Not upheld, no recommendations

Summary

Mr C complained about the care and treatment he received at Inverclyde Royal Hospital for arthritis in his thumbs. He said that following initial treatment with steroid injections, the consultant orthopaedic surgeon at the hospital suggested Mr C have surgery on his left thumb. The procedure involved the removal of the trapezium (a small bone at the base of the thumb) and filling the space with a tendon sling. The surgery was carried out by an orthopaedic registrar under the supervision of the consultant and Mr C said it was unsuccessful.

Mr C raised several concerns about his care and treatment. Mr C complained that despite assurance from the consultant that he would be carrying out the procedure, the consultant unreasonably allowed the registrar to perform it. He also said that at the review clinics following surgery, the consultant dismissed Mr C's concerns about his hand getting smaller, muscle wastage, an enlarged vein in his elbow and pain in his shoulder.

We took independent medical advice from a consultant orthopaedic and trauma surgeon and found that there was no evidence in Mr C's records to indicate that the consultant committed to undertaking the surgery. We acknowledged that Mr C said the consultant gave this undertaking, but without documentary evidence it was not possible to determine exactly what had happened. The adviser said it was appropriate for the registrar to carry out the surgery assisted by the consultant.

The adviser found that the care and treatment following Mr C's surgery was appropriate and that his symptoms were not the direct result of the surgery.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Mrs A). Mrs A's husband (Mr A) underwent surgery at Glasgow Western Infirmary to repair an abdominal aortic aneurysm (a swelling of the main blood vessel that leads away from the heart which, when enlarged, can burst and cause fatal internal bleeding). Mr A's surgery was successful, however he later had to undergo a further operation to address a complication he suffered. This second surgery was also successful. Two days later Mr A had a sudden cardiac arrest and died. This was the result of a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs) from a deep vein thrombosis (DVT - a blood clot in a vein). Ms C asked us to investigate Mrs A's concerns about the medical treatment that Mr A received during the original operation to repair the aneurysm and the risks of DVT.

We took independent advice from a consultant vascular surgeon and found that Mr A suffered an uncommon but recognised complication of his initial surgery, and that this had been dealt with appropriately. The adviser did not consider there to have been any unreasonable failing in the medical treatment provided. In relation to the prevention of DVT, the advice we received highlighted that there had been a reasonable assessment of risk and that preventative measures appropriate to Mr A had been taken. We did not uphold the complaint.

Summary

Mrs C complained that her child (baby A) had been incorrectly treated for tongue tie at Glasgow Royal Infirmary. Tongue tie is a problem affecting some babies with a tight piece of skin between the underside of their tongue and the floor of their mouth. Mrs C also complained that medical staff had provided her with inaccurate advice about her child's care and treatment. Mrs C said that in response to her complaint, medical staff had given misleading accounts of a consultation and a subsequent phone conversation. She also said that she had been denied a second opinion.

We took independent advice from a specialist in surgery for children, who found that baby A had been provided with the appropriate care and treatment. The adviser found that baby A had been referred for a second opinion to a specialist in this type of surgery. We were also advised that the appropriate surgery had been performed and that staff had appropriately suggested that baby A's health visitor make a further referral to Speech and Language Therapy services.

We found there was no evidence that staff had deliberately misrepresented their interactions with Mrs C. We found that the care and treatment was appropriate and that baby A had been referred for a second opinion.

Summary

Mrs C complained that over a 12-month period, two doctors at her medical practice failed to provide her with appropriate clinical treatment for her back. Mrs C said that when an MRI scan was eventually arranged, this showed that she had a tumour on her spinal cord which she had surgery to remove.

Mrs C said the two doctors at the practice failed to listen to her when she explained her ongoing symptoms and asked for help, failed to undertake appropriate assessments and investigations, and failed to arrange appropriate specialist referrals.

We took independent medical advice and found that the two doctors communicated reasonably with Mrs C, undertook appropriate assessments, investigations and referrals and provided her with appropriate treatments based on her clinical symptoms at the time. We found that the doctors followed the Scottish Government back pain guidelines and the Healthcare Improvement Scotland referral guidelines for suspected cancer and said that the care Mrs C received was of a reasonable standard. The adviser also explained that GPs could not arrange referrals for MRI scans and that such scans could only be requested by a physiotherapist or a hospital specialist. We therefore concluded that the doctors did not fail to provide Mrs C with appropriate clinical treatment in view of her reported symptoms and we did not uphold her complaint.

Summary

Ms C had surgery for breast cancer in her right breast. She reported a lump in her breast 11 years later. Further tests were carried out at Forth Valley Royal Hospital but did not show evidence of cancer. Ms C was followed up with repeat tests which identified a local recurrence of cancer. Ms C then had a mastectomy (an operation to remove the breast), which showed no evidence of cancer. Later, a marker clip (a small titanium clip used to mark the site) initially placed at the time of the biopsy was removed along with surrounding tissue, which also did not show evidence of cancer.

Ms C complained that she should have undergone more tests and should have been reviewed every four weeks after the lump was identified. She also complained that the mastectomy may not have been required and had concerns about the lack of action taken in response to the marker clip that had not been removed at the time of the mastectomy.

We took independent medical advice from a consultant breast surgeon and a consultant radiologist. We did not find failings in Ms C's care and treatment before or after the mastectomy. We considered that she received appropriate tests and was reviewed within a reasonable timescale. In addition, given there was evidence of invasive cancer identified from a biopsy and Ms C's history of previous radiotherapy for breast cancer, we considered that the mastectomy was warranted. In terms of the marker clip, we found that there were no failings in relation to mastectomy technique and that reasonable steps were taken to remove it and check the surrounding tissue. We did not uphold Mrs C's complaint.

Summary

Mrs C was required to travel outwith the board area for treatment of a rare condition from which she suffers. She complained that the board's policy of reimbursing after travel, rather than paying upfront, caused her financial hardship. The board confirmed that it was their policy only to reimburse on production of receipts and Mrs C's request for upfront payment was refused. We were satisfied that the board acted in line with their documented procedure and we did not uphold the complaint.

However, the board acknowledged a need to consider exceptional circumstances on a case-by-case basis. They subsequently reviewed their procedure and established that other health boards have an ability to make payment in advance. They updated their procedure to include a provision for making upfront payments where exceptional circumstances are deemed to exist. We considered this action reasonable and had no further recommendations to make.

Mrs C raised further concerns that the board had refused to pay her the associated costs of travel, such as the cost of meals and childcare. We did not take this forward as the board's procedure clearly set out that only the costs of travel and accommodation are eligible for reimbursement. In addition, Mrs C complained that the board had communicated poorly with her and, while we noted there were occasions where they delayed in responding to her requests for information, we were satisfied that they had already explained, and apologised for, these delays.

Summary

Miss C had been experiencing poor health over a number of months and made a suicide attempt by medication overdose. She contacted NHS 24 and was taken to University Hospital Ayr. Miss C's symptoms included slurred speech and problems with walking. Miss C was assessed by nursing, medical and psychiatric staff and was later discharged. The following day, she attended with the same symptoms and was again discharged home. The next day, Miss C's GP arranged for her to attend University Hospital Crosshouse. A scan confirmed Miss C had a brain tumour, which was subsequently operated on. Miss C complained that, despite her presenting symptoms, she was not properly assessed or treated when she attended at University Hospital Ayr.

We took independent advice from a specialist in emergency medicine. We found that at the initial admission, the focus of attention had been on the immediate presenting problems of Miss C's mental health and the effects of the overdose and that the assessment and treatment provided that day were appropriate and reasonable. The adviser said that in normal circumstances, the symptoms Miss C presented with on her second attendance at the hospital should have resulted in further investigation. In this case, however, the adviser noted that the doctors involved had felt it was likely that Miss C's presenting symptoms were related to the overdose the previous day and that it was reasonable that they reached this conclusion. Therefore, we concluded that the assessment was reasonable. We also reviewed Miss C's records and were satisfied that the treatment she received was appropriate. Therefore we did not uphold Miss C's complaint.

Summary

Mr C complained about the care and treatment he received for a diabetic foot ulcer. Mr C had been receiving treatment for diabetes-related foot problems for an extended period. Due to difficulties with recurrent infection and Mr C's difficulty in complying with his treatment programme, he was fitted with a special cast to protect the ulcer on his foot. Mr C complained that the cast had been too tight and had damaged his foot, resulting in the possible amputation of his toe.

The board said no injury had been noted to Mr C's toe prior to the removal of the cast. They suggested that the injury had taken place between the removal of the cast and a subsequent medical review. The board said that the cast had been appropriately applied and reviewed and that the care and treatment had been of a reasonable standard.

We sought independent medical advice and found that Mr C's cast had been an appropriate course of treatment. There was no evidence that it had been incorrectly applied, or that it had damaged Mr C's foot. There was no record of a wound to Mr C's toe when the cast was removed. Mr C's medical review following removal of the foot cast did not attribute the injury to the cast. We also found that Mr C's ulcer had reduced whilst the cast was on his foot, demonstrating that the treatment had worked as planned.

We found that Mr C's care and treatment had been of a reasonable standard. The cast to his foot had been applied and removed by an appropriate specialist and there was no evidence to link the injury to his toe to the cast.

Summary

Mr C complained about the care and treatment he received from his medical practice. He was concerned that the GP inappropriately prescribed him steroid medication for asthma which caused his heart rate to increase, requiring hospital treatment. Mr C felt that his GP dismissed his ongoing concerns about his heart rate and breathlessness.

We took independent advice from a GP adviser and considered that it was appropriate that Mr C's GP diagnosed worsening asthma and prescribed steroid medication in accordance with national guidance. In addition, whilst Mr C had been diagnosed previously with atrial fibrillation (where the heart beats irregularly and faster than normal), the type of steroid prescribed was not specifically associated with this condition. Therefore we considered that it was reasonable practice to prescribe this treatment and did not uphold Mr C's complaint.

Summary

Ms C complained about a three-month suspension from her studies imposed by the University of Glasgow. As an overseas student, she felt that the suspension disproportionately put her visa at risk. She also said that it excluded her from all studies and access to her tutor, caused her to incur unnecessary accommodation and course fees and affected her access to health support services.

We considered that in relation to Ms C's suspension, the university had acted in accordance with their code of student conduct procedures. We noted that when either Ms C or her solicitor contacted the university during the period of suspension with concerns related to Ms C's visa or access to her tutor, the university took reasonable steps to address these matters. In addition, Ms C had access to support services at the university by appointment. We also noted that the university had apologised to Ms C for not clarifying that she could access her student accommodation during the suspension. However, we did not consider this a significant procedural failing and noted that Ms C chose to reside elsewhere at this time. We concluded that the university had fully investigated the consequences of the suspension for Ms C and made reasonable adjustments to the code of student conduct in respect of suspensions. We did not uphold Ms C's complaint.