Examination of Witnesses (Questions 180-199)|
THURSDAY 24 JUNE 1999
180. They have not looked for alternative forms
(Dr Peart) I think the main point is that the vast
majority of people who are prescribed these drugs are prescribed
them for relatively menial, social problems. They only have to
compare the range of physical and mental problems produced by
these drugs with the original condition and the two orders of
181. Dr Peart, are you medically qualified?
(Dr Peart) No. My doctorate is in nuclear physics.
182. I will still ask you the same question.
You used the term "vested interests".
(Dr Peart) Yes.
183. Can you say a little more about how you
see these vested interests impacting upon the concerns that you
have expressed to the Committee? Are you implying that the medical
profession has too close a relationship with the drugs industry
and that there is not the appropriate evaluation of drugs prior
to them being placed in use within the NHS? If that is what you
are implying, briefly, what would you feel should be done about
this? Do you feel any of the procedures that the current government
have introduced of clinical governance, the nice body that has
been brought in to evaluate effectiveness of treatments, will
impact in any way on the future experience of people who may have
similar problems, not necessarily with the drugs you are talking
about, but with other, future drugs?
(Dr Peart) Too many questions. The first question
was about the nature of the vested interests and how they apply
to the drug companies and what should be done. Yes, I think the
whole system of clinical trials, the monitoring of clinical trials
and post market surveillance, is not particularly good in the
case of benzodiazepines. In spite of that, all of the knowledge
that exists today on the benzodiazepines was available in the
1960s. The big problem was that that knowledge never filtered
through and down to the prescribers and to the patients. I think
there was only one reason for that and that was withholding of
information by the drug companies, and at successive layers, including
the Committee on Safety of Medicine etc., a filtering process
occurs. It is filtered out all the way down and the converse happens
with patients' problems. There is a reverse filtering on the way
184. We may well come back to some of these
points because they are very important. Can I at this point bring
in Mr Powell? We have met before some time ago and, as you said
earlier on, the efforts of your group were certainly relevant
to this inquiry being established. Could you say a bit about your
own experiences, which have been very widely reported, and about
the wider concerns of your group as they relate to our terms of
(Mr Powell) Could I say that I am also representing
adult patients who have died and their families and also patients
who are alive and who have received inappropriate medical treatment
and been denied treatment to put that right and have been discredited.
My son died in April 1990 of Addison's disease. It is a treatable
condition which, unknown to my wife or I, had been suspected four
months before his death.
185. Was it suspected by the GPs?
(Mr Powell) By the hospital.
186. Where he was being treated?
(Mr Powell) He was admitted to hospital in December
1989. He was an in-patient for four days and they suspected he
had Addison's disease. It is a treatable condition. It invariably
results in death without treatment.
187. But you can prove that they knew of this
(Mr Powell) Everything I am stating here is fact and
I can give you the evidence. They suspected the disease. They
said that my son needed an ACTH test to confirm the diagnosis.
They did not inform my wife or I, nor did they discuss my son's
condition with us during the four days, although we continued
to ask. My wife was casually told by a consultant paediatrician
my son had gastroenteritis, which we now know did not even fit
the symptoms that he had because he had raised potassium which
is something you do not have when you are vomiting; it usually
lowers. The child was discharged and he became well. Five weeks
later he was seen as an inpatient at the hospital by the paediatrician
who suspected Addison's disease. The consultant told my wife there
was no need to do anything to him. He did not inform her that
the Addison's was suspected nor that the test was needed or had
been postponed and as far as we were concerned gave my son a clean
bill of health and we were happy to receive that. But unknown
until after my son's death, the hospital had written to the GPs
informing them that Addison's was suspected and that my son needed
the ACTH test and to keep an eye on him in case he had a recurrent
episode which could result in death. After the meeting of 18 January,
which was the outpatient's appointment, the consultant wrote to
tell him again about the suspicion of adrenal insufficiency and
that my son should be referred immediately if he had a recurrence
of vomiting or abdominal pain which are frequent to sufferers
of adrenal failure. At the beginning of April 1990 (this is four
months after the hospital admission) my son was seen on seven
separate occasions by five GPs in the local health centre who
had this information in the records. He was seen on 2 April and
we were told there was nothing wrong with him. He was sent home
from school on 5 April. He was seen on 6 April by a doctor. He
was seen again on 11 April when he was vomiting and weak due to
weight loss. These are all signs of adrenal failure. This was
the only GP to look at my son's medical records. He told both
my wife and I that he would refer my son immediately back to the
hospital that day. He did not tell us why he was doing that, nor
could we discuss the serious condition, but he knew that vomiting
was a danger and that my son could possibly die. So his intention
was to refer. Unfortunately, after his death it came to light
that he did not refer him. The referral letter was typed after
my son's death and it was backdated to the time when he was alive
and a statement was made saying that he had been referred and
I have now proven that that letter was written post-death and
backdated. Both my wife and I went on a third consultation on
11th April because we were both worried and I wanted to hear the
doctor say there was nothing wrong with him. On 15 April, which
was Easter Sunday, we telephoned the health centre and asked for
a doctor to come to the house because the child at this time could
not walk unassisted. The GP said that we should call down at the
local hospital and he would see him there, which we did not mind
as at least the child would be seen. So we had to carry the child
to the car and then from the car into the hospital. The doctor
examined him, could not diagnose what was wrong, but he thought
it was possibly glandular fever. He said that the child needed
a blood test. At each consultation we gave the full history as
we knew it to every doctor. He said that he needed blood tests
and that they should be done on Tuesday 17 April because that
was the Tuesday after Easter Monday. We accepted that.
188. The hospital that you were told to take
(Mr Powell) It was the local community hospital.
189. Which is staffed by GPs presumably?
(Mr Powell) Yes, and out of hours, all weekends possibly.
They would call the patients there rather than go round the houses.
190. When your son had been to hospital before
(Mr Powell) It was Morriston Hospital near Swansea.
191. Was this a different hospital?
(Mr Powell) Yes. This was just his local community
hospital. We accepted what the doctor said. We carried our son
home. By this time he was losing weight as he was not eating.
The following day, which was the Easter Monday, he started to
vomit again, so we called the health centre and we had the first
home visit. This was a different GP again. Five GPs had seen this
child. We told this doctor everything. He examined my son and
said that he needed a blood sugar test. Unknown to me low blood
sugar is a symptom of Addison's disease also and the weakness
suggested there may have been low blood sugar. He went to his
car, came back and said that his test equipment was out-of-date
and therefore he would not perform it, but what he said was, "The
test that you need tomorrow should be cancelled. Bring your son
in on Wednesday rather than the Tuesday, but if he deteriorates
or continues to vomit then phone the health centre and we will
have the child admitted immediately." The doctor went away.
The next day my son wanted to go to the toilet, my wife assisted
himsorry, this is very upsettinghe collapsed and
fainted on the bathroom floor, he was unconscious. My wife screamed
and I went to the room. I immediately saw the child, ran down
to the telephone downstairs, telephoned the health centre and
asked for a doctor to come. The doctor who came was actually the
doctor who had seen the child on 6 April, which was the second
consultation. My son had regained consciousness but his pupils
were dilated and his lips were blue, the relevance of which I
did not know at that time. He was dying of adrenal failure. The
GP looked at him, she took the full history, she was told about
seeing him earlier, about the blood test and especially about
the senior partner's view that the child should go to hospital.
The GP refused to admit the child. She said there was nothing
seriously wrong with him. She left. I telephoned the hospital
where Robert had been suspected of Addison's disease, which was
unknown to me, gave the staff nurse the full history and she advised
me to believe in the GP: "If you are worried, Mr Powell,
get the doctor out again." My wife was by the phone and the
nurse told my wife the same because we were concerned that we
had the proper information on what to do. So my son developed
abdominal pain and I immediately phoned the health centre and
this lady doctor came out. She looked at my son and again refused
to admit him to hospital. There then followed a very heated argument.
She then decided that she would, not because of the condition
of my son but because we were insisting that that should happen.
My sister came into my home around the time that the doctor was
writing the referral letter. I wrapped my son in a blanket upstairs,
prepared him to go, came downstairs and in the presence of my
wife and my sister I asked the doctor if she had ordered an ambulance.
She threw the referral letter at me and told me to take my son
by car. She stormed out of the house and that was the last we
saw of her. I put my son in my car, which the doctor did not know
I had, and took him to hospital which didn't take very long because
I went there quite quickly, as you would imagine. We got to hospital,
he stopped breathing and died. Three days after my son's death
I got access to the medical records because I asked to see them
and in there were documents from the hospital confirming that
this disease had been suspected, that the child needed the ACTH
test and that the parents had actually been informed, so I was
obviously very, very angry.
192. Did you say that the hospital had informed
you or the GP had informed you?
(Mr Powell) The letter was from the hospital to the
general practitioners and the letter was headed "Informationneeds
ACTH test. Parents informed".
193. So the GP assumed you knew?
(Mr Powell) They would have assumed that by that,
but they obviously knew because this doctor was a senior partner
who had seen Robbie on the Sunday and he knew that I had not told
him, so the likelihood was we could not have known because obviously
they had discussions before they came to see me. So I saw the
records and I was outraged by this and I knew nothing about Addison's
disease because we had just been informed by the coroner that
it was a natural cause and there would be no inquest. Sadly, coroners
are failing people in this country because there should have been
an inquest. We made a request for an inquest. I even said there
would be a second post mortem in the light of the events which
led to my son's death, but unfortunately the decision not to hold
an inquest was made before I knew that Addison's disease was suspected.
194. Was it made on the basis of what was on
the death certificate?
(Mr Powell) Yes, but what is very interesting is the
pathologist who performed the post mortem on my son omitted all
that relevant information from the post mortem report. It was
inappropriate for her to even perform the post mortem because
that health authority later admitted liability for the death of
my son. So it appears that there was a massive cover-up from day
195. The clear lesson that you would want to
point to from the tragic circumstances that you have been through
would be a distinction in who actually carries out the post mortem
to ensure that there is not the allegation that the person carrying
out the post mortem is within the same organisation that may be
at fault in respect of a death?
(Mr Powell) That is in the Coroners Act. When negligence
is alleged at a health authority or trust a pathologist employed
by that trust should not perform the post mortem. You have got
to remember that we did not know this to challenge it, but it
is an important point because the pathologist had a conflict of
interest. I can prove, although the medical records now refer
to the ACTH test, the suspicion of adrenal sufficiency and everything
else and the pathologist chose not to enter that information into
the report and I feel that there should have been an inquest and
there have been inquests in similar deaths by coroners and I strongly
believe that the cover-up started there. I think coroners should
give people, when there is alleged negligence, a full inquiry.
I found out subsequently that the coroner, in the light of my
allegations of negligence, did not even have preliminary inquiries
and that is a matter of fact. Anyway, the GP came to the house,
I saw the discharge notification and the letter from the hospital.
I was so appalled by it that I decided to have it witnessed. I
am uneducated man, I left school at 14, but I knew the events
leading to my son's death and this information were crucial. I
then found out that Addison's disease is treatable although not
curable. So I asked a Reverend who I knew vaguely, who lived a
few doors down, if he would come to my home and witness my son's
medical records and take a contemporaneous note of the contents.
The Reverend came to my house a quarter of an hour before the
general practitioner came, this being the same GP that brought
the records to me. He was quite shocked to see an independent
witness there with a notebook. However, the Reverend had the notes,
took a contemporaneous note of the contents, specifically the
ACTH test, the fact that the parents had been informed and the
fact that Addison's disease was specifically mentioned and the
document mentioned a hormonal imbalance. The doctor went away.
I asked that doctor subsequently if he would have an inquiry into
the events leading to my son's death, an informal inquiry just
to identify what, if anything, went wrong. He refused to do so.
He left me with no other option but to make a formal complaint.
Six months later, when I get my son's medical records, these crucial
documents have been removed and substituted and to this day that
has been denied. I have forensic evidence to prove that my son's
notes have been altered, yet to date it has not been addressed.
There is no mechanism to address it. The police are reluctant
to look at these cases and I think that they should. There is
no accountability within the NHS. The death was covered up and
I went through the complaints procedure. I represented myself
the first year which was a Medical Services Committee hearing
by the Family Health Service Authority. The chairman treated me
196. This was to do with complaints against
the GP, was it?
(Mr Powell) I felt that my complaint was against the
GP because although the hospital had suspected it and had probably
been negligent by failing to tell me, the GPs could have retrieved
the situation because they had seven opportunities to do that.
I felt that everybody was collectively wrong. When I met the paediatrician
after my son's death he actually criticised the GPs for failing
to get back to him. I went through the complaints procedure. I
eventually had a Medical Service Committee hearing. I proved that
the doctors had stated many, many lies. I had the evidence to
substantiate it: I had witnesses, I had the Reverend Thomas as
a witness. None of our evidence was accepted. Four of the GPs
were found not to be in breach of their terms of service. One
was found to be in breach and that was the doctor who saw my son
on the last day. She was given the minimal reprimand and she was
told to conform in future to her terms of service. I then exercised
my right to appeal against a decision of the four who were found
not in breach to the Welsh Office. The hearing was set for three
days, 17th, 18th and 19th March 1992. I had a barrister, I had
a solicitor and a medical expert.
197. We appreciate that this occurred within
Wales and there are slight differences in the procedures that
we need to learn from, there are some parallels. The equivalent,
one assumes, in England would be the regional executive or what
was then the regional health authority, would it not?
(Mr Powell) I thought it was the same in England and
198. We can look at that in more detail.
(Mr Powell) It is in Wales this happened. I was on
the understanding that England and Wales
199. There are similarities.
(Mr Powell) The hearing was allocated three days.
I was now allowed legal representation. I was not going to go
to another hearing, even if I had to sell my house, and be treated
in the manner that I was treated by that chairman. It came to
light later that he was actually a magistrate. I just could not
belief it. The hearing went on for three days, but because of
a lack of time it had to be adjourned. Allegations were made by
my barrister that my son's medical records had been falsified.
The Welsh Office owned the records. They had introduced them as
evidence and therefore they should have been keeping them safe
during the adjournment. Six months later when we got back to the
appeal hearing in September 1992 we found that the GP records
have gone missing and they have been altered again. We bring this
to the attention of the chairman who refuses any responsibility
by saying, "It is nothing to do with me." He did not
particularly care. We said we were not happy. We wanted him either
to investigate it or call in the police. He said the Welsh Office
were not responsible, it was not his fault and they were not going
to look at it. So we then decided, after taking legal advice,
to withdraw from the appeal. To withdraw from such an appeal you
need the permission of the Secretary of State for Wales. We wrote
and asked for that permission. Unknown to me and my legal team,
the Secretary of State had an internal inquiry into my allegations
that their procedures had been at fault. The internal inquiry
confirmed, unknown to me, that the procedures were not at fault,
that the Welsh Office had acted properly. The Secretary of State
then gave me permission to withdraw but did not tell me that once
I withdrew from that appeal there would be no mechanism to re-open
it, there was no provision in law.