Not upheld, no recommendations

Summary

C complained about the care and treatment that they received from the Beatson West of Scotland Cancer Centre. We took independent advice from an oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that the symptoms C described were not 'red flags' and could have been explained by recovery from the chest infection C had experienced. The response to C's symptoms (including the length of time to request and perform a CT scan) was reasonable in the circumstances. We also found that the communication with C about the results of the CT scan was reasonable

C was also concerned that bleeding at their Dalteparin (anticoagulant that helps prevent the formation of blood clots) injection sites was not appropriately escalated or responded to. The board did not provide us with a contemporaneous record of the advice that was given to C regarding bruising and bleeding at their Daltaparin injection site. We found that it would be good practice for all contact with clinicians to be recorded and we included this as feedback for the board. However, we noted that there was no dispute between the board and C that the advice given on this occasion was for C to contact their GP. We found that the advice given to C was reasonable in the circumstances.

We did not uphold C's complaint.

Summary

C complained that the board failed to carry out an endoscopic retrograde cholangiopancreatography (ERCP, an imaging test involving a combination of endoscopy and X-rays for examination of the bile ducts and pancreas) procedure reasonably which resulted in a retroperitoneal perforation (a tear in the lining of the abdomen) and post-ERCP pancreatitis (inflammation of the pancreas).

We took independent advice from a consultant gastroenterologist and hepatologist (a physician who specialises in the diagnosis and treatment of disorders of the gastrointestinal tract, liver, pancreas and gall bladder). We found that the ERCP was a necessary procedure in C's case, that the perforation and post-ERCP pancreatitis are recognised complications and that appropriate measures were taken to reduce the risk of post-ERCP pancreatitis by administering diclofenac (a non-steroidal anti-inflammatory or NSAID). We did not identify any unreasonable failings regarding C's care and we did not uphold this complaint.

C also complained that they were not informed of the risks of the ERCP (including pancreatitis or duodenal perforation) and that following the ERCP, the tear was not mentioned to C by the consultants and that they were given different stories by them. We took independent advice from a consultant general surgeon. We found that the communication with C regarding the findings of the CT scan (a tear in the lining of the abdomen) was reasonable. We also found that an information booklet was attached to the consent form when it was signed, and that C was appropriately made aware of the risks and complications associated with the procedure. However, we noted that it would be good practice to keep a copy of the information booklet in the medical records and we included this in our feedback for the board. We did not uphold C's complaint regarding the board's communication.

Summary

C sustained severe and multiple injuries to their wrist and pelvis following a road accident. C underwent numerous surgical procedures on their wrist and complained that the care and treatment they received was unreasonable. C felt that due to the placement, the screws that were used caused greater damage. C also said that the board chose not to undertake any further surgery to treat the ongoing pain and limited range of movement that C experienced.

We took independent advice from an appropriately qualified medical adviser. We found that the board provided reasonable emergency care to C immediately after their accident. The surgery carried out was reasonable, with the screws and plates appropriately placed, given the type of injury that C had. We also found that it was reasonable for the board to decide to end the first operation (due to operation length) and undertake further surgery to complete their treatment of C's wrist, and that C's discharge was appropriate. We did not uphold this complaint. However, we noted that earlier counselling around the significance of an injury like this and making sure that C did not have unrealistic expectations, may have been helpful in this case. We provided feedback to the board on this point.

Summary

C complained about the treatment that their parent (A) received at the ophthalmology department (the branch of medicine concerned with the study and treatment of disorders and diseases of the eye) at Aberdeen Royal Infirmary. A had been referred to the hospital by two opticians who believed that A's eyes required a review from hospital specialists. Following the consultation, A was told to use a magnifying glass but that further medical intervention was not required. However, A continued to have problems with their sight within the next year and while abroad had to seek emergency medical review. A had to have surgery for the removal of both cataracts (when the lens, a small transparent disc inside the eye, develops cloudy patches). C believed that A did not receive appropriate treatment at the consultation and that consideration should have been given to the removal of their cataracts.

We took independent clinical advice from an ophthalmologist (a doctor who examines, diagnoses and treatsdiseases and injuries in and around the eye). We found that A was appropriately assessed and treated and at that time there was not a clinical need or indication for eye surgery. It appeared that A's sight deteriorated following the consultation and that could not have been predicted.

We did not uphold the complaint.

Summary

C complained about the treatment for a leg wound which they had received from a podiatrist (a physician who specialises in the study and medical treatment of disorders of the foot, ankle and lower extremity). C felt that the podiatrist was rough and that they had provided inappropriate treatment as the wound had increased in size. C, who has a history of cardiovascular disease (disorders of the heart) and other health issues, required regular podiatry treatment to treat their toes and feet for ulcers. C began to have concerns about a number of podiatrists who had treated them. In particular, C felt that one podiatrist was irate when they had to wait a time for C to answer the door due to their poor mobility. C also found that the wound appeared to worsen after the podiatrist's care.

We took independent advice from an adviser and found that from a clinical perspective, the treatment provided by the podiatrist was reasonable. There was evidence that informed consent for treatment was obtained from C and that their leg wound was treated in accordance with recognised procedures.

We did not uphold the complaint.

Summary

C's adult child (A) had a history of intravenous drug use and was on a methadone programme. A suffered from osteoarthritis (a condition that causes joints to become painful and stiff) in their knee. A sought surgical treatment for this on a number of occasions. On the latter two occasions, the board determined that A was physically suitable for surgery. Surgery was initially scheduled but it did not take place. A sought surgery again the following year, however, the consultant surgeon did not consider A would cope with the possible postoperative pain of a total knee replacement (TKR) and decided not to schedule any surgery. C complained to the the board about this decision.

The board's response noted recent x-rays showed A was physically suitable for surgery but that the board was concerned about how A would cope with the postoperative pain, and noted the likelihood that A would be in more pain following the surgery than previously. The board said that pain control following this operation can be exceptionally difficult and that this, coupled with the high doses of methadone A was prescribed and any heroin injections they may have been taking, meant that there was a risk of A's pain becoming chronic and untreatable after the operation. Clinicians recommended that A's chronic pain be managed, A's dose of methadone reduced and A be free of heroin before surgery be considered. The board said that clinicians intended to await a multidisciplinary team meeting outcome and liaise with A's psychiatrist before discussing options with other colleagues. The board said that A's GP would be updated with information about these outcomes and the board's recommendations at that point.

We took independent advice from an orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the board's reasons for caution regarding A's TKR were well documented and their decisions were reasonable. In considering the complaint, we also took into account that the board, despite deciding not to proceed with surgery at that time, outlined the route that could lead to further consideration of A having a TKR and remained open to that possibility for at least 12 months afterwards. We did not uphold this complaint.

Summary

C moved into their property and began experiencing antisocial behaviour from their neighbours. C complained to the association about their handling of C's reports of antisocial behaviour.

We sought information from the association about C's reports. As part of that, we saw evidence which related to C's neighbours but that we could not share for reasons of confidentiality and data protection.

We found that the association took action to investigate each of C's reports. These actions were undertaken promptly. Some contact from the association took longer than their policy specified, however in the context of the COVID-19 pandemic, this was reasonable.

Information relevant to the investigations was sought from external agencies and relevant investigations were undertaken by association staff. Staff were not able to corroborate all the incidents reported to them. Sometimes there were no other witnesses to the incidents and sometimes it was determined that the noise was not excessive or antisocial.

We were satisfied that the association had investigated each report of antisocial behaviour made to them and that they had taken appropriate action when those incidents had been corroborated. We did not uphold the complaint.

Summary

C is welfare guardian (a court appointed guardian who can make decisions on behalf of an adult with incapacity) for their adult sibling (A). A was assessed in hospital by the health and social care partnership as needing full-time residential adult care. C disagreed with this assessment and considered that A would be better cared for at home. C returned A to their home following their hospital discharge. C maintained that as A had been assessed as requiring full-time care, they were entitled to have this fully funded at home and that they were entitled to be offered the relevant self-directed support payment options for this care. Glasgow City Council refused to provide such funding, maintaining that they were only under a duty to fully fund the care assessed as needed. Adult protection procedures were considered but as C was now providing full-time care to A, alongside a council funded care package, no action was taken.

C complained to the partnership about the assessment outcome and the failure to provide fully funded full-time home care for A. There were considerable delays in responding to the complaint for which the partnership later apologised, however they maintained their view that A was not entitled to full-time fully funded home care and their original assessment had been appropriate.

C brought their complaint to this office and raised further concerns about the tone of partnership's communications and the investigation of their complaint.

We found that A was entitled to assessment under the 1968 Social Work (Scotland) Act and funding to meet the needs assessed. However, the council were not obliged to provide funding to meet care costs where the care being provided did not meet that assessed need (in this case care at home rather than residential care). We concluded that the assessment of A's needs was appropriate and that the council were not obligated to offer self-directed support payments. Therefore, we did not uphold this complaint.

Summary

C complained that they were unreasonably diagnosed with bicuspid aortic valve (a type of abnormality in the aortic valve in the heart where the valve has only two small parts (leaflets), instead of the normal three). C was diagnosed with bicuspid aortic valve by the board and as a consequence, made significant changes to their life and retired early. C was later given a different diagnosis (when they were under the care of a different NHS board) and took the view that the diagnosis given previously was, therefore, incorrect.

We took independent clinical advice from a consultant general cardiologist (specialist in diseases and abnormalities of the heart) and a consultant cardiologist with particular experience in the reading of echocardiograms (a scan used to look at the heart and nearby blood vessels). We found that C had been diagnosed previously with bicuspid aortic valve when they were resident in Wales. Relevant information was passed to C's new GP when they moved to Scotland who made a referral to Perth Royal Infirmary for continued follow-up. A further echocardiogram was performed at that time, which was reasonable and appropriate. We confirmed that although interpretation of C's echocardiogram was not necessarily straightforward because of calcification (a build-up of calcium in body tissue) and the fact that C was not echogenic ('echogram-friendly'), the conclusions reached (of bicuspid aortic valve) and reported to C at the time were entirely reasonable in the circumstances.

While C's diagnosis had since been amended, this did not mean that the diagnosis given by the board was an unreasonable one. We noted that it was not unusual for diagnoses to be amended. Therefore, we did not uphold C's complaint.

Summary

C complained about the psychiatric care and treatment that they received during an admission to University Hospital Wishaw. They complained about the way they had been treated by staff, claiming to have been assaulted and injured. C also complained about their medication regime, stating that they had been given too much medication which caused them to become ill.

In their response to our enquiries, the board set out the circumstances in which C had been restrained, explaining that C tried to run away from the ward and became verbally and physically aggressive. As C was detained under the Mental Health Act, their refusal to return to the ward resulted in the use of restraint using prevention and management of aggression techniques. The board said that the restraint techniques utilised by staff were appropriate and all staff involved were appropriately trained. They expressed regret that C's jacket had been damaged, advising that reimbursement for C's loss had not been paid because C had failed to provide a receipt as requested. While C complained about a separate incident in which they said that they were injured, there was no record of this and as such we could make no finding on this.

We took independent advice from a consultant psychiatrist. We found that the assessment and management of C's symptoms were appropriate. After review of C's medication regime, we found that there was no link with C becoming ill and vomiting. We noted signs of infection which were considered a more likely explanation for C vomiting.

We found that C's care and treatment were reasonable and we therefore did not uphold this complaint.