Not upheld, recommendations

Summary

Mr C, who is a prisoner, wanted his prescription increased due to extreme pain in his knee, and lower back pain. After the consultation, he complained about the medical treatment he received, and was unhappy with the way he had been treated and spoken to by the GP.

We took all the available information into account, including Mr C's relevant clinical records and the complaints correspondence. We also obtained independent advice on Mr C's care and treatment from one of our medical advisers.

We did not uphold the complaint, as our investigation found no specific shortcomings in the way that the GP dealt with Mr C. We were also satisfied that, based on his medical records, Mr C had access to different GPs and was referred for further investigation as well as for a specialist physiotherapy review. Our adviser said that the examination and medication dosage were reasonable, and that the GP had taken Mr C's individual needs into account. However, we were concerned that there was no evidence that the GP spoke to Mr C to exclude any potentially serious cause for his back pain, and we made a recommendation about this.

Recommendations

We recommended that the board:

• draw to the attention of the GP involved our adviser's comments on excluding potentially serious causes for back pain.

Summary

Mr C rents a residential cabin, which is near a number of other cabins. He complained that he was the only occupier to pay Business Stream for water, that this was unfair and that he should be repaid all the money he has paid. He said he had been overcharged and that, without prior notice, Business Stream took an unexpectedly large amount from his account.

We considered all the complaints correspondence, a statement of Mr C's account from 2003, meter readings and copies of Business Stream's computerised records. We also made formal enquiries of Business Stream.

Our investigation found that Mr C paid his bills by direct debit and that, as usual, he was notified of the larger bill at least two weeks before the money was taken from his account. He told us that he had not expected the bill to be any different from previous ones and was not concerned about it. It was not clear whether he had in fact looked at the invoice but, as we found that the information appeared to have been available to him, we did not uphold this complaint.

We found that the bill was particularly high because most of Mr C's previous bills were based on estimated readings. When actual readings were taken, this showed that previous bills had been underestimated. We found no evidence from the readings that Mr C had been overcharged, although our investigation did confirm that he was the only person being billed by Business Stream, even though others appeared to have water services. Business Stream explained to us that they were working with Scottish Water to establish whether others also had a direct supply and should also be brought into charge to regularise this. Although Mr C was unhappy that he was billed while others were not, we did not find it appropriate that he should be reimbursed.

Recommendations

We recommended that Business Stream:

• provide the Ombudsman with a planned programme of the work required to regularise the situation.

Summary

Mr C complained about a number of issues relating to the council's handling of enquiries he had made to them about the prospect of developing a plot of land he had purchased. In particular, he was concerned that the council had released his private email address and information to a councillor and a third party. He also said that the planning officer he had spoken to had acted incorrectly in giving pre-application advice; the council had not acted in an open and transparent way during a phone call about a proposal to place a tree preservation order (TPO) on a tree on the land; and that their action in placing a TPO on the tree was unreasonable.

During our investigation we found no evidence to support Mr C's allegation that the council released his private email address or information to a councillor or third party. We were also satisfied that the planning officer acted correctly in relation to the advice offered. We did, however, take the view that it would have been helpful had the officer clarified that Mr C had the right to submit a planning application and obtain a formal decision from the planning authority.

There was no evidence to support Mr C's concern that a member of staff did not act in an open and transparent manner during a phone conversation about the TPO. We also found that members of the public had written to the council requesting that a TPO be placed on the tree, and that it was appropriate for the council to take the action they did in putting a TPO in place. We were also satisfied that the TPO request was considered under the council's evaluation criteria. However, we did find that some of the terminology used did not reflect current TPO regulations.

Recommendations

We recommended that the council:

• consider explaining in standard responses to pre-application enquiries that a definitive decision on any proposal could only be obtained by submitting a planning application to the authority; and
• ensure the terms used to describe the TPO process reflected the current TPO regulations.

Summary

Ms C's grandmother (Ms D) had lived in accommodation owned by the association, but moved to a nursing home. When the tenancy ended, Ms C visited and arranged for a courier to pick up some of her grandmother's possessions. These were items of sentimental value that Ms C wanted to put in storage, as she lived overseas. The association arranged to have the flat cleared and when the courier arrived, some of the items Ms C had hoped to keep were no longer in the flat.

Ms C said that she had made the association aware of the items she wanted to keep, and so they had known these were being kept separately in a cupboard. However, the association said that the lease made it clear that it was the tenant's responsibility to clear a flat (although they could arrange this for a charge) and that they had not known how many items were to be retained. They also said that it was not their responsibility to ensure that Ms C's courier was able to pick these up.

Although the paperwork did indicate that the association knew Ms C wanted to keep some items, we found that this had been based on a verbal discussion. In addition, our investigation found that the association's policy confirmed that it was a tenant's responsibility to clear their property. Although we sympathised with Ms C's position and recognised her loss, we did not uphold her complaint. However, in light of the difficulties that Ms C indicated she had contacting the association from overseas, we made two recommendations.

Recommendations

We recommended that the association:

• take steps to document (for example, a brief internal note), in appropriate circumstances, that they have explained that they cannot be responsible for items left in a property following a tenancy's termination; and
• take steps to ensure, if practical with their staffing arrangements, that their coordinator's email 'out of office' reply details a named point of contact in his/her absence.

Summary

Mrs C complained about the care and treatment she received when she was admitted to Aberdeen Maternity Hospital to have her baby via an elective caesarean section (a planned operation to deliver a baby). The plan was for Mrs C to have spinal anaesthesia, but staff were unable to numb her spinal area. Mrs C complained that she was in extreme pain and that she asked staff to stop, but they did not listen to her and persisted in trying to provide spinal anaesthesia. Mrs C said that the pain stopped only when she was given a general anaesthetic.

We took independent advice on this complaint from one of our medical advisers. All the available information was taken into account, including Mrs C's clinical records and the complaints correspondence.

Our adviser said that spinal anaesthesia is a technique with a recognised failure rate. The clinical records indicated that the complications of the procedure were explained to Mrs C and alternatives were discussed with her. The adviser also said that the attempts to site the anaesthetic were made by appropriately experienced anaesthetists and the records showed that, given the particular depth of the space in Mrs C's body where they were trying to place the anaesthetic, any attempt to do so would be technically challenging. The records also indicated that because Mrs C wanted to avoid having a general anaesthetic, the anaesthetists persisted in trying to site a regional anaesthetic, and when Mrs C declined the option of awaiting labour, further attempts to site the regional anaesthetic were made. We found no evidence of any significant shortcomings in the management of Mrs C's care. However, we found that the record-keeping was not to an acceptable standard, as it did not conform to Association of Anaesthetists of Great Britain and Ireland guidance and we made a recommendation about this.

Recommendations

We recommended that the board:

• remind anaesthetic staff involved in this case of the importance of maintaining comprehensive records in line with the relevant guidance.

Summary

Mr C complained that the council had incorrectly advised him about his entitlement to council tax exemption and had not administered his application for an exemption properly. Mr C told us he had purchased a house from a builder but that the building work on the property had not been completed. After buying the property, Mr C told the council that he would not be able to move in until works were complete and requested that the appropriate exemptions to council tax be applied. The council said that Mr C did not meet the criteria for a council tax exemption because more than twelve months had elapsed between the last day of the previous occupancy and the date of his entry into the property.

Mr C complained to us that he had complied with advice from the council, but that the evidence he had submitted in support of his application for an exemption had been ignored. He said that they rejected his application, referring to a category he had not applied for; had not acknowledged the contradictions in the advice he had received, nor had they accepted that his documentation had not been processed.

Our investigation found that Mr C had made two council tax exemption applications under different criteria. The council had considered both of these in good time, and had correctly applied the council tax (Exemption Dwellings) (Scotland) Order 1997 and the council tax exemption procedures. We found no evidence that they had provided Mr C with incorrect and misleading advice, or that his applications had been administered inappropriately. We also found they had responded in good time to Mr C's initial complaint, although there was a delay in responding to the complaint at stage 2. Although we did not uphold Mr C's complaints, we made a recommendation about this delay, noting that the council had apologised to Mr C for this before he brought his complaint to us.

Recommendations

We recommended that the council:

• examine the circumstances for the delay in response to Mr C's stage 2 complaint (which was sent to a general mail box) and advise the Ombudsman on the steps taken to avoid such a recurrence.

Summary

A wall between Mrs C's property and neighbouring properties was in need of repair and Mrs C asked a builder to attend to this. However, the council stepped in and said planning consent was needed for the work, which was in a conservation area. It also turned out that the council were partly responsible for the wall. Mrs C complained that the council unreasonably failed to notify her that they were part owners of the wall, failed to repair and maintain it, and required Mrs C's builder to undertake extra work on it at significantly more cost to her.

We took independent advice from our planning adviser on this case. He explained that it was for Mrs C to clarify the ownership of the wall before starting work, by taking her own legal advice or contacting the council's legal department. It was also for her to obtain listed building consent to demolish and rebuild the wall. The adviser said that he would not expect a planning officer dealing with a general phone call about the condition of a wall to know that the council were part owners of it.

We did not uphold Mrs C's complaints. There was no documentary evidence of any phone contact between her and the council about the condition of the wall during the time she was complaining about. The council said that they were unaware that it was in a poor condition, and we took the view that they could not, therefore, be expected to have arranged for it to be repaired or rebuilt.

The council acknowledged that they were part owners of the wall and were liable for some of the costs of repairs and maintenance. Any dispute about this was, however, a private matter between Mrs C and the council and was not something we could consider. It was clear from the advice we obtained that once they knew there was an issue with the wall, the council were entitled, in their role as planning authority, to take steps to ensure that it was rebuilt in accordance with the relevant conservation area and listed building requirements. It was also clear that Mrs C authorised the builder to act on her behalf in these negotiations and so any work was done with her consent. We did make a recommendation as we found that the council had no records of what happened after Mrs C complained.

Recommendations

We recommended that the council:

• ensure that, in future, the council keep records of action taken by their officers in response to planning complaints.

Summary

Mrs C complained about the care and treatment the board provided to her two-year-old son (Master A). She said that he had a high temperature and had been unwell for three to four days, when she took him to Gilbert Bain Hospital accident and emergency department. Mrs C complained that the board did not keep her son under appropriate observations after initial assessment and that he was inappropriately discharged home. Mrs C and her son returned to the hospital the following day, as his condition had deteriorated. After initial assessment, he was seen by a doctor and was admitted to hospital and later flown by air ambulance to a mainland hospital, where he was diagnosed and treated for a type of flu. Mrs C again complained that staff failed to keep Master A under appropriate observation after initial assessment of his condition. She also said that on both occasions there were delays before a doctor saw her son.

We took independent advice on this case from one of our medical advisers, a consultant in emergency medicine. He explained that the doctor's decision to discharge Master A on the first occasion was reasonable. The documentary evidence suggested that Master A was seen 19 minutes after triage (the process of deciding which patients should be treated first, based on how sick or seriously injured they are). The adviser explained that although a target time for Master A to be seen would have been ten minutes, the wait of 19 minutes was reasonable, given that Master A had none of the symptoms of an exceptionally unwell child. On the following day, Master A was triaged, was observed again just over an hour later, and was seen by a doctor about 20 minutes after that. Although his total waiting time was considerably longer than the target time of ten minutes, the adviser indicated that, in the circumstances, this was not unreasonable if there was greater need elsewhere in the department. We also noted that there was a handover between clinical shifts while Master A was waiting to be seen. The adviser noted that on both occasions Master A had a thorough medical review, and there was a defined care pathway for him. Although we did not uphold the complaints, we did make recommendations about two elements on which the adviser commented.

Recommendations

We recommended that the board:

• feed back to the staff involved our adviser's view that it would have been good practice for a member of staff to have come and seen Master A on the second hospital visit, when Mrs C asked for this; and
• feed back our adviser's comments on record-keeping to the staff involved.

Summary

Mr C sustained an injury during spinal surgery and after further surgery his consultant neurosurgeon phoned the spinal injuries unit in the Southern General Hospital and discussed the possibility of Mr C being admitted. When a written referral was made, however, Mr C was refused admission. His MP corresponded with the board about this asking for an explanation and, in responding, the board said that the director of the spinal injuries unit had investigated the complaint.

Mr C then complained to us that the unit had unreasonably altered their decision to accept his referral and that its director had inappropriately been appointed to investigate his complaint. Our investigation found that, although there had clearly been a discussion about Mr C's condition, there was no specific evidence that the unit had agreed to accept the referral during the phone call, and we concluded that there was no evidence that a decision had been altered. Although we did not uphold Mr C’s complaints, we found that the initial use of the term 'investigated' in relation to the director's role was misleading, although his actual role (in providing a summary, comments and feedback) was appropriate. We made a recommendation about this.

Recommendations

We recommended that the board:

• alter their standing response wording to ensure that staff involved in providing information and comments as part of the complaints handling process are not referred to as having 'investigated' the complaint.

Summary

Mrs C complained about the care and treatment she received in Borders General Hospital following an operation for an umbilical hernia (where fatty tissue or a part of the bowel pokes through into an area near the navel). She said that for a number of months afterwards she suffered problems with the stitches in her wound and the hospital did not deal with these adequately; she also said that she was wrongly told that the stitches used were dissolvable. English is not Mrs C's first language, and she told us that she has difficulty with it. Mrs C said she was also told that further surgical investigations could not be carried out at the time because she was pregnant and, as a result, she suffered worry and distress.

We took independent advice on this case from one of our medical advisers. The adviser explained that if stitches close to the skin are causing pain, they may be removed to prevent a breach in the skin and/or possible infection. Mrs C was, however, pregnant and it is accepted practice that non-urgent surgery should not be performed in the first three months of pregnancy. After that, as surgery carries an increased risk of premature labour and miscarriage it is still better to defer non-urgent procedures until after the baby is born. We accepted that the hospital had acted appropriately and in accordance with accepted medical practice when dealing with the problems with Mrs C's stitches. The evidence also showed that both dissolvable and non-dissolvable stitches had been used. It was unclear what, if any, allowances medical staff had made for the fact that English is not Mrs C's first language, and the board accepted that explanations may not have been communicated as clearly as they could have been. We could not reconcile the differing accounts of what the doctors say they told Mrs C and what Mrs C understood she was told. However, there was no evidence that Mrs C was given incorrect information. Although we did not uphold this complaint, we made a recommendation based on the board's acceptance that it was possible that explanations had not been clear due to language difficulties.

Recommendations

We recommended that the board:

• remind the medical staff involved in Mrs C's care and treatment that consideration should be given to the use of the board's Interpretation and Translation Guidelines where a patient's first language is not English.