How worried should Britian be about the Ebola outbreak?

An African villager arrives home after a trip through the jungle, nursing an animal bite. A few days later, we see the same man, sweating and feverish, submitting himself to the care of local doctors. Gradually, the circle widens: the man’s wife, his friends, the doctors themselves, all start to display symptoms. Cut to an international departure lounge, where a Western businessman or holidaymaker is knocking back paracetamol, sure that this nagging flu will have cleared up by the time he gets home.

The fear of pandemics is one that haunts our culture – and it is one that has been given new life by the events in West Africa, where the Ebola virus has claimed almost 4,000 lives. In keeping with the horror-movie narrative, the disease is starting to creep out of Liberia, Sierra Leone and Guinea, with cases reported in Spain and America. Yesterday saw the death of the first suspected British victim, in Macedonia, and the announcement by the Government that it is tightening screening procedures at airports. On Wednesday, the director of the US Centers for Disease Control and Prevention, Thomas Frieden, warned that Ebola may become “the next Aids” – a killer not of thousands, but of millions.

Yet those who have seen this movie before may also feel they know how it ends. When SARS – severe acute respiratory syndrome – appeared in Asia in 2002, we were told that it had a 25 per cent chance of killing “tens of millions”. There were calls for borders to be locked down, and new arrivals showing symptoms to be locked up. But despite a spike in sales of surgical masks, and the hurried cancellation of thousands of holidays to Hong Kong and Thailand, the disease ended up killing only 775 people worldwide.

It was a similar story in 2009 with swine flu. The chief medical officer, Sir Liam Donaldson, warned that 65,000 Britons could die, and the government duly spent more than £1.2 billion to prepare for the viral apocalypse. Yet while the disease was incredibly contagious, infecting millions worldwide, it turned out to be relatively mild. In Britain, only 457 people died – a significant number, but 25 times fewer than the 12,000 who are carried away by normal seasonal flu every year. To make matters worse, some experts later claimed that the £424 million spent on stockpiling 40 million doses of Tamiflu had essentially been wasted: its average effect, they said, was to shorten the disease’s duration from seven days to 6.3 (a finding which its manufacturer, Roche, disputed).

With the Ebola virus, too, there are reasons to believe that the impact in Britain will be relatively limited – which is why, to its credit, the Government appears to be resisting calls to panic. True, the virus is not only horrifically nasty, liquefying the internal organs of those who catch it, but devastatingly effective. 

This article is courtesy of the Telegraph.

Hospital administered three times the recommended dose of sedatives

The family of a woman who died after being given three times the recommended dose of a sedative has been awarded £65,000 in compensation.

Nicola Ames, 35, from Middle Mead, Rochford, died at Southend Hospital in December 2009.

She was admitted with acute pancreatitis and Miss Ames, who had a history of alcohol dependency and epilepsy, became agitated and was sedated.

By the following day, medical staff experienced difficulty in dealing with her agitation, confusion and lack of co-operation even though they had given her a significant dose of sedative Haloperidol.

Despite becoming hypoxic, where insufficient oxygen reaches body tissues, she was not transferred to the intensive care department where she would have been put on a ventilator to help her breath properly.

Despite the hypoxia worsening, and the absence of senior medics, staff continued to administer the sedative, eventually giving her more than three times the recommended dose. Miss Ames suffered a cardiac arrest and died shortly after midnight on December 18.

Lawyers, Attwaters Jameson Hill, acted for Miss Ames’ mother, who asked not to be named, against the hospital.

They claimed medical negligence and settled the case, securing damages for pain and suffering, funeral expenses and a dependency claim.

An investigation later established that over ten-and-a-half hours, Miss Ames was given 55mg of Haloperidol, compared to a recommended daily maximum dosage of 15mg.

Sarah Wealleans, of Attwaters Jameson Hill, said: “Hospital staff basically lost control of the situation and were unable to control Nicola’s alcohol withdrawal.

Rather than intubating her, which would have deemed the patient safe and provided the opportunity for effective treatment, they just kept administering sedatives in huge quantities.

This caused her death.”

Jacqueline Totterdell, the hospital’s chief executive said: “We once again offer our sincere condolences to Nicola’s family and recognise the circumstances leading up to and regarding her death in 2009 have made this a particularly difficult time for them.

“We recognise the standard of care we provided at that time was not of the standard we would expect and again we apologise for this.

“With regards the inquest, it would be inappropriate to comment further at this stage as the coroner’s findings will not be known until the case is reopened.”

This article is courtesy of the Echo.

Girl, 7, dies after hospital sends her away for third time following repeated misdiagnosis

A seven year-old girl died just two hours after being sent away from hospital for the third time following repeated misdiagnosis.

Little Evelyn Smith was rushed to A&E by her parents last September after falling ill suddenly, suffering from a soaring temperature and vomiting.

The youngster was misdiagnosed and sent away from hospital and her GP's surgery.

After her terrified mum Helen took her daughter to see a doctor for the third time in three days, just two hours after being sent away, Evelyn collapsed and died at her home in Warwick.

An inquest into her death discovered she had died from a rare bacterial infection - Bacterial trachetis - as a result of croup.

Even though a doctor had diagnosed Evelyn with viral croup, they failed to recognise the deadly bacterial complications she was suffering from - and a coroner has ruled that Evelyn's death could have been prevented if she had been diagnosed and treated correctly.

Devastated Helen said: "Losing Evelyn has been totally devastating for us.

"She deteriorated so rapidly, even a year on it doesn't seem real. She was such a happy girl - a real livewire, so happy and always smiling. She's left a huge hole in our family.

"We took her to hospital three times in three days - we repeatedly returned for medical help and that should have been a red flag to doctors and nurses.

"I don't want any other parent to go through what we have been through. Trust your instincts - if you think there's something seriously wrong, insist that it is looked at."

The inquest, at Warwick Coroner's Court, head that Evelyn had woken up with a mild headache on Wednesday, September 11, 2013 - but still went to school that day and her ballet class in the evening. But at 2am the next morning, she came bursting into her parents' bedroom shouting that she couldn't breathe.

Helen rushed her to Warwick Hospital Accident and Emergency department, where her temperature had rocketed to almost 40 degrees. She was examined by a doctor, and despite vomiting, discharged a couple of hours later, with advice on how to reduce her temperature.

But when her daughter was still burning up on Friday morning, Helen took Evelyn to her GP surgery, where she was examined by a nurse, who prescribed her penicillin for her inflamed tonsils.

That afternoon her temperature had risen again and Helen took her back to the GP. Their Dr Susan Martin diagnosed her with oxygen saturations and moderate croup and made an appointment for her to come back on Monday.

Tragically, Evelyn collapsed and died at home two hours later leaving Helen to desperately give CPR while she waited for an ambulance to arrive.

At the inquest assistant coroner for Warwickshire, Dr Richard Brittain said: "Evelyn Mary Smith died from the consequences of both a viral and bacterial infection of her upper respiratory tract.

"Her family sought medical attention three times in the days leading up to her death. There were missed opportunities to diagnose and treat Evelyn appropriately on each of these occasions. However, I am satisfied that none of these consultations were neglectful.

Based on the evidence heard, it is more likely than not that her death was preventable; although it has not been possible to conclude the causative impact of each missed opportunity."

Among those giving evidence at the inquest was Warwick Hospital doctor Emma Sexton, who first examined Evelyn on the day before she died. She said the child did not appear to be displaying signs of respiratory distress and her cough sounded like a viral croup, although she had looked for symptoms of other conditions as well.

Dr Sexton added: "Bacterial trachetis is a very rare condition that arises from these symptoms. I had not come across it prior to this case."

Haidee Vedy, head of medical negligence at Alsters Kelley LLP, who represented the family at the inquest said: "Evelyn's death was an absolutely tragedy and should never have happened.

"Her family put their trust in the hands of the hospital and their local GP surgery and it would appear from the evidence presented at the inquest that they were badly let down.

"We will now be investigating further to find out what more could have been done to prevent Evelyn's death."

But at the inquest, Helen Lancaster, the director of nursing, who had commissioned an independent report which highlighted missed opportunities, did accept its findings.

Dr John Omany, medical director for NHS England (Arden, Herefordshire and Worcestershire), who oversee GPs' surgeries, accepted "opportunities were missed" to identify the seriousness of Evelyn's condition.

Mr Omany added: "We have looked into the circumstances of this tragic case and our priority now is to ensure that GPs across our area are aware of the dangers of croup.

"We have also contacted all GP surgeries and all out-of-hours providers to highlight some of the difficulties in identifying seriously ill children, and encourage them to refer children for specialist care as a precaution as soon as they have any concerns.

Evelyn's parents Helen and Trevor are now trying to raise awareness about complications of croup and encouraging parents to trust their instincts.

Helen Smith said: "When she first showed signs of being unwell, it was just a mild headache and that's something that all parents encounter.

"But when she burst into our room at 2am saying 'I can't breathe', that was when we knew it was something serious so I took her straight to A&E.

"We feel bitterly disappointed in the trust for failing to acknowledge that changes in their practice needed to be made to reduce the risk of deaths in the future.

"This has added unnecessary distress to our family. This was compounded by a total absence of any aftercare once we had left the hospital after Evelyn died."

This article is courtesy of the Mirror.

£6.7m award to boy whose life was ruined by ‘devastating’ errors at Portsmouth hospital

A young boy who received catastrophic brain damage due to mistakes made by a Portsmouth hospital has been given a settlement worth more than £6.7m.

At the age of four, the boy suffered devastating brain injuries after staff at St Mary’s Hospital in Milton failed to act quickly enough to spot that he had a serious medical condition.

As a result, he had a cardiac arrest which led to brain damage and left him with severe disabilities.

The child, now aged 12, and whose identity has been protected by a court order, has no independent movements, is reliant on carers 24 hours a day and can only communicate through eye moments and the use of specialist technology.

Lawyers from BL Claims Solicitors pursued a clinical negligence claim on his behalf, alleging there were delays in performing a chest x-ray to diagnose that the boy had a condition called congenital diaphragmatic hernia.

The condition is caused by the failure of the diaphragm to fuse properly while the child is developing in the womb, allowing organs to move from the abdomen up into the chest cavity.

It was also argued that there were delays in inserting a nasogastric tube to decompress the stomach and a delay in summoning specialists when he went into cardiac arrest.

On July 14 in the Royal Courts of Justice, His Honour Judge Moloney QC, sitting as a judge in the High Court, approved a settlement negotiated between the claimant and Portsmouth Hospitals NHS Trust, which runs St Mary’s.

The settlement, estimated to exceed £6.7m, is made up of a lump sum of £3.2m plus annual payments of £265,000 a year until the claimant is aged 18 and then £305,000 a year for the rest of his life.

The money will be used to pay for the specialist care the claimant needs.

Dr John White, of BL Claims Solicitors, acting for the family, said: ‘This significant settlement reflects the devastating consequences of the mistakes made at St Mary’s Hospital and the severity of the claimant’s injuries.

‘If the condition of congenital diaphragmatic hernia had been diagnosed more promptly and staff had acted more quickly to deal with its implications, the outcome would have been very different.

‘The claimant needs round-the-clock care for the rest of his life and this settlement will help to ensure that he receives that.’

The boy’s parents said in a statement: ‘The very tragic part is that if the doctors had listened or taken any notice of what we kept saying as parents then this event would have been easily avoided.

‘Instead our son’s life has been completely ruined. He will never go to his school prom, enjoy playing on the beach or have fun kicking a football around with his friends.

‘One message we would like give to all parents is please always trust your instincts when your child is unwell.

‘If you believe that something is wrong then insist that action is taken by the doctors.

‘Nothing will ever make up for the life that has been taken away from him.

‘Our son and his enormous daily battle are an inspiration to all that know or have met him. This is an absolute tragedy caused by mistakes that should never have happened.’

The claimant was seen at St Mary’s in the early hours of September 30, 2006 after developing pains in his stomach and admitted at around 7am.

Following an original diagnosis, he went into cardiac arrest and was transferred to Southampton General Hospital following being stabalised and underwent surgery to repair the defect in his diaphragm.

The case was initially defended by the trust and had been due to go to trial to decide on the issue of liability in the autumn of 2012.

Judgment was entered in the claimant’s favour in October 2012, and the hearing on July 14 approved the amount of the settlement negotiated between the parties.

This article is courtesy of Portsmouth News.

Hospital apologises for failings after schoolboy died on his 13th birthday

Hospital bosses have apologised for their care of a talented young footballer who died of meningitis on his 13th birthday.

Thomas Smith, from Hednesford, near Cannock, was nicknamed Ronnie by friends who compared his soccer skills to those of Cristiano Ronaldo.

But he fell ill with meningitis during a family holiday to Wales – and died on May 29 last year after being given paracetemol instead of antibiotics.

A coroner yesterday condemned Prince Charles Hospital in Merthyr Tydfil over the error as the teenager’s inquest ended.

Christopher Woolley said: “The failure to administer antibiotics amounts to a gross failure of care.

“Antibiotics should have been given without delay. Where meningitis is suspected it’s essential antibiotics are given immediately. The need for basic medical attention in this form was obvious. The risk of giving unnecessary medication was outweighed by the risk of Thomas having bacterial meningitis.”

Mr Woolley said he was also concerned about “further deaths” at Prince Charles Hospital and ordered a report.

But he said it was not a case of “neglect” and, even if Thomas had been given antibiotics, he would probably have still died.

Mr Woolley recorded a conclusion of death by natural causes.

The inquest earlier heard Thomas complained of six tell-tale signs of meningitis, including a headache and a stiff neck.

But doctors failed to diagnose the illness and did not give him antibiotics for more than four hours.

He was seen by Dr Kwong-Tou Yip and consultant paediatrician Dr Ezzat Afifi, who both gave him paracetomal.

The inquest heard both Dr Yip and Dr Afifi had “failed in their duty of care” for Thomas.

After the hearing at Cardiff Coroner’s Court, Cwm Taf University Health Board – which runs the hospital – said it accepted it had failed the teenager.

Chief executive Allison Williams said: “I would like to extend my sincere apologies to the parents of Thomas George Smith for the loss of their son. This is an extremely sad case and we deeply regret there were failings in the care Thomas received at Prince Charles Hospital.

“As noted during the inquest, the Health Board undertook an investigation which identified lessons learned and recommendations to ensure this will never happen again. A number of changes have already been made to address the failings identified.

“Following the conclusion of the inquest, the Health Board will now consider the coroner’s findings and continue to implement the changes required to address any failings in service.”

This article is courtesy of the Birmingham Mail.

USA Military Care, a pattern of errors but not scrutiny

Jessica Zeppa, five months pregnant, the wife of a soldier, showed up four times at Reynolds Army Community Hospital here in pain, weak, barely able to swallow and fighting a fever. The last time, she declared that she was not leaving until she could get warm.

Without reviewing her file, nurses sent her home anyway, with an appointment to see an oral surgeon to extract her wisdom teeth.

Mrs. Zeppa returned the next day, in an ambulance. She was airlifted to a civilian hospital, where despite relentless efforts to save her and her baby, she suffered a miscarriage and died on Oct. 22, 2010, of complications from severe sepsis, a bodywide infection. Medical experts hired by her family said later that because she was young and otherwise healthy, she most likely would have survived had the medical staff at Reynolds properly diagnosed and treated her.

“She was 21 years old,” her mother, Shelley Amonett, said. “They let this happen. This is what I want to know: Why did they let it slip? Why?”

The hospital doesn’t know, either.

Since 2001, the Defense Department has required military hospitals to conduct safety investigations when patients unexpectedly die or suffer severe injury. The object is to expose and fix systemic errors, often in the most routine procedures, that can have disastrous consequences for the quality of care. Yet there is no evidence of such an inquiry into Mrs. Zeppa’s death.

The Zeppa case is emblematic of persistent lapses in protecting patients that emerged from an examination by The New York Times of the nation’s military hospitals, the hub of a sprawling medical network — entirely separate from the scandal-plagued veterans system — that cares for the 1.6 million active-duty service members and their families.

Internal documents obtained by The Times depict a system in which scrutiny is sporadic and avoidable errors are chronic.

As in the Zeppa case, records indicate that the mandated safety investigations often go undone: From 2011 to 2013, medical workers reported 239 unexpected deaths, but only 100 inquiries were forwarded to the Pentagon’s patient-safety center, where analysts recommend how to improve care. Cases involving permanent harm often remained unexamined as well.

At the same time, by several measures considered crucial barometers of patient safety, the military system has consistently had higher than expected rates of harm and complications in two central parts of its business — maternity care and surgery.

More than 50,000 babies are born at military hospitals each year, and they are twice as likely to be injured during delivery as newborns nationwide, the most recent statistics show. And their mothers were more likely to hemorrhage after childbirth than mothers at civilian hospitals, according to a 2012 analysis conducted for the Pentagon.

In surgery, half of the system’s 16 largest hospitals had higher than expected rates of complications over a recent 12-month period, the American College of Surgeons found last year. Four of the busiest hospitals have performed poorly on that metric year after year.

Surgical Complications
 
Half of the military’s largest hospitals performed worse than established benchmarks in categories such as infections or improperly done procedures, according to a review from the American College of Surgeons. The college compared each hospital with an expected rate of complications based on the procedures it performed and what kinds of patients it served from July 2012 to June 2013.

Little known beyond the confines of the military community, the Pentagon’s medical system has recently been pushed into the spotlight. In late May, Defense Secretary Chuck Hagel ordered a review of all military hospitals, saying he wanted to determine if they had the same problems that have shaken the veterans system.

Mr. Hagel said the review would study not just access to treatment, the focus of investigations at the veterans hospitals, but also quality of care and patient safety — issues that The Times has been looking at, and asking the Pentagon about, for months.

Defense Department health officials say their hospitals deliver treatment that is as good as or better than civilian care, while giving military doctors and nurses the experience they may one day need on the battlefield. In interviews, they described their patient-safety system as evolving but robust, even if regulations are not always followed to the letter.

“We strive to be a perfect system, but we are not a perfect system, and we know it,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. He added, “We must learn from our mistakes and take corrective actions to prevent them from reoccurring.”

The Times’s examination, based on Pentagon studies, court records, analyses of thousands of pages of data, and interviews with current and former military health officials and workers, indicates that the military lags behind many civilian hospital systems in protecting patients from harm. The reasons, military doctors and nurses said, are rooted in a compartmentalized system of leadership, a culture of interservice secrecy and an overall failure to make patient safety a top priority.

The investigations of unforeseen deaths or permanent harm, called root-cause analyses, are widely regarded as a centerpiece of efforts to make care safer. Asked about the military’s missing inquiries, Dr. James P. Bagian, director of the University of Michigan’s Center for Healthcare Engineering and Patient Safety, said, “If in fact unexpected deaths were reported and ignored, there would appear to be no good answer for that except that someone is sleeping at the switch.”

Avoidable errors can and do occur at the best of hospitals. But the military’s reports show a steady stream of the sort of mistakes that patient-safety programs are designed to prevent.

The most common errors are strikingly prosaic — the unread file, the unheeded distress call, the doctor on one floor not talking to the doctor on another. But there are also these, sprinkled through the Pentagon’s 2011 and 2012 patient-safety reports:

A viable fetus died after a surgeon operated on the wrong part of the mother’s body.

A 41-year-old woman’s healthy thyroid gland was removed because someone else’s biopsy result had been recorded on her chart.

A 54-year-old retired officer suffered acute kidney failure and permanent hearing loss after an incorrect dose of chemotherapy.

Such treatment failures are known as “never events,” because they are potentially so grave — and so preventable. They do not happen frequently. But a persistent rate of such mistakes can indicate broader patterns of slipshod care.

Malpractice suits can also be a rough indicator of risk. From 2006 to 2010, the government paid an annual average of more than $100 million in military malpractice claims from surgical, maternity and neonatal care, records show. It would be paying far more if not for one salient reality of military health care: Active-duty service members are required to use military hospitals and clinics, but unlike the other patients, they may not sue. If they could, the Congressional Budget Office estimated in 2010, the military’s paid claims would triple.

Experience in civilian hospitals, and in the veterans system, has shown that stricter procedures and more sophisticated surveillance can limit errors, sometimes markedly. Among some in the military network, concerns about patient safety are longstanding, if rarely acknowledged in public. But calls for change have consistently foundered in the convoluted bureaucracy.

The military health system is split into three major branches, with the Army, Navy and Air Force each controlling its own hospitals and clinics. The Pentagon’s Defense Health Agency also runs the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital, both outside Washington. Any systemwide change involves a carefully calibrated consensus of three equally ranked surgeons general, as well as the Defense Health Agency. Dr. Woodson, who oversees the system, cannot order the surgeons general to act. He can only recommend.

Progress can be glacial: In 2007, for example, the military started rewriting regulations for handling events that harmed or endangered patients. It finished only last October. Several former Pentagon officials said embarrassing statistics were often filtered out, glossed over or buried amid larger data sets before they reached senior health leaders. Two measures used in major civilian hospitals to monitor quality of care — rates of death and readmission, adjusted for seriousness of illness — are simply not tracked.

“The patient-safety system is broken,” Dr. Mary Lopez, a former staff officer for health policy and services under the Army surgeon general, said in an interview.

“It has no teeth,” she added. “Reports are submitted, but patient-safety offices have no authority. People rarely talk to each other. It’s ‘I have my territory, and nobody is going to encroach on my territory.’ ”

In an internal report in 2011, the Pentagon’s patient-safety analysts offered this succinct conclusion about military health care: “Harm rate — unknown.”

Lethal Medical Errors
Katie Guill checked into the hospital at Fort Leonard Wood, Mo., on Christmas morning 2008, expecting to give birth to a healthy baby boy. She left with an infant so severely brain-damaged that at age 5, he cannot crawl, speak or swallow. He must be fed through a pump.

In the three hours before a doctor finally delivered their son, Justen, by cesarean section, the Guills said in a lawsuit, a monitor sounded 32 alerts that the baby’s heart rate had slowed. The suit also said the nurse had warned the doctor on duty four times that the baby was in distress before he arrived at Mrs. Guill’s bedside. The family’s lawyer, Laurie Higginbotham, said she believed the outcome might have been different had the nurse alerted the doctor’s superiors.

The government settled the case for $10 million, but Pentagon records give no indication that a safety investigation was conducted. Nor is there a record of any action taken against the doctors and nurses involved. A spokeswoman said the Defense Department was legally prohibited from discussing how any specific case had been handled.

“We don’t know what went wrong because no one has ever told us,” said Justen’s father, Jon Guill, a former Army mechanic who served 18 months in Iraq.

The Pentagon had promised to look harder at such mistakes.

In 1999, the Institute of Medicine estimated that medical errors killed between 44,000 and 98,000 patients at hospitals nationwide every year. Those numbers — which most experts now consider an undercount — stunned the medical community and kick-started an aggressive effort to protect patients from accidental harm.

Simply penalizing doctors and nurses for malpractice had failed, the institute concluded, because most mistakes arose from weak procedures, not reckless individuals. It called for new strategies, including mandating that medical workers report mistakes and hospitals investigate and correct the lapses that allowed them to occur.

The Pentagon embraced the report, requiring that military treatment facilities produce a written root-cause analysis within 45 days in all cases of unexpected serious injury or death. “Such events are called ‘sentinel’ because they signal the need for immediate investigation and response,” the regulations state. Military hospitals must also report sentinel events to the Joint Commission, an independent accreditation group. Specialists at the Pentagon’s patient-safety center, created in 2001, were told to review the analyses and recommend changes.

Certainly it is difficult to assess such a divided and diverse medical system, with 56 hospitals, domestic and overseas, ranging from the flagship, Walter Reed, to a hospital in the middle of the Mojave Desert with an average of three inpatients a day. They serve not only young, typically healthy active-duty families but also the longest-serving military retirees and their families. Even so, experts say safety reviews can reveal trouble spots as well as patterns of error across an entire system.

But annual patient-safety reports and other internal documents obtained by The Times show that, for years, the center’s analysts have often found themselves staring into darkness.

As early as 2003, a Pentagon audit noted that medical workers had reported 80 cases of severe harm or death in the preceding 12 months, but that only 32 root-cause analyses had been forwarded to the center. Five years later, another audit concluded, “Unfortunately, R.C.A.s are used relatively infrequently.”

The most recent safety reports paint a similar — and more detailed — picture.

In 2011, 50 unexpected deaths were identified but only 25 analyses submitted.

The next year, the center was informed of 110 deaths but received only 44 root-cause analyses.

And in 2013, the report documented 79 deaths and 31 root-cause analyses.

The safety audits also make clear that of the root-cause analyses that are done, the cases of clearest-cut blame — the “never events” — make up the largest group. Even so, the reports show, those mistakes have not subsided.

In 2010, the safety center had sounded a hopeful note. For the first time in nine years, it said, “all surgeries and procedures were performed on the right person.” But the next year, the center said surgeons were still performing the wrong procedure or operating on the wrong patient or part of the body at an “alarming” rate. It called for intensive hospital audits to lower it.

Last year, medical workers reported virtually the same number of errors. They also reported more cases in which medical devices were inadvertently left inside patients than they had four years earlier.

In a written response to questions from The Times, the Pentagon acknowledged that it had taken a decade before the reporting system was “operational and collecting data in a uniform manner.” Not until last October, for instance, were the Army, Navy and Air Force required to identify the facilities where patients were severely harmed or died.

Senior defense health officials say the missing investigations are not a true measure of attention paid to serious harm. “There are many mechanisms for reviewing significant adverse events,” the Pentagon said in a statement.

In an interview, Dr. Woodson said a different kind of inquiry that hospitals conduct — a risk-management investigation — might have gotten to the bottom of what went wrong. Those investigations focus on whether individual doctors or nurses provided substandard care for which the government could be liable.

“I feel confident that we capture and investigate the overwhelming majority of these adverse events,” Dr. Woodson said. “The key is having a robust system and that you pick all of them up and make the changes that are appropriate.”

But military regulations specifically require both types of inquiries, and for good reason, patient-safety experts say: Otherwise, even catastrophic errors — mistakes for which no one is specifically to blame, but that instead result from systemic lapses — can be easily swept under the rug.

Busy but Troubled Hospital

Womack Army Medical Center in Fort Bragg, N.C., is one of the system’s largest, busiest hospitals. Lately it has also been one of its more troubled.

For three years, it has had a higher-than-average rate of surgical complications, and in March it suspended all elective surgery for two days after inspectors found problems with surgical infection controls. Then last month, the Army ousted the hospital’s leadership after the unexpected deaths of two patients in their 20s: a mother of three who had undergone a low-risk surgical procedure and a soldier who had been sent home from the emergency room.

That same day, Defense Secretary Hagel ordered the systemwide review.

At Womack and elsewhere, some doctors and nurses complain that no one listens to their safety warnings. One staff member interviewed by The Times recalled filing roughly 50 reports of safety problems since 2007, each time providing contact information. Only once, the worker said, did a supervisor respond, and then only to express irritation at the fusillade of filings.

“It is an exercise in futility,” said the staff member, speaking on condition of anonymity for fear of job repercussions. “We can jump up and down and shake our fists, but nothing changes.”

Dr. Lopez, the former Army staff officer, said some hospital officials had told her that they felt pressure from superiors to focus on budget cutting and efficiency, while patient safety got a cursory nod.

Across the system, Pentagon officials cite some signs of progress. In 2008, for instance, the composite rate of 11 types of harm — like pressure ulcers and postoperative hemorrhages — was more than twice that of civilian hospitals with a similar patient mix. Last year, it was better than the civilian average, although the Pentagon’s own analysts warned results might be skewed by reporting problems.

Even so, the most recent patient-safety report complained of a general lack of headway in building a safer system. While the number of reports of harm has varied over the last decade, and “there are certainly pockets of excellence,” it noted, “The leading trends remain consistent.” What was needed was “enterprisewide change.”

The operating room has been one focus of concern.

The study by the American College of Surgeons found that in addition to Womack, three other major hospitals — Madigan Army Medical Center in Tacoma, Wash.; San Antonio Military Medical Center in Texas; and Portsmouth Naval Hospital in Virginia — have had high rates of surgical complications for two or three years in a row. Five of the eight cited last year had also been flagged repeatedly for high rates of infection related to surgery.

Dr. Brian Lein, the Army’s deputy surgeon general, said hospitals that fell below the benchmark “have dug deep into the data to find the actual issues and are addressing those issues.” The Navy echoed that response.

With so many young military families, the system’s maternity wards are among its busiest. Pentagon officials say maternity care is top notch, and on some leading measures of safe childbirth, the military hospitals indeed compare well with their civilian counterparts.

For example, their rate of infant mortality was equal to or lower than that of civilian hospitals in the most recent data analyzed by the National Perinatal Information Center, a private group with a Pentagon contract. In routine vaginal births, the rate of injury to the mother has consistently been below the national average.

On other measures, though, the military system lags.

In 40 percent of the military hospitals, mothers were significantly more likely to suffer hemorrhages after birth than at the civilian hospitals tracked by the perinatal center. The hemorrhages can lead to hysterectomies or even death. About 2,500 cases were recorded in military hospitals in 2012, roughly 760 more than if the military had met the civilian benchmark.

If doctors used instruments such as forceps to assist the delivery, mothers in military hospitals were about 15 percent more likely to be injured than mothers nationally, the most recent data shows.

One of the broadest measures of safe childbirth is the rate of injuries to babies, ranging from cerebral hemorrhages to small cuts on babies’ scalps. From 2009 to 2011, according to a Times analysis, the rate at military hospitals was twice the national average.

In 2011, nearly five in every 1,000 babies born at military hospitals suffered some kind of birth trauma. Had the military met the national average, 107 newborns would have been injured instead of 239.

Dr. Woodson said the military is looking “closely at areas where we are falling short” on maternity care and measuring its hospitals against civilian ones in order to improve.

Ordeal Giving Birth

When Stephanie King felt labor pains on Easter in 2004, she drove to Reynolds Army Community Hospital. She was 34, a kindergarten teacher and mother of two. Her husband, an Army artillery officer, was serving six months in Iraq, so her 12-year-old son accompanied her to the hospital.

Her contractions were coming every three to five minutes, court records show, but a resident on the maternity ward refused to admit her, saying her cervix was not sufficiently dilated. The attending physician agreed.

Mrs. King spent the next two hours in the hospital’s first-floor lobby, waiting room, cafeteria and bathroom. She wanted to seek care at the civilian hospital 15 minutes away, but her military insurance would not cover it. In the midst of her ordeal, her husband called from Baghdad to say he was being airlifted to Germany after an emergency appendectomy.

Finally, fearful that she would deliver on the bathroom floor, she took the elevator back to maternity. A nurse greeted her with what seemed to be a joke: " ‘Oh, Mrs. King, you are back,’ ” she recalled the nurse saying. " ‘You don’t look as good as you did when you first came in.’ ”

Any amusement vanished, however, when staff members realized not only that Mrs. King was about to give birth — but that her file showed she carried a common but symptomless strain of group B streptococcus bacteria. Women in labor must be given antibiotics at least an hour before delivering to avoid transmitting the infection to their newborns, hospital workers later testified.

Dawson King was born just 42 minutes after his mother was admitted. Doctors soon determined that he had contracted an infection, and warned Mrs. King that the only effective medication could cause deafness. Four months later, when Dawson did not turn his head when his parents walked into the room, it became clear that he was profoundly deaf.

Only three years later, after Mrs. King filed a malpractice claim, was the case discussed at Reynolds, court records indicate. The attending physician said a risk-management meeting was held to ensure that the standard of care was met. No report was written, and the doctors and the nurse emerged with spotless licenses.

That result that would appear to point to a lapse in hospital procedures. But both the resident and the nurse testified that they had never attended a meeting at Reynolds to discuss what had gone wrong.

“That’s the disturbing part,” Mrs. King said, while Dawson draped himself over the arm of his father’s chair, looking at photos of himself as a 1-year-old, his head swathed in bandages from surgery for cochlear implants. “Doesn’t the hospital want to know what happened?”

Mrs. King believes that she knows: Her file documented her history of strep B infection and the fact that her second child had been born after a 90-minute labor. And the resident testified that he could not recall if he had read her record before declining to admit her. “It boils down to they did not even read my records,” Mrs. King said.

The government settled the Kings’ case in 2009 for $300,000. Mrs. King describes her son, now an engaging, soccer-playing 10-year-old, as “a success story.” Still, she said, “it was devastating how easily it could have been prevented.”

The Kings’ malpractice payout was relatively modest. An examination of court records and Pentagon data from Reynolds and seven other hospitals turned up dozens of settlements, ranging from $30,000 to $10 million, but no record of a root-cause analysis.

Flying Blind on Safety

On Dec. 7, 2011, Dr. Woodson summoned senior health officials to a Pentagon conference room to discuss the safety of military hospitals and clinics. The deputy surgeons general of the Army, Navy and Air Force were present. So was Dr. Ronald Wyatt, then the director of the Pentagon’s patient-safety center.

According to accounts from several people familiar with the session, Dr. Wyatt suggested that the center was flying blind. Without knowing the facilities’ death and harm rates, as well as the rates of paid malpractice claims, he argued, his staff was unable to identify safety lapses — much less correct them.

And serious lapses did exist, he said, for “this system, like many systems throughout the country, hurts and kills people every day.” Angered, Dr. Richard A. Stone, then the Army’s deputy surgeon general, shot back: “I demand that you retract those statements.”

Dr. Warren Lockette, the deputy assistant secretary for clinical policy, stood by Dr. Wyatt. “What I am hearing is you are all satisfied with the status quo,” he said. Dr. Woodson tried to defuse the tension with a compromise: He would recommend that the services turn over the data.

Asked about the meeting, Dr. Stone said that data should be shared but that Dr. Wyatt’s statement was “inflammatory.”

The standoff was typical, former Defense Department officials say, of a continual tug-of-war between health care officials in the Pentagon and in the individual armed services that has crippled efforts to improve patient safety. In such a politicized system, data can be a weapon.

“Why should the Army safety system want to play with D.O.D., because then I have less control over my data, less control over my kingdom, and potentially D.O.D. is going to tell me what to do?” said Dr. Lopez, the former Army health policy officer.

To keep Pentagon overseers at bay, surgeons general have often relied on a provision in a 1986 law, known as 1102, that prohibits disclosure of medical quality assurance records. Originally adopted to ensure that medical personnel could be honestly evaluated without fear of publicity, former department officials say, it became a tool to withhold a broad range of data from the Pentagon itself.

And from the public. In response to Freedom of Information Act requests, the Pentagon provided The Times with thousands of pages of data. But much information was redacted and some reports were withheld as confidential, including all reports by the Navy’s inspector general on patient safety or quality of care. By contrast, the veterans system posts the reports on a public website.

While infighting held the military’s patient-safety programs in check, some civilian hospital systems cut death and harm rates. At Ascension Health and Kaiser Permanente, two of the nation’s biggest nonprofit systems, investigating workers’ reports was just a first step. The companies also analyze a vast array of data, including readmission and mortality rates.

The death rate is a broad measure that cannot pinpoint where care falls short. Nonetheless, “mortality is the mother of all outcomes,” said Ascension’s chief medical officer, Dr. Ziad Haydar. Measured over time, a death rate, adjusted for seriousness of illness, can show if a medical system is getting more or less safe.

Officials at Ascension and Kaiser say their hospitals have gotten safer. Ascension estimates that its safety measures have saved 1,500 lives in the last six years. Doug Bonacum, Kaiser’s vice president for quality, safety and resource management, said the mortality rate at Kaiser’s 38 hospitals had fallen more than 30 percent in the last four years.

The Pentagon does not routinely track the total number of deaths, and has no method yet to calculate adjusted rates. “Frankly it is not yet a helpful measure for assessing quality,” Dr. Woodson said.

As a result, why some military hospitals report many more deaths than others with similar numbers of patients is a mystery. The Army, Navy and Air Force each said that hospitals with above-average death rates treated older, sicker patients, but did not produce statistical evidence to verify that.

When it comes to gauging the frequency of errors, systems like the military’s that rely on workers to report harm have been shown invariably to undercount. Kaiser has long used another technique, called the Global Trigger Tool, that winnows out indicators of poor care from randomly selected patient files.

Using that technique, researchers concluded in 2010 that one-third of patients at three major civilian hospitals had suffered some kind of harm. A similar pilot study by the Pentagon last year found that nearly half the patients whose files were reviewed at a major military hospital had been harmed at least once. The study suggested 99 percent of harm at that hospital was not reported by medical workers.

Communiation Breakdowns

When patients die unexpectedly, medical workers often cite a breakdown in communications.

That appears to be the overriding explanation for the delay three and a half years ago in treating Jessica Zeppa, a case that ended with a $1.25 million malpractice settlement. But that is only conjecture. Her death was apparently never subjected to a patient-safety examination.

Mrs. Zeppa had been married and living at Fort Sill for only nine months when her husband, James, an air defense tactician, was deployed to the United Arab Emirates. She had their two dogs and a cat for company. And to her delight, she was pregnant. “She was just out of this world about it,” said her mother, Mrs. Amonett.

But five months into the pregnancy, Mrs. Zeppa became so weak that she struggled to climb stairs. She complained that it hurt to drink or swallow.

At Reynolds Army Community Hospital, she was initially treated in the obstetrics and gynecology unit, where an ear infection was diagnosed and she was prescribed antibiotics and ear drops, court records show. Three days later, she arrived at the emergency room at 4:51 a.m.; she was prescribed a painkiller for erupting wisdom teeth.

She returned that same evening and was found to have a fever, a fast pulse and an elevated white blood cell count — possible symptoms of serious infection. The emergency room physician, Dr. Raul Young-Rodriguez, treated her intravenously with fluids and a powerful antibiotic and sent her upstairs to the obstetrics and gynecology unit for possible admission.

No one called the obstetrician on duty to inform her of the patient’s condition, the Zeppas’ lawyers, Heather Mitchell and Steven Clark, said in court papers. Nor did the obstetrician, Dr. Debra A. Carson, call Dr. Young-Rodriguez.

As far as she knew, Dr. Carson later testified, Mrs. Zeppa was there for “obstetrical clearance.” She examined her and sent her home within 20 minutes. Mrs. Amonett said she protested but was told her daughter could not be admitted if the fetus was not in distress.

Dr. Carson testified that she had not checked the military’s electronic record system for Mrs. Zeppa’s history, because all too often she had found patient records missing. In Mrs. Zeppa’s case, lab results were posted less than an hour after she left. Had she seen them, Dr. Carson testified, “I would more than likely have admitted her.”

Two days later, Mrs. Zeppa returned to the obstetrics and gynecology unit, insisting that she would not leave until she got warm. A nurse midwife, Kelly West, treated her with intravenous fluids and again released her. Ms. West testified that she did not review Mrs. Zeppa’s records either.

The next afternoon, with Mrs. Zeppa struggling to breathe, her mother summoned an ambulance. Mrs. Zeppa was airlifted the following morning to a civilian hospital in Oklahoma City, where she miscarried 10 days later and died the next month.

Five months after that, facing a malpractice claim, Reynolds officials conducted a risk-management investigation. In an interview, Ms. West, the nurse, said she had been cleared of violating the standard of care. Nor is there any public indication that the two doctors were penalized. They did not respond to requests for comment.

Medical experts hired by the family’s lawyers said that had the Fort Sill doctors recognized that Mrs. Zeppa was suffering from septic shock and immediately hospitalized and aggressively treated her, she and the baby probably would have survived. The government’s experts disagreed, noting that civilian doctors had been unable to save Mrs. Zeppa in five weeks of treatment.

Justice Department lawyers called Mrs. Zeppa’s death a “unique and tragic case, but not a case of bad and actionable medicine.” Beyond the risk-management assessment, they said, they knew of no other inquiry. Ms. West also said she knew of none in the roughly eight months before she left Fort Sill.

That left any missteps that contributed to Mrs. Zeppa’s death unexplained.

“She was really pretty, and she had a really big heart,” James Zeppa, Mrs. Zeppa’s husband, said. Now, he said, he no longer trusts military medicine.

Mrs. Zeppa’s father, Mike Amonett, had one thing to say about the Fort Sill hospital: “I just want that place shut down.”

This article is courtesy of The New York Times.

Reducing medical mistakes

All the talk around patient safety is finally showing signs of translating into action as three different initiatives came together in the same week. On 24 June, Jeremy Hunt formally launched the ‘Sign up to Safety’ initiative, announced in March (blogs passim) which is a voluntary scheme designed to reduce medical mistakes by a third. At the same time, NHS Choices launched its new microsite wherein a range of data relating to patient safety has been published; and a review into the reporting culture of the NHS, led by Sir Robert Francis QC, was announced.  Since the Mid-Staffordshire scandal, patient safety has been top of the political agenda with promises to reform the system coming thick and fast; at last these pledges now seem to be bearing fruit.
 
1. Sign up to Safety
 
This campaign is being led by Sir David Dalton, Chief Executive of Salford Royal Hospital and, so far, 12 NHS Trusts have signed up, developing plans to show how they will reduce ‘avoidable’ harm such as infections caused by lack of cleanliness, medication errors and blood clots.  In other words, by looking after the small stuff, the big stuff has a better chance of looking after itself. This may seem like common sense but, as shown by the scandals following in the wake of Mid-Staffs, some hospitals have had to be reminded what they’re actually there to do and the proper environment in which to do it. So many medical negligence and NHS compensation cases that I see stem from a relatively minor cause or event which, had it been picked up and addressed early on, should not have caused the sort of harm that would lead to a claim. The fact that each ‘Sign up to Safety’ plan has to be reviewed and signed off by the NHS Litigation Authority - which then helps to finance the implementation of the plan - says it all.
 
2. Patient safety data
 
In the quest for openness, the NHS Choices microsite publishes a range of data enabling members of the public to assess their local hospital against seven criteria:  CQC standards; ‘open and honest’ patient safety reporting; safe staffing levels; infection control and cleanliness; assessment for risk of blood clots; responding to patient safety alerts; and, finally, whether staff would recommend their hospital to friends and family. Of course there is the small issue of data interpretation and missing data which skews the results for some hospitals but, overall, this must be a worthwhile project. The latest set of data to be added is that of actual staffing levels - down to ward level - along with planned staffing levels. Naturally this data does need to be viewed with a degree of caution while it beds in – for instance a fifth of NHS acute trusts are rated ‘poor’ for reporting on patient safety. Taken at face value, this sets alarms ringing but is it that patient welfare is seriously compromised in this number of hospitals or is it that they are behind the curve in data collection, management and interpretation? Publishing the data will be an excellent incentive for hospitals to get their acts together.
 
3. The latest Francis Review
 
Sir Robert Francis QC, who led the inquiry into the Stafford Hospital scandal, will be heading up in independent review: ‘An Independent Review into creating an open and honest reporting culture in the NHS’. His objective is to ensure that staff faced with a serious breach of patient safety do not feel prevented in any way from reporting their concerns or to feel that taking such action will compromise their employment.
 
4. Conclusion
 
Some hospitals have already discovered the benefits of gathering and interpreting data to help them improve on services delivered. University Hospitals Trust Birmingham has been using data to drive patient care for some time, helping to uncover trends and promoting best practice across disciplines. Hospitals are large, complex organisms and the level of specialisation means that departments can operate different sets of standards under the same roof. As I’ve said in the past, by being upfront, open and honest about shortcomings and medical mistakes, hospitals can avoid negligence claims being lodged and lay the foundations for future best practice.

This article is courtesy of Jeanette Whyman, a Medical Negligence Claims Solicitor with Wright Hassall; she has successfully secured NHS Compensation for many victims of medical negligence.

NHS Scotland's blunder payouts reach £186m as country's top doctor brands care crisis in hospitals a 'car crash'

The “disgraceful” total has increased sharply in the last two years, from £25.3million in 2011-12 to £35.5million in 2013-14.

Patients’ groups have slammed NHS Scotland for spending more than £186million on compensation claims and legal settlements in the last five years.

The “disgraceful” total has increased sharply in the last two years, from £25.3million in 2011-12 to £35.5million in 2013-14.

Claims from employees have also sky-rocketed – from £1.1million in 2009-10 to £3.4million last year.

This news comes as Scotland’s top doctor branded our crisis-hit NHS a “car crash” and blamed politicians for the disaster.

Dr Brian Keighley, head of the BMA in Scotland, warned that the future of the health service hangs in the balance because of unacceptable queues at A&E and delays in vital cancer treatments.

Dr Jean Turner, executive director of Scotland Patients Association, echoed his concerns and described the sharp rise in compensation payouts as “extremely worrying”.

She said: “These figures are disgraceful. It seems there are more and more people coming forward with complaints about the level of care they receive.

“It is a huge amount of money that could be better spent on drugs, treatment and patient care.

“There are problems with staffing and everyone working is under extreme pressure. This means they are much more liable to make mistakes.”

Scottish Labour’s health spokesman Neil Findlay accused Health Secretary Alex Neil of “jumping from one crisis to the next”.

He said: “Our NHS staff do a terrific job but we know there is huge concern about resources and staffing.

“If that is contributing to our negligence costs, then Alex Neil has to understand he has a problem. “

The Scottish Government said: “Scotland is recognised as having some of the safest hospitals in the world.

“However, it is absolutely essential that when clinical negligence claims do arise, NHS boards learn from these cases and put steps in place to ensure that there is no repeat in future.”

This article is courtesy of the Daily Record.

Mum dies after cervical cancer misdiagnosed 30 times

A mother-of-four died after doctors missed 30 chances to diagnose her cervical cancer, an inquest heard.

Jeannine Harvey, 33, was so debilitated by pain she was unable to get out of bed without help.

However, despite consultations with her GP and doctors at three hospitals, her cervical cancer was repeatedly misdiagnosed as a potential torn ligament, protruding discs, sarcoma and "nerve pain".

Doctors even suggested at one point that her agony was caused by anxiety.

Miss Harvey's sister became so desperate for her sibling to be treated she once got down on her knees and begged doctors to admit her.

By the time medics realised the accountancy student - whose youngest child was only two when she died - was suffering from advanced uterine cancer of the cervix, it was too late.

She died at a hospice in July 2012 - eight months after a blood test first raised concerns.

Miss Harvey died of uterine cancer of the cervix, which was misdiagnosed on more than 30 occasions.

Repeated failures were made by medical staff to recognise, diagnose and treat her, the inquest heard.

Miss Harvey's sister, Marie Donovan, said ahead of the inquest: "All we've ever wanted is for someone to tell us how it was possible for medical professionals to miss so many opportunities to correctly diagnose and treat our sister, whose suffering and death were entirely preventable.

"Throughout Jeannine's illness, we got the impression that no one was listening to us, and felt doctors were constantly patronising us by saying it was Jeannine's anxiety that was making her pain worse."

Speaking three months after her death, Ms Donovan, from West Heath, Birmingham, said her sister's treatment was "like something out of the Dark Ages".

She added: "My beautiful sister was in agony, she was crippled with pain, but no one listened to her."

Miss Harvey left behind four children who, at the time of her death, were Paul, 16, Jack, 12, Frankie, five, and Ella, two.

Miss Harvey, from the West Middlands first complained of pain in her left leg and abdomen in December 2011.

An ultrasound scan - conducted after the blood test for ovarian cancer came back "elevated" - revealed a mass 4cm wide in her pelvic area.

But a laparoscopy six weeks later at City Hospital in Birmingham, appeared to show the mass had vanished, and she was sent back to her GP for physiotherapy.

Days later and still in pain, she was taken to accident and emergency at Sandwell Hospital where doctors diagnosed a possible torn ligament.

An MRI scan in March 2012 led to a new diagnosis of protruding discs, with doctors claiming anxiety was the main source of her pain.

Ms Donovan claims that, when her sister was finally admitted to the Medical Assessment Unit at City Hospital on April 18 2012, she was in such a poor state a nurse assumed she was a cancer patient.

Days later, Miss Harvey was misdiagnosed again, this time with sarcoma - a type of cancer that develops in connective tissues.

A routine biopsy at Birmingham's Queen Elizabeth Hospital prior to starting chemotherapy found squamous cell tissue, which could only have originated in the cervix.

By the time her treatment began, the tumour - now 8cm - had become infected and shattered her pelvic bone. She was admitted to a hospice on July 13 2012 and died ten days later.

Jill Davies, the family's lawyer at national law firm Access Legal, said: "This is one of the most tragic and distressing cases I have seen and it has implications for the diagnosis and timely treatment of cancer on a national basis.

"Even if Jeannine could not have been cured, it is possible that with an earlier correct diagnosis she may have avoided months of pain at the end of her life."

Cervical cancer is a rare type of cancer that develops in a woman's cervix.

It often has no symptoms in the early stages meaning it is often not diagnosed until it is more advanced.

A Facebook page called Justice4Jeannine was set up by Miss Harvey's family shortly after her death to share her story with the wider world.

Ms Donovan said: "Nothing can ever bring our sister back, but we know her story has made a difference.

"We've had messages from people who say Jeannine's case has pushed them not to accept an initial diagnosis, good or bad, and go for further tests.

"Because of Jeannine, many people are alive and receiving treatment today who otherwise might have died in similar circumstances."

Roger Stedman, medical director at Sandwell and West Birmingham Hospitals NHS Trust, said: "Our sincere condolences are passed on to Jeannine's family at this very difficult time and we are sorry for the distress suffered.

"Following Jeannine's death we carried out a detailed internal investigation where we identified several areas where we fell short in our expected high standard of care.

"This included a failure to make an adequate and timely diagnosis and our failure to adequately treat Jeannine's pain as a result, in the last days of her life.

"We have met with Jeannine's family and expressed our sincere apologies for these failings and would wish to extend that apology again.

"Our investigations indicate that an MRI of Jeannine's pelvis should have been carried out following a laparoscopy performed in February 2012, and for this we are truly sorry.

"It is clear that appropriate treatment would have brought forward the date of diagnosis and would have prevented pain and suffering.

"Sadly, it would appear that Jeannine's cancer was already at a stage that it would not have been curable."

This article is courtesy of The New Zealand Herald.

Boy, 7, awarded £8 million compensation package after care "deficiencies"

A seven-year-old boy stricken by catastrophic brain damage after his birth at Queen’s Medical Centre has won an £8 million compensation package - plus a public apology for the "deficiencies" in his care.

The boy, who cannot walk or speak, was left with profound lifelong cerebral palsy after medics mishandled desperate attempts to resuscitate him following his delivery at the hospital in November 2006, London's High Court heard.

Mr Justice Lewis, who approved a settlement designed to meet all the youngster's lifetime needs, said he had "suffered complications" following his birth, after which hospital staff "failed to provide adequate treatment for him".

"There were deficiencies in the way the hospital dealt with the need to resuscitate him", said the judge, who added that the hospital has "since taken steps to correct what went wrong so that other families won't be faced with the same difficulties".

The boy, from Nottingham, is able to smile and respond to his large family - whose devoted care was today praised by the judge.

But he also needs a team of carers to get him through the day and has acute learning difficulties, his lawyers disclosed after the short hearing.

The case reached the High Court as his parents sought the judge's approval for a compensation package to be met by the hospital's managers, the Nottingham University Hospitals NHS Trust, which admitted liability.

The lad's mum was in court to hear the NHS Trust's barrister, William Wraight, publicly apologise for the post natal blunders.

"There were deficiencies in the provision of resuscitation on that day but these problems have been identified and corrected," said Mr Wraight.

Mr Justice Lewis approved a settlement which takes the form of a £3.25 million lump sum, plus annual, index-linked and tax-free payments to cover the enormous costs of his care for life.

Those payments will start at £146,500-a-year, rising to £230,000 beyond the age of 19. Lawyers estimate the total settlement will be worth between £8 million and £9 million over the boy's lifetime.

Mr Justice Lewis said he was satisfied the settlement was "just and appropriate", also commending the boy's parents and family, saying: "He is really lucky to have a family like this. I wish them all well."

Nottingham University Hospitals NHS Trust has apologised to the family.

Chief executive Peter Homa, said: “We reiterate our sincere and unreserved apologies to the family.

“Whilst no amount of money can compensate for nor undo the harm and distress the family have experienced as a result of this tragic case, we hope this settlement provides the family with financial security for the future.”

This article is courtesy of the Nottingham Post.

Maternity services under pressure

A case in which I advised the parents of a four-day old baby who died in 2012 after being deprived of oxygen has recently been in the news as the family has only just received a five-figure settlement and an apology from Warwick Hospital. An inquest, held in June 2013, heard how failings in Daniel’s care during labour had led to his death. These included three different midwives failing to read his mother’s antenatal notes which would have revealed her as a medium risk patient; one of the midwives having a history of making mistakes; and a failure by staff to monitor the foetal heart properly.
 
The testimony of Sarah Kunigiskis, mother of baby Daniel, makes harrowing reading. In addition to the grief of losing her baby was the refusal of the hospital to admit they were at fault while implying that there was something wrong with the baby before delivery. As she noted, the refusal of the hospital to acknowledge that a catastrophic error had occurred, made an awful situation far worse. One of the reasons Sarah was willing to speak out was to help put pressure on hospitals and NHS Trusts to be more accountable for their actions when mistakes are made by encouraging others in 
similar situations to challenge the experts if they feel things are not right.
 
NAO report into maternity services in England
 
The situation endured by the Kunigiskis family is not unfamiliar to medical negligence solicitors. Obstetrics is a particularly challenging area of medicine where there is, on the one hand, a desire not to medicalise a perfectly natural event but, on the other, a need to step in as soon as things start going wrong. A report released by the National Audit Office in November 2013 highlighted that some of the problems faced by maternity services in England were reflected in the fact that a third of the NHS litigation budget was absorbed by medical negligence cases relating to birth complications. In 2012 there were almost 700,000 live births, the highest rate for 40 years, putting considerable pressure on resources. There has also been a noticeable increase in the number of ‘high risk’ births including multiple births, women over 40 and women with obesity or pre-existing medical conditions. Although mortality rates have improved, the NAO report noted that there were ‘wide, unexplained variations in the performance of individual trusts in relation to complication rates and medical intervention rates, even after adjustment for maternal characteristics and clinical risk factors’.
 
Need to improve safety
 
The number of maternity-related medical negligence claims increased by 80% in the five years to 2012-13 resulting in a litigation bill for maternity claims alone amounting to £482m in 2012-13. This figure represents about a fifth of all spending on maternity services which is a sobering fact by anyone’s standards. The NAO report flagged a number of areas which might help to explain why medical negligence claims were so high: more than half the obstetric units in England did not have the number of consultants on site as recommended by the Royal College of Obstetricians and Gynaecologists; and midwife staffing levels fell below that recommended by a national benchmark of 29.5 births per midwife. In order to achieve this ratio, another 2,300 midwives would need to be recruited although even this would be further complicated by the fact that a large number of midwives were reaching retirement age and a growing proportion of student midwives were failing to complete their courses.
 
More cooperation, better data
 
Although, sadly, the Kunigiskis case is, by no means, an isolated incident, and despite the upward pressure on maternity services generally across the country, most women do have positive experiences of giving birth in a NHS hospital. However, there is clearly scope for major improvement, not least in order to reduce the phenomenal amount being paid out in medical negligence claims. Among the NAO recommendations is a call for more and better data on maternity services in order to track trends, outcomes and experiences; and clinical commissioning groups should look at how services are delivered in their area and look to cooperate with neighbouring trusts to ensure all available resources are used efficiently. Last but not least, hospitals need to own up to mistakes at the outset and endeavour to give the families a full an explanation of what went wrong. It is the very least they can do and might even help to reduce the number of claims made against them.
 
This article is courtesy of Jeanette Whyman, a solicitor who specialises in securing NHS compensation for people who have experienced medical negligence and poor treatment.

The family of a baby who died after hospital failings has won a five-figure pay-out

Daniel Kunigiskis died aged just four days after errors made at Warwick Hospital during the baby’s delivery in October 2012.

An inquest in June 2013 heard how Daniel suffered a lack of oxygen at birth, resulting in a severe brain injury. Following legal action, the family has now received a five-figure settlement and apology.

Speaking out for the first time about the case, mum Sarah, who lives in Warwick with her husband Tyron, said: “The death of Daniel has been so traumatic and that pain has been increased by the hospital taking such a long time to admit they were in the wrong.

“The hospital initially tried to imply that there was something wrong with the baby before delivery and would not admit they were at fault. During the labour I had a feeling things were going wrong, because I had given birth before, and I was saying ‘he’s not coming out, he’s not coming out’ and they were saying ‘oh no you are fine’.”

The inquest heard how three different midwives failed to read Sarah’s antenatal notes which would have revealed her as a medium risk patient, one of the midwives having a history of making mistakes and a failure by staff to monitor the foetal heartbeat properly.

Daniel was transferred from Warwick Hospital to Coventry’s University Hospital but sadly died on October 13. A consultant obstetrician indicated that if he had been aware of problems during Daniel’s birth he could have ensured delivery 45 minutes earlier – which would have meant Daniel would have survived.

“You put your faith in them getting it right and then they make these kind of catastrophic mistakes,” added Sarah.

“It’s then made worse when they won’t admit to it.

“By speaking out now about what happened to Daniel, I hope it can help to put pressure on hospitals and NHS Trusts to be more accountable for their actions when mistakes are made. I hope it also raises awareness to individual patients to feel more confident in following their instincts in questioning the process when they believe that things are not right.

“It’s difficult to feel comfortable in making that challenge but I hope my case gives people the strength and courage to challenge those decisions.”

Sarah’s feelings of anger bubbled to the surface recently when her mum was admitted to the ward opposite the maternity ward at Warwick Hospital and was nervous about the care she would receive.

“Thankfully she received fantastic care and even the aftercare was excellent,” added Sarah.
Jeanette Whyman, Sarah’s solicitor and part of Leamington solicitors Wright Hassall’s clinical negligence team, said: “One of the most alarming and frustrating aspects of Sarah’s case was the length of time it took the hospital to admit their mistakes.

“The hospital refused to admit for a long time that the delay in delivery had resulted ultimately in Daniel’s death.

“They admitted there were issues with the birth but they didn’t say that had caused the terrible injuries Daniel suffered.

“There was a total refusal to admit to their negligence.’’

Helen Lancaster, director of nursing said: “At the inquest the Trust accepted that mistakes were made during the delivery of Daniel Kunigiskis, which we sincerely regret. I apologised to the family at the inquest. On behalf of the Trust I would like to apologise again and offer my condolences to Daniel’s family.”

NHS complaints’ procedure slammed - again

As lawyers, we deal with complaints against the NHS on a daily basis when handling clients’ medical negligence claims, and so we’ve tended to become inured to the byzantine nature of its complaints’ procedure. Healthwatch England, the consumer champion for health and care, has recently brought attention to the "hopelessly complicated” complaints system and has called for wholesale reform. This is not a new campaign: at least six other reviews into the NHS complaints’ procedure have been carried out since 1994, all of which have made recommendations for improvement – and most of which seem to have disappeared into a black hole.

Healthwatch England has criticised the confusing and complex nature of the current system noting that an average individual would struggle to navigate their way round it. Recent reports by both the Health Select Committee and Robert Francis QC noted that the complaints system was not fit for purpose. There is clearly no shortage of good advice: the Patients’ Association has recommended standards for good complaint handling and the recent ‘Review of the NHS Hospitals Complaint System’ by Ann Clywd MP and Professor Patricia Hart has set out straightforward, common sense suggestions for improving matters.

Formal complaint or negligence claim?

In 2012/13 the NHS received over 162,000 written complaints (source: Health and Social Care Information Centre), 31.9% of which related to inpatient hospital acute services. Communication with patients accounted for the second highest proportion of complaints received – which comes as no particular surprise given the inept way in which many of them are dealt with.

We come across this regularly: what upsets our clients most is the cavalier fashion in which their initial complaint is often handled. An explanation of what went wrong accompanied by an apology is, in many cases, all that is required to resolve the situation. It is the poor communication around these complaints which often leads to accusations of, and claims for, medical negligence and the discovery by Healthwatch England that over 70 bodies are involved in dealing with complaints goes some way to explaining why.

NHS complaints procedure

One could be forgiven for thinking that the complaints system is deliberately set up to confuse and obstruct. NHS England while stating that it is ‘designed to be as patient focused as possible’ refers to the ‘numerous different organisations’ that comprise the behemoth that is the NHS and acknowledges that it is possible to send a complaint to the wrong section, giving the impression of being passed from pillar to post. It is certainly true that many of the recent criticisms into the failings of the NHS have included the complaints system within their scope.

Is there change on the horizon?

Julie Mellor, Parliamentary and Health Service Ombudsman said: "We agree with Healthwatch that the current complaints system is too complex and we are working with the Department of Health, NHS England and regulators to help people better understand where they need to go when they want to raise a concern." There is also an understanding that the defensive response to complaints is fundamentally detrimental to resolving any issues early on and that this is a cultural issue which needs to change. Clearly, it remains a matter of wait and see.

There is no doubt that it is in the interest of the NHS to make the complaints procedure as straightforward as possible and have appropriate mechanisms in place to respond sensibly to people’s concerns. If complaints could be investigated and dealt with sensitively and promptly, the organisation will almost certainly see a decline in the number of medical negligence claims being lodged. Indeed, Michael Powers QC once said that if complaints were dealt with promptly and appropriately it would reduce the number of medical negligence claims by 70%. Even if the majority of these claims do not proceed, investigating them absorbs time and resources which could be more valuably deployed elsewhere.

Written by Jeanette Whyman, medical negligence solicitor with Wright Hassall.

Wokingham schoolboy wins six-figure compensation payout after hospital blunders left him deaf

A schoolboy who was left deaf because of sub-standard care he received in hospital as a baby has won a six-figure compensation payout from the NHS.

Raphael Hemmings, six, of Wokingham, developed a permanent hearing disability after Royal Berkshire Hospital failed to probe and adequately treat the jaundice he suffered shortly after his birth in May 2007.

Through his father, Raphael launched a claim for damages against Royal Berkshire NHS Foundation Trust, which later admitted liability for his injuries.

On Monday, a judge at London’s High Court approved a compensation settlement worth hundreds of thousands of pounds, which will pay for equipment and educational support to help Raphael “maximise his potential”.

Raphael’s lawyers claimed that medics failed to investigate a bilirubin build-up in his system days after his delivery.

The problem was so serious it left Raphael with permanently damaged hearing.

The trust admitted liability for Raphael’s debilitating condition and agreed to pay him a damages package his lawyers say will allow his family to “look ahead and rest assured that his future needs will be met”.

Judge Stephen Oliver-Jones QC approved the settlement because Raphael is too young to agree it himself.

Shaheen Rahman, representing the NHS, said: “The trust acknowledges the care Raphael received was not of the standard he was entitled to expect.

“I would like to express my sincere apologies, on behalf of the trust, to Raphael and his family.

“We are very pleased a settlement has been reached and we would like to offer Raphael and his family all our best wishes for the future.”

Judge Oliver-Jones said that, despite Raphael’s disability, he has done “very well indeed” at school and that he is in the “top percentage in his year”.

He added: “I have no doubt that with the determination and care he has, he will be able to cope and manage his disability.

“And with the assistance which can be provided in his educational years, he will come out of it, hopefully, with a good career ahead of him.”

Judge Oliver-Jones also paid tribute to the support Raphael has received from his family, telling his father, who was in court: “Money represents inadequate recompense but it is the only way the court can deal with it.”

The judge said he was “perfectly willing and able to approve the settlement”, describing it as a “reasonable” package to secure Raphael’s future.

Speaking after the hearing, Raphael’s solicitor, Leena Savjani, of Irwin Mitchell, said: “The settlement will ensure Raphael has access to the best possible support and that his disability does not prevent him from maximising his potential.”

Ms Savjani said the payout will provide Raphael with “audiological equipment and educational provision” to help him add to his already-impressive achievements at school.

She added: “We hope lessons have been learned by the trust to prevent any other babies from suffering unnecessary disabilities that have a significant impact on their lives.”

This article is courtesy from Get Reading.