Not upheld, no recommendations

Summary

C, a support and advocacy worker, complained to us on behalf of their client (A) about the care and treatment that the partnership provided to A. In particular, C complained that A was not given appropriate support during and after their transfer to adult mental health services.

We took independent advice from an adviser in mental health nursing. We found that A's transition to adult mental health services was reasonably planned and carried out. We also found that A was given reasonable care and treatment after their transfer to adult services. We did not uphold the complaint.

Summary

C has been diagnosed with Emotionally Unstable Personality Disorder (EUPD). C was admitted to a specialist mental health facility on two occasions. Whilst there, C was under the care of a consultant psychiatrist.

C complained to the board about various matters including the decisions to discharge C to care in the community, given C's EUPD diagnosis, and that the community mental health team (CMHT) were providing support only by telephone, rather than face-to-face contact, due to arrangements in place during the COVID-19 pandemic. In their response, the board explained that international evidence advised that patients with EUPD should be cared for in the community wherever possible and that the board had sought to offer C the most appropriate care when they encouraged C to leave the ward.

C was dissatisfied and raised their complaints with this office. We found that C's discharges were reasonable in terms of the planning undertaken, discussions held and arrangements made both in terms of C's diagnosis and the particular circumstances of the time. We also found that these decisions were in line with relevant guidance. We did not uphold this complaint.

Summary

C complained on behalf of their late spouse (A) about the treatment provided to them. A had a history of breast cancer and attended the practice with back pain. A was treated for simple back pain with some sciatic nerve irritation (nerve in the lower back area) and prescribed pain relief. A was later diagnosed with kidney failure caused from metastatic disease (secondary cancer) and died. C complained that the practice had failed to give proper consideration to A's history of cancer when assessing their back pain. C considered that an earlier diagnosis may have increased A's life expectancy as treatment could have been commenced earlier.

We took independent advice from a GP. We considered that A's symptoms had been reasonably assessed and that A's reoccurrence of cancer was not foreseeable any earlier than diagnosed. When A's presentation changed, appropriate steps were taken, with further investigations and referrals to hospital speciality care. As such, we did not uphold this complaint.

Summary

C attended hospital on a number of occasions for the removal of some teeth. At one consultation staff said C was aggressive and asked C to leave the department. C complained about the care and treatment provided to them and that the zero tolerance policy was applied unfairly to them. At a further consultation, C said they were told the hospital would not be able to provide further treatment for them.

We took independent advice from a dentist. We found that the care and treatment provided to C was appropriate and the record-keeping was of high quality. There was good evidence of staff spending time with C to explain their treatment options. We found that staff were entitled to ask C to leave when they perceived C's behaviour to be aggressive and threatening. We also noted that the board had reassured C that they could receive treatment at the hospital, but this would be reviewed if C behaved aggressively again in the future. We did not uphold C's complaints.

Summary

C complained about the psychiatric care and treatment provided to their spouse (A) by the board. C raised a number of issues which included the behaviour and attitude of a psychiatrist during a consultation with A, that the psychiatrist had remained involved in A's care against A's wishes, and that the psychiatrist had made a diagnosis of factitious disorder (serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury), of which they had failed to notify A and the wider clinical team. C also complained about a clinical psychologist's involvement in A's care, specifically that they had prepared a report relating to A which contained a number of inaccurate statements.

We took independent advice from a consultant psychiatrist. We concluded that the board's management of A was appropriate, patient-centred and reasonable. In relation to the specific complaints C had raised, we found there was no evidence within the clinical records to support C's complaint about the attitude and behaviour of the psychiatrist during a consultation with A, although we accepted that some unhelpful language had been used for which the board had apologised.

We found that the records showed that A had generally been kept up to date with changes to their diagnosis, but that A had not been informed about the change in their diagnosis to factitious disorder. Whilst we considered A should have been informed, this was a relatively minor shortcoming in communication and had no detrimental effect on the overall care and treatment provided to A. We also found that the clinical psychologist's involvement in A's care had been appropriate and reasonable. For these reasons, on balance, we did not uphold C's complaint.

Summary

C attended A&E at Glasgow Royal Infirmary with acute pain in their spine; they were admitted in the early hours of the morning and discharged the same day. During their admission, C underwent a hip x-ray scan.

C complained that the care and treatment they received during their visit was not of a reasonable standard. C found their experience to be traumatic and states that it had a lasting emotional impact on them. C had several concerns about their experience; in particular, their pain management and the board's radiology findings.

We took independent advice from an appropriately qualified adviser. We found that the board's approach to pain management was appropriate but felt that it would have been good practice for the board to document C's pain score and actions taken as a result of that score – this was provided as feedback to the board. We also found that C's x-ray was appropriately assessed and concluded that the management of C's radiology (analysis of medical imaging of the body) findings was reasonable.

We considered that the care and treatment offered to C when they attended hospital was reasonable and we did not uphold this complaint.

Summary

C complained to the practice about the treatment that they received when they contacted the practice with back problems. C spoke to a GP and an advanced nurse practitioner (ANP) by telephone during that period due to the COVID-19 restrictions and C was advised to make further contact should their situation worsen. C was taken by ambulance to hospital and after a CT scan was diagnosed as having cauda equine syndrome (a disorder that affects the nerves). C felt that the GP and the ANP should have seen them in person for an examination and that had this been the case, the correct diagnosis of cauda equine syndrome would have been reached sooner and would not have had such a drastic effect on their health.

We took independent advice from a GP and an ANP. We found that C had a previous history of back problems over a number of years which were felt to be sciatica (back and leg pain caused by irritation or compression of the sciatic nerve) and musculo-skeletal in nature and that it was not unreasonable to attribute C's reported symptoms to those conditions. However, when C attended hospital their condition had deteriorated and they had reported new symptoms which were red flag signs of cauda equine syndrome. We did not uphold the complaint.

Summary

C complained to us, on behalf of A, that the board failed to appropriately diagnose and treat A during their attendances at Aberdeen Royal Infirmary. A had chronic obstructive pulmonary disease (COPD, a disease of the lungs in which the airways become narrowed) and had also previously been diagnosed with probable left sided lung cancer several years earlier. At that time, it was agreed that A would receive high dose palliative radiotherapy (a treatment using high-energy radiation).

Over a period of eight months, A was admitted to hospital nine times. The first five of these admissions were to a respiratory ward and the last four to a general medical ward. They were treated for worsening of COPD and increasing frailty. A had a fall during one of the admissions, but was subsequently discharged home. C said that at that time, A was not fit for discharge as they required to be readmitted again a few days later when they were told that they had terminal cancer. A's condition subsequently deteriorated further and they died the following month.

We took independent advice from a consultant geriatrician (a doctor specialising in medical care for the elderly). Although the board had acknowledged that the clinical records did not show that A's underlying diagnosis of cancer was discussed with them in appointments in the final two years of their life, we found that there was no evidence that the board failed to properly diagnose and treat A during the relevant hospital admissions. We did not uphold this complaint.

C also complained that the board failed to communicate appropriately with A during this period, despite them having power of attorney for A. We found that A's care and treatment were discussed reasonably with both C and A and we therefore, did not uphold this complaint.

C complained that the board failed to handle A's complaint in line with their obligations. We were satisfied that the board dealt with A's complaint in accordance with their complaints handling policy and this complaint was not upheld.

Finally, C complained that the board unreasonably failed to certify correctly the cause of A's death. Whilst the initial death certificate was not incorrect, it was revised to give more clarity. Although we found that it would have been better for C to have been provided with a more detailed explanation for the required change in the first place, it is not unusual for death certificates to be revised in these circumstances. We did not uphold this complaint.

Summary

C, a support and advocacy worker, complained on behalf of their client (A) and their partner. A and their partner's child (B) was born at 30 weeks gestation. B was severely disabled and died when they were two years old. B's parents had been told that B had suffered hypoxic ischaemic encephalopathy (HIE, a form of brain injury that occurs when the brain does not receive sufficient oxygen) due to a lack of oxygen in the period prior to their birth. Despite HIE being detailed in B's records as a diagnosis, the board contended that B did not have this condition when responding to B's parents' formal complaint.

B's parents considered there to have been an unreasonable delay to A receiving an emergency section following their urgent referral from Peterhead Hospital to Aberdeen Maternity Hospital. C asked us to investigate whether the level of care that A received from the board fell below a reasonable standard and whether any deficiencies in the standard of care may have contributed to B's health problems.

We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in pregnancy, childbirth and the female reproductive system) and a senior midwife. We found that A was appropriately given a cardiotacograph (CTG, a way of recording the fetal heartbeat and the uterine contractions during pregnancy) at Peterhead Hospital on the first date complained of, and was appropriately transferred to Aberdeen Maternity Hospital. In relation to the second date complained of, we found that A was again appropriately transferred to Aberdeen Maternity Hospital, although we noted that a CTG was inappropriately stopped at one time, once A had been transferred. However, we also found that transfer to the labour ward took place at an appropriate time and that the decision to move A to theatre and carry out an emergency caesarean section was taken at an appropriate time. The advice we were given did not indicate a connection between the results of tests undertaken at this time and any health problems that B suffered following their birth. We considered that the board's overall management of A had been reasonable and did not uphold the complaint. However, we provided feedback to the board regarding record-keeping.

Summary

C's parent (A) had complained for a number of years about pain in their legs. They considered that their concerns had been dismissed and that they weren't reasonably responded to. A later required a stent and an angioplasty (a procedure to widen narrowed or obstructed arteries or veins) after they experienced a blockage of an artery in their leg. While initially successful, the stent then blocked, leading to a second procedure. A later had their leg amputated. C considers this could have been avoided with earlier treatment.

C complained that the board failed to reasonably respond to issues regarding A's feet and legs. We took independent advice from a vascular adviser (treats disorders of the circulatory system). We found that prior to the severe blockage experienced by A, the actions taken by the board in response to their symptoms of pain and numbness were reasonable. We found that these symptoms were unrelated to the sudden onset situation where A had blockage of the external iliac vessel (relating to the large broad bone forming the upper part of each half of the pelvis or the nearby regions of the lower body) on the left side, and we found that the response to this blockage was reasonable. When the stent then became blocked, we found that the response to this was also reasonable. However, communication with A and their family could have been better in terms of explaining A's symptoms, how A was followed up after the procedure and the possibility that the initial stent could fail.

While there were some communication issues and there should have been further follow-up after the first stent was placed, we found that the overall the treatment provided by the board was reasonable. Therefore, we did not uphold this complaint.