SPSO Individual Decisions

Ms C complained about the care and treatment she received from Victoria Hospital. She said that there were delays in receiving appointments and treatment; that she was not properly consented for surgery; that a stent was removed without anaesthetic; and that after surgery she was left with a bulge/hernia that did not receive timely treatment. In responding to the complaint, the board acknowledged that Ms C had incorrectly been sent a letter saying that she was no longer on the waiting list for surgery and incorrectly advising that she would require another GP referral. The board also found that the bulge she was concerned about had not been examined as it should have been; that there were some communication failures; and that an appointment had to be rescheduled twice. The board apologised for these errors. We took independent advice from a consultant urological surgeon (a specialist in diseases of the urinary organs in females and the urinary tract and sex organs in males). We found a number of failings in terms of it being unclear about; what treatment options had been discussed with Ms C; the implications and risks of the change in surgery; poor record-keeping; the removal of the stent was not clearly explained; and no written advice leaflet provided. Therefore, we concluded that Ms C's care and treatment was of an unreasonable standard and upheld her complaint.

Ms C complained about psychiatric treatment she received for anxiety. She complained that there were unnecessary delays and a lack of communication regarding her treatment which added to her anxiety. Ms C complained that her psychiatrist did not assess her properly and proceeded with options for therapy without first carrying out an appropriate assessment. We took independent advice from a consultant psychiatrist. We found that Ms C's assessment had been appropriate and reasonable, and that medical staff tried to work constructively with Ms C and to tailor treatment to her specific needs and wishes for treatment. We considered that the board had taken Ms C's social anxiety into consideration when arranging appointments. Therefore, we did not uphold this aspect of the complaint. Ms C also complained about the board's complaints handling. We considered that the board could have clarified aspects of the complaint at the outset, with a view to agreeing a reduced number of complaints. This may have provided for a more manageable complaint from the point of view of investigation. We noted there had been significant delay in providing complaint responses, which had added to Ms C's stress. We considered that the delays were unreasonable and we therefore upheld this aspect of the complaint.

Mr C, a solicitor, complained on behalf of his client (Mr B) about the care and treatment Mr B's mother (Mrs A) received at Stratheden Hospital after she broke her hip. Mr C complained that Mrs A did not get appropriate treatment for her physical health issues; in particular, that her condition was not appropriately monitored, which led to her becoming dehydrated. Mr C also complained about the nursing care, particularly that Mrs A did not receive appropriate nutritional care and that there was a lack of action in response to her weight loss. Additionally, Mr C raised concerns about the board's complaints handling. We took independent advice from a consultant psychiatrist and from a mental health nurse. We found that Mrs A's treatment plan was reasonable and that she received appropriate treatment for her physical health issues, which led to an improvement in her condition. However, we found that her fluid balance was not recorded appropriately during that time, as the board had acknowledged. We found that after Mrs A's condition improved, the board decided to take a more limited approach to her treatment. We considered that the reasons for that decision were not properly recorded, and Mrs A's condition was not monitored appropriately afterwards. Therefore, we upheld this aspect of Mr C's complaint. In relation to the nursing care provided to Mrs A, we found that insufficient action was taken in relation to her nutrition and weight loss. The board identified these failings and apologised to Mr B. We upheld this aspect of Mr C's complaint. Finally, we found that the board did not clearly respond to all aspects of Mr B's complaint. We upheld this aspect of Mr C's complaint.

Mr C underwent a hip replacement at Victoria Hospital. Mr C complained that the board failed to ensure they had obtained informed consent from him and that they failed to provide him with a reasonable standard of care and treatment. 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 consent process was reasonably documented and that Mr C did provide informed consent. Therefore, we did not uphold this aspect of Mr C's complaint. We found, however, that Mr C had not received proper post-operative care, with delays in his review appointments There was a failure to discuss in full the nature of the nerve injury he had suffered, as well as the possible treatment options. We upheld this aspect of Mr C's complaint.

Ms C, an advocate, complained on behalf of her client (Ms A) about the treatment which Ms A received at the practice. Ms A had reported concerns about hip pain on a number of consultations, but the GPs wrongly diagnosed a soft tissue injury when Ms A had actually suffered a fracture of the hip. We took independent advice from a GP. We found that Ms A had an extensive medical history of hip problems and was under the care of the orthopaedic (conditions involving the musculoskeletal system) team. When Ms A reported hip pain following a fall it was not unreasonable for the GPs to conclude that Ms A had suffered a soft tissue injury as she was able to weight bear. Although it would appear that the fracture had occurred by the time Ms A was seen by the GPs, this was not an indication that the care and treatment was unreasonable. We did not uphold the complaint. Related reading View Decision Report 201811067 as a PDF (23.77 KB) Updated: September 18, 2019

Mr C had a modified Brunelli procedure to his wrist (a surgical procedure that can be used to correct instability in the wrist). Mr C complained that the board failed to inform him of the risks of the anaesthetic, particularly of phrenic nerve palsy (loss of the ability to move the diaphragm and to feel the sensations of the chest and upper abdomen). We took independent advice from a consultant anaesthetist. We found that there was a failure to discuss the common possibility of temporary phrenic nerve injury with Mr C and that Mr C was not provided with any written information about the procedure. We upheld Mr C's complaint.

Ms C attended hospital for minor surgery under anaesthetic. She said that she made it very clear in advance of attending for the surgery that she did not want to have any opioid drugs (common pain relief) administered. However, despite communicating that prior to and on the day of surgery, an opioid was administered whilst Ms C was under anaesthetic. Ms C also had concerns about the staff present in the anaesthetic room. She said no one introduced themselves or explained their role to her; she did not know who one individual was even though they squeezed her arm as a method of tourniquet (device for stopping the flow of blood through a vein or artery) during the insertion of the cannula; and she questioned the appropriateness of the method of tourniquet used. We took independent advice from a clinical adviser. It was noted that staff denied not having introduced themselves to Ms C. They said they had acknowledged Ms C's anxieties and to help with that she was moved to first on the theatre list. We also reviewed a patient leaflet produced by the Faculty of Pain Medicine which indicated that squeezing a patient's arm was an acceptable method of tourniquet. In turning to Ms C's concern that she was administered an opioid against her expressed wishes, the board confirmed the anaesthetist was aware of Ms C's previous unpleasant experience with morphine and recalled reassuring her that they would not use that drug or any long acting opiates. They were not aware that Ms C wished to avoid all opioids. We found that it would have been unreasonable not to administer pain relieving drugs to Ms C during her surgery, because she could have suffered acute pain and distress. Finally, we were satisfied that the board had taken reasonable steps to identify the staff present in the anaesthetic room. In light of the information we saw in Ms C's case, we did not uphold the complaints. Related reading View Decision Report 201808735 as a PDF (24.29 KB) Updated: September 18, 20

Mrs C complained about the care and treatment her late mother (Mrs A) received at the Victoria Hospital. Mrs A had been deemed appropriate for discharge home but Mrs C and her family were concerned that Mrs A had lost weight and that her pain was not under control at the date of discharge. Mrs A had to be readmitted to hospital the day after discharge and passed away a number of hours later. We took independent advice from a consultant geriatrician (a doctor specialising in medical care of the elderly). We found that initially Mrs A had received an appropriate medical review which had determined that Mrs A would be fit for discharge. Mrs A had reported pain while in hospital and additional pain relief had been prescribed to supplement her usual pain relief which she received at home. However, between the period of making the decision that Mrs A was fit for discharge and the actual date of discharge, Mrs A required additional pain relief which had not been resolved at the point of discharge. We found that the staff involved should either have allowed Mrs A to remain in hospital until her pain issues had resolved or discharged her home with additional pain relief. We upheld the complaint.

Mr and Mrs C complained about the treatment Mrs C received both during and after her pregnancy. Mrs C felt unwell throughout her pregnancy with nausea, heartburn and abdominal pain. Mr and Mrs C reported her symptoms during phone calls to the midwife unit. Mrs C was advised to take pain relief and get back in touch if the pain worsened. When Mr and Mrs C attended the Victoria Hospital for their 20 week scan they were told there was no foetal heartbeat. After delivery of the baby Mrs C had bloods taken, and tests from the placenta, but waited more than ten weeks to see a doctor to discuss the test results. After chasing up the results Mr and Mrs C were told that bloods had been lost, requiring Mrs C to return to the ante-natal clinic for further testing. She was subsequently told she tested positive for lupus (an autoimmune condition that affects the body's defences against illnesses and infections) and required further blood testing. Errors in the testing meant that Mrs C had to return to the clinic again. Each time she had to wait with pregnant couples and found this distressing. Mr and Mrs C felt the miscarriage could have been avoided if Mrs C had received better treatment. They complained that Mrs C's lupus should have been diagnosed sooner, and that the loss of their baby might have been avoided. We took independent advice from a midwife and a consultant obstetrician (a doctor who specialises in pregnancy and childbirth). We found that the advice given to Mrs C each time she contacted midwives regarding her symptoms was reasonable. We did note, however, that Mr and Mrs C's account of the reported symptoms was not reflected in the records and we were unable to reconcile the two. We found that testing for lupus during pregnancy is unreliable because results may be falsely positive and that there were no clinical indicators for Mrs C to be screened prior to her miscarriage. We considered that the treatment Mrs C received during her pregnancy was reas

Mrs C complained to us that nursing staff failed to document her concerns appropriately at a pre-operative assessment before she had a wisdom tooth surgically removed. She said that she told them that she was extremely anxious and that it was agreed that she would be taken first on the list for surgery. However, when she attended hospital to have the surgery, she was not first on the list and this made her extremely distressed. We took independent advice from a nursing adviser. We found that there had been a failure to document the concerns Mrs C raised at the pre-operative assessment and that this had made her extremely anxious on the day of the surgery. We upheld this complaint. Mrs C also complained that nursing staff had been rude and dismissive about her concerns when she attended the hospital for the surgery. We did not find any evidence to support this aspect of her complaint and we did not uphold the complaint. Mrs C complained that she had not been given adequate pain relief after the surgery. We found that the board had not documented Mrs C's request for stronger pain relief at the pre-operative assessment and upheld this complaint. Finally, Mrs C complained that she had been discharged from hospital without antibiotics. We took independent advice from a dental adviser. We found that it had been standard practice and reasonable to discharge her without antibiotics. We did not uphold this complaint.

Mrs C complained about the treatment she had received from the practice. She had reported in consultations that her right big toe was cold, blue and painful. The pain continued and she received additional painkillers. Blood tests revealed a low iron count and iron tablets were prescribed. The pain continued and Mrs C also reported pain in her leg at the groin which was diagnosed as a groin strain. Mrs C continued to report problems and a referral was made to the vascular (circulatory) service where it was found she had blood clots in her leg and groin which resulted in her requiring an amputation of a foot. We took independent medical advice from a GP. We found that initially it was felt Mrs C had chilblains (a painful, itch/swelling on a hand or foot, caused by poor circulation in the skin when exposed to cold) which was not unreasonable given the presenting symptoms. However, when the symptoms persisted the practice should have considered an alternative diagnosis of critical ischaemia (limb threat due to peripheral artery disease) rather than continue with chilblains. We also found that the diagnosis of tendonitis (groin strain) was unreasonable as Mrs C had not sustained an injury and that safety netting advice should have been given to Mrs C when she was prescribed painkillers. We upheld the complaints.

Mr C complained about the treatment the practice provided to his mother (Mrs A). Mrs A was attended by a GP at home after it was reported she was having problems with her leg. At this time Mrs A was also receiving nursing care from district nurses. Mr C complained that the practice did not respond to a request from a district nurse for a further home visit the following day. Mrs A's condition worsened and she was admitted to hospital where she later died. We took independent medical advice from a GP. We found that Mrs A's treatment by the practice was reasonable and found no failings in the treatment offered. We saw no evidence a district nurse requested a home visit by the practice. Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201806748 as a PDF (23.67 KB) Updated: June 19, 2019

Miss C suffered from chronic osteoarthritis (a common form of arthritis that leads to pain, stiffness and swelling of the joints) in both of her hips and asked her GP to refer her to a consultant orthopaedic surgeon (a specialist in the treatment of diseases and injuries of the musculoskeletal system) to be considered for hip replacement surgery. The consultant advised that they would not consider Miss C for surgery until her Body Mass Index (BMI, a measure for estimating human body fat) was reduced to an appropriate level. Miss C complained to the board that the consultant wrongly focused solely on her BMI and did not properly examine her or discuss her pain and mobility issues. Miss C requested a private referral for surgery from her GP and underwent hip replacement surgery on both of her hips. The board explained that the consultant did not physically examine Miss C as there was no clinical reason to do so and that there are considerable risks and increased complication in patients who undergo surgery with a BMI greater than 40. Therefore, surgery is not recommended. We took independent advice from an orthopaedic surgeon. We found that the board's approach to dealing with referrals of patients with a high BMI for hip replacement surgery was not sufficiently supported by the available guidance and it did not allow for individualised treatment. We also found that the board failed to carry out a thorough clinical assessment and that their reason for not offering Miss C a second opinion was not in line with the relevant guidance. Therefore, we upheld the complaint.

Mrs C complained on behalf of her husband (Mr A) about the care and treatment he received. Mr A was admitted to Queen Margaret Hospital for surgery to treat a hernia (where an internal part of the body pushes through a weakness in the muscle or tissue near the belly button). He was discharged home on the same day as his surgery. However, Mr A began to experience pain at home that worsened overnight. Early the next morning, Mr A was taken by ambulance to Victoria Hospital. He was found to have suffered a serious complication from his surgery. Mrs C complained that Mr A should not have been discharged home after his surgery at Queen Margaret Hospital. We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that it was reasonable that Mr A was discharged home, as his did not yet have signs of any complication from the surgery and his recovery was as expected. We did not uphold this aspect of the complaint. Mrs C also complained that when Mr A arrived at Victoria Hospital, he was not assessed at A&E before he was transferred to the surgical assessment unit. We took independent advice from an emergency medicine consultant. We found the board's process is that where a patient has recently undergone surgery, they are transferred straight to the surgical assessment unit if they are clinically stable. We found that the process was reasonable and safe and it did not cause any undue delay in Mr A's care and treatment. We did not uphold this aspect of the complaint. Related reading View Decision Report 201708311 as a PDF (24.08 KB) Updated: May 22, 2019

Mrs C complained about the care and treatment she received on the labour ward at Victoria Hospital when she was admitted with a history of reduced fetal movement for 24 hours and no movement felt during the daytime. Mrs C complained that the decision to perform a caesarean section was unreasonably delayed and that once in theatre there was further delay in the delivery of her baby (Baby A) due to the difficulty in achieving an effective spinal anaesthetic. The board carried out a significant adverse event review (SAER, a structured approach to learning from an adverse event) which identified a number of failings in relation to the care and treatment given to Mrs C. Prior to our investigation, the board accepted that there had been a number of failings and detailed the action taken. We took independent advice from a consultant obstetrician and gynaecologist (a  doctor who specialises in the female reproductive system, pregnancy and childbirth) and a midwife. We found that there were failings in relation to the clinical care given to Mrs C which led to the delay in the delivery of Baby A. We were also concerned that there had been a breakdown in communication regarding a post birth anaesthetic review and that there was no evidence that a proposed review meeting between Mrs C and the obstetric consultant had been offered, and either taken up or declined. We also noted that the SAER had failed to identify the anaesthetic involvement in the delay in the delivery of Baby A. In relation to midwifery care, we found that Mrs C's paper records had not accompanied her when she was transferred to another hospital. We considered that the care and treatment Mrs C received was unreasonable and upheld this aspect of her complaint. Mrs C also raised concerns about the handling of her complaint. We found that the board had failed to comply with the NHS model complaints handling procedure. Therefore, we upheld this aspect of Mrs C's complaint.

Mrs C attended the emergency medicine department at Victoria Hospital with abdominal pain. She was reviewed by medical staff and it was considered that she probably had pain related to possible endometriosis (a condition where the tissue that lines the womb is found outside the womb, such as in the ovaries and fallopian tubes). She was discharged home and advised to see her GP. On the following day, Mrs C was admitted to the surgical admissions ward at the hospital under the care of a general surgery consultant. Blood tests were carried out and she was started on intravenous antibiotics. She was found to be improving and was discharged. Mrs C was readmitted to the hospital just over one month later. An ultrasound scan was carried out and an ovarian cyst was detected. Mrs C subsequently had surgery to remove the cyst. Mrs C complained that she had not received a reasonable standard of care and treatment when she attended the emergency department. We took independent advice from an emergency medicine consultant. We found that the standard of assessment and treatment she received there had been reasonable. We did not uphold this aspect of Mrs C's complaint. Mrs C also complained about the surgical care and treatment she received when she was admitted to the hospital. We took independent advice from a general surgery consultant. We found that Mrs C should have had a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan during or shortly after her initial admission. The delay in carrying this out delayed her subsequent surgery. Therefore, we upheld this aspect of Mrs C's complaint. Mrs C also complained about the medical care and treatment she had received during her admissions. We found that she should have had early medical investigation to establish an underlying cause for her symptoms during or shortly after the initial admission. In addition, although antibiotics were prescribed and given, there was no evidence that the sepsis p

Mr C complained about the treatment he received from a consultant psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness) at Whyteman's Brae Hospital. Mr C had been on clonazepam (medication to prevent seizures) which the consultant had withdrawn following Mr C taking an overdose of the medication. Mr C believed that the stopping of the medication adversely affected his health as he started suffering from rapid myoclonic jerks (involuntary contraction of muscles) which was the reason the medication had been prescribed in the first instance. We took independent advice from a consultant psychiatrist. We found that the consultant had appropriately assessed Mr C following the reported overdose and that it was appropriate to stop the medication for some time. The plan was to observe Mr C for a period at the clinic and through his contact with a community psychiatric nurse and when Mr C reported a recurrence of the myoclonic jerks, the clonazepam was reinstated. We did not uphold the complaint. Related reading View Decision Report 201804624 as a PDF (23.82 KB) Updated: March 20, 2019

Ms C complained to us about the treatment she received from her dentist. She said that the dentist had damaged the cartilage in her jaw and it was causing her severe pain. When Ms C reported this to the dentist she was advised to stay on a soft diet and that she would be referred to dental consultants should the problem remain. We took independent advice from a dentist. We found that there was no evidence that the treatment the dentist had provided was inappropriate or that it was the cause of the jaw problems. We found that Ms C had reported problems with her jaw a number of years previously but that no remedial action was required at that time. We found that the advice given by the dentist was reasonable and appropriate. Therefore, we did not uphold the complaint. Related reading View Decision Report 201805288 as a PDF (23.69 KB) Updated: March 20, 2019

Mrs C complained about the care and treatment provided to her mother (Mrs A) by the practice. She complained that Mrs A's symptoms and medical and dental history were largely ignored. Mrs C felt that Mrs A's life was cut short as a result of poor care and treatment by the practice. We took independent advice from a GP. We found that the care and treatment provided to Mrs A by the practice was of a reasonable standard. We found no evidence that the practice had failed to act on abnormal results or that the practice failed to arrange appropriate investigations and referral to secondary care. We did not uphold the complaint. Related reading View Decision Report 201706114 as a PDF (23.6 KB) Updated: January 23, 2019

Mrs C complained about the medical care and treatment her late mother (Mrs A) received when she attended the Victoria Hospital. In particular that more could have been done by the cardiac service to investigate Mrs A's symptoms and diagnose her. We took independent advice from a consultant cardiologist (a doctor who specialises in the heart and blood vessels). We found that there had been some shortcomings in relation to aspects of communication, however, this did not impact on Mrs A's condition. We found that overall the care and treatment Mrs A received had been reasonable. We also noted that the timing of the cardiac tests less than two weeks after a referral from a GP demonstrated good practice and a responsive organisation. We did not uphold Mrs C's complaint. Related reading View Decision Report 201706113 as a PDF (23.72 KB) Updated: January 23, 2019

Mr C complained about the care and treatment he received from the board's mental health services. In particular, he raised concerns about the board only offering appointments outwith his home when he had difficulty leaving his home and that they did not discuss his care plan with him. Mr C also complained about the board's handling of his complaint. We took independent advice from a mental health nurse. We found that there was evidence that a thorough assessment had been carried out in which Mr C was meaningfully involved. We acknowledged that it was clear that leaving the house was anxiety-provoking for Mr C. However, it appeared that Mr C was resorting to managing his anxiety by displaying avoidant behaviour which generally serves to increase anxiety in the long term. We considered that the types of support offered to Mr C, including group and one-to-one sessions aimed at confidence building, were reasonable under the circumstances. We also found evidence that confirmed Mr C's participation in discussions about his care plan. Therefore, we did not uphold this aspect of Mr C's complaint. In relation to complaints handling, the board accepted that there had been unacceptable delays caused by confusion around who was investigating the complaint. We found that the board had unreasonably classified Mr C's original complaint as a 'concern', when it should have been treated as a complaint. Even after it was classified correctly, the board took almost three months to respond to the complaint. We were also critical of the board's failure to send Mr C an application to access his medical records, despite him twice providing the information they had requested. Therefore, we upheld this aspect of Mr C's complaint.

Mrs C complained about the care and treatment provided to her late husband (Mr  A). Mr A was admitted to Victoria Hospital day surgery for an operation. Mrs  C called the hospital the next morning to advise that Mr A was unwell, and was told to call his GP. Following GP review, Mr A was admitted to hospital, where he was subsequently diagnosed with necrotising fasciitis (a very aggressive bacterial infection). He died in hospital less than two weeks later. The board carried out an investigation into the source of Mr A's infection, but concluded that they could not say whether the infection was acquired in hospital or in the community. Mrs C complained about the infection, and that the nurse she spoke to on the phone the day after the surgery was not more supportive. In response to Mrs C's complaint, the board met with her family and explained their findings. The board apologised for the poor communication by the nurse, and shared Mrs C's concerns with the ward for reflection and learning. The board also put in place new procedures for responding to calls from patients or family. Mrs C remained dissatisfied with the board's response, and she brought her complaint to us. Mrs C complained to us that the board unreasonably failed to prevent infection during Mr A's operation. We took independent advice from a general and colorectal surgeon, and from a nurse. We found that, whilst some aspects of the surgical care could have been improved, staff had taken reasonable steps to reduce the risk of infection during the operation, although it was not possible to eliminate the risk entirely. We also found that, once Mr A was re-admitted, staff identified his infection and began antibiotics promptly. We found that the board had carried out a reasonable and timely investigation into the source of the infection, and we agreed with their finding that it was not possible to know with certainty where this was acquired. We did not uphold this aspect of Mrs C's complaint.

Mr C complained about the medical care and treatment he received when he attended Queen Margaret Hospital to have biopsies (a procedure to remove tissue or cells for analysis) carried out. In particular, Mr C complained that, despite telling the operating surgeon that he was in extreme pain the biopsy procedure was continued. He also said that during the consent process for the biopsy procedure, he was not advised there was a risk of major bleeding. We took independent advice from a consultant urological surgeon (a specialist in diseases of the urinary organs in females and the urinary tract and sex organs in males). We found that the operating surgeon should have stopped or acted to address Mr C's discomfort during the biopsy procedure. We were also concerned that, although uncommon, the risk of major bleeding was not explained to Mr C. While we found that the care and treatment Mr C received following the biopsy procedure was reasonable, we were concerned that the level of communication in relation to the discharge letter was unreasonable. Therefore, we upheld Mr  C's complaint.

Mrs C complained about the care and treatment provided to her late husband (Mr  A) by the urology service (the service which deals with the male and female urinary-tract system and the male reproductive organs) at Victoria Hospital. Mr  A had a diagnosis of metastatic prostate cancer (prostate cancer that had spread to his bones) and had been reviewed roughly every three months by prostate cancer nurse specialists. Mr A received hormone therapy injections and his PSA (prostate specific antigen - a protein produced by normal cells in the prostate and also by prostate cancer cells) levels were measured to monitor his disease. Over two years following his diagnosis, Mr A experienced back pain and he had a number of consultations with his GP. After Mr A's condition did not improve, the GP made a referral to the urology service to request urgent investigation. The urology service received the referral one day later and then made a referral to the radiology department to request a scan. A week passed following the initial GP referral, and by this time Mr A was struggling to move. Mr A was then admitted to hospital and a scan was performed. This indicated that he had a spinal fracture and cord compression from metastatic cancer. As a result of his condition, Mr A became paralysed below the waist. Mrs C complained that the urology service did not carry out scans following Mr  A's diagnosis, even though it was known that the cancer had already spread to his bones. 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 oncologist (a doctor who specialises in cancer). We found that it was reasonable for the board to monitor Mr A's prostate cancer using PSA testing and not with routine scans. We did not uphold this complaint. However, we noted that the board had failed to respond to this part of Mrs

Mrs C complained on behalf of her father-in-law (Mr A) about the care and treatment he received from Victoria Hospital and Glenrothes Hospital over a six  month admission period. Mrs C's concerns related to surgical treatment, nursing care, physiotherapy, speech and language therapy (SALT) and medical care. We took independent advice from a general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus), two registered nurses and a consultant geriatrician (a doctor who specialises in medicine of the elderly). In relation to Mr A's surgical treatment, Mrs C felt that a perforated ulcer should have been identified at the time Mr A underwent an emergency operation. We found that it was reasonable that the perforated ulcer was not recognised at the time of the emergency surgery given a number of relevant factors. We did not uphold this aspect of Mrs C's complaint. In relation to the nursing care, Mrs C was concerned that Mr A developed as significant pressure ulcer, monitoring of his fluid intake/output was poor and Parkinson's medication was not administered when it should have been. We found no evidence that administration of Mr A's Parkinson's medication was unreasonable. However, we found significant failings in relation to the prevention, monitoring and management of pressure ulcers and that fluid intake/output charts were not adequately completed. We upheld this aspect of Mrs C's complaint. However, we noted that the board had identified failings in regards to pressure ulcer damage and fluid monitoring and had taken steps to address these issues. In relation to the physiotherapy treatment Mr A received, Mrs C was concerned that there was a lack of regular visits from the physiotherapist. We found that Mr  A received regular visits from physiotherapy staff and that their care was appropriate. We did not uphold this aspect of Mrs C's complaint. Mrs C was also concerned that there was a lack of visits from SALT and a la