Not upheld, no recommendations

Summary

Mrs C complained to us that after having had surgery on her wrist she attended the medical practice to have four stitches removed by the practice nurse. The practice nurse removed the stitches but Mrs C continued to have problems with the wound site and developed infections. She was referred back to the clinic where the surgery was performed and it was discovered that one of the stitches had not been removed and was the cause of the infections. Mrs C believed that the practice had failed to appropriately remove all of the stitches following the surgery.

We took independent advice from an adviser in general practice medicine and a nursing adviser. The clinical adviser said that the practice had provided Mrs C with appropriate treatment when she reported concerns following the surgery. The doctors prescribed antibiotic medication and made an appropriate referral for an orthopaedic opinion. The nursing adviser explained that a recognised complication when removing stitches is that a small piece can remain under the skin but would, over time, make its way to the surface. This could cause infection but would not necessarily indicate that a failing in care had occurred. In light of the advice we received, we did not uphold Mrs C's complaint.

Summary

Mr C complained about the dental care and treatment he received at the dental practice. Mr C attended the practice frequently over the course of a year, both for routine and emergency appointments. Mr C complained that at an appointment a dentist conducted an excessive investigation, causing two of his crowns to fall out during the following months. Mr C also raised broader concerns that failures in his care led his dental health to decline to a point where he required significant restorative work and multiple extractions.

The board considered there was no evidence that an excessive investigation had caused the collapse of Mr C's crowns, which they linked with existing decay. More generally, the board said Mr C's care and treatment was appropriate.

After receiving independent advice from a dental practitioner, we did not uphold Mr C's complaint. We found there was no evidence that an excessive investigation occurred. We found the care and treatment Mr C received was reasonable.

Summary

Mrs C complained about the management of her child's birth at Aberdeen Maternity Hospital. Mrs C's waters broke prior to labour, and although labour then commenced naturally, she made slow progress and developed a high temperature. In view of this, Mrs C was taken to the delivery theatre and, after a failed attempt with forceps, her baby was delivered via caesarean. Mrs C felt staff should have arranged a caesarean earlier and said she asked for this during her labour. She also raised concerns about the caesarean, in particular that there were retained products of conception (pieces of placenta left in the uterus) which caused ongoing complications and further surgery. Mrs C said the doctor was rude, did not adequately explain her treatment, and lied in their response to her complaint.

The board responded to several letters and met with Mrs C twice to discuss her concerns. They apologised that she felt the doctor had been rude to her, and the doctor attended the second meeting to offer their personal assurance that this was not their intention. The board considered Mrs C's medical treatment was appropriate (although they gave conflicting information about whether Mrs C had asked for a caesarean during her labour). They explained that Mrs C had a CT scan (which uses x-rays and a computer to create detailed images of the inside of the body) after the birth. They said that the CT scan was clear, so staff did not consider there were retained products of conception at that time (although they were sorry Mrs C experienced complications from this).

After taking independent medical advice from a consultant obstetrician and gynaecologist, we did not uphold Mrs C's complaints. We found staff had appropriately discussed Mrs C's treatment options, and there was no evidence that she asked for a caesarean during labour. The adviser said the retained products of conception were quite small, so it was not unreasonable that staff missed these (they also noted that cleaning the uterus too thoroughly can cause scarring and reduced fertility). We also found it was reasonable that staff did not identify Mrs C's retained products of conception during her admission, based on her CT scan and symptoms at the time.

Summary

Mrs C complained about the care she received prior to replacement pacemaker surgery at the Golden Jubilee National Hospital. She was concerned that her premedication had worn off before being taken to theatre and that the anaesthetist had missed the vein when cannulating her (inserting a thin tube into a vein). Mrs C was also in great pain when the anaesthetic drug was administered. When Mrs C came round from surgery, the cannula had been transferred to her other hand, and her hair was stained due to the solution used to cleanse the skin prior to the procedure and she had to have her hair cut. Mrs C also said that she had suffered from tinnitus since the procedure.

We took independent advice from an anaesthetist. We found that the medical records indicated a safe, uneventful anaesthetic procedure and that there were no failings. We were also satisfied that there was no evidence suggesting that failings by the anaesthetist led to Mrs C developing tinnitus.

Summary

Mr C complained that a district nurse had wrongly carried out a procedure to reinsert a catheter at home. The district nurse failed to reinsert the catheter three times and he had to be taken to hospital for the catheter to be reinserted. At hospital it was established that a false passage had been created during the attempts at catheterisation. The hospital successfully reinserted the catheter. Mr C felt that the district nurse had not followed protocols when attempting to reinsert the catheter.

We obtained independent advice on the case from a nurse adviser. She said that there were problems when the district nurse tried unsuccessfully to reinsert the catheter and that contact was made with Mr C's GP for advice. It was decided to arrange a non emergency ambulance to take Mr C to hospital for the catheter to be reinserted. The adviser said that Mr C had suffered a relatively rare but recognised complication of catheterisation and that this did not necessarily mean that there had been a failure in carrying out the procedure. It was also noted that attempts at catheterisation were made in the hospital, and therefore we could not be certain exactly when the problem arose. We did not uphold the complaint.

Summary

Ms C complained on behalf of her mother (Mrs A) who had been a patient in Victoria Hospital. Ms C felt that her mother should not have been asked if she agreed to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) being put on her notes, as her mother was in a state of delirium. Ms C said that she, as next of kin, should make the decision, not hospital staff.

We looked at Mrs A's medical records and we took independent advice from an consultant geriatrician. We found that hospital staff had documented their consideration of Mrs A's situation and their actions to a reasonable standard, and they had acted in accordance with the relevant guidance on resuscitation and DNACPR. The guidance is clear that a patient with capacity can consent to or refuse CPR, and if they lack capacity the decision rests not with the next of kin, but with a legally appointed proxy or with the lead clinician. In general terms, overall responsibility for making a decision about CPR rests with the lead clinician. In the circumstances, we did not uphold Ms C's complaint.

Summary

Mrs C suffers from fibromyalgia (a long term condition that causes pain all over the body). Over the course of several years, she received a number of treatments including acupuncture and attended the pain management clinic at Crosshouse Hospital. Unfortunately, none of the treatments resulted in good control of Mrs C's pain and, in early 2014, a decision was made to discontinue her acupuncture course and to discharge her. It was suggested that she attend a pain management programme but Mrs C disagreed and complained to the board.

We took independent advice from a consultant in anaesthesia and pain specialist and we found that Mrs C had received all the standard pain management approaches for fibromyalgia but that her treatment had not been successful. We learned that this was not uncommon. Mrs C had also had a second opinion but it was agreed that there was little that could be done for her that would likely make a significant lasting difference and that it would be futile to continue.

While it was evident that Mrs C suffers considerable pain and it was hugely disappointing that medication or other intervention would not help her, there was no evidence to suggest that this was the consequence of any action or inaction on the part of the board. For this reason, we did not uphold the complaint.

Summary

Mr C contacted NHS24 to tell them that he had taken an overdose of paracetamol. He was advised to go to the local A&E department as soon as possible for blood tests and treatment. He agreed to do so. He called back some time later advising that he no longer intended to go to A&E. As a result, NHS24 asked a doctor from the board's GP out-of-hours service to call him. The doctor called and discussed the potential impact of the overdose and highlighted how important it was to attend A&E but Mr C still refused to attend. Following the call, the doctor discussed Mr C's call with the specialist mental health team and they suggested that the doctor call for an ambulance to attend Mr C's home.

Mr C complained to our office as he was unhappy that the doctor failed to take appropriate steps to ensure he was safe following the call.

We considered Mr C's concerns and reviewed the board's records. We also sought independent advice from an adviser who is a GP. Having done so, we were satisfied that the doctor did provide appropriate advice to Mr C and, by calling an ambulance, the doctor had taken appropriate steps to ensure his safety. As a result, we did not uphold the complaint.

Summary

Mr C complained that the college had behaved in a discriminatory fashion in assessing his eligibility for bursary funding. Mr C said that he was medically discharged from his previous employment and was therefore receiving an occupational pension, but only because he had been deemed unfit to work by that employer. Mr C was refused a bursary to cover the cost of his course expenses by the college. He appealed this, but the college said they were bound to apply the guidance provided by the Scottish Funding Council.

Mr C complained that the determination that he would have to fund his course expenses was unreasonable and that the college's bursary policy was not in keeping with the relevant equalities legislation. He also said they had failed to handle his complaint properly.

We took independent advice from an equalities adviser on the equality and diversity requirements the college's policies had to meet. The adviser said that the college were able to evidence that they had considered the impact of these policies and they could not, therefore, be considered discriminatory.

We found the college had reasonably determined Mr C's bursary application as they had followed the appropriate procedures when doing so. Their bursary policy complied with the relevant equalities legislation. We also found that there was no evidence Mr C had made a formal complaint to the college. As there had been confusion over who he had to complain to about the decision not to grant him a bursary, we exercised our discretion and investigated the case. We did not uphold Mr C's complaints.

Summary

Mr C complained on behalf of his daughter (Miss A) that the Scottish Qualifications Authority had acted unreasonably by failing to follow their marking review procedure in relation to elements of Miss A's Higher Drama exam.

Miss A failed her Higher Drama exam. Her school asked the SQA to review her results. The SQA reviewed her written assessment, but Mr C was unhappy that they did not review the performance aspect of the examination too.

Following our investigation, we established that the marking of the question paper of Miss A's Higher Drama exam had been reviewed within the post-results service offered by the SQA, however, the performance elements had only been given a clerical check (the marks were not reviewed). We were satisfied that the SQA procedure was that centres could opt to record the performing exams. This offers pupils the opportunity to enter into the full marking review process in relation to a review of the performance element. However, recording was not mandatory and centres who chose not to record the performing exam could still request a review of the question paper. Miss A's school had not opted to record the performance and, therefore, they were unable to enter into the full marking review process in relation to the performance elements of her assessment. We were satisfied that the SQA had made centres (including schools) aware of this before the exam. In light of this, we did not uphold Mr C's complaint.