Liverpool Care Pathway - A Continuing Risk

The newspaper article here reproduced is referred to in Dr Rita Pal's reply below. It is taken from the Sunday Times:

Elderly are helped to die to clear beds, claims doctor 

Mark Macaskill and Jon Ungoed-Thomas

2^nd April 2000 

THE callous treatment of the elderly in NHS hospitals has been exposed by a doctor who claims patients are denied life-saving treatment, are grossly neglected and are given drugs which hasten death.  Rita Pal, 28, a junior doctor, was so disturbed by her experiences that she is leaving the profession. This week she will submit a dossier to the General Medical Council (GMC) detailing the cases of abuse that she saw.  "I have witnessed doctors who want to keep beds clear by withdrawing treatment or actively assisting in death to the point where it becomes involuntary euthanasia," she said. She wants the government to set up an independent inquiry. Among the cases which Pal witnessed were:  ·  A doctor who ordered the withdrawal of life-saving medication of a dying patient after stating that the hospital needed beds.  ·  A diabetic patient in her nineties who was deprived of basic medical attention after a nurse commented, "She will die anyway."  ·  Critically ill patients whose lives were cut short after being given "unnecessary" doses of diamorphine, which is commonly known as heroin.  ·  A doctor who, when told about a patient dying from a liver complaint, said, "Well, he is over 60", and made no effort to administer medical attention. Pal, from Sutton Coldfield, West Midlands, trained at University College London. She joined North Staffordshire hospital in 1998 and worked on two general medical wards - each with about 40 patients. In her first month, a senior doctor ordered the medication to be withdrawn from an 89-year-old stroke victim who was critically ill and could not speak because he had a plastic tube down his throat.  "This man was actually conscious and could hear us," said Pal. "The doctor said, 'We need the bed - stop all his medication'. He obviously didn't think he was going to live. I thought: we are killing someone because we want the beds.  "They stopped the medication and at about 9.30pm he started getting short of breath. I held his hand and said, 'You will be all right'. I was sickened by the whole episode."  Pal disobeyed the doctor and gave the patient drugs to help him breathe. He was transferred to another unit, but later died. The doctor, whose name is known to The Sunday Times, declined to comment last night.  Last week one of the man's relatives said: "I think the NHS is atrocious. I don't think they care about old people."  Another elderly woman, who was diabetic, was also allegedly neglected after being admitted in November 1998. She was in danger of dying if her blood sugar went too high, but the nurses failed to monitor her properly. "She was incontinent and they wouldn't even clean her up properly," she said. "I must have asked the nurses at least 10 times to monitor the blood sugar. One nurse said, 'She will die anyway'."  In January 1999, Pal took up a new post at Selly Oak hospital. Although she said ward conditions were better, she was disturbed at the liberal use of diamorphine, which eases pain and is used to treat heart conditions but can also hasten death.  In one case she was so convinced a dose of diamorphine she had been ordered to give would be fatal that she injected it into the patient's mattress.  When another doctor saw that the patient was alive the next day, he said: "Oh, she is still alive - didn't you start her on diamorphine?" The patient, suffering from pneumonia, later recovered and left hospital.  "The doctor ordered that she be given the drug without examining her and I felt his decision was based on her age," said Pal. "I think diamorphine would have killed her because it would have reduced her respiratory rate. The doctor thought she was going to die anyway, but days later I saw her sitting up and putting on her lipstick."  Pal also encountered alleged abuse of diamorphine at North Staffordshire. On one occasion a female patient died after being given what Pal considered an unnecessary dose. "She was dying, but I think this was speeded up," said Pal. "This was involuntary euthanasia."  Her disillusionment with the NHS grew after she failed to save the life of a patient admitted to Worcester Royal Infirmary with internal bleeding after being discharged prematurely. She feared the patient was bleeding to death as he lay on a trolley in accident and emergency, but none of the staff available had the necessary expertise to treat him. The patient started to vomit blood, but there was no intensive care bed available.  When she contacted a senior member of the medical team, the doctor said: "Well, he is over 60." The patient was subsequently given the necessary treatment but died after being transferred to another hospital.  Pal is now studying to be a barrister. "I have lost faith in medicine," she said. "There is a code of silence and it's the hardest thing to stand up and say something."  One doctor who worked with Pal said she had raised legitimate concerns about the use of diamorphine. "It's the question of where you draw the line between relieving pain and terminating life," he said.  Dr Michael Irwin, vice-chairman of the Voluntary Euthanasia Society, said: "My main concern is that diamorphine is being used without consulting patients or talking to relatives.  "That is involuntary euthanasia and although we know it happens, we don't know the extent - there are probably thousands of cases each year."  Dr Nigel Sykes, a consultant in palliative medicine at St Christopher's hospice in London, said: "I have seen patients overdosed with diamorphine so it certainly happens, but I don't believe it is done wilfully."  The cruelty and inhumanity of treatment meted out to some elderly patients in the NHS was exposed two weeks ago by The Sunday Times. An undercover investigation by a reporter in two hospitals revealed that patients were not receiving proper medical attention, were left in soiled clothes for long periods and were routinely neglected. The article prompted a deluge of letters from readers.  Pal's most serious allegations are made in the context, she said, of a health service which is in "disarray" and routinely failing its patients.  Pal, who was regularly working 16-hour days, admits her own supervision was so inadequate that in November 1998 she nearly killed one patient who was suffering from a serious gall bladder infection.  After failing to contact more senior doctors, Pal gave the woman a drip because of her falling blood pressure. The young doctor was, however, so inexperienced that she gave the patient too much fluid too quickly which "tipped" her into heart failure. The woman recovered, but died days later.  Last week North Staffordshire hospital said Pal's allegations will be "taken seriously and fully investigated".  Andrew Reid, medical director of University Hospital Birmingham NHS Trust, which includes Selly Oak hospital, also said Pal's allegations would be investigated if she provided further details. A spokesman for Worcester Royal Infirmary said the liver patient Pal saw had been discharged "inappropriately" but, when readmitted, received the specialist treatment he required.