Not upheld, no recommendations

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.

Summary

C complained about two matters. The first related to whether or not the treatment plan prepared by a dentist employed by the dental practice was clinically necessary. We did not uphold this complaint on the basis that images taken of the teeth and an x-ray showed that the work set out in the treatment plan was required to the teeth as there was decay, part of a filling was missing and part of a tooth was missing. The clinical notes also referred to this.

The second related to a failure to provide C with evidence that the work was clinically necessary when asked to do so. We did not uphold this complaint on the basis that the clinical notes and the images were sent to C by the dental practice. The dentist, who had left the practice subsequently, wrote to C to provide them with information about why the treatment was necessary.

Whilst we did not uphold this complaint we did recognise that communication when dealing with the complaint could have been better and a more coordinated approach between the dentist and the dental practice would have resulted in better complaint handling. We noted the dental practice had already apologised for this and made an offer to C as a good will gesture.

Summary

Mrs C complained that the care her child (Child A) received from the board during their admission for bacterial meningitis (an infection of the protective membranes that surround the brain and spinal cord) was unreasonable. Mrs C said that Child A was not given the full dose of antibiotics and that the day after discharge they had to be re-admitted as the infection had not been cleared. Mrs C also complained that Child A was given an MRI scan using the feed and wrap technique (use of feeding and swaddling to induce natural sleep in infants), which did not work, rather than performing the test under general anaesthetic.

We took independent advice from a consultant paediatrician (a medical practitioner specialising in children and their diseases). We found that, on review of the medical notes, Child A received the stated course of antibiotics, there were no concerns over the timing of the doses, and it was reasonable for Child A to have been discharged initially. We also found that it was reasonable for Child A to have their MRI using the feed and wrap technique in the first instance. As a result, we did not uphold this aspect of the complaint.

Mrs C also complained that the handling of her complaint was unreasonable. We were satisfied that the board had followed the NHS Complaints Handling Procedure and as a result, did not uphold this aspect of the complaint.

Summary

C complained about the care and treatment provided to their child (A). A was treated with intravenous immunoglobin (antibodies) because it was suspected they had an immune-related movement disorder. The focus of C's complaint was about the decision to stop this treatment as they considered it was of benefit to A.

During our investigation we noted that the decision to start and stop this treatment was made by a doctor under a different health board. The treatment plan was commenced at the other board and moved to Fife NHS board because it was more convenient for A and their family to attend. We were therefore unable to comment on whether or not it was reasonable to stop this treatment, as the decision was not made by the board subject to the complaint. In relation to the treatment carried out at Fife NHS board, we found that the infusions of immunoglobin were administered by the board in accordance with the plan that was put in place by clinicians under the other board. We did not uphold this complaint.

We provided feedback to the board in relation to their complaints handling. As this complaint focussed on the decisions made about treatment, it would have been helpful to C and this office if this had been clarified at an early stage so that the correct focus of the investigation (a different board) could have been identified earlier.

Summary

Mr C complained about the treatment which he received at the A&E of Borders General Hospital. Mr C said the doctor failed to diagnose that he had suffered a fracture and dislocation of a finger and that the injury was only picked up a few weeks later following further x-rays being taken.

We took independent advice from an A&E consultant. We found that the doctor who saw Mr C at A&E carried out an appropriate assessment. The doctor could not identify a fracture from the x-ray which was taken and arranged a review at a Virtual Fracture Clinic. The injury was also not identified at the clinic. It was only when further x-rays were taken after a couple of weeks that the fracture and dislocation were identified. Mr C had suffered a rare injury and although the correct diagnosis was not reached at A&E, this did not mean that the treatment was not to an appropriate standard. We did not uphold the complaint.

Summary

C complained that their complaints about the bullying of their child had not been addressed by the school they attended. C met with teaching staff to discuss the incidents giving rise to their complaints and subsequently attended a parent-teacher meeting. C complained that school staff had behaved unreasonably towards them, in particular at the parent-teacher meeting.

We explained to C that we could not determine whether bullying took place. We could look at whether the council took reasonable action after C reported their concerns and whether the school and the council followed the correct procedures in response to those concerns.

We found there was a clear record of C’s reports of incidents of bullying. The school has detailed the action it took to investigate the incidents and was able to provide evidence to support its decisions. This was in line with the council’s anti-bullying policy. We considered that the council handled C's complaints about bullying in a reasonable way.

In considering C’s complaint about how staff had behaved, we reviewed the evidence provided by C and the council. We did not find any supporting evidence to conclude that the school’s staff had behaved unreasonably towards C.

We did not uphold C's complaints.