Not upheld, no recommendations

Summary

Mrs C complained that there were unreasonable delays in her being diagnosed and treated for functional neurological disorder (a problem with the functioning of the nervous system). She also felt that the board's response to her complaint was inadequate, mainly in that there were inaccuracies regarding her care.

The board did not identify any failings in the care but acknowledged that there had been some incorrect dates given in their response to her complaint.

We took independent advice from two of our medical advisers and concluded that Mrs C received timely assessments with treatment given within a reasonable timescale (about a month after the final diagnosis was reached). We also considered that the board's overall responses adequately responded to the complaint with an apology given for the minor inaccuracies.

Summary

Miss C attended an orthodontic clinic for treatment in 2008 and had braces fitted. She was discharged in 2011 but in 2014 returned to say that part of the retainer had cracked. The clinic offered to repair this but said that it would have to be paid for privately as Miss C had already had one course of paid-for NHS treatment. Miss C felt she should not have to pay for private treatment because she felt that her initial NHS treatment had not been completed adequately, and she was of school age when her treatment started in 2008.

We took independent advice from one of our dental advisers who found no evidence to show that Miss C's course of treatment between 2008 and 2011 was unreasonable. Furthermore, from the evidence available, we found that Miss C did not meet the criteria for NHS-funded treatment when she re-attended the practice in 2014.

Summary

Mrs C complained on behalf of Mr A that the vasectomy (where the tubes that carry sperm from a man's testicles to the penis are cut, blocked or sealed) operation he had at Dr Gray's Hospital was not performed properly and that his aftercare was inappropriate. We obtained independent medical advice from a surgeon experienced in carrying out this procedure, and found that there was evidence from the operation records and the samples taken during and after the surgery to show that the operation was carried out to a reasonable standard. We also considered that Mr A received appropriate care for persistent pain following his surgery and that the review appointments and treatment given were in line with national guidance. Whilst we noted that it took around four months for Mr A to be reviewed at a pain clinic, we found that this period was acceptable and with in the timescales set out in national guidance which acknowledges the constraints on pain clinic services.

Summary

Mr C fractured his ankle which was put in a plaster cast for six weeks. He was told not to bear weight on the foot and was prescribed medication to prevent blood clots forming during this period.

When Mr C's cast was removed, the medication was stopped. He was referred for physiotherapy which took place one week later when he was provided with a sandal-type shoe to wear and given exercises to complete. A follow-up physiotherapy appointment was arranged for three weeks ahead.

Mr C died of a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs) and deep vein thrombosis (DVT - a blood clot in a vein) a week before the follow-up physiotherapy appointment.

Mr C's wife (Mrs C) complained to us, and said that a failure to provide Mr C with appropriate and timely treatment following the removal of his plaster cast had allowed a blood clot to form. This caused him to suffer the pulmonary embolism and DVT which caused his death.

We took independent medical advice from a consultant orthopaedic surgeon who said there was no evidence that Mr C's medication should have been continued after the removal of the plaster cast. Our adviser also considered there was no difference between providing a patient with footwear and leaving the ankle completely free after the removal of the plaster cast. Furthermore, the adviser said that starting early physiotherapy treatment was not known to have any impact on the risk of developing a pulmonary embolism and a DVT.

Our adviser also said DVTs are difficult to diagnose. It was uncertain when Mr C's DVT had started, and fatal pulmonary embolism is a rare but an ever-present risk with surgery even if full prevention measures have been taken. On the basis of the advice we received, we found that the treatment Mr C received was reasonable.

Summary

A Getting It Right For Every Child meeting (a meeting with multi-agency representatives in attendance to share information and to identify any potential risks or concerns) was held to discuss the welfare of Mr C's children. He complained that it was improperly convened and did not adhere to relevant protocols. He specifically complained about the actions of a health visitor who worked for the board and convened the meeting. He was unhappy that he had been excluded from the meeting.

We investigated the complaint and took independent advice from an experienced health professional. We found that the health visitor concerned (and, accordingly, the board) acted reasonably and that appropriate guidance was followed. We did not uphold Mr C's complaint.

Summary

Mr C complained about the decision taken by the prison health centre to stop his medication for nerve pain. He said he was told that the medication had been stopped because he was on methadone. In response to his complaint, the board said the prison health centre decided to stop his prescription because they did not think he needed the medication.

We sought independent medical advice from a GP adviser. She reviewed the evidence available and confirmed that Mr C had a history of past and current drug misuse including using a combination of drugs. She said the prison doctor had a responsibility to ensure they were prescribing medication to Mr C safely and responsibly. Our adviser considered that in view of Mr C's drug misuse (including misusing the medication for nerve pain) and the increased risk of addiction, it was appropriate for the prison doctor to try less harmful, alternative drugs for him. The adviser noted that Mr C had been started on an appropriate alternative medication. She said the actions taken by the prison health centre were consistent with General Medical Council guidance and, in her view, the care and treatment provided to Mr C was reasonable.

In light of the evidence available, we did not uphold Mr C's complaint.

Summary

Miss C complained to us about the care and treatment she had received when she attended the A&E department at Forth Valley Royal Hospital. Miss C had gone to A&E after injuring her ankle. She said that she also told staff that she had sickness and diarrhoea, and that she had a rash on her forehead.

Miss C returned to the A&E department two days later with shortness of breath, swelling in the right leg, bruising and a rash. She was assessed as requiring immediate attention and was then diagnosed as having myositis (inflammation of the muscles) caused by group A streptococcus (a bacterial infection). She required treatment in the intensive care unit and several emergency operations, including an above-the-knee amputation of her right leg. She also had surgery on her other limbs.

Miss C said that she had not received reasonable care and treatment when she had first attended the A&E department, and had been seen by an emergency nurse practitioner. We took independent advice from one of our nursing advisers, who is an emergency nurse practitioner. The medical records that were completed when Miss C had initially attended the A&E department only referred to an injury to her left ankle. No other symptoms were documented. We found that it had been appropriate for the emergency nurse practitioner to diagnose and treat this minor injury, and that the care and treatment the nurse practitioner had provided had been reasonable and appropriate. As there was no evidence that Miss C had reported sickness, diarrhoea or a rash when she attended the hospital on the first occasion, we did not uphold the complaint.

Summary

Mrs C complained about the care and treatment her late mother (Mrs A) received at Forth Valley Royal Hospital. Mrs A was admitted with kidney failure and, further to treatment, was discharged eight days later. However, she became ill again the following day and required re-admission. She responded well to treatment, this time for heart failure, but subsequently suffered a sudden heart attack and died. Mrs C raised concerns that the board did not take reasonable account of Mrs A's pre-existing heart problems when treating her kidney failure during her first admission. She felt that this led to them overloading her with fluids, thus contributing to her subsequent heart failure and eventual death. She also questioned the appropriateness of the discharge following Mrs A's first admission, raising concerns that her heart failure should have been detected prior to this and noting that Mrs A had been vomiting on the day of discharge.

We took independent advice from one of our medical advisers, with experience in the acute hospital care of elderly patients with multiple illnesses. He explained that the treatment of kidney failure involves fluids being provided, whereas the treatment of heart failure requires fluid restriction. He advised that a careful balancing act was required where a patient has both kidney and heart problems. He considered that the doctors caring for Mrs A were mindful of this and said the treatment provided to her during both admissions was reasonable. He also considered the interim discharge to have been clinically appropriate at the time. He said Mrs A's sudden heart attack could not have been predicted and was not connected to her treatment. We accepted this advice and did not uphold the complaints.

Summary

Mr C complained that, when his wife (Mrs C) phoned the GP practice for a home visit, the GP should have phoned for an ambulance instead. He also complained that the GP did not arrive at their home for just over an hour.

We took independent advice from one of our GP advisers. They considered that it was clear from the medical records, and from a discussion the GP had with the district nurse who had made a routine visit to Mrs C earlier that day, that there was no reason for an ambulance to have been called on the basis of Mrs C's phone call. We noted that the medical records recorded the call as taking place about half an hour later than Mr C had indicated. However, regardless of the exact time, the adviser considered that the GP had arrived very promptly. When the GP saw and examined Mrs C, the GP felt that Mrs C had a significant infection. In line with relevant medical guidelines, she arranged hospital admission at that time. However, that decision was based on a physical examination, not the phone call. We did not uphold Mr C's complaint.

Summary

Ms C is the mother of a young child who was born with a number of health issues. She complained that when her child was being assessed for support needs, the community paediatric consultant (the consultant) told her, incorrectly, that her child suffered from a particular genetic syndrome. Ms C said that this information was then relayed to other health and social care professionals causing her distress and upset.

We took independent advice from a consultant community paediatrician. We found that there was no evidence to show that the consultant had provided incorrect information and that, as soon as the consultant discovered that incorrect information was being repeated, she took steps to correct it and to advise all concerned. The child was promptly referred to a consultant in clinical genetics to establish a diagnosis. The complaint was not upheld.