SPSO Individual Decisions

Ms C complained that staff at the prison health centre had taken away her TENS machine (a form of pain relief that delivers small electrical pulses to the body via electrodes placed on the skin) that she had been using to manage pain. She also complained that she had not been told why the machine was removed. We took independent advice from one of our medical advisers, who specialises in mental health nursing. We found that staff had removed the machine and offered alternative pain relief to Ms C. Our adviser said that staff had acted correctly in removing the machine as they had concerns for Ms C's safety. We were also satisfied that the board had explained the reason for the removal to her, and we did not uphold her complaints. Related reading View Decision Report 201402848 as a PDF (10.95 KB) Updated: March 13, 2018

Mr C complained that he did not get adequate care and treatment at his prison's health centre for nerve pain resulting from a finger injury. He also questioned the adequacy of his medical records, as the board's response to his complaint included an incorrect date for his injury. We looked at Mr C's medical records, and took independent advice from one of our medical advisers. We found it was appropriate for prison health centre staff to try different treatments, with a view to finding one that would provide Mr C with good pain relief. We also found that, while there was one minor error in a date in Mr C's medical records, this did not impact on the care and treatment provided to him, and the correct date was included elsewhere in the records. Related reading View Decision Report 201401696 as a PDF (10.94 KB) Updated: March 13, 2018

Mr C complained that a prison psychiatrist left out relevant information when referring him to a specialist clinic. Mr C was concerned that the letter did not inform the clinic of details of his diagnosis and previous input he had from psychiatry and psychology. He was of the view that this could have delayed his treatment. We took independent advice on this complaint from one of our mental health advisers, who reviewed the referral letter. He observed that the letter did specifically refer to Mr C's previous psychiatric treatment and, while it did not refer to a formal diagnosis, it mentioned the issues that Mr C was facing. He noted that there was no reference to previous input from psychology but could not say whether the psychiatrist would have been aware of this. In any event, he noted that the clinic would wish to carry out their own detailed assessment, exploring all relevant history, before starting any treatment. He, therefore, did not consider that the omission of some information would significantly impact on Mr C's future treatment. We accepted this advice and did not uphold the complaint. Related reading View Decision Report 201402013 as a PDF (11.11 KB) Updated: March 13, 2018

Mr C had an accident at work and injured his shoulder. He was diagnosed with a sprain at A&E in Falkirk and District Royal Infirmary. No x-ray was taken and Mr C was told to see his GP if the pain continued. Mr C was referred to a specialist who suspected that he might have a rotator cuff tear (a tear to one of the tendons that stabilise the shoulder). The specialist arranged for a scan but no tear was found. Some time later, Mr C was referred to another specialist at Forth Valley Royal Hospital who carried out further tests and a second scan. Mr C was diagnosed with impingement syndrome, a condition where the bone and tendons of the shoulder rub together painfully. He was offered surgery and advised that this had a 60 to 70 percent chance of success. During the operation, the surgeon discovered that Mr C had an abnormality in his shoulder where pieces of bone had not fused together when he was a child. There was an unfused fragment of bone about three centimetres long, which the surgeon could not remove without causing damage. Mr C was advised that if his symptoms did not improve after the operation, he would require further surgery to fix the piece of bone using a screw. Although he was still in pain, Mr C decided not to go ahead with another operation. He then complained that an x-ray or other imaging should have been carried out earlier as this would have highlighted the unfused fragment of bone. He was particularly concerned his surgery went ahead without this being done. After taking independent advice from two of our medical advisers, we found that normal x-rays would not have shown the unfused piece of bone in Mr C's shoulder, as it would only have been visible on a special view x-ray that would not normally be requested. Although our accident and emergency adviser told us x-rays should have been taken after the accident and a review at the fracture clinic offered if Mr C's pain did not get better, our surgical specialist said that, even if it had been ident

Mrs C complained that a consultant at Forth Valley Royal Hospital dismissed an urgent referral from her GP for suspected lung cancer and failed to follow up the suspicion of lung cancer. Mrs C said that the consultant failed to take account of her medical history or a recent x-ray and that, as a result, diagnosis of and treatment for lung cancer were delayed. Mrs C's GP referred her to the respiratory unit because she had a longstanding persistent cough. The consultant there reviewed the referral letter, and as he thought it unlikely that she had lung cancer he decided not to see her at his clinic. He suggested that she first stop taking medication that was known to cause coughs, to see whether this was the cause of her symptoms. After taking independent advice from one of our medical advisers, although we found it acceptable for referrals to be screened in this way we found that the consultant overlooked information in the referral about Mrs C's recent x-ray. Whilst we were satisfied that the advice to alter Mrs C's medication would have been the same had the information about the x-ray been taken into account, we upheld the complaint about the consultant's actions and criticised the board, as this was a key item of information and it was clearly overlooked. We did not uphold the complaint about delay as we were satisfied that although there was some delay in diagnosis, this was not unreasonable in the circumstances. We did, however, uphold Mrs C's complaint about the board's complaints handling as we found that their investigation and response were not thorough enough.

Mr C complained on behalf of his wife (Mrs C) about the care she received from the maternity triage service at Forth Valley Royal Hospital immediately prior to the birth of her daughter. Mrs C had phoned the service twice for advice about coming into hospital as she was concerned about the progress of her contractions, and felt she was dissuaded from going to hospital after speaking to a midwife during her second phone call. Around an hour later, Mrs C gave birth to her daughter at home with the assistance of her husband. She suffered heavy blood loss, paramedics attended and she was transferred by air ambulance to another hospital. We took independent advice on this case from one of our medical advisers, who is a specialist in midwifery. Our adviser was critical of the midwife's actions during the second phone call, as they should have asked Mrs C to attend hospital for assessment of whether or not she was in active labour, given that she had experienced complications during a previous birth. We also found that the maternity triage phone template did not prompt staff to ask women about their previous medical history. We, therefore, upheld Mr C's complaints about the advice Mrs C had received by phone, and the lack of adequate documentation of the advice given. In responding to Mr C's complaints, the board agreed to make triage staff aware that patients should not feel as if they need permission to attend hospital, and acknowledged that the midwife had not documented any advice she had given Mrs C about coming into the hospital. They also took steps to introduce a new national maternity triage template to ensure that appropriate information is captured, and introduced peer review. Although we took the view that the board made reasonable improvements to shortcomings in the triage process, we did not find that the structure in place at the time was inadequate. We also concluded that it was not unreasonable for the board to have staffed the maternity triage service wit

Mr C, who is a prisoner, complained that the prison health centre had unreasonably failed to explain why his complaints were being managed in line with NHS Scotland's policy for dealing with habitual and vexatious complaints. In response to our enquiries, the board confirmed that the prison health centre inappropriately applied the incorrect version of a national policy and said that the decision to manage his complaints in line with that policy had now been revoked. In addition, Mr C said the board failed to respond appropriately to his complaint about the decision to manage his complaints in line with the policy. In response to our enquiry, the board said that they were not in a position to confirm that the steps taken by the prison health centre in responding to Mr C's complaint were appropriate, given that the prison health centre had implemented the incorrect policy. In light of the information available, we upheld Mr C's complaints.

Miss C complained about a dentist. The dental practice acknowledged her complaint and told her they intended to respond within 21 days. On the 21st day they wrote to her saying that they needed more time to reach a decision, and would respond within around two weeks. They provided a final response around two weeks later. Miss C complained that the time taken by the practice to respond had been unreasonable. Our investigation found that the practice's complaints procedure said they would seek to respond within ten working days and would give reasons for any requirement to extend this. As the practice had not given Miss C such reasons we upheld the complaint.

Miss C was unhappy with the care and treatment she received during her pregnancy. She complained there was a failure to provide her with appropriate clinical treatment for an ovarian cyst (a fluid-filled sac) and to provide her with appropriate nursing care during her labour. When Miss C was about 18 weeks pregnant she had experienced severe abdominal pain. She had a consultation with an out-of-hours GP, who referred her to her own GP. She was later admitted to Forth Valley Royal Hospital with a suspected torsion (where the weight of the cyst causes the whole ovary to twist, cutting off the blood supply). A laparotomy (an open operation on the abdomen) was carried out. However, when the surgery was performed, no cyst was present (it appeared to have resolved on its own) and no other reason for Miss C’s pain was identified. Miss C was later prescribed antibiotics because the surgical wound was leaking. She considered the operation unnecessary and that it could have been avoided if she had been given an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body) before surgery. She was also upset about the scar left by the operation, which she felt could have been avoided if she had been scanned or given a laparoscopy (keyhole surgery) instead of the laparotomy. We took independent advice from a GP adviser, a midwifery adviser and an obstetrics adviser (a specialist in pregnancy, childbirth etc). The GP adviser said that it was reasonable for the out-of-hours GP to refer Miss C to her own GP. The obstetrics adviser said that, while performing the operation laparoscopically might have improved Miss C’s experience, the decisions to perform a laparotomy and to do so without a further ultrasound were reasonable. We found that the care and treatment provided to Miss C was reasonable in the circumstances known to the medical staff at the time. In relation to Miss C’s complaint about nursing care during her labour, our

Mr C complained about the treatment and support that his late son (Mr A) received from the board. Mr A had been suffering from low mood and agitation for about two months. He tried to take an overdose, but was stopped by his family. Following a call to the local out-of-hours service, he went to Forth Valley Royal Hospital for a review by their mental health unit. After what Mr C considered to be a very brief assessment, Mr A was discharged home, with phone numbers for three support organisations should he become upset again. Mr A went to his GP two days later saying that he was still depressed and that he had considered taking his own life. His GP referred him back to the mental health unit, where another assessment was carried out and Mr A was discharged home again. He took his own life a few days later. Mr C complained that the mental health unit failed to act on the concerns raised by his son's GP or to properly assess the severity of his condition. He felt that, had they done so, Mr A might have been admitted to the hospital as an in-patient and might have been treated. After taking independent advice on this complaint from one of our medical advisers, who is a consultant forensic psychiatrist, we did not uphold Mr C's complaints. The adviser said that there was clear evidence that the mental health unit had acknowledged the concerns raised by Mr A's GP. The assessments that were carried out were thorough and followed accepted practice. We accepted his advice that, based on the information available to staff at both consultations, there was no cause for Mr A to be admitted as an in-patient. The adviser said that, in the circumstances, it was reasonable for Mr A to be discharged home with advice as to who to contact should he need support. He noted that Mr A was receiving medication from his GP and had reported benefitting from the support numbers he had been given. Related reading View Decision Report 201302687 as a PDF (11.51 KB) Updated: March 13

A clinician at the prison health centre told Mr C, who is a prisoner, that he appeared to have a toenail infection and that she would let the health centre GP know, who might prescribe treatment. However, despite Mr C sending a number of written reminders on complaint forms, nothing happened. Mr C also complained that, despite his reminders, the health centre did not deal with his complaint. Our investigation showed that the complaint had not been answered appropriately, and when Mr C complained to the board, they replied to an earlier complaint that he had made on an unrelated matter. When we became involved, this error came to light. Even then, the board did not say that they intended to put matters right, for example by arranging for Mr C to be re-examined and for any appropriate treatment to be given. Nor did they give any indication that they would be taking action in relation to the health centre's replies to the complaint. We upheld all Mr C's complaints, as we considered what had happened to be unreasonable.

Miss C was diagnosed as having labrynthitis (an inner ear infection affecting hearing and balance). She found this very debilitating and had to take time off work. She went to A&E at Stirling Royal Infirmary twice and after the second time she had a scan, which was reported as normal. Her problems continued and her GP made an urgent referral for her to attend the hospital's ear, nose and throat (ENT) department. Miss C said that the person she saw (who she described as a nurse) told her that everything was normal and that she could stop taking the medication she had been prescribed. She was discharged. Miss C said she had since learned that she should have been weaned off her medication slowly, and she questioned the care and treatment she had received. She complained that this was inadequate and contributed to her illness and the length of time she was ill. We obtained independent advice from one of our medical advisers, who is a consultant ENT surgeon, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that, contrary to Miss C's belief, when she attended ENT she was seen by a specialist doctor who advised her to stop taking her medication and said that her condition would improve with time. Although Miss C said that she understood that she had to wean herself off this medication, this was not the case. We found that Miss C had been assessed and treated entirely appropriately, and we did not uphold her complaint. Related reading View Decision Report 201304812 as a PDF (11.36 KB) Updated: March 13, 2018

Miss C said that she first went to her medical practice about continuing dizziness in April 2011 and was diagnosed with labrynthitis (an inner ear infection affecting hearing and balance). Worsening headaches led her to attend the emergency department in her local hospital and she then had a scan, which was normal. Miss C said her symptoms got worse and she was no longer able to work. The practice made an urgent referral for her to attend a hospital clinic, but after examination and tests everything was found to be normal and the clinic reassured her that her condition would improve over time. She continued to feel ill, however, left the practice, and complained that despite many visits there, they did little to help her. She said that they should have made more timely referrals for her to receive a specialist opinion. We obtained independent advice from one of our medical advisers, who considered all Miss C's medical records. We also took into account all the complaints correspondence. Our investigation showed that over the period concerned, Miss C attended the practice regularly and doctors made a referral for her to be seen urgently at the hospital ear, nose and throat department. She had had a normal scan and further examination and tests confirmed labrynthitis. She was referred to physiotherapy for therapy to retrain her brain to deal with the problems associated with dizziness. We decided that the GPs provided her with good care and support and tried alternative medication for her. Related reading View Decision Report 201304811 as a PDF (11.38 KB) Updated: March 13, 2018

Mrs C cared for her late husband (Mr C) at home with assistance from carers, district nurses, Mr C's GP and the board's palliative care (care provided solely to prevent or relieve suffering) team when necessary. On the day Mr C died, Mrs C had phoned the board's palliative care line as her husband was in severe pain. An out-of-hours (OOH) GP arrived within 47 minutes of her call to provide pain relief to Mr C, who died around an hour later. Mrs C complained about the length of time it took for the OOH GP to attend and administer the pain relief. The palliative care line is part of the board's OOH service and it helps palliative care patients to get help without having to go through NHS 24. It is not an emergency service but the board aims to respond to priority calls within one hour. Mr C was visited within 47 minutes of Mrs C's phone call and, even although Mr C was in a lot of pain, we concluded that this was within a reasonable timescale. We noted that when a palliative care patient is nearing the end of their life, an anticipatory pack of medication is often provided to help with distressing symptoms, such as pain, nausea, agitation and breathlessness. This is, however, a decision for the primary care team involved in the patient's care, not the OOH service. Although we did not uphold the complaint, we made recommendations to address our concerns about this.

Mr C, who is a prisoner, told us that he suffered from severe pain that restricted his ability to leave his cell. He said that gabapentin (pain-killing medication) had been effective in controlling this and complained that the prison health centre had stopped his prescription for it and prescribed various alternative medications. He said these had not helped with his pain and had in fact made him more unwell. He acknowledged that there were security implications about having gabapentin in the prison environment but said that he was prepared to take it under supervision. We took independent advice on this complaint from one of our medical advisers, who is a GP. After reading Mr C's medical records, he said that there was evidence, from these and by Mr C's own admission, of him misusing medication and sourcing drugs from other prisoners. The adviser explained that, as well as the security implications, this dramatically increased the risk of drug interactions which could, in some cases, be fatal. He noted that it was important for there to be trust between the patient and doctor before a drug with dangerous side effects and the potential for abuse could reasonably be prescribed. In addition, he said Mr C was potentially suffering from the recognised side effects of gabapentin and that he was participating in a methadone programme, on which it was important to allow doctors to remove any medications they felt he should not continue. In the circumstances, we found that it was reasonable that the doctors discontinued the prescription. Related reading View Decision Report 201400247 as a PDF (11.37 KB) Updated: March 13, 2018

Mrs C complained on behalf of her son (Mr A) that his medical practice failed to provide him with appropriate care before and during appointments when he attended the practice with concerns about his physical and mental health. She also complained that the practice had, following the appointments, unreasonably removed her and her son from their list of patients. We reviewed the clinical records and obtained independent advice from our medical adviser. Having considered the medical records, he said that the care given to Mr A was reasonable, so we did not uphold this element of the complaint. We noted that, after the second appointment, the police had to be called because of Mr A's violent and threatening behaviour and Mrs C's abusive behaviour, and that it was following this that both were removed from the practice list. Having reviewed the case we established that the practice had followed the correct procedure in terms of removing Mr A from their list because of his violent behaviour, and we did not uphold this aspect of the complaint. However, Mrs C had not been violent and they did not give her a written warning, allowing her the opportunity to modify her behaviour. Before removing a patient whose behaviour is non-violent, but unacceptable, the practice are required to warn them about this, and so we upheld this aspect.

Mr C, who is a prisoner, complained that there was a delay in getting dental care and treatment, and that when he did get care and treatment it was inadequate. We got Mr C's clinical records from the board, and took independent advice from our dental adviser. Mr C was seen often by a dentist and a dental hygienist, and we found no evidence of unreasonable delay. The records showed that Mr C's dental treatment was reasonable, and he had declined treatment that might have helped deal with an abscess. Related reading View Decision Report 201303635 as a PDF (10.81 KB) Updated: March 13, 2018

Mrs C's daughter (Ms A) was admitted to Forth Valley Royal Hospital after taking an overdose of a mixture of medications, including venlafaxine (an anti-depressant) and propanolol (a beta blocker, used to treat conditions such as heart problems, blood pressure and anxiety), which are absorbed into the system slowly. She had called an ambulance herself and was taken to the emergency department, where she was seen immediately by a staff nurse. She was assessed before being seen by a trainee doctor. Ms A was groggy and her blood pressure was low. She was treated with intravenous fluids (fluids put directly into a vein). Blood tests and an electrocardiograph (a test that records the electrical activity of the heart) were also arranged. Over the following hours, Ms A's blood pressure remained low. Around seven hours after being admitted she began to have seizures and breathing difficulties. Her condition deteriorated further and the intensive care unit was asked to review her. Shortly afterwards, Ms A's heart stopped. Attempts were made to resuscitate her and she was treated with glucagon (medication used to increase blood sugar levels, which can be used in the treatment of propanolol overdose). This failed to improve her condition, however, and she died. Mrs C complained that staff did not provide glucagon until it was too late. She considered that, had this medication been provided earlier, Ms A might have survived. She also complained about the board's record-keeping. The board said in response to her complaint that glucagon is not the first line of treatment for propanolol overdose and, as Ms A had been responding to intravenous fluids, it was not considered a necessary treatment for her at the time. After taking advice on this complaint from one of our medical advisers, who is a consultant in emergency medicine, we upheld both of Mrs C's complaints. The adviser reviewed Ms A's medical records, and said that she had not been responding adequately to th

Mr C's late wife (Mrs C) had chronic obstructive pulmonary disease (a disease affecting the lungs). She was admitted twice in one month to Forth Valley Royal Hospital with pneumonia and treated with antibiotics. The following month she was admitted for another two days with vomiting and diarrhoea. During this last admission, tests showed abnormal temperature and blood results. On the day of her discharge, Mrs C felt very unwell and an advanced nurse practitioner found a wheeze in her right lung, but the consultant who reviewed Mrs C decided to discharge her. Mrs C's condition continued to deteriorate and she was admitted to another hospital five days later where pneumonia was again diagnosed. After being discharged from there, she developed a severe infection and irregular heartbeat and was diagnosed with an inflammatory condition of the bowel. She sent us her complaint but died before we could investigate it, and her husband carried it on on her behalf. Mr C complained that the consultant's decision to discharge Mrs C after the episode of vomiting and diarrhoea was unreasonable in light of her symptoms, and said that further investigations should have been carried out. He also complained that the advanced nurse practitioner's findings were unreasonably dismissed and that these failures led to a prolonged period of suffering for Mrs C before she was properly diagnosed and received appropriate treatment. Finally, Mr C complained about the board's complaints handling. We took independent advice on Mr C's complaint from one of our medical advisers, who agreed that Mrs C's discharge should have been delayed for further investigation of her symptoms, and of the abnormal temperature and blood test results. We found that Mrs C was discharged with no clear diagnosis and that she endured symptoms for longer than she should have before she was diagnosed and treated appropriately. The adviser said that the consultant who discharged Mrs C had to make a difficult deci

Ms C, a former prisoner, complained that while in prison her pain relief medication (pregabalin) was stopped suddenly. This was after a spot check of medicines found that she had removed powder from the capsules and not taken them as instructed. Ms C had been prescribed pregabalin for pain caused by nerve damage, and told the prison health centre that she had taken extra medication to help her cope with difficult family circumstances. She also said that she was unable to appropriately progress her complaint through the NHS complaints procedure. We took independent advice on this complaint from one of our medical advisers. Although we found that the prison health centre doctor had noted that Ms C had not demonstrated objective neuropathy (nerve damage), it appeared from the records that the stopping of her medication was influenced by her interference with the capsules (Ms C had been given a warning two months earlier to be more careful with her medication). Our medical adviser said that pregabalin can also be used to treat anxiety, and explained that a patient's perception of pain and their mental health are closely linked, and that treating anxiety can improve the management of pain. We decided that the prison doctor did not give proper consideration either to whether pregabalin assisted Ms C in managing her anxiety, or to gradually reducing the dosage in line with best practice. In terms of the complaints handling, we found that even after Ms C met with the clinical manager to discuss her concerns about a lack of response, she still did not get a reply. Her complaints were logged but not responded to, contrary to the NHS complaints handling guidance. It also appeared that some complaints information was inappropriately held in Ms C’s medical records. We upheld both Ms C’s complaints.

Mrs C's mother (Mrs A) died from complications following surgery for an abdominal aortic aneurysm (bulging of part of the aorta, the body's largest artery). Mrs C complained that there was a delay in diagnosing the aneurysm (a weak point in the blood vessels, which causes them to bulge or balloon out). She said that her mother had been visiting the practice for two years and had been diagnosed with sciatica (back and leg pain, caused by irritation of or pressure on the sciatic nerve). However, she felt that her mother should have been referred to hospital earlier for further tests. She also complained about the follow-up care after her mother had surgery, in particular a delay in identifying post-operative complications. To investigate the complaint, we considered all the relevant documentation, including the complaints correspondence and Mrs A's medical records. We also obtained independent advice from one of our medical advisers. Our investigation found that the practice had acted reasonably, and that there was no evidence of an unreasonable delay in referring Mrs A to hospital for tests. Our adviser said that there was no evidence of specific symptoms that would have alerted the practice to an aortic aneurysm, and that it was in fact picked up by chance during an x-ray to investigate back pain. She also said that as there are usually no symptoms, such aneurysms are often not discovered until they leak or burst. Once the aneurysm was identified, appropriate action was taken to investigate it further and to resolve it. We also found no evidence that the practice had failed to assess Mrs A after her operation or that there was a delay in diagnosing the post-operative complications. The operation was clearly a risky one, as Mrs A had other health conditions. The medical records show that the procedure was complicated, and we noted that doctors had discussed the risks with Mr and Mrs A (Mrs C's parents) before the operation was carried out. Related reading

Mr C, who is a prisoner, submitted a request to the prison health centre for an appointment with the mental health team. This was on the advice of the forensic psychologist who was running the offending behaviour programme that Mr C was attending. As Mr C did not receive a response to his request, he complained to the health board. The board told him that the mental health team had assessed his request and decided that he did not need input from them. Mr C did not dispute this decision, but complained to us that the board had not told him about the decision when it was made. In response to our investigation, the board told us that due to staff shortages in the prison health centre there had been a backlog of referrals at the time Mr C submitted his request. This meant that it was not assessed until almost six weeks later. They confirmed the decision that had been taken but acknowledged that this did not appear to have been communicated to Mr C until he complained. They explained that a reply slip should have been issued, informing Mr C of the decision, and confirmed that they had reminded staff to adhere to this process in future. They also took steps to speak to Mr C and apologise to him. We upheld the complaint, due to the failure to communicate the outcome of the referral to Mr C, but in light of the action already taken by the board to address this, we had no further recommendations to make. Related reading View Decision Report 201303552 as a PDF (11.29 KB) Updated: March 13, 2018

When Ms C hurt her knee she went to Stirling Community Hospital where she was seen by an emergency nurse practitioner (ENP) in the minor injuries unit. She was diagnosed as having a medial collateral ligament (knee ligament) sprain and sprain of her hamstring. She was prescribed co-codamol (a pain reliever) and advised to see her GP if she had further concerns. She was encouraged to walk. Ms C told us that the examination and care given to her were inadequate. She was not given an x-ray, nor was her knee scanned. She said that it was not until a month later, after she attended the accident and emergency department, that her knee was scanned and it was confirmed that her cruciate ligament (another knee ligament) had snapped. During our investigation we carefully considered all the complaints correspondence and Ms C's relevant clinical records, and took independent advice from one of our medical advisers. Our investigation confirmed that Ms C's initial examination had been full and thorough and that the ENP had provided appropriate treatment in accordance with the relevant guidelines. The adviser said that Ms C did not require an x-ray as she had suffered a soft tissue injury which would not be seen on an x-ray. Although Ms C said that her knee had 'popped' and that she had reported this, there was no evidence of this in the records. We decided, on the basis of the available evidence, not to uphold the complaint, as it was not possible to provide independent verification of Ms C's recollection of events. Related reading View Decision Report 201301298 as a PDF (11.37 KB) Updated: March 13, 2018

Mr C, who is a prisoner, complained to us about the board's handling of his complaint to them about healthcare issues. We were satisfied that the board had considered and responded to the issues Mr C raised, but our investigation found that they had failed to deal with the complaint within the timescales detailed in their complaints procedure and had not kept him advised of progress.

Mrs C complained about a specific consultation with a GP in her local practice. She attended with a flare-up of her longstanding physical health problems, which included fibromyalgia and osteoarthritis (conditions that cause the muscles and joints to become painful and stiff). She complained that the GP was dismissive of her problems and suggested that there was nothing wrong with her. In responding to the complaint, the practice said that the GP had felt that there was no physical reason why Mrs C could not get out and go about her normal business. Mrs C strongly objected to this and reported how she struggled on a daily basis and, on some days, was unable to even get out of bed. We obtained independent advice from one of our medical advisers, and this indicated that the advice offered to Mrs C was appropriate for her conditions. We were informed that the management of fibromyalgia would include trying to keep the muscles strong by keeping as active as possible. The adviser noted that Mrs C’s conditions were painful and debilitating and he accepted that she would be limited in her activities. However, he felt it was appropriate for the GP to have tried to encourage her to remain active. Mrs C clearly disagreed with the advice she received, and she was unhappy with the GP's handling of the consultation, and the attitude he displayed. However, in the absence of evidence that the GP acted unreasonably, or offered inappropriate advice, we did not uphold the complaint. Related reading View Decision Report 201302758 as a PDF (11.37 KB) Updated: March 13, 2018