Not upheld, no recommendations

Summary

C has felt that they have obsessive compulsive disorder (OCD) for some years. C has seen various clinicians at the board about this but does not feel that they received appropriate care or treatment. C complained to the board about their care and treatment over the previous years. C said that a psychologist did not provide reasonable care or treatment, that a community mental health nurse did not provide reasonable care and that a psychiatrist unreasonably diagnosed C with anxiety.

In their responses, the board told C that the psychologist had reviewed their care and treatment. The board outlined the care and treatment C had been offered and had taken up and concluded that C’s care and treatment had been handled reasonably. C was dissatisfied with the board’s response and raised their complaints with our office.

We found that the overall standard of treatment provided to C between the period in question by all of the board staff complained of was of reasonable quality and in line with relevant guidance. We did not uphold the complaints.

Summary

C was diagnosed with pleomorphic lobular carcinoma in situ (PLCIS, an uncommon condition in which abnormal cells form in the milk glands (lobules) in the breast). Following excision of the carcinoma, a programme of 15 radiotherapy treatments was undertaken by the board to reduce the risk of recurrence. Subsequently, C experienced breathlessness and an increase in phlegm. Clinicians initially felt this may be due to radiation pneumonitis (inflammation of the lung caused by radiation therapy) before a likely diagnosis of cryptogenic organising pneumonia (COP, a rare lung condition) was reached. A consultant oncologist (cancer specialist) told C’s GP that COP was a rare toxicity of breast radiotherapy. C wrote to and met with the consultant oncologist to detail their concern that the fourth fraction of their radiotherapy had not been undertaken accurately. The consultant oncologist investigated the matter but did not consider there were any discrepancies or irregularities regarding C’s positioning for radiotherapy. C complained to the board about these matters. The board’s investigations did not indicate that their actions had been unreasonable and they advised C of this. C remained dissatisfied and brought their complaint to us.

We took independent advice from an appropriately qualified adviser. We found that the board had provided reasonable treatment to C and had taken steps to rectify the poor communication to C before we became involved with the complaint. We found evidence that it was reasonable to conclude that C was advised of alternative treatments to radiotherapy. We concluded that the board responded reasonably to C’s complaint. We did not uphold C’s complaints.

Summary

C complained that the health board delayed in diagnosing and treating their cancer. C was referred by their GP to a number of specialists to investigate symptoms they were experiencing. C complained that the board failed to act in response to investigations, particularly MRI scans instructed by the pain management service, which showed a lesion (abnormal tissue) on their back. C was referred to hospital by their GP around three months following the MRI scans with increasing symptoms, and the decision was taken for C to undergo surgery to remove the lesion. C complained that as a result of the failure to act urgently on the results of the MRI scans, they had to suffer intense pain and the diagnosis and treatment of their cancer was unreasonably delayed.

In responding to the complaint, the board said that two MRI scans performed by the pain management service showed a lesion, but as there had been no change between the scans a follow-up in six months was indicated, with a referral to neurosurgery (specialists in surgery on the nervous system, especially the brain and spinal cord). When C attended hospital around three months later, a subsequent MRI indicated that the lesion had progressed and it was identified as the cause of C's symptoms.

We took independent advice from a medical adviser who considered that whilst the MRI scans carried out identified a cystic lesion, they did not reveal signs which required urgent follow-up and, at that time, a diagnosis attributed to a pre-existing condition was the plausible cause of C's symptoms. Investigations did not reveal any signs that would be considered urgent and, without progression in symptoms experienced by C, the radiology reports alone would not be acted upon. We found that investigations undertaken by the board were reasonable and we did not uphold the complaint.

Summary

C attended Dr Gray's Hospital after experiencing sudden pain in their knee. C said that, on both occasions, they advised hospital staff they had extreme heat and swelling on the front of their leg. C had a history of varicose veins (swollen and enlarged veins that usually occur on the legs and feet) and requested that their leg be scanned on both occasions, but this did not happen.

C later travelled abroad. Whilst abroad, C was diagnosed with a deep-vein thrombosis (DVT, a blood clot in a vein). They underwent emergency surgery and had stent filters inserted to prevent the clots reaching their lungs, heart or brain. C said that they and their family suffered extreme trauma and worry about the expense of being hospitalised abroad and C has suffered mental and physical health issues since returning home.

C complained that the board failed to carry out a reasonable assessment of their leg symptoms during their two hospital attendances.

We took independent advice from a consultant in emergency medicine. We found that C was appropriately reviewed during their hospital attendances. We noted that whilst it was possible that a DVT was present at this point, it was more likely that it developed during C’s long-haul flight. There was no indication during C’s hospital attendances that a scan or x-ray of their legs should have been carried out. We did not uphold C's complaint.

Summary

Ms C was referred to the ophthalmology department (the branch of medicine concerned with disorders and diseases of the eye) by her optician after she became concerned about the vision in her eye. She attended several appointments with a consultant ophthalmologist but was unhappy with the care and treatment provided. In particular, Ms C felt that the consultant did not take her seriously at her initial appointment. She was also unhappy that the treatments given and tests carried out did not give her a definitive diagnosis or improve the vision in her eye.

We took independent advice from a consultant ophthalmologist. We found that the consultant's assessment, management and onward referral for tests were reasonable. Therefore, we did not uphold Ms C's complaint.

Summary

C attended Dumfries and Galloway Royal Infirmary (DGRI) for a colonoscopy (a procedure where a camera on the end of a flexible tube is inserted into the rectum). During this procedure, polyps (tissue growths) were found and biopsies (a sample of tissue) were taken. C was told that a polyp showed possible signs of cancer. A second colonoscopy was carried out and the doctor attempted to remove the polyp, however the procedure was painful and was stopped. C was discharged home the next day.

Soon after, C had a bloody bowel movement and went to Galloway Community Hospital where they were then transferred to DGRI. C collapsed and was resuscitated, given a blood transfusion and moved to critical care.

C complained that the colonoscopy was not carried out properly, that it was painful and asked whether it should have been done in the first place. C also complained about the decision to transfer them from Galloway Community Hospital to DGRI and about the care they received on arrival at hospital.

We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We considered that the colonoscopy procedure was required as there was evidence C might have cancer. We noted that pain is subjective and the amount of pain relief given to C may not have been sufficient, although it was the recommended dosage. We found that the procedure appeared to have been carried out appropriately.

We also considered that the decision to transfer C from Galloway Community Hospital to DGRI was reasonable. It was possible that C would need surgical intervention which was only available at DGRI. We found that C was promptly assessed and was treated appropriately following their collapse. We did not uphold C's complaints.

Summary

C complained about the care and treatment of their late partner (A) who died from a pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs), secondary to a deep vein thrombosis (DVT, a blood clot in a vein). The complaint related to a GP practice run by the board, which A attended feeling unwell. A was given antibiotics for a suspected infection and a sick note for their employer. A phoned the practice the following week, still feeling unwell, and the antibiotic prescription and sick note were extended. A’s condition deteriorated and they died the following day.

C complained that the GP dismissed the recent history of A's long-haul travel and symptoms indicative of a DVT and misdiagnosed A with an infection. They considered that there was a failure to follow the National Institute for Health and Care Excellence (NICE) guidelines for assessing the possibility of a DVT. C also complained that arrangements were not made for A to be seen when they called the practice the following week. They considered A was denied appropriate follow-up care.

We took independent medical advice from a GP. We found that the recorded symptoms that A presented with were consistent with a diagnosis of infection and not DVT. We considered that the GP’s recorded examination, history and working diagnosis were reasonable at that time.

In terms of A’s follow-up phone call to the practice, we were unable to evidence what was said during the call and whether an appointment was requested. We noted that it is common practice for antibiotic prescriptions and sick notes to be extended without seeing the patient, and we considered that the practice’s actions were reasonable based upon the available evidence. We did not uphold C's complaints.

Summary

C brought a complaint to us about the care and treatment given to their late parent (A) at Dumfries and Galloway Royal Infirmary. C complained that there was a lack of communication between staff and the family throughout A’s treatment. In particular, they said that the severity of A’s illness was not explained to A or the family. C stated that the family remained unclear about the specifics of the cancer A had, that there had been no reaction to A’s early symptoms and that A was advised about their diagnosis by phone with no offer of support provided. C also complained that the administration of A’s medication was unreasonable; in particular, that there was inadequate pain control and that no one took overall control of A’s care and treatment. During the board’s own investigation of the complaint, they accepted that A should not have been advised of their diagnosis by phone, and an apology had been given for that. The board had also indicated this was an area for reflection and learning.

We took independent advice from a consultant hepatologist and gastroenterologist (a doctor who cares for patients with benign or malignant disorders of the gastrointestinal tract, liver, pancreas and gallbladder). We found that while there was some learning for the board in relation to aspects of communication, the overall care and treatment given to A was reasonable. While we did not uphold the complaint, we asked the board to provide evidence of the action taken to ensure alternative methods of communicating a diagnosis to a patient had been considered.

Summary

C complained about the council's involvement in respect of the Welfare Guardianship Order (order which allows someone to make ongoing decisions on behalf of an adult with incapacity) application process. C had applied for a guardianship order in respect of their adult child (A). As part of this process, C's solicitor wrote to the council to request the production of a suitability report. The council allocated a mental health officer (MHO) to carry out this task.

Due to a variety of reasons, the production of a suitability report took a significant length of time. C complained as they felt the council and the MHO unreasonably sought to delay and hinder the progress of their guardianship application. They highlighted that the MHO's communication with doctors required to submit incapacity reports and their involvement in an Adult Support and Protection referral as evidence of this. In C's view, the MHO had acted outwith their remit.

We took independent advice from a social worker. We found that the council and the MHO involved in the guardianship process acted reasonably and within their remit. We acknowledged that the process took an unusually long length of time and that this must have been very frustrating for C. In addition to this, we recognised that the MHO and C held very different opinions on A's capacity. However, we were satisfied that it was appropriate for the MHO to provide their professional views and input as part of the guardianship process and that they had carried out their responsibilities appropriately. Therefore, we did not uphold this complaint.

Summary

C complained about the treatment and support provided by a community mental health team run by the partnership. C said that they were not reasonably assessed by appropriate clinicians and that the partnership failed to provide them with a reasonable diagnosis or treatment. C said that their care was mainly provided by a community mental health nurse whom C did not consider to be appropriately positioned to offer diagnosis or treatment. In addition, C considered that it was unreasonable that they were removed from the list while they awaited an appointment for dialectical behaviour therapy (DBT - a type of cognitive behaviour therapy).

We took independent advice from an appropriately qualified adviser.

C's first complaint related to their diagnosis. While there was a time management issue relating to one of the appointments, the partnership's actions in relation to providing a diagnosis for C was reasonable and in a reasonable timescale. As such, we did not uphold this complaint.

C's second complaint related to the treatment they received. While there was a communication issue in relation to a referral for C, overall the treatment provided by the partnership was reasonable. We did not uphold this complaint.

C's final complaint related to the support the partnership provided to them. We found that the support provided was reasonable while they were being seen by a community mental health nurse. C had also been provided with access to a helpline while they awaited further therapy treatment. As such we did not uphold this complaint.