"I do not forgive the doctor that put my dad on the Liverpool Pathway."Listen from 9 mins to 12 mins. Then 1hr 7 mins to 1hr 11 mins. Then 2hrs 7 mins to 2hrs 14 mins
- Breakfast with John Warnett and Clare McDonnell
05/03/2013 Duration: 3 hours
First broadcast: Tuesday 05 March 2013
Join John and Clare for the latest news, travel and weather, plus local Kent stories.
Transcription follows -
John Warnett -
The daughter of a Kent hospital patient who had his treatment and feeding tubes removed without her permission has been speaking about her anger. Seventy-one year old Sammy di Francisci was in the Kent and Canterbury Hospital when his family were told by nurses he would be allowed to die. However, his consultant, who says he did not order the stopping of the treatment, has warned that doctors should not be allowed to forecast death and treatment was restarted. He went on to live for another 14 months
Report -
[Recording plays of Sammy di Francisci enjoying his grandchildren's company]
Reporter :
Precious moments with his grandchildren, for Salvatori di Francisci would never have lived to see this; that's because weekend staff at Kent and Canterbury Hospital decided to withdraw fluids and drugs, putting him on the so-called Liverpool Care Pathway because they believed he was going to die. His daughter challenged the decision and Sammy, as he is known to his friends, lived a further 14 months, much of which he was cared for at home.
Daughter, Rosaria Squire -
I wasn't even told that he was being put on the Liverpool Pathway, so it was a real shock for me to see my dad die in this position where all the drugs and... [pauses] I do not forgive the doctor that put my dad on the Liverpool Pathway. There was no need for the doctors who put my father on the Liverpool Pathway.
Reporter :
Sammy was a real family man whose experience of the Liverpool Care Pathway has led the consultant who helped the family remove him from the plan at the Kent and Canterbury Hospital to question whether doctors can objectively predict death
Professor Pullicino -
There is no data for telling if someone is in the last hours or days of life, so the actual decision is not a scientific one. The actual decision is an intuition by the group that's making the decision. If you start to say somebody has a poor prognosis, then, um, you make a self-fulfilling prophecy.
Reporter :
Professor Pullicino highlighted his concerns in a documentary for Channel 4. In a statement about the Liverpool Care Pathway, East Kent Hospitals NHS Trust said this requires senior doctors and nurses involved in the patient's care to agree that death may be imminent; this decision should involve the patients and the family wherever possible. The patient should be re-assessed every four hours, but it raises the question, who should decide when someone is dying?
Daughter, Rosaria Squire -
My dad wasn't ready to die. And.. I don't totally disagree on the Liverpool Pathway, but it should be to the right people.
Reporter :
And she says the extra 14 months she had with her father is proof that she was right to challenge the hospital's decision.
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John Warnett -
Good morning, now, the daughter of a Kent hospital patient who had his treatment and his feeding tubes removed without her permission has been speaking about her anger. Seventy-one year old Sammy di Francisci was in the Kent and Canterbury Hospital when his family were told by nurses he would be allowed to die. BBC Radio Kent has obtained figures that show that a wide variation in the numbers of people being put on what's called the Liverpool Care Pathway in the county's hospitals. Will Roffey, has more details on this morning. Will...
Will Roffey -
John...
John Warnett -
Tell us...more about this particular case first of all.
Will Roffey -
Well, Sammy di Francisci was put on the Liverpool Care Pathway in 2010. It's controversial because it involves withdrawing fluids and drugs from patients who medical staff believe are close to death. In Sammy's case, he wasn't. Weekend staff at the Kent and Canterbury Hospital decided to implement the pathway without telling his family or his consultant. They both objected and, after his treatment was restarted, Sammy went on to live for another 14 months, much of that at home. His daughter is Rosaria Squire from Deal
Daughter, Rosaria Squire -
My dad wasn't ready to die. It was a real shock for me to, actually, see my dad dying in this position. All the drugs and... I do not forgive the doctor that put my dad on the Liverpool Pathway. There was no need for the doctors who put my father on the Liverpool Pathway...
Will Roffey -
Well, the experience has led to the consultant who helped the family to remove him from the plan at the Kent and Canterbury, Professor Patrick Pullicino, to question whether doctors can objectively predict death. He spoke to Channel 4's Dispatches programme last night.
Professor Pullicino -
There is no data for telling if someone is in the last hours or days of life, so the actual decision is not a scientific one. The actual decision is an intuition by the group that's making the decision. If you start to say somebody has a poor prognosis, then, um, you make a self-fulfilling prophecy.
John Warnett -
So, what does the hospital, the Kent and Canterbury, say about this case?
Will Roffey -
Well, it's not commented specifically on this family's case, but told us: Decisions whether to put a patient on the Liverpool Care Pathway require senior doctors and nurses involved in the patient's care to agree that death may be imminent. It should involve the patient's family wherever possible and the patient should be reassessed every 4 hours.
John Warnett -
So, Will, how many patients are being put on this system here in the county of Kent?
Will Roffey -
Well, we put a Freedom of Information request into our four Trusts asking that question and also whether relatives are told of decisions by doctors and nurses to put patients on the pathway. There's a wide variation in the figures. Between 2011 and 2012, over 400 patients in the Medway Hospital were put on the programme. About half were between the ages of 80 and 89, and family members were always informed. In East Kent's hospitals, nearly 700 patients went on the pathway, again a majority were between 80 and 89, but it couldn't tell us whether relatives were always informed. In Maidstone and Tonbridge Wells, more than 1200 patients were put on the controversial scheme, the majority aged just 60 to 69, but again it couldn't tell us whether family members were always informed. Meanwhile Darent Valley Hospitals couldn't give us any figures.
John Warnett -
Will, thankyou very much indeed...
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John Warnett -
Now, he wasn't ready to die: the words of the daughter of seventy-one year old Sammy di Francisci who had his treatment and feeding tubes removed by staff at the Kent and Canterbury Hospital without her permission. She objected to her dad being put on what's called the Liverpool Care Pathway. After his treatment was restarted, Sammy went on to live for another 14 months, much of that at home. Well, Sammy's daughter, Rosaria Squire, from Deal is on the line now. Rosaria, good morning to you.
Daughter, Rosaria Squire -
Good morning.
John Warnett -
Well just tell us, how long was Sammy in hospital before this incident occurred?
Daughter, Rosaria Squire -
Probably, around a week before.
John Warnett -
And what did he go in for?
Daughter, Rosaria Squire -
He suffered seizures and he had pneumonia. Em, he went into the hospital. He was doing really well. Obviously he was recovering well. And Professor Pullicino really looked after him
John Warnett -
Mmm. So, what... how, when did you first discover that something changed?
Daughter, Rosaria Squire -
We left him with er feeding tube and medication and then we went to see him the morning after and everything was taken away from him.
John Warnett -
So, no tubes...
Daughter, Rosaria Squire -
No tube, no feeding tube, no drip, er no medication to be seen. I called for a doctor. There was no doctor to be seen; it was a weekend when all this occurred. I asked the nurses what's happening to my dad and they just said to me we're putting your dad in a comfortable position and he's going to die.
John Warnett -
And that's not really what you were expecting. You just told me he was getting better...
Daughter, Rosaria Squire -
That's correct.
John Warnett -
You were quite confident that he would come out of hospital.
Daughter, Rosaria Squire -
That's right, definitely.
John Warnett -
So what did you say when they told you this, that, you know your father was, he was going to die, when basically, they had withdrawn treatment and medication?
Daughter, Rosaria Squire -
I wanted some action. I wanted them to feed my dad, put him back on the drip, give him proper medication as he was having before, and em, they couldn't do that because there was no doctor to be seen. Em...
John Warnett -
Do you know who made that decision, because it wasn't the consultant, was it, because the consultant was, was as distressed as you were that this decion had been made. So who made the decision? Do we know?
Daughter, Rosaria Squire -
The weekend staff on duty.
John Warnett -
And is that a doctor? So, what grade of doctor, do we know?
Daughter, Rosaria Squire -
No, I don't know what grade of doctor; just a doctor and the weekend staff who didn't know my dad. He wasn't aware of my father's condition.
John Warnett -
And, of course, they hadn't had a conversation with you which they are supposed to have, and had they had that conversation, you would have said, wouldn't you, I assume, hang on a minute, my dad's getting better?
Daughter, Rosaria Squire -
That's correct, yeah, you could see the signs that he was getting better. And my dad wanted to come home. We wanted my dad, a dad to me, a husband, a granddad to my children; we loved our dad and we wanted our dad to come home with us.
John Warnett -
Em, was your dad talking at this time; was he lucid, was he able to tell you anything
Daughter, Rosaria Squire -
Well, he kept squeezing my hand; he looked up; he said, Rosaria, I want to come home. Em, he looked at me and then back to sleep he went.
John Warnett -
So, he was in and out of consciousness
Daughter, Rosaria Squire -
That's right.
John Warnett -
Yeah, yeah. So, did you, so did you get anything changed, because you said you want this to be stopped now, you wanted him to be fed and medicated again... They told you that couldn't happen; what happened then? You call for another doctor, did you...?
Daughter, Rosaria Squire -
Well, on Monday, because this all happened on a Friday,
John Warnett -
So, this went on all weekend?
Daughter, Rosaria Squire
We had to wait until the Monday, until I saw the Professor again, who helped me out
John Warnett -
So, your dad, effectively, had no medication and no feeding all weekend?
Daughter, Rosaria Squire -
That's right, yes.
John Warnett -
So, what happened on the Monday?
Daughter, Rosaria Squire -
On the Monday, I got Professor Pullicino's attention and he had an emergency meeting with all the staff and he decided after that my dad should be on medication and have a drip and feed him again.
John Warnett -
Mmm, because we heard from him earlier on; he was saying he was, you know, he had no idea that this decision had been made.
Daughter, Rosaria Squire -
Mmm.
John Warnett -
What's happened since, Rosaria? Have you had any explanation from the hospital?
Daughter, Rosaria Squire -
No. No explanation whatsoever. I'm not here to make money; I just want people to be aware of the Liverpool Pathway and what happens in hospitals.
John Warnett -
Yeah, er, and obviously, the most important thing here is they should discuss it with the family and, had they done that, you could have made your point, couldn't you?
Daughter, Rosaria Squire -
That's correct, yes. My father wasn't able to decide for himself and I was the next of kin so I could decide for him. Em...
John Warnett -
Just to finish the story, em, he was put back on medication and feeding, and how long after that did he leave hospital?
Daughter, Rosaria Squire -
Em, probably a week or two... Maybe.
John Warnett -
And then he came home...
Daughter, Rosaria Squire -
He came home for another 14 months and the time that we had with him was so precious...
John Warnett -
And was it good quality time, would you say?
Daughter, Rosaria Squire -
He had his times when there were lows, but the times when they were good, they were really, really good. He was happy. He was singing, happy, playing, chatting; just my dad back again.
John Warnett -
Rosaria, thankyou very much indeed. Joining us this morning, Rosaria Squire who is the daughter of Sammy di Francisci who, basically, was put on the Liverpool care Pathway in the Kent and Canterbury Hospital without any discussion with his family. East Kent Hospitals Trust told us that decisions whether to put a patient on the Liverpool Care Pathway require senior doctors and nurses involved in the patient's care to agree that death may be imminent. It should involve the patient's family wherever possible and the patient should be reassessed every 4 hours.
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