Not upheld, no recommendations

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.

Summary

C complained that their concerns about changes in their breast had not been investigated adequately by the board. As a consequence, there had been a delay in diagnosing C's breast cancer. C was also unhappy with the treatment that had been proposed for them. C believed that the board was unreasonably denying them breast surgery and was proposing to keep C on potentially harmful chemotherapy indefinitely. C sought a second opinion and did undergo breast surgery shortly afterwards. C believed this demonstrated the treatment proposed by the board was unreasonable.

We took independent advice from an appropriately qualified adviser. We found that the investigations carried out were reasonable. It had not been reasonable to inform C that their breast cancer was inoperable on the basis of the investigations that the board had carried out at that point. However, the treatment provided to C was reasonable and it was appropriate for the initial treatment to be chemotherapy, rather than proceeding directly to surgery. We did not uphold C's complaint.

Summary

C complained to us about the care and treatment their spouse (A) received at the Golden Jubilee National Hospital. A was referred to the hospital after being diagnosed with aortic stenosis (where a valve has narrowed and is restricting blood flow).

We took independent advice from advisers both in cardiology (studies of diseases and abnormalities of the heart) and in cardiology nursing.

C raised concern that A's angiogram (a type of x-ray that uses dye to look at blood vessels) was not carried out reasonably, including the aftercare. We found that A's angiogram was carried out in a reasonable manner and the aftercare was appropriate. We did not uphold this aspect of C's complaint.

C also raised concern about an unreasonable delay in arranging A's heart surgery. We found that the hospital carried out appropriate tests to decide whether to list A for heart surgery. We also found that the hospital's decision not to proceed with heart surgery was reasonable, due to the risks involved from A's other health conditions. We did not uphold this aspect of the complaint.

Summary

C, an advice and support worker, complained on behalf of their client (A) in relation to the care and treatment provided to A by the board.

A attended Forth Valley Royal Hospital as they had suffered a myocardial infarction (heart attack - when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle) the previous week. A presented to the hospital complaining of pain and swelling affecting their wrist. A was examined and treated for this.

A said that the board failed to provide reasonable care and treatment to them as they were not treated appropriately and questioned whether alternative treatments could have been offered. A also said that it took several visits to A&E to be treated appropriately and that they were not referred to a specialist following that first visit.

We took independent advice from an appropriately qualified adviser with expertise in emergency medicine. We did not observe any concerns with the care and treatment that A received and concluded that assessment, treatment and advice given were reasonable. Therefore, we did not uphold C's complaint.

Summary

C complained on behalf of their spouse (A) about the treatment provided to them. A had a history of cancer and attended the practice with urinary symptoms. A was later diagnosed with bowel cancer which had metastasised (spread to other parts of the body). C complained that the practice's response to A's symptoms, and the length of time it took for A's cancer to be diagnosed, were unreasonable.

We took independent advice from a GP. We considered that A's symptoms were reasonably investigated, with appropriately prioritised referrals being actioned in a timely manner. A's history of cancer was considered when assessing their symptoms. A's symptoms initially aligned with a benign (non-cancerous) condition. When A's presentation changed, appropriate steps were taken, with further investigation and referrals to secondary care. A's pain was reasonably managed. Therefore, we did not uphold the complaint.

Summary

C suffers from severe joint and musculoskeletal (relating to the muscles and skeleton) pain throughout their body. C complained that the board did not reasonably test C to establish the appropriate level of pain treatment they required. C wanted medication for pain to be administered by an intrathecal pump (a medical device used to deliver very small quantities of medications to the spinal fluid) and by trigger-point injections (a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax). The board did not consider this to be appropriate.

We considered that the board was aware of the level of pain experienced by C and that the pain management had been reasonable. We found that an intrathecal pump is usually used to target pain in a specific area for cancer patients or in palliative care, rather than where pain is benign (not directly linked to another medical condition) and widespread. We found that an implant can cause infection and that this increases over time and therefore the risk of use is lower for those in receipt of palliative care. We also found that if pain is not responsive to opioids (a type of pain relief) then delivery of opioids by this method is not likely to be effective. We also found that trigger point injections offer short-term relief and their effectiveness reduces when repeated. We therefore agreed with the board that these treatments were not appropriate for C. We did not uphold this complaint.