My Submission to Baroness Neuberger's Review of the Liverpool Care Pathway
Dear Baroness Neuberger
I offer my submission for your review of the Liverpool Care Pathway.
1. I believe my mother, Mary Poulter, 69, was wrongly placed on the LCP and would have continued to live an active life if she had not been terminated.
2. I have serious concerns about this ‘pathway’ because, apart from the suffering it can cause, it can be abused to kill patients who are not terminal and do not wish to die.
3. Mrs Poulter was admitted to Dewsbury District Hospital, West Yorkshire, on 28th June 2004 and treated for an undiagnosed chest infection which had weakened her. She began to recover but transfer was arranged to Kirkwood Hospice, Huddersfield, without prior discussion. Her panic at learning of the transfer was allayed by assurances that she would finish her treatment and convalesce there.
4. Kirkwood Hospice is a service provider to the Hospital and partly-funded by the NHS. Unknown to us, the Hospital doctor, David Currie, had signed a Do Not Attempt Resuscitation Notice, thus placing my mother on the LCP. I believe she was earmarked for termination. Had we been consulted, we would have objected to the imposition of the DNAR Notice and her transfer to Kirkwood.
5. On arrival at the Hospice on 1st July, my mother could walk around her room with assistance and was “alert and communicative with good speech and hearing” and “in no pain”, as stated in their notes. The Hospice doctor, Anne Oliver, advised that she needed oxygen, hydration and antibiotics and would benefit from physiotherapy. I believe Dr Oliver is a caring and empathetic doctor who would not terminate a patient against his/her will.
6. My mother was determined to recover and return home where I would nurse her back to health. She followed Dr Oliver’s advice and refrained from smoking despite the withdrawal symptoms.
7. A different doctor, Peter Fitton, was on duty the following day. I informed him that Mrs Poulter needed hydration but to my bewilderment he asked me what I thought she was there for. I told him she was there to convalesce - to which he responded: “Well I don’t think so and I’ll treat her accordingly!”. This confused and alarmed me.
8. At my mother’s request, I arranged a visit from a registered homoeopath and qualified nurse, Alistair Dempster, who came in the afternoon. He first consulted the Hospice before carrying out an assessment of her and promised to return in the morning with the appropriate remedy to aid her recovery.
9. I later learnt, from their notes, that the Hospice resented the ‘intervention’ of Mr Dempster in their plans. They “did not feel happy about this” and “did not discuss prognosis/management with this gentleman” and would “inform Peter [who] will be attending at 7pm.”
10. Dr Fitton apparently came early, at 6pm, but I didn’t see him. I was not informed that he had instructed the nurse, Julia Carter (now Greenwood), to withdraw all medication, fluids and nutrition, subcutaneously inject my mother with diamorphine and midazolam then terminally sedate her through a syringe driver. Mrs Poulter had not complained of pain (though she was in discomfort due to dehydration and withdrawal of her prescription drugs). There was no medical reason for Dr Fitton to give these instructions, which Nurse Carter readily complied with as though it were her usual routine.
11. Mr Dempster and I didn’t realise that my mother was not simply tired but slipping into unconsciousness from the inappropriate and unnecessary administration of diamorphine and midazolam (which are contra-indicated for patients with chest infections). I was exhausted so I rested in another room, waiting for my mother to wake. I was only called to her bedside when she appeared to drown in her own fluids before dying at 3.45 in the morning (3rd July 2004). I was shocked and distressed, as was Mr Dempster when I cancelled his visit.
12. I didn’t understand why my mother had died until I obtained her medical records and nursing notes and started to investigate. Dr Fitton had certified her death as caused by cancer (she had had a mastectomy in 2001 to remove a small “suspicious” lump) but the records show no evidence of metastasis. I received no real assistance from any official, agency or department other than the NHS Medical Records Officer who expressed his concern. We found that the DNAR Notice had been removed from Mrs Poulter’s records before they were sent to him (after considerable delay and ‘loss’ of the file within the system).
13. The MRO did obtain a copy of the DNAR Responsibility Form which showed that guidelines had not been adhered to. Thereafter, he was seemingly pressured by other officers and took extended sick leave. Ranks closed and my correspondence was referred to the NHS Legal Department in anticipation of a lawsuit – though I had made it clear that it was not my intention to sue the NHS but to expose the shortcomings in the system and try to prevent other deaths.
14. The systematic covering up of mistakes, and the unwillingness of the authorities (including the police and the coroner) to investigate, have compounded the distress I feel at losing my mother in this way. Knowing that she had not wanted to be admitted to the Hospice; may have been aware of what was being done but was unable to communicate because she was sedated; suffered the torture of dehydration; then drowned in her own fluids due to her respiratory system being depressed by the drugs, I have been unable to come to terms with her death and the surrounding circumstances.
15. I have continuously sought to bring these matters to light and am pleased that some action is now being taken.
16. The recommendations following the Shipman Inquiry, to safeguard patients from rogue doctors like Harold Shipman, have not prevented further deaths because the guidelines are not adhered to and there is a lack of accountability. The police are still unwilling to record and investigate criminal complaints by non-professionals against medical and nursing practitioners, particularly those accused of abusing the LCP to kill their patients for financial gain (payments from the government or patients’ relatives).
17. I hope you will ensure that your recommendations are implemented and effective measures are in place to prevent the torture and killing of patients.
Patricia Ann Mallaby
Edinburgh
5 April 2013
