Not upheld, no recommendations

Summary

C complained that the practice failed to provide appropriate care and treatment to their late child (A). A had a lump removed from their eye lid which was subsequently diagnosed to be cancerous. A went to see their doctor with severe pain in their left arm, which moved to their right arm and neck. A was prescribed painkillers and referred to physiotherapy. A returned from a family holiday and, still suffering from severe pain which had worsened, saw another doctor. A's painkillers were changed and they were referred to physiotherapy.

After a further consultation, A was referred for an x-ray which identified that A's C6 vertebrae had collapsed and that there was a cancerous tumour. A died a few months later.

C complained that doctors at the practice failed to respond to A's symptoms in a reasonable manner given A's history of cancer. C complained that it took A to attend the practice on a number of occasions before appropriate treatment/investigations were undertaken. C believed that had doctors taken account of A's previous history, A would have received appropriate treatment sooner. A considered that the practice failed to investigate and respond to their complaint appropriately.

We took independent advice from a medical adviser. We found that the practice's consultations with C were reasonable. There was no unreasonable delay in the decision to refer C for an x-ray. We did not uphold this aspect of the complaint.

With respect to the complaints handling, we found that there was a misapprehension on the practice's part about the handling of the complaint which resulted in a failure to communicate with C in accordance with their complaints handling procedure. However, the practice had investigated the complaint and provided an accurate and detailed response within a reasonable timeframe and, on balance we did not uphold this aspect of the complaint. We provided feedback to the practice on their obligations with respect to complaints handling.

Summary

C complained about the council after being issued with a number of warnings against their tenancy for antisocial behaviour. C said that the reports of antisocial behaviour were false accusations made by a number of neighbours motivated by discrimination. They told us that the council had unreasonably accepted corroboration between the neighbours, who were friends, but would not accept corroboration from C's parents for their counter allegations.

On investigation, we found that the council had a reasonable evidence base to support their decisions. We considered that the council could show that they had considered all of the evidence and circumstances in reaching the decisions to issue warnings and that these were therefore decisions that were reasonably within their discretion to make.

As such, we did not uphold the complaint.

Summary

C's spouse (A) had long term health conditions. A attended a hospital appointment with C in relation to A's health and was told by a clinician that a CT scan (computerised tomography) dating from the previous year showed A had a sticky heart valve (when a valve does not fully open to allow enough blood to flow through). This was the first time that A and C had been told of any heart problem, and A had not undergone any treatment for heart valve problems in the past. Shortly after this, A was examined at hospital and on this occasion found to have a heart murmur. C complained to the board about not being told of the sticky heart valve. In their response, the board said that they could find no evidence in the records of A having been diagnosed with any form of heart problem prior to the detection of a heart murmur.

A later died and following this, C complained to the board about what they considered was a failure to disclose heart problems sooner and provide timely treatment. C was dissatisfied with the board's response to their complaint and asked us to investigate.

We took independent advice from a cardiology adviser. We did not find evidence that the board unreasonably failed to inform A that they had a heart valve condition or that the board unreasonably delayed treating A for a heart valve condition. We therefore did not uphold either complaint.

Summary

C complained about the care and treatment they received from the board. C experienced pain and discomfort when eating and suffered from gastro-oesophageal reflux (stomach acid travelling up towards the throat). C's gastroenterologist (a physician who specialises in the diagnosis and treatment of disorders of the stomach and intestines) ordered a barium swallow test (BST, a special type of X-ray test where barium is swallowed which shows up clearly on an x-ray to help diagnose problems with swallowing and the oesophagus). The radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) who reviewed the images reported them as normal. C complained about the care and treatment provided by the gastroenterologist and the radiologist's interpretation of the BST.

We took independent advice from a consultant radiologist and a consultant gastroenterologist. We found that there were small osteophytes (bony lumps that grow on the bones of the spine or around the joints) in the spine on the BST images. However, these were small and insignificant. We found that images had been thoroughly reviewed by the radiologists and that there was no demonstrable compression of or leakage from the oesophagus. We also considered that the suggestion to change C's medications was reasonable and good clinical practice. The BST showed that no further investigations were required. Therefore, we did not uphold this aspect of C's complaint.

C also complained about how the board responded to their complaint. We found that the complaint response may not have been as in depth as C would have preferred, and that the conclusions of the medical staff were not what C was hoping for, however that did not mean the response was unreasonable. There was a delay in providing a complaint response to C, however we found that these were caused by the COVID-19 pandemic and from a further submission of information by C. We found these explanations to be reasonable and did not uphold this aspect of C's complaint.

Summary

C's spouse (A) had advanced kidney cancer which had spread to their brain. A was admitted to hospital after they developed breathing problems. They were diagnosed with a pulmonary embolus (blood clot in the lung). A agreed for the pulmonary embolus to be treated in hospital, in the hope that they could be discharged once stable, but their condition deteriorated and they died in hospital.

There was a period during A's admission when their medication was stopped while clarification was sought as to their treatment plan. C complained about the clinical decision-making regarding A's care and treatment. C considered that failings in A's care and treatment led to their death in hospital, denying them of the right to be cared for at home. C also complained about the board's communication.

We took independent advice from a consultant physician. We noted how difficult this case was, in particular from the perspective of the family. Although we noted certain areas of care that could have been better, we considered that overall the standard of care and treatment was reasonable and that A was nearing the end of their life by the time of their admission. We did not consider that the outcome would have been different had there not been a period of time during which medication was withdrawn pending clarification of A's treatment plan. Therefore, we did not uphold this complaint.

We noted that a number of physicians were involved in A's care and treatment and that there had been a degree of uncertainty about A's treatment plan. Although some aspects of communication could have been better, we considered that the clinicians did their best to communicate to A's family how ill A was and to have appropriate discussions with them around resuscitation and escalation. Therefore, we did not uphold the complaint about communication.

Summary

C complained about the treatment that they received from the practice during a three year period. C had repeatedly reported symptoms of a cough and breathlessness and was prescribed an inhaler but it took a number of years until they were diagnosed with Sjogren's syndrome (a condition which affects parts of the body that produce fluids like tears and spit (saliva)). C believed that action should have been taken by the GP at the practice to arrive at the diagnosis sooner.

We took independent advice from a clinician and found that the GP had provided C with appropriate medical treatment in view of the reported clinical symptoms and that they made a timely referral to hospital specialists. Although C was subsequently diagnosed with Sjogren's syndrome, this was not as a result of a failing in the treatment provided by the practice. We did not uphold the complaint.

Summary

C complained to the board about the care and treatment which their late parent (A) received at the A&E at Glasgow Royal Infirmary. A had presented as an emergency following them taking too much medication. A was not admitted to hospital but was discharged home and advised to take Codeine (a sleep-inducing and analgesic drug derived from morphine). A died shortly after their discharge from hospital.

We sought independent clinical advice from a professional adviser. We found that apart from a failure to complete some initial observations, staff in A&E performed appropriate investigations and that it was clinically appropriate to discharge A from hospital. There was no indication from the clinical records that staff had prescribed A Codeine on discharge or that this was said to them. We did not uphold the complaint.

Summary

C complained about the treatment which their partner (A) received when they attended their GP practice with confusion and could not walk unaided. A could not provide a urine sample and was given a prescription for antibiotics. A collapsed in the car park following the consultation and was taken to hospital. C believed that the GP should have arranged a hospital admission for A. The practice felt that appropriate clinical treatment had been offered.

We took independent clinical advice from a professional adviser. We found that the GP had carried out an appropriate assessment of A and had diagnosed A as having an infection and therefore prescribed alternative antibiotics with advice to seek further medical advice should their condition deteriorate. It could not have reasonably been foreseen that A would collapse shortly after leaving the GP practice. We did not uphold the complaint.

Summary

C was referred to the Ear, Nose and Throat (ENT) department of board by their GP after suffering extreme sore throats and infections. A diagnosis of recurrent tonsillitis (swelling of tonsils located at the back of the throat due to infection) and possible reflux (the flow of a fluid through a vessel or valve in the body in a direction opposite to normal) or allergy was offered. C was prescribed Gaviscon and recommended allergy tests, which later showed allergies to dust mites. C was seen again in clinic later where their symptoms were reported to have resolved and C was discharged.

Some years later a pre-cancerous lump was found on C's breast. The results of a biopsy confirmed oesophageal (organ which connects the throat to the stomach) cancer, for which C received chemotherapy and an operation.

C believed that they should have been referred to a specialist following their referral to ENT previously and that the prescription of Gaviscon had been unreasonable. C complained to the board. The board responded with the conclusion of their investigation that, in the circumstances, the prescription of Gaviscon was reasonable and no further referral from ENT was indicated. C was dissatisfied and raised their complaint with us.

We took independent advice from a consultant. We found that the board's actions were reasonable in the circumstances, that there was no indication at that time that further investigation or referral was required and that the board did not unreasonably fail to diagnose or treat any condition. We did not uphold the complaint.

Summary

C complained that the board failed to investigate, diagnose and treat gastrointestinal (relating to the stomach and intestines) problems and swallowing difficulties that they had experienced over a number of years. As a result of previous abuse, C required invasive procedures to be carried out under general anaesthetic. C complained that the board placed unreasonable emphasis on their trauma when making decisions about their treatment.

We took independent clinical advice from a consultant in gastroenterology (medicine of the digestive system and its disorders) and hepatology (liver disease). We considered C's initial treatment plan to be reasonable: a CT scan of C's colon followed by an upper GI endoscopy (a medical procedure where a tube-like instrumentis put into the body to look inside) as recommended by the private clinic that they attended, and a colonoscopy (examination of the bowel with a camera on aflexible tube) if indicated by the results of the CT scan. We found that the decision not to carry out a colonoscopy at this stage was reasonable, given the risks of performing this under general anaesthetic and the previous normal investigations.

We were critical of the board's failure to offer C a flexible sigmoidoscopy (an imaging test done to monitor the colon and rectum for the presence of ulcers, polyps or other abnormalities) after they developed rectal bleeding, but noted that this did not impact on C's overall treatment plan. C had gone on to have a colonoscopy under a different NHS board, which did not identify any significant pathology.

We did not consider the emphasis placed on C's childhood trauma to be excessive and we noted that reasonable investigations were carried out into C's swallowing difficulties.

Therefore, we did not uphold this complaint.

With regard to C's complaint that the board's complaint response contained inaccurate information, we found that generally their response was thorough and detailed. With the exception of an incorrect reference to C having anaemia, we found that the board's response to be factually accurate with clear explanations as to what investigations had been carried out and why. We did not uphold the complaint.