Not upheld, no recommendations

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.

Summary

Mr C, who is an MSP, complained on behalf of his constituent (Mr A). He said that the board had failed to provide Mr A with reasonable care and treatment in relation to blisters, fluid, diabetes, constipation and ventilation whilst he was in Hairmyres Hospital. Mr C also complained that that the day after Mr A was discharged, he was admitted to another hospital with renal failure.

We took independent advice from a consultant in acute medicine and from a nursing adviser. We found that Mr A did not develop renal failure as a result of the treatment he had received in hospital. He had chronic kidney disease and this was a longstanding problem that was worsening. Based on his blood tests on admission and discharge as well as what was documented in the notes, we found that it had been likely that he would end up on dialysis (a form of treatment that replicates many of the kidney's functions). That said, Mr A did not seem to be fully aware of this and we brought this to the board's attention.

We also found that the care and treatment Mr A received in relation to blisters and fluid management was reasonable and that there was no evidence in the records to indicate that he was ignored by staff when he informed them of developments regarding his health. In their response to Mr A's complaint, the board had apologised that he was given sugar with his drinks and had stated that they had asked the hostess to review her protocol in relation to this. They had also apologised that one of Mr A's laxatives was not prescribed, although we found that Mr A had received other laxatives and that his constipation had been alleviated. In addition, the board had apologised that he found the temperature in the ward uncomfortable.

On balance, we did not consider that the overall care and treatment provided to Mr A in the hospital had been unreasonable, particularly in relation to the most severe areas such as renal failure. We accepted there were some areas of care that the board acknowledged fell short of expectation, particularly in how some aspects of his care were communicated, but we considered that the board's response to these was reasonable and the steps they took to address the issues were what we would have asked them to do to prevent recurrence. On balance, we did not uphold Mr C's complaints.

Summary

Miss C and Miss B complained to us about the care and treatment their uncle (Mr A) had received from the board. Mr A had been admitted to Monklands Hospital with shortness of breath. He was discharged from hospital three weeks later. Miss C and Miss B complained that it had been unreasonable to discharge Mr A at that time because of his immobility and a lack of adequate discharge arrangements.

We took independent advice from a consultant in acute medicine. We found that Mr A had been medically fit for discharge, although there were some concerns about how he would manage. Although we found that, ideally, there should have been additional support in place for Mr A when he was discharged, we did not consider that the discharge arrangements the board put in place were unreasonable. On balance, we did not uphold this aspect of the complaint.

Miss C and Miss B also complained about the care and treatment Mr A received from both medical and nursing staff at his home when his condition deteriorated. We found that the care and treatment provided to Mr A, including treatment for an infection, had been reasonable. We did not uphold this aspect of the complaint.

Mr A was subsequently readmitted to hospital and died there two days later. Miss C and Miss B complained to us about the standard of care and treatment provided to Mr A in hospital before his death. We found that there had been a short delay in communicating Mr A's deterioration to his family and that the timing in relation to asking the family to complete a document about his interests and preferences at the time he was deteriorating was inappropriate and insensitive. However, we found that the care and treatment provided to Mr A had been reasonable and appropriate. It was also reasonable that he was not transferred to the intensive care unit. In view of this, we did not uphold this aspect of the complaint.

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by GPs at the practice. Ms C complained that GPs incorrectly diagnosed a viral illness, and that they should have recommended hospital admission at an earlier point.

We took independent advice from a GP. We found that, on the two occasions that GPs from the practice attended Mr A, they assessed and examined him reasonably and that, based on this, the diagnosis of viral illness was reasonable as there was no evidence of any more serious cause of Mr A's illness. We did not uphold this complaint.

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by an out-of-hours GP and at Belford Hospital. She complained that the GP did not reasonably assess Mr A and that, when he was later admitted to hospital, there was a delay in diagnosis which resulted in no treatment options being available for his perforated duodenal ulcer (when the lining of the stomach splits due to a sore).

We took independent advice from a GP and a consultant physician. We found that the care and treatment provided to Mr A by the GP was of a reasonable standard and that his symptoms were most fitting with a diagnosis of viral illness at this time. We also found that, whilst there was some delay in diagnosing Mr A when he was admitted to hospital (which the board had acknowledged), this did not have any impact on Mr A's outcome as, due to his other illnesses, surgery would not have been an option for him. We did not uphold this complaint.

Summary

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Over the past twenty years Ms A has suffered from balance issues and problems with her eyes. Over a period of years, Ms A attended the ophthalmology (eye) and neurology (brain and nervous system) departments of Raigmore Hospital. Her symptoms were assessed and investigated and she was referred for a second opinion, but no causes were found for her symptoms. The ophthalmology department decided not to arrange further appointments for her and it was suggested that she attend the rehabilitation clinic. Ms A considered that clinicians had given up on her and that she had been disbelieved. Ms C complained to us that the decision to discharge Ms A to the rehabilitation clinic was unreasonable, as she had not yet been diagnosed.

We took independent advice from consultants in ophthalmology and neurology. We found that all of Ms A's care and treatment had been reasonable and appropriate but that, despite this, Ms A's symptoms remained. It was acknowledged that this was very challenging for her, however we considered that the absence of a diagnosis or abnormal test findings did not mean that she had been disbelieved. Furthermore, we found that it was sensible and reasonable to refer her to the rehabilitation clinic which was best placed to deal with her continuing condition. We did not uphold the complaint.