END OF LIFE DECISION
by Katy Meade, September 5th, 2011
Should patients have a final choice over life and death? Do doctors ultimately know best when life sustaining treatment is futile?
End of life decisions and ‘do not resuscitate orders’ have been the subject of significant debate over the years. Thousands of do not resuscitate orders are added to medical notes each year. While the Department of Health has issued nationwide guidance, the NHS leaves if to individual Trusts to draw up their own policies and protocols relating to such orders.
Mr David Tracey has recently lodged judicial review proceedings against Cambridge University Hospitals NHS Trust and the Department of Health which are likely to re open the debate on end of life decisions.
The case relates to Mr Tracey’s wife who had recently been diagnosed with terminal lung cancer. She was admitted to Addenbrooke’sHospitalafter breaking her neck in a car accident and died sixteen days later. Mrs Tracey had capacity when she died.
Mr Tracey alleges that the doctors at Addenbrooke’sHospitalon two occasions put do not resuscitation orders in his wife’s medical notes. They cancelled the first one after his wife objected however they put the second one in place three days later without her consent or any discussion with her. Mr Tracey claims that his wife had full capacity and said that the lack of standard policy created a system that is “arbitrary, variable between hospitals and open to abuse”. He believes that in his wife’s case the Trust failed to offer a minimum degree of protection of her human rights.
Mr Tracey further alleges that the Trust acted illegally by not having appropriate policy on resuscitation decisions and the health minister failed to issue clear policy or guidance which tell patients and their families of their rights and legitimate expectations.
The solicitors acting for Mr Tracey maintain the view that the current system is open to abuse and can disregard patient choice. They say that the fact that life sustaining treatment can be withheld in a patient with full capacity without their consent or knowledge raises a real risk of violating individuals’ human rights.
It goes without saying that end of life decisions are particularly difficult and emotional decisions for patients and families to consider objectively. For that reason clinical judgement from a reasonable competent clinician is vital at this time. Arguably a nationwide policy which ensures that clinicians work with patients with full capacity and their families to fully inform them of their rights and legitimate expectations is long overdue. At Mayo Wynne Baxter we will be following this case with interest.
By Katy Meade
Quality Care Commission Report on East Sussex Healthcare NHS Trust
by Katy Meade, August 2nd, 2011
Last Friday’s Hastings Observer reported on the Care Quality Commission (“CQC”) investigation into East Sussex Healthcare NHS Trust, the body responsible for the Eastbourne District General Hospital and the Conquest Hospital in Hastings. The CQC investigation has given rise to profound concern about the standard of patient care in both hospitals.
In its original report the CQC found that nursing staff lacked appropriate training; patients were going thirsty after water was left out of reach; and on one occasion it was reported that a pensioner was left on a trolley for seven hours despite suffering from a broken hip.
Following the report the Trust was given until 2 September to improve services or face possible closure of certain services.
Although the Trust issued an apology to patients at the time of the original report in July, the CQC recently revealed that the Conquest Hospital is continuing to fail to reach its targets. This latest report found that in certain wards medical records and care plans were incomplete. In one particular case CQC inspectors noted that a patient was badly bruised, but the medical records for the patient said there was no bruising.
As a result of the these latest findings the CQC has told the Trust that it has two weeks to report back to them on how it plans to improve standards by the September 2 deadline.
Darren Grayson CEO of the Trust has responded to the CQC report saying that “we are committed to get every aspect of care right for our patients” and ”we are confident that the actions we are taking will address the concerns raised by the CQC”
At Mayo Wynne Baxter we are regularly asked to advise on medical negligence claims against this Trust and NHS Trusts across the South of England and it is striking how often failures in basic nursing care of the kind reported by the CQC arise. It is vital that these shortcomings are addressed, as our experience shows how these basic failings can set in train a sequence of events that leads to serious injury or even death in some instances.
If you or a member of your family are concerned about the standard of medical care you have received please contact a member of the Clinical Negligence team through our website at www.mayowynnebaxter.co.uk.
By Katy Meade
Is your child a couch potato?
by Katy Meade, July 13th, 2011
We regularly read reports that sedentary lifestyles and periods of inactivity have been linked to high blood pressure and heart disease. Some of these reports even suggest that those who choose a sedentary lifestyle over exercise are at greater risk of developing a pulmonary embolism, a blood clot on the lungs.
Today, however, the BBC is reporting on the concerns health experts have over children who do not exercise enough and how lack of exercise can be linked with obesity and brain development. A recent study suggests that only 30% of children in England between the age of 2 and 15 get their recommended amount of exercise.
Leading medical experts have now issued new guidelines to parents on exercise for children under five. They recommend that toddlers should be active for at least 3 hours a day and that from birth babies should be encouraged to move around.
Dame Sally Davis, Chief Medical Officer, suggests that “for children who are not yet walking, there is considerable international evidence that letting children crawl, play or roll around on the floor is essential during the early years”. Dame Davis is of the view that what your children do in the early years matters to their health now and their development through childhood and adolescence and impacts on their disease profile in middle age and later life.
Professor Stevenson, of the Royal College of Paediatrics and Child Health, supports Dame Davis by saying that “if a toddler spends too much time sitting passively in front of the TV then problems will be stored up for the future”.
Although a report in 2010 suggested that programmes to tackle obesity may need to focus more on food than exercise, it is clear that with the current obesity levels reaching critical numbers the health experts’ guidance issued today can only be a positive step in reducing childhood and adult obesity and therefore creating a more healthy society.
‘Slash and burn cuts’ to NHS services
by Katy Meade, June 28th, 2011
In this current economic crisis the NHS is faced with having to make £20bn worth of savings within the next four years. With the demand for healthcare increasing NHS managers are faced with the challenge of achieving these saving without adversely affecting front line services and patient care.
While the chairman of the British Medical Association, Dr Hamish Meldrum, accepts that the NHS needs to change he is calling for steady heads. Speaking to the BBC news today Dr Meldrum said he was concerned about the impact of the cuts across the UK. He believes that NHS chiefs are at risk of making ‘slash and burn cuts’ to services in a drive to save money. Dr Meldrum has asked NHS chiefs to enter into real debate to ensure sensible decisions are made.
The effect the cuts are having on services is already being seen country wide. Access for low priority treatment such as; tonsillectomies, varicose veins and IVF treatments have already been significantly curtailed. In North West London alone 84 medical procedures are now restricted. Waiting times are also increasing with the number of areas breaching their waiting time limit doubling in the past year.
At Mayo Wynne Baxter we are also seeing the effect of these cuts. Increasingly we are being approached by clients who have suffered injury caused, or contributed to, by cuts to front line services and patient care. It goes with out saying that the number of patients suffering injury will only increase if, as Dr Meldrum says ‘slash and burn’ cuts to services are implemented.
I would have to agree with the view expressed by Mike Farrar, chief executive of the NHS confederation when he says ‘NHS leaders must avoid such short term tactics if they are to achieve effective change without compromising patient care “.
By Katy Meade
Weight loss surgery should be last resort
by Katy Meade, April 14th, 2011
Described by the chairman of National Bariatric Surgery Registry as a “devastating, disabling and life shortening disease” obesity affects millions world wide.
It is estimated that the cost to the NHS in England of diseases related to being overweight or obese could rise to £6.3 billion by 2015.
Weight loss surgery or, bariatric surgery continues to be the source of great debate with some experts warning that many obese people are opting for a ‘quick fix’ rather than dieting. In 2010 it was reported that more than 32 million pounds a year was being spent on this surgery.
As with any surgical operation, there is always a risk of things going wrong. This could ultimately lead to an increase in medical negligence claims.
On 13 April 2011 the National Bariatric Surgery Registry reported the findings of the UK’s first large- scale study on the impact of weight loss surgery. The study found that type 2 diabetes fell by 50% and on average patients lost nearly 60% of their weight a year after surgery, based on 1,421 operations.
Following the findings of this report the chairman of the National Bariatric Surgery Registry said he believes bariatric surgery could benefit over a million people in the UK and that the treatment should be more widely available on the NHS. He said “an approach that limits treatment to a fraction of those who would benefit is one which the NHS will rue in years to come as these patient’s become an unsustainable burden on the health service”
However despite the reports findings health professionals remain cautious with many saying surgery should be a “last resort “
Sir George Alberti of Diabetes UK has emphasised that diet and lifestyle changes should be tried first.
David Stott, deputy chief executive of the NHS confederation says “we see surgery as one of the options we offer but prevention is better than cure”.
Clearly the findings of the study show that bariatric surgery is effective in the war against obesity. However in this climate of NHS cut backs it is unlikely that the treatment will be made more widely available on the NHS. It is more likely that diet and lifestyle changes will remain as first line treatment with surgery as an alternative when all other attempts to lose weight have failed.
By Katy Meade
Legal Aid Reforms
by Katy Meade, February 4th, 2011
In November 2010 Kenneth Clarke announced major reforms to the civil legal aid In England and Wales. The reforms which are intended to cut the legal aid bill by £350m a year by 2015 will see the end to legal aid funding for almost all clinical negligence claims.
The affect of the cuts will be far reaching as many argue that the reforms will reduce access to Justice.
The Telegraph yesterday described these reforms as ‘bad for Justice and health’. The paper spoke with a gentleman by the name of Johnathon Sinclair Wilson.
Mr Sinclair Wilson’s son, Ben, was one of twins but he was born with severe disability while his twin sister was born healthy. Mr Sinclair Wilson and his wife were convinced that during an amniocentesis before the birth the needle used in the procedure had penetrated Ben’s brain and caused his injuries. Following an investigation it was later proved that the amniocentesis procedure had indeed caused Ben’s injuries.
Mr Sinclair believes that it was only because legal aid was available “extensive and expensive” investigation was carried out.
Earlier this month Mr Sinclair Wilson’s wrote to ministers setting out his concerns about the proposed cuts. In his letter he said that “the principal issues at stake are access to justice, and retaining a vital check on the standards of care in the NHS”.
At Mayo Wynne Baxter we have held a legal aid franchise since 1998.As a result we have successfully acted for a significant number of clients in a similar position to Mr Sinclair Wilson. As a firm we share his concerns. We agree that in the absence of legal aid funding to support the significant costs associated with investigating claims, access to justice will indeed be reduced.
Latest NHS Reforms
by Katy Meade, January 20th, 2011
Dubbed by BBC news as one of the most radical plans in the history of the NHS. On Wednesday 19 January 2011 the government published the long awaited NHS reform bill.
The government described the Bill as “the next step in our programme to radically reform the NHS, to provide more power for health professionals at the NHS front line, a bigger say for patients and an independent inspectorate to raise standards across the country”
In essence the Bill proposes to decentralise power to local GP surgeries and make NHS decision making more patient focussed.
Currently around 80 % of the NHS Budget is managed by primary care trusts. The Bill when enacted will transfer the responsibility of managing this budget from the PCTs to GPs working in consortiums across the country. This will lead to PCTs being phased out over time.
The government believe that as a result of the reforms patients will be handed more choice over how and where they are treated.
The Bill has initiated great debate. It has been criticised widely by The Royal College of GPs, the BMA and trade unions who maintain the changes are unnecessary and could undermine the health service.
John Black, the president of the Royal College of Surgeons told the Guardian newspaper on 17 January 2011 that “the immediate need to save money by going for the soft targets of elective surgery will leave a lot of people with unpleasant symptoms and build up future health problems. Medically it makes not sense”.
However the Government argue that there is enthusiasm for change among the medical profession and the reforms will improve care and accountability.
The reaction among the GPs has been more positive with some consortiums of GPs already showing an interest.
If the reforms are successful it is hoped it will contribute significantly to the £20bn of savings the NHS has been told to make.
David Cameron believes our health service is running behind the rest of Europe. He has defended the reforms saying that ’Doing nothing will end in tears’.
Only time will tell if in fact ‘doing something’ ultimately ends in tears. As one the largest firms of clinical negligence solicitors in Sussex we are watching this closely.
Contraceptive Implant Alert
by Katy Meade, January 5th, 2011
Implanon is a subdermal contraceptive implant that gradually releases the hormone progesterone. It provides protection against pregnancy for up to three years and has a higher efficacy rate among users than the contraceptive pill.
The Daily Mail reports that one in four women who go to family planning clinics get long term contraceptive implants and around 80,000 people use implants the same as Implanon.
Describing it as “one of the worst mass contraceptive failures to hit the NHS in living memory” Jenny Hope of the Daily Mail reports that the NHS has had to pay compensation to women hurt when the implants were inserted.
Channel 4 News said that the NHS have offered settlements totalling nearly £200,000 in seven of the most serious clinical negligence cases arising from more than 1,600 reports citing 2,888 suspected adverse reactions.
Complaints about scarring, incorrect fitting, device failure have also been reported to medical regulators.
A total 584 women have reported unwanted pregnancies to the Medicines and Healthcare regulatory agency. However this figure is likely to be significantly higher as the incidence of unwanted pregnancies not reported remains unknown.
While it is accepted that no contraceptive device is 100 per cent effective a significant number of unwanted pregnancies in Implanon users arises from the implant being incorrectly inserted or, not being inserted at all rather than the efficacy of the contraceptive drug itself.
Doctors have reported that the device is difficult to insert. They have also expressed concern that as the Implanon can not be detected under X-ray it is impossible to check if it has been correctly inserted.
Implanon’s manufacturer has replaced Implanon with a new device called Nexplanon in an attempt to deal with these issues. Implanon has not been recalled however and continues to be used in surgeries.
When a woman makes the decision that they do not wish to fall pregnant the psychological effects of an unwanted pregnancy or having to make the decision to terminate a pregnancy can be devastating and traumatic.
The negative impact on women who have suffered permanent scarring as a result of the Implanon insertion can also not be underestimated.
At Mayo Wynne Baxter we have the benefit of a large and experienced team of lawyers dedicated to clinical negligence claims. We advise in a practical and straightforward way. We are sensitive to the needs of each client and are well aware of the trauma caused by the injuries suffered and the loss of confidence in health care providers. We are happy to give free initial advice on all the options available to you, helping you to decide how you want to proceed.
If you are one of the many women who have experienced an adverse reaction to the Implanon device please contact a member of our clinical negligence team on 01273 223205.
By Katy Meade