Sunday, 20 November 2011

Liverpool Care Pathway – Putting Names To The Faces And Faces To The Victims

Treating someone as a category instead of as a person.

Classifying someone as a candidate for the LCP places them in a particular category. Once they have been boarded on the bus, it blinkers the conductor’s vision to any other eventuality - that, perhaps, they may have been given the wrong ticket. The Pathway has a predetermined destination which finality cannot be emphasised enough. Fact: Death really is the final finality in life.

There are stories and reports of the LCP being a ‘Lazarus Care Pathway’ but these are cases where the patient recovers despite the treatment recommendations of LCP; what proportion of patients do not recover because of the treatment recommendations of LCP?

These recommendations do not pay attention to the symptoms as they present but actually advise to ‘Avoid Delay & Crisis’ by prescribing, even in the absence of the symptom(s), to pre-empt the predicted appearance of the symptom(s)!*

*(End of Life Care - Symptom Control documents from NHS Milton Keynes)

Intrusions and interventions are also discontinued under these treatment recommendations.

“It is one thing to discontinue an intravenous infusion when the end is imminent; quite another to restrict fluids based on a prediction of how much longer a patient has to live.”

The correlation to draw from this statement is that it is unsafe to withdraw an intervention solely on the basis of a prognostic forecast. Prediction is always a hit and miss affair, as any astrologer will tell you!

Then, how unsafe must it be to proceed with an intervention on the same basis? What are the real statistics? Can we know when outcomes are predetermined by therapy and the ‘therapy’ is to place the person on a Pathway to a predetermined destination which really is a final destination?

This is Mail Online:

My husband had beaten cancer, then doctors WRONGLY told him it had returned and sent him to a hospice who let him die

A grandfather who beat cancer was wrongly told the disease had returned and left to die at a hospice which pioneered a controversial 'death pathway'.

Doctors said there was nothing more they could do for 76-year- old Jack Jones, and his family claim he was denied food, water and medication except painkillers.

He died within two weeks. But tests after his death found that his cancer had not come back and he was in fact suffering from pneumonia brought on by a chest infection.

To his family's horror, they were told he could have recovered if he'd been given the correct treatment.

Pat Jones and her late husband Jack
Death pathway: Jack and Pat Jones pictured about ten years ago. Jack was left to die after
doctors decided his 'cancer' was terminal and stopped feeding him

Yesterday, after being given an £18,000 pay-out over her ordeal, his widow Pat branded his treatment 'barbaric' and accused the doctors of manslaughter.

Mr Jones was being cared for at a hospice which was central to the contentious Liverpool Care Pathway under which dying patients have their life support taken away, although the hospice claims it wasn't officially applied in his case.

The scheme is used by hundreds of hospitals and care homes, and is followed in as many as 20,000 deaths a year.

Supporters say it brings dignity to a patient's final hours, but critics fear that some are placed into it incorrectly.

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.

Misdiagnosed: Jack's widow Pat has been paid an £18,000 settlement
although health bosses refused to admit liability

The only medication he was permitted were painkillers, and he slipped into semi- consciousness without the chest infection being diagnosed and died on January 14.

But a post-mortem examination found he was free of cancer and had in fact died of pneumonia.

Reports commissioned by Mrs Jones's solicitor concluded that with antibiotics and a rehydrating drip he could have made a full recovery and survived for at least another two years.

The hospice and the doctors who treated Mr Jones continue to deny liability, but his widow has now accepted an £18,000 out-of-court settlement after being told she would otherwise lose her legal aid.

Yesterday she said: 'If they'd only treated his chest infection, my husband could well still be alive today.

'We fought in the hospice to get Jack the right treatment and they blocked us, making us feel we were a nuisance.

'I was worried it was pneumonia, I wanted them to check his chest, but they wouldn't.'

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.

One article they published together last year said: 'Futile treatments should . . . be discontinued at this time and consideration should be given to the discontinuation of antibiotics and blood tests.'

Mrs Jones's solicitor, Michael Danby, said: 'This is a particularly sad case as it was entirely preventable. If they had examinedhis chest, they would have diagnosed the infection, and he could have been treated.'

The hospice's lawyer, Dorothy Flower, said it had settled the case to enable Mrs Jones to grieve for her husband, but did not accept liability. 'Some things are done for economic reasons, and a case like this costs a huge amount of money, which would do nobody any good,' she said.

Marie Curie Cancer Care said it could not comment on Mr Jones's case due to patient confidentiality. However, it insists that the Liverpool Care Pathway requires doctors to monitor patients regularly.

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