SPSO Individual Decisions

Miss C complained about the medical care and treatment she received following a facial injury she sustained as a result of dental treatment. Miss C pursued a complaint about her dental treatment separately with another organisation and, when that process concluded, she decided not to pursue her complaint with us. Therefore, we closed our file on the complaint and took no further action. Related reading View Decision Report 201605973 as a PDF (10.74 KB) Updated: December 2, 2018

Mr C complained on behalf of his neighbour (Mr A) about the care and treatment provided to Mr A for kidney stones at Raigmore Hospital. Mr A had a number of surgical procedures over the course of a year to remove his kidney stones, however none of these were successful and Mr A was referred to a different health board for further treatment. We took independent advice from a consultant urologist. We found that both the medical and surgical management of Mr A's kidney stones had been reasonable, despite the procedures failing to be successful. Therefore, we did not uphold this aspect of Mr C's complaint. However, we did find that the referral to the other health board was not appropriately recorded in Mr A's medical records and we made a recommendation regarding this. Mr C also complained about the board's communication with Mr A. He said that it had not been explained to Mr A what the treatment plans were, and that the surgeon failed to visit him after his most recent surgical procedure to explain the next steps. We found that, although communication throughout much of the time Mr A was receiving treatment was reasonable, it was not reasonable that the surgeon failed to make plans for post-operative discussions. We also found that there was a failure to make a note of a phone call the surgeon had with Mr A. Additionally, we found that the board's complaint response was poor as it failed to sufficiently cover the points complained about. We upheld this aspect of the complaint.

Mrs C complained about the palliative care and treatment provided to her late husband (Mr A) at Cowal Community Hospital. Mrs C highlighted concerns about the prescription of pain relief, arrangements for a blood transfusion and communication with the family. Mrs C particularly felt that meetings with staff had been misrepresented in his medical records. She also complained that the board had failed to handle her complaints reasonably. As the doctors who cared for Mr A at the hospital were general practitioners, we took independent advice from a GP adviser. The advice we received was that Mr A's pain relief had been appropriately reviewed and adjusted, and that there had been no indication that a blood transfusion was necessary. We did not uphold these aspects of Mrs C's complaint. We did not uphold Mrs C’s complaints about communication or meetings. We found evidence that there had been regular and appropriate communication with Mr A's family, although we acknowledged that Mrs C's recollection differed from that recorded in the medical notes and other records. The advice we received was that the actions taken by the board were reasonable, on the basis of what was recorded in the relevant records. We upheld Mrs C's complaint about the way that the board had handled her complaint. We found that there was an inaccuracy in the final response around the timeframe of Mr A dying and the complaint being raised. We also found that an issue Mrs C had raised had not been fully addressed when the board responded to her concerns. We made two recommendations to address these issues, including one regarding the new model complaints handling procedure introduced in April 2017.

Mrs C complained on behalf of her daughter (Mrs A) about the care and treatment provided to Mrs A at Raigmore Hospital. In particular, she complained that the board had failed to provide reasonable care and treatment when Mrs A had first attended the breast clinic at Raigmore Hospital and that Mrs A's breast cancer, which was diagnosed a few years later, may have been present at the initial consultation. Mrs C also complained that the board had unreasonably delayed in carrying out genetic testing. We took independent advice from a consultant breast surgeon. We found that the care and treatment provided to Mrs A had been reasonable and that there had been no delay in diagnosing Mrs A's breast cancer. We also found that there had been no missed opportunities by the board to have diagnosed the cancer earlier. We did not uphold this aspect of Mrs C's complaint. We also found that there had been no indication for genetic testing when Mrs A first attended the breast clinic and that there had been no red flag criteria to prompt genetic testing at that time. As such, we did not uphold this part of Mrs C's complaint. Related reading View Decision Report 201608061 as a PDF (11.04 KB) Updated: March 13, 2018

Mrs C was admitted to Raigmore Hospital as she had a two day history of stomach pain and vomiting. She was found to have a small bowel obstruction for which she needed major surgery. The operation was carried out the next day and Mrs C was given an epidural (anaesthetic by spinal injection) and a general anaesthetic. After the operation, Mrs C noted reduced mobility in her legs and a scan was carried out, but this showed no abnormality. Mrs C's mobility did not improve and she was seen by a neurologist and a repeat scan was performed but, again, was normal. It was explained to Mrs C that the likely cause of her lack of nerve sensation was a spinal stroke (where there is an interruption in blood flow to the spinal cord). Later, Mrs C complained to the board because she believed that she should not have been given an epidural and a general anaesthetic together because she had a history of heart problems. The board confirmed that she had had a spinal stroke, but said that the reason for it was unclear. Mrs C remained unhappy and brought her complaint to us. We took independent advice from a consultant anaesthetist and a stroke specialist. We found that it was common practice for an epidural to be used in conjunction with a general anaesthetic for post-operative pain relief after major abdominal surgery like that given to Mrs C. We found that there was nothing in her medical history that would have discouraged clinicians from doing this and that the practice was in accordance with Royal College of Anaesthetists' advice. For this reason, we did not uphold the complaint. However, we also found that prior to the operation the full risks of an epidural, including the risk of nerve damage, were not discussed with Mrs C as we would have expected. We found that the consent checklist that was used did not have a box for relating to the risk of nerve damage. We made recommendations to address this failing.

Mr C complained on behalf of his wife (Mrs A) about the behaviour of a consultant psychiatrist towards Mrs A at an appointment at Braeside Day Centre. Mr C also complained about the way the board had handled complaints that Mrs A had raised. We found that the psychiatrist's account of what happened at the appointment differed from Mr C and Mrs A's account. There were no independent parties present at the appointment. In the absence of any independent evidence, we could not prove what was said at the appointment. This meant that we could not reach a finding on this part of Mr C's complaint and, therefore, we did not uphold this aspect of the complaint. We found that the board's handling of Mrs A's complaints was reasonable, and that their response letter to Mrs A was also reasonable. We did not uphold this part of Mr C's complaint. Related reading View Decision Report 201600930 as a PDF (10.97 KB) Updated: March 13, 2018

Mr C complained to us that staff at the dental practice unreasonably informed him that he was exempt from NHS charges for dental treatment. Mr C said that, when he started a course of dental treatment at the practice, he told the staff that he was in receipt of carer's allowance and they completed a form and said that he would be exempt from NHS treatment costs. He was subsequently contacted by NHS Counter Fraud Services who said that he had fraudulently claimed exemption as he had completed the form stating that he was in receipt of income-based Jobseeker's Allowance, which was not the case. Mr C was asked to pay the costs of the NHS treatment along with a penalty charge. He maintained that while he had signed the form, he had not ticked the box which stated that he was in receipt of income-based Jobseeker's Allowance. We took independent advice from an adviser in general dentistry and concluded that there would have been a discussion with staff about whether Mr C was exempt from charges. There was reference in his dental records that Mr C thought he was exempt from charges as he was a full time carer. We were unable to establish who had ticked the box to indicate that Mr C was in receipt of income-based Jobseeker's Allowance, but the form did contain Mr C's signature. The staff maintained that they would not have ticked the box as they do not know the patient's financial situation and that the onus was on the patient to ensure that they were signing a form which was accurate. It was noted that following Mr C's representations, NHS Counter Fraud Services had waived the penalty charge aspect and therefore he was only liable to pay the costs of the dental treatment. We did not uphold the complaint. Related reading View Decision Report 201701087 as a PDF (11.35 KB) Updated: March 13, 2018

Ms C, an advocacy and support worker, complained on behalf of her client (Ms A). Ms C said that, following a referral from Ms A's GP because of her back pain, the orthopaedic department at Raigmore Hospital delayed unreasonably in offering Ms A an appointment and therefore delayed in offering her treatment. The board acknowledged that there had been a delay and apologised for this. They said that this had been due to the demand for orthopaedic services and noted that Ms A had opted to begin investigations of her back pain privately. After a scan was carried out privately, an urgent GP referral was made to the board and Ms A then received an appointment. It was then determined that she would benefit from an operation. However, because the board could not perform the operation within 12 weeks, Ms A exercised her right to have treatment outside the board's area. As a result of her complaint the board apologised and said that they had taken steps to avoid a similar situation occurring again in the future. We took independent advice from a consultant orthopaedic and trauma surgeon. We found that the care and treatment offered to Ms A had been in accordance with national guidance. The adviser noted that Ms A had arranged a private consultation and scan whilst she was on the board's waiting list. The adviser said that this was a matter of her choice, as was her decision to go outwith the area for her operation. Nevertheless, there was no doubt that there had been delay in offering Ms A treatment. The board missed the initial 12 week waiting time after Ms A's first GP referral. They were also unable to meet the target for treatment after Ms A was seen subsequent to the urgent referral. Finally, the board had only discussed Ms A's options for treatment with her after the treatment time guarantee had expired. For these reasons, we upheld the complaint.

Mrs C complained about the care and treatment provided to her late husband (Mr A) at Raigmore Hospital over a number of months leading up to his death. In particular, she said that his medical care was poor. Mrs C said that, despite his many illnesses and poor prognosis, Mr A underwent surgery which may have extended his life but that this was at the expense of his quality of life. She also raised concerns about the nursing care provided to Mr A and complained that the communication with herself and Mr A about his illnesses was not clear. We took independent advice from a consultant surgeon and from a nurse. We found that Mr A's medical care and treatment had been in keeping with standard practice in Scotland. We found that his care had been fully discussed with him and that he had agreed to the treatments he was given. Accordingly, we did not uphold this aspect of Mrs C's complaint. Similarly, we did not uphold Mrs C's complaint about poor communication as there was evidence to show that matters had been fully discussed with Mr A and Mrs C. However, we found that Mr A's nursing care had not been reasonable as we found that the notes kept were poor and were not completed in accordance with the Nursing and Midwifery Council code. We upheld this part of the complaint.

Mr C complained about the care and treatment his wife (Mrs A) received at Dunbar Hospital. Mr C and Mrs A had just moved to the area and had not yet registered with a local GP practice when Mrs A became unwell with flu-like symptoms. NHS 24 advised her to attend Dunbar Hospital, where she was diagnosed with a respiratory infection and prescribed antibiotics. Mrs A had two further attendances and phone contact with the hospital, before registering with a local GP. The GP diagnosed pneumonia, prescribed a new course of antibiotics and subsequently arranged an emergency admission to a different hospital for treatment. Mr C complained that the doctor who initially assessed Mrs A at Dunbar Hospital failed to diagnose her pneumonia. He also complained that Mrs A was assessed by nursing staff on her subsequent attendances at the hospital and not a doctor, despite his understanding that the plan was for further medical review. In addition, he complained that the nurse Mrs A spoke to when she phoned Dunbar Hospital did not make appropriate arrangements for her to be seen by a doctor and simply advised her to register with a local GP. We took independent advice from both a GP and a nurse. Both advisers considered that the respective assessments of Mrs A were reasonable and they considered it appropriate for her to have been advised to register with a local GP. They noted that the out-of-hours service at Dunbar Hospital is for emergency care when GP surgeries are closed. They also noted that routine follow-up and the arrangements of tests is usually carried out by the GP. The GP adviser considered that Mrs A's initial diagnosis and treatment were appropriate and noted that the treatment would have been the same if pneumonia had been suspected initially. We did not uphold this aspect of the complaint. Mr C also raised concerns that the board's response to his complaint contained a number of inaccurate and misleading statements. In particular, he considered that it i

Mrs C complained about the treatment provided to her late husband (Mr A) by an advanced nurse practitioner (ANP). The ANP had attended Mr A at his nursing home as staff had reported that he was having breathing problems. Mrs C said that the ANP did not make arrangements for Mr A to be assessed by a doctor or arrange for him to be taken to hospital. Mr A continued to have breathing issues and was admitted to hospital the following day, where he died two days later. We took independent advice from a nursing adviser. We concluded that the ANP had carried out an appropriate clinical assessment of Mr A's condition by listening to his chest and establishing that there was no evidence of a chest infection or that Mr A was in respiratory distress. We found that the ANP had also appropriately prescribed a treatment to assist Mr A's breathing, and that there was no indication at that time that Mr A had to be reviewed by a doctor or should have been referred to hospital for a specialist opinion. We did not uphold the complaint. Related reading View Decision Report 201702338 as a PDF (11.09 KB) Updated: March 13, 2018

Mrs C complained that, at an emergency dental appointment, the dentist did not communicate adequately with her. Mrs C said that the dentist told her that previous treatment carried out had not been done correctly and that corrective work would be required. Mrs C said that no explanation was given to her of the work required or costs. We took independent dental advice. The adviser said that the dental records showed that the dentist was unhappy with the previous work carried out on Mrs C's teeth, but that it was not clear whether these concerns were communicated to Mrs C. We found that the records showed that the dentist communicated to Mrs C that the appointment in question was only to deal with the pain she was suffering from at that point and not to decide on future treatment. Whilst we considered the dental records could have been clearer in showing what was communicated to Mrs C, we were satisfied that the dentist adequately explained that the emergency appointment was only to treat the tooth that was causing pain, and not to create a treatment plan for the future. We did not uphold Mrs C's complaint. Related reading View Decision Report 201601748 as a PDF (11.09 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). She said there had been a delay in Ms A's medical practice making a referral for her to attend the orthopaedic department when her back problems continued. She further said that the practice failed to follow up on the referral when it was eventually made. While the practice recognised that Ms A felt unsupported, they nevertheless said they had been appreciative of Ms A's difficulties and had tried to help her. We took independent medical advice from a GP. We found that while Ms A attended the practice prior to her referral, the medical records showed that she had been treated reasonably, that her condition had been monitored, that she had been appropriately examined, and that she had been prescribed medication in accordance with her symptoms and published guidance. There were no 'red flags' (signs to warrant urgent referral). Although we found that the practice did not issue the referral immediately, once the error was discovered it was issued and sent within the time-frame required by local guidance. An apology had been given to Ms A for the oversight. We did not uphold Ms C's complaint. Related reading View Decision Report 201603047 as a PDF (11.22 KB) Updated: March 13, 2018

Mrs C complained about the level and type of support her adult son (Mr A) was receiving from community support services to help him manage his mental health. Mrs C was especially concerned that there was no proper regime for cover when the regular support worker was on planned or unexpected leave. Our investigation showed that the board's investigation had not properly considered this matter and could not demonstrate that the proper level and type of support had been in place. Whilst Mrs C told us that the arrangements had improved since she complained, we upheld this complaint and made recommendations to ensure future investigations were appropriately robust and that the improved support arrangement was sustained for the future. Mrs C was also concerned that on one occasion her son had been assessed by the community mental health team because his mental health had been deteriorating, but a decision was taken not to admit him to hospital. Mr A's condition worsened and he later became aggressive and violent towards Mrs C's property, causing her considerable anxiety and distress. The police also became involved and Mr A was admitted to hospital for compulsory treatment. Mrs C considered that Mr A met the criteria for admission when first assessed and that a psychiatrist should have been involved and should have made the decision to admit Mr A at that time. We obtained independent advice from a mental health specialist who concluded that it was not necessary to have a psychiatrist involved in the assessment and that the initial decision not to admit Mr A was reasonable. We did not uphold this complaint.

Mrs C complained that the board unreasonably failed to provide appropriate clinical treatment following her decision not to agree to a lumbar puncture procedure (a procedure where a needle is inserted into the lower part of the spine to test for conditions affecting the brain, spinal cord or other parts of the nervous system). Mrs C was referred to a neurologist at Raigmore Hospital as she was experiencing a range of neurological symptoms. The neurologist conducted an examination, but made no definite findings. Mrs C advised that she did not wish to have a lumbar puncture. A range of scans were subsequently performed, but no definitive diagnosis was reached. Mrs C was subsequently seen by a second neurologist, who again raised the possibility of the lumbar puncture. Further scans were performed, however no definite diagnosis was reached over the course of approximately one year. Mrs C raised a number of concerns, including that she was repeatedly pressured to have the lumbar puncture, that blood tests were not performed timeously, and that she had received inconsistent information from the two neurologists about her condition and the results of scans. The board considered that the care and treatment provided had been appropriate. We took independent advice from a neurologist. We did not find evidence in the medical records to suggest that the neurologists acted inappropriately in offering the lumbar puncture. We found it would have been good practice for the blood tests to have been performed, but noted this was usually done before a patient would be seen by a neurologist. We found that the information provided to Mrs C about the scans and her condition was of a reasonable standard, given the complexity of her case, and that there were different views among the radiologists who reviewed the scans. On balance, we did not uphold Mrs C's complaint. Related reading View Decision Report 201508496 as a PDF (11.5 KB) Updated: March 13, 2018

Mr C complained about the treatment his wife (Mrs A) received at Raigmore Hospital. Mrs A had ongoing problems with both of her knees and underwent physiotherapy treatment and surgery. Due to post-operative complications and continuing problems with her right knee, Mrs A had to undergo further treatment. Mr C complained that there had been unreasonable delays in providing Mrs A with appropriate treatment and that Mrs A's surgical treatment was not of a reasonable standard. Mr C was also dissatisfied with the way that the board dealt with his complaint. We obtained independent medical advice and we found that the time Mrs A waited for knee surgery exceeded national standards with no exceptional circumstances to justify this. We upheld this part of the complaint. We found that the surgical treatment Mrs A received was appropriate and of a reasonable standard, and that the orthopaedic treatment was within the range of accepted good practice. We did not uphold this aspect of the complaint. We found that the board took an unreasonable amount of time to respond to Mr C's complaint, and that they did not address all of his concerns. We upheld this aspect of the complaint. We noted that the consent form Mrs A signed for her surgery should be updated to reflect current guidance on obtaining consent in relation to ensuring there is an appropriate section to document risk. We made a recommendation to address this.

Mr C, who received treatment for high blood pressure and kidney disease, complained that GPs at his medical practice had not monitored his blood pressure reasonably, and that this had caused damage to his kidneys. In response to Mr C's complaint, the practice said that his blood pressure had been monitored in accordance with the relevant guidelines. We took independent medical advice. The adviser was satisfied that it was appropriate for the practice to measure Mr C's blood pressure at whatever time he attended for an appointment and noted that there was no requirement in the guidelines stating that blood pressure cannot be taken in the morning, or after a patient's medication has been taken. The adviser considered that both Mr C's blood pressure and kidney function had been monitored with reasonable regularity and in accordance with the relevant requirements. Furthermore, the adviser did not have concerns about the medication prescribed to Mr C by the practice and concluded that there was no evidence that the practice had failed to adequately monitor Mr C's blood pressure or that their actions had contributed to reduced kidney function. We therefore did not uphold this aspect of Mr C's complaint. Mr C also complained that the practice did not respond reasonably to his complaint. In response to our enquiries, the practice identified that some of the complaint correspondence did not meet a number of the requirements of the Patients Rights (Scotland) Act 2011. The practice told us that the practice manager had undertaken to fully familiarise themselves with the requirements of the Act and that they would update the practice's complaints procedure to reflect the requirements. Although we found that many aspects of the practice's handling of the complaint were reasonable, we were critical that the practice had not followed the guidance in relation to acknowledging complaints and updating complainants after a delay. We therefore upheld this aspect of Mr C's comp

Mr C complained about the care and treatment provided to his wife (Mrs A) at Raigmore Hospital. Mrs A needed surgery to dilate and place a stent (a tiny tube inserted into a blocked passageway to keep it open) in the artery in her chest supplying her left arm, to assist with her kidney dialysis. The board were unable to place the stent in a satisfactory position and carried out surgery to remove the stent. This caused internal bleeding and Mrs A was taken to theatre for emergency surgery. The surgery proved too much for Mrs A's vital organs and she died. Mr C raised several concerns about his wife's care and treatment by the board. These included that the board failed to give Mrs A appropriate explanations about the risk of the stent procedure and failed to obtain Mrs A's informed consent for the procedure. We obtained independent medical advice from a consultant vascular and endovascular surgeon and a consultant interventional radiologist. The board said they did not advise Mrs A of the risk of death, as they consider it to be below the threshold required to be specifically mentioned as a complication. The radiologist adviser said that as Mrs A was unwell and suffered from heart failure and other conditions, the risk that any complication of the procedure would result in very serious consequences for Mrs A was increased. It would, therefore, have been reasonable for the board to have discussed the risk of death with Mrs A. We upheld this part of the complaint. Both advisers said that the evidence suggested that the board failed to follow their consent procedure, as they only appear to have discussed the stent procedure with Mrs A on the day of the operation. Therefore, Mrs A would not have had adequate time to reflect on the surgical options. We therefore considered that the board failed to obtain Mrs A's informed consent for the procedure. We upheld this part of the complaint.

Mrs C complained that she had been given a bill by her dentist which included costs for work which was either corrective or had already been paid for. Mrs C also complained that she was being charged for work that had not been carried out. Additionally, Mrs C complained that the dentist had failed to communicate with her about her treatment needs, in particular that she had once been given a treatment plan with no costs on it. We took independent dental advice. We found that what Mrs C had believed to be a bill was in fact an estimated treatment plan and therefore she was not being charged for work at the time of her complaint. We did not uphold this aspect of Mrs C's complaint. However, we found that it was unreasonable that she had on one occasion been presented with a treatment plan with no costs on it and therefore we upheld this aspect of Mrs C's complaint.

Mr C was referred to a urologist at Raigmore Hospital to have his history of erectile dysfunction and low testosterone investigated. Mr C raised a complaint nine months later as he had not received an appointment and was distressed by his ongoing symptoms. The board informed Mr C that there was a long waiting list. Mr C raised further concerns that he had not received an appointment, 13 months after his original referral. It took until 19 months after his referral for Mr C to be seen by a urologist. We took independent medical advice. We found that Mr C's wait to see a urologist was entirely unreasonable and significantly exceeded the Scottish Government's waiting time of 12 weeks for a new out-patient appointment. We were also concerned that the board had not provided evidence to show whether steps had been taken to reduce the waiting time of the urology clinic.

Mrs C complained that the dental practice failed to deal with her complaints in a reasonable manner. We found that the practice had failed to establish in the first instance what Mrs C's complaint involved and that this resulted in a missed opportunity to resolve the complaint at an early stage. We also found that Mrs C's complaint was not acknowledged by the practice within the three working day timescale set out in the Scottish Government's 'Can I help you?' guidance for handling healthcare complaints, and that the practice did not communicate with Mrs C by her preferred method. Finally, we found that the practice's response to Mrs C's complaint was not sent to her within the 20 working day timescale that is set out in the Scottish Government's 'Can I help you?' guidance. We therefore upheld Mrs C's complaint.

Mrs C complained that an orthopaedic consultant at Raigmore Hospital did not examine her, and instead transferred her care to a different orthopaedic doctor. Mrs C acknowledged that there had been electrical power loss at the hospital affecting the ability to carry out an x-ray of her painful foot. However, she felt that the doctor could have assessed her, given her medical records were available. We took independent medical advice from an orthopaedic consultant. We were unable to clearly determine whether the doctor had access to all of the relevant electronic medical records and previous x-rays taken, given the power loss. We considered that it was reasonable for the doctor to rearrange the appointment and transfer Mrs C's care to the orthopaedic consultant who had previously treated her. However, we were critical that Mrs C had to wait a further three months to be reviewed. We considered this wait to be unreasonable. The board have since taken steps to address the delays by employing more staff. Mrs C also complained that the board's response to her complaint was delayed and contained inaccurate information. We did not identify evidence to support her concern that the board's response was inaccurate. In addition, we found that although there was a delay in the board replying to the complaint, this was not unreasonable given that Mrs C was kept informed about the progress of the board's investigation in accordance with national complaints handling guidance.

Mr C was receiving care and treatment from one of the board's community mental health services. He complained that he was unhappy with aspects of his care and services provided by the board. We took independent advice from a psychiatric adviser and a mental health nursing adviser. The psychiatric adviser found that Mr C's initial referral to the consultant psychiatrist had been lost, and we were critical of this. However, they were satisfied that Mr C received reasonable treatment from the psychiatrists he saw and considered that it was evident from the records that this treatment had resulted in an improvement in his condition. The mental health nursing adviser was satisfied that, for the period the community psychiatric nurse (CPN) was engaging with Mr C, the CPN's input was reasonable and of an appropriate standard. However, the mental health nursing adviser was critical that, following a referral to a practitioner of CBT (cognitive behavioural therapy), the CPN discharged Mr C from their caseload without waiting to see whether the CBT service would take on Mr C. The mental health nursing adviser considered that this had denied Mr C the opportunity to explore other support, and considered that Mr C's continuity of care had been interrupted and that this was unreasonable. We found that the CPN's clinical correspondence could have been better worded, and although the adviser did not consider that the CPN's actions could be considered to be a breach of professional conduct, they felt that this was a learning point. We therefore upheld this aspect of Mr C's complaint. Mr C also complained that when the CPN was absent, the board did not provide him with a replacement CPN. We noted that the board had written to Mr C to ask him to call the service if he wanted a different counsellor in the absence of his CPN. The board said that if there was no response to this letter within two weeks, no follow-up letter would have been sent. The mental health nursing advise

Ms C, and advocacy and support worker, complained on behalf of Ms B about the care and treatment received by Ms B's daughter (Miss A). In particular, that there was an unreasonable delay by the board in diagnosing Miss A's genetic condition. Ms C also complained that Ms B was wrongly advised during the new-born period that Miss A, who was born at Raigmore Hospital, did not have the genetic condition. Finally, Ms C complained that the board's replies to her complaints were unreasonable. We took independent medical advice. We found that there was an unreasonable delay in diagnosing that Miss A had the genetic condition. We also found that Miss A should have been referred for a paediatric cardiology opinion. In addition, the advice we received was that had Miss A been appropriately followed up, the genetic test that became available three years later could have been performed at that time, rather than 12 years after her birth when Miss A was referred to a consultant in clinical genetics. The board said that they now have an IT database which enables them to identify patients who might benefit from changes in genetic testing, but that due to staffing and workload constraints, they were unable to contact all relevant patients. We found that were patients triaged and followed up appropriately, such a database should not be necessary. We therefore upheld Ms C's complaint that there had been a delay in diagnosing the genetic condition. We also found that while Ms B was given an assurance during the new-born period that Miss A did not have the genetic condition at birth, it was not possible to exclude a diagnosis at that time. When responding to Ms C's complaints, the board explained they were unable to say why this assurance had been given. We therefore upheld this aspect of Ms C's complaint. Finally, while the board responded to Ms C's complaints in line with the timescales detailed in their complaints process, we were concerned that they had failed to adequately

Mrs C complained to us that at numerous consultations over a nine-month period, the medical practice failed to provide her with appropriate treatment for her reported pain in her right arm. By the time she was referred for a specialist hospital opinion, a diagnosis of non-Hodgkin lymphoma (a cancer that develops in the lymphatic system) was made. Mrs C believed that the GPs at the practice should have referred her to hospital earlier and that as a result she has had to undergo courses of chemotherapy and radiotherapy. We obtained independent GP advice. We found that during the relevant period, in addition to the consultations at the practice, Mrs C attended the pain clinic and referrals to other departments. She also underwent an MRI scan and x-rays were taken. The symptoms which Mrs C reported to the practice were not in keeping with a diagnosis of non-Hodgkin lymphoma. We found that the practice arranged appropriate referrals and also closely monitored Mrs C's pain relief whilst communicating frequently with the pain clinic specialists. We therefore did not uphold Mrs C's complaint. Related reading View Decision Report 201604585 as a PDF (11.15 KB) Updated: March 13, 2018