Not upheld, no recommendations

Summary

Mr C complained about the care and treatment the ambulance service provided to his late mother (Mrs A).

Mrs A suffered a number of background conditions and she became unwell. The ambulance service received a phone call and paramedics attended. The paramedics assessed Mrs A as likely being medically unwell, with possible sepsis (a blood infection). There were difficulties moving Mrs A, and a second ambulance attended to assist paramedics. Mrs A was taken to hospital where her condition deteriorated and she died.

Mr C raised concerns about the actions of staff, including the time they took to move Mrs A, and the way they moved her. The ambulance service considered that the care and treatment provided to Mrs A was appropriate. They considered that staff performed a thorough assessment, and acted reasonably in the circumstances.

We took independent advice from a paramedic. We found evidence that all relevant observations and examinations were undertaken. Regarding the time taken to move Mrs A, we found that it was appropriate for paramedics to request a second ambulance to assist them in moving her and we found that the delay was not excessive in the circumstances. We found no evidence that Mrs A was incorrectly moved. We did not uphold Mr C's complaint.

Summary

Ms C complained about the medical care and treatment and also the nursing care provided to her when she attended the emergency department at the Royal Infirmary of Edinburgh. Ms C was brought to the hospital by ambulance as she was short of breath and had asthma. She complained that the clinical care and treatment she received was not reasonable and that she was discharged when she was still unwell.

We took independent advice from a consultant in emergency medicine and from a nursing adviser. We found that Ms C was carefully examined and that no abnormal findings were made. As such, we found that the medical care and treatment provided to Ms C had been reasonable, and that it was reasonable to discharge Ms C. We did not uphold this aspect of the complaint. We also found that the nursing care and treatment provided to Ms C at this attendance was reasonable. Therefore, we did not uphold this part of the complaint.

Summary

Mr C sustained a burn to his lower left leg. He received treatment for his injury at the burns unit at St John's Hospital over a number of months. Mr C said that he did not have any feeling in his lower leg, had no movement in his left foot and that his lower leg was cold all the time. He said he was in constant pain and that the painkillers the board gave him did not work anymore. Mr C complained that when he asked the board to amputate his lower left leg, the board refused to do this. Mr C complained to us that the board's decision not to amputate his lower left leg was inappropriate.

We took independent advice from a consultant vascular surgeon. The adviser said that the treatment and advice given to Mr C was appropriate, that it adhered to Scottish and UK guidelines and that there was no indication for amputation of Mr C's left leg. The adviser explained that a patient could not, in law, dictate an operation to a surgeon, and if a reasonable body of medical opinion agreed that an operation was not in the best interests of the patient, such an operation should not be performed on the patient's instructions alone. We considered that the board's decision not to amputate Mr C's lower left leg was reasonable and we did not uphold the complaint.

Summary

Mrs C had a fall in her home and sustained a fracture of her upper arm. She complained about the way a body bandage had been fitted at Monklands Hospital the following day and about the aftercare advice she was given. A nurse had fitted the bandage over her clothing, with advice that the bandage should be removed each night. Mrs C said that when she returned to the fracture clinic three days later, a nurse told her the bandage had been incorrectly fitted, and re-fitted it underneath her clothing.

Mrs C's fracture had not healed properly, leaving her in pain and requiring surgery. She believed that the way the injury was bandaged when she initially attended Monklands Hospital, and the aftercare advice about removing it at night, had caused her ongoing problems.

We took independent advice from a consultant orthopaedic surgeon. The adviser explained that the purpose of the body bandage for fractures of this type is to provide some support and comfort to the patient, not to provide fracture stability. They advised that the way it was fitted was not material to the outcome in terms of Mrs C's recovery. They noted, however, that removing it would have caused her more pain. The only failing the adviser noted was the lack of consistency of advice regarding the way the bandage was fitted, but they noted that the board appeared to have addressed this by coming up with a standard protocol for these fractures.

In relation to the advice to remove the bandage at night, the adviser reiterated that the purpose of the bandage was not to provide fracture stability, and accordingly its removal would not have affected recovery. Because the focus of our investigation was on whether Mrs C's recovery was affected by the fitting of the body bandage and the aftercare advice, we did not uphold the complaints.

Summary

Mrs C complained on behalf of her husband (Mr A) regarding treatment he received at Wishaw General Hospital after collapsing whilst he was out running. Mr A has a history of heart problems so, on admission to hospital, the symptoms he was experiencing, including ongoing headaches and worsening balance, were initially attributed to a suspected heart issue. However, as these symptoms continued to worsen in the following couple of days, a scan was arranged and a bleed to his brain was identified. Mrs C complained that, as a result of the delay in identifying the bleed, the board had failed to provide appropriate treatment for Mr A's head injury.

We took independent advice from a consultant in emergency medicine. The advice we received was that the treatment provided to Mr A was reasonable. The adviser considered that, based on Mr A's presenting symptoms, medical history and the information provided by the ambulance service, it was reasonable for the board to conclude that this was a cardiac event and that they had then offered appropriate treatment for this diagnosis. For this reason, we did not uphold Mrs C's complaint.

Summary

Mrs C complained that the medical practice failed to provide appropriate care and treatment to her late husband (Mr A), who died in hospital of double pneumonia a few days after last seeing a GP. She said that her husband had seen a GP on two occasions before the hospital admission and that the GP had not carried out appropriate assessments to diagnose the pneumonia or to have referred her husband to hospital for a specialist opinion.

We took independent advice from an adviser in general practice medicine and concluded that the practice had provided a reasonable level of care. The records showed that the GP had carried out appropriate assessments and that, based on the symptoms which Mr A had reported, it was reasonable for the GP to have diagnosed a viral illness. The GP had advised Mr A to rest, take fluids and paracetamol. It was clear that, following the last GP appointment, Mr A's symptoms had changed and that he had deteriorated and at that time a hospital referral was appropriate. We did not uphold the complaint.

Summary

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her son (Mr A) who had attended an appointment with one of the GPs with symptoms of sore lungs and a cough. Ms C said that the GP had failed to listen to Mr A's lungs or chest and did not prescribe an antibiotic for him to take. Mr A was still unwell the following week and was taken to hospital, where he was diagnosed with pneumonia.

We took independent advice from an adviser in general practice medicine and concluded that the GP had provided a reasonable level of care. We found that the GP had examined Mr A's lungs and had found no signs of an infection. We also found that an adequate medical history was recorded and that it was not unreasonable for the GP to have diagnosed a viral infection. As such, it was not unreasonable that the GP did not prescribe antibiotics. We did not uphold the complaint.

Summary

Ms C complained on behalf of her late brother (Mr A) about the treatment he received from the practice in the four months prior to his diagnosis of lung cancer. She complained that the standard of care and treatment provided to her brother was unreasonable.

We took independent advice from a GP adviser who said that the initial symptoms Mr A presented with had led doctors to believe that he had a problem with his hormones, and that doctors had referred him appropriately at that time. When Mr A complained of different symptoms, which could have indicated cancer, his GP then asked him to complete a form to arrange an x-ray. The practice were unable to reach Mr A by phone and Mr A either did not receive the letter sent to him, or did not respond to it. When Mr A re-attended the practice it was noted that the x-ray request had not been returned and he was referred urgently to hospital that day. The adviser said that this was reasonable.

We accepted the advice we received and we did not uphold the complaint.

Summary

Mr C was referred to the orthopaedic department at Glasgow Royal Infirmary after he suffered with osteoarthritis (chronic breakdown of cartilage in the joints leading to pain, stiffness and swelling) in the metatarsal phalangeal joint (the second joint from the end) in a toe on his right foot. Surgery was carried out to fuse the joint, but following this Mr C continued to experience pain in the toe. A further procedure was carried out to fuse the interphalangeal joint (the first joint from the end), however, this was not successful and the bones did not fuse together. Surgery was then carried out to remove a broken metal pin from the interphalangeal joint but Mr C continued to experience pain in the toe. After this the board considered that revision surgery was unlikely to be successful and Mr C agreed to the amputation of the toe.

Mr C complained that the first operation was not carried out appropriately. He also raised concern that the board did not provide him with appropriate treatment when he reported ongoing pain, as it had taken over two years following the first operation to resolve his pain. We took independent advice from a consultant orthopaedic surgeon. We found that the first procedure was carried out to a reasonable standard, and we did not find evidence that the first surgery had contributed to the issues Mr C subsequently experienced. We considered that the management of Mr C's treatment following the first operation was appropriate, and we did not consider that there was evidence of any unreasonable delays in Mr C's treatment. We did not uphold Mr C's complaints.

Summary

Ms C, who is an independent mental health advocate, complained on behalf of her client (Mr A) in relation to community mental health (CMH) nursing care Mr A received after discharge from Dr Gray's Hospital. Mr A took a large overdose of alcohol and prescription drugs two weeks after discharge and said that, without the support of his family, he would have completed suicide. In addition to the complaint about nursing care, Mr A also felt that the introduction of occupational therapy (OT) services prior to his discharge could have benefited him and aided his recovery.

We took independent advice from a mental health nursing adviser. We found that the CMH nursing care offered to Mr A had been reasonable. The CMH nurse had visited Mr A within five days of his discharge, which the adviser considered to be good practice. The nurse had appropriately discussed coping strategies with Mr A and had made sure that he was aware of other sources of support available as they were going on leave for two weeks.

The working relationship with the CMH nurse broke down after they returned from leave. Mr A requested a different CMH nurse, but his psychiatrist referred him instead to OT services. This referral was not successful either, again due to problems in the working relationship. We considered that the aftercare provided by the board was reasonable, although the adviser highlighted some shortcomings in the records, which we fed back to the board. The board confirmed that Mr A was involved in his discharge planning, but there was no evidence to support this. Aside from shortcomings in record-keeping, we considered the CMH nursing care provided to Mr A to have been reasonable and we did not uphold Mr C's complaint.

We considered that OT services would largely have overlapped with the support being offered by the CMH team, and saw no evidence to support the complaint that OT input in hospital would have made a significant difference to how Mr A coped post discharge. We did not uphold this complaint.