“If a nurse didn’t like you, you were a goner.” The "difficult" patients killed at Gosport
25 June 2018
Families of those killed demand justice.
A patient with learning difficulties came in for respite care - and died of "excessive" doses of diamorphine
More details are emerging of the scandal in which at least 450, and probably more than 650, people's lives were ended as a result of being given dangerous amounts of unnecessary opiates.
The report of The Gosport Independent Panel into Gosport War Memorial Hospital found that only 45% of those administered terminal quantities of diamorphine (which can be appropriate in alleviating severe pain at the very end of life) were said to be in pain. Many of the case studies showed that even where pain was noted, it was not properly assessed, and the effect of medication was not monitored.
In 29% of cases, no reason or rationale was given for prescribing the lethal doses. In 26%, reasons were given that would "rarely, if ever, be regarded as appropriate indications," such as deterioration, distress, or agitation.
Nurses euthanising difficult patients
Writing in the Times, Dominic Lawson points out that "the ones most likely to get the treatment appeared to be not the sickest, but the most 'difficult'. As the stepson of one of the victims remarked: 'If a nurse didn’t like you, you were a goner.'"
This is clear from the testimony of whistle-blower Pauline Spilker, who said: "It appeared to me then and more so now that euthanasia was practised by the nursing staff. I cannot offer an explanation as to why I did not challenge what I saw at that time . . . I feel incredibly guilty."
In addition to the case she described of an 80 year old man who was active and mentally alert but "difficult" there were other cases of tricky patients being quietened with non-clinically indicated opiates. Dr Barton, who was responsible for the prescribing on the wards, defended the use of diamorphine on a lady with dementia who was "not [in] physical pain but not happy, not comfortable, not easy to look after." Commenting on a report condoning her actions, the panel said: "This is an extraordinary conclusion, explicitly condoning the use of large doses of diamorphine simply to control symptoms of confusion and agitation, contrary to all relevant guidance."
Patient with learning difficulties killed
Dominic Lawson highlights a case that he, as the father of an adult with Down's syndrome, finds particularly shocking - that of 78-year-old Ethel Thurston, who had learning difficulties, and was admitted with a fractured femur.
At another hospital, the doctor assessed her as having the "physical potential to remobilise" and she was admitted to Gosport War Memorial Hospital for rehabilitation, care and mobilisation. Within days, Dr Barton wrote on her notes "please keep comfortable. I am happy for nursing staff to confirm death." These euphemistic words appeared on many patients' records, despite them for the most part being admitted for respite or rehabilitation, not end of life care. The panel also found that the medical team were putting patients onto end of life pathways without proper consultation with them or their families. (Concerns over practices such as these have been raised in the last few years in connection with the now infamous Liverpool Care Pathway and its successors.)
Where have we seen this before?
Miss Thurston was put on high doses of diamorphine and midazolam (the panel noted that the "starting dose of diamorphine was excessive, at least three times the recommended dose equivalent" and it could find no clinical indication for the drugs at all) and died seven hours later.
The cause was said to be "bronchopneumonia". Almost all these deaths were attributed to pneumonia, without any further explanation.
As Dominic Lawson notes: "Exactly the same cause of death was routinely given by those doctors involved in the "life-shortening" of the mentally incapacitated in Germany in 1939-41."
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