Not upheld, recommendations

Summary

Mrs C complained about the care and treatment she received at Galloway Community Hospital for her injured wrist. She said that the locum consultant orthopaedic surgeon who dealt with her did not provide a proper diagnosis, treatment and advice when he saw her at the hospital trauma clinic. She said he only looked at one of four x-rays taken in A&E before telling her that her wrist was not fractured. She said that it was fractured and that the consultant's actions compromised her recovery.

We took independent medical advice on this case from a consultant in trauma and orthopaedics. Our adviser said that the x-rays indicated that Mrs C had fractured her wrist and that the consultant failed to identify this when he saw her at the trauma clinic. His notes and his comments on Mrs C's complaint indicated, however, that he reviewed Mrs C's x-rays. Without independent evidence, it was not possible for us to say whether he failed to examine all four x-rays and this was why he did not correctly identify the fracture. Our adviser explained, however, that in spite of the incorrect diagnosis, Mrs C received the correct treatment for her condition and her recovery was not compromised. We concluded that, on balance, the care and treatment she received was reasonable, although we made recommendations about the incorrect diagnosis.

Recommendations

We recommended that the board:

• feed back the adviser's comments on the consultant's review of Mrs C's x-rays to the consultant, to try to ensure that a similar situation does not occur in future; and
• provide Mrs C with a written apology for failing to provide her with the correct diagnosis.

Summary

Mr C complained about the delay in Scottish Water providing a water connection to his property. It took almost five months from his initial application for the connection to be completed. When Scottish Water responded to Mr C's complaint – and to our investigation – they acknowledged that there had been a delay. However, they also said that providing the connection was complicated because of the physical features of the land, as well as where Mr C's property's was on it. They explained that previous enquiries about connecting the property had been declined for these reasons.

In investigating Mr C's complaint, our role was to consider whether there was evidence of administrative fault, omission or failure by Scottish Water that meant the delay in providing the connection was unreasonable in the circumstances. We found that they had been in contact with him throughout the process and, taking everything into account, we did not uphold his complaint. We did, however, find that Scottish Water extended the delay by a couple of weeks because of an internal processing error about a repair to be done to their water main (although we noted that the repair was needed because of work done by Mr C's contractor). In light of this we made two recommendations.

Recommendations

We recommended that Scottish Water:

• confirm the steps they have taken to address internal communications, as detailed in their response to the Ombudsman; and
• consider refunding a portion of their connection fee to Mr C in light of their failure to raise a service request for the work on the water main.

Summary

Mr C complained that the council failed to maintain an area of the road near his property. He also complained that a nearby sewer was deteriorating, meaning that it was potentially dangerous for people using the area. Mr C brought his complaint to us as he said the council had not addressed either issue, although he had been in correspondence with them for some time.

We reviewed the correspondence and found that the council had explained to Mr C that it was unclear whether they had adopted that part of the road or whether it remained a nearby housing association's responsibility. They said that their solicitors were working to clarify this and provided details of another nearby area where they were carrying out maintenance work, to try to reassure Mr C that they maintained areas for which they were responsible. They also explained that they would write to the housing association and Scottish Water about the sewer, although they explained that it was not the council's responsibility to maintain it.

We reviewed the correspondence and found no evidence to indicate any underlying administrative failure by the council. We did, however, consider that there had been shortcomings in the correspondence, which had caused confusion as to how matters were being progressed and so, while we did not uphold Mr C's complaints, we made a recommendation.

Recommendations

We recommended that the council:

• contact Scottish Water again to request an investigation into the collapsed sewer near Mr C's home.

Summary

Mrs C raised a number of issues about the council's handling of a planning application to build a temporary building in the school next door. She said that they had not provided accurate information about the application, and that although she had been told that the structure would not be higher than her boundary wall, it turned out to be higher than it when built. She also said that the structure affected her privacy and the amount of daylight she received, and that the council had not addressed her concerns about what was being built, or about damage to the boundary wall and the impact on her property. Finally Mrs C said that the council had failed to address her concern that the local councillor was given conflicting information about an offer of compensation.

After taking advice from one of our planning advisers, we did not uphold Mrs C's complaints. Our investigation found no evidence that the council failed to follow the appropriate process to let neighbours know about the application, and there was no clear evidence about what they told Mrs C about the height of the structure relative to the boundary wall. We were also satisfied that the council had addressed her concerns about what was being built on site, although there was some uncertainty about whether the building had been built in accordance with the plans as far as the relative height to the wall was concerned. We were also satisfied that they had responded to Mrs C's concerns about the impact of the structure on her property, and about the boundary wall. The council had explained that the wall had been inspected. We found no evidence of conflicting information in relation to compensation.

Recommendations

We recommended that the council:

• draw this case to the attention of the officers involved, for them to consider whether any lessons can be learnt from the handling of this case.

Summary

Mr C and Mr D own a listed country house hotel with substantial grounds. They had obtained conditional planning consent to build holiday cottages in the grounds. One condition said that the cottages should only be used for seasonal lets, but contained an ambiguous sentence. Mr C and Mr D interpreted this as implying that they could write and ask the planning authority to set aside that condition. When they then decided to sell one of the cottages, they engaged in an extensive pre-application discussion with the council. The council told them that they would require a planning application, which was submitted. Council officers prepared a report indicating that they would be prepared to recommend approval of the proposal, subject to completion of a section 75 agreement (a legal agreement that covers financial contributions to meet the services and infrastructure needs of the local community associated with the new development). A draft agreement was provided and agreed in principle by Mr C and Mr D. However, the council did not issue their decision within the required time period, and Mr C and Mr D submitted a notice of review to the local review body. The review body met, but while awaiting their decision Mr C and Mr D appealed to Scottish Ministers on grounds of non-determination of the original application. The local review board issued a notice of intention some days later, but this was negated by the appeal.

Mr C and Mr D complained to us about the council's handling of this, including how they described the application. They also complained that the council failed to assess the application against relevant planning policies, that they unreasonably required the section 75 agreement without considering other options and that the local review body did not follow due process. Mr C and Mr D also said that the council failed to provide a reasonable response to their complaints. In the light of independent advice from one of our planning advisers, we did not uphold the first four complaints as we did not find evidence of maladministration or service failure, although we did make one recommendation. In terms of the complaints handling, we found that although the council's response to their complaint was concise, it was not unreasonable. Our decision took into account that the issues had by that time been rehearsed with the planning officer, at the local review body and in the appeal to Scottish Ministers against non-determination by the local review body.

Recommendations

We recommended that the council:

• review their procedures for recording Section 75 agreements to ensure that the wording reflects Scottish Government advice.

Summary

Miss C, an advice worker, complained to us on behalf of her client (Miss A) about the handling of Miss A's Shetty Gastro-Jejunostomy (SGJ) procedure (the insertion of a feeding tube into part of the intestines). Miss A suffers from gastroparesis (paralysis of the stomach) which does not allow food to empty from her stomach. She was scheduled for the procedure as a day-surgery case and told that a particular radiologist would carry it out. On the day, however, a different radiologist tried to perform the procedure, without success. They were only able to insert a tube into Miss A's stomach, to prepare for a later attempt to insert the SGJ. Miss A suffered pain after the procedure and was kept in overnight for pain relief. Miss C also said that no written information was passed to the ward about the problems encountered during the SGJ. Miss A eventually had a SGJ inserted some seven weeks later.

Our investigation included taking independent advice from one of our advisers, who said that the attempted SGJ was done in a reasonable manner with evidence of good, and even best, practice. The adviser said that this is a difficult procedure and Miss A's condition made it particularly so. There was no evidence that the radiologist who attempted it did not do so in a reasonable way. The adviser also said that the board's decision to allocate Miss A's procedure to the first available suitably qualified radiologist was a reasonable clinical decision, and that the radiologist's decision to insert a tube into the stomach to help a further attempt of the SGJ procedure was good practice. There are two approaches that could have been taken towards a further attempt - either to do so a few days after the first, or to wait for the track made by the stomach tube to mature (a period of four to six weeks) before making a second attempt. Either approach is reasonable and in this case the clinicians chose the latter, which was successful. Overall, we were satisfied that the care and treatment provided to Miss A was reasonable.

The only concerns we had were about a lack of information on the consent form that Miss A signed and a failure to provide written information to the ward about the problems with the procedure. There had been verbal communication but nothing in writing. The board told us that they have amended their procedures to prevent this happening again, and so although we did not uphold the complaint we made a recommendation about this.

Recommendations

We recommended that the board:

• provides evidence that the remedial action taken in respect of the written information provided by the radiology department is sufficiently robust to prevent a recurrence, and that appropriate information is recorded on consent forms.

Summary

After Mr C suffered blackouts and dizziness in 2009, a GP at his medical practice diagnosed hypertension (high blood pressure). Mr C said he made many visits to the practice after that with symptoms that including falling asleep involuntarily during the day. In August 2010, he told them that he was suffering numerous headaches, he felt dizzy and faint and felt he was going to collapse. In 2012, the GP prescribed an anti-depressant, saying that Mr C's problems were related to his mental health and that an appointment would be made with a psychiatrist. When abroad later that year, Mr C saw an ear, nose and throat surgeon, who diagnosed a number of problems, including hypertension and problems with his nose and airways linked to breathing difficulties. The surgeon referred Mr C to hospital there, where he was diagnosed with obstructive sleep apnoea (OSA – a sleep disorder). He said he was given medical advice, including that he should stop taking the anti-depressant as it was dangerous, given his condition. When he returned to Scotland and went to the practice, they stopped the anti-depressant medication. He told them about the diagnosis of OSA and was referred to a sleep clinic the following month.

Mr C complained that GPs at the medical practice failed to diagnose OSA in 2009. He said that they then continued to maintain that his condition was psychological, and unreasonably failed to accept the diagnosis of sleep apnoea. He said his life was put at risk because of the misdiagnosis.

We took independent advice on this case from one of our medical advisers, who is a GP. Their advice, which we accepted, was that the GPs at the practice acted reasonably in the way they approached Mr C's multiple symptoms. The diagnosis was, however, potentially delayed by the lack of good communication at all consultations, and the adviser noted some issues regarding Mr C's compliance with appointments and medication. This might have partly arisen through a lack of understanding because of language difficulties (English is not Mr C's first language). Although the practice tried to use interpreters in many of their consultations with Mr C, there was scope for them to improve their systems around this. It was, however, impossible to say whether the diagnosis would have been arrived at earlier had an interpreter assisted at all consultations. On balance, given the advice that the practice acted reasonably when responding to Mr C's symptoms, we did not uphold the complaint. However, given that more could have been done to provide an interpretation service for Mr C, we made a recommendation.

Recommendations

We recommended that the practice:

• review their process regarding interpreters and referral letters in the light of our adviser's comments.

Summary

Ms C complained about the treatment that she received from the board for heel pain (plantar fasciitis), and was unhappy with the advice and information provided in relation to this treatment. As Ms C was dissatisfied with the treatment offered by the board she attended a private podiatrist. After receiving treatment from them, she also complained that the board had not offered her that type of treatment.

While investigating the complaint, we took into account all of the complaints correspondence and Ms C's podiatry record. We took independent advice from one of our advisers, who is a experienced podiatrist. We found that the treatment and actions taken by the board were, in the main, appropriate and evidence based and followed best practice. We also found that there was no justification for the suggestion that the board should have offered Ms C the approach adopted by the private podiatrist, and that advice on heel pain management had been clearly presented. Although we did not uphold the complaint, we did make recommendations, as Ms C had not been examined and our adviser said that it would have been advisable for this to have happened, to rule out the possibility of another condition and to check that insoles purchased were the correct fit. We also took the view that information given to a patient should emphasise that medium to long term management of the condition is usually needed.

Recommendations

We recommended that the board:

• consider introducing a protocol, when attempting to manage plantar fasciitis without an examination of the feet, to ensure that any serious conditions that represent differential diagnoses are not missed;
• ensure that, when recommending that patients purchase insoles/orthoses for use in their shoes, the fit is checked by an appropriately trained professional; and
• consider amending the presentation given on the management of plantar heel pain to emphasise the fact that medium to long term management is usually required, along with anticipated time periods.

Summary

Mrs C's young son (Master A) was referred to a speech and language therapy service. Two blocks of treatment were provided and, due to Mrs C's concerns about her son's speech, a second opinion on his treatment was sought in the first month of the second block of treatment. The service did not feel that Master A needed further direct therapy after the second block of treatment, and he was instead seen for a review every three months. Mrs C was unhappy with this and at these appointments asked for additional materials to work on with her son at home. The service, however, were not prepared to provide these. Mrs C emailed them expressing her dissatisfaction and requesting the materials be provided, which the service treated as a formal complaint. Mrs C was unhappy with the outcome of this and complained to us that her son was not provided with adequate care and treatment and that the response to her complaint was inaccurate and insensitive, and implied that she had refused treatment for him.

We took independent advice from one of our advisers, a specialist in working with children with speech difficulties. She said that the service's approach was largely correct and in line with their published guidelines. She also said that, although the service had acted correctly when deciding whether or not to provide materials for home working, they should have taken account of Mrs C's concerns about her son's speech and her determination to work with him at home. We did not uphold the complaint as our investigation found that the service provided a reasonable standard of care and treatment to Master A, although we did make a recommendation based on our adviser's comments. We also found that the language used in the response to Mrs C's complaint was appropriate, and that the letter did not contain any factual inaccuracies about the provision of treatment or the family's engagement with it.

Recommendations

We recommended that the board:

• consider reviewing their guidelines to ensure parental concerns are considered when additional materials for home working are requested.

Summary

Mrs C complained that a nurse delayed in making a referral for a claim for benefit for her late husband (Mr C) when he was diagnosed with a terminal illness. The nurse specialised in palliative case (care to prevent or relieve suffering only). Mrs C said that the nurse visited her husband at home and, during a discussion with him, said that she would make a referral to another agency, who would take his benefit claim forward. There was a delay of several weeks before the claim was processed, and Mrs C said that her husband lost a month's benefit because of this. She believed that the reason for the delay was that the nurse delayed in making the referral.

In response to our enquiries about the complaint, the board told us that community specialist palliative care nurses are not responsible for submitting benefit claims for patients. However, they can help by signposting patients, or contacting the agency who will then take the claim forward on their behalf. The nurse had completed a statement saying that she contacted the agency a week after discussing the matter with Mr and Mrs C. There was a note in her diary that suggested she had contacted them then, but it was not conclusive evidence. The agency who dealt with the claim said that they did not receive the referral until a month after the nurse discussed the matter with Mr C. They then took the claim forward and, in line with the relevant legislation, awarded benefit from the date they said they received the referral from the nurse.

On balance, we found that there was insufficient evidence to decide that it was definitely the nurse who delayed in making the referral. The evidence was conflicting, in that the nurse said that she made the referral on a specific date, but the agency said they had not received it until a number of weeks later. Having carefully considered the matter, we did not uphold the complaint.

However, we recognised that Mr C had lost over three weeks' benefit because of the delay, through no fault of his own, and that this had caused him some distress before his death. The other agency involved does not fall within our jurisdiction, so we could not look at what they did. As it had not been possible to prove which organisation was responsible for the delay, we made recommendations to address this.

Recommendations

We recommended that the board:

• award Mrs C a payment for 50 percent of the benefit that she and her late husband lost out on due to the delay in his claim being actioned; and
• provide the Ombudsman with an update on the action they are taking to prevent this problem recurring.