Not upheld, no recommendations

Summary

Mrs C, who had a history of osteoporosis, fell whilst in Ninewells Hospital. She complained that despite being in a great deal of pain, her back was not x-rayed.

On her discharge, Mrs C complained to the board but they advised that as she had been checked after her fall by increasingly senior doctors who found no bony tenderness, an x-ray had not been required and she had been discharged with appropriate advice. Mrs C learned from a subsequent x-ray that she had suffered a fracture to her spine.

We took independent advice from a consultant in acute medicine. We found that Mrs C had been appropriately assessed and examined after her fall. She had no bony tenderness which would have indicated that an x-ray was required. We also found that even if Mrs C had been x-rayed at the time and a fracture had been found, she would have been given no additional or different medication and her treatment would have remained the same. This was because she was already taking medication for a previous fracture.

We did not uphold the complaint.

Summary

Mrs C suffered hearing loss following minor oral surgery at Perth Royal Infirmary. She complained that the board failed to provide appropriate treatment and failed to adequately explain the risks of the procedure she received.

The board said Mrs C received appropriate treatment. They said the procedure was performed correctly and they considered hearing loss was not a recognised complication, and was unpredictable. They said Mrs C was seen by various specialists, who investigated the complication. The board also considered the risks of the procedure were adequately explained, as the risks Mrs C complained about were unknown and diminishingly rare.

After receiving independent advice from an oral and maxillofacial surgeon, we did not uphold Mrs C's complaint. We found the care provided was appropriate, taking into account the complication could not reasonably have been predicted by the clinicians. We found the board acted appropriately in investigating the complication. We also considered the board did not fail to adequately explain the risks of the procedure, as the risks in question were exceedingly small. We did not uphold Mrs C's complaint.

Summary

Mrs C's husband (Mr A) suffered a suspected stroke at work. An ambulance was called. Mrs C complained that there was an unreasonable delay in an ambulance attending. She was also unhappy that the caller was not properly informed that there were no ambulances currently available and, later, that there was going to be a delay in the ambulance attending.

We took independent advice from a specialist in emergency medicine. The adviser found that the categorisation of the call was reasonable and that, while there was a delay in attending, there are times when demand will exceed capacity and that at these times, it will not be possible to provide a response within an ideal timescale. Therefore, while we accepted that there was a delay, we did not consider that the delay was unreasonable. We also accepted the adviser's view that it was reasonable that initially the caller was told that the ambulance would be there as soon as possible and, in relation to the further call, that it took four minutes before the ambulance arrived, so giving further detail to the caller was not necessary. We therefore did not uphold Mrs C's complaint.

Summary

Mr and Mrs C complained on behalf of their daughter (Miss A) regarding the dental care and treatment she received from the board. Mr and Mrs C complained that Miss A's anxiety was not taken into account whilst the board were attempting to remove two of her teeth over several dental appointments, and that it was decided that the dental treatment was not necessary.

We took independent dental advice and found that the care and treatment provided to Miss A had been reasonable and the board had made many attempts to acclimatise Miss A to receiving dental care. In addition, we found that whilst it had been reasonable for the board to pursue treatment over several months, it was reasonable that they eventually decided not to carry out the treatment as the benefits of treatment no longer outweighed the risks of Miss A's anxiety becoming worse. Therefore, we did not uphold this complaint.

Summary

Mr C told us he waited too long to receive medication for a rash he developed and was unhappy that he had received tablets, rather than ointment or cream, and that this had been discussed with the nurse the previous day.

We found that Mr C had received his medication within roughly 30 hours of asking to see a nurse. He did not receive his medication the same day because, by the time the nurse had discussed his case with a doctor, the deadline for pharmacy orders that day had been missed. Mr C received his medication the following day.

We were satisfied that the treatment suggested, in tablet form, was reasonable. We therefore did not uphold Mr C's complaint.

Summary

Miss C, an advocacy and support worker, complained on behalf of her client (Miss A) that the board failed to provide Miss A with appropriate orthopaedic treatment based on the symptoms she presented with and that they inappropriately treated Miss A less favourably as Miss A has a disability.

Miss A suffered an injury to her shoulder. Miss C raised concerns about a decision by the board's orthopaedic surgeons not to operate on Miss A, including whether the surgeons took into account the views of Miss A's carers and managed her pain appropriately. Miss C also raised concerns about a second opinion provided by another orthopaedic surgeon, who also considered it would not be appropriate to treat the injury surgically.

The board said the care and treatment provided at Monklands Hospital and Hairmyres Hospital was based on the surgeons' assessment of the high risks of surgery and limited likely benefits. The board said this was based on the clinical situation at the time and that Miss A was not inappropriately treated less favourably by reason of disability.

After receiving independent advice from an orthopaedic surgeon, we did not uphold Miss C's complaint. We found it was reasonable of the board's surgeons to have considered there were high potential risks and a limited potential for improving the injury through surgery. We also found that the board appropriately involved Miss A's carers in the decision and managed Miss A's pain reasonably. We found that the board's surgeons were conscious of Miss A's disability in reaching their decision not to operate, but that this was appropriate given the significant impact potential complications would have on Miss A.

Summary

Mr C complained that there was an avoidable delay in a diagnosis of lung cancer after he was referred to Wishaw General Hospital.

We took independent advice from a consultant in general respiratory medicine. The advice we received was that there had been no avoidable delay in making a diagnosis of cancer. Mr C's initial CT scan was abnormal but did not show the typical appearances of lung cancer. The adviser found that the doctors took appropriate steps to ensure the possibility of cancer was not missed. We found that when a further CT scan showed clearer signs of cancer, appropriate management (surgery) was undertaken. We therefore did not uphold Mr C's complaint.

Summary

Mrs C, an advocacy and support worker, complained on behalf of Mrs A that the clinical treatment received by Mrs A at Raigmore Hospital had been of an inadequate standard.

Mrs A had suffered an injury to her calf while on holiday. She had received some treatment, including an MRI scan, but had been told that she did not have an Achilles injury. Mrs A had continued to experience significant pain and discomfort on her return home and attended A&E. Mrs A said she had been examined and told she must walk normally. Mrs A's symptoms did not improve and she attended A&E again on the advice of her physiotherapist. Mrs A was told that she had suffered a calf tear and she was discharged without further treatment.

Mrs A subsequently arranged for her MRI scan to be reviewed privately. This found a tear of her Achilles tendon. When Mrs A returned again to A&E, she was supplied with a protective boot. Mrs A was subsequently seen by an orthopaedic specialist and a complete tear of the Achilles tendon was diagnosed. Her leg was placed in a plaster cast. Mrs C said Mrs A believed that she should have been diagnosed much sooner, that staff had failed to appropriately review the MRI scan results and that they had been unsympathetic to her condition.

The board said they did not believe staff had acted inappropriately towards Mrs A. They said that she had been examined using the standard techniques and that these had not indicated damage to the the Achilles tendon. The board provided information on the reliability of the test, accepting that it was not infallible. They noted the information Mrs A provided about the MRI scan results suggested that she did not have an Achilles tendon injury, which appeared to have been confirmed by her physical examination. The board said that they did not agree with Mrs A's recollections of the attitude of staff towards her.

We took independent advice from a consultant in emergency medicine. The advice we received said there was no clinical reason for staff to question Mrs A's description of the findings from the MRI scan, as this was consistent with the findings from her physical examination. They said that it would not be appropriate for A&E staff to attempt to interpret MRI images as this is a specialist skill. Although the diagnosis had not been accurate, Mrs A's care and treatment had been reasonable.

On the basis of the advice received, we found there were no grounds for upholding Mrs C's complaint. Although the board had failed to identify Mrs A's injury, this was not due to failings on the part of their staff, rather a combination of the original inaccurate interpretation of Mrs A's MRI scan and Mrs A's atypical presentation at the physical examination.

Summary

Miss C complained to us about the failure of the board's radiology department to manage their waiting list in a reasonable manner. She had phoned to cancel an appointment at the Royal Alexandra Hospital for a procedure and was told that as a result she would be placed at the bottom of the waiting list.

Miss C complained to the board that this was not in line with national guidance on waiting times, which stated that the patient should only be placed at the bottom of the waiting list if a reasonable offer (an offer of two or more appointment dates) was declined. In Miss C's case, the board had placed Miss C at the bottom of the waiting list after only one offer and she felt that the board were treating her unfairly.

We found that in terms of national guidance, this was a reasonable approach as long as staff were acting in the spirit of the guidance and provided reasonable explanation for not following part of the guidance.

We found that the board were acting in the spirit of the guidance and that the reason for not making a reasonable offer was reasonable in view of the short timescales for carrying out the procedure. We therefore did not uphold Miss C's complaint.

Summary

Mrs C complained that the board failed to provide her husband (Mr A) with appropriate wound care following his vascular surgery at Queen Elizabeth University Hospital, both at the hospital and after he was discharged home. She said the board failed to respond appropriately when she and Mr A reported concerns about the way Mr A's wound was dressed. She said Mr A should have been referred to doctors to assess his wound and the possibility of re-suturing prior to his discharge from hospital.

We obtained independent nursing advice. The adviser said that the medical records indicated that Mr A's wound was healing well on discharge from hospital and when seen at home by the district nurse and it appeared that after this point, his wound began to dehisce (a surgical complication when the edges of a wound no longer meet).

The adviser considered that the board responded appropriately when Mr A and Mrs C reported concerns about the way Mr A's wound was dressed and that Mr A should not have been referred to doctors to assess his wound and the possibility of re-suturing prior to his discharge from hospital. The adviser said the nursing notes indicated that Mr A's wound was clean and dry on discharge from hospital and therefore there was no need for further review or suturing. We concluded that the board did not fail to provide Mr A with appropriate wound care following his vascular surgery. We therefore did not uphold Mrs C's complaint.