Indian doctor failed to send seriously ill diabetic man, 42, to hospital hours before he died
An out-of-hours doctor has been jailed for two-and-a-half years for manslaughter after he failed to send a seriously ill diabetic man to hospital – diagnosing him as ‘depressed with a headache’.
Dr Bala Kovvali ignored the classic signs of diabetes-related poisonous acids building up in 42-year-old Andrew Fellows’ body, a court heard. Instead of dialling 999 for an ambulance, the on-call locum told Mr Fellows’ mother that her son was depressed and had a headache and should see his own doctor the next day.
Less than nine hours later Mr Fellows died at home from diabetic ketoacidosis.
A test which takes less than a minute would have alerted the GP to raised blood-sugar levels and it is ‘virtually certain’ Mr Fellows would have survived with an insulin injection and rehydration.
Jailing the doctor Judge Roger Keen told him: ‘It was criminal negligence and a wholly preventable death followed.’
Experts who examined the case said any competent doctor would have recognised the classic symptoms of ketoacidosis and Dr Kovvali’s breach of duty to his patient was ‘appalling and gross.’
It was revealed at Sheffield Crown Court that the GP was based in India but flew to Britain to work every summer for two or three months for the nationwide doctors’ deputising service Primecare.
He was arrested in the United States and extradited after a Sheffield coroner adjourned an inquest into Mr Fellows’ death for police investigations.
Father-of-two Kovvali, 64, admitted causing the death of Mr Fellows by gross negligence in failing to carry out an adequate clinical assessment, failing to send Mr Fellows to hospital as an emergency and failing to diagnose diabetic ketoacidosis from which he died.
Michael Burrows QC, prosecuting, said Mr Fellows, who lived with his family in Handsworth, Sheffield had no medical history of diabetes but suffered from anxiety and depression.
In the week before his death, the painter and decorator was working outside and became restless and began drinking huge quantities of water. Both he and his mother Brenda believed he had caught sunstroke.
When her son’s condition worsened Mrs Fellows called Primecare at 17.50 on June 4, 2009. She told a triage nurse her son was ‘very muddled and mumbling’, his breathing was erratic and his eyes were sunken with his breath smelling odd ‘like pear drops.’
She was asked about his depression and replied: ‘He had had episodes before but if this is depression I’ve never seen one as bad as this.’
Dr Kovvali was asked to attend Mr Fellows and arrived at 21.13. Mrs Fellows expected her son to be taken to hospital and had even packed a bag for him.
Mrs Fellows asked if her son was in a coma or had an infection and specifically if he might be diabetic. ‘She says Dr Kovvali shook his head to all these questions,’ said Mr Burrows.
‘According to Mrs Fellows, Dr Kovvali did not have any equipment with him and did not examine her son. He said he was depressed and advised that he should see his own GP the following day for his medication to be reviewed.’
After the doctor left, Mrs Fellows gave her son something to drink but he could not swallow. He appeared so dehydrated she gave him an ice cube at 1am. She returned at 6am to find him dead in bed.
The court heard Mr Fellows had basically run out of insulin in his body. It switched to burning fatty acids and produced acidic ketones. When ketones are produced in excess the blood becomes more acidic and blood-sugar levels rise leading to a coma which can be fatal.
Professor of Forensic Medicine Ian Wall, who reviewed the case, said he considered the patient’s confusion, thirst, smell, sunken eyes and inability to answer were ‘classic symptoms of ketoacidosis.’
Dr Kovvali should have checked sugar levels in the patient’s blood or urine and he should have been immediately admitted to hospital ‘where he could have been treated or saved.’
Professor Robert Tattersall, a retired professor of clinical diabetes, said the GP’s records were ‘grossly deficient’ and he could and should have measured blood sugar.
‘It would have taken less than a minute and shown high blood sugar levels. Dr Kovvali should then have called for for an ambulance as an emergency… the failure to diagnose his condition was the main cause of death.’
Dr Kovvali, who worked as a GP in Sheffield from 1981 to 1988 before returning to India, was arrested in the United States on August 27, 2012 and brought back to the UK.
When questioned he admitted he had a blood-sugar testing kit in his car which he failed to use.
Just a fortnight after Mr Fellows died, Dr Kovvali attended another patient Christopher Timms who had been diagnosed with type 1 diabetes and prescribed insulin.
He felt unwell but the GP told him not to take his insulin as well as failing to examine him or test for ketones.
A consultant said the advice to stop taking insulin was ‘wholly inappropriate’ and lack of insulin would have put the patient ‘in a life-threatening situation in a matter of hours.’
In a victim impact statement Mrs Fellows said that to test her son’s blood ‘would have been such a small thing to do but that one small thing would have saved her son’s life.’
Stephen Climie QC, defending, said the doctor had ‘misdirected’ himself.
He had a particular interest in mental health matters and coupled with Mr Fellows not taking his medication it led him to rule out diabetes as a risk factor.
He qualified as a doctor in India in 1973 and came to the UK a year later. He completed his training before becoming a GP and had been subject to appraisals in the years leading up to these events. ‘He is not allowed to practise without supervision,’ said Mr Climie.
He had now decided to quit as a doctor and ‘will not be working in the UK ever again.’ His wife back in India was ill and lived alone and had been badly affected by his arrest.
Judge Keen told Kovvali: ‘You have devoted your working life to caring for others. I have seen glowing references as to your competence, empathy and thoughtfulness. ‘It is a tragedy for you that this brought about an end to your career, destroyed your good character and your ability to work in this country.’ He went on: ‘However the nature of your offending is too serious for anything other than a custodial sentence.
‘You failed to recognise Mr Fellows’ condition despite the fact that all the classic signs of a diabetic condition were present.’
He had opted for a diagnosis that was contrary to all the evidence. ‘That was a gross breach of your duty of care,’ said the judge. ‘An expert has called your decision appalling. I agree. It was clearly criminally negligent and a wholly preventable death followed.’
After the hearing Mrs Fellows said: ‘We want everyone to know how much we loved Andrew. He was a loving son, brother, grandson, uncle, nephew and cousin and his death has caused a huge hole in the lives of everyone who knew him.
‘He was honest and upright, funny and sensitive. He loved science and nature and was very proud of the fact that he got a BSc degree later in life.
‘He was known to his friends as “Fell” and was described by them as the man with the hundred watt smile.’
Crisis No2 for the man with no shame: NHS chief and the whistleblower paid £500,000 to keep quiet over second hospital
Damning new questions have been raised about the most powerful man in the NHS – by a whistleblower paid £500,000 to stay quiet over the state of his hospital.
Former hospital chief executive Gary Walker sensationally broke his silence to reveal he was driven from his job after warning NHS boss Sir David Nicholson that patients were in danger as long as four years ago.
He received the hush money to prevent him going public with his fears that the ‘target culture’ at the United Lincolnshire Hospitals trust could cost lives – but last night risked legal action from the NHS to speak out.
The trust is now being investigated over fears that as many as 500 patients may have died needlessly because of poor care.
Sir David, who presided over the Mid Staffordshire scandal, said last week he was ‘not ashamed’ to remain in his job despite calls to quit from relatives of those who died because of his failure to take action during his time as a regional watchdog seven years ago.
Now Mr Walker has broken ranks to say that he warned Sir David about the state of care at the United Lincolnshire Hospitals trust four years ago – but was ‘thrown to the wolves’ for speaking out.
Today the trust is at the centre of a major investigation over its alarmingly high death rates. It risks becoming another Mid Staffordshire, where up to 1,200 patients died at Stafford Hospital because of appalling failures in care.
Last night Mr Walker said Sir David ignored him when he raised his concerns in 2009. He was forced out of his job the following year.
He claimed the NHS chief was ‘not interested in patient safety’ and called on him to resign to end the ‘culture of fear’ he had created in the NHS.
Mr Walker has been emboldened by last week’s demand from Robert Francis, QC, who led the Stafford inquiry, that NHS whistleblowers should be protected.
Last night he said: ‘I want David Nicholson to be held to account. I warned him that this was going to happen. ‘I warned him that Lincolnshire was going to become the next Mid Staffordshire. He didn’t investigate those concerns, and now look what’s happened.’
Sir David is already under pressure to leave his £270,000-a-year post over his links to the Mid Staffordshire scandal.
He was in charge of the regional health board that had overall responsibility for the trust between 2005 and 2006.
Sir David also appointed the trust’s chief executive Martin Yeates – even though he had no managerial training – who later sacked dozens of nurses.
Then in 2008, as chief executive of the NHS, he is said to have dismissed concerns of relatives who died at the trust as ‘simply lobbying.’
A petition urging him to resign has so far received 1,800 signatures, and the testimony of Mr Walker will pile further pressure on him to give up his lucrative post.
Mr Walker says he warned Sir David in 2009 that things were going badly wrong at his hospital trust, where hundreds of patients are now suspected to have died needlessly over the past two years.
Managers in the trust had been told their ‘careers rested on delivering the targets’ and so were neglecting patient care, Mr Walker said.
He wrote a three-page letter to Sir David setting out what he thought was wrong and telling him he needed to intervene.
But he says Sir David ignored his concerns. Mr Walker was fired in 2010, apparently for swearing in meetings – but he and his supporters say he was forced out because of his whistleblowing.
After he was dismissed, Mr Walker, whose formerly unblemished career in the NHS spanned 21 years, was forced to sign a £500,000 ‘supergag’ order preventing him from speaking out about his concerns.
A Department of Health spokesman said: ‘It is absolutely critical that all staff working within the NHS feel able to speak up and raise concerns and that every NHS organisation takes concerns seriously and acts on them.
‘The Government has taken a series of steps to encourage an open dialogue, including changing the NHS Constitution to enshrine the fact that NHS organisations should support staff who raise concerns, ensure those concerns are fully investigated and ensure that there is someone independent, outside of their team, to speak to.
‘That change also set out a legal right for staff to raise concerns about safety, malpractice or other wrongdoing without suffering any detriment.
‘We have consistently made clear to the NHS that local policies should prohibit the inclusion of confidentiality “gagging” clauses in contracts of employment and compromise agreements which seek to prevent the disclosure of information which is in the public interest.
‘Sir David Nicholson has also written to NHS organisations reminding them of their responsibilities in relation to compromise agreements.
‘As we made clear in our initial response to the Francis Inquiry last week, the culture in the NHS needs to change and high quality patient care must be paramount’
An NHS Commissioning Board spokesman added: ‘In relation to Mr Walker’s specific comments, we know that he is unhappy about his personal case.
‘Allegations made by Mr Walker regarding behaviour at the SHA have been independently investigated and found to be without merit.
‘It is important to stress that allegations of this nature are taken extremely seriously.
‘Following Mr Walker’s initial concerns raised in 2009 Sir David commissioned a rigorous independent review, following which it was concluded that no evidence whatsoever was found of bullying and harassment by the Trust or SHA.
‘A copy of both the findings of the review and Sir David’s response have also been sent with this statement.’
British PM pledges to overhaul benefits system for immigrants
David Cameron has pledged to overhaul the benefits system for immigrants after disclosing that he believes the current system does not pass the “simple common sense test”.
The Prime Minister said he wants to limit immigrants’ access to British public services to ensure that the UK is “not a soft touch”.
Mr Cameron has said that he wants to reform the system allowing immigrants access to housing, the health service, the justice system and benefits.
His comments came amid a growing debate about the numbers of new migrants preparing to come to the UK next year.
Twenty nine million Bulgarians and Romanians will gain the right to live and work unrestricted in Britain in 2014 under European “freedom of movement” rules.
The Prime Minister chaired a ministerial working group yesterday during which he questioned members of the Cabinet about ways to withhold some benefits from immigrants.
Speaking during Prime Minister’s Questions, Mr Cameron said the Government will look at “every single one of our systems” to ensure that so-called benefits tourists are not taking advantage.
“Britain has always been an open and welcoming economy but it isn’t right if our systems are being abused and that is why I chaired yesterday a committee meeting in Whitehall,” Mr Cameron said. “We are going to look at every single one of our systems – housing, health and benefits – to make sure we are not a soft touch for those who want to come here.
“I think it is absolutely vital that we get this right. There are many parts of our current arrangements which simply don’t pass a simple common sense test in terms of access to housing, access to the health service, access to justice and other things which should be the right of all British citizens but they’re not the right of anyone who just chooses to come here.”
The Home Office has repeatedly refused to put any number on the anticipated arrivals from Bulgaria and Romania.
Ministers are concerned about releasing the research into the possible number of arrivals, which they believe will be compared with a prediction that only 13,000 would move to Britain from Poland and other eastern European countries after 2004.
More than one million eastern Europeans then arrived in one of the biggest waves of immigration seen in the UK.
A report from MigrationWatch, a think tank, claimed that 50,000 people a year would arrive until 2019.
Indians welcome in Britain
There is “no limit” on the number of Indian nationals who can come to Britain to study and work, David Cameron has said.
The Prime Minister will next week visit India to tell prospective students that Britain will be “incredibly welcoming” to them if they come to this country to study and work.
Even as he promises voters to cap immigration and deter the arrival of people from countries like Bulgaria and Romania, Mr Cameron will use his trip to try to persuade more Indians to come to Britain.
University leaders and business groups say the Coalition’s tough rhetoric on immigration is harming Britain’s international competitiveness, concerns that are privately shared by some ministers.
Official figures earlier this year showed that the number of Indians studying at British universities fell by a quarter last year, to 30,000.
In an interview with India’s Sunrise TV before his trip, Mr Cameron said he wanted to make sure that Indians are not put off coming to the UK.
“The fact is today, as we stand, and this is going to be the case going forward, there is no limit on the number of students who can come from India to study at British universities, no limit at all,” he said.
“All you need is a basic English qualification and a place at a British university. And what’s more, after you’ve left a British university, if you can get a graduate-level job there is no limit to the amount of people who can stay and work, or the time that they can stay at work.”
The Coalition has set an annual cap on the number of non-Europeans who can come to work in the UK, and the Conservatives have promised to reduced net immigration to “tens of thousands” by the end of the Parliament.
Although there are annual limits on various groups of workers who are allowed into the UK, a change in the cap made last year means that there is no ceiling on the number of foreign graduates of British universities who can work here.
According to the Home Office, only foreign graduates earning at least £20,000 are permitted to stay in the UK. Officials insisted Mr Cameron’s words did not mark a change in that policy.
Some ministers privately worry that the Coalition has failed to explain its policies properly, something the Home Office has angrily denied.
However, Mr Cameron admitted that ministers have not been clear about immigration, saying: “I think we haven’t perhaps communicated this properly.”
He added: “Now we need to take that message out to talented young people in India and say if you want to make that choice, Britain will be incredibly welcoming. Of course we have to control immigration in all its forms, as any country would, but actually Britain’s got an amazing offer to make to students.
The Higher Education Statistics Authority says there were 29,900 Indian students in the UK in 2011/12, down from 39,090 the previous year.
Mr Cameron said: “We have 40,000 Indian students in Britain, I’m really proud of that, but the offer we’ve got – no limit on the numbers, no limit on how you can work in graduate jobs afterwards – I think is a great offer to make.”
The Prime Minister’s message to prospective Indian arrivals in the UK contrasts with his rhetoric on other would-be immigrants, particularly those from eastern Europe. Citizens of Romania and Bulgaria will be able to work freely in the UK next year, and some Conservatives fear a large influx of new workers.
Society and State in Modern Britain
Former British Prime Minister Margaret Thatcher once famously declared that there was “no such thing as society.” Her remarks referred to the nonexistence of a collective entity.
No Society, Lady Thatcher?
Many on Britain’s left attributed a kind of moral bankruptcy to these remarks. Unfortunately, taken out of context, the phrase provides ammunition for collectivists who wish falsely to portray libertarians as uncaring, egotistical individualists interested only in maximum economic efficiency (or worse—profit). According to such critics, libertarian-minded individuals believe, contra John Donne, that each man is an island, and that what “society” exists at all is only a disconnected assortment of competing atoms, zealous only for their own interests at the expense of all others.
This straw man has proven to be a dangerously effective way of scaring many into collectivist thinking. In reality, any sound description of practical liberty places great importance on the role of society. Society consists of a complex array of fundamental structures, such as the family, as well as myriad other voluntary associations and institutions that tend to grow up organically—that is, without central planning. In fact, the path of modern history demonstrates that unwarranted and immoral State intervention has been the actual cause of social atomization.
Welfare State Atomization
While both classical liberals and conservatives stressed the importance of separate roles for society and State, the twentieth century saw tremendous growth in the latter at the expense of the former.
One prominent—but by no means solitary—example of this diminution of society is the replacement of private charity with the welfare state. From 1987 to 2012, in Britain, State funding of charities rose to such an unprecedented level that some 27,000 charities are now dependent upon the government for more than 75% of their incomes. The so-called “voluntary” sector receives more money from the State than from private donations.
This unnatural intervention weakens the sense of duty, custom, and manners which animate an organic system of civil society. State intervention has not only debased the very concept of charity, but reduced individual responsibility to others to what Kenneth Minogue has called mere “politico-moral posturing.” Such involves merely the desire to project one’s decency. By having the correct socially approved opinions, one needn’t act at all. The morality of crowds is replaced by the burgeoning of bureaucracies. Once we have signaled our rectitude, we can go on behaving as atoms.
Proponents of the welfare state tend to ignore the plain evidence that wherever State interference hasn’t cramped or enervated them, voluntary assistance and mutual aid have been the norm. Before the advent of the welfare state, this assistance came in the form of charity and mutual associations called friendly societies.
In 1911, the year the Liberal government introduced compulsory national insurance, around 9 million people (of the 12 million covered by the scheme) were already members of such mutual aid associations. That’s 75 percent. During the 19th century, there had been a vast proliferation of friendly societies, which sought to provide social security and sometimes medical assistance to their members. Sadly, the imposition of the welfare state, particularly with the post-World War II Labour government, helped undo much of this positive work. (There are similar stories of crowdout in the voluntary sector in the United States.)
The Coalition currently governing Britain has just reached the halfway point in its term. In that time, there has been much debate over the respective roles for society and the State. Prime Minister David Cameron has made much of his flagship policy (known as “The Big Society”), which is ostensibly aiming to “create a climate that empowers local people and communities” that will “take power away from politicians and give it to people.” While this policy sounded to many like a refreshing change, few commentators cottoned onto the inherent contradiction in a bottom-up, grassroots movement being started by a Prime Minister.
Despite the quasi-Burkean rhetoric, the “Big Society” still places the State in role of Nudger. Like most political approaches, it ignores the very edifice upon which a genuine functioning society truly rests: liberty. People do not require prodding from the State to fulfil the roles that society has traditionally performed. Left alone, people in “society” will function entirely naturally because they are capable of crafting effective civil association from the bottom up. Whenever the State assumes a role in this sphere it will have the opposite effect: Voluntary service will be viewed as superfluous, local non-State authorities redundant, charity itself corrupted.
It is remarkable how a once-liberal (i.e., liberty-loving) country could be so steadily inculcated with social democratic ideals. What was once considered healthy and good has come to be seen as aberrant and alien. Thankfully, a persistent germ of the individualist spirit still remains in Britain. Given adequate support, liberty could flourish once more. If Britain is to recover its former freedoms, the voting population must be informed and convinced of the superiority of spontaneous order over statist planning. The Big Society notwithstanding, government will not likely inspire its people to voluntarism.
Bare shoulders too sexy for British TV?
Some people need to get a life
Children are being banned from seeing Keira Knightley in the role of sultry temptress in a TV perfume commercial.
The British actress has ridiculed her lack of curves, however it seems her bare shoulders are enough to confuse and upset some youngsters.
As a result, advertising watchdogs have banned showings of the commercial for Chanel’s Coco Mademoiselle around children’s programmes and films.
The idea that children’s eyes need to be shielded from the British actress’s performance will surprise viewers. Chanel defended the commercial, insisting it was playful and sensual rather than overtly sexual.
However, the Advertising Standards Authority ASA) disagreed at a time when many parents, including the Prime Minister, are becoming increasingly concerned about the sexualisation of children.
At one stage the actress’s bare shoulders are seen, while she is assumed to be naked beneath some sheets.
The full film is here. It’s mainly just “arty” — i.e. without any real narrative. You can read into it what you like. I doubt that it even does a good job of selling perfume. I would explain it to a kid as “just silly stuff”.
Respected British teacher hounded out of job: Career ruined by 7-year-old boy’s unfounded assault claim
A deputy headmaster with an unblemished 41-year career has been forced to quit after an ‘uncontrollable’ seven-year-old boy accused him of assault.
Royden Cope, who had an ‘impeccable’ record as deputy head for 34 years, was ‘marched out’ of a Church of England primary school after the pupil claimed he hit him.
In March last year Mr Cope was alleged to have restrained the unruly pupil by his wrists before slapping him across the face.
He was charged with assault in May. But at the end of a four-month nightmare he was cleared by magistrates after grave doubts were raised about the case.
Despite fierce criticism of the prosecution and massive support for Mr Cope, he remained suspended from his job while education bosses carried out a disciplinary investigation.
Now 63-year-old Mr Cope – who is thought to have suffered a minor heart attack since the court case – has decided not to return to his £44,000-a-year post.
Yesterday Mr Cope from Accrington, Lancashire, would say only: ‘I am sad to leave the profession after 41 years.’
It is believed the youngster who levelled the accusations at Mr Cope is still being taught at the school, St Bartholomew’s in Great Harwood, Lancashire.
Mr Cope’s daughter Joy Corrigan, 33, said that since the allegations she has had to remove her eight-year-old daughter from the school after the girl was ‘goaded’ by the young boy.
Mrs Corrigan, who is also a teacher, added: ‘The saddest thing is that my dad was nearing retirement and after such a long career one of his resounding memories will be being marched off the premises. It should not have ended like this.’
Parents have been left shocked and angry that a highly regarded teacher has effectively been forced out of his job.
Victoria Mather, 34, said: ‘I think it’s horrible what has happened to him in the past year and he went through a lot because of that court case.
‘It is no surprise that this has taken its toll. He’s been in the profession for such a long time – it’s not right that it has come to this but he has always had a lot of support from the parents who stood by him.’
Kerry Molyneux, 30, said: ‘I’m really disappointed that he has chosen to step down but I can understand why. I just don’t think he wanted to have all this added stress. We are sorry to see him go as he was a good long-standing teacher.’
Linda Holt, 63, whose grandchildren attend the school, said: ‘I feel sorry for him and it has probably had a lot of effect on him and his family to be accused of something like that.’
‘Some of the kids today are out of control and they know exactly what their rights are, they say “you can’t touch me”. It was never like that in my day, there isn’t any respect any more.’
But the 38-year-old mother of the pupil – who cannot be named for legal reasons – defended her son and said she was ‘glad to see the back’ of Mr Cope. ‘We didn’t take it to court the police did,’ she said.
The mother, a music teacher, said he had never misbehaved at home and criticised other parents and staff who said he was disruptive.
‘I’m not saying he’s perfect but… he isn’t a devil child how they’ve made out he was,’ she said.
Mr Cope had faced up to six months in jail following the assault allegation.
But in August he was cleared by Blackburn magistrates when the chairman of the bench, Graham Parr, said there were ‘real doubts’ about the case.
The court heard that the boy had been disruptive since starting school and had been removed from classrooms regularly after he was violent towards other children.
In his statement to police Mr Cope said the boy was the most ‘disruptive and aggressive’ he had encountered in his career.
He said: ‘On some occasions he is uncontrollable. As he has got older, he has become more aware of his own physical prowess and he has become more aggressive.’
On the day of the incident in March last year, the boy is said to have ran amok, hitting ten classmates with his bag, pinning one of them to the wall and yelling at teachers. Mr Cope was called to deal with him.
Three days later, the boy told his mother that he had been hit by Mr Cope. She said he had described ‘a struggle’ and said Mr Cope had grabbed his wrists before he ‘slapped him’.
Mr Cope told the court that the youngster had worked himself up into an ‘incandescent rage’.
He said: ‘He was next to a cupboard and a desk leg, and I held him by the hands as I was concerned he would bang his head.
‘I was trying to stop his head from rolling around so I put my hand out to stop him. That’s when he slammed into my hand and there was contact.
‘This allegation has caused me and my family great distress.’
Another teacher, Thomas Lowe, claimed he did see Mr Cope strike the boy. His evidence was rejected by the magistrates.
Mark Mackley, headteacher at St Bartholomew’s, confirmed yesterday that after ‘careful deliberation’ Mr Cope had decided to step down