SPSO Individual Decisions

Mr C complained on behalf of his daughter (Mrs A) who injured her head and neck in a sporting incident. Mrs A was taken to A&E at Forth Valley Royal Hospital and admitted to the orthopaedic ward. X-rays were taken of her neck and finger, and an MRI scan (magnetic resonance imaging scan, used to diagnose health conditions that affect organs, tissue and bone) was taken of her neck. Medical staff did not consider she had a significant head injury and she was discharged after three days. Mrs A continued to suffer symptoms from her accident and was referred to a specialist a few months later. A head MRI was taken which showed she had suffered a head injury and she was referred to the neurology department. Mrs A was diagnosed with post-concussion syndrome. Mr C complained about the delay to Mrs A's diagnosis and expressed his concern that this may have affected her recovery. We were critical of a number of aspects of Mrs A's care. We took independent medical advice from three advisers (a consultant in orthopaedic and trauma surgery; an emergency medicine consultant; and a nurse). We found that Mrs A's symptoms should have prompted a CT scan (computerised tomography scan, which uses x-rays and a computer to create detailed images of the inside of the body) of her head in line with national guidance. We also found that Mrs A's condition was not monitored adequately in A&E, nor were her neurological symptoms adequately monitored in the orthopaedic ward. We were critical of a lack of record-keeping, which prevented us from commenting in detail with regard to a number of points Mr C had raised.

Mrs C developed deep vein thrombosis (DVT, a blood clot in one of the deep veins in the body) after having surgery at Forth Valley Royal Hospital. Mrs C was readmitted to hospital, where the diagnosis was confirmed and she was started on a medication to treat DVT. After she was discharged, Mrs C's GP referred her to an out-patient clinic at the hospital (the Clinical Assessment Unit), as Mrs C's legs were swollen and she was suffering pain. Mrs C was reviewed by a doctor, but not admitted to hospital. Mrs C then received an appointment for a scan at another hospital out-patient clinic (the Day Medicine Unit). When she arrived, the staff were not sure why she was there, and said she did not need a scan. However, a doctor reviewed Mrs C and arranged for her to be seen by a consultant vascular surgeon, who then took over Mrs C's care. Mrs C complained about her overall care and the confusion about her appointment at the Day Medicine Unit. Mrs C was concerned that her DVT may have developed in her first hospital admission (and been misdiagnosed as an infection), that she may have been discharged too early after her second admission, and that she should have been given a CT scan (computerised tomography scan, which uses x-rays and a computer to create detailed images of the inside of the body) or referred to a surgeon earlier. The board apologised for a number of failings. The board took a number of actions to address the issues raised by Mrs C's complaint, including developing a ward checklist for checking the use of anti-embolism stockings (specially fitted elastic stockings used to compress the lower leg and reduce the risk of blood clots); developing a patient information leaflet on DVT; arranging for certain types of DVTs to be referred for a CT scan and discussed with a vascular surgeon as a matter of routine; reviewing the patient pathway for the provision of specialist hosiery; and establishing a seven-day service for management of DVTs within the Day Med

Mr C's GP had referred him to the board in November 2014 as he required the removal of his gallbladder. Although Mr C was not a resident in the board area he had received previous treatment there and his daughter lived nearby. The plan was that Mr C would stay with his daughter on his discharge following the surgery and the board had indicated that they were willing to accept him for surgery on this basis. Mr C emailed the board three times in January 2015 as he had heard nothing more. He was then advised that the board could not accommodate the GP's referral, and that the board had referred him to the health board where Mr C was resident. Mr C complained about the delay by the board in responding to his GP referral. The board apologised for the delay in responding to Mr C's emails and explained that the reason they could not carry out the surgery was due to pressure on their services and that to accept a referral from another health board would put added pressure on an already pressured system. We upheld the complaint and found that between November 2014 and January 2015 there was no action taken regarding the GP referral as two staff members thought the other was dealing with the matter.

Mrs C complained about the care provided to her late mother (Mrs A) by Forth Valley Royal Hospital. Mrs A had dementia and was admitted to the hospital suffering from a urinary tract infection and increased confusion; she was noted to be generally unwell. One evening, Mrs A fell out of bed just before 21:00 but Mrs C was not told about this until the following morning. Mrs A had been reviewed by a doctor and her head and shoulder were x-rayed, but despite having pain in her leg this was not x-rayed. Three days later, after Mrs C pointed out to nursing staff that Mrs A's foot was at an odd angle and she was in severe pain, an x-ray was done and it was found that Mrs A had broken her hip. Remedial surgery was considered but due to Mrs A's on-going and recurrent infection and her general frailty, it was agreed with the family that only palliative (end of life) care was appropriate. Mrs A died less than a fortnight after her fall. Our investigation included taking independent medical advice from two of our advisers, a doctor specialising in care of the elderly and a senior nurse. The advisers found some evidence of reasonable care, especially in Mrs A's initial care - but they were critical of the lack of communication with Mrs C about Mrs A's fall and later about what happens when a patient dies in hospital; the delay in diagnosing Mrs A's broken hip; that at one time Mrs A's notes were missing and later found in another patient's room - resulting in a delay in prescribing pain relief for Mrs A; and that when surgery was still being considered, Mrs A was found to have an incorrect identification wristband on.

Mr C complained to us that the board had unreasonably refused to give him braces when he entered prison. The prison dentist originally told Mr C that he could not have braces because his oral hygiene was poor. He gave Mr C advice about improving this. When Mr C's oral hygiene had sufficiently improved, the dentist took impressions of Mr C's teeth for study models in order that the models could be scored for the Index of Orthodontic Treatment Need (IOTN). However, both the dentist and an orthodontist considered that Mr C did not achieve the minimum score for orthodontic treatment on the IOTN and that he did not meet the criteria for NHS orthodontic treatment. We took independent advice on the complaint from a dental adviser with experience in orthodontics. We found that if Mr C's oral hygiene had remained poor during orthodontic treatment, there would have been a risk of the development of decay and further damage to his teeth around the brace. Mr C was also given reasonable advice and the opportunity to improve his oral hygiene. Mr C's oral hygiene had subsequently improved, however, the impressions that were taken showed that he did not meet the criteria for NHS orthodontic treatment, as he did not achieve the minimum score for orthodontic treatment on the IOTN. Consequently, we found that it had been reasonable for the board not to give Mr C braces and we did not uphold his complaint. Related reading View Decision Report 201404089 as a PDF (11.2 KB) Updated: March 13, 2018

Mr C complained that the board required him to post a complaint to their patient relations team, rather than allowing him to submit a complaint to his prison health centre. Mr C felt this was unfair as he only had access to one second class stamp each week. The board explained that in order to meet the national 20 working day target for dealing with complaints, they had asked prisoners to post their complaints directly to the patient relations team. In the board's view, this helped to remove any unnecessary delays in complaints being passed from the prison health centre to the patient relations team. The board also felt this approach was in line with the national complaints guidance 'Can I Help You' (CIHY). We decided that the board's approach was not in line with CIHY, as the guidance does not specify to whom complaints should be made, only that the board must accept written or verbal complaints. This means complaints can be made to any member of board staff, including prison health centre staff. It is for the board to resolve any internal problems that might delay complaints being passed from the prison health centre to the patient relations team, and we would expect the board to deal with this without requiring prisoners to post a written complaint to the patient relations team. We upheld Mr C's complaint.

Mr C complained that the prison health centre failed to provide appropriate treatment for the injury to his knee. After injuring his knee, Mr C attended the health centre and was prescribed pain medication. Mr C saw the doctor again a few days later because of the pain in his knee and also because the pain medication had given him a rash. The doctor prescribed a different pain medication and referred Mr C for physiotherapy and an x-ray. Mr C said his pain medication was not working but was advised that the doctor would review his medication after the x-ray results were received. The result confirmed Mr C had fluid and a loose fragment in his knee and the health centre referred him to an orthopaedic consultant. NHS Scotland’s national guidelines for the management of knee pain indicates that if a patient presents with a significant knee injury then they should be referred to A&E, a minor injuries unit or to an orthopaedic specialist which would allow for imaging of the knee to be carried out by x-ray or MRI scan. We took independent advice from one of our GP advisers about the treatment Mr C received and they confirmed that the correct referral protocol – as outlined in the guidelines – was not followed by the health centre when Mr C presented with his knee injury. In light of the evidence available, and given our adviser’s view which we accepted, we concluded that the health centre failed to provide appropriate treatment for the injury to Mr C’s knee because they did not refer him to A&E for further assessment when he first presented with the injury. Therefore, we upheld Mr C's complaint.

Mr C complained that the board’s prison health centre doctor unreasonably stopped his pain medication for a long-term knee injury, on the basis of alleged intelligence that Mr C misused another pain relief medication he had previously been prescribed. Mr C was concerned that the doctors at the health centre would not give him painkillers because of someone else’s say so, with no concrete proof or evidence and that in the meantime he had been left without effective medication. We obtained independent medical advice on Mr C’s complaint from a GP. We also sought advice from the office of the Chief Medical Officer (CMO) on disclosure of information/confidentiality. Our adviser noted that Mr C’s records indicated that the decision to stop his co-dydramol and not replace it with co-codamol was made, at least in part due to reported information regarding past drug misuse. However, our adviser explained that the pain guideline followed by the board suggested that there was no evidence for the continued prescribing of opioid based drugs such as tramadol, co-codamol and co-dydramol in patients with unexplained or persistent pain. Our adviser said it was, therefore, not unreasonable for the board to reduce and then stop Mr C’s tramadol or to stop his co-dydramol and not prescribe co-codamol in its place. Our adviser noted that the doctor prescribed appropriate alternative pain relief treatment for Mr C. We were satisfied that Mr C’s pain relief was appropriately managed by the doctor and the medication prescribed was appropriate for Mr C’s condition. In terms of the disclosure of the information about past drug misuse, the doctor confirmed he did not disclose the information to Mr C at the time he made the decision to stop his opioid based medication. Based on the advice received from the office of the CMO, we were not critical of the prison health centre’s actions in this regard. Related reading View Decision Report 201400695 as a PDF (11.48 KB) Updated: March 13, 2018

Ms C's mother (Mrs A) had been admitted to Stirling Community Hospital for palliative care (care provided solely to prevent or relieve suffering). Ms C complained that one day her mother was very distressed, saying she had been forced to get out of bed and stand, despite her begging them not to make her do so, as she had not been out of bed for a long time. Ms C said her mother, therefore, fell on the floor and had to be moved back into bed by a hoist. The board told Ms C that two staff members were moving Mrs A from her bed to a chair, but as she sank down towards the floor, they helped her to the floor, and from there they transferred her back to bed with a hoist. Ms C said her mother would never have agreed to stand or sit, feeling so ill that she simply wanted to lie down all the time. We considered the medical records, which showed that staff wanted to assess Mrs A's mobility needs to see whether it might be possible to meet her wish to return home. The records also said that Mrs A had sat up on occasion. We took independent advice from our nursing adviser, who considered that, although we could not know whether Mrs A had wanted to be moved on the day in question, it was appropriate that staff should try to move her and also, when she moved towards the floor, that they should assist her in doing so, to prevent any injury. We did not uphold this part of the complaint. Ms C also complained about the communication with the family during the admission. The records showed no discussion about necessary end of life planning issues after a certain date - for example, discussions about where Mrs A might want to die. Our adviser considered such discussions were important. In the absence of documentation to show that such discussions took place, we upheld the complaint. The board themselves had already acknowledged that communication could have been better and had taken action to help prevent a recurrence. Our adviser considered that such action was appropriat

Mr C complained about the pain relief he was being prescribed by the prison health centre as he did not find it effective. He also complained about the way the board handled complaints and feedback he had submitted. The board considered that Mr C was being prescribed appropriate medication to manage his pain. After taking independent advice from one of our GP advisers, we upheld this part of Mr C's complaint. The adviser did not consider that a thorough enough assessment of Mr C's pain had been recorded to determine if the pain relief he was prescribed was appropriate. In looking at the board's handling of Mr C's complaints, the evidence available confirmed that they did not respond to feedback that he had submitted in line with the relevant process and had failed to identify this during their investigation of his subsequent complaint. We also upheld this part of Mr C's complaint.

Mrs C had a history of longstanding abdominal (stomach) pain. She complained that, despite an operation, she had never been given an explanation for her pain or for the procedures she had subsequently undergone and she had not been given a definitive diagnosis. Mrs C said that she remains in pain and suffers panic attacks and depression. She complained to the board who said that there was no surgically treatable cause for her ongoing pain and symptoms, and that she had been referred to a pain clinic to try to help her. They did, however, acknowledge some problems with communication and said procedures had been put in place to avoid this happening again. We took independent advice from a surgeon about this case. Our adviser said that since her operation all Mrs C's treatment had been reasonable and appropriate. Despite many investigations, however, it had not been possible to determine the exact cause of her pain, and our adviser confirmed that there was no surgically treatable cause. However, there was evidence that communication between the board and Mrs C was confused and that there had been a delay in informing her of the outcome of a scan, so we upheld this aspect of her complaint.

Mrs C told us that she suffers from fibromyalgia (a long-term condition that causes pain all over the body) and attends a pain clinic. In 2012, she began to experience further pain, which she did not believe was as a result of fibromyalgia. She said that she was virtually suicidal but that clinicians failed to investigate alternative sources for her pain and continued to treat her for fibromyalgia. She said that she should have been x-rayed or scanned and that the board's failure to do so meant that the true nature of the problems with her spine were not identified. We took independent medical advice from consultants in rheumatology and orthopaedics. We found that while it was more than likely that Mrs C had fibromyalgia, her diagnosis had not been confirmed by a specialist. When Mrs C began to suffer further pain, advice was taken from another practitioner who admitted that this was not his area of expertise. Our advisers said that while the subsequent advice given to Mrs C was mostly correct, it may have been misleading and advice should have been sought from a specialist. Doctors did not carry out further investigations into her pain to exclude either another diagnosis or a further illness. Although our advisers did not agree that Mrs C needed an x-ray or scan, we upheld her complaint, as we found that the board had failed to carry out an appropriate investigation into her pain.

Mr C complained because he said the prison health centre had unreasonably stopped or reduced his medication. In particular, he said that omeprazole (medication for stomach acid) and vitamin B had not been prescribed. He also said his diabetic medication had been reduced without explanation. The board confirmed that prisoners were responsible for reordering some medication themselves, including omeprazole. They also confirmed that the health centre at Mr C's previous prison had stopped his prescription for vitamin B. The prison doctor confirmed that he prescribed Mr C's diabetic medication to be taken twice a day, rather than three times. He was unsure why he had reduced the medication but confirmed that he had since increased the dosage back to three times a day. We took independent medical advice, and asked our adviser whether the decision to reduce Mr C's diabetic medication was reasonable. Our adviser noted the doctor's comments and suggested that the reduction had most probably occurred as a result of an error when writing up the prescription. The adviser said it would be unusual to reduce a patient's diabetic medication without close monitoring or evidence of improvement in blood sugar levels. They also said that because Mr C's medication was increased after he reported raised sugar levels, he was unlikely to have suffered any harm. In light of the evidence, and having considered the views of our medical adviser, we did not uphold Mr C's complaint, although we made a recommendation.

Mr C complained about the treatment he received in Forth Valley Royal Hospital, Stirling Community Hospital and Falkirk Community Hospital. He said that the board had inappropriately continued with phototherapy (ultraviolet light treatment) he was receiving for a skin condition after he experienced an adverse reaction. He did not think that he should have had this treatment in the first place because of his skin type and believed that this led to him getting skin cancer. After taking independent advice from one of our medical advisers, we found that the board had assessed Mr C's skin type before starting the treatment, and because of it had selected a very gentle regime. Our adviser said that it was appropriate to undertake phototherapy as long as the protocol was followed and caution taken. We found that the protocol had been followed, and the medical adviser did not consider that the phototherapy had caused Mr C's skin cancer. We did not uphold this part of Mr C's complaint. Mr C also complained that when he was referred for treatment of his skin cancer, the surgeon initially forgot to remove a skin lesion (an area of abnormal tissue) on his neck. We found that the surgeon had been concerned that a lesion on Mr C's scalp was the primary source of the cancer and had prioritised removing this. Our adviser pointed out that if there are time constraints on an operating list, it is reasonable to prioritise clinical treatments. Mr C also said that there was a delay in administering antibiotics for the skin graft applied during the operation. However, we found that antibiotics are not prescribed routinely when skin grafts are applied and we did not uphold this part of the complaint. Mr C then complained about the ophthalmology (the branch of medicine that deals with the anatomy, physiology and diseases of the eye) treatment he had received. We found that the treatment was appropriate and timely and resolved Mr C's problems, so we did not uphold this complaint.

Mr C had an elective arthroscopy procedure (a type of keyhole surgery) on his right knee at Forth Valley Royal Hospital. The surgery took longer than anticipated. Mr C was discharged home the following day but was readmitted with an infection in his knee several days later. He had to undergo two washouts of the knee (a technique that involves flushing the joint with fluid) and was prescribed antibiotics to treat the infection, although Mr C said that hospital staff did not give him several doses of the antibiotics. The board agreed that this had happened. Mr C then complained that the care and treatment he received during and after his knee surgery was unreasonable. We took independent advice from a consultant in orthopaedic and trauma surgery, who explained that Mr C had suffered a severe complication of a joint infection after surgery, which is a recognised risk but is a rare complication. The adviser said that overall Mr C's care and treatment was appropriate and the failure to provide him with antibiotics on a number of occasions did not significantly alter the eventual outcome of the infection he acquired. Nevertheless, the adviser considered the failure to administer antibiotics was either due to failure by staff to be aware of the potential complications of this, or an indifference to 'getting it right' and was, therefore, a failing by the board in their duty of care to Mr C. We were, therefore, satisfied there was a failure in Mr C's care and treatment. We noted that a senior charge nurse had apologised to Mr C for the failure to give him antibiotics and that other nursing staff had been spoken to, to ensure that this was addressed. However, we thought that the board should apologise to Mr C as well. The adviser had further commented that although the board's explanation about the duration of Mr C's surgery was reasonable, the operation notes did not mention any particular problems or difficulties. We would have expected the reasons for the length

Mr C complained that prison healthcare staff behaved unreasonably towards him, after he complained about another matter regarding one of the staff. Mr C told us that he had a meeting with two nurses - one of them the person about whom he had complained - during which the nurses were confrontational and threatened him. In general terms, it is not unusual for prison healthcare staff to visit complainants to discuss their complaint face-to-face at an early stage, to see if they can resolve the matter quickly. However, even at such an early stage, it is important to ensure that the complaint is dealt with impartially. This is in keeping with the NHS' Can I Help You? Guidance, and we agreed with the board’s comment in their response to Mr C’s complaint that the nurse he previously complained about should not have attended the meeting. Where there are differing accounts of what was said or what happened in a particular situation, however, it can be difficult to prove what actually happened. In such cases, we primarily base our findings on written records. There was no audio recording of the meeting and, therefore, there was no way to determine what was said, or how people behaved. We could not resolve Mr C's complaint given these differing accounts. However, that did not mean we believed one account over another. As there was insufficient evidence to ascertain what was said, we did not uphold the complaint. Related reading View Decision Report 201404281 as a PDF (11.32 KB) Updated: March 13, 2018

Mr C submitted a request to see a prison dentist, saying that he had severe dental pain. Seven days later, Mr C had not received an appointment and he complained to the board. The next day, Mr C had a triage appointment with a nurse, who arranged an urgent dental appointment three days later. At this appointment the dentist found that the nerve in Mr C's tooth had died, and root canal treatment was required. The board did not uphold Mr C's complaint, as he had received an appointment by the time this was considered and they found the delay was reasonable for a 'routine referral'. Mr C was dissatisfied with this response, and complained to us about the delay in his dental treatment. We asked the board why Mr C's referral was classified as 'routine', given that Mr C was not seen by any healthcare professional until his triage appointment a week later. They explained that requests for appointments were reviewed by healthcare staff, and any requests which were considered urgent were seen by a healthcare professional within 24 hours. After taking independent advice from our dental adviser, we upheld Mr C's complaint. We found that the board did not follow their guidance on referrals, as Mr C's referral should have been classified as 'urgent' and he should have been seen within 24 hours. We also found that it was unreasonable for the board to classify the referral as routine without actually reviewing Mr C, given that the symptoms he described were in the 'urgent' category.

Mr C complained to us about the care and treatment he had received from his prison health centre in relation to pain in his wrist and jaw. Mr C had been prescribed tramadol (a strong painkiller) and the dosage had been gradually increased. He was then reviewed by a doctor, who considered that the tramadol he was receiving was inappropriate. The doctor recorded that the tramadol should be reduced and stopped and that it should be replaced by other painkillers. Mr C was unhappy with the decision to stop the tramadol. We took independent medical advice and found that the overall management of Mr C's pain had been reasonable. It had also been reasonable to reduce and then stop the tramadol and to try other medications to see if they addressed his pain. Consequently, we did not uphold this aspect of Mr C's complaint. Mr C also complained about the board's handling of his complaint. However, we found that the board had adequately investigated and responded to the issues he had raised and we did not uphold Mr C's complaint about this. Related reading View Decision Report 201400050 as a PDF (11.07 KB) Updated: March 13, 2018

Ms C’s daughter (Miss A) broke her leg and was admitted to Forth Valley Royal Hospital. Her leg was put in plaster and managed conservatively (without surgery). In the three months after her accident, Miss A was provided with a number of plaster casts but continued to experience pain and discomfort. Miss A went abroad and, while she was there, had to seek medical attention as she continued to suffer pain in her leg. After seeing an orthopaedic surgeon there, she was admitted to hospital for surgery. Ms C said that doctors there told her that, without this, there would have been long term complications. She complained that her daughter did not receive appropriate treatment for her broken leg from Forth Valley Royal Hospital and had not given informed consent for the conservative treatment she received there. We obtained independent medical advice from an experienced consultant in trauma and orthopaedic surgery. We found that there would be variations in approach about the treatment of this type of injury, and differing views between countries, between different hospitals in the same country and between individual surgeons in the same orthopaedic unit. Our adviser said that both conservative management and surgery are well supported managements for this type of injury and both are considered to be appropriate treatment. Once the decision was made to manage Miss A’s injury in plaster, the care and treatment she received was correct and plaster casts were left on for the appropriate length of time before they were removed. We also found that Miss A was able to give informed consent for her treatment. On one occasion, there was a failure to carry out an x-ray after Miss A’s plaster was changed. The board had acknowledged this and had already apologised. Our adviser considered that they had taken appropriate action and did not identify any other failings in Miss A’s treatment. The adviser also said that Miss A’s medical records did not support the criticism of her trea

Ms C complained about her dentist. In particular, she said that his care and treatment had been unreasonable and inappropriate and that this caused her pain and upset. Ms C also said that the dentist had delayed in making a referral for her to a dental clinic and that when she attended the clinic, the referral was unnecessary. She further said that unsuccessful work had been carried out on one of her teeth which then had to be extracted at her own expense. We took independent advice from a senior dental practitioner and our investigation showed that when Ms C first saw the dentist it was for an emergency appointment. She was immediately given appropriate treatment. She attended again and after an x-ray, treatment options were discussed and Ms C made decisions about her preferred treatment. Later, because a problem with one of her teeth was not settling, it was agreed with Ms C that she should be seen at a dental clinic and a referral was immediately made. However, the dental clinic had problems with their email and it was not received. As soon as this was discovered, the dentist made a further referral and Ms C was seen. Although she complained about her treatment it was established that it had been reasonable and appropriate in the circumstances. Related reading View Decision Report 201401913 as a PDF (11.2 KB) Updated: March 13, 2018

Mrs C was admitted to Forth Valley Royal Hospital suffering from shortness of breath and oedema (swelling) caused by fluid retention due to her chronic (long-term) congestive heart failure. She also suffered from kidney disease and insulin-dependent diabetes. Despite treatment, Mrs C died some two weeks later, and her husband (Mr C) then complained about her care and treatment. As he held power of attorney (PoA - a legal document appointing someone to act or make decisions for another person) for Mrs C, Mr C said it was inappropriate for staff to speak to his wife alone about her condition and treatment, and he complained that he and his family were not kept informed about her care and treatment. We took independent advice on Mr C's complaint from two of our advisers, a doctor and a nurse, and we also reviewed the relevant legislation and medical guidance. Mr C was concerned that one of the drugs (furosemide) that his wife was prescribed for fluid retention was making her worse and contributing to the worsening of her kidney disease. National guidance says that this is the recommended first-line treatment, but that it can cause kidney damage and needs to be carefully monitored. We found that it was monitored and that when Mrs C's kidney function continued to deteriorate the drug was stopped. Mr C also had concerns that Mrs C's diabetes was not being appropriately managed but this was not supported by the evidence in the medical and nursing notes, and there was evidence of regular reviews by a diabetic nurse specialist and a dietician. We were, therefore, satisfied that the care and treatment provided to Mrs C was reasonable, appropriate and timely. In relation to the PoA and general communication issues, the PoA clearly stated that it was to be invoked only if Mrs C lacked capacity - this is in line with the relevant legislation (the Adults with Incapacity (Scotland) Act 2000). Guidance issued by the General Medical Council (GMC) and Nursing and Midwifery C

Ms C complained that her dentist failed to examine her or treat her reasonably or appropriately. She said that it was only shortly afterwards, when she changed to a new dentist, that she learned the extent of her problems, which she said the first dentist had allowed to develop. We took independent advice from a senior dental practitioner and we found that as the appointment concerned had been on an emergency basis, Ms C had been given immediate treatment on the particular problem she presented with. The appointment was not routine, and so the dentist had not been expected to make a full examination of Ms C's mouth. We found the treatment he gave her had been appropriate in the circumstances. Related reading View Decision Report 201401911 as a PDF (10.94 KB) Updated: March 13, 2018

Mr C complained that he was not properly assessed by his prison health centre after he submitted an emergency nurse triage form saying that he was unfit to work because he was suffering from leg cramps, a black toe and being unable to sleep. A meeting was held with Mr C to discuss his concerns and the board told him that there was no record of the health centre having received a triage form from him on the date in question. However, they said he had submitted a triage form (assessment form) four days before the date he referred to in his complaint and was seen by a nurse who assessed him and then arranged a consultation with the doctor at Mr C's request. The board concluded that the clinical team had dealt with Mr C appropriately. We could not find clear evidence that Mr C submitted a triage form on the date he said he did. However, we noted that he had done so four days before, for the same problems, and that the triage nurse did not consider that he was unfit for work at that time. We considered it unlikely that the problems he raised would have prevented him from working then. The nurse should have documented her judgement that Mr C was fit for work and we drew this to the board's attention. They confirmed they would take steps to highlight to staff the importance of accurate record-keeping. We did not, however, consider this to be a significant failing and we were satisfied that the board were taking reasonable action to ensure the matter does not happen again. We concluded that Mr C was reasonably assessed. Related reading View Decision Report 201305580 as a PDF (11.34 KB) Updated: March 13, 2018

Mr C complained because he felt a nurse had inappropriately disclosed his medical information at a meeting with prison staff. He also complained about the way the board handled his complaints. In response to our enquiries, the board confirmed the nurse discussed issues in relation to Mr C at the meeting but she did not disclose any medical information. They also confirmed that Mr C had given instructions to the board that his information should not be shared but those instructions were given after the meeting in question had taken place. The board provided a copy of a patient registration form that Mr C signed when he was received into the prison healthcare system which advised him that the NHS may need to share information about his health and medication with people outside the NHS, such as prison staff. In light of this, we did not uphold his complaint about this. However, in looking at the board's handling of Mr C's complaints, the evidence available confirmed that they did not respond to some of them and for those they did respond to, they could have provided a fuller reply. We upheld this part of Mr C's complaint.

Mr C complained about the nursing care and treatment provided to his late wife (Mrs C) and also complained that when her condition deteriorated she was not transferred to the Intensive Treatment Unit (ITU). Mrs C had a previous medical history which included Type II diabetes, heart disease, and kidney problems and she had been progressively unwell several months before she was admitted to Forth Valley Royal Hospital. At that time she was complaining of a six-week history of breathlessness, an unproductive cough, reduced exercise tolerance, and increasing leg oedema (swelling due to fluid retention). Mrs C was treated with drugs to fight infection and to reduce fluid retention but her condition failed to respond and she died around four weeks after being admitted. We took independent medical advice from one of the Ombudsman's nursing advisers and a consultant who specialises in care of the elderly. We found that although the nursing treatment was reasonable, appropriate and timely, there were some failings in the nursing care provided including failure to appropriately supervise Mrs C when she was self-administering her insulin (a drug used to treat diabetes); to deal appropriately with urine samples; and to communicate the seriousness of Mrs C's condition to Mr C and members of the family. These failings had already been acknowledged and apologised for by the board in their responses to Mr C's complaint to them, and an action plan had been implemented to address the issues, including ongoing staff education. Therefore, although on balance we upheld this aspect of Mr C's complaint, we did not make any recommendations as we considered that appropriate action had already been taken by the board. On the medical treatment provided to Mrs C, our consultant adviser said that Mrs C received appropriate assessments, investigations, specialist reviews and modifications of treatment where required. On the specific issue of transfer to the ITU, we found that when Mrs C's