Not upheld, no recommendations

Summary

Miss C was diagnosed as having labrynthitis (an inner ear infection affecting hearing and balance). She found this very debilitating and had to take time off work. She went to A&E at Stirling Royal Infirmary twice and after the second time she had a scan, which was reported as normal. Her problems continued and her GP made an urgent referral for her to attend the hospital's ear, nose and throat (ENT) department. Miss C said that the person she saw (who she described as a nurse) told her that everything was normal and that she could stop taking the medication she had been prescribed. She was discharged. Miss C said she had since learned that she should have been weaned off her medication slowly, and she questioned the care and treatment she had received. She complained that this was inadequate and contributed to her illness and the length of time she was ill.

We obtained independent advice from one of our medical advisers, who is a consultant ENT surgeon, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that, contrary to Miss C's belief, when she attended ENT she was seen by a specialist doctor who advised her to stop taking her medication and said that her condition would improve with time. Although Miss C said that she understood that she had to wean herself off this medication, this was not the case. We found that Miss C had been assessed and treated entirely appropriately, and we did not uphold her complaint.

Summary

Miss C said that she first went to her medical practice about continuing dizziness in April 2011 and was diagnosed with labrynthitis (an inner ear infection affecting hearing and balance). Worsening headaches led her to attend the emergency department in her local hospital and she then had a scan, which was normal. Miss C said her symptoms got worse and she was no longer able to work. The practice made an urgent referral for her to attend a hospital clinic, but after examination and tests everything was found to be normal and the clinic reassured her that her condition would improve over time. She continued to feel ill, however, left the practice, and complained that despite many visits there, they did little to help her. She said that they should have made more timely referrals for her to receive a specialist opinion.

We obtained independent advice from one of our medical advisers, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that over the period concerned, Miss C attended the practice regularly and doctors made a referral for her to be seen urgently at the hospital ear, nose and throat department. She had had a normal scan and further examination and tests confirmed labrynthitis. She was referred to physiotherapy for therapy to retrain her brain to deal with the problems associated with dizziness. We decided that the GPs provided her with good care and support and tried alternative medication for her.

Summary

Mrs C went to her GP twice after noticing a lump in her abdomen. She complained to us that he did not perform appropriate examinations to establish the cause of her symptoms and did not offer her a NHS referral.

Mrs C said that the doctor was dismissive of her concerns about the lump, and she asked him to give her a private referral for specialist opinion. This resulted in a diagnosis of ovarian cancer. She said that there had been a delay in diagnosis and that, had she not insisted on a private referral, there would have been further delay. The GP said that he had carried out appropriate examinations and that it was his intention to make a NHS referral but Mrs C had insisted on a private referral.

We took independent advice on the complaints from one of our medical advisers, who is a GP. As our investigation found that the GP had carried out appropriate clinical assessments and made an appropriate referral, we did not uphold the complaint. We did not make any recommendations, although we did point out to the GP that if a similar situation arises in future he should record why a private referral has been requested and agreed.

Summary

Mr C's GP referred him to Queen Margaret Hospital's orthopaedic department because he was having pain in his knee despite having received physiotherapy treatment. Mr C was reviewed by an orthopaedic registrar who said that he had a medial meniscal tear (cartilage problems). After Mr C had a scan of his knee, an orthopaedic consultant wrote to him advising that there was no tear and surgery was not required but recommended more physiotherapy. Mr C then attended a private consultation with an orthopaedic doctor who thought that Mr C did have a meniscal tear. Mr C had private surgery a few weeks later and told us that he was able to return to work within four weeks. He complained to us about the treatment he received at Queen Margaret Hospital, saying that he was not offered surgery and that the orthopaedic consultant reached a decision without examining him.

After taking independent advice from one of our medical advisers, we found that the scan did not show that Mr C had a meniscal tear. There was, however, an indication of degenerative changes (osteoarthritis - a common form of arthritis) behind the knee cap, and the board had treated him in accordance with the national guidance for the management of this that was in place at the time. Our adviser also said that there was no assurance that the surgery was the sole cause of Mr C's improvement, as the symptoms of degenerative knee disease may improve on their own. We concluded that the orthopaedic registrar's examination was appropriate, and that it was reasonable for the consultant to not have seen Mr C in person, given that he had reviewed the scan results.

Summary

Mrs C complained about the care and treatment provided to her late mother (Mrs A) in Borders General Hospital. She said that her mother was not provided with reasonable care and treatment and that the board's responses to her complaints were unreasonable.

Mrs A was 93 years old and lived alone, with assistance from her family. She had a history of heart and lung problems and was registered blind. She went into hospital because she had a chest infection that was making her existing lung disease worse. Mrs A was treated with antibiotics and oxygen therapy, but her condition continued to deteriorate and three days after going into hospital she asked staff to stop treating her. She died later that day.

Mrs C was concerned that her mother was not considered suitable for cardiopulmonary resuscitation (CPR - where the heart and/or breathing is re-started if it stops) or for transfer to the intensive care unit. Mrs C did not find out that doctors had completed a Do Not Attempt CPR (DNACPR) form for Mrs A until she saw it in her mother's notes. After a discussion with the doctor in charge of Mrs A's care, the decision was reversed to a limited degree (where Mrs A's heart would be shocked into a normal rhythm if it became irregular but full CPR would not take place) but the form was not removed from the notes. Mrs C was also concerned when Mrs A started to refuse food, fluids and medications, and said that Mrs A told her that this was because she did not trust staff after being given a bed bath by a male nurse that morning. Mrs C discussed this with a nurse on the ward and was assured that a female nurse had given the bed bath but that a male nurse would have assisted with changing the bedsheets.

During our investigation we took independent advice from two of our advisers - a doctor specialising in the care of the elderly and a senior nurse. We found that the care and treatment provided to Mrs A was reasonable and appropriate. The advisers considered that there was evidence in both the medical and nursing notes that appropriate and timely assessments, monitoring and evaluation of Mrs A's treatment took place, and that the actions around the DNACPR decision complied with national guidance. We also found evidence that when Mrs A began to refuse treatment, appropriate assessments were done to establish that she had the capacity to decide this for herself. Mrs C had been concerned that Mrs A had wished to die at home and that staff ignored this. However, the medical notes showed that Mrs A's desire to go home was noted and considered, but the doctor in charge of her care at that time thought that she would be unlikely to survive the journey. Our medical adviser agreed with this view.

Summary

Miss C's mother (Mrs A) had been diagnosed with cancer, and admitted to Ayr Hospital. She was discharged, but was readmitted four days later with a chest infection. During Mrs A's admission, Miss C and her sister met with the palliative care nurse (a nurse specialising in care solely to prevent or relieve suffering) to discuss support for caring for Mrs A at home. They told the nurse and doctor that Mrs A wished to return home as soon as possible, and the nurse agreed to refer Mrs A to the hospice home care team.

The palliative care nurse was away from the hospital the next day, but intended to make the referral when she returned the day after. At that time, the nurse and the doctors expected that Mrs A would be in hospital until the next week for treatment for her chest infection. However, Mrs A discharged herself, against medical advice. The ward staff were not able to contact the palliative care nurse, but told Mrs A's GP that she had discharged herself, and arranged for district nurses to visit. Miss C called the hospice home care team for support, but was told that no referral had been made and that hospice support would, therefore, not be available until the following week. The hospice team then called the palliative care nurse, who immediately processed the referral. Mrs A died at home three days after discharging herself, before hospice support was put in place. Miss C then complained that the nurse had unreasonably delayed in referring Mrs A to the hospice home care team.

After taking independent advice on Miss C's complaint from one of our advisers, who is an experienced nurse, we did not uphold it. Our adviser said that, in the circumstances, it was not unreasonable for the nurse to wait a day before making the referral, as she had expected Mrs A to be in hospital until the following week. Our adviser also said that ward staff had taken reasonable steps to try to contact the palliative care nurse and to arrange some support for Mrs A by contacting her GP and district nursing.

Summary

Miss C's mother (Mrs A) went to a medical practice with abdominal (stomach) pains. She was repeatedly referred for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body), but did not attend on three separate occasions and no further appointment was made. Ten months later, Mrs A again went to the practice and was treated for a suspected infection. However, Miss C was very concerned about her mother's weight loss and took her to A&E, where she was treated for a suspected urinary tract infection and discharged. Two months later, Mrs A went again to the practice with worsening back pain, nausea and weight loss. A GP told Mrs A that it was possible she had cancer, and arranged for x-rays, which showed that Mrs A had arthritis. However, as no cause for Mrs A's weight loss had been found, the GP arranged for an urgent abdominal scan, which showed possible cancer of the liver. Further tests confirmed this diagnosis and Mrs A died six weeks later.

A few days before Mrs A's death, the GP visited Mrs A at home and there was an altercation between the GP and the family. Miss C and the GP gave slightly different versions of what happened, including what was said about Mrs A's treatment and whether the GP intended to leave without prescribing pain relief. Miss C then complained that the practice had failed to investigate Mrs A's symptoms appropriately, causing a delay in accurately diagnosing her cancer, and that the GP did not appropriately communicate with Mrs A and her family during the home visit.

After taking independent advice from one of our medical advisers, we did not uphold Miss C's complaints. Our adviser said that the practice had acted correctly in referring Mrs A for a scan each time she went to them with abdominal pain. However, Mrs A had decided not to go for the scans. Once a scan was carried out, the practice acted promptly in making the appropriate referrals to confirm the diagnosis and arrange treatment. In relation to communication, our adviser said that the reasonableness of the GP's actions depended on precisely what had happened. As there were different versions of events, which were not resolved one way or the other by the GP's written records from the time of the event, we could not find evidence to uphold Miss C's complaint.

Summary

Company C complained on behalf of their client (Mrs A) who was receiving bills for non-domestic water charges, although she said she had no water facilities in the outbuilding that she used for her business. Mrs A said that as she paid her domestic water through her council tax and the business premises had no water facilities she should not be charged business rates.

Our investigation found that there were two entries for the premises on the Scottish Assessors Association (SAA) website (which provides information about all properties in Scotland). One entry listed the premises as domestic, and the other listed the premises as business. This meant that Business Stream were correct to charge the business rates, based on their dual-use policy.

Summary

Mr C complained that Business Stream failed to properly invoice his company for outstanding water charges, unreasonably disconnected the water supply and failed to respond reasonably to his contacts with them.

When we investigated this, we found that Business Stream had written to his company in February 2013 introducing themselves as the water supplier and asking him to contact them. In August they began sending him invoices, reminders and final notices, and at the end of January 2014, they sent a disconnection warning letter. About two weeks later, Mr C made his first contact with them by completing an online form, saying he was very unhappy with the charges and had contacted the SPSO. An officer from Business Stream tried to contact Mr C about his concerns but received no response and closed the case. Business Stream disconnected the supply in early March.

Having reviewed all the evidence, we were satisfied that Business Stream properly invoiced Mr C for his company's water charges, and noted how many times they contacted him about these. However, with the exception of the online form, and a single phone call, Mr C did not attempt to resolve this with them or complain until after they disconnected his supply. We reviewed the disconnection process and found that it was in line with the code of conduct laid down by the Water Industry Commission for Scotland. As we found no evidence to suggest that Business Stream had not complied with their responsibilities, we did not uphold Mr C's complaints.

Summary

Mr C complained that Business Stream were using the wrong rateable value (RV) in their charges for his wife's business. He said that they had refused to recognise that the valuation had decreased when the unit was renovated and made smaller in 2003, and he believed they were basing their charges on out-of-date plans. Mr C said that Business Stream should be using the current RV, which was less than half of what they were using to calculate charges.

Our investigation found that Business Stream had followed their policy, and acted on advice received from the relevant assessor. We checked with the assessor and it was verified that, whilst there had been a substantial reduction in the RV from the original figure, this was due to a general revaluation and not a material change to the property. In the circumstances, there was no evidence that Business Stream's decision was based on wrong information.