THE Welsh health board now at the centre of a police investigation following allegations of neglect and avoidable deaths in its hospitals was made aware of the same serious malpractice as long ago as 2010 – and covered it up.
The Abertawe Bro Morgannwg University (ABMU) Health Board (Eyes passim) assured the family of an elderly woman who, amid other mistreatment, had been wrongly deprived of fluid, food and vital heart and other medication over an entire weekend, that police and social services were involved in a full Protection of Vulnerable Adults (POVA) investigation into her treatment. In fact managers kept the lid on the family’s complaints and did little or nothing until two years later, when some of the same staff on the same ward in the Princess of Wales hospital subjected the same unfortunate patient, Lilian Williams, to very similar ill-treatment.
Only then did her family learn that they had been seriously misled by ABMU in 2010, when senior managers told them that other agencies were involved and that lessons had been learned. According to Lilian’s son, Gareth Williams, instead of ensuring no one else would suffer, hospital managers allowed “institutionalised neglect to fester”. Almost unbelievably, Mrs Williams was subjected to episodes of cruelty on each of her four separate admissions to two of ABMU’s hospitals – the last two under the noses of police and social services, who had by then been alerted by the family and were part of a genuine POVA investigation.
Three nurses have so far been arrested for allegedly falsifying medical records. Others are thought to have been suspended or moved as the police investigation – known to have involved at least 39 other patients – continues. However, reports from a packed public meeting last month organised by Action Against Medical Accidents (AvMA), the patient safety charity, suggest that ABMU’s failings may be on a similar scale to the Mid-Staffordshire scandal, where patients were found to be routinely neglected, humiliated and left in pain, as the trust focused on cost-cutting and government targets.
Peter Walsh, AvMA’s chief executive, who was involved in the Mid-Staffs inquiry, is compiling a dossier of complaints and evidence. “It’s early days, but most centre upon lack of care and neglect of elderly patients. However, we have also received serious allegations about maternity care, paediatrics, surgery and community services,” he said.
‘Most sincere apologies’
A newly formed ABMU Victims Support Group is pressing the Welsh government for a public inquiry, concerned that their voice will be excluded from a growing number of ABMU and government-ordered “reviews”. One of their worries is that David Sissling, chief executive at ABMU when Lilian’s family first complained, is now chief executive at NHS Wales.
Paul Roberts, who took over from Sissling in April 2011, and under whose watch Lilian also suffered, wrote to Mr Williams in 2013, offering his “most sincere apologies” for the “totally unacceptable care”. Roberts claimed there was no intention to deceive the family when the board decided not to alert social services and the police. It was, he said, done to “expedite” matters.
Lilian, then aged 80, had diabetes and dementia but was bright and able to communicate and was first admitted to ABMU’s care in August 2010 with shingles. After visiting on a Friday, when she had appeared to be recovering well, the family returned to find her looking very unwell and lying in soiled incontinence pads. Above her bed was a sign saying “nil by mouth” – a nurse was apparently concerned Lilian might choke. Despite protests that no intravenous drip had been set up and that Lilian was dehydrated and becoming confused, they were told she could have nothing until properly assessed.
Concerned, they gave her some food and water, after which they say she became far more coherent, complaining of thirst and a headache. They helped her use the bedpan. But Lilian was still denied her medication to prevent strokes, heart attack and diabetic deterioration, and became seriously ill. She was not seen until Monday by a doctor, who prescribed antibiotics for a chest infection she had developed in hospital.
Too busy to help
The family virtually camped by the bed until she was out of danger, helping with food and drink and changing her soiled pads and clothing. They noticed that medication was rarely given on time – if at all. Sometimes pills were found in Lilian’s clothing or bed, even though her records suggested she had taken them. Staff said they were too busy to help her eat and drink and, because it took two members of staff to help her use a bed pan or commode, it was easier to rely on incontinence pads. So she was often left in her own waste.
Eventually Lilian was discharged. However, in May 2012 Lilian was admitted again with a chest infection and soon the nightmare resumed. This time the family bypassed hospital managers and complained to social services. Gareth Williams took video evidence of her medication lying on the floor among soiled swabs. Worse, he discovered that while staff were protesting that Lilian was refusing to take the pills, they were managing to sedate her “unnecessarily” with zopiclone and temazepam. A staff nurse said it was because she was “distressed and shouting out”. Had anyone bothered to find out why, they would have realised she was in pain because her below-knee prosthetic leg had not been removed – even at night. Her leg was sore and encased in soiled padding.
Lilian again recovered and spent June and July at home with her family (pictured here at that time). In August she was re-admitted with a urine infection. But as she didn’t want to go anywhere near the Princess of Wales, she went to the Neath and Port Talbot. Ward staff were told of Lilian’s miserable history of ABMU care, and the family said they would come night or day to assist if necessary. But the neglect started again. She was sedated, while not receiving her necessary medication. The family saw staff recording observations that had not been carried out.
So Lilian was sent back to the Princess of Wales – only for her once again to be rendered “nil by mouth”, this time for five days, but at least she was given a hydration drip and feeding tube. “This was happening under our noses while a multi-agency investigation was under way – and we felt utterly helpless,” says Mr Williams.
The final shock for the family was when doctors felt Lilian was not responding to treatment for pneumonia and decided – against their wishes – to withhold all treatment. The family kept a long vigil by her bedside until she died some days later on 17 November 2012. The consultant recorded the primary cause of death as pneumonia. But, prompted by a whistleblower who said that “this is happening far too much”, the family asked for an autopsy. Lilian did not have pneumonia; she died of chronic heart disease.
A lost opportunity
The family’s lawyer, Helen Rundle, is investigating whether Lilian’s treatment could have played any part in her failing health and death. One worrying aspect is how often doctors, relying on her records, believed she was not responding to medication when in reality it had not been given.
The family, meanwhile, remains concerned that ABMU is still covering up, because of continuing difficulties in obtaining all medical records.
Mrs Rundle said of comparisons now being made between events in Wales and Mid-Staffs: "As far as we are aware, what distinguishes the issues arising in Wales is the way the complaints of concerned families have been handled. There was a lost opportunity while Lilian was alive to address issues which are now the subject of police investigation and political scrutiny.” Only a full Mid-Staffs-type inquiry will discover how many others also suffered unnecessarily like Lilian.