Not upheld, no recommendations

Summary

Mrs C said that her husband (Mr C) experienced a seizure while driving his taxi, and an ambulance was called. After Mr C was assisted out of the taxi and into the ambulance, Mrs C alleged that the ambulance staff used unreasonable restraint, which resulted in a compression fracture (when the bones of the spine become compressed due to trauma). She said that her husband could no longer work or enjoy the quality of life he had enjoyed previously. When Mrs C complained about what had happened, the paramedics involved denied that any unreasonable restraint had been used and the Scottish Ambulance Service said that his back injury was likely to have occurred as a result of his seizure. They said that this was not unusual.

As part of our investigation of the complaint, we took independent advice from one of our medical advisers. We took all the available information into account, including complaints correspondence, staff statements and patient report forms. Our investigation found that Mr C had had a tonic-clonic seizure (a seizure which affects all of the brain) and, as such, the adviser said that Mr C was likely to have been confused and disorientated. They said that a person suffering such events was not likely to remember what happened. This was confirmed by Mr C, who said that his recollection of events, in part, was unclear. The adviser also said that Mr C had suffered a compression fracture but that this was not, in his view, consistent with pressure exerted in a downward direction when a patient was lying on his back. The adviser confirmed that it was most unlikely that Mr C's injury had been caused in the way Mrs C alleged, and that it had likely occurred during his seizure.

Summary

Miss C submitted a repeat prescription request to the medical practice on behalf of her mother. When she went to the pharmacy to collect the prescription over the next few days, it was not available. It was not until several weeks later, when she called about another matter, that she found out the prescription had been lying at the practice awaiting collection. Miss C complained that the practice did not tell her that the prescription was waiting to be picked up, and felt they should have been responsible for dropping it off at the pharmacy.

During our investigation we took independent advice from one of our medical advisers. The adviser said that responsibility for collecting prescriptions and taking them to a pharmacy lies with the patient or their carer. He noted that pharmacists often collect prescriptions from GP surgeries, but that this is a goodwill service and they are not obliged to do so. We considered that it would have been reasonable for Miss C to have asked what had happened to the prescription. We also noted that when the complaint reached us, the prescription had still not been collected, although Miss C had been aware for some time that it was waiting to be picked up. In the circumstances, we did not uphold the complaint.

Summary

Miss C complained that when she had a nerve block (an anaesthetic injected directly into the nerves before surgery to numb the area) some of the anaesthetic went into her artery and caused her heart to stop. She had to be resuscitated and was transferred to the intensive treatment unit (ITU) for observation for 24 hours. Miss C also complained that she was prematurely discharged from the ITU.

Our investigation, which included taking independent advice from two of our medical advisers, found that the care and treatment provided to Miss C had been reasonable. Our anaesthetist adviser (anaesthetic specialist) reviewed the clinical records and was satisfied that there had been no error with the administration of the injection. Nerve blocks should be administered under guidance from ultrasound scanning (a special scanning technique using sound waves to produce internal images of the body). It should also be administered at a specific speed. The anaesthetist adviser was satisfied that both of these were carried out correctly and that Miss C had suffered a known, but rare, complication of this type of anaesthesia. The adviser also said that Miss C's collapse was picked up right away and correct action was immediately taken to revive her. The adviser also considered it reasonable that Miss C was sent to the ITU to be observed for 24 hours following her collapse.

On the matter of Miss C's discharge from hospital the following day, both medical advisers considered that she had been appropriately assessed on admission to ITU and prior to discharge. Although Miss C's next of kin had initially been told that she would likely be transferred to a general ward before discharge home, the advisers both considered that it was reasonable that she was discharged directly home. Miss C had been assessed on the morning after the incident as being alert, mobile about the ward, eating and drinking and had passed urine following the removal of her catheter. On the decision to send her home in a taxi, the nursing adviser said that a routine ambulance can take up to 24 hours to arrange so it was reasonable to avoid this delay by sending Miss C home in a taxi.

Summary

Ms C complained to us that, at a medical appointment, a GP unreasonably requested her granddaughter (Miss A) to make a further appointment to discuss her low mood. This was the third issue that Miss A raised during the consultation, and Ms C felt that her granddaughter had little choice but to comply with the GP's request. Ms C felt that this had left her granddaughter in a vulnerable position.

As part of our investigation, we took independent advice from one of our medical advisers. The adviser noted that low mood was a potential symptom of depression. However, the adviser also noted that a doctor would, ordinarily, assess the patient while the patient was making such a statement (for example, by observing eye contact). The adviser also noted that there was a delay of around a month before the subsequent appointment was made, at which point Miss A declined the offer of assistance from a mental health worker.

Even taking account of the doctor/patient dynamic and acknowledging that it took courage for Ms C's granddaughter to raise the issue with her GP, the adviser noted that the GP had followed accepted practice. In addition, the delay in Miss A making the subsequent appointment (in addition to the offer of a mental health worker being refused) indicated that the GP's request was reasonable.

Summary

Ms C complained about the length of time that it took to provide a diagnosis for her father (Mr A), who was eventually diagnosed with pancreatic cancer. Mr A initially attended his medical practice complaining of abdominal pain, weight loss and vomiting. He was prescribed medication, blood samples were taken, and he was referred for an endoscopy (a medical procedure where a tube-like instrument is put into the body to look inside). This found a hiatus hernia (where part of the stomach pushes up into the lower chest) and gastritis (inflammation of the lining of the stomach), for which Mr A had already been given medication. The blood tests, however, showed abnormalities, and Mr A's GP remained concerned. She referred Mr A for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body). This came back normal, but the head of Mr A's pancreas was not visible. The GP remained concerned, so she referred Mr A for an urgent CT scan (a special scan using a computer to produce an image of the body) through an urgent suspected upper gastro-intestinal cancer pathway (a route into further treatments not available to GPs directly).

We took independent advice from our medical adviser, which indicated that the steps taken by the GP in reaching a diagnosis were appropriate. The adviser noted that pancreatic cancer is difficult to diagnose. The diagnostic path required several tests, but there was no evidence of any delays within the practice in either making referrals or passing on test results. Our investigation also found no evidence of delays in providing test results.

Summary

Mr C's wife (Mrs C) visited a medical practice on a number of occasions complaining of stomach pain. Mr C complained that the practice unreasonably delayed in diagnosing his wife's illness. The practice initially gave Mrs C painkillers. When the pain did not go away the practice took blood tests to rule out cancer. Mrs C then started to complain of weight loss as well as pain. When these symptoms occurred together the doctor referred her to general surgeons at the local hospital, where Mrs C was diagnosed with mesenteric ischemia (a condition that reduces blood flow to the bowel).

To investigate the complaint we took independent advice from one of our medical advisers. He explained that this diagnosis was difficult to make, and would need to be made at a hospital as it required detailed investigations to confirm it. The adviser was satisfied that the practice had referred Mrs C appropriately when she started to have increasing pain and weight loss. The adviser confirmed that there was no evidence of an unreasonable delay in diagnosis.

Summary

Mr C suffers from ulcerative colitis (a disease where inflammation develops in the large intestine). When he became unwell, his GP advised him to go to the accident and emergency department. Mr C was admitted to hospital and given an intravenous steroid (a drug used to treat inflammation, introduced directly into a vein) while awaiting a gastroenterology (digestive system and its disorders) review. After the review, because Mr C was eating and drinking, the doctor who reviewed him prescribed the steroid in oral form (to be taken by mouth). After a discussion with the hospital pharmacist, the doctor noted that before Mr C was admitted to hospital, he had been taking a different oral steroid. The doctor, therefore, changed the prescription and put Mr C back on the steroid he had been taking before admission. Mr C was unhappy with this, as he felt that steroid had not been helping him, and he discharged himself from the hospital.

As part of our investigation we took independent advice from a medical adviser. The advice we received indicated that it was appropriate to give intravenous medication after admission to hospital, until tests are carried out and it is established that the patient can tolerate oral medication. The adviser also confirmed that the decision to re-prescribe the steroid that Mr C had been taking prior to admission was reasonable, as the effects of both steroids were similar.

Summary

Mrs C complained to the board about the care and treatment that her late husband (Mr A) received in hospital when he attended the emergency department. Mr A was discharged home but around two months later he was admitted to the hospital again where it was identified that he had terminal lung cancer that had spread to his liver and bones. Mrs C said that her husband had been suffering agonising pain in his leg over a few months and had been frequently attending his medical practice.

After taking independent advice from one of our medical advisers, we did not uphold Mrs C's complaint. Her husband had presented at the emergency department with pleuritic chest pain (pain associated with the lungs). Our investigation found that the hospital carried out appropriate assessments and investigations at this time. In addition, a chest x-ray and blood tests had given no indication of pneumonia or malignancy.

Summary

Mr A was an elderly man who was admitted by ambulance to a hospital accident and emergency department after complaining of chest pains. His son (Mr C) complained that the board failed to carry out appropriate investigation, diagnosis and management of Mr A's condition before deciding to discharge him from the hospital, and unreasonably failed to place Mr A in isolation. Mr C also complained that the board failed to provide an appropriate response to his complaint.

We did not uphold Mr C's complaints. After looking at Mr A's hospital records and taking independent advice from our medical and nursing advisers, our investigation found that the decision to discharge Mr A was reasonable and was taken after appropriate investigation, diagnosis and management were carried out. Mr A's chest pain was investigated through observation, an electrocardiogram (a test that records the electrical activity of the heart) and a blood test. Mr A had taken aspirin before going to hospital, and so we found it was reasonable that other medicines were not administered. We also found that Mr A did not meet the criteria for isolation, in that he was not considered to have a diagnosis of infectious diarrhoea or diarrhoea associated with recent antibiotic use, or both. Nor was there any need to place Mr A in a single room and the decision not to initially place Mr A in one was reasonable. The board's response to Mr C's complaint was reasonable in light of the medical and nursing care provided and Mr A's hospital records, and we concluded that it addressed all the issues Mr C raised.

Summary

Mr C was unhappy with the academic appeals process that he had to follow when he claimed that his dissertation (document of research and findings, submitted in support of candidature for an academic degree or professional qualification) was unfairly marked. He had been given a fail grade, which meant that he would not be able to go on to study for a doctorate. We explained that we could not look at academic appeals other than where there was a failure of process or mismanagement. Mr C complained that he had not been able to see the comments on his dissertation before the appeals decision meeting, and that the university had not followed their appeals procedures.

After we investigated, we did not uphold Mr C's complaints. Our investigation found that the university had followed its feedback policy, and that comments on final assessments were available if individual students approached their tutor or supervisor. They had advised Mr C to do this, but he had not. The appeals procedure did not enable individuals to question academic judgement or to debate the assessment. The university had followed its procedures in checking that assessment guidelines had been followed, and all markers were in agreement about the grade awarded. The stages of the appeals process had been followed and were clearly documented.