Not upheld, no recommendations

Summary

Mr C complained about the care and treatment provided to his late father (Mr A) when he was admitted to Aberdeen Royal Infirmary early in 2015. Clinicians said Mr A had an inflammatory mass in keeping with complicated appendicitis (inflammation of the appendix) and was treated with antibiotics and discharged. Mr A was readmitted to hospital the following month when his abdominal pain worsened and he was diagnosed with an aggressive form of cancer that had spread. Mr C complained that despite Mr A presenting with symptoms indicating a serious condition, clinicians failed to consider the possibility of bowel cancer and carry out appropriate tests, investigations and referrals.

We took independent advice from our medical adviser. We found that the care and treatment provided by the board was reasonable including that referrals and investigations were arranged within a reasonable time during both of Mr A's admissions to hospital. We were also satisfied there was no evidence suggesting that hospital clinicians missed symptoms suggesting bowel cancer.

Summary

Mr C said that his late father (Mr A) attended the GP practice on a number of occasions with symptoms indicating a serious condition. He said that the practice unreasonably failed to consider the possibility of bowel cancer and carry out appropriate tests, investigations and referrals. Mr A died a few months after several admissions to hospital where he was diagnosed with bowel cancer.

We took independent advice from a GP adviser. We found that the care and treatment provided by the practice was reasonable including that referrals and investigations were arranged within a reasonable time before Mr A's first admission to hospital. We also found no evidence suggesting that the practice failed to monitor Mr A appropriately when he was discharged from hospital.

Summary

Mr C, an advice worker, complained about the treatment which his client (Mr A) received when he attended a consultation. Mr A had a previous medical history of facial and arm weakness and was thought to have long-standing hydrocephalus (build-up of fluid on the brain). He saw a GP as he wanted to have further investigations in order to reach a diagnosis. Mr A felt the GP had dismissed his symptoms. Mr A was admitted to hospital two days later with worsening neck and back pain, increasing confusion, poor mobility, right upper limb weakness and urinary incontinence. Over the next six months Mr A was found to have stable chronic hydrocephalus along with possible abscesses (painful swellings caused by a build-up of puss) of his neck and the area between the spine and spinal cord. It was subsequently discovered he had chronic discitis (infection of the vertebral disc space). Mr A believed that the GP had dismissed his symptoms and that his condition had deteriorated because of the delays which he had encountered.

We took independent medical advice from a GP and concluded that the GP had provided a reasonable level of care. When Mr A had attended the consultation the GP was aware of Mr A's medical history, including that he had attended hospital the previous day. He carried out an appropriate examination given the symptoms which were presented. There was no indication at that time for a hospital admission. It was clear from the records that Mr A's condition deteriorated two days after the GP consultation and it was only then that a hospital admission was appropriate. We did not uphold the complaint.

Summary

Miss C complained about the care and treatment received by her late father (Mr A). Mr A had an MRI (magnetic resonance imaging) scan at Forth Valley Royal Hospital to investigate leg weakness. The scan revealed an incidental finding of a six centimetre abdominal aortic aneurysm (AAA - a bulging of the aorta, one of the largest blood vessels in the body, which runs from the heart to the legs). This had not yet been shared with Mr A when he took unwell a few days later and, while being transported to hospital in an ambulance, he went into cardiac arrest and died. Miss C complained about the time taken to share and act upon the findings of the MRI scan.

The board informed Miss C that, in line with normal practice, the MRI was flagged for urgent reporting within two to three days. They explained that immediate intervention would only be arranged where there was evidence that the AAA had ruptured, which there was not in Mr A's case. They noted that the MRI was reported three days later and an urgent referral was made to the vascular team two days after that. This was the day of Mr A's death. The board noted that further tests would have been required and the national target for elective treatment of aneurysms is 42 days. They therefore considered that even if Mr A had been referred to the vascular team on the same day as the MRI scan, it would have been a few weeks before he received treatment.

We took independent medical advice from a consultant physician. They noted that, while they could not be certain of the cause of death, the risk of the AAA rupturing was low and that the board attributed Mr A's death to a heart attack. They noted that Mr A did not have any symptoms suggestive of a rupture at the time of his scan and they considered that the scan was reported and acted on within an appropriate timeframe. We accepted this advice and concluded that the outcome could not reasonably have been prevented.

Summary

Mr C complained that the board had failed to carry out the hernia surgery at Forth Valley Royal Hospital that he had consented to and that they had failed to provide him with appropriate treatment following the surgery. Mr C said as consequence he suffered from regular and severe pain, which impacted on his quality of life and ability to work.

We found Mr C underwent surgery in the summer of 2012 without incident, although he did then attend the A&E department at the hospital complaining of pain at the wound site. He was examined and discharged as no cause for alarm could be identified. Mr C was reviewed in late 2012 and early 2013, and although a further review appointment was made, Mr C did not attend. In the absence of contact from Mr C, no further appointments were offered.

Mr C was re-referred by his GP and seen in 2015. He was reviewed in clinic by the surgeon who had performed the operation and provided with a scan of the area, which confirmed that the hernia had not reoccurred. Mr C was unhappy with the outcome of this review and a second opinion was arranged.

We took independent advice from a consultant colorectal surgeon, who said that the treatment Mr C had received was appropriate. The relevant consent documents had been filled in and signed and the operation had been performed in accordance with normal surgical procedure. There was no evidence that the operation performed was not the one Mr C consented to. The adviser also said the reviews of Mr C had been carried out appropriately post-surgery and it was reasonable to have referred him for a second opinion when the relationship with medical staff broke down.

We found there was no evidence Mr C had not consented to the operation performed on him, or that he had received inadequate care following the second surgery and did not uphold the complaint.

Summary

Ms C complained about the care and treatment she had received from her former GP practice. Ms C felt that doctors there had not managed an ongoing medical condition effectively and that there had been a delay in treating her acne. Ms C was also concerned by the practice's approach to her mental health.

After taking independent advice on this case from a GP, we did not uphold Ms C's complaint. The advice we received was that there were no failings in the care or treatment of Ms C's physical or mental health. The adviser reviewed Ms C's medical records and commented that her acne had been appropriately treated on the first occasion it was mentioned in her notes. They advised that responsibility for managing her ongoing condition lay with the local NHS board, rather than the practice, and that appropriate action had been taken in relation to Ms C's mental health.

Summary

Mr A's mother and partner complained about the care that Mr A received from the medical practice after he visited them with a number of different symptoms including tiredness, sweating and backache. Mr A was later diagnosed with testicular cancer and they felt that doctors has incorrectly attributed his symptoms to his existing long-term condition. They were concerned that there had been a failure to conduct appropriate investigations as a result and that an emergency hospital referral should have been made when Mr A's condition deteriorated.

After taking independent advice from a GP, we did not uphold these complaints. We received advice that there was no evidence that doctors had attributed Mr A's symptoms to his existing condition and we found that they had arranged appropriate investigations to determine the cause of his illness. The adviser also considered that the practice had made appropriate timely referrals for Mr A.

Summary

Mr C complained to us about the care and treatment provided to his mother (Mrs A) at Dumfries and Galloway Royal Infirmary before her death. Mrs A's GP had referred her to hospital. At that time, she had end stage kidney failure, but did not want dialysis (a form of treatment that replicates many of the kidney's functions) for this. Mrs A died four days later and the cause of death was recorded as pneumonia. It was also recorded at that time that Mrs A had deteriorated despite antibiotics and that her kidney function had worsened. Mr C had subsequently complained to the board about the care provided to Mrs A.

We took independent advice on Mr C's complaint from a medical adviser who is a consultant geriatrician. We found that although it would have been better to carry out an x-ray on Mrs A on the night she was admitted rather than waiting until the following morning, this delay did not alter her treatment. It would, however, have given the clinicians and Mrs A's family more information about her condition. We also found that Mrs A had been able to make her own decisions and had expressed strong wishes that she did not wish to be subjected to cardiopulmonary resuscitation in the event of a cardiac arrest. Although the form confirming that she should not be resuscitated had not been countersigned by a senior doctor as required, the senior doctors had recorded their agreement with the decision in the notes.

It is difficult balance between very active care to keep patients alive and then switching to palliative care once it is clear they are dying. We found that, overall, the care provided to Mrs A before her death had been reasonable. We did not uphold Mr C's complaint.

Summary

Miss C's baby was not lying properly, but was in the breech position (legs downward). After unsuccessful attempts to turn the baby, she was booked in for a caesarean section (an operation to deliver a baby which involves cutting the front of the abdomen and womb). However, several days before the planned caesarean, Miss C began experiencing labour pains and called Ayrshire Maternity Unit. She was asked to come in and was reviewed, then sent back home. Two days later she called again and was asked to come in. Miss C was then admitted and monitored on the ward. She was reviewed by a doctor on several occasions, but told she was not in active labour and a caesarean was planned for the following morning. However, Miss C continued to experience symptoms and a consultant reviewed her and found she was in active labour. Miss C was sent immediately to the labour suite, where her baby was born a few minutes later. Miss C complained about the advice she was given on the phone and the management of the birth, in particular that staff did not recognise that she was in labour and arrange an emergency caesarean.

Staff from the board met with Miss C to discuss her complaint. They explained that when she was examined by the first doctor her cervix was closed, which meant that she was not in active labour. They also explained that, because Miss C's baby was under 39 weeks, the doctor wanted to prescribe steroids and allow time for these to work before conducting a caesarean (to decrease the risk of breathing problems for the baby).

After taking independent obstetric and midwifery advice, we did not uphold Miss C's complaint. We found that Miss C experienced rapid labour, which could not have been predicted by staff, and the care and treatment was reasonable in light of the circumstances known to staff at the time.

Summary

Miss C complained that her university did not support her after she returned from suspension of studies, and about the university's handling of her academic appeal.

We considered the information provided by Miss C and the university. We found that the university, in good faith, accepted certification from Miss C's GP that she was fit to return to study, and that Miss C had given the university no reason to question this until she appealed against the decision to withdraw her from study. The university provided evidence of email exchanges between Miss C and staff from after she returned from suspension and they reiterated that Miss C was certified by her GP as fit to study and that she did not inform the university of any problem at the time. They also said that there were no procedures relating to specific support in a situation where a student was returning from suspension of studies having been declared fit to return. We also found that the university dealt with Miss C's appeal in line with their procedures.

On the matter of Miss C's academic appeal, we saw no evidence that the university's handling of the appeal was inadequate and we therefore did not uphold this aspect of her complaint.

We were in no doubt that Miss C had health issues that had a significant impact on her, and the university were also aware of this. However, we found no evidence that the university failed to follow their procedures and, therefore, we did not uphold Miss C's complaints.