Not upheld, no recommendations

Summary

C complained about the care and treatment that the board provided to their parent (A). The complaint relates to several different primary and secondary care services, including A’s medical practice, which was managed directly by the board. A had a long history of peripheral arterial disease (a condition where a build-up of fatty deposits in the arteries restricts blood supply to leg muscles).

A experienced gradually worsening pain in both their legs and had contacts with the Out of Hours (OOH) service, their GP and the board’s vascular team. Ultimately, A was admitted to hospital due to worsening critical limb ischaemia (severely blocked flow to one or multiple hands, legs or feet). It was decided to amputate A’s leg but, following the surgery, A’s condition deteriorated. They were diagnosed with myocardial infraction (a heart attack) and died in hospital.

C complained about several aspects of A’s care and treatment which covers both the period up to, and the time during, A’s admission to hospital. Firstly, they complained that the OOH Advanced Nurse Practitioner (ANP) failed to provide reasonable care and treatment. The board’s position was that the care and treatment provided by the ANP was reasonable but they apologised that C and A had been given the expectation that an OOH GP would attend.

We took advice from an independent GP adviser. We found that the care and treatment provided was reasonable, and that the ANP had appropriately reviewed A’s medical history before attending. Therefore, we did not uphold this complaint.

C’s second complaint related to A's medical practice. C stated that a GP in the practice had unreasonably failed to diagnose A’s condition correctly and provide appropriate treatment. The board concluded there were missed opportunities to see A face to face. However, they considered the practice’s clinical decision-making to be reasonable.

We took advice from an independent GP adviser. We found that different GPs may have taken different courses of action based on the same set of circumstances. However, this did not mean that the course of action taken here was unreasonable. Overall, we found that the care and treatment the practice provided to A was reasonable. Therefore, we did not uphold this complaint.

C’s third complaint related to the outpatient vascular care and treatment that the board provided to A prior to their admission to hospital. In C’s view, the Vascular Consultant involved in A’s care unreasonably refused to admit A to hospital in conjunction with A’s GP. The board concluded that A’s care and treatment plan under the care of the vascular team was managed appropriately. While they regretted not admitting A earlier, this would have been unlikely to change the outcome.

We took independent advice from a vascular consultant. We found that the vascular input provided by the board prior to A’s admission to hospital was reasonable. We also found that given A’s circumstances, the decision not to insist that admission to hospital was urgent represented established good practice. Therefore, we did not uphold this complaint.

C’s fourth complaint related to the clinical treatment provided to A following their admission to hospital. We took independent vascular advice on this complaint. We found that the clinical decision-making of the vascular team was reasonable. This included the decision to proceed with amputation in the absence of any alternative treatment options. In respect of A’s myocardial infraction, we found that the care and treatment from a vascular perspective was reasonable. We also concluded that there was a record of appropriate discussions regarding DNACPR and the risks of amputation. Given this, we did not uphold this complaint.

C’s fifth complaint related to the nursing care provided to A during their admission to hospital. The board had acknowledged some failings in this respect, particularly around communication. We did not uphold this complaint.

C’s final complaint related to the end of life care provided to A. We took independent nursing advice. We found that the end of life care, as documented in the records, was reasonable. We did not doubt C’s account of how traumatic A’s death was. However, in the absence of additional evidence that indicated staff failed to carry out the kind of actions that they should have, we did not conclude that the care provided was unreasonable. Given this, we did not uphold this complaint.

Summary

C complained about the care and treatment of A, who had a background of complex medical conditions, including a history of diabetes, heart disease, chronic kidney disease and cardiorenal syndrome (a chronic disorder and imbalance of the heart and kidney function).

A was admitted to hospital three times over the course of approximately eight weeks. A had surgery for a fractured hip. After surgery, A developed bilateral non-arteritic anterior ischaemic optic neuropathy (NAION, a rare condition that causes sight loss). C complained about the medical and nursing care that A received.

We took independent advice from a consultant renal physician (a specialist in kidney conditions), a consultant ophthalmologist (a specialist in eye conditions) and a cardiac nurse (a nurse who specialises in heart conditions). We found that the board provided reasonable medical care to A over the course of their three admissions. Therefore, we did not uphold this part of the complaint.

We found that on one occasion, A was unreasonably recorded as being able to attend the toilet independently overnight, when A had an accident. In all other aspects, the board provided reasonable nursing care to A. Therefore, on balance, we did not uphold this part of the complaint.

Summary

C complained that there had been a lack of neurological (of the nervous system) support for their family member (A). A sustained a traumatic brain injury (TBI) that required emergency surgery, and was transferred to the board under the care of neurology. C said that staff dismissed their concerns about A’s worsening condition and that A was being managed for their epilepsy as opposed to someone with a TBI. They also complained that there had been an unreasonable delay in identifying the disconnected shunt (a thin tube implanted in the brain to direct excess cerebrospinal fluid (CSF) to another part of the body), despite A’s symptoms.

The board said that the neurology team had been managing A’s epilepsy but in the absence of a consultant in neurological rehabilitation they had been seeking to provide general support and make appropriate referrals. It was acknowledged that there was a lack of NHS services for TBI rehabilitation generally throughout Scotland. The board also said that the disconnected shunt was not necessarily the cause of A’s symptoms.

We took independent advice from consultant neurologist. We found that the management provided to A was appropriate with relevant referrals made. However, given the significant head injury suffered by A, we found that the consultant neurologist could have met with them at an earlier date. The information available indicates that the first meeting did not take place until some 14 months after A’s head injury. An earlier meeting would have assisted A in terms of general support and also in managing their expectations whilst providing confidence and reassurance that their condition was being managed in the best way possible. In relation to the time taken to identify the disconnected shunt, we considered that the evidence available indicated appropriate and timely steps were taken by clinical staff.

We did not uphold C's complaints. However, we did provide feedback to the board in relation to the timing of the first meeting between A and the consultant neurologist.

Summary

C complained on behalf of their partner (A) about the care and treatment provided to A by the board when they presented to the obstetric triage department 25 weeks’ gestation with pain and abdominal tightening. A was assessed as having Braxton Hicks (when the womb contracts and relaxes during pregnancy, also known as ‘false labour’) given advice on what to do if their condition worsened, and discharged. Four weeks’ later A suffered preterm prelabour rupture of the membranes (PPROM) and their child was delivered prematurely.

C complained about the care and treatment provided to A as they considered the assessment at 25 weeks’ gestation was a missed opportunity for further investigation or follow-up.

The board’s complaint investigation identified that according to local guidelines, A should have been reviewed by a more senior doctor. However, they were of the view that it was unlikely that this would have led to a different outcome.

We took independent advice from a medical adviser. We found that while there were some areas for potential improvement, overall the care and treatment provided to A was reasonable. We therefore did not uphold C's complaint, though we did provide feedback to the board according to the adviser’s comments.

Summary

C complained about the council’s decsion to build a prison facility next to their and others’ property. C’s complaint covers the council’s planning and environmental health services.

Regarding the planning process, C considered the council had failed to safeguard neighbouring residents when granting planning permission. C said the council did not consider the proximity of the houses to the prison and the soil type present on the site. They also felt that a Noise Impact Assessment should be carried out. C said this resulted in damage to property, issues with noise and vibration, and the loss of house value.

We took independent advice from a planning adviser. We concluded that the council had carried out their planning obligations, in line with relevant legislation, guidance and policies. We recognised that C disagreed with the council’s position but concluded that the council handled the planning applications reasonably. Therefore, we did not uphold this part of C’s complaint.

In respect of the environmental health service, C said that the council failed to safeguard them during the construction of the new facility. They explained that they experienced noise and vibration issues. C said these vibrations caused visible damage to their property.

We found that the council’s environmental health service acted reasonably in response to concerns raised by C. It was for the council to decide whether the threshold was met for noise and vibration from the construction site to be considered a statutory nuisance. We were satisfied that the council had provided reasonable explanations for why this threshold was not met. Therefore, we did not uphold this part of C’s complaint.

Summary

C complained about the care and treatment they received from the board when they attended the hospital with pain and a tight feeling in their leg. C raised concerns that the board failed to: reasonably assess them on admission to hospital, and undertake the correct scans; provide them with timely information about their test results; reasonably identify an arterial clot and diagnose their condition; and provide them with reasonable treatment following admission to hospital.

We took independent advice from a consultant in acute medicine. We found that a detailed clinical assessment of C’s right leg and foot was carried out on their admission to hospital, and that it was reasonable that the clinicians did not identify an arterial clot at that time. We found that the possible diagnoses that were considered at the time were correct, and the diagnosis of plantar fasciitis was a reasonable conclusion to have reached. We also found that the correct scan had been carried out to exclude deep vein thrombosis (DVT, a blood clot in a vein) as a cause of C’s symptoms, and that the care and attention C received from medical staff was reasonable.

Therefore, we did not uphold C’s complaint.

Summary

C complained about the standard of medical care and treatment provided by the board to their late sibling (A) during a long admission to hospital. A’s medical history was complex as they suffered from a number of life threatening conditions during their hospital admission and they were under the care of a number of specialities. It was not until after A died, when the post mortem was performed, that A’s cancer was identified.

C said that the various clinicians should have identified A’s cancer, and that communication was not reasonable. C also said clinicians did not manage A’s pain well which was unreasonable and very distressing for the family.

We took independent advice from specialists in urology (urinary system and male reproductive organs), cardiology (heart), radiology (imaging) and end of life care. We found that treatment decisions were reasonable, and that the board managed A’s pain in a reasonable way. We also found that it was reasonable for clinicians not to have diagnosed A with cancer. Therefore, we did not uphold C’s complaints.

However, there were aspects of communication that the board should consider improving and we provided this as feedback.

Summary

C complained on behalf of their late partner (A) who died from a stroke caused by a blood clot. A was admitted to hospital with seizures after collapsing at home and sustaining a head injury. A couple of days later A was identified to have had a stroke, and they died the next day. C complained that an MRI scan was not carried out in order to verify the cause of A’s seizures (a blood clot), in a timely manner to enable acute stroke interventions.

We took independent advice from a consultant in intensive care medicine and a consultant stroke physician. We found that receiving a CT head scan when A first presented was appropriate. A working diagnosis of seizure was reasonable at that time. We found that it was reasonable that time critical acute stroke interventions were not indicated, and therefore an MRI was not indicated. A repeat CT scan did not show any significant changes from the initial scan. We noted that an MRI scan at this point would have been unlikely to have altered A’s immediate management.

C was concerned that placing A in a medically induced coma masked the progression of the stroke, however, we found that this action was in keeping with guidelines. We considered that the clinical management of A was reasonable. Therefore, we did not uphold C’s complaint.

Summary

C complained in relation to their late child (A) and the actions of the social work services. A suffered from significant and life-limiting health conditions. During the final months of A’s life, a number of healthcare and education professionals raised concerns about C’s approach to A’s medical needs and care. Social workers made contact with C and initiated a child protection investigation, which ultimately did not establish child protection issues.

C complained that contact that they received from the partnership, both via the phone and in person, was harassing and unreasonable. C considered that the partnership failed to recognise that the reports of other agencies were inaccurate, and harassing in nature, and had displayed bias by ignoring C’s views in this regard.

We took independent advice from an experienced social worker. We found that it was evident that healthcare professionals had been concerned about A and had notified social workers of these concerns. In making enquiries and initiating a child protection investigation, social work services had followed the process set out in the National Guidance for Child Protection and in doing so had acted appropriately. While we recognise the difficult circumstances involved, I did not uphold C’s complaint.

Summary

C is a kidney transplant patient who was suffering from COVID-19 when they were admitted to hospital. C’s COVID-19 worsened and C developed blood clots in their lungs. C was treated with anti-coagulant medication. However, over time C developed a haematoma (a collection of blood) in their right arm and a large haematoma which caused permanent damage to nerves in C’s left thigh. C complained that staff had not been proactive enough in monitoring the effects of the anti-coagulant medication or in managing the blood clots and haematomas. C also complained that a referral to a neurologist should have taken place at the time and would have improved their long term prognosis.

The board explained that the effect of the anti-coagulant was not usually measured, but could be useful in patients with kidney disease. They had therefore monitored as required. Medication was changed due to concerns that the blood clots were getting worse and then stopped in light of the bleed into C’s thigh. A neurology referral was not made, as following discussion with surgical and radiological experts it was determined that supportive therapy was the most suitable management strategy for C’s case.

We took advice from a consultant haematologist and consultant neurologist. We found that C had both blood clots and significant bleeding. Both can be life-threatening, and treating one may make the other worse. We found that the monitoring and management of the anti-coagulant medication and the management of the haematomas and blood clots was reasonable and that it was reasonable not to refer to neurology and not to have considered femoral neuropathy. Therefore, we did not uphold the complaint.