Not upheld, no recommendations

Summary

Mr C complained that, following major infrastructure works to install a water pipeline, the council failed to ensure that a specific area of park was returned to an acceptable condition.

We found that, when the council were served notice of the works by the water company, they were told that after the works were completed the land would be reinstated to the council's satisfaction. Mr C felt that the area of the park he was concerned about had been changed and not returned to an acceptable condition. In the council's view, the reinstatement was sympathetic to the area where the works took place, and the council regarded reinstatement of the site as satisfactory. As it was the council's land, it was for them to be satisfied.

Although we appreciated that Mr C disagreed with the council's view, that disagreement was not evidence of an administrative failing by the council. There was no definition of what was regarded as satisfactory or acceptable condition, therefore, the matter came down to the professional judgement of council officers on whether the reinstatement was satisfactory. In the absence of evidence of an administrative failing, we could not question the council's decision. We did not uphold Mr C's complaint.

Summary

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Mrs B) about the communication with Mrs B's husband (Mr A). Mr A suffered some stroke like symptoms and his GP referred him to the hospital for a scan to check if he had had a stroke or transient ischaemic attack (TIA or 'mini-stroke'). A doctor discussed the results of the scan with Mr A in an appointment at the TIA clinic, about two weeks after his initial symptoms. It was recorded that Mr A was at risk of a further stroke, and the doctor recommended that he take medication to reduce this. Mr A suffered a further stroke some months after this, and later died. Mrs B said that Mr A never told her about the results of the scan, and she queried whether he had fully understood this, given he was suffering from confusion. Mrs B felt it was unreasonable for the doctor to share this information with Mr A at an appointment he attended alone, and not with her.

We took independent advice from a consultant in general medicine and medicine for the elderly. We found that Mr A's confusion was temporary and that there was nothing in the records to suggest he was not able to understand the information given or that he needed support during the appointment. We did not uphold Mrs C's complaint. We noted that the board had said that they had learned from the complaint and that they were changing the appointment letters for this clinic to suggest that patients may wish to bring someone with them.

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by the ambulance service. She felt that the service should have taken Mr A to hospital when they attended him and he was unwell with diarrhoea, because several days later Mr A was diagnosed with a perforated duodenal ulcer (when the lining of the stomach splits due to a sore).

We took independent advice from a consultant in emergency medicine who is involved in the training of paramedics and who works alongside them in the provision of pre-hospital care. We found that the ambulance service appropriately assessed Mr A and reasonably contacted an out-of-hours GP to further assess Mr A. We did not uphold this complaint.

Summary

Miss C complained about the care and treatment provided by the ambulance service to her mother (Mrs A). Miss C raised concerns that the ambulance crew did not handle Mrs A's transfer to hospital appropriately. In particular, that she had been dropped in the vehicle and that she had bruising on her back. Miss C also complained that the ambulance services' investigation and response to her complaint were unreasonable.

We took independent advice from a registered nurse who is experienced in moving and handling issues. We found that based on the paramedic records, staff undertook the handling and transfer of Mrs A appropriately. Therefore, we did not uphold this aspect of Miss C's complaint.

In relation to complaints handling, we found that there was no evidence of factual inaccuracy in the complaints response from the ambulance service, and that they had apologised for the delay in providing the response. Therefore, we did not uphold this complaint.

Summary

Following an x-ray of her spine, Mrs C's GP made a referral for a DEXA scan (dual-energy x-ray absorptiometry scan - a scan which is used to measure bone density). This referral, and a further referral, were rejected by the board as Mrs C did not meet the criteria. Mrs C was unhappy with this decision and complained to the board. The board said that because DEXA uses ionising radiation and they were required to assess whether the radiation detriment was outweighed by the benefit of receiving the scan. The board said that the referral criteria require a patient to have a predicated fracture risk of 10%, and since Mrs C's calculated risk was lower than this she did not meet the referral criteria.

We took independent advice from a general medical adviser. We found that the board's referral criteria were based on appropriate national guidance, and we were satisfied that it was reasonable not to offer Mrs C a DEXA scan as she did not meet the criteria. We did not uphold the complaint.

Summary

Mr C, who is a solicitor, complained on behalf of his client (Mr A) about the treatment Mr A had received from the prison health centre. Mr A was assaulted and suffered a broken jaw. Some months after this, he started experiencing headaches. Mr A attended a number of GP consultations and his pain relief medication was adjusted at various points as a result. When Mr A suggested that the prescribed medication was not effective, he was referred to neurology (a branch of medicine that looks at the brain and nervous system) and had a scan. The results of this came back as normal and Mr A continued to be treated through adjustments to his pain relief medication. Mr C complained that the pain medication provided to Mr A was not reasonable or appropriate.

We took independent advice from a GP adviser. We were satisfied that Mr A had been treated in line with General Medical Council and World Health Organisation best practice guidelines. We found that the medication prescribed had been appropriate.

The board acknowledged that they did not pass on Mr A's scan results to him and apologised to him directly for this. They also outlined steps that they had taken to ensure this didn't happen again. We were satisfied that the fact that Mr A was not provided with his scan results had no impact on the treatment provided or medication prescribed. On balance, we did not uphold the complaint.

Summary

Mr C complained about the treatment he received form the prison health care service. He reported numerous health problems including persistent headaches, bodily twitching, and concerns about his testicles.

We took independent advice from a GP adviser. We found that Mr C had received a reasonable standard of treatment. He had been referred to urology (the area of medicine specialising in the kidneys, bladder, urinary tract and men's sexual organs) and neurology (the area of medicine specialising in the brain and nervous system) on several occasions, and we considered that the referrals had been made appropriately and in line with clinical guidelines, without any delay.

We found no evidence that Mr C's treatment was not of a reasonable standard. We, therefore, did not uphold his complaint.

Summary

Mr C complained that the board unreasonably refused to support an out of area referral for a specialist neurosurgical assessment of his chronic migraines. Mr C suffered from chronic migraines for a number of years and had explored non-surgical treatment options but they did not help his situation. He wished to receive a professional opinion on surgical treatment options including occipital nerve stimulation (a procedure where a surgical implant is inserted near the occipital nerve - a nerve in the brain - which can be controlled by the patient to deliver electrical impulses with the aim of masking pain). However, this treatment is not available in Scotland. Mr C saw a consultant neurologist (a doctor who specialises in the brain and nervous system) in another Scottish health board area, who wrote a referral to a specialist centre in England. However, Mr C's consultant neurologist at his local board refused to support such a referral and funding was not approved. The board's view was that there was not a good evidence base for such interventions for patients with migraine. Mr C was unhappy with this response and brought his complaint to us.

We took independent advice from a professor of neurology with specialist expertise in headache disorders. We found that the board's decision was reasonable and was consistent with relevant guidance. Therefore, we did not uphold this complaint.

Summary

Miss C complained to us that she had attended a nurse practitioner for banding of haemorrhoids (treatment to cut off blood supply to swollen blood vessels) but that she continued to be in pain and noticed a discharge from the wound site. She was told it would take time to heal and she attended her GP who advised her that she had an infection and prescribed antibiotics. Miss C was then informed that she had developed an anal fissure (small cut or tear in the anal canal). Miss C complained that the care she received was unreasonable.

We took independent advice from a clinical nurse specialist. We found that the banding of haemorrhoids is an interventional procedure usually performed in an out-patient clinic. The procedure can be carried out by consultants or nurses who have passed a level of competency. The records indicated that Miss C's procedure was carried out without complications, that gel was applied to ease the discomfort of the procedure and that she was provided with an information leaflet. We found that some patients do experience some pain during the following week and are prescribed pain relief. This is a minor procedure and as long as the patient understands the treatment then only informed or verbal consent would be sought. There was no indication from the records that the care which was provided was unreasonable and it was noted that an anal fissure is a common side effect of the procedure. We did not uphold the complaint.

Summary

Mrs C, who works for an advocacy and support service, complained to us on behalf of her client (Ms A) who had concerns that she was inappropriately discharged from the community mental health team (CMHT) following a single consultation with a community psychiatric nurse (CPN). Ms A felt that, as she suffered from depression, she would require on-going professional clinical support. However, the CPN told her that the depression was caused by external situational and societal factors and gave her information on stress control classes, depression management, self help websites, advice regarding job seeking and training, and advice on money matters. Ms C complained that Ms A was unreasonably discharged from the CMHT service.

We took independent advice from a mental health adviser and concluded that the CPN had appropriately assessed that Ms A's mental health status was influenced by a range of social, economic and environmental factors. We found that it was appropriate that the CPN gave Ms A information on support options such as non-medical groups, websites and other resources, which is sometimes referred to as social prescribing. This allows the opportunity to address people's needs in a holistic way rather than resorting to unnecessary medication remedies or clinical solutions which could be disproportionate in relation to the patient's needs. The CPN had also advised Ms A that should her symptoms deteriorate then she should contact her GP who could make a further referral to the service. We found this to be reasonable and we did not uphold the complaint.