Not upheld, no recommendations

Summary

Mrs C complained about the treatment she had received from her GP when she reported a lump in her breast. Mrs C attended the medical practice twice before being referred to the breast clinic where she was later diagnosed with breast cancer.

Mrs C said that she should have been referred to the breast clinic sooner and was concerned about the GP's attitude. Mrs C also said that when she was referred, the referral should have been classed as urgent rather than routine.

During our investigation we asked for independent advice from one of our GP advisers. Our adviser found that the GP had conducted a thorough examination of Mrs C and gave her appropriate advice regarding monitoring the lump. The adviser said that it was hard to judge the attitude of the GP through the medical notes, however, based on the record of Mrs C's condition at the time of the referral, and relevant National Institute for Health and Care Excellence (NICE) guidance, a routine referral was appropriate. We did not uphold Mrs C's complaints.

Summary

Ms C, who is an advocate, complained to us on behalf of her client (Mr A) that the board's response to his complaint was inadequate.

Mr A had complained to the board about the conduct of a nurse. The board investigated Mr A's complaint and, in their written response, acknowledged that his experience was distressing and they apologised. The board explained to Mr A that their investigation had been conducted in line with their Management of Employee Conduct Policy, and that they were unable to share any actions arising from the investigation due to the confidentiality of employee matters. In a further letter to Mr A, the board confirmed that he would not be notified of the outcome of any internal board process.

We concluded that it was reasonable in the circumstances that the board did not tell Mr A whether his complaint was or was not upheld. This was because the standard complaints procedure, under which Mr A submitted his complaint to the board, was superseded by the Management of Employee Conduct Policy due to the nature of the allegations made in Mr A's complaint. This was why the board decided they could not tell Mr A whether his complaint about the nurse had or had not been upheld, as to have done so would breach employee confidentiality. Although we thought that they could have explained the sequence of events more clearly, we considered that the board's response to Mr A's complaint provided relevant information that they were able to share with him in the circumstances, and we did not uphold the complaint.

Summary

Mr C complained that the board had failed to provide his partner (Mr A) with appropriate and timely treatment for a needlestick injury (when the skin is accidentally pierced by a needle), when he attended the A&E department at the Southern General Hospital. He said that Mr A had to wait for two and a half hours to see a doctor and that other people who arrived after him were seen before him. Mr C complained that they refused to give Mr A post exposure prophylaxis (PEP - short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure), despite the fact that the needle had been discarded close to the home of an HIV positive drug user. He also said that Mr A was not offered a polymerase chain reaction (PCR) test (a test that can be used to identify HIV) which can be done around ten days after the exposure.

After obtaining independent advice from our medical adviser, we found that the care and treatment provided to Mr A had been reasonable, appropriate and in keeping with standard care. Patients with a community-acquired needlestick injury are not treated as a priority when they attend A&E. It was not unreasonable that some patients with other conditions who arrived after Mr A were assessed before him. The board had acted in line with their guidelines in relation to providing PEP and it was not given because any benefit would have been outweighed by the risk of side effects. It was also appropriate that a PCR test was not used, as another test was available. In view of all of this, we did not uphold the complaint.

Summary

Mrs C had a history of abdominal (stomach) pain, for which no specific cause had been found. In June 2010, she and her husband (Mr C) went for fertility treatment, and a scan revealed a large endometriotic cyst (a blood-filled sac) on Mrs C's ovary. This was removed and Mr and Mrs C were referred for fertility treatment. At that point, Mrs C's levels of AMH (a hormone that gives an estimate of the capacity of the ovary to provide egg cells capable of fertilisation) were within normal range. Some time after this, a scan showed another large cyst - this was removed and Mrs C was given treatment to reduce the chances of this happening again.

Mr and Mrs C were seen again in July 2012 before starting fertility treatment at Glasgow Royal Infirmary, at which time Mrs C's AMH level had decreased to a 'less than a normal' range. The first cycle of treatment was unsuccessful and the fertility unit recommended a different procedure for the next cycle. Before this could happen, however, the board closed the unit because of poor fertilisation rates (possibly related to contamination from nearby building works). The board wrote to Mrs C explaining this and offering the couple a complimentary treatment cycle.

Mr and Mrs C complained about Mrs C's care and treatment, saying that the cysts were not diagnosed quickly enough and that she should have had regular scans after the first operation. They also said that the board did not provide a reasonable standard of care and fertility treatment, that their communication about the problems was inadequate and their guidance to affected patients confusing. Mr and Mrs C thought they should be offered a third fully funded cycle of treatment.

After taking independent advice on this complaint from two advisers - one a surgeon (adviser 1) and the other a specialist in assisted conception treatment (adviser 2) - we did not uphold Mr and Mrs C's complaints. Adviser 1 said that the board reasonably investigated and treated Mrs C's earlier abdominal symptoms and found no evidence that the cysts were related to these. Adviser 2 also said that care and treatment in relation to the cysts was reasonable, and that Mrs C's decreased AMH levels were likely to have been due to the second operation, rather than any delay in identifying the second cyst.

The board had acknowledged the problems in relation to assisted conception, and had taken steps to address them. Adviser 2 said that it was probable that the first cycle failed because of the environmental contamination, and that the board's offer of one further complimentary cycle was reasonable. They did not think that there was a failure in care and treatment by the board, who were dealing with a complex and fast-changing situation, and we found that the board's communication was reasonable in the circumstances. We were also satisfied that their guidance for affected patients was intended to ensure that no-one was at a disadvantage, so that each couple received two fully funded NHS cycles of treatment.

Summary

Since 2010, Mrs C had been attending her medical practice complaining of stomach and breast pain. She said that she was incorrectly treated for thyroid problems and an ulcer and complained that the extent of her pain was never recognised and that she was not referred for tests. More recently Mrs C was diagnosed with a carcinoid tumour in her liver (a rare cancer). She felt that as a fit and healthy patient attending the doctor a lot, with symptoms that were not resolving, the practice should have sent her for tests and sought specialist help.

We took independent advice from one of our medical advisers and, after considering this, we did not uphold the complaint. Our investigation showed that over the period of time concerned, Mrs C was treated correctly in accordance with her symptoms. Amongst other things, she had symptoms suggestive of an underactive thyroid and an ulcer, for which she was treated appropriately. She also had a breast scan that showed a breast lump, but this was benign. It was only in late 2013 after an emergency admission to hospital and extensive investigations, including an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body) and a scan of her abdomen, that Mrs C was diagnosed with the tumour, which was noted to be extremely rare. Our adviser said that until then doctors had always provided reasonable diagnoses to explain Mrs C's symptoms.

Summary

Mr C complained that prison healthcare staff behaved unreasonably towards him, after he complained about another matter regarding one of the staff. Mr C told us that he had a meeting with two nurses - one of them the person about whom he had complained - during which the nurses were confrontational and threatened him.

In general terms, it is not unusual for prison healthcare staff to visit complainants to discuss their complaint face-to-face at an early stage, to see if they can resolve the matter quickly. However, even at such an early stage, it is important to ensure that the complaint is dealt with impartially. This is in keeping with the NHS' Can I Help You? Guidance, and we agreed with the board’s comment in their response to Mr C’s complaint that the nurse he previously complained about should not have attended the meeting.

Where there are differing accounts of what was said or what happened in a particular situation, however, it can be difficult to prove what actually happened. In such cases, we primarily base our findings on written records. There was no audio recording of the meeting and, therefore, there was no way to determine what was said, or how people behaved. We could not resolve Mr C's complaint given these differing accounts. However, that did not mean we believed one account over another. As there was insufficient evidence to ascertain what was said, we did not uphold the complaint.

Summary

Mr C complained to us about the care and treatment he had received from his prison health centre in relation to pain in his wrist and jaw. Mr C had been prescribed tramadol (a strong painkiller) and the dosage had been gradually increased. He was then reviewed by a doctor, who considered that the tramadol he was receiving was inappropriate. The doctor recorded that the tramadol should be reduced and stopped and that it should be replaced by other painkillers. Mr C was unhappy with the decision to stop the tramadol. We took independent medical advice and found that the overall management of Mr C's pain had been reasonable. It had also been reasonable to reduce and then stop the tramadol and to try other medications to see if they addressed his pain. Consequently, we did not uphold this aspect of Mr C's complaint.

Mr C also complained about the board's handling of his complaint. However, we found that the board had adequately investigated and responded to the issues he had raised and we did not uphold Mr C's complaint about this.

Summary

Mrs C complained about the medical care her late mother (Mrs A) received at University Hospital Ayr. Mrs A had suffered from diabetes for over 40 years. She was admitted to the hospital and diagnosed with diabetic ketoacidosis (a condition where consistently high blood sugar levels can result in severe insulin deficiency). Mrs C said that Mrs A did not receive appropriate medical treatment, was discharged home on too high a dosage of insulin, and that her blood sugar was not monitored at home. Mrs A's condition deteriorated at home and she was re-admitted to the hospital five days later having collapsed. She went into a coma and died around four weeks later.

We did not identify any failings in the medical treatment of Mrs A. There was evidence to show that she was given appropriate treatment in the form of intravenous fluids and insulin. We noted that Mrs A had a history of poor diabetic control. However, the insulin dosages were appropriate and, after she returned home, the specialist diabetic nurse had contacted Mrs A to monitor her condition and make changes in her prescription.

Summary

Ms C complained to us on behalf of her relative (Ms A) in relation to the care and treatment of Ms A's late baby (Baby A). Baby A was born at University Hospital Crosshouse following a normal delivery, and was assessed at birth to be fit and well. Around three hours after birth, the baby's temperature was taken using an adult thermometer, as no paediatric thermometer could be found. As the temperature was found to be low, Baby A was placed under an overhead heater, and was monitored carefully. After half an hour a paediatric thermometer was used to take Baby A's temperature, which had returned to normal levels. A paediatrician reviewed Baby A an hour later, and assessed Baby A as fit for transfer to the maternity ward. Following another 20 hours of monitoring, mother and baby were assessed as fit for discharge.

Two weeks later, Baby A took severely ill and was taken to A&E. Baby A was treated by a team from the intensive care team from the nearest children's hospital, and was immediately transferred there. Baby A died four days later, from late onset Group B streptococcal septicaemia (a bacterial infection of the blood), which developed into meningitis (an infection of the lining of the brain).

Our adviser found that the monitoring of Baby A's temperature in the first 24 hours of life was appropriate. He also noted that, while one temperature reading was not taken appropriately, this was rectified soon after, and subsequent readings were appropriately timed and were taken with the right equipment. The adviser considered the standard of care to be good, and did not raise any concerns about the management of Baby A's temperature. He also clarified that concerns about Baby A's temperature in the first day of life did not have any impact on the subsequent infection. On the basis of this advice, and as the board met with the requirements of the guidance on the management of infection in new-born babies, we did not uphold this complaint.

Summary

Mr C complained that the university had failed to allow sufficient time for his submission to be marked in order that he could obtain a qualification. He told us that if he had obtained the qualification by a specific date, he would have received an increase in his salary. Mr C had missed the original deadline for submitting the work. The deadline was then extended and a further extension was subsequently agreed with Mr C. He paid the required fee and submitted the work on the date that had been agreed, which was just under six weeks before the date he needed to obtain the qualification in order to obtain the salary increase.

The university's programme guide for the course stated that students should expect to receive feedback within six weeks of the date the work is submitted. In Mr C's case, we found no evidence that he was told that he would receive the feedback within a shorter time period. The work was in fact marked and returned to Mr C with feedback just over three weeks after he submitted it. This left just over two weeks for Mr C to resubmit the work in order to obtain the qualification. However, the university told us that his submission had fallen far short of what was needed in order to pass, as could be seen by the extensive feedback provided, and it would have taken him several months to do the work required to obtain the qualification. They pointed out that, if the submission had been a marginal fail, they would have supported him if he had wished to make a resubmission and to have that result approved in time. They also said that they could not reasonably have known the extent of the corrections required, or how long it would take to bring the submission to the required standard, before Mr C submitted it.

We found that there were no unreasonable delays or failings by the university that left Mr C with insufficient time to achieve the qualification and the salary increase. He had been aware of the tight timescale, and it was his choice to submit the work at that time and pay the required fee. We were satisfied that the reason that he was unable to resubmit the work at the required standard within the deadline was because of the revisions that were required and not because of delays by the university. In view of this, we did not uphold the complaint.