Not upheld, no recommendations

Summary

C is an advocate who complains on behalf of A. A has a brain injury which impacts on their daily living tasks and functioning. C complained that A received poor treatment from their GP practice and that there were delays in making referrals for specialist input following a fall down stairs which made A’s existing health conditions worse.

We took independent advice from a GP adviser. We found that A's treatment had been reasonable. We noted that A had come to the practice with a number of previous unresolved problems. We considered that A's new GPs were right to be mindful that A's neurological symptoms had already been assessed as 'functional', meaning they had no known physical cause.

C also complained about repeated prescription of antibiotics. We found that this did not seem excessive given the poor general state of A's health and that referrals for specialist input had been appropriate. Therefore, we did not uphold C's complaints.

Summary

C has Asperger's Syndrome (a form of autism, in which people may find difficulty in social relationships and in communicating) / Autistic Spectrum Disorder and a diagnosis of chronic fatigue and Functional Neurological Symptom Disorder (symptoms in the body which appear to be caused by problems in the nervous system but which are not caused by a physical neurological disease or disorder). They were referred by their GP to neurology (specialists in the nervous system) to explore a possible neurological basis for their pain symptoms. C raised a number of concerns about this consultation. C complained that no meaningful assessment took place, that the conclusions were unreasonable and that the consultant neurologist wrongly stated a psychiatric opinion by stating that they had a complex personality disorder. C also noted that there were inaccuracies in the board's response to their complaint.

The board responded to C's individual concerns and concluded that overall, they considered the assessment was reasonable.

We reviewed the relevant medical records, evidence provided by C and took independent advice from a consultant neurologist adviser. We found that there were not any significant failings and that the assessment was of a reasonable standard, consistent with General Medical Council guidelines and that the reasons for the referral were reasonably addressed. We did not uphold the complaint.

Summary

A was admitted to A&E at the Royal Hospital for Sick Children with symptoms including retching, a purple rash on their leg and feeling agitated. A had a diagnosis of quadriplegic cerebral palsy (form of cerebral palsy in which all four limbs are affected), was non-verbal and received PEG feeding (passing a thin tube through the skin to give food, fluids and medicines directly into the stomach). A was subsequently admitted to hospital after assessment.

A was observed in hospital and underwent a number of investigations. A gastrojejunal tube (when a thin, long tube is threaded into the jejunal portion of the small intestine) was inserted to address concerns about A's nutrition. A became increasingly distressed following the procedure and their condition deteriorated. A underwent emergency surgery where a caecal volvulus (obstruction of the bowel) was diagnosed.

C complained to the board that they had missed several opportunities to diagnose and treat the bowel obstruction which was causing A's symptoms. The board produced a report detailing the history of A's care and decision making during the period. The main finding was that there were no identified failings in the care provided to A and that there was no misdiagnosis of A's condition.

Dissatisfied with the board's response to the complaint, C brought their complaint to our office. We took independent advice from a paediatric gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas) and a paediatric radiologist (a specialist in the analysis of images of the body). We found that the investigations and treatment provided were appropriate. There was a delay in obtaining a CT scan, however the delay was relatively small in the context of the period of A's admission. As such, we found that the care and treatment provided to A was reasonable and we did not uphold the complaint.

There were some aspects of care which we identified as being suitable to feedback to the board for reflection and consideration.

Summary

C complained to the practice about a failure of their GP to offer them a face to face consultation when they reported being concerned about a breast lump. C was given a telephone consultation only. C was not seen for a further three months and when they attended the breast clinic, C was diagnosed with breast cancer.

We took independent advice from a GP. We found that the GP had acted reasonably in that the plan was to review C two weeks following the telephone consultation should the symptoms not have resolved. C did not contact the practice for a number of months and when they did, appropriate referrals were made to specialists for further consideration. We did not uphold the complaint.

Summary

C's parent (A) had been treated for kidney cancer and then developed cancer of the bladder. They were receiving dialysis three times a week. The GP practice in this case is managed by the board. A developed back pain and called out a GP, who prescribed dihydrocodeine (an opiate painkiller). They remained in pain the following day and called out another GP, who prescribed diazepam (a medicine used to treat anxiety) and told A to double the dose of dihydrocodeine. After increasing the dosage of dihydrocodeine A became drowsy and unresponsive. They were admitted to hospital and transferred to the Intensive Care Unit for dialysis but did not improve and died of multiple organ failure, and presumed ischaemic bowel disease (lack of blood flow to the intestine). Their death certificate also recorded end stage renal failure and a trial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate). C complained that A's GPs should not have prescribed these medications because of A's renal failure.

We took independent advice from a GP adviser. We found that each GP had assessed and treated A appropriately, taking into account their presenting symptoms and existing health concerns. We noted that A's treatment options were significantly limited by their renal failure. We found that it was appropriate to prescribe opiates, as pain control was the objective and A was due dialysis which would significantly reduce the risk of toxicity. We found that although the medications had a sedative effect, they did not cause A's subsequent death. We found some shortcomings in documentation but were satisfied that the board had addressed this matter. We found that the GP treatment provided to A was of a reasonable standard and therefore did not uphold this complaint.

Summary

C complained that the council failed to communicate with them reasonably in respect of the strategies used to prevent their child (A) being bullied at school by another pupil (B). Specifically, C complained about not being aware of the strategy in place for B at lunchtimes which resulted in A meeting B unaccompanied. C also complained about the effectiveness of the strategies used to protect A from B, noting their particular concern about both pupils being taught in the same location. However, in accordance with the SPSO Act 2002 we refrained from commenting on the quality of the strategies used. Rather, we investigated whether the council had acted in keeping with their policies and procedures.

We found that the council had implemented strategies in line with their policies and procedures, and that these were kept under review. We also found evidence of regular communication with C and A. Of note, the incident where A encountered B occurred outside of school grounds. As the strategies in place where only applicable within the school and its grounds, we did not find the communication with C on this matter to be unreasonable. We also concluded that the strategies implemented by the school were in keeping with the council's policies and procedures and that steps had been taken to mitigate against A encountering B.

Therefore, we did not uphold C's complaint.

Summary

C's late partner (A) tested positive for COVID-19. A's condition worsened over time and C called 111 as they were concerned A's breathing was becoming laboured. C had to wait around 20 minutes before the call was answered. Once connected, the call lasted around 30 minutes. The call handler contacted the Scottish Ambulance Service (SAS) and said that they were 'looking to arrange an immediate response for a patient'. A's condition deteriorated further and C made a 999 call around ten minutes after ending the call to 111, as assistance had not yet arrived. However, by the time paramedics arrived, A had stopped breathing and could not be resuscitated.

C complained about the length of time it took for an ambulance to arrive. They complained that paramedics did not arrive in personal protective equipment (PPE), and considered that they wasted time getting dressed outside when it was an emergency call. C also queried whether a defibrillator (an electronic device that applies an electric shock to restore the rhythm of a fibrillating heart) had been used as they could not hear any shock being administered.

We took independent advice from a paramedic. With regard to the initial call from NHS 24, we found that this had been dealt with appropriately. The call taker had assigned the request for an ambulance the correct level of priority, in terms of the SAS coding system in place at the time. Therefore, we did not uphold this aspect of the complaint. However, we noted weaknesses in the NHS 24-SAS service interaction and suggested that SAS review the process and consider making improvements if necessary.

We found that the response to the 999 call was reasonable, proportionate and timely. We noted that it would not have been appropriate to provide shock to A, given their clinical condition. We also accepted SAS' explanation as to why crew required to put on PPE when they arrived at the scene, which was necessary for infection control. We did not uphold this complaint.

Summary

C complained about delays in treatment that was meant to be provided to their late spouse (A). They told us that A had been referred to the board from another area for heart surgery, but that this took so long to arrange, A's condition deteriorated to a point that surgery was no longer viable and they subsequently died. C was also concerned about the board's handling of their complaints about the matter.

We took independent advice from a cardiology consultant (a specialist in diseases and abnormalities of the heart). We found that, while there were delays in arranging scans, these were the responsibility of the board in A's home area, so Lothian NHS Board could not be said to be responsible for this.

With regards to C's concerns about complaints handling, we found that the board's approach had been reasonable, with appropriately empathetic language used throughout and regular updates provided.

Given these points, we did not uphold C's complaints.

Summary

C, an advocate, complained on behalf of their client (B) about the care and treatment provided to B's late spouse (A). A had attended their GP practice complaining of pain between the shoulder blades and breathlessness on exertion and was seen by a nurse practitioner. The nurse referred A to hospital for a chest x-ray which they received the next day. A then received further x-rays throughout the month following attendances at A&E. They were referred to another hospital where they were later diagnosed with advanced lung cancer.

B complained about the about the nurse's assessment and that the practice failed to follow up on the chest x-ray they referred A for, and failed to follow up on their various attendances at A&E. Had they done so, B considered that A might have been diagnosed sooner.

We took independent advice from a nurse and a GP. We found that the assessment by the nurse practitioner was reasonable and the decision to refer A for chest x-ray and spirometry (a simple test used to help diagnose and monitor certain lung conditions) was appropriate.

In relation to the x-ray taken after the nurse's referral, the results recommended referral to respiratory medicine but the practice did not receive the report until after A's death. We found that it was the responsibility of radiology (specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) to send the x-ray report to the GP, which in this case had not happened and would not expect a practice to chase up records. We also noted that the practice now log all investigation requests and check that results have been returned, which is good practice and above the standard level of care.

In relation to the various attendances at A&E, we found that it is not expected of the practice to follow up on these attendances. There was no mention in the discharge letters sent to the GP of any action required.

Therefore, we did not uphold C's complaints.

Summary

C complained that the board failed to provide them with reasonable treatment. C was hospitalised with a right sided homonymous hemianopia (a visual field defect involving the two right, or the two left, halves of the visual fields of both eyes). C believed that a previously diagnosed arachnoid cyst (a non-cancerous fluid-filled sac that grows on the brain or spinal cord) could be the underlying cause of their clinical symptoms. C underwent CT and MRI scanning.

The board concluded that C's arachnoid cyst was stable and unchanged from a previous MRI, and was unlikely to be the cause of their vision loss. Following a deterioration in their symptoms, C sought private neurosurgical opinion (specialist in surgery on the nervous system, especially the brain and spinal cord) and underwent a craniotomy (procedure to open skull to gain access to the brain) to drain the cyst resulting in partial and ongoing recovery of their vision.

C complained to the board that they should have been referred for neurosurgical review and received treatment through the NHS pathway sooner. They said that clinicians leading their care had repeatedly dismissed their concerns that the cyst could be the underlying cause of their symptoms and had excluded several sources of significant information from the clinical decision-making process, including a discrepancy in the scan measurements which had in fact shown the cyst had increased in size.

We took independent advice from a neurosurgical adviser. We found that, despite a marginal increase in the cyst identified through retrospective radiology analysis, C's progressively worsening symptoms could not have been explained purely on the basis of imaging, and there was no evidence to support an argument that an earlier opinion from a neurosurgeon should have been requested. Our investigations found that although multi-disciplinary opinion may have been helpful in this particular case given C's continuing and unexplained neurological symptoms, the board had carried out appropriate investigations and specialist opinions had been sought on multiple occasions to inform decision-making regarding C's care pathway. Therefore, we did not uphold the complaint.

In investigating C's complaint, the board identified that there had been a break in their communications with C. We considered the action taken by the board to address this had been reasonable; however reminded them that in line with the published Model Complaints Handling Procedure, steps should be taken to ensure complainants are kept up to date and given revised timescales for response.