Professor of dentistry told woman suffering from tumour in her jaw to chew sugar-free gum and misdiagnosed 32 others, tribunal hears
A professor of dentistry misdiagnosed patients who had cancer – prescribing one with sugar-free chewing gum when she had a tumour in her jaw and another with iron supplements for skin cancer – a tribunal has heard.
Philip Lamey allegedly misdiagnosed seven people with mouth cancer – four of whom later died – at the School of Dentistry in Royal Victoria Hospital, Belfast.
In total 135 patients were recalled after doubts were raised about their biopsy results, a hearing of the General Dental Council (GDC) in London was told today.
Professor Lamey, who is being represented by lawyers at the hearing, faces 46 charges after concerns were raised about his diagnosis of 33 patients.
David Bradly, counsel for the GDC, said on one occasion the dentist’s blunders caused a patient to be rushed to hospital after a wrong diagnosis. The patient was told she had temporomandibular joint dysfunction (TMD) – chronic jaw pain – when she in fact had a tumour in her jawbone.
Mr Bradly said: ‘Professor Lamey gave a diagnosis of TMD and prescribed sugar-free chewing gum for treatment and said he would see her in three months.
‘She actually had a tumour in the mandible and was admitted to hospital. She had a squamous cell carcinoma – a type of skin cancer – and had radiotherapy following an operation.’
On another occasion he diagnosed an elderly patient as having a traumatic ulceration of the tongue. He repeatedly prescribed iron supplements to the 78-year-old, but eventually again made a late diagnosis of squamous cell carcinoma.
Mr Brady added: ‘Professor Lamey failed to review the diagnosis of trauma.’
He also wrote in his notes that the patient declined a biopsy, when no biopsy was even offered to the pensioner.
While treating another patient, Professor Lamey diagnosed a traumatic mucocele in the upper lip, which can be a sign of a tumour on the salivary gland, but got a dental trainee to carry out the biopsy.
And the professor caused ‘unnecessary delay’ removing a patient’s mercury fillings and prescribing antibiotics when a patient actually had lesions spreading through her mouth.
Mr Bradly said: ‘Medications were not going to work because this lesion was a tumour. ‘This patient should have been referred for a biopsy. It was all an unnecessary delay.’
The hearing, expected to take 19 days, will focus on seven mouth cancer patients who were wrongly treated by Professor Lamey, among others.
Someone must take blame for the Mid Staffs scandal, says David Cameron
David Cameron said he could understand public anger that, despite hundreds of unnecessary deaths, no one had been held properly accountable or punished for the failings that led to them.
Instead, some NHS managers had been allowed to retire with their pensions or even promoted, he said. He pointed out that a recent public inquiry had unearthed a “huge amount of information” about the scandal, which he suggested could be used by the police.
The inquiry, led by Robert Francis QC, found that up to 1,200 people died needlessly in Mid Staffordshire Trust hospitals between 2005 and 2009 due to poor care and bad management. The report has been followed by growing political demands for police action. The Telegraph’s Put Patients First campaign has highlighted concerns about the case.
Speaking to reporters on a trip to India, the Prime Minister said: “We have to make sure that when a failure like this takes place there is proper accountability. There hasn’t been in this case. We need to put that right.” Amid mounting pressure, Staffordshire Police has said it will review the evidence around the scandal with a view to possible charges. The Telegraph disclosed this week that the force is looking at “new information” not revealed by the Francis Report.
Mr Cameron said he could not intervene in police operations but suggested that the Francis Report might lead to prosecutions. “The Mid Staffs inquiry has made available a huge amount of information. It’s for others to decide what it means for them.”
The Prime Minister said one of the worst aspects of the affair was that people were not held to account.
“You can see exactly what happened to the people who were involved. Some of them were allowed to retire, some of them were allowed to move within the health service.” He added: “There wasn’t proper accountability, there were not proper consequences. That is not acceptable.”
Some campaigners have called for the resignation of Sir David Nicholson, who oversaw the Stafford hospital trust in 2005 and is now the chief executive of the NHS. A Downing Street spokesman said Mr Cameron retained full confidence in Sir David.
Concerns have also been raised about gagging clauses that prevent former NHS managers from speaking out after leaving. Mr Cameron said: “You shouldn’t need to rely on whistle-blowing in the NHS, we should be discovering problems much more swiftly.”
A “transparency agenda”, including allowing patients to rate their hospital treatment, plus stronger independent regulators, will mean whistle-blowing is less and less relevant, he said.
Mr Cameron has promised that the Government will learn the lessons of mismanagement at Stafford, reforming NHS management to ensure the scandal cannot be repeated. A former government health adviser warned that the same waiting targets that some experts blame for problems at Stafford are still being promoted “very heavily” in the NHS.
Matthew Cooke, the Government’s A&E adviser until November, said new measures to see how hospitals are performing had not been brought in. He told the Health Service Journal: “The [four-hour waiting] A&E target is still being pushed very heavily.”
Another extreme outpouring of hate — against a very popular Royal Princess
Ms Mantel. We would seem to have here a case of a fat old bag hating someone much more attractive and pleasant than herself. Mantel is very egotistical and a former member of the Young Communist League — an unsurprising combination
She is a double Booker Prize winner, the darling of the literary establishment. And Hilary Mantel has used her position among the novel-writing elite to launch an astonishing and venomous attack on the Duchess of Cambridge.
Mantel, whose latest books are set in the Tudor court, dismissed Kate as a ‘machine-made’ princess, ‘designed by committee’.
Mantel, 60, also scorned her as a personality-free ‘shop window mannequin’ with a ‘plastic smile’.
She compared Kate unfavourably to both Anne Boleyn – one of her historical heroines – and to Princess Diana, insisting both had more personality.
She said Kate had gone from being a ‘jointed doll on which certain rags are hung’ to a woman whose ‘only point and purpose’ was to give birth.
Mantel said Kate ‘appeared to have been designed by a committee and built by craftsmen, with a perfect plastic smile and the spindles of her limbs hand-turned and gloss-varnished’.
She said the Duchess was quite unlike Anne Boleyn, who was ‘a power player, a clever and determined woman.’
Mantel contrasted her appearance to Prince William’s mother, Diana, ‘whose human awkwardness and emotional incontinence showed in her every gesture’.
Mantel, the author of Wolf Hall and Bring Up The Bodies, the acclaimed novels which detail the failure of Henry VIII’s wives to produce an heir, used a lecture to examine the prospects for the future queen consort.
Mantel said that when she first saw Kate Middleton, she struck her as ‘a shop-window mannequin, with no personality of her own, entirely defined by what she wore.’
Ms Mantel’s comments on the Duchess of Cambridge’s appearance comes shortly after she spoke about having body issues of her own.
Ms Mantel went from a size ten to a size 20 in nine months after she was diagnosed with severe endometrosis at the age of 27.
The treatment, which included surgery removing her womb leaving her infertile, caused her to gain four stone.
The 60-year-old author said she sometimes dream of being thin again.
Mantel went on to say that female Royals were ‘at the most basic… breeding stock, collections of organs.’
Although she is usually referred to simply as the Duchess of Cambridge, Catherine’s full title and style is Her Royal Highness Princess William, Duchess of Cambridge, Countess of Strathearn, Lady Carrickfergus. No wonder Mantel hates her.
Mantel’s quite explicit refusal to see the Duchess as as human being is very Communist. Leftists generally seem to see classes of people only, not individual people.
And as a monarchist happily living in a constitutional monarchy, I feel perfectly entitled to refer to Mantel as a “fat old bag” — in response to much worse that she said about a member of the Royal family. The Royal family themselves will of course have no comment on the matter
The cartoonists have now had a go at Mantel here.
British teacher returns to school after appeal over smacking
The head teacher sounds a complete bull-artist
A drama teacher who successfully appealed against a conviction for smacking a 13 -year -old boy in the head with a folder because he was talking has returned to the classroom.
Vanessa Hermione Greening, 49, was found guilty of assault after a court heard she lost her temper after he spoke during a drama performance in February last year. She faced magistrates after parents of the pupil at Alexandra High School, in Tipton, West Midlands, complained to teachers who then contacted the police.
The schoolboy admitted speaking, but claimed when Miss Greening lashed out with the binder he had not said a word. The court heard the boy was shocked but uninjured and told police “it didn’t really hurt”.
Miss Greening, from Bearwood, Birmingham, was sentenced at Sandwell magistrates’ court in November to a six -month community order. After an appeal the following month she was cleared of any wrongdoing. This week the school lifted her suspension.
Ian Binnie, the school’s head teacher, said Miss Greening had been phased back into work since February.
Alexandra High School is described as a large comprehensive with about 1,400 pupils.
Writing on the school’s website, Mr Binnie describes the children as “very friendly and eager to learn”.
He said: “Most of the pupils are lovely. Their parents send them to school well turned out, ready to work and tell them to behave themselves. Most do. They welcome new teachers and are both loyal and generous.”
By-election controversy in Britain
A Conservative Cabinet minister has defended the party’s Eastleigh by-election candidate after she said it was “impossible” for her son to get the education he needs at a state school.
Grant Shapps, the Conservative Party chairman, said it was quite right that Maria Hutchings, should be able to send her child to a private school if she chose to do so.
Mrs Hutchings, the Conservative candidate to take the Eastleigh seat previously held by Chris Huhne, has faced Labour attacks for a comment she made about the education one of her children.
Last week, she is reported to have said that her son could not get an appropriate education in the state sector.
She said: “William is very gifted which gives us another interesting challenge in finding the right sort of education for him – impossible in the state system. He wants to be a cardio-respiratory surgeon.”
Ed Miliband, the Labour leader, said Mrs Hutchings had “insulted every pupil and teacher at our state schools, including those in Eastleigh.”
Mr Shapps told the BBC’s Sunday Politics that Mrs Hutchings had every right to educate her son privately if she chose.
He said: “It’s perfectly reasonable to look for the best options for your children.”
Mrs Hutchings has four children and the Conservative campaign in Eastleigh has presented her as a “local mother”.
Labour and Liberal Democrats in Eastleigh have suggested that one of her children attends a private school shows she is not committed to the area’s state schools.
Mr Shapps insisted that Mrs Hutchings supports state schools, saying some of her children go to them.
“The fact that she’s got four children and two or three of them are in the state system, I think rather illustrates that she believes in it,” he said.
Mr Shapps also used the row to make a jibe at Nick Clegg, the Lib Dem leader, who is expected to send his son to an independent school later this year.
“I think every parent wants the best for their child whether that’s Nick Clegg or Ed Miliband or Maria Hutchings or myself,” he said.
David Cameron: Immigration rhetoric hasn’t damaged relationship with India
David Cameron claims Britain’s debate over immigration hasn’t damaged our relationship with India, saying Indian students recognise the need for a “controlled” policy.
David Cameron, who is in New Delhi on an official visit to India, said that the students he had talked to during his tour understood the need for the UK to clampdown on bogus colleges which has previously offered young Indians an easy route into Britain.
The Prime Minister claimed that the Coalition inherited 180 “bogus” colleges in the UK that were helping Indians gain visas only for them to turn up “in the economy doing unskilled jobs”.
Bonafide Indian students recognised why the Coalition had to shut them down, according to Mr Cameron.
“They recognise we are making a very generous offer in saying their is no limit to the number of students from India who can come and study at British universities.”
His comments follow his announcement yesterday of plans to amend the visa system to allow Indians coming to the UK on business to get a visa in just one day.
Britain already runs the largest visa operation in the world in India, processing over 400,000 visa applications a year and granting 9 out of 10 applicants a visa, Mr Cameron said in Mumbai yesterday.
A curb on a free Press never seen in a democracy: Leading peer attacks Labour attempt to shackle media
Labour-inspired proposals on media law would curb the free Press in a way ‘never seen in any democratic country’, a senior peer warned last night.
Eminent QC Lord Lester said controversial amendments to the Defamation Bill pushed through with Labour support this month would damage free speech and break European human rights laws if they were allowed to stand.
He accused Labour of ‘hijacking’ the legislation in an attempt to force the Government to implement Lord Justice Leveson’s plans for regulation of the Press in the wake of the phone hacking scandal.
Ministers are said to be so concerned by the proposals that the entire piece of legislation could be abandoned.
But Lord Lester, the architect of the Defamation Bill, said this would be a travesty, as vital reforms of Britain’s notorious libel laws would also be lost.
His intervention comes amid growing Government anxiety about an amendment pushed through the Lords by 272 votes to 141 earlier this month.
The amendment, put forward by Labour-supporting film director Lord Puttnam, would introduce an arbitration service for members of the public wronged by the Press.
The legislation would mean that newspapers that did not join the system could be punished by courts awarding potentially ruinous damages and costs.
Crossbench peer Lord Skidelsky, who is backing the move, yesterday suggested the arbitration system could help prevent the publication of ‘things which may be true, but whose publication has no sufficient reason’.
He suggested newspapers should face exemplary damages if they failed to get approval from the new regulator before publication.
But Lord Lester said this form of ‘prior restraint’ – which was demanded by former Formula One boss Max Mosley – was only used in a handful of former Soviet states.
Lord Lester said the impact of the Puttnam amendments would be to introduce ‘a form of coercion I have not seen in any democratic country’.
He told the Daily Mail: ‘The scheme they are recommending would be totally incompatible with human rights and free speech. Instead of having self-regulation, which I believe strongly in, you would have a coerced system of arbitration.’
Lord Lester, a Liberal Democrat peer, said the amendment was ‘inappropriate’ as it tacked controversial privacy issues on to legislation on libel reform which has cross-party support, including the stated support of Labour.
He added: ‘They have taken the Bill hostage in order to put pressure on the party leaders and the Press over the implementation of the Leveson reforms.
‘But Leveson wasn’t interested in libel law, he was interested in privacy.
‘I very much hope that when the Bill comes back to the Commons we can get agreement across the parties to release the Bill from the limbo it is now in so that we can get these reforms onto the statute book.’
The Defamation Bill, which has all-party support, would bring in long-overdue reforms to Britain’s antiquated libel laws.
The political parties are still locked in stalemate over how to implement Lord Justice Leveson’s reforms.
Labour is demanding new laws to back up a new independent Press regulator.
But David Cameron has warned that legislation could prove to be the thin end of the wedge and allow future politicians to interfere with Press freedom.
He wants a new regulator to be established by Royal Charter.
Don’t muzzle our ‘cruel’ lawyers – I’ll need one to keep me out of jail
By Peter Hitchens
I genuinely fear that I will go to prison before I die, for writing or saying something that is no longer allowed. I have met quite a lot of people who hate me and my views so much that they would very much like this to happen.
Our society is already a hundred times more intolerant than it was when I was born. In recent years, police officers have actually questioned prominent people because of opinions they have expressed, a thing unthinkable even 30 years ago.
Of course the main threat to free speech is not prison but the loss of your job, as anyone in the public sector knows very well.
But the limits on what can be said shrink all the time, and the powers of the police and prosecutors grow.
At some point these two curves may meet, and I may find myself on the receiving end of one of those nasty, well-publicised dawn raids that the police like so much.
My only hope, if this happens, will be in the courtroom. That is one reason why I urge you not be seduced by calls to limit the freedom of defence lawyers.
Witnesses do lie and make things up. Juries are often pretty feeble and too easily led. Since they abolished the property qualification and brought the age limit down to 18 (it may soon be 16), the chances of having your case heard by educated or experienced people have shrivelled.
And since the disgraceful introduction of majority verdicts, one or two wise jurors cannot hold out for long against a lazy, bored majority who think there’s no smoke without fire, and want to go home.
So unless defence lawyers have full freedom to question prosecution witnesses, the defendant in a modern British trial might as well go straight to jail and get on with his sentence.
Like any civilised person, I grieve at the death of Frances Andrade, who killed herself after giving evidence against Michael Brewer, during which she was vigorously cross-examined.
May she rest in peace. But I object strongly to the way in which many people have used this event to argue for limits on the freedom to cross-examine.
We do not really know why she took her life, though I would point out that, like a frightening number of suicides, she was taking so-called ‘antidepressant’ drugs, which are known in some cases to promote suicidal feelings in those who take them.
Think of this another way. A trial is not just an argument after which everyone goes home. If the accused is found guilty, he goes to prison and – if he has until then been a respectable person, who will suffer greatly in jail – his life is more or less at an end. Some people deserve this. But their guilt must be proved first. If trials become mere formalities, in which we go through the motions of justice while forgetting its principles, we will be a tyranny.
The patients prescribed up to 25 different drugs a day with devastating results
This is alarmingly common. When people go into hospital, they usually take their normal medications with them. So when I went into hospital last year at age 68, my medications should have come with me. Excerpt there weren’t any. I practice skepticism as well as preach it. A nurse who looked into my medication cupboard said it was the only empty one she had ever seen. The hospital was a top private one so nearly all the patients were older people
Jean Smith felt as if a thick fog had descended on her brain as once again she found herself having to re-read sentences three times so she understood what they meant.
‘Even when I talked I struggled to find the right words,’ recalls Jean, a 63-year-old former civil servant, who lives in Liverpool with her husband, Kenneth, 58, a factory supervisor.
‘I told Kenneth the same things over and I never knew what the day was. ‘I just couldn’t think clearly and was worried I was beginning to lose it.’
She was also sleeping more than usual.
In fact, Jean’s brain was absolutely fine — the real problem was the dozens of medications she’d been prescribed by her GP.
Jean was on a cocktail of more than 25 pills, patches and creams a day, from an anti- hypertensive drug for high blood pressure to painkillers for arthritis.
The prescriptions had increased during a 15-year period.
‘The effects built up gradually as my prescriptions escalated. I felt I was under a chemical cosh,’ recalls Jean.
‘To be fair, my GP is pretty good at checking up on how I get on with new drugs — the problem is like most people I just wasn’t aware that some of the symptoms I had were actually side-effects of drugs.’
But last November, after Jean experienced dizzy spells and sudden low blood pressure, her doctors and GP decided to reduce her drugs down to just nine.
‘They were unsure whether my symptoms were linked to a new medical condition or were a symptom of drug interactions. It actually turned out to be a combination of both.’
For although the bad news was that Jean had another problem — an autoimmune condition affecting her adrenal glands — coming off some of her drugs actually cured her memory problems.
‘I can think clearly again and I’m not forgetting things,’ she says happily. ‘I don’t feel like I’m drugged up to the eyeballs any more.’
Jean is one of a growing number of patients in the UK on a daily cocktail of drugs to treat medical conditions, prevent others and increasingly, to deal with the side-effects of prescribed medication (in other words, the drugs they are given for their genuine ailments in turn create symptoms).
The annual number of prescriptions per head of population has increased from 11.9 in 2001 to 18.3 per person in 2011.
Most of this increase has been in prescribing for the elderly. Almost half the over-65s have three chronic health problems, such as high blood pressure, diabetes, and arthritis. It’s quite common for this age group to be taking eight to 12 different types of medication daily.
Taking lots of different prescription pills and medicines — known as polypharmacy — is a major issue for this age group, says Dr Chris Fox, consultant old age psychiatrist at the Norfolk and Suffolk Mental Health NHS Foundation Trust and a senior lecturer at the University of East Anglia.
Experts warn the problem is partly due to prescribers being too quick to medicate — without always checking what other medication the patient is already on. As we shall see, GPs are also effectively incentivised to put patients on pills.
Elderly patients often don’t know why they are on so many drugs, says Dr Trisha McNair, specialist in medicine for the elderly at Milford Hospital, Surrey: ‘One GP friend of mine says she had a patient who kept all her pills on a huge glass bowl on the kitchen table and just took a random handful when she was passing.’
Dr McNair says she often sees patients who are on between 12 and 20 different types of medication, including pills, sprays and creams.
The problem with polypharmacy is that the more drugs you take, the more likely you are to experience side-effects that are then misinterpreted by the healthcare practitioner as a symptom of disease that needs treating with additional medicine, explains Dr Fox.
‘Many older people on beta-blockers for blood pressure, for example, will report depression.’
This could be because depression is a known side-effect of beta-blockers.
But some patients may not need the beta-blockers at all — the problem is the drug then slows down their heart too much and it is this that makes them tired and depressed.
‘This may lead to them being prescribed anti-depressants they don’t need.
‘Others who are on statins might suffer from muscle pain and this may mean they need painkillers, which may then have more side-effects, including gastric problems, which then necessitate more drugs.
‘A lot of these drugs do prevent illness, it’s true, but there is often a price to pay in terms of side-effects.’
It’s not just that the drugs can cause side-effects — there’s also the problem of them interacting with each other.
‘A big part of our workload is sorting out whether these patients’ symptoms are an illness or a result of drug interactions,’ says Dr McNair.
This task is not helped by the fact that drugs are not tested on patients who are on multiple pills for different conditions, adds Dr Fox.
‘I was always taught that if you take more than three drugs at a time you can expect interactions — but these days it’s not unusual for the over-65s to be on five or more different drugs for three or more chronic health conditions. No one really knows what the cumulative effects of this are yet.
‘Although GPs use computerised prescribing systems that should flag up drug interactions, they may also write paper prescriptions on home visits and not have access to this, so the system is not infallible,’ says Dr Fox.
The elderly are more at risk of drug side-effects because their metabolism is slower, meaning drugs build up in their systems, he adds.
Dr Fox recently published research that suggested commonly prescribed anticholinergic drugs — used for treating movement disorders, incontinence and chronic obstructive pulmonary disease — are associated with cognitive decline in the elderly and an increased risk of death.
An estimated 20 to 50 per cent of all over-65s are being prescribed at least one anti-cholinergic drug, and while the effects of some are small, their cumulative effects may cause significant mental deterioration in older people who already have some cognitive problems, warns Ian Maidment, a senior lecturer at Aston University’s School of Pharmacy and joint author of the study.
‘Doctors can definitely do more harm than good by prescribing too many drugs — GPs are ideally placed to take a holistic view of the patient’s overall health, but they are hard-pressed.
‘And sometimes the patient is under four or five different specialists and it can be hard for GPs to find out why a patient has been prescribed a particular drug, so they tend to leave them on it.’
‘We need more research into poly-pharmacy to see what the effects are. It requires a co-ordinated response from community pharmacists, patients and their carers too.’
There is an added problem with patients self-medicating with over-the-counter drugs and herbal remedies, says Dr Fox.
Tackling polypharmacy can make a significant difference, as Jean Smith discovered.
Her experience is borne out by an Israeli study in 2010 that found that when the elderly patients in a nursing home were taken off some of their medication (under supervision), 88 per cent reported improvements in their overall health.
Fifty-six of the 70 participants reported improvements in their cognitive health.