Liverpool Care Pathway – An Oft- Recurring Theme..?

From The Sunday Times - May 25, 2008

When Edna Purnell was referred for “gentle rehabilitation” at a local healthcare unit after a hip replacement operation, her family thought she would be given exercises to get her back on her feet and sent home after a fortnight.

Instead she was put to bed in a darkened room and put on a regime of morphine within a day of her arrival. Less than a month later she was dead.

From the NMC complaint letter - November 12, 2009

My elderly mother went into Caterham Dene, ostensibly, for two or three weeks respite care…

While 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…

On Friday [within a day of her arrival], 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 there; those were her last coherent words to me in this life!

Her pain killer, prescribed for the back condition, had been replaced by morphine…

Within the space of just two days, she was reduced to a condition of complete unresponsiveness…

From the NMC complaint letter - February 01, 2011

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 at the hospital. No, they were calling Thamesdoc! An hour later, another call revealed that Thamesdoc were unavailable and so they had called an ambulance.

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 cyanose, been left to deteriorate to a catastrophic life-threatening condition - and they called Thamesdoc. 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.

 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 lend it assistance!

Letters sent to the District Nurses Office to discover 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.

As is borne out by testimony of the correspondence documents, my mother was subjected to actual harm both by action and by inaction at crucial points in her treatment, or rather mistreatment. By negligence, incompetence, malpractice or by design, this did cause her to suffer and to perish at their hands. And if they have nothing to hide, why - counter to all commonly accepted standards and contrary to the sources which we have cited – do they persist in denying us this most basic and fundamental knowledge of the names of these persons at Caterham Dene to whose charge she entrusted her well-being – and her life?

Accordiing to PALS, this ‘policy set in place at Caterham Dene’ is the Liverpool Care Pathway.