Sunday, 14 October 2012

Liverpool Care Pathway – The Evidence Continues To Stack Up

This is the Liverpool Care Pathway in action -

"'I couldn’t understand why they assumed she was going to die so quickly'"
"Mr West said his wife told him: ‘I have fought this far. Why would I want to die now?’"

Here is the MailOnline -

MailOnline - news, sport, celebrity, science and health stories
Cancer mum denied chance to say goodbye 'because doctors did not try to keep her alive': Grieving husband says she could have lived another two years

Mother-of-six Andrea West, 35, went into palliative care centre last month
But she died within days of being admitted for what was a 'routine infection'
  • Her husband Chris had found her labelled with 'do not resuscitate' notice
  • This was against the wishes of her family, who wanted to prolong her life



The family of a 35-year-old mother who died under NHS respite care have accused doctors of  making no attempt to save her life because they assumed she was dying anyway.

Andrea West was suffering from cancer but had been told she could live for a further two years.

But the mother of six died within days of being admitted to a palliative care centre last month with what her family thought was a routine infection.

Tragic: Andrea West who passed away at Priscilla Bacon Lodge in Norwich, Norfolk, with son Honiahaka
Tragic: Andrea West who passed away at Priscilla Bacon Lodge in Norwich, Norfolk,
with son Honiahaka

The day before her death last month, she had been looking forward to going home, chatting with her children, eating crackers and drinking cola, her family claim.

But when her husband Chris visited her the following day he found her heavily sedated.

When he urged unit staff to send her to hospital for treatment, they refused – saying she would only die in the ambulance.

Mr West had already become concerned about his wife’s treatment after finding she had been labelled with a ‘do not resuscitate’ notice. 
    The notice, which meant she would not be revived if she suffered a medical crisis, went against the wishes of Mrs West and her family, who were desperate to prolong her life so she could spend precious months with her children, aged between one and 17.

    Yet Mr West said he and his wife had to ask five times to have the notice removed.

    After her death, Mr West claims he was told by a nurse and his GP that despite being expected to live for at least 18 months, his wife had been put on the Liverpool Care Pathway, the controversial system designed to ease the suffering of the dying in their final hours.

    Last night the clinic denied that Mrs West had been placed on the LCP.

    Marriage: Andrea West, pictured on her wedding day in August 2006 with her husband Chris
    Marriage: Andrea West, pictured on her wedding day in August 2006 with her
    husband Chris

    But the case will reignite debate over the treatment of those who are believed to be dying.

    Thousands of patients are placed on the LCP every year, which some medics say leads to the premature deaths of more than 100,000. Mr West said: ‘Andrea had a lot of things she wanted to do for the children. She didn’t get a chance to say goodbye to them.’

    'Andrea had a lot of things she wanted to do for the children. She didn’t get a chance to say goodbye to them'
    Chris West
    The Norfolk Community Health and Care NHS Trust, which runs the unit where Mrs West died, declined to give further information on the case before Mrs West’s inquest. The LCP was devised in the 1990s and involves the heavy sedation of a patient and the removal of tubes providing food and fluid.

    However its use was criticised in the summer by a senior consultant, Professor Patrick Pullicino, who told a medical conference that nearly a third of NHS deaths now involve patients on the pathway.

    He said a decision to put a patient on the LCP has become ‘a self-fulfilling prophecy’, adding that ‘factors like pressure on beds and difficulty with nursing confused or difficult-to-manage elderly patients cannot be excluded’.

    Mrs West, who had two children from a previous marriage and four – aged seven, four, three and one – with her husband, was diagnosed with cervical cancer in January last year which later spread to her lymph nodes.

    Andrea West Collect picture of Andrea West


    Mother-of-six: Mrs West (pictured left, and right with other people at her wedding), had two children
    from a previous marriage and four - aged seven, four, three and one - with her husband

    Her husband said she had been given between 18 months and two years to live. Mr West, a former care worker who now looks after his children full-time, said a nurse had advised him last month that his wife should be admitted to Priscilla Bacon Lodge in Norwich for palliative care. 

    PLAN FOR THE DYING: THE LCP

    The Liverpool Care Pathway was devised in the city in the 1990s to make the dying as comfortable and free of pain as possible.
    It was recommended to hospitals across the UK by the National Institute for Health and Clinical Excellence in 2004.
    The Pathway is designed to come into operation when doctors believe it is impossible for a patient to recover and death is imminent.
    Patients on the pathway are sedated with drugs and deprived of nutrition and hydration by tube.
    On average a patient will die 33 hours after entering the pathway.
    Critics of the system claim it is increasingly being applied to patients without their families’ knowledge.
    ‘I believed she had an infection,’ he said. ‘She had had the same symptoms in the past with infections. I didn’t think it was serious at all.’

    Mr West and the children visited Mrs West on September 19. ‘She was active, cheerful and looking forward to going home,’ Mr West said. ‘She spoke to her children, she was eating cheese and crackers, and she was drinking Coke with lemon.’

    However, he said, his wife was concerned because she had been told doctors had placed a ‘do not resuscitate’ notice in her notes. Mr West said his wife told him: ‘I have fought this far. Why would I want to die now?’

    However, he said, it took five requests from himself and his wife before medics removed the DNR notice. The following day, at 6.30am, Mr West was phoned by nurses to be told his wife had been bleeding and vomiting. He was, he said, told she was likely to die that day.

    ‘I couldn’t understand it at all,’ he said. ‘I couldn’t understand why they assumed she was going to die so quickly.’ On arriving at the unit he said he found that his wife had been heavily sedated and no tubes for artificial hydration or nutrition had been connected.

    Sad case: Her husband said she had been given between 18 months and two years to live
    Sad case: Her husband said she had been given between 18 months and two years to live

    He said he was later told she had been placed on the LCP. ‘I asked a nurse and she said, “We are treating her on the Liverpool Care Pathway. The papers have been prepared by the doctor and she is being treated as a dying lady on the LCP”.’

    He said he ‘argued with’ doctors to provide his wife with intravenous fluid and this was done. As her condition worsened he threatened to call an ambulance to take her to hospital.

    'I couldn’t understand it at all. I couldn’t understand why they assumed she was going to die so quickly'
    Mr West
    ‘They said I shouldn’t do that,’ he said. ‘They said it would disturb her dignity and she would die in the ambulance.’ His wife died at 8.30pm that evening.

    ‘Her death was sudden and very unexpected,’ he said. ‘She would have been shocked at the idea that she was dying. We all thought she had a year, probably a year and a half. She wanted to make boxes for the children, with pictures and other things to remember her by.’

    He added: ‘One day she was eating and drinking. The next she was dead. It makes no sense to me.’

    A spokesman for the Norfolk Community Health and Care NHS Trust said: ‘We can confirm this patient was not on the Liverpool Care Pathway. However, we have been advised by the coroner that it would be inappropriate to comment further at this time as it may be subject to a coroner’s inquest.’

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