NHS and Government Contacted 10/7/09

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This letter was sent to Gordon Brown M.P., Dept. of Health lots of M.P.'s, other interested parties and latterly, the Doctors involved in the case.

I am writing to you with the hope that you can help me, and help any poor soul that comes to the end of their life on an NHS Palliative Care Ward.

My father died three and a half years ago in anguish after having received shambolic care on the Palliative Care Ward of the Northern General Hospital, Sheffield.

I have gone through the NHS Complaints procedure correctly but some serious questions remain unanswered.

After emergency admittance to the A. & E. Ward on Saturday 12.00 noon 7th January 2006 my father unknowingly to us was ressuscitated (the Nurse never told us and I only found out once I has obtained the medical notes). They had done this when there was a clear DNR order in the medical notes. He then began to receive morphine and midazolam injections whilst on the MAU ward where he was cared for ‘par excellence’notwithstanding the fluctuations of the adminstering of medication. (see Case Points 7/1/06-11/1/06)

At 2.00a.m. on the 9th January 2006 a syringe driver was set up containing 10mg morphine and 10mg midazolam over 24 hours with prescription prn (extra morphine and midazolam) as required.

At 18.00p.m. on the 9th January 2006 14 hours after the set up of this syringe driver which contained 10mg. Morphine and 10mg. Midazolam he was transferred to the Palliative Care Ward.

From 18.00p.m. on the 9th until 8.10a.m on the 10th he needed 6 ‘top ups’ of his prescribed prn – given by a very caring nurse on night duty. (My father kept getting agitated every couple of hours but this prn afforded him some more restful periods where he was relaxed and able to talk to us.) The medical notes state the he ‘was agitated, breathless and in pain’ throughout that first night on the PC Ward.

The Treating Consultant did a round at 10.30a.m 10/1/06 with a group of students.
The syringe driver was still holding 10mg. morphine and 10mg. midazolam and had been in place for 32 ½ hours, during this time he had NEEDED extra prn.

(I am now led to believe that this really should have indicated to the Consultant that the syringe driver strength should have been increased to take into consideration the amount of extra morphine and midazolam that had been required).

A change of staff in the afternoon of the 10th January 2006 brought about a change of care!

The nurse, who had just come on duty and said that she had not read the notes, refused to give any ‘top up/extra’ medication. My father was becoming increasingly restless and agitated. He was crying out in anguish and pain. This afternoon nurse also failed to pad him, as had previously been done (he was bleeding rectally due to his terminal leukaemia) and he ended up laying in blood and urine. He also wet the floor and my elderly mother wiped this up while the nurse and assistant nurse watched on and did nothing to help and they did not even bring a mop and bucket afterwards to disinfect the floor!

On the change of staff at around 9.00p.m. 10/1/06, the kind and caring staff of the previous night returned. Without being asked by us they noted his agitation and immediately resumed his prescription prn. (He was agitated in the same way during the afternoon but no prn had been allowed.) The syringe driver still held 10mg. morphine and 10mg. midazolam – it had now been in place for 43 hours.

The Medical notes written by this night nurse at 6.15a.m. on the 11th January, 2006 state that ‘Tom very agitated, very restless and in pain had to have a lot of prn, request Drs. review medication.’

This nurse on commencement of her shift also changed his bed, padded him up at the back and fitted a convene to his penis – she was caring and kind.

At 7.30a.m. on the 11th January, 2006 I arrived on the ward, (my mother had let me sleep on in the visitors room instead of what had been our couple of hours rotational rest periods) my father was pulling at the bed sheets with tears coming down his face. (The syringe driver still only held 10mg. morphine and 10mg. midazolam and had been in place for 53 ½ hours).

I went to the nurse’s station and 2 seemingly young ‘trainee’ nurse’s said they couldn’t do anything and that we would have to wait until the Dr’s did their rounds. They could not give me a time for this.

Not knowing what to do I went outside and called my father’s G.P on my mobile phone.

A Junior Dr. arrived changed the Syringe Driver to 20mg. over 24 hours and 1 hour later my father died in my arms.

My daughter, who had been present on the afternoon of the 10th, wanted to disclose the affair to the Press. I, with hindsight, naively thought that by writing to the Treating Consultant, this matter would conclude satisfactorily and that the uncaring nurses would have at least been disciplined.

How wrong was I.

I have had to keep to timescales over this matter. The NHS have not.

I now have 9 explanations as to why my father was not given his prescribed prn on the afternoon of the 10th January, 2006 and again around 8.00a.m. on the 11th January, 2006.
All of which do not resemble each other in any way.

The Healthcare Commissions Report of the case said that ‘seeing as there wasn’t any prn Breakthrough Medication given on the 10th the amount of Morphine and Midazolam in the Syringe Driver was low in the circumstances’.The Report also made recommendations for the ‘Trust’ to implement in the future.

I could then have gone to the Press at this point but went perhaps misguidedly down the Legal route. The NHS has failed to reply to numerous letters from my Solicitor and the matter was heading out of the timescale for which I paid to extend that time limit. It will finally run out on the 14th July, 2009.

On the 10th June, 2009 I was offered an appointment with my Solicitor, a Barrister and the Medical Expert (presently working for the NHS in Leeds) who had been employed to write a Medical Report for me. This Report turned out to be farcical.
Firstly the Expert had not been sent the full Complaints file - as this had not been disclosed by the Defendant NHS Trust - and so she did not address the events of 10/1/06 and 11/1/06.
Originally when questioned about this report, the Expert sent an amendment letter to my Solicitor setting out some further comments which contradicted points made in her Medical Report!

At short notice my husband and I travelled from abroad where we were on holiday and once in the UK travelled by car to Barnsley in order to meet with the Professionals in ‘Conference’ and finally get some answers to our questions. The Medical Expert had, unknowingly to us, decided not to come along but joined us by telephone.

The first question to her was ‘You say that the ‘gap’ in prn on the 10th coincided with the set up of the Syringe Driver, but in your report you state that the Syringe Driver was set up at 2.00a.m. on the 9th, 36 hours previously’ to which the ‘Expert replied ‘I am not in Court, I do not have to answer these questions’.

This Expert gave some varying explanations as to possibly why prn had not been given, but
my Counsel, Solicitor and myself agreed that if any of these were the reasons why prn was withheld, the Treating Consultant that I had written to in the first instance on 21/1/06 should have explained this.

The Treating Consultants original explanation was that she had asked my father a string of questions that made her concur with the nurse that he did not need any prn and indeed that my father didn’t want any more medication. This is not true of course; my mother, my daughter and myself were there at the time. My father was very deaf due to haemorrhaging in the ears and when I finally obtained the notes they were truly a revelation.

On admittance onto the Palliative Care Ward at 18.00p.m. on the 9/1/06 the Medical Notes state ‘Tom too ill to have discussion with staff’.

(N.B. A spokesperson from the Sheffield Hospital Trust said about the matter in the Sunday Telegraphs piece 5.7.09 ‘When asked by a Doctor (14.00p.m. 10th) Mr. Milner ‘indicated’ he was not in pain and therefore the doctor agreed with the nurse that further medication was not required’. He also said that ‘staff acted appropriately and within professional guidelines’. The ‘Bozo Line’ SEE RANGE OF STANDARDS UNDER CASE POINTS ON TOMSANGUISH.COM (measure of acceptable ‘professional standards’ shows how the standard doesn’t have to be that high/great. It goes somewhere to explain why the Treating Consultant wrote (16.2.06) saying that ‘We will be able to reflect on your father’s case and hopefully improve our service in the future’.)

The Medical Notes of the 9th and 11th state that my father WAS in pain.

The explanations, excuses and many other discrepancies that have come to light during the past 3 ½ years would make a screenwriter proud.

i.e. In a letter from the Trust dated 24/3/06, it states ‘The Staff Nurse said that if he became agitated she would give him some more medication’.

The Medical Notes actually say ‘His wife was giving him some mouth care – Dandelion and Burdock – I (nurse) explained that this intervention was sufficient to make him comfortable and he did not require prn medication’

Needless to say I have pages and pages and pages of these ‘discrepancies’.

Such as in the same letter from the Trust dated 24/3/06 it states’ From the records, the doctor on the morning ward round assessed his additional medication and increased the dosage in his syringe driver’.

The Medical Notes actually say ‘9.00 call from Mr. Milner’s G.P. to let me know his daughter had telephoned her very concerned that her father was uncomfortable and would like a doctor to review him’.

In an ‘Incident Report’ made by the nurses sometime after my father’s death signed by the nurse who had
admitted him to the Palliative Care Ward, which states ‘in my opinion Tom did not require any prn as he was not agitated’.

The Medical Notes actually say, written by this nurse,
‘Tom very agitated, in pain needed oranmorph and further prn of Morphine and Midazolam’.

Integrity is lacking when the treating Consultant on this Palliative Care Ward replied to me in her first letter dated 16.2.06 stating that ‘The nurse on night duty felt he was comfortable when she entered her notes a 6.15a.m. on 11/1/06’.

The Medical Notes 6.15a.m. say, ‘Tom very agitated, restless and in pain. Needed a lot or prn. Request Dr’s review medication.

NO WONDER THIS CONSULTANT TRIED TO BLOCK ME FROM OBTAINING THE MEDICAL NOTES.

So after 3 ½ years I have come to the conclusion that there is a protectionist regime within parts of the NHS. Things went terribly wrong due to the fact purely and simply that the nurse on duty on that fateful afternoon really did not have any ‘Bedside Manner’. She obviously was ‘put out’ when my mother said she had been a nurse 30 year’s prior and that things had changed. Her attitude was made clear to us when she said ‘I’m in charge here’.

Added to this it is now apparent that the Syringe Driver should have been increased and the Consultant Doctor failed to take into account the amount of extra Morphine(6 x 5mgs.) that had been given prior to her round on the morning of the 10th. during the previous 17 hours whilst my father had been on the Palliative Care Ward.
She failed him by not allowing titration of the syringe driver and by allowing it to only hold 10mgs. Morphine for it’s duration 55 hours in all.

However I am wholly disgusted with the apparent lack of integrity of the ‘Medical Expert’ who has taken her lead from the NHS Correspondence, the Medical Notes - which also have 18 essay like pages added on after my father’s death - which amount to more ‘notes’ than were written in the time my father was alive and being looked after at the Northern General Hospital.

These 18 pages are degrading remarks about me and my family and refer to us as being ‘drunken bag ladies’. My father’s G.P who helped in the end has kindly supplied me with my mother’s medical notes that state clearly that my mother is TEA TOTAL!
(I had commented on a full alcoholic drinks trolley placed outside a room set out for a meeting. I was told it was for patients – but in the 40 hours on that ward I had never seen this trolley before only at 8.00a.m. on the 11th outside a Conference Room! Perhaps this gave them the idea (hook) for their ‘post mortem’ entries into the Medical Notes that could be entered into the ‘Booker Prize’ Competion.)

A spokesperson at ‘Elderabuse’ has said that ‘this is normal’. When the NHS has made a mistake they make personal attacks on the family.
As indeed was reported in the Sheffield Star a little time ago, where the staff alleged that an Irish family of a patient, had threatened the staff with the IRA – this was retracted when the staff had been made aware
that a solicitor present said ‘nothing of this nature had been said’. The Legal representative of the Hospital said there had been a ‘misunderstanding’!

The Medical Expert, whom we had employed, said she was the Leading Expert in pain management and had been there from the start of Palliative Care in 1987.

She dismissed the findings of the Healthcare Report.

In her Report she said that my father was probably ‘toxic on morphine’ and that is why he wasn’t given his top up medication on 10/1/06 (although there is no clinical evidence of this).

In her amendment letter she said that the lack of prn on the afternoon 10th coincided with the start of the syringe driver. (The syringe driver was set up 36 hours earlier).

Lastly in Conference by phone with myself, my husband, my Solicitor and my Barrister together, she said that ‘he shouldn’t have been on morphine at all’.

So she has put a cap on all legal proceedings which may had brought this uncaring team to book.

www.sin-medicalmistakes.org in a recent meeting I attended at the House of Commons where my fathers case was discussed.

WE WERE NEVER LOOKING FOR MONETARY COMPENSATION WHICH WE HAVE MADE CLEAR THROUGHOUT IN OUR CORRESPONDENCE WITH THE ‘TRUST’.
I JUST WANTED CANDOUR AND TRANSPARENCY AND PERHAPS AN APOLOGY.

I have been billed by this ‘Medical Expert’:
£920 for the Medical Report produced on the wrong documentation disclosed by the Defendant Trust.
£670.83 for and add on letter which contradicts the original Medical Report.
£575.00 for attending a ‘Conference’ via telephone where she said that she ‘I don't have to answer any questions, I am not in Court’.

If only I had known of the BBC Report on the Sheffield University research programme into Palliative Care which concluded 6 months prior to my father being admitted to the Northern General Palliative Care Ward – I would certainly have thought twice before allowing transferral onto that ward. This BBC Report stated ‘Elderly denied dignified death. Inherent age discrimination in NHS Palliative Care services prevents many older people from having a dignified death’.

http://news.bbc.co.uk/2/hi/health/4575641.stm

It is a great shame that the uncaring attitude and behaviour of some medical professionals, either Doctors or Nurses, and their lack of integrity puts the whole NHS into a bad light. But unfortunately there is a LOT OF ROT in the system.

When we went to see my father laid out later, the Nurse
who had refused to give my father his prescribed morphine was sat at the Nurses station and I said ‘You denied my father his medication’ SHE JUST GRINNED AT ME!

This is a system that should be working for us the Taxpayer, a system that my father had paid into all of his life, a system that let him down at the end of his life just when he needed it!

One day WE may need this ‘service’ and it needs improving immensely.

I will now strive for Medical notes to be written in numbered booklets so as to STOP the tampering/altering of them.

I think CCTV would be a good addition to any Geriatric or End of Life Ward (as are in use in some wards at the moment).

I think also a photograph of the elderly should be on the bedside cabinet to show that these people were once young and not always as they may have ended up!

God help us all and shame on them. Perhaps it is now time to let the Press get involved.

Yours faithfully,

Copies sent to:
Lady Finlay of Llandaff - who replied 'Lessons must be Learnt' from my fathers case!!!
Gordon Brown P.M. - referred me to the Department of Health who in turn referred me back to the Sheffield Hospital
David Cameron Conservative Leader - Will reflect on our story
Nick Clegg Lib Dem Leader - Replied that he would bear my father's case in mind for future Lib Dem Health Policies
Various Ministers and Shadow Ministers of Health
Various Ministers within the Health Committee and other interested parties.

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