SPSO Individual Decisions

Mr C complained about the treatment which he received when he attended the Western General Hospital for reported left upper abdomen pain. He said he had advised staff that he was allergic to aspirin and penicillin but was prescribed diclofenac medication (pain relief) on discharge. When he returned home, Mr C took two further diclofenac tablets and experienced breathing difficulties. He attended his GP the following day who prescribed alternative pain relief. Given his allergies, he felt that the diclofenac should not have been prescribed. We took independent medical advice from a consultant. We found that although diclofenac would not normally be prescribed for a patient allergic to aspirin it was not absolutely contraindicated and should be used with caution. We also found that diclofenac was a non-steroidal anti-inflammatory medication (NSAID) and Mr  C had advised the staff that he was able to tolerate some NSAIDs. We noted that Mr C had been given diclofenac whilst in hospital and that it had a good effect on his reported abdomen pain and he was given advice to seek further medical attention should his condition deteriorate following discharge. On balance, we found that it was reasonable for the doctor to have prescribed the diclofenac. We did not uphold Mr C's complaint. Related reading View Decision Report 201803249 as a PDF (23.96 KB) Updated: December 19, 2018

Mrs C complained about the care and treatment that her late husband (Mr A) received in A&E at the Royal Infirmary of Edinburgh. Mr A was taken to hospital after becoming unwell with chest pains and was treated for a suspected heart attack. Tests carried out showed that Mr A was not having a heart attack and he was referred for a CT scan (a scan that creates detailed images of the inside of the body) to investigate other causes. Before the scan took place, Mr A collapsed and staff were not able to resuscitate him. The cause of death was a thoracic aortic dissection (a condition where the lining of the main blood vessel from the heart is injured). Mrs C felt that a CT scan should have been ordered sooner. We took independent advice from a consultant in emergency medicine. We found that it was appropriate to investigate and treat Mr A for a heart attack as this is what his symptoms suggested. When a heart attack was ruled out, we noted that a CT scan was ordered within a few minutes and that there was no unreasonable delay in relation to the wait for the scanner to become available. We did, however, identify an unreasonable failing in the observations of Mr A's vital signs as there was a gap in the records of over four hours. On balance, we upheld the complaint and made recommendations in this connection.

Mr C complained about the care provided to his wife (Mrs A) when she attended A&E at the Royal Infirmary of Edinburgh. Mrs A presented to the department with severe pain in her shoulder. Shortly after admission Mrs A was given morphine for her pain and was assessed by an emergency medicine consultant. Mr C raised concern about the delay in triage (a process in which things are ranked in terms of importance or priority), inadequate pain management, and the failure to use a cubicle. The board acknowledged that Mrs A should have been moved to a cubicle after morphine was given and apologised for this. We took independent advice from an emergency medicine adviser. We found the care provided to be reasonable, however, the failure to use a cubicle may have impacted on Mrs A's dignity. We upheld this aspect of Mr C's complaint. As the board had apologised for this failing and taken adequate steps to address this issue, we did not make any further recommendations. Mr C also raised concern about a letter sent to Mrs A's GP in relation to the admission. We found that the letter contained an inaccuracy and upheld this aspect of Mr C's complaint. Finally, Mr C complained that the board failed to investigate his complaint reasonably. We noted that many aspects of the complaint handling were reasonable, however, we found that the board had not investigated his complaints about hygiene. Therefore, we upheld this aspect of Mr C's complaint.

Mr C complained about two consultations he attended at Edinburgh Dental Institute following a referral from his dental practice relating to temporomandibular disorder (a problem affecting the 'chewing' muscles and the joints between the lower jaw and the base of the skull). In particular, Mr C was unhappy with the assessments carried out and the lack of treatment provided. We took independent advice from a consultant oral and maxillofacial surgeon (a specialist in the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck). They considered that most aspects of the clinical management in the department were reasonable. However, they considered that Mr C's medication history was not recorded adequately at the first consultation. In relation to the second consultation, they were critical that an examination was not performed. We upheld these aspects of Mr C's complaint. Mr C was also unhappy that a clinic letter relating to one of the consultations contained an error and was sent to the wrong address. We upheld this aspect of Mr C's complaint. However, we noted that the board had apologised to Mr C and identified appropriate action to help prevent the issue reoccurring. Finally, Mr C was unhappy about the way the board handled his complaint. The board acknowledged that their response was delayed and apologised to Mr C for this. We considered that the board's communication about the delay was poor and upheld this aspect of Mr C's complaint.

Mrs C had knee replacement surgery at the Royal Infirmary of Edinburgh. She also underwent manipulation under anaesthetic (MUA - a procedure to try and improve movement) to try and relieve knee stiffness after the operation. Mrs C complained about the board's communication with her following the knee replacement surgery. In particular, she complained that she was not properly informed that, should MUA be unsuccessful, there was a possibility that nothing more could be done for her knee. She also complained that she was not told why she had been sent for a second opinion. We took independent advice from an orthopaedic consultant (a doctor who specialises in the musculoskeletal system). We found that the majority of the communication with Mrs C had been reasonable, and that the advice she was given about MUA was reasonable. However, we found that consent process for the MUA was unreasonable, and that the communication around the second opinion had been poor. On balance, we upheld the complaint.

Mr C complained that there was a delay in him receiving medication at St John's hospital when he was admitted after having seizures during the night. We took independent advice from a hospital doctor. We found that, when Mr C initially arrived in A&E at the hospital, a consultant set out a plan for the medication he was to receive. We found that Mr C was to be prescribed and administered medication in A&E, but that when he was transferred to a ward this had not happened and he ultimately did not receive his medication until he was seen by a doctor the following morning. We found that Mr C should have received the medication in A&E, and we upheld his complaint. We noted that the delay in receiving the medication did not put Mr  C at high risk of having another seizure, however we considered that this should have been communicated to him. The board said that they had already taken action to ensure that medical staff in A&E were aware of the importance of giving medications to patients when appropriate. We asked for evidence of this. We also noted that in their complaints responses the board issued inconsistent accounts of what staff were aware of, and when they were aware of it, on the night of Mr C's admission, and so we made some recommendations regarding this.

Mrs C complained about the care and treatment her late son (Mr A) received when he was admitted to the Western General Hospital. Mr A had duchenne muscular dystrophy (a genetic disorder characterised by progressive muscle degeneration and weakness) and an associated heart condition and was admitted to the hospital with abdominal pain and swelling. He died in the hospital a week after he was admitted. We took independent advice from a consultant general surgeon and a nurse. We found that it had been reasonable to admit Mr A to a surgical ward. He was examined by a surgical registrar and the on-call medical registrar which was an example of good care. However, we found that there had been a number of failings in the care and treatment provided to Mr A. In particular that: • he should have been treated by a multi-disciplinary group of consultants, including a cardiologist (a doctor who specialises in the study or treatment of heart diseases and heart abnormalities); • it was unreasonable for a consultant from the hospital's ventilation service not to take appropriate steps to evaluate Mr A when they were informed of his admission; • it was unreasonable not to record Mr A's fluid intake/output; • staff failed to act appropriately on an abnormal CT scan; • staff unreasonably failed to reconsider the diagnosis of kidney infection; • it was unreasonable for a junior doctor to propose discharging him; • communication between general surgery and urology (the branch of medicine and physiology concerned with the function and disorders of the urinary system) was poor; • no moving and handling assessment was carried out when Mr A was admitted to hospital; and • no equipment was available for the safe movement and transfer of Mr A three days after he was admitted to hospital. We upheld Mrs C's complaint about the care and treatment provided to Mr A, however, we found that it was highly likely that the outcome would have been the same for Mr A if these failings had not occur

Mr C was seeking a referral to children's Occupational Therapy (OT) services for an assessment. Mr C was told he was not eligible for this service as he was 17  and no longer attended school. He was asked to make a new referral for adult OT services. Mr C did this and was assessed but discharged as the OT decided that his needs would be best met by local services in a community setting. Mr C was unhappy about this and complained to the board. He made a further referral to children's OT Services at the same time as his complaint and was this time seen by the service. Mr C complained that the board failed to progress his referrals to OT in a reasonable manner. Mr C had also highlighted that the NHS website states the children's OT service is for children aged 0-18 and, therefore, he should have been assessed by them from the outset. The board responded by initially reiterating that Mr C was 17  years old and not at school so was more suited for adult services. However, in subsequent responses to Mr C they clarified that the children's OT service only has standardised assessments from age 0-16. They also advised there is no set criteria but instead, a flexible approach is adopted depending on the patient's individual circumstances. They acknowledged that Mr C had not received a clear explanation about why he was referred to adult OT services and apologised for this failing. We considered that there had been poor communication and mixed reasons given to Mr C for directing his referral and upheld his complaint. However, the board advised that they had taken steps to review the triage service (a process in which things are ranked in terms of importance or priority) for the OT department. This included staff phoning children or parents who made referrals to gather more information to help signpost or assess patients from the outset. Additional staff have had training to make these calls and the board advised that the data they had reviewed so far indicated thi

Ms C complained about the care and treatment she received at St John's Hospital following breast surgery. In particular, that the board failed to listen to her when she asked for medication for the pain she was experiencing, failed to provide appropriate medication to address her pain and failed to appropriately recognise and act on seeing her red wristband for known allergies to certain painkillers. We took independent advice from a consultant in general medicine and a senior nurse. We found that Ms C's records suggested medical and nursing staff had listened to her regarding her post-operative symptoms, made appropriate changes to her pain medication and provided a reasonable level of care. We also found that staff were aware of Ms C's allergies and acted appropriately. We considered that Ms C's care was reasonable and did not uphold her complaint. Related reading View Decision Report 201703637 as a PDF (11.01 KB) Updated: December 2, 2018

Miss C was admitted to the Royal Infirmary of Edinburgh with severe sudden onset headache. A lumbar puncture procedure (a medical procedure where a needle is inserted into the lower part of the spine to test for diseases in the brain, spinal cord or central nervous system) was carried out but the results were negative and she was discharged the following day. However, she subsequently suffered ongoing headaches and low back pain. She complained that she had not been advised long term pain was a possible risk of the lumbar puncture. She also complained about how the procedure was carried out, expressing unhappiness that it was carried out by a junior doctor and questioning what had gone wrong to cause her so much pain. She also asked what her long term prognosis was. We took independent medical advice from a consultant physician. We found that an initial headache and back pain are recognised complications of lumbar puncture procedures, but that the pain usually settles within a few days and severe ongoing pain is rare. As such, we found that it would not be expected practice for clinicians to advise patients of a risk of long term pain. We did not uphold this aspect of the complaint. In terms of Miss C’s long term prognosis, the adviser suggested it might be helpful for her to have her symptoms reviewed by a specialist and we suggested the board might consider offering a neurology appointment. We found no evidence to indicate that there were any failings in the way the procedure was carried out that might reasonably explain Miss C’s ongoing pain. We also found that it is appropriate for junior doctors to carry out such procedures, under supervision, when they are at the stage of their training that the doctor who carried out Miss C's procedure was at that time. We did not uphold this aspect of the complaint. Related reading View Decision Report 201705674 as a PDF (11.5 KB) Updated: December 2, 2018

Mr C complained on behalf of his wife (Mrs A) who has multiple sclerosis (MS - a condition which can affect the brain and/or spinal cord). Mrs A began to experience leg and back pain and a scan showed she had a ruptured disc. She was referred to see a consultant neurosurgeon (a doctor who specialises in conditions of the nervous system, including the brain, the spine, the spinal cord and nerves). Mr C complained that, despite a number of consultations and opinions, Mrs A was not given a proper diagnosis for the cause of her leg and back pain, nor was she offered surgery or a referral out-with the board's area. We took independent advice from a consultant neurosurgeon and that we found that Mrs A's case was complicated by her MS. We found that the care provided to Mrs A was in accordance with national guidelines and that clinicians involved made a well reasoned decision not to undertake surgery or refer her elsewhere. We were satisfied that Mrs A had been given reasonable care and treatment. We did not uphold the complaint. Related reading View Decision Report 201705871 as a PDF (11.12 KB) Updated: December 2, 2018

Mrs C complained to us about the care and treatment her sister-in-law (Mrs A) received at the Royal Infirmary of Edinburgh after taking two overdoses of medication within a few days. On the first occasion, Mrs A was assessed in the emergency department for risk of liver damage and then admitted to the acute medical unit. She had a psychiatric assessment the following morning and it was decided that she did not need any further in-patient psychiatric care. Mrs A discharged herself from the hospital later that day against medical advice. Mrs A was brought back to the emergency department on the following day after taking a further overdose and was then admitted to the toxicology unit. On the following day, she was transferred to a specialist liver transplant unit, although it was decided that she was not a candidate for a liver transplant. She was subsequently moved to intensive care after it was recorded that her kidneys were failing. Mrs A died there several days later. Mrs C complained about the care and treatment provided to Mrs A during each admission to the hospital. We took independent advice from an emergency medicine consultant, a psychiatric consultant, a general medical adviser and a consultant in anaesthesia and intensive care medicine. We found that the care and treatment provided to Mrs A in the hospital throughout all admissions had been reasonable and appropriate. We did not uphold Mrs C’s complaints. Related reading View Decision Report 201702496 as a PDF (11.26 KB) Updated: December 2, 2018

Ms C complained to us on behalf of her sister (Ms A). Ms A had sustained a head injury after a climbing accident. She attended hospital and was kept in overnight. After being discharged, Ms A became unwell, was visited at home by an out-of-hours GP and was then taken by ambulance to the emergency department at another hospital, St John's Hospital. She was diagnosed with post-concussion syndrome (when concussion symptoms last for weeks or even months after the injury which caused the concussion) and was discharged home. Ms A still felt unwell and was subsequently admitted to a third hospital and where she was diagnosed as having had a series of mini-strokes. Ms C complained that the board failed to provide Ms A with appropriate care and treatment when she attended St John's Hospital and unreasonably discharged Ms A from St John's hospital. We took independent advice from a consultant in emergency medicine, a general medicine consultant with experience in stroke medicine and a radiologist (a doctor who uses medical imaging such as x-rays, ultrasounds and scans). We found that there were two documented symptoms that should have prompted the emergency staff to consider a diagnosis of stroke for Ms A. We also found failings in the board’s handling of the radiology aspects of Ms C’s complaint and her concerns about the out-of-hours GP’s notes on their assessment of Ms A. We upheld this aspect of Ms C's complaint. In terms of Ms A’s discharge, we found that Ms A was not well enough to have been sent home and should not have been discharged from hospital. We considered that her working diagnosis should have been stroke, not post-concussion syndrome, and she should have been referred to the hospital’s stroke team. We, therefore, upheld this aspect of Ms C's complaint.

Mrs C complained on behalf of her adult son (Mr A) about the care he received when he presented to the emergency department at St John's Hospital. Mr A has autism (a developmental disability that affects how a person communicates with, and relates to, other people) and a learning disability and attended A&E after suffering a dissociative episode (disruption in aspects of consciousness). We took independent advice from an emergency medicine consultant. The adviser noted that the board failed to meet contemporary best practice when taking the decision to perform a sternal rub (rubbing knuckles on the sternum as an act of stimulation); however, we did not conclude that this action was unreasonable. We found that, in one instance, staff did not communicate reasonably with Mr A. We also noted that the emergency department team did not meet with Mrs C after she made a complaint, which showed a lack of supportive partnership working. Therefore, we upheld Mrs C's complaint.

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A) about the care and treatment Ms A received at the Royal Infirmary of Edinburgh. Ms A had painful and uncomfortable symptoms in her throat and neck, which affected her breathing and swallowing. After investigations were carried out, Ms A was told that no physical cause was found to explain these symptoms. Ms A was referred to psychiatry and she was diagnosed with somatoform disorder (a syndrome where someone has recurring physical symptoms thought to be caused by psychological or emotional factors). Ms A complained that following this diagnosis, she was not given treatment for her physical symptoms. We took independent advice from a consultant psychiatrist. We found that Ms A's psychiatry assessment was comprehensive and she was diagnosed with somatoform disorder with the appropriate input of various medical specialists. We also found that a reasonable decision was made not to investigate Ms A's physical symptoms any further, as that can be harmful for someone with somatoform disorder. We did not uphold Ms C's complaint. Related reading View Decision Report 201705433 as a PDF (11.15 KB) Updated: December 2, 2018

Mr C complained on behalf of his late wife (Mrs A). Mrs A attended the Emergency Department (ED) at the Royal Infirmary of Edinburgh. When she attended she was unable to walk and required a wheelchair. Mr C said that Mrs A waited for nearly four hours before she was seen by a doctor, during which time her requests for pain relief were ignored. He complained that the care and treatment given to Mrs A in the ED was unreasonable. He also complained that the board gave incorrect or inaccurate information when they responded to his complaint about this. We took independent advice from a consultant in emergency medicine. We found that in the ED Mrs A had been appropriately examined, that many aspects of her care were reasonable and that she was appropriately discharged. However, we found that she was not assessed, and reassessed, for her pain as she should have been. We found that she was given two paracetamol three hours after arriving, and then oral morphine an hour and a half later. However, we found that this delay was unreasonable and contrary to the Royal College of Emergency Medicine guidelines. We upheld this part of Mr C's complaint. We found no evidence that the board had provided Mr C with incorrect or inaccurate information, and so we did not uphold this aspect of Mr C's complaint.

Miss C complained about the care and treatment provided to her by the board. She complained that the board did not identify that she had an anal fissure (cut or tear in the tissue inside the anus) during an examination under anaesthetic. She also complained about the length of time she had to wait for that examination. We took independent advice from a consultant colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus). We found that it was reasonable that the board did not identify an anal fissure because it was in remission at the time of Miss C's examination under anaesthetic. However, we found that there was a delay in Miss C receiving the examination and that this exceeded the national waiting time standards. We considered that this was unreasonable given the amount of pain she was experiencing. We upheld Miss C's complaint.

Mrs C complained about the care and treatment which she received during her pregnancy at the Royal Infirmary of Edinburgh. She had attended for a check-up where her baby's heartbeat was checked and blood tests were taken. Mrs C said that a nurse said that she might have an infection, but sent her home without medication. Mrs C then developed acute back pain and returned to hospital where she was admitted. Mrs C's condition deteriorated and she developed abdominal pain and was placed on a monitor. There were signs of fetal distress and it was decided to proceed to caesarean section (an operation to deliver a baby involving cutting the front of the abdomen and womb) where her baby was born. Mrs C then suffered a massive bleed and a hysterectomy (a surgery to remove the womb) had to be performed. Mrs C complained that there had been a delay in deciding to proceed to caesarean section and that antibiotics should have been prescribed earlier which would also have stopped her suffering from sepsis (a blood infection). We took independent advice from a consultant obstetrician (a doctor who specialises in pregnancy, childbirth and a woman's reproductive system) and we found that Mrs C had received a reasonable standard of care and treatment. We found that staff adopted a conservative approach initially to establish if Mrs C would be able to deliver naturally and they kept her under observation. When it became clear that there were signs of fetal distress then it was appropriate to move to a caesarean section. There was no evidence of any delay and the caesarean section was carried out to an acceptable timescale. There was also no evidence that antibiotics should have been administered to Mrs C at an earlier stage and they were provided when she showed symptoms of infection. We also found that, when it was realised that Mrs C had suffered a bleed, staff acted appropriately in accordance with the national guidance that in such cases staff should resort to hysterectomy sooner

Mrs C complained on behalf of her child (Child A) about the care and treatment they received at the Royal Edinburgh Hospital. Child A was admitted to hospital and diagnosed with a severe depressive episode and suicidal thoughts. Child A remained in hospital some months, and mental health staff consulted with social work about alternative accommodation (as it was not appropriate for Child A to return to the family home at that time). However, Child A's behaviour became increasingly violent, and Child A was discharged with a few days' notice to social work staff, who arranged accommodation at a young people's centre. Child A ran away from the centre threatening to harm themselves on several occasions, and had to be detained by the police. Child A was then transferred to secure accommodation, where they remained for several months. Mrs C complained that the board inappropriately discharged Child A without ensuring adequate arrangements were in place for their safety and welfare. We took independent advice from a psychiatrist and found Child A's discharge to be unreasonable. We found that the discharge decision was made at short notice, without adequate planning for Child A's future accomodation and follow up care. We were also critical that a psychiatrist at the hospital instructed other staff not to detain Child A under the Mental Health Act if they returned to hospital. The adviser noted that detention under this Act is an important option to protect people who are a risk to themselves or others, and it was unreasonable for staff to try and remove the availability of this protection. Therefore, we upheld this aspect of Mrs C's complaint. Mrs C also complained that the board used different diagnostic labels at different times to influence the management of Child A's care. We found that a mixture of diagnostic labels were used during Child A's admission, and it was not clear that a structured approach was used to formulate a diagnosis. However, we did not find

Mrs C complained about the respiratory care (care of the lungs and other organs) and treatment provided to her by the board. She said that she did not feel she was given appropriate follow-up care and that this resulted in her respiratory problems becoming worse. We took independent advice from a consultant in respiratory medicine. We found that Mrs C was appropriately investigated and that no follow-up was necessary. We also found that there was no evidence that her respiratory problems had been caused by, or became worse as a result of, lack of follow-up. We did not uphold Mrs C's complaint. Related reading View Decision Report 201706050 as a PDF (10.87 KB) Updated: December 2, 2018

Mr C complained about treatment he received at the Royal Infirmary Edinburgh after suffering a head injury. He raised concerns that the board had failed to identify a fracture to his skull on his first attendance, as they did not carry out a CT scan until he was referred back to hospital by his GP two days after being discharged. This case was very similar to a complaint we had recently upheld (201508264). In that case, we recommended that the board carry out an audit of similar head injury cases treated at the hospital. As the audit was still in progress at the time of Mr C's complaint, we asked the board to include his case in their consideration. They did so, and repeated what they had told Mr C in their response to his complaint - that they considered the treatment he received was appropriate. They also maintained this position in response to enquiries we made throughout our investigation. We took independent advice from a consultant in emergency medicine. The adviser told us that the board's failure to carry out a CT scan on Mr C's first admission was unreasonable as the board had recorded that Mr C had a severe and persisting headache and Mr C had suffered a fall from a height greater than one metre. Under guidance from the Scottish Intercollegiate Guidelines Network  (SIGN) and the board's protocol in place at that time, this should have led to a CT scan being arranged. We also found that the board had failed to carry out enough observations of Mr C's level of consciousness. In particular, the board had failed to record that Mr C was reviewed by an experienced doctor before being discharged. SIGN guidelines specify that an experienced doctor should review all head injury patients before they are discharged to ensure that six specific criteria are met. However, this failling had since been remedied by a new procedure implemented following case 201508264. We were also concerned that, despite a number of these failings being a repetition of those high

Ms C complained to us about the care and treatment her mother (Mrs A) had received after she was admitted to St John's Hospital with bipolar disorder (a mental health condition marked by alternating periods of elation and depression). Ms C complained about a number of issues in relation to the nursing care provided to Mrs A. We took independent advice from a mental health nurse. We found that it had been unreasonable for nursing staff to allow Mrs A off the ward without an escort. Although Mrs A came to no harm, her safety and wellbeing were placed at undue risk as a result of this. We also found that, despite it being known that Mrs A had medication compliance issues, there was no evidence in the records of a coherent care plan designed to promote her compliance with oral medication. Neither her care needs nor her nursing care had been effectively planned or kept under review. Care plans in the records were dated four weeks after Mrs A had been admitted to hospital and we found that the manner in which the documentation had been used and completed was ineffective and unreasonable. In view of these failings, we upheld Ms C's complaint about the nursing care provided to Mrs A. Ms C also complained about a number of aspects of the psychiatric and medical treatment Mrs A received in the hospital. We took independent advice on these issues from a psychiatric consultant. We found that there had been a delay in actioning Mrs A's electrocardiograph (ECG - a test that records the electrical activity of the heart) results and that the consultant psychiatrist had failed to make themselves aware of these results. We also found that it was unreasonable that specialist cardiology advice was not sought and that anti-psychotic drugs were prescribed to Mrs A without attention being paid to the cardiac risks or guidance being given to staff that she should be closely monitored after taking these. In addition, Mrs A received two anti-psychotic drugs at the same time, when

Ms C complained about the care and treatment provided to her by the board. She complained that, when she suffered a slipped disc in her back, she was not given appropriate neurosurgical treatment during two periods of care. Ms C also complained that she was later not provided with reasonable treatment by the department for infectious diseases, cardiology, or rheumatology. We took advice from a neurosurgeon, a consultant in infectious diseases, a cardiologist and a rheumatologist. We found that, whilst overall the neurosurgical care given to Ms C was reasonable, there was a failure to properly document an appointment; that there was no evidence that the likely outcome of surgery was discussed with Ms C; and that there was a delay in follow-up after Ms C underwent surgery. We upheld this aspect of Ms C's complaint. We found that the care and treatment provided by the department for infectious diseases, cardiology, and rheumatology was of a reasonable standard and we did not uphold this aspect of Ms C's complaint.

Mr C underwent nasal surgery at St Johns Hospital and subsequently had ongoing issues with nasal obstruction, facial pain, breathing issues and sinus infections. Mr C complained that he was not warned of the recognised risks associated with the procedure and that the surgery itself was not performed to a reasonable standard. Mr C also complained that the board did not handle his complaint reasonably. We took independent advice from an ear, nose and throat consultant. We found that appropriate information was provided to Mr C regarding the recognised risks of the surgery. We also considered that the nasal surgery was performed to a reasonable standard. We did not uphold these aspects of Mr C's complaint. However, we noted that there was a delay in removing Mr C's nasal splints (temporary splints which are used to stabilise the nose after surgery) and made a recommendation in light of this. In relation to complaints handling, we found that there was a delay in issuing a response to Mr C and that there was insufficient detail about the surgery included in the letter. We considered that the board did not handle Mr C's complaint reasonably and upheld this aspect of his complaint.

Mr C complained that his late mother (Mrs A) did not receive appropriate physiotherapy and rehabilitation whilst she was a patient at Tippithill Hospital. He was also concerned that the consultant in charge of Mrs A's care had unreasonably refused consent for another doctor to examine her. Mr C also complained that the board's response to his complaint was inadequate. We took independent advice from a consultant in old age psychiatry. We found that Mrs A had advanced dementia and that she did not have the potential for further rehabilitation as a result. We found that there had been appropriate referrals and assessments for physiotherapy, which took reasonable account of the risks involved in Mrs A's case. We did not uphold Mr C's complaint about physiotherapy and rehabilitation. We also did not uphold Mr C's complaint that consent had been refused to allow a further doctor to examine Mrs A. We found no evidence that consent had been refused, although it was confirmed that an examination by the further doctor did not take place. The advice we received was that, in the particular circumstances of Mrs A's case, it was reasonable that this examination was not carried out. We found that the doctor in question had previously reviewed Mrs A and did not consider this to have been of any assistance to the management of her care. Regarding the board's response to Mr C's concerns, we found that they had not directly addressed Mr C's complaint and that, when Mr C alerted them to this, they advised that they had nothing further to add. We considered this response to be inadequate and we upheld this aspect of Mr C's complaint.