SPSO Individual Decisions

C's parent (A) developed breathing difficulties and underwent investigations and treatment, including hospital admission, for bilateral pneumonia (inflammation of both lungs). As they had ongoing symptoms, the possibility of a cardiac (heart) cause was raised by A's GP. A CT scan of the chest was undertaken and confirmed pneumonia. An electrocardiogram (a test that records the electrical activity of the heart) identified an abnormality with A's heart so an echocardiogram (a heart scan that uses sound waves to create images) was requested. Shortly after this, A attended their GP with ankle swelling and was prescribed diuretic tablets. They also had a follow-up appointment with respiratory. Communication sent to the GP following this appointment referred to A's echocardiogram report as showing 'impaired left ventricle' and that cardiology opinion was awaited. A died suddenly before being seen in the cardiology out-patient clinic. C complained that the practice failed to provide appropriate treatment for A's heart condition, that they failed to communicate properly to A about their heart condition, and that they failed to ensure relevant information about A's family history was shared with hospital consultants. Related reading View Decision Report 201909321 as a PDF (24.38 KB) Updated: August 18, 2021

C complained about a failure to accurately diagnose and treat their parent (A)'s pancreatic cancer. A was being investigated by Raigmore Hospital in the months prior to their death. C complained that too many invasive tests were carried out and an accurate diagnosis was not established. We took independent medical advice from a consultant surgeon, who noted that A had an advanced pancreatic cancer which can be difficult to diagnose. We considered that repetition of invasive tests was reasonably required in order to pursue a diagnosis. We noted, however, that A's lung abnormalities were discussed by a lung multidisciplinary team (MDT), but an upper gastrointestinal MDT was not involved despite the fact the suspicion of pancreatic cancer could not be ruled out. We fed this back to the board. However, overall, we considered that there was a comprehensive attempt to obtain a diagnosis. On balance, we did not uphold this complaint. C also complained about a failure to communicate clearly with A and the family regarding the diagnosis. They said that they were never made aware of the suspected cancer diagnosis, despite this having been documented throughout the records. We found no evidence to support that timely and meaningful discussions took place with A and their family. A consented to multiple invasive tests without being made aware that suspected cancer was being investigated. We considered that the risks and benefits of these tests should have been clearly discussed with A, in order for them to have made a fully informed decision as to whether to proceed with them. In the circumstances, we upheld this complaint. We also noted that the board's response to C's complaint did not provide a sufficient explanation of the extent of the tests carried out.

C, a support and advocacy worker, complained on behalf of their client (B) in relation to care and treatment provided by the board to B's parent (A). C complained that the board had delayed in performing a CT scan when A presented at Belford Hospital with symptoms associated with a stroke. When a CT scan was performed four days after A's admission, it confirmed that A had suffered a stroke. C also complained that the board again delayed investigating symptoms suggesting that A had suffered a further stroke when A was re-admitted to Belford Hospital the following month. A CT scan performed three days after A's re-admission showed that A had suffered a new stroke or a worsening of the previous one. C also said that the specialist stroke team based at another hospital had not been contacted for clinical input in A's case. We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly). We found that, in relation to A's first admission, A was not examined with sufficient care and that the clinicians involved did not act upon symptoms commonly associated with a stroke. As a result, performance of a CT scan had been unreasonably delayed. In relation to A's second admission, we found that A's new symptoms were also inadequately investigated, which led to an unreasonable delay before a further CT scan was performed. We also noted that A's clinical records indicated A's case would be discussed with the specialist stroke team at another hospital but this did not appear to have taken place. We upheld C's complaint but were unable to conclude if A's outcome had been made worse as a result of the shortcomings in the care provided. When reviewing the complaint, we also found that the board's investigation into C's complaint was unreasonably delayed and that C was not provided with sufficient information about the reasons for the delay or a revised timescale as to when the investigation would be completed.

C was referred to a consultant obstetrician and gynaecologist (specialises in the medicine of the female genital tract and its disorders) regarding a skin lesion they had on their vulva. At the first appointment, the consultant removed the lesion under local anaesthetic. C complained to the board that the consultant decided to remove the lesion without properly examining it, that proper anaesthesia was not applied, and the consultant and nurse demonstrated a lack of preparedness. The board provided assurances that the consultant did examine the lesion and proceeded with the procedure after discussing the options with C. Additional anaesthesia was applied when C said they could feel the incision. The board also explained that equipment had to be retrieved from the theatre. We took independent clinical advice and reviewed the medical records. We found that the consultant failed to offer a third treatment option which was to have a smaller biopsy taken for the purpose of making a formal diagnosis and arranging a full excision at a later date. This may or may not have been the best choice, however it would have allowed C to make a more informed decision. There was no evidence to suggest C was not examined properly and we noted the consultant did apply further anaesthesia when C reported feeling pain. Overall, we concluded the General Medical Council principles of decision-making and consent were not fully met and as such the care and treatment provided was unreasonable. We upheld the complaint.

C complained about the care and treatment provided to their parent (A). A was reviewed in the A&E department of a GP led community hospital with epigastric pain (pain or discomfort right below the ribs in the area of the upper abdomen). A felt that the pain was coming from their gallbladder. Tests for a urinary tract infection (UTI) were carried out and A was admitted to a ward for fluids and treatment with an antibiotic. A few days later, the decision was taken to transfer A to another hospital. Further tests carried out there revealed A's gallbladder had perforated causing an abscess on their liver. They were then subsequently diagnosed with gallbladder cancer. C complained about the care and treatment provided to A at the community hospital. The board said that gallbladder pain usually radiates to the shoulder which was why this was considered unlikely in A's case. A was stable but diagnosis was unclear so they were admitted for observation and antibiotics for a UTI, which had been confirmed on testing. We took independent advice from an appropriately qualified clinical adviser. We found that A did not have specific clinical features of a UTI and urinalysis was not convincing for a bacterial infection. The clinical presentation of nausea, sweating and epigastric pain accompanied by the finding of the right upper quadrant tenderness was more in keeping with gallbladder pain and infection. We also noted that once A's abnormal blood results were known, the decision should have been taken on that same day (the day following admission) to consider transferring A to secondary care, because their clinical condition and abnormal blood results suggested something that could not be managed properly or adequately in a GP led community hospital. We also found that A was given too much IV fluid during their admission. Given A's known history of heart failure, the administering of fluid should have been regularly reviewed. We upheld C's complaint.

C was admitted to New Craigs Hospital following an overdose. They complained about the care provided, specifically the assessment of their condition, the suggestion to take part in a group class and a lack of access to pain medication for their migraines. C also complained about the boards response to their complaint. We took independent advice from a consultant psychiatrist. We found that appropriate assessments were carried out and the working diagnosis was supported by the notes. The suggestion of a class was not unreasonable and C was able to decline to participate in that option. There was limited evidence about the prescription/requests for pain medication. We found the care provided to be reasonable and did not uphold this complaint. In relation to complaint handling, we found the board did not proactively update C as often as they should have. We also found that the complaint was not fully responded to and the information given about bringing pain medication from home was not accurate. Therefore, we upheld this complaint.

C complained that they were unreasonably discharged from the pain clinic on two occasions. C had their first session with the pain clinic and then their first telephone session with a nurse the following month. In the interim, C was admitted to hospital for their mental health. At a multidisciplinary team meeting (MDT) it was decided to discharge C from the pain service due to their psychiatric admission. C was later reinstated to the pain service and was offered an appointment but later complained about the service. C was discharged from the service again because of a statement they made in their complaint which led the board to believe C did not want any further contact from the pain service. C complained about both decisions to discharge them from the pain service. We took independent advice from a consultant psychiatrist. We found that it is routine management to prioritise one acute (immediate) health issue over other longer term issues. Those longer term issues may complicate the management of the immediate health issue. In this case, that would have been C's recent mental health admission. We also noted that the board had acknowledged and apologised for communicating their decision about the first discharge poorly. We found that C had said in their complaint to the board that they did not want the services of the pain clinic anymore. While it would have been good practice to clarify what the patient truly wanted before discharging them from the service, it was not unreasonable to take C's statement at face value. We did not uphold C's complaints. Related reading View Decision Report 202001260 as a PDF (24.46 KB) Updated: May 19, 2021

C complained that the actions taken in initiating a child protection assessment following an attendance at A&E at Raigmore Hospital with their young child (A) were unreasonable and excessive. A attended with an oral wound and head injury following a fall. During the attendance C also raised concerns about A bruising easily, which prompted the child protection assessment. We took independent medical advice from an emergency medicine consultant. We considered that the actions taken were reasonable; both in relation to the presenting injury and the concerns surrounding bruising. We noted that medical staff had a professional obligation to report any child protection concerns, and considered they took appropriate action in this regard. We also took advice from a paediatric consultant regarding the actions following A's admission to the children's ward. We considered that the actions taken were reasonable and in line with relevant guidance. However, we found elements which could have been better, particularly surrounding the communication with C. There was no evidence of medical staff having discussed with C some of the recorded bruises. We noted that clear communication should take place with parents regarding any injuries that cause concern, so that an explanation can be sought to clarify concerns. We fed this back to the board. However, on balance, we did not uphold this complaint. Related reading View Decision Report 201905897 as a PDF (24.4 KB) Updated: May 19, 2021

C, a support and advocacy worker, complained on behalf of their client (A) who was diagnosed with cervical cancer whilst they were undergoing fertility treatment. C complained that the board failed to investigate A's symptoms which they had been experiencing for a number of months, and that this led to a delay in diagnosis. C also complained that the board failed to carry out a reasonable investigation of the complaint as their response did not demonstrate that any real analysis was undertaken of the care and treatment provided to A. The board confirmed their view that appropriate investigations were carried out. They explained that A had a type of cancer (endophytic, where there is no obvious cancer as it is within the body of the cervix) which is more difficult to diagnose. We reviewed the clinical records and took independent advice from a consultant in gynaecologic oncology (a specialist in the diagnosis and treatment of cancers of the female reproductive system). We found that the referrals, tests and assessments were in line with best medical practice and within reasonable timeframes. As such, there was no missed opportunity to diagnose the cancer sooner. We also found evidence that the board's internal investigation of the complaint was thorough and reasonable. We did not uphold C's complaints, however, we did provide feedback on the board's handling of the complaint. Related reading View Decision Report 201904901 as a PDF (24.41 KB) Updated: March 24, 2021

C was diagnosed with pleomorphic lobular carcinoma in situ (PLCIS, an uncommon condition in which abnormal cells form in the milk glands (lobules) in the breast). Following excision of the carcinoma, a programme of 15 radiotherapy treatments was undertaken by the board to reduce the risk of recurrence. Subsequently, C experienced breathlessness and an increase in phlegm. Clinicians initially felt this may be due to radiation pneumonitis (inflammation of the lung caused by radiation therapy) before a likely diagnosis of cryptogenic organising pneumonia (COP, a rare lung condition) was reached. A consultant oncologist (cancer specialist) told C’s GP that COP was a rare toxicity of breast radiotherapy. C wrote to and met with the consultant oncologist to detail their concern that the fourth fraction of their radiotherapy had not been undertaken accurately. The consultant oncologist investigated the matter but did not consider there were any discrepancies or irregularities regarding C’s positioning for radiotherapy. C complained to the board about these matters. The board’s investigations did not indicate that their actions had been unreasonable and they advised C of this. C remained dissatisfied and brought their complaint to us. We took independent advice from an appropriately qualified adviser. We found that the board had provided reasonable treatment to C and had taken steps to rectify the poor communication to C before we became involved with the complaint. We found evidence that it was reasonable to conclude that C was advised of alternative treatments to radiotherapy. We concluded that the board responded reasonably to C’s complaint. We did not uphold C’s complaints. Related reading View Decision Report 201802758 as a PDF (24.59 KB) Updated: February 17, 2021

C had taken steps to obtain a Welfare Guardianship Order in respect of their adult child (A). Part of this process involved C's solicitor requesting the production of a suitability report from the local council. Due to a variety of reasons, the production of a suitability report took a significant length of time. As part of the application process, C's solicitor sought an Adults with Incapacity report from A's new GP. Following this request, A's GP submitted an Adult Support and Protection (ASP) concern referral in respect of A. This referral was received by the board's Social Work Adult Services. In response to this referral, the social worker who was allocated to A carried out a number of inquiries. This included contacting the mental health officer (MHO) at the council, who was tasked with producing the suitability report. C complained about the social worker's involvement in the guardianship application process. In C's view, the social worker inserted themselves into the application process in a manner that was beyond their remit and sought to delay or hinder the application. C also complained that the board and the social worker did not act in line with the relevant procedures in respect of the ASP process after receiving the concern referral. We took independent advice from a social worker. In respect of the guardianship application process, the social worker did not act beyond their remit. Under the circumstances, it was appropriate for the social worker to make contact with the MHO after receiving the ASP concern referral. It was also appropriate for the social worker to provide their professional opinion in respect of the guardianship application. As such, we did not uphold this aspect of the complaint. In respect of the ASP process, the board carried out their duties in line with their obligations and their inquiries were appropriate. However, the board failed to provide a reasonable level of clarity about whether their actions were taken und

C had concerns about the care and treatment they received in the A&E at Raigmore Hospital. C had experienced a headache and visual disturbance. After initially attending their GP practice, C was taken to A&E by ambulance. Shortly after arriving at the hospital, C was assessed by a doctor. Later that evening, a CT scan (computerised tomography - a scan that uses x-rays and a computer to create detailed images of the inside of the body) was performed and this showed that C had experienced a type of stroke (a serious medical condition that happens when the blood supply to part of the brain is cut off). C had concerns that assumptions were made about the timing of the onset of their symptoms. C also considered that there was a delay in them receiving a CT scan, which prevented thrombolysis (a treatment involving a drug that aims to disperse the clot and return the blood supply to the brain. Not all stroke patients are suitable for this treatment). C was also unhappy that the stroke team were not immediately involved in their care. We took independent advice from an emergency medicine consultant. We found that the history obtained, examination and investigations performed in the emergency department were reasonable. We did not identify a delay in performing a CT scan and we found that the rationale for not offering C thrombolysis treatment was reasonable. Finally, we found it was reasonable that the stroke team were not involved with C's care at the time of admission. We concluded that C received reasonable care and treatment and we did not uphold this aspect of the complaint. C was also unhappy with the board's investigation and response to their complaint. We were satisfied that all aspects of the board's complaint handling were in accordance with the NHS Scotland Complaints Handling Procedure. We did not uphold this aspect of the complaint. Related reading View Decision Report 201906595 as a PDF (24.63 KB) Updated: January 20, 2021

C complained about the care and treatment provided to them by the board when they presented with abdominal pain. C complained that they were repeatedly unnecessarily catheterised, their symptoms and clinical context were ignored, and they were misdiagnosed as having a bladder tumour instead of an ovarian tumour. We took independent advice from a nurse, a radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans), a urologist (a doctor who specialises in the male and female urinary tract, and the male reproductive organs), and a sonographer (a healthcare professional who performs diagnostic medical sonography, or diagnostic ultrasound). We found that both nursing and urology care and treatment provided to C was reasonable. However, we found that an ultrasound scan incorrectly interpreted a mass as being a bladder tumour, when in fact the mass represented a large ovarian tumour. Though this was a misinterpretation of the scan, we found that given the clinical information available at the time, this misinterpretation was not unreasonable. We did not uphold this aspect of C’s complaint. C also complained about the board's handling of their complaint. We found that there were significant complaint handling failings, including failure to advise C in a timely manner which aspect of the complaint they would investigate; failure to update C in a timely manner throughout the investigation; incorrect information being contained in the complaint response and no apology being given for this. We therefore upheld this aspect of C's complaint.

Ms C, who works for an advocacy and support agency, complained on behalf of a family about the care and treatment that their relative (Mr A) received from the board. Mr A was admitted to Raigmore Hospital with endocarditis (an infection of the inner lining of the heart). He was discharged home for out-patient parenteral antibiotic therapy (where antibiotics are given to a patient in their own home). Mr A's condition worsened and he died a few weeks later. Ms C complained about Mr A's medical care and treatment, and that he was not medically fit to be discharged home. We took independent advice from a cardiologist (specialists in the heart and blood vessels) and from a nurse. We found that Mr A's condition was diagnosed in a timely manner and he was given appropriate treatment. We also found that it was reasonable that Mr A was discharged home, as there was an appropriate plan to continue his treatment at home. Ms C complained about the communication with Mr A's family. We found that the medical and nursing records showed evidence of appropriate communication with Mr A's family. Ms C further complained that Mr A was discharged home without appropriate care planning and an appropriate care package. We found that there was appropriate multi-disciplinary care planning for Mr A's discharge home. Ms C also complained about the board's complaints handling; in particular, that there was a delay in their response and its tone lacked empathy. We considered that as it was a complex complaint, it was reasonable that the investigation took longer than usual and regular updates were provided. We did not consider the tone was inappropriate. We did not uphold Ms C’s complaints. Related reading View Decision Report 201806450 as a PDF (24.53 KB) Updated: November 18, 2020

C complained about the care they received from their GP practice when they presented with problems with their sight and a headache. Whilst in the waiting room, C became more unwell. Following an examination, an emergency ambulance was called and C was taken to hospital where they were later diagnosed with a stroke. C complained that more immediate action should have been taken when they initially contacted and then attended the practice. The practice did not identify significant failings during their complaint investigation, but noted that some aspects could have been handled better. We took independent advice from a GP. We found that the practice’s initial handling of C’s call to the practice was reasonable, and it was appropriate that C was signposted to contact an optician. Furthermore, we found that, once C attended the practice, the care provided was reasonable and consistent with clinical guidance on assessment, history taking and examination. We did not uphold C’s complaint. Related reading View Decision Report 201907395 as a PDF (24.22 KB) Updated: November 18, 2020

C complained about the care and treatment provided to their parent (A). A was diagnosed with cancer and was admitted to hospital. As the hospital team struggled to control A’s pain, A was transferred to hospice care, where they later died. C complained about the care and treatment offered to A at the hospice and asserted that it was not reasonable. C’s position was that as a result of that unreasonable care and treatment, A experienced chronic pain and died prematurely. C stated that they believed that staff involved in A’s care failed to act in line with guidelines and ignored medical guidance. The board found no evidence to support C’s assertions that A was not provided with reasonable care and treatment. The board said that a multi-disciplinary, patient-centred approach was taken to A’s care and many clinicians contributed to A’s pain management strategy. We took independent advice from a medical adviser. We did not find any failings in A’s care and treatment and did not consider that it was unreasonable. Therefore, we did not uphold this complaint. Related reading View Decision Report 201901333 as a PDF (24.21 KB) Updated: November 18, 2020

Ms C complained to us about the care and treatment provided to her late partner (Mr A) by Raigmore Hospital during an admission. Mr A was assessed and a crisis plan was agreed; Mr A was then discharged home, but soon after he died. Ms C complained that the board unreasonably discharged her partner home. She also raised concerns about the significant adverse event review (SAER) carried out by the board into Mr A's care and treatment. We took independent advice from a mental health nurse and from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness). We found that the board carried out an appropriate and systemic risk assessment. We found that a coherent short-term crisis plan was agreed with Mr A, until he could engage with his local mental health services. We found that the decision to discharge Mr A home was reasonable. We did not uphold this aspect of Ms C's complaint. We found that the board's SAER process and report was reasonable; and it identified appropriate learning. However, we noted that when Ms C complained to the board, they said that they would address her concerns through the SAER. In the circumstances and given the time it took to complete the SAER, we considered that the board should have kept Ms C updated more regularly on its progress. We upheld this aspect of the complaint.

Miss C complained about the care and treatment her late mother (Mrs A) received at Raigmore Hospital after she was admitted with symptoms of bleeding from her stoma (an artificial opening made into a hollow organ, especially one on the surface of the body leading to the gut or trachea). Mrs A died around three weeks later following surgery to revise the stoma (resected ileostomy). Miss C raised concerns that the surgery was unnecessary and Mrs A had not properly consented to it; that the nursing care was poor (in terms of wound management, personal care, repositioning Mrs A and cables that had tied down her hands); and that the board did not handle Miss C's concerns through the NHS Model Complaints Handling Procedure (MCHP) appropriately. We took independent advice from a consultant general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We considered that the decision to operate was reasonable on the basis that Mrs A had multiple admissions in the period immediately prior to this admission and required blood transfusion. In addition, Mrs A had undergone appropriate investigation to identify the source of gastrointestinal blood loss and that the pathology report of the resected ileostomy had confirmed that it was the source of bleeding. In addition, we were of the view that although Mrs A had experienced a rare complication of the surgery, there was no evidence that it had fallen below a reasonable standard. However, we found that there was insufficient evidence to show that any of the recognised risks of the surgery had been discussed with Mrs A. We considered this unreasonable and not in accordance with guidance. Therefore, we upheld this aspect of Miss C's complaint. We noted that the board's investigation had accepted that the documentation regarding communication was of an unreasonable standard and that the staff involved had reflected on their practice for learning and improvement. The board also took st

Mrs C complained about the care and treatment provided to her child (Child A). Mrs C felt that Child A was denied access to NHS doctors with experience in paediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS - a neurological and psychiatric condition in which symptoms are brought on or worsened by infection). She also felt that the board had unreasonably refused to treat Child A with antibiotics and had instead suggested mental health treatment as an alternative. Mrs C had requested that Child A be referred to specialist clinicians in England and felt that the board had unreasonably denied this request. We took independent advice from a paediatrician. We found that there was evidence that the board were engaged with the medical literature on PANDAS and used this to inform their decision not to offer antibiotic treatment. We considered this to be a reasonable position and concluded that the board provided appropriate care and treatment in this respect. We also considered that the board's approach to obtaining second opinions and referring Child A to alternative clinicians was reasonable. We did not uphold this aspect of Mrs C's complaint. Mrs C also complained about the board's communication with her. We found that there was evidence in the records of timely and appropriate communication, and there was no evidence of unfair treatment. We did not uphold this aspect of Mrs C's complaint. However, we did identify that there were issues with the board's handling of Mrs C's complaint, as there was a delay in issuing a response and the response did not address all the issues Mrs C had raised. Therefore 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.

Mr C complained about the treatment the board provided to him following his surgery for Dupuytren's Contracture (a condition in which one or more fingers become permanently bent in a flexed position). Mr C complained that he had suffered an infection post-operatively which was not appropriately treated. We took independent advice from a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that the board had provided a reasonable standard of treatment to Mr C. He was seen regularly after the operation and no concerns were recorded by clinical staff that Mr C was suffering from a post-operative infection that was clinically significant (required treatment). Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201806255 as a PDF (24.11 KB) Updated: October 21, 2020

Mrs C complained about the care and treatment she received during childbirth from the board. Mrs C's baby was born by low cavity forceps delivery which required her to have her legs in supports. She found the process painful and traumatic and complained that staff failed to explore or act upon her pain. She also said that the orthopaedic (specialists in the musculoskeletal system) care she received after the birth was unreasonable and that she was not satisfied with the way the board investigated her complaint. The board said that as a result of her complaint they had learned not to make assumptions when a woman was very vocal during labour but that she had had anaesthetic to deal with pain. They also apologised for the lack of support she had received and for poor communication. We took independent advice from a midwife and consultants in orthopaedics, and obstetrics (the medical specialism for pregnancy and childbirth) and gynaecology (medicine of the female genital tract and its disorders). We found that it had been reasonable to undertake a forceps delivery as Mrs C had been pushing for an hour without her baby being delivered. To assist this, Mrs C's legs had been placed in lithotomy (leg restraints). This was associated with symphysis pubic diastasis (the separation of normally joined pubic bones, as in the dislocation of the bones, without a fracture) in up to 25% of cases and Mrs C suffered this. While Mrs C said that she was crying out in pain as a consequence, the clinical records did not support this, therefore, we could not conclude that she was ignored. However, we noted that there was no mention of a pudendal block (local anaesthesia commonly used to relieve pain during the delivery of a baby by forceps) in Mrs C's records. On this basis, we considered that the board failed to explore or act upon the causes of Mrs C's pain and upheld this aspect of her complaint. We found that Mrs C's orthopaedic care and management after the birth had been

Mr C complained that the board failed to follow relevant procedures for moving his mother-in-law (Mrs A) from a hospital in Scotland to a residential care home in England. We took independent advice from a social worker. We found that there are three contractual routes available and that the board entered into a Route 2 contract without giving Mr C a choice about the contractual route he wished to take. This was contrary to the guidance that was in place at the time of events and we upheld this aspect of Mr C's complaint. Mr C also complained that the board failed to communicate reasonably with him about the process of moving Mrs A to a residential care home in England. We found that there was no clear communication with Mr C about the process for a cross-border placement, the contractual requirements, or transport arrangements. We upheld this aspect of Mr C's complaint.

C, an advice and support worker, complained on behalf of their client (A) who had concerns about the treatment which A had received at Raigmore Hospital. A had a kidney stone and was operated on, which resulted in a ureteric stent (a thin tube structure allowing urine to drain into the bladder) being inserted. The stone remained in place and Levofloxacin (an antibiotic) was prescribed and A was discharged from hospital. A then began to suffer from leg pains, attended their GP and was readmitted to hospital after a few days with tendon issues. The stent and the kidney stones were removed and the antibiotic was stopped. A felt that the kidney stone should have been removed at the initial surgery and that Levofloxacin should not have been prescribed as this would have prevented their tendon issues which were as a result of a reaction to the Levofloxacin. We took independent advice from a consultant urologist (a doctor specialising in the diagnoses and treatment of disorders of the kidneys, ureters, bladder, prostate and male reproductive organs). We found that A received an appropriate standard of care and treatment, but suffered a rare but recognised complication of antibiotic medication. We did not uphold the complaint although we highlighted as feedback that the board may wish to review their antimicrobial guidelines. Related reading View Decision Report 201909748 as a PDF (24.4 KB) Updated: September 23, 2020

C complained on behalf of their parent (A) about the care and treatment A received at Raigmore Hospital. C was concerned that A was told by the hospital, following a CT scan, that they had a brain tumour (and likely metastases due to their lung cancer) when it later became apparent after an MRI scan that A had a stroke rather than a brain tumour. We took independent advice from a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays and other scans) and a consultant in acute medicine. We found many aspects of A's care and treatment to be reasonable. However, the CT scan report stated there was uncertainty over a diagnosis of metastases and that an MRI scan should be carried out. Over a 24-hour period, a diagnostic momentum increased. This meant whilst there was uncertainty around this diagnosis it was not picked up by successive clinicians and the working diagnosis became more certain despite a confirmatory MRI having yet to be carried out. A and their family were led to believe by successive clinicians over a 7-day period that A had a brain tumour when this was not certain. Therefore, we upheld C's complaint.

C was referred to the ear, nose and throat (ENT) service by their GP practice because they had been suffering from worsening headaches, balance problems and nausea. C was reviewed several times by the ENT service. C later returned to the practice because their symptoms were not improving. A referral was made to a private healthcare provider for C to see a neurologist. An MRI scan was arranged and following that, C was diagnosed with a brain tumour. C complained to the board. They felt that the ENT service had failed to adequately investigate their symptoms and, because of that, they failed to diagnose C's brain tumour. In response, the board confirmed it was felt that C was experiencing vestibular migraine (a nervous system problem that causes repeated dizziness), based on the symptoms. It was noted that a neurological examination was not performed at the initial examination, but was carried out at a subsequent review. The board accepted it would have been preferable to perform the neurological examination at the initial appointment, although in C's case it was unlikely to have led to an earlier diagnosis. We took independent advice from a clinical adviser who is an ENT consultant. We found that the tumour was a rare find in what was a common presentation of vertigo and headaches. It was difficult to know whether or not there would have been any earlier cues to instigate the MRI scan. We noted information from C's first encounter with the ENT service was limited but, overall, the evidence available suggested that the initial diagnosis and treatment were reasonable. We did not uphold the complaint. Related reading View Decision Report 201906538 as a PDF (24.54 KB) Updated: September 23, 2020