Not upheld, no recommendations

Summary

Mrs C had a complex medical history including pelvic, back and shoulder pain, arthritis, kidney problems, ovarian cysts, endometriosis, hypertension, depression and gastric problems. Over the course of 2009 to 2012 she attended her medical practice for pain management and treatment of these and other illnesses. GPs referred her to a number of specialists for treatment and exploratory tests, including consultants in neurology, neurosurgery, pain management and gynaecology. GPs also prescribed Mrs C with various drugs to treat her pain symptoms, including a number of different types of opioid analgesics (pain relief that acts on the central nervous system), but with limited success.

In July 2011, Mrs C became very unwell with dizziness and weakness and was confined to bed. A GP diagnosed severe postural hypotension (a drop in blood pressure than can cause dizziness), which they considered was likely to be drug-induced with inactivity contributing to it. They advised Mrs C to reduce her intake of opioid medications. During a hospital admission, specialists noted that Mrs C had a decreased level of a particular hormone and carried out extensive tests. These established that she was suffering from drug induced suppression of another hormone. Mrs C complained to us that between 2010 and 2012 the practice did not provide her with appropriate care and treatment.

As part of our investigation, we obtained independent advice from our medical adviser, who said that this is a recognised, but rare side-effect of long-term opioid analgesic use. However, he advised that the treatment that the practice prescribed for Mrs C was appropriate, and was taken with the appropriate secondary care advice, and that the referrals made were reasonable. We, therefore, did not uphold this complaint.

Summary

Mrs C, complained to us about the care and treatment of her late mother (Mrs A) who had a complex medical history, including bowel cancer. After falling, Mrs A was admitted to a hospital high dependency unit. She was given a blood transfusion and antibiotics for a urinary tract infection. As doctors thought Mrs A had suffered a stroke she was moved to the stroke ward at 03:30.

Shortly after admission to the stroke ward, Mrs A stopped eating, experienced constipation and complained to her daughter of knee pain. Six days after she was moved there, her condition deteriorated rapidly and Mrs C’s husband telephoned Mrs C saying that the hospital had called to say that Mrs A had taken a bad turn and Mrs C should go to the hospital. Mrs A passed away shortly afterwards. The death certificate noted Mrs A’s cause of death as toxins and a perforated bowel.

Mrs C complained about these events, saying that staff should have dealt with Mrs A’s problems sooner and that her mother was transferred from one ward to another at an inappropriate time. She also said that she suspected that the suppositories or other medical interventions might have caused her mother’s deterioration and death, and was unhappy about the attitude of nursing staff. She said that they showed unprofessional attitudes to her and her mother and failed to properly contact her on the morning of Mrs A’s death.

The board’s reply to Mrs C’s complaint recognised that there were some problems with communication between nurses and Mrs A’s family. They also recognised that the early morning transfer between the high dependency unit and the stroke ward was inappropriate as there was no clinical need for it to be done at this time. They agreed that staff should have known to contact Mrs C directly on the morning of her mother’s death. They apologised and ensured that the relevant managers were made aware of the issues.

We did not uphold Mrs C's complaints. After reviewing the board’s file and Mrs A's medical records, and taking independent advice from our medical and nursing advisers, we found that the general quality of care provided was reasonable. We also considered that the board had taken reasonable steps to resolve the issues about communication, transfer and contact. We considered that the medication provided to Mrs A during her stay was appropriate and could not reasonably be linked to Mrs A’s death. We found no evidence of unprofessional behaviour by nursing staff towards Mrs C or her family.

Summary

Mr C complained that the medical practice had acted unreasonably in refusing him a repeat prescription for an inhaler. He had made a repeat prescription request, but this was refused and he was told to attend an asthma review clinic two weeks later. He was unhappy that he had not been given his medication at the time he needed it, which he felt was a risk to his health.

The practice's response to Mr C indicated that before he made the prescription request he had been sent four letters inviting him to attend the asthma clinic but he had not gone. The prescription record also showed that Mr C was not using his inhaler regularly. They had, therefore, felt unable to issue the prescription until he had complied with their requests for an asthma review. They said they had a clinical, ethical and legal responsibility to review his medication and clinical condition before issuing a prescription. They offered him the opportunity to have the review undertaken in a manner and at a time which suited him, and to refer him to a respiratory specialist.

We took advice from our medical adviser, who considered Mr C's medical records. He said that treatment cannot be given without reasonable and correct supervision, and that the practice had given Mr C various opportunities to attend for the review. Given the pattern of inhaler use, he also considered that such a review would be good clinical practice. We concluded that the practice did not act unreasonably, and did not uphold the complaint.

Summary

Ms C's mother (Mrs A) was admitted to hospital with community-acquired pneumonia. During her stay, Mrs A also complained of constipation, nausea and vomiting. On the final day of her admission, Mrs A’s condition worsened considerably. She was transferred to the hospital’s medical high care area and, within hours, to the highest level of care within the intensive care unit, where she died.

Ms C considered that the care provided to her mother was inadequate. In particular, she felt that staff failed to properly address Mrs A’s constipation and that nursing staff acted rudely and unprofessionally towards Ms C and her family. Ms C also considered that medical staff failed to act quickly enough to transfer Mrs A to medical high care and felt that, if Mrs A had been transferred earlier, she might not have died.

We did not uphold Ms C's complaints. After obtaining independent advice from our nursing adviser, we decided that the nursing care provided to Mrs A was reasonable, that nursing staff acted appropriately to the reports of constipation and that recorded communication with Ms C and her family was reasonable. As there was no corroboration of events, we were unable to come to an accurate conclusion about the manners of particular nursing staff. We also obtained independent advice from our medical adviser, and found that medical staff took appropriate action to monitor Mrs A’s condition and investigated and addressed her medical problems reasonably. We found that the timing of Mrs A’s transfer to medical high care was reasonable and saw no evidence to suggest that staff should have taken the decision to transfer her earlier.

Summary

Ms C complained about long-term flooding in her area and that Scottish Water had failed to resolve the matter. Our investigation revealed that Scottish Water were not at fault. Although their water pipes did not have sufficient capacity, their funding regime does not provide for the circumstances in question, where a major upgrade of the local pipe network is needed. We explained the situation in detail to Ms C and also passed on information from Scottish Water that they were working with other organisations, in the hope that some form of joint project, with funding coming from elsewhere, might be possible in a few years' time. We acknowledged that Ms C would be likely to find this disappointing but concluded that, as there had been no failings by Scottish Water, there were no grounds to uphold her complaint.

Summary

A prison decided to restrict the exercise arrangements for protection prisoners (prisoners held separately from the main prison population for their own safety). The arrangements were that prisoners could only return to their residential area from the exercise area after thirty minutes or at the end of the exercise session (which lasts for one hour).

Mr C, who is a prisoner, complained about that decision. He said the decision was unfair because it restricted protection prisoners' access to facilities in the residential area throughout the exercise period. He said that this was discriminatory as the same restrictions did not apply to mainstream prisoners. In response to his complaint, the internal complaints committee (ICC) recommended that the prison allow protection prisoners to return to their residential area from the exercise area at twenty minute intervals. The prison governor endorsed the recommendation. However, the prison did not implement it and Mr C complained to us about this.

We explored with the prison why the ICC's recommendation was not implemented. We found that the prison considered two very important factors – the risk presented to the safety of prisoners and staff on the exercise route, and the risk presented to the good order of the prison. The prison also considered the physical location of the exercise yards for both protection and mainstream prisoners and took into account the impact that changing the current arrangements would have on available resources. The evidence available confirmed the prison appropriately explored whether the ICC's recommendation was possible but after careful consideration of relevant and important factors, decided not to implement it. In light of this information, we did not agree that the prison unreasonably failed to implement the recommendation and we did not uphold Mr C's complaint.

Summary

Mr C, who is a prisoner, complained that the prison unreasonably failed to respond to a complaint he submitted to them in February 2012. The prison assured us that they had no record of having received this complaint. We noted that Mr C had been transferred between prisons and that it was possible that the complaint might have gone missing because of this. However, in the absence of any evidence that the prison received the complaint, we could not conclude that the failure to respond was unreasonable.

Summary

Mr C, who is a prisoner, complained to the prison about the delay in carrying out his generic assessment. This is an assessment individual prisoners may receive to determine whether or not they need to participate in any offending behaviour programmes. In responding to Mr C's complaint, the prison told him they were aiming to assess him by April 2013. Mr C said that was an unreasonable timescale.

In investigating Mr C's complaint, the prison explained to us that they prioritise prisoners for assessment in line with their critical dates - these dates include when the prisoner might become eligible for progression to less secure conditions, or their parole qualifying date. Having reviewed the evidence available in Mr C's case, we were satisfied the prison were managing his case appropriately and in line with the normal process. Because of that, we did not uphold the complaint.

Summary

Mr C, who is a prisoner, complained that there had been an unreasonable delay in completing his end of programme report for Constructs (an offending behaviour programme in which some prisoners may participate). Mr C felt the delay in completing his report was preventing him from progressing through the prison system to less secure conditions.

The prison confirmed that the completion of Mr C's report had been affected because of staff absences, the delivery of another programme and development of the programmes environment. The prison also confirmed there was no timescale laid down for the completion of reports. In an effort to progress outstanding reports, the prison told us a list was created for prisoners who were awaiting end of programme reports for Constructs. This list ran in order of individual prisoners' parole qualifying dates and reports were dealt with in that order to ensure critical dates were not missed which would impact on progression. The Scottish Prison Service also told us that they estimated the timescale for the completion of an end of programme report for Constructs would be three months from the end of the programme, but this would depend on the complexity of the individual report. In addition, there was no evidence to support Mr C's claim that the completion of his report was preventing him from progressing to less secure conditions. For a prisoner to progress to less secure conditions, they must be approved by the prison's progression risk management team (PRMT). At the time of making his complaint, Mr C had not been approved.

Our investigation found that the available information confirmed that a number of factors had impacted on the completion of Mr C's report. However, it was in fact finalised just over three months after he completed the programme. After this, he was referred to the PRMT but his progression to less secure conditions was refused. In light of this information, whilst we recognised Mr C's report was not completed as quickly as he would have liked, we felt the time taken was reasonable and we did not uphold his complaint.

Summary

Mr C, who is a prisoner, complained that the prison delayed in assessing him for offending behaviour coursework. The prison explained that they prioritise prisoners in line with their progression (movement through the prison system to less supervised conditions) dates. They assured him that he was on the waiting list and would be assessed in due course.

Our investigation found that Mr C was not eligible for parole for over eighteen months and there was sufficient time for him to be assessed for, and access, any required coursework. As we could see no evidence of unreasonable delay, we did not uphold the complaint.