Page last updated at 15:31 GMT, Monday, 20 April 2009 16:31 UK

Fears of 'culture of euthanasia'

By Michael Stoddard and David Fenton
BBC News

Seven of the 10 patients were - (clockwise from top left) - Sheila Gregory, Robert Wilson, Enid Spurgin, Geoffrey Packman, Elsie Devine, Arthur (Brian) Cunningham and Ruby Lake
The patients died at GWMH between 1996 and 1999

The jury at the inquests into 10 deaths at a hospital in Hampshire heard from many medical experts during four weeks in court, but there was one they were not allowed to hear from.

Professor Gary Ford, a professor of pharmacology at Newcastle University, prepared a report for Hampshire Constabulary on a total of five deaths - two of which were the subject of the inquests - which occurred at the Gosport War Memorial Hospital more than 10 years ago.

He was one of many experts consulted when detectives opened an investigation into families' claims that patients had died after sedatives such as diamorphine were over-prescribed by staff.

Families of 92 patients came forward with concerns which led to police handing 10 files to the Crown Prosecution Service (CPS), but in October 2007, the CPS said there was not enough evidence to charge anyone.

There was certainly no sign of him coming to the end of his life when I last saw him
Charles Farthing

Following a long campaign and calls for a public inquiry, the inquests into 10 of the 92 deaths were opened last month with the jury returning a narrative verdict.

The jury found the administration of medication "contributed more than minimally" to five of the deaths, with three of those not receiving "appropriate" medication for their symptoms.

In the other five cases it was found the medication did not contribute to their deaths.

But the panel of five women and three men was not shown Professor Ford's report.

In legal arguments, the families' lawyers called for the report to be included in evidence but the coroner refused and instead relied on two other medical experts who had also prepared reports - of Professor David Black and Professor Andrew Wilcock.

In his findings, Professor Ford raised concerns there may have been a "culture of involuntary euthanasia on the wards" and claimed the levels of diamorphine administered through syringe drivers were "reckless" and "poor practice".

One of the deaths he looked into was that of former World War II pilot Brian Cunningham.

Brian Cunningham
Brian Cunningham died while being treated at the hospital

The jury found the administered medication did contribute to his death but the drugs he was given were appropriate for his condition.

Prof Ford's report states the 79-year-old was suffering from Parkinson's disease, dementia, depression and had difficulty walking, and was admitted to the hospital on 21 September 1998 with a serious bed sore.

His stepson, Charles Farthing, said he was ill but not dying.

"He was weak and frail I would say, yes, but he was 100% there mentally. He was still very lucid and a reasonable sort of chap.

"There was certainly no sign of him coming to the end of his life when I last saw him."

On the first day of his admission, Mr Cunningham was put on a syringe driver and given 20mg of diamorphine - a drug two to three times stronger than morphine.

Four days later the diamorphine was increased from 20mg to 60mg a day.

'Rapid deterioration'

Professor Ford said in his report: "The subsequent threefold increase in diamorphine dose later that day to 60mg [over] 24 hours is in my view very poor practice.

"Such an increase was highly likely to result in respiratory depression and marked depression of conscious level, both of which could lead to premature death."

He said although Mr Cuningham was admitted for treatment to his bed sores "ward staff appear to have considered he was dying and admitted for terminal care".

The diamorphine dose was later increased to 80mg before Mr Cunningham died on 26 September.

His death certificate recorded the cause as bronchopneumonia.

Robert Wilson
Robert Wilson was transferred to the Memorial Hospital with a broken arm

His stepson said: "I didn't believe what was on the certificate, I was certain it was due to the drugs he had been given in hospital and I wanted that shown."

Professor Ford also looked into the death of Robert Wilson, jurors found the medication he received was not appropriate.

The 74-year-old was admitted in 1998 after suffering from a broken arm.

Mr Wilson, who also had liver problems due to a long-standing drink problem, had made an "immense recovery" but died four days later after being given diamorphine through a syringe driver, the inquest heard.

Prof Ford noted: "Mr Wilson was admitted for rehabilitation not terminal care.

"Following treatment Mr Wilson was noted to have had a rapid deterioration.

'Hospital pressures'

"The medical and nursing teams appear to have failed to consider that Mr Wilson's deterioration may have been due to the diamorphine infusion.

"In my opinion when Mr Wilson was unconscious the diamorphine infusion should have been reduced or discontinued."

The report also states the increase in diamorphine was "not appropriate when the nursing and medical notes record no evidence that Mr Wilson was in pain or distressed at this time."

During the inquest, the claims diamorphine caused the premature deaths of patients were rebuffed by other medical experts and staff at the hospital, including Dr Jane Barton.

She was responsible for the care of the 10 patients and the prescribing of their pain medication.

Dr Jane Barton
Dr Jane Barton said she raised her concerns with health managers

She told jurors of the pressures at the hospital with managers sending more and more seriously ill patients because of a bed blocking crisis at the local general hospital.

"I could have said I couldn't do the job any more and walked away, but if I did, I felt I'd be letting down the staff and, more importantly, my patients," Dr Barton told the inquest.

She said that as a result of the pressures, her medical notes were sometimes "sparse" and that she started a system of "pro-active prescribing" - where prescriptions could be written in advance.

In a statement after the inquest Dr Barton said: "I can say though that I have always acted with care, concern and compassion towards my patients.

"I very much appreciated the kind and supportive comments of the nursing staff who gave evidence at the inquest.

"I am pleased the jury recognised that in all of these cases, drugs were only given for therapeutic purposes."

The inquest also heard families had "unrealistic expectations" about their relatives' chances of survival.

Professor Ford said the skills of nursing and non-consultant medical staff, "particularly Dr Barton, were not adequate".

In his conclusion he said: "Routine use of opiate and sedative drug infusions without clear indications for their use would raise concerns that a culture of involuntary euthanasia existed on the ward."

He added closer scrutiny into the ward practice would be necessary to "establish if this was the case".

His findings were passed to Hampshire Constabulary in 2001, but no criminal prosecutions have ever been brought despite three police investigations.

Some families have vowed to fight for a full public inquiry.



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SEE ALSO
Drugs led to deaths of patients
20 Apr 09 |  Hampshire
Unlawful killing claim sparked inquiry
20 Apr 09 |  Hampshire
Use of morphine in medical care
20 Apr 09 |  Hampshire
Painkiller patient given morphine
07 Apr 09 |  Hampshire
Doctor denies 'end of line' ward
03 Apr 09 |  Hampshire
Morphine 'shortened man's life'
31 Mar 09 |  Hampshire
Inquest hears man was 'executed'
27 Mar 09 |  Hampshire
Doctor 'warned of care pressures'
26 Mar 09 |  Hampshire

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