Not upheld, no recommendations

Summary

Ms C complained about the treatment which her mother (Mrs A) received from district nursing staff while she was in a care home. Mrs A had entered the care home for respite for one week but ended up in the care system for more than five months. Mrs A had developed pressure ulcers in her heels and although care was provided by the district nursing team, Ms C felt the care was inadequate and that it resulted in Mrs A's ulcers becoming infected, which affected her mobility.

We took independent advice from an adviser in district nursing. We found that the district nurses had provided appropriate care to Mrs A in that her pressure ulcers were treated and dressed, and that appropriate pressure relieving aids such as a special mattress and boots were in use. There was also an appropriate referral to podiatry to provide the ongoing management of Mrs A's foot care. We did not uphold the complaint but did provide feedback to the staff about a lack of record-keeping which would have highlighted which risk assessments had been carried out in order to substantiate the need for the treatment options which were put in place.

Summary

Miss C complained to us that the medical practice had failed to provide her with appropriate care and treatment. She had attended the practice for a medical certificate following her recent attendance at A&E where she was diagnosed with a fractured finger and had her fingers strapped. Miss C said that the practice failed to manage her care appropriately in liaising with hospital staff and delayed making a referral to the hand clinic.

Summary

Mrs C complained about the treatment she received from the practice for an infection in her leg. Mrs C attended an out-of-hours surgery over the weekend prior to attending her local practice on the Monday. The practice adjusted Mrs C's medications and arranged a follow-up appointment with a nurse for wound dressing. Mrs C's leg grew worse and a GP was called to her home. The GP arranged for Mrs C's admission and further assessment at a hospital.

We took independent medical advice from a GP. We found that Mrs C's treatment by the practice was reasonable and found no failings in the treatment offered. Therefore, we did not uphold Mrs C's complaint.

Summary

Mr C complained that the board had not provided him with appropriate care and treatment for pain in his knee and thigh.

We took independant advice from a GP. We found that appropriate investigations had been carried out into both issues, appropriate referrals to other services had been made, and pain had been managed in line with guidance. We did not uphold Mr C's complaint.

Summary

Ms C complained about the care and treatment she received following a total abdominal hysterectomy (surgery to remove the womb). The day after the surgery, Ms C began to feel unwell and experienced severe pain in the lower right-hand side of her abdomen. Ms C requested help from a nurse and was advised that her symptoms could have been wind. Based on this, the nurse gave her some peppermint water. After the pain persisted, Ms C asked to be seen by a doctor. Ms C was given pain relief and monitored throughout the night. The following day, Ms C's haemoglobin level dropped and she required surgery to treat a rectus sheath haematoma (internal bleeding). Ms C felt that the hospital should have identified earlier that she was bleeding internally. She also complained about the nursing care she received while in hospital, especially in relation to one particular nurse who Ms C felt displayed inappropriate attitude and behaviour.

We took independent advice from a consultant gynaecologist and a nurse. We found that it was not unreasonable for the rectus sheath haematoma not to be identified or addressed earlier. We considered that the board's actions, including their post-operative treatment plans for Ms C's care, were reasonable. Therefore, we did not uphold this complaint.

In relation to nursing care, we found that it was not unreasonable for nursing staff to have suggested Ms C's pain was caused by wind and there was nothing in the medical records to suggest nursing staff unreasonably delayed contacting a doctor. We noted that the medical records indicate that there was some conflict or difficulty in the communication between Ms C and nursing staff. However, we did not consider what was recorded in the records to be unreasonable or a cause for concern. We acknowledged that Ms C's account differed from what was recorded in the medical records and that we had no reason to doubt what she had told us. However, we concluded that we would not be able to reach a conclusive view on the interactions between Ms C and the nursing staff, as there was no evidence that the nursing care provided was inappropriate or unreasonable. We did not uphold this complaint.

Summary

Mrs C complained to us that she had unreasonably been removed from the ear, nose and throat in-patient waiting list because she had cancelled three planned admissions. Mrs C felt that the board had not listened to her reasons for the cancellations as some were outwith her control.

We took independent advice and considered the guidance around removing patients from the in-patient waiting lists. We found that from a clinical perspective, there was no life-threatening reason for Mrs C to have remained on the waiting list and from a procedural aspect, staff had followed the guidance on removing a patient from the waiting list after three cancelled appointments. We did not uphold the complaint. However, we established that Mrs C had been reinstated to the waiting list and would be offered one further appointment.

Summary

Mr C complained about the treatment he received when he attended an out-of-hours service (OOHS) GP at Peterhead Hospital. Mr C said that he had collapsed at home and was taken to the OOHS where the GP performed a cursory examination and sent Mr C home. Mr C was subsequently admitted to hospital the following day and treated as an in-patient for a week.

We took independent clinical advice from an GP. We found that the OOHS GP had carried out an appropriate examination after taking into account a report from the paramedic who brought Mr C into the OOHS along with a history provided by Mr C. It was reasonable to have reached a diagnosis that Mr C had taken a reaction to the medication which had previously been prescribed by his GP and that there was no clinical indication for a hospital admission at that time. The OOHS GP could not have predicted that Mr C would then go on to develop a chest infection. We did not uphold the complaint.

Summary

Ms C, an advocate, complained on behalf of her client (Mr A) about the care and treatment he received following a referral to the board's musculoskeletal (MSK) hub (a specialist physiotherapy service) and following his referral to neurosurgery (branch of medicine concerned with the brain and other nerve tissue). Mr A was experiencing shooting pains down his legs.

We took independent advice from a specialist musculoskeletal physiotherapist and a consultant neurosurgeon. We found that it was reasonable for a physiotherapist to assess Mr A initially and then refer him directly to the MSK hub when there was no improvement in his condition. We also found that the MSK hub appropriately assessed Mr A in accordance with relevant guidelines and referred Mr A for an MRI scan at the appropriate time.

We found that it was reasonable for neurosurgery to send Mr A back to the MSK hub because a further period of conservative management of his symptoms might have been successful and might have avoided the need for an operation. We did not uphold Ms C's complaints.

Summary

Mr C complained about the care and treatment he received for back pain while in prison. He had previously been prescribed dihydrocodeine and found this effective. The board's treatment plan included physiotherapy, a transcutaneous electrical nerve stimulation (TENS) machine (method of pain relief involving the use of a mild electrical current), heat packs and non-steroidal anti-inflammatory drugs, but he complained that these were not effective. He had also been referred to a pain management clinic.

We took advice from an independent GP adviser. We considered the board's prescribing for Mr C's pain to be reasonable, along with the other supportive measures referred to above. We noted Mr C's wish to take dihydrocodeine for his pain, but highlighted that this is an opiate and that the prescribing of opiates in the prison setting leads to risk of misuse. The fact that the board's GPs chose not to prescribe dihydrocodeine, does not suggest that the care they have provided was below a reasonable standard. We considered that Mr C's treatment was in line with guidance on good medical practice, and therefore did not uphold this complaint.

Summary

Mr C complained about the treatment the practice provided to his mother (Mrs A). Mrs A was attended by a GP at home after it was reported she was having problems with her leg. At this time Mrs A was also receiving nursing care from district nurses. Mr C complained that the practice did not respond to a request from a district nurse for a further home visit the following day. Mrs A's condition worsened and she was admitted to hospital where she later died.

We took independent medical advice from a GP. We found that Mrs A's treatment by the practice was reasonable and found no failings in the treatment offered. We saw no evidence a district nurse requested a home visit by the practice. Therefore, we did not uphold Mr C's complaint.