Not upheld, no recommendations

Summary

C complained about the board, regarding their treatment of a benign cyst. C complained that since being seen by the board they failed to take a proactive approach despite the pain and discomfort they were experiencing. C also complained that the board unreasonably prescribed antibiotics for an infection of the cyst which later transpired to not have been present.

On investigation, we took independent advice from a GP clinical adviser. We found that the board's treatment of C had been overall reasonable. On this basis, we did not uphold C's complaint.

Summary

C complained about Scottish Ambulance Service's (SAS) failure to take appropriate action in response to patient A's symptoms. A had been ill for approximately two days with a high temperature, fever, followed by diarrhoea, trouble passing urine, extreme pain, breathlessness and struggling with mobility. When the SAS crew attended to A at home, an assessment was carried out and senior clinical advice was sought from the out-of-hours GP. It was decided that A did not require to be admitted at that time.

The following day A was admitted to hospital and later died from sepsis (blood infection). C complained that the SAS crew failed to recognise the signs of sepsis and to take the appropriate action in response to their symptoms.

As part of our investigation, we reviewed the relevant records and sought independent advice from a registered paramedic. We found that the SAS crew carried out an appropriate assessment of A's condition and that there was sufficient evidence that the possibility of sepsis was considered. We found that the SAS took the appropriate action in response to A's symptoms and we did not uphold the complaint.

Summary

C's child (A) had complex needs as a result of a brain injury sustained when they were four years old. Given A's care needs, they had an Anticipatory Care Plan (ACP) in place which was reviewed regularly.

A was admitted to a general ward at Ninewells Hospital with a high temperature and was subsequently moved to a high dependency unit. A died three days following admission.

C complained about the inappropriate use of Hi-Flo Nasal Cannula Oxygen (high-flow oxygen, a form of respiratory support) despite concerns raised at the time. C complained that incorrect decisions were taken with respect to A's care and treatment, including that clinicians did not have appropriate regard to the ACP that was in place.

In response to the complaint, the health board carried out a Mortality Review and shared its findings with C. The findings were that care was maximised in the High Dependency Unit as it was not felt A would survive admission to Paediatric Intensive Care Unit, and that this decision together with the decision not to intubate was made with C's input. The variation in care from the ACP was discussed with C and highlights plans are flexible.

C complained to our office that clinicians failed to follow the ACP, that they did not take their views into consideration and that A died of carbon monoxide poisoning as a result of the decisions made in relation to A's treatment and care.

We took independent advice from a consultant paediatrician. We found that there was good documentation evidencing that clinicians had discussed A's care with C, including decisions not to intubate A. We considered treatment with high-flow oxygen was reasonable in the circumstances. Whilst the ACP was not followed, and the board identified this, the ACP is not a legally binding document and the decisions to deviate from the ACP were reasonable in the circumstances. A's cause of death is consistent with the evidence within the medical records. We concluded that A's care and treatment was reasonable and did not uphold the complaint.

Summary

C attended the A&E at Ninewells Hospital with back pain and leg weakness, and was discharged with a diagnosis of suspected sciatica (back and leg pain caused by irritation or compression of the sciatic nerve). C had attended a neurology (the science of the nerves and the nervous system, especially of the diseases affecting them) out-patient clinic earlier that day regarding a separate matter, and the neurologist had noted a foot drop (a muscular weakness or paralysis that makes it difficult to lift the front part of the foot). C complained that the A&E failed to accurately assess them and refer them on to neurosurgery (surgery of the brain or other nerve tissue). C was assessed by neurosurgery four days later, following an urgent GP referral, and was diagnosed with disc prolapse (ruptured disc in the spine) and nerve compression (direct pressure on a nerve) requiring surgery that same day.

The board advised that, while the A&E doctor noted reduced power in C's left leg, they did not feel that foot drop was present and that they felt that sciatica was the most likely diagnosis. The board noted that the neurologist's observation that C had foot drop was not based on a physical examination, whereas the A&E doctor documented a physical examination. The board also noted that local neurosurgical referral guidelines state patients with back pain and sciatica with neurological deficit should be referred to physiotherapy prior to referral to neurosurgery. They concluded that C received appropriate care that was in keeping with relevant guidelines.

We took independent advice from a consultant in emergency medicine. We found that C's assessment and management in the A&E was reasonable and appropriate. We found that the mild weakness documented on assessment in the A&E was not in keeping with a foot drop and that it did not indicate that a neurosurgical referral was required at that time. The A&E discharge letter documented that C was advised to see their GP, and we noted that it was reasonable and in line with common practice for the A&E to ask the GP to follow-up rather than refer directly to physiotherapy. Therefore, we did not uphold the complaint.

Summary

C complained about the treatment provided to their late partner (A). A had reported a number of symptoms by telephone to their practice but they had not made arrangements to see them in person and C said that, as a result, they did not receive appropriate care and treatment. A reported symptoms over a period of time. However, A began to have seizures and tests revealed that A had lesions on their brain. C believed that the practice should have acted earlier and that A's condition could have been diagnosed sooner.

We took independent advice from an adviser who is an experienced GP. We found that the practice had provided A with appropriate care and treatment based on their reported symptoms. There was no evidence that A required an earlier face-to-face appointment or that red flag symptoms were missed.

We did not uphold the complaint.

Summary

C, a support and advocacy worker, complained on behalf of their client (A). A presented to the practice with symptoms of stomach pain and upper and lower backpain. Following several consultations, a GP referred A for an abdominal and renal ultrasound on a routine basis. A was contacted by the hospital with an appointment and was advised that their GP could expedite this if they considered it appropriate. A was referred on an urgent basis by the practice to gastroenterology (specialism of the treatment of conditions affecting the liver, intestine and pancreas) which later confirmed A's diagnosis of cancer.

A complained to the practice that they had failed to expedite the referral despite their worsening symptoms. A believes that if they had been referred to secondary hospital services punctually and had obtained a timely diagnosis, their medical treatment would not have been as invasive and that the risk of cancer spreading to other organs would have been reduced.

In response to the complaint the practice said that an urgent referral was sent to gastroenterology when it was clear that A's symptoms had progressed. A was dissatisfied with the practice's response and C brought the complaint to our office on A's behalf.

During our investigation we requested independent advice on the practice's consultations with A and the arrangements for referring A for further investigations. We found that the decision to refer A initially on a routine basis for an ultrasound was reasonable, given A's symptoms. We found that the medical records indicated consultations with A were reasonable and on the basis of the progression of A's symptoms, there was no unreasonable delay in the urgent referral to gastroenterology being made. We found that the referrals were reasonable and there was no unreasonable delay in making them, as such we did not uphold the complaint.

We provided some feedback to the practice on the management of A's pain.

Summary

C complained that the practice failed to provide appropriate care and treatment to their late child (A). A had a lump removed from their eye lid which was subsequently diagnosed to be cancerous. A went to see their doctor with severe pain in their left arm, which moved to their right arm and neck. A was prescribed painkillers and referred to physiotherapy. A returned from a family holiday and, still suffering from severe pain which had worsened, saw another doctor. A's painkillers were changed and they were referred to physiotherapy.

After a further consultation, A was referred for an x-ray which identified that A's C6 vertebrae had collapsed and that there was a cancerous tumour. A died a few months later.

C complained that doctors at the practice failed to respond to A's symptoms in a reasonable manner given A's history of cancer. C complained that it took A to attend the practice on a number of occasions before appropriate treatment/investigations were undertaken. C believed that had doctors taken account of A's previous history, A would have received appropriate treatment sooner. A considered that the practice failed to investigate and respond to their complaint appropriately.

We took independent advice from a medical adviser. We found that the practice's consultations with C were reasonable. There was no unreasonable delay in the decision to refer C for an x-ray. We did not uphold this aspect of the complaint.

With respect to the complaints handling, we found that there was a misapprehension on the practice's part about the handling of the complaint which resulted in a failure to communicate with C in accordance with their complaints handling procedure. However, the practice had investigated the complaint and provided an accurate and detailed response within a reasonable timeframe and, on balance we did not uphold this aspect of the complaint. We provided feedback to the practice on their obligations with respect to complaints handling.

Summary

C complained about the council after being issued with a number of warnings against their tenancy for antisocial behaviour. C said that the reports of antisocial behaviour were false accusations made by a number of neighbours motivated by discrimination. They told us that the council had unreasonably accepted corroboration between the neighbours, who were friends, but would not accept corroboration from C's parents for their counter allegations.

On investigation, we found that the council had a reasonable evidence base to support their decisions. We considered that the council could show that they had considered all of the evidence and circumstances in reaching the decisions to issue warnings and that these were therefore decisions that were reasonably within their discretion to make.

As such, we did not uphold the complaint.

Summary

C's spouse (A) had long term health conditions. A attended a hospital appointment with C in relation to A's health and was told by a clinician that a CT scan (computerised tomography) dating from the previous year showed A had a sticky heart valve (when a valve does not fully open to allow enough blood to flow through). This was the first time that A and C had been told of any heart problem, and A had not undergone any treatment for heart valve problems in the past. Shortly after this, A was examined at hospital and on this occasion found to have a heart murmur. C complained to the board about not being told of the sticky heart valve. In their response, the board said that they could find no evidence in the records of A having been diagnosed with any form of heart problem prior to the detection of a heart murmur.

A later died and following this, C complained to the board about what they considered was a failure to disclose heart problems sooner and provide timely treatment. C was dissatisfied with the board's response to their complaint and asked us to investigate.

We took independent advice from a cardiology adviser. We did not find evidence that the board unreasonably failed to inform A that they had a heart valve condition or that the board unreasonably delayed treating A for a heart valve condition. We therefore did not uphold either complaint.

Summary

C complained about the care and treatment they received from the board. C experienced pain and discomfort when eating and suffered from gastro-oesophageal reflux (stomach acid travelling up towards the throat). C's gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) ordered a barium swallow test (BST, a special type of X-ray test where barium is swallowed which shows up clearly on an x-ray to help diagnose problems with swallowing and the oesophagus). The radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) who reviewed the images reported them as normal. C complained about the care and treatment provided by the gastroenterologist and the radiologist's interpretation of the BST.

We took independent advice from a consultant radiologist and a consultant gastroenterologist. We found that there were small osteophytes (bony lumps that grow on the bones of the spine or around the joints) in the spine on the BST images. However, these were small and insignificant. We found that images had been thoroughly reviewed by the radiologists and that there was no demonstrable compression of or leakage from the oesophagus. We also considered that the suggestion to change C's medications was reasonable and good clinical practice. The BST showed that no further investigations were required. Therefore, we did not uphold this aspect of C's complaint.

C also complained about how the board responded to their complaint. We found that the complaint response may not have been as in depth as C would have preferred, and that the conclusions of the medical staff were not what C was hoping for, however that did not mean the response was unreasonable. There was a delay in providing a complaint response to C, however we found that these were caused by the COVID-19 pandemic and from a further submission of information by C. We found these explanations to be reasonable and did not uphold this aspect of C's complaint.