Tuesday, 2 August 2011

Liverpool Care Pathway – Apology Is Policy

We visit my mother's grave throughout the year, but this 22nd July was four years to the day this dear lady was taken from us. We went to pay our respects, to celebrate her life and to mourn her death at the hands of staff at Caterham Dene Hospital.

There is much explaining to do. This lady was sharp and attentive, as the two and a half Specialist Nurses, Heidi (and her daughter, present on work experience) and Diane, may testify. In Caterham Dene, she was taken off all ongoing medication; they broke her hearing aid and reduced her to a condition of utter stupor. She was so laced with morphine she could neither talk nor order her thoughts to think and died of heart failure. 

Such semi-comatose condition in an elderly person already targets them for terminal diagnosis and conveyance onto the Pathway.

I must clarify for those who have not read previous posts and reiterate for those who have that my mother did not leave this world at Caterham Dene. They waited until the point was reached that death was inevitable and only then decided to telephone Thamesdoc before phoning for an ambulance one hour later upon the non-attendance of Thamesdoc. At least, whatever may be in the written record, an hour elapsed between the two telephone calls they made to me and I actually arrived at East Surrey Hospital A & E before the ambulance, and was present when they brought her in already dead.

The nurses at Caterham Dene had been permitted to administer the prescribed dose of morphine as they thought fit. The Trust had to require Caterham Dene, on the Commission's recommendation, to change this.

Upon our arrival at Caterham Dene, I was taken aside into an office and asked, in the event of anything happening - not that it would – do I want them to move mum to ESH where there are emergency facilities available? What a peculiar question to ask. It makes no sense to ask such a thing except in the context of a policy being set in place at Caterham Dene to let them go and actually help them on their way. As now confirmed by PALS, that is the case, and that policy is called The Liverpool Care Pathway!

At the end of life’s road, what is there up ahead, just around the turning? Should that make a difference? It is enough to know our lives are finite and that we must submit to the call when it comes. In many cultures, the old are afforded a pride of place, not merely as a courtesy but as a right. And when our old ones have attained the age of respect, what then?

When our old ones have outlived their usefulness, cheapened to nuisance and ridicule, borne more as a burden than seen as a resource of experience; when they are fading in body and mind, how comforting to know they may be conveyed to Hospital and Home where the signs may be sought and looked out for to enable a diagnosis of ‘dying’ to be made. How reassuring that their elder years already stand them in good stead for such a diagnosis to be made and that they may be put on this pathway to death and pass peacefully from this world and from our lives, without trauma or too much trouble and inconvenience.

How nice to know that our elders are not pressurised to take their own lives to make it easier for their families and may, instead, be consigned to such a NICE-approved setting.

In many cultures, the old are valued. And in ours?

The fact is that this dear lady's life was not worth a jot. When it became quite clear that we could not obtain justice through the complaints process, we approached a number of solicitors. We were told, quite plainly and simply, that it was all about money. Loss of future earnings was zilch and mum had no dependents. The three days of suffering at Caterham Dene was but a trifle and all she was worth was the cost of her funeral expenses. The case was not financially viable enough to proceed with. It may sound callous, they told us, but that was the way it was. Well, they were honest with us, at least, which is more than can be said of the liars and deceivers in the NHS.

From correspondence:

I also asked you to confirm – or deny – that it is within the remit of the PCT to conceal facts, that is, to lie by omission rather than by commission. I asked that you please respond to this clearly and unequivocally and without benefit of double-talk? I ask you now, once more, is it within the remit of the PCT to conceal facts and to lie?

These questions were not answered; they were simply ignored.

One such solicitor actually confided to us that, in her own experience, this sort of thing is not uncommon in the NHS and a culture has developed of nurses taking it upon themselves to determine quality of life and put people down like pets at a veterinary surgery! She made these comments in response to our account of what occurred at Caterham Dene.
 The use of CDS across the UK is far from uncommon.  
Clive Seale, professor of medical sociology at Bart's and the London School of Medicine and Dentistry

Nurses are no longer Angels of Mercy; they are Angels of Death.

But is this ‘diagnosis by death’, euthanasia, or - murder?

Dr Philip Harrison, a GP now based in New Zealand, set out his concerns recently in the British Medical Journal, following the death of his father in Doncaster Royal Infirmary.

"There was no reason on earth why he would have wished to have been put to sleep, unless he was obviously distressed or agitated or in pain.

"But there was no evidence he was in pain at any stage during his admission."

Dr Harrison, who has long experience in palliative care, decided not to sue the trust - but he did try to get reassurance that it couldn't happen again.

Despite an apology he is still not satisfied.

"I have never seen that in my medical practice before. I've seen euthanasia once, but I've never seen anybody being put to death without consent."

"I don't know what the legal term is but to me it was as near to a form of murder that I had come across," he said.

Despite apologies and assurances that learnings have been taken, we are not satisfied!

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