Healthwatch Enfield and Haringey question 'palliative' death increase at North Middlesex Hospital

North Middlesex University Hospital questioned over high number of deaths recorded as 'palliative'

North Middlesex University Hospital questioned over high number of deaths recorded as 'palliative'

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Health watchdogs have called on a commissioning body to investigate the increase in deaths recorded as ‘palliative' at North Middlesex University hospital.

Healthwatch Haringey and Healthwatch Enfield have come together to ask the Care Quality Commission (CQC) to investigate the way in which the hospital in Sterling Way, Edmonton, calculates the standards of care it offers to patients.

The request has come in the light of numbers showing a dramatic increase in patient deaths coded as ‘palliative’, meaning that death was expected because the patient was terminally ill.

In 2008, the percentage of deaths coded palliative was 4.76 per cent, but figures in 2012 show 31.48 per cent, a jump of 26.72 per cent in four years and the fifth biggest increase of all NHS hospitals in the country.

Healthwatch Haringey Chairman Sharon Grant said: “It is important that people have accurate information about the standards of care, and death rates at a hospital can be an important indicator of quality, along with other measures commonly used.”

A North Middlesex University hospital spokesman said: "We are disappointed that Healthwatch did not discuss their concerns with us. Had they done so we would have reassured them there is an issue about the way some mortality figures are measured rather than an issue with our quality of care and safety.

"The way we measure palliative care is in line with national standards and is independently audited every year. There has never been any suggestion that we provide inappropriate care or that our data is not robust.

He added: "One measure of hospital mortality rates - the HSMR - includes palliative care which it is agreed can skew the results.

"However, we perform very strongly against the now more widely used Summary Hospital-level Mortality Indicator (SHMI) which does not include palliative care and which is produced by the Health and Social Care Information Centre.

“We are one of the best performers with regards to SHMI in the country - among only 12 trusts with lower than expected mortality rates. We are also one of the best performers against a broad range of other quality measures.

"We have already offered to meet Healthwatch and discuss this issue with them. We hope the Care Quality Commission will also be able to explain it to them."

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11:18pm Thu 10 Apr 14

mericansiz says...

Dear Editor,

Below is part of a report that I am currently getting ready to send to NICE and QCC re the appalling lack of care that my father received whilst at NMH.

10/02/2014
Mr Arif Durmush DOB: 29/10/1936 was referred by his GP Dr Raj of Arcadian Medical Centre, 1 Arcadian Gardens, Bowes Park, London, N22 5AB on Monday 10th February 2014 after attending a GP appointment to obtain results of various tests.
All tests had come back as normal except the blood test results which showed that the haemoglobin levels were low. The GP advised that this may be due to Mr Durmush being anaemic.

Mr Durmush was in a lot of pain and stated that he felt his whole stomach was burning. He was crying with the pain.
His daughter Ms Meric Batili asked if Dr Raj could write a referral to a private doctor as her father was clearly very unwell.
Dr Raj stated that he would refer Mr Durmush to the hospital for further investigations. He hoped to get the patient into hospital by the end of the week. He advised that this route would be far quicker than referring to a private doctor/hospital.

At approximately 13.00PM later that day, Dr Raj called Mr Durmush's daughter Ms Meric Batili and asked her to collect the referral letter and take her father to the North Middlesex University Hospital's Acute Assessment Unit where he had spoken to the consultant who had agreed to see the patient.

Mr Durmush arrived at the AAU with his daughter who handed in the letter. As there were no examining rooms or beds available they waited for at least an hour.
Whilst waiting in the waiting room Mr Durmush's blood pressure was taken, he also had blood tests and was also examined by a junior doctor on the unit in what amounted to a large storage cupboard with a doctors couch.
He was later taken for an xray and also had a urine test.

Ms Batili asked if the unit was planning to do a scan. The junior doctor advised that this was not on the list. Ms Batili insisted that a scan was done as her father had already had an xray very recently and this had shown nothing. She was advised that the junior doctor would talk to a senior member of staff.
Mr Durmush later had a scan at around 19.00PM.
By this time a bed had already been identified for Mr Durmush and he was required to stay overnight for further tests the next day.

Mr Durmush had not eaten or drank anything since the morning as he was told that the team were planning to put a tube with a camera attached to it down his throat. It was later decided that it was too late in the day to perform this and so he was given four cheese sandwiches and a cup of tea.

11/02/2014
Mr Durmush is visited on the ward by Drs Laura Spanou (Consultant Surgeon) and Myers (Oncology) and their teams.
Present at the time was Mrs Bahire Durmush (patient's wife) and Mr Levent Batili (patient's grandson).
Mr Durmush is given the news that he has cancer of the colon, cancer of the liver with metastasis and also tumours in the stomach area. He was told that the cancer was advanced at stage four.
He was advised that a camera would be inserted through his nose the next morning for further investigations.
Mr Durmush had a cannula inserted and then a tube feeding his body with serum attached to the cannula. Some of his medication/painkille
rs were also given in this manner. The medication prescribed were paracetamol, buscapan, anti sickness medication and an anti coagulant and morphine. To date Mr Durmush has refused the morphine stating that the paracetamol is controlling the pain.
A catheter was also attached to Mr Durmush's urethra through his penis. He was also Nil By Mouth
Mr Durmush then had diahorrea throughout the night.

12/02/2014
Mr Durmush was again seen on the ward by Dr Myers with his daughter Ms Batili present. Dr Myers once again explained Mr Durmush's diagnosis and asked him if he wanted intervention and therapy. Mr Durmush confirmed that he did. Dr Myers said that there were procedures that could be performed and the surgeon would see him again.
Some time later Dr Spanou arrived. Mr Durmush was told that a stent could be put in to bypass the blockage and allow him to have normal bowel movements which would also mean he could eat normally. He was told that this procedure could only be done at Northwick Park Hospital in Harrow. The family were told that he was on the list for a bed there.
Later in the afternoon, Mr Durmush was visited by Dr Wasim from the Oncology Team together with Emma Foster from the MacMillan Cancer Team. Dr Wasim spoke of another procedure that would be done at the North Middlesex University Hospital. This left the family feeling very confused as they had been told of two different procedures at two different hospitals. Upon further questions, it was ascertained that the procedures were one and the same but the family still remained confused as to where this procedure would be performed.
Dr Spanou was very clear that the procedure could not be performed at the North Middlesex University Hospital as they did not have a long enough cable in theatre.
Later that night Mr Durmush was moved from the AAU to ward T6 on the 6th floor of the Tower building to room 10, a side room due to his diahorrea and constant need for a toilet.

13/02/2014
Mr Durmush is continued on the serum and medications. Dr Spanou and her team visit and again advise that they have referred Mr Durmush to Northwick Park Hospital and he has been accepted by them. They are just awaiting a bed.
Mr Durmush's family are concerned that he has had nothing but he serum since Tuesday morning and he is dehydrating.
Dr Spanou agrees that if he is able to tolerate it, he can be given sips of water and pure apple juice as well as clear broth (made from boiled chicken, potato and carrot). He is only allowed the clear juice and nothing else.

14/02/2014
Mr Durmush is continued on the serum, medication and the water, juice and clear broth as agreed. The family notice that he is becoming weaker since being admitted to the hospital and are concerned for his health.
The ward manager is asked if there is any news on a bed at Northwick Park Hospital. There is still no news, contrary to what the family were told earlier in the week.

15/02/2014
As above, there is still no news. The ward have been on to the bed/site manager. Ms Batili has also been to the site manager's office about a different issue on the ward but also mentions that they are still awaiting news on the bed at Northwick Park Hospital.
Family are becoming alarmingly concerned at the deterioration of Mr Durmush since arriving on the ward.
An on call doctor, Dr Phoebe sees Mr Durmush during the night and advises that he should be on 3 litres of serum rather than two and prescribes the additional litre which is commenced straight away.
Dr Phoebe also promises to chase up the bed at Northwick Park Hospital.
Dr Phoebe is also advised that the family wish to seek a second opinion from Dr Helen Pardoe at the Homerton Hospital in Hackney, London.
She advises that she will write the wishes of the family in Mr Durmush's patient notes.

16/02/2014
There is no change over the weekend. Dr Phoebe continues to chase the bed/site manager re the bed at Northwick Park Hospital.
Mr Durmush continues with his serum and prescribed medications.
Mr Durmush's moral is now at an all time low. He has started to think that there is no bed for him and no plans for a procedure.
He continues to have diahorrea. Occasionally he has stomach cramps but these are controlled with the Paracetamol given to him as well as Buscopan if it gets too painful.

17/02/2014
It is now eight days since Mr Durmush walked into hospital, he now needs the assistance of two to walk to the toilet as he is becoming weaker and his moral continues to plummet.
At this point his three daughter's, Ms Malatani, Ms Batili and Ms Nowaz decide to approach anyone to assist them as they are fearful that their father is being starved to death.

Ms Nowaz approaches, PALS.
Ms Malatani speaks again to the ward nurses.
Ms Batili once again visits the site manager's office.

The ward staff have no new news.
The site manager advises that he has been on the case all weekend and will be calling Northwick Park Hospital again.
PALS calls the professionals involved.

Late in the afternoon, the consultant responsible for T6 ward (Dr Choudry, his registrar Jonas and another doctor from the Gastro Team meet with Mr Durmush's daughters. He apologises for the lack of communication to the family from the professionals involved in the care of their father.
Jonas advises that he has prescribed energy drinks (Ensure Plus) x 3 a day as well as extra vitamins to be given via the cannula.
Dr Choudry advises that he is happy to deal with the medical side of Mr Durmush's care but has no involvement on the surgical or oncology side.
Ms Batili advises that the family are not willing to entertain the idea of 'the Liverpool Care Pathway'. Jonas tells her that this is no longer practiced. However, Ms Batili feels that the fact hat the teams have not been giving the right amount of fluids till now in part constitutes this.
Ms Batili manages to have a brief conversation with Alex, one of Dr Spanou's team. She reiterates that the family wish to seek a second opinion from Dr Helen Pardoe, they also want to know why only Northwick Park Hospital has been approached when they have investigated as a family and found out that the UCLH also do this procedure. She also advises that the family have heard there is another procedure called TEMS and wish Mr Durmush to be considered for this. Alex advises that he has not heard of TEMS. He advises that he will put the family's wishes to the team.

18/02/2014
Mr Durmush and his family are given the news that a bed is available at the UCLH in Euston and he will have the stent procedure performed there on Thursday 20/02/2014.
Mr Durmush is advised that the energy drinks will be stopped from the night of the 18th of February 2014 and the sips of water will be stopped from the later afternoon of the 19th of February 2014. He will still have the fluids via the cannula.

19/02/2014
Mr Durmush is continued on his fluids and medication. He is also given an enema twice during the day to clear his bowels in preparation for the stent procedure. He is give three different times for transfer to the UCLH. These vary from 10.00AM to 12.30PM.
HIs daughter Ms Malatani is advised that she will be able to travel in the ambulance with him as he is very anxious. This is documented a number of times. However, later in the day, Ms Malatani is told that she cannot travel with her father as a nurse will be travelling with him and there will not be enough room.
Ms Malatani makes alternative arrangements to travel to the UCLH.

20/02/2014
Mr Durmush is transferred to the UCLH and arrives at 12.03PM. He is met there by his daughter Ms Malatani.
At 15.30 Ms Malatani texts her sister Ms Batili stating, 'Dad is out Meric, it's not good, they couldn't do it... if you can call NM and tell them to have a Dr waiting to see us... they will find an alternative and it's going to be today!'

It transpires that the space in the colon is so small due to the tumour that the team doing the endoscopy and stent procedure are unable to continue for fear of rupturing part of the bowel and causing internal bleeding.

Mr Durmush is transferred back to the North Middlesex University Hospital.

In the meantime Ms Batili calls the North Middlesex University Hospital to speak to Dr Spanou or a member of her team. She is advised by switchboard that they are unable to put patient's family's through to consultants.
Ms Batili then calls PALS. She explains the situation. PALS are unable to assist as they cannot get involved in medical decisions. They are also unable to assist when she advises that the family would like Mr Durmush transferred to the UCLH where her sister has been told that they could do another operation where they can open the abdomen and cut out the tumour.

Ms Batili then tries Dr Pardoe and gets through to the Sheryl who is covering her secretary who is on leave. Sheryl advises that Dr Pardoe is away till Monday. She takes Ms Batili's mobile number and agrees to look for the referral for a second opinion.
Sheryl calls back and advises that a referral for a second opinion has not been received either by the Homerton Hospital or Dr Pardoe's office.

Ms Batili makes her way to North Middlesex University Hospital where she arrives at the same time as her father and sister.
Surprisingly on the way back to the NMUH there are no issues about Ms Malatani travelling in the ambulance with her father and the nurse.

Once their father has been settled back on T6 ward in his room, Ms Batili speaks to the nurse in charge about getting energy drinks for her father who has now not had any nutritional drinks for three days and is getting weak again. She is advised that the drinks have been crossed off the list of prescribed medications. She asks that the on- call doctor prescribes these. The nurse tells her that the on call doctor is also the A&E doctor who advised that they would come up if they get time. The on- call doctor never came.

Ms Malatani demands to speak with a consultant. After being told that nurses are not allowed to call them after five o'clock she is finally put through to Dr Choudry who is at home with his family.
Dr Choudry advises Ms Malatani that he is no longer involved in her father's care as the medications he has prescribed for Mr Durmush have been crossed off the list by Dr Spanou's registrar without consulting him.
Once again, Mr Durmush has spent another day getting weaker due to insufficient fluid intake.

Two of his daughters stay overnight instead of just one as they feel their father is very weak from the combination of drugs, not enough fluids, no nutritional intake and having travelled for a number of hours, being consciously sedated and then prodded for over an hour with no result.

Mr Durmush is helped by his daughter's to the toilet a number of times as he is still suffering the effects of the enema and gas given prior to the aborted procedure.

21/02/2014
Ms Batili relays the days events to a member of staff who advises her that the nurse in charge could have gone downstairs to A&E and got the doctor to write in the energy drinks onto Mr Durmush's drug chart.

Ms Batili liaises with her sister Ms Nowaz who advises that she has called PALS and left a message.
Ms Batili goes down to the PALS office and explains what has happened since her sister Ms Nowaz met with the team on Monday 17th February 2014.
The PALS team try to find out what is happening. She advises Ms Batili that Dr Miller is now the consultant in charge of her father's care. He is the consultant for care of the elderly. Ms Batili queries why it is this consultant and not either Ms Spanou or Mr Myers.
The PALS worker offers to go onto the ward with Ms Batili to sort things out.

When they arrive on the ward, Dr Choudry is there and he is speaking to Jonas about Mr Durmush.
The PALS worker introduces herself.

Dr Choudry has been trying to locate Dr Spanou and has left several messages for her. He explains why he is no longer looking after Mr Durmush as he feels Dr Spanou's registrar is undermining him and there has been no liaising between his team and Dr Spanou's team.

Dr Choudry finally manages to speak to Dr Spanou who advises she will come to meet with Mr Durmush's family in 15 minutes.

Dr Spanou arrives on the ward and has a meeting with Ms Batili, Ms Malatani and the PALS worker. The meeting goes on for over an hour.

Mr Durmush's daughter's request a transfer to UCLH. Dr Spanou advises that their father cannot be transferred because the operation can take place at the North Middlesex University Hospital.

Mr Durmush's daughter's ask if a referral has been made for a second opinion to Dr Helen Pardoe. Dr Spanou replies that it has not as her team looked up Dr Pardoe and decided that she was not the right person as her expertise was in TEMS and this could not be performed on Mr Durmush due to his tumour being too high in the colon.

Mr Durmush's daughters advise that their father wishes to proceed with the larger more complicated operation. Dr Spanou is not in favour of this. She advises that there are three options.
There is talk of Mr Durmush being given a day to decide. Ms Batili states that as a hospital Social Worker it is her professional opinion that operations should not be carried out over the weekend due to skeleton staff being on duty. Dr Spanou advises that there are always enough staff. Ms Batili disagrees.
They agree to speak with Mr Durmush as ultimately it is his decision.

Dr Spanou explains and Ms Malatani interprets the parts that Mr Durmush may find hard to understand but he says that he has understood it all. He advises Dr Spanou to do what she must. He tells her he wants the operation and he s leaving it to her to decide which option is best.

At this point Dr Spanou states to Mr Durmush's daughter's that as a doctor and a daughter 'if I may' that she is prepared to do the larger operation as in her opinion Mr Durmush is not as weak as she thought and he confirms the following:

1) He has not vomited since the first night.

2) The pain is not too bad.

Dr Spanou's team arrive and get the paperwork ready.

The anaesthetist arrives and asks questions, she explains the procedure to Mr Durmush and tells him that he is scheduled in a few hours time as the theatre is currently in use.

Mr Durmush is very anxious about the operation but he feels that this is the only choice left to him if he is to have some quality of life in what remains of his life.
From the time that Mr Durmush has been told he has psyched himself up for this operation.
At approximately 16.30PM Dr Bashir arrives. Neither Mr Durmush or the family have met him before. He has been asked by Dr Spanou to give a second opinion on the operation to be carried out. He states that in his professional opinion the surgery should not go ahead as planned. He states his reasons as following:
1) He believes that this surgery is not the right one for Mr Durmush.
2) A biopsy has not been done. He further states that a biopsy cannot be performed at this late hour of the day.

Mr Durmush's two daughter's are not happy.
They state that in their opinion their father is being starved to death.
They make it clear that they will take further action both legally and in the press.

They ask Dr Bashir what exactly are the 'new plans'. He states that there will be a multidisciplinary meeting which will take place on Monday at 12.00PM. He agrees that the meeting will not finish before 14.30 PM.

When asked what will be discussed at the meeting he states the teams involved in Mr Durmush's care will discuss whether a biopsy is needed or can they go ahead without this. If a biopsy is needed it will take a least a week for the results to come back.
They also question why a biopsy has not taken place in the 11 days that their father has been at the hospital. Dr Bashir is unable to answer.

Mr Durmush is clearly upset. The whole family is devastated.
The two sisters are then joined by heir older sister Ms Malatani and they give her the latest news. Dr Bashir agrees to speak with the sisters away from others.
Once again Ms Malatani asks about a transfer. Dr Bashir advises that this is not wise as the transfer from one hospital to another is too tiring for Mr Durmush.

Once again the sisters voice their concerns that their father is deteriorating and is being starved as he has not had any nutritional drinks or extra vitamins for three days now.
Dr Bashir agrees to write up a prescription for the drinks to cover the weekend.

Ms Batili sees Jonas on the ward and he too states his frustration at what has been happening to Mr Durmush.

In my professional opinion, Mr Durmush has been left to die for the following reasons:

1) He is 77 years of age

2) He was not given sufficient fluids for almost a week.

3) He was not commenced on energy drinks for over a week.

4) He was not commenced on extra vitamins for over a week.

5) He has been denied a second opinion from the consultant of choice as the NMUH team have not sent his medical notes to Dr Helen Pardoe.

6)The team at NMUH only referred Mr Durmush for the stent procedure at Northwick Park Hospital. By doing so, they seriously limited the chance of success as a whole week went by.

7) They only referred to UCLH after the family insisted and got PALS involved.

8) They agreed to the operation which Mr Durmush wanted, only to do a U turn at the last minute .

9) Stopping his nutrition intake has seriously depleted his energy, causing weakness.

10) Mr Durmush has been there for two weeks and a biopsy has not been done as yet.

Whilst at the NMH photos and videos were also taken, some show how the drips were so slow that they would hasten death if continued. He was on 87mls per minute which were put up to 125mls per minute after confrontations. He was so seriously dehydrated when he got to UCLH that he was immediately put onto 250mls per minute.

I also believe that although the NMUH claims not to practice the 'Liverpool Care Pathway' what they have been doing to Mr Durmush seriously constitutes a practice that is dangerously similar to this cruel practice in everything but name.

Meric Batili
On behalf of Mr Durmush and his family


Since the above was recorded, Mr Durmush's family hired a private ambulance with crew. He self discharged on Monday 24/02/2014 and was taken straight to UCLH where he was admitted by that evening and operated on four days later on the 28/04/2014.
He was discharged home on the 26/03/2014 with enablement POC, however, sadly he has deteriorated and is now under the care of the Macmillan nurses.

Whilst as a family we understand our father was terminally ill, we do not understand why it was felt that he was not worth making comfortable in his last few weeks. We also believe that the delay tactics by the NMH have hastened his imminent death.

I am currently finishing off my report and it will also highlight bad practice of this particular ward by certain nurses, care assts etc.
I am more than happy to speak to you in more depth as we fell as a family it is our duty to help others less fortunate than our father.
Dear Editor, Below is part of a report that I am currently getting ready to send to NICE and QCC re the appalling lack of care that my father received whilst at NMH. 10/02/2014 Mr Arif Durmush DOB: 29/10/1936 was referred by his GP Dr Raj of Arcadian Medical Centre, 1 Arcadian Gardens, Bowes Park, London, N22 5AB on Monday 10th February 2014 after attending a GP appointment to obtain results of various tests. All tests had come back as normal except the blood test results which showed that the haemoglobin levels were low. The GP advised that this may be due to Mr Durmush being anaemic. Mr Durmush was in a lot of pain and stated that he felt his whole stomach was burning. He was crying with the pain. His daughter Ms Meric Batili asked if Dr Raj could write a referral to a private doctor as her father was clearly very unwell. Dr Raj stated that he would refer Mr Durmush to the hospital for further investigations. He hoped to get the patient into hospital by the end of the week. He advised that this route would be far quicker than referring to a private doctor/hospital. At approximately 13.00PM later that day, Dr Raj called Mr Durmush's daughter Ms Meric Batili and asked her to collect the referral letter and take her father to the North Middlesex University Hospital's Acute Assessment Unit where he had spoken to the consultant who had agreed to see the patient. Mr Durmush arrived at the AAU with his daughter who handed in the letter. As there were no examining rooms or beds available they waited for at least an hour. Whilst waiting in the waiting room Mr Durmush's blood pressure was taken, he also had blood tests and was also examined by a junior doctor on the unit in what amounted to a large storage cupboard with a doctors couch. He was later taken for an xray and also had a urine test. Ms Batili asked if the unit was planning to do a scan. The junior doctor advised that this was not on the list. Ms Batili insisted that a scan was done as her father had already had an xray very recently and this had shown nothing. She was advised that the junior doctor would talk to a senior member of staff. Mr Durmush later had a scan at around 19.00PM. By this time a bed had already been identified for Mr Durmush and he was required to stay overnight for further tests the next day. Mr Durmush had not eaten or drank anything since the morning as he was told that the team were planning to put a tube with a camera attached to it down his throat. It was later decided that it was too late in the day to perform this and so he was given four cheese sandwiches and a cup of tea. 11/02/2014 Mr Durmush is visited on the ward by Drs Laura Spanou (Consultant Surgeon) and Myers (Oncology) and their teams. Present at the time was Mrs Bahire Durmush (patient's wife) and Mr Levent Batili (patient's grandson). Mr Durmush is given the news that he has cancer of the colon, cancer of the liver with metastasis and also tumours in the stomach area. He was told that the cancer was advanced at stage four. He was advised that a camera would be inserted through his nose the next morning for further investigations. Mr Durmush had a cannula inserted and then a tube feeding his body with serum attached to the cannula. Some of his medication/painkille rs were also given in this manner. The medication prescribed were paracetamol, buscapan, anti sickness medication and an anti coagulant and morphine. To date Mr Durmush has refused the morphine stating that the paracetamol is controlling the pain. A catheter was also attached to Mr Durmush's urethra through his penis. He was also Nil By Mouth Mr Durmush then had diahorrea throughout the night. 12/02/2014 Mr Durmush was again seen on the ward by Dr Myers with his daughter Ms Batili present. Dr Myers once again explained Mr Durmush's diagnosis and asked him if he wanted intervention and therapy. Mr Durmush confirmed that he did. Dr Myers said that there were procedures that could be performed and the surgeon would see him again. Some time later Dr Spanou arrived. Mr Durmush was told that a stent could be put in to bypass the blockage and allow him to have normal bowel movements which would also mean he could eat normally. He was told that this procedure could only be done at Northwick Park Hospital in Harrow. The family were told that he was on the list for a bed there. Later in the afternoon, Mr Durmush was visited by Dr Wasim from the Oncology Team together with Emma Foster from the MacMillan Cancer Team. Dr Wasim spoke of another procedure that would be done at the North Middlesex University Hospital. This left the family feeling very confused as they had been told of two different procedures at two different hospitals. Upon further questions, it was ascertained that the procedures were one and the same but the family still remained confused as to where this procedure would be performed. Dr Spanou was very clear that the procedure could not be performed at the North Middlesex University Hospital as they did not have a long enough cable in theatre. Later that night Mr Durmush was moved from the AAU to ward T6 on the 6th floor of the Tower building to room 10, a side room due to his diahorrea and constant need for a toilet. 13/02/2014 Mr Durmush is continued on the serum and medications. Dr Spanou and her team visit and again advise that they have referred Mr Durmush to Northwick Park Hospital and he has been accepted by them. They are just awaiting a bed. Mr Durmush's family are concerned that he has had nothing but he serum since Tuesday morning and he is dehydrating. Dr Spanou agrees that if he is able to tolerate it, he can be given sips of water and pure apple juice as well as clear broth (made from boiled chicken, potato and carrot). He is only allowed the clear juice and nothing else. 14/02/2014 Mr Durmush is continued on the serum, medication and the water, juice and clear broth as agreed. The family notice that he is becoming weaker since being admitted to the hospital and are concerned for his health. The ward manager is asked if there is any news on a bed at Northwick Park Hospital. There is still no news, contrary to what the family were told earlier in the week. 15/02/2014 As above, there is still no news. The ward have been on to the bed/site manager. Ms Batili has also been to the site manager's office about a different issue on the ward but also mentions that they are still awaiting news on the bed at Northwick Park Hospital. Family are becoming alarmingly concerned at the deterioration of Mr Durmush since arriving on the ward. An on call doctor, Dr Phoebe sees Mr Durmush during the night and advises that he should be on 3 litres of serum rather than two and prescribes the additional litre which is commenced straight away. Dr Phoebe also promises to chase up the bed at Northwick Park Hospital. Dr Phoebe is also advised that the family wish to seek a second opinion from Dr Helen Pardoe at the Homerton Hospital in Hackney, London. She advises that she will write the wishes of the family in Mr Durmush's patient notes. 16/02/2014 There is no change over the weekend. Dr Phoebe continues to chase the bed/site manager re the bed at Northwick Park Hospital. Mr Durmush continues with his serum and prescribed medications. Mr Durmush's moral is now at an all time low. He has started to think that there is no bed for him and no plans for a procedure. He continues to have diahorrea. Occasionally he has stomach cramps but these are controlled with the Paracetamol given to him as well as Buscopan if it gets too painful. 17/02/2014 It is now eight days since Mr Durmush walked into hospital, he now needs the assistance of two to walk to the toilet as he is becoming weaker and his moral continues to plummet. At this point his three daughter's, Ms Malatani, Ms Batili and Ms Nowaz decide to approach anyone to assist them as they are fearful that their father is being starved to death. Ms Nowaz approaches, PALS. Ms Malatani speaks again to the ward nurses. Ms Batili once again visits the site manager's office. The ward staff have no new news. The site manager advises that he has been on the case all weekend and will be calling Northwick Park Hospital again. PALS calls the professionals involved. Late in the afternoon, the consultant responsible for T6 ward (Dr Choudry, his registrar Jonas and another doctor from the Gastro Team meet with Mr Durmush's daughters. He apologises for the lack of communication to the family from the professionals involved in the care of their father. Jonas advises that he has prescribed energy drinks (Ensure Plus) x 3 a day as well as extra vitamins to be given via the cannula. Dr Choudry advises that he is happy to deal with the medical side of Mr Durmush's care but has no involvement on the surgical or oncology side. Ms Batili advises that the family are not willing to entertain the idea of 'the Liverpool Care Pathway'. Jonas tells her that this is no longer practiced. However, Ms Batili feels that the fact hat the teams have not been giving the right amount of fluids till now in part constitutes this. Ms Batili manages to have a brief conversation with Alex, one of Dr Spanou's team. She reiterates that the family wish to seek a second opinion from Dr Helen Pardoe, they also want to know why only Northwick Park Hospital has been approached when they have investigated as a family and found out that the UCLH also do this procedure. She also advises that the family have heard there is another procedure called TEMS and wish Mr Durmush to be considered for this. Alex advises that he has not heard of TEMS. He advises that he will put the family's wishes to the team. 18/02/2014 Mr Durmush and his family are given the news that a bed is available at the UCLH in Euston and he will have the stent procedure performed there on Thursday 20/02/2014. Mr Durmush is advised that the energy drinks will be stopped from the night of the 18th of February 2014 and the sips of water will be stopped from the later afternoon of the 19th of February 2014. He will still have the fluids via the cannula. 19/02/2014 Mr Durmush is continued on his fluids and medication. He is also given an enema twice during the day to clear his bowels in preparation for the stent procedure. He is give three different times for transfer to the UCLH. These vary from 10.00AM to 12.30PM. HIs daughter Ms Malatani is advised that she will be able to travel in the ambulance with him as he is very anxious. This is documented a number of times. However, later in the day, Ms Malatani is told that she cannot travel with her father as a nurse will be travelling with him and there will not be enough room. Ms Malatani makes alternative arrangements to travel to the UCLH. 20/02/2014 Mr Durmush is transferred to the UCLH and arrives at 12.03PM. He is met there by his daughter Ms Malatani. At 15.30 Ms Malatani texts her sister Ms Batili stating, 'Dad is out Meric, it's not good, they couldn't do it... if you can call NM and tell them to have a Dr waiting to see us... they will find an alternative and it's going to be today!' It transpires that the space in the colon is so small due to the tumour that the team doing the endoscopy and stent procedure are unable to continue for fear of rupturing part of the bowel and causing internal bleeding. Mr Durmush is transferred back to the North Middlesex University Hospital. In the meantime Ms Batili calls the North Middlesex University Hospital to speak to Dr Spanou or a member of her team. She is advised by switchboard that they are unable to put patient's family's through to consultants. Ms Batili then calls PALS. She explains the situation. PALS are unable to assist as they cannot get involved in medical decisions. They are also unable to assist when she advises that the family would like Mr Durmush transferred to the UCLH where her sister has been told that they could do another operation where they can open the abdomen and cut out the tumour. Ms Batili then tries Dr Pardoe and gets through to the Sheryl who is covering her secretary who is on leave. Sheryl advises that Dr Pardoe is away till Monday. She takes Ms Batili's mobile number and agrees to look for the referral for a second opinion. Sheryl calls back and advises that a referral for a second opinion has not been received either by the Homerton Hospital or Dr Pardoe's office. Ms Batili makes her way to North Middlesex University Hospital where she arrives at the same time as her father and sister. Surprisingly on the way back to the NMUH there are no issues about Ms Malatani travelling in the ambulance with her father and the nurse. Once their father has been settled back on T6 ward in his room, Ms Batili speaks to the nurse in charge about getting energy drinks for her father who has now not had any nutritional drinks for three days and is getting weak again. She is advised that the drinks have been crossed off the list of prescribed medications. She asks that the on- call doctor prescribes these. The nurse tells her that the on call doctor is also the A&E doctor who advised that they would come up if they get time. The on- call doctor never came. Ms Malatani demands to speak with a consultant. After being told that nurses are not allowed to call them after five o'clock she is finally put through to Dr Choudry who is at home with his family. Dr Choudry advises Ms Malatani that he is no longer involved in her father's care as the medications he has prescribed for Mr Durmush have been crossed off the list by Dr Spanou's registrar without consulting him. Once again, Mr Durmush has spent another day getting weaker due to insufficient fluid intake. Two of his daughters stay overnight instead of just one as they feel their father is very weak from the combination of drugs, not enough fluids, no nutritional intake and having travelled for a number of hours, being consciously sedated and then prodded for over an hour with no result. Mr Durmush is helped by his daughter's to the toilet a number of times as he is still suffering the effects of the enema and gas given prior to the aborted procedure. 21/02/2014 Ms Batili relays the days events to a member of staff who advises her that the nurse in charge could have gone downstairs to A&E and got the doctor to write in the energy drinks onto Mr Durmush's drug chart. Ms Batili liaises with her sister Ms Nowaz who advises that she has called PALS and left a message. Ms Batili goes down to the PALS office and explains what has happened since her sister Ms Nowaz met with the team on Monday 17th February 2014. The PALS team try to find out what is happening. She advises Ms Batili that Dr Miller is now the consultant in charge of her father's care. He is the consultant for care of the elderly. Ms Batili queries why it is this consultant and not either Ms Spanou or Mr Myers. The PALS worker offers to go onto the ward with Ms Batili to sort things out. When they arrive on the ward, Dr Choudry is there and he is speaking to Jonas about Mr Durmush. The PALS worker introduces herself. Dr Choudry has been trying to locate Dr Spanou and has left several messages for her. He explains why he is no longer looking after Mr Durmush as he feels Dr Spanou's registrar is undermining him and there has been no liaising between his team and Dr Spanou's team. Dr Choudry finally manages to speak to Dr Spanou who advises she will come to meet with Mr Durmush's family in 15 minutes. Dr Spanou arrives on the ward and has a meeting with Ms Batili, Ms Malatani and the PALS worker. The meeting goes on for over an hour. Mr Durmush's daughter's request a transfer to UCLH. Dr Spanou advises that their father cannot be transferred because the operation can take place at the North Middlesex University Hospital. Mr Durmush's daughter's ask if a referral has been made for a second opinion to Dr Helen Pardoe. Dr Spanou replies that it has not as her team looked up Dr Pardoe and decided that she was not the right person as her expertise was in TEMS and this could not be performed on Mr Durmush due to his tumour being too high in the colon. Mr Durmush's daughters advise that their father wishes to proceed with the larger more complicated operation. Dr Spanou is not in favour of this. She advises that there are three options. There is talk of Mr Durmush being given a day to decide. Ms Batili states that as a hospital Social Worker it is her professional opinion that operations should not be carried out over the weekend due to skeleton staff being on duty. Dr Spanou advises that there are always enough staff. Ms Batili disagrees. They agree to speak with Mr Durmush as ultimately it is his decision. Dr Spanou explains and Ms Malatani interprets the parts that Mr Durmush may find hard to understand but he says that he has understood it all. He advises Dr Spanou to do what she must. He tells her he wants the operation and he s leaving it to her to decide which option is best. At this point Dr Spanou states to Mr Durmush's daughter's that as a doctor and a daughter 'if I may' that she is prepared to do the larger operation as in her opinion Mr Durmush is not as weak as she thought and he confirms the following: 1) He has not vomited since the first night. 2) The pain is not too bad. Dr Spanou's team arrive and get the paperwork ready. The anaesthetist arrives and asks questions, she explains the procedure to Mr Durmush and tells him that he is scheduled in a few hours time as the theatre is currently in use. Mr Durmush is very anxious about the operation but he feels that this is the only choice left to him if he is to have some quality of life in what remains of his life. From the time that Mr Durmush has been told he has psyched himself up for this operation. At approximately 16.30PM Dr Bashir arrives. Neither Mr Durmush or the family have met him before. He has been asked by Dr Spanou to give a second opinion on the operation to be carried out. He states that in his professional opinion the surgery should not go ahead as planned. He states his reasons as following: 1) He believes that this surgery is not the right one for Mr Durmush. 2) A biopsy has not been done. He further states that a biopsy cannot be performed at this late hour of the day. Mr Durmush's two daughter's are not happy. They state that in their opinion their father is being starved to death. They make it clear that they will take further action both legally and in the press. They ask Dr Bashir what exactly are the 'new plans'. He states that there will be a multidisciplinary meeting which will take place on Monday at 12.00PM. He agrees that the meeting will not finish before 14.30 PM. When asked what will be discussed at the meeting he states the teams involved in Mr Durmush's care will discuss whether a biopsy is needed or can they go ahead without this. If a biopsy is needed it will take a least a week for the results to come back. They also question why a biopsy has not taken place in the 11 days that their father has been at the hospital. Dr Bashir is unable to answer. Mr Durmush is clearly upset. The whole family is devastated. The two sisters are then joined by heir older sister Ms Malatani and they give her the latest news. Dr Bashir agrees to speak with the sisters away from others. Once again Ms Malatani asks about a transfer. Dr Bashir advises that this is not wise as the transfer from one hospital to another is too tiring for Mr Durmush. Once again the sisters voice their concerns that their father is deteriorating and is being starved as he has not had any nutritional drinks or extra vitamins for three days now. Dr Bashir agrees to write up a prescription for the drinks to cover the weekend. Ms Batili sees Jonas on the ward and he too states his frustration at what has been happening to Mr Durmush. In my professional opinion, Mr Durmush has been left to die for the following reasons: 1) He is 77 years of age 2) He was not given sufficient fluids for almost a week. 3) He was not commenced on energy drinks for over a week. 4) He was not commenced on extra vitamins for over a week. 5) He has been denied a second opinion from the consultant of choice as the NMUH team have not sent his medical notes to Dr Helen Pardoe. 6)The team at NMUH only referred Mr Durmush for the stent procedure at Northwick Park Hospital. By doing so, they seriously limited the chance of success as a whole week went by. 7) They only referred to UCLH after the family insisted and got PALS involved. 8) They agreed to the operation which Mr Durmush wanted, only to do a U turn at the last minute . 9) Stopping his nutrition intake has seriously depleted his energy, causing weakness. 10) Mr Durmush has been there for two weeks and a biopsy has not been done as yet. Whilst at the NMH photos and videos were also taken, some show how the drips were so slow that they would hasten death if continued. He was on 87mls per minute which were put up to 125mls per minute after confrontations. He was so seriously dehydrated when he got to UCLH that he was immediately put onto 250mls per minute. I also believe that although the NMUH claims not to practice the 'Liverpool Care Pathway' what they have been doing to Mr Durmush seriously constitutes a practice that is dangerously similar to this cruel practice in everything but name. Meric Batili On behalf of Mr Durmush and his family Since the above was recorded, Mr Durmush's family hired a private ambulance with crew. He self discharged on Monday 24/02/2014 and was taken straight to UCLH where he was admitted by that evening and operated on four days later on the 28/04/2014. He was discharged home on the 26/03/2014 with enablement POC, however, sadly he has deteriorated and is now under the care of the Macmillan nurses. Whilst as a family we understand our father was terminally ill, we do not understand why it was felt that he was not worth making comfortable in his last few weeks. We also believe that the delay tactics by the NMH have hastened his imminent death. I am currently finishing off my report and it will also highlight bad practice of this particular ward by certain nurses, care assts etc. I am more than happy to speak to you in more depth as we fell as a family it is our duty to help others less fortunate than our father. mericansiz
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