SPSO Individual Decisions

Mr C complained about a dentist's failed attempts to restore his broken tooth with a white composite filling. The filling fell out a week later and was replaced but unfortunately it failed again and fell out two days later. The option of fitting a crown was discussed but Mr C did not consider that he should have to contribute to the cost of this. He subsequently changed dentist and requested that the cost of subsequent treatment under the new dentist was reimbursed. We took independent advice from a dentist. We found that the treatment provided in attempting to restore Mr C's broken tooth was reasonable and in line with standard clinical practice. The dentist had no obligation to contribute to the cost of any treatment Mr C received from his new dentist. Therefore, we did not uphold the complaint. Mr C also complained about concurrent root canal treatment he was undergoing on a different tooth. This was carried out over several visits and, at the second visit, the dentist temporarily restored the tooth and booked Mr C a further appointment. However, Mr C reported that the tooth broke around four hours later when he was eating soft food. We found that the treatment provided was reasonable and in line with normal clinical practice. There was no evidence to support Mr C's concerns that failings in his treatment contributed to the tooth breaking a few hours later, and did not consider that the quality of this treatment should be associated with the subsequent extraction of the tooth by the new dentist. We did not uphold the complaint. Related reading View Decision Report 201803462 as a PDF (24.44 KB) Updated: March 18, 2020

Ms C complained to us about the care and treatment she received at University Hospital Ayr. Ms C underwent total hip replacement surgery (a surgical procedure where a damaged hip joint is replaced with an artificial one) on both hips. Ms C raised concerns that the risks of each surgery were not communicated appropriately to her; there were failings in carrying them out, which caused her to experience pain and mobility issues; and her post-surgical care was unreasonable. We took independent advice from a medical adviser who is a consultant orthopaedic and trauma surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). For both surgeries, we found no evidence of failings in carrying them out. We found that Ms C experienced recognised complications of total hip replacement surgery. We also found that Ms C's post-surgical care was reasonable. However, we found that there was no evidence Ms C was appropriately informed of the risks involved in each surgery during the consent process. Therefore, we upheld Ms C's complaints.

Mrs C complained about the care of her late father (Mr A) at University Hospital Ayr. Mr A underwent surgery to remove bowel cancer and required further surgery due to a complication. He remained unwell thereafter and, due to his poor nutrition and weight loss, a decision was made to start nasogastric (NG) tube feeding (where a tube is placed through the nose into the stomach). However, the NG tube was mistakenly inserted into Mr A’s lungs instead of his stomach and this was not recognised prior to commencement of NG feeding. This error caused a severe deterioration in Mr A’s condition and he died just over a week later. The board carried out a Significant Adverse Event Review (SAER) and the Crown Office and Procurator Fiscal Service (COPFS) also looked into the circumstances of the death. As Mrs C was unhappy with the outcome of the board’s SAER and response to her subsequent complaint, she contacted the SPSO. We took independent advice from a consultant gastroenterologist (a physician who specialises inthe diagnosis and treatment of disorders of the stomach and intestines)(a physician who specialises inthe diagnosis and treatment of disorders of the stomach and intestines). We considered that the board’s SAER process was reasonable and recommended appropriate policy changes to prevent a similar future recurrence. It was identified that there were some departures from existing policy but these did not contribute to Mr A’s death. These included record-keeping deficiencies and a failure to take all advised steps to obtain an aspirate (where a small amount of stomach content is sucked through the tube and the acidity checked to confirm correct placement of the tube). As the tube was incorrectly placed in this case, the further advised steps would have been unsuccessful anyway and an x-ray would still have been required. The significant failing was a consultant surgeon’s incorrect interpretation of the x-ray and consequent failure to identify the misplacemen

Miss C complained about the clinical and nursing care and treatment given to her late father (Mr A). We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and from a nursing adviser. In relation to the clinical care and treatment, we found that the clinical records evidenced that an appropriate assessment of Mr A was carried out and that reasonable efforts were made by clinical staff to treat Mr A's condition. We found that, overall, the clinical care and treatment given to Mr A was reasonable and we did not uphold this aspect of the complaint. In relation to the nursing care and treatment given to Mr A, we found that the nursing records were of a reasonable standard and that they demonstrated that there had been a risk-based assessment of Mr A. There was also evidence of care planning related to the level of risk and ongoing documentation around delivery of daily care for Mr A. However, we found that the documentation around the injury to Mr A's foot could have been better and we drew this to the board's attention. On balance, we found that the nursing care and treatment was reasonable and did not uphold this aspect of the complaint. Lastly, Miss C complained about the communication from the hospital with her and her family. We found that the clinical records demonstrated an appropriate level of communication and we did not uphold the complaint. Related reading View Decision Report 201802170 as a PDF (23.91 KB) Updated: October 23, 2019

Ms C complained about the care and treatment provided to her by Crosshouse Hospital both during and after her pregnancy. She felt that she was not monitored appropriately during pregnancy and that her concerns had not been taken seriously. She also raised concern that she had requested a caesarean section but this had been denied, and that planning for delivery had not been reasonable. We took independent advice from a midwife and an obstetrician (a doctor specialising in pregnancy and childbirth). We noted that there was an inappropriate remark recorded in Ms C's records by a midwife and we made a recommendation to the board about this. We found that, whilst many aspects of the care and treatment provided to Ms C were reasonable, there was a failure to take appropriate and timely action when Ms C presented with polyhydramnios (increased fluid) and accelerated foetal growth. Therefore, we upheld this aspect of Ms C's complaint. In relation to Ms C's concerns about post-pregnancy care, we found that this was appropriate and in line with standard practice. Therefore, we did not uphold this aspect of Ms C's complaint.

Mr C complained about the care and treatment he received at Ayr Hospital. Mr C attended the orthopaedic department (specialising in the treatment of disease and injury of the musculoskeletal system) in relation to knee pain. He had surgery but despite that he continued to experience pain. Mr C was unhappy because he was discharged by the consultant without his pain being fully investigated. We took independent advice from an orthopaedic consultant. We found that the standard of care that Mr C received for his knee was reasonable and that post-operative follow-up was appropriate. Therefore, we did not uphold this aspect of the complaint. In addition, Mr C became aware of comments written in his clinical record by the consultant which Mr C described as slanderous. We found that the language used was unreasonable, inappropriate and unfair. However, we noted that the consultant had apologised to Mr C and had reflected on the fact that the language used was open to misinterpretation. We upheld this aspect of the complaint.

Mrs C complained about the care of her child (Child A) in Ayrshire Central Hospital. In particular, she complained that Child A was prescribed antihistamine medication as a sleep aid, without proper instruction or explanation of potential side effects. A meeting was held but Mrs C did not consider that the board's subsequent written response reflected the detail of what was discussed. The full findings and decision outcome were not detailed or explained in the response. Neither was the action plan that the board had put in place. The response did not comply with the requirements of the NHS Complaint Handling Procedure and we referred the matter back to the board for further work. Following the board's further response we investigated whether the actions in prescribing medication were reasonable and whether the board's handling of the complaint was unreasonable or not. We took independent advice from a consultant paediatrician (consultant specialising in the medical care of children) and concluded that clinicians acted reasonably in assessing Child A for prescription medication. We did not uphold this aspect of the complaint, however, we provided feedback to the board that medical records should reflect all discussions regarding a patient's care and that those records should be legible. With respect to the handling of the complaint, we found that the board unreasonably failed to respond to Mrs C's initial complaint, and also failed to provide adequate detail in their response following the involvement of our office. We identified that the board had failed to produce a report of their investigations, communicate whether the complaint was upheld or not, and did not keep Mrs C adequately updated as to their progress. We upheld the complaint and made recommendations with respect to ensuring that the board take actions to implement recommendations from a previous case we investigated.

Mrs C's mother (Mrs A) was transferred to hospital by ambulance with low oxygen levels. Mrs C had a power of attorney (POA) in place, enabling her to make decisions on Mrs A's behalf. Mrs A was admitted to hospital and the following day medical professionals spoke with her regarding a 'do not attempt cardiopulmonary resuscitation' (DNACPR) agreement, without first consulting Mrs C. Mrs C complained to the board that it was inappropriate for medical professionals to speak with Mrs A regarding the DNACPR as she had dementia and did not understand what was being said. Mrs C also complained about the lack of knowledge of the POA that was in place. In their response, the board explained that it was a priority to complete a DNACPR given Mrs A's deteriorating condition, and it was appropriate in the circumstances to discuss this with her. The board said that they were aware of the POA and this was appropriately recorded in Mrs A's medical records. Mrs C complained that the board's actions in implementing a DNACPR were unreasonable, that they unreasonably failed to clearly record in Mrs A's records that a POA was in place and that the handling of the complaint was unreasonable. We took advice from an independent medical adviser. With respect to the actions in implementing the DNACPR, we found that given Mrs A's state of health on admission to hospital, it was appropriate for medical professionals to consider a DNACPR and discuss this with Mrs A. Whilst there were concerns about Mrs A's capacity, the records indicated that this was considered by medical professionals. It was reasonable for medical staff to decide DNACPR was required and that Mrs A had capacity at the time to be involved in the discussions. We did not uphold this complaint. With respect to the complaint that the POA was not clearly recorded in the file, we found that at the time of Mrs C's complaint, the board were unable to locate a copy of the POA on file. Whilst the medical notes showed the medi

Mrs C complained on behalf of her daughter (Miss A) about the care and treatment she received for ongoing ear problems. Miss A had received care and treatment at Crosshouse Hospital over a number of years. Mrs C complained about information that was shared with her about Miss A at an Ear Nose and Throat (ENT) clinic consultation, specifically that Miss A might be putting fake blood in her ear; the decision to cancel another opinion; and the decision to discharge Miss A from the ENT service and refer her to mental health services. Mrs C also complained about the length of time it took the board to respond to her complaint. We took independent advice from a consultant ENT surgeon. We considered that it was reasonable to consider the possibility of a psychological factor, cancel the third opinion, and refer Miss A to mental health services, on the basis that extensive investigations and treatments had not identified a physiological disorder. We also noted that Miss A had not been discharged from the ENT service but had been referred to mental health services. However, we found that there was no definitive evidence to clearly show that a fluid sample taken was in fact fake blood. In addition, we considered that the way in which the matter was approached with the family could have been more appropriately dealt with by mental health staff or at the very least their opinion should have been sought in the first instance. We considered that elements of Miss A's care and treatment were not handled reasonably and we upheld this aspect of Mrs C's complaint. In relation to complaint handling, we found that the board had not responded to Mrs C's complaints correspondence within the 20 working day timescale. Mrs C was advised on two occasions that this may not be possible. We considered that this was reasonable given the board would have needed to review a number of years of care and treatment. However, we were critical that there were many occasions where Mrs C had to

Mr C complained about the treatment his wife (Mrs A) received from the board for breast cancer. Mrs A attended University Hospital Crosshouse where she was diagnosed with breast cancer and underwent chemotherapy (a treatment where medicine is used to kill cancerous cells), surgery and radiotherapy (a treatment using high-energy radiation). Mrs A was later diagnosed with metastatic breast cancer (cancer that spreads to other parts of the body) and died. Mr C complained that Mrs A did not receive appropriate treatment, that an alternative surgery would have provided a better outcome and that the treatment provided was experimental. We took independent advice from a consultant clinical oncologist (cancer specialist). We found that Mrs A's treatment by the board was reasonable and found no failings in the treatment offered. Therefore, we did not uphold Mr C's complaint. However, during the consideration of the complaint we found there were factual errors in the board's complaint response. We made a recommendation under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Ms C complained about the care and treatment her husband (Mr A) received from the board at University Hospital Crosshouse. Ms C complained that there was a delay in diagnosing and treating Mr A's squamous cell carcinoma (a type of cancer of the skin's cells). Mr A had been under the care of the board, as he had a suspicious area of damage on his tongue. Mr A was later diagnosed with cancer in his tongue, which had spread to his neck. Mr A's cancer appeared to have been successfully treated with surgery and chemo-radiotherapy (where drugs and high-energy waves are used to treat cancer cells), however, Mr A's cancer was later found to have returned and spread further. Mr A died of widespread cancer later that year. We took independent advice from a consultant ear, nose and throat (ENT) and head & neck surgeon. We found that there was an unreasonable delay in telling Mr A he might have cancer in his tongue and in carrying out surgery on Mr A's tongue, once the decision to treat it had been made. We also found that when Mr A later complained of pain in his shoulder, this should have been noted in his medical records and it was not. Therefore, we upheld Ms C's complaint.

Miss C complained about the care provided to her late mother (Mrs A) at University Hospital Ayr. Mrs A was receiving dialysis (a treatment which mimics many of the kidney's functions). Miss C complained about the care provided to her mother in relation to an arteriovenous fistula (a blood vessel created in the arm for transferring blood into the dialysis machine and back again) following a dialysis session. Miss C considered that the interruption in her mother's normal dialysis routine as a result of the fistula problems impacted on her renal (relating to the kidneys) care and her overall deterioration. We took independent advice from a consultant physician with experience in dialysis. We found that the care provided in relation to the insertion of the needles at the fistula was reasonable. We found that the most likely cause of extensive bruising to Mrs A's arm was caused by a pseudoaneurysm (a collection of blood that forms behind the two outer layers of an artery) behind the fistula and that the cause of the bleed was difficult to determine. We also found that, given the condition of Mrs A's arm, the decision to the continue with dialysis using a permcath (a type of venous catheter) was the most appropriate treatment option and that there was no unreasonable delay in changing to this option. We found that the interruption to Mrs A's normal dialysis routine as a result of the fistula problems did not impact on her renal care and her overall deterioration. We did not uphold Miss C's complaint. Related reading View Decision Report 201700711 as a PDF (24.04 KB) Updated: March 20, 2019

Ms C and Ms C raised their concerns about the care and treatment their late mother (Mrs A) received when she was admitted to University Hospital Crosshouse, in particular, about the clinical and nursing care and treatment Mrs A received. They also complained about the communication with their family and that the board had failed to handle their complaint in a reasonable way. We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) and a nursing adviser. We found that there had been a failure to identify how unwell Mrs A was and a delay in initiating a higher level of care. We considered that the clinical care Mrs A received was unreasonable and upheld this complaint. However, we noted that it was possible that Mrs A would have died even with appropriate care, given the severity of her illness. In relation to the nursing care given to Mrs A, the board acknowledged that Mrs A would have found it difficult to use the call system. As a result of a fall that Mrs A had suffered, the board staff had been advised that all patients with any degree of cognitive impairment should not be left unassisted within the ward where they could not been directly seen by nursing staff. We were satisfied with the action taken by the board. We also found no failings on the part of nursing staff regarding Mrs A's dehydration and dietary intake, medicine administration and Mrs A's personal care. Therefore, we did not uphold this aspect of the complaint. In relation to communication, while we found there was evidence of some good communication, we found that overall the communication was poor, particulary after it was clear to medical staff that Mrs A's condition had deteriorated. We also found failings in relation to the communication surrounding the Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision. Therefore, we upheld this aspect of the complaint. Finally, in relation to complaint handling, we found that the boa

Mr C complained that his shoulder dislocations went undiagnosed for around eight months after he attended the emergency department on a number of occasions at Crosshouse Hospital and during an in-patient stay. After Mr C's shoulder dislocations were identified at an orthopaedic (the branch of medicine specialising in the treatment of diseases and injuries of the musculoskeletal system) clinic appointment, he underwent shoulder replacement surgery. Mr C also complained that he was not informed about heart problems he experienced whilst he was an in-patient and that the board failed to handle his complaint appropriately. We took independent advice from a consultant in emergency medicine and a consultant in acute medicine. We found that the board had acknowledged that Mr C's injury should have been picked up during his admission and had apologised to him. The board also took steps to share Mr C's case with medical staff for learning and improvement. However, we found that there was no evidence to demonstrate that Mr C's shoulders had been examined on one occasion when he had attended the emergency department. In terms of Mr C's concerns that he was not informed about the heart problem he suffered during his admission, we found that there was no records to show that this had been explained to him and understood given he had memory loss. In relation to the board's handling of Mr C's complaint, we found that the board took ten months to respond. We acknowledged that Mr C's case was complex, however, we considered that this delay was unreasonable. We also found that the board took four months to arrange a meeting to discuss his complaint and that the written response lacked detailed explanation. We upheld all of Mr C's complaints.

Mrs C complained about the care and treatment that was provided to her at University Hospital Crosshouse for a melanoma in situ (an early stage of skin cancer where the cancer cells are in the top layer of skin) on her face. Mrs C was concerned that the consent process for the procedure to remove the melanoma was inadequate, as she had been unaware that she would be left with a scar far larger than the area of skin removed. Mrs C complained about the procedure that was carried out and considered that the overall handling of her complaint was unreasonable. We took independent advice from a consultant maxillofacial surgeon (a doctor who specialises in treating diseases and injuries to the mouth, jaws, face and neck). We found that the procedure carried out to remove the melanoma in situ was appropriate for Mrs C and there were no concerns about the standard of the surgery itself. However, we found that the consent process had been inadequate and that the operation note was not sufficiently detailed. Neither of these records included a diagram to aid understanding of the procedure, and there was no evidence that the extent of the wound Mrs C would be left with had been discussed before the surgery. The advice also highlighted that, despite the fact that the melanoma in situ was in a cosmetically sensitive area on Mrs C's face, no photographs were taken prior to initial investigations. We upheld Mrs C's complaint about care and treatment. In relation to complaints handling, we found that the board had not responded within the 20 working day target and that Mrs C had not been kept timeously updated. We upheld this complaint.

Mr C complained to us about two periods when his brother (Mr A) was admitted to University Hospital Crosshouse. During these admissions, legislation contained in the Adults with Incapacity (Scotland) Act 2000 was utilised by the clinical team as they considered Mr A unable to consent or make decisions on treatment. Mr C complained that the Adults with Incapacity legislation was not used appropriately and that its use was not communicated reasonably to Mr A and his family. In addition to this, Mr C complained about the general level of care and treatment provided during Mr A's admissions. We took independent advice from an adviser who is a registered medical practitioner with a background in psychiatry. We found that, given Mr A's circumstances during his admissions, the use of Adults with Incapacity legislation was reasonable. In addition to this, we did not identify any concerns about the general level of care provided, although we acknowledged that Mr A's experience may have differed from the information contained in the relevant documentation. However, we identified shortcomings in relations to the recording and documentation of the use of Adults with Incapacity legislation. In addition to this, there was evidence of gaps in understanding of the Adults with Incapacity Act on a practical level, with factually incorrect information being provided on at least one occassion. Therefore, although it may have been appropriate to utilise Adults with Incapacity legislation, we concluded that there were service failings relating to the understanding of the legislation, the documentation of its use and the resulting communication with Mr A and his family. Therefore, we upheld Mr C's complaint.

Miss C complained that she was unreasonably refused treatment in A&E at University Hospital Ayr. She said that staff referred her back to her GP as she was already receiving treatment for the same medical condition. We took independent advice from an experienced practitioner in emergency medicine. We found that Miss C was appropriately assessed in A&E and did not have a life threatening illness or injury that required hospital admission or referral to another hospital specialist. We found that the appropriate route for Miss C was to report her health problems to her GP. We did not uphold Miss C's complaint. Related reading View Decision Report 201801382 as a PDF (10.88 KB) Updated: December 2, 2018

Mrs C complained about the care and treatment provided to her late mother (Ms  A) at Woodland View. Ms A was transferred there for rehabilitation after several weeks in hospital, where she was treated for recurrent urinary tract infections (UTIs), and delirium. Ms A suffered further UTIs and did not make progress with her medication. She was transferred to a mental health ward for treatment of her delirium, low mood and physical symptoms. Ms A also had a background history of bipolar disorder (a mental health condition marked by alternating periods of elation and depression). Ms A's condition deteriorated further and she was transferred back to hospital with aspiration pneumonia (a  type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs). She was given palliative care and died in hospital. Mrs C complained that there was inadequate care planning to manage Ms A's delirium and UTIs. She felt staff focussed on Ms A's age and bipolar disorder as an explanation for her condition and did not fully appreciate the impact of the UTIs and delirium. Mrs C was also concerned about the way the hospital and ward transitions were managed, and about Ms A's overall care and treatment. Mrs C said she was not involved in care planning and decisions, despite being Ms A's carer and welfare power of attorney, and she felt some nursing staff were hostile or resistant when she made suggestions for Ms A's care. The board met with Mrs C when she first complained (during Ms A's admission) and a number of actions were agreed, but Mrs C said these were never completed. The board also gave a written response to Mrs C's later complaint (following Ms A's transfer back to hospital). Mrs C was unhappy with this response and brought her complaint to us. We took independent advice from a mental health nurse. We found there was a lack of proactive care planning for Ms A's UTIs and delirium at times, and Ms A had also had an

Mr C complained about his care and treatment when he attended Crosshouse Hospital after experiencing stroke-like symptoms. Mr C was taken to the emergency department (ED) and was told he would be admitted to a ward but he was discharged a few hours later. Mr C suffered a seizure later that day and was returned to hospital by ambulance. He was admitted to the high dependency unit and kept in for two days for investigations. Mr C complained that it was not reasonable for staff to discharge him when he first attended. He was concerned he was not monitored frequently and that staff did not give him a clear explanation or diagnosis. The board acknowledged that nurses should have recorded more frequent ward rounds and apologised for this. However, they explained that Mr C was also kept under observation via electronic monitors. The board considered that the medical care and treatment was reasonable. Mr C was unhappy with this response and brought his complaint to us. We took independent advice from a consultant in emergency medicine, a consultant in general medicine and a nurse. We found that Mr C was given prompt treatment for tonsillitis (inflammation of the tonsils) and suspected meningitis (infection of the coverings of the brain). We noted that this was investigated further but it was found that he did not have meningitis. Mr C was followed up by the neurology department (branch of medicine that deals with the anatomy, functions, and disorders of nerves and the nervous system) after his discharge and was diagnosed with hemiplegic migraine (a rare and serious type of migraine that has symptoms similar to those of a stroke). We considered that Mr C's medical care and the decision to discharge him was reasonable. We did not uphold these aspects of Mr C's complaint. In relation to the nursing care Mr C received, we found that nurses had not clearly recorded what action was taken when he had a high National Early Warning Score (NEWS, an indicator of a patient

Mr C attended University Hospital Crosshouse after sustaining a tear in the anterior cruciate ligament (a ligament in the knee) and damaged cartilage (connective tissue). Mr C complained that the board took too long to provide appropriate treatment following a referral from his GP, failed to provide a reasonable standard of treatment and failed to communicate reasonably with him about his condition and treatment. In relation to the treatment time, we found that the board had breached the treatment time guarantee of 12 weeks and considered that this was unreasonable. We upheld this aspect of Mr C's complaint. In relation to Mr C's treatment, we took independent advice from a consultant orthopaedic surgeon (a surgeon who diagnoses and treats a wide range of conditions of the musculoskeletal system). We found that the original injury Mr  C sustained to the knee appeared to be significant but that he had also sustained further injury to the knee while waiting for surgery. However, no updated scan of Mr C's knee was performed and the first time that Mr C was examined by the surgeon under the anaesthetic was when the situation was found to be more complex. The surgery did not proceed and Mr C required to be referred to another specialist for surgery. We considered that there was a failure to provide Mr C with a reasonable standard of treatment and upheld this aspect of his complaint. Finally, we found that the board could have been more proactive about communicating with Mr C and should have ensured that their response was mindful of the relevant legislation and guidance. Therefore, we considered that the board failed to communicate reasonably with Mr C and upheld this aspect of his complaint.

Mrs C complained to us that the practice had failed to provide appropriate care and treatment to her late daughter (Miss A). Miss A had attended the practice with her partner and had reported symptoms of severe headaches, tiredness and constantly dropping items from her left hand. The GP took Miss A's blood pressure and gave her a vitamin injection. Miss A died at home the following day. We took independent advice from a GP adviser. We found that the doctor should have arranged further investigations of Miss A's weakness and dropping items with her left hand as this was a new symptom. The doctor should have arranged for an urgent review by a stroke specialist to establish if there were signs of a Transient Ischaemic Attack (a mini stroke) which was a risk factor for subsequent stroke or myocardial infarction (heart attack). However, we found that the doctor had carried out a reasonable assessment and examination which was in line with national guidance. There was no indication at that time that Miss A required an urgent hospital admission. Miss A had a complex medical history and her symptoms of high blood pressure, headache and tiredness were longstanding. On balance, we took the view that the doctor provided reasonable treatment and we did not uphold the complaint. Whilst we did not uphold the complaint we provided feedback to the doctor that they should review the standard of their record-keeping and refresh their knowledge about the presenting symptoms of a Transient Ischaemic Attack. Related reading View Decision Report 201800568 as a PDF (11.35 KB) Updated: December 2, 2018

Mr C complained about the care and treatment his late wife (Mrs A) received at University Hospital Crosshouse. In particular, Mr C complained that Mrs A's medication had been changed and that she had not been provided with a reasonable standard of clinical care and treatment during two admissions to the hospital. We took advice from a consultant hepatologist and gastroenterologist (a  specialist in the diagnosis and treatment of disorders of the digestive tract and liver). We found that it had been reasonable to have treated Mrs A with strong immunosuppressants (a drug that can suppress or prevent the immune response) and that the change in her medication was reasonable. We did not uphold this aspect of Mr C's complaint. In relation to both of Mrs A's hospital admissions, we found that the management of her care and treatment had been reasonable. We also noted that, during her first admission, Mrs A was booked in for an ultrasound scan as an out-patient, with an ear, nose and throat review afterwards. We considered that this action was reasonable and in line with national guidelines. We did not uphold Mr C's complaints. Related reading View Decision Report 201705203 as a PDF (11.13 KB) Updated: December 2, 2018

Mrs C complained about the care and treatment provided to her late mother (Mrs A) while she was a patient at two different hospitals. Mrs A was admitted to University Hospital Crosshouse with a hip fracture following a fall at home. Mrs A was then transferred to Ayrshire Central Hospital for rehabilitation and physiotherapy. While she was there, Mrs A had a fall and hit her head. Mrs A was then transferred back to University Hospital Crosshouse. Mrs C was concerned about the medical treatment Mrs A received at University Hospital Crosshouse and the nursing care she received at Ayrshire Central Hospital. Regarding Mrs A’s medical treatment, Mrs C complained about the length of time it took the board to carry out a test to see if Mrs A had deep vein thrombosis (DVT, a blood clot in a vein). We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that the board did not consider the cause of Mrs A’s initial fall and that Mrs A was not seen by a geriatrician during her first admission. We found that there was an unreasonable delay in ordering and performing a scan of Mrs A’s leg. When it was suspected that Mrs A had a clot in her leg, Mrs A’s dose of dalteparin (medication that helps to reduce the risk of blood clotting in the legs) was increased from a preventative dose to a treatment dose. Mrs A received clopidogrel (medication to prevent clots that cause strokes and heart attacks) at the same time as the treatment dose of dalteparin. We found that it was unreasonable that Mrs A’s clopidogrel medication was not stopped at the same time that the dose of dalteparin was increased. We upheld this aspect of Mrs C's complaint. Mrs C had a number of concerns about the nursing care provided to Mrs A, in particular about the communication from nursing staff, that Mrs A’s care needs and preferences were not taken into consideration, that adequate pain relief was not provided to Mrs A, that steps were not taken to

Mr C was admitted to University Hospital Crosshouse with pain in his side, where he received scans and tests. He was discharged three days later with a diagnosis of non-specific abdominal pain. Mr C was admitted to hospital again a number of months later when he was diagnosed with acute appendicitis (inflammation of the appendix). Mr C complained that there was a failure to diagnose the appendicitis on his first admission. We took independent advice from a surgeon. We found that there were clear symptoms that Mr C had appendicitis on his first admission. We found that, at a minimum, Mr C should have been alerted to the possibility of appendicitis and made aware of the symptoms to look out for. We upheld this aspect of Mr C's complaint. Mr C also complained that the board did not provide a reasonable response to his complaint. We found that the response from the board failed to reasonably acknowledge that Mr C had symptoms of appendicitis on his first admission. We also considered that the board's complaint response failed to reasonably explain why Mr C was given a different diagnosis and why no follow-up appointment was arranged. We upheld this aspect of the complaint.

Mr C made a number of complaints about the care and treatment that his late wife (Mrs A) received in University Hospital Crosshouse. Mrs A had a complex medical history and was admitted in relation to a skin condition. Mrs A became increasingly unwell during her admission and developed hospital acquired pneumonia (an infection of the lungs). Mr C complained about the nursing care that Mrs A received. Mr C also complained about the medical care that Mrs A received in relation to the insertion of a central line (a tube placed by needle into a large, central vein in the body to administer drugs or take blood samples), prescription/management of fluids, how she came to develop hospital acquired pneumonia and the prescription of pain relief. Mr C was also concerned about the DNACPR (do not attempt cardiopulmonary resuscitation) that was in place for Mrs A and that no post-mortem was carried out following her death. Mr C also considered that the handling of his complaint by the board was unreasonable. We took independent advice from a nurse in relation to Mrs A's nursing care. While we did not find failings in relation to many aspects of Mrs A's care, we found that the appropriate skin assessment had not been carried out following her admission. The adviser highlighted that appropriate care and assessment could have avoided a pressure ulcer that Mrs A later developed. We upheld this aspect of Mr C's complaint. We took advice from a consultant in acute medicine in relation to Mrs A's medical treatment. We noted that most aspects of Mrs A's care had been reasonable and that Mrs A's very low weight on admission to hospital made management of her fluid balance difficult. We found no failings in relation to the prescription of pain relief. The adviser highlighted that hospital acquired pneumonia is a risk for all patients, but particularly those who are frail and bed-bound. However, we found that there was a lack of evidence of an appropriate consent process for t