Not upheld, no recommendations

Summary

C complained about the care provided to their late parent (A).

The practice visited in the morning and found them to be coherent and capable of declining a full examination. A's carers left around midday and did not have any specific concerns about A. By the evening, A's condition had deteriorated and they were taken to hospital. A died two days later.

We took independent advice from a GP adviser. We found that there was evidence of appropriate communication between the GPs and other professionals and agencies involved in A’s care. Therefore, we did not uphold the complaint.

Summary

C complained about the care and treatment a close family member (A) had received from the practice. A was admitted to hospital having suffered a heart attack and stroke. On further investigation masses were found on both of A’s ovaries, later confirmed to be ovarian cancer. A died a short time later.

C complained to the practice that they had not given proper consideration to A’s presenting symptoms and had missed opportunities to identify A’s cancer and start treatment sooner. C also complained that the practice had not given appropriate consideration to the family’s history of breast cancer or undertaken CA125 testing (blood test to check for raised levels of a protein called CA125, which is linked to ovarian cancer).

The practice apologised for being unable to detect A’s cancer at an earlier stage, noting ovarian cancer often only presents at a very advanced stage which had been the case for A. They explained a CA125 test had not been checked as the clinical information available at that time had not suggested malignancy. They also noted that a family history of breast cancer would not directly predispose to a risk of ovarian cancer in the absence of evidence of BRCA gene (specific mutations to this gene increase lifetime risk of cancer) positivity. They did not identify any substantive failings in A’s care and treatment, but agreed to use A’s case for reflective learning.

To investigate the handling of this complaint, we sought independent advice from a GP. We found that CA125 testing is not an effective screening tool for ovarian cancer. While A’s initial presentation at the practice had met the National Institute for Health and Care Excellence (NICE) criteria for considering checking CA125 levels, A had undergone further gynaecological review a few months later, which had suggested no evidence of an abdominal pelvic mass. Overall, we considered that the practice had not acted unreasonably in not identifying A’s malignant diagnosis prior to their presentation with a heart attack and stroke. Therefore, we did not uphold C’s complaint.

We did, however, provide feedback to the practice. We asked the practice to ensure relevant staff were familiar with the NICE criteria for considering checking CA125 levels, as well as the significant limitations of this test.

Summary

C complained to us about the medical and nursing care their late parent (A) received. A attended hospital for a bronchoscopy (a procedure to look directly at the airways in the lungs using a thin, lighted tube) and a biopsy (a medical test to determine the presence or extent of disease). A became unwell and was admitted. The biopsy result confirmed that A had cancer. It was considered A was not fit for treatment and a palliative approach to care was recommended. A’s condition worsened and they died in hospital.

C complained about aspects of A’s care and treatment. C also complained about the communication from medical staff. The board did not uphold C’s complaint but apologised because they felt that communication had been poor. C remained unhappy and escalated the complaint to us.

We took independent advice from a specialist in general medicine and in acute nursing. We found that A’s care and treatment was reasonable. We also found that the communication with C and A was reasonable. Therefore, we did not uphold C’s complaints. However, we did provide the board with feedback on telephone updates to patient’s families.

Summary

C complained about the length of time taken by their housing association to carry out repairs on their property and of them subsequently being substandard. C was concerned that the types and number of repairs required were indicative of subsidence and caused the property to fall below the tolerable standard for living. C also complained that the housing association had failed to take these matters into account when assigning points for their housing transfer application. On requesting a review of their transfer application by another organisation, C complained that their housing association failed to handover all of the necessary information.

We found that the housing association made reasonable attempts to timeously carry out the repairs on C’s home and had offered solutions to work around the needs of the tenants. To ease C’s concerns about subsidence, the housing association offered to request an independent survey of the property, however we found that this was not progressed due to difficulties agreeing a suitable time to access C’s home. We did not uphold this aspect of the complaint.

We also found that the housing association awarded points for their transfer request in accordance with their policies, and that they appropriately shared the necessary information with the other housing association. As such, we did not uphold these complaints.

Summary

C complained about the care and treatment that their grandparent (A) received at the Royal Infirmary Edinburgh (RIE). A was admitted to the RIE following a fall. Following a period of recovery, A was discharged to their home. A was subsequently readmitted to the RIE a short time later and died in hospital following this second admission.

C complained to the board about aspects of A’s care during their first admission to RIE, including the board’s management of A’s nutrition and hydration, the physiotherapy A received, and the planning for A’s discharge, but the board did not identify any failings.

We took independent advice from a geriatrician adviser. We found that the management of A’s nutrition and hydration, the provision of physiotherapy to A, and the planning for A’s discharge was reasonable. We did not uphold C’s complaints.

Summary

C complained on behalf of their partner (A) about the care and treatment provided by the board when A had hip replacement surgery. Specifically, C complained about the management of A’s pain in the post-operative period. The board acknowledged the discomfort experienced by A, but when it became apparent that surgeons could not manage A’s pain effectively, the Pain Management Team was involved. The board considered the care delivered following surgery, and in reducing medication after discharge, was reasonable.

We took independent advice from an anaesthetics and pain management adviser. We found that whilst pain management in the post-operative period is challenging, the board’s management of A’s pain was reasonable following surgery. We did not uphold this aspect of the complaint.

Additionally, we found that, with respect to reducing A’s medication, the advice provided by the board to A following discharge was appropriate. On this basis, we did not uphold this aspect of the complaint.

Summary

C was referred by their local health board ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) department to the general hospital for specialist eye surgery. C underwent a vitrectomy procedure (the surgical operation of removing the vitreous humour from the eyeball) which they felt was not managed appropriately as their retina was still detached following the procedure and they had to undergo further surgery from an independent health provider. The board felt that they had provided an appropriate standard of care and treatment to C.

We took independent clinical advice from an ophthalmology adviser. We found that there were no concerns about the standard of treatment which was provided to C. C had suffered a serious eye injury and although the retina was not fully reattached during surgery, this was a recognised complication of the surgery, and that further surgery would be required at some point. We did not uphold the complaint.

Summary

C complained that there was an avoidable delay by staff at a community hospital in referring them to the specialist clinic at the local general hospital when they suffered a detached retina. C attended four consultations at the community hospital before they were referred to the specialist clinic and they felt that the delay had had an adverse effect on their sight. The board maintained that appropriate treatment was provided.

We took independent advice from an ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) adviser. We found that the clinicians at the community hospital had taken advice from specialists at the general hospital and had monitored C’s condition by regular ultrasound scans. When C’s condition deteriorated and evidence of retinal detachment was found on a scan, C was referred to the specialist for continuing treatment. We therefore did not uphold the complaint.

Summary

C complained about treatment provided to their late parent (A) from the board during a hospital admission. C complained that A had been discharged from hospital when it had been unsafe to do so, that staff had failed to insert an intravenous line so that A could receive fluids, that A had developed a pressure sore on their sacrum (a bone in the spine), and that insufficient investigations had been carried out to establish the cause of A’s refusal of treatment.

The board stated that A had received fluids intravenously on admission but that their cannula (a tube that can be inserted into the body) had become blocked. Further unsuccessful attempts were made to reinsert the cannula before A declined any more attempts to be made. A also had refused to accept oral treatment and did not wish to undergo investigations to establish cause of their illness, preferring instead to be discharged home. The board also stated that A had been non-compliant and had not wished to change position in bed resulting in the development of a pressure sore, for which arrangements were put in place with district nurses upon A’s discharge.

We took independent advice from a consultant geriatrician. We found that the investigations the board had carried out to establish the cause of A’s illness had been reasonable as had the overall treatment provided during A’s admission. We noted that the records showed A had declined several attempts to treat their symptoms and carry out further investigations and that there was no evidence in the available records to indicate that A had lacked capacity to make decisions about the medical treatment that they wished to receive. In relation to A’s discharge, the records also showed that the board had requested an assessment of A to be carried out by their Integrated Assessment Team but that this could not be completed due to A leaving the hospital. We found that management of A’s pressure sore had reasonable.

For these reasons, we did not uphold the complaint.

Summary

C complained that the practice failed to provide their late spouse (A) with appropriate care and treatment. C said that GPs at the practice failed to see their partner at face to face consultations where they could observe their reported symptoms of facial weakness. Phone calls were made on a Friday and Monday but A was still not seen despite contacting the Out Of Hours Service (OOHS) at the weekend. A died a few days later of a stroke.

C felt that the practice should have seen A face to face rather than via telephone consultations. The practice believed that the GPs involved had provided A with appropriate care and treatment based on their reported symptoms at the time.

We took independent advice from an appropriately qualified adviser. We found that the practice had provided a reasonable level of care based on A’s reported symptoms. Therefore, we did not uphold the complaint but provided the practice with feedback concerning the standard of record keeping.