Monday, 4 July 2011

Liverpool Care Pathway - An Orwellian Newspeak

Continuation sheets:

Section 2: About the incident

What happened? (Please describe what happened. There may not have been one major incident but, rather, a series of smaller things over time.)

PALS have supplied me with this form to pursue a complaint with the NMC. This concerns treatment my mum, Mrs.g gg, received during her brief stay at Caterham Dene Hospital.

Mum went into Caterham Dene on the basis of core care objectives she herself agreed with nurses upon their visit to her home; it was not to commit a seriously ill patient to hospital care. 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.

The steep stairs, noted as such by her GP, Dr gg, had become a hurdle, a barrier, in her daily life, and had confined her to her room for nearly two weeks. This confinement had caused leg weakness and melancholy.

The core care objectives were clear and simple. A brief stay in a small, five-bed ward at Caterham Dene Hospital was recommended which would give her the opportunity to improve her mental outlook and aid her recovery. The nurse said that this wasn’t depression; she was just down in the dumps and needed a fresh outlook.

Whilst at Caterham Dene, they would also look into the persistent back pain her GP had put down to a posture problem, but which a visiting nurse thought might be a hip problem. Dr gg had actually advised upon his visit the day prior to her 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 mum following application of a cream prescribed by Dr gg. This was in remission, but still obstinately hanging on, although the Consultant Dermatologist at ESH, was pleased with mum’s progress at a recent appointment in ESH.

Mum had some catarrh and this was presenting green. gg acknowledged this and said they would, no doubt, give her antibiotics on the ward.

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 to go into Caterham Dene. An ambulance was arranged, most promptly, that very afternoon such that we barely had time to pack her things. We were most surprised.

Upon admission, a bed was already arranged and an x-ray revealed that she had actually suffered two crushed discs. 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 phoned that evening to ask after her, the nurse said that mum had settled in and had asked after me.

On Thursday, mum was alert and communicative. She was off her food but able to feed herself. By next day, everything had changed disastrously. 

Upon my arrival on Friday, I found them moving mum 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 were her last coherent words to me in this life! Mum was in obvious emotional distress at her situation.

The nurse informed me that mum was incontinent with diarrhoea and seemed most upset and flustered by this. This nurse was of stocky build, brusque, and most offhand, as though mum and I were just another inconvenience she could well do without. I am informed that her name was gg, although this is not certain as it is some time ago. I waited outside to permit them to settle mum into her new quarters.

When I returned, gg was still there with a colleague. I noticed mum’s hearing aid was hanging out of her ear and that 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. I drew the nurses’ attention to this fact. They denied all knowledge of how this damage to her hearing aid might have occurred. gg 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.

Mum had been made comfortable in her bed, but appeared insensible. The nurse was giving mum some medicine. To my consternation, I was informed this was morphine. In my presence, gg asked my mother if she would like some more, offering it almost as if it were a treat. 

Mum was clearly confused, incoherent and in a state of semi-consciousness, just grunting responses which could not in any way be interpreted as consent, seemingly, barely aware of my presence even. When I objected that to proceed would be counter to mum’s wishes because mum had always said she wouldn’t have morphine, gg  became hostile and accused me of attempting to persuade mum, against her wishes, to refuse the morphine!

I was most upset. Mum could no longer consciously acknowledge her wishes and I was made to feel I was not acting in her best interests. 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. gg just looked askance and calmly said that she had already administered two doses to my mother. I felt isolated. What do you do when a medical person insists that something has to be done? gg became most belligerent and stormed off. I looked across to the door and saw a member of the ancillary staff, a look of apparent shocked admiration on her face.

I was required to leave because they wanted to change the dressings. When I returned they were still there. They appeared surprised at what they obviously viewed as an uninvited intrusion. I was informed that they hadn’t “started yet,” and this must have been two hours or so later. What they had been doing in the intervening time I could not imagine. I was forced to leave mum once again. In the corridor, I was confronted by another member of the ancillary staff, mop in hand. She met my gaze and, unprompted, commented, “They turned you out.” I nodded in response. She replied, “They do that; they don’t let anyone in there with them.”

We later discovered, to our dismay, that mum’s entire ongoing medication had been withdrawn. This was done 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 had been prescribed paracetamol for her back pain. This had been recently stepped up, reluctantly, to solpadol by her GP. We were later informed that “solpadol and morphine act differently, and are effective for different types of pain.” Dr. gggg prescribed the solpadol for mum’s back pain; for what, then, had the morphine been prescribed in Caterham Dene?

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 agreed core care objectives were all 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 gg put it. Her condition, though chronic, was not dire or perilous. Mum had only recently attended an appointment with Dr gg, Consultant Dermatologist at ESH in regard to the skin condition. Dr gg 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. This is from
“The simple answer is that morphine and other opiates can hasten death in anyone, but particularly children or the elderly.
Opiates are very effective pain killers, but as a consequence can also cause sedation and reduce breathing. This combination can be lead to death, and is particularly important when given to a patient who already has compromised respiration such as through a chest infection.”
Mum 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! I made persistent calls, in utter desperation, to the District Nurses’ office. 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.

Nurses permitted mum’s BP to drop such that she presented cyanosed overnight on the Saturday and did nothing. No antibiotics were prescribed for her chest infection. I received a call early on Sunday morning to say mum 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. 

An hour later, we received another call. We were informed that Thamesdoc were unavailable to attend and so they were going to summon an ambulance to take mum to ESH.

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 by way of explanation at the very apparent bruising upon her.

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The Response of the NMC:
"We are not empowered to undertake a general investigation into the performance or conduct of unnamed individuals at a particular institution or organisation where it is said that there have been general failings on the part of that institution or organisation or its staff in general."

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