Surgeon jailed for negligence & nurse found guilty of mis-conduct

Yesterday David Sellu, a consultant surgeon, was jailed for 2 and a half years for manslaughter after he failed to act quickly enough to examine and operate on a patient he had diagnosed with a rupture in his bowel. The judge said that the surgeon should have prescribed antibiotics and looked at abdominal scans earlier. Although there was a chance that the patient would die even if he had received treatment, the risks were increased by the delay in action.

Elizabeth Joslin, a lawyer for the Crown Prosecution Service, said: ‘David Sellu’s care fell far below the expected standard, with terrible consequences. Prosecution of doctors for gross negligence manslaughter is rare and the threshold for criminal prosecution is high, but this doctor’s actions were not mistakes or errors of judgment, but negligence so serious that he has now been convicted of a criminal offence.

You can read more about the case in the Guardian here

I thought it was quite interesting that also in the news this week, Janice Harry, chief nurse at Stafford Hospital between 1998 and 2006, was given a 5 year caution, but was still found fit to practice for her part in the Mid-Staffs scandal.

A Nursing and Midwifery Council panel heard that during some night shifts, a single nurse was looking after 17 patients on a ward. It said Mrs Harry should have been focused on staffing levels but she was distracted by ‘training, targets and other matters‘.

The panel told her ‘you had effectively closed your mind to your direct operational responsibilities and had limited yourself to the strategic role. You had the professional responsibility for every nurse in the Trust….you had in the past placed patients at risk of harm.

You can read more about the case here

I think that both these cases show how important it is that doctors and nurses should always put the patient first, and I think it is a good thing that there are stricter controls in place now to ensure that bad practice does not happen in the future. However, it has made me realise just how big a responsibility medicine is, and I will have to make sure that I am always focussed on the patient first and not distracted by other things like targets. I also think it shows how important it is for everyone involved in caring for a patient to work as a team, and to report anything that falls below standard.

The General Medical Council and Tomorrow’s Doctors

The General Medical Council have recently published a news article about the failure to prosecute 4 doctors who held management positions at Stafford Hospital, because of a lack of evidence against them.

They are currently working with the Department of Health: ‘…to see what more can be done to increase appropriate accountability when things go wrong. In particular we have been exploring a number of changes to our powers to make our fitness to practise procedures more effective. We want to be able to hold doctors to account where they have harmed patients or put them at risk, even if they have subsequently shown insight and can claim they are no longer a risk to patients. We also want to have a right of appeal against panel decisions by the Medical Practitioners Tribunal Service – this would allow us to act when we believe the panel has been too lenient. We hope these changes will form part of the Law Commission’s current wide ranging review of the law governing the regulation of health care professionals.

You can read the article here.

The GMC also sets standards for teaching, learning and assessment and they have issued a document called Tomorrow’s Doctors for medical students which sets out the knowledge, skills and behaviours that medical students must learn at UK medical schools and be able to demonstrate.  

image from http://www.gmc-uk.org/Tomorrow_s_Doctors_1011.jpg_49300474.jpg

Stafford Hospital – Day 4

This morning I arrived at the hospital early so that I could get to theatre and change into scrubs. I had to wear special shoes and tie my hair up inside a hat. When we went into theatre I had to make sure my hands were thoroughly clean and I wasn’t allowed to touch anything to prevent the spread of infection. There was a patient having open surgery so they had to be put to sleep with a general anaesthetic. The surgeon explained to us what he was doing, as he opened up the abdomen and looked at the large intestine. There was a lot of smoke produced as the surgeon cut into the patient’s abdomen and it didn’t smell very pleasant, but I was really lucky to be able to stand so close and see right down inside the patient. The surgeon had to remove part of the patient’s bowel because it was badly infected and the surgeon said this could either be due to diverticulitis or cancer but he found that the patient had severe diverticulitis. Once he had removed the diseased part of the bowel and reattached it, he had to make sure that it was completely sealed. They filled the abdomen with water and pumped air through the intestine; there were no bubbles, which meant that the bowel had been stitched together and there were no gaps. The surgeon was then able to put in a drain, and then two other surgeons stitched the patient back up. The whole operation took about three hours and it was really fascinating to watch and I was glad that I got through it without feeling queasy. I was surprised at how many people were involved in the operation. There were a few nurses, two anaesthetists monitoring the patient and giving them medication throughout the procedure as well as the consultant surgeon and two other surgeons who helped him operate. It was really exciting to watch how they all worked together efficiently and to see how they worked as a team with the consultant surgeon and the anaesthetist in charge. 

After lunch I went to an occupational therapist outpatient clinic, which was really interesting. They specialised in hands, and many of the patients had sprained or fractured part of their hand and needed to rebuild the strength by doing special exercises and they also had to bathe their hand in hot and cold water. I was able to try out some of the exercises and have a go with some of the weights used to build up strength in your hands. It was really good fun and I got a good insight into another healthcare profession with a lot of patient contact. 

Stafford Hospital – Day 3

I started the day in Endoscopy with a gastroenterologist who did two colonoscopies, while we observed. It was really fascinating to watch as it was like surgery but less invasive and the patient didn’t have to be anaesthetised. It was like playing on an x-box or playstation as the doctor had to have very good hand-eye coordination to navigate the endoscope through the large intestine. I watched as the doctor stopped some bleeding in the bowel of a man who had had radiotherapy, and then watched the doctor remove three polyps from a man’s bowel.

Then in the afternoon I went to Cardiology and watched a transesophageal echocardiogram – it was interesting to watch how the doctor gained the trust of the patient before giving them an anaesthetic to put them to sleep. Afterwards I attended the Angina Clinic, where patients were doing exercise tests to see if they suffered chest pain when their heart was stressed. I enjoyed the clinic as the doctor had time to chat to the patient and gain a history before examining them and then working out a plan for treatment if needed. 

In the afternoon a nurse showed us around a cardiovascular ward, telling us about some of the different patients. She told us how the patients who were violent, or at a high risk of falling due to a stroke were in beds opposite the nurses’ station so there would always be someone watching them to make sure they were OK. She taught us how to take blood pressure and measure temperature and oxygen levels of patients, which I really enjoyed because I had to use practical and communication skills. We were also able to talk to a junior doctor about applying to medical school and about what life is like in a medical career, which I found really useful and informative.

Stafford Hospital – Day 2

In the morning, we went to see Diagnostic Imaging. First I looked at x-ray pictures of different parts of the body and saw how the image diagnoses illnesses, such as secondary lung cancer, because the tumours show up as small black marks in the lungs. I saw collapsed lungs, joints and fractures and saw how the image can tell you how a patient broke a bone because they fell in a certain way.

Then we had a talk from a nurse about the importance of hand washing and keeping clean in the hospital, to stop people suffering as a result of illness picked up at the hospital. She also showed us the radio substances containing barium or iodine, that patients drink so that images can be taken inside their body, and she showed us catheters and instruments used when operating, such as stents.

Afterwards I went to the general x-ray area where all of the x-rays are done. The nurse showed me how they receive a request form for an x-ray which tells them the area to x-ray; why they need to x-ray that area; and some information to justify why an x-ray will be beneficial to the patient, because there is a risk when an x-ray is taken as it is radioactive and can cause mutations.

She showed us the x-ray rooms and explained how they worked. The nurses told us that if a patient is at risk because they have had a lot of x-rays, a warning flashes up on the screen and they have to question whether an x-ray is actually beneficial or not. We also saw a CT scan which was really interesting to observe.

In the afternoon we went to Critical Care and saw the amazing facilities for the critically ill patients there. There were lots of dialysis machines and ventilators, which most of the patients there relied on. There were trollies ready for emergencies – e.g. one patient’s tube in his trachea came out and he couldn’t breathe so it had to be put back in immediately.  There were also rooms for families to sleep and live in if their relative was critically ill, so they could stay near them in their final days. I also learnt that all of the doctors in Critical Care were anaesthetists, because the patients there were so ill and relied on drugs to keep them alive. There were some alcoholic patients who were suffering withdrawal symptoms and needed full time care and supervision because they could be violent. Lastly, we had an interesting talk from a doctor there who told us about some different specialities and medicine in general.

 

Stafford Hospital – Day 1

Today I started my week on the Aspiring Doctors Programme at Stafford Hospital.

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I met up with the six other work experience students in the Postgraduate Centre and we had an introduction to the Programme from a surgeon. Then I went to the Acute Medical Unit (AMU) with four of the other work experience students and we split into two groups to go on ward rounds with the consultants. The first patient we saw had quite severe dementia and she was confused and was attacking the nurses who were cleaning her. When the doctor examined her she appeared quite reluctant to be seen and didn’t really seem to understand what was happening. She had also refused to eat or drink anything and had spat out the medication she’d been given at her care home. The doctor said afterwards that patients with such severe dementia probably wouldn’t be resuscitated if they suffered from a cardiac arrest.

We also saw another elderly patient who started crying when I asked her how long she’d been in hospital. She said she’d been having hallucinations and could see people around her, calling her names. First the doctor asked her some simple questions, which either she couldn’t answer or made her confused and then he examined her movements, which weren’t very good, so he decided to refer her to the mental health ward, and said she was probably developing dementia.

Many of the patients in the AMU ward were elderly (from 85 to 90+) and there were also a lot of patients who were alcoholics, which meant that some were quite violent and difficult to treat. The consultant examined all of the patients before making a list of possible causes (differential diagnosis). Then he arranged for tests such as CT scans to find out the diagnosis so that a plan for treatment could be made. He said that it was usually a very simple test, such as a urine dipstick test, that would diagnose a patient.

Unfortunately, one of the work experience students then fainted, so she was given a bed and her blood pressure was checked. It was very low, so she was taken down to A & E for an echocardiogram.

At the end of the ward round all of the doctors and the head nurse came together to review all of the patients and discuss what needed to be done. It was really interesting to see a typical morning for a doctor in AMU, and to gain an insight into some of the challenges that doctors face; patients who don’t want to go home; patients with dementia who won’t comply because they’re not competent; and violent patients who have problems with drugs or alcohol.

After lunch we had some paediatric basic life support training, where we learnt how to resuscitate babies and young children, by doing mouth-to-mouth resuscitation and compressions on dummies. We also learnt what to do if a child or baby is choking and had a chance to ask a nurse about what it’s like working in paediatrics.

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Later, we learnt some surgical skills from a surgeon who taught us how to tie together blood vessels and different ways to stitch up wounds, which I really enjoyed.

Interview for the Aspiring Doctors Programme at Stafford Hospital

Today I was interviewed for a week’s work experience placement by Mr Gwynn MD, FRCS, FRCS(Edin), the director of the Postgraduate Centre at Stafford Hospital. He looked at my CV and asked about my grades, universities I’m looking at, and general questions about applying to medical school. He also asked me why I want to be a doctor, and what qualities I have which would make me a good doctor, as well as questions about other work experience I’ve had, and my time at Medlink. It was the first medical interview I’ve had and I thought it was a really valuable experience. I came out of it feeling very positive, especially as he offered me a place on their Aspiring Doctors Programme in July, which I’m really looking forward to. Over 5 days, I’ll be shadowing doctors in different clinical departments in the hospital, including the breast care unit, dietetics, nuclear medicine, therapy services, wards and x-ray. I shall also have the opportunity to go into surgery and learn some first aid skills. 

Stafford Hospital goes into administration

Today, Stafford Hospital will be the first foundation trust to go into administration, as it is ‘no longer clinically or financially sustainable’. Instead, it will be run by two specially appointed administrators to ‘safeguard the future of health services’. The health regulator, Monitor, has recommended the closure of the hospital’s maternity unit, intensive care unit and accident and emergency department. Instead, it suggests patients should go to Stoke, Wolverhampton or Walsall hospitals. 

image from http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2012/9/11/1347380180987/Stafford-hospital-009.jpg

Stafford is my local hospital, where my sister and brothers were born. My brother went to A&E there just last week and had an x-ray and plaster cast put on his ankle, which was badly sprained. It would have been much harder for him if he’d had to travel further away for treatment, but unfortunately, patients are still suspicious of what sort of care they will receive there after the scandal, and I think it will be a long time before people can forget about its history.

image from http://news.images.itv.com/image/file/190446/image_update_2d9963eefa18b4bb_1366035691_9j-4aaqsk.jpeg

According to this BBC news article, ‘Monitor said the administrators would have 145 days to work with commissioners and other local healthcare organisations to produce a plan for patients that was “sustainable in the long term”.’

This Saturday, there will be a march in Stafford town centre by the Support Stafford campaign group, which is supported by our local MP, Jeremy Lefroy.

image from http://www.supportstaffordhospital.co.uk/Gallery/postersmall.jpg

I have applied for work experience at Stafford Hospital in July, and I’ve got an interview there this Friday. I think it will be really interesting to compare it with Southampton Hospital where I worked in February, and with Queen Elizabeth’s Hospital in Malawi, where I worked last summer. I’ll let you know how I get on.

Stafford Hospital

Hundreds of hospital patients died needlessly. In the wards, people lay starving, thirsty and in soiled bedclothes, buzzers droning hopelessly as their cries for help went ignored. Some received the wrong medication; some, none at all…. patients were left so dehydrated that some began drinking from flower vases.

Having lived in a Third World country for 5 years, this description of a hospital in the Telegraph last month shouldn’t have shocked me. But this isn’t describing an African hospital, or a hospital in a war zone or disaster area….this is Stafford Hospital, my local hospital. My sister and brothers were born there; I went there when I broke my arm. And yet, today, it is at the centre of one of the UK’s biggest scandals.
image from http://img.thesun.co.uk/multimedia/archive/01649/Staffordshire_Gene_1649604a.jpg

The article describes the terrible conditions that so many people needlessly endured at Stafford Hospital over the last few years. It explains how patients were not given the care they needed, because the hospital was so focused on achieving targets and gaining a ‘foundation trust status’. Sadly there are so many stories of people who died, when their deaths could have been prevented.

This story from yesterday’s Guardian describes how John Robinson was misdiagnosed, and discharged from the hospital only to pass away the following morning, due to his untreated ruptured spleen. It really moved me, and I hope that it will also move others so that it can be prevented in the future. 

image from http://www.thetimes.co.uk/tto/multimedia/archive/00077/77933421_Stafford_77680c.jpg

Of course everyone makes mistakes, but as a doctor, or a nurse, you have to deal with life and death situations and making mistakes can be fatal. However, the mistakes made should not have been covered up by the hospital and the NHS, as the relatives of those who suffered have a right to know the truth.

These stories made me realise the huge responsibilities that doctors and nurses have. I hope that in the future, patient care and the interests of the patient will always come first, and that if conditions do deteriorate, patients, relatives, doctors or carers are able to speak out and be heard straight away.