Not upheld, no recommendations

Summary

C, an EU student with disabilities, began an MSc at the University of St Andrews. A few weeks later, their symptoms worsened, leading to an inability to continue studies. The university issued a Termination of Studies notice, which C successfully appealed with medical evidence. The university rescinded the termination and applied v-coding (displayed in place of a grade on the transcript in the affected semester(s) and permits the modules to be re-taken, removes the modules from the degree classification algorithms and degree pathway) to the semester, allowing C to restart the course. However, C was required to pay tuition fees again, which they considered unfair and discriminatory, arguing that the university failed to make reasonable adjustments under the Equality Act 2010. C believed that the fee policy ignored the impact of their disability on meeting withdrawal deadlines and contradicted the academic appeal outcome.

The university’s response maintained that C had accepted their Terms and Conditions, including the Tuition Fee Liability policy. Since C did not withdraw or take a leave of absence before the week five deadline and had access to academic materials, they were liable for fees. The university acknowledged C’s circumstances and granted academic adjustments but upheld the fee charges, citing policy compliance.

On enquiry from the SPSO, the university explained that while they lack a formal tuition fee waiver process, they nevertheless consider exceptional cases. They demonstrated that their Tuition Fee Liability, Extenuating Circumstances, and Equality, Diversity and Inclusion policies serve distinct purposes and align with the Equality Act 2010.

The SPSO found no maladministration and noted that discrimination could only be determined by the courts. We concluded that the university reasonably applied their policies and considered C’s circumstances. We did not uphold C's complaint.

Summary

C complained that the Scottish Ambulance Service (SAS) unreasonably delayed in dispatching an ambulance for their late parent (A) and, as a result, this had an adverse impact on A’s care and treatment. C questioned why an SAS call handler initially advised them that an ambulance was not needed, when a locum GP subsequently arranged for one as soon as they learned of A’s condition. Shortly after arriving at A&E, A died following a cardiac arrest.

We took independent advice from a paramedic adviser. We found that the actions of the SAS in relation to the allocation and dispatch of an ambulance for A were reasonable, based on the information, resources, and systems in place at the time. We also found that the project improvement initiatives the SAS are undertaking to mitigate the challenges with the triaging of abdominal pain are reasonable. Therefore, we did not uphold the complaint. We did, however, provide feedback to the SAS that when responding to a complaint, where possible, it would be helpful if they provided the complainant with information and explanation of any improvement initiatives that they are taking to address issues raised within the complaint.

Summary

C complained about the treatment provided to their partner (A) when they were admitted to hospital. A presented to the A&E after they woke up feeling generally unwell. A experienced weakness, lost vision, and pins and needles in their hands and feet. When assessed in the A&E, A gave a history of a three-day headache.

There was a delay in A being assessed in the A&E. Given A’s symptoms, the consultant’s working diagnosis was an atypical migraine. They considered the possibility of a stroke but concluded this was less likely based on A's presentation. A was then transferred to the Acute Medical Unit before quickly being transferred to the care of the Stroke Team. A Computerised Tomography (CT) brain scan was carried out and confirmed a stroke. A further CT scan the next day confirmed that A had suffered a second stroke.

C complained that there was an unreasonable failure by the A&E to diagnose that A had suffered a stroke. In addition to this, C complained that A was not provided appropriate treatment in the form of thrombolysis (medicine to get rid of blood clots in the brain) or thrombectomy (surgery to remove a blood clot or drain fluid from the brain).

We took independent advice from an emergency medicine consultant. We found that an atypical migraine was a reasonable working diagnosis. We found that reasonable consideration was given to the possibility of a stroke and A’s history of diabetes was taken into account.

We considered that there was sufficient reason to arrange a CT scan to assist diagnosis while A was admitted to the A&E. This was due to C’s symptoms and the diagnostic uncertainty. However, earlier imaging was unlikely to have made a material difference to the outcome. In addition to this, we noted that A had suffered a posterior circulation stroke, which is known to be challenging to identify.

We concluded that there was not an unreasonable failure to diagnose A's stroke because of the atypical features of A’s presentation. In addition to this, A was appropriately transferred to the AMU for further investigation, which was promptly carried out. Given the above, we did not uphold this complaint. However, we provided the board with feedback that earlier CT imaging was warranted.

In respect of the treatment provided to A, we found that A would not have been eligible for either thrombolysis or thrombectomy. Overall, we considered the treatment provided to A in the A&E was reasonable. Therefore, we did not uphold this complaint.

Summary

C complained about the care and treatment provided to their late parent (A) by a GP Practice. Following a road traffic accident, A was found to be in atrial fibrillation (a type of heart rhythm where the heartbeat is not steady). The hospital asked the GP to review A for anticoagulation (medication to prevent blood clots from forming or growing) once their injuries had resolved. Several weeks later A had an appointment at the practice and was referred for a 24-hour ECG (a medical test that records the heart’s activity over a 24-hour period). Before the results could be assessed by the practice, A suffered a stroke. C complained that the practice unreasonably delayed in initiating anticoagulant therapy.

We took independent advice from a GP. Following our initial enquiries, the practice provided additional explanation regarding the complexity of the decision making as to whether to prescribe anticoagulation to A, and the reasoning behind their decision to wait for the results of the 24-hour ECG. Following this additional explanation, we considered that the practice’s position and treatment plan was reasonable. We therefore did not uphold the complaint. However, we noted that not everything the practice had said in their further explanation was documented in the medical records and we provided feedback to the practice on this point.

Summary

C complained about the board’s assessment of their parent (A) and the decision not to admit A to hospital for further assessment and treatment. C felt that the board inappropriately relied on information provided on behalf of A, rather than speaking with A directly, and that decisions were based on unreliable information.

A tested positive for COVID-19 in their care home and the following day, care home staff contacted NHS24 about A’s condition and the call was passed to NHS Lanarkshire Out of Hours service. The call was triaged for a clinician to call back, and an out of hours GP contacted the care home shortly afterwards. During the call with the out of hours GP, the decision was taken not to admit A to hospital, but for care home staff to contact A’s GP the following day. A died later that day. In their response, the board explained that the out of hours GP spoke with A’s carers and concluded that an appropriate assessment was undertaken.

We took independent advice from a specialist in general and geriatric medicine. We found that the assessment of A conducted over the telephone was reasonable. The record of the assessment was of the level and standard expected. We concluded that the assessment of A’s condition and the decision not to admit A to hospital at that time was reasonable. We therefore did not uphold the complaint.

Summary

C complained about the care and treatment that they received from the board. In particular, C complained that the board had failed to recognise or timeously act on the significance of the severity of their pain and abdominal symptoms. C later received emergency surgery in treatment of a ruptured caecum including formation of a stoma.

We took independent advice from an obstetric adviser and a general surgery adviser.

We found that C’s care had been reasonably managed in relation to their discharge from obstetrics and their re-admission when symptoms continued. We considered that the plan made for surgery was reasonable, noting the rare and rapidly progressing nature of the complication C experienced. We also considered the board’s own review of the episode of care was reasonable.

We found that there were aspects of C’s care which were unreasonably managed, specifically, that there were incomplete medical records kept following a surgical review. On balance, we considered the standard of care provided to C was reasonable. We did not uphold this complaint.

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.