Some upheld, no recommendations

Summary

Mrs C complained that the care and treatment provided to her late mother (Mrs A) was not reasonable. She particularly complained about lack of pain relief, inadequate palliative (end of life) care, and communication failures. Mrs A, who was 94, had been admitted to hospital after a fall at home. On examination she was found to have a tumour in her chest. She was treated for her pain and for urinary back-up (where urine passes back up into the kidneys) but otherwise her care was non-interventional. Mrs A's condition deteriorated and she died two days later.

During our investigation we took independent advice from two advisers, a medical and nursing adviser. Both advisers considered that the care and treatment provided to Mrs A was reasonable and that appropriate and timely actions had been taken to monitor, review and address her pain. Urinary back-up is a common symptom in elderly patients and Mrs A's treatment for her pain may also have contributed to this. The medical adviser was of the view that appropriate action was taken to address this problem, and we did not uphold Mrs C's complaints about care and treatment.

The board acknowledged and apologised for communication failures between staff and the family. They reviewed the provision of palliative care in their region and additional training, including communicating with patients and families, has either taken place or is on-going. In view of this, although we upheld this element of the complaint, we did not need to make a recommendation.

Summary

Mr C complained about the care and treatment that his brother (Mr A) received from the board in the month before his death. Mr A was admitted to hospital suffering from pains in his chest, upper abdomen and down his right arm, and an initial diagnosis of heart attack was made. While Mr A was in hospital it also became apparent that he had a pneumonic chest infection (lung infection). This became the leading diagnosis, with an underlying diagnosis of heart disease, with evidence that Mr C had suffered a previous heart attack. Treatment was based on this assessment, and once Mr A was considered to be well enough, he was discharged. He was not referred for an angiogram (an image of the blood flow through the heart) while in hospital, and Mr C complained specifically about this. Mr A was referred for a follow-up echo-cardiogram test (ECG - a test to measure heart activity) and was given medication to reduce the risk and possible complications of a further heart attack, but he died five days after being discharged.

Shortly after Mr A died, Mr C complained to the hospital about his brother's care and treatment. He waited over two months for the board's response, and when he received it, Mr C was still unhappy about their decision. The board commissioned an independent review of the case, to determine whether there was any fault that they had not identified in Mr A's care and treatment. The report did not identify any failings, and was followed up by a further, final response from the board to Mr C. Mr C then complained to us about his brother's care and treatment and about the way the board handled his complaint.

We obtained independent advice on this complaint from a medical adviser. Their advice indicated that Mr A's symptoms were hard to diagnose, particularly at the early stages, as his symptoms were not typical and related to the interaction of two conditions - chest infection and heart disease. However, the adviser said that Mr A's treatment was reasonable and in line with the Scottish Intercollegiate Guidelines Network (SIGN) guidelines on acute coronary syndromes. In particular, the advice indicated that it was appropriate to delay the angiogram until after discharge, once the chest infection had resolved.

In relation to the handling of Mr C’s complaint, we found that the board had failed to provide a timely response. As the board had already acknowledged this failing, taken action and apologised, we did not make a recommendation.

Summary

Mr C is a holder of a disability blue badge, and had applied to the council for a disabled parking bay to be marked out in front of his home. The council had also just received a similar request from a blue badge holder in the house opposite. The area committee agreed that both bays should be placed on the street, but on the opposite side to Mr C's home. Mr C was not happy with the council’s consideration of that request. He complained to us and we gave our decision (201000579) in 2011. We made six recommendations, including that the council should provide the committee with a new report on the two applications. The area committee reconsidered the matter in September 2011 and agreed that the issue should be the subject of a Road Traffic Regulation Order (RTRO) consultation.

After the consultation, the committee confirmed that both parking bays should be marked out on the opposite side of the street. Mr C had, meanwhile, again complained to the council and to us about the process under which his request was being considered. His complaint to us contained five elements; that since our previous decision was issued, the council had failed to deal appropriately with his application; that the second report prepared for the area committee was not fit-for-purpose and misled the committee; that his complaints to the council were not investigated appropriately, and they did not answer his complaints satisfactorily; and that the council made unsubstantiated accusations and allegations against Mr C and his wife, and gave them no right to refute or rebut these.

As we considered that the council had complied with our previous recommendations by October 2011, we did not uphold Mr C’s first complaint. Our investigation found that the report to the area committee was fit-for-purpose but that it did mislead with regard to the circumstances of the other applicant. We did not uphold the remaining three complaints, as we did not find any fault in the way the council dealt with these issues.

Summary

Mrs C complained that the housing association failed to follow their allocations policy by allocating a flat, which was adapted for wheelchair access, to a couple, rather than to her mother (Mrs A), who had a higher medical priority. She said that, despite her complaint, the association failed to put a hold on the tenancy and, when it was established that they had indeed made a mistake, they unreasonably delayed in arranging a mutual exchange with the couple who had moved into the property and who were willing to exchange with Mrs A.

The association identified, when carrying out their own investigation into the complaint, that they had failed to follow their allocations policy. We also found that they had missed a number of opportunities to rectify this mistake before the tenancy agreement was signed, and we upheld this complaint.

However, we did not uphold the complaint that they failed to put the tenancy on hold when Mrs C complained as, by this stage, the tenancy agreement was signed and could not be revoked. In addition, it was clear from our examination of the housing association's actions following this complaint that they had acted appropriately by trying to resolve this unfortunate situation in the best interests of all parties. We found no evidence that they unreasonably delayed in arranging a mutual exchange.

Summary

Mrs C's late sister (Mrs A) suffered from dementia and lived in sheltered housing. Mrs C held welfare power of attorney for her. When Mrs A first joined the medical practice, she was on regular medications for a number of conditions, including dementia, and was under the care of her GP and a community psychiatric nurse. She was prescribed an antidepressant and medication for her dementia. Care staff, however, became increasingly concerned about her challenging behaviour. After visiting Mrs A in response to a phone call from care staff , her GP prescribed diazepam on an ‘as required’ basis. Several days later, Mrs C contacted the GP expressing concern about the prescription and the fact that the GP had not consulted Mrs C about it, given that she held welfare power of attorney for her sister. Mrs C also believed that the GP prescribed the diazepam on the basis of a phone call with staff, and did not see Mrs A in person. Mrs C said that during a meeting with the community psychiatric nurse the day before the prescription, they had agreed to continue to monitor Mrs A's progress on the antidepressant.

Mrs C complained that care staff may be trained to administer medication, but they are not qualified to make medical decisions about when the medication is required and that the practice failed to ensure there was an appropriate system for administering the drugs. Mrs C said that within days of Mrs A moving to another practice, the GP said she needed a full assessment and admitted her to hospital where her medication was reduced and where she stayed for three months before moving to a nursing home.

Several days after the prescription of diazepam, Mrs C phoned the GP to discuss her concerns. She followed this up by letter. She did not hear from the practice and approached the health board with a complaint three weeks later. The health board forwarded her written complaint to the practice who responded in writing two weeks later. Mrs C was unhappy with the practice's complaints handling.

After taking independent advice from one of our medical advisers, we upheld only two of Mrs C's six complaints. We found that the prescription of diazepam was reasonable in relation to both the prescription and the system to administer the drugs. We also found that the GP's assessment of Mrs A's medication and care needs was reasonable. However, we found that the GP's communication with Mrs C was unreasonable, given that under the Adults with Incapacity (Scotland) Act 2000 Mrs C should have been consulted about the prescription of diazepam, and that there were shortcomings in the way the practice dealt with her complaint. As result of Mrs C's complaint, the GP and the practice took action that we considered appropriate, therefore, we did not find it necessary to make recommendations.

Summary

Mrs C was treated in hospital for a sub-arachnoid haemorrhage (bleeding into the area between the brain and the thin tissues that cover it) that required emergency surgery. She complained that during her stay in hospital, she contracted bacterial meningitis (inflammation of the protective membranes covering the brain and spinal cord) as a result of an external ventricular drain (a device used in neurosurgery) that was inserted to control an abnormal build-up of cerebrospinal fluid (a clear colourless fluid produced in part of the brain). Mrs C was treated with antibiotic therapy administered intravenously (into a vein) and intrathecally (into the spinal subarachnoid space - the compartment within the spinal column which contains the cerebrospinal fluid). Her condition stabilised and she was later discharged home.

Mrs C told us that she continued to suffer a number of debilitating symptoms including no sense of smell or taste, frequent headaches, and lack of

co-ordination and concentration; and said that she has been unable to return to work. She attributes this to receiving inadequate care and treatment during her stay at the hospital. Mrs C also complained about matters related to the patient's charter, prescribed medication, her visitor allocation, treatment by staff and the response to her complaint.

As part of our investigation, we obtained independent advice from two medical advisers, who considered all aspects of Mrs C's care. We took account of their advice alongside all the documents provided by Mrs C and the board. Our investigation found no evidence of any failure in the care and treatment Mrs C received, either in relation to the fact that she contracted bacterial meningitis, or with her medication, visitors or treatment by staff. We did uphold her complaints about the patient's charter and the board's complaint response, but did not find it necessary to make any recommendations.

Summary

Mrs C complained that when she was admitted to hospital with a broken ankle, staff administered an unreasonable level of morphine, resulting in a severe reaction. She also complained that when she raised her concerns about this with the board, they failed to provide her with a sufficiently detailed response, and failed to respond within a reasonable timescale.

We investigated Mrs C's concerns, and sought independent advice from one of our medical advisers. Our adviser noted that Mrs C was given a fairly high dose of morphine, both orally and by injection, and suffered a subsequent reaction (opiate toxicity). However, we did not uphold this complaint as the adviser said that the levels prescribed were not unreasonable, given Mrs C's condition and the fact that she was about to undergo a plaster replacement on her ankle which would have resulted in an increase in pain.

We also reviewed the board's complaints correspondence and were satisfied that they provided a reasonable response to Mrs C's concerns. However, to the extent that there was at one stage a delay in responding to Mrs C's correspondence, we upheld this complaint, although we did not find it necessary to make any recommendation.

Summary

Miss C, who lived with her partner, complained when she unexpectedly received a retrospective bill for council tax when the council removed a single occupancy discount from the account. Miss C said the council should not have applied a single occupancy discount when her partner had not applied for it. She said the council should have known that he was no longer a single occupant because he was a council tenant and they had attended the council's housing office together to enter into a joint tenancy. Miss C complained because she said that when they went to the council an officer had told them that they did not have to do anything more, and that their rent and council tax payments would stay the same. Miss C also complained that she had been caused a great deal of frustration by the council's poor handling of her initial enquiry and complaint.

The council said they could not be sure what advice was given to Miss C and her partner when they went to the council office to sign the new tenancy agreement. They said there was no agreement in place to exchange information between the housing team and the revenues team administering council tax. They said that they would consider whether such an agreement would be useful in future.

We did not uphold Miss C's complaint. Our investigation found that the council sent revised council tax notices after the joint tenancy had been entered into, as well as a new council tax notice at the start of each new financial year. These clearly indicated that a discount had been applied on the basis of sole occupancy. This was clearly incorrect and Miss C and her partner should have brought this to the attention of the council.

We did, however, find shortcomings in the council's handling of Miss C's initial enquiries and complaint. Officers had not taken ownership of the issues, and unreasonably referred Miss C back to the council's contact centre when it was clear she was dissatisfied and had a complaint. The contact centre had not passed details of Miss C's enquiries to the relevant officers. In responding to our investigation, the council themselves identified a number of shortcomings in their handling of the matter and said they were taking steps to establish what improvements could be made in light of Miss C's complaints to avoid this happening again.

Summary

Mr C complained about various aspects of the council's decision to remove his wheeled rubbish bin and replace this service with plastic bags.

We agreed with Mr C that the council had failed to appropriately consult with, or notify him, of their decision to remove his bin. As, however, the council had already apologised for this and said they would make changes to ensure that in future landlords who reside elsewhere are informed of proposed changes, we did not make any recommendations.

Mr C also made three other complaints: that in making the decision to remove his bin, the council unreasonably failed to take into account the fact that he has no outside storage area to store rubbish between collections; that they were treating his property differently from other similar local properties by moving him to plastic bag collection; and that they were failing to ensure other residents who have outside storage areas remove their wheelie bins from the pavements where they cause an obstruction. We did not uphold any of these complaints as we found that the decision was one the council had the right to make and that his property was not being treated differently to other similar ones. On the final point, we found that the council agree that there is a problem with householders not removing their bins and are trying to address the matter. However, we did not uphold the complaint because this was not relevant to the council's decision about whether or not Mr C's property should be provided with a bin.

Summary

Mr C applied, through architects, for planning consent to demolish a small bungalow and to build a substantial two storey house. There were no objections to his application and it was determined under the council's scheme of delegation (where the decision is taken by planning officers rather than by a committee of the council). Although a supportive engineer's report and landscape report were provided, the planning case officer had reservations about recommending approval. There was also a replacement local plan being discussed. Because of this, the officer suggested three times that the application should be withdrawn and resubmitted. Mr C, however, insisted on continuing with the application. When officers decided to refuse planning permission, Mr C engaged a planning consultant and requested that the decision be reviewed. The local review board considered this and, by a narrow majority, upheld the officers' decision. Mr C complained to the council about the handling of the application and the review process.

Mr C then made seven complaints to us detailing a large number of points that he wished considered. Four of the seven complaints were about his concerns that there were deficiencies in the processing of the initial application and the report of handling; two were about the administration and conduct of the local review board; and the seventh was about the council's handling of his complaint. We upheld two of the complaints - about the processing of the initial application and inadequacies in the report of handling. We did not, however, find that the officers unreasonably withheld consent, and we did not find it necessary to make any recommendations. Our investigation found that, in large measure, identical issues had been set out in the planning consultant's very detailed submission to the local review board. We did not uphold Mr C's other complaints.