SPSO Individual Decisions

C’s sibling (A) attended the practice with constipation and blood in their urine. C was referred to the local health board’s urology department (specialists in the male and female urinary tract, and the male reproductive organs) where they were diagnosed with pedunculated fibroids (benign (non-cancerous) growths in the uterus). This diagnosis was later found to be inaccurate and the growths were found to be cancerous. C complained that the practice failed to provide reasonable treatment to A when they attended the practice in response to their symptoms. We took independent advice from a GP. We considered that the actions and investigations carried out by the practice were reasonable at each appointment, based on the information available at the time. A was referred to appropriate specialities and prescribed reasonable medication in response to their symptoms and the diagnosis made by urology. We did not uphold the complaint. Related reading View Decision Report 202000410 as a PDF (24.17 KB) Updated: November 18, 2020

C complained to us about the board regarding treatment of their child (A). A became unwell and was referred to Victoria Hospital, where they were diagnosed as having gastroenteritis (inflammation of the stomach and intestines) by a paediatric nurse practitioner and discharged home. Three days later, A suffered a seizure and was readmitted to the hospital. They were transferred to a hospital in another health board area and diagnosed as having pneumococcal meningitis (a life-threatening infectious disease that causes inflammation of the layers that surround the brain and spinal cord). They remained in hospital where they later died. C complained to the board about their initial assessment and treatment of A. They complained that A was misdiagnosed and that staff did not follow the correct procedures when reviewing their condition. C also felt that A should have been seen by a doctor before the decision was made to discharge them. The board arranged for a Significant Adverse Event Review (SAER) to be carried out by doctors not involved in A’s care. The SAER identified a number of areas where the board could have acted differently in A’s case. However, C still had a number of concerns and asked that we conduct a further review of the case. We took independent advice from a consultant paediatrician. We found that, overall, the SAER had appropriately identified the key failings in the board’s care, including that the original diagnosis of gastroenteritis was unreasonable based on A’s symptoms. However, we found some additional failings in record-keeping, and highlighted that we would have expected the misdiagnosis to have been identified when the nurse practitioner discussed A’s case with a doctor before discharge. We also considered there had been failings in the handling of C’s subsequent complaints. For these reasons, we upheld all of C’s complaints.

C attended the minor injuries unit at Queen Margaret Hospital and was unhappy with the way they were dealt with by a member of staff in the reception area. C considered that the board's investigation of their subsequent complaint was incompetent and lacked professionalism. We found that the board failed to take timely and robust action to investigate and respond to C's complaint. The complaint was initially dealt with as a concern at C's request, however, we considered it should have been dealt with as a formal complaint investigation from the outset, or at least immediately upon C expressing dissatisfaction with the response to their concern. It was not logged as a complaint until the board met with C a few weeks later. The timescale for responding to C's complaint was excessively beyond the 20 working day target timeframe. There was ongoing confusion as to the identity of the individual C's complaint was about, which was never resolved. The board did not take robust steps to try to identify and obtain written statements from the individuals present. By the time they requested CCTV footage of the incident, it was no longer available. C continued to seek answers and had two post-complaint meetings. We found that there was a failure to adequately follow up on agreed actions points from the first of these meetings. Overall, we concluded that the board's handling of the complaint was unreasonable and we, therefore, upheld this complaint.

C underwent surgery at Victoria Hospital to repair a fracture in their left wrist. Following the surgery, infections developed and this led to several further procedures being required to clean the wound and address damage caused by the infections. C complained that the board failed to provide them with appropriate care and treatment. Their concerns included that the board did not detect and effectively treat the infections, and that blood tests were not carried out to check for infection after C was discharged from hospital. 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 recognised complications (including infection) were discussed with C as part of the consent process and that there did not appear to have been undue delay in identifying C's first infection. We also found that blood tests to check for infection were carried out with reasonable frequency. However, the board should have ensured that blood test results were monitored and acted on timeously. Though we noted that there was a delay in responding to a blood test result, which suggested infection was present, this could not itself be said to have negatively affected the overall outcome for C. We concluded that the overall care and treatment provided to C was reasonable. It was noted that the board had acknowledged the blood test result failing and taken appropriate remedial action. As such, we did not uphold the complaint. Related reading View Decision Report 201810858 as a PDF (24.46 KB) Updated: October 21, 2020

C complained on behalf of the child (A) about the care and treatment received by the board. A was referred to neurology (the branch of medicine concerned with the diagnosis and treatment of disorders of the nervous system) after reporting that they were experiencing upper body jerks and involuntary twitching. A review was undertaken by a private healthcare provider on behalf of the board as part of a neurology waiting list initiative. The neurologist agreed that an MRI scan and an EEG (electroencephalogram - a test used to evaluate the electrical activity in the brain) would be carried out. Some years later, A was admitted to hospital after a seizure. It was noted that the earlier EEG referral was not progressed. Another EEG was arranged and following that, A was diagnosed with epilepsy (a condition that affects the brain and causes frequent seizures). C said that they considered the failure to carry out the EEG meant there was a delay in diagnosing A's epilepsy. The board said it was the neurologist's intention to have the scan carried out. An apology was given for the lack of follow-up in A's case. The evidence available confirmed that the neurologist appropriately considered the possibility that A was suffering from myoclonic epilepsy (brief shock-like jerks of a muscle or group of muscles), and intended to order appropriate investigations. However, there was no evidence available to confirm that the request for the EEG was actioned or followed up. The relevant paperwork was not available to reflect back on what may have happened. We took independent advice from an appropriately qualified adviser. We found that an EEG should have been carried out in A's case. The relevant guidance indicates the significance of arranging an EEG in cases of suspected myoclonic epilepsy. We upheld the complaint but did not recommend any further action because the board had already apologised for not actioning the EEG. In addition, the board also told us they no longer u

C complained about the care and treatment provided to their child (A). A was treated with intravenous immunoglobin (antibodies) because it was suspected they had an immune-related movement disorder. The focus of C's complaint was about the decision to stop this treatment as they considered it was of benefit to A. During our investigation we noted that the decision to start and stop this treatment was made by a doctor under a different health board. The treatment plan was commenced at the other board and moved to Fife NHS board because it was more convenient for A and their family to attend. We were therefore unable to comment on whether or not it was reasonable to stop this treatment, as the decision was not made by the board subject to the complaint. In relation to the treatment carried out at Fife NHS board, we found that the infusions of immunoglobin were administered by the board in accordance with the plan that was put in place by clinicians under the other board. We did not uphold this complaint. We provided feedback to the board in relation to their complaints handling. As this complaint focussed on the decisions made about treatment, it would have been helpful to C and this office if this had been clarified at an early stage so that the correct focus of the investigation (a different board) could have been identified earlier. Related reading View Decision Report 201900038 as a PDF (24.33 KB) Updated: September 23, 2020

C complained about the care and treatment they received from the board. C said that a ruptured Achilles tendon (the band of tissue that connects calf muscles at the back of the lower leg to the heel bone) was not identified in a timely way. We took independent advice from an advanced nurse practitioner and from a consultant physiotherapist. We found that the care and treatment provided to C was consistent with the National Institute for Health and Care Excellence (NICE) guidance on when to suspect an Achilles tendon rupture, and with the board’s own pathway. We did not uphold this aspect of the complaint. C also complained about the way the board handled their complaint. We did not find any failings regarding the way the board handled C’s complaint. Therefore, we did not uphold this aspect of C's complaint. Related reading View Decision Report 201906775 as a PDF (24.09 KB) Updated: August 19, 2020

Mr C complained on behalf of his daughter (Ms A) in relation to charges for treatment provided to Ms A in Victoria Hospital. Ms A was visiting the UK from overseas and attended A&E with palpitations (noticeably rapid, strong or irregular heartbeat). Following assessment in A&E, Ms A was admitted to an acute medical ward before she was later discharged. Ms A reattended the hospital the following week for a check-up and at this time an interview to assess charges for overseas visitors was also performed. Ms A subsequently received an invoice for the admission. Ms A had extensive contact with the board's finance and patient feedback teams in relation to the invoice. She remained dissatisfied with the board's final response and Mr C brought the complaint to us. Mr C firstly complained that the board failed to inform Ms A that she would be charged for treatment when she attended A&E. We found that, due to the timing of the attendance and discharge from the hospital, it was reasonable that Ms A was not informed she would be charged for treatment until the interview performed in the week following the admission. We did not uphold this complaint. Mr C also complained that the board failed to charge and invoice Ms A appropriately for treatment provided. In response to Ms A's complaint, the board identified and apologised for issues with the invoicing process. We found that the board's documentation of the assessment of liability for charges was poor. We were unable to determine that the board had followed the correct process for establishing liability and fully established that no exemptions applied to Ms A's treatment. On this basis, we upheld the complaint. Finally, we identified a number of failings in the board's handling of Ms A's complaint. We noted that there had been a delay in signposting Ms A to the complaints procedure; that the board's correspondence contained inaccurate information; and that the final response did not address all the points raised.

The board carried out a significant adverse event review (SAER) into the care provided to Mr C's family, following the death of their baby. The SAER identified various issues in the care provided to Mr C's family and it identified actions to address them. Mr C raised concerns with us that the board might not have carried out all of those actions appropriately and he wanted us to independently assess this. We took independent advice from a midwife and from a consultant obstetrician (a doctor who specialises in pregnancy and childbirth). We found that the actions set out in the SAER were appropriate to address the issues in care and treatment that it identified. We also considered that the board had provided us with sufficient evidence that those actions were carried out appropriately. We did not uphold the complaint. Related reading View Decision Report 201810039 as a PDF (24.07 KB) Updated: July 22, 2020

Mrs C complained about the care and treatment provided to her father (Mr A) at Victoria Hospital. Mrs C was also concerned that the investigation of her complaint to the board had been inadequate. Mr A had been admitted to hospital for treatment of a heart condition. Mrs C believed that his assessment had been inadequate and that he had been prescribed a drug which had caused a severe reaction when combined with the medication Mr A was already taking. Mr A had developed ulcers in his left eye and then contracted cellulitis (an infection of the deeper layers of skin), which had affected both eyes. Mr A had required surgery to his left eye. Mrs C believed this experience had rapidly increased the onset of Mr A's dementia, leaving him incapable of managing by himself, where as he had previously had a significant degree of independence. Mrs C said that this could have been avoided, had his medication been checked properly before he was prescribed new drugs by the hospital, as ulceration was a known complication. We took independent advice from an appropriately qualified adviser. We found that Mr A's care and treatment had fallen below a reasonable standard, because his medication had not been properly reconciled prior to the prescription of a new drug. We could not state for certain that Mr A's deterioration was solely attributable to this error, as the side effects he suffered could have been caused by the new drug by itself, rather than in combination with his existing medication. We upheld this aspect of the complaint. We also found that the board's investigation of the complaint had been inadequate, as it had not identified the failure to reconcile Mr A's medication. Therefore, we upheld this aspect of the complaint.

Ms C returned to her GP after being discharged from the board's community psychiatric nursing (CPN) service as she was experiencing coping difficulties and anxiety. A further referral was submitted to the service but was refused. The local mental health team's view was that ongoing support for Ms C would not be appropriate or required because it was unlikely that she would derive any therapeutic gain. In her complaint to the board, Ms C said she was unreasonably discharged from the service and that this had not been communicated to her clearly. She also complained about the decision to refuse the further referral to the service. The board said that Ms C's discharge from the service was well planned and discussed with her. It was also noted that Ms C had received extensive input from the service so it was felt she would not gain anything further and no plans were made to see her again after her GP referral. Ms C was unhappy with this response and brought her complaint to us. We took independent advice from a mental health nurse. We found that Ms C's discharge was reasonably planned and phased and took place with her agreement and input. However, we were unable to identify a crisis plan within the records. A plan of this nature would have been helpful to all stakeholders in their efforts to support Ms C when her emotions fluctuate. It was unreasonable that no such plan appeared to be in place for Ms C. With that said, whilst it was clear from the GP's referral letter that Ms C was experiencing an increase in anxiety, there was no evidence to suggest that she was in crisis at that point. Given the evidence available, we concluded that Ms C's discharge from the CPN service was reasonable and that it was communicated to her appropriately. We also found that the local mental health team's response to her GP's referral was reasonable. Therefore, we did not uphold Ms C's complaints. Ms C also complained that the board failed to handle her complaint reasonably.

C complained about the care and treatment provided to their late spouse (A) by the practice. A had reported symptoms of excessive wind, bloating, nausea and loss of appetite. A was later diagnosed with metastatic melanoma (skin cancer that has spread). C complained that the practice delayed in carrying out an appropriate assessment of A's symptoms and that they failed to follow up on A's treatment and referrals. The practice considered that A was seen promptly following triage and that according to the Scottish Referral Guidelines, A did not warrant an urgent referral based on their symptoms at the time. We took independent advice from a GP. We found that the assessment of A's symptoms was appropriate and the relevant guidelines for suspected cancer were followed appropriately by the practice. We also found that the referral for an urgent endoscopy (a procedure whereby a flexible tube with a camera is used to view the organs inside the body) was timely and appropriate. We did not uphold the complaint. Related reading View Decision Report 201900587 as a PDF (24.21 KB) Updated: July 22, 2020

C attended an appointment at Victoria Hospital to have a stent (a splint placed temporarily inside a duct, canal, or blood vessel to aid healing or relieve an obstruction) removed. The procedure, scheduled for the morning, was not performed until the evening, and when C was transferred to a ward they had not eaten for over 24 hours or drunk for around 18 hours. The board accepted that C had been fasted of food and liquid for longer than guidelines recommended. The board apologised for this and committed to reviewing their fasting guidelines and discussing these with staff. C had also not received all of their regularly required medication during this time in the hospital. The board apologised for this and explained that a full medication history should have been obtained via discussion with C and took steps to improve medicines management. During the process of complaining about their experiences, C agreed with a patient relations officer that a meeting to discuss their complaints, as offered in the board's first response to them, would be arranged. C subsequently received a second response from the board but no further communication about the expected meeting. We investigated C's complaints about these matters. We upheld C's complaint about being fasted for an unreasonable length of time and found the actions that the board had committed to had not been undertaken. We upheld C's complaint about the failure to provide their regularly prescribed medication, given these had not been provided and there was no evidence a medication history had been completed as per normal processes. The board explained that they had decided the second response was the appropriate way to provide the clarification that a meeting would have delivered. Given C had reached a similar conclusion and had not pursued the matter further with the board, we did not uphold their complaint about the board's failure to complete the arrangements.

Miss C complained about the care and treatment provided to her late father (Mr A). Mr A had been diagnosed with advanced prostate cancer and was admitted to a community hospital for rehabilitation and intensive physiotherapy after he had undergone chemotherapy and radiotherapy. Mr A's care and treatment was provided by a team of medical professionals including a GP and nursing staff. Mr A's condition deteriorated and he died during his admission. We took independent advice from a GP and a nurse. Miss C was concerned that there was a failure to diagnose and treat Mr A's lower respiratory tract infection and pneumonia and questioned the administration of an antidepressant medication to Mr A. We found that the infection was identified appropriately and appropriate treatment was provided. In addition, it was reasonable to have prescribed the medication and that there was no connection between this and Mr A's deterioration and death. Miss C also raised concerns about the physiotherapy and rehabilitation provided to Mr A and the input from the dietician service. We found that the records documented Mr C had received reasonable physiotherapy and dietary care. In relation to Mr A's end of life care, we found that it was not required that a GP attend Mr A in the 24 hours before he died. We also found that appropriate nursing care was provided to Mr A. For the reasons outlined above, we did not find evidence of unreasonable failings in the care and treatment provided to Mr A and, as such, we did not uphold this complaint. Miss C further complained that there was a lack of reasonable communication with her and her family about Mr A's care and treatment. While we found there was evidence of appropriate communication about Mr A's care, including about Mr A's end of life care, we took account of the board's complaint response to Miss C which identified areas for improvement and learning and accepted that unintended distress was caused to Miss C and her family. Therefore,

C attended the practice a number of times over several years with recurring urinary tract infections (UTIs). C said that in that period, the practice had failed to undertake a test for a prostate specific antigen (PSA test) despite C's repeated requests. When the practice did agree to undertake a PSA test the result for this was high and caused the practice to urgently refer C to the local NHS board's urology department for further investigation. Subsequently, C was informed that they had prostate cancer. C complained that the treatment provided by the practice was unreasonable. We took independent advice from a GP. We found that the practice provided reasonable treatment to C. We considered that C's condition of recurrent UTIs had been identified by the practice, who appropriately noted that this should be managed by the urology department. The referral to this department was in line with General Medical Council's Good Medical Practice as the ongoing symptom management of the patient lay outwith the practice's professional expertise. We concluded that the care provided by the practice was reasonable. We did not uphold this complaint. Related reading View Decision Report 201905840 as a PDF (24.3 KB) Updated: July 22, 2020

Mrs C complained to the board on behalf of her son (Mr A), who had a diagnosis of autism. Mrs C was unhappy with aspects of the care and treatment provided to Mr A by the mental health service at Queen Margaret Hospital. Mrs C firstly raised concern about the communication surrounding the prescription of a medication. The board upheld Mrs C's complaint and apologised that the information provided about the dose was not clear.We found that Mr A had taken a greater dose than intended; however, the dose taken was still within the safe limits of prescribing for this medication. We concluded that the board had taken reasonable action in light of the matter. We upheld the complaint but did not make recommendations. Mrs C was also unhappy with the psychiatric care and treatment provided to Mr A more generally. We took independent advice from a consultant psychiatrist. We found that there was a reasonable level of assessment, treatment, and clinical management of Mr A during his consultations with the service. We did not uphold this complaint. Finally, Mrs C raised concern about some of the language used in the board's complaint response. We considered that the use of one term or another was a matter of preference and we did not conclude that there were failings in the language used. However, we did consider that the time taken for the board to respond to Mrs C's complaint was excessive. On balance, we upheld this aspect of the complaint.

C complained about various aspects of the care and treatment that their parent (A) received from the board. We took independent advice from a consultant geriatrician (a doctor specialising in medical care of the elderly) and from a nurse. We found that A was unreasonably discharged from Victoria Hospital when they had an infection, which may only have been partially treated, and that there may have been uncertainty about the effectiveness of the antibiotics A was receiving. We also found that A did not receive medical reviews when their delirium was active; that there should have been an earlier assessment of the possibility that A had a chest infection; that A was discharged from Queen Margaret Hospital to a care home without a prescription for stronger pain medication; and that no nursing transfer letter or discharge summary was provided to the care home when A was transferred from Queen Margaret Hospital. We upheld C's complaint that the care and treatment provided to A was unreasonable. C also complained about the board's communication. We found that there was a failure to discuss A's transfer arrangements, ongoing care (including palliative care) and medication with C prior to A's transfer to the care home. Therefore, we upheld this aspect of C's complain.

Mr C complained about the treatment which he received at the Ear, Nose and Throat (ENT) Department at Queen Margaret Hospital. He had been referred by his GP for further investigation of hearing loss. Mr C said that he also had discharge from his ears. He said that the consultant had told him to leave his ears alone as they were fine and did not prescribe any drops or medication. Mr C then attended his GP later that day and a swab was taken and he was prescribed capsules and cream until the results were known. The swab result confirmed an infection and antibiotics were prescribed. Mr C felt that the consultant had dismissed his concerns about the discharge from his ears. We took independent advice from an ENT consultant. We found that the consultant in the ENT Department had carried out an appropriate examination to establish the cause of Mr C's hearing loss. It was also not unreasonable that the consultant had determined Mr C had caused trauma to his ear canals by using cotton buds and gave advice to stop using them and to wait to see if the inflammation settled in due course. At that time it was not appropriate to issue antibiotics. We did not uphold the complaint. Related reading View Decision Report 201903798 as a PDF (24.29 KB) Updated: June 17, 2020

C complained about a failure on the part of the board to discuss their eye conditions and possible treatments before they were referred to another board for an operation. We found that, whilst the referral to the other board was reasonable, the fact that C was not involved in a discussion, or advised about possible options for treatment prior to the referral, was unreasonable. Therefore, we upheld this aspect of the complaint. C also complained about a failure on the part of the board to transfer all relevant medical information to the other board prior to the operation. We found that it was reasonable practice for the board to state that the other board could contact them for relevant information if they considered it necessary to do so, given they had already met with C and had notes about their condition. We did not uphold this aspect of the complaint.

C has a family history of bowel cancer polyps (abnormal growths) on the colon and was admitted to hospital on several occasions over many months with abdominal pains and vomiting. C complained to the board that, despite their family and medical history, the board unreasonably delayed to perform a scan, which resulted in a delayed diagnosis of bowel cancer. C also complained that the board failed to accurately report on a scan, as a subsequent review identified the presence of cancer. The board advised that a scan was not indicated when C first presented to hospital. They also advised that the initial report on the scan was adequate, and it was only when additional clinical information became available (blood test results), that a second review changed the diagnosis. We took independent advice from a consultant colorectal (bowel) surgeon. We found that there was insufficient consideration given to C's own medical history and that an x-ray taken was not appropriately followed up or acted upon. We concluded that there were several missed opportunities to perform a scan or colonoscopy (an examination of the bowel with a camera on a flexible tube) when C had attended hospital. We upheld this aspect of the complaint. However, we concluded that the initial report on the scan was adequate. We did not uphold this aspect of the complaint.

Mrs C complained about the care and treatment she received from Victoria Hospital following a car injury. She attended A&E with injuries to her right hand. An x-ray identified a fracture at the joint of her right middle finger. Mrs C was advised to keep her hand elevated in a high arm sling but the injured finger was not strapped or splinted. The following week, she was reviewed by an orthopaedic consultant (a specialist in the treatment of diseases and injuries of the musculoskeletal system) at a fracture clinic. Mrs C stated that, at that point, the tip of the injured finger was noticeably bent over. After assessing Mrs C's injury, the consultant did not consider any additional treatment to be required at that time and discharged Mrs C to the care of her GP. However, Mrs C's finger continued to be bent over and she was later assessed by a consultant hand surgeon who identified this as a mallet deformity. Mrs C complained that she did not think the board had treated her injured finger appropriately. She queried why her finger was not strapped when she attended A&E and why it was left untreated following the consultation at the fracture clinic. In addition to this, Mrs C queried why she was not referred to a hand surgeon and was not provided with appropriate advice and information on how best to aid the recovery of her hand. We took independent advice from an orthopaedic consultant. In respect of the care and treatment provided in the emergency department, we found that it would have been appropriate to apply a mallet splint at this point. Although a mallet injury may not have been visible at this point and it could not be known at the time whether splinting Mrs C's injury would have a beneficial outcome, we were satisfied that the evidence suggested it would have been reasonable to support splinting the finger on a 'just in case' basis. Therefore, we upheld this aspect of the complaint. In respect of the care and treatment provided following Mrs C's disc

C submitted a complaint on behalf of their child (A) about the treatment provided by the board in relation to A's eating disorder. C said that A had been diagnosed with Avoidant Restrictive Food Intake Disorder (ARFID), however, in subsequent contact this term was not used by board staff. We took independent advice from a consultant psychiatrist who had experience working with people with eating disorders. We found that the board had provided reasonable treatment to A. It was recognised that A would benefit from intensive input and the board offered an individualised approach to treatment. The board set out a clear rationale for the proposed treatment that was appropriate for A's identified needs. While there was inconsistency in using the term ARFID to describe A's diagnosis this did not impact on the treatment offered to A. Therefore, we did not uphold C's complaint. While we did not uphold this complaint, we have made recommendations to the board for failing to explain the varying use of ARFID in the complaint response. We have made these recommendations under section 16G of the SPSO Act 2002, which requires the Ombudsman to monitor and promote best practice in relation to complaints handling.

Miss C complained about a number of aspects of the care and treatment her mother (Mrs A) received at Victoria Hospital. We took independent medical advice from three advisers – 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), a consultant gynaecologist (a doctor who specialises in the female reproductive system) and a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). Miss C said that a radiologist failed to identify the thickened area in part of her mother's bowel on a CT scan. We found that an opportunity was missed at the time of the reporting of Mrs A's CT scan to identify a tumour in this area, in addition to making the new diagnosis of an ovarian tumour. However, given the limited sensitivity and specificity of unprepared CT scan for bowel tumours, we consider this not to be unreasonable. Miss C complained that there was a delay in Mrs A's hysterectomy (surgical removal of the uterus) taking place which she said was due to the gynaecologist's leave delaying Mrs A's case being discussed at the multi-disciplinary team meeting. We found that Mrs A was referred for her case to be discussed at the next gynaecology multi-disciplinary team meeting the day after she was admitted to hospital. This was then processed in accordance with the department's normal procedures and Mrs A's case was discussed at the next available multi-disciplinary team meeting. We considered that the consultant gynaecologist's leave was not relevant to Mrs A's care and did not delay it in any way. Miss C said that following the results of Mrs A's CT scan and the suspicion of cancer, the board should have carried out Mrs A's colonoscopy (examination of the bowel with a camera on a flexible tube) and PET scan while she was still in hospital. We found that Mrs A's colonoscopy was carried out within appropriate times

Mr C complained about the care his mother-in-law (Mrs A) received at Victoria Infirmary Hospital. Mrs A has emphysema (a lung condition that causes shortness of breath) and has particular difficulty with her breathing when moving around. Mr C raised concern that when he made enquiries about Mrs A receiving ambulatory oxygen therapy (the use of supplementary oxygen during exercise and activities of daily living) it was unreasonably refused. We took independent advice from a consultant physician in general and respiratory medicine. We found that it was reasonable for board staff to have reached the view that ambulatory oxygen was not indicated in accordance with guidance issued by the British Thoracic Society. We, therefore, did not uphold the complaint. However, we also considered that board staff should have offered Mrs A a second opinion and so we provided feedback to the board for reflection in this respect. Related reading View Decision Report 201808114 as a PDF (24.21 KB) Updated: March 18, 2020

Mr C complained about the lack of care which his wife (Mrs A) received from the Victoria Hospital Kirkcaldy. Mrs A had suffered from chronic knee pain for a number of years and had undergone episodes of arthroscopy (surgical technique to diagnose and treat problems in the knee joint) in the past. She requested further surgery but the surgeon decided that further surgery would not be of benefit and that she should continue with conservative treatment. Mrs A asked for a second opinion and another consultant discussed Mrs A's condition with the surgeon; it was again decided to continue with conservative treatment. Mr C thought that the decision of the surgeon was unreasonable and that they had influenced the decision from the consultant. 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 decision by the surgeon not to offer further surgery was reasonable in the circumstances. If a patient still suffers from pain following repeated arthroscopic surgery, it would not be appropriate to continue with the surgical interventions when there is no notable benefit for the patient. We also found that it was not unreasonable for the consultant and the surgeon to have discussed treatment options for Mrs A and that the decision to persevere with conservative treatment was appropriate. We did not uphold the complaint. Related reading View Decision Report 201901595 as a PDF (24.39 KB) Updated: March 18, 2020