Not upheld, no recommendations

Summary

Mrs C owns a property which is adjacent to a park owned by a community trust. A number of years ago the park authority granted permission for an extension to the park. Mrs C complained to the park authority about the development, as she believed the park authority should have required the community trust to apply for planning permission for the new play equipment as she felt the new play equipment was situated too close to her boundary and obscured the view from her property. In their response to her complaint the park authority said that, as the permission was for the extension of an existing playpark, planning permission was not required.

Mrs C complained to us that the park authority unreasonably failed to require a planning application for the new playpark facilities. We took independent advice from a planning adviser who noted that the planning consent from when the park authority had originally granted permission for the extension had lapsed. Therfore, we considered whether the park authority acted reasonably in deciding not to require the community trust to apply for permission again. We found evidence that the park authority had made a considered and proportionate decision regarding whether to take enforcement action. We did not uphold the complaint.

Summary

Mr C complained about the council's handling of a planning application which proposed the erection of a new house directly opposite his own. Mr C told us that this application should not have been approved as the council's Local Development Plan (LDP) only allowed for one new house to be built in rural hamlets the size of his during every five year plan period, but this was the third application that had been approved in less than 18 months. In response to his objection and complaint, the council had explained that the reason this had occurred was because one LDP had expired at the end of the year, but the new five year LDP could not be approved until a few months into the new year, due to a Scottish Government review. They said that this meant that the interim period had to be considered a second term of the older LDP, with its own allowance for rural expansion.

We took independent advice from a planning adviser, who told us that the council's interpretation of the legislation was correct and, therefore, their approach was reasonable. As such, we did not uphold this complaint.

Mr C also complained that the council had not taken account of an objection he made regarding the accuracy of the plans. He said that the levels shown on the plans were not consistent with the gradient of the site. On investigation, we found that Mr C had objected about this issue seperately from his original objection, and outwith the timescale for consultation. As such, the council did not accept it as a valid objection. However, they received a similar objection from another party, so this matter was considered during the process. They also treated Mr C's objection as a planning enforcement matter and attended the site to visually compare the levels against the gradient. Having done so, they concluded that the plans were a reasonable representation of the plot. We concluded that the council's actions in this respect had been reasonable and we did not uphold this complaint.

Summary

Mrs C was referred by her GP to the orthopaedic department (the area of medicine which deals with the musculoskeletal system) at Ninewells Hospital for consideration of knee replacement surgery. However, there were problems with the communications from the board which resulted in her missing a scheduled out-patient clinic appointment. Mrs C questioned this with the board and she was told that arrangements had been made to reschedule the clinic appointment. However, she was then told that the rescheduled appointment had been cancelled and that the consultant had carried out a virtual assessment of the symptoms reported by the GP, and had subsequently discharged her. Mrs C complained that it was unreasonable that she had been discharged from the orthopaedic clinic without a face-to-face consultation.

We took independent advice from an orthopaedic consultant. We found that, on occasions, it can be appropriate for clinicians to carry out virtual assessments based on the information provided from the GP referral and that, in Mrs C's case, it was reasonable to discharge her from the clinic without a face-to-face consultation. We did not uphold the complaint. However, we were critical of the letter sent to Mrs C by the consultant as it did not contain sufficient advice as to what alternative options could be considered, and we fed this back to the board for their consideration.

Summary

Ms C complained that the care and treatment she received from her medical practice was unreasonable. Ms C said that she called the practice for an emergency appointment because she was experiencing extreme pain, and that it was only after she called a number of times that she was given an appointment. She was diagnosed with a vaginal swelling, given antibiotics and advised what to do should her condition worsen. Ms C was seen again at the practice the next day, when it was decided that she should be admitted to hospital. Ms C complained that there had been a delay in offering her a GP appointment, and that she had been incorrectly treated with antibiotics rather than referred to hospital.

We took independent advice from a GP adviser. We found that Ms C was given an appointment within a reasonable time. We also found that it was in accordance with General Medical Council good practice advice that she was given antibiotics and advice in the first instance. We did not uphold the complaint.

Summary

Mrs C complained about the care and treatment which she received during her pregnancy at the Royal Infirmary of Edinburgh. She had attended for a check-up where her baby's heartbeat was checked and blood tests were taken. Mrs C said that a nurse said that she might have an infection, but sent her home without medication. Mrs C then developed acute back pain and returned to hospital where she was admitted. Mrs C's condition deteriorated and she developed abdominal pain and was placed on a monitor. There were signs of fetal distress and it was decided to proceed to caesarean section (an operation to deliver a baby involving cutting the front of the abdomen and womb) where her baby was born. Mrs C then suffered a massive bleed and a hysterectomy (a surgery to remove the womb) had to be performed. Mrs C complained that there had been a delay in deciding to proceed to caesarean section and that antibiotics should have been prescribed earlier which would also have stopped her suffering from sepsis (a blood infection).

We took independent advice from a consultant obstetrician (a doctor who specialises in pregnancy, childbirth and a woman's reproductive system) and we found that Mrs C had received a reasonable standard of care and treatment. We found that staff adopted a conservative approach initially to establish if Mrs C would be able to deliver naturally and they kept her under observation. When it became clear that there were signs of fetal distress then it was appropriate to move to a caesarean section. There was no evidence of any delay and the caesarean section was carried out to an acceptable timescale. There was also no evidence that antibiotics should have been administered to Mrs C at an earlier stage and they were provided when she showed symptoms of infection. We also found that, when it was realised that Mrs C had suffered a bleed, staff acted appropriately in accordance with the national guidance that in such cases staff should resort to hysterectomy sooner rather than later. While we noted that the decision to proceed to hysterectomy appeared to be taken by a single consultant, it would have been normal practice to have a discussion with a senior colleague if appropriate. That said, the decision to proceed to hysterectomy was appropriate and completed in a timely manner. We did not uphold the complaints.

Summary

Mr C complained that the board had unreasonably failed to reimburse the costs of his Clomiphene medication (medication to increase levels of the hormone testosterone) which had previously been prescribed outwith the UK. Mr C also complained that the board had refused to reimburse his costs for attending an endocrinilogist (a medical professional who specialises in hormones) outwith the UK. Mr C maintained that the medication and service provided by the endocrinologist improved his health.

We took independent advice on Mr C's complaint from a consultant endocrinologist. We found that, although Clomiphene is effective in raising testosterone levels, it has not yet replaced the currently used testosterone supplements in the management of hormone deficiency in men. The treatment is unlicensed in the UK and, whilst a clinician could prescribe it, it would be a discretionary matter to do so, and they would have to make a specific request. We found that the board's decision not to fund the medication or the consultation costs on the basis that it was not licensed, alternative appropriate medication was available, and the condition is commonly managed in the UK, was reasonable. We did not uphold the complaints.

Summary

Mr C complained on behalf of his wife (Mrs A) who has multiple sclerosis (MS - a condition which can affect the brain and/or spinal cord). Mrs A began to experience leg and back pain and a scan showed she had a ruptured disc. She was referred to see a consultant neurosurgeon (a doctor who specialises in conditions of the nervous system, including the brain, the spine, the spinal cord and nerves). Mr C complained that, despite a number of consultations and opinions, Mrs A was not given a proper diagnosis for the cause of her leg and back pain, nor was she offered surgery or a referral out-with the board's area.

We took independent advice from a consultant neurosurgeon and that we found that Mrs A's case was complicated by her MS. We found that the care provided to Mrs A was in accordance with national guidelines and that clinicians involved made a well reasoned decision not to undertake surgery or refer her elsewhere. We were satisfied that Mrs A had been given reasonable care and treatment. We did not uphold the complaint.

Summary

Miss C was admitted to the Royal Infirmary of Edinburgh with severe sudden onset headache. A lumbar puncture procedure (a medical procedure where a needle is inserted into the lower part of the spine to test for diseases in the brain, spinal cord or central nervous system) was carried out but the results were negative and she was discharged the following day. However, she subsequently suffered ongoing headaches and low back pain. She complained that she had not been advised long term pain was a possible risk of the lumbar puncture. She also complained about how the procedure was carried out, expressing unhappiness that it was carried out by a junior doctor and questioning what had gone wrong to cause her so much pain. She also asked what her long term prognosis was.

We took independent medical advice from a consultant physician. We found that an initial headache and back pain are recognised complications of lumbar puncture procedures, but that the pain usually settles within a few days and severe ongoing pain is rare. As such, we found that it would not be expected practice for clinicians to advise patients of a risk of long term pain. We did not uphold this aspect of the complaint.

In terms of Miss C’s long term prognosis, the adviser suggested it might be helpful for her to have her symptoms reviewed by a specialist and we suggested the board might consider offering a neurology appointment.

We found no evidence to indicate that there were any failings in the way the procedure was carried out that might reasonably explain Miss C’s ongoing pain. We also found that it is appropriate for junior doctors to carry out such procedures, under supervision, when they are at the stage of their training that the doctor who carried out Miss C's procedure was at that time. We did not uphold this aspect of the complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care and treatment Ms A received at the Royal Infirmary of Edinburgh. Ms A had painful and uncomfortable symptoms in her throat and neck, which affected her breathing and swallowing. After investigations were carried out, Ms A was told that no physical cause was found to explain these symptoms. Ms A was referred to psychiatry and she was diagnosed with somatoform disorder (a syndrome where someone has recurring physical symptoms thought to be caused by psychological or emotional factors). Ms A complained that following this diagnosis, she was not given treatment for her physical symptoms.

We took independent advice from a consultant psychiatrist. We found that Ms A's psychiatry assessment was comprehensive and she was diagnosed with somatoform disorder with the appropriate input of various medical specialists. We also found that a reasonable decision was made not to investigate Ms A's physical symptoms any further, as that can be harmful for someone with somatoform disorder. We did not uphold Ms C's complaint.

Summary

Mrs C complained to us about the care and treatment her sister-in-law (Mrs A) received at the Royal Infirmary of Edinburgh after taking two overdoses of medication within a few days. On the first occasion, Mrs A was assessed in the emergency department for risk of liver damage and then admitted to the acute medical unit. She had a psychiatric assessment the following morning and it was decided that she did not need any further in-patient psychiatric care. Mrs A discharged herself from the hospital later that day against medical advice. Mrs A was brought back to the emergency department on the following day after taking a further overdose and was then admitted to the toxicology unit. On the following day, she was transferred to a specialist liver transplant unit, although it was decided that she was not a candidate for a liver transplant. She was subsequently moved to intensive care after it was recorded that her kidneys were failing. Mrs A died there several days later. Mrs C complained about the care and treatment provided to Mrs A during each admission to the hospital.

We took independent advice from an emergency medicine consultant, a psychiatric consultant, a general medical adviser and a consultant in anaesthesia and intensive care medicine. We found that the care and treatment provided to Mrs A in the hospital throughout all admissions had been reasonable and appropriate. We did not uphold Mrs C’s complaints.