Father died on hospital bathroom floor after junior doctor failed to give him life-saving drugs
Nobody gave a damn
A father-of-three died on the bathroom floor of a hospital after a junior doctor left life-saving drugs off his medication chart, an inquest has heard.
Medics failed to realise Edward McKean, 52, was not receiving vital blood-thinning drugs for six days after he underwent brain surgery to remove a benign tumour. Mr McKean did not receive the drugs – designed to reduce the risk of blood clots – because a junior doctor missed them off his treatment chart when she copied it up.
As a result, a clot formed in Mr McKean’s leg, broke free, and blocked an artery, causing a fatal pulmonary embolism – a blood clot in the pulmonary artery – as he walked to the bathroom.
A post-mortem examination found he had already suffered a smaller embolism which could have alerted doctors to their mistake and saved his life.
A coroner ruled that doctors and nurses missed numerous opportunities to spot their mistake and said ‘neglect’ had been a contributing factor to his death.
An inquest at Coventry Magistrates Court on Friday heard that the keen walker’s life could probably have been saved if the mistake had been picked up.
Mr McKean had surgery to correct a rare tumour in his nasal cavity and skull at University Hospital Coventry, in Walsgrave, on April 3 last year. He initially received the anti-coagulant medication after the opeation but stopped receiving it following the error.
The contracts manager, from Solihull, West Midlands, died as he walked to the bathroom on April 22, almost three weeks after his operation.
Mr McKean’s partner, Susan Rickards, told the inquest she had ‘fought for a year’ to stop the tragedy being ‘swept under the carpet’.
Describing the moment she learned of his death, she told the inquest: ‘The hospital rang me at five in the morning and told me there was an emergency, so I shot up there. ‘I thought if he saw I was calm it would help him to keep calm.
‘I thought he might have broken his arm or leg, but when I got to the ward they told me he was gone.’
Consultant neurosurgeon Hussien El-Maghraby admitted the mistake should have been detected sooner. He said: ‘What is serious is that it was not picked up for six days.’
Mr El-Maghraby added that when he learned what had happened, he sent an email to the hospital’s chief executive.
Deputy coroner Louise Hunt asked him: ‘On a scale of one to ten, how serious would you say these collective failings were?’
He replied: ‘Very serious, ten out of ten. ‘That’s what made me send an email.’
The inquest heard the hospital had since improved ward rounds and made other changes to minimise the risk of a similar tragedy.
Ruling that neglect had contributed to Mr McKean’s death, Ms Hunt asked the hospital to send her written confirmation that it had implemented measures to prevent similar mistakes occurring again.
Dr Mike Iredale, deputy medical director, apologised to the family for the ‘unimaginable distress and grief’ the hospital had caused them.
He accepted serious mistakes were made and promised the hospital would continue to improve its procedures.
Giant ‘major incident’ tent pitched outside hospital to look after patients who were trapped in queuing ambulances for up to THREE HOURS
A major hospital was so overrun by patients and queuing ambulances that bosses had to erect a major incident tent normally used to treat casualties after disasters such as air and rail crashes.
Up to 15 ambulances were kept waiting outside the A&E department at the Norfolk and Norwich University Hospital on Easter Monday.
Some stood more than three hours before patients were admitted.
The situation got so bad that a major incident tent similar to a field hospital was put up so paramedics could drop off their patients.
Frustrated ambulance staff said the emergency tent was normally reserved for plane and train crashes and putting it outside the hospital was ‘unheard of’.
But hospital bosses said it was only erected ‘as a precaution’ for 1 hour and 45 minutes and in the end no-one had to be treated in it.
The hospital faced a similar problem last month when all 17 ambulances were left queuing outside A&E. On that occasion the East of England Ambulance Service was left unable to attend 12 other 999 calls and ambulances had to be drafted in from further afield.
The latest incident came after the hospital’s director of medicine and emergency care, Chris Cobb, said they should be able to cope with 15 ambulances turning up at once.
One ambulance crewman said: ‘We are so fed-up with getting slated and being made to look as if the ambulance service is to blame for the delays – but it’s not us, it’s A&E.
‘They want to get out and save lives. That’s all they want to do and they are getting caught up in a political row.
‘The tent is usually used at plane crashes and big events, such as the Lord Mayor’s parade. To put it up outside the A&E is unheard of.’
Another ambulance worker, who also asked to remain anonymous, said: ‘It’s a mini-hospital in a tent.’ ‘It will usually have in it treatment bays, drugs, oxygen, the same stuff on board an ambulance but inside a tent – which is a lot colder.’
Ambulance service spokesman Oskan Edwarson said: ‘Between 11am and 8pm the trust had an average of between six and 15 vehicles queuing for up to three plus hours.
‘Clearly this led to ambulances not being available to respond to other patients in the community. ‘We worked closely with the hospital and clinical commissioning group throughout the afternoon and deployed the the trust major incident tent to help release ambulances back on to the road.
‘The trust is pleased that this issue is now resolved following much hard work by the hospital and the ambulance service and that in the end no patients were required to be treated in the major incident tent at this time.’
Hospital chief executive Anna Dugdale said: ‘We were extremely busy over the weekend. ‘We made a decision with the ambulance trust to put the tent up simply as a precaution at about half-past six last night. ‘We agreed by quarter-past eight that we didn’t need it.
‘The demand on emergency services over the bank holiday weekend had been exceptionally high and the ambulance tent was erected for a short period as a precautionary measure.’
Now a local MP has demanded answers from the hospital and called for an investigation to ensure patients at the hospital receive the appropriate care.
Health Minister Dr Dan Poulter, MP for Central Suffolk and North Ipswich, said: ‘This is clearly some unacceptable poor standard of care for 999 patients in Norfolk and Suffolk.
‘Front line paramedics are doing their best to get their patients into the care of the Norfolk & Norwich and it seems the hospital system of triage is not up to standard. ‘It is time the hospital management learned lessons and improve triage process.
‘Clearly there are very busy days but the N&N has a poor history on ambulances not being able to deliver 999 patients.’
British schools expel 15 sex bullies a day: Even primary pupils driven to assaults by internet porn
Fifteen children are expelled from school for sexual misconduct on average every day. At least one of these will be from primary school, official figures show.
More than 3,000 children are excluded every year for offences including sexual bullying, sexual assaults and harassment.
The revelation comes amid increasing concern over the prevalence of ‘sexting’, when boys share explicit pictures of girls, often leaving the victims feeling suicidal.
Only yesterday the National Union of Teachers warned that sexual equality has been ‘rebranded by big business’ into a ‘raunch culture’ which is damaging the way girls view themselves.
Playboy bunnies adorn children’s pencil cases, pole dancing is portrayed as an ‘empowering’ form of exercise and beauty pageants have become a staple of student life, delegates said.
Statistics from the Department for Education show that in 2009/10, there were 3,330 exclusions for sexual misconduct. In 2010/11, a further 3,030 children were excluded for the same reason.
The 6,000-plus cases cover lewd behaviour, sexual abuse, assault, bullying, daubing sexual graffiti, and sexual harassment.
The 2010/11 total includes 200 exclusions from primary schools: 190 suspensions and ten expulsions.
There have been warnings that the number of expulsions may only hint at the true scale of the problem.
England’s deputy children’s commissioner has told MPs that head teachers are reluctant to tackle sexual exploitation of children for fear of the message it will send out about their schools.
Sue Berelowitz said schools were not facing up to the fact that some bullying amounts to sexual violence.
There were 2,830 exclusions from secondary schools – 2,760 suspensions and 70 permanent.
A survey by the NSPCC last year found that 30 per cent of secondary school teachers and 11 per cent of primary teachers were aware of incidents of ‘sexually coercive’ behaviour by pupils towards classmates over the past year.
And Floella Benjamin, the former children’s presenter, warned of an ‘epidemic’ of violent online porn which is leading youngsters on a ‘seemingly unstoppable march into a moral wasteland’.
Baroness Benjamin, who sits as a Lib Dem peer, said girls were becoming increasingly sexualised while boys were treating them as little more than ‘sexual objects’.
Lib Dem peer and former children’s presenter Floella Benjamin, left, warned that children are being led towards a ‘moral wasteland’
Last night Claire Perry, the Prime Minister’s adviser on childhood, said: ‘These statistics on expulsions confirm the uneasy sense that many parents have; that our children are operating in an increasingly sexualised culture which is spilling over into the classroom.
‘We need to be aware of the problem and crack on with plans for family-friendly internet filters, clean wi-fi and improved adult content blocks on mobile phones, as the Government has promised.’
The Daily Mail has been campaigning for tough restrictions on web porn amid fears that it is warping children’s views of sex and relationships.
David Cameron has promised that all new computers will be fitted with web filters unless parents specifically lift them, but no timetable has yet been put in place.
Last week the Association of Teachers and Lecturers heard that girls as young as 13 are taking part in homemade porn movies and 12-year-olds are waxing or shaving intimate areas.
Many agree to boyfriends’ demands to send revealing photos of themselves, only for the images to be shared around or posted online.
Jon Brown of the NSPCC said: ‘We have seen a surge in calls to ChildLine from girls who have been victims of sexual violence, often linked to “sexting” and online pornography.
Teachers need proper training in dealing with this issue and we must educate young people about what is and isn’t acceptable behaviour.’
In December, an investigation by Channel 4 News revealed that boys and girls as young as 13 routinely swap explicit pictures of themselves. Youngsters say the practice has become ‘mundane and mainstream’.
One girl told researchers: ‘I get asked for naked pictures at least two or three times a week’, while another referred to sexting as ‘the new flirting’.
A boy said: ‘You would have seen a girl’s breasts before you’ve seen her face.’
A spokesman for the Department for Education said: ‘Exclusions for sexual misconduct are extremely rare and are decreasing, with these statistics representing less than 0.05 per cent of pupils across the country.
‘Nevertheless we know headteachers take this issue extremely seriously, and this Government has reinforced their powers to tackle poor behaviour, including giving schools the final say on the reinstatement of permanently excluded pupils.’
Parliament has become Britain’s worst enemy of free speech
Too many of our laws are being used simply to silence ‘unacceptable’ views, writes Philip Johnston
The cause of free speech has produced some unsavoury champions down the years, but few can have been less attractive than John Wilkes. During the current debate about press regulation, this 18th-century degenerate has often been cited as an exemplar of the sacrifices made in defence of liberty. Indeed, in his time, Wilkes was a national hero. Yet today, his reputation has dwindled almost to naught, and his name and activities are highly unlikely to feature on Michael Gove’s list of historical facts that all schoolchildren are expected to learn.
But they should – because Wilkes, for all his flaws, embodied the spirit of liberty that is a defining characteristic of this nation, but which is all too easily undermined by indifference and ignorance.
By all accounts, including those of his friends, Wilkes was an unpleasant individual. He was a member of the Knights of St Francis of Wycombe, otherwise known as the Hellfire Club or the Monks of Medmenham Abbey. This libertine group made the Bullingdon look like the Mothers’ Union. It was renowned for its debauchery, its anti-Catholic ribaldry, and orgies with women dressed as nuns (during which members dressed in Franciscan robes).
Wilkes’s renown as a defender of free speech stems from an event that took place 250 years ago this month: the publication of issue No 45 of a radical newsletter called The North Briton. This was a virulently anti-government pamphlet that Wilkes, an opposition MP, penned with his friend Charles Churchill in order to torment the prime minister, the Earl of Bute. It was a scabrous riposte to a government-friendly paper, The Briton, edited by Tobias Smollett, the novelist and historian.
The North Briton was the Private Eye of its day, only without the latter’s customary restraint or attention to facts. Insults, scandal and rumour were its stock in trade, with attacks on senior members of the Establishment that were extraordinary for the time – even if they might now look uncontroversial.
But on April 23, 1763, Wilkes over-reached himself with a sustained attack on the King’s Speech for the new parliament, which was considered an unacceptable piece of lèse-majesté. Wilkes was arrested and charged with seditious libel – only to be cleared by sundry juries and re-elected to the Commons on several occasions, even when the authorities tried to bar him from standing. He was a true people’s tribune, and a hero to the Founding Fathers of the United States of America. The free speech provisions in the US constitution, and several subsequent rulings of the American courts, cite the Wilkes case; yet in his native land he is largely forgotten, save when free speech is under threat, as it is now.
Wilkes fought for the right to publish an opinion, however outrageous or erroneous it might be, without being told by people in power what to say or prevented from saying what they did not want to hear. Until relatively recently in this country, this was the accepted state of affairs. By and large, people were free to say what they thought, provided they did not incite violence; state regulation of newspapers was considered anathema.
Yet today, neither is true. People have been arrested and sent to prison for making “hateful” statements that were not physically threatening. And Parliament, for the first time in 300 years, wants to force the press to subscribe to a set of regulatory structures set up by the state.
The hate laws introduced in recent years are, in reality, the attempted prohibition of ideas that are considered inappropriate because they do not conform to the views we expect to hear expressed in a civilised society. But as long as there is no attempt or intention to provoke violence, should that be a matter for the criminal law? Some take the view that we need laws to protect minority groups from abuse; but the problem is that such laws can also be used to shut down perfectly legitimate opinion, for instance on the rights and wrongs of gay marriage.
There have been attempts to stop this slide. In January, Theresa May announced that it would no longer be an offence under Section 5 of the Public Order Act 1986 to insult someone. Yet at the same time, the Home Secretary acknowledged that this would make no difference, because the word “insulting” could safely be removed from the Act without undermining the ability to bring prosecutions.
In other words, this was not a victory for free speech at all, since the various cases that triggered the campaign to repeal this provision (like the arrest of a preacher for saying homosexuality was a sin) would still have gone ahead and will do so in future. The amended statute will allow the police to arrest people on the same basis as before – for expressing views that might be considered offensive, but which in a free country they should be allowed to say. That is why, as I argue in my new report for the think-tank Civitas, the relevant section of the Act should be scrapped in its entirety.
We have far too many laws in this area circumscribing free speech – not just Labour’s hate crimes legislation, or the Public Order Act, but also the Communications Act 2003 and the Malicious Communications Act 1988. As a result, the police and prosecutors are able to move from one to the other to close down views deemed to be unacceptable.
The fault here lies with the foe that Wilkes fought, even though he was a member of it: Parliament. The conclusion that the Americans reached when they introduced the First Amendment to the constitution was that the legislature could not be trusted to uphold free speech. It states bluntly that “Congress shall make no law… abridging the freedom of speech, or of the press”. That leaves legislators unable to interfere in any way at all with free speech, whereas here they have done nothing but meddle.
We do not have a written constitution – or rather we do not have a constitution that is codified. But as Lord Judge, the Lord Chief Justice, said in an important and insightful speech shortly before the Leveson Inquiry began its work, “the fact that there is nothing in statute which states expressly that the independence of the press is a constitutional principle does not diminish the principle”. Lord Judge also quoted Wilkes: “The liberty of the press is the birthright of a Briton, and is justly esteemed the firmest bulwark of the liberties of this country.”
As Lord Judge observed, this was a more profound observation than it at first appears. Wilkes, he said, “was asserting that the liberty of the press is the birthright of every citizen, that is, the community as a whole. It is a birthright of the citizen that the press should be independent. It is therefore not a right of one section of the community, not just a sectional right. It is the right of the community as a whole. It is, if you like, our right, the right of every citizen. And that is why, if you accept it as I do, the independence of the press is not only a constitutional necessity, it is a constitutional principle.”
So, too, is free speech. And as a constitutional principle, it must be inviolable – defended from interference not just by this Parliament, but by those yet to come.
Does religion still have a place in today’s British politics?
The recent row between Churches and state over welfare policy shows how the power of the clergy is waning, argues Paul Goodman
The Church’s report was seen as an attack on the Government, and the counter-assault from the Conservatives came quickly. “Pure Marxism,” said a Cabinet minister. A Tory MP added that it had been produced by “a load of Communist clerics”. The Prime Minister complained to a friend that the document contained “nothing about self-help or doing anything for yourself”.
The indignant vigour of that last sentiment gives the game away. The report in question wasn’t The Lies We Tell Ourselves, the recent attack on the Government’s welfare reforms produced by the Baptist Union of Great Britain, the Methodist Church, the United Reformed Church and the Church of Scotland, and the offended prime minister wasn’t David Cameron. It was Faith in the City, issued in 1985 by a special commission to the then Archbishop of Canterbury, Robert Runcie, and the leader in question was Margaret Thatcher.
Mind you, comparing and contrasting the two rows should indeed bring Karl Marx to mind. After all, they provide yet another reminder that he was wrong. For today, history is repeating itself as farce – without, as Marx claimed, repeating itself first as tragedy.
The contrast between Faith in the City and The Lies We Tell Ourselves is telling. Whatever one thinks of its conclusions – not least the idea that Thatcherism was to blame for the growing spiritual and economic poverty of Britain’s inner cities – the first was a serious and detailed piece of policy work, one capable of inspiring a follow-up report 10 years later. The second contains no recommendations. It is simply a plea on behalf of those claiming benefits – and therefore one on behalf of the benefits system itself.
Indeed, the entire dispute is artificial. The Lies We Tell Ourselves was published over a month ago. It seems to have been rehashed by the BBC over the weekend – on the verge of the Government’s changes to the welfare system going live. (Bias, anyone?). Whatever the background, the diminished vision of the report, and the muted reaction of ministers, says much about how Britain has altered.
Three big social changes have taken place since the rumpus over Faith in the City. First, churchgoing has continued to decline. Roughly 10 per cent of the population did so when that report was issued. Now it is under 5 per cent. While unvarnished attendance figures can be misleading, the long-term trend – and the ageing of congregations – is unmistakable.
Second, Britain has seen the rise of the new atheism – the polemical version mass-marketed by Richard Dawkins. The last census showed that the number of declared atheists has doubled to 14 million. The reasons for the rise are disputed, but one is unmistakable: militant Islamism has inspired a reaction against religion in general. So, too, have child abuse scandals within the Churches.
This has assisted the third cultural shift, and the biggest of all. There was no Human Rights Act in 1985, when Faith in the City was published. And there was no Equalities Act, either. Now we have both – and a human rights culture underpinned by the European Court of Human Rights in Strasbourg.
Religion may be a protected characteristic under this new dispensation. But when faith clashes with the new secularist ethos, the former tends to lose out. So it is that Catholic adoption agencies felt they had no option but to close rather than allow children to be adopted by same-sex couples, and Lillian Ladele, a Christian registrar, lost in Strasbourg over her refusal to conduct same-sex marriages.
No wonder, then, that David Cameron is relatively relaxed about criticism from those in dog collars, whether it comes in the guise of those Reformed Churches campaigning against welfare reform or George Carey, the former Archbishop of Canterbury, complaining about same-sex marriage. These two strands of criticism combine in being reactionary, in the real sense of the word: both are reflexive protests against the way the world is changing.
Voters’ views about welfare claimants are hardening. The great wave of immigration that has broken over Britain since 1997, the largest in the county’s history, has much to do with that. Social attitudes are changing, too. On same-sex marriage, they divide between the generations. Mr Cameron’s gamble is that the Churches are often out of touch not just with opinion on the street but in the pew, too.
He isn’t always right. The bias in government childcare policy against single-earner couples risks an electoral penalty in 2015, and his backing of same-sex marriage – for which he had no manifesto mandate and for which there was no public pressure – has already cost him dear, given the scale of party resignations and defections to Ukip. And it can also be argued that the Prime Minister’s commitment to protecting Christianity’s place in the public square is shallow: appointing Sayeeda Warsi as Minister for Faith, sticking to his pledge to spend 0.7 per cent of GNP on overseas aid and sending out Christmas messages quoting St John’s Gospel doesn’t add up to a thought-through policy on faith.
But is Mr Cameron letting the Churches down, or vice-versa? The answer lies back in the early days of this Government, when Steve Hilton was in Downing Street and the Big Society was all the rage. Mr Hilton had a vision of clubs, charities, co-operatives and, yes, churches running public services.
To a degree, this has long been happening. Churches and faith communities have always been the Big Society in action – the “little platoons” that Burkean Tories revere. The Church Urban Fund, for example, supports 300 projects that tackle poverty directly.
The Cabinet Office, which contains a strong network of evangelical Christians, is funding evangelical-led projects such as the Cinnamon Network. “Christians on the ground know that Britain faces 10 years of austerity,” one church source told me, “and are bypassing the official structures, providing food banks and housing and employment advice on the ground.”
This raises questions about those “official structures” – in particular, those of Britain’s two largest ecclesiastical players, the Catholic Church and the Church of England. The former was suspicious of Michael Gove’s academies initiative. Although there have been changes at the Catholic Education Service, its energies are still directed inwards – towards preserving the Catholic ethos of its schools.
The Church of England is less centralised: the toing-and-froing between St Paul’s and the Occupy movement last year was but one small reminder of this. But like parts of the Catholic Church and the Reformed Churches, a large part of the bench of bishops harks back, in that reactionary way, to the Attlee government of the 1940s as its ideal, and to the welfare state as that government’s greatest achievement.
Mr Hilton – and the Prime Minister himself – thus have reason to be disappointed. The Churches on the Continent are not so tethered to an ageing model. In Germany, the Catholic Church runs more than 25,000 kindergartens, hospitals, homes and care facilities. Jeremy Hunt’s hospital reforms – a response to disasters such as Mid-Staffs – rely on new discipline from above and visitor pressure from below (with the latter probably to prove the more effective). Hospitals have failed elderly and frail patients because we live in a culture that doesn’t value age and experience. The ethos of the Churches contradicts that culture – indeed, it created our hospitals in the first place. There is a role here that they could revive.
We have grown used to political interventions from Rowan Williams and other churchmen that could double as editorials in the Guardian or New Statesman. But the truth is that until the Church of England and others reoccupy the ground they once held, they will be driven further out of people’s everyday lives. The more ground they are forced to abandon, the safer politicians will feel in ignoring them.