NHS negligence – the Sue Marsh case and related personal experiences
May 25, 2012 10 Comments
I was recently directed via various Facebook and Twitter contacts to a post on the ‘A Latent Existence’ blog regarding the case of the disability campaigner Sue Marsh who having gone into hospital for a serious bowel operation was given a post op recovery pain killer (Fentanyl) that she was apparently allergic to and which had the effect of intensifying her post op pain rather than relieving it. This incident occurred despite the facts that Sue was apparently wearing an allergy bracelet, her allergy was notified on her consent forms, and she had agreed with hospital staff that an alternative painkiller would be administered having suffered ill effects from Fentanyl on a previous occasion. According to ‘A latent Existence’, Sue was then left in the recovery room in agony, and despite raising the issue with staff was apparently ignored, her only relief coming when she managed to communicate her situation beyond the hospital via mobile communications to Twitter which was answered by the journalist Sonia Poulton who apparently managed to arrange assistance.
Now shocking as this story is, such lack of care, attention and empathy is something that I have witnessed personally and indirectly affecting different family members on numerous different occasions, leading me to believe that as a problem it is far more widespread than realised. As such in light of the Sue Marsh case I thought I would relate a few stories of my own involving my Father, my Grandfather, my Wife and a close Cousin.
My Dad has unhappily had to suffer a number of painful illnesses over the last few years including angina, a heart attack and pancreatitis amongst others, all of which have involved various stays in hospital during which a number of incidents occurred showing a demonstrable breakdown in care.
Firstly, having suffered from undiagnosed angina for a number of years, Dad suffered a heart attack at 47 years old, upon which he was admitted to the coronary care unit at one of two local hospitals in the area. Generally at the time of my Fathers attack, heart attack patients would be diagnosed and stabilised in this hospitals coronary care unit, and then transferred if necessary to a cardiac unit in Edinburgh to undergo an angiogram and possible angioplasty whereby through keyhole surgery a mechanical catheter is inserted into an artery, and navigated to the cause of the attack, usually a congested coronary artery. Surgeons can then through the use of various miniature tools attached to the catheter including an inflatable balloon, clear the blockage and leave behind a small metallic tube called a stent which permanently holds open the artery and allows blood to flow through it to the heart. Upon successful treatment, patients can be allowed home to recover. At the hospital Dad was in the time from admittance to treatment and getting home was about 3 or 4 days.
However, the cardiac unit of this hospital was overseen by and subdivided patient wise between two coronary surgeons, one of whom at the time of my Dad’s attack was absent taking part in a lecture tour. We were soon to discover that this would mean Dad would be left to languish in his hospital bed watching all of the patients under the other surgeon come in, be treated and sent home to recover within a 3 or 4 day turnaround. Dad was in this hospital for the better part of a fortnight because the lecture tour doctors patients were not being processed in his absence until eventually the other surgeon stepped in. In addition to and during the course of this, instead of receiving swift treatment, Dad suffered a second more minor heart attack because a member of staff made him walk upstairs while the cause of the initial attack (a congested artery) had not yet been treated.
The question arises therefore, while there is nothing wrong with a surgeon giving lectures and being absent, during their time away surely provision should be made to ensure that all patients are cared for properly? The fact was that Dad seemed the only one left without treatment for this period of time, yet upon eventually receiving angioplasty, he was able to return home to recover.
Also at the time of this hospital stay there was a rumour doing the rounds that some patients having been taken by ambulance to Edinburgh for angioplasty in their backsideless hospital gowns were allegedly left to make their way home from Edinburgh by bus or taxi as the ambulance was no longer available to them, though still in their hideous bed clothes, although this thankfully did not happen to Dad. I cannot confirm the validity of this story, but if true it wouldn’t surprise me, and it certainly did nothing to build confidence in the care he was receiving at the time.
The second major illness Dad suffered was pancreatitis, a highly painful condition caused when pancreatic digestive fluid becomes activated in the pancreas, and begins to digest it causing intense abdominal pain and pancreatic swelling. Dad was admitted to hospital a couple of times for this, and on both occasions negligence occurred.
On one occasion late at night Dad was admitted into A&E at the other local hospital which I attended with Mum. We sat with him a good 40 minutes while he was in agony on the hospital gurney. No staff attended the cubicle during this time from the moment he was admitted. Now I could understand this if A&E was packed with patients on a busy night, however on this night it was not; there could not have been more than one other patient if any at all. The place was empty of patients and seemingly staff.
Eventually as the pain got too much for Dad and time stretched on I decided to nose around and see if I could find anyone to attend. I looked round the first corner I came to and found a doctor sitting at a desk casually scribbling notes. I asked him if there was anyone to attend to Dad, and he appeared confused that a patient was waiting to be seen before attending the cubicle. Once roused from his desk he was able to administer some morphine for the pain and at last treatment could begin. It was nonetheless quite shocking that no one in A&E knew Dad was there given he was brought in by ambulance. The next day following a fairly quick though misleading recovery, Dad was swiftly mis-diagnosed, and sent home only to have to be re-admitted through A&E later that night so that they could begin actually treating his illness.
On Dads second pancreatitis episode he was this time taken back to the first hospital in which he was treated for the heart attack, this time for a few days. Initially he was sent to a ward to await diagnostic tests necessitating a 24 hour nil by mouth regime.
Mum and I attended visiting time from work the following afternoon while this regime was in place. It was in fact the hottest and sunniest day of that summer so far, and because the ward faced south it caught the sun all day. Inside the ward was stifling, the windows were closed in Dads cubicle, the curtains were wide open, and Dad was lying in his hospital bed in the full glare of the sun. Nothing to eat, nothing to drink, sweltering in the sun, suffering from severe dehydration and barely able to talk was how we found him that day, an intolerable situation. I couldn’t believe he had been left like this without even a fan to cool him down, although staff had left some damp squabs (pieces of sponge on the end of a cocktail stick dipped in water which were about as much use as a chocolate kettle) so off I went to find the nurses.
I didn’t have to look far, as in a scene I have gotten quite used to over the years of hospital visits, the nurses on duty were not looking after patients, but instead were all sitting around a desk in the ward corridor chatting, well out of sight of patients. On the desk in front of them and around which they were huddled were three desktop electric cooling fans all switched on to cool ‘them’ down as they were obviously feeling the heat. Things were about to heat up a little more when I approached them to complain about the conditions Dad was being kept in, and after a few terse words they eventually took a fan into his room. The thing that really annoyed me was that they were aware of his discomfort, but other than the useless swabs, did nothing. Couldn’t they at least have drawn the curtains against the sun? A shocking lack of patient care and consideration.
A few years later, my Grandmother and Grandfather became ill. Gran was taken to one of the two local hospitals, while Grandad was taken to the other hospital to be treated for a urinary infection. He ended up being in for a long stay as he quickly contracted Clostridium Difficile (more commonly known as C Diff) on the hospital ward necessitating isolation. This seems a quite common hospital infection given that the elderly mother of a family friend contracted the same bug, in the same hospital, in the same ward at the same time . During Grandad’s stay he was in and out of awareness, on some days knowing we were there, on others not knowing. However during the course of his ‘treatment’ he suffered numerous traumatic experiences at the hands of hospital staff.
The first incident started shortly before afternoon visiting time. We arrived to find him not in bed but instead with a ‘nurse’ being fitted with an intravenous drip. The staff nurse sent us to a waiting room until they were finished. Time passed, and after about half an hour we decided to enquire again. What we found was unacceptable. The nurse he had been left with was in fact a trainee, and it quickly became obvious that she was not skilled enough to fit the IV unsupervised, particularly where due to his age the trainee could not find a vein. However rather than requesting assistance, the trainee had just continued to sit jabbing away at his arm with the needle. By the time we found them Grandad although incapable of communicating and likely not fully aware of what was happening was nonetheless in very deep distress and pain, and I can only imagine he was suffering a waking nightmare. It was however only on our intervention that the trainee was removed and a competent medic was called to resolve the situation. What I can’t understand is why a trainee was left to do this unsupervised, and why she did not request assistance sooner rather than just continuing to cause pain and suffering in her failure. As you will see however this wouldn’t be the last time that trainees would be responsible for traumatising family members in this story.
Problems with Grandad’s intravenous drip continued the following afternoon where on visiting we found him in bed, again unresponsive due to illness, but this time with a massively swollen arm due to the fact that the IV drip inserted the previous day had also missed his vein and had been leaking fluid into the surrounding tissue of his arm. Grandad was at his age quite frail, but with the drip working away all night and through that morning, a large quantity of fluid had gathered in the tissue of his arm leaving him looking like Popeye or Arnold Schwarzenegger on one side, a condition which was incredibly obvious, and would have been so throughout at least the preceding morning and possibly through the night given that it immediately caught your eye upon entering the room. Again we went to find a staff nurse who was totally shocked by his condition, but no more shocked than we were by the fact that the problem was so obvious that the only conclusion we could draw was that he had not been checked on at all throughout that day, and had just been left alone in silent pain. The Nurse herself seemed to confirm this as she had no knowledge of anyone having checked on him throughout that morning.
On another day (I can’t recall specifically which day though for the duration of his stay we attended every day) we again needed to ask the nurse something regarding his treatment. We went to the nurses station to find it unattended, so we looked into the surrounding rooms of the ward and could find no one. No one was in attendance on the ward floor. We later discovered that the staff had all gone for their tea break, all at the same time, leaving the ward unattended. Now there is nothing wrong with hospital staff getting breaks, but all at the same time?
Lastly, one of the things that the hospital asked visitors to do on arriving in the ward and leaving was to wash your hands. Throughout the ward were numerous hand washing stations consisting of a pump action bottle of a self evaporating alcohol based sterilising fluid that you rubbed into your hands and allowed to dry off. Fair enough. Except that during the course of that week most of the bottles were permanently empty. In light of growing cases of MRSA, norovirus and other ward infections, and the fact that Grandad was in an isolation ward due to infection, you would think that maintaining these bottles would be paramount. Seemingly not so in this ward.
Hospital Reception Toilets
Special mention must be given to the public reception area toilets in the hospital at the time of Grandad’s stay. On the door was a sign proudly telling you the toilets were cleaned on a rote and regular basis. Yet if you used the toilets you really had to watch your feet as not only were the toilets reeking, there was urine all over the floors, toilet paper scraps lying around the floor in the urine, and generally a feel that the loo’s had not seen a mop that day, never mind at any time within the so called door schedule. Even the door handles were wet which is something I personally despise in public toilets as you have no idea what you are touching, or trailing back out on the soles of your feet! An experience I did not choose to repeat on subsequent visits. Wonder why super-bugs and infections get into hospitals? The toilets are indeed one possible unguarded gateway.
A number of years ago my wife had to attend the hospital in which Dad was treated for his heart attack for a minor day procedure. A number of issues occurred this day.
Firstly on arrival on the way to the day patient centre we passed the hospitals main operating theatre. Outside the double swing door entrance to the operating theatre was a sign stating: ‘These doors must be kept closed at all times’. Imagine our surprise to find both doors off their hinges and lying against the wall, beyond which was a tiled corridor with what appeared to be blood splatter stains on the walls. Nice. Whether the theatre was in operation or not we could not tell, however if it were, then I would hope never to be taken there.
Later that day following surgery and in recovery my wife found no nurses in attendance, no one to bring her anything to eat or drink which she needed following the surgery. Eventually a hospital cleaner working on the ward brought her a cup of tea and some toast. Not a member of the medical team, even though fluid intake was a necessary part of her recovery.
In 1998 Louisa, my close cousin, was admitted to an NHS A&E department with suspected meningitis. Luckily she did not have meningitis, just a run of the mill viral bug. However what she experienced in hospital she may suffer from for the rest of her life. This was not the same hospital(s) mentioned above, but a hospital just outside of London.
Having conducted some preliminary white blood cell tests on Louisa which turned out to be normal, it appeared on the day of the incident that hospital staff were satisfied that meningitis was not in play, negating the need for the customary and highly painful draining of cerebrospinal fluid for analysis by lumbar puncture.
Nonetheless in what appears to have been the exploitation of an opportunity for some student training, medical staff decided to proceed with a lumbar puncture anyway. In this case however rather than the procedure being conducted by a trained doctor, 6 students were unleashed on Louisa.
5 agonising and failed puncture attempts were subsequently made by the students during which time Louisa was bent over on the bed. The proceeding was also conducted in an open and public A&E ward rather than a private cubicle as it should have been. With each attempt Louisa’s pain continued into extremes, and despite her screaming for them to stop, she was pinned down by the students, and her agony continued. Eventually after the fifth failed attempt a ‘trained’ surgeon stepped in.
By this time however damage had been done to the surrounding tissues of the puncture sites, and substantial inflammation had set in. No painkillers, muscle relaxant or other anti inflammatory medicines were administered. Working too quickly to complete the procedure, the trained surgeon then pierced a nerve in Louisa’s spine.
This caused Louisa to go into spasm whereby her entire body convulsed backwards onto the needle. The needle resultantly lodged further into her spine, severing the nerve already pierced. She was then thrown forward by the convulsion onto the bed frame injuring her hips and pelvis. This was of course agonizing, Louisa recounts feeling great pain and a sensation of being electrocuted when the nerve was pierced, something I can attest to having suffered a similar though infinitely more minor incident in a dentists chair where a needle pierced a nerve in my jaw creating a feeling of localised electrocution and fire throughout my lower jaw and tongue. Louisa’s trauma was substantially worse.
Indeed she was left with no feeling in her lower body following the puncture, and was incapable of walking for a while after the incident, something she only recovered from through great effort and determination after having been told by one doctor in recovery that as a result of the incident she would be in a wheelchair by the time she was 30. These were not her only injuries however.
During the convulsion Louisa hit her head on hospital apparatus when rearing up, and suffered debilitating damage to her hips and pelvis on the bed frame as stated. Only in the last year having suffered from hip problems since the lumbar puncture has she finally been diagnosed as suffering from a displaced hip (a femoral acetabular impingement) which it is suspected was caused during the nerve severing convulsion, and which may require additional surgery in years to come.
Following the puncture, Louisa was left in agony overnight; no painkillers were administered which it was suspected was for reasons of keeping the incident off record as the administering of medicines would have been recorded in her records. Things weren’t quite over yet however.
The following morning, Louisa was still in recovery having been placed into a flat bed upon which it had been clearly noted on her bed chart that the bed was not to be raised. That morning however the hospital tea and breakfast lady came round and in complete ignorance of the bed instructions ratcheted Louisa’s bed up to an angle. Louisa ended up suffering a faint due to the resultant pain and more worryingly may have suffered a painful spinal bulge and scarring as a result.
Over a substantial period of time since, Louisa has through intense hydrotherapy, physiotherapy and one to one training slowly recovered as much as she could though still suffers from the incident, including the stated hip displacement. Following the incident and during recovery while she was learning to walk again she sadly lost a highly promising corporate job due to uncertainty over her recovery period (although Louisa does say that her employer was very good about it during the time and she holds no malice toward them). She resultantly found herself spiralling into debt as her savings were swallowed up by medical, transportation and therapy costs and she was forced to undertake loans and overdrafts to cover the shortfall.
Indeed Louisa eventually went into training as a therapist to better understand her injuries and self medicate to keep costs down. Nonetheless she suffered substantial losses, both monetary and physically, including the end to an actual career and a potential career as a professional dancer, something she had worked towards much of her life until then.
Understandably Louisa decided to pursue a compensation claim against the hospital. However in this she encountered an evasive authority, one which sought hard to avoid her claim.
Firstly in order to make a claim, Louisa had to obtain an independent medical opinion on her condition. However incredibly such opinion had to be obtained from a practitioner of the hospitals choosing, and the hospital would be the one to pay for it; a highly questionable closed ranks posture which rings numerous conflict of interest alarm bells. Almost inevitably the ‘independent’ opinion favoured the hospital by arguing that Louisa would make a full recovery, which time has shown to be woefully incorrect. On the basis of this opinion the hospital then fallaciously ruled that Louisa was not entitled to compensation, and even went on to accuse her of lying regarding her condition.
Now it should be stated, a successful clinical negligence claim hinges on numerous requirements including the claimant establishing breach of a duty of care by the hospital, injury or loss caused by that breach of duty, and resultant loss or damage. The fact that a patient should expect a full recover (however false) is not however something that should prevent a successful claim, such issue having bearing only on the quantum of future losses to be calculated. In this case, Louisa had already suffered substantial pain, suffering, and financial expenses loss, and would continue to do so beyond that point as time has shown. It is reasonable to surmise that somewhere in her experiences lay the possibility of a substantial and successful claim.
At the time Louisa enlisted the help of a no win no fee solicitor, but for some reason had to prepare most of the paperwork herself. Not only this but the hospital mysteriously lost all of her medical notes when asked for copies by her solicitor. The solicitor seemingly then failed to argue her case properly and in perhaps relying too much on the hospitals questionable advice and ‘independent’ review, advised Louisa that she should drop the case as it would take years to pursue. In the end a highly unfair offer was made by the hospital in which they would compensate Louisa for half of her expenses up to that day provided she sign a waiver against making any future claims. Louisa by this point suffering from great and ever increasing stress due to her growing debt and ongoing injury acquiesced.
However she continues 14 years later to struggle with life changing injuries sustained during the course of that fateful hospital visit in 1998, and I don’t doubt that you would agree that the entire course of highly negligent and evasive events on the part of the hospital was scandalous and in many ways indefensible.
My thanks to Louisa for agreeing to talk about these difficult experiences.
Much is made today of government financial cutbacks and the effect they may have on the ability of the NHS to provide the levels of care expected. All of the incidents related above however occurred under the former Labour government when the money according to T. Blair (who was always good at delivering the cancer, cataracts, coronary care improvement argument at PM’s questions) was flowing. All of them also occurred not through a lack of funding in my opinion, but through a lack of pure and simple care on the part of the staff involved and a marked lack of any kind of discernible organisation or patient empathy in evidence. I am left to wonder how representative these incidents are of the NHS as a whole?
Many of these issues made me extremely angry at the time. Many of them still do, and I do not apologise for the subjective nature of this article; these people are close to me and these events did happen.
I now personally believe that the incidence of clinical and other staff related negligence occurring in our hospitals could be far higher than is known, particularly where with all of the incidents above excluding that of Louisa, complaints were never made beyond staff on the ward and not pursued as proper claims. Today I regret that to a certain extent, and not for reasons of monetary gain, but from the standpoint that such incidents simply should not happen. I believe that only through visible complaints and action being taken so that the public and media can be made aware of what goes on in our hospitals, can the evasive and apparent couldn’t care less attitude that I and my relatives have experienced be changed.
We pay dearly for these hospitals, and yet to me they are places that I now fear having to attend as in my mind I am gambling on only coming out worse for it. The NHS has the potential to be and has been a great thing in the past. It could and should still be.
Lastly I accept that not all hospital staff fall within the ‘couldn’t care less’ bracket, there are undoubtedly many highly dedicated individuals employed within the NHS whom I would like to think are in the majority. However too many of the ones that I have encountered do fall within the negative bracket, and that is too many. At the end of the day, my family are not so unlucky as to have coincidentally encountered the sole incidences of mistreatment at every turn.
I would be interested to hear the experiences of others.
Mike Farrell-Deveau May 2012