Liverpool Care Pathway - A 'Legal' Euthanasia.

We’ve been following a complaint ever since 2007 about the treatment my mum received that resulted in her death.

Letters sent to the District Nurses Office to determine what had transpired were actually returned ‘refused’ by Royal Mail and the person to whom we had written and who had offered help transferred, or was transferred, elsewhere.

It soon became plain to us that there is a policy at Caterham Dene Hospital where her life was taken to make no great effort to intervene to preserve life, to ‘let them go’ and even to ‘help them on their way’. That is why there was no effort at all by nursing staff, as is now admitted, to monitor mum’s status. This was not as a result of a failure in the nursing procedure, however, but adherence to hospital policy.

We said this repeatedly, over and over, but, rather than comment or, you would think, dismiss our allegation, they chose, simply, to ignore it. This is, surely, euthanasia after all and euthanasia is still not legal in this land. Only now have we discovered it is not ‘euthanasia’ but the Liverpool Care Pathway and that, apparently, is legal!

Mum was taken from us these three and a half years ago. It was Thursday 19th July 2007. How vividly and how well I recall that Thursday morning. A nurse from the District Nurses Office had invited two specialist nurses to my mother’s home. The first arrived a half-hour early, accompanied by her daughter who was present on work experience. The second followed not long after. It was all so jovial, so happy, so promising, so positive. Mum was quite taken by all the attention. I joked that there were not two but two and a half nurses present. That appeared to provide some amusement.

My mother was not suffering a terminal illness of any sort by any standard except that set by those who actually view old-age itself as a terminal illness. Although, at 92 years young, mum fell well within that category. Mum went into Caterham Dene on the basis of core care-objectives she herself agreed with the two and a half specialist nurses upon their visit to her home that day; it was not to commit a seriously ill patient to hospital care.

These core care-objectives were clear and simple. A brief stay in a small, five-bed ward at Caterham Dene Hospital was recommended. This would give her the opportunity to improve her mental outlook and aid her recovery. A flattering description was made of this small hospital, apparently, more akin to an old-fashioned cottage hospital. This would also permit me to prepare the room downstairs while we awaited delivery of the motorised recliner chair/bed already placed on order.

Mum had been becoming more dejected by the day. Heidi confirmed my own concern in that regard but remarked to mum that this wasn’t depression; she was just down in the dumps and needed a fresh outlook. She was feeling that way wasting away in her bedroom. She needed a more positive outlook, uplifting. The steep stairs, noted as such by her GP, had become a hurdle, a barrier, in her daily life, and had confined her to her room for nearly two weeks.

Whilst at Caterham Dene, they would also look into the persistent back pain her GP had put down to a posture problem, a result of inactivity, but which a visiting nurse thought might be a hip problem. He advised, upon his visit on the day prior to mum's consignment to Caterham Dene, that I assist her in walking about the room to get her posture back into shape.

They would also continue to treat the bullous pemphigoid that had recently afflicted her following application of a cream prescribed by another Dr. from the same practice. A new regime was also suggested to, finally, deal with the last vestiges of the Pemphigoid. This was in remission, but still obstinately hanging on.

Mum had some catarrh and this was presenting green. This was acknowledged and it was said that they would, no doubt, give her some antibiotics on the ward. It was also agreed that her leg weakness was a result of her confinement to her room.

It was decided that these would be the treatment goals in Caterham Dene to remedy her situation. On that basis, and that basis alone, mum agreed. An ambulance was arranged, most promptly, and I accompanied her to Caterham Dene that very afternoon.

Upon admission, a bed was already arranged and an x-ray revealed that she had suffered two crushed discs. So much for her GP who, clearly, could not diagnose a drunk in a brewery. Mum was made comfortable in her bed and I left her there with high hopes, looking forward to my visit the following day. When I rang that evening to check on her, I was told that mum had actually asked after me and that she was comfortable. What followed was a cruel betrayal of expectation and trust.

On Thursday, mum was alert and communicative. She was off her food but able to feed herself. By next day, everything had changed disastrously. On Friday, they had moved her into a side room. She was, at best, described as confused, but she imparted to me that she didn’t like them in there; those words were her last coherent words to me in this life!

By Saturday, mum was completely insensible. I could not believe it. The nurse to whom I spoke on Friday denied any knowledge of the agreed core objectives. My mother was in Caterham Dene, she said, because she could not be cared for at home. The treatment prescribed by the specialist nurse was wrong and would not proceed. The core care objectives were disregarded and denied. This was more than a betrayal of trust; this was a Breach of Duty to respect the patient’s wishes.

My mother went into Caterham Dene, ostensibly, for two or three weeks respite care; fundamentally, this was to ‘cheer her up’ as the nurse had put it. Her condition, though chronic, was not dire or perilous. Mum had only recently attended an appointment with Dr Nazir, Consultant Dermatologist at ESH in regard to the skin condition. Dr Nazir was pleased with my mother’s progress, not considering a further appointment necessary until September 2007. That is all the more reason, then, to wonder at my mother’s sudden decline and demise at Caterham Dene.

Within the space of just two days, she was reduced to a condition of complete, vegetative unresponsiveness; by the Saturday, she could not feed herself and was unable even to lift a beaker of orange juice to her lips. I am not certain that she was even aware of my presence as I spoon-fed her her meal!

Her pain killer, prescribed for the back condition, had been replaced by morphine. Morphine is noted for having such effects as sedation and producing extreme confusion, and particularly so in the elderly. I protested that my mother had always insisted she would never have morphine and expressed my concerns that, in an elderly person with a weak heart, the administration of morphine could lead to heart failure. The nurse just looked askance and calmly said that she had already administered two doses to my mother.

In my presence, the nurse asked my mother if she would like some more morphine, offering it almost as if it were a treat. My mother was clearly confused, incoherent and in a state of semi-consciousness, just grunting responses which could not in any way be interpreted as consent, barely aware, as I have said, of my presence even. When I objected that to proceed would be counter to mum’s wishes, the nurse became hostile and accused me of attempting to persuade mum against her wishes to refuse the morphine!

We subsequently discovered that my mother’s entire ongoing medication had been withdrawn, without our knowledge, and replaced with morphine, again, commenced without our knowledge. We were not even aware that this was a nurse driven hospital and that there was no doctor present at weekends.

Mum’s hearing aid was hanging out of her ear and the tube had been damaged. This would not have been at all helpful in the very necessary communication process to make her wishes clear and understood and yet it was insisted that she had assented to the morphine. Additionally, all knowledge of how this damage to her hearing aid might have occurred was denied. It was even suggested that it may have occurred in the ambulance transport to the hospital but I had to maintain that the ambulance personnel were both most particular in their care.

In the Healthcare Commission report, it is stated that, “solpadol and morphine act differently, and are effective for different types of pain.” Solpadol was  prescribed for mum’s back pain. For what, then, had the morphine been prescribed in the Dene? Explanation has been sought and demanded, but none has been offered.

The requirement upon Caterham Dene made by the PCT to apply new guidelines regarding analgesics demonstrates that what I saw to be the case was indeed the case. My mother was dosed into a condition of utter insensibility. I could not believe it. I actually could not believe the condition they had reduced her to in such a brief space of time, a matter of mere hours! Hence the persistent calls I made in utter desperation to the District Nurses’ office throughout her brief incarceration. I truly believed that they would pick up the calls on the Monday and we could get her out of there. I never believed they could possibly dispose of mum in the space of just one weekend.

In the Healthcare Commission report, the nursing adviser refers to poor nursing practice and there is an admission that the medical notes kept are inexact and slapdash, not to be trusted and not to be relied upon for their accuracy. It must be significant therefore that, following the Healthcare Commission report and the PCT’s review, recommendations were made in respect to the administration of analgesia that Caterham Dene were required to put in place!

The Commission’s GP advisor expressed concerns about “undated entries being entered on to the wrong notes” and cast doubt upon the accuracy of blood pressure readings. These are damning words which cast into actual doubt the validity of the medical evidence! Lack of care and attention to properly and accurately maintain the written record constitutes a negligence which directly threatens the well-being and safety of the patient.

What record is there of administration and dosages of analgesics? How much morphine was my mother plied with to reduce her to that state I found her in? Was there proper care and attention to accurately maintain the written record in that regard? Given the slackness to record the detail in other regards, it is fair to surmise there was slackness in this. The Commission expressed concern that no ‘learning has been identified’ by the Trust.

The nursing sister took me aside and spoke to me in her office upon the day of my mother’s admission. She asked me, if anything should happen – not that it would! – do I want them to have my mother moved to ESH. I thought nothing more of that. Yes, of course I do! That went without saying. In the context of what we now know, that all makes sense.

They permitted my mother to present cyanosed on the Saturday and did nothing. I received a call early on Sunday morning to say she was suffering from heart failure and that they were getting the doctor. Still unaware of the reality of the situation, we thought they were actually getting the doctor on the ward. No, they had called Thamesdoc! This we discovered an hour later when they called us again. Thamesdoc were unavailable, they said, and so they had called an ambulance! Excuse me?

To recapitulate: We were not aware, had not been informed, that this was a nurse-led hospital and that there was no medical doctor on site at the weekend. My mother had presented cyanosed, been left to deteriorate to a catastrophic life-threatening condition - and they called Thamesdoc. Only after an hour of fruitless waiting for Thamesdoc to attend and following Thamesdoc's failure to attend did they decide to summon an ambulance!

My mother actually perished halfway between Caterham Dene and ESH, paramedics ramming tubes down her throat in frantic, vain attempts to revive her. This was reported to me in A & E in explanation of the very apparent bruising upon her person.

It is a duty incumbent upon every medical person to protect life and to do no harm. And yet, it is now plain to us that there is – or was - a policy set in place at Caterham Dene to make no great effort to intervene to preserve life, to ‘let them go’ and even to ‘help them on their way.’ That is why there was no effort at all by nursing staff, as is now admitted, to monitor my mother’s status. This was not as a result of a failure in the nursing procedure; they were following policy in not doing so, to permit nature to take its course and even to lend it assistance.

Our suspicions - we now know - were correct: that policy was - and is - set in place. The Hippocratic oath has been thrown out the window  in favour of the blind, tick-box dictats of the Liverpool Care Pathway!

Sign to ban this scandal now.