Oct. 26, 2012

I survived the death pathway: Patricia, 82, was given two days to live, but her family defied doctors and gave her water through a straw – now she’s planning a world cruise

Doctors at Blackpool hospital put 82-year-old on the Liverpool Care Pathway

Her family defied orders and gave her water after which she recovered

Ministers are investigating Liverpool Care Pathway after accusations it hastens death of patients

By John Stevens

PUBLISHED: 23:01, 26 October 2012 | UPDATED: 00:12, 27 October 2012

http://www.dailymail.co.uk/news/article-2223836/I-survived-death-pathway-Patricia-82-given-days-live-family-defied-doctors-gave-water-straw–shes-planning-world-cruise.html

Her devastated family had been told Patricia Greenwood was dying.

Doctors at the hospital had removed all feeding tubes and drips and placed the 82-year-old grandmother on the Liverpool Care Pathway. Her children and grandchildren were told to say their last goodbyes.

But they said no. And after they defied hospital orders and gave Mrs Greenwood drops of water, her family helped her make a remarkable recovery.

Within hours, Mrs Greenwood was eating and drinking for herself and is now back at home and proud to call herself a Liverpool Care Pathway survivor. The former singer and pub landlady is planning to go on a world cruise, looking after her great-grandchildren at home and will attend her son-in-law’s 50th birthday party this weekend.

The hospital concerned has been paid more than £600,000 in the last two years to hit targets for the number of patients who die on the Pathway, according to documents uncovered by the Mail.

Last night Mrs Greenwood said she is angry that doctors gave up on her and has welcomed the announcement of a review into the ‘end of life’ treatment regime.

The Mail has highlighted growing fears of patients’ relatives and doctors that the Pathway is being applied to patients without their families’ knowledge and when they still have a chance of recovery.

The regime, which involves the withdrawal of food and fluids as well as medical treatment, is designed to be used on patients who are dying. Doctors try to ease their suffering in their final hours instead of trying to save them. Yet critics say it is impossible to predict accurately when a patient may die and that the Pathway instead becomes a ‘self-fulfilling prophecy’ that hastens their death.

The average survival of a patient on the Pathway is just 29 hours. But some patients taken off the Pathway at the insistence of their relatives have lived for several months.

Last night, Mrs Greenwood told how she survived being put on the Pathway.

‘I fought it,’ she said. ‘I wasn’t going to go, I was not ready. I’ve got my grandchildren and great-grandchildren and another great-grandchild on the way. I’ve been pottering around at home, we have some fun.

‘It frightens me because I could have missed all of this. It’s not right, if you’re not ready to die, you’re not ready to die – and I was not prepared to die.’

‘FAMILIES MUST BE CONSULTED’

Jeremy Hunt has hit out at the ‘unforgivable failure’ of some doctors to inform relatives that their loved one has been put on an ‘end of life’ programme.

The Health Secretary told the Daily Mail that hospitals accused of misusing the Liverpool Care Pathway must carry out detailed investigations to ensure similar scandals do not happen again.

He demanded that the NHS ensure everyone approaching their last days is treated with ‘dignity and respect’.

Since taking the health role last month, Mr Hunt has told his department he wants older people to be a priority.

In response to the Mail’s revelations, he said: ‘People in the last days of their life deserve to be treated with dignity and respect, which at a minimum means involving individuals and their family in any decision regarding their care.

‘I would expect any trust accused of such an unforgivable failure to investigate fully and learn lessons.’

Stephen Dorrell, chairman of the Commons health select committee, said there were clearly problems at some hospitals with the way the pathway was being used.

He added: ‘The idea that a person can be cared for at the end of life without the family being involved – that is not high-quality care as anyone would understand it.’

Mrs Greenwood was admitted to the Victoria Hospital in Blackpool in August after a problem with her heart valve led to fluid in her stomach. Her health deteriorated rapidly after she had a fall in hospital that fractured her hip and she was put on morphine to ease the pain.

Her two sons and daughter were called in to a meeting with a doctor who told them their mother had only two days to live and that they should say their last goodbyes.

Her son Terry Greenwood, 57, said: ‘The doctor said he had taken her off all feeding tubes because he did not expect her to live past the weekend. We were devastated.

‘But when we told her granddaughters the news they went mad and said that grandma was a fighter and we should not give up on her. We went to Mum’s bedside and started talking to her. We knew she could hear us. She kept smiling when anyone said something funny.

‘I asked Mum if she was thirsty and she nodded. I held a cup of water to her lips, but she was not strong enough to suck on the straw. So I put my thumb over the end of the straw and dipped it in the water so I could feed her a full straw of water.

‘I fed her for more than an hour with the straw and she opened her eyes and could talk to us, the water seemed to stimulate her.

‘The day after I did the same, but a nurse took my wife to one side and told her that I should not be feeding her this way because she might choke.

‘I was livid. The nurses could see what we were doing and every time we gave her water she came round and could talk to us.’

Doctors, who could not deny the positive response by Mrs Greenwood, agreed to the family’s request to put her back on a drip, and the next day she was sitting up in bed eating and drinking by herself.

Mrs Greenwood, who entertained troops during the war as a singer, has returned to the home she shares with her daughter and son-in-law. She walks with the help of a Zimmer frame and plans to attend his 50th birthday celebrations at a pub this weekend.

‘They thought I was not going to make it, I proved them wrong. Looking at the other old ladies in hospital, you would see them in bed and think “oh they’re be alright tomorrow” and they weren’t, they were in a coffin. Oh no, I’m sorry, not for me. I’m only 82, I’m only young yet.’

Mr Greenwood said: ‘If you asked people what they would give to just spend ten more minutes with their mother or father, people would give their right arm, and we’ve had so much more than that.’

Mrs Greenwood’s daughter Tina Hopkins, 52, added: ‘I know that my mum would not have wanted to have died the way that she was – bruised and battered and broken.

‘To get her back home now, to see how she is now, yes, anything could happen in the next month or the next year, but we will still have had that time with our mum.’

Blackpool Teaching Hospitals NHS Trust is one of several hospitals that the Mail has discovered are being paid incentives to ensure a set percentage of patients who die on their wards have been put on the controversial regime.

Payments are made through a system called Commissioning for Quality and Innovation, which channels money to hospital trusts through NHS ‘commissioners’.

Documents show that for the financial year that ended in March there was a target of 35 per cent of all deaths on the LCP.

Over the past two years, £680,000 in bonuses have been available to the Trust for achieving goals related to ‘end-of-life care’.

Last night Mr Greenwood was appalled at the revelation the hospital was receiving money for meeting targets for putting patients on the pathway.

‘I am absolutely disgusted,’ he said.

‘This puts this whole thing in a totally different light. They’re making money out of killing people.’

Nearly one in three of all patients who die in hospitals are on the Pathway, which often involves sedation with morphine and the removal of tubes providing nutrition or fluids to the patient.

Marie Thompson, Director of Nursing and Quality at Blackpool Teaching Hospital NHS Foundation Trust said: ‘The Liverpool Care Pathway is a model of care which enables healthcare professionals to focus on the holistic care of the patient in the final stages of life when death is imminent.

‘It is tailored to the person’s individual needs and includes consideration of their physical, social, spiritual and psychological needs, so that a person can die with dignity and in their preferred place of care.

‘The Liverpool Care Pathway has transformed the care of dying patients and therefore Commissioners, as part of the contracting process, require the Trust to meet targets set out in ‘the ‘Commissioning for Quality and Innovation payment framework’, which are used to improve the quality of care that we provide for patients, including those at end of life.

‘The CQUINS monies are not bonuses; these are monies that are withheld from the Trust by Commissioners until we can evidence the quality of the care that we provide.’ She said no complaint had been received about Mrs Greenwood’s care at the hospital.

‘With regard to the case of Mrs Greenwood, the Trust has not received a complaint either at the time of Mrs Greenwood’s stay in hospital or following her discharge home. We would be more than happy to discuss any concerns with Mrs Greenwood and her family.

‘All complaints received are thoroughly investigated and where there are lessons to be learnt we will take these on board.’

At last, ministers launch inquiry

By Steve Doughty

Ministers yesterday officially launched a wide-ranging investigation into the Liverpool Care Pathway after accusations it hastens the deaths of patients.

It will examine complaints to hospitals from families about the way patients have been put on the system, which typically ends in death after 29 hours.

Care Minister Norman Lamb said: ‘We need to know how patients and families feel about the care they receive.

‘We need to make sure that health professionals have the best tools to help them with this sensitive work.’

hospitals investigation

But MPs and doctors criticised the inquiry for not being independent. It will be run by a Heath Department organisation, the National End of Life Care Programme, and medical organisations which have been deeply involved in promoting and operating the Pathway.

Dr Philip Howard, a consultant physician based in London, called for a judge or senior barrister to be in charge.

‘It was only two or three weeks ago that creditable organisations were saying the LCP was a framework for good practice that did not hasten death,’ he said.

‘The very same people are now saying they are conducting the inquiry. It’s like the fox guarding the henhouse.’

Julian Brazier, Tory MP for Canterbury, said: ‘There should be an independent inquiry and not one run by the practitioners.’

Dr Tony Cole, chairman of the Medical Ethics Alliance, said: ‘The inquiry will only command public confidence if it is independent.

‘There are many people who contacted the Press with dreadful stories and this inquiry should be open and their voices heard.’

The decision to undertake an inquiry was revealed by the Daily Mail this week. It will have two elements. In the first, the £300million NELCP will look into complaints about end of life care, including the Liverpool method. A group called Dying Matters will also talk to families.

The second element will involve consulting medical professionals about their views on the Liverpool pathway and other similar methods.

It will be led by the Association for Palliative Medicine, which represents 1,000 doctors.

The inquiry findings will be sent to the Department of Health but there is no pledge to make them public.

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