Not upheld, no recommendations

Summary

Mr C complained about the care and treatment of his late wife (Mrs C). Mrs C had developed a cough and, when it persisted, she visited her GP. She was given a range of medication over the next six weeks. When the cough did not clear up, the GP referred her for a chest x-ray, which was reported as normal, and she was referred to a respiratory consultant. While Mrs C awaited this appointment, her symptoms persisted and she developed a pain in her hip. She was given painkillers and referred for an x-ray of her pelvis. This was also reported as normal. When the pain continued and Mrs C also developed numbness in her shoulder, she was given an urgent referral to orthopaedic services. The hospital changed this to a normal referral. When this was identified, the GP changed the referral back to urgent. By this time, Mrs C had seen the respiratory consultant, who diagnosed her with a viral infection. When Mrs C had still not been seen by orthopaedic services a week later, her GP sent her to the hospital with an urgent referral. Mrs C was admitted, and was diagnosed with lung cancer.

Mr C complained that the medical practice failed to diagnose lung cancer for several months. Our investigation reviewed the NHS guidance on suspected cancer, and we took independent advice from one of our medical advisers. We did not, however, uphold Mr C's complaint. The advice we received was that the medical practice acted appropriately, based on the information they had. Mrs C was at low risk of lung cancer, and chest x-rays are the standard initial diagnostic tool. The lack of evidence of lung cancer was borne out by the chest physician's diagnosis of a viral infection. We also found that the medical practice referred Mrs C appropriately for x-rays and specialist opinion.

Summary

Mrs C visited her GP after having had a cough for three months, and was prescribed antibiotics. Mrs C returned a few weeks later. She said she told the GP that she was unable to climb 20 stairs and that the GP noted Mrs C's breathlessness when talking to her. Soon after that, Mrs C visited the medical practice again, saying her cough was no longer a problem but that she was still breathless even when exerting herself very little. At a further consultation about a month later, Mrs C said she told the GP she could no longer climb the stairs, was using the lift at work and her inhaler was not working. The GP then prescribed steroids, referred Mrs C for a blood test and discussed referring her to a chest physician.

About a week after that, Mrs C said she attended the practice for blood tests but asked to see a GP. Mrs C said that the steroids were not helping and she was unable to walk the few metres into the consulting room without stopping. The GP agreed to refer Mrs C to a private consultant to speed up diagnosis. Later that month, however, Mrs C was taken to a hospital accident and emergency department with an acute attack of breathlessness, where she was quickly diagnosed with a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs) that needed immediate treatment. Mrs C complained that her GP did not recognise the worsening symptoms or treat them with any sense of urgency, and did not adequately record the problem with breathlessness. She believed the delay in diagnosis caused a chronic (long-term) condition and that a potentially life-threatening situation could have been avoided.

As part of our investigation we took independent advice from a medical adviser, who studied Mrs C's medical records. The adviser said this was a complicated matter as, in his view, it involved two diagnoses, one related to the ongoing symptoms and the other to the acute symptoms. The adviser said that he considered that the early symptoms that Mrs C described were the result of pulmonary hypertension (raised blood pressure in the blood vessels that supply the lungs) and that later symptoms could have been caused by either this or the pulmonary embolism. He concluded that Mrs C had developed a progressive disease (pulmonary hypertension), but that the actions of the GPs had not changed the long term outlook. We did not uphold the complaint, noting that pulmonary embolism is difficult to diagnose and that the practice had throughout actively managed Mrs C's worsening symptoms and provided her with a reasonable standard of care and treatment.

Summary

Mr C complained to the medical practice about the level of treatment he had received there over a period of a few years. They responded, acknowledging that there had been communication difficulties with Mr C, and that actions of and comments from the GPs had been made with the best of intentions.

It was their view that Mr C had misinterpreted these. However, as a result of the complaint, the practice said that they had learned that they should be more sensitive and vigilant towards any patient who is dissatisfied or unhappy with any member of staff.

Our investigation found that the medical records confirmed the information in the practice's response to Mr C, and that they had carried out a thorough investigation into his complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr C), who had heart problems, during three admissions to hospital. Mr C was to have an operation to improve the blood flow to his heart. Mrs C said that, over the three admissions, her husband's transfer to a second hospital for the procedure was cancelled five times. He was eventually transferred, but died late the following evening. Mrs C also complained that it was unreasonable that she was referred to the second hospital for information about the cancellations, and that the board's response to her complaint glossed over the reasons for one of Mr C's discharges from hospital and was not consistent with the response from the second 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 his clinical condition at the time. They also said that the procedure he was to undergo was designed to relieve chest pain. However, because of his other serious medical conditions, even if the procedure had been carried out during Mr C's 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.

On the matter of Mrs C being referred to the second hospital for further information on the cancellations, we found this was not unreasonable. Cancellation decisions were made jointly on the basis of her husband's clinical condition and the second hospital had the final say in whether or not he was fit to undergo the procedure. It was, therefore, reasonable that Mrs C should be referred to them for further information. Our investigation also found that the reasons for her husband'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.

Summary

Mr C has dementia. His wife (Mrs C) complained that the care and treatment provided to her husband by two hospitals was below a reasonable standard. She also said that when Mr C was reviewed by two doctors from an out-of-hours GP service they ignored her concerns that Mr C had a deep venous thrombosis (DVT – a blood clot in a vein). Mrs C also complained about a lack of communication from staff about Mr C's condition.

Mr C normally lived at home but in April 2011 he was in respite care when he became ill. His confusion increased and his mobility was affected. He was admitted to hospital but discharged three days later. Just over a week after he was discharged, Mrs C reported that Mr C was feeling terrible and had swollen legs and feet. He was seen on two consecutive days by GPs from the out-of-hours service. No definitive diagnosis was reached at either of these visits and Mrs C was given advice on managing Mr C's condition and to contact them again if his condition worsened. Mr C was, however, admitted to hospital again two days later, where DVT was diagnosed. He was transferred to another hospital, where he remained for three months before he was discharged.

We did not uphold Mrs C's complaints. Our investigation, which included taking independent medical and nursing advice, found no failings in the care and treatment provided to Mr C. Mrs C had been particularly concerned about two drugs given to her husband, an antipsychotic and a tranquiliser. Although more commonly used to treat mental illness, these drugs have been found to be useful, in low doses, for short periods under careful monitoring for those displaying the anxiety and agitation that can be a part of dementia. Our advisers were satisfied that the dosages were appropriate and that careful monitoring, dosage reduction and eventual withdrawal followed.

Our investigation found evidence of regular communication from staff to the family, in face to face or phone conversations. Mrs C complained that the family had had to seek out information and take the first steps in communicating with staff, but we found that it would be impractical and unreasonable to expect staff to always be proactive in communicating with patients' relatives. We found no evidence that the family were refused, or had any difficulty in obtaining, information about Mr C's condition.

Our investigation also found that the records showed that the out-of-hours GPs made appropriate and thorough examinations of Mr C. They considered DVT as a possible diagnosis but could make no definitive diagnosis at the time of the visits. Our medical adviser found no evidence of failure on the part of either GP.

Summary

Miss C complained that the university refused to terminate her lease under their exceptional circumstances policy, when she applied for this on medical grounds. She appealed against the decision but her appeal was not upheld. Miss C took alternative accommodation but was still liable for lease payments at her university residence. She also complained that student accommodation staff did not respond to her emails and other communications alerting them to her problems.

After investigating these complaints, we did not uphold them. Our investigation found that the university had applied their policy and correctly followed their procedures. They had repeatedly given Miss C advice about the specific medical evidence she needed to obtain in support of her application, but she had not produced this. We found that staff replied promptly and helpfully to all but one email. This was about her request for a move to en-suite accommodation, as they had none to offer at the time and it was not their policy to respond to requests that could not be met. We did, however, point out that they might wish to consider how they could better respond in future to such requests.

Summary

Mr C has a commercial workshop in his garden. After he fitted a toilet in the workshop, Business Stream issued him with invoices for water and water services. As the premises concerned were not metered, they based the charges on rateable value. Mr C was unhappy with this, and disconnected the water to the toilet. He complained that Business Stream continued to invoice him for water services only, which he considered unreasonable.

Our investigation took all the relevant information into account, including the complaints correspondence and details of Mr C's account, as well as Business Stream's internal computerised records and investigations with Scottish Water. This confirmed the situation as described by Mr C but the investigation also showed that, in terms of the relevant legislation, Business Stream were obliged to charge non-domestic premises on the basis of their rateable value, whether there was a connection or not. Business Stream were not charging for either waste water or drainage. They had, however, recognised Mr C's concerns and provided a number of options to resolve his problem. They also allowed him to pay money outstanding over a fifteen month period.

Summary

Mr C's clients occupied premises where it had been established ten years before that the premises were not connected to surface water drainage but that rainwater drainage flowed into a river. Mr C brought this to the attention of Business Stream in 2012. They reassessed the account and sent Mr C's client a refund for the last five years. Mr C complained about this, saying that the refund was not for the entire time his clients had occupied the premises. Business Stream refused further payment and said that in terms of the Prescription and Limitation (Scotland) Act 1973 (the Act) they were not obliged to go back further than five years.

We investigated the complaint and considered all the relevant documentation and customer invoices. We also took into account the Act and Business Stream's redress and compensation policy. Our investigation found that the facts of the case were not in doubt but although Mr C considered that the overpayment should be backdated to his client's date of entry, Business Stream said they were only backdating it for a maximum of five years, in accordance with their usual procedure. We found that their policy confirmed this to be the case and that Mr C appeared to be complaining about the merits of the policy rather than that Business Stream had not acted properly, for instance by not applying the policy properly.

Summary

Mr C, who is a prisoner, complained that the Scottish Prison Service (SPS) inappropriately took account of false information when considering his application for release under the home detention curfew (HDC) scheme. The SPS said they refused Mr C's application because he had outstanding charges against him but Mr C said that was not true.

In investigating Mr C's complaint, we obtained evidence from the SPS that confirmed that there were outstanding charges against Mr C, which were being investigated by the procurator fiscal. Because of these charges, the SPS felt that Mr C was too high risk to release under the HDC scheme. We were satisfied that the SPS appropriately considered relevant information when considering Mr C's application and because of that, we did not uphold his complaint.

Summary

Mr C, who is a prisoner, complained that he was subjected to discriminatory abuse by a fellow prisoner. Our investigation considered the steps that the Scottish Prison Service (SPS) took to deal with the abuse, and we were satisfied they were reasonable in the circumstances. There was no evidence that the SPS had failed to administer the matter appropriately, and we did not uphold the complaint. We noted that the SPS also made sure that Mr C could report any further abuse to prison staff.