SPSO Individual Decisions

Ms C complained about matters related to the care and treatment of her son (Mr  A), who had been an in-patient at the Royal Edinburgh Hospital. Mr A had a diagnosis of schizophrenia (a long term mental health condition that causes a range of different psychological symptoms) and had been subject to a Compulsory Treatment Order (an order that allows professionals to treat a person's mental illness). During the in-patient admission, the local authority's social work staff were working towards finding a suitable supported accommodation vacancy for Mr A, with input from clinicians. Ms C firstly raised concerns that board staff had contributed to delays in progressing Mr A towards discharge. We received independent advice from a consultant psychiatrist. We found that the clinical team reasonably fulfilled their responsibilities to identify a suitable accommodation placement for Mr A. We did not uphold this complaint. On a particular occasion during the admission, Mr A did not return to the hospital following an agreed one hour period of leave. The hospital notified the police the next morning and informed Ms C later that day. Ms C raised concerns that the board failed to apply the correct risk level to Mr A's absence. We did not find evidence that the board had acted in accordance with the procedure for missing persons that was in use at the time. We upheld this complaint, however, we noted that the board had since revised and improved this procedure. We also noted that the board's complaint investigation referred to the relevant procedure but did not identify that staff had not complied with this. We were critical of the complaint investigation and made a recommendation in relation to this. Ms C was also unhappy with the level of communication with her during the time Mr A was absent from the hospital. In response to her complaint, the board acknowledged that there had been a delay in contacting Ms C to notify her. We found limited documentation of communic

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

Ms C complained about a number of aspects of the mental health care and treatment provided to her by the board over a number of years. In particular, Ms  C felt that the board failed to provide her with appropriate crisis support and appropriate psychiatric treatment. Ms C also complained that their communication around these matters was unreasonable and that their handling of her complaint was poor. We took independent advice from a mental health nurse and a psychiatrist. We found that some of the crisis care provided to Ms C was reasonable, however, there were a number of areas where care could have been improved. We were not satisfied that the board had taken appropriate action, following an upheld complaint about staff attitude, to ensure that this issue did not impact on Ms C's access to the service in future. The mental health adviser noted that an out-of-hours care plan was not reviewed within the appropriate scheduled timescale and that the board held conflicting information in relation to Ms C's ability to access other services. Therefore, we upheld this aspect of Ms C's complaint. In relation to Ms C's psychiatric treatment, we found that the care provided by a psychiatrist and a psychologist was reasonable. The psychiatric adviser noted that both the psychological treatment that Ms C received, and the administration of medication, was appropriate. Therefore, we did not uphold this aspect of Ms  C's complaint. Additionally, Ms C felt that the board's communication around these matters had been poor as she had been unreasonably excluded from meetings where her care was being discussed. The psychiatric adviser considered that the board followed their usual and appropriate practice in relation to meetings held about a patient. We did not find evidence to suggest that Ms C had been unreasonably excluded from these meetings and that the boards communication with her was unreasonable. Therefore, we did not uphold this aspect of Ms C's complaint. Final

Mr C complained about the lack of treatment which he received at St John's hospital. He had been referred to the mental health service by his GP for an assessment. Mr C complained that the board failed to carry out appropriate mental health assessments. He was also dissatisfied that the board would not arrange a further medical opinion. We took independent advice from a consultant psychiatrist (a specialist in the diagnoses and treatment of mental illness). We found that Mr C was seen on two occasions by a doctor in training who discussed Mr C with a supervising consultant psychiatrist. There was evidence that thorough assessments were carried out on both occasions which resulted in a reasonable management plan. Mr C was then assessed by another consultant psychiatrist, who again carried out an appropriate assessment in view of Mr C's reported symptoms. The clinicians reasonably concluded that Mr C was not suffering from a diagnosable mental health disorder. We considered the assessments to be reasonable and did not uphold this aspect of Mr C's complaint. In relation to a further medical opinion, we noted that Mr C had been assessed twice by a trainee doctor, under supervision of a consultant psychiatrist, and also by an additional consultant psychiatrist. Therefore, we found that it was not unreasonable that the board did not offer Mr C a further medical opinion. We did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201802106 as a PDF (23.96 KB) Updated: December 19, 2018

Mr C complained on behalf of his friend (Mrs A) about the care and treatment she received at the Western General Hospital. Mrs A was referred to neurosurgery (the branch of medicine that deals with the anatomy, functions, and disorders of nerves and the nervous system) and was found to have signs of wear and tear to the discs in her cervical spine (the soft cushions of tissue between the vertebra), which was causing compression (squeezing) to her spinal cord. A scan showed that this had caused mature damage in one area of her spinal cord. Mrs A was referred for surgery to prevent her condition from worsening. Specifically, an anterior cervical discectomy and fusion (where disc material is removed to reduce spinal cord compression). After her surgery, Mrs A experienced weakness and reduced mobility. The board carried out a further scan, which found that Mrs A had mature damage in a second area of her spinal cord. Mr C complained that the surgery went wrong and that Mrs A was never told that surgery could make her condition worse. We took independent medical advice from a consultant neurosurgeon. We found that Mrs A was appropriately referred for surgery, as she had signs and symptoms of spinal cord compression. However, we found that there was insufficient evidence that the risks of surgery, and of not having surgery, were clearly explained to Mrs A in the consent process. We also found that as Mrs A signed the consent form on the morning of the surgery, she was not given a reasonable timeframe to consider the risks listed on it. We considered that the surgery might have caused Mrs A's new mature spinal cord damage, given the steps involved. However, we also found there were signs that Mrs A's spinal cord compression had worsened in the months before her surgery. Therefore, we were unable to definitely conclude that the surgery had caused her new mature spinal cord damage. Nevertheless, we found that the possibility of this happening and the other risks i

Mrs C complained about the care her mother (Mrs A) received at St John's Hospital. Mrs C complained about the number of ward moves that Mrs A experienced. Mrs A had dementia and Mrs C said that the number of ward moves caused Mrs A to become disorientated. Mrs C also complained about the personal care that Mrs A received and the communication from nursing staff. We took independent advice from a nursing adviser. We found that: • the number of ward moves that Mrs A experienced was unreasonable in view of her reduced cognitive function and delirium (sudden confusion) • the board had failed to keep adequate records regarding the risk assessment and decision making for Mrs A's ward moves and how Mrs A and her family were informed of the ward moves • the board failed to adequately assess and document Mrs A's care needs. In particular there was no care plan in place to cover Mrs A's personal hygiene needs • a “Getting to Know Me” document was not in use during Mrs A's admission to St John's Hospital. In light of the above we upheld Mrs C's complaint.

Mr C complained that he had been on two types of long term painkilling medication which the practice had failed to keep under regular review. Mr C was admitted to hospital as an emergency with symptoms of bleeding from his rectum. Mr C believed that he should not have been on both medications at the same time and that they caused his rectal bleeding. He felt that if the medication had been reviewed regularly then the bleeding would have been prevented. We took independent advice from a general practitioner. We found that it was appropriate for the practice to have prescribed both types of medication for Mr C and that there was no requirement to keep the medication under regular review. It was also found that there was another cause of Mr C's bleeding which was not connected with the medication. We did not uphold Mr C's complaint. Related reading View Decision Report 201803268 as a PDF (10.99 KB) Updated: December 2, 2018

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

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

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

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

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

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

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

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

Mr C complained about the care and treatment provided by the practice to his late child (Baby A). Baby A was taken to the practice with a blocked nose and congestion. The doctor considered that Baby A was suffering from a respiratory tract infection, but that there was no evidence of a more serious infection requiring any treatment or hospital admission at that time. The following day, Baby A suffered cardiac arrest at home and was taken by ambulance to hospital. They did not regain consciousness and died a number of weeks later. Mr C complained that the practice failed to carry out an adequate assessment and failed to make a hospital referral for further investigation, despite Baby A's history of bronchiolitis (a lower respiratory tract infection that affects babies). Prior to Baby A's death, they were found to have been positive for Respiratory Syncytial Virus (RSV - a virus which causes respiratory tract infections, and the most common cause of bronchiolitis). Mr C complained that the practice failed to detect RSV. We took independent advice from a GP adviser. We found that the doctor's assessment was reasonable and in line with relevant guidelines, which did not indicate that a hospital admission was required, based on the clinical findings. We found that hospital admission with bronchiolitis is normally only required when there are difficulties breathing or feeding, and the GP assessment did not identify any difficulties in Baby A in either regard. We found that the hospital consultant did not consider that RSV and bronchiolitis was the definitive cause of Baby A's death. We found no evidence that the practice overlooked any relevant factors in their assessment of Baby A and we did not uphold the complaint. Related reading View Decision Report 201709235 as a PDF (11.41 KB) Updated: December 2, 2018

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

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

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

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

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

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

Ms C attended an antenatal screening which tested for Down's syndrome before the birth of her child (Child A) and it was determined that she was at low risk to have a child with this condition. Following the birth, Child A was diagnosed with Down's syndrome. Ms C said that the board's communication with her about Down's syndrome, before and after the birth was unreasonable. During the pregnancy, an ultrasound scan confirmed Child A had a hole in their heart. Child A died a few months after birth and Ms C complained that the board had unreasonably failed to diagnose, discuss and treat Child A's heart condition and breathing problems. We took independent advice from a midwife and consultants in cardiology, emergency medicine and neonatology. We found that, before the birth of Child A, Ms C was given reasonable information about the Down's symdrome screening process but after their diagnosis there was little evidence of what had been said and discussed. There was no record of the conversation telling Ms C about Child A's diagnosis and the immediate plan for them. We upheld this aspect of Ms C's complaint. In relation to Child A's heart condition and breathing problems, we confirmed that there are limitations in the antenatal screening process, with screening identifying only half the number of heart defects. We found that Child A's heart and breathing problems had been reasonably diagnosed and treated but that there were also lung problems which could have not been predicted. We did not uphold this aspect of Ms C's complaint.

Mr C complained that the board had unreasonably failed to reimburse the costs of his Clomiphene medication (medication to increase levels of the hormone testosterone) which had previously been prescribed outwith the UK. Mr C also complained that the board had refused to reimburse his costs for attending an endocrinilogist (a medical professional who specialises in hormones) outwith the UK. Mr C maintained that the medication and service provided by the endocrinologist improved his health. We took independent advice on Mr C's complaint from a consultant endocrinologist. We found that, although Clomiphene is effective in raising testosterone levels, it has not yet replaced the currently used testosterone supplements in the management of hormone deficiency in men. The treatment is unlicensed in the UK and, whilst a clinician could prescribe it, it would be a discretionary matter to do so, and they would have to make a specific request. We found that the board's decision not to fund the medication or the consultation costs on the basis that it was not licensed, alternative appropriate medication was available, and the condition is commonly managed in the UK, was reasonable. We did not uphold the complaints. Related reading View Decision Report 201706645 as a PDF (11.17 KB) Updated: December 2, 2018

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