SPSO Individual Decisions

Mrs C complained about the care and treatment provided to her late brother (Mr  A) by the board. Mrs C was concerned that failings in Mr A's care and treatment led to his death. The cause of Mr A's death was pulmonary embolism (a blood clot in the lungs). Mrs C complained that the board did not give Mr A an appropriate consultation or examination when he attended the out-of-hours service and was seen by a doctor and a nurse. We took independent advice from a GP adviser and from a nurse. We found that the board held no records of Mr A's consultation with the doctor or the nurse, and we considered this to be unreasonable. In response to our investigation, the board acknowledged that they did not hold adequate records. They said that a reminder had been issued to out-of-hours staff about good record-keeping standards, and that audits of reports had since been carried out. We asked to see evidence of this. We upheld this aspect of Mrs C's complaint. Following Mr A's attendance at the out-of-hours service, he attended A&E at Monklands Hospital. Mrs C complained that appropriate investigations were not carried out. We took independent advice from a consultant in emergency medicine. We found that the majority of the investigations carried out in A&E were reasonable. We also found that the history and examinations undertaken would not reasonably have led doctors to suspect a pulmonary embolism. However, we found that there was a failure to investigate an abnormality on Mr  A's electrocardiogram (ECG - a test which records the electrical activity of the heart). This abnormality would indicate the possibility of an acute coronary sydrome (when the heart is not getting enough blood), which should have been excluded through further investigations. We noted that, even if these further investigations had been carried out, it is not possible to conclude that Mr A's pulmonary embolism would have been identified. We upheld this aspect of Mrs  C's complaint. We also f

Mr C complained about the care and treatment provided to him at one of the board's addiction clinics. In particular, he felt that he did not receive appropriate support in order to help him withdraw from his diazepam medication (medication to help anxiety or withdrawal symptoms) in a safe and controlled manner. He said that he had been discharged back to the community mental health team without any assistance to reduce his medication. We took independent advice from a psychiatrist. We found that Mr C's consultant psychiatrist had referred him to the addiction unit for advice and support to assist in his withdrawal from diazepam. The referral to the addiction team was on a time limited basis, with further care and treatment to be provided by the community mental health team. The addiction team made appropriate slight amendments to the dosage of Mr C's medication. We also found that Mr C received appropriate advice on psychological support services which were available in the community. We found that it was also appropriate that a long term treatment plan to enable Mr C to reduce his diazepam dosage was managed by the community mental health team as Mr C had a number of other health issues which would have been outwith the scope of the addiction unit. We did not uphold the complaint. Related reading View Decision Report 201800547 as a PDF (11.17 KB) Updated: December 2, 2018

Mr C complained about the care and treatment provide to his late father (Mr A) by the practice. Mr A was referred to a cardiology consultant (a doctor who specialises in the heart and blood vessels) by his GP following complaints of breathlessness. The consultant gave the practice some guidance about future treatment, and Mr A visited the practice a number of times over the next few weeks. Some changes to his medication were made and he was again referred to cardiology. Following this, Mr A was diagnosed with pulmonary fibrosis (a rare condition causing scarring of the lungs) and he died a few weeks later. Mr C complained that the practice had not followed the guidance of the consultant. We took independent advice from a GP adviser. We found that the practice did follow the advice of the consultant, and that the eventual diagnosis of pulmonary fibrosis could not have been foreseen during the period when the practice was responsible for Mr A's care. We did not uphold the complaint. Related reading View Decision Report 201708396 as a PDF (11.08 KB) Updated: December 2, 2018

Mrs C complained to us about the care and treatment she received at Wishaw General Hospital following a fall at her home. Mrs C had hit her face and suffered deep cuts to her head which required stitches. Mrs C also sustained a fracture to her wrist. Mrs C was concerned that she was not admitted to hospital for observation and that no x-ray or scan was taken of her head. We took independent advice from an adviser in emergency department medicine. We concluded that Mrs C received a thorough assessment when she attended the Minor Injuries Unit and that appropriate follow-up at the Fracture Clinic and Ear, Nose and Throat deparment were made. We found that there was no clinical justification for staff to arrange a head x-ray or a scan when Mrs C attended the hospital and that there was no requirement for her to be admitted to hospital for further observations. We did not uphold the complaint. Related reading View Decision Report 201800038 as a PDF (11.01 KB) Updated: December 2, 2018

Mrs C complained to us that the medical practice had failed to provide appropriate care and treatment to her mother (Mrs A) at a home visit. She said that her mother had been dizzy, light-headed and off her feet and that she suffered from high blood pressure. Mrs C said that the GP recognised her mother's high blood pressure but did not take any further action and told her to wait for the district nurses, who were scheduled to visit in three days time, and that they would take further blood pressure readings, which Mrs C considered to be unreasonable. Mrs C called out the out-of-hours GP later that evening as her mother's blood pressure was still high. The offer of a hospital referral was made but Mrs A declined the offer. Mrs A was admitted to hospital two days later for a suspected heart attack and remained a patient for nearly two weeks. We took independent advice from a GP adviser and concluded that the practice had provided a reasonable level of care. We found that the GP had carried out a reasonable examination and had concluded that there was no indication of an acute illness. The GP felt that the cause of the high blood pressure was caused by Mrs A's anxiety. It was appropriate to check the blood pressure readings and we considered that, as the district nurses were scheduled to visit a couple of days later, the matter would receive appropriate follow-up at that time. We did not uphold the complaint. Related reading View Decision Report 201800348 as a PDF (11.28 KB) Updated: December 2, 2018

Mr C complained about the care and treatment provided to his late mother (Mrs A) at Monklands Hospital. In particular, he complained that Mrs A had been inappropriately discharged. He also complained that the board's communication about Mrs A's positive Methicillin-resistant Staphylococcus aureus (MRSA, a strain of antibiotic-resistant bacteria) result was unreasonable. We took independent advice from a consultant in acute medicine and a nurse. Regarding Mrs A's discharge, we found that she had been fit for discharge and that the discharge planning for her had been reasonable. We also found that Mrs A's nutritional care had been reasonable. Therefore, we did not uphold this aspect of Mr C's complaint. In relation to the communication about the positive MRSA result, we found that the level of communication with Mr C and his family had been unreasonable and that the board had failed to follow their policy for the control and management of patients colonised or infected with MRSA. We also noted that the board had accepted and apologised for the breakdown in communication in relation to the MRSA result. We upheld this aspect of Mr C's complaint.

Mrs C compained about the care and treatment that her husband (Mr A) had received during a number of admissions to Hairmyres Hospital. Mr A had initially been admitted with abdominal pain, and he was found to have a stone in his urinary tract and some thickened loops of small bowel. His pain decreased and, after review by the urologist (a doctor who specialises in the male and female urinary tract, and the male reproductive organs) and general surgeons, he was discharged home. Mr A was readmitted three weeks later with similar symptoms and required surgery. During his stay he had thromnophlebitis (inflammation of a vein related to a blood clot) in his arm and it was felt that he should have his blood thinned with warfarin (a medication used to thin the blood and prevent blood clots). He was then discharged home, but was readmitted five days later because he had very high Internalised Normalised Ratio (INR - the higher the number, the longer the takes the blood to clot). Mrs C complained that the board failed to provide reasonable treatment to Mr A. We took independent advice from a consultant general surgeon. We found that it had been reasonable to discharge Mr A following his first admission. However, when he was readmitted he was prescribed warfarin outside of the guidance for anticoagulation (blood thinning), as thrombophlebitis is not an indication for anticoagulation. The justification for this had not been clearly recorded. We found that, whilst it had not been unreasonable to give Mr A warfarin, the clinical reasons for this should have been clinically documented. We also found that there was some confusion about the dose of warfarin that Mr A should take at home. We found that Mr A's readmission with high INR could have been avoided by ensuring that his anticoagulation was stable before discharge. We found that the board's anticoagulation guidelines needed to be updated. In addition, we found that a blood sample had gone missing when Mr A was in h

Mrs C complained about the care and treatment she received at Wishaw General Hospital. Following a heart attack, Mrs C attended the hospital on a number of occasions in the period whilst she waited for heart surgery. She was unhappy with the way the board managed her condition in this period and the way the board coordinated her care. We took independent advice from an emergency medicine consultant, an acute physician and a consultant cardiologist (a doctor who specialises in finding, treating and preventing diseases of the heart and blood vessels). Mrs C firstly raised concern that the board failed to investigate her symptoms and provide her with appropriate treatment. We found that, during the first admission, Mrs C was diagnosed with an acute coronary syndrome (symptoms attributed to obstruction of the coronary arteries). Mrs C also had hyperglycaemia (high blood glucose) but was not prescribed insulin. The adviser noted that tight blood glucose control is important in acute coronary syndrome and considered that the board failed to monitor Mrs C's blood glucose levels appropriately and failed to prescribe insulin. We also concluded that there had been a delay in Mrs C being reviewed by a cardiologist and that a GRACE score (which takes into account a patient's age, heart rate, systolic blood pressure, kidney function, signs of heart failure, as well as other parameters in order to calculate the risk of in hospital death) should have been calculated earlier as this can inform the need for angiography (a type of x-ray used to check the blood vessels). In relation to a later hospital admission, we considered that it was unreasonable for the board to have discharged Mrs C without assessment by a senior physician, in view of her medical history and presenting symptoms. We upheld this aspect of Mrs C's complaint. Mrs C also complained that the board failed to coordinate her surgery with another NHS organisation that was involved in her care. The board acknowle

Ms C, who is a patient adviser, complained on behalf of her client (Mr B), who was unhappy about the care and treatment provided to his mother (Mrs A) at Hairmyres Hospital. Mrs A experienced a stroke and was assessed in the emergency department before being transferred to a medical ward. A week following her admission to the ward, Mrs A was admitted to a specialist stroke ward. Soon after the transfer, she experienced a further stroke and died a number of days later. Mr B complained that there had been a delay in assessing and treating Mrs A in the accident and emergency department. We took independent advice from a consultant geriatrician (a doctor who specialises in medicine of the elderly) with experience in stroke care. We found that the records showed that Mrs A was assessed almost immediately following admission and that a scan was arranged promptly. We did not find evidence that there was an unreasonable delay in assessing and treating Mrs A, and we did not uphold this part of Ms C's complaint. Mr B was also concerned about the care provided on the medical ward. We found that the board had apologised to Mr B for the delay in transferring Mrs A to a stroke ward. We considered that it was unreasonable that Mrs A was not transferred to a stroke ward sooner. While we considered that the general medical care provided was reasonable, we were critical that Mrs A did not receive the benefit of specialist stroke unit care sooner. We upheld this aspect of the complaint. Finally, Mr B was unhappy with the level of communication with the family. We found limited evidence of staff communicating with the family in the period following Mrs A's admission and prior to her deterioration. We, therefore, upheld this aspect of Ms C's complaint.

Ms C complained about the treatment she received at Wishaw General Hospital when she attended the emergency department (ED) after a road traffic accident. We took independent advice from a consultant in emergency medicine. We found that Ms C had been correctly triaged (a process in which things are ranked in terms of importance or priority) when she attended the ED, that the history taking had been of a good standard, the examination carried out was thorough and of a good standard and the treatment was reasonable. Therefore, we did not uphold Ms C's complaint. Related reading View Decision Report 201703330 as a PDF (10.87 KB) Updated: December 2, 2018

Mr C complained to us on behalf of his client (Mrs B) in relation to the care provided to her late husband (Mr A). Specifically, Mrs B had concerns about the end of life care Mr A received. During our investigation, Mrs B advised us she wished to withdraw the complaint and explained she was considering legal action. Related reading View Decision Report 201702515 as a PDF (10.72 KB) Updated: December 2, 2018

Mr C complained about the care and treatment he received at Wishaw General Hospital (WGH) when he attended the emergency department after falling at home and injuring his lower back. Mr C was concerned that he was discharged home without having had an x-ray. He was also dissatisfied about the in-patient hospital care he received after being admitted to hospital two days later at which time an x-ray confirmed a spinal fracture. Mr C was unhappy about delays in transferring him to a different hospital spinal unit and being informed that he had a second spinal fracture. We took independent advice from a consultant in emergency medicine and a consultant orthopaedic surgeon (a specialist concerned with the musculoskeletal system). In relation to the care Mr C received in the emergency department, we considered that the decision not to do an x-ray and the delay in diagnosis were reasonable given that a number of factors made this type of injury unlikely in Mr C's case. Therefore, we did not uphold this aspect of Mr C's complaint. In relation to the orthopaedic care received, the board acknowledged that it would have been appropriate to have discussed Mr C's case again with the spinal unit of another hospital. We found that there was a lack of communication with Mr C in relation to his second fracture and that a more senior discussion with the spinal unit may have led to more timely transfer. Therefore, we upheld this aspect of Mr C's complaint. However, we noted that these issues were unlikely to have influenced his subsequent treatment.

Ms C complained about the care and treatment provided to her late sister (Miss  A). Miss A had attended a routine appointment with a practice nurse for her asthma, and had reported symptoms of a urinary tract infection. The nurse had taken a urine sample and had the on-call GP prescribe antibiotics. Several days later Miss A's condition deteriorated and she was admitted to hospital with sepsis (a blood infection), where she then died. Ms C complained that the practice nurse should have realised how unwell Miss A was and carried out further checks such as heart rate, temperature and blood pressure. Ms C felt that if these had been carried out Miss A would have had appropriate treatment sooner. We took independent advice from a practice nurse and a GP. We found that there was nothing in the medical record to note what symptoms Miss A presented with or any assessment undertaken, and we considered this to be unreasonable. We found that based on the symptoms described by the practice nurse in her complaint investigation statements, the practice nurse should have undertaken a thorough history of Miss A's symptoms, checked her temperature, pulse and blood pressure, and checked for signs of pain. We upheld this aspect of Ms C's complaint. Ms C also raised concerns that Miss A's blood test results were not acted upon in the weeks leading up to her death. We found that the blood tests that were being monitored were part of the practice's routine screening for chronic disease, and that any abnormal results were followed up appropriately and were not related to Miss A's later diagnosis of sepsis. We did not uphold this aspect of Ms  C's complaint. Finally, Ms C complained about the practice's handling of her complaint. We found that the practice failed to handle Ms C's complaint reasonably and that it did not meet the complaints handling guidance in place at the time. We upheld this aspect of Ms C's complaint.

Mrs C complained about the care and treatment she received at Wishaw General Hospitial in relation to her fertility treatment. In particular, Mrs C stated that she had been misinformed that the medication she was taking would not affect her fertility. We took independent advice from a consultant obstetrician and gynaecologist (the medical specialty that deals with pregnancy, childbirth, and the post-partum period and the health of the female reproductive systems and the breasts). We found that the correct investigations in relation to Mrs C fertility problems had been performed in a timely manner. We also noted that it was explained to Mrs  C at an early stage about the contributory factors to the fertility problems she was experiencing and the treatment which would be required. We found that there was no evidence that Mrs C had been misinformed about the cause of her fertility problem and that she had been kept advised of the results of the various investigations carried out as they proceeded. Therefore, we did not uphold the complaint. Mrs C also complained that the board had failed to adequately address her complaint. We found that the board had handled the complaint in line with their complaint process and had offered the opportunity to meet with senior staff to address any outstanding questions. We did not uphold the complaint. Related reading View Decision Report 201700107 as a PDF (11.23 KB) Updated: December 2, 2018

Mr C complained about the care and treatment his late wife (Mrs A) received while she was a patient in Wishaw General Hospital. Mr C was concerned about both the medical and nursing care Mrs A received, and about the way that the board handled his complaint. In regards to Mrs A's medical treatment, Mr C questioned the length of time a central line (a tube placed by needle into a large, central vein of the body to administer drugs or take blood samples) was in place. Mr C also complained that there was an unreasonable delay by medical staff in reviewing blood test results, and subsequently in Mrs A receiving antibiotics. Mr C believed that, because of poor treatment, Mrs A was denied the opportunity of starting chemotherapy treatment. We took independent advice from a consultant general surgeon with experience in oncology (cancer treatment) We found that, following Mrs A's admission surgery and further investigations being carried out, it was confirmed that she had extensive, incurable cancer and all further treatment was to be palliative (end of life care). We considered that the length of time Mrs A's central line was in place and the actions of medical staff in prioritising the alleviation of Mrs A's severe pain was reasonable. However, we found that there was a significant delay of several hours in reviewing Mrs A's blood test results and starting appropriate antibiotics. While we found that it was unlikely that the delay in starting antibiotics significantly changed Mrs A's outcome, given her underlying condition and poor prognosis, the delay was unacceptable. Therefore, we upheld this aspect of Mr  C's complaint. The board had already acknowledged that there was an unacceptable delay, due to a breakdown in communication involving both junior and senior doctors, and had noted that this has been addressed with staff. In relation to Mrs A's nursing care, Mr C was concerned over elements of record- keeping and the frequency and recording of some of Mrs A's

Ms C complained about the treatment she received at Wishaw General Hospital. Ms C became pregnant and had a high body mass index (BMI, a measure for estimating human body fat) when she booked in for a scan. As a result, Ms C was tested for gestational diabetes (diabetes that develops in women who did not have diabetes before their pregnancy) and was later prescribed medication to reduce her high blood sugar levels. This dose was later increased as her blood sugar levels remained high. Ms C was admitted to hospital as her baby stopped growing and had an emergency caesarean section to deliver her baby. After she was discharged home, Ms C developed an infection and her stitches burst. She later went on to develop nerve damage and fibromyalgia (a long term condition that causes pain all over the body). Ms C complained that the treatment she received towards the end of her pregnancy led to nerve damage and fibromyalgia. We took independent advice from a consultant obstetrician and gynaecologist (the medical specialty that deals with pregnancy, childbirth, and the post-partum period and the health of the female reproductive systems and the breasts). We found that Ms C was correctly started on medication because of her persistently high blood sugar levels and that this helped with problems associated with gestational diabetes. This was in keeping with national guidelines. We noted that Ms C's high BMI and gestational diabetes were significant risks in pregnancy and wound healing. While Ms C suffered nerve damage and developed fibromyalgia, these were not known to be associated with caesarean section surgery. Therefore, we found that she had been treated reasonably and appropriately. We did not uphold Ms C's complaint. Related reading View Decision Report 201701462 as a PDF (11.45 KB) Updated: December 2, 2018

Mrs C attended the practice with symptoms of a hoarse voice, burning and tightness in her chest, decreasing over five days. Mrs C explained to the practice that she was due to go on holiday in three days and queried whether she was fit for travel. The doctor considered that she was suffering from a viral infection, recommended fluids and paracetamol and considered her to be fit for travel. However, in the following days her condition worsened, causing her to attend a hospital's emergency department who prescribed antibiotics. Mrs C was still unwell when her holiday commenced. Mrs C complained that the practice had not provided her with reasonable treatment, which caused her to be unwell on her holiday. We took independent advice from a GP. Based on the information available at the time, we considered that the practice provided a reasonable standard of medical treatment and that the practice could not have foreseen that Mrs C's condition would worsen, impacting on her holiday. Therefore, we did not uphold the complaint. Related reading View Decision Report 201708674 as a PDF (11.09 KB) Updated: December 2, 2018

Following a fall at home, Mrs C was taken to Wishaw General Hospital where scans were taken. Mrs C was told by a doctor that the scan results suggested that breast cancer, which she had suffered from previously, had returned. Discussions were held with the breast cancer nurse and the oncology (cancer  treatment) department, who were not convinved that the results were evidence of metastases (when cancer spreads from the initial site to a secondary site). Mrs C had to wait until the outcome of further scans over an eight week period before being told that her condition was benign (non-cancerous) and that there was no metastases. Mrs C complained that it was inappropriate for staff to have told her that scans had shown the possibility of metastases. We took independent advice from a consultant radiologist. We found that it was reasonable for staff to conclude that intial scan results showed signs which could have been attributable to metastases. We found that Mrs C had symptoms that are considered concerning for metastatic disease from breast cancer. We, therefore, considered that it was appropriate to make Mrs C aware of the concerns around potential metastases. We also found that there was no delay in reaching a definite diagnosis. We did not uphold the complaint. Related reading View Decision Report 201705974 as a PDF (11.21 KB) Updated: December 2, 2018

Mr C noticed a lump in his chest and he was concerned that it was related to a previous abscess (a painful swelling caused by a build-up of pus) he had suffered with. His GP referred him to Hairmyres Hospital for a scan, where it was found that he had an abscess in the fat under the skin that was unlikely to be tracking elsewhere in his body. Mr C had a procedure to have this abscess drained at the hospital and afterwards he began to feel very unwell. He attended a private hospital and was found to have a very large, deeper abscess that was spreading down under his liver and pushing up to his chest. Mr C complained that the board had unreasonably failed to diagose and treat this abscess. We took independent advice from a consultant vascular and general surgeon. We found that Mr C's condition was appropriately assessed and investigated when he attended the hospital. The adviser explained that the scan that had been taken did not show any deeper abscess. We noted that Mr C did not have symptoms that suggested a larger, deeper abscess. We found that, although Mr  C would have had the larger, deeper abscess when he attended the hospital, the failure to diagnose was not unreasonable. We did not uphold Mr C's complaint. Related reading View Decision Report 201705682 as a PDF (11.19 KB) Updated: December 2, 2018

Mr C complained about the care and treatment provided to his late father (Mr A) at Monklands Hospital. Mr A had terminal cancer and was admitted to hospital after he developed pneumonia (a lung infection). Following admission, Mr A received an x-ray, pain medication, fluids and antibiotics, and test results indicated that he had neutropenic sepsis (a potentially fatal complication of anti- cancer treatment in which the ability of bone marrow to respond to infection is supressed). During the admission, doctors considered whether to transfer Mr  A to the Intensive Care Unit (ICU). It was felt that, due to the severity of Mr  A's presenting illness as well as the background of cancer undergoing palliative treatment (end of life treatment), ICU treatment would not have altered his chance of survival. Mr A continued to receive treatment on the medical ward, and he died the day following admission to the hospital. Mr C was unhappy that Mr A was not treated in ICU and he felt that Mr A did not receive appropriate care and treatment during the admission. We took independent advice from a consultant in acute medicine. We found that Mr A received rapid assessment and treatment on admission to the hospital and we considered that the care provided was reasonable. We also considered that the board's decision not to treat Mr A in ICU was reasonable in the circumstances. The adviser noted that specialist cancer nurses had been involved in Mr A's care and they considered that the care provided both before and after the nurses' involvement was reasonable. We did not uphold Mr C's complaint. Related reading View Decision Report 201706304 as a PDF (11.37 KB) Updated: December 2, 2018

Mr C complained on behalf of his late wife (Mrs A) about the treatment she received at Monklands Hospital. Mrs A attended her GP with pain in her right chest wall and was referred to hospital for an x-ray which found no significant abnormalities. Mrs A later attended her GP with worsening shoulder pain and her GP sent an urgent referral to the orthopaedics department (the branch of medicine concerned with the musculoskeletal system). This referral was downgraded by the board from urgent to routine. Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the board unreasonably failed to check the x-ray for signs of cancer and that they unreasonably downgraded the urgent referral to routine. We took independent advice from a consultant radiologist. We found that Mrs A had been referred for an x-ray due to an injury and that an x-ray is not the correct test to reliably pick up on a tumour. We also noted that the x-ray had showed a subtle change in bony texture of the clavicle (collar bone). As Mrs A had been referred for an x-ray due to an injury and the abnormality was so subtle, it would have been unreasonable to expect a radiologist to pick this up. Therefore, we did not uphold this aspect of Mr C's complaint. In relation to the referral downgrade, we took independent advice from a consultant physician. We found that the orthopaedic referral letter did not suggest any need for the appointment to be urgent, no mention of cancer and no indication that the problem was considered to be anything other than shoulder pain that had not responded to physiotherapy. Therefore, we did not uphold this aspect of Mr C's complaint. Related reading View Decision Report 201703848 as a PDF (11.35 KB) Updated: December 2, 2018

Mr C complained on behalf of his late wife (Mrs A) that the practice failed to provide a reasonable standard of care and treatment. Mrs A attended the practice with pain in her right chest wall which was thought to be related to an injury. The practice noticed a small lump over her clavicle (collar bone) and requested an x-ray, which showed no significant abnormality. Mrs A attended the practice again with worsening shoulder pain and was referred to orthopaedics (the branch of medicine involving the musculoskeletal system). Mrs A was later diagnosed with bone and liver cancer. Mr C complained that the practice failed to note Mrs A's history of breast cancer on the x-ray request form and that they had not chased up the orthopaedic referral. We took independent advice from a general practitioner. We found that there was no indication for the practice to consider cancer as a possible diagnosis. The practice had been investigating Mrs A's shoulder pain and lump as an injury and we considered that the practice's diagnosis was reasonable. We did not uphold Mr C's complaint. However, we identified failings in the way the practice handled his complaint and made recommendations in light of this.

Mr C complained that the board unreasonably failed to provide him with appropriate care and treatment for his prostate cancer. He said that a consultant urologist (a doctor who specialises in medicine focusing on diseases of the urinary tract and the male reproductive organs) at Hairmyres Hospital advised him that his cancer was confined to his prostate, that it was T3 (had grown through the prostate capsule, outwith the prostate and was just outside the prostate) and that a laparoscopic radical prostatectomy (removal of the prostate via a small incision using robotic surgery) was an appropriate treatment. The consultant referred Mr C to a second consultant urologist at another board. Mr C said that when he was seen by the second consultant, he was told that the surgery proposed was not appropriate. We took independent advice from a consultant urologist. We found that the first consultant referring Mr C for consideration of laparoscopic radical prostatectomy was appropriate and was in keeping with the West of Scotland Management Guidelines for prostate cancer. We found that, ideally, the first consultant should have pointed out that in their opinion Mr C's disease was suitable for radical prostatectomy, but that the final decision on suitability for surgery lay with the surgeon performing the surgery. The adviser explained that the main issue was one of a difference in clinical opinion between surgeons, and not a change in the extent of Mr C's cancer during the time between his appointments. On balance, we did not consider that the board unreasonably failed to provide Mr C with approprite care and treatment for his prostate cancer, and we did not uphold this aspect of the complaint. Mr C also complained that the board unreasonably failed to arrange his referral for prostate surgery within a reasonable time and that they did not take the issue of the delay in arranging the referral appointment seriously. We found that the board had failed to respond to Mr C's

Miss C complained to us that she had attended a nurse practitioner for banding of haemorrhoids (treatment to cut off blood supply to swollen blood vessels) but that she continued to be in pain and noticed a discharge from the wound site. She was told it would take time to heal and she attended her GP who advised her that she had an infection and prescribed antibiotics. Miss C was then informed that she had developed an anal fissure (small cut or tear in the anal canal). Miss C complained that the care she received was unreasonable. We took independent advice from a clinical nurse specialist. We found that the banding of haemorrhoids is an interventional procedure usually performed in an out-patient clinic. The procedure can be carried out by consultants or nurses who have passed a level of competency. The records indicated that Miss C's procedure was carried out without complications, that gel was applied to ease the discomfort of the procedure and that she was provided with an information leaflet. We found that some patients do experience some pain during the following week and are prescribed pain relief. This is a minor procedure and as long as the patient understands the treatment then only informed or verbal consent would be sought. There was no indication from the records that the care which was provided was unreasonable and it was noted that an anal fissure is a common side effect of the procedure. We did not uphold the complaint. Related reading View Decision Report 201705963 as a PDF (11.29 KB) Updated: December 2, 2018

Ms C complained on behalf of her daughter (Miss A) about the care and treatment she received from her psychiatrist. Miss A has a diagnosis of bipolar affective disorder (a mental health condition marked by alternating periods of elation and depression) and received care and treatment from the board's Child and Adolescent Mental Health Services for a number of years. Miss A was later transferred to general adult services under the care of a consultant psychiatrist, who met with Ms C and Miss A on three separate occasions. Ms C complained that the treatment Miss A received during this period was unreasonable. Ms C's concerns related in particular to treatment decisions, management plans, communication and attitude. We took independent advice from a psychiatrist. We found that the consultant acted reasonably in relation to treatment decisions and management, and that, while there was evidence that one of the consultations was challenging for all concerned, there was no evidence that communication was of an unreasonable standard. Therefore, we did not uphold this complaint. However, we made recommendations to the board in regards to record-keeping and the transition from adolescent to adult services.