Wednesday, 14 October 2009

If Only Harold Shipman Had Waited A few More Years...

...he could have terminated those elderly nuisance patients with no comebacks:
Mr Jones, a retired bricklayer with two daughters, was diagnosed with stomach cancer in May 2005. After undergoing chemotherapy, he had his stomach removed by surgeons at Royal Liverpool Hospital that September.

He was told he was in remission from cancer, but the grandfather of two continued to suffer pain following the operation as well as difficulties in eating, and on January 3, 2006, he went to the city's Marie Curie hospice for respite care.

While there, however, his family were told the cancer had returned by Dr Alison Coackley, a palliative medicine consultant who played a key role in drawing up the Liverpool Care Pathway.

Despite the fact that no tests were carried out to confirm the diagnosis, his family say doctors instructed nurses to stop giving him food and fluids.
He died. Not of cancer. Of pneumonia.

And his widow has accepted an £18,000 legal settlement because if she continues her court action, she risks losing her legal aid.

Get you coming and going, don't they?
Mrs Jones and the family want to know whether her husband was treated under the Liverpool Care Pathway.

She added: 'Jack was the life and soul of the party. He was a true gentleman. As far as I'm concerned, his death was manslaughter. It's barbaric and I don't want any other family to go through what we've had to.'

The 75-year-old, of Childwall, Liverpool, plans to report Dr Coackley and another doctor to the General Medical Council. Dr Coackley, 45, worked with Professor John Ellershaw at the hospice in Liverpool at a time when he was heading the writing of the LCP policy.
I wish her luck, but I think we all know just how useless the GMC is, don't we?

23 comments:

Rob said...

"Care pathway". Or starving people to death, as an honest person would describe it.

No "Death Panels" in the NHS. The British people are roused into a patriotic fervour over an institution which does this.

The country is insane.

Clarissa said...

The cynic in me has always wondered if the authorities debated between prosecuting Shipman for murder or rewarding him for his initiative in cutting costs...

Sounds as if it would have been the later if only his MO had been different.

Fat Hen said...

What I find amazing is that there are not a lot more dead doctors and social workers who got their comeuppance from the people they kill, rob and persecute...

We don't jail killers and other toerags anymore(or if we do it's more of a formality than a real punishment), so how long before Joe Public realises that it's actually a free-4-all and those that are prepared to mete out maximum grief & trouble get left alone by the pesky jobsworth who are too lazy to deal with difficult cases that would mean they'd actually have to work instead of loaf'n'lord?

People already have very little left to lose, and the way things are going, we'll soon have DIY justice in many spheres of life.

(you realise we haven't heard of another Tony Martin case for a long time? Why is that then... -- no-one breaking into farmhouses anymore? Or perhaps, could it be, that people are not stupid enough anymore to call the cops to mop the resulting mess up?)

Sue said...

That's just so cruel. How on earth can people who swear an oath to help the sick behave that way?

MrAngryman said...

FFS The Liverpool Care pathway does not advocate starving people to death. It is used to minimise all invasive treatment that would otherwise prolong an inevitable death. It should be initiated by a Consultant with agreement from another senior doctor, and the reasons why they are placing the patient onto the pathway should be clearly documented in both the medical notes and on the pathway documentation itself.

This sounds like a terrible error where a patient was misdiagnosed and died as a result. Unfortunately it happens, you pray to god that it isnt your loved one, Doctors are human and make mistakes unfortunately unlike someone who misprices something at tescos when Doctors get it wrong someone dies.

I imagine that all the medical and nursing staff involved in this tragic case are constantly revisiting this.

The liverpool care pathway is a valuable tool to be used in the last stages of a patients life and is an evidence based tool. However it is only as good as those who use it and if the initial diagnosis is wrong then its clearly inappropriate.

The LCP was set up to give Medical and Nursing staff some guidance on how to care for those at the end of life and to help ease the suffering of the dieing patient. It seeks to minimise intrusive and painful interventions and provides a framework to enable medical and nursing staff to allow the patient to die with dignity.

This case is a horrible error and the medics and nurses will have to account for this. It is not evidence of some plan to kill off old people.

Im sorry if i ramble its just i feel that its important that the LCP is seen for what it is.

JuliaM said...

"No "Death Panels" in the NHS. The British people are roused into a patriotic fervour over an institution which does this."

Indeed. Where's our Sarah Palin, to begin to rouse people against this?

"The cynic in me has always wondered if the authorities debated between prosecuting Shipman for murder or rewarding him for his initiative in cutting costs..."

Maybe that's why he got away with it for so long?

"What I find amazing is that there are not a lot more dead doctors and social workers who got their comeuppance from the people they kill, rob and persecute..."

Me too. Usually, in a TV drama, a serial killer targetting doctors and nurses would be the villian of the piece. How long before he's the hero?

"How on earth can people who swear an oath to help the sick behave that way?"

I'd like to think it's because they really believe, deep down, that they are 'caring' for the sick.

But I suspect a lot of them are well aware that in reality, they are caring for the NHS budget instead...

JuliaM said...

"This sounds like a terrible error where a patient was misdiagnosed and died as a result."

That's exactly what it is. Is it an isolated case?

Well, no.

"This case is a horrible error and the medics and nurses will have to account for this. It is not evidence of some plan to kill off old people."

As we can see above, and to quote the old saying, 'Once is happenstance. Twice is coincidence..'

If there's a third case (and this publicity may well bring it out), we should feel free to consider it 'enemy action'.

"Im sorry if i ramble its just i feel that its important that the LCP is seen for what it is."

Me too, MrAngryman. Me too...

JuliaM said...

"This case is a horrible error and the medics and nurses will have to account for this."

Read the story at the link. They will not have to account for this action. The widow was forced to halt her legal action due to lack of money.

Not one of the doctors or nurses involved will see as much as a warning letter, I'll be bound...

MrAngryman said...

Julia, do you have any idea of how many people the NHS treats in a year? How many of them are cured and get better with no ill effects? You highlight three tragic incidents and whilst they do have something in common, they do not represent a policy of trying to finish off old people.

The LCP is useful in giving nurses and medics the framework to say enough is enough and allowing the patient to die, pain free and with as much dignity as possible. The aim is to spare the needless interventions which merely prolong the inevitable, and cause pain, discomfort and distress to patients and their relatives. The LCP gives guidance so that invasive procedures are kept to a minimum, (Observations are not carried out so as to minimise disturbance to the patient) medications that will have no effect are discontinued, again to minimise the disturbance and pain to the patient, analgesia, and anti emetics are prescribed as routine, along with a sedative (if required) and also an antimuscarinic to prevent secretions so as to alleviate choking, or drooling. Intravenous fluids are or are not discontinued dependant on the patients overall prognosis and the likely timescale of death. This is very much up to the individual clinician.

This tragedy has little to do with the use of the LCP and more to do with the misdiagnosis of the patient in the first place.

The Doctors involved will perhaps have seen many such cases and will have made an error. a tragic mistake, as i have stated earlier mistakes in the health service have much bigger consequences than mistakes in Tesco's.

Im not here to slag off your comments i merely wish to point out that this case is a tragedy and i feel some small degree of shame that this can occur in the NHS, however i feel that the LCP has nothing to do with this particular issue and this is a case of misdiagnosis.

JuliaM said...

"Julia, do you have any idea of how many people the NHS treats in a year? How many of them are cured and get better with no ill effects?"

'The NHS: We don't kill all our patients!'

That's some advertising slogan...

"Intravenous fluids are or are not discontinued dependant on the patients overall prognosis and the likely timescale of death. This is very much up to the individual clinician."

There's the problem, then. It should be up to the patient (having made a living will) or the next of kin.

"Im not here to slag off your comments i merely wish to point out that this case is a tragedy and i feel some small degree of shame that this can occur in the NHS..."

Do you? I feel a huge amount of shame that we can allow death by starvation and dehydration by unaccountable public servants in what purports to be a civilised country.

Anonymous said...

MrAngryman, "The LCP is useful in giving nurses and medics the framework to say enough is enough"?? Give me a break. That's what's wrong with this.

Reducing this to a bureaucratic process, a set of rules to follow and boxes to tick, might make the nurses and doctors feel better. After all, they can console themselves that it wasn't their decision - the "Pathway process" told them what to do. The Pathway is for the benefit of medics, not patients.

Decent doctors don't need written rules to tell them when to let a patient go.

Anonymous said...

Want a third case? http://www.telegraph.co.uk/health/healthadvice/maxpemberton/6139668/Liverpool-Care-Pathway-The-decision-to-withdraw-treatment-from-a-patient-is-an-incredibly-complex-one.html

MrAngryman said...

Julia and adam do either of you have any clinical experience? Have either of you sat their at the end of a bed whilst relatives pray that the suffering of their loved one ends? Have either of you you talked to the soon to die and asked them of their wishes? The death by dehydration angle is bollox if the tool is used properly. All the LCP does is allow medics to stop all the extraneous shit that can cause pain or discomfort in the dieing.

IV fluids are poorly absorbed by patients who are in the final stages of death, they add strain to the heart and can cause excess fluid to accumulate in the tissues (causing pain or ulceration) or end up on the lungs causing the patient breathlessness and causing more pain and discomfort. In the worst case scenario it causes pulmonary oedema and actually can hasten death so how is this a benefit? Would you rather your loved one was kept comfortable and their symptomology controlled and they died peacefully holding your hand or would you like them to die leaking from all their tissues rattling and coughing themselves to death?

The LCP is not a beurocratic exercise, it is evidence based researched by experts, peer reviewed and is a useful tool if used properly. It was implemented NOT because nurses and doctors wish to off as many patients as they possibly can, but because they as professions are so shit at saying enough is enough. As professions they are not good enough at withdrawing treatment when it is warranted and are very good at continuing no matter what. This tool allows Doctors and Nurses the framework to stop treatment when it is warranted.

I say again this has fuck all to do with the LCP and more to do with a misdiagnosis of a patients overall condition. It is tragic and i have no doubt that we should be shocked and angered by this however the LCP has nothing to do with it and mistakes do happen.

Again im not here to cause trouble but i fundamentally disagree with you both in this respect. I do agree that this was a horrific death and in a modern society this should not have happened.

Anonymous said...

MrAngryman, see my blog to find out whether I know what I'm talking about. http://adamcollyer.wordpress.com/

JuliaM said...

"Julia and adam do either of you have any clinical experience?"

I don't require clinical experience to know right from wrong. Or bravery from cowardice.

"The death by dehydration angle is bollox if the tool is used properly. All the LCP does is allow medics to stop all the extraneous shit that can cause pain or discomfort in the dieing."

Except of course, as you pointed out in your post at 18:18, it requires them to load up the patient with other drugs to ease the problems brought on by dehydration and starvation, and make it easier for the medics to rationalise it away as causing no suffering.

Well, hell, if they are so concerned not to cause suffering, and so certain of their diagnosis, why not administer a lethal injection? Why take this cowards way out, so they can comfort themselves with the fact that they aren't the gause of death?

Why not be honest with the public?

"I say again this has fuck all to do with the LCP and more to do with a misdiagnosis of a patients overall condition."

It has EVERYTHING to do with the LCP. Because we now have several cases where the LCP has been used inappropriately. And we'll have more. Mark my words.

"Again im not here to cause trouble but i fundamentally disagree with you both in this respect. I do agree that this was a horrific death and in a modern society this should not have happened."

But in any society run by humans and governed by budgets, this sort of thing is inevitable.

JuliaM said...

And one final point: you ask 'Have either of you sat their at the end of a bed whilst relatives pray that the suffering of their loved one ends?'

Well, as Adam says, you can check his blog to see his experience, and I trust you'll draw the right conclusion from that.

Me, I've watched a friend die from cancer, and noone would have been agreeable to starving and dehydrating her to death.

If you think I have a downer on the NHS and medical staff, well, you may be right. For the past two weeks my father has neen in our local hospital (not with anything fatal, thank god - unless he's caught something while in there) and as my mother doesn't drive, I've been taking time off work to driver her there and get their shopping.

I have witnessed mostly incompetence (not issuing antibiotics for his diagnosed chest infection because 'they weren't available on the ward', not issuing him his heart pills, leaving a cannula in for four days until his arm swelled up like a balloon), lots of miscommunication (he's coming out today - no, he's not) and my mother has heard the stories of all the other patients relatives while she awaited pickup. Still, she was entertained by a chap playing a grand piano in the foyer, which was somewhat ironic as she's just witnessed a stand-up row between the ward sister and the matron over lack of staffing...

You claim that the NHS will not use this LCP to save money. Yet only a few months ago, the papers were in uproar over the fact that elderly people with macular degeneration were left to go blind in one eye before treatment.

So, what makes you so sure? It can't be past experience. Can it?

sandra said...

If I may interject here
The Mr Jones concerned was my father.

It was indeed a case of misdiagnosis that lead to him being put on the pathway and consequently euthanazed.

But the salient point is, we knew it was a chest infection and begged the doctors concerned to put him on a drip and antibiotics.

They refused, because, 'nothing can help him now'.

we asked every day for a week, untill he died.

The doctor who refused us and made the mis diagnosis was Dr alison coackley.

She helped devise the liverpool pathway
Her paper, The terminal phase.
written with john ellershaw is the seminal work on entering the pathway

a small quote.......


Barriers to diagnosing ‘dying’
• Hope that the patient gets better
• No definitive diagnosis
• Pursuit of unrealistic/futile interventions
• Disagreement about the patient’s condition between
members of the multi-professional team
• Failure to recognize key symptoms and signs
• Lack of knowledge about prescribing
• Poor ability to communicate with family/patient
• C oncern about withdrawing/withholding treatment
• Fears about shortening life
• C oncerns about resuscitation
• C ultural and spiritual barriers
• M edico-legal issues



she rail roaded my father onto her precious pathway. Ignoring all her own recommendations and the loud protestations of myself and my mother.


My concern is, If Alison Coackley isn't capable of diagnosing an obvious chest infection.
Is she really capable of designing and implementing a nationwide program for diagnosing dying ?

Anonymous said...

Can you get in touch with Louise please over the liverpool care pathway Review whitewash....https://www.facebook.com/Against.Liverpool.Care.Pathway Ellershaw ought to be ruddy struck off....

Who Let Binding and Hoche back into Medicine???? said...

re the neuberger whitewash....apparently those drugs dont kill when administered by a trained palliative care specialist (ho ho) ..anyone want to put in a class action for a health and safety complaint over the lack of training? https://www.facebook.com/Against.Liverpool.Care.Pathway

Anonymous said...

My son aged 41 was deliberately killed.

Anonymous said...

Well said Fat Hen I thought I must have been the only one to think that this might be the only shake up these people might finally understand.

Anonymous said...

Well said Fat Hen. I thought I was the only one who thought that this would be the only way to get through to these 'people' after my wife was deliberately killed and then my son. Different MO each time same catastrophic result.

Anonymous said...

Lord Denning said the same thing as well. If the people don't get justice eventually they will take it.