SPSO Individual Decisions

C broke their leg and underwent an operation. Following a scan the next day, C was told that the results were fine and that they could be discharged home. However, a few days later, C was contacted and told that a further review of the scan indicated that they would require further surgery, and this was performed by another surgeon a few days later. C complained to the board about several aspects of their treatment. The board apologised that C was told two different things about their scan results and explained that there was an anomaly in the image that wasn’t seen at first, but was noticed on further review. C remained dissatisfied and raised their complaints with the SPSO. We took independent advice from an adviser specialising in orthopaedic surgery. We found that a note of a discussion between clinicians in C’s medical record does not accord with another clinician’s later view, and that the board’s position that the discussion was wrongly recorded was the most likely explanation of what occurred. This meant that, from C’s perspective, the board had unreasonably reached different conclusions following the two reviews of the scan. Given these circumstances, the complaint was upheld.

C complained about the lack of care and understanding for their parent (A) who died in hospital. C referred to incorrect information being passed to the family and the lack of notes and records of events which occurred during A's admission. C said that while the board replied with some apologies and acknowledgement that errors were made, they did not fully explain the actual events that happened in the lead up to A's death. Having sought initial advice, we agreed to investigate the care and treatment provided to A and the board's communication with the family. Related reading View Decision Report 202402836 as a PDF (24.04 KB) Updated: August 20, 2025

C complained about the care and treatment provided to their friend (A) when they were admitted to hospital. A was in hospital for around three and a half months after being admitted with weakness and reduced mobility, with a short history of dysuria (pain or discomfort when urinating) and urinary urgency. A died during their stay in hospital. C complained about several aspects of the nursing care provided to A. In addition to this, they complained about the physiotherapy input provided to A. Finally, C complained about what they considered to be insufficient detail in A’s death certificate. In respect of the nursing care provided to A, the board acknowledged that there was learning or areas for improvement. We took independent nursing advice. We found that the board provided A with a reasonable standard of care. We recognised that there was learning to take from A’s experience, however, we did not consider that the care provided unreasonable. Therefore, we did not uphold this complaint. In respect of the physiotherapy provided to A, we took independent physiotherapy advice. We found that the physiotherapy input provided to A was reasonable, given the circumstances at the time. Therefore, we did not uphold this complaint. Related reading View Decision Report 202210447 as a PDF (24.33 KB) Updated: December 18, 2024

C complained on behalf of their parent (A). A had a long history of contact with mental health services at the board. They had a diagnosis of paranoid and antisocial personality disorder for several years before it was changed to paranoid schizophrenia. A later received an occupational therapy assessment but did not receive support and was referred to social work. A few months later, A was referred to mental health services by their GP due to confusion. A failed to attend two appointments and was discharged. The following year, A was admitted to hospital with confusion and left side weakness. A CT head scan showed an established infarct (an area of necrosis (tissue death) due to blood vessel blockage, often caused by a stroke). A was discharged from hospital and mental health services two months later. A did not receive a psychiatric assessment prior to, or following, discharge and did not receive any community support. C complained that A had not received appropriate support, had not received a psychiatric assessment for several years, and was unsure of their diagnosis. C requested a second opinion but this was refused. The board said that A had received consultant psychiatric assessments, including two prior to their discharge. They advised that the diagnosis was paranoid and antisocial personality disorder and refused to offer a second opinion. We took independent advice from a consultant psychiatrist. We found that the board’s response could not be verified by the records and seemed to contradict the diagnosis of paranoid schizophrenia that was given previously. The records did not offer a clear clinical rationale for changing the diagnosis to paranoid schizophrenia and it was not clear that the A had been informed. Given the confusion around A’s diagnosis and lack of psychiatric assessment, we considered that it was unreasonable not to offer a second opinion. Therefore, we upheld C’s complaints.

C complained that the practice failed to reasonably respond to their complaint. C had made a complaint to the practice about communication and the service provided by them, particularly in relation to their appointment services, phone lines, and frontline staff. C was concerned by the content and tone of the practice’s complaint response. We found that the practice’s handling of C’s complaint was unreasonable, including the tone and language of their response and a failure to signpost to the SPSO. We considered some of the language used in their response came across as overly defensive and failed to maintain an appropriately conciliatory tone. The practice also failed to have an appropriate two-stage complaint procedure in place that follows the NHS Scotland Model Complaints Handling Procedure, as they were unaware this applied to them. Therefore, we upheld C’s complaint.

C complained on behalf of their parent (A) about the care and treatment A received from the board while they were in hospital. C complained that the hospital failed to consider the relevant medical and practical considerations, particularly with respect to A’s medication and whether it may have contributed to delirium and the falls A suffered while in hospital. C also complained that the board had failed to adequately consult with family members when the decision was made to discharge A. C further complained that the board’s handling of their complaint was unreasonable. We took independent advice from a consultant specialising in the care of the elderly. We found that C had raised legitimate concerns that the medication could contribute to delirium and the risk of falls. It appeared that the dose prescribed had changed on a number of occasions without a clear rationale recorded in the records and that the care provided with respect to prescribing and monitoring A’s medication fell below a reasonable standard. We therefore upheld this aspect of the complaint. We also identified a lack of detail in the pre-discharge assessment of A, and a lack of discussion with the family. We upheld this aspect of the complaint. Lastly, there were elements of C’s complaint that were not adequately or accurately addressed in the board's complaint response and on this basis we upheld this aspect of C’s complaint.

C complained about the care and treatment that their late parent (A) received during their attendance at A&E. A was seen in A&E as a GP referral to the hospital’s medical team. C complained that the medical team failed to recognise the nature and severity of A’s condition and their general vulnerability, that they failed to institute an appropriate and timely treatment plan and that there was a failure in record keeping. C also complained that A was discharged home without appropriate medication, without an appropriate discharge letter and without alerting their family and that the board had ignored their Duty of Candour and Ethics Code. When responding to C’s complaint, the board accepted that there were failings in relation to some aspects of A’s care and treatment. They apologised that C had not been informed about A being discharged. They explained that this had been shared with relevant staff and that they were making changes to ensure families and carers were contacted prior to the patient being discharged. The board also accepted that A should have been provided with a copy of their discharge letter given their vulnerability. They explained that consideration would be given to printing off discharge letters and giving them to medical patients in certain circumstances. Further, the board accepted that there had been failings in relation to record keeping and in relation to A’s medical notes. They indicated that this would be brought to the attention of the relevant staff, would be part of the medical induction and would be discussed in a clinical forum. We took independent advice from a consultant in emergency medicine. We found that the care and treatment given to A whilst in A&E was reasonable as was the decision to discharge A. There was no evidence to suggest that A's death was linked to any aspect of the care and treatment they received in A&E. However, we found that, in addition to the failings identified by the board that are detailed above, there was n

C complained about the actions taken by Borders NHS board in relation to diagnosing their child (A) with attention-deficit hyperactivity disorder (ADHD, a condition that affects people's behaviour, including restlessness and impulsiveness). C said that A’s initial referral was rejected and when an assessment did take place it failed to diagnose A’s ADHD. Requests for second opinions were then refused. C said that A was diagnosed with ADHD but not until some years after the initial referral and this was an unreasonable length of time. We took independent advice from a consultant child and adolescent psychiatrist. We found that while the initial refusal of the referral and first assessment were reasonable, the decision to refuse the request for a second opinion and further assessment was not. This led to an unreasonable delay in diagnosing A with ADHD. As such we upheld the complaint.

C, a support and advocacy worker, complained on behalf of their client (A) who was unhappy with the care and treatment they received during the birth of their child (B) and whilst they were a patient on the postpartum ward. A's labour progressed very quickly, B's heart rate dropped, and decisions were made to deviate from the birthing plan as a result. A was unhappy with decisions that were made, the care received from midwives, and the lack of communication with them about what was happening. A also had concerns about the postpartum care they received, as they required a blood transfusion and felt their concerns were ignored by staff. The board considered appropriate guidelines were followed and appropriate action and decisions were made in the circumstances. There was a need to deliver B urgently as there was evidence of distress. In relation to the care A received after the birth of B, the board said they did not consider there were any delays in the care provided to A, or the monitoring of their condition. They did identify an issue with documentation and highlighted that there should always be a handwritten contemporaneous record. This was addressed with staff members involved. We took independent advice from two clinical advisers: a consultant obstetrician (a specialist in pregnancy and childbirth) and a registered midwife. We found that the care and treatment provided to A during labour was reasonable in the circumstances. We also considered the care and treatment provided by midwives on the postnatal ward was reasonable. We noted that there was a debrief in this case however, given the events of the birth, further debriefing at a senior level may have been helpful. We provided the board with feedback on this point. We found that the care and treatment provided to A during the birth of their child and postnatally was reasonable and required in the circumstances in which B's health was at significant risk. Therefore, we did not uphold C's complaints. Related r

C complained about the board's handling of their grandparent's (A) consent for a surgical procedure. A had vascular dementia (a common form of dementia, caused by problems in the supply of blood to the brain) and was resident in a care home. A had Adults With Incapacity (AWI) status and their child had Power of Attorney (PoA) for their welfare and financial needs. A was admitted to hospital due to abnormal liver function tests. It was subsequently decided that they should undergo an invasive procedure. C complained to the board that A’s consultant obtained their consent for the invasive procedure without any contact being made with A’s next of kin or listed PoA. In response to C’s complaint, the board said that the relevant consultant considered that A had the capacity to make this decision. The board reiterated that the presence of a PoA does not mean that an individual is unable to make their own decisions. They said that it was the consultant's clinical professional opinion at that time that A had the capacity to consent to the invasive procedure as they were aware of being previously offered the procedure and said that they wanted something done. We took independent advice from a mental health nurse adviser. We found that there was sufficient information available in the clinical records to highlight A’s potential capacity issues and it was unreasonable that this was not properly considered. We found that A’s consent for the procedure was not properly obtained. In light of this, we upheld the complaint.

C complained about the care and treatment their adult child (A) received from the practice. A had undergone surgery to remove infected fluid on the right lung. Gabapentin (an anticonvulsant medication primarily used to treat partial seizures and neuropathic pain) was prescribed to manage nerve pain at the incision site. The practice later stopped prescribing gabapentin and A’s mental health deteriorated significantly. C complained about the abrupt withdrawal of gabapentin. They highlighted that gabapentin had been prescribed to manage ongoing nerve pain following surgery and noted the risks of sudden withdrawal. The practice stated that prior to the discontinuation of gabapentin there had been an increase in early requests for renewal of medication, which caused concern. A had not attended appointments with the GP or with cardiology (specialists in diseases and abnormalities of the heart). The GP felt that they could not justify further prescription of controlled drugs without seeing the patient. We took independent advice from a GP. We found that there was no record of any significant harm from gabapentin or evidence of overuse, or had there been any discussion around reducing or stopping gabapentin. We noted that gabapentin is known to cause problems during the withdrawal period and it should therefore be withdrawn slowly. We also found that no withdrawal support was given. In light of this, we considered that the practice had failed to appropriately manage A’s prescription for gabapentin and upheld C’s complaint. We also found failings in the practice’s handling of C’s complaint.

C complained about the care and treatment that they received from the board. C said that they had been incorrectly diagnosed with Avoidant Personality Disorder (APD). C said that the board had failed to carry out a proper assessment of their presenting symptoms and incorrectly relied on historic information in reaching their diagnosis. They complained that the board's diagnosis had prevented them from accessing appropriate supports and treatment for other comorbidities. According to NHS Inform, based on statistical information from England, personality disorders can affect one in 20 people and can be very difficult to live with. In this case, we took independent advice from an adult psychiatry adviser. We considered that the board's diagnosis had been reasonable, however the possibility of a depressive disorder co-existing with this disorder's traits, and a physical disorder contributing to mood change, had not been adequately investigated. We also found that the board did not have an appropriate care pathway for APD, that staff had been unaware of it and that there was a lack of continuity in the board's procedures for requesting both internal and external opinions. Therefore, on balance we upheld this complaint.

C complained on behalf of their client (A) who underwent a cystoscopy (bladder examination using a narrow tube-like telescopic camera). C said that the procedure had life-altering consequences for A, causing bleeding for nine days and leaving them permanently incontinent and susceptible to ongoing urinary infections. C complained that the board had no urology (a specialty in medicine that deals with problems of the urinary system and the reproductive system) specialists available over the period of A's procedure and that this caused a delay in recognising the symptoms A was experiencing and their significance. C submitted a complaint to the board regarding A's experiences. C said that, whilst the board apologised to A, they provided little explanation as to what happened or any potential treatment options that may have been available to A. We found that A's medical history meant that they were at an increased risk of complications such as bleeding and incontinence following surgery. We were critical of the board for a lack of evidence of A being made aware of these risks when consenting to the surgery. We also found that, whilst the board were aware that there would be no specialist urological support available within the hospital following A's surgery, this was not communicated to A. Support was available from a neighbouring health board, however, we found that the board's staff did not seek their input as early as they could have when A began to show signs of postoperative complications. We upheld this aspect of C's complaint. We also found that there was a lack of accurate record-keeping with regard to A's care at Borders General Hospital and upheld this aspect of the complaint. We were satisfied that the board handled C's complaint reasonably and did not uphold this aspect of the complaint.

C was dissatisfied with the treatment received from the board following an urgent referral to the gastroenterology department (specialists in the diagnosis and treatment of disorders of the stomach and intestines) from their GP after experiencing back pain and rectal bleeding. The referral was triaged by the board and a colonoscopy (examination of the bowel with a camera on a flexible tube) was arranged. Following the colonoscopy, C was advised there was a probable tumour in their lower bowel. C’s treatment was discussed at a multi-disciplinary team meeting (MDT) and C was advised that a referral to a hospital within another board had been made for a Transanal Endoscopic Mucosal Surgery (TEMS, a minimally invasive surgery) procedure. C was examined by a colorectal surgeon (a surgeon who specialises in conditions in the colon, rectum or anus) at the other board and the TEMS procedure was scheduled. Further MDTs took place where the question of an anterior resection (a surgical procedure to remove the diseased portion of the bowel and rectum) being a more appropriate treatment was considered. C had a meeting with a consultant surgeon at Borders General Hospital and their understanding following this meeting was that clinicians would further consider and reach a decision on what the most appropriate treatment for C was. The consultant surgeon’s letter to C’s GP indicated that their understanding of the outcome of the meeting was that C had expressed a preference for TEMS with further steps, such as an anterior resection, afterwards if needs be, and had made arrangements for C to be seen by the TEMS team. C attended an appointment at the other board where the colorectal surgeon said that C had refused an anterior resection. C denied this. It was also decided that a further biopsy would be undertaken. Whilst awaiting the results of the biopsy, C complained to the board and had further correspondence with them whilst also approaching this office about their concerns. We t

C complained that the care and treatment they received from the practice was unreasonable. C said that they had developed an intolerance to a number of medications, some of which they had previously tolerated. C sought a referral to pharmacology (the branch of medicine concerned with the uses, effects, and modes of action of drugs) through the practice but complained that they unreasonably failed to facilitate this. C complained that the GPs at the practice were dismissive of C’s symptoms without reasonable investigations being carried out. C said that their symptoms were inappropriately attributed to anxiety or panic attacks and that GPs provided misleading information in referrals that suited their own presumptions about C’s diagnosis. We took independent advice from a GP. We found that, whilst the GPs and C disagreed about the likely cause of C’s symptoms, the GPs did not rule out C’s opinion or block their access to specialist investigations. We were satisfied that the practice’s GPs made referrals based on their assessments of C’s symptoms, but put forward C’s opinion for consideration by the receiving specialists. We were satisfied that the practice’s GPs made appropriate referrals and did not promote their own ideas about C’s likely diagnosis. Whilst we considered that one of the GPs could have communicated more clearly with C about the reasons behind one of the referrals, overall, we found the care and treatment provided by the practice to be reasonable. We did not uphold this complaint. Related reading View Decision Report 201901939 as a PDF (24.44 KB) Updated: October 20, 2021

C complained about the care and treatment provided to their late spouse (A) who had a history of superficial bladder cancer (early bladder cancer when the cancer cells are only in the inner lining of the bladder and has not spread beyond it) and prostate cancer. C complained about the care and treatment provided during two short admissions to Borders General Hospital. A was passing blood in their urine and had unexplained pain. C specifically complained that A was not thoroughly assessed and that further investigations should have been carried out. A chest x-ray was later performed which identified a shadow on A’s lung. A’s condition deteriorated and they died a few weeks later. The board confirmed that they considered the care and treatment provided to be reasonable and that there was no suggestion at the time to indicate that further tests were necessary. We took independent advice from a consultant uro-oncologist (a specialist in diagnosing and treating cancers of the male and female urinary tract and the male reproductive organs) with a speciality in dealing with bladder and prostate cancer. We found that there was a failure to take the appropriate action in response to the findings of a previous cystoscopy (bladder examination using a narrow tube-like telescopic camera) which showed a thickened bladder, and that during the first admission it was incorrect to state that the findings of this procedure were normal. We also considered that the board failed to fully investigate the cause of A’s bleeding, nor the thickened bladder, and that not enough regard was given of A’s deterioration. We upheld the complaints, concluding that these failings led to a delayed diagnosis of A’s cancer. However, we acknowledged that these failings did not impact on A’s ultimate prognosis.

C underwent shoulder surgery at Borders General Hospital. Following the surgery, C’s shoulder dislocated on a number of occasions and they were referred to another hospital outwith the board area for consideration of further treatment. C was advised that the cause of the problems was that the glenoid socket (socket part of the ball-and-socket shoulder joint) had been placed at an incorrect angle during the original surgery and that it was the cause of their continuing symptoms. C believed that there had been a failure in treatment. We sought independent clinical advice from an orthopaedic (conditions involving the musculoskeletal system) consultant. We found that from a clinical perspective, there were no indication that problems had been encountered during the original surgery or that the glenoid socket had been mispositioned. We did not uphold the complaint. Related reading View Decision Report 202003940 as a PDF (24.11 KB) Updated: September 22, 2021

C complained that the care and treatment they received from the board was unreasonable. C was added to the general surgery waiting list for gallbladder removal via keyhole surgery. The board determined that C would require an Intensive Care Unit (ICU) bed booked for the time of surgery, in case the operation needed to be converted to open surgery. C waited several months for surgery, and the board stated that this was due to a high level of demand for hospital services, including ICU beds. C eventually underwent surgery but did not improve postoperatively and developed a wound abscess (a painful swelling caused by a build-up of pus) and sepsis (blood infection). The abscess was drained, and C was treated with antibiotics. C raised concerns that there were unreasonable delays to their initial surgery, which allowed their condition to deteriorate. C also complained that there was not enough care taken during their two surgeries and they developed sepsis, which they considered could have been avoided. We took independent advice from a consultant general surgeon and a nurse. We found that the sequence of events, the management of C's booking for surgery, the preoperative assessment, C's medical state, and the anaesthetic view did not support the board's statement that the delay in C's operation was due to lack of ICU beds. In addition, we found that the board failed to meet the Treatment Time Guarantee in C's case and to properly advise them of this under the relevant regulations. We considered that the delays C experienced were unreasonable. With regard to C's surgery and postoperative infection, we found that the initial surgery and the surgery to drain their abscess was carried out appropriately. The diagnosis and management of their sepsis postoperatively was also reasonable. However, we found that there was a lack of documentation to demonstrate that medical staff discussed C's condition and management with either C or C's partner and this was unreasona

C complained about their urology care (the branch of medicine and physiology concerned with the function and disorders of the urinary system) and treatment at Borders General Hospital. C has a complex past urological and surgical history including a total cystectomy (bladder removal), and was referred to urology with ongoing pain and discomfort around their stoma region (an opening in the abdomen formed during a colostomy procedure). C complained that the urologist did not see them and that they were instead seen by a general surgical registrar who failed to identify symptoms of a kidney stone. C subsequently became very unwell and was admitted to hospital with an obstructed infected kidney. In their response to C's complaint, the board confirmed that the urologist felt it best for C to be seen by the consultant general surgeon who had carried out their most recent hernia (a weakness in the abdominal wall beside a stoma which allows the bowel to protrude outwards) repair surgery. They noted that, when C was then assessed by the surgical registrar, they did not have any specific symptoms which would have indicated the presence of a kidney stone. We took independent medical advice from a consultant urological surgeon. We found that it was reasonable for C's clinical assessment to have taken place with either the surgical or urological consultant team. We, therefore, did not uphold C's complaint about a lack of urological review. We considered that C was appropriately assessed by the surgical registrar, and there was no clinical evidence at that time to indicate the presence of a kidney stone. We did not uphold C's complaint about a failure to diagnose their kidney stone. We noted, however, that C should have been seen by the consultant general surgeon, rather than a surgical trainee, in light of their complex history. We fed this back to the board. Related reading View Decision Report 201905731 as a PDF (24.64 KB) Updated: March 24, 2021

C complained about the care and treatment their relative (A) received from the board; in particular, about the mental health care they received at Borders General Hospital following an impulsive overdose and their subsequent community health care. The board’s investigation found that A’s care and treatment was appropriate and timely. However, the board suggested exploring possible improvements in information sharing between public and private sector professionals. We took independent advice from a consultant psychiatrist and a mental health adviser. We found that the hospital care and treatment, including changes to A’s medication were reasonable and appropriate. We considered that there was a shortcoming in care as there was no follow-up out-patient hospital appointment after the discharge from hospital to assess A, despite a significant change in their medication and a new diagnosis. However, we did not consider this was an unreasonable failing given there was a plan for care by community psychiatric nursing who would have had access to psychiatric advice as and when required. We did not uphold this complaint. In terms of the community mental health care, we were critical that A did not receive a face-to-face assessment even though multiple concerns were raised by various individuals about A’s deteriorating behaviour; and particularly given A had not made themselves available to be seen. For this reason, we upheld this complaint.

C complained on behalf of their spouse (A) about the mental health care and treatment provided to A by the board. A has ongoing mental health difficulties and has been supported by both psychiatry and community psychiatric nurses, as well as more recently having psychology input. We took independent advice from a psychiatrist (a doctor who specialises in the diagnosis, treatment and prevention of mental ill health conditions). We found that, whilst there were aspects of care and treatment that were reasonable, there had been a delay in A being given a psychiatry appointment. We upheld the complaint on this basis; however, as the board had previously acknowledged and apologised for this failing, we did not make any further recommendations. Related reading View Decision Report 201910096 as a PDF (24.08 KB) Updated: January 20, 2021

C, a support and advocacy worker, complained on behalf of their client (A) about a failure to provide them with reasonable care and treatment for a rectal prolapse (a condition where the rectum protrudes through the anus). We took independent advice from a consultant colorectal consultant (a surgeon who specialises in conditions in the colon, rectum or anus). We found that A’s initial symptoms were indicative of haemorrhoidal disease (swollen veins in the lower part of rectum and anus). We noted that A was appropriately treated with banding (a procedure whereby the base of the haemorrhoid is tied with a small rubber band to stop the blood flow to the haemorrhoid as first line treatment). A later developed a full thickness prolapse and treatment for this changed accordingly at that time. We did not consider A had been misdiagnosed as their condition deteriorated over time. However, prior to the full thickness prolapse developing, we noted that the team continued to give A painful banding treatment for two and a half years when there was little prospect of improving A’s symptoms. Whilst A’s consent was given for this, we could not see any notes to indicate that there was a discussion with A about possible surgical removal of haemorrhoids which would have been reasonable to expect. We therefore upheld the complaint on the basis that it would have been reasonable to expect alternative treatment was discussed. C also complained about the board’s failure to provide a clear response to the complaint. We found that, whilst in the complaint response there was reasonable general information about prolapses, there was no reference to A’s specific case. A thought that they had been misdiagnosed. The board did not explain the decisions made by the clinical team and how they were informed by A’s symptoms at each appointment. This would have provided A with the information they were looking for and it was reasonable for A to expect this would be provided. We upheld this complaint.

Ms C complained about the care and treatment provided to her by the board in relation to rheumatology (the branch of medicine that deals with rheumatism, arthritis, and other disorders of the joints, muscles, and ligaments), radiology (medical discipline that uses medical imaging to diagnose and treat diseases), and respiratory (the branch of medicine that deals with conditions affecting the lungs) care and treatment. We took independent advice from a rheumatologist, a radiologist, and a respiratory physician. We found generally that the care and treatment provided to Ms C was reasonable. However, we identified that there was a scan which had been reported inaccurately, and this was unreasonable in that it missed acute inflammation. Therefore, we upheld Ms C's complaint about radiology but did not uphold her complaints in relation to her rheumatology and respiratory care and treatment. Ms C also complained about the board's handling of her complaint. We found that there was an inaccuracy in the complaint response and upheld her complaint on this basis.

C complained about the treatment the board provided to their spouse (A). After falling unwell, C had contacted NHS 24 on A's behalf as they were concerned that A's symptoms may have been due to a cardiac (heart and its blood vessels) issue. A then spoke to a medical professional from NHS 24 who signposted them towards Borders Emergency Care Service (BECS), an out-of-hours service, which they attended. When A attended BECS, they were examined by a trainee advance nurse practitioner (ANP). After examining A and taking a history from them, the trainee ANP's view was that A's symptoms were due to a muscular strain rather than being cardiac in nature. A was discharged on this basis but died four days later as a result of coronary artery atheroma (fatty deposits that build up on the walls of arteries around the heart). C complained that A's death was preventable and that they were not examined appropriately when they attended BECS. We took independent advice from a nurse. We found that the examination of A, and the trainee ANP's decision-making, were reasonable given the information provided to them. In addition to this, it was appropriate for a trainee ANP to examine A and reach conclusions on their treatment. We concluded that A received appropriate treatment when they attended BECS. Therefore, we did not uphold this complaint. Related reading View Decision Report 201907297 as a PDF (24.41 KB) Updated: October 21, 2020

Mr C complained about the treatment which he received at the A&E of Borders General Hospital. Mr C said the doctor failed to diagnose that he had suffered a fracture and dislocation of a finger and that the injury was only picked up a few weeks later following further x-rays being taken. We took independent advice from an A&E consultant. We found that the doctor who saw Mr C at A&E carried out an appropriate assessment. The doctor could not identify a fracture from the x-ray which was taken and arranged a review at a Virtual Fracture Clinic. The injury was also not identified at the clinic. It was only when further x-rays were taken after a couple of weeks that the fracture and dislocation were identified. Mr C had suffered a rare injury and although the correct diagnosis was not reached at A&E, this did not mean that the treatment was not to an appropriate standard. We did not uphold the complaint. Related reading View Decision Report 201809991 as a PDF (24.13 KB) Updated: September 23, 2020