Mrs T, who was in her nineties, complained with the help of her representative, that her GP inappropriately prescribed her Doxazosin. She said this caused postural hypotension (a fall in blood pressure when she stood up) and led to her being admitted to hospital. When she was discharged, she had a stroke and had to live in a residential home. She said this caused her financial injustice as she had to fund her own residential home costs.
What happened
Mrs T was diabetic and had a history of high blood pressure. Her GP provided care and treatment not only when she was at home, but also in a residential care home and as an inpatient at a trust community hospital.
Mrs T's GP began prescribing Doxazosin to treat this in 2007. In late summer 2011 Mrs T experienced a loss of consciousness and was admitted to hospital. Clinicians felt that she had collapsed due to a combination of her blood pressure medication and having just eaten, and stopped the Doxazosin.
Mrs T was subsequently transferred to a Trust community hospital. Her GP (who was also contracted to work for the Hospital Trust) saw her and decided to restart her on Doxazosin because her blood pressure was high. The next day, the same GP decided to double the dose.
Mrs T stayed in hospital for about a month and experienced further collapses. She was discharged to a residential care home for respite care because she was unable to look after herself at home.
In winter 2011 Mrs T saw a consultant cardiologist. Following his advice, Mrs T's GP stopped Doxazosin in an attempt to improve her postural hypotension.
In early 2012 Mrs T was told that she had suffered a minor stroke caused by her high blood pressure. She remained at the residential care home until her death in winter 2014. We continued to investigate her case.
What we found
We partly upheld this complaint against the Hospital Trust as it employed the GP.
The GP's decision to restart Doxazosin and then to double the daily dose went against the standards set out in the General Medical Council's Good Medical Practice 2006. This guidance says that doctors must only prescribe drugs or treatment when they have adequate knowledge of the patient's health and are satisfied that the drugs or treatment serve the patient's needs. We did not think that the GP acted in accordance with this guidance and we considered this fell so far below the relevant standard that it amounted to service failure.
However, it was not possible to say that restarting Doxazosin caused Mrs T to have a stroke. She was already at a greater risk of a stroke because of her age and her diabetes. There are a number of possible reasons why Mrs T suffered a stroke and it was not possible to link this solely to restarting Doxazosin. When the consultant cardiologist wrote to Mrs T's GP and asked him to stop prescribing her Doxazosin, the GP Practice acted on this advice. We concluded that the Practice acted in line with established good practice in this instance, properly taking note of specialist advice. We therefore did not uphold the complaint against the GP Practice.
Putting it right
We did not make any recommendations as the failings did not result in an injustice.
A GP practice
Torbay and Southern Devon Health and Care NHS Trust
Devon
Came to an unsound decision
Did not apologise properly or do enough to put things right
Not applicable