Not upheld, no recommendations

Summary

C underwent an emergency caesarean section (an operation to deliver a baby. It involves cutting the front of the abdomen and womb). Following this, the stitches holding C's wound together failed. C believed they had not been properly cared for after their surgery. They said they had experienced abnormal levels of pain and discomfort. These had been incorrectly attributed to other causes such as constipation, but C believed they were a sign their wound closure was failing. C also noted significant amounts of fluid had leaked from the wound. C felt this was excessive, but that it had not been properly considered by nursing or medical staff. C said the experience had been very traumatic for them and for their spouse.

The board had conducted an internal review into the failure of the stitches. C felt they had not been properly involved in this and that it had not recognised properly the seriousness of the incident, or the implications of its conclusion that incorrect suture material was used.

We took independent medical advice which stated the complication suffered by C was rare. C's condition was monitored appropriately postoperatively, including escalation for medical review due to the concerns about wound leakage and pain levels. Although the documentation was poor, there was no evidence of operator error, or that the specific suture material used had contributed to the failure of the wound. We found C's care and treatment had been of a reasonable standard. Therefore, we did not uphold the complaint.

The board had acknowledged there had been confusion between the complaints process and the serious adverse event review process and that this had led to delays and poor communication with C. We found that the board's handling of the complaint had been unreasonable, but they were able to demonstrate that they were taking steps to address this issue.

Summary

C complained that they were unreasonably discharged from the pain clinic on two occasions. C had their first session with the pain clinic and then their first telephone session with a nurse the following month. In the interim, C was admitted to hospital for their mental health. At a multidisciplinary team meeting (MDT) it was decided to discharge C from the pain service due to their psychiatric admission.

C was later reinstated to the pain service and was offered an appointment but later complained about the service. C was discharged from the service again because of a statement they made in their complaint which led the board to believe C did not want any further contact from the pain service. C complained about both decisions to discharge them from the pain service.

We took independent advice from a consultant psychiatrist. We found that it is routine management to prioritise one acute (immediate) health issue over other longer term issues. Those longer term issues may complicate the management of the immediate health issue. In this case, that would have been C's recent mental health admission. We also noted that the board had acknowledged and apologised for communicating their decision about the first discharge poorly. We found that C had said in their complaint to the board that they did not want the services of the pain clinic anymore. While it would have been good practice to clarify what the patient truly wanted before discharging them from the service, it was not unreasonable to take C's statement at face value. We did not uphold C's complaints.

Summary

C complained that the actions taken in initiating a child protection assessment following an attendance at A&E at Raigmore Hospital with their young child (A) were unreasonable and excessive. A attended with an oral wound and head injury following a fall. During the attendance C also raised concerns about A bruising easily, which prompted the child protection assessment.

We took independent medical advice from an emergency medicine consultant. We considered that the actions taken were reasonable; both in relation to the presenting injury and the concerns surrounding bruising. We noted that medical staff had a professional obligation to report any child protection concerns, and considered they took appropriate action in this regard.

We also took advice from a paediatric consultant regarding the actions following A's admission to the children's ward. We considered that the actions taken were reasonable and in line with relevant guidance. However, we found elements which could have been better, particularly surrounding the communication with C. There was no evidence of medical staff having discussed with C some of the recorded bruises. We noted that clear communication should take place with parents regarding any injuries that cause concern, so that an explanation can be sought to clarify concerns. We fed this back to the board. However, on balance, we did not uphold this complaint.

Summary

C complained on behalf of their spouse (A) about the care and treatment A received from the board. A has Parkinson's disease (a condition in which parts of the brain become progressively damaged over many years, causing physical and neurological symptoms). A was admitted to the Queen Elizabeth University Hospital with a suspected clot. Staff thought that A had suffered a stroke and physiotherapy was arranged as part of their recovery. Following an MRI, it was found that some of A's vertebrae (the bones of the spine) were displaced and were compressing the spinal cord. A was transferred to a consultant neurosurgeon (specialist in surgery of the brain or other nerve tissue).

We took independent advice from a consultant geriatrician (a doctor specialising in medical care for the elderly) with a special interest in Parkinson's disease. We noted that A had had Parkinson's disease for 15 years. They had also had surgery to their neck and lumbar stenosis (narrowing of the bone spaces where the nerves leave the spine in the lower back). A was reviewed by the Parkinson's specialist who suggested that a CT brain scan be carried out. This showed a minor change in the brain which could have been consistent with a small stroke. However, a later scan ruled this out. An MRI scan was ordered of the spine and it was following this scan that A's condition was diagnosed.

We noted that A had a complex medical condition and the symptoms they were exhibiting could have come about by a number of different causes. We found that the board worked through reasonable diagnoses and requested appropriate medical imaging. Therefore, we did not uphold the complaint.

Summary

C complained that their partner (A) was inappropriately prescribed a strong opiate painkiller by their GP, that they developed severe mental and physical health problems as a result of being kept on this medication for too long, that A was not appropriately reviewed while on this medication, and that their requests for help were not acted upon.

We took independent advice from a GP, who considered whether the prescribing to A was reasonable in the circumstances. They found no evidence to support that the long-term prescribing of the medication contributed to the deterioration in A's mental and physical health. They noted there was evidence of regular review and discussion of A's pain and pain relief. We accepted this advice and did not uphold this complaint.

However, we noted some complaint handling issues. The practice did not initially request consent from A to enable them to take C's complaint forward. Additionally, there were subsequent delays in preparing their response and they did not keep C updated or agree an extension to the target timeframe. We advised the practice to review their handling of C's complaint and ensure mechanisms are in place to ensure compliance with the NHS Scotland Complaints Handling Procedure.

Summary

C complained about the care and treatment they received at Dumfries & Galloway Royal Infirmary, after they had fallen and hurt their leg. C raised various concerns about how their injury was diagnosed and their discharge home.

We took independent advice from an adviser in emergency medicine. We found C was given appropriate care and treatment in relation to their injury. We also found it was reasonable C was discharged home. Therefore, we did not uphold the complaint.

Summary

C underwent planned laparoscopic cholecystectomy surgery (surgery to remove the gall bladder through several small cuts made in the abdomen) at University Hospital Crosshouse and was dissatisfied with the care and treatment they received. C stated that prior to discharge they felt unwell but asserted that their concerns and symptoms were dismissed, their request for review by a doctor was dismissed and they were forced out of recovery for discharge home. C experienced worsening symptoms thereafter and was readmitted to hospital ten days later. C underwent further care and treatment in the hospital setting.

The board said that there were no complications during C's planned surgery or thereafter. C met discharge criteria, so it was appropriate that they were discharged. The board acknowledged that C was readmitted and underwent further treatment but said that the only potential explanation was that a recognised complication arose.

We took independent advice from an appropriately qualified adviser. We found that the standard of C's planned surgery, performed by a registrar, was reasonable and supervised by the consultant. There was no evidence to suggest that the surgery was done without care nor that there were any problems. We noted that complications can occur despite a reasonable standard of surgery. During the immediate postoperative period, the management and provision for C's pain control appeared reasonable; C was regularly reviewed and given adequate pain control with satisfactory support from nursing staff. Despite this, C's symptoms should have prompted a review by a member of the clinical team. However, we noted that nurse-led discharge criteria give broad latitude to judgement on when to call the medical team and give inadequate guidance about when to seek support. On balance, we did not uphold this complaint. However, we provided feedback to the board with suggested improvements to their discharge criteria.

Summary

C, a support and advocacy worker, submitted a complaint on behalf of their clients (A and B) regarding the support provided to them by the council's social work service. B is A's main carer and they had concerns that their needs were not assessed appropriately and that they have not been able to use the Self-Directed Support and respite allocation flexibly to meet their needs.

We took independent advice from a social work adviser. We found that there was evidence in the records that the council collaborated and consulted appropriately with A and B, had appropriately assessed A's needs and had taken into account information from health professionals involved in A's care. We also noted that the council acted reasonably regarding the flexibility of the Self-Directed Support and respite allocation for A and B and it was reasonable that the direct payment was in A's name given that A is the adult with the assessed health needs. We also considered that reasonable action was taken by the council regarding care and support for A, when B was recovering from operations.

We did not uphold C's complaint that the support provided to A and B was unreasonable.

Summary

C complained that Live Borders had failed to deal with their complaint appropriately. We found that it had been reasonable for the organisation not to pursue contact with witnesses who C had referred to and to instead ask that C obtained statements from them. We also found that the organisation had reasonably investigated the matter and had issued a reasonable response to C's complaint. Whilst there was a clear disagreement between C and the organisation about what had happened, there was no evidence that the organisation did not intend to conduct a genuine investigation or that they supplied dishonest and false information to C. We did not uphold the complaint.

Summary

C complained on behalf of their family member (A) about Hillcrest Housing Association. A had been a tenant of the association and reported various problems with the property some years ago. Following a chartered surveyor's report, which identified several issues, a number of alterations were made to the property.

C disagreed that the association had repaired the property to a tolerable standard.

In recent years, A reported an alleged insect infestation. Various investigations were done, and A was decanted from the property for a temporary period. C disputed the association's view that there was no evidence of an insect infestation. C also complained that the association failed to provide A with alternative accommodation.

We found that there was evidence that the association had followed their decant process when dealing with the concerns that A had raised. We considered that the association took the concerns about infestation seriously and acted reasonably to address allegations of an ongoing pest infestation. We did not uphold this aspect of the complaint.

We also found that the association made reasonable efforts to offer alternative accommodation in response to A's ongoing concerns. We did not uphold this aspect of C's complaint.

In terms of repairs to the property, we identified evidence to demonstrate that the association had responded reasonably to the reported concerns. Overall, we found no reason for the association to doubt the professional judgement of those involved. We, therefore, did not uphold this aspect of the complaint.