SPSO Individual Decisions

Mr C complained to us that the medical practice had failed to provide appropriate care and treatment to his wife (Mrs A). He said that Mrs A had been seen by two GPs at the practice within three days with complaints of severe abdominal pain and dehydration, and that she had not taken food or fluids for a week. Mrs A deteriorated and was admitted to hospital where she underwent surgery for a small bowel obstruction. Mr C believed that the GPs at the practice should have realised that his wife was in severe pain and that she should have been admitted to hospital as an emergency. The practice told us that on initial assessment, taking into account the medical history and examination findings, the GP did not believe there was any indication for a hospital admission at that time. The GP felt it was reasonable to diagnose a possible flare of diverticulitis (a common disease of the digestive system). The GP prescribed appropriate medication and gave advice to contact the out-of-hours service if required. The second GP visit was due to Mrs A not taking her medication due to nausea and the inability to swallow. The GP was inclined to agree with the first diagnosis and decided that Mrs A could be managed at home if she could tolerate her medication. Advice was given to assist taking the medication but that a hospital admission would be considered if Mrs A was unable to comply with the treatment plan. We took independent medical advice from a GP and concluded that the practice had provided a reasonable level of care. It was felt that at both consultations the GPs had carried out an appropriate history and examination of Mrs A. In particular there was assessment of her abdomen so as to rule out any acute problem necessitating emergency hospital admission. The prescribing appeared to be appropriate and the working diagnosis of a flare-up of pre-existing diverticulitis was not unreasonable. In addition, Mrs A was not showing symptoms or signs which necessitated emerge

Mr C complained that the prison health centre unreasonably decided to discontinue his medication when he failed a medication check. Mr C said the prison health centre failed to take account of the fact that he had reported to them that he was being bullied for his medication. The prison health centre considered that Mr C had not been taking the medication as prescribed and therefore the medication was stopped to maintain his safety. The decision was reviewed by a multi-disciplinary team who assessed that there was no significant clinical risk to Mr C ceasing to receive the medication. Before we reached a decision on Mr C's complaint, he requested to withdraw his complaint. Therefore, we closed the complaint without reaching a decision. Related reading View Decision Report 201604927 as a PDF (10.91 KB) Updated: March 13, 2018

Mr C underwent an operation at Ninewells Hospital to remove a skin tag on his penis. He was concerned about the outcome of the operation and the appearance of the resulting scar, and he said that he was left with some disfigurement. Mr C complained that the consultant urological surgeon told him before the operation that the appearance of his penis would improve with surgery and that he was not warned that there was any risk of disfigurement. Mr C also had concerns about the standard of the operation itself, and follow-up care. We took independent advice from an adviser who specialises in urological surgery. We found failings in the consent process. We found that there was no evidence that Mr C had been warned of the risk of scarring and that the outcome of the surgery may not meet his expectations until the day of the operation. This meant that he had not been given enough time and appropriate information to make an informed decision, particularly in light of his additional needs. We found no evidence to suggest that the standard of the operation was not reasonable and while there were failings in relation to a follow-up appointment, this was addressed by the board.

Mr C complained to us that when he took his son (child A) to the emergency out-of-hours service, he was not satisfied with the treatment given for child A's swollen eye and temple by the attending GP. The GP diagnosed child A was suffering from a chest infection. Child A subsequently underwent neurosurgery to remove an abscess (a swollen area within the body tissue, containing an accumulation of pus) from the eye socket and was admitted for over six weeks. We took independent GP advice and concluded that the GP had provided a reasonable level of care. The GP had noted a history of upper respiratory symptoms for two days (suggestive of viral/cold symptoms) and that both parents had similar symptoms. The GP examined child A's chest, breathing rate and temperature. The GP found that child A was likely to have a chest infection. Child A was given treatment and the family was told to return should they have further concerns. We found that this was a reasonable management plan. The adviser noted that swollen/puffy eyelids can be common in children with viral illness due to them rubbing their eyes. If there was no evidence of a pus collection, then it was reasonable for the GP to adopt a 'watch and wait' management plan. We found that as the symptoms described could be consistent with a viral illness, it was not unreasonable that the GP did not diagnose the abscess during the visit. We therefore did not uphold Mr C's complaint. Related reading View Decision Report 201604614 as a PDF (11.34 KB) Updated: March 13, 2018

Mrs C complained about the care and treatment she received at Ninewells Hospital after having her jaw joint replaced with an artificial joint. Prior to then, Mrs C had been under the care of an oral medicine consultant who had tried a range of non-surgical methods to manage the pain she was having in her jaw joint. Mrs C was then referred to a specialist surgeon, who recommended surgical replacement of the joint. Mrs C proceeded with the surgery but suffered complications that resulted in the artificial joint being removed for several months and replaced with a different type. Mrs C was concerned that the risks of surgery had not been properly explained to her, about the sourcing of the artificial joint, that special equipment to detect nerves was not used during the surgery, and that there was a delay in identifying problems with the replacement joint. We took independent advice from an oral and maxillofacial (the speciality concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck) surgeon. We found no failings with the standard of surgery performed or the type of artificial joint used. We also considered that Mrs C's ongoing problems were reasonably reviewed with no undue delay in providing treatment. However, we considered it unreasonable that there was no evidence to show that a discussion took place with Mrs C at any out-patient appointment with regard to all the benefits and recognised risks associated with the surgery. The only records of such discussions were during a phone call, where not all the risks were documented, and on the day of Mrs C's surgery, where it was unclear what had been explained to her. We therefore upheld Mrs C's complaint.

Miss C's father (Mr A) attended his medical practice with urinary problems. Tests and investigations indicated prostate cancer had spread to his bones and Mr A was admitted to Ninewells Hospital. His condition deteriorated significantly due to sepsis (a life-threatening bacterial infection of the blood) and he died two days later. Miss C complained about clinical failings in relation to investigations and treatment decisions by nursing and medical staff, including that Mr A's deteriorating condition was not recognised within a reasonable timeframe. We took independent advice from a nursing adviser, a specialist in urology and a specialist in nephrology (the study of the kidney). In relation to the standard of nursing care provided, including communication, we found that in the main this was reasonable. We therefore did not uphold this aspect of Miss C's complaint. With regard to the medical care and treatment provided, we found that medical staff had unreasonably failed to recognise Mr A had been suffering from sepsis and that there had been an unacceptable delay in administering antibiotics. We were also critical that medical staff failed to investigate fully Mr A's kidney injury. We therefore upheld this aspect of Miss C's complaint. However, due to Mr A's limited life expectancy as a result of his cancer, we could not say what the outcome would have been had Mr A had been investigated in a reasonable manner and treated with antibiotics earlier. However, the failings identified meant that it was possible that an opportunity to extend Mr A's life had been missed. Miss C also complained that the board failed to respond to her complaint within a reasonable timeframe. The board acknowledged this and apologised to Miss C. We therefore upheld this aspect of Miss C's complaint.

Mr C was diagnosed with kidney cancer and underwent an operation at Ninewells Hospital to remove one of his kidneys. Mr C felt that, had staff acted appropriately in response to his emails, his cancer may have been diagnosed sooner and he may not have had to undergo the procedure. Mr C said that he had reported a decline in his health in an email to the neurology department. He said that had staff reviewed him in the neurology clinic following this, his kidney cancer may have been diagnosed sooner. We took independent advice from a consultant neurologist. They did not consider that the content of Mr C's email indicated that he needed to be reviewed in the neurology clinic or that he needed clinical attention at this time. In view of this, we did not uphold this complaint. Although the adviser was satisfied that staff had not failed to provide treatment to Mr C, they noted that staff had not responded to Mr C's email to advise him that he did not require clinical review. They were critical of this and suggested steps the board might consider taking. Mr C also raised concerns about the board's actions following a further email, in which he reported further symptoms. The adviser found that, in response to this email, the board had advised Mr C to see his GP, which we considered to be reasonable. We noted that Mr C was subsequently reviewed in the neurology clinic and a blood test performed. The adviser found that the results of the test indicated that Mr C had elevated levels of one of his liver enzymes and that the board had written to Mr C's GP regarding this, which the adviser considered to be appropriate. We therefore did not uphold this aspect of Mr C's complaint. We found that Mr C's GP had arranged an ultrasound test of Mr C's abdomen to explore whether the increased liver enzyme levels were significant to the condition of Mr C's liver. The adviser noted that this ultrasound scan identified a lesion on Mr C's kidney, which was confirmed as cancerous.

Mrs C complained about the care and treatment provided to her father (Mr A) during his admission to Ninewells Hospital. In particular, Mrs C had concerns that the effects of the medication Mr A was prescribed for delirium were not monitored, and that after a fall whilst in hospital he was given a further dose of this medication. She also complained that he had not been reasonably checked and monitored throughout the night. By the time nursing staff came to check his observations the next morning, Mr A had died. During our investigation we took independent medical and nursing advice. We found that the effects of the delirium medication were well monitored and that tests were carried out to ensure that there were no rare side effects. Therefore we did not uphold this aspect of Mrs C's complaint. The medical adviser suggested, however, that given Mrs C's concerns, the clinical team could have considered trialling a different medication. They also suggested that while overall the monitoring was reasonable, it would have been good practice to perform a test to check that Mr A's blood pressure did not fall significantly on standing. We made recommendations to address these points. We found that after Mr A fell on the ward, he was not given any further dose of medication, but was checked thoroughly by medical staff and then reasonably monitored by nursing staff. Therefore we did not uphold these aspects of Mrs C's complaint.

Miss C complained about the care and treatment provided to her father (Mr A) when he attended his medical practice with urinary problems. Tests and investigations indicated prostate cancer that had spread to Mr A's bones and he was admitted to hospital shortly after. Mr A's condition deteriorated significantly due to sepsis (a bacterial infection of the blood) and he died a few days later. Miss C complained that the practice failed to properly investigate Mr A's symptoms, that the treatment decisions were unreasonable and that the family's concerns were not taken seriously. We took independent advice from a specialist in general practice. We found the standard of care and treatment provided was reasonable, including the investigations carried out and Mr A's referral to hospital. We did not find that the practice failed to take seriously the concerns of Mr A's family. We therefore did not uphold Miss C's complaint. Related reading View Decision Report 201507658 as a PDF (11.05 KB) Updated: March 13, 2018

Mrs C suffered hearing loss following minor oral surgery at Perth Royal Infirmary. She complained that the board failed to provide appropriate treatment and failed to adequately explain the risks of the procedure she received. The board said Mrs C received appropriate treatment. They said the procedure was performed correctly and they considered hearing loss was not a recognised complication, and was unpredictable. They said Mrs C was seen by various specialists, who investigated the complication. The board also considered the risks of the procedure were adequately explained, as the risks Mrs C complained about were unknown and diminishingly rare. After receiving independent advice from an oral and maxillofacial surgeon, we did not uphold Mrs C's complaint. We found the care provided was appropriate, taking into account the complication could not reasonably have been predicted by the clinicians. We found the board acted appropriately in investigating the complication. We also considered the board did not fail to adequately explain the risks of the procedure, as the risks in question were exceedingly small. We did not uphold Mrs C's complaint. Related reading View Decision Report 201507949 as a PDF (11.07 KB) Updated: March 13, 2018

Mrs C, who had a history of osteoporosis, fell whilst in Ninewells Hospital. She complained that despite being in a great deal of pain, her back was not x-rayed. On her discharge, Mrs C complained to the board but they advised that as she had been checked after her fall by increasingly senior doctors who found no bony tenderness, an x-ray had not been required and she had been discharged with appropriate advice. Mrs C learned from a subsequent x-ray that she had suffered a fracture to her spine. We took independent advice from a consultant in acute medicine. We found that Mrs C had been appropriately assessed and examined after her fall. She had no bony tenderness which would have indicated that an x-ray was required. We also found that even if Mrs C had been x-rayed at the time and a fracture had been found, she would have been given no additional or different medication and her treatment would have remained the same. This was because she was already taking medication for a previous fracture. We did not uphold the complaint. Related reading View Decision Report 201602512 as a PDF (11.1 KB) Updated: March 13, 2018

Mr C complained on behalf of his wife (Mrs A) about aspects of the care and treatment she received at Ninewells Hospital and Perth Royal Infirmary following an injury to her shoulder. He complained that surgery was not carried out when the injury was first diagnosed and that when surgery was carried out, Mrs A was given inaccurate information about the reduction in her pain. Mr C also complained that Mrs A was not warned that general anaesthetic could cause memory loss. We took independent advice from a consultant orthopaedic surgeon and found that the decision to initially manage Mrs A conservatively (without surgery) was reasonable practice. There was evidence to show that Mrs A had consented to surgery after she was informed of the appropriate risks. We also obtained independent advice from a consultant anaesthetist in relation to Mrs A's concerns about not being warned about the potential risk of memory loss following general anaesthetic. They noted that it is not standard practice to discuss this with patients prior to surgery because it is not considered to be the type of risk that falls into either of the two categories set out in the General Medical Council's guidance on consent. We therefore did not uphold Mr C's complaint. Related reading View Decision Report 201507446 as a PDF (11.21 KB) Updated: March 13, 2018

Mr C complained that his prison healthcare centre stopped prescribing medication he had been taking for physical and mental problems. Mr C also complained that the board ignored his complaint, which resulted in his health worsening. We took independent medical advice and found that the healthcare centre had discussed Mr C's medications with him. We considered that the decision to stop Mr C's medications was appropriate and in line with guidance issued by the General Medical Council and the National Institute of Excellence. We considered that it would have been helpful for the board, in their written reponse to Mr C's complaints, to have given more detailed information about why some of his medications were not being prescribed. However, we found overall that their comments were reasonable. Related reading View Decision Report 201508622 as a PDF (10.97 KB) Updated: March 13, 2018

Ms C, who works for an advocacy and support agency, complained on behalf of Mrs A about care provided by a dentist. Mrs A attended with a painful front tooth and it was decided that root canal treatment was needed to save it. Mrs A had this treatment over two appointments. However, the tooth later broke while she was eating. Mrs A saw the dentist and emergency treatment was provided. Mrs A experienced pain and swelling following this and saw the dentist about this a few days later. At this meeting, there was a breakdown in the dentist/patient relationship. The dentist completed the treatment and Mrs A later registered with a new dentist. Ms C complained that Mrs A had not been offered options for treatment and that the risks had not been properly explained. She also raised concerns about the dentist's attitude towards Mrs A, and that the dentist had not followed the proper process as they had threatened to deregister Mrs A. Ms C's final complaint was that the handling of Mrs A's concerns had not been reasonable. We took independent dental advice. The advice we received was that the treatment provided was appropriate and was the only option to save the tooth. However, the adviser highlighted that there was no evidence that the risks of the treatment had been properly explained to Mrs A. There was also a lack of records for one of her consultations. We therefore upheld Ms C's complaint. The adviser noted that there was no evidence that steps had been taken to deregister Mrs A and we therefore did not uphold this aspect of Ms C's complaint. We found that the dentist had not included all appropriate information in the response to the complaint and that there were inconsistencies between the complaints handling procedure and the associated staff guidance document. We therefore upheld Ms C's complaint in relation to this.

Mr C complained that the board delayed in giving him his cardiac medication after he was admitted to prison. Mr C had a heart attack two days later and required surgical treatment. He was unhappy that the board withheld the medication he had in his possession at the time of admission to prison. The board accepted that it had taken 24 hours longer than it should have done to verify and prescribe Mr C's medication. They apologised to Mr C and advised him of the steps they had taken as a result of the incident to reduce the likelihood of it recurring. We took independent advice from one of our GP advisers and found that it was appropriate for the board to confirm Mr C's prescribed medication in line with General Medical Council guidance. However, we were critical that there was an unreasonable delay in this being done, although it was unlikely to have caused Mr C's heart attack. Whilst we upheld the complaint, we made no recommendations as the board had taken reasonable action as a result of the incident to identify learning and improve their practice to ensure the matter would not recur. Related reading View Decision Report 201507727 as a PDF (11.13 KB) Updated: March 13, 2018

Mrs C complained that her husband (Mr A) had received inadequate nursing care and treatment when he was a patient at Perth Royal Infirmary. Mr A had a number of health problems including diabetes and had previously had a toe amputated. He then had a major stroke and was transferred to the hospital for rehabilitation. We took independent nursing advice on the complaint. We upheld Mrs C's complaint as we found that staff had initially failed to dress Mr A's toe amputation wound when he was admitted to the hospital. They had also failed to ensure that his feeding tube (a tube passed through the abdominal wall) was regularly flushed. In addition, nursing staff had failed to inform both Mrs C and the vascular nurse of a wound on one of Mr A's other toes. However, we were satisfied that the board had apologised to Mrs C for the failings in Mr A's care. Mrs C also complained to us that staff had failed to ensure that suitable arrangements were in place when Mr A was discharged. We found that the discharge planning had been reasonable and we did not uphold this aspect of her complaint. We upheld Mrs C's complaint that staff had failed to respond appropriately to her verbal complaints. The board had already accepted that complaints she made to staff in the hospital could have been dealt with more effectively and appropriately at the time. They had told Mrs C that they would review the complaints awareness training needs of frontline staff and had apologised to her for the events she had described.

Ms C, an advocacy and support worker, complained on behalf of Mr A about the care and treatment he received from the orthopaedic and physiotherapy departments at Ninewells Hospital after he fractured his fibula (shin bone). Mr A was unhappy that he was not given surgery at this time and that he was only discharged with crutches and pain relief with no follow-up appointment. Mr A continued to experience pain and self-referred to physiotherapy, which did not help his pain. He was dissatisfied that the physiotherapist did not query why his leg was not improving and he felt there was a missed opportunity to identify the lack of healing. We took independent advice from two clinical advisers on the care and treatment Mr A received. We found that the orthopaedic care was reasonable and in keeping with this type of fracture. In addition, there was evidence that appropriate advice was given at the time Mr A was discharged from hospital. Although a follow-up appointment was not felt to be necessary, Mr A was informed at the time of discharge that he could contact the fracture clinic if he experienced any problems, which he did. We found that he was reviewed further and that the decision to continue conservative (non-surgical) management was appropriate. However, we were critical that there was poor communication between the orthopaedic ward staff and physiotherapy department prior to Mr A's discharge from hospital which meant that he was not reviewed by a physiotherapist. The board had apologised to Mr A but we made a further recommendation to ensure the matter does not recur. We were also critical that the physiotherapy care Mr A received as an out-patient failed to document relevant factors in order to properly assess his calf pain. Therefore we upheld this complaint.

Mr C attended the chest clinic at Ninewells Hospital with shortness of breath. He said that he was told by the doctor at the clinic that he would be referred for an echocardiogram (a scan used to look at the heart and nearby blood vessels) and an exercise test and that it would be four to six weeks until the tests were carried out. Mr C said that when he phoned the board four weeks later, he was told there was a 28-week waiting time for the echocardiogram/exercise test from date of referral. Having complained to the board about the delay and received no response, Mr C arranged to have the echocardiogram/exercise test done privately and it was carried out that month. Mr C said that two weeks after the test, the board advised him that he would be given an appointment for the test in two weeks' time. Mr C said that had he known this he would not have arranged the test himself. Mr C also complained that the board unreasonably refused to pay the costs of the test he obtained privately. We obtained independent medical advice on the complaint from a consultant physician in respiratory and general medicine. The adviser said that in Mr C's case, the echocardiogram and exercise tests would be considered routine, rather than urgent. The adviser said the original waiting time given by the doctor of four to six weeks would have been given in good faith and as the test would be provided outwith his own department, they would probably not have been aware of the actual wait. The adviser said a 28-week wait for the test was undesirable but was an unfortunate consequence of resourcing issues at the board. Whilst it was understandable that Mr C was anxious to determine the cause of his symptoms and therefore arranged for the tests to be done privately, we considered it was not unreasonable for the board to refuse to pay the costs of Mr C's private treatment. Related reading View Decision Report 201508297 as a PDF (11.47 KB) Updated: March 13, 2018

Mrs C complained on behalf of her husband (Mr A) about the way a consultant at Ninewells Hospital managed his care and treatment following the discovery of a nodule (a growth of abnormal tissue) in his lung. Mr A was reviewed over three years and then received a letter discharging him from the clinic because the nodule appeared stable. At Mrs C's persistence, the consultant reviewed Mr A again and further investigation identified that the nodule was a slow growth tumour. We took independent medical advice and found that Mr A had been appropriately managed up until being discharged from the clinic. However, we considered that Mr A's latest scan results should have been discussed at a multi-disciplinary team meeting prior to taking the decision to discharge him as it showed other lung changes. We also found it unreasonable that the consultant had referred to these lung changes in the discharge letter rather than discussing them in person with Mr A.

Mr C complained that the dentist carrying out work on his teeth over a number of appointments acted unreasonably by treating what Mr C considered to be a healthy tooth. We took independent advice from a dental surgeon. They noted that no unnecessary work had been carried out on Mr C's teeth and that his dental records confirmed that treatment had been carried out on teeth needing treatment. Mr C does not speak English as a first language and during the course of our investigation we found that an interpreter was not present at every appointment. Mr C may not have understood fully the treatment that was being carried out. We therefore made a recommendation to address this.

Mr C complained that following surgery for a hernia repair at Stracathro Hospital, he suffered severe and continuing pain. Mr C complained to the board about the surgery and the reasons for his continuing pain, which he said had an adverse effect on his daily life. Mr C was dissatisfied with the response he received from the board. We took independent advice from a consultant surgeon experienced in performing hernia repairs and related complications. They advised that the treatment Mr C received was appropriate. The adviser did not identify failings in either the surgical procedure or in Mr C's post-operative care. The adviser said that Mr C was one of the small percentage of patients who develop pain following this procedure. The steps taken by the board to address Mr C's ongoing pain had been appropriate and reasonable. We accepted this advice and did not uphold Mr C's complaint. Mr C also complained that the board had failed to respond appropriately to his complaint. The board had accepted they had not dealt with Mr C's complaint in a timely and reasonable manner and that the delay in responding to the complaint was unacceptable. The board had apologised and mentioned action taken to improve their complaints handling. It was clear to us that the board had failed to deal with Mr C's complaint in a timely manner and in accordance with their complaints procedure. We also considered in particular that their communication with Mr C about the reasons for the delay was poor. We therefore upheld this complaint.

Mrs C complained to us about the care and treatment her late mother (Mrs A) had received in Ninewells Hospital before her death. In particular, she complained about the management of her mother's oxygen therapy immediately before her death. Mrs A had a number of health problems, including idiopathic pulmonary fibrosis (a lung condition that causes scarring of the lungs and where the cause is unclear). She was receiving oxygen therapy and a trial had indicated that she required a consistent high level of oxygen via a rebreathing mask (a mask that provides a high concentration and flow of oxygen and is used to provide patients with very specific oxygen needs). However, a nurse had put in place a nasal cannula (two prongs that sit at the bottom of the nose and are more comfortable to wear, but which deliver a lower concentration of oxygen than a rebreathing mask), to allow Mrs A to eat her lunch and drink. A nurse had then observed Mrs A to be alert after lunch, but ten minutes later, Mrs A was found to be dead. She did not have the mask on at that time. We took independent advice on Mrs C's complaint from a consultant in respiratory medicine. We found that, in general, the clinical treatment provided to Mrs A had been reasonable. However, the fact that her oxygen saturation had dropped to low levels when her oxygen had been disconnected several days earlier should have alerted medical staff to the fact that she needed oxygen via a rebreathing mask and not a nasal cannula. We found that her oxygen saturation levels should have been monitored during and after her lunch if the rebreathing mask was to be removed, although there was no clear evidence that Mrs A's death resulted from this. We upheld this aspect of Mrs C's complaint. We also upheld her complaint that the board did not respond reasonably to her enquiries and complaints in view of their delays in responding to her.

Miss C complained about the clinical treatment provided to her late brother (Mr A). Mr A was admitted to Ninewells Hospital with chest pain. He was diagnosed with a chest infection and discharged the next day. Mr A died of a heart attack a few weeks later. Miss C was concerned that the hospital did not find a problem with Mr A's heart, particularly as he was admitted with chest pain and had a family history of cardiac (heart) problems. In response to Miss C's complaint to them, the board said Mr A did not show signs of a heart attack during his admission and that they considered the care provided to have been reasonable. They noted that recovering from a chest infection can put an extra strain on the heart, which may have precipitated a heart attack, but that this could not have been predicted. After taking independent medical advice, we upheld Miss C's complaint. While we were advised that the care provided was reasonable at first, it was not clearly recorded in the medical records that Mr A was properly reviewed before discharge and that he had no ongoing symptoms of concern. However, we were not critical of the hospital not identifying a problem with Mr A's heart. The adviser explained that the investigations carried out were reasonable and supported the diagnosis of a chest infection. Based on the information available to the hospital at the time, the adviser considered it was reasonable that the doctors did not investigate a possible cardiac cause for Mr A's pain.

Mrs C complained to us that her husband (Mr C) did not receive a reasonable standard of care from his GP practice. Mr C had been a patient at the practice for three months, having transferred from a different practice, when he suffered a heart attack and died. Mrs C felt that the practice should have requested a chest x-ray and an echocardiogram (a test which records the rhythm and electrical activity of the heart). She said that there had been a sequence of failed attempts to diagnose and treat Mr C. We took independent advice from a GP adviser. They found that Mr C had received reasonable care from the practice. The adviser noted that Mr C had been appropriately referred to the hospital respiratory medicine department and consequently considered that it was not unreasonable that Mr C was not referred for a chest x-ray or an echocardiogram. We accepted the adviser's comments and we did not uphold this complaint. Related reading View Decision Report 201507985 as a PDF (11.06 KB) Updated: March 13, 2018

Ms C works for an advice and support agency. She brought the complaint on behalf of her client (Mr B). Mr B had concerns about the treatment his daughter (Miss A) received at Ninewells Hospital after she was referred by her GP with suspected appendicitis. Miss A was reviewed and appendicitis was considered to be unlikely. She was prescribed antibiotics for a urinary tract infection and was discharged home. Miss A did not improve and had to be taken back to the hospital two days later. Although initial assessment found appendicitis to be a possible cause of her symptoms, she was discharged after two days with a diagnosis of gastroenteritis (inflammation in the intestines caused by infection). Her condition did not improve and she had to be readmitted four days later. Miss A underwent surgery to investigate further. During this procedure her appendix was removed as it was found to be gangrenous. An abscess was also discovered. Miss A did not recover well and had to undergo more surgery as she had developed a deep pelvic abscess. In addition to his concerns about the treatment provided to his daughter, Mr B was dissatisfied with the time the board had taken to deal with his complaint. After taking independent advice on this case from a consultant surgeon, we upheld the complaint about the treatment provided to Miss A. The adviser considered that Miss A's appendicitis could have been diagnosed and acted on at her second attendance at the hospital. We were advised that this would have lessened the risk of a pelvic abscess developing and the further problems that she experienced. The adviser also commented that the information about risks of the initial surgery had not been recorded comprehensively enough. As the board had introduced a new patient pathway document for children with suspected appendicitis following Mr A's complaint, the adviser was asked to review this. The adviser considered that it would benefit from further consideration by the board in