Not upheld, no recommendations

Summary

Mrs C, who is an advocate, complained to us that her client (Mr A) had suffered depression as a result of the community mental health team stopping his anti-psychotic medication. We sought independent advice from one of our medical advisers who told us that Mr A's medication had been stopped in line with national guidelines. The adviser also said that research has shown that there was no recorded evidence that such action can cause depression.

Summary

Mr C was transferred between prisons and, as is routine for new arrivals, had a GP appointment at his new prison's health centre the day after he arrived. The GP decided to reduce and later stop Mr C's headache medication. This was because in the first prison Mr C had been found to have less of the medication in his possession than he should have had, and so he was in breach of prison protocol about this.

Two days after his GP appointment, Mr C was found to be concealing his medication in his mouth, rather than swallowing it. This was also in breach of a protocol, which said that if a prisoner was found to be concealing medication that they were being given on a supervised basis (as in Mr C's case), the clinical need for it would be reassessed. On reassessment, it was decided to stop the medication with immediate effect. The medical records indicated that Mr C was offered an alternative but declined. Mr C complained that the decisions to reduce his medication on arrival at the new prison and to stop his medication after reassessment were both unreasonable.

We took independent advice from one of our medical advisers and found that on both occasions medical staff acted appropriately. The medication in question was one which is often abused in a prison environment (for example, by prisoners selling it to other prisoners). Drug security in prison is very important and the NHS have to have firm policies for such security and follow them.

Summary

Mr C's son (Master A) was diagnosed with epilepsy in 2013, and was being treated by a consultant neurologist from another NHS board. In January 2014 Master A was having significant episodes, and Mr C's GP contacted hospitals in both NHS boards for advice. The GP received some conflicting advice as, because of his age, Master A was regarded by some services as an adult and by others as a child. The Southern General Hospital said that they dealt with adults and advised the GP to contact the board's children's hospital, but the GP did not do so as they understood that the children's hospital only dealt with younger patients. The board's response to Mr C's complaint indicated that had the GP contacted that hospital, Master A would have been seen there. However, he was not taken to hospital at that time.

Master A's condition did not improve and four days later Mr C took him to A&E at the Southern General Hospital. Master A was assessed and examined, and diagnosed with hyperventilation (abnormally fast breathing), but was not found to have had a seizure. He was discharged without treatment and was told to go to his GP and his consultant neurologist for follow-up (he already had an appointment scheduled with the consultant). Mr C was not satisfied with this and complained to the board about a lack of neurology service. He was dissatisfied with their responses and with the time taken to investigate his concerns.

Our investigation included taking independent medical advice from one of our advisers, who is an A&E consultant. We found that staff assessed and examined Master A appropriately, and that their decisions about discharging him were clinically reasonable. It did take some time for the board to respond to the complaints, but these were complex and involved consulting staff from various departments. For the most part Mr C was kept informed of the progress of the investigation and the timescales set out in NHS Scotland guidance on complaints handling were met. On one occasion this did not happen and we brought this to the board's attention, but we did not uphold Mr C's complaints.

Summary

Mr C said that when he arrived in prison he was in a poor state of mental health, and he complained about the time it took to see a doctor and a psychiatrist. He was also unhappy that he was refused specific medication for his attention deficit hyperactivity disorder (ADHD) and said that he got no benefit from the medication that was prescribed.

We took independent medical advice from two advisers, one a GP and the other a mental health specialist. We found that Mr C was seen by an experienced doctor the day after he arrived in the prison, and a reasonable assessment of his physical and mental state was made. In addition, there was no indication that Mr C needed to urgently see a psychiatrist. We also found that, given his medical history, the medication he was prescribed for agitation and ADHD was appropriate, and in line with national guidance.

Summary

Mr C had been diagnosed with alopecia (hair loss) when he was a child. His condition deteriorated and progressed over the years to the extent that he has now been diagnosed with alopecia universalis (a condition were a patient has no body hair). He complained that his GP failed to show him any sympathy or understanding and that the effectiveness of the prescriptions he was given was not reviewed. He said that he was not referred to a dermatologist until his condition had reached a stage where little could be done.

We took independent advice from a dermatology adviser and found that Mr C had been treated reasonably and appropriately in accordance with the symptoms he presented with; there was no evidence to suggest that his GP had been either unsympathetic or showed a lack of understanding. His medication was monitored and Mr C had declined some treatment which would have led to an earlier hospital referral.

In the circumstances, we did not uphold Mr C's complaint.

Summary

Mr C was Mrs A's carer, and complained on her behalf that a community health partnership did not identify that she had an infected leg wound. Mr C said that district nurses did not maintain the dressings appropriately, and an ulcer became infected. He also said that Mrs A's GP failed to diagnose the infection. Mrs A was later admitted to hospital, where she developed sepsis (a serious blood infection).

We took independent advice from two advisers; one a GP and the other a specialist in district nursing. Our GP adviser noted the condition of Mrs A's leg ulcer when she was examined by the GP, and said there was no evidence at the time of the examination, or when Mrs A was admitted to hospital, that her ulcer had become infected. Our adviser also clarified that the source of Mrs A's sepsis was never identified when she was in hospital.

Our district nursing adviser reviewed the care and treatment Mrs A was given by district nursing staff prior to her admission to hospital. This adviser explained the expectations around treatment of leg ulcers, and said that it was appropriate for staff to replace Mrs A's dressings every two days. She said that Mrs A's care and treatment was in line with national guidance and good clinical judgement, and our decision reflected this advice.

Summary

Mr C complained about the treatment he received at the Victoria Hospital over a period of months. He was admitted there suffering from stomach pains. He had an operation to treat a blockage in his bowel and was discharged, although he was readmitted soon after and operated on again. Mr C remained in the hospital and his condition deteriorated further, resulting in two more operations and a series of significant complications. He said that this had a substantial effect on him, including memory loss, mood swings and depression. He now struggles to work, and felt these complications could have been avoided had his care and treatment been of a higher standard.

As part of our investigation we took independent medical advice from an experienced surgeon. He acknowledged how serious Mr C's complications had been but said they were not due to medical or surgical failings. He said there had not been a delay in Mr C's operations and explained that one of them had only become necessary following Mr C's sudden deterioration. In addition, he explained that surgery prior to this sudden deterioration would have been inappropriate.

Although we recognised how significant this matter had been for Mr C and his family, our role was to consider whether the evidence available indicated that his treatment was unreasonable in the circumstances at the time. Importantly, this did not include the benefit of hindsight. Although we took Mr C's concerns into account, we did not find that there had been any failing in care, or unreasonable treatment.

Summary

Mr C complained that the prison health centre were failing to prescribe appropriate pain medication for his knee. He was due to start a detox programme and because of that, the decision was taken to stop the pain medication he was being prescribed and to provide an alternative.

We examined Mr C's medical records and we took independent medical advice from one of our GP advisers. They explained that the steps taken by the prison health centre in Mr C's case were appropriate because the effects of the pain medication he was being prescribed would have been blocked by the effects of the detox programme. Our adviser also confirmed that the alternative pain medication prescribed to Mr C was appropriate. We accepted the view of our adviser and we did not uphold Mr C's complaint.

Summary

Ms C had a complex medical history including extensive long-standing urological (urinary tract) problems dating back to childhood. She had her left kidney removed, with a segment of the tube that carries urine from the kidney to the bladder (ureteric stump) being left in place. In October 2012, Ms C's GP referred her to a urologist at Ailsa Hospital for recurrent urinary tract infections and to a consultant surgeon because of gastroentology (digestive system) symptoms including abdominal pain, bloating, variation in bowel habit, diarrhoea and intermittent rectal bleeding. Following investigations, the ureteric stump was removed in March 2013 and Ms C's urological problems improved. However, her gastroenterology symptoms continued and in October 2013 she was diagnosed with irritable bowel syndrome.

Ms C complained that her urological symptoms were not investigated within a reasonable time and that there was an unreasonable delay in removing the ureteric stump. She also believed that her urological and gastroenterological symptoms were related and was concerned about her continuing severe gastroenterological symptoms, which she said worsened after the surgery to remove the ureteric stump and were not properly investigated. Finally, Ms C complained that she had not been told about the diagnosis of irritable bowel syndrome.

We took independent advice on this case from two of our medical advisers. Turning first to the care and treatment in relation to Ms C's gastroenterology symptoms, our adviser said that Ms C was appropriately investigated and treated for her symptoms. In relation to her urology symptoms, the advice we accepted was that this too was reasonable. Both our medical advisers pointed out that Ms C had a complex medical history and that, in relation to her urological condition, her case was rare and unusual. However, we found that the board appropriately arranged for further follow-up for her gastrointestinal problems. Ms C felt strongly that both sets of symptoms were directly linked, but our medical advisers said there was no evidence that this was the case. We were concerned that there was no direct evidence in Ms C's medical records that the diagnosis of irritable bowel syndrome was discussed with her, but we noted that the board had taken steps to address this. We were satisfied by the evidence from the medical records that, with the exception of this, the standard of care and treatment was reasonable.

Summary

Mr C was a registered student with a disability, with a disabled driver's parking permit. Before his end of year exams Mr C had an accident and needed knee surgery, which he discussed with department staff. He was allocated an exam room on the fourth floor of a building with no lift. He said that he suffered considerable pain throughout the exam because he had to climb the stairs. He complained that the university had not met their responsibilities to him as a disabled student, and that he should be allowed to re-sit the exam. The university investigated, but did not uphold his complaint.

Our investigation considered all the university's relevant policies and procedures, including arrangements for students with disabilities, complaints handling and regulations on equality and building standards. We also examined all correspondence between Mr C and university staff, the university's records of Mr C's disability and their investigation and responses to his complaint. We found that Mr C had not told the university that he had mobility issues and needed disabled access. He had assumed that all rooms were accessible, without checking locations with which he was not familiar. The university had carried out a thorough investigation and provided detailed responses to his complaint and had clearly communicated the procedures students should follow. We did not uphold his complaint, as the university could have only put in place appropriate arrangements if they were told about the mobility difficulties that Mr C later reported.