Not upheld, no recommendations

Summary

C's spouse (A) had advanced kidney cancer which had spread to their brain. A was admitted to hospital after they developed breathing problems. They were diagnosed with a pulmonary embolus (blood clot in the lung). A agreed for the pulmonary embolus to be treated in hospital, in the hope that they could be discharged once stable, but their condition deteriorated and they died in hospital.

There was a period during A's admission when their medication was stopped while clarification was sought as to their treatment plan. C complained about the clinical decision-making regarding A's care and treatment. C considered that failings in A's care and treatment led to their death in hospital, denying them of the right to be cared for at home. C also complained about the board's communication.

We took independent advice from a consultant physician. We noted how difficult this case was, in particular from the perspective of the family. Although we noted certain areas of care that could have been better, we considered that overall the standard of care and treatment was reasonable and that A was nearing the end of their life by the time of their admission. We did not consider that the outcome would have been different had there not been a period of time during which medication was withdrawn pending clarification of A's treatment plan. Therefore, we did not uphold this complaint.

We noted that a number of physicians were involved in A's care and treatment and that there had been a degree of uncertainty about A's treatment plan. Although some aspects of communication could have been better, we considered that the clinicians did their best to communicate to A's family how ill A was and to have appropriate discussions with them around resuscitation and escalation. Therefore, we did not uphold the complaint about communication.

Summary

C complained about the treatment that they received from the practice during a three year period. C had repeatedly reported symptoms of a cough and breathlessness and was prescribed an inhaler but it took a number of years until they were diagnosed with Sjogren's syndrome (a condition which affects parts of the body that produce fluids like tears and spit (saliva)). C believed that action should have been taken by the GP at the practice to arrive at the diagnosis sooner.

We took independent advice from a clinician and found that the GP had provided C with appropriate medical treatment in view of the reported clinical symptoms and that they made a timely referral to hospital specialists. Although C was subsequently diagnosed with Sjogren's syndrome, this was not as a result of a failing in the treatment provided by the practice. We did not uphold the complaint.

Summary

C complained to the board about the care and treatment which their late parent (A) received at the A&E at Glasgow Royal Infirmary. A had presented as an emergency following them taking too much medication. A was not admitted to hospital but was discharged home and advised to take Codeine (a sleep-inducing and analgesic drug derived from morphine). A died shortly after their discharge from hospital.

We sought independent clinical advice from a professional adviser. We found that apart from a failure to complete some initial observations, staff in A&E performed appropriate investigations and that it was clinically appropriate to discharge A from hospital. There was no indication from the clinical records that staff had prescribed A Codeine on discharge or that this was said to them. We did not uphold the complaint.

Summary

C complained about the treatment which their partner (A) received when they attended their GP practice with confusion and could not walk unaided. A could not provide a urine sample and was given a prescription for antibiotics. A collapsed in the car park following the consultation and was taken to hospital. C believed that the GP should have arranged a hospital admission for A. The practice felt that appropriate clinical treatment had been offered.

We took independent clinical advice from a professional adviser. We found that the GP had carried out an appropriate assessment of A and had diagnosed A as having an infection and therefore prescribed alternative antibiotics with advice to seek further medical advice should their condition deteriorate. It could not have reasonably been foreseen that A would collapse shortly after leaving the GP practice. We did not uphold the complaint.

Summary

C was referred to the Ear, Nose and Throat (ENT) department of board by their GP after suffering extreme sore throats and infections. A diagnosis of recurrent tonsillitis (swelling of tonsils located at the back of the throat due to infection) and possible reflux (the flow of a fluid through a vessel or valve in the body in a direction opposite to normal) or allergy was offered. C was prescribed Gaviscon and recommended allergy tests, which later showed allergies to dust mites. C was seen again in clinic later where their symptoms were reported to have resolved and C was discharged.

Some years later a pre-cancerous lump was found on C's breast. The results of a biopsy confirmed oesophageal (organ which connects the throat to the stomach) cancer, for which C received chemotherapy and an operation.

C believed that they should have been referred to a specialist following their referral to ENT previously and that the prescription of Gaviscon had been unreasonable. C complained to the board. The board responded with the conclusion of their investigation that, in the circumstances, the prescription of Gaviscon was reasonable and no further referral from ENT was indicated. C was dissatisfied and raised their complaint with us.

We took independent advice from a consultant. We found that the board's actions were reasonable in the circumstances, that there was no indication at that time that further investigation or referral was required and that the board did not unreasonably fail to diagnose or treat any condition. We did not uphold the complaint.

Summary

C complained that the board failed to investigate, diagnose and treat gastrointestinal (relating to the stomach and intestines) problems and swallowing difficulties that they had experienced over a number of years. As a result of previous abuse, C required invasive procedures to be carried out under general anaesthetic. C complained that the board placed unreasonable emphasis on their trauma when making decisions about their treatment.

We took independent clinical advice from a consultant in gastroenterology (medicine of the digestive system and its disorders) and hepatology (liver disease). We considered C's initial treatment plan to be reasonable: a CT scan of C's colon followed by an upper GI endoscopy (a medical procedure where a tube-like instrumentis put into the body to look inside) as recommended by the private clinic that they attended, and a colonoscopy (examination of the bowel with a camera on aflexible tube) if indicated by the results of the CT scan. We found that the decision not to carry out a colonoscopy at this stage was reasonable, given the risks of performing this under general anaesthetic and the previous normal investigations.

We were critical of the board's failure to offer C a flexible sigmoidoscopy (an imaging test done to monitor the colon and rectum for the presence of ulcers, polyps or other abnormalities) after they developed rectal bleeding, but noted that this did not impact on C's overall treatment plan. C had gone on to have a colonoscopy under a different NHS board, which did not identify any significant pathology.

We did not consider the emphasis placed on C's childhood trauma to be excessive and we noted that reasonable investigations were carried out into C's swallowing difficulties.

Therefore, we did not uphold this complaint.

With regard to C's complaint that the board's complaint response contained inaccurate information, we found that generally their response was thorough and detailed. With the exception of an incorrect reference to C having anaemia, we found that the board's response to be factually accurate with clear explanations as to what investigations had been carried out and why. We did not uphold the complaint.

Summary

C complained on behalf of their late child (A) who died of cancer. A received treatment from the dermatology department for a mole on their back. The mole was removed and, following testing, it was found to be cancerous.

A had further treatment from the plastic surgery department to excise (remove by cutting) more tissue from the area, which was tested and confirmed no cancer cells were present. After, A presented with abnormal lymph nodes, tests confirmed that they were cancerous. A underwent a procedure to remove the lymph nodes and some painful lumps on their body. After this procedure, A refused any further treatment.

C complained that the board did not do enough in the early stages to treat A's cancer. C felt that the procedure to remove the initial mole should have been more thorough, that A should have been monitored more closely for any spread of cancer, and that other treatments should have been considered at an earlier date. C said that they were unhappy with the board's communication with A and their family and that they were unhappy with the way in which the board handled their complaint, as they felt it was not consistent with their recollection of events.

We sought independent advice from clinical advisers with relevant experience. Both advisers reached the view that the care and treatment provided to A by the dermatology and plastic surgery departments were reasonable both in the early stages, and when the cancer later returned. It was also their view that the board's communication with A and their family members was reasonable.

In light of the evidence and the advice received, we found that the care and treatment provided to A and the communication from the board to A and their family was reasonable. We also found that the board's response to C's complaint was in line with what was recorded in the medical records. Our investigation did not identify any evidence that would cause us to doubt the board's position as detailed in their response. Therefore, we considered that the board handled and responded to C's complaint reasonably.

For the reasons set out above, we did not uphold C's complaints.

Summary

C complained that Business Stream had not billed their business accurately. C said that they had been told by an employee of Scottish Water that their premises did not drain into the public network, but into a nearby river. Business Stream had initially not accepted this, stating that Scottish Water required further site visits to verify the situation. C also complained that Business Stream had taken too long to resolve the situation.

We found that, although Scottish Water had initially considered that C was being charged for water they were not liable for, they thereafter wanted to investigate matters further. We found that Business Stream had tried to resolve matters for C and were acting in good faith on the advice that they had received from Scottish Water in this connection. Therefore, we did not uphold this aspect of C's complaint.

We also found that, although colleagues of C's had contacted Business Stream on several occasions to complain that they were not liable for drainage charges, they had not provided the information Business Stream had requested, nor had they followed up the complaints. We considered that Business Stream had explained clearly what information they required and that they had pursued the matter with Scottish Water once this had been provided. We found that they had handled C's complaint reasonably and did not uphold this aspect of the complaint.

Summary

C complained on behalf of their parent (A). A had dementia, lived in their own home and took a number of medications. C raised concerns that A was not able to take their medication safely without supervision.

We took independent advice from a GP. We found that the primary responsibility of the practice was to prescribe appropriate medication for A's condition. They also had a role in assessing A's mental state and making appropriate referrals to other specialists. In terms of those responsibilities, we found that there was no evidence of failure on the practice's part.

There was a problem with one of A's prescriptions when they changed pharmacy. The practice addressed this problem quickly and an appropriate apology was given. As such, we did not uphold the complaint.

Summary

C complained on behalf of their parent (A) about the actions taken by the board. A took a number of medications and over the years C became concerned about A's capacity to administer their own medication safely. There was an accidental overdose when A took too much Warfarin (a blood thinning medication). C complained about the care and treatment that A received following the overdose and that the board failed to ensure A could safely administer their medication.

We took independent advice from a specialist district nurse. We found that, as A was not bleeding, it was suitable for them to be treated in the community. Appropriate monitoring was carried out and no untoward events occurred for A while they were managed in the community.

We noted that district nurses had a role to play in keeping A safe. However, it was not normally their role to administer regular medication and not their sole responsibility to ensure that A was supported in their home to carry out everyday tasks safely. We found that the district nurses had acted reasonably and appropriately, and responded promptly when problems had arisen. We also noted that the record-keeping was of a very high standard.

We did not uphold C's complaints.