Not upheld, no recommendations

Summary

C complained about the treatment which they received from the practice. C said that they were ill and had been discharged from hospital following a diagnosis of pancreatitis (inflammation of the pancreas). C saw a GP twice in one month, who diagnosed gastric issues and prescribed Peptac (medication for heartburn/indigestion). C said that they continued to worsen and saw the GP again, who again felt the problem was gastric issues and increased the dosage of Omeprazole (medication for heartburn/indigestion). C said that their condition again worsened and two days later C was admitted to hospital as an emergency where it was found that they had a pancreatic infection, and C remained as an in-patient for some weeks. C felt that their concerns had been dismissed and that, had appropriate treatment been given, their condition would not have been so severe or life-threatening.

We took independent advice from a GP. We found that the practice had provided appropriate care and treatment in view of C's reported symptoms and medical history. There was no clinical requirement that C should have been admitted to hospital at an earlier date. We did not uphold the complaint.

Summary

C, an advice and support worker, complained on behalf of their client (A). A suffered an industrial injury, with a steel beam falling on their head and shoulder. A had been receiving various forms of treatment since, including cortisone injections (an anti-inflammatory steroid injection used to treat a range of conditions), physiotherapy (a therapy to restore movement and function) and surgery. However, A was concerned that they did not receive any treatment for their head injury. A also considered that there were unreasonable delays in providing treatment and that communication with them had been unreasonable.

We took independent advice from a consultant orthopaedic surgeon (a doctor specialising in the treatment of diseases and injuries of the musculoskeletal system). We found that the treatment received and communication had been reasonable, with the exception of a problem with a referral for physiotherapy, which the board had already identified as part of their own complaint investigation. In addition, there was no evidence that A had complained of a head injury on first attending. We did not uphold C's complaint.

Summary

C complained about the clinical care provided to their child (A) by the board, specifically, that a Chiari malformation (where the lower part of the brain pushes down into the spinal cord) was visible on a magnetic resonance imaging (MRI) scan performed by the board and that the abnormality was not noted until they insisted on a further MRI scan being carried out many years later.

A suffered from a number of symptoms including headaches, tinnitus (ringing or buzzing in the ears), vertigo (a sensation of loss of balance or that objects around you are spinning) and drop attacks (sudden falls to the ground) for a number of years. A had MRI scans performed by the board to try to determine the cause of these symptoms. A had a further MRI scan performed by a different health board and it was found that A had a Chiari malformation.

We took independent advice from a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans). We found that it was reasonable to ask only about a possible tumour, and that it would not be possible to make a definitive diagnosis of Chiari malformation from the first MRI images. We concluded that the MRI scan performed then was performed and reported to a reasonable standard. We, therefore, did not uphold the complaint.

Summary

C was an in-patient in a general adult psychiatry ward at a hospital outwith the Lothian NHS board area. A referral was made to transfer C and their baby to the Parent and Baby Psychiatric Unit at St John's Hospital but this was refused. C said that they were finding caring for their baby difficult in an adult environment and complained that the refusal was unreasonable.

We took independent advice from an appropriately qualified adviser. We found that the decision not to approve the transfer was reasonable from a clinical perspective. We did not uphold the complaint.

Summary

C complained on behalf of their late sibling (A). A was admitted to hospital to have their pacemaker and the leads, which attach it to the heart, extracted. There was a 2-3% risk of major bleeding and A signed a consent form for the procedure. During the operation, the surgeon successfully removed one of the pacemaker leads but whilst attempting to remove the final two, A's blood pressure suddenly dropped. This was recognised by the anaesthetist and the major haemorrhage protocol was activated. An emergency call for surgical assistance was placed. Despite chest compressions and fluids, staff were unable to stop the bleeding and A died. When the surgeon had tried to remove one of the leads, a tear had been created in one of the major veins around the heart. C complained that the surgery had not been carried out to a reasonable standard.

We took independent advice from a consultant cardiologist (a doctor that specialises in diseases and abnormalities of the heart). A's pacemaker, at several years old, would be well embedded in scar tissue. There was infection at the site, and the device was pushing through the front wall of A's chest. There were other options for treating this, but laser lead extraction was the best option for a long-term recovery. The operation appeared to have been carried out reasonably, with staff taking prompt and appropriate action when A's blood pressure dropped. There was nothing more the staff could have done to save A's life once the bleed occurred.

We did raise concerns about the consent process. We noted that A had signed a consent form on the day and the risk of major bleeding was noted. However, the board should have used a more detailed consent form with other fields, including alternative treatment options, and that consent should have been obtained prior to the day of surgery as well as the day of it. On balance, we did not uphold the complaint as the evidence indicated that the standard of A's surgery was reasonable.

Summary

C has an adopted child who has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). A's behaviour is so challenging that both parents fear A will cause serious harm to themselves or to them.

C wished A to be prescribed medication for their ADHD, but Child and Adolescent Mental Health Services (CAMHS) said that they required to carry out a face-to-face assessment before medication could be prescribed. They said they were unable to offer this at present because of COVID-19 restrictions. C considered that A needed urgent input, but the board said that A's need was not considered urgent. The board said that they would see A as soon as they were able to. C complained that the board had failed to assess A's need for CAMHS treatment as urgent.

We took independent advice from a consultant child and adolescent psychologist. We considered that A's need for treatment had been appropriately assessed with reference to COVID-related criteria. We did not uphold C's complaint.

We were, however, critical of the delays in assessment of A's condition and commented that, were it not for these delays, A should by now have had the opportunity of psychiatric review and clinical treatment.

Summary

C had concerns about the care and treatment they received in the A&E at Raigmore Hospital. C had experienced a headache and visual disturbance. After initially attending their GP practice, C was taken to A&E by ambulance. Shortly after arriving at the hospital, C was assessed by a doctor. Later that evening, a CT scan (computerised tomography - a scan that uses x-rays and a computer to create detailed images of the inside of the body) was performed and this showed that C had experienced a type of stroke (a serious medical condition that happens when the blood supply to part of the brain is cut off).

C had concerns that assumptions were made about the timing of the onset of their symptoms. C also considered that there was a delay in them receiving a CT scan, which prevented thrombolysis (a treatment involving a drug that aims to disperse the clot and return the blood supply to the brain. Not all stroke patients are suitable for this treatment). C was also unhappy that the stroke team were not immediately involved in their care.

We took independent advice from an emergency medicine consultant. We found that the history obtained, examination and investigations performed in the emergency department were reasonable. We did not identify a delay in performing a CT scan and we found that the rationale for not offering C thrombolysis treatment was reasonable. Finally, we found it was reasonable that the stroke team were not involved with C's care at the time of admission. We concluded that C received reasonable care and treatment and we did not uphold this aspect of the complaint.

C was also unhappy with the board's investigation and response to their complaint. We were satisfied that all aspects of the board's complaint handling were in accordance with the NHS Scotland Complaints Handling Procedure. We did not uphold this aspect of the complaint.

Summary

C, an advice and support worker, complained on behalf of their client (A). A was diagnosed with diabetic retinopathy (a complication of diabetes caused by high blood sugar levels damaging the back of the eye). As part of their treatment for this, A received intravitreal injections (this involves injection of medication into the vitreous – a jelly-like fluid at the back of the eye).

A received a number of these injections without incident, however, during one procedure, the tip of the needle touched the lens of A's right eye. This resulted in a traumatic cataract (a clouding of the lens, occurring after either blunt or penetrating trauma to the eye, that disrupts the lens fibres) that required further treatment. As a result of this, A had concerns about the administration of the injection. A felt the injection was not carried out appropriately or in line with relevant guidelines.

We took independent advice from a consultant ophthalmologist (a doctor who specialises in eye and vision care). We found that the complication experienced by A was uncommon but recognised. However, there was no evidence to indicate that the injury to A's eye was the result of failings on the part of the administration of the injection. Furthermore, such complications can occur despite the correct guidelines being followed and appropriate measurements being used. We agreed with the board's conclusion that there was no way to conclusively know what factors led to the injury to A's eye. As such, we did not uphold this complaint.

Summary

C, an advocacy and advice worker, complained on behalf of their client (A) regarding A's admission to Queen Elizabeth University Hospital. A is a diabetic and had a gastric band procedure (a band is used to reduce the stomach's size, so a smaller amount of food is required to result in feeling full) completed privately several years prior to admission. This had been successful, however, A was having difficulty eating and was admitted as an emergency. A's surgical band was deflated. Subsequently, A's blood sugar level was not stable. A considered this was not monitored properly and they were also unhappy with the feeding regime put in place. The emergency team refused to re-inflate the gastric band and referred A to the Exceptional Bariatric Review to discuss bands filled in the private sector. A was unhappy with this decision as they wanted the band to be reflated afterwards.

We considered that A was admitted as an emergency and it was reasonable to resolve the urgent situation by deflating the gastric band, as it was pressing on A's oesophagus. However, when the emergency had been resolved, any refilling of the band would not be regarded as a medical emergency. We found that the board followed their policy when referring A to the Exceptional Bariatric Review for bands filled in the private sector. We also noted that when A was admitted as an emergency their blood sugar levels were unstable but this was monitored and treated appropriately, as A did not have diabetic ketoacidosis (a potentially life threatening complication of diabetes, which happens when the body starts running out of insulin). We also found that the feeding regime put in place was reasonable and that A was appropriately referred so that future weight management could be discussed. We did not uphold this complaint.

Summary

C underwent right knee replacement surgery and complained about the care and treatment they received as they suffered severe pain and limited movement following surgery. It was C's understanding that something went wrong during the surgery and they also considered that the board had failed to provide the appropriate aftercare.

The board said there was no suggestion that anything went wrong during the surgery and noted that C underwent physiotherapy to help alleviate their pain.

We took independent advice from an orthopaedic surgeon (a surgeon specialising in the treatment of diseases and injuries of the musculoskeletal system). We found that there was a five degree misalignment in C's knee; however, it is unlikely that this would cause the pain C subsequently experienced. There are associated risks with the type of surgery C had and around 20 percent of patients may not experience a satisfactory outcome. There was no evidence that C's surgery was not carried out appropriately. We also found that the appropriate investigations were carried out to check that the knee joint was properly aligned post-surgery. As such, we did not uphold C's complaint.