Not upheld, no recommendations

Summary

C's late partner (A) tested positive for COVID-19. A's condition worsened over time and C called 111 as they were concerned A's breathing was becoming laboured. C had to wait around 20 minutes before the call was answered. Once connected, the call lasted around 30 minutes. The call handler contacted the Scottish Ambulance Service (SAS) and said that they were 'looking to arrange an immediate response for a patient'. A's condition deteriorated further and C made a 999 call around ten minutes after ending the call to 111, as assistance had not yet arrived. However, by the time paramedics arrived, A had stopped breathing and could not be resuscitated.

C complained about the length of time it took for an ambulance to arrive. They complained that paramedics did not arrive in personal protective equipment (PPE), and considered that they wasted time getting dressed outside when it was an emergency call. C also queried whether a defibrillator (an electronic device that applies an electric shock to restore the rhythm of a fibrillating heart) had been used as they could not hear any shock being administered.

We took independent advice from a paramedic. With regard to the initial call from NHS 24, we found that this had been dealt with appropriately. The call taker had assigned the request for an ambulance the correct level of priority, in terms of the SAS coding system in place at the time. Therefore, we did not uphold this aspect of the complaint. However, we noted weaknesses in the NHS 24-SAS service interaction and suggested that SAS review the process and consider making improvements if necessary.

We found that the response to the 999 call was reasonable, proportionate and timely. We noted that it would not have been appropriate to provide shock to A, given their clinical condition. We also accepted SAS' explanation as to why crew required to put on PPE when they arrived at the scene, which was necessary for infection control. We did not uphold this complaint.

Summary

C complained about delays in treatment that was meant to be provided to their late spouse (A). They told us that A had been referred to the board from another area for heart surgery, but that this took so long to arrange, A's condition deteriorated to a point that surgery was no longer viable and they subsequently died. C was also concerned about the board's handling of their complaints about the matter.

We took independent advice from a cardiology consultant (a specialist in diseases and abnormalities of the heart). We found that, while there were delays in arranging scans, these were the responsibility of the board in A's home area, so Lothian NHS Board could not be said to be responsible for this.

With regards to C's concerns about complaints handling, we found that the board's approach had been reasonable, with appropriately empathetic language used throughout and regular updates provided.

Given these points, we did not uphold C's complaints.

Summary

C, an advocate, complained on behalf of their client (B) about the care and treatment provided to B's late spouse (A). A had attended their GP practice complaining of pain between the shoulder blades and breathlessness on exertion and was seen by a nurse practitioner. The nurse referred A to hospital for a chest x-ray which they received the next day. A then received further x-rays throughout the month following attendances at A&E. They were referred to another hospital where they were later diagnosed with advanced lung cancer.

B complained about the about the nurse's assessment and that the practice failed to follow up on the chest x-ray they referred A for, and failed to follow up on their various attendances at A&E. Had they done so, B considered that A might have been diagnosed sooner.

We took independent advice from a nurse and a GP. We found that the assessment by the nurse practitioner was reasonable and the decision to refer A for chest x-ray and spirometry (a simple test used to help diagnose and monitor certain lung conditions) was appropriate.

In relation to the x-ray taken after the nurse's referral, the results recommended referral to respiratory medicine but the practice did not receive the report until after A's death. We found that it was the responsibility of radiology (specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) to send the x-ray report to the GP, which in this case had not happened and would not expect a practice to chase up records. We also noted that the practice now log all investigation requests and check that results have been returned, which is good practice and above the standard level of care.

In relation to the various attendances at A&E, we found that it is not expected of the practice to follow up on these attendances. There was no mention in the discharge letters sent to the GP of any action required.

Therefore, we did not uphold C's complaints.

Summary

C complained that the board failed to provide them with reasonable treatment. C was hospitalised with a right sided homonymous hemianopia (a visual field defect involving the two right, or the two left, halves of the visual fields of both eyes). C believed that a previously diagnosed arachnoid cyst (a non-cancerous fluid-filled sac that grows on the brain or spinal cord) could be the underlying cause of their clinical symptoms. C underwent CT and MRI scanning.

The board concluded that C's arachnoid cyst was stable and unchanged from a previous MRI, and was unlikely to be the cause of their vision loss. Following a deterioration in their symptoms, C sought private neurosurgical opinion (specialist in surgery on the nervous system, especially the brain and spinal cord) and underwent a craniotomy (procedure to open skull to gain access to the brain) to drain the cyst resulting in partial and ongoing recovery of their vision.

C complained to the board that they should have been referred for neurosurgical review and received treatment through the NHS pathway sooner. They said that clinicians leading their care had repeatedly dismissed their concerns that the cyst could be the underlying cause of their symptoms and had excluded several sources of significant information from the clinical decision-making process, including a discrepancy in the scan measurements which had in fact shown the cyst had increased in size.

We took independent advice from a neurosurgical adviser. We found that, despite a marginal increase in the cyst identified through retrospective radiology analysis, C's progressively worsening symptoms could not have been explained purely on the basis of imaging, and there was no evidence to support an argument that an earlier opinion from a neurosurgeon should have been requested. Our investigations found that although multi-disciplinary opinion may have been helpful in this particular case given C's continuing and unexplained neurological symptoms, the board had carried out appropriate investigations and specialist opinions had been sought on multiple occasions to inform decision-making regarding C's care pathway. Therefore, we did not uphold the complaint.

In investigating C's complaint, the board identified that there had been a break in their communications with C. We considered the action taken by the board to address this had been reasonable; however reminded them that in line with the published Model Complaints Handling Procedure, steps should be taken to ensure complainants are kept up to date and given revised timescales for response.

Summary

C complained about the board regarding treatment provided to their late spouse (A) at the end of their life. C was concerned that the board had failed to provide A with reasonable care and treatment, and failed to manage their diet appropriately. C was also concerned about the board's recording of an incident where A fell and broke their hip, as well as that the board refused to allow A to attend a relative's funeral.

We took independent advice from an appropriately qualified clinician. We found that the board had provided reasonable care and treatment throughout, including managing A's diet appropriately and keeping a reasonable record. There was no record in the clinical notes that the board had refused to allow A to attend a relative's funeral.

Given these points, we did not uphold C's complaints.

Summary

C is the owner of a 'four-in-a-block' flat and the other three properties in the block are owned by the council. The council undertook a programme of external works in C's local area to upgrade the properties that they owned. The council told C that the works were required and C's share of the cost would be £14,127.44.

C felt that the amount they were expected to pay was too high. C told the council that they did not consent to the works proceeding. C asked for the option of their property being excluded from the works as C felt other homeowners had been given this option.

The council said that they carried out a consultation and that C had the opportunity to vote against the works, provide their own quotes, and appeal the decision to proceed. The council gave C extra time to appeal against their decision. No appeal was submitted to the courts and the council proceeded with the works.

C complained that, despite their objections, the works went ahead, that the council did not explain what they meant when they mentioned C's title deeds, that the council appeared to have an inconsistent approach, and that they communicated unreasonably with C.

We found that the council took reasonable action in line with the title deeds and their own procedures. Whilst it appeared some other properties in the area had not had works completed, we did not find evidence to suggest that the council had an inconsistent approach. The way in which the council made the decision to proceed with works was reasonable.

We also found that, whilst there were two occasions where the council failed to respond to C and one where the response was sent to a councillor, in general, the council communicated reasonably. They explained the process, provided additional advice on where to find financial support, directed C to seek legal advice, and extended the timescale for C to submit an appeal to the court if they wished. On balance, we found that the council's communication with C was reasonable.

As such, we did not uphold C's complaints.

Summary

C complained to the practice about a delay in prescribing them with medication for high blood pressure, and as a result C suffered a heart attack. C said that they had attended the practice on a number of occasions within a few months with recurring chest pains, breathlessness and dizziness. C had their blood pressure read and electrocardiograms (ECGs) taken a number of times. C saw a GP and reported chest pain and dizziness. The GP put this down to muscle spasm and arranged another ECG and blood pressure reading. C was then given tablets for their blood pressure. The following day, C was admitted to hospital to have a stent inserted as they had suffered a heart attack.

The practice explained that C had had a number of contacts within a few months, and was seen by 11 GPs. Most of the contacts related to C's respiratory problems of Chronic Obstructive Pulmonary Disease (COPD). C's blood pressure was discussed with a GP and further readings were arranged either at the practice or read by C at their home and telephoned to the practice. It was when C reported chest pain a few months later that further investigations were conducted and the decision was taken to provide antihypertensive medication (used to lower high blood pressure).

We took independent clinical advice from a GP. We found that the practice had provided a reasonable standard of treatment to C. Their blood pressure readings were monitored both in the practice and at home and subsequently, arrangements were made to prescribe medication when it was appropriate to do so. We did not uphold the complaint.

Summary

C was a patient of the practice for a number of years where they were treated for thyroid (a gland in the front inside area of the neck) problems and anaemia (a deficiency in the number or quality of red blood cells in the body). C began to experience changes in their behaviour. Following an incident, the police and social work became involved and C was admitted to hospital. C was discharged the following day after a psychiatric assessment. However, C subsequently had to attend court. When gathering information for their court appearance, C obtained a copy of their medical records from the practice. Upon reviewing these, C considered that there had been failures to diagnose deficiencies of vitamin B12 and vitamin D. C also considered that there had been issues with the practice's management of their anaemia and thyroid problems and the long-term prescription of a proton-pump inhibitor (a class of medications that cause a profound and prolonged reduction of stomach acid production).

C submitted a formal complaint to the practice regarding their care and treatment and their handling of C's medical records. C said that, whilst the practice responded to their concerns about the medical records, they did not address the complaints about C's care and treatment due to the time that had passed.

We took independent advice from a GP. We found that, whilst C did have some abnormalities in their blood tests, these were relatively minor and would not have caused the behavioural changes C experienced. We found that the long-term proton-pump inhibitor prescription was reasonable and that C's thyroid problem was routinely monitored and managed. We found that the practice failed to notify C of their low vitamin D results, but concluded that the implications of this oversight were minimal. We did not uphold this aspect of C's complaint.

With regard to the practice's handling of C's complaint, we found that that their decision to rule the complaint as outwith the time limit was reasonable in the circumstances and in line with their complaints handling procedure. We did not uphold this aspect of C's complaint.

Summary

C complained that they had been unreasonably removed from the practice list without prior warning due to alleged verbal abuse.

We reviewed the guidance provided by the General Medical Council (GMC), British Medical Association (BMA) and the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2018. We took independent advice from a GP. While we appreciated that C disagreed that their behaviour was inappropriate, this is how the staff at the practice perceived the behaviour. This was also supported by extracts from the contemporaneous records detailing that the practice found C's behaviour to be abusive and upsetting.

The Regulations and the guidance from the GMC and the BMA indicate that a warning should be given to the patient, giving the reasons for the possibility of removal from the practice list. The only exceptions to the requirement to give a warning appear to be on the grounds of violence where the police and/or the procurator fiscal are involved, or where the practice believes that issuing the warning would put the safety of members of the practice or those on the premises at risk or it is, in the GP's opinion, not otherwise reasonable or practical for a warning to be given.

The practice decided that a warning letter did not apply due to how upset a staff member was. We found that the practice appeared to have taken the view that issuing a warning to C would not be appropriate due to the impact of this incident on the member of staff. We found that the practice acted reasonably (by requesting C's immediate removal from the practice list) and within established rules for removing a patient from the list.

We did not uphold C's complaint.

Summary

C complained to the practice about the lack of treatment when they attended two consultations reporting a breast lump. C felt that the GPs they saw gave them false reassurance that there was nothing to worry about. C then attended the hospital specialists for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body), biopsy (tissue sample) and mammogram (an x-ray of the breast) and received results which showed evidence of a cancerous lump which required chemotherapy (a treatment where medicine is used to kill cancerous cells) and surgery.

We took independent advice from a GP. We found that the GPs involved carried out appropriate examinations and that it was appropriate to refer C to the hospital specialists for further examination.

We did not uphold the complaint although some feedback was provided to the practice in an effort to improve learning.