Second open letter to
Dr Dyer, former Medical Director, Torbay Hospital/TSDHT in the first instance,
and copies to
Chairman of TSDHT – Admiral Sir Richard Ibbotson KBE, CB, DSC - ‘Provider’ body
Dr Paul Johnson Chairman of the Devon Clinical Commissioning Group -‘Commissioning’ body
Professor Adrian Harris Executive Medical Director and Deputy Chief Executive, Royal Devon and Exeter and to those with ultimate responsibility-
Mr Matthew Hancock Secretary of State for Health and Social Care, NHS Improvenent, and Mr Jepson – NHS Providers.
and to some of the MPs in Devon who are not holding the executive to account
First open letter - https://dhalpin.infoaction.org.uk/37-articles/nhs/330-letter-to-dr-robert-dyer-mb-chb-medical-director-at-torbay-hospital
Dear Dr Dyer,
I wrote to you on the 2nd of November. There has been various correspondence since which I will refer to briefly.
Re Case 1. The most abysmal treatment I have ever seen since qualification at St Mary's in 1964.
I attempted to contact you at Torbay but ended with Ms Fox, PA to Ms Davenport. She told me you were 'off site' (I presume either at the Exeter ''Nightingale'' or re STP SW). She was reading my correspondence to you - as I understand it. I asked on a Friday for the records of Mrs Jean Owen (JO) to be sent to me on the Monday. She had sent written permission to you for release of her records to me. I was trying to get skilled help for her left arm, loss of which was threatened. An image taken in her home by Jo Clarke-Irons, about 2 months after presentation with a fracture of her olecranon process at Torbay A&E- ? open ? closed, is within the link above on my website. Lay people should be warned – disturbing. Incidentally, I have never seen such thick nylon sutures before.
The records have never arrived here. I probably asked also for the links to the digitised radiographs, in part to see whether there was evidence of ?open, ?closed fracture.
I received an offer for a virtual conversation with yourself and the Chief Nurse. I did not respond because I later had a toothache and intermittent heart block with a rate of 37, but this latter with no ill effects. I think paracetamol had potentiated the 120 mg bd of sotalol. I required emergency private dental care. (I had previously suffered two apical abscesses during particular strain whilst working with a small group of doctors in pleading for an inquest on the unnatural death of Dr David Kelly MD CMG, which has never, uniquely, been subject to an inquest. I had been strained by my efforts to get help for Mrs Jean Owen. I am very familiar with the lighting up of indolent infection with extra strain. I have seen a good number of cases of osteomyelitis and septicaemia throughout my work in OUR NHS)
I now respond by thanking you, and saying that I would have wished to have a face to face conversation. However, my long letter to you and others was explicit and discussion was largely unnecessary.
I spoke with Jean's GP, Dr Sharon Hiley, whom I believe understood my great concern for the patient and her septic left elbow. I tried to contact two orthopaedic surgeons at the Princess Elizabeth Orthopaedic Unit, the successor to the Hospital. First via its switchboard - a voice 'recognition' system which I complained about 6 years ago. It did not recognise 'Princess Elizabeth' x2. > Online - a website page in red mostly, like the generic NHS hospital ones, BUT headed Nuffield ... However, I got the 'phone numbers for the secretaries of Mr Jonathan Howell, the Clinical Director, and Mr Matthew Hubble. The former was in theatre, and the latter was in a clinic. I did not get to speak to either. However, Mr Howell has kindly 'phoned me since. I spoke of JO, and of the PEOC. (I have offered to speak there of Freddie Durbin, the lynch pin of the PEOH). I have since written 2 letters to Jonathan asking him as Clinical Director if he could speed the consultation of JO with Mr Andrew Kitson, to whom she had been referred by Mr Simon Lambert BSc(Hons) MBBS FRCS Edinburgh FRCS EnglandFRCSEdOrth of the Upper Limb Service UCL.
Without any certainty of her seeing surgeons at Exeter who have sometimes to revise septic total hip replacements, which must include removal of all dead and infected tissue, I spoke with a friend noted for his surgery and intellect - to do with the brachial plexus especially – Rolfe Birch. He recommended Simon Lambert and put me in contact that day with the PA for the four surgeons in that unit, Ms Anca-Debora Balint. She took hold of the baton with all efficiency and kindness. UCL provided transport – collecting JO at 4am at her little flat in Torquay on Friday 20th November.
Mr Lambert and his team saw her with respect and kindness in the clinic. A swab was taken of the sinus. The summary to Dr Hiley, which JO has, included referral to Mr Andrew Kitson at the PEOC. He was well known to Mr Lambert and concentrates his work on the shoulder.
JO has had no appointment from the PEOC in spite of the PALS officer at the RD&E, Mr Moraes, kindly liaising with the surgeons there. She has been attending the GP surgery for weekly dressings. You will recall that when she last was discharged from Torbay she had neither dressings (until a kindly nurse obtained two) nor any arrangements for nursing care of her elbow and sinus.
JO has also received a letter 8 days ago (completion of this letter today - 23-12-20) from Ms Davenport dated 14-12-20, the Chief Executive, which questions her veracity indirectly at several points. It states for instance that the first operation took place 3 days after the injury. JO is adamant that she was told she would be called back in a few days for necessary surgery, but that did not happen for about 10 days. Ms Davenport notes the initial report on the radiographs - “ a multi-fragmented displaced fracture to the olecranon (elbow) with associated joint effusion”. (I conclude that this comminuted fracture was closedm and not open/compound. However, there was an abrasion and later death, with subsequent infection, was likely given that the olecranon is immediately beneath the skin. At the foot - ‘copied to Mr Halpin’ but no copy received by me.
I received the original letter yesterday by post, but a kind officer in TSDFT is sending a copy directly to me. The letter apologises for several failings but understandably lacks interpretation out of medical knowledge. Instead the prime responsibility is of the surgeon in charge of a case to answer serious complaints, as I had to do. The records do not show which of 16 orthopaedic and trauma surgeons headed her ‘care’. An earlier appointment letter to JO had in the box for ‘consultant’ “Mr T. TRAUMA”. One received recently by JO had printed simply “TRAUMA”
She has recently understood from Dr Hiley via the practice nurses that the condition has resolved. This is highly unlikely and I will explain based on my clinical experience and my good knowledge of pathology. Her good friend, Jo Clarke-Irons who has done everything to support JO in her distress. Her report of the current state – edited
“I’ve just seen Jean. She realises now that it is most important to get her elbow sorted out first, and is going to ring Mr Pullin’s ** secretary on Monday, explain what is going on, that she still has an open wound, and that she may be called in to Exeter at any time. She says that she will not let anybody down by refusing to go to Exeter if an appointment is arranged for her.
She got through to Torbay Pals on Tuesday. She asked why you had not been given her records as she had specifically asked, in writing. The woman she spoke to said that getting records is very difficult, which Jean did not believe, but gave her this number for you to call -
Data Access Discloser ( disclosure?) 01803 654868
While I was there, I put a clean dressing on for her. The GP and nurse had told her that the wound had healed - no hole. This is a direct lie. The wound is certainly smaller and better looking than it was, but there is still a slit about 2cm long on the point of her elbow, and it is still discharging yellowish-brown matter onto the dressing.
** JO suffered a perforation of a duodenal ulcer 2 years ago (on ibuprofen and a smoker). Mr Pullin, a general surgeon at Torbay, saved her. She has an incisional hernia which Mr Pullin was kindly planning to repair 5-01-2021. I did pass on the message that the discharging sinus would be a likely reason to delay this elective surgery.
Currently - I understand that JO feels there is ‘sand in her palm’ and constant pins and needle in her fingers. The latter were intermittent when I examined her about 5 weeks ago. She still has constant pain but she can distract herself in conversation with her good friend. She moves the left arm at the elbow, and indeed I recorded an arc of flexion from extension of about 100 degrees previously. (It is extraordinary that she moves the ‘elbow’.) I visualise that the remants of the olecranon process at least is dead and infected. So too might be the distal end of her humerus. These elements will have been walled off by a vigorous inflammatory reaction. This has proceeded to fibrosis. My concern is that her vital median nerve is being constricted, and its blood suply via the vasa nervorum restricted. If function disappears in the median nerve – supplying sensation in the radial 4 digits, and motor function in the forearm and hand,it is unlikely to be cured by surgery.This is one of several of my current, great concerns for her.
Jean Owen, a pensioner without any independent means, requires the skill of a surgeon NOW, and the loving care of the team with that surgeon. Any further delay caused by the ‘system’ as ocurring
at present only conpounds the abysmal nature of the ‘care’ she has received since the injury 17-09-2020. The first stage of surgery will not be complex but instead very careful. If full healing is obtained and infection vanquished, the ‘fitting’ of an endoprosthesis will be more demanding, and the instrument will be made for her alone. Having dealt with complex revisions of THRs and TKRs myself, including a minority with deep infection, I state that I would have taken Jean Owen’s unusual problem on, without demur. In fact, I could deal with it now but I am no longer registered – like Mr Muhammad Adil.
What has been happening at Torbay Hospital in the last few weeks?
Case 9 An 89 yr old, our neighbour and tenant for the last 10 years. My wife Susan has been his lynch pin over these years, but especially since the C19 plandemic. The ‘social care’ trumpeted for people like him being ‘shielded’ proved to be a sham. He paid eventually for fortnightly care which was insubstantial. We informed the general practice of our concern over 3 weeks ago – some confusion, and 15 little piles of pills about the cottage. Monday 30-11-2020, Sue found him more confused at 3pm, sitting on his bed. Abrasions of both knees suggesting previous falls. “I think we should call the doctor Norman”. At 4pm she found him semi-conscious, prone with his face against the side of the divan. 999. Excellent paramedics attended quickly – Chloe and Perry.
Pulse 37, systolic 180, cold. ?Hypothyroid. > Torbay. ?AMU. Dr Nigel Poland, and later Dr ?Hutchison ‘phoned us to ask for more details about Norman’s health. We appreciated the kind concern of both for detail in their assessment of a very sick man. Dr Poland said he would include thyroid tests. (Hypothyroidism shown - ?degree)
Sue ‘phoned the next day – not well, and ‘not appropriate to consider ITU’.
She ‘phoned again Sunday 6-12-2020 – put through to another number for ‘in-patient’ enquiries ?call centre. Not the next of kin – so no information given. She ‘phoned his niece who had been listed as next of kin when Norman was in Torbay 2 years ago – (following a trans- thoracic wall treatment of a ‘cancer’ at the RD&E. A novel method.) The niece ‘phoned Torbay and learned that Norman had died on Thursday 3-12-2020, 4 days prior to this call.
Case 10 Heard this morning – hearsay. A slight lady who cannot give an account of herself had pain and a lump in her groin. (?Femoral hernia) Sent by GP as an emergency on Monday pm 14-12-2020 to Torbay. Husband allowed entry given her lack of ‘cognition’. He ‘phoned Tuesday and Wednesday but was not able to get through to the ward to learn of her treatment and her condition. The hospital ‘phoned him on the Thursday to ask him to pick her up in order to take her home. He found out via the discharge summary that she had been operated on during the Monday evening.
Addendum.
Dear Jo Clarke-Irons
Thank you for your email dated 8 November 2020 received by Dr Rob Dyer and passed to the Feedback and Engagement/Complaints Team to action.
I am sorry that you have found cause to raise concerns about services provided by Torbay and South Devon NHS Foundation Trust (the Trust), on behalf of Mrs Jean Owen. Please be advised that the Trust takes all complaints extremely seriously and we have spoken directly to Mrs Owen regarding her concerns.
As agreed with Mrs Owen we will be investigating the concerns raised in line with the Trust’s Complaint Policy and NHS Complaints Regulations and all correspondence will be shared with Mr Halpin at the request of Mrs Owen.
In order for our communication to be effective, I would ask that any further correspondence be sent directly to The Feedback and Engagement Team.
With kind regards
Juliet
A good summary of JO’s complaints followed but I noted the absence of a named consultant in correspondence.
To Dr Paul Johnston of Devon CCG and his 6 GP colleagues
I have had no response from yourself or from the CCG directorate. I have in front of me page 4 of last week’s Mid Devon Advertiser. I know you are aware that I have given reasons in my opinion pieces in this paper why Teignmouth Hospital – built c.1951, should be re-opened. These beds on the two floors re-opened for a. acutely ill patients within the scope of general practitioners, and b. for several other functions including progress from DGH towards home. In addition, I have spoken against an £8 million project in clogged up Brunswick Street.
The paper is well onside I see with your plans, and those of the Torbay ‘Trust’. A large strap headline - “61% support health proposals” with copy below filling the bottom half.
Quote - “During the 8 week consultation, to October 26, 1,013 people submitted responses. Of these 89.73 % said they thought integrated (joined up) services were important.
This begs the question as to how our present NHS and the medical services are ‘integrated. But the defects in your consultation are much wider, as correspondence in the local press has said.
You polled the people of Teignmouth and Dawlish – total population 27, 500 – we note the 1,013, much ‘online’. Taking in Teignbridge – 134,000 and Torquay 65,245, was necessary because of the valuable day case lists at Teignmouth Hospital available to all residents, young and old in South Devon.
Did you observe the Gunning Principles for Public Consultation? Here -
1. that consultation must be at a time when proposals are still at a formative stage
2. that the proposer must give sufficient reasons for any proposal to permit of intelligent consideration and response
3. that adequate time is given for consideration and response
4. that the product of consultation is conscientiously taken into account when finalising the decision.
Many say that you and your 5 fellow GPs, and the board, have not observed any one – neither in part nor fully. You have persisted with a ‘consultation’ during ‘lockdowns’ etc when many have been scared out of their remaining wits. This is immoral and the opposite of natural justice.
There have been all sorts of contradictory announcements – one I recall from Mrs Lesley Darke of the TSDHT which was deeply opaque. The discussions held 2 years ago about the Brunswick Street site were ‘behind closed doors’. The long serving Devon County Councillor, Mrs Sylvia Russell, would not divulge the details because of ‘commercial sensitivity’. Those details should have been published as part of the ‘consultation’.
It is a trite phrase which I do not like, but ‘not fit for purpose’ fits the CCG. It has helped the downward motion summarised by my ‘destabilise>demoralise>dismantle’.
You and your GP colleagues should resign. You have failed in your central duty as medical practitioners - ‘do no harm’. Instead you have done much harm, and in the last 9 months sat silent whilst C19 has added further great harm to our medical services. A long list.
To Professor Adrian Harris,
I have had no word from you, the officer responsible for the medical services at the RD&E and more widely, and for the standards held. I cited case 7 and 8 within your ambit.
As to the first – what factors overrode the usual precautions and observations afforded a patient who had undergone a major operation, especially a mastectomy in an 89yr old lady – her daughter being called to collect her within an hour of the operation finishing? Were there no beds nor nurses and doctors? As well, the inhumanity is obvious to all. How did the surgeon, who I believe was Mr Fergusson, look upon this precipitous discharge of his patient. How would his college and mine regard this with all its advice?
As to the second, our 23yr old grand daughter, I am no expert. But the evidence is against an assumed diagnosis of ‘alcoholic intoxication’ and more in favour of a malign introduction of a poison into a drink. There are plenty of reports of death in young people with the benzodiazepine, flunitrazepam – Rohypnol. The suddenvomiting and unconsciousness suffered by Isabel fits with that. She was ‘monitored’ electronically, but I imagine that if the alarm went off with cessation of pulse or breathing, or both, resuscitation might have failed. What is your response regarding her care, given you long experience in the field of emergencies?
I conclude thus in my first open letter. There is good evidence that the Torbay Trust, and its commissioner, the CCG is failing very badly in its central duties. Resignation of the boards of both is surely indicated, followed by a public inquiry of the Stafford/QC Francis type.
I add though, that there are many very skilled and conscientious people serving in OUR NHS. They suffer under central diktats and ever changing ‘policies’. ‘Managerialism’ is rife. It is said that administrative staff numbers at Torbay Hospital are in excess of the medical. A ‘clearing of the decks’ is needed, and can only come with a public inquiry – set up urgently. I attach a colourful letter in metaphor. ‘SS NHS – letter Western Morning News 27-03-14’.
