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GP Negligence prescribed sleeping pills which caused urine retention and an indwelling catheter to be put in - Quality of life ruined by GP negligence!!


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I suspect the “retention” you refer to as “water retention” is instead “urinary retention”

 

(“water retention” from right heart failure leads to swollen ankles / legs. “Urinary retention” is when urine can’t be passed and the bladder gets painful from distension).

 

I suggest you ask the GP to restart the prostrate meds, and then see if the Consultant will review their decision. Was the Consultant a Urologist or e.g. a Physician (or Physician with an interest in Care of the Elderly) ?

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  • 4 weeks later...

HB, you called? :)

 

For there to be medical negligence there must be:

a) a duty of care,

b) a breach of that duty of care,

c) harm resulting, and

d no intervening act or event that led to the ham (instead of it being the breach of duty of care causing the harm).

 

a) isn't an issue, doctor owes their patient a duty of care.

c) isn't hard to demonstrate, if there was no urinary catheter before, and there is one now - the GP would hjave to show that the sleeping tablets weren't the 'tipping point' for the catheter, and it was going to happen then (and not later), anway.

d) You'd need access to the notes -was / were there any intervening event(s)?.

 

b) is the issue. The leading case of Bolam stood the test of time for many years regarding breach of duty in medical negligence casses, but has now been amended with the Bolitho case.

 

https://www.lexology.com/library/detail.aspx?g=ee2ee1a1-6753-4f37-9b6f-3fbe254430bc

 

Bolam in effect says that if there were a multitude of opinions as to the cause of action, let is say A, B and C, (and D to F+), THEN even if A and B are diametrically opposed, but 48 % of practitioners would do A, 47% would do B, 2% would do C, and <1% would do D to F+), then a 'reasonable body of practitioners' would do A or B, and neither would be a breach of duty of care.

 

So, it would depend why the GP prescribed the sleeping tablets, if this was done deliberately knowing of the risk of urinary retention, in a 'I klnow there is the risk, but the likely benefit exceeds the risk' way, and if a body of their colleagues, in the sane circumstances would have done the same. It doesn't matter if another body of their colleagues would say "I wouldn't have done that" if a reasonable body still would have (back to A and B may even be diametrically opposed courses of action).

 

So, you ideally want the notes. If there is a careful record of the GP considering using the sleeping tablets even with the side effect risk, then you'd need expert opinion on if it was a reasonable risk to take  / if a body of their colleagues would have done so too.

If there is no record of it being a conscious risk/benefit based decision, it is harder for the GP to argue it was a deliberate choice, rather than they made a mistake. Most GP's use a system that alerts them when medicines may interact, but so many medicines interact with so many others that it often alerts for people on multiple meds.

 

Bolitho shifts the position, but not as much as at first glance.

It modifies Bolam, which said, in effect, it is for the responsible groups of doctors to decide. So, back to the example above, A and B were not breaches of the duty of care.

Bolitho says that even if a responsible body would do B (so not a breach under the Bolam test), if a court decides that B is 'manifestly illogical' then it doiesn't matter that a reasonable group of practitioners would do it - that no longer counts, a judge can over-ride the option of that group of professionals.

It marks a shift from 'doctors know best' to 'judges know better', but given it is rare for a group of doctors to be 'manifestly illogical', it hasn't opened a floodgate of cases where Bolitho leads to a different outcome than Bolam would have.

 

Get the notes (if you are able to act for the relative ; is there a lasting power of attorney for 'Health and Welfare) if the relative's dementia is severe enough to mean they lack competence to act for themselve)

 

Ask for an explanation from the GP's. Don't make it a complaint (yet), as if you complain to the GP's, it may mean you can't later complain to the CCG instead

 

 

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The CCG (for out of hours or secondary care) or NHS England (for primary care, within hours) are the commissioners.

 

The Commisioners can look at an initial complaint (as can the practice), and MIGHT review a complaint that has already been made to a practice, but aren’t supposed to!.

 

The escalation if unhappy with a practice’s response is supposed to be to the PHSO (& they aren’t quick!).

 

https://www.ombudsman.org.uk/sites/default/files/How_to_raise_concerns_about_a_general_practice_0.pdf

 

So NHS England / the commissioner doesn’t fit as a second stage within the NHS’s complaints flow chart. There are meant to be two alternative first stage options, with the PHSO as the second stage.


most practices don’t know this! (And depending who you get in NHS England they might not either!!).

Even if the practice does know : they might not argue (given they probably don’t want a complaint to NHS England, but don’t want it going to the PHSO even more!)

Edited by BazzaS
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A Deputy-ship is an expensive process, overseen by the Court of Protection (a division of the High Court), but may be the only option  (for the family to formally act on the patient's behalf)  if the relative's dementia is severe enough to mean they do not have capacity to create Lasting Powers of Attorney (both Financial, and Health / Wellbeing).

 

I'd start by having the next of kin enquire for the details / an explanation from the practice, making clear that, at this stage, it is an ENQUIRY,  NOT a complaint.

 

There is a practice manager who posts here on CAG from time to time who notes that such a letter doesn't have to be perfect, just set out what the issue is, and what outcome is desired.

So, the OP doesn't need much / (any??) help to draft the letter ... they can use what they've written here, and the points that have been made by contributors.

 

Thus they can produce a draft, and if they post it up,  can be helped with any 'tweaks' needed.

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Just to point out: it doesn’t matter if the diagnosis is dementia, or any other problem causing loss of cognitive function….. what will matter (for the release of info) is if the relative has capacity to

a) request the release of info themselves, or

b) authorise an advocate to act on their behalf.

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The simplest way is if a healthcare professional at the GP’s believes the relative to have capacity to give authority.

 

If they do, consider getting lasting powers of attorney (both sets) while they have capacity.

 

If those healthcare professionals don’t believe the patient has capacity, and the family agree : then they don’t have capacity.

 

If those healthcare professionals don’t believe the patient has capacity, and the family disagree and believe they do : it might need expert opinion.

 

(I’m aware, albeit from many years ago, of a high wealth individual, who was elderly and frail but was still very astute, and clearly had capacity. They knew their will would be contested by some of their family, likely on grounds of “they didn’t know what they were doing” or “had been coerced”

 

They arranged, via their solicitor, who was an executor of the will, for two Consultants in Psychiatry (each with a special interest in Psychiatry of the Older Patient) to interview them, each separately, to assess their cognitive function, and to discuss their wishes and reasoning behind those wishes.

 

Their expectation was that the will would be challenged, and that the solicitor could, on their behalf, robustly refute any such challenge to the will.

 

So, if it comes to it : expert opinion.

 

back to the OP’s post : the relative can sign such a consent form, but the practice don’t have to accept it if they believe the patient doesn’t have capacity to give that consent.

Edited by BazzaS
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Different practices use different online systems, (not just for appointments but for patient records).

There is a standard NHS app, but some practices use other apps (such as ‘Patient Access’), too.

 

So, it is worth a try, but no guarantee.

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See previous.

 

The issue isn’t:

a) that they were prescribed : that much isn’t in doubt

b) why they were prescribed : likely for agitation or poor sleep,

 

The issue isn’t even : why were they prescribed with the potential for ‘tipping the BPH into urinary retention’

 

The issue will be was this;

i) a deliberate decision balancing the risk of precipitating urinary retention against the benefit of prescribing that group of sleeping tablets, or

ii) was an error made in prescribing them.

 

That would be your aim to establish by asking to see the entry / entries in the records when they were prescribed, and by asking the prescribers.

 

However, one still has to ask: what is your desired outcome here?. All of this is to little avail if it doesn’t give you what you are looking for.

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“Justice” isn’t something easy to achieve without having an idea of what you want (in practice).

 

Compensation?. The GP ‘struck off’? An apology?

One , two (which?), or all of those? Any other outcome(s)?.

 

As for the letter,

a) I’ve already said what I feel you should be asking, and

b) did so in the post (currently number 43), to which I’m not adding much here, just restating what I’ve said already.

 

For a) : if you ask for the reasoning, they’ll likely reply with what you have already stated “Reason: poor sleep / agitation”.

You need to ask for the rationale behind the choice(s) - see post 43.

 

Sorry if I haven’t said what you wanted to hear, but

i) without knowing what practical outcome(s) you want people will find it hard to advise on any letters to best achieve those outcomes

ii) it will be hard to advise if those outcomes are realistic.

 

I can see you are angry. I’m just not sure you’ll get the outcome(s) you want, especially if you don’t state clearly, on CAG, what you want.

Edited by BazzaS
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Seems like you’ve decided you want “all 3” including the GP struck off, because “your brother’s life is ruined”, and “apologies aren’t enough”

 

Yet, I don’t think you are at the stage that you know the GP acted wrongly yet, or that they actually should be apologising ….

 

It’ll be a long post to illustrate why, so I’m left with the choice of:

a) wrote a letter for you that I don’t (yet) believe in, or

b) illustrate why.

So, I’m choosing option b), but it’ll need to be later when I have time to do it properly.

 

As for your later post about “no bladder scan done after catheter put in”. If urine was obtained when the catheter was sited, and urine then continued to flow : I can’t see why a bladder scan was needed (either time a catheter was sited).

 

If there was evidence the catheter wasn’t working (bladder again filling up to the degree it became distended or urine stops draining), then it might be needed, but not if urine was obtained.

If the catheter was removed (to see if the catheter had allowed the retention to resolve, or if a catheter was going to be needed long term) : again it doesn’t mean anything wrong has been done.

 

So, it reads to me like you want to make multiple complaints “because your brother’s life has been ruined”.

 

I think you need to take a step back.

a) You yourself have said that your brother was going to need a catheter at some point, so the issue becomes not that he has a catheter, but rather if he has ended up with one sooner due to negligence

b) you need to be asking for explanations, but not while you are angry. You are focusing on what you see as having been done wrong, without first checking for if wrong has been done.

 

I’ll post later with 2 scenarios for you to tell us what the ‘just’ outcome for each is.

 

For now, bear in mind that a complaint, even if unjustified, takes up masses of the GP / NHS trust’s time.
 

If a complaint is unjustified, even if the practitioner knows they’ve done no wrong, it is deeply distressing for them, and takes up time they’d prefer to be using for patient care.

You need to be establishing first if wrong has been done, rather than lashing out.

 

Explanations first. You seem to have decided there is a “guilty” verdict, not just before the trial, but even before you’ve sought the evidence.

Edited by BazzaS
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OK, here goes.

I'm going to construct 2 artificial scenarios, both based loosely on the situation you've described, but each at opposite ends of a scale.

 

I'm not saying either are what has happened with your relative, only that I'll try to make them both compatible with what you've posted to date (so, if there are features that you haven't mentioned that make either incompatible with your relative's scenario ..... that isn't down to me, as I'm not psychic!).

 

Patient A. Dementia, Benign Prostatic Hypertrophy (BPH), sleep disturbance, agitation. Goes to GP A, who prescribes sleeping tablet type X that can precipitate urinary retention. This flashes up on the prescribing system with a "are you sure" alert, and GP A clicks "yes, sure", without further thought, despite sleeping tablet type Y being a far better option, with no risk of precipitating urinary retention, and no other reasons not to use sleeping tablet type Y.

 

Urinary retention occurs, Consultant in hospital says "sleeping tablet X has precipitated the urinary retention" because it has, (though is silent as to if this was a negligent choice, because they don't know the background as to why it was chosen).

 

What is a just outcome for patient A and GP A?.

 

Patient B. Dementia, BPH, sleep disturbance, agitation. Goes to GP B.

GP B is actually a GP Speciality Trainee towards the end of their GP training, one week to go to complete. They've passed their MRCGP exam, flown through all their assessments, and are highly regarded. So much so that the practice has offered them a job, pretty much on the terms Dr B wants, as they are desperate to keep them there for fear of losing such a good practitioner to a different practice when its so hard to recruit the best GPs.

 

They've carefully considered all aspects of the consultation and Patient B's background, even to the point of noting that prostate surgery was considered for patient B, but it was considered as too high risk.

 

They've looked at all the options, and none are great.

They could not give sleeping tablets at all, but Mr B is sleeping poorly and getting agitated.

They've considered sleeping tablet X, but it carries the risk of precipitating urinary retention.

They've thought about tablet Y, but it can't be used with the other medicines Mr B is on.

They looked at sleeping tablet Z, but it might tip Mr B into heart failure.

 

There is no 'good' option, but on balance tablet X seems the "best option" of a not great bunch :

it might tip Mr B into urinary retention, but it might not.

 

Even if it does, Mr B is going to need a catheter at some point, so it isn't causing something that would never have happened, only make it happen sooner (if it does precipitate it).

 

They don't actually NEED to discuss this case with their educational supervisor, but because they are confident enough in their abilities that they aren't scared to discuss complex cases, they go and run the options and state their preferred option with the Senior Partner who is also their Educational Supervisor (not that they need much supervision these days .... the practice staff all want them to be their nominated GP next week when they join the practice as a fully fledged GP!).

 

Being long in the tooth, the Senior Partner also raises the theoretical option of tablet W, not much used these days, just to show they are old and wise, (and know a few tricks) but says it is also a poor option, as it runs too high a risk of causing renal failure, and patient B's renal function is already not great due to their age and BPH.

 

So, Dr B's choice is agreed as the most appropriate, and Dr B notes this in the medical record, (including  details of the thought process and why the decision was reached, and of there being a discussion with a senior colleague).  

 

 Urinary retention occurs, Consultant in hospital says "sleeping tablet X has caused the urinary retention"  because it has, (though they are silent as to if this was a negligent choice, because they don't know the background as to why it was chosen).

 

What is 'justice' for patient B that is also a just outcome for GP B?.

 

This is why I've been suggesting that the first step is to find out what happened BEHIND the decision to use sleeping tablet X (and if it was noted in the records). Even if it wasn't noted, you might still find out by asking.

 

Sorry, what bit are you complaining about?.

 

The 6 hour wait in A&E once the catheter was in?. What would you have preferred instead?

(If they'd sent him home with the catheter in? - would you then be complaining that they didn't give him a trial without catheter.....)

 

If they'd waited less time? would you then be complaining that they removed it too soon, and the retention was bound to recur?

 

I've answered already about the bladder scan (or lack thereof).

 

It seems to me that your current mindset is that they are "damned if they do, and damned if they don't"

 

For the hospital, why not approach PALS? again, not as a complaint, but wanting to understand what happened ; if you calmly ask questions you may find they help you come up with the right questions, for you to get answers (and it might even turn out you then find you don't need to complain......)

Edited by BazzaS
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Yet again : does your brother have capacity to sign such a letter?. If not, it would be a nullity - as if it wasn’t signed.

 

I’ve already explained this previously.

it could be as simple as the practice asking him what his wishes are … what do you think would happen?

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From my reading of it, the 6 hours wait in A&E was 6 hours after the catheter had been sited, not a 6 hour wait to be treated.

 

There are a multitude of possible reasons for this delay, indeed : it might have been part of a deliberate treatment plan.

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  • 4 months later...

The key determinant to moving forward with the OP’s questions remains:

 

1) does the brother have capacity to authorise the GP’s to discuss their care with her?

2) Even if the OP feels the answer to 1) is “yes”, does the practice agree?

 

if the practice feel he can’t give valid consent they may be unable to discuss his care with the OP unless she obtains a ‘Health & Well-being” deputyship from the Court of Protection and registers it with the Office of the Public Guardian.

Edited by BazzaS
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  • 2 weeks later...
On 22/09/2021 at 21:02, BazzaS said:

The key determinant to moving forward with the OP’s questions remains:

 

1) does the brother have capacity to authorise the GP’s to discuss their care with her?

2) Even if the OP feels the answer to 1) is “yes”, does the practice agree?

 

if the practice feel he can’t give valid consent they may be unable to discuss his care with the OP unless she obtains a ‘Health & Well-being” deputyship from the Court of Protection and registers it with the Office of the Public Guardian.


 

Still applies.

If the OP doesn’t deal with this aspect, they may find they are “stuck”

 

Replying 2 weeks later, but without addressing this key issue, OP risks going round in circles (& slow circles, at that!).

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57 minutes ago, linzie said:

Capacity is there, the GP can disagree but there have been a series of life changing events caused by the GP practice that have impacted my brother overall health and wellbeing.

 

 

 

See above,

my Q.2 was IF the GP’s disagrees.

 

you say they “can disagree”.

It doesn’t matter that they CAN disagree (which no one doubts).

What matters is if they DO disagree (and you seem to be studiously ignoring that question!)

 

I doubt anyone here will be able to help until that is addressed.

 

Edited to add: no useful info re: capacity added since May, and as time goes on, if the relative has more and more conditions, the likelihood of capacity can only decrease.

Edited by BazzaS
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  • 2 weeks later...

You keep posting here (lots!) about help with a letter, but haven’t really engaged with the advice given.

 

A print out of what you have said here, with a list of the questions you want answered should suffice as “the letter”.

you’ve expressed yourself adequately here, and any complaint letter doesn’t have to be word perfect : just set out what you believe the problems to have been, and what you want done about it.

 

see posts #27, #43, #47

 

You don’t have any more rights (automatically) now your relative has died (in fact, fewer automatically, as they now can’t consent which they could have done before (if competent)).

what may give you rights is if you are a beneficiary of their estate, or an executor of their will ; if you are a beneficiary and not an executor, you’ll need a letter stating why you have authority from the executor of the estate.

 

What will you do if the reply comes back “they died of dementia and poor nutrition due to the dementia”?

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Which doesn’t (fitting the pattern of your previous posts!) address the issue(s) I’ve raised.

 

What does the (Dr issued) death certificate say (the medical certificate of cause of death : MCCOD - the one that gets taken to the Registrar to register the death), IF one has been issued (& who by?).


I’m aware most people with dementia die of a condition caused by the dementia, rather than the dementia itself.

So, the MCCOD likely won’t have dementia at 1(a), but I bet it features in 1(b) or 1(c), rather than in section 2 (or not featuring at all!)

 

Not all deaths (outside hospital) are yet being scrutinised by a Medical Examiner.

IF your relative’s death is being scrutinised by a (RCPath)ME, have you made your concerns known to the ME? (Or to the ME’s Officer - the MEO)?

 

If you believe the death was caused by neglect / negligence by the GP, have you asked for the death to be referred to Her Majesty’s Coroner (or spoken to the Coroner’s officer)?

Edited by BazzaS
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On 23/10/2021 at 12:59, BazzaS said:

If you believe the death was caused by neglect / negligence by the GP, have you asked for the death to be referred to Her Majesty’s Coroner (or spoken to the Coroner’s officer)?


Linzie:

 

almost a week on.

no reply regarding the most pressing point.

 

Is it that you just want to “vent” on this thread rather than wanting advice on the issues you state you want advice on?

 

That is fine if it is the case, but then people can choose if they want to spend time answering your questions, or just agree with you how awful it is………..

 

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I asked (a year ago, post #75)  if you had asked for the death to be reported to HM Coroner / discussed it yourself with the Coroner’s Officer.

 

A week later (post #77)  I called this “the most pressing point”.

 

Was the death reported to HM Coroner by the clinician (at your request or otherwise)?

if not, did you speak to the Coroner / the Coroner’s officer? (as I’d advised).

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