Not upheld, no recommendations

Summary

Mrs C's complained about the care and treatment provided by the board to her husband (Mr A) over several of years, in a number of respects. Mrs C said that this had an adverse effect on the care provided to Mr A and, as a result, his mental health had suffered.

We took independent advice from an adviser who specialises in psychiatry. We found that the standard of care and provision of treatment was reasonable in all respects and we did not uphold this aspect of the complaint.

Mrs C was also concerned about the way the board had handled her complaint. We found that the board's complaint response reflected the findings of their investigation and was reasonable. Therefore, we did not uphold this aspect of Mrs C's complaint.

Summary

Mr C complained to us on behalf of his late father (Mr A) who was diagnosed with and subsequently died as a result of septic arthritis (a serious type of joint infection). Mr C complained that the practice failed to provide reasonable care and treatment in relation to Mr A's shoulder pain, including providing phone consultations rather than face-to-face assessments and that the practice did not refer Mr A for x-ray or to orthopaedics (specialism that deals with diseases and injuries of the musculoskeletal system). Mr C considered that this had caused delays with Mr A being diagnosed with joint sepsis.

We found that the practice's consultations and care and treatment that Mr A received were reasonable, including referring Mr A to physiotherapy. Therefore, we did not uphold this complaint.

Summary

Mrs C complained that she had not been provided with appropriate treatment at a dental hopsital. Mrs C said that she had been suffering from severe pain for an extended period, due to a poorly fitting denture.

We took independent advice from a dental advisor. We found that Mrs C had been reviewed appropriately and when she had expressed concerns, her care and treatment had been assessed by a number of different specialists. Mrs C had been treated reasonably and appropriately.

Mrs C also complained that a referral to a specialist at a different health board had been cancelled by Tayside NHS board. Mrs C felt this was also unreasonable. We found that Mrs C had not met the criteria for a referral to a different board, as her treatment could reasonably be provided locally.

We also found that Mrs C's complaint was handled by the board in line with their complaints handling process and whilst we recognised that she did not agree with the outcome, this did not constitute evidence of maladministration on the part of the board.

We did not uphold Mrs C's complaints.

Summary

Mrs C complained about the failure of the practice to refer her late father (Mr A) to hospital skin specialists for investigation of a lesion on his forehead. By the time a referral was made, it was too late to attempt surgery and palliative care was instigated. Mr A had a previous history of skin cancer and Mrs C felt that an early and urgent referral to the skin specialists should have been made. We took independent medical advice from a GP. We found that it was not unreasonable for the practice to have thought that Mr A had a cyst and that it was appropriate to transfer his care to district nursing staff in order that they could dress the wound. When the district nurses requested antibiotics the practice made out an appropriate prescription. It appeared that there was a change in the appearance of the lesion after Mr C had been seen by the practice. We did not uphold the complaint.

Summary

Mr C complained about the treatment he received at St John's Hospital. He said that his GP had been treating him for a suspected urinary tract infection and referred him to hospital. Initially staff felt that he had a viral infection, but subsequent investigations found that he had a prostatic abscess (accumulation of pus within the prostate gland) and had also developed staphylococcus aureus bacteraemia (a bacterial infection). Mr C felt that there had been an undue delay in reaching an accurate diagnosis.

We took independent professional advice from a consultant physician. We found that staff had performed a number of investigations to establish the cause of Mr C's symptoms and that it was not initially unreasonable to have diagnosed him as suffering from a viral illness. His temperature fluctuated and appropriate antibiotics were administered at an early stage. The staff also arranged further appropriate investigations in case there was a danger of Mr C losing his sight or requiring heart surgery. We did not uphold the complaint.

Summary

Mr C complained about the change in the way his medication was administered at the Royal Infirmary of Edinburgh. In the past, Mr C received IV morphine (injection into a vein) but had now been changed to subcutaneous morphine (injection under the skin). Mr C believed that the change meant he was in pain for a longer period of time and that it was not as effective. He believed that the decision to change the method of administration of the morphine was unreasonable.

We took independent medical advice from a clinician and found that the board had implemented a new Recurring Pain Pathway which included guidance in appropriate cases that morphine should be given subcutaneously (under the skin). This would have the effect of a slower absorption with fewer side effects. We also found that the board staff had explained the rationale for the change to Mr C in a sensitive manner taking into account his other health issues. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment provided to her late husband (Mr A) who had a rare and aggressive form of bladder cancer. Mr A received care and treatment at the Royal Infirmary of Edinburgh and the Western General Hospital.

We took independent advice from urology (specialism that deals with the male and female urinary tract, and the male reproductive organs), oncology (cancer) and general surgery advisers. We found that the time taken to investigate and begin treatment for Mr A's bladder cancer was reasonable and in accordance with the Scottish Government's cancer waiting time targets. We also found that chemotherapy treatment commenced within a reasonable timescale. The level of information about treatment options, including their risks and benefits, provided to Mr A was also reasonable. This included sufficient information about the specific risk of pulmonary embolism (a clot in the blood vessel that transports blood from the heart to the lungs), a complication Mr A subsequently experienced.

In the context of Mr A's rapid deterioration, the level of planning for end of life care was reasonable. When Mr A subsequently experienced bowel obstruction, it was reasonable that he was treated on a surgical ward. While Mr A's pain was difficult to manage, the attempts by the clinical team were reasonable, as was the aim to discharge Mr A home. When Mr A's condition deteriorated, he was transferred to a hospice without unreasonable delay.

We did not uphold Mrs C's complaints.

Summary

Mr C complained to us that his GP practice had unreasonably notified the Driver and Vehicle Licensing Agency (DVLA) that he had alcohol issues. We found that the practice had previously discussed this matter with Mr C and that it had been reasonable for them to contact the DVLA regarding their concerns about Mr C's health and alcohol intake. We did not uphold Mr C's complaint.

Summary

Ms C saw her dentist about a number of issues and agreed to undertake a course of dental treatment which included denture fittings over a number of months. However, Ms C told us that once treatment had been completed the dentures were ill-fitting and the cost of the planned treatment had not been made clear to her.

We took independent advice from a dental adviser. We found that the evidence from Ms C's dental records showed the standard of treatment provided at each appointment during this period was reasonable and that treatment decisions were in line with options under the NHS. We also found that the evidence showed the planned treatment costs were discussed with Ms C and adjustments were made to meet Ms C's communication needs. We did not uphold the complaint.

Summary

Ms C complained about the care and treatment she received when she was admitted to A&E at the Royal Infirmary of Edinburgh. In particular, that she had been catheterised without her consent and against her will. She also complained that unnecessary restraint had been used.

We took independent advice from a consultant in emergency medicine. We found that the care and treatment given to Ms A was reasonable, and that the history, examination and investigations had been appropriate and reasonable. In particular, we found that this had been a potentially life threatening emergency and the decision to insert a catheter had been reasonable. We considered that it was extremely unlikely that Ms C would, at that time, have had the capacity to consent to medical treatment. As such, an adult with incapacity assessment had been completed before the decision to insert the catheter had been made. We also found there was no evidence in the medical records that unnecessary constraint had been used. We did not uphold Ms C's complaint.