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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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This is from NHS England on complaining about a GP.

 

https://www.england.nhs.uk/contact-us/complaint/#complain

 

And information on acessing medical records. Stu007 has a point, has your relative had a formal diagnosis of dementia and do they have capacity to sign a letter of authority for someone else to act for them?

 

https://www.nhs.uk/using-the-nhs/about-the-nhs/how-to-access-your-health-records/

 

Just to mention that we had a previous thread here where the GP who was subject to the complaint arranged for the patient to see a different doctor in the practice, as they felt the relationship had broken down. I can find a link if you're interested.

 

HB

Illegitimi non carborundum

 

 

 

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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 e

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),

Hi   Does the relative that you state has Dementia had that formally diagnoised by the Hospital and not just a GP at the Surgery saying it?   What is the name of the Sleeping Pills

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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This is the letter requesting medical records from the Gp for my brother, i think it need tweaking

 

Access to Health Records under the Data Protection Act 1998 (Subject access request)

Patient’s authority consent form for release of health records (Manual or Computerised Health Records)

 

Date of request XX/XX/XXXX

To: F.A.O. the Practice Manager. [edited] Medical Practice

Re: Brothers name / NHS Number

From : Mr Speedfreek, 15 Milky Button Towers Lego Land, D.O.B. xx/xx/xx, Telephone xxxxxxxxx, NHS Number xxxxxxxxx

 

Please accept this as a formal request as above for a copy of all computerised health records held by yourselves relating to my brother from xx/xx/xxxx to present day. If there are additional paper records please could you indicate what these are? If you redact any of my record please could you provide a summary of what you have redacted and a explanation of why you have done this?

I understand that a fee of £10 is chargeable for this request.

If required you can contact myself on the telephone number xxxx xxx xxxx. It has an answering service, so if I am unavailable please leave a message.

 

Yours faithfully

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This is the letter requesting an explanation why the medicine was prescribed. Really not sure how to write this without making it look like a complaint letter. This initial letter needs to be worded really good. I don't think there is a need to go into detail about anything else all thats needed is an explanation why the Gp prescibed the medication. This is going to need major tweakings.

 

(Insert the name of the person dealing with your complaint                             (Insert your name)
– i.e. chief executive/complaint manager)                                            (Insert your full address)
                                            (Insert the date)

(Insert their full address)

 

Re: Brother (dob) NHS Number


Dear Sirs
I wish to enquire why (medicine name here) was prescribed to my brother, can you provide an explanation? What was the reasoning behind the prescripton?

 

 

Yours faithfully

Edited by linzie
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How does this sound? Different gps have prescribed the sleeping medicine.

 

Dear Sirs
Please can you provide an explanation why GP1 (name here) on xx/xx/xx, GP2 (name here) on xx/xx/xx and GP3 (name here) on xx/xx/xx prescribed (medication) to my brother? What was the reasoning behind the prescripton?

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Hi

 

Does the relative that you state has Dementia had that formally diagnoised by the Hospital and not just a GP at the Surgery saying it?

 

What is the name of the Sleeping Pills that were Prescribed?

 

 

 Post#28 your SAR request make sure and Title it 'Subject Access Request' (also see below)

 

Please accept this as a formal request for ALL DATA whatever format you may hold this in whether it be written, computerised etc. relating to (insert full name, Date of Birth, Full Address).

 

If any records are redacted could you provide clarification as to why this has been done and under which parts of the Data Protection Act/General Data Protections Regulations you are relying on to do this.

 

If you require to contact me on this matter my full details are as follows (Insert full Name, Address, Phone Numbers, Email)

 

(Note you do not have to put £10 as a Subject Access Request is FREE so leave that out and the time limit for a SAR is 30 Calender days only starts once the GP Surgery has aknowledged your SAR Request and does not ask you for further identification which then extends the request time limit)

 

I would leave out the part to leave a message on your answer machine as most surgery's will not do this as they do not know who has access to that answer machine and what they are discussing still comes under Data Protection Act/Medical Confidentiality.

 

 

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I cannot give any advice by PM - If you provide a link to your Thread then I will be happy to offer advice there.

I advise to the best of my ability, but I am not a qualified professional, benefits lawyer nor Welfare Rights Adviser.

Please Donate button to the Consumer Action Group

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Dementia diagnosed in hospital,

Medication name I will need to find out.

 

Changed the letter to now read

 

Subject Access Request Access

 

 

 

Date of request XX/XX/XXXX

To: F.A.O. the Practice Manager. xxxx Medical Centre

Please accept this as a formal request for ALL DATA whatever format you may hold this in whether it be written, computerized etc. relating to (insert full name, Date of Birth, Full Address).

If any records are redacted could you provide clarification as to why this has been done and under which parts of the Data Protection Act/General Data Protections Regulations you are relying on to do this. If you redact any of my record please could you provide a summary of what you have redacted?

Yours faithfully

 

Do I have to make clear I'm requesting the medical records on his behalf or is the letter o.k in first person format as above? Will the surgery ask further identification?

 

Edited by linzie
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See whst others think, but I would put 'the record' instead of 'my', to avoid confusion.

 

As I understand it, you would still need a letter of authority from your relative asking the surgery to release the information, as I said. Did the hospital indicate if he has capacity to sign documents? My mother was diagnosed with dementia by a psychiatrist, is that what happened here?

 

HB

Illegitimi non carborundum

 

 

 

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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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Is this o.k for consent, my brother can sign it. He is able to talk in small sentences,  read and write.

 

Consent form

Patient details

Patient name

 

 

Date of birth

 

 

Address

 

 

 

 

 

Postcode

 

 

 

I am a patient of The Cambridge Practice and understand I need to give consent for another individual to have access to my medical records and/ or to discuss my medical requirements. I understand the contact details of the individual will be recorded on my medical record.

 

Signature of patient/ guardian:

Relationship to patient: Sister

 

Date:

 

 

Contact details for the individual who I wish to grant access

Full name

 

Linzie

Telephone number

 

 

Relationship to patient

 

Sister

 

(Please tick)

 
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Does the OP need to prove their brother has capacity to authorise the request or is it for the recipient of the SAR to show they do not?

 

It's certainly the case with some forms of dementia (eg Lewy Body dementia) that the sufferer experiences periods of lucidity when they have full cognitive capacity.

 

I wonder if it's worth trying to get the brother to sign an authorisation?

 

Edit:  Cross-posted with Linzie.  I'd be inclined to try to get the brother to sign the form she's uploaded.  Would that be the wrong approach?

Edited by Manxman in exile
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Can the medical records be accessed via the Gp online service which you use to book online appoitments?  If this is the case, it would be much quicker to save and print them out.

 

Edited by linzie
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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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BazzaS can the medical records be accessed via the Gp patient online appoitment system which patients are given a username password to book appointments, view test results, order repeat prescriptions etc?

Edited by linzie
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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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BazzaS i have been able to view online records which show dates when patient went/called Gp's, with whatever medical issue, what the Gp thought, the diagnosis and any medication given - are these medical records?

 

I been able to view when the sleeping pills were prescribed by 3 different Gp!

 

With the letter asking for explanation why the sleeping pills were prescribed, is this good enough?

Dear Sirs
Please can you provide an explanation why GP1 (name here) on xx/xx/xx, GP2 (name here) on xx/xx/xx and GP3 (name here) on xx/xx/xx prescribed (medication) to my brother? What was the reasoning behind the prescripton?

 

 

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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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BazzaS,

My brothers life is ruined by Gp negligence, it should never have happened. Justice for my brother. Gps involved need to be investigated by approproiate medical bodies. If that means the Gp's involved need to be repremanded then be it. If it's happened to my brother, how many other people has the same thing happened/happening at the Gp practice involved. Maybe other patients in a similar situation have not raised the issue?

 

I've seen the entries online which show Gps name, date sleeping tablets were presribed, reason poor sleep, and possible agitation etc. This is the Gp's reasoning.

 

The pharmacy which sent the medication is also negligent by not providing medical instructions with the medicine. If medical instructions were provided. There is possibility his family would have read the instructions and seen urinary retention as warning and not given the medication.


Does the below letter need more tweaking before its sent to the Gp asking for an explanantion?

 

Please can you provide an explanation why GP1 (name here) on xx/xx/xx, GP2 (name here) on xx/xx/xx and GP3 (name here) on xx/xx/xx prescribed (medication) to my brother? What was the reasoning behind the prescripton?

 

 

 

 

 

Edited by linzie
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BazzaS,

My brothers life is ruined by Gp negligence, it should never have happened. Justice for my brother. Gps involved need to be investigated by approproiate medical bodies. If that means the Gp's involved need to be repremanded then be it. If it's happened to my brother, how many other people has the same thing happened/happening at the Gp practice involved. Maybe other patients in a similar situation have not raised the issue?

 

I've seen the entries online which show Gps name, date sleeping tablets were presribed, reason poor sleep, and possible agitation etc. This is the Gp's reasoning.

 

The pharmacy which sent the medication is also negligent by not providing medical instructions with the medicine. If medical instructions were provided. There is possibility his family would have read the instructions and seen urinary retention as warning and not given the medication.

 

BazzaS, The sleeping tablets precipitated pushed foreward urinary retention, it was going to happen sooner or later given the prostate issue. The sleeping tablets just made the urinary retention happen quicker. If it wasn't going to happen now it would have happened maybe in a few weeks/months time. The consultant said this.


Does the below letter need more tweaking before its sent to the Gp asking for an explanantion?

 

Please can you provide an explanation why GP1 (name here) on xx/xx/xx, GP2 (name here) on xx/xx/xx and GP3 (name here) on xx/xx/xx prescribed (medication) to my brother? What was the reasoning behind the prescripton?

 

 

 

 

 

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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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BazzaS, outcomes required because

 

1. Get medical records

2. Rationale behind the choice - when/why sleeping pills were prescribed?

3. See the entry / entries in the records when they were prescribed?

4. See your post 46 - Compensation?. The GP ‘struck off’? An apology - All 3 if possible because my brothers life is ruined. Apologies are not enough now. Gp's at this surgery need to be investigated and if the medical authorities to remove them for gross negligence that is o.k.

 

If after doing point 2 above, the family is not happy with reply from Gp surgery is the next step

 

4. Raise issue with CCG

If not happy with CCG response then

 

5. Raise issue with PHSO

 

6. Last raise issue with GMC after going to the CCG and PHSO?

 

BazzaS, now knowing the desired outcomes can you tweak the letters drafted up here

 

 

 

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Does complaitn need to be raised to the hospital being made to wait 6 hours plus in A&E given my brothers age, dementia, with blood passing through the catheter into the catheter bag. After bloods taken being told to wait for Dr to arrive to bladder scan urine levels in bladder before/after catherer removal but no scan was done no dr showed up. Nurse came removed the catheter. Patient went home, overnight urine rentention happened again. Back to hospital for urine drainage with catheter and a new catherer put inside patient but no bladder scan done again to check if bladder completely empty or if the bloody urine or any debri left in bladder.

 

My brother passing white bits in urine into the catherer bag the district nurse who came to the house said bladder washout should have been done at hospital to completely clean out the bladder of any bloody debri due to trauma.

 

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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.

Edited by BazzaS
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