Mrs Patricia Perry
Mrs Patricia Perry died in Mayday Hospital in April 1999. Her family were not happy with several aspects of the care that she was provided with during the three months that she was cared for by the Mayday University Hospital Trust.
The complaints centred around, the control of infection in the hospital: the contribution of the MRSA infection to Mrs Perry's death; and the quality of the medical and nursing care that she had received in the hospital. Keith Ford the Chief Executive responded to the complaints but Mrs Perry's daughter were not satisfied with his response and as a result an Independent Review Panel was convened on the 5th September 2000 Chaired by Mrs Rhoda Goldberg, the other panel members being Mr Cedric Briscoe and Mrs Mary Wells. The panel had to advise it Dr J Fowler FRCP a Consultant Physician and Mrs C Robson BSC(Hons) RGN Dip.Coun. FETC a Nurse Adviser.
The view of the family was that when Mrs Perry was admitted to Mayday she had been a very fit eighty-five year old woman who only had a problem with her foot and they were concerned about her care from "day one". The independent panel confirmed in December 2000 the following:-
1). That in terms of the cleanliness of the wards that Mrs Perry had stayed on that there were undoubtedly issues regarding the basic cleaning and standards of cleanliness on both Fairfield 1 and Kenley 1.
2). That in relation to the family's distressing experience with a disturbed patient on Kenley 1, in particular the occasion on which she placed a blood clot in Mrs Perry's daughters hand, which she had just removed from a wound on her head. The panel found that the nursing staff were in a the extremely difficult position of trying to meet all of the care needs (physical, psychological and social) of a very diverse group of patients. Whilst it was clearly not desirable to have a patient touching her own wounds and then touching telephones etc, the Panel were satisfied that the nurses did all they could within the resources available to them to deal with this situation.
3). That in relation to Mrs Perry's Open Wound the Panel stated that issue of communication pervades this case. The panel stated that there was no doubt that Mrs Perry's family did not feel properly informed about their mothers surgery. The consultant orthopaedic surgeon Mr Williams, who Mrs Perry's family claimed they had not met, told the panel that he had tried to explain to Mrs Perry's daughters what was happening on his ward rounds, but that he had been unable to clearly convey his message in view of one of the daughters agitation. However, the Panel stated that whatever the circumstances, patients have a right to give informed consent and in order to do so must be aware of the nature of the surgery proposed, what it entails and the likely outcome. The panel noted that in relation to Mrs Perry's wound that she did have a pair of foam slippers issued by the hospital to wear when she needed to walk to the bathroom (one was left in the behind in the bathroom) but unfortunately, there had not been enough supervision to make sure she kept them on.
4). In relation to the MRSA infection which Mrs Perry acquired while in Mayday Hospital and the cause of death. The Panel came to the conclusion that as these infections occur commonly in hospital everywhere and the surgical and nursing rituals used to contain their spread are, at best partially effective they felt that
5). The Independent Panel found that there were a number of things that were clearly unsatisfactory. There was found to be a general lack of awareness of and lose adherence to Control of Infection Guidelines and the Panel found that Mayday needed a more standardised response to managing MRSA.
6). In relation to a letter written by the Chief Executive Keith Ford ( who was recently awarded the OBE for services to health and who has just been put in charge of Merton, Sutton and Mid Surrey's healthcare redevelopment) in response to the family's complaints on the 11th January 2000. The Independent Panel found that it contained several inaccuracies. The medical evidence and advice clearly showed that Mrs Perry did have MRSA infection in her chest and that this was partly the cause of her death. The Panel were offered no explanation as to why Mr Ford repeated Dr Williams statement that the MRSA was localised to Mrs Perry's foot. The comments that Mr Ford made about Mrs Perry's ability to eat were also inappropriate. The Panel recommended that Mr Ford apologised for the insensitivities included within his letter.
7). The Panels conclusions regarding the nursing a patient with Mental Health Problems were that they accepted the difficulties of nursing patients with differing needs and insufficient staff to meet all these needs in the best way. The Panel went on to say that they thought the Mayday Trust might consider carrying the cost of a constant one-to-one care assistant in order to protect the privacy, dignity and comfort of all concerned, as the Trust is required to do in accordance with the Patients Charter. The Panel noted that the problem was worse at weekends.
8). In relation to Nursing issues the Panel found that the Mayday Trust did not take up the family's concerns about Mrs Perry's care soon enough. The Panel agreed that the swallowing difficulties that Mrs Perry experienced and their causes were not adequately investigated early enough. The Panel also agreed the complete unacceptability of the Mayday Trust describing Mrs Perry as "refusing to eat rather than unable to swallow".
9). The Panel believed the relatives accounts of having to wait for help to change soiled bed clothes sheets - the ward sisters admitted that it could happen. Again this is a contravention of the Patient Charter rights to consideration for privacy and dignity. It seems clear that there was a division of labour between healthcare assistants and qualified nurses, and that the healthcare assistants were expected to perform these menial tasks to leave the nurses free for those tasks that only they were skilled to perform. However, it seems uncaring to leave a patient in a mess to wait for two free healthcare assistants if there were nurses available to help. The Panel recommended that the Trust consider what should be done to ensure that patients receive prompt and caring attention.
10). The Panel found that the standard of nursing care provided to Mrs Perry was variable, from very caring to inconsiderate. When this was drawn to the attention of those responsible it caused hard feeling. The nursing staff took the criticism personally and then seemed unable to consider the issues dispassionately. Undoubtedly the relatives were demanding but with good cause. The Panel's nursing adviser felt that these difficulties were caused by the Ward Sister's inability to fully establish their ward teams and had to rely on transient staff.
11). Mrs Perry's family complained that the record keeping in relation to drug prescribing were not properly kept. In relation to this the Panel stated that they were extremely concerned that there was no care plan for Mrs Perry, this being an obligatory measure rather than an optional one. The Panel were also concerned that despite the serious allegations being made by the family about prescribing records, that the Mayday Trust did nothing to investigate this until the Independent Panel itself asked for the outcome of their inquiry of May 2000. The Panel found that although there might be staff shortages that there are no short cuts to good record keeping and whilst it is acknowledged that this often fails to the core members of the ward teams, it is fundamental to their practice and if required for their safety as well as the safety of the patients in their care. In order to place this in perspective, it should be noted the, "Guidelines for Records and Record Keeping" (UKCC1988) advises that, "The approach to record keeping which courts of law adopt tends to be that, if it is not recorded, it has not been done".
Was Mrs Perry treated with the respect and dignity that she was entitled to expect from the NHS when she was admitted to Mayday Hospital? I leave you to make your own judgement, but remember we will all be old one day and how will you hope to be treated when you need hospital treatment in your old age.