Not upheld, no recommendations

Summary

C complained about the treatment for a leg wound which they had received from a podiatrist (a physician who specialises in the study and medical treatment of disorders of the foot, ankle and lower extremity). C felt that the podiatrist was rough and that they had provided inappropriate treatment as the wound had increased in size. C, who has a history of cardiovascular disease (disorders of the heart) and other health issues, required regular podiatry treatment to treat their toes and feet for ulcers. C began to have concerns about a number of podiatrists who had treated them. In particular, C felt that one podiatrist was irate when they had to wait a time for C to answer the door due to their poor mobility. C also found that the wound appeared to worsen after the podiatrist's care.

We took independent advice from an adviser and found that from a clinical perspective, the treatment provided by the podiatrist was reasonable. There was evidence that informed consent for treatment was obtained from C and that their leg wound was treated in accordance with recognised procedures.

We did not uphold the complaint.

Summary

C's adult child (A) had a history of intravenous drug use and was on a methadone programme. A suffered from osteoarthritis (a condition that causes joints to become painful and stiff) in their knee. A sought surgical treatment for this on a number of occasions. On the latter two occasions, the board determined that A was physically suitable for surgery. Surgery was initially scheduled but it did not take place. A sought surgery again the following year, however, the consultant surgeon did not consider A would cope with the possible postoperative pain of a total knee replacement (TKR) and decided not to schedule any surgery. C complained to the the board about this decision.

The board's response noted recent x-rays showed A was physically suitable for surgery but that the board was concerned about how A would cope with the postoperative pain, and noted the likelihood that A would be in more pain following the surgery than previously. The board said that pain control following this operation can be exceptionally difficult and that this, coupled with the high doses of methadone A was prescribed and any heroin injections they may have been taking, meant that there was a risk of A's pain becoming chronic and untreatable after the operation. Clinicians recommended that A's chronic pain be managed, A's dose of methadone reduced and A be free of heroin before surgery be considered. The board said that clinicians intended to await a multidisciplinary team meeting outcome and liaise with A's psychiatrist before discussing options with other colleagues. The board said that A's GP would be updated with information about these outcomes and the board's recommendations at that point.

We took independent advice from an orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the board's reasons for caution regarding A's TKR were well documented and their decisions were reasonable. In considering the complaint, we also took into account that the board, despite deciding not to proceed with surgery at that time, outlined the route that could lead to further consideration of A having a TKR and remained open to that possibility for at least 12 months afterwards. We did not uphold this complaint.

Summary

C moved into their property and began experiencing antisocial behaviour from their neighbours. C complained to the association about their handling of C's reports of antisocial behaviour.

We sought information from the association about C's reports. As part of that, we saw evidence which related to C's neighbours but that we could not share for reasons of confidentiality and data protection.

We found that the association took action to investigate each of C's reports. These actions were undertaken promptly. Some contact from the association took longer than their policy specified, however in the context of the COVID-19 pandemic, this was reasonable.

Information relevant to the investigations was sought from external agencies and relevant investigations were undertaken by association staff. Staff were not able to corroborate all the incidents reported to them. Sometimes there were no other witnesses to the incidents and sometimes it was determined that the noise was not excessive or antisocial.

We were satisfied that the association had investigated each report of antisocial behaviour made to them and that they had taken appropriate action when those incidents had been corroborated. We did not uphold the complaint.

Summary

C is welfare guardian (a court appointed guardian who can make decisions on behalf of an adult with incapacity) for their adult sibling (A). A was assessed in hospital by the health and social care partnership as needing full-time residential adult care. C disagreed with this assessment and considered that A would be better cared for at home. C returned A to their home following their hospital discharge. C maintained that as A had been assessed as requiring full-time care, they were entitled to have this fully funded at home and that they were entitled to be offered the relevant self-directed support payment options for this care. Glasgow City Council refused to provide such funding, maintaining that they were only under a duty to fully fund the care assessed as needed. Adult protection procedures were considered but as C was now providing full-time care to A, alongside a council funded care package, no action was taken.

C complained to the partnership about the assessment outcome and the failure to provide fully funded full-time home care for A. There were considerable delays in responding to the complaint for which the partnership later apologised, however they maintained their view that A was not entitled to full-time fully funded home care and their original assessment had been appropriate.

C brought their complaint to this office and raised further concerns about the tone of partnership's communications and the investigation of their complaint.

We found that A was entitled to assessment under the 1968 Social Work (Scotland) Act and funding to meet the needs assessed. However, the council were not obliged to provide funding to meet care costs where the care being provided did not meet that assessed need (in this case care at home rather than residential care). We concluded that the assessment of A's needs was appropriate and that the council were not obligated to offer self-directed support payments. Therefore, we did not uphold this complaint.

Summary

C complained that they were unreasonably diagnosed with bicuspid aortic valve (a type of abnormality in the aortic valve in the heart where the valve has only two small parts (leaflets), instead of the normal three). C was diagnosed with bicuspid aortic valve by the board and as a consequence, made significant changes to their life and retired early. C was later given a different diagnosis (when they were under the care of a different NHS board) and took the view that the diagnosis given previously was, therefore, incorrect.

We took independent clinical advice from a consultant general cardiologist (specialist in diseases and abnormalities of the heart) and a consultant cardiologist with particular experience in the reading of echocardiograms (a scan used to look at the heart and nearby blood vessels). We found that C had been diagnosed previously with bicuspid aortic valve when they were resident in Wales. Relevant information was passed to C's new GP when they moved to Scotland who made a referral to Perth Royal Infirmary for continued follow-up. A further echocardiogram was performed at that time, which was reasonable and appropriate. We confirmed that although interpretation of C's echocardiogram was not necessarily straightforward because of calcification (a build-up of calcium in body tissue) and the fact that C was not echogenic ('echogram-friendly'), the conclusions reached (of bicuspid aortic valve) and reported to C at the time were entirely reasonable in the circumstances.

While C's diagnosis had since been amended, this did not mean that the diagnosis given by the board was an unreasonable one. We noted that it was not unusual for diagnoses to be amended. Therefore, we did not uphold C's complaint.

Summary

C complained about the psychiatric care and treatment that they received during an admission to University Hospital Wishaw. They complained about the way they had been treated by staff, claiming to have been assaulted and injured. C also complained about their medication regime, stating that they had been given too much medication which caused them to become ill.

In their response to our enquiries, the board set out the circumstances in which C had been restrained, explaining that C tried to run away from the ward and became verbally and physically aggressive. As C was detained under the Mental Health Act, their refusal to return to the ward resulted in the use of restraint using prevention and management of aggression techniques. The board said that the restraint techniques utilised by staff were appropriate and all staff involved were appropriately trained. They expressed regret that C's jacket had been damaged, advising that reimbursement for C's loss had not been paid because C had failed to provide a receipt as requested. While C complained about a separate incident in which they said that they were injured, there was no record of this and as such we could make no finding on this.

We took independent advice from a consultant psychiatrist. We found that the assessment and management of C's symptoms were appropriate. After review of C's medication regime, we found that there was no link with C becoming ill and vomiting. We noted signs of infection which were considered a more likely explanation for C vomiting.

We found that C's care and treatment were reasonable and we therefore did not uphold this complaint.

Summary

C underwent a septoplasty (procedure to straighten bone and cartilage in nose). Around nine years later, C was referred to neurology (the science of the nerves and the nervoussystem, especially of the diseases affecting them) with symptoms of migraine. C believed that their pain and symptoms were related to physical issues with their nasal passages, rather than being neurological in origin.

C underwent an MRI scan to investigate their history of recurring pain and headaches. The board's conclusion was that there was no abnormal findings and ruled out issues with C's septum and nasal passages being the cause of their symptoms. C complained to the health board that the findings from the MRI scan were incorrect and that the board refused to offer C a second opinion.

The health board responded to C's complaint advising that the results of the MRI were reported accurately and that there was no evidence of failures with respect to the assessment of the imaging. Repeat imaging was arranged but C cancelled the appointment and advised that they did not want this to go ahead.

C brought the complaint to us that the health board had failed to appropriately assess the MRI scan and take appropriate action to resolve their symptoms. We sought advice from an independent adviser and we found that the board appropriately assessed the MRI scan and took appropriate action for follow-up imaging to be arranged. We identified that it may have been beneficial had the health board clarified the deviated septum identified in the imaging was considered incidental and therefore not included in the imaging report. This was fed back to the board. Given that the assessment and treatment was reasonable, we did not uphold the complaint.

Summary

C complained about surgery carried out by the board. C underwent abdominal surgery and immediately after the procedure, experienced issues and severe abdominal pain.

C was made aware by the surgical staff that there had been complications during the operation, but was advised that this would not have caused the issues. C underwent a second procedure and a diagnosis was made during this surgery.

C complained about the board's handling of the first operation and the surgeon's failure to make a diagnosis during the first procedure. We found that, whilst there were complications during the first procedure, these occurred despite the board's staff taking all reasonable precautions. We accepted advice that, due to the nature of C's condition, it was not unreasonable that no diagnosis was confirmed during the first procedure. We could find no clear link between events during the first surgery and the problems C later experienced. We did not uphold C's complaints.

Summary

C complained that the care and treatment provided to their partner (A) was unreasonable. During a routine scan around 20 weeks into A's pregnancy, their cervix was found to be short, putting them at risk of miscarriage. A suture (a stitch or row of stitches holding together the edges of a wound or surgical incision) was inserted in their cervix that day. In hospital the following day, it appeared that A's membranes had ruptured and that the decision was taken to remove the suture. A and C were advised their baby was unlikely to survive. They were offered medication to abort the foetus and condolences were given. They chose to continue with the pregnancy and as time passed it appeared that the initial diagnosis had been incorrect. A was monitored for a few days on the ward and was discharged with follow-up arrangements when their condition was deemed to be stable.

At a follow-up appointment a few days after discharge from hospital, the consultant advised that a further suture was required to protect the pregnancy. The procedure was carried out that day. A few weeks after the second suture was inserted, A went into labour and their baby was born three months prematurely.

C complained that the decision to remove the first suture was unreasonable. They also complained that they had been told their unborn baby was dead.

We took independent clinical advice from a consultant obstetrician and gynaecologist (specialist in pregnancy, childbirth and the female reproductive system). We found that in deciding to remove the suture the clinicians were acting in good faith with the information available and in the best interests of the mother, at a stage when the foetus could not survive if delivered. Appropriate discussion took place with the on-call consultant who was in agreement with the instruction that the suture should be removed if there was any sign of ruptured membranes. This is a recognised indication for removal of a cervical suture as it increases the risk of maternal sepsis (blood infection).

Given the likelihood that the patient would go on to miscarry, we found that it was appropriate to offer condolences. We found no evidence in the notes that staff told the patient their baby was dead. The adviser noted that the foetal heart was heard using sonic aid and that the patient reported feeling foetal movements.

Therefore, we did not uphold either complaint.

Summary

C complained that the practice had unfairly accused them of being threatening and aggressive, resulting in their removal from the practice list and that C had been unreasonably placed on an opiate reduction programme. C said that they had been targeted because they had successfully complained about the services provided by the practice in the past. C said that the practice had misrepresented the opiate reduction as mandatory, when in fact they were only required to review opiate use. C said that the practice had not taken into account the impact of the opiate reduction on them.

The practice said that they had a zero tolerance for aggressive or inappropriate behaviour. C had abused the prescription request service and had entered the practice and refused to leave unless they were provided with an additional prescription. The practice had, after review, reinstated C to the practice, but C had continued to request medication early, breaching their agreements with the practice. This had resulted in their removal from the practice lists. The practice had reviewed and reduced C's medication in line with best practice and health board guidance. C had previously sought medication early and was considered by the practice to meet the criteria for opiate reduction.

We took advice from an independent medical adviser. We found that the practice had acted reasonably in seeking to reduce C's opiate use. We also found that arguably the practice should have provided C with a written warning prior to the first decision to remove them from the practice list. When C had appealed against this decision, however, the practice had reviewed it and agreed to reinstate C subject to commitments about their behaviour. C's second removal had been due to the practice's view that the agreements reached with C had been breached. The practice were entitled to reach this decision and had acted reasonably. Therefore, we did not uphold the complaint.