April 12, 2019

The haphazard care offered by Britain's NHS can kill

Below is just the beginning of a HUGE BBC report on the avoidable death of a Downs syndrome little boy.  It is some tribute to Britain's legal system that the death was taken very seriously and extensively  investigated.

When I saw that the doctor convicted of "manslaughter by negligence" was of Nigerian Muslim origins, I thought I knew the beginning and ending of the story.  I was wrong.  Doctors of African ancestry are often pushed through medical school on the basis of the color of their skin rather than how much they have learnt. But there was no sign of that in the case of this doctor.

It is certainly true that she was part of a system that gave the boy insufficient care but the system was in chaos on the day.  Even the computers weren't working and key staff were simply missing, just not there in the ward.  And the doctor who was there had been given the job with no warning and had never been trained to work in that ward.  Understaffed is hardly the word for it.  It was a caricature of a medical service.  In the circumstance the doctor was run off her feet and could not be expected to think of everything and do everything.

Her conviction was indeed a sham and a coverup. There was only one defendant who should have been in the dock -- the NHS. The NHS simply has neither the money nor the staff to provide even a safe service, let alone a curative one. With most illnesses people do after a while get better of their own accord and that is the only reason for a majority of the successful discharges from NHS hospitals.

The whole idea of the NHS is faulty.  Governments are not fit to run hospitals.  In the case of the NHS there is a vast  bureaucracy that never has a shortage of clerks and administrators --  while the service has a gross shortage of doctors and nurses.  Firing the bureaucrats would instantly free up enough money to hire the most desperately needed medical staff.

I can't help comparing what I read about the NHS with the care that I receive in the private hospital I go to.  In that hospital there are always plenty of nurses around and a call button gets a 5 minute response.  I am rarely admitted for anything too serious but I still get my BP taken every hour during the day and am given all sorts of small attentions. And any scans I might need are done and interpreted within an hour of my arrival.  Anything that might help me is done promptly.

So why the difference?  I have private health insurance.  And that is not unusual in Australia,  Where only 7% of Britons have private health insurance, 40% of Australians do -- which shows a high level of affordability.  I am not remotely unique in being able to receive hospital care of the highest international standard

Given the differences I have just outlined, I cannot see any case for such a thing as a government hospital to exist.  All that is needed to provide for the poor is for the government to foot the bill for their private care

When a junior doctor was convicted of manslaughter and 

struck off the medical register for her role in the death of 

six-year-old Jack Adcock, shockwaves reverberated

through the medical profession. 

Many doctors have argued that Dr Hadiza Bawa-Garba was

unfairly punished for mistakes she made while working in

an overstretched and under-resourced NHS - and on 

Monday the Court of Appeal ruled she should not have

been struck off.

With access to full trial transcripts, witness statements 

and internal hospital inquiries, Panorama talks to 

Dr Bawa-Garba and to the parents of Jack Adcock 

in order to tell the story in detail.

Jack Adcock wasn’t himself when he returned from school.

He later started vomiting and had diarrhoea, which continued through the night.

In the morning Jack was taken to the GP by his mother, Nicola, and referred directly to Leicester Royal Infirmary’s children’s assessment unit (CAU).

Less than 12 hours later he was dead.

“Losing a child is the most horrendous thing ever. But to lose a child in the way we lost Jack – we should never have lost him,” Mrs Adcock says.

08:30

Trainee doctor Hadiza Bawa-Garba arrived at work expecting to be on the general paediatrics ward - the ward she’d been on all week.

She had only recently returned to work after having her first baby. Before her 13 months’ maternity leave, she had been working in community paediatrics, treating children with chronic illnesses and behavioural problems.

But when medical staff gathered to discuss the day’s work, they were told someone was needed to cover the CAU – the doctor supposed to be doing it was on a course. And Dr Bawa-Garba volunteered to step in.

She also carried the bleep – which alerts the doctor that a patient needs seeing urgently on the wards or in the Accident and Emergency unit, across four floors of the busy Leicester Royal Infirmary – and was required to respond to calls from midwives, other doctors or parents.

Soon after Dr Bawa-Garba took over, the bleep went off – a child down in the accident and emergency unit, several floors below, needed urgent attention and she missed the rest of the morning handover.

10:30

Back in the CAU, Dr Bawa-Garba was asked to see Jack Adcock by the nurse in charge, Sister Theresa Taylor, who was worried he had looked very sick when he had been admitted.

She was the only staff nurse that day. Because of staff shortages, two of the three CAU nurses were from an agency and not allowed to perform many nursing procedures.

“Jack was really lethargic, very sleepy. He wasn’t really very with it,” says Mrs Adcock. She told medical staff he had been up all night with diarrhoea and sickness.

The boy’s hands and feet were cold and had a blue-grey tinge. He also had a cough.

“I knew that I had to get a line in him quickly to get some bloods and also give him some fluids to rehydrate him,” says Dr Bawa-Garba. He didn’t flinch when she put his cannula in.

Because of a pre-existing heart condition, Jack had been taking enalapril – a drug to control his blood pressure and help pump blood around his body – twice a day.

But Dr Bawa-Garba says she didn’t want him to have the enalapril, because he was dehydrated and it might have made his blood pressure drop too much.

Because of this, she says, she left it off his drug chart.

She then asked for an X-ray to check Jack’s chest. Blood was taken – some was sent down to the labs, while a quicker test was done to measure his blood acidity and lactate levels – the latter being a measure of how much oxygen is reaching the tissues. The tests revealed his blood was too acidic.

“A normal pH is 7.34 – but Jack’s was seven and his lactate was also very high. A normal is about two and his was 11, so I knew then he was very unwell,” Dr Bawa-Garba says. She gave him a large boost of fluid – a bolus – to resuscitate him.

Her working diagnosis was gastroenteritis and dehydration.

But she didn’t consider that Jack might have had a more serious condition. It was a mistake she regrets to this day.

11:00

Jack had been admitted under the care of Dr Stephen O’Riordan, the consultant who was supposed to be in charge that day – but he hadn’t realised he was on call and had double-booked himself with teaching commitments in Warwick and hadn’t arrived at work.

Another consultant based elsewhere in the hospital had said she was available to help and cover him if needed – although she had her own duties.

After an hour of being on fluids to rehydrate him, Jack seemed to be responding well.

“He was a little more alert and we thought he was getting better,” Mrs Adcock says.

Dr Bawa-Garba thought that too.

One of the less experienced doctors in the unit had been unable to do Jack’s next blood tests. They had tried but couldn’t get blood, so Dr Bawa-Garba went to do it herself.

This time, when Dr Bawa-Garba went to take blood from his finger, Jack resisted, pulling away.

“That kind of response, to me, said that he was responding to the bolus,” she says. “Also, the result I got showed that the pH had gone from seven to 7.24. In my mind I’m thinking this is going the right way.”

However, not enough blood had been taken to get another lactate measurement.

12:00

Dr Bawa-Garba looked for Jack’s blood results from the lab. She had fast-tracked them an hour-and-a-half earlier. But when she went to view them on the computer system, it had gone down.

The whole hospital was affected. This meant not only that blood test results were delayed, but also that the alert system designed to flag up abnormal results on computer screens was out of action.

She asked one of the doctors in her team to chase up the results for her patients, and took on some of that doctor’s tasks.

Those tests would have indicated that Jack may have had kidney failure and that he needed antibiotics.

SOURCE   

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