SPSO Individual Decisions

Mrs C complained about the care and treatment provided to her late brother (Mr A), who had chronic obstructive pulmonary disease (COPD) (a disease of the lungs in which the airways become narrowed) and a mental health condition. Mrs C complained that the practice failed to admit Mr A to hospital in the months leading to his death. Mrs C had contacted the practice to raise concern about Mr A's physical health. Shortly following this, the GP attempted to carry out a home visit, but found no response on attendance at Mr A's property. A week later, Mr A was examined during a home visit by one of the board's out-of-hours doctors who initiated treatment for his COPD. At this time, Mr A had very low oxygen saturation and potential signs and symptoms of heart failure. A report of the out-of-hours consultation was sent to the practice. The practice arranged to visit Mr C again approximately ten days later, but when the GP attended Mr A refused an examination. The GP felt that the symptoms were likely due to COPD and treatment was commenced with a plan to review Mr A in ten days time. Mr A died on the date of the planned review, with the cause of death unknown. We took independent advice from a GP adviser. We were unable to conclude that the practice reviewed the details of the out-of-hours report, which contained details of concerning symptoms, and used this to determine a working diagnosis and management plan at the penultimate home visit attempt. We considered that the practice's decision that that there was no clinical indication for hospital admission following the home visit was unreasonable. We upheld this complaint.

Mrs C complained about the care and treatment provided to her daughter (Miss A) when she was admitted to Aberdeen Royal Infirmary for abdominal pain, vomiting, and a high temperature. Mrs C felt that there was a delay in diagnosing Miss A with pelvic inflammatory disease (infection of the organs of the reproductive system). We took independent advice from a general surgeon, a radiologist, and a gynaecologist (a doctor who specialises in the treatment of women's diseases, especially those of the reproductive organs). We found that the care and treatment provided to Miss A was reasonable and that it would not have been possible to diagnose her with pelvic inflammatory disease any earlier. We did not uphold this complaint. Related reading View Decision Report 201708489 as a PDF (23.67 KB) Updated: July 24, 2019

Mrs C complained about a number of issues with the care and treatment she received from the board. Mrs C had a complex medical history and had accessed a number of different services provided by the board. Firstly, Mrs C raised concern that the board had not provided her with timely and appropriate maxillofacial (relating to the jaws and face) care and treatment. Mrs C was referred to the maxillofacial service for extraction of a tooth. After an initial consultation, Mrs C was listed to have the tooth extracted. At the subsequent consultation, a different doctor found that the tooth was vital and could be restored with further treatment. Mrs C was discharged from the service. Mrs C's general dental practitioner made a further referral to the service and after further consultations Mrs C's tooth was extracted. She felt that the board's actions had prolonged her pain. We took independent advice from a speciality doctor in oral and maxillofacial surgery. We considered that the care provided to Mrs C was reasonable. We did not uphold this complaint. However, we found evidence of issues with record-keeping in the service and we made a recommendation in relation to this. Mrs C also raised concern that the board had not provided her with timely and appropriate orthopaedic (the branch of medicine involving the musculoskeletal system) care and treatment. Mrs C had a number of consultations in the orthopaedic service and was unhappy with the way clinicians investigated her orthopaedic condition and managed her care. In response to Mrs C's complaint, the board acknowledged that she had experienced delays and they described that they were reviewing the referral process to reduce delays. We took independent advice from a consultant orthopaedic surgeon. We found no medical failings in Mrs C's orthopaedic care, however, we noted that there was evidence of a significant delay in Mrs C being offered an appointment following a referral from her GP. We upheld this aspe

Mr C complained about the treatment provided to his late son (Mr A) who died during a hospital admission. Mr A was suffering from heart failure secondary to Friedreich's ataxia (an autosomal recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs and impaired speech that worsens over time). After being administered calcium gluconate treatment for high potassium levels, Mr A vomited and collapsed with a cardiac arrythmia (irregular heartbeat) from which he could not be resuscitated. Mr C complained that the most junior doctor on the ward was given the responsibility of carrying out Mr A's treatment. He also complained that it had taken hours to carry out relevant tests on Mr A. The board acknowledged that a number of attempts were made to obtain blood for testing, spanning a period of several hours. We took independent advice from a consultant cardiologist (doctor who deals with diseases and abnormalities of the heart). We found that there was no clinical need for Mr A's treatment to have involved more senior staff, noting that the challenging issue in this case was the emergency management of an elevated potassium level in a patient who was taking digoxin (a steroid used in small doses as a cardiac stimulant) medication with a higher than desirable blood level. While Mr A's blood potassium was at such a high level there was a risk of cardiac arrest at any time. We found that because of the metabolic complexity of the case and the excessive level of digoxin, full supportive measures should have been in place. In particular, we considered that there should have been continuous ECG (a test that records the electrical activity of the heart) monitoring. We were critical of the fact that there was no record of the junior doctor having discussed the complication of the excessive digoxin level with the cardiology registrar. We noted that the board had subsequently made changes to their protocol for treating hyperkalemia

Mr C complained about the treatment he received when he attended an out-of-hours service (OOHS) GP at Peterhead Hospital. Mr C said that he had collapsed at home and was taken to the OOHS where the GP performed a cursory examination and sent Mr C home. Mr C was subsequently admitted to hospital the following day and treated as an in-patient for a week. We took independent clinical advice from an GP. We found that the OOHS GP had carried out an appropriate examination after taking into account a report from the paramedic who brought Mr C into the OOHS along with a history provided by Mr C. It was reasonable to have reached a diagnosis that Mr C had taken a reaction to the medication which had previously been prescribed by his GP and that there was no clinical indication for a hospital admission at that time. The OOHS GP could not have predicted that Mr C would then go on to develop a chest infection. We did not uphold the complaint. Related reading View Decision Report 201804843 as a PDF (23.8 KB) Updated: June 19, 2019

Ms C, an advocate, complained on behalf of her client (Mr A) about the care and treatment he received following a referral to the board's musculoskeletal (MSK) hub (a specialist physiotherapy service) and following his referral to neurosurgery (branch of medicine concerned with the brain and other nerve tissue). Mr A was experiencing shooting pains down his legs. We took independent advice from a specialist musculoskeletal physiotherapist and a consultant neurosurgeon. We found that it was reasonable for a physiotherapist to assess Mr A initially and then refer him directly to the MSK hub when there was no improvement in his condition. We also found that the MSK hub appropriately assessed Mr A in accordance with relevant guidelines and referred Mr A for an MRI scan at the appropriate time. We found that it was reasonable for neurosurgery to send Mr A back to the MSK hub because a further period of conservative management of his symptoms might have been successful and might have avoided the need for an operation. We did not uphold Ms C's complaints. Related reading View Decision Report 201803955 as a PDF (23.89 KB) Updated: June 19, 2019

Mrs C complained to us that she had unreasonably been removed from the ear, nose and throat in-patient waiting list because she had cancelled three planned admissions. Mrs C felt that the board had not listened to her reasons for the cancellations as some were outwith her control. We took independent advice and considered the guidance around removing patients from the in-patient waiting lists. We found that from a clinical perspective, there was no life-threatening reason for Mrs C to have remained on the waiting list and from a procedural aspect, staff had followed the guidance on removing a patient from the waiting list after three cancelled appointments. We did not uphold the complaint. However, we established that Mrs C had been reinstated to the waiting list and would be offered one further appointment. Related reading View Decision Report 201805245 as a PDF (23.69 KB) Updated: June 19, 2019

Mrs C complained about the care and treatment which her late brother (Mr A) received at Aberdeen Royal Infirmary. Mr A died suddenly at home, two days after being discharged from hospital. The cause of death was recorded as colonic impaction (hard stool in the colon) and renal failure (kidney failure). Mr A had been admitted to hospital as an emergency with colonic impaction and problems with urination. A manual evacuation of the bowel was carried out under anaesthetic along with trials of catheterisation (a flexible tube inserted through a narrow opening into a body cavity, particularly the bladder, for removing fluid). Mr A was discharged with a catheter in situation and arrangements made for a urology review as an out-patient. Mrs C believed that Mr A had received inadequate care in hospital. We took independent advice from a consultant general and colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that while in hospital Mr A did undergo a number of appropriate investigations such as blood tests; radiographs of the abdomen and chest; bladder scan; suppositories; manual evacuation of the bowel under anaesthetic; and catheterisation. However, on the day of discharge there were signs that Mr A was still unable to manage a normal bowel motion and his urine output was low compared to his normal urine output levels. We found that staff should have arranged a urology review in hospital prior to discharge rather than refer for an out-patient appointment in due course. We also found that arrangements should have been made for urgent review of Mr A's inability to manage a normal bowel motion in the days after discharge from hospital. We upheld the complaint.

Mr C complained about aspects of his care and treatment which he received at Aberdeen Royal Infirmary. Mr C said that he received inconsistent explanations from staff about the cause of his back pain. He was also dissatisfied with the pain relief which was provided as it did not meet his needs. We took independent medical advice from a consultant neurosurgeon (surgeon of the brain or other nerve tissue). We found that Mr C had a complex surgical history and a chronic pain condition. We found that although the staff had referred to the cause of Mr C's back pain differently at times, the explanations had the same meaning and that did not mean that his treatment was inappropriate. We also found that there was record of Mr C reporting pain and that the actions of staff by prescribing different painkillers and referring Mr C to the pain clinic were appropriate. We did not uphold the complaints. Related reading View Decision Report 201806145 as a PDF (23.75 KB) Updated: May 22, 2019

Mr C complained about the treatment which he received at Aberdeen Royal Infirmary. He had attended for a regional anaesthetic (nerve block) procedure. During the procedure he suffered a reaction and became unwell with severe breathing difficulties and had to undergo Cardiopulmonary Respiration (CPR) (medical procedure for a patient in cardiac arrest). Mr C wondered if the nerve block procedure had been carried out correctly. We took independent advice from a consultant anaesthetist and found that the nerve block procedure was performed to an appropriate standard but unfortunately Mr C had an adverse reaction, possibly due to a combination of factors. When it became evident that Mr C was experiencing problems, staff appropriately carried out CPR as a precaution. We did not uphold the complaint. Related reading View Decision Report 201806118 as a PDF (23.73 KB) Updated: April 17, 2019

Ms C, an advocacy and support worker, complained on behalf of her client (Mrs  A) about the medical and nursing care and treatment Mrs A received when she was admitted to Aberdeen Royal Infirmary. Ms C also complained about Mrs  A's discharge, delays in receiving a neuropsychology (the study of the relationship between behaviour, emotion, and cognition on the one hand, and brain function on the other) assessment and neurosurgery (surgery on the nervous system, especially the brain and spinal cord) follow-up and that the board had failed to respond to her complaint in a reasonable way. We took independent advice from a consultant neurosurgeon and a nursing adviser. We found that both the medical and nursing care and treatment given to Mrs A was reasonable. We did not uphold these aspects of Ms C's complaint. In relation to Mrs A's discharge, we found that Mrs A had been medically fit for discharge and that nursing staff had reasonably managed the discharge planning. However, the board accepted that there had been a failure to provide appropriate information and literature to Mrs A and her family on discharge and had taken action as a result of these failings. We upheld this aspect of Ms C's complaint. In relation to Mrs A's neuropsychology assessment, we found that there had been a delay in arranging this. We also found that Mrs A was not advised of the progress of her neurosurgery follow-up appointment when the timescale was not met. Therefore, we upheld these aspect of Ms C's complaint. Finally, we found that the board had failed to comply with their complaints handling procedure and we upheld this aspect of Ms C's complaint.

Mr C had been in contact with mental health services for a number of years and was informed by his current psychiatrist (a medical practitioner who specialises in the diagnosis and treatment of mental illness) that he had a diagnosis of borderline personality disorder. Mr C complained that his previous psychiatrist had failed unreasonably to diagnose him with this and provide the appropriate treatment. We took independent advice from a medical adviser. We found that the standard of communication in relation to the diagnosis was unreasonable and that this led to uncertainty and distress for Mr C. While, we did not find this had an adverse effect on his management or treatment, we recognised that not learning of his diagnosis until recently lead to a great deal of uncertainty and distress. On balance, we upheld the complaint.

Mr C complained about the medical care and treatment that his wife (Mrs A) received from the board. Mrs A had a diagnosis of cancer and had a number of admissions to Aberdeen Royal Infirmary over a two month period. We took independent advice from a consultant clinical oncologist (a doctor who specialises in the diagnosis and treatment of cancer). We found that: Mrs A was discharged from hospital before the results of a stool sample were obtained and while she was experiencing diarrhoea there are no written records of the phone calls that the doctor had with Mrs  A or her GP following a positive result for Clostridium difficile (a bacterium that causes diarrhoea and more serious intestinal conditions) Mrs A was not readmitted to hospital as soon as the Clostridium difficile result became available. We considered the medical care and treatment to be unreasonable and upheld this aspect of Mr C's complaint. Mr C also complained about the nursing care and treatment that Mrs A received. We took independent advice from a nursing adviser. We found that: the board's response in relation to hand gels was inaccurate in that hand gels are ineffective when caring for patients with Clostridium difficile Mrs A's personal hygiene requirements were not recorded consistently and daily records were not kept to indicate what personal hygiene assistance Mrs A had received or had been offered nursing staff did not appear to adhere to the Infection Control Policy. nursing staff did not record how they knew about Mrs A's shingles (a viral infection that causes a painful rash) diagnosis or whether this information had been passed on to the admitting doctor. We considered the nursing care and treatment to be unreasonable and upheld this aspect of Mr C's complaint. Mr C also complained that the board did not handle his complaint reasonably. We found that the board failed to keep Mr C updated about the reason for the delay in responding to his complaint and to provide a revised timescale for

Mr C complained about delays in the care and treatment he received for his eye at Dr Gray's Hospital and Aberdeen Royal Infirmary (ARI). Mr C had developed diabetic retinopathy (a complication of diabetes, caused by high blood sugar levels damaging the back of the eye, which can cause blindness if left undiagnosed and untreated). He also complained about the impact the delays had on his sight, which he said left him almost blind, and about the delay in his treatment following routine diabetic screening by the board at a local health centre. We took independent advice from a senior consultant ophthalmologist (a  specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye). We found that there were delays in Mr C being seen following his initial appointment at Dr Gray's Hospital and following his original laser treatment at the hospital. It appeared that due to a failure in the booking system, the board failed to arrange a follow-up appointment for Mr C at ARI after his original laser treatment. The board accepted and apologised for this failing, and indicated that remedial action has been taken. However, we considered that further action should be taken by the board in this area and we addressed this in our recommendations. We upheld this part of Mr C's complaint. In relation to the follow-up appointment's, we found that the delay contributed to him developing more severe diabetic retinopathy and the subsequent need for surgery. Although the surgery was successful, the poor clarity of vision that finally occurred was possibly not related to the delay and may have been due to other elements of diabetic retinopathy. We also found that there was a long delay of over three months from Mr C's diabetic screening at the health centre to his laser treatment at ARI. This was outwith the timescales recommended and we considered that Mr C should have been seen within a shorter timescale. We noted it was difficult to

Mr C complained that he was not made aware of the risk of having a skin-sensitive test before it was performed and that the board failed to ensure the test was carried out in a reasonable way. Mr C suffered from urticaria (hives) and he underwent a Minimal Erythema Dose (MED, short exposure to ultraviolet radiation) test to help inform phototherapy (light) treatment for the condition. Mr  C said that after the test he was left with scarring on his lower back. We took independent advice from a specialist in dermatology (the branch of medicine concerned with the diagnosis and treatment of skin disorders). We found that there was evidence that the treatment was confirmed to Mr C and the possible side-effects were explained to him. We also found that Mr C signed the form saying the treatment and side-effects had been explained to him. Therefore, we did not uphold this aspect of Mr C's complaint. In relation to how the test was carried out, we found that Mr C experienced a normal darkening of his skin as a result of the process and this was temporary. We also found that there was no evidence to show the test was carried out in an unreasonable way. Therefore, we did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201801256 as a PDF (23.91 KB) Updated: February 20, 2019

Ms C complained about the care and treatment her mother (Mrs A) received at the practice. Mrs A had a history of a number of health issues and Ms C said that the practice failed to monitor her properly or to ensure that she saw a cardiologist (a doctor who specialises in diseases and abnormalities of the heart). She further complained that Mrs A's symptoms were not treated reasonably and the medication she was prescribed was inappropriate. We took independent advice from a GP. We found that Mrs A had been regularly seen, review appointments had been arranged and the medication prescribed was reasonable. At a previous surgery, Mrs A was managed in secondary care (in a hospital by a cardiologist) who had the responsibility for ensuring her ongoing cardiology follow-up and monitoring. We found that the practice had noted that Mrs A had not been to a follow-up and they contacted the hospital to advise them as was appropriate. Therefore, we did not uphold Ms C's complaint. Related reading View Decision Report 201801491 as a PDF (23.82 KB) Updated: February 20, 2019

Ms C was admitted to Aberdeen Maternity Hospital as she had symptoms of preeclampsia (a pregnancy-related condition involving a combination of raised blood pressure and protein in the urine). Ms C complained about decision making in terms of induction of labour, and the care and treatment provided during her labour, including administration of opiate pain relief and the decision that it was appropriate to proceed with a vaginal delivery, rather than a caesarean section. Ms C's baby experienced breathing difficulties following birth, believed to be associated with the opiate pain relief Ms C received, and was cared for by the neonatal team for around five days before they were both discharged home. Ms  C also complained that the board's view that her baby's physical and mental development will not be affected by this was unreasonable. We took independent advice from a consultant obstetrician and gynaecologist (a  doctor who specialises in pregnancy and childbirth as well as the female reproductive system). We found that it was reasonable to induce Ms C's labour in the circumstances of her case. The records indicated that appropriate discussions had taken place with Ms C and that she had taken the decision to proceed with induction. Therefore, we did not uphold this aspect of Ms C's complaint. In relation to Ms C's concerns about care and treatment during her labour, we found that it was reasonable to provide opiate pain relief. We found that the guidance indicates that whilst morphine administration may have significant side effects for mother and baby, these side effects are considered to be short-term. We found that the board had already offered an apology to Ms C in relation to delays in obtaining blood test results and that they had taken steps to improve service in this area. We noted that the blood should have been sent urgently for testing but that the delays were unlikely to have had any bearing on the care and treatment that Ms C received. We also

Ms C complained about the care and treatment her late mother (Mrs A) received at Aberdeen Royal Infirmary. Mrs A had a history of a number of health issues and was admitted to the cardiology unit (the branch of medicine that deals with diseases and abnormalities of the heart) with a diagnosis of atrial fibrillation (a  heart condition that causes an irregular and often abnormally fast heart rate) and congestive heart failure. While she was in hospital, Mrs A had a heart attack but Ms C said that she was not told about this. She also said that Mrs A was not properly monitored nor given dialysis to reduce the fluid she retained. Mrs A's condition deteriorated and she later died. We took independent advice from a consultant cardiologist. We found that Mrs  A's symptoms should have alerted staff to the possibility of internal bleeding and that neither the additional diagnosis of unstable angina (chest pain caused by reduced blood flow to the heart muscles) nor a management plan were documented. Therefore, Mrs A's emergency management plan could have been affected, however, it is unlikely to have changed her immediate outcome. There was also no evidence that Mrs A's deteriorating condition had been communicated to her family. Therefore, we upheld Ms C's complaint.

Mr C complained that the practice failed to discuss the risk of testosterone replacement when it was prescribed to him. We took independent advice from a GP. We found that at the start of his prescription, there was no evidence in Mr C's medical records to show that the risks and benefits of the treatment had been discussed with him as required by General Medical Council guidance. Therefore, we upheld Mr C's complaint.

Mr C was attending the endocrinology (the branch of medicine concerned with endocrine glands and hormones) department at Aberdeen Royal Infirmary for tests associated with his body's ability to make a natural steroid hormone. Several month's later he suffered a stroke and he believed that this was a result of him taking testosterone replacement therapy. Mr C complained that during a clinic attendance he was not warned about the risks and benefits of this therapy. We took independent endocrinology advice. We found that Mr C had been prescribed testosterone replacement therapy by his GP and that it was the responsibility of the prescribing doctor to discuss the risks and benefits with him. When hospital clinicians became aware of the testosterone therapy, they contacted the GP practice to obtain more information and suggested a way forward. We considered this to be reasonable and did not uphold Mr C's complaint. Related reading View Decision Report 201800349 as a PDF (23.79 KB) Updated: February 20, 2019

Mr C complained about the care provided to his late mother (Mrs A) by the practice. In particular, Mr C said the practice knew that his mother had cancer and had had chemotherapy. However, the family had concerns that on one occasion there was a failure to admit Mrs A to hospital and, on another, a GP had refused to make a home visit. When Mrs A was seen by a different GP the same day, she was admitted to hospital. Mr C felt that given his mother's medical history, the practice could have provided more appropriate care. We took independent medical advice from a GP. We found that the GPs involved in Mrs A's care carried out appropriate assessments given the reported symptoms. On the first occasion, the GP had contacted the oncology (cancer) specialists for advice as Mrs A was experiencing the side effects of chemotherapy. At that time, it would not have been appropriate to have referred Mrs A to hospital due to the increased risk of her catching an infection from other patients who may have been unwell or from hospital acquired infections. On the second occasion, there was a change in Mrs A's symptoms from when the initial request for a home visit was made. As a result a home visit was arranged and Mrs A was appropriately admitted to hospital at that time. Therefore, we did not uphold Mr C's complaint. Related reading View Decision Report 201805241 as a PDF (24 KB) Updated: February 20, 2019

Mr C complained about the care and treatment he had received at Dr Gray's Hospital. Mr C, who had a history of heart problems, had attended a consultation at the cardiology unit (the branch of medicine that deals with diseases and abnormalities of the heart) where investigations were carried out and he was told there was no cause for concern. However, Mr C suffered a heart attack three months later and had to be fitted with a stent (tube inserted in a blocked artery to keep it open). Mr C felt that the previous investigations must have shown that he was at risk of a heart attack and that preventative action should have been taken. We took independent advice from a cardiac consultant. We found that the previous investigations were appropriately carried out and reported on and it was reasonable for the clinicians to have diagnosed that Mr C had mild and stable angina (chest pain). The clinicians involved could not have predicted that Mr C would go on to suffer a heart attack after such a short period of time. We did not uphold the complaint. Related reading View Decision Report 201803549 as a PDF (23.85 KB) Updated: January 23, 2019

Mr C complained about the care and treatment he received at Woodend Hospital. Mr C had suffered knee problems for a number of years and had been refused surgery as his Body Mass Index (BMI - weight health calculation) was too high. Mr C lost a substantial amount of weight and reduced his BMI. Mr C was then reviewed by a consultant who said that they would not consider surgery unless he lost at least a further three and a half stone in weight. We took independent advice from an orthopaedic consultant (a specialist in the treatment of diseases and injuries of the musculoskeletal system). We found that Mr C had previously been given a target BMI which he reached. However, when Mr C was reviewed by the consultant, they felt that Mr C needed to achieve an even lower BMI before they would consider surgery. We considered that Mr C had persevered with his weight loss attempts and that it was then unreasonable for the consultant to have decided that Mr C continue to lose a further substantial amount of weight. Therefore, we upheld Mr C's complaint.

Mr C complained about the care and treatment that his wife (Mrs A) received from the board's gastroenterology department (the branch of medicine which deals with disorders of the stomach and intestines) at Aberdeen Royal Infirmary for her abdominal problems. A number of tests were carried out and it was considered that she had probable small bowel Crohn's disease (a long-term condition that causes inflammation of the lining of the digestive system). We took independent advice from a consultant gastroenterologist. We found that Mrs A's case was complex. Whilst there had been a short delay in her seeing a consultant, this was not unreasonable. That said, we found that there had then been an unreasonable delay in carrying out an urgent colonoscopy (examination of the bowel with a camera on a flexible tube) that had been requested for her. However, in their response to Mr C's complaint, the board said that this had been reviewed and action had already been taken to prevent similar delays. We also found that given staff were aware of Mrs A being atypical for a Crohn's disease patient, alternative / additional diagnoses, including a psychological diagnosis, should have been considered, documented, discussed and treated earlier in the course of her assessment. Staff should have concentrated more on controlling Mrs A's symptoms and considered more active treatment for irritable bowel syndrome type symptoms. In view of these failings, we upheld this aspect of Mr  C's complaint. Mr C also complained that the board's response to his complaint was unreasonable. Given the symptoms Mr C had described in his complaint to the board, we found that the board should have explored what further treatment should be provided to Mrs A and referred to this in their response. Given the failure to do so, we also upheld this aspect of Mr C's complaint.

Mrs C complained about the care and treatment her late husband (Mr A) received from the board's out-of-hours emergency care centre and during his time as an in-patient at Aberdeen Royal Infirmary. In particular, Mrs C was dissatisfied that the out-of-hours service did not admit Mr A to hospital at the time and that after he was admitted around a week later, he died following a head scan. We took independent advice from a general practitioner in relation to the out-of-hours care and treatment. We found that an appropriate medical history was taken and an appropriate examination performed. We considered that it was not necessary to repeat blood tests that had been done at Mr A's GP practice which were found to be abnormal. We found that the out-of-hours service's decision not to admit Mr A to hospital was in keeping with national guidelines on the treatment of community acquired pneumonia (an infection of the lungs) and that appropriate antibiotic treatment was prescribed with follow-up review advised. Therefore, we considered that the out-of-hours care was reasonable and we did not uphold this aspect of Mrs C's complaint. In terms of the hospital care and treatment, we took independent advice from a consultant in general medicine. We considered overall that there was evidence to show that the severity of Mr A's illness was recognised and responded to appropriately. We found that it was reasonable to perform a head scan given Mr  A's increasing confusion and there was evidence to show that his clinical observations (temperature, pulse, blood pressure and breathing rate) were stable before it was carried out. We found that there was evidence to support that communication took place with Mrs C and the family regarding Mr A's deteriorating condition and the possibility that he might not survive. We did not uphold this aspect of Mrs C's complaint but provided feedback to the board about checking a families understanding of information given to them. Related readi