Not upheld, no recommendations

Summary

C complained on behalf of their sibling (A) about the care and treatment that they received during a hospital admission. A had a cannula (a thin tube inserted into a vein or body cavity to administer medication, drain off fluid, or insert a surgical instrument) fitted which then became infected and caused them to develop sepsis (an infection of the blood stream). C complained that A had requested the cannula be removed sooner and that this was declined. C also complained that A had advised staff that they felt unwell and that this was not taken seriously, and also that their medication had not been properly managed.

We took independent advice from a consultant in acute internal medicine. We found evidence in the medical records that A declined to have the cannula removed. There is no other documentary evidence from the time about A either refusing, or requesting, to have the cannula removed. We found that the care and treatment provided was reasonable.

We also found that A's medication had been properly managed and that they did not note any failings in the communication with A and their family. We did not uphold this complaint.

Summary

C complained about the care and treatment that their child (A) received from the board. A had an autistic spectrum disorder (ASD) diagnosis and a history of treatment through the board's Child and Adolescent Mental Health Service (CAMHS). A was placed on an urgent waiting list for further assessment and treatment. A was assessed and was assigned medication and individual therapeutic work. Following a number of appointments, A was discharged from the individual appointments, was seeking support in the community and was supported with accommodation.

C reported concerns about A's behaviour, including an incident where they set a mattress on fire. A subsequently attended another appointment thereafter.

C complained that professionals failed to respond adequately to an escalation in A's behaviour which should have prompted an urgent appointment. C also complained that a later appointment did not result in a reassessment of A and the support that they required. In response to the complaint, the board said that there was no evidence of any new psychiatric symptoms that required urgent assessment, and that the later appointment was appropriate with a plan for A agreed at the time.

We took independent advice from a mental health services specialist. We found that appropriate assessments were completed following C's reports of concerns about A's behaviour. We found that the decision not to carry out an urgent psychological review was reasonable and that the records showed a thorough and detailed assessment was carried out at the later appointment. We found that the conclusions reached were reasonable. As such, we did not uphold the complaints.

Summary

C complained about the care and treatment provided to their partner (A). A had been suffering from an extended period of constipation which the District Nursing Team had attempted to treat at home. A's GP referred them to hospital for further treatment. A died following a fall in hospital.

C raised a number of concerns about the GP's assessment of A's condition and the decision to refer them to hospital. C said that the GP should have visited A at home, should have considered alternative treatments at home, and that the GP made assumptions about A's wishes and condition. C believed that there were no grounds for admitting A to hospital and that the GP's actions led directly to A's death.

We took independent advice from a general practitioner adviser. We found that the care and treatment provided to A was of a reasonable standard. It was not a requirement for the GP to visit A at home prior to referring them for admission. The admission had been discussed with C, and the decision to refer A for hospital admission was a reasonable clinical judgement for the GP to make in the circumstances. The GP's referral had acknowledged C and A's wishes for resuscitation to be attempted and the advice did not consider that there was an unreasonable focus on this in the admission.

We found that the care and treatment provided to A was reasonable and that the practice had acted appropriately when considering and responding to C's concerns. We did not uphold C's complaints.

Summary

C complained to the board about several aspects of the care and treatment provided to their parent (A) during their time in hospital and also about the discharge planning on each occasion.

A was diagnosed with terminal cancer and was in hospital for treatment before being discharged home. A was later readmitted to hospital with illness. A was discharged home again and later died.

The board's position was that the discharge planning for A on each occasion was appropriate. There was discussions about what supports could be offered, and it was frequently documented that A's wish was to be at home. Discharge plans were discussed on a daily basis.

With respect to the care and treatment provided to A during the second admission, the board commented that A was being treated for a chest infection and apologised if C was not aware of A's chest infection. The board said that there was no indication to replace the nasogastric tube (tube used to deliver food or medicine to the stomach for people who have difficulty eating or swallowing).

We took independent advice from a consultant geriatrician (doctor who specialises in treating older patients) and from a registered nurse. We found that the care and treatment provided to A during their admission was reasonable. We also found that given A's condition and prognosis, the decision that A was suitable to be discharged was also reasonable. We did not uphold the complaint about care and treatment.

With respect to the planning made for A's discharge home, we found that the planning on each occasion was reasonable. On A's first discharge from hospital, appropriate assessments were carried out and discussions documented about supports which could be put in place for A's return home. It was documented that these were declined by A.

With respect to the second discharge, whilst there was no formal discharge plan, given A's prognosis and assessment that they were independent and requesting to go home, it was reasonable to discharge A.

Whilst we determined that the arrangements for A's discharge were reasonable, and did not uphold these complaints, we provided feedback to the board with respect to the absence of some records which we would have expected to see and/or be updated more regularly.

Summary

C made a complaint to the practice regarding the care and treatment provided to their late spouse (A). A attended the practice with pain and a family history of cancer. C said that the practice caused unnecessary suffering and stress to A and their family through misdiagnosis of A's condition. They also said that there was an unreasonable delay in progressing the ultrasound and that this led to poor management of A's pain. A was later diagnosed with lung cancer.

We took independent advice from a general practitioner adviser. We found that overall the practice did provide reasonable care to A. We found that the practice took reasonable steps to investigate A's symptoms and their actions were reasonable based on the information known at the time. As such we did not uphold the complaint.

Summary

C cares for their spouse (A) who has Alzheimer's disease. C complained about the council's social work department, after they took action under their Adult Support and Protection (ASP) procedures, including obtaining a warrant to remove A from home. C complained that false allegations about them resulted in the warrant being issued and served. They complained that social work staff had presented unsubstantiated claims of neglect and abuse during the ASP proceedings.

We took independent social work advice. We noted that there was evidence that C was experiencing stress in their caring role and that there was a difficult relationship with social work. We noted that there were periods during which A was locked in the house alone and C had mentioned that A may have bruising on them and would not allow access for a GP to assess A at that moment in time. We found that there was sufficient evidence to indicate that the council had a statutory duty to investigate the circumstances and put in place an action to safeguard A's welfare.

We found that the council followed the ASP process reasonably, seeking input from C and relevant professionals. A number of actions were agreed to ensure that both C and A had the support they needed in place and once it was established that the appropriate support was in place the ASP process was ended. We were also satisfied that it was reasonable for certain meetings to take place without C and A's involvement. Therefore, we did not uphold this part of C's complaint.

C also complained about the council's communication in respect of these matters. We found that the council had attempted to communicate clearly and openly with C. We considered that the circumstances themselves and the stress and anxiety involved likely contributed to a breakdown in communication. Therefore, we did not uphold this part of C's complaint.

Summary

C complained to the council about the way in which they had handled their reports about anti-social behaviour by C's neighbours. C also complained about how the council had managed the situation once C had been offered a housing transfer to remove them from the situation. The council investigated and responded to C's complaints, however C and their advocates continued to complain to the council about matters which were considered closed following the local complaint investigation.

We found that the steps taken by the council to resolve C's complaint were reasonable. On recognising C's vulnerabilities, and it being unlikely the dispute between the neighbours would be resolved, we found that the subsequent handling of C's housing transfer was also reasonable.

During our investigation it was noted that the council had invoked their Unacceptable Actions Policy in principle in relation to one of C's advocates. However, as they had indicated that they would not be contacting the council again, the advocate was not formally notified they were being managed in line with this policy. We gave feedback to the council on this matter, noting that complainants and their advocates should be informed when their behaviour is considered unhelpful and challenging to ensure that they have the opportunity to engage more meaningfully.

Overall, we found that the actions taken by the council were reasonable and we did not uphold C's complaints.

Summary

C, an adult with attention deficit hyperactivity disorder (ADHD), autism, and pathological demand avoidance (PDA) complained that the board failed to diagnose their conditions when they should have done.

C told us that the board said they stopped considering diagnosis of conditions such as ADHD and autism when a patient reached the age of 25 years old. C complained that this practice led to them being misdiagnosed which prevented them from obtaining access to appropriate medication, particularly, medication to help with the management of ADHD.

The board said that the understanding of developmental disorders in adulthood, including high functioning autism and ADHD was very limited during the mid 1990s (when C felt they should have been diagnosed). The board felt any potential delay in diagnosis should be considered in line with the expectations and understanding of psychiatric practice at the time. In C's case, it appears C experienced a number of other physical and mental health problems that would not be solely accounted for by diagnoses of autism and/or ADHD, although these conditions may have been predisposing factors.

We took independent advice from a general adult consultant psychiatrist. We found that the timing of the recognition and diagnoses made were reasonable and that there was no evidence to suggest that the recommended treatment for ADHD was delayed or withheld because of prescriptions of other medications. We also noted, at this point in time, there are appropriate guidelines and clinical guidance for clinicians to follow, in relation to pervasive developmental disorders in adults.

Whilst we recognise that C was not diagnosed with ADHD and autism until relatively recently, we consider that the care and treatment provided to C was reasonable in the circumstances at that time. We also consider treatment provided for other diagnosed conditions was reasonable and did not prevent or delay C's later diagnoses of ADHD and autism.

We noted that the board may have diagnosed these conditions differently in the past but did not see any evidence to suggest that the board's current practice fails to consider diagnoses of ADHD and/or autism in adults over the age of 25 years old.

Therefore, we did not uphold C's complaint. We did note that it may have been helpful to carry out a more detailed ADHD assessment before commencing medication and provided the board with some feedback on this point.

Summary

C complained about the care and treatment provided to their late spouse (A). A was suffering from facial pain and numbness and underwent an MRI scan. The MRI reported a benign slow growing tumour at the base of A's skull which can usually be managed with pain killers or sometimes stereotactic radiosurgery (SRS, a high dose of radiotherapy to a small area) is considered. Shortly after, A's local health board referred A to Lothian NHS Board for treatment. A attended a telephone consultation with a neurosurgery consultant (specialist in surgery on the nervous system, especially the brain and spinal cord). A was not considered to have a diagnosis of cancer given the findings of the MRI scan and was referred on a routine basis for consideration of SRS treatment.

A's case was subsequently reviewed at a multidisciplinary team meeting by clinicians at Lothian NHS board. It was identified from a review of the MRI report received from A's local health board, that there were other not previously identified lesions in A's brain, which were in keeping with metastases (cancer that has spread from other areas of the body). A was referred on an urgent basis to their local health board for further investigations including an MRI scan and CT scan. A was diagnosed with cancer and died shortly after.

We took independent advice from a consultant neurosurgeon. We found that the MRI report did not show any sinister findings which required urgent intervention and that the board took appropriate action. However, the review of the MRI at the subsequent multidisciplinary team meeting identified metastatic lesions. We considered that the review of the MRI took place within a reasonable timeframe.

We took additional advice from a consultant radiologist (specialist in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) about the findings of the MRI performed by A's local board. We found that the report had not detected tiny abnormalities which, if identified at the time, would have raised the suspicion of metastases and led to earlier investigation to look for the source of the primary tumour elsewhere in the body. However, we considered that the undetected findings were subtle and likely to have been missed by a number of radiologists. Therefore, the MRI report findings were of a reasonable standard.

We considered that the board had provided A with reasonable care and treatment on receipt of the referral from A's local board. Therefore, we did not uphold C's complaint.

We provided some feedback to the board with respect to the importance of acknowledging and responding to concerns raised by GPs about a patient's symptoms, particularly pain.

Summary

C complained on behalf of their spouse (A) about the care and treatment they received from the board. A was reviewed by the vascular surgery service (specialists in the treatment of diseases affecting the vascular system including diseases of the arteries, veins and lymphatic vessels) after sustaining an injury to one of their fingers. The injury initially caused some infection which progressed to gangrene (a serious condition where a loss of blood supply causes body tissue to die). A's finger was amputated but the wound did not heal and deteriorated further, leading to the amputation of A's hand. C raised concerns about the timeliness of A's initial finger amputation and that had this been done before the infection progressed, this would have avoided the need for full amputation of A's hand.

We took independent advice from a vascular surgeon. We found that the decision to admit A to hospital and treat with intravenous antibiotics was timely and appropriate. There was evidence of regular review and high quality multi-disciplinary working. We also found that the finger amputation was performed in a timely manner and that there were no published guidelines that were not followed. We considered there was no indication that performing the finger amputation earlier would have prevented the need for hand amputation. Therefore, we did not uphold C's complaint.