Thursday, 21 November 2013

Perhaps we should stop calling them paramedics?

In May 2007 an ambulance was called to a young woman, Sarah Thomas, who was having trouble breathing. Miss Thomas was recovering from a brain tumour and was lapsing in and out of lucidity, but she knew she was ill and called the ambulance at 1am. She was known to have diabetes and to have had her pituitary gland removed after surgery for the tumour. She also thought she had a gastric infection as her father had also experienced a tummy bug a few hours earlier.

You do not need to be a paramedic to know that if someone's brain is being treated and they are calling an ambulance, and they can't breath reliably, are dehydrating and have diabetes and no pituitary gland, the place to go is a hospital and let the grown-ups deal with it.  Common sense tells you that this is way out of one's own league. 

Instead, the paramedics carried out an incompetent assessment and persuaded the parents to sign to say that they had done their job. They persuaded the patient not to go to hospital.   The parents were there and were fully able to explain that their daughter had recently had brain surgery. Note that Miss Thomas, a 30 year old woman, was apparently not in a condition to sign, which is another clue that she should have been removed to a hospital. Had she gone to hospital the doctors and nurses would have been in a position to give her the stabilizing treatment she needed.

After only six years the coroner managed to return a narrative verdict in February 2013, in which he noted discrepancies between the accounts given by the ambulance crew and the family.  He gave the  medical classification for the death 
Mr Philip Rogers said he would record the medical cause of her death as:
 1a circulatory collapse as a result of gastroenteritis, with
 part two, panhypopituitarism and adrenal insufficiency.
The adrenal insufficiency in particular would have been treatable with an injection. Due to the limitations of what a paramedic can be expected to know about, he ruled that 
...this cannot be labelled as gross failings
Yes it is gross failing and obviously so.  They did not carry out a competent assessment.  They persuaded the patient and her parents not to go to hospital when it was apparent that the patient was losing the capacity to take decisions at all.  If she had called a cab instead of an ambulance, Miss Thomas would have stood a better chance of survival because at least the cab driver would not have played at being a doctor.
After a further ten months disciplinary action was finally taken.  The paramedics were removed as it became clear that the 'discrepancy' was more than just two different view of the situation.  The disciplinary panel revealed that not only had they failed to carry out a proper assessment but they then
colluded to fabricate a patient record.  
 They tried to cover up the error.

But why did they not do the the obvious thing and just take her to the hospital that night?

Below the line in the Mail (usual caveats) is an interesting comment:
Unfortunately, ambulance staff have been pushed towards not taking people to hospital to ease pressure on the hospitals. This practice of using them as "poor mans doctors" is widespread because you have almost no chance of getting doctors out in the evening. .......Increasingly the ambulance service is led away from its primary duty ,which is to promote life by giving aid and getting you to hospital.This is an unfortunate case but is one that we will probably see more of in the future unless someone" grasps the nettle" and gets back to basics.
The names of the paramedics are not relevant here and are available from the links. They certainly made a willful and serious mistake and compounded that by trying to fiddle the records. The latter, in my view, should be a criminal matter and not just a disciplinary one.
However, if  hospitals are pressuring ambulance staff to not bring sick people to hospital in order to hit admission time targets, then it is even more important to know that a political decision is being made which results in unnecessary deaths.


call me ishmael said...

That's just how things are, it's like that everywhere, My own take on it is that instead of recruiting and paying the right people properly the nation instead offers yellow jackets with inbuilt bullying rights. The vast numbers of cheap shits in all walks of life who now feel empowered to bully one is astonishing. I won't fly because airport security goons are like fucking Nazis, enabled, of course, by the convenience for Power of the Security state. The cops see everyone as a criminal who must prove his or her innocence; somehow, we have permitted the growth of a Bouncer Industry, consisting of people who should be in remedial education, psychiatric care or prison; even the binmen, for God's sake, are now empowered to sift our rubbish for its correctness.

I guess if you keep everyone at war with everyone else, even to the extent of paramedics v patients, then they won't notice their pockets being picked, their rights being trampled, their lives being stolen.

If its medical mistreatment and neglect you fear then move to Scotland, we are miles ahead of England, it's not perfect but if I was ill, as I often am, I would crawl up the M6 on my hands and knees to get over the health border.

JuliaM said...

"If she had called a cab instead of an ambulance..."

I'm reminded that it was a humble cab driver who raised the alarm about Victoria Climbie too...

Sevvy Balesteros said...

I've done both crime and now health (civil service whore I guess, should get a proper job or marry Kylie) but in both instances miscoding was egregious to the point of startling disparity with the only sanction being post audit 'are you sure about this, do you wanna re-submit them?'

These Keogh investigations that have obvious political frequency are reporting on information that's already known. Hang on a mo:

And the ancillary which is:

It is beyond my comprehension what more data would be required to fully map service provision as a measure of quality or indeed ability but then i'm not waving my cock about in a full public meeting trying to distract grieving relatives from the total horseshit i'm babbling. The Leeds maternity unit imbroglio almost gave the public an insight into the true considerations at play when those bastards at UCL (Dr Foster) had the temerity to say 'hang on a mo, your figures are shite' so institutional arm twisting coupled with photos of their kids had to be deployed to get the bastards to just shut the fuck up, pronto - here, have some cash, capiche?

Cynicism doesn't even come close to it anymore, this is intentional and endemic arse covering from the very top - punters die, get over it. Envy of the world dontcha know?

I'm not gonna sign this as I am a whore but it's not funny, really, and i'm in no position to fix it yet other than to say never ever go to hospital alone.

MTG said...

All our layer cake public services provide multi-tiered responses which correspond to who you are or who you know. Excellence is reserved to a few and notably diverted to the urgent needs of generous fee-payers. Such unaccountable public services are analogous to binning the best cuisine so that ordinary diners can be presented with meagre helpings of left-overs.

Obsessive lying is the penultimate product of septic barrels brimming with bad apples. The process squanders resources into maintaining illusion. Inevitably, performance falls whilst pressure mounts to portray all critics and complainants, as villains.

Strangest of all is our fascination with the worst of these symptoms which draws attention from the disease itself.

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