Not upheld, no recommendations

Summary

C fell and injured their head, requiring emergency surgery and the removal and replacement of part of their skull. Tayside NHS board carried out the surgeries and provided rehabilitative care. C complained that the board failed to properly insert the ceramic bone replacing the portion of skull taken out, causing disfigurement. C was also not satisfied with the explanations given by the board in relation to the care provided.

We took independent advice from a consultant neurosurgeon (a surgeon specialising in surgery of the brain and nervous system). We found that the board provided reasonable treatment to C. C’s injuries required two emergency operations, both of which were reasonably carried out. The board provided a custom-made plate to replace the portion of the skull lost due to the head injury. The surgeries and follow-up care provided to C were of an extremely high standard. While there was a complication with one of the surgeries, this was a known complication for cranial surgery which the board accepted and apologised for. After the operations were completed, the board provided rehabilitation to C through multiple rehabilitation schemes. This was reasonable. As such, we did not uphold this aspect of C's complaint.

We also considered C’s complaints that the board had failed to provide a reasonable explanation about the treatment they received. We found the board provided reasonable explanations to C about the treatment they provided. Clinicians spoke with C on multiple occasions to discuss the outcomes of the surgeries. The board took account of C’s cognitive difficulties when communicating with them and exceeded the level of standard care required in terms of communication. The board’s response to C’s complaint explained the outcome of C’s surgeries including the impact on C’s facial appearance. This was reasonable. As such we did not uphold this aspect of the complaint.

Summary

C complained about the treatment their late spouse (A) received from Tayside NHS board. Following a fall, A required emergency hip replacement surgery. A developed a severe infection in their wound following the surgery and later died as a result of this infections. C complained that the board inappropriately ignored issues with A’s stomach when prescribing antibiotics. C also considered that A was required to attend hospital appointments unnecessarily when their condition became untreatable. C stated that at a meeting to discuss their complaint after A’s death the board told them that A had not been expected to live. C said they were shocked and had not been told this before.

The board stated A’s treatment had been reasonable. Staff had responded appropriately to A’s serious infection. Although every step had been taken to avoid infection, these did occur. A’s condition had been regularly reviewed and advice taken from microbiology specialists to try and optimise A’s treatment.

We took independent medical advice from a orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found A’s treatment was reasonable. They were regularly reviewed and their antibiotics were changed in order to try and improve their outcome. In addition, we noted that A’s condition was such that it was not unreasonable for them to have their wound dressed as an out-patient. Therefore, we did not uphold C’s complaints.

Summary

C’s child (A) was referred to have a tonsillectomy (surgical removal of the tonsils) and grommets (a small tube inserted in the eardrum to drain fluid) inserted as they had been experiencing seizures and recurrent ear infections. On the day of surgery, the surgeon decided not to insert grommets as A's ears were healthy and there was potential for an unnecessary intervention. C complained that the surgeon failed to carry out the agreed surgery.

We took independent advice from an ear, nose and throat consultant. We found that it was appropriate for the surgeon to make a clinical judgement on the day of surgery based on the clinical presentation of the child. We noted that the clinical decision was supported by clinical research and it was therefore reasonable. As such, we did not uphold the complaint.

Summary

C, an advocate, complained on behalf of their client (A). The complaint related to an incident that occurred when A was a patient in hospital. After receiving treatment in hospital, A was taken to a single room to recover. Another patient entered A’s room several times in an erratic and alarming manner before being removed by nursing staff. However, during the night, the other patient entered A’s room again and sexually assaulted them. When nursing staff became aware of A shouting, they removed the other patient from the room. After this, the other patient did not interact with A again and A later reported the incident to the police.

C complained as A felt that not enough was done to prevent the other patient from interacting with A and ultimately sexually assaulting them. In addition to this, C complained about the board's handling of A’s complaint.

We took independent advice from a nurse. We found that nursing staff acted reasonably, both before and after the incident. We acknowledged that A had been through an extremely distressing experience, however, based on the circumstances at the time, and in the context of a hospital environment, we concluded that there was no indication that nursing staff failed to carry out any actions that they should have done. As such, we did not uphold this aspect of the complaint.

In respect of how the board handled A’s complaint, we were satisfied that this was done in a reasonable and appropriate manner. From our review of the evidence, it appeared that the board did not receive documentation from A’s advocate. This meant that the board communicated directly with A and appeared to have been genuinely unaware that an advocacy service was assisting A. The board had also arranged to provide the stage 2 response to A at a home visit. While we appreciated that it would have been helpful for A to have sight of the board’s stage 2 response before the visit took place, we did not consider this amounted to a significant failing on the board’s part. Overall, we considered the evidence suggested that the board took this complaint very seriously and that they made a genuine attempt to handle it in a sensitive and person-centred manner. As such, we did not uphold this aspect of the complaint.

Summary

C complained about the care their partner (A) received at an orthopaedic clinic in Inverclyde Royal Hospital. A was assessed for knee pain by an advanced physiotherapy practitioner (APP). C complained that the APP incorrectly diagnosed A as having a degenerative lateral meniscal tear (torn cartilage between the thigh bone and shin bone) and mild osteoarthritis (chronic breakdown of cartilage in the joints leading to pain, stiffness and swelling) and unreasonably decided to manage the condition by avoiding invasive measures as opposed to surgically. An orthopaedic review and scan the following year found no evidence of a tear. A ultimately required partial knee replacement surgery. C complained that the initial misdiagnosis and management plan contributed to the subsequent deterioration.

In responding to the complaint, the board said that the APP gave appropriate advice and treatment in keeping with the clinical picture at the time. They noted there was a subsequent deterioration of A’s knee over the following year.

We took advice from a consultant physiotherapist (a person qualified to treat disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise), who considered that the APP carried out an appropriate examination and reached a reasonable conclusion as to the cause of A’s knee pain. There could have been a tear that did not show up on the MRI scan. We also noted the x-ray evidence showed that A had some arthritic change in their knee. There wasn’t sufficient evidence to say what the primary cause of A’s knee pain was, however, the treatment plan would have been the same regardless. We found that the decision to recommend conservative management was reasonable and in keeping with relevant guidelines. We did not uphold this complaint.

Summary

C, an advocate, complained on behalf of their client (A). A was given a diagnoses and later the board provided A with a second opinion. During the consultation the board say A became angry and behaved in a threatening way. The board said they would be happy to offer treatment to A, but this would be dependent on A following a set of recommendations. A said that during the second opinion consultation they were being called a liar, and while they raised their voice, they were not threatening. A told us that they had tried to meet the board’s recommendations, but that the board would not accept that they complied with the recommendations made.

We took independent advice from a consultant psychiatrist (a doctor who specialises in the diagnosis, treatment and prevention of mental ill health conditions). We found that the board’s response to A’s behaviour was reasonable and in line with NHS policy. We did not uphold this aspect of the complaint. The recommendations the board made to A were reasonable. Due to A’s diagnosis, treatment would be most successful if A was able to make some changes to their behaviour. We did not uphold this aspect of the complaint.

Summary

C brought a complaint to us about the care and treatment given to their late child (A). A was admitted to the Neo-Natal Unit at Forth Valley Royal Hospital due to prematurity and respiratory (the branch of medicine that deals with conditions affecting the lungs) distress and was a few weeks later admitted to the Children’s Ward. A was later diagnosed with cardiac (heart and its blood vessels) conditions. A underwent open heart surgery at the Royal Hospital for Children but later died.

C complained that the care and treatment provided to A was unreasonable because there were missed opportunities to diagnose A’s cardiac condition and that, had it been diagnosed earlier, there would have been a positive outcome.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth) and from a consultant in respiratory medicine. We found that overall the care and treatment was reasonable. In particular, there was no evidence that would suggest A’s heart condition had been missed in the neonatal period. We also found that, based on the available evidence, it was not possible to say conclusively that there had been an unreasonable delay in diagnosing A’s cardiac condition from a paediatric perspective. We did not uphold the complaint.

Summary

C complained to the practice about a consultation they had. They said that they reported symptoms of severe pain and swelling of the abdomen and that they were grey in colour and had difficulty standing up. C said the practice prescribed them with laxatives (medication to help increase bowel movements). C continued to deteriorate and days later was admitted to hospital as an emergency, where it was found they had perforated diverticular (diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older) disease. C said they had to undergo emergency surgery and were an inpatient for a month. C felt that the practice should have diagnosed their serious condition and arranged an urgent hospital admission.

We took independent advice from a medical practitioner. We found that the GP involved had carried out an appropriate examination based on C’s presenting symptoms and that a diagnosis of constipation was reasonable. There was no clinical indication that C’s health was going to suddenly deteriorate with severe diverticular disease and that they would require a hospital admission. We did not uphold the complaint.

Summary

C complained about the care and treatment their ex-partner (A) received from the board during a hospital admission. A was taken to hospital after self-harming. They had also written a suicide note, which was taken to hospital with them. After being assessed by psychiatric clinicians, it was decided that A did not require hospital admission for psychiatric observation or detoxification. It was also concluded that A showed no evidence of a specific plan or intent to carry out suicide and did not present with a mental illness. A was discharged that day but completed suicide the following day.

C complained to us about the general care and treatment provided to A and the fact that they were discharged home. In addition to this, C complained that they were not informed that A had been admitted to and discharged from hospital, given that they were still A’s next of kin.

We took advice on this complaint from an appropriately qualified adviser with a background as a consultant psychiatrist. We found that staff carried out an appropriately detailed assessment of A and made decisions that were in line with relevant guidance, based on the information available to them at the time. The board had previously acknowledged that the suicide note had not been reviewed by the clinicians who attended A and we agreed that this was a shortcoming. However, despite the outcome, we were satisfied that the board had provided a reasonable and appropriate level of care and treatment to A overall. Therefore, we did not uphold this aspect of the complaint.

In respect of whether C should have been notified of A’s admission and discharge, we concluded that the board’s actions were reasonable. Although C was listed as A’s next of kin, A was living with their father at the time. It was reasonable for the hospital to conclude that A’s father was the most appropriate point of contact at that time. Therefore, it was reasonable for the hospital to discuss matters with A’s father rather than with C. With this in mind, we did not uphold this aspect of the complaint.

Summary

Mr C complained that Business Stream incorrectly arranged for a meter to be installed at a vacant property belonging to his business, and were not entitled to charge for the provision of water and waste water services. Business Stream explained that following inspections by Scottish Water, it was established that there was a live supply to the property, that the meter which had been present was no longer there and, in the absence of evidence that a formal disconnection had been requested, they were entitled to install a meter and charge for relevant services. Mr C was not satisfied with the response and brought his complaint to us.

We saw evidence of Scottish Water undertaking inspections at the property. These established the presence of a live supply to the property, albeit the meter had been removed and the connection was not in use. There was no evidence of a formal disconnection, or one having been requested. In the circumstances, and in accordance with changes in government policy, Mr C's business was liable for charges for a live connection to the water network, regardless of whether the property was derelict. Scottish Water were entitled to install a meter and Business Stream were entitled to charge for services. We did not uphold the complaint.

Mr C also complained that Business Stream's handling of his complaint was unreasonable. We found that Business Stream carried out a reasonable investigation and provided Mr C with appropriate responses. We did not uphold the complaint.