Not upheld, no recommendations

Summary

Miss C complained about care her late mother (Mrs A) received from the medical practice. Mrs A had experienced chest pains and called an ambulance. Paramedics came to Mrs A's home and carried out an echocardiogram (a way of monitoring the heart). The paramedics did not believe Mrs A was suffering angina (chest pain caused by a problem in the blood supply to the heart) or a heart attack. They offered to take her to hospital. Mrs A, however, declined and said she would attend her GP the next morning.

Mrs A attended the practice the following morning, where she was seen by a GP. She was diagnosed with acid reflux and was prescribed medication for this. Mrs A passed away at home later that day.

We took independent advice from one our medical advisers who is a GP. They considered the evidence and found that the GP who treated Mrs A had made a reasonable diagnosis based on the symptoms at the time, and the previous advice of the paramedics. Therefore, we did not uphold the complaint.

Summary

Miss C attended the practice on a number of occasions for acute stomach pain, and was treated with omeprazole (medication for an acid-related stomach disorder or ulcer). Miss C then visited a private GP, who suggested she try esomeprazole (another stomach medication). Miss C told the practice this gave her some relief from her symptoms, and they gave her a repeat prescription. The practice also referred Miss C to a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas) when she requested this (about six weeks after she first reported symptoms). Miss C later arranged a private endoscopy overseas, which showed that she had probably had a stomach ulcer which had now healed.

Miss C complained that the practice failed to diagnose a stomach ulcer and delayed in referring her to gastroenterology. She was also unhappy that the practice did not prescribe esomeprazole until she had received this from a private GP, and she raised concerns that her ulcer could have been caused by the practice prescribing ibuprofen in the past.

After taking independent advice from a GP, we did not uphold Miss C's complaints. We found that the practice's treatment was reasonable, and in line with national guidance on dyspepsia (indigestion) at the time. The adviser explained that Miss C did not have any 'alarm features' to warrant referral to gastroenterology, and omeprazole was an appropriate medication to treat both ulcers and gastritis (inflammation of the stomach). The adviser said Miss C did not take this medication for a long enough period to know whether or not it was effective (before switching to esomeprazole). The adviser also considered that it was reasonable that the practice previously prescribed ibuprofen (while this can cause either ulcers or gastritis, this is rare in patients under 60).

Summary

Miss C suffered from stomach pain and was given medication by her GP practice for an acid-related stomach disorder or an ulcer. She attended the out-of-hours clinic a few days later and was given antibiotics for a urinary tract infection. Miss C continued to suffer symptoms and she was referred for an appointment with a gastroenterologist (a doctor specialising in the treatment of conditions affecting the liver, intestine and pancreas). However, the appointment was delayed and when she was seen about three months later she had few symptoms. The board said Miss C told the gastroenterologist she had stopped taking her stomach medication before the appointment, but Miss C said the gastroenterologist told her during the appointment to stop taking her stomach medication.

The gastroenterologist told Miss C that, if her symptoms returned, her GP could call his secretary to arrange an endoscopy (where a tube-like instrument is put into the body to look inside). Miss C's symptoms returned over the next week and she asked her GP to do this, but her GP had not yet received the clinic letter with these instructions. Miss C then arranged a private endoscopy overseas, which showed she had probably had a stomach ulcer which had now healed.

Miss C complained that the out-of-hours doctor did not diagnose or treat her stomach ulcer, and the gastroenterologist did not arrange an endoscopy. She also raised concerns about the delay in the clinic letter.

After taking independent advice from a GP and a gastroenterologist, we did not uphold Miss C's complaints. We found that the out-of-hours treatment was reasonable, and it was appropriate for them to refer Miss C back to her own GP for management of ongoing symptoms. We also found the gastroenterology care was reasonable, as there was no clinical need for an endoscopy. While there appeared to have been a misunderstanding about the medication, there was no evidence that this was due to a failing by the gastroenterologist. Although the two-week delay in sending the clinic letter was not ideal, we found this was reasonable in the context of Miss C's clinical condition.

Summary

Miss C's mother (Mrs A) was admitted to hospital at Mearnskirk House, following her discharge from the Prince and Princess of Wales Hospice where she received five weeks' care with advanced cancer. Miss C's sister (Mrs D) took their mother home from the hospital and Mrs A was officially discharged from the hospital into Mrs D's care three days later, following a meeting earlier that day at the hospital with medical staff and the family to discuss Mrs A's care.

Miss C complained about the board's decision to discharge her mother from the hospital and the way this decision was made. She listed a number of concerns, including that her mother was discharged without any input from her GP, with no care package in place and with no referral to a district or palliative care team.

We obtained independent medical advice on Miss C's complaint from a consultant physician in elderly care medicine. The adviser said this was an unusual case in that Mrs A had been taken home by Mrs D for a week's trial prior to her formal discharge. The board did not have time to plan Mrs A's discharge in the normal way. Mrs A and Mrs D were adamant that Mrs A should go home and the adviser said it would, therefore, be difficult to be critical of the board if their normal discharge procedure was not followed when they were trying to accommodate Mrs A and Mrs D's wishes. Therefore, we did not conclude that the board unreasonably discharged Mrs A from the hospital.

Summary

Mr A had mental health problems. His mother (Mrs C) complained to us about the care and treatment Mr A received when he attended the Western Infirmary on three occasions after taking overdoses. We took independent advice from a medical adviser, who is a consultant in emergency medicine, and from a psychiatric adviser. We found that the medical care and treatment provided to Mr A when he attended the hospital, along with the care he had received there for his mental health problems, had been reasonable. We did not uphold this aspect of Mrs C's complaint.

Mrs C also complained that staff in the hospital had not treated Mr A with respect and that a member of staff had shouted at him. The notes in the medical records about this specific incident were detailed. However, as always with written records, the exact content of the conversation was impossible to determine and there were differing views of the conversation. There was no clear and objective evidence that a member of staff had shouted at Mr A or that staff had failed to treat him with respect. In the absence of such evidence, we did not uphold this aspect of the complaint.

Finally, Mrs C complained that the follow-up arrangements each time Mr A was discharged from the hospital were unreasonable. We found that Mr A had been physically fit on each occasion that he was discharged, and that the discharge plans in relation to his psychiatric care were reasonable and appropriate. We did not uphold this aspect of Mrs C's complaint.

Summary

Mrs C complained about her mother (Mrs A)'s discharge from Forth Valley Royal Hospital. Mrs A was 82 years old at the time and was admitted with chest pains, later diagnosed as a heart attack. Further to treatment, plans were made to discharge Mrs A but her family were concerned that she remained in poor health. Mrs C said they had alerted staff to Mrs A's breathing difficulties, shivering, leg swelling, lack of appetite and general weakness but were assured that she was fit to go home. Following discharge, Mrs A was readmitted in the early hours of the following morning. She was diagnosed with sepsis and did not recover. She passed away five days later.

Mrs C considered that the signs of sepsis were present prior to Mrs A's discharge and were not detected by staff. The board advised that the results of pre-discharge tests were not consistent with a diagnosis of sepsis. We took independent advice from a consultant in general and geriatric medicine. They noted that Mrs A's symptoms, observations and blood test results were considered prior to discharge and were relatively normal. In particular, they noted that her blood test results were sufficiently normal to allow discharge to proceed. They did not consider that there was any evidence Mrs A was suffering from sepsis at the time and, overall, they considered it reasonable for her to have been discharged. They noted that she was re-admitted a short time later and subsequently died but were not of the view that this could have been reasonably predicted at the time of discharge or that it was due to poor medical care during Mrs A's admission. We did not uphold Mrs C's complaint.

Summary

Mrs C brought a complaint to us on behalf of her late husband (Mr C), in relation to the care and treatment he received over a five week period shortly before his death. She was concerned that the medical practice had not acted with enough urgency when she felt Mr C's condition was deteriorating. He had three consultations with a GP over a four week period. At the final consultation the GP had concerns about his breathing and referred him for an x-ray, which took place the next day. The results of the x-ray indicated that Mr C had pleural effusion (a build-up of excess fluid around the lungs). The results arrived in the practice the following day, and the GP referred Mr C back to hospital when he viewed the results on his return to work the day after. Mr C was treated in hospital, and was discharged home, to await further treatment. He died before this further treatment could take place.

We sought independent advice from a GP adviser. The adviser reviewed all three consultations, and was satisfied that the GP had taken appropriate action, on the basis of the symptoms which Mr C presented with. They noted that there was no indication of pleural effusion until the third consultation.

The adviser also reviewed the practice's response to the x-ray results, and noted that the results did not indicate a need for urgent action. They considered the practice's response to the x-ray results to have been reasonable.

We noted concerns that Mrs C had raised which were beyond the scope of this investigation, in relation to conversations which could not be corroborated. We noted the adviser's comments in relation to the GP's actions, and we did not uphold Mrs C's complaint.

Summary

Mrs C complained that the university did not tell her sooner that the course she applied for was full. She also complained that the university did not deal with her application in line with their process, and about their handling of her complaint.

We found that the university told Mrs C that the course was full as soon as they knew this to be the case, which was the day after the school exam results were issued; it was only then that it became clear to the university that the course had no places available. We also found that the university followed the correct procedure in considering Mrs C's application, and when investigating and responding to her complaint. We did not uphold Mrs C's complaints.

Summary

Mr C complained that his university withdrew him from his course because he failed to attend classes, and about their handling of his appeal.

We found that Mr C was warned about his lack of attendance at classes, and when he was further warned that his case was being considered by a university panel, he failed to engage properly with the process. The university followed the process for dealing with Mr C's lack of attendance and considered the evidence available to them at the time and, on that basis, decided to withdraw him from the course. We also found that the university followed the process for dealing with Mr C's appeal. We did not uphold Mr C's complaints.

Summary

Ms C complained that she had made the university aware of issues she was experiencing at home during her third year of studies in relation to childcare and illness, but they had not informed her of the mitigation process. She also complained that communication she had had with the university had not been responded to. She identified four specific emails to two members of staff which were not responded to.

We found that, in the context of seeking an extension for an assignment and explaining why she had been unable to attend academic support sessions, she had informed staff on these particular occasions that she (or her child) had been unwell or had issues with childcare. It did not appear that Ms C was seeking advice or support on these issues and their impact on her studies; rather they were an explanation for the extension request or the reason for not attending meetings. Therefore, we did not consider that it was unreasonable that staff had not mentioned the mitigation process to her directly in response to these emails. The university also provided us with a copy of the student programme handbook for the course which provided details of how and when to apply for mitigation. We considered that it was Ms C's responsibility to familiarise herself with the information the university had provided. Therefore, we did not uphold her complaint.

In relation to Ms C's second complaint about emails not being responded to, unfortunately, because of the length of time which had passed since these emails had been sent, both the university and Ms C were unable to provide us with sufficient evidence to allow us to establish whether the emails were received and responded to or, if they were not, whether this was unreasonable. Therefore, there were no grounds for us to uphold Ms C's complaint.