Queen Elizabeth Hospital NHS Trust,
Queen Elizabeth Hospital,
London SE18 4QH.
18th January 2010
On Wednesday 14th January I was taken to your A&E Department on the recommendation of my G.P. I have written up my experience for another purpose but as it tells the whole story, the same text is enclosed with this letter of complaint. Unless you can see something I have missed I dont think there is a complaint against the principal medical staff but the treatment overall was appallingly bad.
I was barely able to move and in acute pain but given no physical help at any stage except that the ambulance crew found me a wheel chair. After I had been on morphine and drips for about three hours, an X-ray convinced the doctor that I should be kept in and I went through the admission procedure. However as the four hour target approached I had the drips removed and told to get dressed and get out. No one enquired how that was to be achieved and I was left in a collapsed state writhing in pain in the almost empty waiting area. No one enquired why I was there although there were at least three people on the desk. I had no money with me and no one with me or at home. I eventually managed to phone a friend who made arrangements for my journey home but was left in acute pain alone and barely able to get to water for a further 48 hours.
I do not know if the doctor who wanted to keep me in was aware of the situation, my attempt to contact him before my ejection from A&E failed, in part at least because I was told I had not been registered on the computer.
Why is someone requiring morphine for pain control ejected with no one at all concerned for his future? And why do none of your support staff show any inclination to help? Quite the reverse in fact. The various times and treatment details, together with my wristband number are all included in the attachment. I shall expect a full report into every aspect of the attached report and your reasons being prepared to sacrifice health or even lives in return for fiddling statistics.
For most of Tuesday 13th January (after a restaurant meal on Monday) things didnt feel entirely normal and by late evening and through the night the problem was taking its normal course - me writhing about in severe pain and crawling between bed and bathroom, not that anything can pass, and occasionally losing consciousness. Standing up and walking is near impossible. Morning did not bring the usual relief and things got worse. A friend dropped by and called my doctor (G.P.) who whilst sympathetic could only advise calling an ambulance. We agreed that if things werent on the mend I would dial 999 by 3 p.m. Meanwhile I was on my own, my only English speaking neighbours being away for a couple of days and my nearest relative being totally snowbound in North East Hampshire.
At 5.03 p.m., weak and still writhing, I managed to tap out 999 and made arrangements with the ambulance control to somehow get to my door and open it so that the ambulance crew could come straight in. Before long there was a knock on the door and I managed to call from a window that the door was open but two women insisted I get to the door and let them in. In practice it made little difference as the ambulance carried neither a stretcher nor a wheelchair and I had to make all progress myself anyway. I crawled like an animated inverted horseshoe to the ambulance parked in the snow some 50 feet away and struggled for some while to mount its steps. At no time did either women put out a steadying hand to minimise the stumbling through the snow or problems climbing the steps. I lay on the ambulance bunk while questions were asked and forms filled in. I noted that they claimed to have arrived at 5.17 - which I do not dispute - and we departed for Woolwich around 5.30. I became nauseous lying on the bed and when opting for the chair had to be strapped in with a belt across the most painful part of my anatomy.
En-route and stuck in the traffic one of the ambulance crew remarked Now you know what a woman feels like when having a baby. I wasnt crying out in pain, it doesnt actually do any good and I come from a generation of men that wasnt allowed near birthing facilities so I have no idea how the experience compares. Neither does the ambulance woman unless she perhaps suffers from coeliac disease too. What I do know about child birth is that the cause of the pain is obvious and from what I have seen on TV a variety of pain killers are freely administered. I was denied any by the ambulance crew, maybe for good reasons, and I had been in that untreated state for 24 hours and unknown to me at the time was going to be for most of the following 48 hours. The comparison wasnt valid and the remark insensitive, especially as I was due to become a grandfather for the first time later the same week.
On arrival at the QE Hospital I was asked if I needed a wheelchair and one of the ambulance crew went to fetch one. From comments passed to another ambulance crew I learned that mine was the only available chair in the department. I went through the reception area at 5.50 and was taken with almost no delay to a cubicle and somehow finished up slumped in a chair and alone. I slithered to the floor from where I had no inclination to get up. I was soon told by a female voice (I was in no state to look at or remember faces) that you cannot lie there, get on the trolley. The trolley must have been three feet off the ground and after a couple of failed attempts I managed to clamber on board. While I struggled someone observed that I was looking very pale but at no point did anyone offer a hand in support and my mouth was so dry that my tongue had stuck to the side of my mouth. Someone gave me a mild telling off for not speaking clearly.
The doctor (male) came quite quickly and said he would have to do some tests before he could attempt to ease the pain. So there was a prick to the right thumb, blood drawn from the left arm and a rather painful procedure on the right arm which I gather from overheard comments was something to do with blood sugar levels. This was then repeated equally painfully because as the doctor said, the first one didnt play the game. Meanwhile there were checks of temperature, blood pressure and heart rate, so pretty thorough I would think. Whilst the second blood sugar test was being done a lady appeared (someone called her Sister unless I am mistaken) and had a whispered mini-argument with the doctor stating clearly that pain relief is second only to airways and why wasnt I on a drip? In fact a drip plug thing had already been poked into my left arm and I was soon given morphine through it. When that had no noticeable effect a second shot was applied which didnt get rid of the pain by any means as had been implied (you will be happy within 30 seconds) but it undoubtedly helped as did the constant drip to back it up, along presumably with something for my dehydration.
The doctor popped in quite often, asked a lot of questions about my coeliac history and seemed generally sympathetic. At 20.10 (I asked him the time) he said he thought I might be able to go home soon and I wondered how and whether I would be able to find someone who could come and collect me. While contemplating my predicament the doctor returned and said he was concerned we were jumping to too many conclusions in blaming the coeliac disease and started feeling my abdomen for other clues. He then sent me for X-ray and off I went with little delay on a trolley to a darkened X-ray department where I was surrounded by a small group of rather loud young children. When the X-ray staff dealt with me they never stopped discussing their social activities and I was barely aware of their instructions, let alone understanding of them, as they took two X-rays. I was processed like some piece of meat without any recognition that I may have been a just about living human. There was a bit of a wait before I went back to my A&E cubicle but once there the doctor soon showed up again. There is a lot of inflammation in the intestine and a big pile of poo stacked up behind putting pressure on it. We are going to have to keep you in. So confirmation that I was suffering the same as in previous attacks except that this one was more intense and going on far longer than usual.
Within minutes someone came in to repeat some of the tests, temperature, blood pressure, pulse rate (I think) and take my personal details - for the third time. I was tagged with a wrist band bearing my name, date of birth and the number X400988285. Provided with a green plastic bag to store my clothes and the drip was removed (and then replaced) so that I could take off my shirt and get into a hospital gown. And there I waited, still in pain but less acute than before.
At 21.45 in came a lady who removed my drip and said I had to go home. No one enquired how I planned to get home through the snow, whether I had any money to get myself home (I had not) or whether there was anyone there or prepared to stay there when I arrived. There was not. So I was unceremoniously bundled out of A&E, with no medication for the problem, cause or effect, into the waiting area (with a short detour via a filthy toilet) where I was able to call a friend who I asked to arrange something on my behalf and then collapsed into a horizontal position and began the twitching while struggling to contain the pain. There were three staff at the desk when I went into the near empty waiting area and they neither knew where I had come from or asked why I was writhing about. I was there for 40 minutes before I was ferried to an empty house and no one at the waiting room reception desk had the decency to ask if I was OK. I was probably dismissed as yet another unshaven drunk.
So I spent the Wednesday night writhing in pain, alone, as I had done the previous night. Someone again called in next day and persuaded me to call my G.P. again. I was told he would call in to see me, but instead only phoned back to renege on the promise and offer platitudes. By lunchtime I was able to source, via friends, every laxative known to man; three self-administered enemas during the previous 24 hours had all failed to have any effect at all. At much the same time as the new medication arrived the seat of my pain moved slightly, which I regarded as a good sign, and it was a little bit less intense. However it was more than 24 hours later that the laxatives had any effect and the pain finally went away; something like 72 hours after it first appeared.
The hospital timings are interesting. As far as I can tell the medical care offered was pretty much OK, but someone in admin. over-ruled the doctors decision to admit me for further treatment within five minutes of the magic cut-off time; the four hour target imposed by our useless Labour government with the object of distorting statistics in yet another of their attempts to bamboozle the no longer gullible public. Obviously I should have argued my case more strongly. I did ask to speak to the doctor again before being shunted out of the cubicle but was told by a man on the internal reception desk he wasnt available. Also that my name wasnt registered on his computer so there was nothing at all that could be done to help. I should have become more assertive but being near doubled over with pain isnt the best position from which to stand ones ground.
Even if we are to be bundled out of A&E to satisfy a political target and our lives put in jeopardy as a direct result, surely someone should have the decency to enquire if we have a means of getting home and whether there is anyone to look after us? Decency and humanity, however, is not something the Queen Elizabeth Hospital, Woolwich deals in, at least not at management level.
Mr. Chris Streather,
South London Healthcare NHS Trust,
Queen Elizabeth Hospital,
London SE18 4QH.
15th March 2010
Dear Mr. Streather,
Thank you for your letter referenced 2052/10 (dated 24th February, postmarked by QEH 3 March and delivered 8th March) in response to my complaint about the decision to admit me on the evening of 14th January and its reversal within minutes of the four hour government target for A&E admission. I provided a detailed account of the events leading to that action and you have provided a very comprehensive commentary on every aspect apart from the main issue which has been neatly circumvented.
Using your own subject categories...
London Ambulance Service
There is no easy access to the rear of the house, it is secured and opened only for occasional gardening purposes. The ambulance crew was standing next to the unlocked door through which they were eventually admitted. I assumed that they refused to enter, invited but unaccompanied, under some politically correct instruction. If that is not the case I can only assume that there was an inexplicable failure to understand. No one gets directed to the garden for entry, there is a sliding patio door there but I dont regard it as a visitors access point. I am surprised that the ambulance service should be so unwise as to tell me that it is five metres from my house to the road where the ambulance was parked when their knowledge of it is never likely to be as comprehensive as my own. For the record it is 13 metres from the door to the boundary and a further two or three across the pavement and into the road where the ambulance was parked. My opinion of the ambulance service has not been enhanced but I nevertheless regard all issues with the ambulance service as being at an end.
Left unattended in a cubicle
I dont think I made any complaint about staff I, as a patient, regarded as medical rather than auxiliary. I appreciate that the Senior Sister may regard the whole service as being her responsibility but I did not leave the hospital thinking that she had personally failed in any way and, certainly the lady who administered the morphine and who I believe was the Sister, was not faulted by me. I would be disappointed if my complaint about being discharged to meet the four hour timetable has also been represented to the Sister as a sequence of medical failures prior to that discharge.
Assessment by ED doctor I made no specific complaint about the doctor who attended me who you say was Doctor Allanha. I said in my report, that as far as I could judge as a patient he was thorough. However your report which you attribute to him is simply untrue.
After the X-ray he came back to tell me that my intestine was severely inflamed and that he was going to have to admit me. If he did not say that why would someone come to take my details again, remove the drip(s) so that my shirt could be exchanged for a hospital gown and my clothes and belongings packed away for me in a green plastic container? The only diagnosis I received was of inflammation in the intestine and a big pile of poo stacked up. Viz. The diagnosis which led to his decision to admit me and the consequent gowning etc. Contrary to your claim, no advice on analgesia and laxatives was provided. It would have been nice to have had some and not be totally reliant on friends and pharmacists for treatment advice over the following days but then a doctor who had just arranged admittance cannot reasonably be criticised for not offering home treatment advice.
I have no further comment and regard the issue as closed.
It is not worth pursuing which word best describes the sudden reversal from hospital gown awaiting admission to get dressed and go. However it is probably relevant that no one on the desk immediately outside the cubicle had any knowledge of my existence. A search of the computer database was made using a variety of search criteria but all drew a blank and the absence of data strongly implies that the hospital rewrites history by delaying the logging of events to the computer which would make target compliance so much easier to achieve. You imply that I was with you close to three hours; you arrived at the ED at 6.10pm and you were admitted and discharged in a little over three hours rather than the near four. The latter is the sort of inaccuracy which would flow from such a malpractice and can be disproved by the time record of my phone call for help and perhaps your CCTV records too.
I did not enquire about transport home nor expect it. I thought I had taken some money when I left home but when in the waiting area, couldnt find it and feared it had been lost when my clothes were transferred from chair to bag and back again. In the event the money was found next day at home.
You say that had staff been aware that you had collapsed ... they would have sought medical assistance. Forgive me for laughing at that, but I was right under their noses for approximately 40 minutes in an almost empty waiting room.
It is noteworthy that your letter that so comprehensively analyses and answers my compliant on most things suddenly manages to miss the most important part. The description of how the drip was removed etc, because of the decision to admit me. You write as if that never happened offering instead the comment your agreed discharge was based on your diagnosis; a precise reversal of the facts. Nowhere else in your letter has there been even the slightest hint that my description was inaccurate yet here when we get to the crux of the matter you make statements which cannot possibly be true unless it is your intention to cast doubt on the veracity of my entire complaint.
In almost every detail you have accepted my report and apologised for various things but failed to respond to my description of having the drips swapped around, gowned etc. Instead you have put forward a description of events which would only make sense if I had lied. Did my description of the admittance procedure sound like a lie? Would a patient who was not put through those procedures and never been admitted to hospital before be able to give such a description?
My name was not registered on the hospital computer at the time of my discharge and the doctors notes are said to make no reference to his decision, following the X-ray, to admit me. Why not? How did he expect my condition to be improved by the withdrawal of pain relief and with no action taken to treat the cause? Is he that uncaring a doctor (it wasnt my impression at the time) or is not the plain fact of the matter that he decided to admit, made the necessary arrangements and that someone over-ruled him?
If this complaint is to be resolved you must provide an explanation of how the gowning and consequent reconnection of the drips, the additional note-taking and making safe my clothes etc. can be reconciled with discharge with no further treatment or advice around 30 minutes later. From my viewpoint the failure of the support staff to find me on the computer now looks to be a carefully practised conspiracy designed to make the books balance when the facts might otherwise be less palatable.
Mr. Chris Streather
South London Healthcare NHS Trust,
Queen Elizabeth Hospital,
London SE18 4QH.
7th July 2010
Dear Mr. Streather,
Thank you again for the letter referenced CW/JJ/2052 dated 30th June.
It is not surprising to hear that the A&E staff are unable to add anything further. After an interval of six months it is inevitable that you cannot remember me, the precise chronology of every event, or what was said to me, whereas I was able to come home and dictate it to a friend and the memory is still fresh. Except when stating current policy, anything new you say now is inevitably guesswork or possibly made up and may explain why your latest letter is so full of contradictions of earlier correspondence.
It may be worth reminding you that I made no complaint about the medical skills encountered, on the contrary I said the medical staff were sympathetic and I thought the doctor and sister were really rather good and thorough at the investigatory stage. It is true that you found minor procedural errors within my description of my time at A&E but I dont believe either the doctor or the sister were found lacking. The only complaint that really mattered to me was the one about the peremptory discharge as the four hour limit approached. Last time you wrote you provided some timings said to be recorded on the files you couldnt find on the day in question but I know them to be false and you have chosen to ignore my evidence and challenge in your latest reply. The same technique adopted in your first reply when a truthful answer would be incriminating.
You dont admit that I was a victim of government policy (which would have brought an immediate end to this correspondence) and ask me to believe that no patient still in need of care would be discharged in order to meet a target. To suggest that this never happens is to invite total disbelief; any newspaper reader will know of too many reports to the contrary and if true would cast doubt on the wisdom of the targets abolition by the new government because it distorts patient care. Am I supposed to believe that QEH is the sole paragon of virtue which has never erred?
You have referred to the issue of medical care. What care? You did nothing to remedy the cause of my acute pain. The doctor identified the cause after examining the X-ray results and told me what he planned to do about it but nothing was done about it. I was given a gown, drip tubes swapped around and all the blood pressure and similar tests were repeated as previously described as a preliminary to the promised care, but no actual care, none at all. Within minutes I was shown the door.
For convenience here is an extract from my first complaint
There was a bit of a wait before I went back to my A&E cubicle but once there the doctor soon showed up again. There is a lot of inflammation in the intestine and a big pile of poo stacked up behind putting pressure on it. We are going to have to keep you in.
Within minutes someone came in to repeat some of the tests, temperature, blood pressure, pulse rate (I think) and take my personal details - for the third time. I was tagged with a wrist band bearing my name, date of birth and the number X400988285. Provided with a green plastic bag to store my clothes and the drip was removed (and then replaced) so that I could take off my shirt and get into a hospital gown.
None of that fits your current claim that the gown is to enable easier access for examinations and tests, I had them all on admittance long before the gown was provided.
In your first reply you detailed a list of procedural shortcomings which I hadnt noticed and for which you apologised. The gown timing was not on that list but now because it suits you it has suddenly become the key to your latest excuse. All the drips, examinations and visit to the X-ray department took place while I was in my own clothes. If I had been taken undressed into the public area of the X-ray department surrounded by noisy children and visitors I would have complained about that six months ago. I was given the gown only when the doctor said I had to be admitted, How many times do we have to go over the same ground?
If we ignore for a moment the gown and drip rearrangements why would the doctor, having reached a diagnosis based on the X-ray, want to send me home with no remedial treatment whatever, not even a recommended course of action for me to follow at home? In your enthusiasm to refute my complaint about an administrators target manipulation you contrive to condemn your medical staff to a charge of negligence. Are your doctors really so uncaring that they identify a problem but order the patient home without any treatment whatever? None was given was it? Or are you going to magically find evidence among your files that I was treated in some way that has so far not been mentioned by either of us and cannot be remembered by the A&E staff?
In my experience avoiding the truth gradually drags you into deeper trouble and so it is in this case. If you wont simply admit that someone decided that the target was more important than me and bring this correspondence to an immediate halt, then I must formally ask why I was left in my own clothes while being treated with morphine and for dehydration and sent to the X-ray department and only given the hospital gown when being prepared for admission more than three hours later. Your new statement being that correct procedure is to put patients into gowns on admission. Why was this failure not on your original list of failings and apologies?
Also, in view of your claim that no one in need of care would be discharged, why did you offer no care or remedy whatsoever, preferring as you did to see me collapse in the waiting area with no money to hire transport home?
Alternatively I would be content to hear an admission that government targets took priority over medical decisions and drop the matter.
Dr. Elizabeth Sawicka
Divisional Director - Emergency Care and Specialist Medicine
South London Healthcare NHS Trust,
Queen Elizabeth Hospital,
London SE18 4QH
15th November 2010
Dear Dr. Sawicka, You are right, there is no point in pursuing this matter further; too much time has been allowed to elapse, even your four month delayed reply reached me 12 days after its date.
The correspondence has nevertheless been revealing. We can now be pretty certain that I was not registered on your computer until after my discharge, that would explain why the people manning the internal reception desk couldn’t find me by name or address and it fits with your assertion that I was discharged around 9 p.m. when it is beyond doubt that it took place at 10 p.m. Without a computer record you simply had to make a guess.
You have made no effort to explain why someone on morphine would be unceremoniously bundled out into the night penniless with no word of advice on what should be done by way of further treatment. A cavalier disregard for the wellbeing of a patient.
Your attempt to blame an untraceable locum is despicable. The Doctor and the Sister, while they attended to me were beyond reproach, though some of the non-medical staff weren’t in the same league, and I do not believe for one moment that people who showed that degree of care would shunt me out without a word of explanation; they had kept me fully informed until then.
I shall not take up the suggestions in the complaints leaflet you supplied but prefer to put all this year’s correspondence on the web so that everyone within your catchment area and beyond can judge for themselves whether you failed totally to offer proper emergency care and whether or not your letters are truthful or evasive. Currently the saga is on page 2 of a Google search for “Queen Elizabeth Hospital Woolwich”. Presumably things will get even worse in Queen Elizabeth A&E by the end of the month, if that is possible.