The cosmetic treatment industry is an ugly business

There's something grotesque in the business of selling beauty. Bruce Keogh's review into the regulation of the cosmetic treatment industry – covering implants, surgery, fillers, injections, and every other way of primping, plumping, shrinking and smoothing your face and body – reveals a world of hard sell for hard bodies. Loss-leading free consultations draw customers into clinics (and despite the fact that the industry offers invasive medical procedures, the review shows that it treats those in its care as customers, not patients), and multibuy offers put the decision to get silicon bags inserted in your chest or fat siphoned out of your thighs on a par with chucking an extra packet of chicken joints into your trolley during a Bogof offer.

And if your treatment doesn't work out quite the way it was sold? That, as they say, is tough titty: there's no clear legal responsibility for cosmetic practitioners to provide aftercare. During the PIP implant scandal, the Transform Cosmetic Surgery Group and the Hospital Group initially refused to pay for the removal of implants containing non-surgical grade silicon. Under pressure from the Department of Health and huge adverse publicity, they reversed that decision – but women were still left to pay for their own replacements.

If your supermarket chicken pieces are bad, the shop doesn't just take the bad pack back: it's also obliged by the Sale of Goods Act to replace or repair it. Yet the rules for surgical implants are apparently more lax. I can't even say the cosmetic surgery business treats women like meat, because actually it offers a lower standard of care to its patrons than your average butcher. And for decades, shamefully, this has been tolerated, with inadequate legislation allowing inadequate treatment to continue. Reading the report, the collective negligence of the industry sticks out like a bone in an eyeball (yes – one woman grew bone fragments in her eyes as a result of an experimental stem cell cosmetic procedure).

Slack regulation of advertising allows surgeries to use high-pressure tactics like time-limited offers while minimising the "cutting you open, putting something inside you" aspect of their procedures. There's no specialist register of cosmetic surgeons – and amazingly, the title "surgeon" isn't even protected, meaning that practitioners may use it while having no surgical expertise. Private providers currently aren't required to perform a clinical audit, and data collection is so sloppy and vague, we don't even have a figure for how many procedures are performed each year. Oh, and consent for your own personal slicing and dicing can be obtained with a single signature in a meeting with a sales rep.

The whole industry starts to look like a nightmarish, tentacled beast stretching secretively through clinics and salons, invading bodies and injecting its poisons, and the people who are undergoing these treatments are often those who should have a particular claim on protection. Another thing the cosmetic surgery industry doesn't have is a standardised psychological assessment for those seeking treatment: those giving evidence to Keogh felt that enough was already done to pick up potential patients with body dysmorphia or personality disorder, but isn't it somewhat remarkable that we accept the pursuit of radical, appearance-altering surgery as rational until proved otherwise?

There's a sorry lack of longitudinal research on the psychology of those who seek and have cosmetic surgery (another example of the industry's commitment to high standards of medical evidence and patient care), but some of what is known is worrying. Some studies have found an increased risk of suicide among women with breast implants – not necessarily suggesting that implants cause suicide, but perhaps that women who have implants are more likely to be pre-disposed to suicide. And while there's limited evidence that plastic surgery creates a short-term improvement in satisfaction with the relevant body part, there's no evidence that it's actually the best therapy for unhappiness about the way you look.

The cosmetic surgery industry is based on telling women (and increasingly men, though they're still in the minority of patients) that they could have better, happier lives if only they'd make themselves look a bit more perfect. As an individual decision, everyone has the right to do as they wish with their own body within reasonable protections; as the basis for an industry, with advertising designed to show up your flaws and credit agreements to help you pay for their remedy, it's repugnant. The Keogh review shows how much the cosmetic interventions industry needs to do to fix up its face, but its ugliness runs way below the surface.

This is courtesy of theguardian.

Parents of aspiring midwife, 16, who died after doctor dismissed DVT symptoms considering legal action as inquest clears medics of negligence

A teenager died from undiagnosed deep vein thrombosis just hours after visiting an out-of-hours doctor’s surgery.

Student Shannon Deakin, 16, limped into the surgery with 'knife-like' pains after her left thigh became swollen and turned red.

Newly-qualified locum general practitioner Dr Karim Mohammed diagnosed an infection and gave her antibiotics and anti-inflammatory drugs at the Care UK walk-in centre.

Shannon, of Hoyland in South Yorkshire, was told to see her own GP within 24 or 48 hours and have an ultrasound scan if she was not any better - but she collapsed and died at home about 12 hours later.

After the Sheffield inquest her parents Bryan, 59, and Sue, 44, said they were considering taking legal action against the GP and Care UK.

Mr Deakin said of their only child: 'We don’t think she was given a chance.'

An expert emergency medical consultant Dr Alan Fletcher told the Sheffield hearing if Shannon had been referred to hospital that day she would likely have shown a high score on tests for DVT.

She would have been given an ultrasound scan which would have led to treatment and her chances of survival would have been greatly improved.

But he could not say Shannon, who had 11 GCSEs and was training to be a midwife, would 'more likely than not have survived if she had reached this point in treatment.'

The GP should also have examined Shannon’s calves where swelling is a tell-tale sign of DVT but it was so rare in someone of her age a GP would think it was the least likely option.

Delivering a narrative verdict, coroner Chris Dorries said he had considered whether there was 'culpable human failure' in Shannon’s death or whether it had been 'contributed to by neglect' but he found the appropriate legal criteria were not met.

The inquest heard Shannon had been prescribed the Dianette pill by her GP which is known to increase the chances of developing blood clots.

She had been taking the pill for a month after complaining of acne affecting her back, chest and face but came off it because of side effects just a month before she died on December 4 last year.

The pill was rated as a 'low risk' factor by experts who gave evidence.

A post mortem showed Shannon died from a pulmonary embolism caused by a blood clot moving from her leg through her heart towards her lungs which pathologist Dr Mudher Al-Adnani said was 'extremely rare' in one so young.

Dr Mohammed, who was on-call at the clinic based in Barnsley Hospital, said she came in complaining of a pain in the left side of her abdomen radiating to her groin.

During a ten-minute consultation he noted a large, warm patch of redness on the front of her left thigh.

Because of her brief period on the pill and a lack of negative family history he did not ask any further questions and excluded DVT from his diagnosis. 'I explained it was highly unlikely that it was a clot and my findings were more of an infection or muscular pain,' he said.

But Shannon’s mother Susan, 43, who accompanied her daughter, told the inquest Dr Mohammed failed to notice her daughter’s swollen left foot and she left 'walking on the back of her pump'. The doctor told her: 'It’s either a blood clot or an infection.'

Shannon even texted her cousin four hours after the consultation with the same message and a later text read 'moving a tiny amount kills'. Just 12 hours later she collapsed on the settee at the family’s home.

GP expert Dr James Gray said the locum’s assessment was 'reasonable' but it may have been prudent for him to arrange an ultrasound scan and he did not pick up on Shannon’s swollen foot which could have raised suspicions of a blood clot in the lower leg.

He remained 'unconvinced' the GP had looked into all the risk factors associated with DVT.

Mr Dorries’ conclusion read: 'Shannon Deakin died in consequence of an undiagnosed DVT.

'Shannon had sought medical assistance at lunchtime the previous day and whilst there are unresolved conflicts of evidence about that consultation it cannot be said, even at its highest, that the examination and assessment amounted to gross failure.

'Furthermore, even if diagnosed at that time it cannot be said that a referral to hospital would more likely than not have saved Shannon’s life.'

After the hearing Mrs Deakin said: 'We took the GP at his word. Things could definitely have been done more differently and Shannon might have stood a chance.

'We haven’t a clue how she got DVT. I kept asking her if she had suffered a fall or a bump but she said not. It is a complete mystery.'

Mr Deakin said: 'She was perfectly fine three days earlier. It just came on so quickly. Since her death it has been a total living nightmare. The day Shannon died we died.'

This article is courtesy of the Daily Mail.

Family sues out-of-hours GP provider and nurse over death liability

The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.

Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.

Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.

Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.

The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.

With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.

The legal wrangle became so protracted that for three years the family could not afford the £1,200 to inter their daughter's ashes. Michael Secker said he wanted this to be "sorted for my daughter Clare and my grandson Tyler".

He added: "We are forced to go to court and keep reliving what happened. We can't believe no one will take responsibility, even though they were at fault and it shouldn't have happened and Clare should be with us now."

The family, who live in Great Yarmouth, Norfolk, is claiming damages of £250,000, saying the sum will help secure Tyler's future. "It's so hard, especially at this time of year. It's nearly four years now and we know we can't ever have our Clare back and Tyler won't have his mum, but we just want it all to be sorted so we can just get on with bringing Tyler up and not having to relive this nightmare over and over again," Michael Secker added.

The family's lawyer, Sandra Patton, head of medical injury at Ashton KCJ solicitors, said: "This has been a horrendous ordeal for the family, and for those responsible to now argue in front of them about who is legally accountable is unacceptable and cruel."

Patton pointed out that if a patient is hurt or dies as a result of NHS care then the health service assumes responsibility, making payouts from a state-backed insurer called the NHS Litigation Authority. She added: "As NHS services are increasingly provided by private companies, this is going to happen more and more, unless something is done to establish a clear line of accountability.

"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."

The local NHS that contracted out the service, NHS Norfolk and Waveney, says it expects the private firm to be insured. A spokesperson said: "We have every sympathy with the family involved in this case. Although the PCT funds the healthcare received by its local population, in the rare and unfortunate event that things go wrong, it is the provider of that care that will be responsible for paying any damages in the event that liability to do so is established."

The company had been owned by Take Care Now in 2008, before being sold to Harmoni. It is now part of Care UK.

A spokesperson for Care UK, which now owns the firm, said: "The company is very keen to see resolution of what is clearly a complex case, which has caused great distress to the Secker family. We urgently want to work with the other parties involved, including all the relevant insurers, to get the right solution for everyone as quickly as possible."

This article is courtesy of theguardian.

'Make home circumcision illegal'

Following the death of a baby in Manchester after a home circumcision a mother has called for mobile circumcision services to be banned.

The trial of nurse Grace Adeleye who carried out the circumcision on Goodluck Caubergs heard that up to three children a month are admitted to the Royal Manchester Children's Hospital because of bleeding after home-based circumcisions.

Adeleye was found guilty of the manslaughter of Goodluck by gross negligence by a jury at Manchester Crown Court on 14 December.

Manchester-based solicitors JMW are currently investigating a separate case of a family from West Sussex who claim their son was left in "excruciating pain" after a home circumcision.

The doctor involved in the case said the redness and swelling her son experienced was a normal part of the healing process.

The mother said she had arranged for her son to be circumcised at home because she did not live near to a clinic that offered the procedure.
Trusted the doctor

Explaining why she wanted her son circumcised, she said: "I found a mobile circumcision doctor on our local mosque's website.

"My husband is Muslim and proud to be Muslim and our children are Muslim too.

"We put our trust in the doctor, going to a clinic would have involved a lot of travelling but it was because he is a doctor that swung it."

She said the doctor visited their home in September when her son was aged 22 months.

About five days after the circumcision she said the swelling on her son's penis started increasing and he was in "excruciating pain".

She said she took him to her GP who prescribed antibiotics for an infection.

The mother said she contacted the doctor who performed the circumcision who said she should wait three weeks for the skin to heal.

Her doctor said: "In my leaflet and at the time I went to do the circumcision I did explain redness and swelling is normal in healing, that it will go away in two weeks but it can happen."

He said he did not think there were any complications arising from the procedure.

The mother said she took her son to a paediatric urologist who she said told her not enough skin had been removed and her son would require surgery to remove some skin and a granuloma which had formed to prevent deformity as he grew up.

"I've been left with a child who refuses to have his nappy changed, who screams if you go to touch it [his penis] and he needs surgery to fix it," she said.

She said she would like mobile circumcisions to be made illegal and better signposting from GPs to private clinics for parents who want the procedure.

But her doctor said a clinic is no more sterile than a home environment.

He said: "It's not illegal or unethical to do it at home.

"I use a one-use pack of sterile instruments. An operating theatre has special ventilation to make it sterile but a clinic doesn't."

Melissa Gardner, a specialist medical negligence solicitor at JMW, said: "Given the impact on their child, the family has significant concerns about the way the procedure was conducted.

"While it is too soon to know what the long-term effects will be, this case highlights the need for extreme care when performing circumcisions."

The mother said she has also referred her case to the General Medical Council.

While circumcision is available on the NHS in England for medical reasons different primary care trusts take different stances on whether or not to commission the service for their communities.

In Chadderton, where the family of Goodluck Caubergs lived, NHS Oldham only funds circumcisions for medical reasons.

But the trust recommends an accredited private provider based at Glodwick Primary Care Centre in Oldham, where people can pay £100 for male circumcision for religious reason on infants aged between one and six months.

One trust which does offer the procedure is NHS Tower Hamlets.

The London trust charges a fee from £120 depending on the borough of residence and that the baby is "fit and well" and aged from six weeks to five months.

In general the Department of Health maintains that NHS circumcision should be carried out only for medical reasons, not for ritual or cultural beliefs.

But a department spokesman added: "However, PCTs are responsible for commissioning services to meet the health needs of local communities.

"In some areas, particularly where they feel children are at risk from unsafe procedures, PCTs do work with local providers and communities to ensure that a safe service is available."
'No record'

In 2010 senior doctors urged the NHS to offer circumcisions to avoid botched operations.

A study into circumcisions performed at an Islamic school in Oxford found that 13 out of 32 boys who had the procedure suffered medical problems.

Paediatric surgeon Simon Huddart said the British Association of Paediatric Surgeons (BAPS) and the British Medical Association have issued guidance on circumcision.

He said: "It shouldn't happen in a home. BAPS guidance says it should be in an operating theatre or an appropriate environment for a child.

"An appropriate environment should be clean with good lighting and sterile instruments - I can't believe you could achieve a sterile environment in a home.

"A range of complications can occur outside hospital but that's not to say you don't have complications in hospital as well."

Glen Poole, strategic director of The Men's Network, a charity which aims to improve men's health and education in Brighton and Hove, writes a blog about the issues raised by male circumcision.

He said people need to talk about male circumcision to help inform the debate about when it might be deemed "unnecessary".

"Some people think it should only be done in a medical setting, others think it should not be done at all without a strong medical reason or the child's consent," he said.

"Our first concern is that there is no record of how many are performed in the community and the level of complications," he added.

"We only know if they turn up in hospital so at the very least I would like to see a register and a ban on the procedure being carried out by non-medical people."

This article is courtesy of BBC News.

Stroke patients face unnecessary delays 'because of ambulance computer error'

More than half of strokes were not even diagnosed by the current system for assessing 999 calls, a new study has found.

Called the Advanced Medical Priority Dispatch Software (AMPDS), the system is designed to help staff who are not medically trained to assess the level of care patients need.

But stroke patients are only categorised as a life-threatening emergency, and an ambulance despatched to reach them within eight minutes, if they are unconscious.

Other stroke victims are attended by an ambulance within 19 minutes.

The study looked at thosuands of admitted patients, 126 patients of whom were admitted to hospital and subsequently diagnosed as having had a stroke.

Researchers found that the software had correctly identified only 60 of the stroke patients, with the rest given a different diagnosis.

Additionally, 62 of the wider group of patients were wrongly listed as having had a stroke or mini-stroke.

Fewer than one in four stroke patients were deemed as the life-threatening emergency, the study, published in the Emergency Medicine Journal, also found.

Around 110,000 people suffer a stroke in Britain every year.

Evidence shows that prompt treatment can significantly reduce the chances of them dying or being left with a disability.

The report concludes that of all the patients finally diagnosed with a stroke the software allocated a correct diagnosis only "in approximately half of these patients".

The authors, from South Central Ambulance Service NHS Trust in Hampshire, said that a significant number of patients would still receive an ambulance swiftly because they had collapsed or were unconscious.

But the underlying diagnosis of stroke would still be missed by the system, they said.

They also called for a review into services by the Department of Health.

"The current recommendations for a 19-minute response to (stroke) patients should be reviewed with the aim of upgrading to an eight- minute response," they said.

The study looked at patients arriving at the North Hampshire Hospital A&E department by ambulance.

Joe Korner, from The Stroke Association, said: "Stroke should always be treated as a medical emergency.

"Getting to hospital promptly after the onset of symptoms enables the patient to receive a brain scan to determine the type of stroke they have suffered.

"Arriving at hospital by ambulance is the best way to get access to acute stroke care and help reduce the risk of major disability."

This article is courtesy of The Telegraph.
 

Doctors too scared of getting sued to find cure for cancer, says Lord Saatchi

Doctors are too scared of getting sued to make any steps forward in finding a cure for cancer, Lord Saatchi said as he launched a Private Members' Bill which will give legal defence for doctors who make medical innovations.

Fear of litigation is acting as a deterrent in the development of cutting-edge cancer treatments, the advertising mogul said.

He said that innovation is stifled by medical negligence law because no doctor has a defence against negligence claims if they have deviated from standard procedure.

The bill aims to clarify the differences between ''responsible innovation'' and ''reckless experimentation'', he said.

Work towards the Medical Innovations Bill, began one year ago – only months after his wife Josephine Hart died from a form of ovarian cancer.

The novelist, whose debut novel Damage sold more than one million copies, was 69 when she died.

Her death in June last year left Lord Saatchi grief-stricken and angry at the lack of treatment available.

''Cancer is a disease which is relentless, remorseless and merciless,'' he told the Press Association.

''I also found the treatment was medieval, degrading and ineffective.

''The survival rate for gynaecological cancer is zero and the mortality rate is 100 per cent. These figures are the same as they were 40 years ago. That is because the treatments, the drugs, the procedures and the operations are exactly the same as they were 40 years ago – therefore more innovation is required.''

He said the aim of the bill is to ''cure cancer'' by encouraging innovation in medicine.

''Will the bill cure cancer? No – but it will encourage the man or woman who will," he said. ''At the moment, the law is disincentive to innovation – the current law is a barrier to progress in curing cancer.

''At present, any deviation from standard procedure is likely to result in a guilty verdict of medical negligence. Innovation is a deviation – no deviation is no innovation.

''Fear of litigation is a deterrent to innovation in cancer treatments. By defining what is responsible innovation, that will encourage innovation.''

The bill, which sets out measures doctors should take to make ''responsible innovation'', will encourage advancement as well as deterring reckless medics.

It has received backing from many medical professionals and legal experts.

Professor Alan Ashworth, chief executive of The Institute of Cancer Research, said: ''I fully support Lord Saatchi's Bill which highlights an important issue.

''If we are to improve outcomes for cancer patients it is essential that clinicians are free to innovate as long as appropriate safeguards are in place.

''This is particularly true for new therapies, which are being developed at an ever-increasing pace.''

 This article is courtesy of The Telegraph.