Not upheld, no recommendations

Summary

Mrs C complained about the care and treatment she received at Ninewells Hospital. Mrs C had previously received treatment for breast cancer and had been monitored over the years following this.

Mrs C complained that a mammogram (an x-ray test of the breasts) was not performed at a review appointment. The board said that Mrs C had already received the last of the planned annual follow-up mammograms and she did not require one when she attended for a review.

We took independent advice from a consultant breast surgeon. We found that Mrs C had received follow-up mammograms in accordance with national and local guidelines. We concluded that it was reasonable that Mrs C was not offered a mammogram at the review. We did not uphold Mrs C’s complaint.

Mrs C also complained that she was not offered an emergency appointment for breast imaging following a consultation with the Lymphoedema Service (a service managing problems with the lymphatic system, a network of vessels and glands spread throughout the body). We found that it was reasonable that Mrs C was not offered emergency breast imaging and we did not uphold this complaint.

Finally, Mrs C considered that the board’s response to her complaint contained inaccurate information. We reviewed the evidence available and we were unable to conclude that the board had provided inaccurate information. We did not uphold this complaint.

Summary

C, who had a history of breast cancer, complained that the board failed to provide them with appropriate care and treatment at the Western General Hospital for a lump on their breast. The lump was investigated but found to be of no concern. Two years later, a clinically suspicious lump was identified and investigations showed evidence of an invasive carcinoma (cancer). C raised a number of issues including why a trainee doctor was allowed to perform a biopsy on the first lump identified on their breast and whether the doctor performed the procedure correctly. C also questioned why the lump in their breast was not removed or investigated further.

We took independent advice from a consultant breast surgeon. We found that it was acceptable for the trainee doctor to perform the procedure under the supervision of the consultant surgeon, as was the case here, and that there was no evidence that the procedure was performed incorrectly. We also considered that the decision taken by the board at that time not to remove the lump or carry out further investigation was reasonable. C’s case went through the correct process and we determined that C’s treatment was reasonable. We did not uphold this part of the complaint.

C also complained that the board failed to provide them with a reasonable response to their complaint. C raised a number of issues, including that the board’s response did not address their specific concerns. We considered that the board’s response generally addressed the questions raised by C and we did not uphold this part of the complaint.

Summary

C complained about the care and treatment their parent (A) received at St John's Hospital. C considered that A did not receive reasonable medical or nursing care and treatment; in particular, that their ward placement on a ward which was only used during the winter period to provide additional medical capacity was inappropriate and resulted in A not receiving continuity of care. C raised concerns about A’s weight management and the board’s response to A’s concerns about their vision.

The board indicated that they considered that A was appropriately placed and received the same standard of care they would have on any other ward. The board acknowledged that one weekly weigh-in had been missed for A but indicated that improvements had been made in the form of more robust processes in this area of patient care.

We took independent advice from a geriatric (medicine of the elderly) and general medical adviser and a nursing adviser.

We noted that the board had missed one weekly weigh-in for A and that there had been a delay in ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye) input. However, we concluded that overall A received reasonable care and treatment. Whilst some shortcomings were identified, A was placed in an appropriate ward that, on the whole, appropriately met their needs and they received the same care and treatment that they would have had they been on a general medical ward. Therefore, we did not uphold C’s complaints.

Summary

C complained about the care and treatment provided to their parent (A). A, who has vascular dementia and Alzheimer’s, suffered from ill health and C sought medical care and treatment from A’s practice on numerous occasions for what they suspected were urinary tract and chest infections.

A had three hospital admissions during this period and C was concerned about the care and treatment provided in particular in the time leading up to each hospital admission. C said that the GPs at the practice focused too much on A’s dementia and unreasonably failed to take C’s concerns about A’s condition seriously. As a result, C said the GPs had failed unreasonably to investigate and treat A’s deteriorating condition including a number of serious infections.

We took independent advice from an adviser who specialises in general practice. We found that GPs at the practice had taken C’s concerns seriously and assessed and treated A in a reasonable way. We did not uphold the complaint.

Summary

C, a Patient Advice and Support Service adviser, brought the complaint on behalf of their client (B) with regard to the care and treatment provided to B’s late spouse (A). A had a compromised immune system and received regular immunoglobulin therapy (a blood-based treatment to increase the number of antibodies in the immune system). A was admitted to hospital with a high temperature and was found to have acute leukaemia. They deteriorated over several weeks and died a short time later. C complained about a number of aspects of A’s care and treatment including a change in their immunoglobulin brand; that A’s reason for admission to hospital was not clearly communicated; that A had cellulitis (a type of skin infection) in their hand; and that A being incorrectly administered a diuretic (a type of medication which increases the passing of urine) indirectly led to their death.

We took independent advice from a consultant haematologist (a specialist in diseases of the blood and bone marrow). We found that the care and treatment provided to A was reasonable. Specifically, we found that there was no indication the change in immunoglobulin brand caused A’s deterioration; there were several terms that could have been used to describe the reason for A’s admission to hospital and the board’s actions in this regard were not unreasonable; it did not appear that A had cellulitis in their hand; and the incorrect administration of a diuretic was not a cause or contributor to A’s death.

Therefore, we did not uphold C’s complaint. However, we noted some feedback for the board with regard to communication about A’s prognosis.

Summary

C underwent knee surgery, following which the hospital provided them with a sick note. At the end of that sickness period, they were told that they required two more weeks of recovery before they could return to work. When C approached the practice, they were told they should be given a sick note by the hospital. C then went back and forth between the practice and the board. C said they were told by the board’s complaints team that it was the practice’s responsibility and that if the practice refused to provide a sick note, they would be in breach of their NHS contract.

C said the process was very stressful and at one point they were without a sick note. While they were issued with one by the hospital, it was reiterated to C that this should have been the practice’s responsibility.

The practice told us they had taken advice on whether it was their responsibility to provide a sick note for C. They said that the Lanarkshire Local Medical Committee (LLMC) had told them it was the responsibility of the hospital who had operated on C. They said that the LLMC was taking the matter up with the board more generally. The practice said that they would have provided C with a sick note, but by that time, the hospital had done this.

We took independent advice from an appropriately qualified adviser. We found that records stated that C was the responsibility of the hospital until they were fully discharged. This meant that whilst C still had out-patient appointments to attend, the practice were correct to state that they were not responsible. We did not uphold C's complaint.

Summary

C complained about the care they received from their GP practice when they presented with problems with their sight and a headache. Whilst in the waiting room, C became more unwell. Following an examination, an emergency ambulance was called and C was taken to hospital where they were later diagnosed with a stroke. C complained that more immediate action should have been taken when they initially contacted and then attended the practice. The practice did not identify significant failings during their complaint investigation, but noted that some aspects could have been handled better.

We took independent advice from a GP. We found that the practice’s initial handling of C’s call to the practice was reasonable, and it was appropriate that C was signposted to contact an optician. Furthermore, we found that, once C attended the practice, the care provided was reasonable and consistent with clinical guidance on assessment, history taking and examination. We did not uphold C’s complaint.

Summary

C complained about the care and treatment provided to their parent (A). A was diagnosed with cancer and was admitted to hospital. As the hospital team struggled to control A’s pain, A was transferred to hospice care, where they later died. C complained about the care and treatment offered to A at the hospice and asserted that it was not reasonable. C’s position was that as a result of that unreasonable care and treatment, A experienced chronic pain and died prematurely. C stated that they believed that staff involved in A’s care failed to act in line with guidelines and ignored medical guidance.

The board found no evidence to support C’s assertions that A was not provided with reasonable care and treatment. The board said that a multi-disciplinary, patient-centred approach was taken to A’s care and many clinicians contributed to A’s pain management strategy.

We took independent advice from a medical adviser. We did not find any failings in A’s care and treatment and did not consider that it was unreasonable. Therefore, we did not uphold this complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of a family about the care and treatment that their relative (Mr A) received from the board. Mr A was admitted to Raigmore Hospital with endocarditis (an infection of the inner lining of the heart). He was discharged home for out-patient parenteral antibiotic therapy (where antibiotics are given to a patient in their own home). Mr A's condition worsened and he died a few weeks later. Ms C complained about Mr A's medical care and treatment, and that he was not medically fit to be discharged home.

We took independent advice from a cardiologist (specialists in the heart and blood vessels) and from a nurse. We found that Mr A's condition was diagnosed in a timely manner and he was given appropriate treatment. We also found that it was reasonable that Mr A was discharged home, as there was an appropriate plan to continue his treatment at home.

Ms C complained about the communication with Mr A's family. We found that the medical and nursing records showed evidence of appropriate communication with Mr A's family.

Ms C further complained that Mr A was discharged home without appropriate care planning and an appropriate care package. We found that there was appropriate multi-disciplinary care planning for Mr A's discharge home.

Ms C also complained about the board's complaints handling; in particular, that there was a delay in their response and its tone lacked empathy. We considered that as it was a complex complaint, it was reasonable that the investigation took longer than usual and regular updates were provided. We did not consider the tone was inappropriate.

We did not uphold Ms C’s complaints.

Summary

C was diagnosed with a meningioma (a tumour that forms on membranes that cover the brain and spinal cord just inside the skull), which required surgical removal. C complained about the failure of the practice to appropriately assess their symptoms in the years preceding diagnosis. C said their records showed that they presented at the practice with red flag symptoms on a number of occasions dating back years. C also said that the practice failed to make appropriate referrals for investigation.

We took independent advice from a GP. We considered that C had been assessed appropriately by the practice. We found that C’s care was reasonable and in line with General Medical Council Good Medical Practice. We did not consider that there had been any missed opportunities to refer to secondary care in respect of C’s meningioma, taking into account their presenting symptoms. We did not uphold either aspect of C's complaints.