Not upheld, no recommendations

Summary

Mrs C, an advocacy worker, submitted a complaint on behalf of her client (Ms A) regarding the care and treatment received by Ms A's late brother (Mr A) from his medical practice. Ms A complained about the time taken for the practice to diagnose her brother's cancer and about a failure to involve her in his care and listen to her concerns about his deteriorating condition. Mr A had a history of mental and physical health problems and had been diagnosed with renal cancer several months after being discharged from hospital, where he had been an in-patient for over 15 years. After being diagnosed with cancer, Mr A died the following month.

We took independent medical advice from a GP. The adviser did not consider that there were any unreasonable delays in investigating Mr A's symptoms and referring him to a hospital specialist. They noted that the practice took reasonable steps to try to have hospital investigations happen sooner and remained alert to the potential need for hospital admission. The adviser observed that Mr A had capacity and was entitled to decline investigation, as he did on occasion. However, they considered that the relevant investigations were carried out and that additional assessments, at the times these were declined, would not have changed Mr A's diagnosis or treatment plan. They also considered that, from the available evidence, Mr A's care appeared to have been appropriately discussed with Ms A and her concerns taken into account. We accepted the advice received and did not uphold the complaints.

Summary

Miss C said that although she had been attending her GP since January 2013, he failed to take her concerns and symptoms seriously. She said that it was not until she attended the surgery with her partner in August 2014 that she was referred to a hospital consultant. She was then diagnosed with a brain tumour.

The complaint was investigated and we took independent advice from a medical adviser who is a GP. We found that early in 2013, Miss C's optician had written to her GP asking him to arrange for her to see an ophthalmologist (a doctor who specialises in diseases and injuries in and around the eye). He did so and Miss C attended the ophthalmology clinic. She remained in ophthalmology care until her discharge four months later. After that, Miss C saw her GP twice, both times for shoulder complaints. It was not until she attended her GP in August 2014 complaining of previously unrecorded symptoms that the possibility of a brain tumour was suspected and then diagnosed following her referral to hospital. We found no evidence of delay or a failure to treat appropriately.

Taking all of this into account, whilst recognising the challenges Miss C has had to face, we did not uphold the complaint.

Summary

Mrs C, who is an advocacy worker, complained on behalf of her client (Mrs B). Mrs B said that her mother (Mrs A) was left without proper care and support from her local medical practice. She said that they failed to recognise the seriousness of Mrs A's condition and she died as a consequence.

We took independent advice from a medical adviser who is a GP. We found that Mrs A had very complex medical problems. She had severe artery disease and had already had a leg amputated above the knee. She also had severe heart disease. Mrs A was being cared for in the community. When the practice were alerted to the fact that she had a small necrotic area (a patch of dead tissue) on her leg stump which had been there for three to four weeks, a GP assessed Mrs A at home and decided that she be reviewed urgently. A day later, the practice were advised that the affected area was deteriorating. Contact was attempted with both Mrs A and the warden of her accommodation but this proved impossible as neither answered the phone. A home visit was then arranged for the next day. Meanwhile, Mrs A was taken into hospital where she died a few days later. We did not uphold the complaint as we were satisfied that the practice had taken all reasonable action in the circumstances.

Summary

Mrs C complained on behalf of her mother (Mrs A). Mrs A had been diagnosed late with Hodgkin lymphoma (a type of cancer of the lymphatic system, a network of vessels and glands throughout the body). Mrs C believed that the practice had failed to spot clear symptoms of the disease over an extended period.

We took independent advice from a medical adviser who is a GP. The adviser reviewed Mrs A's medical records in detail. They noted that some of the tests Mrs C believed should have been performed could only be requested by a specialist following review in hospital. The adviser stated that Mrs A had not presented with typical symptoms of Hodgkin lymphoma and her existing medical conditions had made her diagnosis more complex. Mrs A had not met the criteria for referral under Scottish cancer referral guidelines and had been referred urgently for investigation by the practice on several occasions.

We found that the practice had provided a reasonable standard of care and treatment to Mrs A. We found there was no evidence that symptoms of Hodgkin lymphoma had been overlooked, or that referrals should have been made sooner.

Summary

Mr C's daughter (Ms A) gave birth to a baby boy. Her pregnancy had been normal until the 32nd week when her blood pressure was noted to be high. She was monitored for pre-eclampsia (a pregnancy-related condition involving a combination of raised blood pressure and protein in the urine). Following the birth, Ms A suffered episodes of diarrhoea. This appeared to resolve and she was discharged home with her new baby. Midwives visited her at home over the following days and noted that she had had further episodes of sickness and diarrhoea, but again these were noted to have resolved.

Nine days after the birth, Ms A advised the attending midwife that she was unwell with tiredness, light-headedness, diarrhoea and vomiting. The midwife also recorded concerns about the baby's weight. Whilst arrangements were made for the baby to go back into hospital for checks, Ms A advised that she would attend her GP. Ms A became increasingly unwell and called Mr C for assistance. He took her to the Royal Alexandra Hospital where her condition continued to worsen. Ms A died of sepsis (infection in the blood) eleven days after giving birth to her son.

Mr C raised a number of complaints about the board's monitoring of Ms A's condition, the midwives' failure to note how ill Ms A was, and their failure to take Ms A back to hospital at the same time as her son. In each instance, we were satisfied that, based on the information available to staff at the time, there was no indication of a serious underlying condition. We acknowledged that the board had already highlighted some issues and had taken action to prevent these from happening again. We did not consider that these issues would have impacted on Ms A's care.

Summary

Mrs C complained about the care her son (Mr A) received from Cornhill Hospital in 2014. Mrs C was unhappy that Mr A's anti-psychotic medication was reduced and that his short-term detention under mental health legislation was revoked.

We took independent advice on this case from two mental health specialists. We found that it was reasonable for the medication to be reduced given that Mr A had not shown signs of psychosis or mood disturbances during his hospital admission. We also found that the decision to revoke the short-term detention was appropriate and in accordance with mental health legislation which sets out that at all times the least restrictive option is consistent with best practice.

Summary

Mrs C complained that her brother (Mr A), who has mental health problems, was able to access alcohol and/or illicit drugs while he was a patient in the Forth Valley Royal Hospital. Mr A did not give his consent for Mrs C to pursue her complaint on his behalf with the board or us, so we were unable to investigate her specific concerns. However, we did investigate the matter in general terms to ensure that the board had sufficiently robust policies and procedures in place to address the types of concerns Mrs C was raising.

We took independent advice from a mental health nursing adviser. We reviewed the relevant national legislation, the Mental Health (Care and Treatment)(Scotland) Act 2003 and the Mental Health (Safety and Security)(Scotland) Regulations 2005. The adviser was satisfied that the board's policies and procedures complied with the legislation and were practical, clear and reasonable. In these specific circumstances, we were unable to determine if the policies and procedures had been followed in Mr A's case. However, we were satisfied that the policies and procedures were sufficiently robust to ensure patient safety if used appropriately.

Summary

Mr C complained that the decision to stop his prescription for co-codamol was unreasonable. He said he had been prescribed the medication for around two years for arthritis but the doctor stopped it without explaining why.

We reviewed Mr C's medical records and we took independent advice from a medical adviser who is a GP. We found that the prison health centre doctor took the decision to stop Mr C's prescription for co-codamol because there was no medical evidence available to indicate that he had arthritis. The adviser told us that the doctor's decision was reasonable. They also confirmed that the doctor prescribed another suitable medication for Mr C's muscular and bone pain.

In light of this information, we did not uphold Mr C's complaint.

Summary

Mrs C complained on behalf of her son (Mr A) who had been admitted to Forth Valley Royal Hospital with chronic liver disease. Mrs C said she believed the care and treatment provided to her son had been inadequate, highlighting poor dietary input as a particular concern. Mrs C also said the decision to discharge him had been inappropriate, as he had refused all treatment at home and died a few days later.

We took independent medical advice on Mr A's treatment and discharge. The adviser said that Mr A had been provided with all treatments short of a liver transplant. The advice noted that Mr A had been adamant that he wished to be discharged and that he was prepared to refuse to eat or drink in order to achieve this. Although it was arguable Mr A should have been made to discharge himself, he had been provided with follow-up care as an out-patient. Mr A had refused to engage with this treatment.

We found Mr A's care and treatment had been reasonable and that the decision to discharge him was also, on balance, reasonable.

Summary

Mr C complained to us about the care and treatment he had received from the board at a prison health centre in relation to his stomach pains. We took independent advice from a medical adviser. We found that the care provided to Mr C in relation to his stomach pains had been of a reasonable standard and we did not uphold the complaint.

Mr C also complained that the board failed to provide a reasonable response to his complaints about this. We were satisfied that the board had acted in line with their complaints procedure and that they had issued a reasonable response to Mr C's concerns. In view of this, we did not uphold this aspect of Mr C's complaint.