Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment that her late father (Mr A) who was 93 years old, received from his medical practice. In January 2012, Mr A went to his GP with backache. He said that he was told he was wearing too many clothes and to return to see the nurse for blood and urine tests. Mrs C contacted the practice and arranged for a nurse to call at the house, but she only took blood tests. Mr A continued to deteriorate and his GP said he would refer him to hospital as he had swallowing difficulties. Mr A went to the hospital on a number of occasions and was seen in various departments. A scan in June 2012 confirmed lesions in Mr A's pancreas, and that this was likely to be pancreatic cancer. A multi-disciplinary team met in the hospital, and decided that Mr A would not be offered surgery in view of his age, other medical conditions (including diabetes) and because it was unlikely to be successful. Palliative care was to be offered instead. The hospital wrote to the practice with the results of the scan 17 days later. Mr A's condition continued to deteriorate and Mrs C requested a home visit from the GP, who was delayed in getting there. When he arrived and assessed Mr A, the GP requested an ambulance to admit Mr A to hospital. Mr A died six days later.

Mrs C complained that the practice did not treat her father's backache, and did not treat or refer him to hospital for problems with his diabetes. In his last few weeks, Mr A stopped eating, lost a tremendous amount of weight and was bedridden. She said that the practice also failed to offer additional homecare. Mrs C said that the GP should have visited and admitted Mr A to hospital earlier. She believed that the practice displayed a lack of care and attention towards Mr A and failed in their duty of care to him.

As part of our investigation we took independent advice from one of our medical advisers. The advice, which we have accepted, was that the practice provided a reasonable standard of care to Mr A (including diabetic care) and that the family were offered additional homecare on a number of occasions, but Mr A's wife declined this. It was also clear that communication was reasonable and that the practice tried to provide Mrs C and her family with information, but that this was hampered by delays by the hospital. We were satisfied that the standard of medical care provided to Mr A by the practice was reasonable.

Summary

Mrs C received hospital treatment for a cerebrospinal fluid (CSF - the fluid that surrounds the brain and spinal cord) leak in 2009. As other procedures had been unsuccessful, a shunt (a device inserted to transport excess fluid elsewhere) was inserted, but Mrs C believed this to have been too short, and that this contributed to her subsequent stroke.

She complained that the treatment she received to try to repair the CSF leak was unreasonable, that it took too long to identify that she had suffered a stroke, and that the board unreasonably failed to tell her in advance that there was a risk that the treatment might lead to a stroke.

After taking independent advice from a medical adviser, although we recognised Mrs C's concerns, we did not uphold her complaints. After inspecting Mrs C's medical records, the adviser said that her care and treatment was entirely reasonable, and that the shunt was not too short, but had probably moved, which is a common and recognised complication of that procedure. He was clearly of the opinion that this could not have caused the stroke. He also said that there was no sign of delay in identifying that Mrs C had experienced a stroke, and no identifiable risk that the treatment might lead to one. It was not unreasonable that Mrs C was not warned of this.

Summary

Mr C complained that his medical practice refused to update him on changes in his son (Master A)’s medical file, about which his estranged wife had not told him. Mr C also complained that the practice had prevented him from transferring his son to an alternative practice in the area.

We looked at the information provided by Mr C and obtained information from the practice. We also took independent advice from our GP adviser. Our investigation found that the practice were not required to keep Mr C informed, and that it was a matter for him and his estranged wife to resolve. We also found that the practice had acted correctly dealing with Mr C's request to transfer Master A, as it was not reasonable for one parent to try to re-register a child without the other parent's knowledge.

Summary

Mr C complained that staff failed to involve him and his brother in discussions about future care plans for their mother (Mrs A). He said that staff decided that their mother was to be moved to another hospital to be assessed for a nursing home without any consultation with the family. We found that this was a difficult situation where Mr C and his brother, along with the health care team, were trying to get the best outcome for Mrs A. It appears that Mrs A was not able to return home and staff did their best to involve Mr C and his brother in the discharge arrangements. There was clearly some confusion regarding Mrs A's transfer to another hospital. The records showed that Mr C was told that his mother would have a further assessment for a nursing home there. The doctor also tried to contact Mr C again to discuss this before Mrs A was transferred, but there was no answer.

We did not uphold Mr C's complaint about this, as we found that the records provided evidence that staff spoke to Mr C and his brother very frequently throughout their mother's stay in hospital. There was no evidence of shortcomings in relation to communication and we were satisfied that staff took on Mr C's concerns about Mrs A's future care plans when he later complained about this.

Mr C also complained that staff inappropriately assessed Mrs A without ensuring that her hearing aid was in place. Although Mrs A lost her hearing aid on several occasions, we were satisfied that staff took reasonable steps to obtain replacements. Ideally, a patient should be wearing a hearing aid when being assessed. However, where this is not possible, as in Mrs A's case, it is reasonable for staff to carry out an assessment without the hearing aid in place, providing that they speak clearly and loudly during the assessment. Finally, Mr C complained that staff failed to adequately investigate his concerns that some of Mrs A’s clothing had been lost. We were satisfied that staff adequately dealt with his concerns about this.

Summary

Mrs C complained that her GP had failed to diagnose her heart condition, and that as a result she had suffered a heart attack and had needed hospital treatment.

Our investigation found that Mrs C had gone to her GP with symptoms of postural hypertension (changes in blood pressure, caused by changes in position, such as moving from sitting to standing). After taking independent advice from one of our medical advisers, we did not uphold the complaint, as we found the treatment she received was appropriate for this condition. There was no evidence that the GP had failed to identify symptoms of an imminent heart attack.

Summary

Mr C complained about the university's handling of his appeal. Mr C was withdrawn from his post-graduate research because of unsatisfactory progress. He considered the decision had been made hastily and unfairly. He appealed, and the university upheld his appeal taking into consideration some difficult circumstances he had faced. The decision, however, required him to participate in a review procedure that he had complained about in his appeal, saying it was not being properly conducted. He, therefore, did not accept the offer of resuming his post-graduate studies and brought his complaints to us. He also complained in his appeal that procedures had not been followed when he was withdrawn and so he had lost time by having to appeal that decision. Our investigation found, however, that the university had reasonably carried out the review process and followed procedures in withdrawing Mr C and we did not uphold his complaints.

Summary

Mr C failed a practical element of an examination and submitted an appeal, which the university upheld. However, Mr C was not happy with the remedy they put in place and complained to us that the university did not offer him another attempt at the whole examination without penalty.

As part of our investigation, we looked at the information provided by Mr C and the university. We did not uphold the complaint, as we found that the university had acted in line with their regulations and normal practice, and Mr C had not been disadvantaged.

Summary

Miss C appealed against the university's decision to discontinue her studies and not to allow her to re-sit examinations. She submitted medical evidence she felt was not taken into account at the appeal stages and said that she was not invited to attend meetings. The university determined that there were no grounds to consider her appeal. Miss C then complained to us.

Our investigation found that throughout the appeal process her medical and personal circumstances were fully taken into account and that the university had given her numerous repeat attempts to achieve the credits needed for her degree. We did not uphold her complaint, as we found that the university had followed their appeal procedures and acted reasonably throughout the process.

Summary

Mrs C complained about the care and treatment provided to her by an optometrist (a healthcare professional concerned with the health of the eyes). When Mrs C had problems with her right eye, she went to her GP, who prescribed eye drops and referred Mrs C to her local opticians. The opticians were members of the Grampian Eye Health Network, which provides assessments and treatment in the community for certain eye conditions. The network is supported by advice from a local hospital eye clinic via a phone helpline, which members can also use to make urgent referrals to hospital.

Mrs C was seen by the optometrist several times that month and was diagnosed with ulcers or marginal keratitis (inflammation of the outer layer of the eye). The optometrist advised her to continue with the drops prescribed by her GP, and added further treatments. They also took advice from the eye clinic via the helpline. Mrs C's condition seemed to improve, as the ulcers were reducing in size, but by the start of the next month she was still experiencing pain and inflammation. She phoned the optometrist saying that following research on the internet she had stopped all treatment and was requesting a referral to the hospital eye clinic. She was seen at the opticians the following day. The ulcers were found to have increased in size again and the optometrist made an urgent referral to hospital. Mrs C was seen in the eye clinic the next day, was admitted to hospital and received in-patient treatment for ten days.

After taking independent advice from one of our medical advisers we found that the care and treatment provided to Mrs C was reasonable, appropriate and timely. The adviser considered that the optometrist had prescribed reasonable treatment, which followed the advice and guidance of the network and also complied with that issued by the Royal College of Optometrists.

Summary

Mr C said that Transport Scotland had not properly investigated his complaint about a rail provider. Mr C originally complained to a rail provider when a member of station staff refused to issue him with a discounted ticket that he was entitled to under the terms and conditions of a new deal railcard. Mr C said he felt bullied and humiliated by the member of staff. Dissatisfied with the response to his complaint, Mr C escalated it to Transport Scotland who had responsibility for the franchise agreement with the rail company. He said that Transport Scotland unreasonably concluded that the rail company had properly investigated his complaints. He said that they had accepted, without reasonable investigation, the rail provider's claims that he had changed his route when in fact his start and destination stations had remained unchanged throughout and that there were suitable available alternatives for the purchase of discounted tickets. He also said that Transport Scotland had failed to establish whether his complaint had been escalated to the director of the rail provider.

We concluded, however, that Mr C's complaints had been reasonably investigated. Transport Scotland had questioned the rail provider when Mr C disputed the statements they made about the purchase of tickets. They had also investigated, as far as it was possible to do so, whether Mr C's complaint had been escalated to the director. They did not investigate the matter of Mr C having changed his destination stations, because Mr C had never made this point clearly to them. In terms of whether the rail provider had reasonably investigated Mr C's complaint, we concluded Transport Scotland had considered the matter appropriately. They had established how the complaint had been responded to and what actions had been taken to prevent recurrence. We could not find any fault or omission in the investigation process that would lead us to question Transport Scotland's decision.