SPSO Individual Decisions

Ms C, who is an advocacy and support worker, complained on behalf of her client (Mrs B) about the care and treatment provided to Mrs B's son (Mr A) at the Royal Edinburgh Hospital. Mr A had a range of complex psychiatric and physical health conditions and spent long periods of time in hospital. Mr A's health deteriorated while he was in the hospital and he was transferred to another hospital for treatment and died the following day. Ms C complained that the board failed to provide Mr A with appropriate treatment for both his mental health and his physical health. She also complained that the board failed to respond appropriately to Mr A's deteriorating physical health in the two weeks leading up to his death. We took independent medical advice from a psychiatrist, a mental health nurse, and a consultant in general medicine. We found that Mr A received appropriate mental health treatment and that the board had followed the relevant guidelines. We did not uphold this part of the complaint. In terms of Mr A's physical health conditions, the psychiatric adviser said that a more systematic approach to assessing/managing Mr A's risk of infection should have been taken. We also found failings in Mr A's nursing care, including a failure to adequately complete charts to monitor his weight, food and fluid intake. We upheld this part of the complaint. On the events leading up to Mr A's death, we found that his deteriorating physical condition was not responded to adequately, on occasion, by nursing staff and that there was a delay in requesting a medical review. Based on the evidence provided, we upheld the complaint. However, the advisers said that the remedial action taken by the board in relation to this part of the complaint was reasonable and we therefore had no further recommendation to make regarding this aspect of the complaint.

Mr C complained about the care that his wife (Mrs A) received as a patient at both the Western General Hospital and Astley Ainslie Hospital. Mr C was unhappy that Mrs A was occasionally attended to by male nurses. Mr C also felt that Mrs A was given unreasonably high doses of medication. We took independent advice from a nurse. The adviser explained that male nurses routinely carry out the same care as female nurses, for both female and male patients. This includes personal care such as toileting and washing. The adviser reviewed Mrs A's medical records and found that it was reasonable in the circumstances for her to be attended to, on occasion, by male nurses. The adviser also found that Mrs A was not kept sedated and was given the recommended doses of medication. We did not uphold Mr C's complaints. Related reading View Decision Report 201609020 as a PDF (10.97 KB) Updated: December 2, 2018

Mr C was diagnosed with motor neurone disease (MND - a rare condition that progressively damages parts of the nervous system) a number of years ago, and his health has been regularly monitored since then. When his condition did not progress in the way that would be expected of MND he was sent to another consultant neurologist for a further opinion as to the likely cause of his symptoms. This consultant told Mr C that they did not think he had MND. Following that consultation he was seen a few months later by his regular consultant, although the notes from the previous consultation were not available at that time. Once Mr C's regular consultant had obtained the notes, they followed up with a letter to Mr C's GP. In this letter the consultant advised that Mr C was thought to have distal hereditary motor neuropathy (a progressive disorder that affects nerve cells in the spinal cord which results in muscle weakness and affects movement). The letter, a copy of which the GP provided to Mr C, contained a lot of medical terminology. Mr C contacted the consultant's secretary, saying he did not understand the new diagnosis and wanted more information. He hoped to have another appointment at which he could ask some questions, but was given a routine appointment for a year ahead. He was unhappy about the refusal of an earlier appointment, as the matter was causing some anxiety. He also wondered why it had taken so long to reach the new diagnosis. We took independent advice from a consultant neurologist, who considered the consultant's communications to have been clear and detailed. The adviser noted that a covering letter was sent out after Mr C expressed some confusion about the letter with a lot of medical terminology in it. The adviser considered that this covering letter could have been sent out with the inital letter. Although the adviser was not critical of the clinical care, they considered that it would have been better practice for the consultant to have a

Mrs C complained about the care and treatment provided to her late mother (Mrs A) by the practice. Mrs C complained that the practice failed to appropriately monitor and treat Mrs A's symptoms after she was diagnosed with a heart condition. Mrs A was referred to cardiology by the practice a number of years ago and was diagnosed with a heart condition known as mitral regurgitation (when blood back flows through a valve in the heart called the mitral valve). She was prescribed diuretic medication (also known as water tablets - tablets which can help reduce the fluid build up that can occur when the heart is not working normally). When Mrs A was reviewed by cardiology again two years later, the condition was noted to have resolved and the cardiology clinic advised that the diuretic medication could be reduced and stopped. In line with Mrs A's wishes, she continued to take the medication for a further three years before it was stopped when she was found to have low sodium levels. In the interim, Mrs A had also been given a steroid inhaler for suspected asthma. Mrs A suffered a heart attack and died less than two months after stopping the diuretic medication. Mrs C complained that stopping the diuretic medication contibuted to her mother's death. She raised concerns that closer monitoring of Mrs A's known heart condition did not occur. She also raised concerns that the steriod inhaler prescribed for breathlessness may have masked the underlying problems with Mrs A's heart. In particular, Mrs C did not consider that Mrs A received the appropriate attention required to properly identify the cause of the symptoms she presented with in the final months of her life. We took independent advice from a GP adviser. We found that the management of Mrs A's symptoms was reasonable. The adviser noted that the cause of the mitral regurgitation was never established and that, when it appeared to have resolved, no ongoing cardiology follow-up was arranged. Had heart valve d

Mrs C complained about the nursing care that her father (Mr A) received whilst he was an in-patient at the Western General Hospital. During his admission, Mr A developed a pressure ulcer and Mrs C was concerned that this was not maintained hygienically or to a reasonable standard. Additionally, Mrs C complained that her father's discharge home was unreasonably delayed by a member of nursing staff. We took independent advice from a nursing adviser. We found that Mr A's risk of developing a pressure ulcer had not been accurately assessed and that pressure ulcer care had not been provided in line with relevant guidance. The advice we received highlighted a number of issues with record-keeping in relation to pressure ulcer care and also hygiene, including that a wound assessment chart was not completed for Mr A. We also found that a pressure relieving mattress was not ordered for Mr A until he had already developed a pressure ulcer. There was also no evidence that appropriate specialist input was sought with regards to Mr A's care. We upheld Mrs C's complaint about maintaining Mr A's hygiene and the pressure ulcer. Regarding Mr A's discharge, the advice we received was that the delay of a few hours was reasonable as nursing staff were concerned that there may not have been anyone at home to be with Mr A when he arrived. We did identify communication issues around this, which were drawn to the board's attention, however, we found that the actions of nursing staff were reasonable and we did not uphold this aspect of Mrs C's complaint.

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her father (Mr A) who had fallen whilst coming out of the shower. Mr A was seen by three GPs from the practice over a two week period, who treated him for a knee injury. Mr A then called an out-of-hours service and was seen by a different GP. It was found he had a fractured hip and he was taken to hospital where a rod and pins were inserted into his leg. Mrs C felt the GPs at the practice had failed to diagnose the hip fracture. We took independent advice from an adviser in general practice medicine and concluded that at no time during the three GP consultations did Mr A complain of hip pain or hip injury and that there were no symptoms which indicated that his hip was fractured. There was also no report that he was unable to walk or bear weight which would have been an indication of a hip problem. We found that the GPs involved reasonably concluded from Mr A's reported symptoms that he had injured his knee and they provided appropriate treatment. We did not uphold the complaint. Related reading View Decision Report 201703692 as a PDF (11.14 KB) Updated: March 13, 2018

Ms C complained about the medical care and treatment and also the nursing care provided to her when she attended the emergency department at the Royal Infirmary of Edinburgh. Ms C was brought to the hospital by ambulance as she was short of breath and had asthma. She complained that the clinical care and treatment she received was not reasonable and that she was discharged when she was still unwell. We took independent advice from a consultant in emergency medicine and from a nursing adviser. We found that Ms C was carefully examined and that no abnormal findings were made. As such, we found that the medical care and treatment provided to Ms C had been reasonable, and that it was reasonable to discharge Ms C. We did not uphold this aspect of the complaint. We also found that the nursing care and treatment provided to Ms C at this attendance was reasonable. Therefore, we did not uphold this part of the complaint. Related reading View Decision Report 201609385 as a PDF (10.99 KB) Updated: March 13, 2018

Mr C sustained a burn to his lower left leg. He received treatment for his injury at the burns unit at St John's Hospital over a number of months. Mr C said that he did not have any feeling in his lower leg, had no movement in his left foot and that his lower leg was cold all the time. He said he was in constant pain and that the painkillers the board gave him did not work anymore. Mr C complained that when he asked the board to amputate his lower left leg, the board refused to do this. Mr C complained to us that the board's decision not to amputate his lower left leg was inappropriate. We took independent advice from a consultant vascular surgeon. The adviser said that the treatment and advice given to Mr C was appropriate, that it adhered to Scottish and UK guidelines and that there was no indication for amputation of Mr C's left leg. The adviser explained that a patient could not, in law, dictate an operation to a surgeon, and if a reasonable body of medical opinion agreed that an operation was not in the best interests of the patient, such an operation should not be performed on the patient's instructions alone. We considered that the board's decision not to amputate Mr C's lower left leg was reasonable and we did not uphold the complaint. Related reading View Decision Report 201606239 as a PDF (11.17 KB) Updated: March 13, 2018

Ms C's late partner (Ms A) was given drug treatment for multiple sclerosis (a condition which can affect the brain and/or spinal cord). During the treatment, Ms A experienced stomach pain. After this she was referred for tests and she was diagnosed with cancer. Ms A underwent surgery to treat the cancer, however her condition deteriorated after the surgery and she later died. Ms C complained that Ms A was not appropriately monitored during her multiple sclerosis treatment. Ms C considered there was a delay in diagnosing the cancer and that cancer treatment options were not fully discussed with Ms A. In addition, Ms C complained that the risk of surgery was not fully explained to Ms A and that the decision to go ahead with the surgery was unreasonable. Ms C also had concerns about the nursing care Ms A received after the surgery and about how the board dealt with her complaint. We took independent advice from a consultant neurologist, a consultant gynaecologist and a nurse. We found that Ms A was appropriately monitored during her multiple sclerosis treatment. We found that there was no unreasonable delay in diagnosing Ms A's cancer. We also found that the decision to proceed with surgery was appropriate and that the nursing care Ms A received afterwards was of a reasonable standard. Therefore, we did not uphold these aspects of Ms C's complaint. However, we did find that the discussions with Ms A about the cancer treatment options available to her were not properly recorded. We found that the consent form she signed for the surgery did not document all of the risks. We also found that the board did not respond appropriately to all of the concerns that Ms A raised and that there were delays in investigating the complaint, which the board had acknowledged. Therefore, we upheld these aspects of the complaint.

Mr C complained about the care and treatment he received from the board in relation to his mental health whilst he was in prison. We took independent advice on the complaint from a consultant psychiatrist. We found that the care and treatment provided to Mr C had been reasonable. He had received mental health nursing reviews, a full psychiatric assessment and had also seen a number of other healthcare staff. The management of his medication had also been reasonable. Whilst there had been a delay in arranging for Mr C to see a psychiatrist, we found that this was not unreasonable. He saw other healthcare staff during this period and they discussed his care with the psychiatrist and put interim measures in place. We did not uphold this aspect of Mr C's complaint. Mr C also complained that staff in the prison health centre failed to provide appropriate treatment in relation to his cellulitis (an infection of the deeper layers of skin and the underlying tissue). We took independent advice on this aspect of his complaint from a GP adviser. There was no evidence in Mr C's medical records that he had cellulitis, although the records showed that he had been treated for scabies. We found that the care and medication provided by the board in relation to scabies had been reasonable and we did not uphold this complaint. Finally, Mr C complained that the board had failed to respond appropriately to his complaints. We found that Mr C had made a large number of complaints. Whilst there had been some delays by the board in responding to these complaints, these delays had not been unreasonable. We considered that the board had issued a reasonable response to the issues Mr C had raised and did not uphold this aspect of the complaint. Related reading View Decision Report 201603637 as a PDF (11.29 KB) Updated: March 13, 2018

Mrs C underwent a pubovaginal sling procedure (a surgical procedure used to manage urinary incontinence) and a cystoscopy (a bladder examination using a narrow tube-like telescopic camera) to address her stress incontinence. She was reviewed a few months later, and she reported a loss of sensation and significant distress about the appearance of her scars. She was referred to plastic surgery to see if anything could be done about the scarring. Mrs C complained to the board about her treatment, and one month later she was advised that her complaint had been forwarded for investigation. Five months later Mrs C wrote to the board to raise concerns about the long wait for a response to her complaint. Upon receiving Mrs C's letter, the board discovered that her complaint had inadvertently been closed five months previously. Some weeks later, the board phoned Mrs C to explain that the complaint had been inadvertently closed and to discuss Mrs C's concerns about the delay in responding and her concerns about her treatment. The board then referred Mrs C to a different consultant urologist, and agreed that they would look into why the complaint had been closed. They also suggested that they would arrange an external review of the case, and they said that they would update Mrs C when they had further information. Despite phoning several times over a period of a further four months, Mrs C heard nothing from the board about her complaint. When she did manage to speak to the board again Mrs C asked to be sent a letter with the findings of the board's investigations. Mrs C did not receive a letter, and she then brought her complaints to us. Mrs C complained to us about the medical treatment she received and the board's handling of her complaint. We took independent advice from a urologist. We found that the treatment that had been carried out was reasonable, and that it had achieved the outcome of restoring continence, even though there were some problems with loss of

Mr C attended his dentist over a period of months for treatment for severe tooth pain. The dentist extracted one tooth and referred Mr C to the dental hospital to have a second tooth extracted. When Mr C attended the hospital, they identified a number of issues regarding his teeth. Mr C complained that his dentist had failed to provide the appropriate dental treatment and that, as a result, he had suffered with severe pain over a prolonged period of time. We took independent dental advice. The adviser noted that the dentist did not keep adequate clinical notes in accordance with the guidance published by the General Dental Council. The dentist also did not appear to carry out some of the more basic investigations available for determining the cause of dental pain, and he did not report the findings of an x-ray he took of his Mr C's teeth, which is a requirement of the Ionising Radiation (Medical Exposure) Regulations (2000). We upheld Mr C's complaint and made recommendations.

Mrs C complained to us about the care and treatment her husband (Mr A) had received from the board's evening district nursing service. Mrs C contacted us before we completed our investigation to say that she no longer wished to pursue the complaint, as the circumstances had changed. As such, we did not reach a decision on Mrs C's complaint. Related reading View Decision Report 201508214 as a PDF (10.73 KB) Updated: March 13, 2018

Mrs C's GP referred her to St John's Hospital for a blood transfusion because she was anaemic, had chest pains and was breathless. However, Mrs C said that when she was in the hospital the blood transfusion did not happen. She was discharged and told that an urgent endoscopy (a procedure where a tube-like instrument is put into the body to look inside) and colonoscopy (an examination of the bowel with a camera on a flexible tube) would be arranged for her. Mrs C said that she did not hear anything further and that the following month she was admitted to hospital again. She had a scan which showed a large tumour and she was diagnosed with bowel cancer. Mrs C complained that she was not properly cared for and treated during her first attendance at hospital. We took independent advice from a consultant gastroenterologist. We learned that Mrs C did not have a blood transfusion because her blood flow was not compromised and she showed no symptoms of active bleeding. While we found it was reasonable to discharge Mrs C home with plans for urgent endoscopic investigations, the board subsequently failed to deal with this as a matter of urgency. We found that this was unreasonable and we upheld Mrs C's complaint.

Miss C complained to us that, when she attended her local opticians, she reported symptoms of flashing lights in her left eye. The optometrist said there was nothing to worry about and did not offer her a follow-up appointment. When she saw another optometrist six months later, she was urgently referred to the eye hospital where it was discovered she was blind in her left eye. Miss C said that the first optometrist should have taken her concerns seriously. We took independent advice from an adviser in optometry and concluded that the first optometrist had provided a reasonable standard of care. This optometrist had seen Miss C on two occasions. At the first appointment there was no record that Miss C had reported flashes in her left eye. Her vision had deteriorated from her last annual check-up, however there was nothing to suggest that Miss C should have been referred to a hospital specialist at that time. At the second appointment two months later, it was noted that Miss C had reported flashes in her left eye and was worried about going blind. The optometrist offered to perform a dilated examination (detailed eye examination following administration of eye drops) but Miss C declined the offer. The adviser noted that although there was no explanation as to what the optometrist felt was the cause of the flashes, there was no clinical evidence of additional problems or a need for a specialist referral. We did not uphold the complaint. However, we found that the first optometrist should have arranged for Miss C to attend an earlier recall for the recent onset of flashes in line with the local referral protocol. This would have resulted in an earlier check-up, which would have been in advance of Miss C's appointment with the second optometrist. We offered some feedback on this to the opticians. Related reading View Decision Report 201609013 as a PDF (11.43 KB) Updated: March 13, 2018

Mr C complained to us about the failure of staff at the Royal Infirmary of Edinburgh to identify that he had sustained a fracture of his spine after a fall at home. It was only when Mr C attended an appointment with a clinician six months later that he was told about the fracture. Mr C wanted to know why the fracture was not identified sooner as this would have allowed him to receive additional treatment. We took independent advice on Mr C's complaint from an adviser in emergency department medicine and an adviser in radiology. We found that the imaging which was carried out when Mr C attended the hospital immediately after his fall showed subtle signs of a fracture of Mr C's spine. However, this was with the benefit of hindsight. We concluded that, due to the subtle findings which were evident, it was not unreasonable for the staff who reviewed the imaging at that time not to have identified the fracture. We did not uphold the complaint. Related reading View Decision Report 201700036 as a PDF (11.05 KB) Updated: March 13, 2018

Mr C complained that the time his son (child A) had to wait to have treatment by the child and adolescent mental health services (CAMHS) was unreasonable. Mr C also complained that the board failed to take into account all of child A's circumstances before reaching a decision to refuse a referral to CAMHS a number of years earlier. Mr C also raised concerns about the board's handling of his complaint. During our investigation we took independent advice from a CAMHS nurse. We found that whilst waiting times for CAMHS are long nationally, the government's waiting time target is for treatment to begin within 18 weeks of referral. In this case, child A had waited eight months from referral to treatment. We found this to be unreasonable. The board told us that families are encouraged to go back to the referrer whilst they are waiting for treatment if they are worried about a deterioration in a child's condition. However, we found no evidence that this had been communicated to Mr C or child A and we were critical of this. We upheld this aspect of Mr C's complaint. In relation to Mr C's complaint about the board refusing a referral for his son to CAMHS at an earlier date, we found that the referral letter did not mention any mental health concerns. We found the letter only mentioned issues such as family relations and behavioural problems, which would not normally be treated by CAMHS. We therefore found that it was reasonable for the board not to have accepted a CAMHS referral for child A at that time. We did not uphold this aspect of Mr C's complaint. We found that the board's handling of Mr C's complaint had been unreasonable. Whilst we considered the board to have taken reasonable steps to ensure patients are aware of the complaints process, we found that the board had failed to meet the 20 working day target for the full response to Mr C's complaint as set out by the Scottish Government's 'Can I help you?' guidance. The board stated that they considered th

Mrs C complained about her transvaginal tape (TVT) surgery not being performed appropriately at St John's Hospital, as she suffered heavy post-operative bleeding. Mrs C also complained that her post-operative bleeding was not treated appropriately at the Royal Infirmary of Edinburgh. In particular, Mrs C complained that she was given painful vaginal packing (an emergency treatment for excessive bleeding of the vagina) before she was referred for surgery to stop the bleeding. During our investigation we took independent advice from a consultant gynaecologist. We found that Mrs C had suffered a rare but well-recognised complication of surgery, which did not evidence that the TVT surgery was carried out improperly. The adviser considered that Mrs C was given appropriate treatment for her post-operative bleeding as it was reasonable to try conservative management to try to stop the bleeding before referring Mrs C for surgery. We did not uphold the complaint. However, the adviser considered that the consent form should have documented the risks of TVT surgery so we made a recommendation in light of our findings.

Mr C attended A&E at the Royal Infirmary of Edinburgh on two occasions. The first occasion was for constipation and increasing back pain. Mr C's second attendance was due to concern that he may have deep veinous thrombosis (a blood clot in a vein). Mr C complained that when he attended A&E, the board failed to provide him with reasonable nursing and medical care. He also complained about the way the board dealt with his complaint. In reply, the board said that Mr C had been treated in accordance with his symptoms and with national and local guidance. However, they apologised to Mr C for the delay in responding to his complaint. We took independent nursing and emergency medicine advice. We found that on his first attendance, Mr C was examined in a reasonable way and had been checked for any symptoms requiring urgent admission or imaging. None were present. We found that on his second attendance, the doctor failed to conduct a Wells test (a test to ascertain the risk of blood clot) and that the neurological examination of Mr C's lower limbs was not thorough or to a high standard. In light of these failings, we upheld the complaint and recommended that the board issue an apology to Mr C. Although the board had taken steps to address Mr C's complaint, they took 120 days to reply. The board's timeframe for responding to complaints is 20 days. We therefore upheld this aspect of Mr C's complaint.

Mrs C complained about the care and treatment her late husband (Mr A) received from his medical practice. She said that over an eight week period, staff at the practice failed to provide her husband with appropriate clinical treatment in view of his reported symptoms. Mrs C said her husband was subsequently diagnosed with terminal lung cancer and died shortly after. Mrs C complained that the practice failed to look at, examine and listen to her husband. She complained that they were dismissive and that they took too long to recognise how ill he was. She said her husband had a past diagnosis of cancer and that this should have alerted the practice to the possibility of a return of the cancer. We obtained independent advice on the case from a GP. We found that the care and treatment the practice provided to Mr A was appropriate. We found that Mr A's medical records did not evidence any failure in taking his history or in examining him, that Mr A's investigations and referrals were of a reasonable standard and there was not any significant delay in these being carried out. The adviser did not consider that a history of treated cancer 37 years earlier should have alerted the practice to consider an alternative diagnosis in Mr A's case. We found that Mr A's chest x-ray, taken in hospital approximately six weeks after Mr A first attended the practice, was normal with no evidence of lung cancer. We found his case records did not contain evidence of him reporting red flag symptoms or signs to either the GP or to the hospital doctor. We concluded that the practice did not fail to provide Mr A with appropriate clinical treatment in view of his reported symptoms and we did not uphold Mrs C's complaint. Related reading View Decision Report 201604553 as a PDF (11.39 KB) Updated: March 13, 2018

Mrs C complained on behalf of her late husband (Mr A) who was being treated for a brain tumour at Dumfries and Galloway Royal Infirmary. Mrs C enquired with the board about the methylated status of Mr A's brain tumour as she had learned that it was useful to know this in deciding whether to accept chemotherapy. (Methylation is a chemical change which alters the MGMT gene, making treatment more effective.) The board told Mrs C that this information was not available at the time she enquired. Mrs C complained that the board failed to perform a test to confirm the methylated status of Mr A's brain tumour. She also complained that the board failed to respond to her queries within a reasonable timescale. The board responded and advised that the test was not available in the board area at the time. In investigating Mrs C's complaint, the board carried out the test and it was found that the tumour was unmethylated. The board also confirmed that the methylation test is now carried out in all grade 3 and 4 gliomas (malignant tumours of the glial tissue of the nervous system) in the board area. We took independent advice from a consultant neurosurgeon. The adviser noted that knowing the methylation status of the tumour would have some bearing on the likelihood of the chemotherapy being effective. Our investigation found that even though the test was not routinely carried out by the board at the time Mr A was receiving treatment, the test could have been requested from another department. We also found the board failed to deal with Mrs C's complaints within the required timescale and they failed to advise her of their need to extend their response time. We upheld both of Mrs C's complaints and recommended that the board provide Mrs C with a written apology.

Ms C complained that her dentist failed to give her appropriate treatment. In particular, she complained that the dentist may have fractured the root of her tooth during root canal treatment. During our investigation we took independent advice from a dental surgeon. The adviser said that a root canal was the appropriate treatment for Ms C's tooth, and found that the root canal had been carried out appropriately, with Ms C's root fracture happening over a year later. We, therefore, did not uphold the complaint. Related reading View Decision Report 201606479 as a PDF (10.8 KB) Updated: March 13, 2018

Ms C complained that a dentist failed to carry out reasonable investigations to find the cause of her dental pain over the course of a year. She also complained that the dentist broke the root of her tooth and left it in her gum during the extraction of her tooth. We took independent advice from a dental surgeon and found that the dentist took reasonable steps to identify the cause of Ms C's dental pain, and that the delay was due to the time she had to wait for an appointment with a specialist. We did not uphold this aspect of the complaint. Whilst the adviser considered the tooth extraction was carried out properly, they felt that Ms C should have been advised that the likelihood of her tooth fracturing during the extraction was high, and offered a referral to a specialist to carry it out. We upheld this aspect of the complaint.

Mr C complained that his GP practice had unreasonably delayed in informing him that he had a stroke diagnosis. Mr C presented at the emergency department with symptoms that were initially considered to be consistent with Bell's Palsy (weakness down one side of the face sometimes due to nerve damage). Mr C had a history of labyrinthitis (inflammation of the inner ear) and was also vomiting and dizzy when he presented to the emergency department. Staff were satisfied that Mr C had responded well to treatment/medication at that time. Mr C was seen about four months later at the ear, nose and throat department (ENT) when a scan showed what appeared to be a lacunar infarct (a type of stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked). The practice printed the results of the scan but assumed that the ENT department would follow up the diagnosis and the results with Mr C. However, the registrar who had seen the scan had missed the significance of the diagnosis. Mr C was advised of the diagnosis two months later after asking at his practice why he was eligible for a flu jab. He complained that the practice had unreasonably delayed in informing him of the diagnosis after printing the results of the scan. We took independent GP advice. Despite the practice stating in their response to Mr C's complaint that they accepted they were partially responsible for following up the scan results due to the abnormalities identified (although they felt that ENT should have followed up on the results with him), we found that the practice could not be held responsible for the failure of the ENT department to follow up on the scan results or the failure to refer management of the findings back to the practice. As a result, we did not uphold the complaint by Mr C although we did make a recommendation.

Mrs C complained on behalf of her late husband (Mr A) about the orthopaedic care he received at the Royal Infirmary of Edinburgh and about the length of time it took for the board to respond to the complaint. Mrs C complained that the board unreasonably failed to offer Mr A the opportunity to obtain a second opinion within the NHS, that they unreasonably failed to arrange a scan and that they failed to respond to complaints in a timely manner. We took independent advice from an orthopaedic adviser. Although the board had said that Mr C had preferred to be seen privately for a second opinion, we did not identify sufficient evidence to indicate whether any discussion had taken place around the option of an NHS referral for a second opinion. We upheld this aspect of the complaint. We considered that the standard of Mr C's assessment by the orthopaedic staff at the hospital was of an entirely reasonable standard where an accurate diagnosis was reached without the need to perform a scan to confirm this. We did not uphold this aspect of the complaint. We found that the board had appropriately apologised for the time taken to respond to the complaint and have since accepted the delay was unreasonable. We also identified that they did not provide proactive updates regarding the delay or inform Mr C of his right to contact this office after the 20 working day response time was exceeded. We upheld this aspect of the complaint.