Not upheld, no recommendations

Summary

Ms C complained about the decision of staff at the Royal Hospital for Sick Children to assess that two referral letters from her child's (Child A) GP should be graded as routine rather than urgent. Child A had ankyloglossia (tongue-tie); this occurs where the strip of skin connecting the baby's tongue to the bottom of their mouth is shorter than usual which affected their ability to feed. As the board had added Child A to the routine waiting list, Ms C paid for the procedure to be completed on a private basis, and Child A immediately improved their feeding ability. Ms C believed that the GP referral letters should have been graded as urgent which would have allowed the procedure to be carried out sooner.

We took independent advice from a consultant paediatrician (consultant specialising in the medical care of children). We found that as Child A was able to feed using a bottle and was gaining weight, there was no need to classify the referral letters as urgent; this was in line with board policy. We did not uphold the complaint.

Summary

Ms C complained about the medical care and treatment provided to her father (Mr A) when he was an in-patient at the Royal Infirmary of Edinburgh. Ms C had concerns about the medical reviews, the decision to withdraw treatment/fluids, the monitoring of Mr A's condition, whether Mr A had an infection, the decision to reinstate active treatment, and communication with Mr A's family.

We took independent advice from a consultant in geriatrics (a doctor who specialises in medicine of the elderly) and general medicine. We found that the care and treatment provided to Mr A was reasonable and decisions were made sensitively to balance the wishes of Mr A's family and to reduce distress for Mr A. We did not uphold this complaint.

Summary

Mrs C complained about the care and treatment her late brother (Mr A) received from the practice. Mr A attended two consultations at the practice as he had experienced shortness of breath on exertion for the previous few weeks. The GP arranged for a chest x-ray and blood tests to be carried out. These tests did not highlight any concerns but Mr A confirmed that his breathing difficulties were ongoing. The GP felt his breathing difficulties could have been caused by angina (chest pain caused by reduced blood flow to the heart muscles) and increased his medication for this with the intention to refer Mr A for more specialist assessment if his symptoms persisted. Mr A died suddenly one week after his second consultation. Following a post-mortem, it was confirmed that the primary cause of death was a pulmonary embolism (a blockage in one of the pulmonary arteries in the lungs, caused by a blood clot). Mrs C complained to the practice and queried why the GP did not look at Mr A's medical history, as this included details of a previous blood clot. In addition to this, Mrs C queried why no further investigation was carried out after the second consultation when Mr A's x-ray results were confirmed as clear. In their response to Mrs C's complaint, the practice concluded that the GP's clinical assessment and decision-making, based on the information at the time, was considered and reasonable. Mrs C was unhappy with this response and brought her complaint to us.

We took independent advice from a GP. We found that the care and treatment the practice provided to Mr A was reasonable. We were satisfied that appropriate consideration was given to Mr A's medical history in respect of blood clots when assessing his breathing difficulties. We also concluded that the practice's actions, after Mr A's x-ray results were known, were reasonable and appropriate. We were satisfied that the records indicated the practice had a firm treatment plan in place for Mr A and had clearly detailed the reasons for this approach. Therefore, we did not uphold Mrs C's complaints.

Summary

Ms C complained about the dental assessment she received from a consultant in restorative dentistry at the board and the consultant's report of their findings. Ms C said that the consultant failed to consider her health/dental health issues and the views of her own dentist appropriately. She complained that the consultant unreasonably concluded that she did not qualify for specialist treatment at the board. Ms C felt that the consultant should have agreed for her to have dental implants.

We took independent advice from a dentist. We found that Ms C's dentist felt that her natural dentition should be removed to make way for dentures and that they referred Ms C to the board for a second opinion. We found that dental implants were not available on the NHS, other than in exceptional circumstances, which Ms C did not meet those criteria. We noted that the two alternative treatment options identified for Ms C by the board consultant would most appropriately be carried out by her own dentist rather than a specialist at the board. We also found that Ms C's health and dental phobia issues would usually be managed by a patient's dentist and would not be the remit of a restorative consultant. However, we noted that if these proved to be too complex, then a patient should be referred to the Public Dental Service, where dentists are better versed in treating patients with medical, behavioural or phobia issues

We concluded that the board provided Ms C with appropriate care and treatment and, therefore, did not uphold the complaint.

Summary

Mr C complained about the way the practice removed his Duloxetine medication when he reported that it was not giving him adequate pain relief. When the medication was removed Mr C suffered from withdrawal symptoms and had to be admitted to hospital.

We took independent advice from a GP. We found that the practice had reduced Mr C's medication in line with accepted medical practice, while at the same time introducing an alternative painkilling medication. Unfortunately, Mr C then developed some signs of withdrawal, but this was not as a result of inappropriate medical treatment. We did not uphold the complaint.

Summary

Mr C complained about the care and treatment he received at University Hospital Monklands in relation to hip pain. In particular, Mr C was concerned that the board mismanaged his condition and did not identify that he required a hip replacement following scans and x-rays.

We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the care and treatment provided to Mr C was reasonable. We noted that, based on the findings of the x-rays and the scan, there was no indication that Mr C should have been offered surgery at that time. We did not uphold Mr C's complaint.

Summary

C complained to the board about their discharge from hospital. The discharge letter to C's GP said that C would be followed up by a consultant psychiatrist in an out-patient clinic and by C's community psychiatric nurse (CPN). C attended the consultant psychiatrist's out-patient clinic. Based on their assessment of C on that day, the consultant psychiatrist discharged C from the clinic. Later, C became concerned about a related matter. When pursuing this further, C spoke to their GP who told C that they had been discharged from the consultant psychiatrist's clinic. C complained to the board that they had not been advised of being discharged. The board told C that the consultant psychiatrist recalled that the discharging had been discussed. C disputed this and also complained that a promised referral for CPN follow-up had not taken place. The board reiterated their response regarding the discharge and explained that a referral to a CPN was not felt to be required following an occupational therapy assessment in the days following their discharge from hospital. The board apologised that this had not been communicated to C appropriately. C was dissatisfied and raised their complaints with this office.

We took independent advice from a suitably qualified adviser. We concluded that the failure to action the promised referral for CPN follow-up had been reasonable in the circumstances and that the available evidence indicates that C was advised that they would be discharged by the consultant psychiatrist. We did not uphold C's complaint.

Summary

C complained about the ophthalmology (eye) care and treatment provided by the board when they had surgery for cataracts (when the lens, a small transparent disc inside the eye, develops cloudy patches). There had been a complication during the procedure which meant that C had to undergo further surgery at a later date. C was concerned that the procedure was not carried out appropriately and that the follow-up was not reasonable.

We took independent advice from an ophthalmologist. We found that all aspects of care, from the decision to carry out cataract surgery and do this under local anaesthetic, to the management and follow-up of the complication, was appropriate. We therefore did not uphold C's complaint.

Summary

C complained on behalf of A, who has a history of complex congenital heart disease (a problem with the structure of the heart). A was admitted to Hairmyres Hospital, treated for paroxysmal atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) and a possible chest infection, and discharged a few days later. A was readmitted to hospital three weeks later and diagnosed with endocarditis (an infection of the heart valves). A said that they had asked a doctor specifically about endocarditis during the first admission, but the doctor told them they had been tested for endocarditis and did not have it. C complained that A should have had blood cultures (a test used to detect bacteria or fungi in a person's blood) taken to test for endocarditis during this first admission.

The board did not uphold C's complaint. They said that doctors considered whether A had endocarditis, but ruled this out because A did not have symptoms of endocarditis at the time. The doctor said they told A that tests showed they did not have a significant underlying infection, but not that they had been tested specifically for endocarditis.

We took independent medical advice from an appropriately qualified adviser. We found that endocarditis was considered, but it was reasonable for doctors to rule this out based on the evidence at the time. We also found that it was reasonable for doctors not to take blood cultures during this admission, based on A's symptoms. The medical records stated A was told that they did not have a 'significant infection' (rather than endocarditis specifically), and we did not consider A was given incorrect information about being tested specifically for endocarditis. We did not uphold this complaint.

Summary

Mrs C, an MSP, complained on behalf of her constituent (Ms A). The complaint related to the care and treatment provided by the board to Ms A's late partner (Mr B) who died by suicide.

Mrs C complained that the board had failed to provide appropriate care and treatment in respect of Mr B's mental health. We took independent advice from a consultant psychiatrist. We found that the care and treatment the board provided was reasonable and appropriate. We acknowledged that we could not know for certain what was discussed between clinicians and Mr B or Ms A. However, we concluded that the records made by different clinicians were consistent with each other and the board provided appropriate care and treatment to Mr B, based on the information known at the time. The board had acknowledged some failings in respect of providing information about self-referral to addiction services. However, we considered that this related to communication rather than care and treatment. As such, we did not uphold this complaint.

Mrs C's second complaint was that Mr B's medical records repeatedly state he was using cannabis in the days before his death. However, the post-mortem and toxicology report indicated that there were no drugs in his system when he died. Mrs C complained that the board had not provided a satisfactory explanation for this. The board said that they could not establish why the post-mortem and toxicology report did not find drugs in Mr B's system or explain the apparent contradiction between this and the medical records. We were not able to confirm exactly what was discussed during the consultations before Mr B's death. However, given the consistency of the medical records, it was reasonable to conclude that the understanding of the clinical staff who reviewed Mr B was that he was using cannabis on an ongoing basis at that time. Therefore, we did not uphold this complaint.

Mrs C also complained that the board's out-of-hours service failed to respond to Ms A's request to provide medication for Mr B in a reasonable or appropriate manner. Ms A stated she was told that urgent medication to calm Mr B down could not be issued and that she felt her concerns were dismissed. We took independent advice from a GP. We found that the care and treatment provided by the out-of-hours service was reasonable and appropriate. We found that the decision not to provide or prescribe medication was appropriate and in line with relevant guidance. The out-of-hours service appropriately arranged an appointment with the Community Mental Health Team and advised Mr B to attend the emergency department if necessary. We did not uphold this complaint.

Finally, Mrs C complained about how the board handled Ms A's complaint and the standard of their communication during the complaint process and related reviews. In particular, Mrs C highlighted what they considered to be miscommunication over the scope and process of the review, delays in the board issuing their stage two complaint response, and questioned the investigating officers impartiality.

We found that it was appropriate for the board to carry out a Suicide Review before issuing a stage two complaint response. Although it took longer than the standard 20 working day timescale for the board to provide a stage two response, we did not consider their handling of the complaint to be unreasonable. We did not consider there to be any evidence that the investigating officer failed to investigate the complaint impartially. We also noted that comments provided by other senior staff during the course of the complaint investigation were reflected accurately in the stage two response. We considered the handling of the complaint to be reasonable and did not uphold this complaint. However, we acknowledged there was some confusion caused by the board referring to both a Significant Adverse Event Review and a Suicide Review and fed this back to them.