Not upheld, no recommendations

Summary

C complained about the care and treatment A had received at Inverclyde Royal Hospital before their death. A was admitted to the hospital where they saw a liaison community psychiatric nurse (CPN) who carried out an assessment. The decision reached was that admission for in-patient psychiatric care was not indicated and that A should re-engage with community services. They were discharged from the hospital that afternoon. A completed suicide on the following day.

We found that whilst the assessment completed by the CPN was not entirely transparent and lacked structure, on balance, it was adequate. The decision not to admit A to hospital was reasonable. It was also reasonable for the CPN to explore A's past and current substance misuse and there was no sense from the records that they did so disproportionately. The CPN also checked that A's case with addiction services was still open and we found that a psychiatrist had both sufficient and current knowledge to make an informed decision on the case. Whilst there was an error in the CPN's assessment letter, there was nothing to suggest that this error made a material difference to the CPN's decision-making. We found that there were no significant errors in A's care and treatment and therefore, we did not uphold the complaint.

Summary

C complained to us about the board, as they held a number of concerns regarding the board's management of their medication for ADHD, pain (they suffer from fibromyalgia), and insomnia. C also considered that the board had failed to take reasonable account of their needs in the way they had communicated with them.

We took independent advice from a consultant psychiatrist. We found that C's medication was appropriate for the management of their diagnosed conditions. We did not consider that there was any evidence of unreasonable communication which failed to take account of C's needs. Therefore, we did not uphold C's complaints.

Summary

C, a support and advocacy worker, complained on behalf of their client (B) whose adult child (A) had developed deep vein thrombosis (a blood clot in a vein) and pulmonary embolism (a blocked blood vessel in the lungs) requiring treatment in hospital. Despite receiving blood thinning medication, A developed further pulmonary embolism. A's medication was revised and arrangements were made for A to be seen as an out-patient. A died after returning home following a later review appointment. B questioned the quality of care A had received from the board.

We took independent advice from a consultant respiratory physician (a doctor who specialises in treating and managing patients with conditions affecting their lungs). We found that A received a good standard of care both as an in-patient and as an out-patient in line with the relevant guidance and good practice. There was no evidence that A's outcome could have been changed had the board acted differently. We did not, therefore, uphold C's complaint

Summary

Mr C was referred for orthotics and fitted with insoles. He attended a follow-up appointment with a private consultant as his symptoms were not improving and was diagnosed with anterior impingement syndrome (compression of the bone or soft tissue). After the consultation Mr C decided surgery was his preferred option. Mr C's GP subsequently referred him to the orthopaedics department (specialists in the treatment of diseases and injuries of the musculoskeletal system) at Hairmyres Hospital. His referral was refused as consultants considered that he was receiving appropriate first line care already. Mr C was unhappy with his treatment and told us that, had consultants acted on the report of the private consultant, he would have had surgery much earlier and his pain and suffering would not have gone on for so long.

We took independent medical advice from a clinical adviser who is experienced in orthopaedics. We found that Mr C was treated in accordance with guidelines and that conservative treatment was the appropriate response. It is not uncommon for medical professionals to have different views on treatment, but that the board's treatment following the GP's referral was appropriate. We did not uphold the complaint.

Summary

C, an advice and support worker, complained on behalf of their client (A) who had concerns about the treatment which A had received at Raigmore Hospital. A had a kidney stone and was operated on, which resulted in a ureteric stent (a thin tube structure allowing urine to drain into the bladder) being inserted. The stone remained in place and Levofloxacin (an antibiotic) was prescribed and A was discharged from hospital. A then began to suffer from leg pains, attended their GP and was readmitted to hospital after a few days with tendon issues. The stent and the kidney stones were removed and the antibiotic was stopped. A felt that the kidney stone should have been removed at the initial surgery and that Levofloxacin should not have been prescribed as this would have prevented their tendon issues which were as a result of a reaction to the Levofloxacin.

We took independent advice from a consultant urologist (a doctor specialising in the diagnoses and treatment of disorders of the kidneys, ureters, bladder, prostate and male reproductive organs). We found that A received an appropriate standard of care and treatment, but suffered a rare but recognised complication of antibiotic medication. We did not uphold the complaint although we highlighted as feedback that the board may wish to review their antimicrobial guidelines.

Summary

C was referred to the ear, nose and throat (ENT) service by their GP practice because they had been suffering from worsening headaches, balance problems and nausea. C was reviewed several times by the ENT service.

C later returned to the practice because their symptoms were not improving. A referral was made to a private healthcare provider for C to see a neurologist. An MRI scan was arranged and following that, C was diagnosed with a brain tumour.

C complained to the board. They felt that the ENT service had failed to adequately investigate their symptoms and, because of that, they failed to diagnose C's brain tumour. In response, the board confirmed it was felt that C was experiencing vestibular migraine (a nervous system problem that causes repeated dizziness), based on the symptoms. It was noted that a neurological examination was not performed at the initial examination, but was carried out at a subsequent review. The board accepted it would have been preferable to perform the neurological examination at the initial appointment, although in C's case it was unlikely to have led to an earlier diagnosis.

We took independent advice from a clinical adviser who is an ENT consultant. We found that the tumour was a rare find in what was a common presentation of vertigo and headaches. It was difficult to know whether or not there would have been any earlier cues to instigate the MRI scan. We noted information from C's first encounter with the ENT service was limited but, overall, the evidence available suggested that the initial diagnosis and treatment were reasonable.

We did not uphold the complaint.

Summary

C complained about the treatment they received at the Queen Elizabeth University Hospital. They were treated for sigmoid diverticulitis (colon disease) and were prescribed antibiotics and discharged home. C continued to suffer from abdominal pains and saw their GP, who referred them back to the hospital. C then underwent surgery to resolve their symptoms.

C felt that the surgery should have been performed on the initial admittance and that it was unreasonable to discharge them home on antibiotics.

We took independent advice from an appropriately qualified adviser. We found that in the initial admission it was appropriate to treat C with antibiotics rather than proceed to surgery, which could have left C with a permanent stoma (large intestine diverted through opening on abdomen to collect waste in bag or pouch). Additionally, when C was readmitted, it was also appropriate to administer antibiotics in the first instance and it was only when C's condition deteriorated that it was appropriate to proceed to surgery. We did not uphold the complaint.

Summary

C complained about the treatment they received from the practice. C had a pre-existing diagnosis of Chronic Fatigue Syndrome (CFS). C attended the practice about back pain they were experiencing. They were referred to neurology (specialists concerned with the diagnosis and treatment of disorders of the nervous system), urology (specialists in the male and female urinary tract, and the male reproductive organs), rheumatology (specialists that deals with rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments) and orthopaedics (specialists in the treatment of diseases and injuries of the musculoskeletal system) on a routine basis. The neurological service performed two MRI scans which identified a lesion (a region in an organ or tissue which has suffered damage through injury or disease, such as a wound, ulcer, abscess, or tumour). C was advised by specialists to come back in six months for a review. At around this time, C was advised that, despite referrals to orthopaedics, they would not be offered an appointment as they had passed the referral to the pain clinic. The practice followed this up with the service, requesting further MRI scans.

On several occasions, C consulted with the practice regarding severe pain and worsening symptoms. C was later seen by neurosurgeons, who confirmed that the lesion was the cause of the pain and C underwent surgery. The lesion was cancerous, and C underwent therapy to treat it.

C said that the practice showed a lack of understanding of the pain and symptoms that they presented with and failed to prioritise investigations which would have resulted in a timelier diagnosis. C considered that there was an assumption that the pain had an underlying psychological element.

We took independent advice from an appropriately qualified adviser. We found that GPs were responsive to C's requests for further investigations and appropriate referrals were made. There was no significant delay in any referrals being sent. The practice had appropriate discussions with C regarding pain relief, the addictive qualities of medication and sought advice from specialists about managing pain. We found that the care and treatment provided by the practice was reasonable. We did not uphold the complaint.

Summary

C complained about the care and treatment they received from the practice after attending with concerns relating to swelling of the parotid gland (a salivary gland that lies immediately in front of the ear). C attended the practice several times and was eventually diagnosed with cancer. C later learned that it was terminal. C said that the practice had failed to treat their symptoms appropriately and that it took too long to refer them to the ear, nose and throat (ENT) department.

We took independent advice from a GP. We found that the practice had provided reasonable care and treatment to C, that they treated their symptoms appropriately and made appropriate and timely referrals to ENT. Therefore, we did not uphold C's complaint.

Summary

Miss C complained that the board did not provide her with reasonable care and treatment during her admission to Royal Cornhill Hospital. She also complained that the board's staff did not communicate reasonably with her during this admission.

Miss C said that she was not given clear information about her condition or possible treatment and that her treatment plan was decided upon before she was assessed. Miss C said that she was prescribed an unreasonable amount of medication and that there was an unreasonable delay before she was seen by the dietician. She also felt that there was a lack of structured therapeutic activity and she was often left for many hours without contact from members of staff. Miss C said that decisions about her discharge and the arrangements put in place were unreasonable.

We took independent advice from a consultant psychiatrist. We found that an appropriate management plan for Miss C's care and treatment was put in place which included a care and recovery plan. The evidence showed that the aims of Miss C's admission and the plan of treatment were discussed with her and that the treatment plan was reasonable. There were also timely referrals to the dietician and the medication Miss C was prescribed was in keeping with national guidance. We also found that the approach taken in relation to the management and the arrangements for Miss C's discharge were reasonable, as was communication between staff and Miss C. We did ask the board to provide feedback with regards to an incident during which Miss C was restrained. The evidence showed that staff recorded after the incident that a particular type of restraint was not appropriate for Miss C given her personal circumstances. The board also provided us with further information about their more recent restraint policy and practices which we found to be reasonable.

We did not uphold Miss C's complaints.