A & E had assessed and managed Mrs C appropriately. The board also considered Mrs C received a CT scan within a reasonable timeframe. The board said emergency admissions impacted on the timescale for Mrs C's surgery; however, they said she ultimately received treatment within an appropriate timescale. The board said the timescales did not impact on Mrs C's recovery. The board did not comment on Mrs C's concerns about the care and treatment provided at the second operation. After receiving independent advice from an orthopaedic surgeon, we did not uphold Mrs C's complaints about her care and treatment. We found the A & E diagnosis had been reasonable as documented in the medical records. We found the timescales for receiving the CT scan and the surgery were reasonable. We found that it was not likely that these timescales caused Mrs C's slow recovery. We also found that the care and treatment provided at the second operation was reasonable. We upheld Mrs C's complaint about the board's handling of her conc

Mr C has suffered from spondylolisthesis (where a bone in the spine slips out of position, either forwards or backwards) for a number of years. After his lower back pain became worse his GP referred him for physiotherapy. Mr C attended an appointment with a physiotherapist and was told to self-manage his condition by undertaking core stability exercises and maintaining posture awareness. Mr C had previously found massage therapy to be beneficial to him and he was unhappy that this treatment was not offered to him despite his requests. Mr C had previously obtained massage therapy privately but no longer had the resources to do so. Mr C wrote to the board to complain that the exercises recommended by the physiotherapist were not helping his condition. Mr C stated that he had obtained private treatment (for massage therapy) on occasion, and that he believed that this treatment should be offered by the NHS. The board investigated Mr C's complaint and concluded that whilst massage therapy can help lower back pain for short periods of time, the exercise programme recommended to Mr C was the most appropriate for managing his condition. After taking independent medical advice from a musculoskeletal out-patient physiotherapist, we did not uphold Mr C's complaint. The adviser concluded that it was reasonable of the board to refuse Mr C massage therapy as there was limited evidence to support the effectiveness of the treatment in managing chronic lower back pain. The adviser also thought that the exercise programme treatment that was recommended to Mr C was reasonable. In view of this, there was no evidence that the board had unreasonably refused to offer Mr C massage therapy and we did not uphold the complaint. Related reading View Decision Report 201507814 as a PDF (11.39 KB) Updated: March 13, 2018

Mr C complained about the care and treatment he received from the medical practice. In particular, he raised concerns about a specific consultation where he felt that he should have been referred to a psychiatrist due to him suffering from severe depression. He was not referred to psychiatry until around a year later and he considered this to have been to the detriment of his mental health in the interim period. He also complained that the practice had increased his dosage of antidepressant medication to what he considered to be an unsafe level. We obtained independent medical advice from a GP. They noted that details of the consultation in question had not been recorded and they were, therefore, unable to assess whether a referral to psychiatry was indicated at that time. While they did not consider that there was any indication for a referral at subsequent consultations six and eight months later, due to the fluctuating nature of Mr C's mental health difficulties we could not conclude that the same applied at the time of the relevant consultation. With regard to Mr C's medication, the adviser noted that it was prescribed at dosages within recommended levels and they could find no evidence of unsafe prescribing. In light of the identified record-keeping failure, we were unable to evidence that Mr C had been appropriately assessed and, in turn, whether the decision not to refer him to psychiatry was reasonable. Therefore, on balance, we upheld the complaint and made some recommendations to the practice relating to record-keeping.

Ms C, who is an advice worker, complained on behalf of Mrs A about the care and treatment she received at Raigmore Hospital. In particular, Mrs A said that the hospital failed to communicate adequately with her and her family during her admission. She also said that the hospital failed to provide an appropriate standard of nursing care or appropriate medical treatment. We took independent advice from a nursing adviser and a medical adviser who is a hospital consultant. We found that the level of communication with Mrs A and her family was reasonable, as was the level of communication between medical staff. However, our investigation showed that the board failed to provide Mrs A with an appropriate standard of nursing care. We were mindful that the board had accepted there were failures in relation to nursing care and had taken action to address these matters. We found that the medical care and treatment Mrs A received in the hospital was reasonable.

Ms C complained about the nursing and medical care received by her brother (Mr A) over two admissions to Belford Hospital. Mr A's first admission was due to severe abdominal pain and vomiting. He was treated and discharged the same evening. Mr A's second admission was two days later after he was found disorientated in his home. He was assessed and a request was made for an out-of-hours (OOH) scan of his brain. This was refused and the scan was not carried out until the following morning. The scan showed bleeding on Mr A's brain and he was transferred to another hospital for surgery. Ms C also complained that the board had failed to respond appropriately to their complaint. Ms C said Mr A was not properly assessed during his first admission. She said he should not have been discharged after receiving morphine and said Mr A had no memory of when he was discharged or how he got home. Ms C said Mr A had been left in soiled clothing during his second admission, which had been distressing for his family. She said nursing staff had failed to provide personal care until the family had insisted. Ms C also said the failure to perform a brain scan sooner had put Mr A's life in danger. Ms C said the family had repeatedly told medical staff they believed Mr A was displaying symptoms of a brain injury. We took independent medical advice from a consultant physician. The adviser said that Mr A's care and treatment during the first admission was adequate. However, the adviser said that Mr A was displaying sufficient symptoms of brain injury to justify OOH scanning earlier than he received the scan. This was unreasonable and should have been addressed in the board's complaint investigation. We also took independent advice from a nursing adviser. They noted the records showed that staff had attempted to provide personal care to Mr A during his second admission, but that he had not been compliant. We found the nursing care provided to Mr A was of a reasonable standard.

Mr C, who works for an advice agency, complained to us on behalf of Mr A that the board had failed to diagnose what was causing his hypoglycaemia (low level of glucose in his blood). Mr A had been diagnosed with type 1 diabetes as a child. In his early twenties, he started to have hypoglycaemic episodes and was told to reduce his doses of insulin. He continued to have these episodes and was admitted to hospital on a number of occasions to be monitored. We took independent advice on the complaint from a medical adviser, who is a consultant in medicine and endocrinology. We found that Mr A's recurrent hypoglycaemia had been promptly and appropriately investigated by the board and they had reasonably tried to manage this by giving him an insulin pump. We did not uphold this aspect of the complaint. Mr C also complained that nursing staff had failed to provide reasonable treatment to Mr A when he was in Broadford Hospital. However, we found that the nursing staff had acted appropriately and we did not uphold this complaint. Finally, Mr C complained about the board's handling of Mr A's complaint. We found that there had been an unreasonable delay by the board in responding to the complaint, although they had apologised for this delay in their response to Mr A. The board had also failed to respond to Mr A's complaint about nursing staff in Broadford Hospital. In view of these failings, we upheld this complaint.

Miss C's young daughter (Miss A) has suffered gastrointestinal problems for most of her life and has had many hospital admissions. Miss C complained that she was treated unprofessionally and made to feel uncomfortable and inadequate by staff at Raigmore Hospital. She said that meetings were held behind her back and she was given very little notice about a multi-disciplinary meeting held to discuss her daughter's care. Miss C complained that the board failed to communicate with her appropriately about her daughter and that her daughter had not been provided with appropriate clinical treatment. The board apologised if Miss C had been made to feel uncomfortable and said that this had not been their intention. They also said that meetings held to discuss Miss A had been routine and in her best interest; they said that she had been treated appropriately. We took independent advice from a consultant paediatrician and we found that while Miss A's initial care was reasonable, given her longstanding problems, her admission to hospital to consider her symptoms should have taken place earlier than it did. Also, by the time a specialist dietician became involved in her care, Miss A had dietary deficiencies which had been likely to have been present for some time. We were also critical that some of the dietician notes were not available when we asked for Miss A's full medical record, so we made a recommendation to address this issue. In relation to the way the board communicated with Miss C, the evidence showed that Miss C was given very little notice of a multi-disciplinary meeting held to discuss her daughter's care. There appeared to have been no effort to arrange a suitable date and time with her and she was put under unreasonable pressure to attend. We also found that she had not been given an explanation for meeting to discuss a child plan for her daughter. We therefore upheld Miss C's complaints.

Mrs C complained that the practice cancelled an important appointment with the practice nurse without giving her notice. Mrs C moved to a different practice, and she complained there was delay in sending her medical records to the new practice. We found that the practice could have told Mrs C sooner that the appointment had been cancelled, and there was no record that they had tried to contact her before she arrived for the appointment. We also found that the practice should have tried to re-arrange the appointment for Mrs C, or arrange an alternative appointment nearby. In addition, we found that there was an unexplained delay of several weeks in the practice sending Mrs C's medical records to her new practice. We upheld Mrs C's complaints. Shortly after Mrs C complained to the practice, it changed management from GPs to the local health board, as the GPs had left the area. Given these specific circumstances, we did not make recommendations to the health board, as they were not responsible for running the practice at the time of the events complained about. However, we asked the board to confirm whether any relevant staff currently working at the practice were there at the time of the events complained about and, if so, to share our findings with them so they could learn lessons from what happened, to try to ensure that similar problems do not arise again. Related reading View Decision Report 201502517 as a PDF (11.24 KB) Updated: March 13, 2018

Mr C complained to us about how the board had handled his enquiries about NHS continuing health care. His mother had been assessed as needing continuing care, but was in hospital in another health board's area. Mr C had written to the board to ask for further information about this. The board did not respond and he had to contact them again. Despite this, he still did not receive a response and in view of this, we upheld this aspect of Mr C's complaint. Mr C also complained that the board had failed to handle his complaint about this matter in accordance with their complaints procedure. We found that the board had adequately responded to the points Mr C had raised in his complaint. We also found that it had been reasonable for the board to contact his mother's power of attorney to obtain consent to share the details of the investigation with him. However, we found that there had been a delay in responding to Mr C's complaint and we also upheld this aspect of his complaint.

Mr and Mrs C complained to us that the board had failed to inform Mrs C of a diagnosis of diverticulitis (a common disease of the digestive system) that was reached when she had a colonoscopy (examination of the bowel with a camera on a flexible tube) under the Scottish bowel screening programme. Mrs C had undergone the colonoscopy following the detection of blood in samples she submitted under the bowel screening programme. During the colonoscopy, a minor non-cancerous growth had been removed and it was assumed that this had been the cause of the blood. The unit who carried out the colonoscopy wrote to Mrs C's GP practice to inform them of this. However, in the cover letter sent to the GP practice, they did not refer to a diagnosis of diverticulitis that had also been made during the colonoscopy. They also failed to inform Mrs C that she had also been diagnosed with diverticulitis at that time. We took independent advice on Mrs C's complaint from a medical adviser who is a GP and from another medical adviser who is a consultant physician. Mrs C clearly should have been informed of the diagnosis of diverticulitis and we found that the unit who had carried out the colonoscopy should have made her aware of this. We considered that this problem originated from the lack of clarity in the board's procedures in relation to the Scottish bowel screening programme regarding sharing information with patients. We upheld the complaint, although we found that the board had already apologised to Mrs C for this. Mr and Mrs C also complained that the board had failed to provide Mrs C with treatment for diverticulitis within a reasonable timescale. We found that it was unlikely that she required any treatment for this, although she should have been told to increase the fibre in her diet. We did not uphold this aspect of the complaint.

Mrs C, who is an advice worker, complained to the practice about a lack of urgency in acting on Ms A's concerns about a problem with her young daughter's hip. She said that Ms A reported that her daughter's left leg was longer than her right leg and that one of the GPs failed to thoroughly examine her daughter. In addition, it was only after Ms A continued to report her concerns that her daughter was referred to hospital. However, one of the GPs marked the referral as non-urgent and Ms A had to ask the practice again to make an urgent referral. Her daughter was diagnosed as having a dislocated hip. The practice apologised for the delay and said they had learned from the complaint. They were now aware that they can directly ask for an ultrasound scan of the hip in such circumstances. The GPs were more aware of the signs to look for and would mark any referrals as urgent. The practice apologised for the distress which was caused. We took independent advice from a medical adviser who noted that the response from the practice to Ms A's complaint was thorough and explained the shortcomings which they had identified. The practice said that their GPs were now more aware of the referral options, the need for urgency and the later signs of congenital dislocation of the hip. However, we identified further failings by one of the GPs in regards to the inadequate examination and recording of findings related to Ms A's daughter and a failure to stress the urgency of the situation in the hospital referral letter, so we upheld the complaint.

Mr C complained about the medical and nursing care and treatment he received in Raigmore, Broadford and Ross Memorial hospitals between June and December 2012. Mr C had a complex medical history and began to experience chronic back pain at the end of June 2012. This proved to be a lumbar disc infection and he was treated conservatively. Mr C complained about various aspects of his care and treatment during his various admissions to the hospitals including the frequency and standard of consultant review, treatment decisions, diagnosis, pain management, communication and the decisions to discharge him home or to other hospitals. We took independent advice from a nursing adviser and two medical advisers, one in emergency medicine and the other in orthopaedics (conditions involving the musculoskeletal system). We found that the standard of medical care and treatment provided by Raigmore Hospital was reasonable and that the nursing treatment was also reasonable with the exception of the use of a commode for showering purposes. We made a recommendation to address this. We also found that the standard of medical and nursing care and treatment provided by Broadford Hospital was reasonable. However, in relation to the standard of medical care and treatment at Ross Memorial Hospital, while we found no failings in relation to nursing care, we found that there was a missed opportunity to potentially manage Mr C's pain more effectively and that a planned discharge home was unreasonable. We made a number of recommendations to address these failings.

Ms C, who works for an advice agency, complained on behalf of Ms A about treatment she had received from the medical practice. Ms A has chronic psoriasis (a long-term, recurring skin disease, which causes sore or itchy patches of skin) on her hands and feet. She sought treatment for this at her practice but continued to suffer symptoms. Following a visit from a district nurse, Ms A was referred to a podiatrist (a clinician who diagnoses and treats abnormalities in the lower limbs). Ms C complained about the delay in Ms A being referred to a podiatrist. We took independent advice from a GP adviser. The adviser said that the practice had made appropriate investigations into Ms A's condition and recommended reasonable treatments. As the psoriasis affected Ms A's hands as well as her feet, they did not believe a referral to a podiatrist was appropriate at that time. For this reason, we did not uphold the complaint. Related reading View Decision Report 201503311 as a PDF (11.05 KB) Updated: March 13, 2018

Miss C was examined by her current GP and had a contraceptive coil removed. However, at that time, Miss C had thought that all coils had already been removed; therefore, she thought her previous GP had failed to remove a coil. We looked at the file on Miss C's complaint, at her medical records from her current and previous GPs, and we took independent advice from a GP adviser. We noted the adviser's comments that patients should be aware if they have a coil in place and if it needs to be removed, and that it is a patient's responsibility to tell their GP if they wish to have an existing coil removed. We found that the care provided by Miss C's previous GP in relation to fitting and removing coils was reasonable in the circumstances at the time. Therefore, we did not uphold Miss C's complaint. Related reading View Decision Report 201501740 as a PDF (11 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment received by her late husband (Mr C) while he was a patient at Raigmore Hospital. Mr C underwent surgery to treat colon cancer but he continued to experience health problems and had a number of readmissions over the course of the following months. Around five months after surgery, investigations showed a recurrence of Mr C's cancer. He was admitted to a hospice for palliative care and died two months later. Mrs C raised concerns about the steps taken to investigate her husband's ongoing symptoms and pain following the surgery. She also complained about a lack of planned follow-up action, including the omission of a referral to oncology. We obtained independent advice from a consultant colorectal and general surgeon, who considered that the investigations undertaken during Mr C's admissions were reasonable and consistent with applicable guidance. The adviser noted that it was unfortunate that the investigations did not detect the recurrence of Mr C's cancer earlier but did not consider that this was due to a failing on the part of the board. We accepted this advice and did not uphold this complaint. In relation to the decision not to refer Mr C to oncology following his surgery, the board indicated that the multi-disciplinary team had not felt that he would be fit enough to undergo chemotherapy. They noted that this was discussed with Mr C at the time but this discussion was not recorded in the clinical records. They acknowledged that it might have been useful for Mr C and his family to have met an oncologist to discuss the risks and benefits of chemotherapy and they apologised that this was not arranged. While accepting that Mr C was unlikely to have been fit enough for chemotherapy within the relevant time period, the adviser agreed that the opportunity to speak to an oncologist should have been considered. The adviser was critical of the board's failure to record their discussion with Mr C and noted that this

Miss C said that although she had been attending her GP since January 2013, he failed to take her concerns and symptoms seriously. She said that it was not until she attended the surgery with her partner in August 2014 that she was referred to a hospital consultant. She was then diagnosed with a brain tumour. The complaint was investigated and we took independent advice from a medical adviser who is a GP. We found that early in 2013, Miss C's optician had written to her GP asking him to arrange for her to see an ophthalmologist (a doctor who specialises in diseases and injuries in and around the eye). He did so and Miss C attended the ophthalmology clinic. She remained in ophthalmology care until her discharge four months later. After that, Miss C saw her GP twice, both times for shoulder complaints. It was not until she attended her GP in August 2014 complaining of previously unrecorded symptoms that the possibility of a brain tumour was suspected and then diagnosed following her referral to hospital. We found no evidence of delay or a failure to treat appropriately. Taking all of this into account, whilst recognising the challenges Miss C has had to face, we did not uphold the complaint. Related reading View Decision Report 201501792 as a PDF (11.2 KB) Updated: March 13, 2018

Mr C had a longstanding spinal problem and the board had been providing treatment to him for many years. When Mr C's condition deteriorated to the point that he could no longer walk 100 yards without pain, his regular consultant at Raigmore Hospital referred him to a specialist colleague. Mr C said he heard nothing and after 12 weeks he phoned the board. He was told they did not know when he would be offered an appointment. He phoned again two weeks later and was told the same thing. After 18 weeks Mr C complained. He said there had been an unreasonable delay and no communication from the hospital. We upheld both of Mr C's complaints. We found that the time taken to give Mr C an out-patient appointment (30 weeks) was too long. We found the board had not been proactive in communicating with Mr C, which they should have been, given the known pressure the service was under at the time.

Mrs C said that she had moved to a new GP surgery, where her symptoms had been quickly diagnosed as due to hyperthyroidism (excess thyroid hormone). Mrs C then complained to her former GP practice that she had reported the same symptoms to them for the past two years but they had failed to reach the true diagnosis. She complained that she may have been prescribed inappropriate medication. The practice maintained that they had provided appropriate treatment based on the symptoms reported at the time. They apologised for the failure to order a set of blood tests on one occasion and said this was caused by an administrative failure. They said that it was not possible to say that hyperthyroidism was present at that time. We sought independent advice from a GP adviser. The adviser considered that, other than the failure to carry out specific blood tests on one occasion, the practice had performed appropriate investigations in an effort to reach a diagnosis. The symptoms which Mrs C had shown during the period were not classically suggestive of hyperthyroidism. The adviser did not think it was a failure that the GPs at the practice were not alerted to a possible alternative diagnosis. We did not uphold the complaint. Related reading View Decision Report 201502050 as a PDF (11.18 KB) Updated: March 13, 2018

Miss C said that she had attended the Early Pregnancy Clinic at Raigmore Hospital as she was considering having a medical termination of her pregnancy. She had experienced bleeding and was concerned that she was going to miscarry. She was unhappy that the consultant had told her to take the contraceptive pill, and that she had to return the following day for a medical termination of her pregnancy. Miss C continued to suffer from pain. She attended her GP, who told her not to take the contraceptive pill and that she would probably miscarry without medical intervention. Miss C did not return to the clinic but subsequently attended her GP. The GP arranged for a pregnancy test which proved to be negative. Miss C felt that it was inappropriate for the consultant to have ordered her to take the contraceptive pill. We took independent advice from a nursing adviser. The adviser said that the medical record of Miss C's attendance at the clinic was detailed. It contained information regarding the plans for a medical termination of her pregnancy, and confirmed that Miss C was advised to seek medical advice if she should have additional bleeding or pain. The adviser felt that in such situations it would also be appropriate for a consultant to discuss family planning matters such as contraception. We did not uphold the complaint. Related reading View Decision Report 201504022 as a PDF (11.18 KB) Updated: March 13, 2018