Not upheld, no recommendations

Summary

C complained to the council about the way in which they had handled their reports about anti-social behaviour by C's neighbours. C also complained about how the council had managed the situation once C had been offered a housing transfer to remove them from the situation. The council investigated and responded to C's complaints, however C and their advocates continued to complain to the council about matters which were considered closed following the local complaint investigation.

We found that the steps taken by the council to resolve C's complaint were reasonable. On recognising C's vulnerabilities, and it being unlikely the dispute between the neighbours would be resolved, we found that the subsequent handling of C's housing transfer was also reasonable.

During our investigation it was noted that the council had invoked their Unacceptable Actions Policy in principle in relation to one of C's advocates. However, as they had indicated that they would not be contacting the council again, the advocate was not formally notified they were being managed in line with this policy. We gave feedback to the council on this matter, noting that complainants and their advocates should be informed when their behaviour is considered unhelpful and challenging to ensure that they have the opportunity to engage more meaningfully.

Overall, we found that the actions taken by the council were reasonable and we did not uphold C's complaints.

Summary

C, an adult with attention deficit hyperactivity disorder (ADHD), autism, and pathological demand avoidance (PDA) complained that the board failed to diagnose their conditions when they should have done.

C told us that the board said they stopped considering diagnosis of conditions such as ADHD and autism when a patient reached the age of 25 years old. C complained that this practice led to them being misdiagnosed which prevented them from obtaining access to appropriate medication, particularly, medication to help with the management of ADHD.

The board said that the understanding of developmental disorders in adulthood, including high functioning autism and ADHD was very limited during the mid 1990s (when C felt they should have been diagnosed). The board felt any potential delay in diagnosis should be considered in line with the expectations and understanding of psychiatric practice at the time. In C's case, it appears C experienced a number of other physical and mental health problems that would not be solely accounted for by diagnoses of autism and/or ADHD, although these conditions may have been predisposing factors.

We took independent advice from a general adult consultant psychiatrist. We found that the timing of the recognition and diagnoses made were reasonable and that there was no evidence to suggest that the recommended treatment for ADHD was delayed or withheld because of prescriptions of other medications. We also noted, at this point in time, there are appropriate guidelines and clinical guidance for clinicians to follow, in relation to pervasive developmental disorders in adults.

Whilst we recognise that C was not diagnosed with ADHD and autism until relatively recently, we consider that the care and treatment provided to C was reasonable in the circumstances at that time. We also consider treatment provided for other diagnosed conditions was reasonable and did not prevent or delay C's later diagnoses of ADHD and autism.

We noted that the board may have diagnosed these conditions differently in the past but did not see any evidence to suggest that the board's current practice fails to consider diagnoses of ADHD and/or autism in adults over the age of 25 years old.

Therefore, we did not uphold C's complaint. We did note that it may have been helpful to carry out a more detailed ADHD assessment before commencing medication and provided the board with some feedback on this point.

Summary

C complained about the care and treatment provided to their late spouse (A). A was suffering from facial pain and numbness and underwent an MRI scan. The MRI reported a benign slow growing tumour at the base of A's skull which can usually be managed with pain killers or sometimes stereotactic radiosurgery (SRS, a high dose of radiotherapy to a small area) is considered. Shortly after, A's local health board referred A to Lothian NHS Board for treatment. A attended a telephone consultation with a neurosurgery consultant (specialist in surgery on the nervous system, especially the brain and spinal cord). A was not considered to have a diagnosis of cancer given the findings of the MRI scan and was referred on a routine basis for consideration of SRS treatment.

A's case was subsequently reviewed at a multidisciplinary team meeting by clinicians at Lothian NHS board. It was identified from a review of the MRI report received from A's local health board, that there were other not previously identified lesions in A's brain, which were in keeping with metastases (cancer that has spread from other areas of the body). A was referred on an urgent basis to their local health board for further investigations including an MRI scan and CT scan. A was diagnosed with cancer and died shortly after.

We took independent advice from a consultant neurosurgeon. We found that the MRI report did not show any sinister findings which required urgent intervention and that the board took appropriate action. However, the review of the MRI at the subsequent multidisciplinary team meeting identified metastatic lesions. We considered that the review of the MRI took place within a reasonable timeframe.

We took additional advice from a consultant radiologist (specialist in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) about the findings of the MRI performed by A's local board. We found that the report had not detected tiny abnormalities which, if identified at the time, would have raised the suspicion of metastases and led to earlier investigation to look for the source of the primary tumour elsewhere in the body. However, we considered that the undetected findings were subtle and likely to have been missed by a number of radiologists. Therefore, the MRI report findings were of a reasonable standard.

We considered that the board had provided A with reasonable care and treatment on receipt of the referral from A's local board. Therefore, we did not uphold C's complaint.

We provided some feedback to the board with respect to the importance of acknowledging and responding to concerns raised by GPs about a patient's symptoms, particularly pain.

Summary

C complained on behalf of their spouse (A) about the care and treatment they received from the board. A was reviewed by the vascular surgery service (specialists in the treatment of diseases affecting the vascular system including diseases of the arteries, veins and lymphatic vessels) after sustaining an injury to one of their fingers. The injury initially caused some infection which progressed to gangrene (a serious condition where a loss of blood supply causes body tissue to die). A's finger was amputated but the wound did not heal and deteriorated further, leading to the amputation of A's hand. C raised concerns about the timeliness of A's initial finger amputation and that had this been done before the infection progressed, this would have avoided the need for full amputation of A's hand.

We took independent advice from a vascular surgeon. We found that the decision to admit A to hospital and treat with intravenous antibiotics was timely and appropriate. There was evidence of regular review and high quality multi-disciplinary working. We also found that the finger amputation was performed in a timely manner and that there were no published guidelines that were not followed. We considered there was no indication that performing the finger amputation earlier would have prevented the need for hand amputation. Therefore, we did not uphold C's complaint.

Summary

C complained about how the practice had managed their lithium prescription (a medication used to treat mood disorders).

We took independent advice from a GP. We found that the practice acted reasonably in requesting that C arrange blood tests every three months to monitor their medication levels. We were also satisfied that the practice had provided reasonable advice about how to ensure C did not run out of medication.

We did not uphold C's complaint.

Summary

C complained about the care and treatment their adult child (A) received from the board. A had a complex medical history including a diagnosis of Complex Regional Pain Syndrome (CRPS, a rare condition where persistent and severe pain occurs following an injury). A attended A&E complaining of an elevated heart rate and fatigue. A working diagnosis of sinus tachycardia (a faster than usual heart rhythm) secondary to medication was made. A was discharged home with no further treatment. A couple of months later, A was admitted to A&E following a collapse, racing heart and swelling of their hands and feet. A was admitted to hospital where their condition deteriorated overnight. A's condition continued to deteriorate and they were transferred to the Medical High Dependency Unit (HDU) and the Intensive Care Unit (ICU). Ultimately, it was decided that A should be transferred to a hospital in another health board area where cardiology and advanced cardiac (heart) support would be available. A's condition did not improve and they died a few days later.

C raised a number of complaints with the board regarding the care and treatment A received. The board investigated C's concerns and undertook a Significant Adverse Event Review (SAER). However, C remained dissatisfied with some aspects of A's care.

We took independent advice from an appropriately qualified adviser. We found that when A initially presented at A&E, the clinical staff were aware of their history of CRPS and existing medications, that a full examination was carried out along with blood tests which were normal and that there was no obvious reason to admit A to hospital at that time. We found that the treatment A received during this admission was reasonable and appropriate and that onward referral was unlikely to have changed the outcome for A.

In relation to their second attendance, we noted that A was acutely unwell. We found that appropriate investigations were carried out in a timely manner and that, as A's condition deteriorated, their care was appropriately escalated through the HDU and ICU to transfer to another hospital where specialist equipment was available. We found that where the board had identified areas for improvement in their review of matters, the action they had taken was appropriate. We considered that the board provided A with appropriate treatment and investigations in response to their presenting symptoms and that they escalated A's care appropriately in recognition of the seriousness of their deteriorating condition.

We did not uphold C's complaints.

Summary

C, a support and advocacy worker, complained on behalf of their client (A) who was unhappy with the care and treatment they received during the birth of their child (B) and whilst they were a patient on the postpartum ward.

A's labour progressed very quickly, B's heart rate dropped, and decisions were made to deviate from the birthing plan as a result. A was unhappy with decisions that were made, the care received from midwives, and the lack of communication with them about what was happening. A also had concerns about the postpartum care they received, as they required a blood transfusion and felt their concerns were ignored by staff.

The board considered appropriate guidelines were followed and appropriate action and decisions were made in the circumstances. There was a need to deliver B urgently as there was evidence of distress. In relation to the care A received after the birth of B, the board said they did not consider there were any delays in the care provided to A, or the monitoring of their condition. They did identify an issue with documentation and highlighted that there should always be a handwritten contemporaneous record. This was addressed with staff members involved.

We took independent advice from two clinical advisers: a consultant obstetrician (a specialist in pregnancy and childbirth) and a registered midwife. We found that the care and treatment provided to A during labour was reasonable in the circumstances. We also considered the care and treatment provided by midwives on the postnatal ward was reasonable. We noted that there was a debrief in this case however, given the events of the birth, further debriefing at a senior level may have been helpful. We provided the board with feedback on this point.

We found that the care and treatment provided to A during the birth of their child and postnatally was reasonable and required in the circumstances in which B's health was at significant risk. Therefore, we did not uphold C's complaints.

Summary

C complained on behalf of their adult child (A). A has received support for addiction from the partnership for a number of years. However, C complained that the partnership failed to provide evidence of a recovery plan, to explore all possible treatment options, unfairly stated A was difficult to engage with, and failed to reasonably communicate with C.

The partnership acknowledged that there had been a gap in the services provided to A due to staff absence and difficulty recruiting, however a recovery plan was in place for A.

We took independent advice from an adult psychiatry adviser. We found that the support provided to A was appropriate and reasonable and that there was a clear management plan in place. Despite the difficulties faced by the partnership in terms of staffing, we concluded that appropriate drug addiction support was provided to A and we did not uphold the complaint.

Summary

C complained about the level of supervision that their spouse (A) was provided with while they were detained in hospital under the Mental Health (Care and Treatment) (Scotland) Act 2003. A was diagnosed with bipolar affective disorder (a condition that affects a person's mood) and was noted to be disinhibited. A later told C that A had entered a patient’s room and had sexual intercourse with them. C acknowledged that this could not be corroborated by the board, but considered that the board had failed to address their concerns regarding the known issues of A’s disinhibited behaviour and them entering other patient’s rooms.

On the basis that there was no available evidence to establish the circumstances surrounding the alleged incident and whether there was any failure by ward staff to monitor A at that time, our consideration of this complaint was limited to reviewing whether the observation arrangements in place were reasonable and appropriate for minimising the risk of such an incident.

We took independent advice from a psychiatry adviser. We found that appropriate risk assessments were carried out throughout A’s admission. We were satisfied that A was given a level of supervision that was in-keeping with national guidance and their assessed risks at that time. In the circumstances, we did not uphold this complaint.

Summary

C complained about the care and treatment that their spouse (A) received from the board. A was diagnosed with colorectal cancer (bowel cancer) and underwent colon cancer surgery abroad, before returning to the UK. They were reviewed by the board’s oncology team (cancer specialist team) and it was determined that the cancer had spread and that chemotherapy was required.

Although A initially responded well to chemotherapy, once the chemotherapy course ended, the cancer was found to have spread further. A was not considered fit enough to undergo further chemotherapy and died.

C complained to the board that, following the positive indications, the board failed to communicate clearly with A and their family about their prognosis, treatment and next steps. C raised particular concerns that clinicians were unwilling to give information about the nature and extent of A’s deterioration, the sizes of tumours identified and information about the treatment that could be provided.

C considered that the board failed to provide A with appropriate treatment during their time in hospital and that these failures could have resulted in A not being able to recover sufficiently to undergo further chemotherapy. C was concerned that A suffered a series of issues related to their stoma site (opening in the body) and C complained that these issues were not treated with sufficient urgency or concern.

In response to the complaint, the board provided a detailed account of the care provided to A and their communication with A's family. The board acknowledged that A responded well to chemotherapy but once the first six cycles were complete, the cancer started to grow aggressively and A never regained the fitness required to restart treatment. The board explained that following further review of A, it was established that surgery was not an option for A and gave their view as regards the progression of A's illness and recurrent infections which necessitated admittance to hospital. Additionally, the board clarified their understanding with respect to the communication with A and their family and explained why they considered this to be reasonable in the circumstances.

We took independent advice from a senior clinical oncologist. We found that the assessment and treatment of A’s cancer during the period concerned was reasonable. We considered a period of care during which A experienced difficulties with respect to their stoma site and infections and considered the care provided to be reasonable in the circumstances. We found that whilst there were clearly difficulties with respect to communication between clinicians and the family, medical professionals tried to answer questions about A’s care and there was evidence of appropriate communication with the family.

With respect to the care and treatment provided to A, we found that an appropriate diagnosis was made, with a reasonable treatment plan and follow up testing to monitor the effectiveness of treatment. Despite initial good progress, A's cancer progressed and decisions made about A's treatment, including that A was not fit for surgery, were clear with demonstrable reasoning. A suffered difficulties with infections and complications which, again, were appropriately responded to and treated. Overall, the care and treatment provided to A was reasonable and in line with good practice. As such, we did not uphold the complaint.

With respect to communication with A and their family, the records demonstrated that A and their family asked a lot of questions to help their understanding. There was evidence of frustration on both sides regarding the level and extent of communication and information requested. There may have been opportunity for clinicians to consider and better manage the family’s expectations about the level of detail which could be provided about the treatment and prognosis. However, we found that the level of detail about A’s care and treatment was in line with what would reasonably be expected in the circumstances and we did not uphold this complaint.