Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment the board provided to her late husband (Mr C) before his death. Mr C had been diagnosed with bladder cancer, and also had heart disease, diabetes, high blood pressure and arthritis. His bladder cancer was managed through intravesical BCG treatment (a vaccine for tuberculosis put directly into the bladder, which can help stop or delay bladder cancers), because he was not considered fit to undergo cystectomy (surgery to remove all or part of the bladder). This required weekly urethral catheterisation (insertion of a tube into the bladder).

Mr C developed a reaction to his intravesical BCG therapy, called BCG-osis (where the BCG organism has spread to cause an infection outwith the bladder), and was admitted to hospital. He was treated for this and then discharged. Mr C then developed a dramatic deterioration in his renal (kidney) function and was readmitted to hospital as an emergency with nausea, vomiting and anorexia. He was found to have developed acute kidney injury and pulmonary oedema (build-up of fluid in the lungs) and required kidney dialysis. Mr C died in the hospital from a presumed heart attack around ten days later.

Mrs C complained that the board failed to provide appropriate clinical treatment when her husband developed the reaction to his treatment. We took independent advice on this from one of our medical advisers, a specialist in treating bladder cancer, and found that it had been reasonable to manage Mr C's cancer by intravesical BCG treatment. We also found that the action taken to investigate, diagnose and treat his reaction to it was reasonable and appropriate. Mr C was appropriately discharged from hospital and our adviser did not consider that there were deficiencies in his care and treatment, nor alternatives that would have improved Mr C's prognosis. There was no evidence that the reaction that arose from the BCG therapy, or the treatment Mr C was given for this, contributed to the deterioration in his renal function. Our adviser said that it was likely that the deterioration resulted from the effects of gastroenteritis (inflammation of the stomach and intestines). We did not uphold Mrs C's complaint as we found that the medical care provided to Mr C was of a good standard.

Summary

Miss C, who is an advice worker, complained to us on behalf of her client (Mr B). Mr B had made a formal complaint to the board about the medical treatment provided to his late father. The board, however, said that the complaint was out of time as the matters complained about had occurred over 12 months previously, and as it was more than six months since Mr B was aware he might have had cause to complain.

We considered the evidence provided by Mr B and by the board, including the contact that took place between the board and the family and advice worker. We confirmed that the normal time limits that applied were that a complaint should be made either within six months of the event that gave rise to the complaint or up to six months from the patient/relative becoming aware of a cause for complaint ,but normally no longer than twelve months after the event. We found no indication in the information provided that the board's decision was unreasonable, and we concluded that they were entitled to decide that the complaint was made to them outwith their time limits.

Summary

Mrs C complained that a GP failed, during two consultations, to properly examine her father (Mr A) who was suffering from diarrhoea, vomiting and abdominal pain, which resulted in him being admitted to hospital where he was found to have a ruptured bowel, and needed surgery.

After taking independent advice on the complaint from one of our advisers, who is a GP, we did not uphold it. Our adviser examined Mr A's clinical records and his view was that the GP had carried out a proper examination and had diagnosed that Mr A was suffering from gastroenteritis. He said that in view of the diagnosis, which was reasonable, the GP's actions were in keeping with current guidelines for the treatment of that condition.

Summary

Mr C complained about the care and treatment provided to his father (Mr A) by the medical practice after he raised concerns about Mr A's deteriorating health. Specifically, he was concerned that doctors failed to assess his father's deteriorating mental health. Mr A refused to go into respite care, was suffering from kidney failure and liver disease and was an alcoholic. Mr C felt that his father no longer had capacity to make decisions for himself. The practice agreed that Mr A's medical condition was very poor. However, they considered that, despite not being willing to go into respite care, stop drinking or allow some visits by doctors, Mr A did have capacity to make his own decisions about his health and welfare.

We reviewed the complaints correspondence and medical records and sought independent advice from our medical adviser, who is a GP. We found that a formal mental health assessment was carried out a couple of weeks before these events and that Mr A had scored highly. In addition, our adviser noted that doctors reviewed Mr A's mental health whenever they visited him and that the records of this did not show any concerns. In addition to the reviews by doctors from the practice, Mr A attended the local renal unit for kidney dialysis, where he had to give informed consent for this procedure to be carried out three times a week. Doctors in the renal unit were also content that he had capacity to make such decisions. As we found no evidence to support the view that doctors had failed to properly assess Mr A's mental health, and as the care provided was reasonable in this regard, we did not uphold the complaint.

Summary

Mrs C complained about a specific consultation with a GP in her local practice. She attended with a flare-up of her longstanding physical health problems, which included fibromyalgia and osteoarthritis (conditions that cause the muscles and joints to become painful and stiff).

She complained that the GP was dismissive of her problems and suggested that there was nothing wrong with her. In responding to the complaint, the practice said that the GP had felt that there was no physical reason why Mrs C could not get out and go about her normal business. Mrs C strongly objected to this and reported how she struggled on a daily basis and, on some days, was unable to even get out of bed.

We obtained independent advice from one of our medical advisers, and this indicated that the advice offered to Mrs C was appropriate for her conditions. We were informed that the management of fibromyalgia would include trying to keep the muscles strong by keeping as active as possible. The adviser noted that Mrs C’s conditions were painful and debilitating and he accepted that she would be limited in her activities. However, he felt it was appropriate for the GP to have tried to encourage her to remain active.

Mrs C clearly disagreed with the advice she received, and she was unhappy with the GP's handling of the consultation, and the attitude he displayed. However, in the absence of evidence that the GP acted unreasonably, or offered inappropriate advice, we did not uphold the complaint.

Summary

When Ms C hurt her knee she went to Stirling Community Hospital where she was seen by an emergency nurse practitioner (ENP) in the minor injuries unit. She was diagnosed as having a medial collateral ligament (knee ligament) sprain and sprain of her hamstring. She was prescribed co-codamol (a pain reliever) and advised to see her GP if she had further concerns. She was encouraged to walk.

Ms C told us that the examination and care given to her were inadequate. She was not given an x-ray, nor was her knee scanned. She said that it was not until a month later, after she attended the accident and emergency department, that her knee was scanned and it was confirmed that her cruciate ligament (another knee ligament) had snapped.

During our investigation we carefully considered all the complaints correspondence and Ms C's relevant clinical records, and took independent advice from one of our medical advisers. Our investigation confirmed that Ms C's initial examination had been full and thorough and that the ENP had provided appropriate treatment in accordance with the relevant guidelines. The adviser said that Ms C did not require an x-ray as she had suffered a soft tissue injury which would not be seen on an x-ray. Although Ms C said that her knee had 'popped' and that she had reported this, there was no evidence of this in the records. We decided, on the basis of the available evidence, not to uphold the complaint, as it was not possible to provide independent verification of Ms C's recollection of events.

Summary

When Mrs C's young daughter (Miss A) became ill, she was taken to her medical practice, where she was treated for an upper respiratory tract infection. The next day Miss A attended an emergency appointment there, as her condition had deteriorated. As she was clearly unwell, the practice referred her urgently to hospital. She was treated for a viral infection and discharged home without follow-up. A few days later, she was again taken to a further emergency appointment at the practice, where, in view of the hospital's recent diagnosis, doctors advised Mrs C to continue with the treatment previously recommended. However, Miss A's condition continued to decline and she was admitted to hospital. She later spent a number of weeks in intensive care after being diagnosed with pneumonia.

Mrs C complained that the practice showed little concern or empathy for her daughter's declining condition. She said that they had failed to take appropriate action on her symptoms as a consequence of which Miss A suffered distress and unnecessary suffering. We took independent advice on this case from one of our medical advisers, and took all the relevant information (including the complaints correspondence and Miss A's clinical notes) into account. We did not uphold the complaint, as our adviser said that the records indicated that the treatment given to Miss A was reasonable and that doctors made a reasonable working diagnosis. The adviser also said that Miss A went on to develop a rare and unusual medical condition, and there was nothing in her notes to suggest that this was developing.

Summary

After Mr C'’s daughter (Mrs A) experienced several episodes of breathlessness, she was seen by her GP, who concluded she had a virus. Over the following days, Mrs A remained breathless. She collapsed at home and her GP was called out. He found that her blood pressure was low, but rising. He concluded that she had had a vasovagal episode (a temporary loss of blood to the brain) but was improving. Mrs A had further collapses over the following days and was eventually taken by ambulance to hospital. Shortly after arriving there, Mrs A collapsed again and, despite attempts to revive her, she died. Mrs A was found to have had a pulmonary embolism (a blockage in the artery that transports blood to the lungs). Mr C felt that Mrs A’'s GP could, and should, have diagnosed Mrs A'’s pulmonary embolism or could have arranged for more urgent investigations to establish the cause of her symptoms.

We took independent advice on this case from one of our medical advisers. We found that, with the benefit of hindsight, it was likely that Mrs A’'s collapses at home were caused by initial smaller thromboembolic (blocking of a blood vessel by a blood clot) events. However, there was evidence to suggest that Mrs A was also suffering from a viral infection, which may have contributed to her symptoms. We accepted the adviser's view that Mrs A’'s symptoms were consistent with a viral infection rather than a pulmonary embolism. There was clear evidence that the GP had considered a number of possible diagnoses but had ruled out pulmonary embolism. Based on the information available to him at the time, we were satisfied that his examinations of Mrs A were thorough and his conclusions reasonable.

Summary

Mr C was referred for hospital physiotherapy treatment but, as he had not received an appointment after two months, he complained to the board. In their response, the board acknowledged that their waiting list for routine physiotherapy appointments was much longer than they would like it to be. They apologised to Mr C and explained the steps they were taking to try to reduce the waiting list. They also confirmed that they had sent him a separate letter offering him an appointment. However, as Mr C did not receive this, he was unable to respond to the offer, and because of this he was removed from the waiting list and discharged. When he contacted the board to ask why he had not heard anything, he found out he had been discharged and brought his complaint to us.

Our investigation found that although the board do not keep copies of appointment letters, they had recorded on their system that a letter had been sent to Mr C and the date it was sent. They also provided us with evidence that they had notified Mr C’s GP of his discharge. We obtained independent advice from our medical adviser, who is a GP. The adviser confirmed that this was reasonable and that the onus was then on Mr C to get in touch. We noted that, despite having been told by the board that an appointment letter had been sent, he waited over six months to get in touch with them to tell them he had not received it. When he did get in touch, the physiotherapy service phoned him to explore the possibility of reinstating his referral but Mr C indicated that he no longer wished an appointment.

As we considered the board’s response to the initial complaint to have been reasonable, and as Mr C himself appeared to have delayed in querying why he had not received the appointment letter, we did not uphold the complaint.

Summary

Mr C complained that the university had treated him unfairly when they did not consider his academic appeal, and that this had a serious impact on progress towards completing his degree. He submitted a formal complaint about all the incidents where he considered the university had not treated him fairly and not followed their academic policies and regulations. At the final stage of his complaint he claimed that the university had not fully responded to his complaints.

Our investigation found, however, that Mr C had not met the eligibility requirements for an appeal and that the university had reasonably applied their appeals policy and procedures. We also found that they had thoroughly investigated his complaints of unfair treatment, and had taken considerable steps to assure him of their support.