Not upheld, no recommendations

Summary
Mr C was unhappy about the poor service he said he received from his medical practice, in particular the long wait for an appointment. He also said the practice had failed to advise him of the appointment procedure when he and his wife joined the practice and that their complaints procedure was not fit for purpose.

We found that the practice did operate an appropriate appointments procedure which complied with the guidance set out by Health Rights Information Scotland. We also found no evidence to suggest that the practice had failed to advise Mr C about the appointments procedure when he joined. Our investigation of Mr C's complaint showed that the practice's complaints procedure was accessible and fit for purpose.

Summary
Mrs C complained that medical staff delayed in diagnosing her son’s appendicitis. She said that this left him in severe pain and distress. We investigated the complaint and took specialist medical advice. Although it did take some time for appendicitis to be diagnosed, the advice we received was that that there were good reasons for this. Mrs C’s son’s clinical history and his signs and symptoms were not those of classical appendicitis. We found that it was appropriate for staff to consider other potential diagnoses. We also found that staff carried out appropriate investigations during that time, and that there was no delay in taking Mrs C's son to theatre after the results of a scan were reviewed.

Summary
Mrs C complained about the care and treatment she received at a dermatology clinic for a lesion on her breast. Mrs C developed a rash that spread to both breasts and was of the view that Dermol 500 (a moisturiser with antiseptic agent) was the underlying cause of scarring to her breasts. Mrs C was seen frequently over a five month period and was prescribed various topical creams. Mrs C also said that one of the doctors had not examined her and felt that, had he done so, the problems she experienced could have been avoided.

In response to the complaint, the board advised that they did not believe that this cream was the cause of the rash. However, they said that Mrs C had been advised to avoid using it.

We did not uphold Mrs C's complaint. Our medical adviser was unable to identify the cause of the rash, but considered that it was unlikely to be Dermol 500 as it is a moisturiser widely used for adults and children, and allergic reactions are very uncommon. The clinic had conducted a patch skin test but did not include the agents within Dermol 500. Whilst, therefore, there is a small possibility that an allergy could occur, we considered that the clinic took reasonable action in advising Mrs C to stop using it. Also, although it is unclear how thoroughly the doctor examined Mrs C, the clinical records reflected that a visual examination was carried out. We considered that a physical examination would not have been expected in this case.

We also considered that the strength of the topical steroid prescribed as a short-term measure was appropriate and would not have caused significant thinning of the skin. A biopsy result showed Mrs C's skin to be eroded in a relatively superficial way. We concluded that Mrs C's overall treatment was appropriate and that residual staining of the skin was likely due to the severe rash.

Summary
Mr C complained that, on two separate occasions, a physiotherapist made inappropriate remarks to him. He also complained that the board's complaint investigation was unfair because it was mostly done by a senior colleague of the physiotherapist.

We obtained Mr C's physiotherapy records and the board's complaint file. However, we were unable to establish whether the remarks had been made. The physiotherapist herself, and one of her colleagues (who had been present on the second occasion) disputed Mr C's account. There were, therefore, no grounds on which we could uphold the complaint about her behaviour.

We explained to Mr C that it was appropriate, under the NHS complaints procedure, for the lead physiotherapist to carry out the investigation. We also explained that she had not been responsible for the complaint decision or the replies to Mr C: they had been drafted by the complaints team and considered, and signed, by the board's chief executive in recognition of his overall responsibility for complaints. The complaint file also showed that the investigation had been thorough and that Mr C had been given a full and fair hearing.

Summary
Mr C was admitted to hospital after suffering a significant stroke. He underwent physiotherapy at three different centres (Centre 1, 2 and 3) specialising in stroke rehabilitation, to progress his recovery and achieve his goals of independent mobility and returning to work. Mr C complained about the care and treatment he received at two of the centres.

Mr C complained that he sustained a serious chest and shoulder injury while on a ward at Centre 1 as a result of inappropriate handling by nursing staff and that it had been aggravated by a physiotherapist working there and at Centre 2. Mr C was unhappy with Centre 2, saying that they did not provide physiotherapy for his specific needs. He also said they blocked his request to return to Centre 3, and cancelled his appointments following his complaint.

In response to the complaint, the board said that on admission to Centre 1, Mr C's shoulder was partly dislocated. They provided a shoulder support but he was allergic to this, so pillow support was provided instead. The board told Mr C that he received appropriate physiotherapy at Centre 1 and Centre 2. They said that there was no clinical indication that Mr C needed to return to Centre 3 and that his appointments were cancelled as he no longer wanted to be treated at Centre 2.

After referrring Mr C's medical records to one of our medical advisers, we did not uphold any of Mr C's complaints. We found that while the records showed that it was difficult for him to position his arm on the pillow, which might have led to some of his pain and injury, there was insufficient evidence to support his concern that staff at Centre 1 caused damage to his shoulder through poor handling. We also established that although there was no specific record of an incident at Centre 1 that could have caused trauma to Mr C's shoulder, there were clear notes of his pain and the effect this was having on his mobility and participation in therapy. We concluded, however, that there was evidence to show that Mr C had been assessed, with treatment plans, goals and physiotherapy interventions in line with national guidelines for the management of stroke patients.

We found that the physiotherapy sessions at Centre 2 were not as regular as planned. It also appeared that Mr C was not initially provided with a home exercise programme. However, we concluded that overall his treatment was reasonable and there was evidence to show that physiotherapists there carried out an appropriate assessment, with a problem list drawn up and treatment plans put in place.

There was also evidence to show that Centre 2 fully considered Mr C's request to return to Centre 3 and gave reasons why it would not be appropriate to do so. We agreed with this decision as Mr C's level of function did not require in-patient care, and it was important at that stage for him to be in a home environment as recommended in the national guidelines.

Finally, we identified from Mr C's clinical records that referral to community physiotherapy was discussed with him as an alternative to being treated at Centre 2, as he did not want to continue his sessions there. We did not consider that Centre 2 acted inappropriately in referring Mr C for community physiotherapy treatment, as he was clearly dissatisfied with the service they were providing.

Summary
Mr C's wife (Mrs C) was treated at a hospital for a number of health problems over a period of 13 years. This included a hip replacement in 2001, following which Mrs C developed a bacterial infection - Methicillin-resistant Staphylococcus aureus (MRSA). This was treated at the time, but Mrs C complained of pain in the hip from that point on.

In 1998, Mrs C was referred to haemotology for investigation of a blood abnormality. The subsequent investigations concluded that it was likely that she had a cancerous mass on her pancreas. A whipple's resection (an operation) was carried out to remove part of her stomach, duodenum, bile duct and head of pancreas. The mass was found to be benign.

Mrs C, however, experienced complications of the surgery, which left her with gastrointestinal problems (problems with the stomach and large and small intestines). In 2005, these began causing her to collapse. One such collapse caused the dislocation of Mrs C's hip replacement. The hip was put back in place, but Mrs C was discharged without a clear diagnosis of the cause of her collapse. In 2008, the hip scar became inflamed and swollen, then burst, releasing a large amount of blood and pus and immediately resolving her pain. Tests found that the hip replacement was infected with MRSA. Revision surgery was carried out, but as the bone had degraded, it was decided not to provide Mrs C with another hip replacement.

Mr C complained that the whipple's procedure had been unnecessary. He was also critical of the board's investigation of the cause of Mrs C's blackouts and the failure to resolve her MRSA infection. He believed that this had been present since 2001 and had caused the bone degradation which prevented a further hip replacement from being provided.

We did not uphold Mr C's complaint. We took advice from one of our medical advisers, who said that the risks associated with the whipple's resection were significantly lower than that of carrying out a biopsy (which might lead to a false-negative result and a lack of treatment for an incurable cancer). If identified early enough, pancreatic cancer can be cured by surgical resection and we, therefore, found it appropriate for the whipple's resection to go ahead without tissue analysis.

We found that there was an opportunity to diagnose Mrs C's gastrointestinal problems after she collapsed in May 2005. However, appropriate investigations were carried out to rule out obvious causes for her collapse and we found the conclusions reached to be reasonable. A clear diagnosis was made within the following four weeks and treatment was provided quickly.

With regard to the MRSA infection to Mrs C's hip, the evidence that we reviewed suggested that it was very unlikely that this had been present since 2001. Our adviser explained that infection can be contracted through any part of the body via a number of means and can accumulate at a single site. X-ray evidence showed no sign of bone degradation in 2006, but it was obvious in 2008. We, therefore, considered that surgery in 2005 was a likely source of the infection and the bone degradation would have occurred after that.

Whilst the combination of significant, overlapping, health issues clearly had a significant impact on Mrs C's overall wellbeing, we were generally satisfied that the board provided reasonable and appropriate treatment through each of the three departments that treated her.

Summary
Eighteen months after being awarded a masters degree by the university, Miss C complained that she had received inappropriate supervision during her course. The university initially accepted her complaint but, after considering it, decided that it was out of time in terms of their complaints procedure. Miss C complained to us that the university handled her complaint incorrectly and failed to give proper consideration to the reasons why she said she could not complain earlier.

We obtained all the relevant correspondence and guidance, made enquiries of the university and checked their complaints procedure. In all the circumstances, we did not uphold the complaint. We established that, although Miss C provided very detailed reasons why she had not felt able to complain earlier, there was no evidence to suggest that these had not been properly taken into account or that the complaints procedure had not been followed.

Summary
Mr C was a student at the university. During his third year he fell and injured his elbow. He said that his academic performance suffered as a result of the pain he was in and the medication he was taking. He completed his fourth year in June 2011 and was awarded a lower second class degree (2:2). He submitted an appeal for this to be increased to a 2:1 due to his medical situation having affected two of his third year results. The university did not accept his appeal as it referred to academic results from 2010 and there was a 20 working day deadline for submitting appeals.

Mr C complained to us that the university unreasonably applied their time limit, as his appeal concerned the 2011 decision to award him a 2:2, rather than the 2010 assessment of his third year work. The university took the view that, as honours classification is a mathematical calculation based on academic results over the third and fourth year, Mr C's appeal had to be viewed in terms of his third year results. Their appeals procedure allows for late appeals to be considered where there are exceptional circumstances preventing the student from raising their medical situation within the proper timescale. However, they did not consider Mr C's circumstances to be exceptional. Having looked at all the information, we did not uphold Mr C's complaint as we found that the university took into account the relevant evidence when deciding not to accept his appeal.

Mr C raised a further complaint that the university did not make him awarethat there was a potential remedy - to exclude his third year results from the calculation of his overall Honours classification. Although the university did not specifically advise Mr C of this, we found that their appeals procedure put no restrictions on the grounds for appeal claimed by students or the remedies sought. Ultimately, as Mr C's overall appeal was time-barred this became irrelevant. However, we were satisfied that there were no barriers to this remedy being sought or achieved if the university considered it appropriate.

Summary
Mr C's daughter was unsuccessful in her application to study medicine at the university, and started a degree course at another university. When she reapplied the following year she was again unsuccessful because the university does not allow transfers for students who have started other degree courses. Mr C complained that his daughter’s application was rejected on grounds other than merit, which he believed was in direct contradiction of the university’s admissions policy. He said that the rule concerning transfers into the school of medicine, which applied to his daughter’s application, was not adequately communicated and, as a result, both he and his daughter were misled into choosing a course of action which fell foul of that rule.

We did not uphold the complaint, as we found that the university had offered advice to applicants who were unsuccessful in their application and that Mr C's daughter had not fully taken up that offer. In addition we found that there was comprehensive advice available on the subject on the university's website.

Summary
Mr C, who is a prisoner, complained to us about the prison's complaints handling. He said that he had submitted a number of complaints, but the prison had failed to respond to them. He felt that staff were deliberately ignoring the rules about prisoner complaint forms.

We made enquiries with the prison. The prison provided records showing the complaints received from Mr C and what happened to them. There was also evidence that they had discussed Mr C's concerns with him. The information available told us that Mr C's complaints were responded to. We did not uncover any evidence to support Mr C's claim and we did not uphold his complaint.