To be worried about these notes on DS's Medical notes

(66 Posts)
dashoflime Wed 05-Sep-12 18:48:03

During my pregnancy, I moved house and, despite me updating the midwifes and registering with a new GP, three appointment letters for scans got sent to my old address. My "failiure to attend" those three times triggered a whole load of intervention including an investigation by social services, which was thankfully concluded very quickly. The social worker found that the mix up had been the fault of the NHS and has no further concerns about me. She also Encouraged me to make a complaint to the NHS and promised to write to all agencies and ask them to remove any notes on my file about not engaging with services.
The issue is refusing to go away however as today at my 6 week check up the GP asked me why I missed appointments.I explained the situation and said that I was disappointed that the information was still on file. The GP told me she couldn't remove the note but could add something amending it. When she showed me what she had added it said: "patient is extremely distressed by involvement of social services"
So now my records not only say I don't engage but also that social services were involved and that I am distressed about it. If I read those notes I would assume "extremely distressed" was a euphamism for shouty and irrational.
Am I being unreasonable to be concerned about this? I feel like I have been stereotyped as a bad parent already and I'm worried this will be held against me in future, for example if DS ever needs treatment for an injury or something.

auntpetunia Wed 05-Sep-12 18:56:06

I would write to local nhs pct giving all details you've given here and the name of the social worker who was on your side and insist they delete all comments from your notes within 1 month. And I would contact the social workers direct and tell her its still not gone away. Good luck.

catwoo Wed 05-Sep-12 19:05:36

i don't understand.were the scans and appointments for you or uour dc?

dashoflime Wed 05-Sep-12 19:06:18

Thanks Aunt Petunia. I think I will do that

carabos Wed 05-Sep-12 19:11:39

Why do SS get involved if someone misses an ante-natal appointment? When did attendance become compulsory? I moved from one end of the country to the other when pregnant with DS2. I didn't book in at my original address because I knew I was moving. I didn't book in initially in the new area because we stayed with friends for a couple of months while, so when I eventually booked in I was 30 weeks. No one batted an eyelid.

lisaro Wed 05-Sep-12 19:12:33

You miss appointments and it's on your son's medical notes and there's a wholr Social Services enquiry launched? I feel there's more back story you're not telling.

lisaro Wed 05-Sep-12 19:13:38

whoir = whole

dashoflime Wed 05-Sep-12 19:17:25

Sorry Catwoo, the scans were of unborn DS in the womb. As it turned out (when they finally got me in for a scan) he was actually too small and had a dodgy heart beat and needed to be delivered immidiately by C Section. Up to that point I was blissfully unaware. Sending me appointment letters to the wrong address could have been life threatening for him. I am very upset that their response to their own fuck up has been to put a lot of stressful scrutiny on me, rather than apologising for nearly killing my child. Melodramatic I know but that's how I feel today. I think I definately will write that complaint letter

ToothbrushThief Wed 05-Sep-12 19:19:39

She is correct - if someone misses appointments concerning a child, it's deemed a child protection issue. Miss your own appts and that's your choice but a child has no choice.

I'm sure this does seem big brother to some but.. it's a big but ..... the people who have killed and battered children avoid their routine appointments. It is a red flag.

OP PALS can be useful

This sounds like a data protection issue to me (not an expert). The notes retained must be accurate. I agree that recording a DNA as a DNA is wrong BUT the whole story should be retained. The GP is correct that she should amend the record. PALS may help you bring this to a better conclusion. I would want a clear record showing their mistake

hopkinette Wed 05-Sep-12 19:22:18

Sending your scan letters to the wrong address isn't the same as nearly killing your child. Get a fucking grip.

ToothbrushThief Wed 05-Sep-12 19:23:18

Sounds like you've lost your grip hop...

ToothbrushThief Wed 05-Sep-12 19:25:11

OP I would share your disgust that the poor record keeping could have led to poor consequences for your baby.

The whole 'policy' for missed appointments is for child protection ironically. To then be accused must have really compounded things

booflebean Wed 05-Sep-12 19:26:48

Wouldnt you know you were due a scan????

Hop stop being so rude. What is with people wound here recently.

booflebean Wed 05-Sep-12 19:27:36

Putting that aside, yes I would be livid at those notes given the circumstances and write to all the people necessary to get them removed.

They won't be able to delete anything that's already in your file, that would be against the medical code of conduct, so there's no point putting your foot down and insisting about that bit. What you need to ask for is to add your version of events to the file.

I agree you should make a complaint though about the original error and the continued misreading of the situation by your doctor.

LividDil Wed 05-Sep-12 19:31:14

This is a DPA issue. They have statutory obligation to ensure that personal data they retain is accurate. The Information Commissioner's guidance says:-

You should write to the organisation explaining what the problem is and where appropriate provide them with any evidence to show what the information should say. Keep copies of this correspondence. If, after a reasonable amount of time (we would recommend 28 days) the information has not been corrected, you can make a complaint under the Data Protection Act. Please ensure that you supply copies of your correspondence, evidence and, if applicable, any response you receive.
^ Back to top
At the very least even if they refuse to delete the misleading information they must add notes to show that the notes are incorrect and explain why that is the case. The added notes shouldnt be misleading in themselves! If you don't get any joy then you can contact the ICO to make a complaint.
You also have a right to see all your personal data under the DPA (subject to some exemptions) so it may be worth asking to look at everything to make sure they haven't made misleading statements elsewhere.
Your NHS trust is likely to have it's own Data Protection officer who will be more clued up than the medical staff - if you can make direct contact with him/her that might speed things up

LividDil Wed 05-Sep-12 19:33:27

Just for the record it's only the second para in my post above that is an ICO quote.

dashoflime Wed 05-Sep-12 19:39:20

Lisaro: I was surprised as well. To be fair it was a very short investigation. Just a phone call from the social worker really. I sent in photocopies of my pregnancy record showing all the appointments I had been to, she double checked with my new midwife. I visited the social services office at the hospital a few days after the birth just to double check it was all resolved. That was it.

"I feel there's more back story you're not telling."

This ^ is exactly why i'm concerned about the mention on my sons file. People are going to make that assumption aren't they?

Hopkinette: The hospital was concerned my baby wasn't developing properly in the womb and wanted a scan to check. They sent appointments for scans to the wrong address three times and as a result I didnt get a scan for several months after they first became concerned. When they finally did the scan, he was very small, had not enough fluids round him and seemed in distress> They were worried enough to do a C-Section there and then. So yes, he could have died as a result of that error. I was being a dramatic, which I acknowledged in the post. But honestly, not very.

Toothbrushtheif: thank you for your reply. That was very useful

StrawberryMojito Wed 05-Sep-12 19:40:40

I don't understand, didn't you know you were supposed to be having a 12/20 week scan? Why didn't you chase up your appointment.

Other than that YANBU, the comment that GP made about being distressed would have pissed me off too.

StrawberryMojito Wed 05-Sep-12 19:41:09

Sorry x-post

But surely you knew to expect a scan appointment. When you didn't receive one, why didn't you call the hospital?

BarbarianMum Wed 05-Sep-12 19:48:00

<<I don't understand, didn't you know you were supposed to be having a 12/20 week scan? Why didn't you chase up your appointment.>>

I would assume that these would be additional, rather than routine scans, in which case how exactly was the OP to know?

dashoflime Wed 05-Sep-12 19:52:57

Booflebean and StrawberryMohito:

It was an additional scan not a regular one. I had been told something verbally by a nurse along the lines of "your baby seems a bit small, we might want to monitor it, there may be an appointment in the post" This was in the hospital when I was being seen for a bleed (which thankfully turned out to be nothing). I should have chased it up but i didn't. I wont be making that mistake again. sad

dashoflime Wed 05-Sep-12 19:53:23

x post

LividDil Wed 05-Sep-12 19:56:56

Hope my post was useful as well

dashoflime Wed 05-Sep-12 20:17:56

yes very smile thank you

ToothbrushThief Wed 05-Sep-12 20:25:36

"I feel there's more back story you're not telling."

This is exactly why i'm concerned about the mention on my sons file. People are going to make that assumption aren't they?^

Case proven! You are right to make further checks/complaints and chase this up OP. Good luck

RainbowSpiral Wed 05-Sep-12 20:55:05

I think it is crap this can't just be removed from your record, I have similar concerns about very old mental health problems on mine.

carabos Wed 05-Sep-12 21:38:37

Nope, sorry, still not getting it.

Having read through the thread, it appears that if during the course of ante natal check ups that there may be a problem with the foetus and the m2b takes no action, then SS can become involved shock.?

This is the slippery slope. Do SS become involved if m2b smokes cigarettes in the face of advice to the contrary and scan based evidence that a baby is small? I bet they don't.

There's more to this than meets the eye.

ToothbrushThief Wed 05-Sep-12 21:38:58

Rainbow -it's half to protect OP. There should be a record of their incompetence. If for example it happened again and she wished to complain there would be no evidence. However what is very important is that the information is very clear and accurate.

It should make clear that OP did NOT fail to attend appts. She was therefore incorrectly referred to a social worker and the stigma was both upsetting and unfair for her. It should be very clear that an error was made and by whom. I would hope that OP is given access to whatever record is then stored. I'd strongly recommend getting an advocate like PALS so that you are not persuaded to accept something you are not content with

Very old records cease to matter tbh Rainbow and speaking as someone who has seen a lot of records (and have quite a few of my own!!) it is only on-going and current records that are kept 'alive'. There are policies regarding record retention. I think it's 7 yrs and if the issue is in the past i.e. not on-going they will be removed from your current notes. (I am ready to be corrected by someone who actually knows what they are talking about smile)

ToothbrushThief Wed 05-Sep-12 21:46:46

<sigh>

Taken from the patient.co.uk site regarding recognition of child abuse:

Persistent failure to attend important child health programmes or follow-up appointments

SummerSolstice Wed 05-Sep-12 21:52:07

Sorry you've been through this OP, how is your son now?

I called one morning to rearrange a routine appointment with the midwife (one of the ones where they check your BP and send you packing). I had my appointment, a whole seven days later, I was quizzed as to why I 'failed to attend' (even though I had called ahead). The midwife explained that missed/cancelled visits were monitored so needed to document a reason. I fully believe a referral was made to Social Services for the reason the OP detailed above, and three missed scans.

catwoo Wed 05-Sep-12 21:58:27

Toothbrush- but wasn't a child's appointment she didn't attend.It was her own .

Why do SS get involved if someone misses an ante-natal appointment

Many on here know my job role and in the OP's defence if the safeguarding in a LA is what it should be then this will flag up.

This came into the fore front after the body of Fred West's pregnant daughter was found, questions were asked if pregnant women should be monitored for appointments and checks that a birth has happened and mum and baby are well.

This was decidedon that it should, to protect pregnant women and many need this protection.

There were other cases of women being killed in different circumstances during pregnancy, but not detected until long after.

Women can be very vulnerable during pregnancy for a varity of reasons and the threat usually comes from their own family, or partners family.

OP, you need to contact the complaints manager at your SW department, via telephone at first. You will get an answer within 28 days outlining what is happening, then take it from there.

I always recommend MP's, the LA take notice of them.

ToothbrushThief Wed 05-Sep-12 22:09:41

It was her own appt but concerns an unborn child. Unborn children have their own register for child protection.

We have a policy for missed ante natal appts. It's because for some women it can be an indicator of 'issues' relating to future child abuse.

It's not a policy which would pick up women who actively choose to decline ANC - that's a different issue and often those women are very well informed and motivated (whatever you think of their choice). Nor is it designed to pick up women who miss one appt accidentally. 3 recuurent missed appts in a pregnancy where there are health concerns IS a trigger.

In this case the investigation was informal and uncovered the facts (errors) and OP was 'cleared'.

As she is correctly pointing out ...... some people will jump to conclusions. I'm only posting because a) I know this policy of referral following missed appts (in a pattern) exists and b) I feel damn sorry for the OP facing that assumption

Regarding everyone's feelings about the level of supervision and registers etc. I share your sense of WTF! BUT it is to protect the Victoria Climbies of this world, not to smack hands of ordinary mums.

Emmielu Wed 05-Sep-12 22:10:08

Are you sure SS DID ask for those missing appointments to be taken off? Do you have a letter from them confirming that?

Just to add that now SW cannot just remove data, it has to happen via legal/management.

If i make a mistake on notes, i cannot change them, i have to add an amendment.

This protects the service user.

OP, a professional wouldn't not interpret distressed as 'shouty' ect.

UnexpectedItemInShaggingArea Wed 05-Sep-12 22:14:48

YANBU, I would be angry too.

I hope your baby is coming along nicely after a scary start in life.

The average gestation period for safeguarding the unborn to click in is 20 weeks +, however it can be sooner.

catwoo Wed 05-Sep-12 22:17:36

As I understood it mothers (in the UK) have no legal responsibility towards their unborn children.They can drink themselves silly jump on their belly decline medical intervention to save the life of the foetus.
Therefore social services are, in my opinion, overstepping the mark and attempting to unilaterally impose a responsibility which does not in law exist.

ToothbrushThief Wed 05-Sep-12 22:51:01

ok catwoo. Whatever.

BadEducation Wed 05-Sep-12 23:04:05

I'm confused. Antenatal treatment isn't compulsory is it?

Antenatal treatment isn't compulsory is it

That is a grey area as it depends on what the anti-natal treatment is and why it is being refused, that is what SS find out.

It protects women who may be depressed or have MH problems, as well as other situations.

If a woman refuses tests that would determine whether her baby was still alive, for example, then carrying that child could put her life at risk, then the MH process may be needed, until an investigation is done then no-one knows.

As I understood it mothers (in the UK) have no legal responsibility towards their unborn children

They don't, as such, but the LA does, after a certain point in pregnancy.

There are laws around who oversees/attends a birth etc.

There have been to many cases in the past, where mums have hidden their own still born babies, out of shock and not sought help.

seeker Wed 05-Sep-12 23:18:56

Can someone clarify? Ante natal care isn't compulsory is it? Non attendance with no other red flags wouldn't trigger social service involvement?

ToothbrushThief Wed 05-Sep-12 23:24:49

Catwoo If you really feel that chid protection measures are illegal check out some of these links - they provide references for the legislation/research etc on which the policies are based. I'm offering this up not intending to be confrontational but as information

Scotland

Sussex policy

South west

another

Just a few examples. I'm sitting here recognising the threat that child protection measures present to many people (judgement about lifestyle/smoking drinking/drugs and other) but at the same time conscious that a responsibility to child protection does exist and should exist. Are we just saying chuck babies out into the big wide world ? Death and abuse of children inflicted by a parent is common. Child protection cannot exist without policies/triggers and guidance. It's a blunt tool usually, but attempts to take away from personal opinion/judgement and bias and base the 'triggers' etc on reasearch

ToothbrushThief Wed 05-Sep-12 23:32:28

seeker - if you said upfront to the midwife that you didn't wish any further tests - no blood tests/scans etc that would be a choice you made. I don't personally think it would be considered a red flag

Most mums consciously rejecting ante natal care are informed motivated and making a choice. They will also often discuss that decision with a midwife. IME the vast majority accept some care but make it clear what they don't want - they also are flexible, so if the situation changes they listen to advice and make a further choice based on new info.

There is a big difference between that and mums who are at risk and possibly hiding from the services because they have something to hide. Evasive as opposed to open rejection of the service?

I told my GP that I was rejecting ante natal care ... (I didn't actually carry it through) but I know he didn't place me on the unborn baby register.

catwoo Wed 05-Sep-12 23:38:57

Well i'm seeing lots of guidance and protocol, but no legislation saying a mother can be neglectful of an unborn child.

VivaLeBeaver Wed 05-Sep-12 23:43:40

Antenatal treatment isn't compulsory but not accessing it will usually result in a social services referral. Mainly in cases where the woman seems to have gone AWOL. If a woman presents to a midwife and then tells the midwife they don't wish to access any further care then that's perhaps slightly less likely to result in a referral.

Any late booker (after 20weeks) is an automatic social services referral, even in cases where the woman states she didn't know she was pregnant! They investigate and in 99% of cases will not need to do anything. But it is a red flag that that person may down the line neglect a child, etc.

When dd was a baby me and dh went on a tour of Europe for a few weeks. He was unemployed, I was on mat leave so we packed the car and went. Came home to umpteen letters and messages from HV who when I rang her said she was very close to ringing SS as was becoming concerned aout our wherabouts!

ToothbrushThief Wed 05-Sep-12 23:44:20

You can always chat to your MP about it

Well i'm seeing lots of guidance and protocol, but no legislation saying a mother can be neglectful of an unborn child

It isn't the mother that is neglectful.

The LA has duties towards the unborn and the mother, which means an investigation can be carried out.

The UK would not go down the leglislation route at present as it isn't needed.

This is a safeguarding issue that is fully covered in other leglislation.

No punishment is directed towards the mother, that isn't what this is about, it is designed to be protective.

ArthurandGeorge Thu 06-Sep-12 00:05:39

A mother can behave in a way during pregnancy that gives you concern for the welfare of the unborn child once it is born iyswim. Eg unsupported mum who drinks heavily and abuses drugs is unlikely to be able to meet the needs of her newborn infant. Unborn babies can be made subject to child protection plans but these relate to what happens to the baby after birth rather than to make the mother behave in any particular way.

Failure to attend appointments might be concerning as a red flag for the welfare of the woman as well as a possible risk factor for neglect or harm of the chid once born. Clearly in the case of the OP the error is from the health service and needs to be corrected.

carabos Thu 06-Sep-12 07:47:22

Wait a minute viva! "a mother goes AWOL" - AWOL means "absent without leave". Are you seriously suggesting that a pregnant woman needs some sort of official permission to take a holiday?? shock.

Are you saying that if someone decides to move house, which may mean moving area during her pregnancy, she is required to discuss that with a HCP? She can't be trusted to book in (or not) in a new district?

I wouldn't dream of doing that (and in fact didn't) I just eventually went along to the GP when we got settled and said that I was pregnant.

I'm totally shock at what people are saying on this thread and glad I'm done with having babies.

WipsGlitter Thu 06-Sep-12 07:50:29

Why didn't you get your post redirected?

VivaLeBeaver Thu 06-Sep-12 07:55:17

Not at all, I just used an expression - seemingly the wrong one. I just meant that if they disappeared without anyone knowing where they'd gone.

They don't need permission but yes if a pregnant woman moved out the area and her community midwife didn't know then the community midwife would have to try and track her down. Normally this would be quite easy as you'd ask the gp and the gp would say "such and such gp in another town requested her notes" that midwife would then ring the midwife at that surgery and make sure she had booked in.

I'm sure that you and 99% of women can/should be trusted to move house house and sort out antenatal care in a new area. Sadly I also know that some women try to disappear off the radar for other reasons, some through their own choice and some for even worse reasons. It can very much be a child protection concern and even a concern for the well being and safety of the woman.

It's a requirement that hospitals have a proceedure in place to chase up and find women who have missed antenatal appointments.

carabos you are deliberately reading into this.

You eventually turned up.

Had you not and you were past a certain point in pregnancy then enquireis would have been made.

If you were locked in a room somewhere waiting to give birth and find out the gender before it was registered, then you would be extremely grateful that those enquiries take place.

Likewise if you had prenatal depression, you would, also eventualy be gladof the system that we have in the UK.

You may not need this protection, but thousands do, in our society and billions of women world wide.

You are picking up on what words suit you in viva's post.

That is fine, but those of us that know what has gone on in the past, that is now safeguarded against, realise why this is needed.

Not wanting this guidance in place is an extension of the 'i'm allright jack' attitude that seems to cross into the safety of the most vulnerable.

The system is there to protect, it isn't going to go backwards and be removed as it saves lives.

All that happens is a few checks take place, questions asked, if needed and then that is the end of it.

ToothbrushThief Thu 06-Sep-12 08:12:58

I look after a group of patients with a life threatening condition. If they tell us they are moving I organise a transfer of their care. If they don't tell us of their move I do several checks nationwide to try and transfer their care.

Because I'm trying to save their life...

Policies exist to protect me from any litigation saying that I didn't make enough effort to look after them.

The paranoid might interpret this as not allowing them free will, not trusting them, trying to control etc etc

It is a fine line between care and control, but i have worked in social care (and take note of what hapens in our society) for 28 years and we don't have the tragedies, or as many people slipping through the net, with serious consequences, that could have been prevented with a greater emphasis on safeguarding, as we used to.

Also the lives of the most vulnerable and females, in general is improving.

cory Thu 06-Sep-12 09:51:25

Birdsgottafly, I don't think the OP is just quibbling with the level of supervision, but more with the wording of the amendment of her files.

I have been in a similar situation several times, where I have pointed out a mistake, and the amendment has been made in such a way as to suggest that it is my reaction, not the initial mistake, that is the problem.

This can affect how medical professionals react to your concerns at a later stage and hence can delay diagnosis of a genuine condition. If they have already been told that you have anxiety problems and get extremely distressed, they may be less keen to do that extra test to rule out an unusual condition. There are some seriously dodgy bits in dd's medical files: places where the doctor has clearly heard the direct opposite of what I actually said, because he has already had a preconceived idea of me as a parent. Fortunately most of it is now buried under so much other stuff that it would take a very dedicated doctor to find them.

I am all for control. But not for the cliches of over-anxious mothers to be trotted out every time you disagree with the doctors.

Why would it have been so difficult in the present case to have written an amendment that simply stated:

"It has later been shown that the lack of attendance was due to a misunderstanding: SS have no concerns about this patient".

That would have covered the case without laying either side open to further criticism or suspicion.

For some medical professionals, blaming the patient seems to be something of a default reaction. In fact, I have noticed that comments about my state of mind are almost exclusively confined to doctors who have made some kind of misdiagnosis of dd.

dashoflime Thu 06-Sep-12 11:09:25

Thanks for all the replies, particularly Toothbrushtheif and Birdsgottafly.

Here is the letter I've drafted to the hospital ;

"Dear (complaints person),

Complaint RE: Maternity Department, Patient dashoflime and son,

I am writing to complain about an admin error which I believe was made by the Maternity department at the Hospital.

I moved house on 20/05/12 from (old address) to my current address (new address)

I telephoned the Hospital to inform them of my new address and also registered with a new GP and midwife at (local) Health Centre.

In May I had a bleed and attended the hospital as an emergency. A scan was performed and I was informed that my baby was too small and that additional scans would be needed to monitor. I was told that an appointment would be sent by post.

Unfortunately it appears that my records had not been updated with the new address and I understand that the appointment letter was sent to my old address. I understand that two subsequent appointment letters were also sent to my old address.

As a result of these errors, I was unaware of the appointments and therefore could not attend. The necessary scan was eventually carried out on 19/07/12, it was found that the baby was in distress and an emergency C-Section was performed.

Although, thankfully, my baby and I are both healthy, the delay in obtaining treatment could have had very serious consequences.

In addition my “failure to attend” triggered an investigation by Social Services. This caused me additional cause of stress at a difficult time and also created unnecessary work for Social Services. The investigating social worker, ……., found that my failure to attend had been entirely due to the letters being sent to the wrong address and has encouraged me to make this complaint.

The error continues to affect me, as I understand that both my own and my son’s medical records now show failure to attend appointments and social services involvement, but do not make clear the role of the clerical error in this. In the absence of this context, I believe the information gives a misleading impression.

I therefore request that Princess Royal Hospital acknowledge their error.

I also request that a further note is added to both my own and my son’s medical records, making clear the role of the error in both the “failure to attends” and the subsequent involvement of social services.

I look forward to the speedy resolution of this problem,

Yours Sincerely,

dashoflime"

Unexpected Item: The baby is fine thanks. Still a bit on the small side but basically ok.

VivaLaBeaver: Im very impressed at you driving round Europe with a new baby. That sounds brilliant

VivaLeBeaver Thu 06-Sep-12 11:26:08

Sounds a good letter.

Yes Europe was fab though I think when I told the HV we'd been living in a tent and a vauxhall cavalier for nearly two months with a new baby she probably did want to ring SS. grin

Pomtastic Thu 06-Sep-12 12:39:43

Glad your DS is ok OP smile

Just in case you hadn't realised (you might be fine with it anyway) - but the actual hospital name is in the last post.

(and from the experiences of friends with that particular hospital, I'm not surprised to hear it's them...)

crashdollGOLD Thu 06-Sep-12 12:41:54

That an excellent letter, well worded and you've kept emotion out of it which I imagine isn't easy. All the best of luck.

ToothbrushThief Thu 06-Sep-12 22:28:46

Excellent letter - I might possibly throw in a reference to the Data Protection Act and ask them to confirm that they intend to reassure you they are going to comply with it smile

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