Not upheld, no recommendations

Summary

C complained to us on behalf of their child (A) about the care and treatment A received from child and adolescent mental health services (CAMHS). Specifically, C complained that A was unreasonably discharged from CAMHS.

We took independent advice from a child and adolescent psychologist and also from a mental health nurse. We found that there was a delay in CAMHS offering A video appointments following the COVID-19 lockdown but we found that the delay was not unreasonable, as they needed time to set up the necessary IT systems. We also found that all relevant information was taken into account about A's condition before CAMHS decided to discharge A. Therefore, we did not uphold the complaint.

Summary

C complained about care and treatment provided to their parent (A) by a district nurse from the partnership.

A was fitted with a catheter. C contacted a community nurse team to raise concerns that A's catheter was draining slowly and that there was blood in their urine bag.

The district nurse visited A later the same day. C was present during this visit. The district nurse assessed A, changed their catheter bag and provided advice. After the visit, the district nurse discussed their actions with a GP. The GP agreed with the district nurse's actions and their assessment of A. The district nurse called C afterwards to inform them of this and to reiterate their earlier advice.

Later that evening A's catheter blocked. C called 111 and A was subsequently admitted to hospital. A was diagnosed with urosepsis (a serious infection of the urinary tract). A subsequently died in hospital.

C complained to the partnership about A's care and treatment, but they failed to identify any failings. C remained unhappy and asked us to investigate. C complained that the district nurse had failed to provide A with appropriate care and treatment despite knowing that they had a urinary tract infection.

Following investigation, and receipt of independent advice, we found that the district nurse had acted reasonably. We found insufficient evidence to illustrate that the district nurse knew that A had a urinary tract infection. We found that the care and treatment provided was reasonable in light of the information available at the relevant time. We did not uphold C's complaint.

Summary

C complained about care and treatment provided to their parent (A) by a duty general practitioner (GP) at the practice.

C contacted a community nurse team to raise concerns that A's catheter was draining slowly and that there was blood in their urine bag.

A nurse visited A at their home later the same day. They changed A's catheter bag and provided advice. After they had left A's home, the nurse discussed their actions with the GP. The GP agreed with the nurse's actions and their assessment of A.

Later that evening A's catheter blocked. A was subsequently admitted to hospital and diagnosed with urosepsis (a serious infection of the urinary tract). A subsequently died in hospital.

C complained that the GP had failed to visit A despite being provided with information indicating that they had a serious infection. C also complained that the GP failed to provide A with medical treatment.

We took independent advice from a GP. We found that the GP acted reasonably and noted that they were not provided with information indicating that A had a serious infection. We found that the GP’s agreement with the treatment and advice provided by the nurse was reasonable in light of the information available to them at the relevant time. We did not uphold C’s complaints.

Summary

C's parent (A) was admitted to Raigmore Hospital following a fall at home. A was diagnosed with delirium. After six weeks on the ward, A was discharged home with a package of care. A required readmission shortly after discharge and their condition deteriorated further. C complained that A's food and fluid intake were inadequately monitored during this period. C complained that the concerns they raised about their parent's physical and mental health were ignored.

C also complained about the hospital discharge process. C held Power of Attorney (POA) in respect of A and complained that the board did not have due regard to that. C complained that the board did not appropriately involve them in planning for A's discharge.

We took independent nursing advice. Although we were critical of aspects of the board's communication with A's family, we noted that on the whole, A's care and treatment were of a reasonable standard. We therefore, did not uphold the complaint. We were critical of the board for their delay in referring A to a dietitian, but we noted that the board had apologised for this and confirmed learning.

We considered that A's family could have been involved at an earlier stage when plans were being made for discharge. Overall, however, we noted that the discharge planning was reasonable, involving appropriate assessments and discussion with C. We did not uphold this complaint.

Summary

C complained about the board, regarding their treatment of a benign cyst. C complained that since being seen by the board they failed to take a proactive approach despite the pain and discomfort they were experiencing. C also complained that the board unreasonably prescribed antibiotics for an infection of the cyst which later transpired to not have been present.

On investigation, we took independent advice from a GP clinical adviser. We found that the board's treatment of C had been overall reasonable. On this basis, we did not uphold C's complaint.

Summary

C complained about Scottish Ambulance Service's (SAS) failure to take appropriate action in response to patient A's symptoms. A had been ill for approximately two days with a high temperature, fever, followed by diarrhoea, trouble passing urine, extreme pain, breathlessness and struggling with mobility. When the SAS crew attended to A at home, an assessment was carried out and senior clinical advice was sought from the out-of-hours GP. It was decided that A did not require to be admitted at that time.

The following day A was admitted to hospital and later died from sepsis (blood infection). C complained that the SAS crew failed to recognise the signs of sepsis and to take the appropriate action in response to their symptoms.

As part of our investigation, we reviewed the relevant records and sought independent advice from a registered paramedic. We found that the SAS crew carried out an appropriate assessment of A's condition and that there was sufficient evidence that the possibility of sepsis was considered. We found that the SAS took the appropriate action in response to A's symptoms and we did not uphold the complaint.

Summary

C's child (A) had complex needs as a result of a brain injury sustained when they were four years old. Given A's care needs, they had an Anticipatory Care Plan (ACP) in place which was reviewed regularly.

A was admitted to a general ward at Ninewells Hospital with a high temperature and was subsequently moved to a high dependency unit. A died three days following admission.

C complained about the inappropriate use of Hi-Flo Nasal Cannula Oxygen (high-flow oxygen, a form of respiratory support) despite concerns raised at the time. C complained that incorrect decisions were taken with respect to A's care and treatment, including that clinicians did not have appropriate regard to the ACP that was in place.

In response to the complaint, the health board carried out a Mortality Review and shared its findings with C. The findings were that care was maximised in the High Dependency Unit as it was not felt A would survive admission to Paediatric Intensive Care Unit, and that this decision together with the decision not to intubate was made with C's input. The variation in care from the ACP was discussed with C and highlights plans are flexible.

C complained to our office that clinicians failed to follow the ACP, that they did not take their views into consideration and that A died of carbon monoxide poisoning as a result of the decisions made in relation to A's treatment and care.

We took independent advice from a consultant paediatrician. We found that there was good documentation evidencing that clinicians had discussed A's care with C, including decisions not to intubate A. We considered treatment with high-flow oxygen was reasonable in the circumstances. Whilst the ACP was not followed, and the board identified this, the ACP is not a legally binding document and the decisions to deviate from the ACP were reasonable in the circumstances. A's cause of death is consistent with the evidence within the medical records. We concluded that A's care and treatment was reasonable and did not uphold the complaint.

Summary

C attended the A&E at Ninewells Hospital with back pain and leg weakness, and was discharged with a diagnosis of suspected sciatica (back and leg pain caused by irritation or compression of the sciatic nerve). C had attended a neurology (the science of the nerves and the nervous system, especially of the diseases affecting them) out-patient clinic earlier that day regarding a separate matter, and the neurologist had noted a foot drop (a muscular weakness or paralysis that makes it difficult to lift the front part of the foot). C complained that the A&E failed to accurately assess them and refer them on to neurosurgery (surgery of the brain or other nerve tissue). C was assessed by neurosurgery four days later, following an urgent GP referral, and was diagnosed with disc prolapse (ruptured disc in the spine) and nerve compression (direct pressure on a nerve) requiring surgery that same day.

The board advised that, while the A&E doctor noted reduced power in C's left leg, they did not feel that foot drop was present and that they felt that sciatica was the most likely diagnosis. The board noted that the neurologist's observation that C had foot drop was not based on a physical examination, whereas the A&E doctor documented a physical examination. The board also noted that local neurosurgical referral guidelines state patients with back pain and sciatica with neurological deficit should be referred to physiotherapy prior to referral to neurosurgery. They concluded that C received appropriate care that was in keeping with relevant guidelines.

We took independent advice from a consultant in emergency medicine. We found that C's assessment and management in the A&E was reasonable and appropriate. We found that the mild weakness documented on assessment in the A&E was not in keeping with a foot drop and that it did not indicate that a neurosurgical referral was required at that time. The A&E discharge letter documented that C was advised to see their GP, and we noted that it was reasonable and in line with common practice for the A&E to ask the GP to follow-up rather than refer directly to physiotherapy. Therefore, we did not uphold the complaint.

Summary

C complained about the treatment provided to their late partner (A). A had reported a number of symptoms by telephone to their practice but they had not made arrangements to see them in person and C said that, as a result, they did not receive appropriate care and treatment. A reported symptoms over a period of time. However, A began to have seizures and tests revealed that A had lesions on their brain. C believed that the practice should have acted earlier and that A's condition could have been diagnosed sooner.

We took independent advice from an adviser who is an experienced GP. We found that the practice had provided A with appropriate care and treatment based on their reported symptoms. There was no evidence that A required an earlier face-to-face appointment or that red flag symptoms were missed.

We did not uphold the complaint.

Summary

C, a support and advocacy worker, complained on behalf of their client (A). A presented to the practice with symptoms of stomach pain and upper and lower backpain. Following several consultations, a GP referred A for an abdominal and renal ultrasound on a routine basis. A was contacted by the hospital with an appointment and was advised that their GP could expedite this if they considered it appropriate. A was referred on an urgent basis by the practice to gastroenterology (specialism of the treatment of conditions affecting the liver, intestine and pancreas) which later confirmed A's diagnosis of cancer.

A complained to the practice that they had failed to expedite the referral despite their worsening symptoms. A believes that if they had been referred to secondary hospital services punctually and had obtained a timely diagnosis, their medical treatment would not have been as invasive and that the risk of cancer spreading to other organs would have been reduced.

In response to the complaint the practice said that an urgent referral was sent to gastroenterology when it was clear that A's symptoms had progressed. A was dissatisfied with the practice's response and C brought the complaint to our office on A's behalf.

During our investigation we requested independent advice on the practice's consultations with A and the arrangements for referring A for further investigations. We found that the decision to refer A initially on a routine basis for an ultrasound was reasonable, given A's symptoms. We found that the medical records indicated consultations with A were reasonable and on the basis of the progression of A's symptoms, there was no unreasonable delay in the urgent referral to gastroenterology being made. We found that the referrals were reasonable and there was no unreasonable delay in making them, as such we did not uphold the complaint.

We provided some feedback to the practice on the management of A's pain.