Not upheld, no recommendations

Summary

C attended their GP with shoulder pain and was referred to orthopaedics (specialists in the treatment of diseases and injuries of the musculoskeletal system) who, during the initial consultation, reviewed x-rays and ultrasound imaging and concluded no broken bones were shown. A was diagnosed with muscle patterning (when the pattern of muscle contractions is altered) and referred to the physiotherapy department for treatment.

C had a number of follow-up appointments and was discharged around four months later as it was considered that there was no further treatments they could be offered to alleviate the symptoms. C was then referred to the neurology department (the branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system). Around the same time, after seeing a private doctor, C had an MRI scan and the results showed that C had broken ribs. C considered that medical professionals focused on their disability and other medical conditions, unreasonably delayed in diagnosing the broken bones and that it was only because they instructed a private consultant, that the injuries were diagnosed.

We took independent advice from an appropriately qualified medical professional. We found that the board performed appropriate investigations following C's referral by their GP. There was an appropriate multidisciplinary approach following the initial consultation involving physiotherapy, rheumatology (the branch of medicine that deals with rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments), orthopaedics and neurology. The fractures identified occurred after the initial consultation and investigations carried out following the GPs referral. We considered that there was no unreasonable delay in diagnosing C's broken bones and therefore we did not uphold the complaint.

Summary

C complained on behalf of A who has a terminal cancer diagnosis. A was diagnosed with a metastatic carcinoma (a cancer that grows at sites distant from the primary site of origin) of possible colorectal (colon) or ovarian origin and progress lung nodules. C complained that A was misdiagnosed multiple times and given the wrong treatment.

The board said that A underwent a number of investigations in order to identify the source of the primary cancer. They explained that surgery was not a viable treatment option.

We took independent advice from a consultant clinical oncologist (a doctor who specialises in the diagnosis and treatment of cancer).

We found that the investigations carried out were appropriate and the length of time taken reflected the challenges faced in trying to identify the source of the primary cancer. There was no evidence to suggest that A was misdiagnosed or given the wrong treatment. We identified that there was a delay in completing the colorectal investigations however, on balance, we did not consider that this delay was significant as it did not have a detrimental impact on A's prognosis. As such, we concluded that the care and treatment was reasonable and we did not uphold the complaint.

Summary

C's adult child (A) had anxiety and a functional neurological illness (a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts). One morning A was found to be anxious and unwell. A's other parent (B) thought that it appeared different to A's previous episodes and called the GP who visited A at home.

The GP believed that A should be admitted to hospital and called 999. An ambulance crew attended the scene. There was some discussion between the GP and the hospital about which department A should be admitted to; the Mental Health Unit or the Clinical Assessment Unit. The ambulance crew transported A to hospital where A was quickly assessed and taken to the Intensive Care Unit. A died later that day.

C complained that the GP had not properly assessed A, they had not taken blood pressure readings or their temperature. C said that the GP assessed A through the prism of mental health and had not properly considered whether there could be another cause to their presentation, which was different from previous ones.

We took independent advice from a GP. We found that it was appropriate for the GP to consider A's prior medical history when assessing their condition. We found that the GP correctly identified that assessment at hospital was needed, recognising the seriousness of A's condition.

On the basis of information available to the GP at the time, their assessment and conclusions were reasonable. Therefore, we did not uphold the complaint.

Summary

C's spouse (A) received care and treatment from the board for a recurrence of bowel cancer. C complained that the communication and actions by the board in relation to that were unreasonable.

C complained that the board failed to provide reasonable treatment to A. We took independent advice from a senior clinical oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that the treatment offered to A was reasonable and in line with guidance. We did not uphold the complaint.

C complained that the board failed to provide reasonable care to A. We found that the board had acknowledged there were some failings relating to staff responding to care requests and there were challenges when a procedure was undertaken. Overall we found that while there were failings in specific instances, the care provided over the entire period was reasonable. On balance, we did not uphold the complaint.

C complained that the board failed to reasonably communicate with A and C in relation to A's diagnosis and the potential risks of treatment. We found, based on the written records available, that the communication was reasonable, noting that the written records could not illustrate the level of empathy exhibited by clinicians. The written records did demonstrate that the risks relating to treatment were discussed. We did not uphold the complaint.

Summary

C complained about their urology care (the branch of medicine and physiology concerned with the function and disorders of the urinary system) and treatment at Borders General Hospital. C has a complex past urological and surgical history including a total cystectomy (bladder removal), and was referred to urology with ongoing pain and discomfort around their stoma region (an opening in the abdomen formed during a colostomy procedure). C complained that the urologist did not see them and that they were instead seen by a general surgical registrar who failed to identify symptoms of a kidney stone. C subsequently became very unwell and was admitted to hospital with an obstructed infected kidney.

In their response to C's complaint, the board confirmed that the urologist felt it best for C to be seen by the consultant general surgeon who had carried out their most recent hernia (a weakness in the abdominal wall beside a stoma which allows the bowel to protrude outwards) repair surgery. They noted that, when C was then assessed by the surgical registrar, they did not have any specific symptoms which would have indicated the presence of a kidney stone.

We took independent medical advice from a consultant urological surgeon. We found that it was reasonable for C's clinical assessment to have taken place with either the surgical or urological consultant team. We, therefore, did not uphold C's complaint about a lack of urological review. We considered that C was appropriately assessed by the surgical registrar, and there was no clinical evidence at that time to indicate the presence of a kidney stone. We did not uphold C's complaint about a failure to diagnose their kidney stone. We noted, however, that C should have been seen by the consultant general surgeon, rather than a surgical trainee, in light of their complex history. We fed this back to the board.

Summary

C complained that Scottish Water had failed to respond appropriately to a number of flooding incidents in their property. C said that Scottish Water had not been open or honest about the cause of the flooding and were refusing to take the only action which would guarantee the protection of their property. C said that Scottish Water’s position had changed whenever they were presented with evidence, which suggested they were responsible for the flooding.

Scottish Water denied that they had acted unreasonably, or that they had failed to investigate the causes of the flooding experienced by C’s property. Scottish Water said that they were not responsible for damaged pipework within the property and the public sewerage network had been working properly. They said that there were likely to be different causes for the flooding incidents C had experienced, but that all of them had been investigated. Scottish Water acknowledged that this had taken time, but said there had been a need to liaise with a number of other stakeholders, including the local authority and utility companies.

We found that Scottish Water had investigated the incidents of flooding. Additionally, they had correctly informed C that they were not responsible for flooding which emanated from private pipework. C maintained that the private pipework had been damaged by the failure of the public sewer network, which Scottish Water were responsible for. We did not find evidence which supported this, and it was not the only possible cause of damage to the pipework as C had suggested. Therefore, we did not uphold the complaint.

C also complained that Scottish Water failed to handle their complaint reasonably. We considered that Scottish Water investigated the complaint appropriately. We did not uphold the complaint.

Summary

Mr C complained about the actions of the council’s social work services department. This was following referrals made by Police Scotland and an NHS board, after there were concerns about Mr C’s whereabouts and wellbeing. On the basis of these referrals, the council wrote to Mr C and advised him that they did not feel there was a need for Adult Services to intervene at that time but that he could contact them if there was anything else he felt they could support him with.

In Mr C’s view, the council unreasonably failed to contact him by telephone and within 24 hours, despite assurances that were given to him by other parties. In addition to this, he said that the council’s conclusion that there was no requirement for Adult Services at that time was unreasonable.

We took independent advice from a social worker. We concluded that it was reasonable for the council to write out to Mr C rather than phoning him within 24 hours. This was because the referral information provided to the council by Police Scotland and the NHS board did not indicate that there was a requirement to contact him by phone or within 24 hours.

We also found that it was reasonable for the council to conclude that there was no role for Adult Services at that time. Again, the council’s decision was based on the referral information provided by Police Scotland and the NHS board. This information stated that there were no immediate concerns for Mr C’s welfare and that he was not presenting as having any acute mental ill health conditions. Therefore, based on the information known to them at the time, we considered the council’s actions to be reasonable. Therefore, we did not uphold Mr C’s complaints.

Summary

C had a child (A). C was subject to a Pre-Birth Risk Assessment. The council put in place a rehabilitation plan to support C in caring for A. It was accepted that this plan did not clearly communicate the council’s concerns to C. The council decided to restart the rehabilitation process (though a shorter one) and considered providing feedback in a different way. The second rehabilitation plan was unsuccessful and A was placed in foster care full-time.

C complained that the council did not provide them with sufficient support to enable A to live with them.

We took independent advice from a social worker. We found that the council provided C with reasonable support to enable them to care for A, and noted that C did not always engage with this support. For this reason, we did not uphold the complaint.

Summary

C complained about the partnership's decision to conduct Adult Support and Protection (ASP) enquiries following receipt of concerns about their child (A). C complained that social work acted upon false information and that A did not meet the criteria for commencing an ASP investigation. The partnership advised that their social work staff acted in accordance with their procedures.

As part of our investigation, we reviewed the case records and sought independent advice from a social worker. We found that there was reasonable evidence that A met the criteria for an ASP investigation and, based on the information received by the partnership at the time, it was reasonable that they conducted enquiries under their ASP duties. There was no evidence that the partnership did not follow their procedures correctly, therefore we did not uphold the complaint.

Summary

C complained on behalf of their parent (A) about the care and treatment they received during an admission to Ninewells Hospital. A was given a working diagnosis of a urinary tract infection (UTI) with delirium but was later diagnosed with encephalitis (inflammation of the brain). C said that because A regularly suffered UTIs, assumptions were made that A was experiencing the same again. C said that, as a result, appropriate investigations were not carried out and there was an unreasonable delay in diagnosis which affected A's outcome.

The board said that a UTI had been given as a reasonable working diagnosis and that blood and urine tests confirmed this. They considered that A had been treated reasonably in the circumstances.

We took independent medical advice. We found that at the time of their admission, A had non-specific symptoms which were reasonable to diagnose as a UTI. When A deteriorated and their symptoms changed, A was cared for reasonably with an appropriate degree of urgency, and a prompt diagnosis of encephalitis was made. While A suffered a poor outcome, we could not conclude that this was as a result of an unreasonable delay in diagnosis. We did not uphold C's complaint.