Not upheld, no recommendations

Summary

C complained about the care and treatment they received from the board having required hip surgery following a fall. Specifically, C was concerned about the type of hip surgery they received, their post-operative care, the arrangements made for their discharge home, and the way in which the board had responded to their complaint. In responding to C, the board did not uphold the failings they had identified, and they provided a rationale for the type of surgery C received, and for the care and treatment given.

We took independent advice from an orthopaedic surgeon (specialist in the treatment of diseases and injuries of the musculoskeletal system). We considered the procedure chosen for C to be evidence based and appropriate to their particular circumstances. We also found the post-operative care and discharge planning for C to be reasonable. Finally, we considered the board’s complaint response to have appropriately responded to the matters they had complained about. Therefore, we did not uphold C’s complaints.

Summary

C complained on behalf of their parent (A) for whom they hold power of attorney. C complained that the practice had incorrectly diagnosed and treated A with chronic back pain. C stated that A was later admitted to hospital with a fractured back and pneumonia.

The practice advised that there was nothing to clinically suggest a fracture at the time and it would not have altered treatment. They noted that A did not have pneumonia as per hospital discharge.

We took independent advice from a GP. We found that a thorough physical examination was undertaken which did not raise concerns of a fracture. We also found that appropriate pain relief is the only immediate treatment for vertebral fractures. There were no symptoms of pneumonia when the patient was seen by the GP and no suggestion of pneumonia in the medical records. We did find one mention of pneumonia in a letter between two third party medical professionals, who were not involved in A’s hospital care. Therefore, we did not accept this as evidence of a pneumonia diagnosis. In light of this, we found that the overall care and treatment provided to C was reasonable and did not uphold C’s complaint.

Summary

C complained about treatment they received in relation to an alleged failure to promptly identify and treat developing symptoms of cauda equina syndrome (CES, compression of the nerve roots in the lower back affecting various neurological functions). C was initially admitted to hospital within another health board area before being discharged the following day on the basis that there was no evidence of CES at that time. However, C re-presented to the emergency department at the same hospital four days later with new symptoms thought to be CES. On the basis of advice provided by NHS Greater Glasgow and Clyde’s neurosurgical department at the Queen Elizabeth University Hospital (QEUH) to clinicians at the health board, C was fasted and underwent an MRI scan the following morning, which showed a large disc protrusion compressing the cauda equina nerve roots. C was thereafter taken by emergency ambulance to the QEUH where they underwent surgery the same day.

In order to investigate the neurosurgical advice provided by NHS Greater Glasgow and Clyde to the other health board, we took independent advice from a consultant neurosurgeon. We found that the advice provided had been reasonable given that it was well accepted practice that surgery to decompress the cauda equina nerve roots should be performed within 24-48 hours of a patient presenting to hospital, which had occurred in this case. Therefore, we did not uphold C's complaint.

Summary

C complained that the board did not repeat a test for Helicobacter pylori (H. Pylori, bacteria usually found in the stomach) given their symptoms, abnormalities in their blood tests and low ferritin (a blood protein containing iron) levels. C was of the view that had their symptoms been properly investigated, they would have been found to have H. pylori and would have been treated earlier.

We took independent advice from a consultant gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines). We found that C did not have Helicobacter associated symptoms which would have triggered re-testing (such as indigestion symptoms). As there was no clinical indication to repeat a test for H. pylori, we did not uphold C’s complaint.

Summary

C complained regarding the treatment that they had received from the board in relation to a pharyngeal pouch (a pocket in the lining of the pipe that carries food from the mouth to the stomach). They complained about issues regarding the surgery they had in relation to this and about the information they were given.

We took independent advice from an ear, nose and throat (ENT) surgeon. We found that C was given reasonable information in advance of their surgery and that it was reasonable to examine a pharyngeal pouch through surgery. It was appropriate that C's pharyngeal pouch was emptied of partially digested food as otherwise it would not have been possible to examine it. It was also reasonable that C was offered a cricopharyngeal myotomy (where a surgical cut is made in the muscle that allows swallowing to weaken it) to treat their pharyngeal pouch, as it is one of the treatment options set out in the relevant clinical guidance. Although an external myotomy was recommended, C was given the option to explore alternative approaches, but the clinicians felt the pouch was too small for stapling. In addition, it was reasonable that C's outpatient appointment with the ENT surgeon was cancelled, given they were unhappy to proceed with the proposed treatment option.

Therefore, we did not uphold the complaint.

Summary

Following a short psychiatric hospital admission, C presented unwell on several occasions over the course of the next month. C complained that they weren’t sectioned under the Mental Health Act and given appropriate treatment. C’s behaviours at that time had prompted police involvement and the outcome of clinical assessments concluded that these behaviours were not driven by a mental health problem. C disagreed with this and was very distressed to subsequently be subject to a short imprisonment, before a judge ordered that they be admitted to a psychiatric unit.

We took independent advice from a consultant psychiatrist. We found that based on the information available at the time, reasonable conclusions were reached by the clinical team regarding the nature of C’s condition and the cause of their behaviours. We found that the action taken was in line with accepted practice in the circumstances. The clinicians all reached a consistent view as to the nature of C’s presenting condition and none were able to identify an underlying psychotic issue. We considered that C’s condition at that time was significantly different to when they were subsequently admitted to hospital, at which time a psychotic cause had become apparent. We did not uphold this complaint.

Summary

C complained about the follow-up care provided to their late partner (A) who died around four months after suffering a heart attack. The board said that A was followed up by the cardiac rehabilitation service in line with established practice. We took independent advice from a consultant cardiologist (a specialist in diseases and abnormalities of the heart). We found that A's follow-up care was reasonable in the circumstances (of no face-to-face consultations due to the COVID-19 pandemic). We also found that it was reasonable for the board not to follow up on blood tests taken at A&E following A's attendance with chest pain. The board said that the test results showed no evidence of a new cardiac injury. We considered it reasonable to have excluded a new cardiac injury as the cause of A's chest pain, and we were not critical of the care provided. Therefore, we did not uphold these aspects of C's complaint.

C also complained about the conduct of a telephone consultation with a cardiac rehabilitation nurse. A called to report symptoms of breathlessness and C complained that the nurse diagnosed a chest infection and/or anxiety over the phone, and did not arrange for A to be seen. However, the nurse did not recall making such a diagnosis, and their recollection was that there was no apparent indication for A to be seen. We were unable to reconcile the differing recollections, and we considered that the actions of the nurse appear to have been consistent with reasonable practice. C was unhappy that the call was not documented. The board said that the call was not documented as A had been discharged from the cardiac nurse service, and in such circumstances patients are directed to their GP for any advice required. We noted that referral back to primary care for non-urgent symptoms is consistent with established good practice. We did not uphold this complaint.

Finally, C complained that A's post mortem described A as having severe heart disease, and they complained that they had been advised everything was fine following A's heart attack and stent insertion. We found that comparison between findings pre and post death, four months apart, is problematic and can be complicated by a number of factors. We noted that the disease seen at post mortem may not have been present four months earlier and we considered A's care was reasonable based on what was known at the time. We did not uphold this complaint.

Summary

C complained about the treatment that they and their child (A) received from the board. Over the course of nine months, C and A attended a number of appointments with the board's Child and Adolescent Mental Health Service (CAMHS) in respect of difficulties A was experiencing. C complained about the content and nature of these sessions. In their view, the board failed to progress a neurodevelopmental assessment of A within a reasonable timescale, which C considered was one of the key reasons for the referral. C also felt inappropriate assertions were made about them and their parenting skills. In C's view, they were unreasonably picked on during sessions with CAMHS. As a result of this, C's view is that CAMHS failed A and did not provide them with reasonable care and treatment.

C also complained about a child concern referral that was made by the CAMHS service. C considered this to be inappropriate and that it was done in response to them raising concerns about the actions of CAMHS.

We took independent advice from two advisers: a mental health nursing specialist and a clinical psychologist, both with a background in CAMHS. We found that the care and treatment provided by CAMHS was reasonable in the circumstances. Given the content of the referrals from A's GP and social worker, CAMHS embarked on an appropriate course of treatment and therapy. While we recognised that this did not result in a positive outcome for C or A, we did not consider the board's actions to be unreasonable. Therefore, we did not uphold C's complaints about the care and treatment provided by CAMHS.

Summary

Following the extraction of a wisdom tooth in hospital, C's follow-up care was undertaken by their family health service dentist. C suffered altered sensation following the tooth extraction. Over the course of eight months, C arranged three consultations with their dentist at which the altered sensation was discussed. C was concerned that the dentist's actions had not addressed the altered sensation and raised complaints about this with them and, subsequently, with this office.

We took independent advice from a dentist. We found that the dentist provided reasonable care to C and did not uphold the complaint.

When this report was first published on 21 September 2022, it was incorrectly categorised as being about a medical practice. This was due to an administrative error which we discovered on 20 October 2022, and for which we apologise.

Summary

C's spouse (A) became unwell with severe lower abdominal pain and vomiting. C phoned for an ambulance and was told by the Scottish Ambulance Service (SAS) that A's symptoms did not warrant an emergency attendance and transferred the call to NHS 24. A's condition worsened over the next couple of days and A was taken to hospital, where they were found to have a perforated bowel (hole in the bowel) and kidney failure. A was given palliative care and died in hospital shortly afterwards.

C complained about the SAS decision not to dispatch an ambulance to A and considered that the call out system failed to save A's life. We took independent advice from a paramedic. We found that the telephone assessment conducted was reasonable and that appropriate questions were asked. From the responses provided, it was reasonably determined that there were no immediately life threatening symptoms that required dispatch of an emergency ambulance at that time. On this occasion, it was reasonable to transfer the call to NHS 24 for secondary triage to allow a more in depth line of questioning to be carried out to try to understand more about presentation of A's complaint. We, therefore, did not uphold the complaint.