SPSO Individual Decisions

Mrs C, who works for an advice agency, complained on behalf of her client (Miss A), who said she was suffering from Jarisch Herxheimer's reaction (a physical reaction to the death of microorganisms within the body during antibiotic treatment). Mrs C said Miss A believed that she had not received the appropriate care and treatment from her medical practice. Miss A believed that she had not been prescribed antibiotics appropriately and that the practice had inappropriately interfered with her consultations with hospital specialists. We took independent medical advice from a GP adviser. The adviser said, and we agreed, that Miss A had been treated appropriately. Jarisch Herxheimer's reaction was an unusual condition and would require diagnosis by a hospital specialist. Miss A had received the appropriate referrals, but the specialists in question had confirmed that Miss A did not have this condition. We found that there was no evidence that the practice had acted inappropriately or that they had attributed Miss A's problems to her mental health. We found that the care and treatment provided was of a reasonable standard and we did not uphold the complaint. Related reading View Decision Report 201508658 as a PDF (11.13 KB) Updated: March 13, 2018

Mrs C attended Raigmore Hospital with an injury to her ankle. She complained about the care and treatment provided, in particular that there was an unreasonable delay in providing her with orthopaedic treatment. During our investigation we took independent advice from a consultant radiologist and a consultant trauma and orthopaedic surgeon. The consultant radiologist considered that an abnormality on Mrs C's first x-ray was missed, and as a result there was a delay in being referred to an orthopaedic surgeon and in a diagnosis being made. In addition, the consultant radiologist considered that the abnormality was also missed on an x-ray taken 15 months later and that had this been noticed, Mrs C may have been referred for imaging earlier than she was. We found that there were no long-term orthopaedic consequences for Mrs C's ankle as a result of the delays. However, we were concerned that the delays added to Mrs C's distress and that she had continued to suffer pain and discomfort when this could possibly have been avoided. We considered that a delay between Mrs C being placed on the waiting list for an orthopaedic appointment and being advised four months later that she would not be offered an appointment within the target timescale was unreasonable. We also found that the delay between Mrs C attending hospital for her injury and being seen in an orthopaedic clinic was unreasonable. However, we noted that action was being taken by the board to address the delays. We upheld Mrs C's complaint.

Ms C, an advocacy and support worker, complained on behalf of Mr A. Mr A was referred by his GP to orthopaedics for a knee problem from which he was suffering. He waited around 13 weeks to be seen and was told he required a replacement knee. Mr A also had an active skin condition which the orthopaedic consultant said would need to be controlled as it increased the risk of infection following surgery. Mr A was not added to the surgery waiting list. His GP was asked to make a dermatology referral. After a further 12-week wait, Mr A saw a dermatologist and was referred on to a more local facility for phototherapy for his skin condition. The phototherapy was successful but the good effects were short-lasting. Mr A had still not been placed on the waiting list and had to undergo a further pre-assessment and round of dermatology treatment before his surgery took place, meaning that he had to wait 15 months from the time he was referred until he received treatment. We upheld Ms C's complaint. We found that more could have been done in the chain of communication, and that a degree of difficulty in scheduling surgery around such a skin condition might have been predicted. We also found a letter between two departments had not been sent to a named consultant and there was no evidence it had been actioned.

Mrs C complained about the care and treatment provided to her father (Mr A) by the practice. She said that the care had been poorly organised and gave specific examples of what she believed was a substandard examination of Mr A by a GP and a failure to follow up on blood test results. Mrs C also said the practice had insisted on some care being provided by the practice nurse, whom she said was not competent. Mrs C felt the practice's response to her complaint had also been inaccurate. Mrs C believed that had the care Mr A received been of a higher standard, he may have been able to undergo treatment before his cancer became terminal. We took independent medical advice. We found that Mr A's examination had failed to identify a condition which merited urgent referral. We therefore upheld this aspect of Mrs C's complaint. This failure had not, however, had any impact on Mr A's prognosis as the condition was unrelated to Mr A's cancer. The other aspects of Mr A's care were, however, reasonable. We also took independent nursing advice. The adviser said that the actions of the practice nurse were adequately documented and there was no evidence of incompetency. We found that while Mr A did not receive a reasonable standard of examination from the practice on one occasion, in other respects his care, including his nursing care, was reasonable. The practice's complaint response was detailed and provided a full explanation of Mr A's care and showed the practice had reflected carefully on the actions they had taken. We therefore did not uphold these aspects of Mrs C's complaint.

Mrs C, an advocacy and support worker, complained on behalf of Mrs A that the clinical treatment received by Mrs A at Raigmore Hospital had been of an inadequate standard. Mrs A had suffered an injury to her calf while on holiday. She had received some treatment, including an MRI scan, but had been told that she did not have an Achilles injury. Mrs A had continued to experience significant pain and discomfort on her return home and attended A&E. Mrs A said she had been examined and told she must walk normally. Mrs A's symptoms did not improve and she attended A&E again on the advice of her physiotherapist. Mrs A was told that she had suffered a calf tear and she was discharged without further treatment. Mrs A subsequently arranged for her MRI scan to be reviewed privately. This found a tear of her Achilles tendon. When Mrs A returned again to A&E, she was supplied with a protective boot. Mrs A was subsequently seen by an orthopaedic specialist and a complete tear of the Achilles tendon was diagnosed. Her leg was placed in a plaster cast. Mrs C said Mrs A believed that she should have been diagnosed much sooner, that staff had failed to appropriately review the MRI scan results and that they had been unsympathetic to her condition. The board said they did not believe staff had acted inappropriately towards Mrs A. They said that she had been examined using the standard techniques and that these had not indicated damage to the the Achilles tendon. The board provided information on the reliability of the test, accepting that it was not infallible. They noted the information Mrs A provided about the MRI scan results suggested that she did not have an Achilles tendon injury, which appeared to have been confirmed by her physical examination. The board said that they did not agree with Mrs A's recollections of the attitude of staff towards her. We took independent advice from a consultant in emergency medicine. The advice we received said there was no clinica

Mrs C had attended a series of physiotherapy appointments at the Victoria Integrated Care Centre. However, her symptoms related to a degenerative disc disease in her spine were unresponsive and she was referred back to her GP for further management. She was provided with a home exercise programme and advised of the symptoms of cauda equina syndrome (a spine disorder affecting the nerves). Mrs C's pain continued and her GP referred her to Queen Elizabeth University Hospital where she had an MRI scan. The scan showed that she had a bulging disc in her lower back which was pressing on the nerves of her leg. Before Mrs C could attend a further specialist consultation which had been arranged, her situation deteriorated. She attended A&E at the Royal Alexandra Hospital with symptoms of cauda equina syndrome and was admitted. The next day Mrs C underwent surgery. Mrs C complained that the physiotherapist she attended failed to treat her appropriately and that she should have been referred for an MRI scan. We investigated the complaint and took independent physiotherapy advice. We found that although Mrs C's symptoms were noted to be developing, she was reviewed and her treatment amended accordingly. However, her symptoms did not meet the criteria that would have required her to have an MRI scan and she was given appropriate advice and treatment and referred back to her GP. We therefore did not uphold Mrs C's complaint. Related reading View Decision Report 201600574 as a PDF (11.3 KB) Updated: March 13, 2018

Mrs C, who works for an advocacy and support agency, complained on behalf of her client (Ms A). Mrs C said that staff had failed to diagnose that Ms A had suffered a fracture to her right tibia and broken bones in her right knee when she attended A&E at Raigmore Hospital. Ms A was given painkillers and discharged home. She continued to suffer pain and two weeks later an x-ray revealed the fracture and broken bones. Ms A felt the staff should have arranged an x-ray when she attended A&E. The board said that Ms A was appropriately assessed by nursing and clinical staff who diagnosed a soft tissue injury and that an x-ray was not required. We took independent medical advice from a consultant in emergency medicine and found that the staff had carried out an appropriate assessment based on the presenting symptoms and reached a reasonable diagnosis of soft tissue injury. There was no requirement to have arranged an x-ray at that time, although it was subsequently established that the fracture had occurred. We did not feel that the actions of the staff were unreasonable and therefore we did not uphold Mrs C's complaint. Related reading View Decision Report 201603748 as a PDF (11.16 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs B about the care and treatment given to Mrs B's husband (Mr A) after he had two wisdom teeth extracted under general anaesthetic at Raigmore Hospital. Ms C said that on his return home after discharge, Mr A became very unwell. Mrs B twice phoned the hospital for advice but it was only after her second call that he was asked to return. When Mr A returned to the hospital, no record was found of the calls made. After examination and a scan, Mr A was diagnosed with sepsis and was admitted to intensive care where he stayed for about a week. Ms C said that information about Mr A's discharge failed to reach his GP and dentist in a timely way. Mrs B made a formal complaint to the board about these matters. Ms C complained that they failed to properly address Mrs B's concerns. The board were of the view that they had treated Mr A reasonably although they recognised a number of shortcomings (namely that records of phone calls to the hospital were not properly recorded and that letters and discharge information were delayed). We took independent advice from a consultant in oral and maxillofacial surgery and found that there was no record of phone conversations prior to Mr A's admission. However, after his re-admission Mr A's care had been reasonable. We also found that there had been delays in issuing discharge letters and that addresses had been omitted. Furthermore, Mrs B's complaint had not been properly addressed in that although these shortcomings had already been identified by the board, they had put no plan in place to prevent the same thing happening again. We therefore upheld Ms C's complaint.

Mrs C, who works for an advice and support agency, complained on behalf of her client (Ms A) that her medical practice had failed to investigate, diagnose and treat her symptoms. We took independent medical advice and found that Ms A had previously been referred to a number of specialists. She had no new symptoms that warranted further investigation and it was reasonable not to refer her back to the specialists. We found that the care provided by the practice had been of a reasonable standard and we did not uphold this aspect of Mrs C's complaint. Ms A considered that she was suffering from Jarisch Herxheimer's reaction (a physical reaction within the body during antibiotic treatment). Mrs C complained that the practice had unreasonably stated that this was not the cause of Ms A's symptoms. We found that this had already been investigated in hospital and there was no evidence that this was the diagnosis. We considered that the practice's comments in relation to this matter had been reasonable and we did not uphold the complaint. Mrs C also complained that it was unreasonable for the practice to suggest in their diagnosis that that there were psychological or psychiatric factors which were worsening Ms A's physical symptoms. We found that the practice's clinical assessment and opinion on this matter had been reasonable and we did not uphold this aspect of the complaint. Related reading View Decision Report 201600555 as a PDF (11.23 KB) Updated: March 13, 2018

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly. We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint. Related reading View Decision Report 201601310 as a PDF (10.76 KB) Updated: March 13, 2018

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly. We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint. Related reading View Decision Report 201601426 as a PDF (10.76 KB) Updated: March 13, 2018

Mrs C complained that her dentist had failed to provide her with appropriate treatment for an infection in her gum. Mrs C said that this had caused her stress and anxiety as she felt she had not been diagnosed correctly. We took independent dental advice and found that both the examination and the treatment Mrs C received were reasonable and appropriate. We did not uphold the complaint. Related reading View Decision Report 201601424 as a PDF (10.76 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment provided to her by her medical practice in relation to her ongoing ankle pain. During our investigation we took independent advice from a GP adviser. The advice we received was that the care and treatment provided by the practice in relation to the ongoing management of Mrs C's ankle injury was of a reasonable standard and no failings were identified. We did not uphold the complaint. Related reading View Decision Report 201508674 as a PDF (10.78 KB) Updated: March 13, 2018

Mrs C complained that when the board decided to change follow-up appointments for some cancer patients from face-to-face appointments to phone appointments, the decision was notified to her in an inappropriate way, that the decision was unreasonable and that there was an unreasonable delay in providing a copy of the discharge letter sent to her GP. Mrs C received treatment for cancer which was thought to be of low risk of recurrence. She was told she would be followed up for a period of three years at six-monthly clinic appointments. However, before the sixth appointment she was sent a letter informing her that the appointment had been changed to a phone appointment. The letter was undated, on plain notepaper and had no signature or indication of the author. Our investigation found that the decision to move to phone appointments was reasonable and in line with guidance from the Department of Health. However, the manner in which Mrs C had been notified of this change was unacceptable. The board explained that the consultant in charge of Mrs C's care had drafted a letter to inform patients of the change. It was then circulated to the multi-disciplinary team for review and once approved was sent to Mrs C without being transferred to headed notepaper and having the date, the name of the consultant and their signature added. Since Mrs C's complaint the letter had been amended. Mrs C did not receive a copy of the GP letter until several weeks after her phone appointment. We considered this and other administrative failures which occurred during the complaints process to be unacceptable.

Mrs C complained about the treatment she received for her injured hand following a fall. Mrs C attended A&E at Caithness General Hospital. An x-ray was taken the next day and no bone injury found. Further x-rays were taken after Mrs C attended her GP. However, a fracture was only identified seven months later, following a scan. Mrs C complained that she had not been provided with reasonable treatment and that she had not been referred to a specialist within a reasonable timescale. The board had accepted that they were not meeting the 48-hour target for a formal report to be issued in relation to x-rays and had taken action. They also accepted and apologised for the delay in diagnosing the fracture Mrs C suffered. During our investigation we took independent advice from three advisers: a consultant in trauma and orthopaedic surgery (adviser 1), a consultant radiologist (adviser 2) and a consultant musculoskeletal physiotherapist (adviser 3). Adviser 1 noted that the overall orthopaedic treatment Mrs C received was correct but that access to treatment was not as timely as it could have been. This related to the delay in a scan being carried out. However, the adviser also said that the delays experienced by Mrs C would not have altered the treatment or long-term outcome from an orthopaedic point of view. Both adviser 1 and adviser 2 were of the view that the board's decision to delay carrying out an x-ray until the day after the injury was sustained was not reasonable. Adviser 2 did not agree with the board's policy of waiting on a formal report of an x-ray before taking a further x-ray. The advice we received from adviser 3 was that overall the physiotherapy treatment Mrs C received was reasonable. The board accepted that they were not meeting the 12-week target for out-patient appointments and apologised that the specialist in this case had been unable to prioritise Mrs C and for the delay in being seen by the specialist. While the board outlined the actio

Mrs C complained that a dental hygienist carried out a scale and polish procedure inappropriately and that this caused extensive damage to her teeth. We took independent dental advice. We found that there was no evidence to suggest the hygienist failed to carry out the procedure appropriately, or that this had caused damage to Mrs C's teeth. We did not uphold this complaint. Mrs C also complained that the subsequent treatment and advice she received from a dentist was unreasonable. We were advised that the records indicated that appropriate treatment was provided and correct advice offered. We did not uphold this complaint. In addition, Mrs C complained about the board's response to her complaint. She felt that they unreasonably disregarded the evidence of the further treatment that she received, which she considered supported her concerns that the scale and polish procedure damaged her teeth. She was also unhappy with the dentist's indication that they offered fluoride treatment for sensitivity when she said it was offered to address the damage to her teeth. We were advised that the further treatment Mrs C required was due to her teeth being worn and not as a result of any unreasonable prior treatment. We were also advised that fluoride treatment is usually offered to treat sensitivity or decay, and not damage to teeth such as that described by Mrs C. We therefore concluded that the board's response was reasonable and we did not uphold this complaint. Related reading View Decision Report 201508436 as a PDF (11.2 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs A about the care and treatment given to Mrs A's husband (Mr A), who had been diagnosed with chronic liver disease. Ms C said that despite regular testing since his diagnosis, there had been a failure to pick up Mr A's deteriorating condition and she was concerned that he had not been offered a liver transplant. Mr A died following discharge from hospital. Ms C also complained about a delay in receiving a response from the board. We took independent advice from a consultant gastroenterologist (a doctor who specialises in the treatment of conditions affecting the liver, intestine and pancreas). Mr A had been regularly monitored and checked but the nature of his disease was unpredictable and his diagnosis had not always been clear. We also found that Mr A's case had not been appropriate for liver transplant as the severity of his illness (based on an established scoring system) had not been high enough to justify it. We therefore did not uphold this aspect of Ms C's complaint. However, the adviser said that the board should have involved the Macmillan palliative care team at an earlier stage to provide symptomatic help for Mr A and support for his family. We found that there was an unreasonable delay on the part of the board in responding to Ms C's complaints and in addressing her concerns.

Mrs C's mother (Mrs A) was admitted to Raigmore Hospital with a broken arm. Mrs A was transferred to Nairn Town and County Hospital six days later for rehabilitation and discharged home. During this period, Mrs C became concerned that Mrs A had broken her arm again and complained about a number of aspects of the discharge arrangements including the inadequacy of the discharge package. Shortly after her discharge home, staff decided to place Mrs A in a care home because it became apparent that the discharge package was insufficient to help her remain at home safely. Mrs A returned home six weeks later but was later readmitted to Raigmore Hospital, where she died. Mrs C was also concerned that district nursing staff had failed to successfully treat Mrs A's pressure ulcer. Finally, Mrs C complained that the board failed to provide her with a full copy of their internal review of the discharge. We took independent advice from an orthopaedic adviser and a nursing adviser. We found that the medical care and treatment was reasonable, including the decision to treat the fracture conservatively (giving no medical treatment involving radical therapy or an operation), and that while the fracture did not heal as expected, this did not indicate a further fracture or an unreasonable standard of care. We also found that the pressure ulcer care was reasonable, as was the decision to send a summary of the key findings of the internal review to Mrs C. We therefore did not uphold these aspects of Mrs C's complaints. However, in relation to the discharge we found significant failings around discharge planning and the subsequent package, which meant that Mrs A had to be transferred to a care home for a short period. We therefore upheld this complaint. However, in light of the actions already taken by the board to address these failings, and their acknowledgement and apology to Mrs C, we made no recommendations. Related reading View Decision Report 201508646 as a PDF (11.51 K

Miss C complained that a GP with whom she had been discussing rape and sexual assault unreasonably referred her to a psychiatrist. In particular, Miss C raised concerns that the medical practice had been dismissive of her history and circumstances. She also raised concerns that the practice referred her unreasonably on the basis of previous psychiatric history. She said that the referral should have been to another specialist. The practice said that the GP referred her to the psychiatrist as it was clinically indicated to do so. They also said the referral was not based on Miss C's previous psychiatric history, but on the GP's concerns about Miss C. The practice also understood that Miss C was in contact with a rape counselling service. After receiving independent medical advice, we did not uphold Miss C's complaint. We found the referral was reasonable based on the clinical signs recorded in the medical records, which may have been consistent with certain mental health conditions. We also found that the GP considered appropriately the reported history of abuse in making the referral. Related reading View Decision Report 201508482 as a PDF (11.11 KB) Updated: March 13, 2018

Miss C complained that a psychiatrist failed to reach a reasonable diagnosis on the basis of her circumstances and medical history. In particular, Miss C raised concerns that the psychiatrist did not appropriately address her reported history of abuse in reaching the diagnosis. Miss C also questioned whether the psychiatrist considered other factors that would have impacted on her presentation at the psychiatric consultation. Miss C said a different diagnosis should have been reached and that the psychiatrist did not engage appropriately with her spiritual beliefs. Miss C questioned whether the diagnosis was based on an appropriate level of assessment. The board said the psychiatrist was appropriately concerned that Miss C was suffering from psychiatric illness. After receiving independent psychiatric advice, we did not uphold Miss C's complaint. We found the psychiatrist appropriately considered Miss C's history and other factors impacting on her presentation at the consultation. We found that the psychiatrist conducted an appropriate assessment and that the diagnosis reached was reasonable in the circumstances. Related reading View Decision Report 201508671 as a PDF (11.03 KB) Updated: March 13, 2018

Ms C complained on behalf of Miss A who said she suffered from Jarisch Herxheimer's reaction (a severe but treatable reaction to antibiotics). Miss A said doctors at Raigmore Hospital had failed to treat her properly by refusing to accept that she suffered from this condition and refusing to admit her to hospital for a week-long course of supervised antibiotics that would have demonstrated that her condition was genuine. We took advice from a consultant in infectious disease medicine. The advice said the condition was normally found in patients being treated with antibiotics for a specific type of bacterial infection, such as syphilis or Lyme disease. Miss A had been tested for these and been found to be clear of infection. She had also been tested for latent tuberculosis. The advice said Miss A's doctors had eliminated any possible infections that might cause the condition when treated with antibiotics. It would not be appropriate to provide antibiotic treatment to a patient without an identified infection. This could lead to an increase in antibiotic resistance both in Miss A and the general population, reducing the effectiveness of future treatments. It would also put Miss A at risk of side effects including possible significant bowel disease. We found that Miss A had been provided with a reasonable standard of care and treatment. While it was acknowledged that Miss A had suffered a very distressing experience, there was no medical evidence to show she suffered from Jarisch Herxheimer's reaction and we did not uphold the complaint. Related reading View Decision Report 201508051 as a PDF (11.35 KB) Updated: March 13, 2018

Miss C attended her GP after injuring her leg in a fall. Her pharmacist thought she might have a deep vein thrombosis (DVT) but after examination she was diagnosed as having a calf strain. However, her pain continued and the next day she attended Raigmore Hospital. She was diagnosed with a soft tissue injury to her lower leg. Over the next few days Miss C made three further visits to the A&E department and on her second visit she was seen by a nurse practitioner. A fracture was diagnosed and she was put in plaster. It was not until after another two visits that serious circulation problems were diagnosed but by this time, Miss C's leg was so affected that it required to be amputated below the knee. We took independent advice from a consultant in emergency medicine. We found that the diagnosis of a soft tissue injury after the first visit to hospital had been a reasonable one. Miss C had been thoroughly and appropriately examined. The possibility of a DVT had been considered but there was no evidence of this. However, after her second unplanned visit to the emergency department, she should have been seen by a more senior doctor rather than a nurse practitioner. Her subsequent visits should also have been treated more seriously and a senior emergency doctor should have been involved. This did not happened and thus there was delay in diagnosing Miss C's condition. We upheld this aspect of the complaint. Miss C also complained that the board failed to fully respond to points raised in her complaint and that they provided inaccurate information. The adviser said that he could see no evidence that the correspondence contained incorrect information and was satisfied with the action taken. We did not uphold this aspect of the complaint.

Mr C's late father (Mr A) was admitted to Lawson Memorial Hospital for several months for a period of rehabilitation following a stroke. He was then discharged to a care home but died two days later. The cause of death was established as methicillin-resistant staphylococcus aureus (MRSA), which came as a shock to Mr C and his family as it had not been communicated to them that Mr A had been diagnosed with this. Mr C complained about the lack of communication in this regard and also about a lack of treatment for MRSA. We took independent medical advice from a hospital consultant who considered that the evidence available to demonstrate the clinical thinking behind Mr A's care was poor. They noted that Mr A's care was complex and that there would have been other factors for medical staff to consider. They said that more consideration should have been given to urine culture results and the potential for persistent infection. Consideration should also have been given to changing his catheter in line with NHS guidelines and the board's own policy on treating infections but there was no evidence that this happened. Neither was there any evidence of Mr A being informed of his diagnosis. The adviser said that this should have been communicated to Mr A and his permission sought to share this information with the family. We upheld this complaint. Mr C also complained about the appropriateness of Mr A being discharged with MRSA. While Mr C considered that Mr A was still displaying symptoms of urine infection around the time of his discharge, we were advised that an appropriate medical review was carried out and no evidence was found to suggest that the discharge could not go ahead. We noted that the board's MRSA policy confirmed that a diagnosis of MRSA should not prevent discharge of a patient. We did not uphold this complaint.

Mrs C, who works for an advice agency, complained to us on behalf of Miss A. Miss A had attended her medical practice after falling over on her ankle. Her appointment was made by her pharmacist, who thought Miss A might have a deep vein thrombosis (DVT, a blood clot in the vein). Miss A was examined by a doctor, who diagnosed a calf strain. She was advised to take pain relief. However, Miss A's pain continued and she attended A&E on a number of occasions, where she was diagnosed with a fractured ankle. Miss A continued to report problems and was subsequently referred to a vascular surgeon (a surgeon who treats disorders of the circulatory system). A DVT was found and Miss A was required to have her leg amputated below the knee. Mrs C complained to us that the practice failed to appropriately diagnose and treat Miss A and about the way they dealt with Miss A's subsequent complaint. We took independent advice from a GP. They found that Miss A's diagnosis had not been unreasonable, that she had been appropriately examined and that her circulation was reasonably assessed. They also found that Miss A's complaint received a reasonable reply. We therefore did not uphold Mrs C's complaints. However, the adviser noted that Miss A's GP had not been alert to Miss A's early signs of PVD (peripheral vascular disease, or peripheral arterial disease (PAD)) which should have been followed up. We therefore made recommendations to address this.

Ms C was pregnant with twins when she was taken to Raigmore Maternity Unit by paramedics. She was found to be in premature labour and despite attempts to stop her contractions, her twins were delivered prematurely with very low birth weights. Ms C was 20 weeks pregnant at the time of the delivery and her twins did not survive. Ms C complained about the care and treatment that was provided to her and the twins. She also complained about the information and advice provided by the board on taking the babies away from the hospital. Ms C was concerned about the board's final response to her complaints as she felt this took a long time to be issued and contained a lot of mistakes. After taking independent advice on this case from a midwife, an obstetrician, a neonatologist and a consultant physician, we did not uphold Ms C's complaints about the care and treatment. The advice we received was that the care was appropriate and no failings were identified in this regard. We also did not uphold her complaint about the information or advice that was given on taking the babies away from the hospital as this was considered to be reasonable in the circumstances. We did, however, make recommendations in this respect. We upheld Ms C's complaint about the board's final response to her concerns. We found that while the response was issued within a reasonable timescale, there were a number of factual errors with details such as dates.