SPSO Individual Decisions

C complained about the medical and nursing care and treatment given to their late parent (A) during their admission to Wishaw General Hospital. They also complained about the way staff behaved and communicated with the family and the way the board responded to their complaints. A was admitted to hospital suffering from breathing difficulties, after a chest infection. A was registered blind and had poor hearing and limited mobility. C was concerned about A's level of confusion, as well as a lack of personal care from nursing staff. Although C had power of attorney for A and had provided this to the board, they were not informed for a number of days that staff considered A lacked the mental capacity to make decisions about their treatment. C said that on one occasion they had overheard staff making derogatory remarks about C and A. Although C had felt that A was improving during their last visit, A was found dead early the following morning. C complained to the board about A's care and treatment and met with medical and complaints staff twice. C was unhappy with the board's records of these meetings, as they had taken their own notes and they felt there were significant and substantial differences between the two. C felt that the board's complaint response was inaccurate and the findings inadequate. C told us they felt they had let A down and it was clear from C's submissions that the experience had been distressing for them. We took independent advice from a consultant geriatrician and a nurse. In relation to A's medical care and treatment, we found that treatment of A's infection and the management of A's medication was appropriate. There was, however, a failure to monitor or assess A's delirium appropriately, and for this reason we found the medical care and treatment they had received fell below a reasonable standard. We upheld this aspect of C's complaint. In relation to nursing care, we found that aspects of A's care had fallen below a reasonable st

Mr C was referred for orthotics and fitted with insoles. He attended a follow-up appointment with a private consultant as his symptoms were not improving and was diagnosed with anterior impingement syndrome (compression of the bone or soft tissue). After the consultation Mr C decided surgery was his preferred option. Mr C's GP subsequently referred him to the orthopaedics department (specialists in the treatment of diseases and injuries of the musculoskeletal system) at Hairmyres Hospital. His referral was refused as consultants considered that he was receiving appropriate first line care already. Mr C was unhappy with his treatment and told us that, had consultants acted on the report of the private consultant, he would have had surgery much earlier and his pain and suffering would not have gone on for so long. We took independent medical advice from a clinical adviser who is experienced in orthopaedics. We found that Mr C was treated in accordance with guidelines and that conservative treatment was the appropriate response. It is not uncommon for medical professionals to have different views on treatment, but that the board's treatment following the GP's referral was appropriate. We did not uphold the complaint. Related reading View Decision Report 201802816 as a PDF (24.35 KB) Updated: September 23, 2020

C complained about the time taken by the practice to refer them to the breast clinic. C initially attended at the practice with pain in their breast, which was diagnosed as musculoskeletal pain. C later returned to the practice with ongoing pain and a new lump in their breast. The practice referred them urgently to the breast clinic and a scan found a large breast cancer. We took independent advice from a GP and from a breast surgeon. We found that the treatment provided at the initial appointment was, for the most part, reasonable, and we did not find sufficient evidence to conclude that the practice missed the breast cancer in that appointment. However, we considered that the practice should have advised C, at their initial appointment, to return within three months (in keeping with guidelines). Ideally, the practice should also have sent the referral to the breast clinic as 'urgent – suspected cancer' rather than simply 'urgent', although we accepted that, on balance, this was not unreasonable. Based on the failings identified, we upheld C's complaint. We noted that the practice accepted both these points and considered the action taken was appropriate for reflection and learning . Under section 16G of the SPSO Act, SPSO has a responsibility to monitor and promote good practice in complaint handling by organisations under our jurisdiction. We found that the practice failed to fully reflect on and learn from C's complaint until prompted by this office. We therefore made recommendations to address the failings we identified.

Mrs C, who has power of attorney for her mother (Mrs A) complained about the treatment provided to Mrs A at the eye clinic at Wishaw General Hospital. Mrs C had been referred from her optician with symptoms of distortion in her right eye which had been present for two months. An Optical Coherence Tomography diagnostic test (a non-invasive imaging test which uses light waves to take pictures of the retina) was performed and the result was subsequently reviewed by a consultant ophthalmologist (a specialist in the branch of medicine concerned with the study and treatment of disorders and diseases of the eye). The consultant reviewed the test results and phoned Mrs A to advise her that she had Age Related Macular Degeneration (ARMD, eye disease which can lead to severe loss of vision) and that due to previous scarring, injections would not improve the vision in her right eye. Mrs A’s obtained a second opinion privately. The private opinion was that Mrs A required an injection which would stabilise her condition. Mrs C complained that the consultant relayed the results of the diagnostic test over the phone to Mrs A without seeing her and that as a result she had to obtain a private opinion. We took independent advice from an ophthalmologist. We found that it was reasonable that the consultant had diagnosed that Mrs A had advanced ARMD which was unlikely to improve with injections and that it was appropriate for the consultant to have called Mrs A with the result and to arrange a follow-up at the clinic. We did not uphold the complaint. Related reading View Decision Report 201904498 as a PDF (24.5 KB) Updated: August 19, 2020

C complained about the care and treatment provided to them by the board when they presented with a suspected ectopic pregnancy (a pregnancy in which the fetus develops outside the uterus, typically in a fallopian tube). C’s main concern was that they were not scanned on arrival at the hospital as it was outwith scanning hours. C ultimately had surgery to remove the ectopic pregnancy and a fallopian (tubes along which eggs travel from the ovaries to the uterus). C was concerned that had a scan occurred at an earlier point, it may have resulted in a better outcome. We took independent advice from a consultant obstetrician and gynaecologist (a doctor who specialises in the female reproductive system, pregnancy and childbirth). We found that C was triaged and transferred within a reasonable timescale on arrival to the hospital and that their management was appropriate in the context of being seen outwith the working hours of the early pregnancy assessment scanning service. We did not uphold C’s complaint. Related reading View Decision Report 201903205 as a PDF (24.24 KB) Updated: August 19, 2020

Mrs C, an MSP, complained on behalf of her constituent (Ms A). The complaint related to the care and treatment provided by the board to Ms A's late partner (Mr B) who died by suicide. Mrs C complained that the board had failed to provide appropriate care and treatment in respect of Mr B's mental health. We took independent advice from a consultant psychiatrist. We found that the care and treatment the board provided was reasonable and appropriate. We acknowledged that we could not know for certain what was discussed between clinicians and Mr B or Ms A. However, we concluded that the records made by different clinicians were consistent with each other and the board provided appropriate care and treatment to Mr B, based on the information known at the time. The board had acknowledged some failings in respect of providing information about self-referral to addiction services. However, we considered that this related to communication rather than care and treatment. As such, we did not uphold this complaint. Mrs C's second complaint was that Mr B's medical records repeatedly state he was using cannabis in the days before his death. However, the post-mortem and toxicology report indicated that there were no drugs in his system when he died. Mrs C complained that the board had not provided a satisfactory explanation for this. The board said that they could not establish why the post-mortem and toxicology report did not find drugs in Mr B's system or explain the apparent contradiction between this and the medical records. We were not able to confirm exactly what was discussed during the consultations before Mr B's death. However, given the consistency of the medical records, it was reasonable to conclude that the understanding of the clinical staff who reviewed Mr B was that he was using cannabis on an ongoing basis at that time. Therefore, we did not uphold this complaint. Mrs C also complained that the board's out-of-hours service failed to respond to Ms A's

C complained on behalf of A, who has a history of complex congenital heart disease (a problem with the structure of the heart). A was admitted to Hairmyres Hospital, treated for paroxysmal atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) and a possible chest infection, and discharged a few days later. A was readmitted to hospital three weeks later and diagnosed with endocarditis (an infection of the heart valves). A said that they had asked a doctor specifically about endocarditis during the first admission, but the doctor told them they had been tested for endocarditis and did not have it. C complained that A should have had blood cultures (a test used to detect bacteria or fungi in a person's blood) taken to test for endocarditis during this first admission. The board did not uphold C's complaint. They said that doctors considered whether A had endocarditis, but ruled this out because A did not have symptoms of endocarditis at the time. The doctor said they told A that tests showed they did not have a significant underlying infection, but not that they had been tested specifically for endocarditis. We took independent medical advice from an appropriately qualified adviser. We found that endocarditis was considered, but it was reasonable for doctors to rule this out based on the evidence at the time. We also found that it was reasonable for doctors not to take blood cultures during this admission, based on A's symptoms. The medical records stated A was told that they did not have a 'significant infection' (rather than endocarditis specifically), and we did not consider A was given incorrect information about being tested specifically for endocarditis. We did not uphold this complaint. Related reading View Decision Report 201811064 as a PDF (24.55 KB) Updated: July 22, 2020

C's parent-in-law (A) suffered from symptoms that they later learned were caused by having a stroke, and was taken by emergency ambulance to University Hospital Monklands. A CT scan carried out that day was reported as normal, but A's condition continued to deteriorate and they were admitted to the intensive care unit and put on life support. The following day, a repeat CT scan was performed which showed evidence of A having had a severe stroke and, following discussions with family, their life support was switched off and they died. C was concerned about the time it took staff to diagnose A with a stroke. We took independent advice from a medical adviser. We found that the management of A including investigations and treatment decisions were appropriate and carried out within a reasonable time. Clinicians considered the possibility that A had a stroke and took appropriate action by arranging a CT scan, and then a further CT scan the following day. We did not uphold the complaint. Related reading View Decision Report 201808408 as a PDF (24.22 KB) Updated: July 22, 2020

C complained about the ophthalmology (eye) care and treatment provided by the board when they had surgery for cataracts (when the lens, a small transparent disc inside the eye, develops cloudy patches). There had been a complication during the procedure which meant that C had to undergo further surgery at a later date. C was concerned that the procedure was not carried out appropriately and that the follow-up was not reasonable. We took independent advice from an ophthalmologist. We found that all aspects of care, from the decision to carry out cataract surgery and do this under local anaesthetic, to the management and follow-up of the complication, was appropriate. We therefore did not uphold C's complaint. Related reading View Decision Report 201900598 as a PDF (24.05 KB) Updated: July 22, 2020

Mr C complained about the way the practice removed his Duloxetine medication when he reported that it was not giving him adequate pain relief. When the medication was removed Mr C suffered from withdrawal symptoms and had to be admitted to hospital. We took independent advice from a GP. We found that the practice had reduced Mr C's medication in line with accepted medical practice, while at the same time introducing an alternative painkilling medication. Unfortunately, Mr C then developed some signs of withdrawal, but this was not as a result of inappropriate medical treatment. We did not uphold the complaint. Related reading View Decision Report 201909348 as a PDF (24.03 KB) Updated: July 22, 2020

Mrs C complained to us on behalf of her late son (Mr A). Mr A was admitted to University Hospital Monklands for surgery to treat perianal abscesses (a collection of pus or infected fluid near the anus). Mr A was discharged home and received visits from district nurses to check his surgical wounds. Mr A began to feel unwell and he died a few days after his discharge home. Mrs C complained that Mr A did not receive reasonable care and treatment in the hospital and that district nurses failed to recognise Mr A was seriously unwell. We took independent advice from a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) and a nurse. We found that the care and treatment Mr A received in the hospital was reasonable and there was no indication Mr A should not be discharged home. We found no evidence that district nurses were aware that Mr A was feeling unwell. Therefore, we did not uphold the complaint. Related reading View Decision Report 201800345 as a PDF (24.16 KB) Updated: July 22, 2020

Mrs C complained about the care and treatment of her late son (Mr A). Mr A had a history of mental health and addiction problems. Mrs C complained about the role of the board's addictions service in Mr A's treatment. Mrs C said that Mr A was prescribed drugs that had a damaging effect on his mental state. She considered that the drugs should not have been prescribed in combination, and without appropriate supervision. She raised concerns that she was unable to support Mr A as she was excluded from discussions about his care. While it was on record that Mr A did not wish for information about his care to be shared with his mother, Mrs C did not consider that Mr A had capacity to make that decision. In any event she considered that the clinicians' duty of care and Mr A's right to life should have overridden any obligations to protect his right to confidentiality. We took independent medical advice from a consultant psychiatrist. We found that the drugs prescribed to Mr A are commonly prescribed alongside one another and were appropriate for the treatment of his problems. We considered that there was appropriate monitoring of Mr A's clinical state, and that it was appropriate for clinicians to act in line with Mr A's expressed wish for information not to be shared with Mrs C. We noted that the assessment of Mr A's capacity appeared reasonable and that Mr A's recorded clinical presentation was reasonably not viewed as meeting exceptional circumstances that would have permitted breaching his confidentiality. We did not uphold the complaint. Related reading View Decision Report 201805653 as a PDF (24.47 KB) Updated: July 22, 2020

C's spouse (A) suffered from chronic pancreatitis (inflammation of the pancreas) and was receiving care and treatment from the board. A attended hospital multiple times over several months. A was discharged home but the following day they were admitted again with significant pain and died. C complained to the board, raising a number of specific questions about the treatment provided to A and was of the view that more could have been done to help A. We took independent advice from a consultant general surgeon. We found that while during the majority of A's admissions, the treatment provided by the board was reasonable, there was a significant failing in relation to A's discharge the day before their death. At the time A was discharged, their observations were still abnormal, A's pain score remained high and there was no evidence that the blood test results had been reviewed prior to discharge. We concluded that to discharge A at that time was unreasonable. Therefore, we upheld C's complaint.

Mr C complained about the care and treatment he received at University Hospital Monklands in relation to hip pain. In particular, Mr C was concerned that the board mismanaged his condition and did not identify that he required a hip replacement following scans and x-rays. 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 care and treatment provided to Mr C was reasonable. We noted that, based on the findings of the x-rays and the scan, there was no indication that Mr C should have been offered surgery at that time. We did not uphold Mr C's complaint. Related reading View Decision Report 201906299 as a PDF (24.05 KB) Updated: July 22, 2020

C complained to the board about their discharge from hospital. The discharge letter to C's GP said that C would be followed up by a consultant psychiatrist in an out-patient clinic and by C's community psychiatric nurse (CPN). C attended the consultant psychiatrist's out-patient clinic. Based on their assessment of C on that day, the consultant psychiatrist discharged C from the clinic. Later, C became concerned about a related matter. When pursuing this further, C spoke to their GP who told C that they had been discharged from the consultant psychiatrist's clinic. C complained to the board that they had not been advised of being discharged. The board told C that the consultant psychiatrist recalled that the discharging had been discussed. C disputed this and also complained that a promised referral for CPN follow-up had not taken place. The board reiterated their response regarding the discharge and explained that a referral to a CPN was not felt to be required following an occupational therapy assessment in the days following their discharge from hospital. The board apologised that this had not been communicated to C appropriately. C was dissatisfied and raised their complaints with this office. We took independent advice from a suitably qualified adviser. We concluded that the failure to action the promised referral for CPN follow-up had been reasonable in the circumstances and that the available evidence indicates that C was advised that they would be discharged by the consultant psychiatrist. We did not uphold C's complaint. Related reading View Decision Report 201901018 as a PDF (24.4 KB) Updated: July 22, 2020

C complained about the care and treatment their relative (A) received at Wishaw General Hospital. A had been admitted to hospital in relation to an infection. They developed hospital acquired pneumonia and died days later. C was concerned that the Hospital Emergency Care Team (HECT) did not respond appropriately to A's deteriorating condition, and that that there had been a failure to contact the family when A's condition deteriorated. In response to the complaint the board acknowledged, in hindsight, that HECT should have reviewed A in person rather than a telephone discussion having taken place between HECT staff and ward staff. The board said that they were unable to say whether or not A's management would have changed, had they been seen by HECT. The board accepted that the family should have been contacted and they apologised for this. Action was also taken to remind staff of the importance of contacting relatives. We took independent advice from a consultant in geriatric (elderly) and general medicine. We found that when A deteriorated overnight, they should have been seen by HECT. We also considered that A should also have been examined the following morning. A had delayed recognition and treatment of the infection as a result. This reduced A's chances of surviving the infection, but we could not say with certainty that this would have significantly improved the chance of survival. We were also critical that the record-keeping by HECT was not in line with the Nursing and Midwifery Code. We agreed that the family should have been contacted and recommended further action to be taken by the board for further learning and improvement. We concluded that A did not receive a reasonable level of care in keeping with local and national standards and, therefore, upheld the complaint.

Mrs C complained about the care and treatment of her late son (Mr A). Mrs C complained that Mr A was prescribed drugs that had a damaging effect on his mental state. She considered that the drugs should not have been prescribed in combination, and without appropriate supervision. She raised concerns that she was unable to support Mr A as she was excluded from discussions about his care. It was on record that Mr A did not wish for information about his care to be shared with Mrs C. Mrs C did not consider that Mr A had capacity to make that decision, and felt that the clinicians' duty of care and Mr A's right to life should have overridden any obligations to protect his right to confidentiality. We took independent medical advice from a GP and a consultant psychiatrist. We found that the drugs prescribed to Mr A are commonly prescribed alongside one another and were an appropriate treatment option. We considered that the monitoring of Mr A's clinical state was reasonable, and that it was appropriate for clinicians to act in line with Mr A's expressed wish for information not to be shared with Mrs C. We found that the assessment of Mr A's capacity appeared reasonable and that Mr A's recorded clinical presentation was not viewed as meeting exceptional circumstances that would have permitted breaching confidentiality. We did not uphold the complaint. Related reading View Decision Report 201804269 as a PDF (24.37 KB) Updated: July 22, 2020

Mr C complained about the care and treatment his mother (Mrs A) received at University Hospital Monklands during her initial admission and subsequent readmission to hospital for treatment for supraglottis with parapharyngeal oedema (infections of the upper airways/throat). We took independent advice from an ear, nose and throat consultant and from a consultant radiologist (a doctor who specialises in diagnosing and treating disease and injury through the use of medical imaging techniques) with experience in interventional procedures (procedure used for diagnosis or treatment that involves incision; puncture; entry into a body cavity; or the use of ionising, electromagnetic or acoustic energy). Mr C said that the board unreasonably discharged Mrs A from hospital following her initial admission. We found that, at the point Mrs A was discharged, there were no clinical indicators to suggest that this was the wrong decision and, based on what was recorded in the nursing and medical notes at that time, she appeared to be improving at that stage. We did not uphold this aspect of the complaint. Mr C also said that the board failed to provide Mrs A with appropriate care and treatment following her readmission to hospital. We found that the decision to undertake a scan-guided drainage of Mrs A's abscess was reasonable in the circumstances in order to improve her condition, which was very serious at the time, and to avoid major surgery to her chest. The procedure was a technically difficult one, but it was clinically successful because it did lead to draining of the abscess. The catheter becoming dislodged during this is a common problem with any drainage procedure and it was not possible to conclude that the blood clot that developed was either a result of the procedure itself, or the dislodging of the catheter, rather than a result of Mrs A's condition at that time. We did not uphold this aspect of Mr C's complaint. Lastly, Mr C complained that the board failed to resp

Mr C complained that there was an unreasonable delay in diagnosing his late mother (Mrs A) with cancer. Mrs A had a number of consultations in the respiratory clinic at University Hospital Monklands and had a background of chronic obstructive pulmonary disease (a type of lung condition that causes breathing difficulties) and bronchiectasis (a long-term condition where the airways of the lungs become abnormally widened). During the period of care under consideration, Mrs A experienced an increase in frequency of chest infections, and her chest x-ray results showed progressive changes. We took independent advice from a consultant in respiratory medicine. We found that it was reasonable to consider that the progressive changes, and increase in symptoms, to be part of the progression of Mrs A's lung disease. In this context, we found that it was reasonable that investigations were not arranged earlier. We did not find that there had been a delay in diagnosing Mrs A's cancer and therefore we did not uphold Mr C's complaint. Related reading View Decision Report 201803620 as a PDF (24.23 KB) Updated: June 17, 2020

C, a support and advocacy worker, brought a complaint on behalf of their client (A). A was concerned that the Child and Adolescent Mental Health Service (CAMHS) did not follow the correct process regarding a childhood autism assessment and about the communication from CAMHS about the process for getting an autism assessment. We took independent advice from a registered mental health nurse. We found that it was reasonable for CAMHS to conclude that A would have to access an autism assessment through their GP because A was over 16 years of age at the time. We also found that the board had communicated reasonably with A and A's parent about the process of getting an autism assessment. We did not uphold these aspects of C's complaint. C also complained about the way the board handled the complaint. We found that there was a delay in responding to C's complaint and that they were not kept updated on the progress of their complaint or provided with a revised timescale for the response. We upheld C's complaint that the board had failed to handle the complaint reasonably. The board have already apologised for this failing but we have made a further recommendation for learning and improvement.

C complained about the care and treatment they received from the urology (a speciality in medicine that deals with problems of the urinary system and the male reproductive system) service at Wishaw General Hospital. C was referred to the service with penile fracture symptoms. Following the referral, C was reviewed by two consultant urologists and investigations were performed over the following months. These investigations did not identify what the precise cause of C's symptoms were. We took independent advice from appropriately qualified advisers. We identified a number of delays in the investigation of C's symptoms and concluded that there had been an unreasonable delay in making a diagnosis. We also found that there was an unreasonable delay in the board sending a discharge letter to C's GP after a surgical procedure was performed. Therefore, we upheld C's complaint.

Ms C complained that the board failed to take reasonable steps to prevent her father (Mr A) from falling in hospital. We took independent advice from a nursing adviser. We found that staff had completed the required risk assessments prior to Mr A's fall and that the fall would have been hard to predict. However, updates to the care plan in place for Mr A lacked detail and the plan itself was not updated to address the changes in Mr A's functional ability. Although there was an indication on the falls risk assessment that Mr A was attempting to walk alone, there was nothing recorded in the nursing records or care plan to support or address this. Staff also failed to follow the board's policy in relation to the assessment and use of the bedrails. In addition, there was no evidence of nursing staff updating Mr A's falls risk assessment or his care plan immediately after the fall, nor was there a record of a delirium screening at that time. In view of these failings, we upheld this aspect of the complaint. Ms C also complained that staff failed to contact the family to inform them of the fall until the following morning. We found that, as Mr A had sustained a significant injury, staff should have called the family at the time of the fall, when the harm was confirmed, or earlier in the morning before the shift changed. Given this, on balance, we also upheld this aspect of the complaint. Finally, Ms C complained that staff had attempted to use inappropriate equipment on Mr A after his second operation. Staff had to use a commode to transfer Mr A to the toilet because the stand aid had been condemned and the hoist had no battery. We found that when the decision was taken to use a commode in this way, a risk assessment should have been completed and recorded and an agreed approach noted in Mr A's care plan. Given the failure to do this, we upheld this aspect of the complaint. We noted that the board had apologised for these failings and have made further recommen

Ms C had cataract surgery (a procedure that involves replacing a cloudy eye lens with a clear artificial one) at Hairmyres Hospital. Ms C stopped using the eye drops she had been prescribed and she began to have a feeling of discomfort in her eye. Ms C visited her optician who said there seemed to be a scratch on its surface. Ms C complained that something went wrong during her cataract surgery. We took independent advice from an ophthalmologist (a specialist in eye disorders). We found that Ms C's cataract surgery was technically successful. We considered it was most likely that Ms C had suffered a small accidental scratch to the lens of her eye during the cataract surgery, which is a recognised complication. However, we found that there were no failings in how her cataract surgery was carried out. We also found that Ms C was given appropriate treatment for the discomfort she experienced. We did not uphold Ms C's complaint. Related reading View Decision Report 201810555 as a PDF (24.19 KB) Updated: June 17, 2020

Mrs C complained on behalf of Mr B about the care and treatment provided to Mr B's late wife (Mrs A). Mrs A had an underlying heart condition and her medication had to be carefully balanced to avoid kidney damage. Mrs A saw her GP about problems with bowel function and her deteriorating general condition. The GP referred her to the colorectal (relating to or affecting the colon and rectum) clinic. Blood tests taken around the same time showed her kidneys were deteriorating and she was referred for an urgent renal (relating to the kidneys) appointment. During her colorectal consultation, Mrs A was offered various investigations but a CT scan (a scan that uses x-rays and a computer to create detailed images of the inside of the body) and colonoscopy (examination of the bowel with a camera on a flexible tube) both involved some kidney risk, so she wished to wait for her renal appointment before making a decision. She received a renal appointment four months after her GP appointment and was admitted the following day for further tests including a CT scan performed without contrast (contract material is a dye used to help highlight areas of the body being examined) as this was safer for her kidneys. Around a month after admission for tests, stage 4 cancer was found in bowel, stomach and lungs, which Mrs A was advised had been present for months. A decision had been taken to downgrade Mrs A's renal referral without seeing her, and without informing her GP. Mrs C complained that this decision was unreasonable. The board confirmed that Mrs A's urgent renal referral was downgraded without her being seen, based on the likelihood that her renal dysfunction was a composite of her heart disease and medication. As her blood test results were relatively stable the board had considered there was no need for an urgent referral. The board apologised that the GP had not been informed. We took independent advice from a nephrology (the branch of medicine that deals with the p

Ms C complained on behalf of her in-law (Mr B) about the care and treatment provided to his wife (Mrs A). Mrs A was diagnosed with breast cancer and a full computerised tomography (CT) scan was carried out. The CT scan of Mrs A's chest, abdomen and pelvis showed liver and bony metastases (the development of secondary malignant growths) at a distance from a primary site of cancer. The head scan showed a 6mm lesion of uncertain significance on the left frontal lobe of Mrs A's brain. The consultant oncologist (a doctor who specialises in the diagnosis and treatment of cancer) involved in Mrs A's care advised her of the liver and bony metastases. However, they did not share the results of the head scan. Following this, the board's records indicate that the results of this scan were not shared with Mrs A by the consultant oncologist, the clinical nurse specialist (CNS) involved in her care, or any other member of staff. Ms C complained that the board had unreasonably failed to disclose information about the lesion on Mrs A's brain. We took independent advice from an oncology adviser. We found that it was unreasonable for the board not to disclose this information to Mrs A. The board had advised that the medical professionals involved did not disclose this information to avoid causing further anxiety or upset to Mrs A. Even if the board had good intentions, we considered the evidence to strongly indicate that this was not a reasonable course of action to take and, under the circumstances, was not a medical professional's choice to make. This evidence included the General Medical Council's (GMC) guidance Good Medical Practice and Consent: Patients and Doctors Making Decisions Together. We concluded that it was not reasonable for information about the head scan not to be shared with Mrs A. Therefore, we upheld this aspect of the complaint. Ms C also complained that, following the head scan, the board unreasonably failed to provide appropriate treatment to Mrs A