Not upheld, no recommendations

Summary

Mr C, who is a solicitor, complained on behalf of his client (Ms A) that her housing association had unreasonably refused to install a level access shower at her home. The association explained that they were unable to fund such a major adaptation to a property where a new bathroom had recently been installed. They explained, however, that Ms A could carry out the works herself, at her own cost, providing they met the association's specification. As an alternative, they said that she could apply for a transfer to a suitably adapted property in the same block.

We reviewed the association's policies as well as government guidance on adaptations. We found that the association did not have a duty to provide this adaptation. We noted that they had considered Ms A's request for the adaptation and clearly explained why they felt they could not provide it in her case. We also noted that they had tried to assist Ms A by providing her with alternative options. As the association did not have a responsibility to provide this adaptation and as they had tried to work with Ms A to find solutions to her access difficulties, we did not uphold the complaint.

Summary

Mrs C's daughter (Miss A) fractured her forearm and received treatment under anaesthetic at the hospital to manipulate the bone back into position. A cast was placed on Miss A's arm and she was reviewed on four occasions by a consultant surgeon. As Mrs C had concerns about the treatment the consultant provided, Miss A was referred to a second consultant. Miss A then had further surgery as the forearm fracture had become displaced. Mrs C complained that the first consultant had not taken corrective action when he became aware that the fracture had moved. She was unhappy because her daughter sustained permanent scarring and may not regain the full movement of her arm.

Our investigation found that Miss A had corrective surgery five months after her injury. After taking independent advice from one of our medical advisers, we considered that the treatment provided by the first consultant was reasonable. We also found that there was a possibility that corrective surgery was carried out too early because the bone might have corrected itself over the course of six to eighteen months. Our adviser said that fractures in children heal very fast, and as a child grows there is great remodeling capacity as long as there is about 18 months growth left. Miss A was eight years old at the time of her injury. We did not uphold Mrs C's complaint, as we concluded that there was no unreasonable delay in Miss A's treatment.

Summary

Mrs C's late mother (Mrs A) was prescribed methotrexate (a disease-modifying anti-rheumatic drug) from October 2008 for rheumatoid arthritis. She was monitored on a four-weekly basis, her GP practice took blood tests and she was seen regularly by the rheumatoid clinic at the hospital. In April 2012, however, Mrs A was admitted to hospital where she was diagnosed with pancreatic cancer. She died the following month.

Mrs C complained that her mother should have been taken off the medication because her immune system started to deteriorate and because she had a sore stomach around mid-2011. She also complained that the practice failed to reasonably treat her mother's stomach pain, which Mrs C believed was an indicator that her mother had pancreatic cancer. Finally, Mrs C said that in October 2011 a blood test was carried out showing high levels of inflammation, which she believed indicated cancer, but the practice then failed to carry out any further tests.

After taking independent advice from one of our medical advisers, we found that the practice had properly monitored Mrs A while she was prescribed methotrexate. Moreover, there were no specific entries in Mrs A's medical records in 2011 showing that she attended the practice complaining of a sore stomach. We were, therefore, satisfied that there was no evidence that the care and treatment Mrs A received fell below a reasonable standard.

Summary

Miss C complained that her late mother (Mrs A), was inappropriately discharged from hospital while still suffering from a urine infection. Mrs A had diabetes and lung disease. She was admitted to hospital suffering from a number of symptoms, including confusion and fever. Mrs A was diagnosed with a urine infection and was treated with intravenous (IV) antibiotics. Mrs A was discharged after five days, but two days later was admitted to another hospital, where she died soon after admission. The cause of death was urine infection leading to kidney failure. Miss C was concerned that during Mrs A’s stay her fluid balances had not been sufficiently monitored and that she had been discharged too soon.

Our investigation, which included taking independent advice from two of our medical advisers, a doctor and a nurse, found that the care and treatment provided to Mrs A was reasonable. It was reasonable to treat Mrs A with IV antibiotics and the blood and urine tests done during her stay showed that her condition improved. The specific bacteria causing the infection was not identified until after she was discharged. This was thought to be due to the fact that Mrs A was already being treated with antibiotics before admission, which can slow down the rate at which specific bacteria can be identified in the laboratory. In the light of the improving laboratory results, it was reasonable to discharge Mrs A with oral antibiotics to continue her recovery at home. In the event, the specific bacteria proved to be a serious and potentially fatal one which was resistant to the antibiotics prescribed. However, overall we considered Mrs A’s treatment, and the discharge were reasonable.

On the matter of the fluid balance charts, both advisers commented that these charts are notoriously unreliable as so many factors influence fluid balance. However, both also noted that the charts completed in Mrs A's case were of a reasonable and acceptable standard.

Summary

Mrs C complained that the care and treatment provided to her sister (Ms A) was unreasonable. Ms A had a history of chronic obstructive pulmonary disease (a long-term lung condition), osteoporosis (thinning of the bones) and heart problems. A GP from the medical practice visited and, after examining her, prescribed antibiotics and steroids (drugs commonly used to fight infections) in tablet form. Ms A had trouble taking these as she was normally unable to swallow tablets and usually had medication in liquid or powder form. Her condition did not improve.

A second GP visited the next day and again examined Ms A but was unable to take her temperature as his thermometer was broken. The GP prescribed a different antibiotic, again in tablet form. Neither GP considered that Ms A's condition warranted emergency admission to hospital and the second GP said that Ms A had specifically told him that she did not want to go to hospital. Ms A's condition continued to deteriorate and Mrs C called NHS 24 (a national advice helpline) later that evening. Ms A was taken by ambulance to hospital where she was found to be suffering from sepsis (serious infection) and hypothermia (where the body temperature falls below the normal range). She was admitted, but died shortly afterwards.

We did not uphold any of Mrs C's complaints. Our investigation, which included taking independent advice from a medical adviser, concluded that the examinations and management plan for Ms A had been reasonable. In particular, the adviser said that in light of Ms A's reluctance to go to hospital it was appropriate to take her views into consideration and to manage her condition at home. The family disputed that Ms A did not want to go to hospital, but the records showed that the ambulance paramedics had recorded her reluctance to go there. The practice acknowledged that Ms A had medication in liquid form, but there was nothing specific in her notes to highlight that she had difficulty in swallowing tablets. In any event, the second GP did not have access to the notes on his visit as he had been passed the call while out of the practice doing other home visits. There was also no clear evidence that Ms A or the family specifically told either GP that Ms A could not swallow tablets.

Summary

Ms C's daughter (Miss A) was diagnosed with throat cancer and was admitted to hospital for chemotherapy and radiotherapy. She was found to have chest and urinary infections, so her chemotherapy and radiotherapy were postponed until these were treated. When her condition improved, Miss A received chemotherapy. After a second course of chemotherapy, she became neutropenic (the blood cells that fight infection had reduced) and was taken to another hospital, where she died.

Ms C complained that her daughter's condition was not properly monitored. In particular, she noted that blood tests were not taken daily, as had happened with another family member with cancer. Ms C felt that, had Miss A's blood results been closely monitored, she could have been treated and her prognosis might have been better. Ms C also complained about staff communication with the family. She was told after Miss A's death that the tumour was one of the largest the consultant had seen. She said that had she known this earlier, she might have decided to keep Miss A at home during her final days.

We took independent advice from one of our medical advisers, who confirmed that blood tests are not carried out daily following chemotherapy. This is because it will already be known that the treatment makes the patient neutropenic. Neutropenia is only an issue if the patient develops sepsis (a severe blood or tissue infection), and this is not diagnosed through blood tests, but from the patient's physical symptoms. If there is evidence of sepsis, then blood tests would be carried out. We found that Miss A’s treatment and monitoring was in line with the board's protocol for treating patients with head and neck cancers.

The evidence also suggested that communication with the family was good, although we were unable to establish whether specific information was provided about the size of the tumour. It was, however, clear from the records that both Miss A and her sister were told the tumour was extensive; and that Miss A continued with hospital treatment in full knowledge of this.

Summary

Mr C went to the practice because he had lower back and left leg pain, together with numbness. After his second visit, he was referred for physiotherapy, and then to hospital for a consultant opinion and an MRI scan (a scan used to diagnose health conditions that affect organs, tissue and bone). The hospital, however, returned the referral to the practice on the basis that there were no 'red flag' symptoms (symptoms indicating a possible serious condition).

Three days after being referred, Mr C went to a hospital accident and emergency department with increasing pain and numbness. He was ultimately given a scan that confirmed a central prolapsed disc (where the centre of a disc in the spine pushes out into the spinal column) which required emergency surgery. Mr C questioned the treatment he had been given by the practice, as he believed they should have done more. He claimed that as a consequence, his outcome was poorer than it would have been.

To investigate this complaint we considered all the available documentation and relevant clinical records. We also obtained independent advice from one of our medical advisers. We did not, however, uphold Mr C's complaint. Our adviser said that, overall, Mr C's care and treatment had been entirely appropriate and reasonable. The adviser also said that the practice had correctly identified red flag symptoms and made an appropriate, immediate referral, which the hospital had declined to accept.

Summary

Mrs C's late mother (Mrs A) was admitted to hospital following a stroke. She was transferred to another ward a few days later. The day after her transfer to the ward, Mrs C told a nurse that her mother had a headache and needed pain relief. Mrs C said that the nurse was very defensive and extremely rude when she tried to discuss her concerns about her mother's pain relief. A scan was carried out, which did not show any physical cause for Mrs A's headache, and a psychiatrist later diagnosed a chronic tension headache.

Mrs C complained about the nurse's attitude and that Mrs A's pain relief was not reasonably managed after her stroke. After taking independent advice from one of our medical advisers, we found that Mrs A was given appropriate pain relief within a reasonable time, as only certain types of pain relief are normally provided after a stroke, to avoid affecting the patient's brain function. We found no evidence that the nurse had behaved inappropriately or in an unreasonable manner towards Mrs C.

Summary

Mr C did not achieve all the passes that he needed in his Master of Business Administration course. The university decided to withdraw him from the course, and awarded him a postgraduate diploma instead. Mr C was unhappy with this and appealed. However, the university rejected his appeal. Mr C then complained that, in doing so, the university did not take into consideration medical evidence and other circumstances.

Our investigation found that the university had accepted Mr C's appeal, even although it was outwith the normal timescale, when he told them that he had not received his exam results until a month after they were issued. He had not, however, provided evidence that met the requirements of the university's policy for academic appeals and the mitigating circumstances guideline. We found that the university had appropriately followed their policy and procedures, and had clearly explained why the information he provided had not met the grounds for appeal.

Summary

Mr C, who had heart problems, was to undergo elective (non-urgent) surgery in the hospital to improve the blood flow to his heart to relieve the symptoms of angina (chest pain) he was suffering. His wife (Mrs C) complained that his planned transfer from another hospital for this procedure was cancelled five times. Mr C was eventually transferred, but died late the following evening. Mrs C also complained that the hospital's response to her complaint glossed over the reasons for one of her husband's discharges from hospital and was not consistent with the response from the other hospital.

Our investigation, which included taking independent advice from a medical adviser who is a consultant cardiologist (heart specialist), found that the reasons for the multiple cancellations of Mr C's transfer were all medically based. The adviser was of the view that each of the cancellations was reasonable, based on Mr C's clinical condition at the time. The adviser said that the procedure was designed to relieve chest pain. However, because of Mr C's other serious medical conditions, even if the procedure been carried out during his first admission to hospital it would have been unlikely to have changed the eventual outcome or to have prolonged his life. This is because Mr C's eventual condition would not have been cured, altered or improved by the procedure.

Our investigation also found that the reasons for Mr C's discharge were clear and had been made clear at the time. He was discharged so that another medical condition could be addressed to try to ensure that he was fit enough to undergo the surgical procedure, and we took the view that this was reasonable. Similarly, we found that there was no contradiction in the information provided in the complaint responses. Although we appreciated that this had been a very difficult time for Mrs C and her husband, we were satisfied that the overall care and treatment provided was reasonable.