Patient Protect

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Why do we need Patient Protect ?   

Most patients enter hospital with the belief that they will be treated by competent staff, and that they will receive whatever treatment they need in order to achieve a successful outcome.    The Patients’ Charter, recently abolished by this Government, actually stated that these beliefs amounted to a right, presumably protected by the Government.

The reality, however, is there is not enough money in the pot to allow everyone to get the treatment they need, and rationing is here to stay.    Although most hospital staff are caring decent people, many can and do work beyond their level of competence, free from accountability, with their mistakes and identities hidden from the public.

Most rationing in our hospitals also goes on in secret.    The elderly are usually the targets, although anyone who can be labelled as an unproductive member of society is at risk.    As well as working to stop this discrimination, Patient Protect aims to make patients aware of what is happening.    After all, secret rationing can only survive if it is kept secret.

Although the initial focus of this site was on NHS Hospitals, it is now clear that the problems we see are common to all areas of the health care system, both NHS and Private.    For more details of the state of the private sector, check the article "Private Hospitals can damage your health".    At present it seems that hospitalisation is safest as a private patient in an NHS hospital.

How rationing actually works.   

1) Why the young, the elderly and the disabled are targeted for rationing.    

The first thing to understand is that the new "NHS Trust Hospital" is really nothing more than a commercial business, run by business managers whose chief responsibility is to work within the budget set by the government.

The managers know that there is not enough money to allow all the patients to get the treatment they need (and which they were promised under the Patients' Charter) but they also know that to fail in their duty to provide proper treatment can lead to huge awards of damages in the courts. The solution to this problem is to exploit the method the courts use to decide what the level of damages should be. 

If the hospital negligently kills a 30 year old family breadwinner, they can end up compensating the family for the loss of future earnings - this can be millions of pounds.    Similarly, killing a mum with three young kids can lead to big payments for hiring cook, nanny, housekeeper plus compensation for any income she may have had.

Negligently killing a young child, an elderly person or someone disabled, however, is virtually free of these risks, for the simple reason that there is hardly ever any dependency requiring compensation.    Of course, families can and do complain bitterly, but 'toughing out' a complaint is cheap, as is the eventual issuing of an apology.   

Government, of course, knows what is going on, but chooses to do nothing. Please read Watch out, you old chickens! for why.

2) How rationing works at the level of the ward.

Compared with wards for younger adult patients, wards for the elderly are affected in three ways by rationing:

i)reduction in quality and quantity of staff

ii)reduction in quality and quantity of equipment

iii) tighter controls on what treatments can actually be carried out, regardless of how necessary they are.   

A phenomenon known as "supply driven demand" then operates as staff learn not to ask for things they know they will not get.    Why do staff, whose primary duty is to put the interests of the patient first, accept these restrictions?

First, many of the staff who find these restrictions intolerable either avoid working on the wards for the elderly or quit altogether.

 

Second, of the staff who remain, some do care , but feel powerless to do anything.    All nurses know that if they complain, or stand up for the patients, they are going to face hardship and sooner or later get fired; all nurses know the story of nurse Pink.    Doctors also know that 'troublemakers' and 'whistleblowers' do not get good references or promotions and may, like Dr Bolsin have to leave the country to find work.    A recent survey in The British Medical Journal found that a quarter of staff in an (unnamed) NHS Trust reported that they had been subjected to bullying in the previous year. Third, some staff simply do not appear to care. Staff guilty of awful cruelty and neglect can avoid a guilty conscience by using 'techniques of neutralisation'. Examples of these techniques in use include:

"The funding cuts aren't my fault" (denial of responsibility)

"She was going to die anyway" (denial of victim)

"The resources are better used on someone else" (appeal to higher loyalty)

Fourth, some staff have ended up callous and heartless.    Although they would not be tolerated on other wards, management allow them to remain on the elderly wards, presumably because they can be relied on never to stand up for the elderly patients.

3) How rationing works at the level of the patient.

It can be summed up as 'Lambs to the Slaughter'.    Most patients and relatives will not realise (and will certainly not be told) that they are not getting a pressure relief mattress, even after they have developed bed sores; they naturally believe that the 'Nil by Mouth' sign over the bed is there for the patient's benefit (in some cases, no staff will admit to putting the sign there in the first place);    'Do not resuscitate' orders written in the notes frequently come to light only after the patient has died.    Even if the relatives or patients do realise what is happening, it is often too late to reverse the damage. Patients, their relatives and their friends usually lack the experience and assertiveness to get past a skilful gatekeeper.

Secret rationing of treatment is bad enough, but there is worse.    Although some patients may die promptly following withdrawal of treatment, others are stronger and threaten to linger on.    These 'bed-blockers' often receive a helping hand with, for example, overdoses of diamorphine or diuretics.    Diamorphine (heroin) is fast and effective, especially in someone unused to the drug and already weak. First it induces coma, followed by respiratory depression, and death.    For the hospital, this has the advantage of having the patient slip away quickly and quietly without any fuss.    Diuretics cause dehydration, and although the result is ultimately the same as with diamorphine the patient may survive, conscious, for up to a week even with the imposition of a 'Nil by mouth' regimen.    Relatives who do not know the signs of dehydration may be tricked into believing that the rapid deterioration is due simply to the underlying illness.

How to protect yourselves from rationing.

1) Prevention

Staff are likely to be more diligent and much less willing to participate in rationing and abuse if they know they can be identified later.    Always keep a notebook and pen handy, and keep them visible. Ask at the nurses' desk which nurses are responsible for hydration, nutrition and pain control.    Write these names down as you get them.    These names should be clearly stated in the Nursing Care Plan. Write down the name of the person you are talking to.

Ask for the name of the consultant responsible for the patient, and also ask for the name of the doctor who will be responsible for the day to day management of the case.

If you ask all these reasonable questions in a friendly manner, you can expect straightforward civil answers.    If you feel you are getting fobbed off with excuses like 'it's confidential' or 'too busy' or 'you don't need to know' then do not get upset.    Simply go to (or phone) the Customer Services Officer and ask them to find out for you (don't forget to ask for their name).    Explain that it is important that you know who is responsible for what in order that communication can be improved and problems can be avoided. If this does not work then send written complaints (see next section).

2) How to stop existing problems.    

The first step is to recognise that rationing and neglect are taking place.    Dehydration, bed sores and a general lack of attention from qualified staff (e.g. soiled bedding, call button out of reach, regular observations not being done) are all reasons to suspect neglect.    Are the staff reluctant to show you the patient's records and discuss the drugs being used?    Is Diamorphine PRN on the prescription chart?    Is a DNR order in the notes without your knowledge? Are you told that the Consultant/Doctor/Surgeon is too busy to see you? If you feel that the patient is deteriorating rapidly and their treatment seems to be the cause, rather than the cure, then step two is to complain effectively. Rationing and neglect are top-down processes, so

*    Complain by fax/email to the Chief Executive of the Health Authority responsible for the hospital (phone the local Community Health Council for his name, fax and phone numbers) and

*    Copy this by fax/email to the Chief Executive of the hospital and Consultant responsible for your relative's care.

*    Immediately follow up with a call to their secretaries and confirm receipt of the fax.    Stress to them that you will take things further if nothing is done.    Ask for their name, write it down together with the time of the conversation.    Send faxed copies to the other organisations (see below).    Keep fax receipts.

*    Keep records of all significant events - keep a diary with names of staff, what they do/do not do, etc, record conversations (use recording walkman, dictaphone, mp3 recorder, mobile phone etc), photograph evidence of neglect.

*    If the situation does not improve rapidly, demand to see the Consultant and demand an immediate transfer for your relative.

*    The following is a suggested outline - contact    us if you can suggest any improvements. Please cut and paste to your word processor:

[Name and address of CEO of Health Authority]

Dear [Name of CEO]

I have reason to believe my relative [Patient's name], [Date of Birth], [Hospital Record Number] is not being treated at [Name of Hospital] in accordance with Article 2 of the Human Rights Act .

My main concerns are: (e.g. lack of treatment, attitude of staff, unhygienic conditions, patient lying in excrement, bed sores, dehydration, inappropriate use of diamorphine, etc)

1) ( write main concerns )

2)

3)

I require an urgent review of [Patient's name] and if this does not improve the situation , I would like to request a transfer to a different unit.    Staff in this hospital have been negligent in the care of [Patient's name]. Their names are

1)    Dr [Name]

2)    Nurse [Name]

3)    etc

I enclose an extract of my diary of the events leading up to my dissatisfaction .

Failure of your health authority to improve the standard of care immediately will result in litigation on the grounds of negligence.    In addition , if my relative, [Patient's name], dies , you will be liable for manslaughter in addition to knowingly being in breach of the Human Rights Act .

I look forward to an immediate review . My telephone number is xxxxxxxxxx.    The telephone number of the ward where [Patient's name] is located is xxxxxxxxxx .

Yours sincerely ,     

[Your Name]

[Date and Time]

cc The Chief Executive of the [Name of hospital]

cc [Name of Consultant responsible for your relative's care]

cc Department of Health

cc Mr David Hinchcliffe, Chairman, Parliamentary Committee on Health

cc [name of local MP], MP

cc Editor [Name of local newspaper]

cc [Name and Firm of your solicitor]

cc Dossier to European Court of Human Rights

You can find the name   of your M.P. and a contact address at http://findyourmp.parliament.uk/

In the meantime, visit your relative and stay constantly, take pictures and tape any conversations. Note down everything in detail. That is the key . Dehydration can cause death in as little as three days, so it is important to spot it early.    The first effect of dehydration is a sensation of thirst, so complaints about feeling thirsty should be taken seriously.    The depression, confusion and delusions which follow as the dehydration deepens are also important signs which are often assumed by relatives to be part of some natural downhill progression.    One useful test for serious dehydration is to gently pinch some loose skin between thumb and forefinger.    Dehydrated skin stays 'pinched' whereas normal skin returns to its original shape (try this on yourself first!).    Other effects of dehydration include dry mouth and throat and shortness of breath (in turn making speech and swallowing difficult), deafness, swollen tongue, constipation and pneumonia.    Dehydration weakens skin, and once the patient is too weak to move, bed sores can quickly develop.    

Bed Sores (also known as pressure sores, decubitus ulcers) develop as a result of lying in the same position for too long. Constant pressure on the same spot reduces the flow of blood to the extent that the skin dies.    If the pressure continues the area and depth of the tissue necrosis ncreases.    Necrotic (dead) tissue quickly becomes infected and this infection can spread to the blood.    Poor nutrition and hydration increase the risk of bed sores.    The risk of bed sore development should always be assessed and reassessed frequently, and staff who fail to do this or who fail to act appropriately to an assessment are clearly negligent.    Make sure you get to see if the patient's back and heels look healthy.    Staff should routinely conduct an objective pressure sore risk assessment, such as the Waterlow pressure sore 'Risk Score'. The assessment is very simple to do yourself; just get a copy of the form, print it and then fill it in.    If the patient appears to be at risk, ask a senior nurse if she agrees with your score.    The Waterlow website has useful information on both prevention (you can buy a download ‘Pressure Sore Prevention Manual’) and treatment. Diamorphine, otherwise known as Heroin, is usually used in palliative care and heart attack patients. It is injected subcutaneously (under the skin) or intravenously (through a vein). Placing it through a vein makes the drug act faster. Its effects are multiple. Used usually for pain relief, it can also depress respiration thus decreasing your drive to breathe. It also relieves anxiety e.g. in heart attack patients. It is a drug that is useful in heart failure enabling the load of the heart to be less thus relieving the problems of the failing heart coping with a large amount of blood.

It can be prescribed as a PRN (dose) which means as "as much as necessary"(necessary for what?). Being a controlled drug, it has to be signed for two people when giving it. Usual doses are 2.5-5mg. It may be placed in a syringe pump, usually in palliative care, (e.g. for terminal cancer patients) to relieve pain and distress. Diamorphine is contraindicated in people with respiratory conditions because it may cause respiratory arrest.

How incompetence is concealed. This section is in preparation. If you need information on this section, please email me at info@patientprotect.org or phone me at 01227 713661 .

How to protect yourselves from incompetence. This section is in preparation. If you need information on this section, please email me at info@patientprotect.org or phone me at 01227 713661 .

Complaints and the NHS

The original purpose of this website was to help to prevent the elderly and other vulnerable groups from becoming victims of secret rationing.    Sadly most feedback to this site is to report first hand experience of cruelty and neglect in our hospitals.    Most people report being stonewalled by hospital staff handling their complaint, and remain dissatisfied with the explanations they have received. What follows in this section is a very brief survey of your options.

Hospital (or GP) Records - Patients, and relatives of deceased patients, are entitled to see and receive an explanation of the original records and/or have photocopies of the originals supplied at cost. The Access to Health Health Records Act 1990 gives you a right of access to health records of a deceased relative from 1 November 1991.    The Data Protection Act 1998 , which repealed most of the 1990 Act, allows living patients to access their own records, paper and computerised, with no limit to how far back you can go.    

The fees involved are modest and are limited by statute, but if you have difficulty finding the money, please give me a quick call.    Please note, that radiographs (x-rays) are very expensive to copy, and it may be better to leave a request for copies of these out of the initial enquiry unless they are central to your complaint.    Instead, ask for a list of any X-rays and scans held by the hospital, and ask them to include dates, views and name of doctor requesting them.    

Hospitals can usually supply explanatory notes and an application form on request, but you can cut and paste the sample letter below.    The holder of the health record has a period of 40 days from the date of your application within which to provide the copies requested.    Make sure that you enclose evidence as to your identity with your application - the 40 days only starts when they are satisfied as to your identity.    There are a limited number of reasons for withholding access to records, but these will rarely apply. Please contact me if you need help organising or understanding your copies of the health records.

[Your Address]

[Date]

Dear Sir/Madam

Re: [Patient's name], deceased, dob [date of birth]

I wish to apply for copies of any records you hold for the above patient. I am the next-of-kin of [Patient's Name], and this application is made under S3(1)(f) of the Access to Health Records Act (1990). [Patient's Name] was a patient of yours in [year(s)]

I understand that a fee will be payable to cover the cost of making the copies and postage. In view of the high cost of copying radiographs and other images, please do not copy these, but instead provide me with a complete list (including dates, views, name of Doctor requesting them) of what, if any, you are holding.  Please contact me at the above address if you require payment in advance.

Yours sincerely    

[Your Name]    

NHS Complaints Procedure - Most complainants find these procedures a complete waste of time.    The Local Investigation of the complaint usually exceeds all time limits, results in nothing new being revealed, and merely provides the staff with an opportunity to discover what evidence you have against them.    According to a recent study by the Public Law Project: "The overwhelming feelings that that complainants were left with, following attempts at local resolution in these cases, were that issues had been covered up, staff had been protected, and that no one was prepared to take responsibility" ( Section 2.53, Cause for Complaint? An evaluation of the effectiveness of the NHS complaints procedure).    Independent review is far from independent (mine was denied by the Acting Chairman of the Trust) and when a review is granted the evidence is often presented in a biased way or even tampered with.  The Ombudsman's staff seem to spend most of their time presenting excuses for not holding an investigation. It is important to note that attempting to reason with administrators at each of these levels is very time consuming, and care must be taken not to exceed the three year limitation period for Civil Litigation, after which civil actions are normally barred.    NHS procedures are not available if you have stated, in a letter or orally, that you intend to take legal action.    A critique of the NHS Complaints Procedure prepared by SIN also suggests that the whole procedure is a complete waste of time. Complaints to the UKCC about poor nursing standards are also likely to be a waste of time - please see the review of the state of the UKCC, copied from the NHS-Exposed site.

The following three subsections are in preparation. If you need information on these sections, please email me at info@patientprotect.org or phone me at 01227 713661 .

Civil Litigation - The new website http://www.medicalclaims.co.uk/ is free and provides information on clinical negligence claims.

Criminal Prosecution    

Inquest - One of the most common ploys used by coroners trying to avoid an inquest is to say that they are satisfied that death was due to natural causes.    The cause of death is usually written by the hospital's own pathologist, who is hardly likely to want to draw attention to dehydration, who is hardly likely to want to draw attention to dehydration, diamorphine or negligence as being significant factors in causing death.    A recent court case has made the 'natural causes' excuse for not holding an inquest much less tenable.    The judges in this case made it very clear that if the patient suffered from a condition which, if not monitored and treated in a routine way will result in death, and, for whatever reason, the monitoring and treatment is omitted, then the coroner must hold an inquest unless he can say that there are no grounds for suspecting that the omission was an effective cause of death.

News   

* Newspaper and other Reports

* House of Commons Health Select Committee and Legislation

* Meetings

* Newspapers on the Web

Newspaper and other Reports

BBC Website, 25 May 2004 Abused pensioner's body to be exhumed - An order has been obtained by police to remove the body of William Pettener, 95, who was a resident at a private nursing home in Porthmadog in Gwynedd. A member of staff at the Bodawen nursing home has been suspended following allegations made by several members of staff concerning abuse by a fellow worker at the home.    Members of staff alleged that a colleague used verbal abuse against them and both verbal and physical abuse against residents. The retired engineer, from Ormskirk, died at the home on 12 April, with the cause of death given as bronchopneumonia. It is thought the exhumation will take place next week.

Stockport Express, 19 May 2004 Shamed social services say ? Sorry ? for neglect - Social Services chiefs have apologised to the son of a pensioner who died through neglect.    Frail Mary Sharpe, 86, died after developing a pressure sore on her back. She was discharged from Stepping Hill Hospital after being left bedridden following two strokes - but her son claims staff at the care home where she was nursed did not turn her regularly and left her on her back for 40 days.    Geoffrey, of Cherry Tree Drive, Hazel Grove launched his crusade for answers back in November 2001. An initial inquiry by the Independent Inspection Unit claimed there was no evidence of neglect. Now Social Services chiefs have been forced to make a full apology to her angry son who has been fighting for justice since his mum’s death. He alleges he only discovered the bedsore when it became infected and began to smell. Geoffrey claimed: ? I walked through the door and was appalled to find the flesh around the wound had begun to rot and was exposing the spine. I was furious. She was unable to walk, talk, or swallow and had little movement. She was literally on her deathbed but was even robbed of dignity there.?

Ananova, 19 May 2004 Nurses found guilty of killing patient by neglect - Two nurses have been found guilty of killing an elderly patient at a nursing home.    Dennis Latham, 33, from Blackburn, Lancashire and Barbara Campbell, 62, from Glasgow, were found guilty of the manslaughter of 77-year-old Marion Dennis by a jury at the Isle of Man High Court of Justice, in Douglas. Latham was the nursing services manager at the home at the time of the death. Campbell was his deputy. During the five-week trial the jury were told that Latham and Campbell were guilty of gross negligence in their care of Mrs Dennis. Mrs Dennis died in July 1999 from septicaemia resulting from pressure sores the "size of a fist" that developed while she was a resident at Ballastowell Gardens nursing home in Ramsey.    Medical experts gave evidence confirming that when she was admitted to hospital from the nursing home she had infected ulcers, more commonly known as pressure sores, that had penetrated to the bone.    She died seven days after being admitted to Noble's Hospital.

The Daily Telegraph, 13 May 2004 Care is being jeopardised and hospital resources squandered in a Government drive to bring down waiting lists before the next election, NHS doctors warned yesterday. Orthopaedic surgeons are concerned that an initiative to employ overseas doctors in special private centres could lead to inferior and sometimes "botched" operations. They say the move will end up costing the taxpayer more because the NHS will have to correct poor surgery and replace hip and knee implants sooner than normal. Their concerns follow an NHS inquiry into an unnamed South African doctor employed by a private company.   The surgeon, who worked at the Royal Hospital, in Gosport, Hants, returned home after carrying out seven hip operations, of which five were found to have potential problems. Two patients needed emergency surgery after their new hips dislocated. John Timperley, consultant orthopaedic surgeon at the Princess Elizabeth Orthopaedic Centre, Exeter, whose letter in The Daily Telegraph today is signed by 42 other surgeons, said: "It is all down to political imperative". He continued “A good hip replacement operation will last decades but an inferior one only six months. This initiative will endanger patients and be a false economy as the NHS will have to put it right."

Independent, 13 May 2004 Incompetent student nurses are being allowed to qualify because hospital examiners are too reluctant to fail them, an industry report warned yesterday. The Nursing And Midwifery Council, which regulates the profession, strongly criticised senior nurse mentors who assess trainees on the wards for passing sub-standard students as fit to practice.   Patients may be put at risk because mentors are "failing to fail" students who, in some cases, have repeatedly had concerns raised about their ability to perform clinical tasks, the report said.

Andy McGovern, a mentor at Newham General Hospital in east London, said he knew of cases where students who were clinically incompetent had been passed as fit to practice and allowed on to the wards as a fully-fledged nurse. "Sometimes mentors just cannot face failing students because they are scared of the reaction," he said.

The Guardian, 13 May 2004 Hospital Meal Times to be Sacrosanct- the government has told NHS hospitals to return to the values of Florence Knightingale by introducing strict mealtime discipline on the wards to ensure that patients eat their food. Health ministers want nurses to adopt procedures trialled at King's College hospital in London where doctors and visitors are kept out of the wards during meals to let patients eat without interruption. Caroline Lecko, a matron on the neuro-science unit at King's, said medical staff were too busy to notice whether patients ate meals provided by catering contractors. They carried on with tests and procedures which sometimes made it impossible for patients to eat food while it was hot. "We saw patients were not being prepared for meals, not in a comfortable position and with food left out of reach. Food was placed on the table next to bottles of urine and vomit bowls. It was awful. Patients would be eating when someone was taking blood at the next bed or putting a patient on a commode."  She said the contracting out of catering over the last 10 years may have contributed to the downgrading of meal times. Recent NHS research found that 40% of people coming into hospital were malnourished and of those 70% became further malnourished during their stay in hospital. Her response was to introduce a "protected mealtime", setting aside two hours from noon for eating and rest. Doctors were told to keep away unless there was an emergency and visitors were discouraged unless they came to help the patient eat. The diagnostic department which used to do all inpatient tests during lunchtime has rescheduled to take only outpatients then.    

Daily Telegraph, 29 April 2004 Nurse 'tried to kill elderly to free beds' - A ward sister tried to murder four of her elderly patients in a ruthless drive to free hospital beds, a court was told yesterday.    Barbara Salisbury, 47, crossed the line between "humane nursing and callous dispatch", it was claimed.    She gave a 76-year-old man an excess of diamorphine, telling him as she did so: "Give in. It's time to go."    On another occasion she instructed a nurse treating a 92-year-old: "Lay him flat. With any luck his lungs will fill with water and he'll die."    She justified her administering of diamorphine to an 88-year-old woman at Leighton Hospital, Crewe, Cheshire, with the observation " Robin Spencer, QC, prosecuting at Chester Crown Court, said: "Barbara Salisbury arrogated to herself the right to decide when patients should die, and attempted by her actions to shorten what remained of their lives.    "If she thought a patient had no hope of recovery she didn't want to have to wait too long. If a patient could be made well enough she would aim for that. If not, she would hasten death.    "One way or another, she wanted these patients off her ward." Mr Spencer alleged that Salisbury, who had worked at hospitals in Peterborough, Cambs, and King's Lynn, Norfolk, before moving to Leighton in 1993, made little or no secret of what she was doing. Eventually some of the junior staff on her ward felt compelled to speak out. The trial continues.    

The Sunday Times, 25 April 2004 How extra spending failed to improve the public services - confidential research prepared for senior ministers and aides showed that, although the government had pumped billions of extra taxpayers? money into the public sector, large amounts had apparently been wasted. Since Labour was elected in 1997, total public spending has risen almost 50% to £459 billion. But the research found the taxpayer, hit by a series of stealth taxes, had not received value for money. Much of the cash had been swallowed up by an inefficient bureaucracy and nflation-busting pay rises for civil servants. The revelations, contained in cabinet committee minutes  leaked to The Sunday Times, may have lasting consequences for Blair and Labour come the general election, which is expected next year. The reports showed public sector productivity ? the key measure of efficiency ? has ?fallen steadily? since 1997. According to official data never previously released, efficiency has dropped 10% over the past seven years. In health and education, the key election battlegrounds, it has slumped by between 15% and 20%. In the past, the government has only ever admitted to a 3% fall in productivity since the 1997 election. In basic terms, this means the extra money being spent on the public sector is not being adequately reflected in better services. Economists found that the massive ?inputs? into the public sector were not being matched by enhanced ?outputs? in the form of better schools, hospitals and police forces. Experts calculate the slump in productivity means Labour is wasting £20 billion a year ? equivalent to almost 6p on the basic rate of income tax. The government is also expected to be forced to admit that it will not meet its pledge to employ 7,500 more NHS consultants by the end of this year. It claims to have met the target for GPs but professional bodies say many new GPs are part-timers. The Audit Commission reported last week that, despite the billions ploughed into the NHS, hospital trusts now had a cumulative debt of £500m.

Times, April 24 2004 GMC ignored surgeon warning - the future of the General Medical Council (GMC) was back under the spotlight yesterday after the disclosure that it could have acted against a disgraced gynaecologist ten years before he was struck off. Police warned the GMC in 1988 that Richard Neale was already banned from working in Canada, two years after he began operating in England. He was found guilty in 2000 of 34 charges of serious professional misconduct linked to a dozen botched operations that left some patients with lifelong complications. The revelation could not have The revelation could not have come at a worse time after a leak from the inquiry into Harold Shipman, the serial killer GP, suggested that its final report will criticise GMC actions and attitudes before and after 1996, when it started reforms designed to win back public confidence.    Neale worked for nine years at the Friarage Hospital, Northallerton, and later at hospitals in Leicester and London. The GMC had maintained that it was unaware that the consultant was practising in Britain until 1998. Correspondence has now emerged, however, that shows that the GMC was consulted about Mr Neale by North Yorkshire Police in 1988, when a decision to take no action against him was made by Lord Walton, who was the council’s president. All GMC papers relating to the episode have been destroyed, but a file found by the police was handed to a government inquiry into the NHS's handling of the Neale case. Its findings are expected to be announced this year.    The GMC admitted it was warned about Mr Neale by Canadian medical authorities in 1985. It blamed administrative blunders for its failure to act when he arrived in Britain a year later. It issued an unreserved apology yesterday. Its chief executive, Finlay Scott, described the council’s conduct in 1988 as “extraordinary and inexplicable”.    An official added: “A situation like this could not arise again.”

   

Guardian, 10 March 2004 Doctors violated disabled boy's rights - The human rights of a severely disabled boy and his mother were violated when doctors who thought he was dying overrode his mother's objections and gave him diamorphine to ease his death, the European court of human rights ruled yesterday. The unanimous ruling by seven judges in Strasbourg means that, except in a clear emergency, doctors should seek high court approval before treating a child against the express wishes of a parent. The court awarded David Glass, who survived and is now 18, and his mother, Carol, pounds 7,000 in damages and pounds 10,500 in costs for a breach of article 8 of the European convention on human rights, the right to respect for private life. The judges said: "The court considered that the decision to impose treatment on David in defiance of his mother's objections gave rise to an interference with his right to respect for his private life, and in particular his right to physical integrity." A "do not resuscitate" (DNR) order was put in his notes without telling his mother. David's condition deteriorated and doctors recommended diamorphine, which depresses breathing, to relieve his distress. Ms Glass did not agree that he was dying. She asked to take David home if he was dying, but a police She asked to take David home if he was dying, but a police officer summoned by the doctors advised her that if she attempted to remove him, she would be arrested.    David was given diamorphine and his condition deteriorated. His family demanded it be stopped, but a doctor said this was possible only if they agreed not to resuscitate him. Relatives tried to revive him and a fight broke out in which doctors and police officers were injured. While the fight was going on, Ms Glass successfully resuscitated David. His condition improved and he returned home. Three family members were later jailed for violent disorder and causing actual bodily harm. Ms Glass took her case to Strasbourg after failing to win redress in the high court and court of appeal.

Guardian, 11 February , 2004 Relatives demand prosecutions for hospital abuse - Relatives have today rejected a trust's 'unreserved apology' and demanded prosecutions following an internal inquiry that found vulnerable older people were assaulted by its mental health staff. Norma Chatt, whose 81-year-old mother spent more than a year on Rowan ward at Withington hospital in Greater Manchester, said today: “I want the people responsible brought to justice, that is what all the relatives want. What use is an apology nearly two years later?"    She claimed her mother, who has Alzheimer's disease, suffered six black eyes while on the ward. She said: "When all the relatives got together and compared what had been going on it was awful. There were reports of patients being scalded, not being fed and having soap put in their mouths." The call for prosecutions comes a day after a report into the inquiry by the mental health trust, which was responding to a damning inspection last year of care standards on the ward by the Commission for Health Improvement (Chi). Chi inspectors found poor management and supervision and low staffing levels.

The inquiry report revealed patients with dementia, schizophrenia and depression on Rowan ward were kicked, slapped and beaten by staff. It concluded standards of nursing care were outdated, doctors failed to report patients injuries, systems to detect abuse were poor and there was a culture of "intimidation and even fear" among staff on the ward. However the report failed to single out who was to blame for the injuries and concluded they were "unattributable".

Greater Manchester police said today that it had conducted an investigation but that its file was closed last September. A spokeswoman said: "Following advice from the Crown Prosecution Service no charges were brought against staff members."   

Sunday Times, 08 February 2004 Coroner seeks inquiry into ?mass euthanasia? at hospital - A Coroner is demanding a public inquiry into claims that 11 hospital patients were deliberately starved to death. He believes that it could be Britain’s first case of forced ? mass euthanasia?. Peter Ashworth, the coroner for Derby, will open an inquest later this year into the suspicious deaths at for Derby, will open an inquest later this year into the suspicious deaths at the city’s Kingsway hospital.    He considers the matter so serious that he has written to the Department of Health asking for the inquest to be superseded by a judicial inquiry with powers to investigate practices at the hospital.

There is now increasing concern across Britain about the way hospitals appear to be hastening the deaths of elderly patients. Police in Leeds and Hampshire are also looking into similar cases.    The 11 patients, all men aged between 65 and 93, died in the Rowsley ward for the elderly at Kingsway. A review of the cases, ordered by the coroner, found evidence that their deaths may have been speeded up speeded up by withholding sufficient food. The allegations first surfaced after Jayne Drew, a healthcare assistant, alerted the hospital managers after the deaths of Simon Smith, 74, and Arthur Boddice, 81, in the summer of 1997.    Families of fellow patients at the hospital claimed that some staff had become so upset at seeing elderly people being starved that they had taken it upon themselves to feed them secretly. One relative has described how it was distressing to see his father go without food. Andrew Hughson said his 75- year-old father, also called Andrew, would vainly stretch his hand towards meals being delivered to other patients. ? We kept being told that feeding him would be bad for his general health, and he was too frail to tell us otherwise,? he said. Simon Smith’s son Michael said ?At the time we thought my father’s treatment was consistent with what you would expect. Now it appears he was not being fed. We all want to know the precise causes of these deaths and we still haven’t had an answer.? Ann Alexander, the solicitor acting for the bereaved families, said it was unfair that top QCs and junior counsel were being provided out of public funds to represent the health authority, medical and nursing staff at the inquest while no legal representation was being provided for the families. Police are also investigating the unexpected deaths of 62 patients ? all pensioners ? who had been admitted for postoperative rehabilitation at the Gosport War Memorial hospital in Hampshire.    In Leeds, the death of Ethel Hall, 86, allegedly poisoned by a massive insulin injection, has sparked a police review of the records of 18 other elderly patients who died at the city’s General Infirmary.  

  

CHI Press Release, 22 January 2004 CHI gives evidence to Health Select Committee on the abuse of older people - The plight of older people who are abused while receiving NHS services was highlighted before a Government inquiry today. "Some older people are among our most vulnerable citizens and that makes it possible for them to become victims of abuse. It must be a matter of extreme concern that even then we would expect them to be safe in the care of the NHS, some older people are still at risk," said Commission for Health Improvement (CHI) chairman Dame Deirdre Hine. "We know that most NHS staff are caring and committed and give sensitive care to older people. However, caring for older people is a demanding and complex job, especially if the patients are showing challenging behaviour. If staff don’t get the full support, training and supervision that they need, then this can result in some older patients being abused. That abuse can take the form of physical abuse, but also emotional abuse, neglect or inappropriate restraint and sedation". "Our findings so far show that older people’s services are generally given low priority in comparison with other services. We believe that the standard of care of older people nationally is worrying and what is more, the NHSwhat is more, the NHS doesn’t seem to be learning because the same issues keep coming up again and again," said Dame Deirdre. "Despite the best efforts of many staff, we are seeing too many cases where older people are not getting the care they need and this is unacceptable. We are delighted the Health Select Committee is holding this inquiry and we hope the resulting report will lead to action to help ensure a greater focus on older people’s services," said Dame Deirdre.

Friday, 16 January 2004 Cancer ward nurse arrested after patient's suspicious death - Murder squad    detectives have arrested a nurse in connection with the death of a pensioner and are investigating the cases of other patients who were treated on the same cancer ward.    The 25-year-old was arrested on suspicion of administering a noxious substance at Hull Royal Infirmary.

   

Wednesday,   24 December 2003 Patient challenges doctors for right to live - Aman with a degenerative brain condition has launched an unprecedented human rights challenge to guidance for doctors which he believes could allow them to end his life by legally sanctioned euthanasia. Leslie Burke, who has cerebellar ataxia, is mounting a right-to-life challenge to General Medical Council guidelines on withholding and withdrawing life-prolonging treatment which spell out when doctors can stop artificial feeding and let a patient die.    

Yorkshire Evening Post Source, 23 December 2003 'Our gran died after long wait on trolley' - an 86-year-old woman died of a brain haemorrhage after being left for eight hours on a hospital trolley. Her family claim they were told she was suffering from a simple chest infection. Dorothy Atkinson's relatives say they were told by Leeds Infirmary that she was "fine" and were urged "not to worry." But hours later tests showed the great great grandmother was suffering from a brain tumour and was bleeding heavily. Two days later she was dead. The retired hospital worker was taken to LGI after was taken to LGI after collapsing at her nursing home in Pudsey on Thursday, December 11. She was admitted to hospital just after 5am. Soon afterwards her family telephoned the hospital to check on her. They say they were told she was "fine" but was suffering from a chest infection. But when they arrived at the hospital at around 1pm that day, they say they found her lying on a trolley in the found her lying on a trolley in the corridor, unable to move and covered in her own vomit. Her son, Peter, said she was eventually moved to a bed but only after the family "caused a scene." On the Friday she was taken for tests and a CT brain scan revealed she had a tumour and was suffering a major haemorrhage.

   

Daily Mail, 17 July 2003 NHS targets ? cost lives" - Patients are being left to die by hospitals forced to meet ?meaningless" targets rather than give proper care, it was claimed yesterday (16/07/03). Liberal Democrat health spokesman Dr Evan Harris claimed the latest NHS star ratings showed only how well hospitals could hit targets and fill in spreadsheets. He said, ?Star ratings divert the attention of doctors and nurses and force hundreds of managers to spend their time collecting information, not improving patient care."  

The Guardian, 18 December 2003 Mental health patients 'neglected' - Chronic staff shortages in NHS mental health trusts in England and Wales are causing patients to be neglected and exposed to violence on the wards, government inspectors warned yesterday. The Commission for Health Improvement said mental health remained "the poor relation of the NHS", four years after ministers pledged to make it a priority. Its inspectors found that "significant national shortages of psychiatrists and nurses are having a major impact on clinical leadership and quality of patient care". Mental health trusts commonly relied on excessive numbers of agency staff who did not have the skills needed to cope with a violent incident, the commission said. This left permanent staff working long hours and feeling unsafe. Patients were also concerned about their exposure to violence from other patients. Bed shortages led to inappropriate mixes of patients with different needs. Staff struggled to stop illicit drugs and alcohol.

The Daily Telegraph, 04 December 2003 IVF mother was killed by negligence of hospital staff - medical negligence by her own hospital colleagues led to the death of a doctor just hours after the birth of the twins for which she had yearned. A verdict of "medical misadventure to which neglect contributed" was recorded at an inquest into the death of Dr Sandyha Senanayake, who gave birth to a boy and a girl at the hospital where she worked, only to die shortly afterwards of internal bleeding. 30,000 nurses desert the NHS . RECORD numbers of nurses are quitting amid growing concern about the continuing staff crisis in the Health Service.    The number who left the UK nursing register almost doubled last year, reaching the highest level since the 1980s. The exodus of 30,200 nurses almost cancelled out 31,700 new recruits, many from overseas. In the previous year, 18,700 nurses left the profession. The Royal College of Nursing said it feared the loss of experienced nurses heralded a 'demographic timebomb' with increasing numbers of NHS staff becoming eligible for early retirement. Daily Mail. 02 December 2003 . Life-saving treatment 'denied to over-70s' with breast Life-saving treatment 'denied to over-70s' with breast cancer' THOUSANDS of older women are being denied surgery for their breast cancer because of their age, a cancer surgeon will claim today. Ian Fentiman, professor of surgical oncology at Guy's and St Thomas's Medical School, London, says that as a result many die needlessly from cancers which are potentially curable. Instead of surgery, many women over 70 were only given the standard breast cancer drug, tamoxifen - but in many cases without the test which would show whether the drug was likely to work for them or not, he says. Prof Fentiman, an eminent cancer surgeon, is speaking at a debate today run by Cancer Research UK.    He told The Daily Telegraph yesterday: "Older women are dying needlessly because of this attitude. These deaths are happening largely because there is better treatment available and they are not getting it. "This practice is very widespread. Across the nation it must run into thousands.

The Daily Telegraph, 29 October 2003 . June 18, 2003 . 'Ignored' surgeon's fury at death of patient, 85 - Staff at a hospital with one of the highest death rates in the country are alleged to have allowed an elderly women to die against the specific instructions of her surgeon. David Shields said that he was overruled behind his back by anaesthetic staff at Oldchurch Hospital, in Romford, East London, who refused to resuscitate his patient even though he believed she could recover from her operation. The woman’s family have complained to the hospital and called for an independent inquiry. In March, the independent Dr Foster guide to hospitals said that Oldchurch had one of the highest mortality rates for emergency admissions. It awarded it one star out of a possible ten. The hospital denies the allegations and said that an internal inquiry had found that the patient should not have been operated on because she was suffering from a number of pre-existing medical conditions. Mr Shields, who was working as a locum at the hospital, resigned, saying that he was appalled at the management of patients there. He added that the woman’s care had been his responsibility, not that of the anaesthetists who run the high dependency unit, where the patient was being treated.

?I am not prepared to accept responsibility for the death of patients under my care when treatment is either not given or withdrawn by others without my consent,? he said. He has won support from SOS NHS Patients in Need, which represents the families of patients whom it believes die unnecessarily in hospitals. ?This highlights the fact that so many doctors are prepared to write off someone just because they are elderly,? Julia Quenzler, a spokeswoman, said. The affair began when the 85-year-old woman was admitted to the hospital on April 19 with an apparent obstruction of the bowel. She was taken to the high dependency unit and operated on by Mr Shields. His instructions had been that in the event of cardiac arrest she should be resuscitated. The next day, he said, he saw her twice and she appeared stable. But on his ward round the following morning he was told she had died and from the medical notes discovered that a decision had been made by the anaesthetic staff not to resuscitate her. A report prepared by another surgeon, Shukri Sami, said the death was caused by heart disease and failure, with no evidence that a medical intervention had caused the death. Mr Sami blamed a ? lack of communication ? between the surgical and anaesthetic teams for confusion over resuscitation. Mr Shields resigned immediately. He was suspended from operating and caring for his patients. ? Accordingly, the person who drew the trust’s attention to the problem has been removed, instead of the problem being addressed,? he said. ? So much for the Government’s charter for whistleblowers.? The hospital said that the order not to resuscitate had been entirely appropriate in this case, and claimed that it had been agreed by Mr Shields, who had subsequently changed his mind. A spokeswoman said an inquiry had found Mr Shields should not have operated on the patient because she was not in a suitable medical position. She said the surgeon had then tried to influence the woman’s family, who had agreed that she should not be resuscitated, to change their minds after the event. Mr Shields denies all these claims. He also strongly denies the trusts's claim that he had been in favour of a DNR order. ? The form was actually signed by the anaesthetic senior house officer, who certainly knew my view,? he said. view,? he said. Mark Rees, chief executive of Oldchurch Hospital, said in a statement: ?The trust has investigated the whole of this case and will now refer its findings regarding Mr Shield’s management of this patient to the General Medical Council. ?We have met with the patient’s daughter and would wish to make it clear that they are understandably unhappy with the management of their relative’s care. However the decision made by the clinician after discussion with the family to implement the ? do not resuscitate ? policy was in our opinion clinically correct.?

June 18, 2003 Nurse 'tried to kill five patients' By Russell Jenkins . POLICE have charged a hospital nursing sister with the attempted murder of five elderly patients who later died. Barbara Salisbury, 47, who worked at Leighton Hospital, in Crewe, Cheshire, appeared before South Cheshire magistrates yesterday. She had answered police bail at Crewe police station after an investigation by Cheshire police. It is understood that the inquiry, led by Detective Chief Inspector Adrian Wright, has centred on medication administered to patients while under her care on a general ward. Detectives began their investigation in May 2002 after colleagues raised concerns in relation to a ?number of issues? over her treatment of four men and one woman in the NHS hospital who later died. It is understood that detectives looked at many other cases as part of their inquiry.

Mrs Salisbury went on holiday in June last year for two weeks and returned to discover that she was suspended from duty. She has remained off work on full pay since. She lived with her family in Crewe at the time of the alleged offences but is understood to have moved away. The brief hearing before magistrates was told that Mrs Salisbury had been charged with the attempted murder of five patients between May 1999 and April last year. She is alleged to have attempted to murder James Byrne, 76, on or around May 18, 1999, Reuben Thompson, 81, between February 22 and March 14, 2002, Frances Mary Taylor, 88, on March 21, 2002, Frank Owen, 92, on March 31, 2002, and Bertram Madeley, 76, on April 28, 2002. All five have since died. Mrs Salisbury was released on conditional bail to reappear next week. An order was made by magistrates banning the publication of her address. Leighton Hospital is part of the Mid Cheshire Hospitals NHS Trust, which also includes Crewe and Victoria Infirmary. Simon Yates, the chief executive, said: ? The trust understands that, following a police investigation, which began in May 2002, a member of staff at Leighton Hospital has now been charged with serious offences.? Michael Mackey, the nurse’s lawyer, said that she would fight the charges. ?All I can say is that these charges will be strenuously denied and this will be contested,? he said. ? She has been conditionally bailed and was due to appear at Chester Crown Court on Tuesday.?

Shipman experts aid inquiry into hospital deaths Shipman experts aid inquiry into hospital deaths

An expert in the use of the heroin-based painkiller diamorphine is to be appointed by police conducting an investigation into the deaths of more than 50 elderly patients at a community hospital. Relations allege that the drug, used by Harold Shipman to kill many of his patients, was overprescribed at the Gosport War Memorial Hospital near Portsmouth. Detectives are preparing to interview relations of those who died at the 180-bed hospital amid claims of unlawful killing.

The Times 7/11/02 Page 3 Police investigate deaths of 30 elderly patients Police are investigating the hospital care of up to 30 elderly patients after relatives complained that they may have died from overdoses of powerful painkillers. The families have hired the solicitor who represented many of the relatives in the Shipman case to put the argument for a full public inquiry into the deaths. All of the patients who died were admitted to Gosport War Memorial Hospital in Hampshire to recuperate, and their families were told that they should make a full recovery.

The Times 5/11/02 Page 5 . July 2000

   

Telegraph, 15 July 2000 Jail for relatives in hospital fight over boy - A judge yesterday jailed three relatives of a severely disabled boy after violence broke out around the hospital bed of David Glass, then 12, as an uncle and two aunts fought with two paediatricians trying to administer diamorphine, which his relatives claimed would have killed him. After the confrontation at St Mary's Hospital, Portsmouth, 21 months ago, the diamorphine was withdrawn and David was discharged that evening to return home.    His mother, Carol, said last night that her son, who will be 14 later this month, was "very well" and that her brother and two sisters "had definitely saved his life" by their intervention. Despite pleas yesterday by their defence counsel for any sentence to be suspended because David's relatives were vital for his round-the-clock care, Judge Roger Shawcross jailed all three, saying "I accept that your absences will be detrimental to his care but it's your fault that David has suffered and yours alone."    He also refused an emergency bail application pending an appeal against sentence to the High Court. James Bullen, for Davis, said the case was "a million miles from those of drunken violent disorder". He said the family was "fighting for David because, if the diamorphine had continued, he would have died." David had a chest infection in October 1998 and two doctors,two doctors, Mark Ashton and Joanne Walker, expected him to die within hours. The previous day doctors had stopped feeding him and they administered diamorphine. See Jill Baker's comments. Complaints by the family that both doctors should be accused of attempted murder were investigated by Hampshire police but the Crown Prosecution Service decided there was insufficient evidence to charge them.

   

Telegraph, 6 June 2000 Sick boy's relatives 'attacked doctors' - A hospital ward erupted into violence when the family of a seriously ill child turned on doctors who were "trying to kill" the boy, a court was told yesterday.    Alastair Malcolm, for the prosecution, told the court that the doctors had given David diamorphine as a painkiller and to help him breathe but the family ordered that the dose be reduced and accused them of trying to hasten the child's death.    Raymond Davis, 43, Julie Hodgson, 37, and Diane Wild, 42, all of Portsmouth, deny violent disorder and assaulting Dr Mark Ashton at the hospital in October 1998. Wild also denies assaulting Dr Walker on the same date.    Davis and Hodgson denied being involved in the attack and Wild claimed that she had acted in self-defence after being punched by Dr Ashton. The accused are aunts and uncle of the boy.    Twelve-year-old David Glass, who is severely disabled, survived the chest complaint and was later discharged from hospital.

Times, 5 June 2000 Consultant is suspended over organ disposal - hospital consultant pathologist, Geoffrey Hulman, has been suspended following allegations about the disposal of dead babies' organs. Mortuary workers at the King's Mill Centre in Sutton in Ashfield, Nottinghamshire claimed they were ordered to throw babies' brains and hearts into rubbish sacks for incineration as well as the vital organs of adults. They said that they had been ordered to clear them out soon after guidelines relating to organ disposal were published by the Royal College of Pathologists in March. The guidelines advised hospitals to search records to see if organs had been kept without relatives' permission. They also alleged that in some cases they had been told to destroy evidence ofdestroy evidence of identity. John Watkinson, chief executive of the King's Mill Centre for Health Care Services, said that following post-mortem examinations the disposal of tissues as clinical waste was "normal practice"  

    

Sunday Telegraph, 30 April 2000 Doctors leaving young disabled to die - Seriously disabled children and young people are being left to die because doctors have deemed there quality of life so poor that they do not merit being kept alive.    Hospitals and care homes are increasingly placing secret DNR (Do Not Resuscitate) orders in their notes which effectively means they are "written off".    In recent weeks, concern has grown about the withholding of treatment from the elderly. Now patients' groups are worried that a similar policy is being applied to the young disabled. Mother demands inquiry into delays at son's death - Although 25-year-old Stephen Hill had spina bifida and was paralysed from the waist down, he was a keen football supporter who led an active life and attended college in Bedfordshire near his residential home. In 1995 he complained of neck pains and headaches and, when he became breathless, a nurse was called. She arrived 10 minutes later and felt a faint pulse but agreed, as she later admitted in an inquiry statement, that she did not resuscitate him for three minutes "because of his physical disabilities and the suddenness of his death". The nurse was cleared of negligence in an inquiry by Staffordshire Social Services but Stephen's mother, Ann Hill, is making an    official complaint to the local authority ombudsman.    She cannot discover if a Do Not Resuscitate notice was added to her son's notes because she has not been allowed access. Mrs Hill believes that her son could have been saved. She says: "Although Stephen had spina bifida he enjoyed life and went to college. He should not have been treated in this way. I believe vulnerable people are in danger." Mrs Hill, who lives at Cannock, Staffordshire, added: "We have conflicting statements from staff at the home and the two GPs who attended Stephen on the day of his death, which have never been resolved. The tactics at the hearing were to discredit Stephen, painting a picture of a poor individual whose life had hardly been worth living and to discredit us, our evidence and our knowledge of Stephen." Staffordshire Social Services says it cannot comment on the case.

Toni Hunt, 22, a mother of two, who suffered a brain stem stroke, had a DNR order put on her notes at the Norfolk and Norwich hospital. She recovered and although now confined to a wheelchair, leads an active life. She did not learn of the DNR notice until a decade later. She says: "I was very angry they had taken that decision. Although I was not able to speak at the time my parents would never have agreed not to resuscitate."

Daily Mail, 28 April 2000 Written off by doctors, the 100 elderly patients - Campaigners for the elderly have compiled a shocking dossier of 100 cases where doctors have failed to tell hospital patients that they have been deemed not worth trying to resuscitate. These cases, where 'Do not These cases, where 'Do not resuscitate' amounts to 'Do not treat' are believed by leading geriatric care expert, Professor Ebrahim, to be the tip of the iceberg.    He went on to say that disrespect of the elderly was rife among hospital doctors.    A spokesman for the charity Age Concern said "the Government must launch an immediate, independent public inquiry into the scandal ... given the growing body of evidence we are astonished that the Government is not doing anything to address these concerns".    A Department of    Health spokesman said "...the NHS is about saving and prolonging life...".

    

Guardian, 28 April 2000 Call to outlaw medical ageism - Doctors regularly issue "do not resuscitate" orders for patients without their or their families' knowledge, according to a professor of social medicine who is calling for ageism to be outlawed in the NHS. Professor Shah Ebrahim from Bristol University, who wrote in the British Medical Journal today, said there is evidence that doctors allow their prejudices to interfere in the decision as to who should be resuscitated after a cardiopulmonary arrest.    He went on to say that there was evidence "suggesting that doctors have stereotypes of who is not worth saving".    Older people are more likely to be the subject of a 'Do not resuscitate' order than younger people, and research in Europe shows that in over two-thirds of cases, patients and their families had not been consulted. Professor Ebrahim also hit out at the entrenched ageism in the NHS. "Medical students still rejoice in their stereotypes of 'geriatric crumble' and 'GOMER' (get out of my emergency room) patients... Eradicating ageism in the NHS will almost certainly require legislation.

Times, 22 April 2000 Relatives try to halt 'mercy killings' - A group of bereaved relatives claims that the Government has failed to uphold its statutory duty to protect vulnerable elderly patients from doctors who deliberately withhold intravenous fluids to hasten death.    This practice, admitted by doctors and nurses to be widespread, is said to have received tacit approval in many hospitals in order to relieve pressure on NHS beds.    The group's legal action will use the Human Rights Act 1998 to challenge the BMA's guidelines allowing starvation and dehydration of certain groups of the elderly even when they are not terminally ill.

Sunday Times, 16 April 2000 Paramedic tells of hospital leaving pensioners to die - Ambulance paramedic, David Moore of Nottingham, has described how his team resuscitate and rush elderly patients to hospital, only to find that they are left to die on arrival, without even receiving a full medical assessment.       His claim highlights growing concern that hospitals across the country are hastening the deaths of elderly patients by withdrawing food and fluids, mistreating them or leaving them untreated.    "Doctors are just writing these people off.    Often the patients are not even particularly old.    You get people in their sixties and seventies being left on trolleys to die.    We try our absolute hardest to revive these people, but when you get them to hospital they are greeted with indifference. It's terrible."     

Independent, 16 April 2000 Fifty elderly on NHS dossier of death - Damning evidence that hospitals are routinely designating elderly patients as "not for resuscitation" without consent has emerged as a leading charity prepared to hand over a dossier to a government investigation.       Age Concern said that the 50 "do not resuscitate" cases which were reported to them in the course of just two days were the "tip of an iceberg". A spokesman for Age Concern said "Not for resuscitation" orders rarely become apparent because case notes are not easily available and the orders are often written in coded language known only to hospital staff." A spokesman for the Department of Health said "We will not tolerate any discrimination on the grounds of age...".

Daily Mail, 14 April 2000 Fury over hospital OAP's left to die by doctors - The Health Secretary, Alan Milburn, has ordered an urgent inquiry into why hospitals are being allowed to 'write off' the lives of elderly patients.    Milburn was said to be "appalled to discover" that doctors regularly put 'do not resuscitate' orders in patients' notes without their knowledge or consent.    He branded the practice as "unacceptable" following the case of cancer sufferer Jill Baker, 67, whose secret 'do not resuscitate' order was written by a junior doctor who had not even examined her.    Mrs Baker is now in remission and at home. Campaigners claimed that 'do not resuscitate' orders were only one of a host of methods used by doctors to ensure the premature death of elderly patients who require costly, time-consuming treatment.    Other methods include withdrawal of food and fluids and the use of lethal doses of painkillers such as diamorphine (heroin). Dr Michael Wilkes, chairman of the BMA's ethics committee, said

 "Doctors are not deliberately withdrawing care from elderly patients on the grounds of age or resources".    Age Concern said, however, that they hear of several cases each month of elderly patients being written off this way because of a doctor's decision. Sam Ahmedzai, professor of palliative care at the University of Sheffield, said decisions about treatment are written in code so relatives cannot understand them. There are currently five separate inquiries involving the police into involuntary euthanasia in hospitals.

House of Commons Hansard Written Answers, 3 Apr 2000 To ask the Secretary of State for Health if he will initiate an inquiry into age discrimination against elderly patients in the NHS. ( Speaker: Mr. Paul Marsden) Mr. Hutton: Discrimination on the grounds of age within the National Health Service is completely unacceptable. Action is and will be taken to challenge and correct any such unfair practices. The task now is to get on with ensuring this delivers the improvements we intend, so that eliminating discrimination and promoting fair access are firmly embedded as mainstream business for the NHS.

The provision of first class care on the NHS is our priority and later this year we will be publishing the National Service Framework (NSF) for Older People. This, for the first time, will set national standards for the care of older people, driving up quality and reducing the variations. The NSF will include performance measures for monitoring progress. The development of the NSF has involved many groups, including service users and carers, and has included the issue of access to services.

We have no plans however to set up any inquiry. Equal opportunities and work against discrimination must be embedded in our total way of working, rather than being treated as a separate and one-off activity.

Sunday Times, 2 April 2000 Elderly are helped to die to clear beds, claims doctor - The callous treatment of the elderly in NHS hospitals has been exposed by a doctor who claims elderly patients are denied life-saving treatment, are grossly neglected and are given drugs which hasten death. Rita Pal, a junior doctor, said: "I have witnessed doctors who want to keep beds clear by withdrawing treatment or actively assisting in death to the point where it becomes involuntary euthanasia." She also spoke of critically ill patients whose lives were cut short after being given ?unnecessary" doses of diamorphine.

In one case she was so convinced a dose of diamorphine she had been ordered to give would be fatal that she injected it into the patient's mattress. When another doctor saw that the patient was alive the next day, he said: "Oh, she is still alive - didn't you start her on diamorphine?" The patient, suffering from pneumonia, later recovered and left hospital.

In another case, a senior doctor ordered the medication to be withdrawn from an 89-year-old stroke victim who was critically ill and could not speak because he had a plastic tube down his throat. "This man was actually conscious and could hear us," said Pal. "The doctor said, 'We need the bed - stop all his medication'. He obviously didn't think he was going to live. I thought: we are killing someone because we want the beds. Pal disobeyed the doctor and gave the patient drugs to help him breathe. He was transferred to another unit, but later died. Dr Michael Irwin, vice-chairman of the Voluntary Euthanasia Society, said: "My main concern is that diamorphine is being used without consulting patients or talking to relatives. "That is involuntary euthanasia and although we know it happens, we don't know the extent - there are probably thousands of cases each year." Pal is now studying to be a barrister. "I have lost faith in medicine," she said. "There is a code of silence and it's the hardest thing to stand up and say something."   

Sunday Times, 12 March 2000 Revealed: cruelty of staff in NHS hospitals - Shocking inhumanity, negligence and criminality are everyday features of the National Health Service, an undercover investigation at Whipps Cross and Colindale Hospitals has revealed. Members of the parliamentary all-party select committee on health expressed dismay at the revelations. The physical condition of some patients and the lack of care was striking. One man on Bracken ward at Whipps Cross had fluid seeping from open sores on his lower leg. His toenails were gnarled and overgrown and clearly had not been clipped in months. On the same ward an elderly woman pleaded to be taken home. She had soiled herself, but her cries of "please clean me up" were ignored.

Another patient on Peace ward was confined to a wheelchair and unable to speak or communicate because of her condition, she had soiled herself. However, when nurses transferred her to a bedside chair, they made no effort to clean her and she was left in her own excrement for more than an hour. It was clear that nurses struggled to cope in the face of severe staff shortages. But there was also a culture of neglect. Some had open contempt for their patients.One old lady in Colindale complained of abusive treatment by nurses and said: "I've been here for weeks now and the treatment is terrible. But nobody knows what goes on here and I doubt people ever will. Who is there to hear us?"

Sunday Times, 12 March 2000 Editorial: Hospitals that sicken- Hospitals are stressful places at the best of times. Patients require constant attention and medical emergencies are part of the daily routine. Staff shortages and the growing demand for hospital beds have increased over the years and ministers face       a recurring crisis. The latest figures show that nearly 1.2m people are waiting for what they hope will be the best possible treatment in a caring environment. Tragically, that can no longer be taken for granted, as the incidents witnessed by our reporter at two London hospitals show.

They point to an appalling degree of indifference and disregard for the basic rights of patients and confirm our worst fears about declining standards in the National Health Service. We are entitled to expect, however, that no hospital allows its standards of care to fall below an acceptable minimum, that patients are not humiliated and that staff do not exploit the vulnerability of those they are committed to serve. Once the culture of neglect takes over, the nightmare of abuse is not far behind. The lack of respect for the elderly is especially worrying.       More people than ever are living into their seventies and beyond in reasonably good health. But Britain's ageing population will inevitably add to the burden on the NHS and its geriatric services. The scene we report shows a shocking contempt that bodes ill. The government has made great play of its determination to make the NHS fit for the world's fifth-largest economy. No amount of extra cash will achieve that without better hospital management, a caring staff and respect for patients.

The Times, 3 February 2000 Casualty bosses ordered 'cover-up' - Hospitals rigged the results of a nation-wide survey of casualty waiting times by pressuring nurses to "hide" patients, according to the Royal College of Nursing. Following an annual survey organised by the Association of Community Health Councils, the RCN had reports that many hospitals were covering up their problems.

The RCN received phone calls from nurses in more than 18 casualty units complaining that they had been asked to move patients for the purposes of the inspection. "A couple of them were in tears, they were so distressed," Mrs Wilkinson said. "They have been struggling with long waits for patients for so long, but all of a sudden on Monday the senior management arrived to tell them they could not be made to look bad."       Nurses, speaking in confidence, reported being forced to move patients to the wrong ward or rushing patients home, while one hospital opened an empty ward over the weekend to provide temporary relief to casualty. Donna Covey, the director of the Association of Community Health Councils, said that she was very disappointed. "This is yet another example of the cover-up culture that exists in parts of the health service," she said.

Sunday Times, 19 December 1999 Blunders by doctors kill 40,000 a year - Medical error is the third most frequent cause of death in Britain after cancer and heart disease, killing up to 40,000 people a year - about four times more than die from all other types of accident. Provisional research figures on hospital mistakes show that a further 280,000 people suffer from non-fatal drug prescribing errors, overdoses and infections. The victims spend an average of six extra days recovering in hospital, at an annual cost of ￡730m in England alone.

The study shows that one in 14 patients suffers some kind of adverse event such as diagnostic error, operation mistake or drug reaction. Charles Vincent, head of the clinical risk unit at University College London, who is leading the study, has pioneered efforts to examine the extent of clinical errors in Britain.       Vincent believes the death rate may be even higher than indicated by the preliminary figures " It is a substantial problem."       In America, where there have been similar findings, it is likely that a new federal agency to protect patients from medical error will be set up.

Anne Rogers is the victim of one of these mistakes in Britain. Her husband Brian, a father of 10, bled to death after Christopher Ingoldby operated on him for stomach cancer. He is one of 11 patients whose deaths have been linked to treatment by Ingoldby. Pinderfields and Pontefract NHS Trust is investigating 40 other cases of alleged malpractice involving the surgeon, who has been suspended since January. But Rogers said last week: "There is no point in making an example of Ingoldby if they are going to allow another one like him to come and take his place."

Bill Twist, 42, from Essex, lost his wife Sue, 37, through misdiagnosis and delay in treating her malignant skin cancer. "If people are dealt with properly, thousands more could be cured, instead of spending vast sums on litigation and extra treatment for those who are terminally ill," he said.

Graham Neale, former professor of clinical medicine at Trinity College Dublin, who is a leading expert on medical risk management, said: "In Britain outside the weekday hours of nine to five, medical emergencies, which are often the most difficult things to treat, are left to the most junior doctors. "It is disgraceful that nothing has been done. There are far too many errors happening that are nothing to do with NHS understaffing. They are happening simply because we have not examined how to avoid them."

Every year in Britain 156,000 people die from cancer and 140,000 from heart disease. Somebody suffering a full cardiac arrest has a 30% chance of survival in the American city of Seattle - but only a 1%-3% chance in a British hospital. In a confidential inquiry's report into perioperative deaths published last month, doctors admitted that 20,747 British patients had died unexpectedly during operations or shortly after surgery. A study of junior doctors at 20 hospitals in the north of England revealed that 46% admitted they had given a wrong drug or the wrong dose at least once in the period under investigation.

Telegraph, 10 December 1999 Doctors angered by Tory's anti-euthanasia Bill - The row over allegations that elderly patients were left to die in NHS hospitals continued yesterday as Ann Winterton, the Tory MP, unveiled plans to introduce an all-party Private Member's Bill next month that would prevent doctors intentionally bringing about the death of patients, either by deliberate acts or their failure to take steps to keep people alive. Mrs Winterton's Medical Treatment (Prevention of Euthanasia) Bill stands a good chance of making progress. However, her allegation that "euthanasia by another name" was being practised by some doctors infuriated the British Medical Association.

Mrs Winterton said the law had been undermined by guidance drawn up by the BMA this year on withholding and withdrawing life-prolonging treatment in special cases, such as patients in a persistent vegetative state. However, the BMA insisted that its guidance was intended to help doctors make compassionate decisions about treatment at the end of life, for patients with no prospect of recovery.   

Telegraph, 6 December 1999 Elderly Patients 'left starving to death in NHS' - Elderly patients are dying because of an unspoken policy of "involuntary euthanasia" designed to relieve pressure on the National Health Service, said Dr Adrian Treloar, consultant and senior lecturer in geriatrics at Greenwich Hospital.       Sir John Grimley Evans, professor of clinical geratology at Oxford University has written to the NHS pleading for more open data on age discrimination by health authorities. Evidence of pervading ageism is manifested in attitudes of staff, cases of neglect and allegations that elderly people are dying unnecessarily by being left untreated and uncared for in geriatric wards across the country. One member of a health authority in the north of England, who did not want to be named, said "If this is a decision which is being made by trusts about the way we treat the elderly and by doctors who have taken the Hippocratic Oath, then I cannot square that. It needs to be out in the open. If as a society this is what we want to happen and that is acceptable, then so be it. But let's not have it going on behind closed doors.

'People are just being written off by the system' - The testimony of powerless adults who have watched their parents die in hospital wards in pain, discomfort and without dignity is compelling evidence of age discrimination in the NHS. These shocking accounts could be dismissed as anecdote, or exceptional cases, were it not for the experiences reported by doctors. These are backed by research carried out by physicians and various relevant charities. Dr. Mike Pearson, spokesman of the British Thoracic Society, said "People are just being written off. There is a difference between a person's biological age and their chronological age. If you are young biologically, you will do just as well from intensive care whether you are 60 or 80".

They are the forgotten patients, treated as subhuman - Gillian Rooney describes the geriatric ward at the Thanet General Hospital in Margate, Kent, as a dumping ground.  Her 89 year old father, Herbert Baker, had previously been treated on a medical ward and the contrast in the conditions between the two wards was immediate and stark. "When we arrived on the ward we were shocked by the conditions.  The filth and air of neglect were truly awful. Mr Baker's call button was out of reach, and he was forced to lie in a cold, urine soaked bed, and Mrs Rooney believes these unhygienic conditions caused the severe infection which ultimately led to her father's death.

Sunday Times, 5 December 1999 Doctor 'forced' to take child organs - Dick Van Velzen, the pathologist at the centre of the row over the removal of organs from dead children has claimed that he was pressured into taking hundreds of hearts and lungs out to augment collections at Liverpool's Alder Hey hospital. "They had body parts that had been there for decades. I repeatedly expressed concerns about it, but they were brushed aside by the management." He went on to say "I knew it was ethically improper and I told them so. I told them they should get specific parental consent for what they were doing, but the hospital ethics committee decided that wasn't necessary ." Van Velzen has kept a 7in-high pile of documents detailing numerous requests to hospital managers for action to end the organ scandal. He insisted: "I will come to England with all my papers. I will meet any parents, face any inquiry or any court case."

Times, 4 December 1999 Organs 'outrage' triggers inquiry.  Alan Milburn, the Health Secretary, ordered an inquiry yesterday into complaints from parents that Alder Hey Children's Hospital in Liverpool had removed and stored organs from their dead children without consent. The complaints concern the discovery in a laboratory store of 850 organs from dead babies and more than two thousand children's hearts removed during post-mortem examinations. Hospital management claim to be 'devastated' to learn that so many had been retained without the knowledge of the hospital, its doctors or parents. Solicitors acting for 80 of the families, said: "Our fundamental desire is to get to the truth. The parents want to know why and where their babies' organs have been stored, have they been tested, who was aware of this and has there been a cover-up?"  Throughout the country, the practice is thought to have affected 11,000 families over the past 40 years.

Times, 23 November 1999 Children 'put at risk to protect health funding - Stephen Bolsin, the whistle-blower who exposed the Bristol heart babies scandal said yesterday that the hospital had sacrificed young children to protect its funding. He said that the infirmary had continued with high-risk cardiac surgery on babies under one year old "regardless of the cost to patients ... the view was that this was a train and the occasional passengers might fall off, but the train had to keep moving". He also said that he was threatened with losing his job by Dr Wisheart when he first raised his concerns in August 1990. Dr Bolsin's draft statement to the inquiry had suggested that the influence of Freemasonry within the Bristol health community had played a part in frustrating his inquiries, but that section had later been deleted from his final statement.

Woman's Hour, BBC Radio, 22 November 1999 Co-Director of S.I.N.( Sufferers of Iatrogenic Neglect ), Mrs. Gillian Bean, took part in a discussion with Mr. Alan Bedford, Chief Executive of East Sussex, Brighton& Hove Health Authority on the subject of the present NHS Complaints Procedure. Mr. Bedford, who is on the Committee set up in January 1999 by the Secretary of State for Health to review the NHS Complaints System, seemed unaware of the inadequacies of the NHS Complaints System, despite the fact that Mr. Frank Dobson, former Secretary for Health, after oral evidence was heard at the Health Service Select Committee said publicly: "The present system of protecting patients is a bit of a shambles".  For more details please read the open letter recently sent by SIN to Mr. Stephen Thornton, Chief Executive, Confederation of NHS Managers.

Times, 19 November 1999 Family to sue over fatal operation - A mother of two who died when a routine operation went wrong at the Kings Mill Centre in Sutton-in-Ashfield, Nottinghamshire which has been the subject of a number of allegations of poor standards of treatment in recent years. Mrs Herbert's husband and daughters said yesterday that they would sue for compensation after the coroner said he was satisfied that the cause of death was related to the original operation.

Times, 18 November 1999 Hospital staff shortages 'are killing the old' - The National Confidential Enquiry into Perioperative Deaths (Cepod) has found that elderly people are dying after operations because of hospital staff shortages, poor training, and dangerous negligence. A fifth of those who died were put at risk because emergency surgery was delayed by hospital mismanagement. Despite the vulnerability of the patients, they were mostly operated on by inexperienced doctors." An increasingly elderly population does require urgent improvement of skills in this area," said John Williams, chairman of Cepod "At present there is a grave shortage of trained staff who can provide the best care." The report focused on the 1,428 people aged over 90 who died within a month after operations last year, although Dr Williams said the same dangers were likely to apply to those over 70.

Times, 16 November 1999 Stressed doctors 'hate' their patients - Research at the University of Northumbria has found that stress causes two fifths of doctors to become aggressive or violent towards their patients, with 2 per cent admitting to killing someone through negligent care and 8 per cent to making "serious mistakes", although they did not lead to death. Doctors blamed the failings on the levels of pressure they faced in order to pay for the economies that they say have been made by the Government in the health service. Two thirds of doctors report using alcohol to cope with stress and one third of junior doctors suffered from serious stress-related disorders, such as depression or alcoholism.

Sunday Times, 7 November 1999 GPs caught in ￡80m 'ghost' patient fraud - some doctors' lists have up to 5% bogus patients (about 3 million nationally). Ghost patients can be created either when people move to other GPs' practices or die and their names are not removed, or by doctors who intentionally invent names. This is just part of the fraud and mismanagement that is costing the health service up to ￡2 billion a year, and diverting resources away from necessary treatments in hospitals. Other scams include .Top hospital trust executives fraudulently awarding themselves extra salary and bonuses worth tens of thousands of pounds. Hospital consultants claiming full or nearly full NHS salaries while much of their time is spent working in the private sector, some earning ￡1m a year on top of their NHS pay. Doctors' leaders confirmed last week the problem of "inflated" GPs' lists, but the health department said last week that it could not comment on the problem because it had not yet "formally received" the report compiled by the Audit Commission.

Sunday Telegraph, 7 November 1999 Doctors will be sacked in NHS standards drive - Alan Milburn, the Health Secretary, will be setting doctors national standards, with regular inspections backed up by the threat of the sack for the first time in NHS history. Health authorities will get powers to suspend poor performers following scandals such as the deaths of the Bristol heart babies. The aim is to root out lazy doctors who fail to keep up with the latest treatments and good practices, and surgeons who are not proficient. [...but what about all the doctors who efficiently terminate elderly patients? RMG].

Observer, 24 October 1999 Doctors 'blacklist' dissatisfied patients- NHS closes ranks against sick who dare to complain about their treatment. Patients are being blacklisted by doctors and sometimes struck off by their GPs for daring to complain about their treatment under the NHS. Many believe that it is pointless and perhaps even dangerous to use the medical complaints system, described by the former Health Secretary, Frank Dobson, as 'a shambles', because it is so heavily weighted against them. This is set to change when a forthcoming report from the Health Select Committee condemns the NHS complaints system and recommends reforms that would make the procedure independent, and seen to be so. 'It is certainly true that patients are blacklisted by consultants and GPs,' said David Hinchcliffe, chairman of the Select Committee. Now a group of patients have formed a campaign group to fight back. They are called SIN: Sufferers of Iatrogenic Neglect. 'Iatrogenic means being damaged by medical intervention,' explains co-founder Gillian Bean. 'It is not snappy, but then neither is Creutzfeldt-Jakob disease, and people know what that means.' SIN knows of 40 cases where patients claim they have suffered on two counts: through human error and because they have complained and now are blacklisted. 'There is a "not in my back yard" attitude because doctors are frightened of being brought in to a case that often involves very senior members of their specialist discipline,' alleged Bean.

Times, 24 October 1999 Women's breasts removed in cancer diagnosis error - A sample 2,000 out of 75,000 people originally tested for suspected cancerous growths revealed at least half a dozen women may have had breasts removed or been given toxic drug treatment after being wrongly diagnosed.  A male patient appears to have undergone treatment for non-existent bowel cancer. The cases were discovered during a review of screening results made between 1990 and 1995 at the Kent and Canterbury hospital.  Although it is at least six weeks since the cases were identified, none of the patients or families of those concerned has yet been contacted. The Royal College of Pathologists (RCP) was directed to review treatment of other forms of cancer at the hospital after the deaths of eight women from cervical cancer and emergency surgery on another 30 who had been wrongly told they did not have cervical cancer. Three pathologists who were working at the Kent and Canterbury hospital at the time are under investigation by the General Medical Council. Two have since retired.

Times, 21 October 1999 Records of 70 dead patients sought- Northallerton Community Health Council acted, following complaints of injury by over 100 former patients of consultant gynaecologist Richard Neale.       Police are also investigating the deaths of three of Neale's patients following his departure from The Friarage Hospital, North Yorkshire, where he had worked for ten years until receiving a ￡100,000 pay-off.  Neale had been struck off in Canada in the early 1980s after the death of a patient in his care. Last month he was suspended pending a GMC hearing.

Telegraph, 13 October 1999 Patients unhappy at handling of cases against GPs- The Consumers' Association found that most patients who complain about their doctors to the General Medical Council are dissatisfied, feel that they have been treated unfairly and feel the GMC acts more in the interests of doctors than patients. Which? found that 82 per cent were dissatisfied with the process, 79 per cent with the way their complaint was handled, 77 per cent with the support they received and 63 per cent with the way they were kept informed. Patients usually complained about standards of care, rudeness and poor attitude among doctors, and found it unfair that they were not allowed to see the doctor's response to their complaint.

Charlotte Gann, editor of Health Which?, said yesterday: "We are left asking the question whether self-regulation of the medical profession is working in the interests of patients". Complaints to the GMC have trebled since 1993 to 3,000 a year, but the GMC rejected 88 per cent of all cases.     

British Medical Journal, Editorial, 9 October 1999 Stumbling into rationing - A national debate on values is needed to sustain the NHS.  While some countries tackle a problem like the rationing of health care head on - admitting the problem at the highest level, analysing it, declaring their values, and beginning to work on a just, transparent solution - the British deny the problem and nibble at its edges. Surely we can do better.    This government, like the last, avoids the word rationing, but it knows that not everything can be done for everybody. So it has constructed machinery with Orwellian names - health improvement plans and the National Centre for Clinical Excellence (NICE) - to do some of the inevitable job of denying access to effective interventions... If the government wants to sustain the NHS then it needs to engage the public... That engagement might also lead to more resources being put into the NHS.

Times, 30 September 1999 The bereaved daughter of a woman admitted to hospital with a leg ulcer wants her body to be exhumed after a leading expert concluded that she was the victim of involuntary euthanasia. Aged 86, Olwen Gibbings had been heavily dosed with a heroin-based painkiller that can hasten death, and her medical notes were marked "not for resuscitation". "We were told by an independent medical expert that she could have been treated, but no treatment was given. She was not terminally ill. She died from respiratory failure, the result of an opiate overdose. I want her body to be exhumed so hair-shaft tests can be carried out to determine the level of diamorphine in her." The medical expert who assessed the case for the police was a colleague of the doctor at the centre of the allegations; the Crown Prosecution Service then ruled that there is insufficient evidence to prosecute. Within hours of admission, Mrs Gibbings slipped into unconsciousness and was gasping for breath. Her death, on November 6, 1996, was analysed by Michael Irwin, vice-chairman of the Voluntary Euthanasia Society and chairman of Doctors for Assisted Dying, after her daughter, Olwyn Bowen, sent him the papers. Dr Irwin, who supports euthanasia by consent only, said: "I believe that involuntary euthanasia was performed on Mrs Gibbings. Involuntary euthanasia can be defined as ending someone's life who could consent but does not. Such an action is indistinguishable from criminal homicide. Cardiff Royal Infirmary issued a death certificate listing septicaemia as the principal cause of death. Mr Bowen said: "The only thing my mother-in-law was guilty of was being 86. She was written off."

Sunday Mirror, 26 September 1999 A couple who have spent 10 years and almost all their money fighting to find out the truth about their son's tragic death have finally won a review of the case. Detectives have re-opened inquiries and the new Welsh Assembly is under pressure to hold a full inquiry. A parliamentary committee already taking evidence has heard that doctors failed to carry out proper tests, or find out what was wrong, and later resorted to falsifying medical records. In a note to police in April, 1996, Prof Charles Brook of the Royal Free Hospital School for Medicine, said "proper diagnosis and treatment would have saved Robert's life at any time up to his terminal illness." For more information about the circumstances of Robert's death and the subsequent cover-up, please visit Robbie's Story

Guardian, 22 September 1999 Researchers at the Public Law Project heavily criticised the NHS complaints procedure, saying that there was a lack of impartiality, complainants did not get a fair hearing, and complaints against GPs disappeared into "a black hole”. Researchers were most concerned over cases that raised serious questions about doctors' or nurses' performance, conduct or competence.

A copy of this Public Law Project report may be obtained by sending an A4 size envelope (stamps = ￡1.05p) to:

Henrietta Wallace

Public Law Project

Room E608

Birkbeck College

University of London

Mallet Street

London

WC1E 7HX

Times, 19 September 1999 Student nurses at Tolworth hospital in Surbiton, Surrey reported 30 cases of sadistic and inhumane treatment - eight staff have been suspended.  Elderly patients had been taunted, left naked for long periods and one had been forced to eat scalding hot food. Similar allegations of cruelty, followed by suspensions, have occurred at St Ebba's hospital, Epsom, a few miles from Tolworth.       Suspended staff blame staff shortages, hospital managers blame staff for not reporting problems.

Times, 2 September 1999 Police are investigating deaths of over 30 elderly patients at the Kingsway Hospital, Derby. Death by dehydration and starvation has been alleged. Death certificates failed to reveal true cause of death, and case only came to light after nurses reported senior colleagues to police.      

BMA 16 January 1999 Police and health officials are investigating at least 50 deaths of patients around England amid accusations that the deaths were hastened by denying the patients intravenous fluids. The inquiries centre on hospitals in Derby, Surrey, Kent, and Sussex. Most of the inquiries are looking into individual cases, but the Derby investigation is probing the deaths of 40 patients with dementia on a psychogeriatric ward at the Kingsway Hospital between 1993 and 1997. In a number of cases patients were allegedly sedated while denied hydration. A former nurse triggered the investigation in Derby. Three nurses have been suspended since the start of the inquiry in November 1997.

No charges have yet been laid, but staff could face charges of manslaughter by criminal neglect. Papers are expected to go to the Crown Prosecution Service (CPS) in the spring. A CPS spokeswoman said: "We have given advice to the police on legal issues." Charges could also follow the death of an 81 year old woman in a Surrey hospital. Her relatives claim she was relatively healthy but died as a result of dehydration.

Doctor and Hospital Doctor, 7 January 1999 Patients are suffering and some have died as a result of rationing and being denied hospital care in the NHS, doctors have claimed. Of 3,000 doctors surveyed, 20% know patients who have suffered harm and over 5% know of patients who had died as a result of rationing.    Ministers claim rationing is not necessary in the NHS but doctors claim rationing is inevitable.

Sunday Telegraph, 6 July 1997 A Doctor's Right to Lie - In an astonishing Judgement last week, the Appeal Court ruled that the medical profession has no duty to tell the truth to parents of sick children who die. The Judgement referred to the case of Robbie Powell, a ten-year-old child, who died in 1990, from a treatable condition, called Addison's disease. The Judgement was based on the assumption that the Powells' pleaded case would have been proven i.e. that the doctors' negligence had caused Robert's death; that the doctors falsified medical records after death and lied in response to a formal complaint and that these actions had in turn caused Robert's parents psychological damage. Ironically, the doctors were funded by the Medical Protection Society and the Medical Defence Union who both purport publicly to advise doctors to apologise when something goes wrong and claim that patients are entitled to a full and candid explanation of events. In response to the Judgement, Dr Brian Goss of the British Medical Association [BMA] stated, "GPs could now put a gloss on the cause of death without fear of litigation". For more information about the circumstances of Robert's death and the subsequent cover-up, please visit Robbie's Story. Robert's father, Will Powell, comments on the implications of this judgement at www.patientprotect.org/Powell.html

House of Commons Health Select Committee and Legislation . The Committee heard evidence on Elder Abuse in January 2004.The uncorrected minutes include evidence from CHI on elder abuse within the NHS.

The Committee sat during the summer of 1999 and considered the subject of Procedures related to Adverse Clinical Incidents and Outcomes in Medical Care (i.e. Complaints). Minutes of these meetings are available online at the following address

www.parliament.the-stationery-office.co.uk/pa/cm/cmhealth.htm

A response by the Department of Health to the Report of the Health Select Committee (1998-99 session) on Procedures Related to Adverse Clinical Incidents and Outcomes in Medical Care was published sometime in April 2000.  No fanfare, and it was not easy to find (surprise surprise). SIN have written a critique of the NHS Complaints Procedure entitled " The Emperor Has No Clothes" which can be found on the Bristol Inquiry website at: www.bristol-inquiry.org.uk/brisphase2_Responses.htm. Will Powell, of the Bereaved Parents Group, has prepared a press release covering self regulation and its problems, and issued a press release concerning the DOH response

www.patientprotect.org/Powell.html

The Public Interest Disclosure Act 1998 The most far-reaching whistleblower protection law in the world is now on the statute book.       For information on how this new law offers protection to Whistleblowers, please see an extract from       the resource pack produced by Public Concern at Work, which includes a summary of the Act. Public Concern at Work are an independent charity and leading authority on public interest whistleblowing and was closely involved in setting the scope and detail of the Public Interest Disclosure Act 1998.       The Act is still regarded by many, however, as being unacceptably weak. Please check the website at Freedom to Care for further details.   

Meetings . The listing of events and meetings maintained by the King's Fund is excellent, and is at the following address:

www.kingsfund.org.uk/eventlist/default.htm

If there are any other events you would like to announce, please let me know by email at info@patientprotect.org and I will include them here.

Newspapers on the Web Several newspapers are archived and accessible through the web. Registration is sometimes required, but this is usually free, and needs to be done the first time you visit. There is a lot of variation in what can be done. For example, the Times allows you to retrieve back issues by date (so you have to know the date of the piece you are looking for); the Telegraph allows you to search its database for key words. I have found the following addresses useful - if you know of any more, please let me know:

www.telegraph.co.uk

www.sunday-times.co.uk/news/pages/Times/frontpage.html?999

www.guardian.co.uk

   

 

   

  

In the meantime, visit your relative and stay constantly, take pictures and tape any conversations. Note down everything in detail.    That is the key . ehydration can cause death in as little as three days, so it is important to spot it early.    The first effect of dehydration is a sensation of thirst, so complaints about feeling thirsty should be taken seriously.    The depression, confusion and delusions which follow as the dehydration deepens are also important signs which are often assumed by relatives to be part of some natural downhill progression.    One useful test for serious dehydration is t

Bed Sores (also known as pressure sores, decubitus ulcers) develop as a result of lying in the same position for too long. Constant pressure on the same spot reduces the flow of blood to the extent that the skin dies.    If the pressure continues the area and depth of the tissue necrosis increases.    Necrotic (dead) tissue quickly becomes infected and this infection can spread to the blood.    Poor nutrition and hydration increase the risk of bed sores.    The risk of bed sore development should always be assessed and reassessed frequently, and staff who fail to do this or who fail to act appropriately to an assessment are clearly negligent.    Make sure you get to see if the patient's back and heels look healthy.    Staff should routinely conduct an objective pressure sore risk assessment, such as the Waterlow pressure sore 'Risk Score'.    The assessment is very simple to do yourself; just palliative care and heart attack patients. It is injected subcutaneously (under the skin) or intravenously (through a vein). Placing it through a vein makes the drug act faster. Its effects are multiple. Used usually for pain relief, it can also depress respiration thus decreasing your drive to breathe. It also relieves anxiety e.g. in heart attack patients. It is a drug that is useful in heart failure enabling the load of the heart to be less thus relieving the problems of the failing heart coping with a large amount of blood.

It can be prescribed as a PRN (dose) which means as "as much as necessary"(necessary for what?). Being a controlled drug, it has to be signed for two people when giving it. Usual doses are 2.5-5mg. It may be placed in a syringe pump, usually in palliative care,

   

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