Care of the Elderly

The shocking report of the Care Quality Commission (CQC)  (http://www.cqc.org.uk) is no surprise.

Central to the poor care of the elderly in our hospitals is a lack of leadership and compassion.  This "culture" of poor care arises out of a lack of accountability.    Those who know what is right and what is wrong are often too fearful to speak out.  Whistle blowing, far from being encouraged, is condemned.  Whistle blowers are ostracised and punished for speaking out.  Understandably so few have the courage to do so.  I have represented many families at inquests where their only interest is to bring out into public exposure the appalling levels of care which contributed to the deaths of their loved ones in the most despicable circumstances.

On this morning's Today Programme on Radio 4 at 08.10, the Health Secretary Andrew Lansley encouraged everyone to speak out wherever shameful treatment of patients occurs.  I believe that all NHS staff, patients and their relatives have this responsibility.  They should speak to the hospital managers and copy correspondence to the CQC.

I have been around in medicine and the law for a long time.  Robbie's Law Trust (RLT) has been campaigning for years for honesty and accountability in the NHS.  There needs not only to be an enforceable professional responsibility to ensure that patient's interest are always put first and that bad practice and behaviour is exposed, there needs also to be legal responsibility at contractual level.  Consideration should be given to an enforceable statutory duty (with appropriate penalties for failure) on all healthcare workers to report care which places patients at risk of physical or mental harm or abuse.

With some trepidation, I would ask those healthcare workers who are aware of these practices which those of good conscience recognise as unacceptable to write in confidence to me at powersqc@medneg.co.uk.  I will do my best to reply.  If, for no other reason, copying me in (without disclosing patient identity) may offer some further protection to those who have the courage to speak out.  

This is in the public interest.

Cause of Death: The Cause of Dr Kelly's Death

Cause of Death: The Cause of Dr Kelly's Death: "The group of doctors seeking a proper inquest into the death of Dr David Kelly have always taken the view that he is extremely unlikely to..."

The Cause of Dr Kelly's Death

The group of doctors seeking a proper inquest into the death of Dr David Kelly have always taken the view that he is extremely unlikely to have died from haemorrhage from his left ulnar artery.

That view was publically supported by a second group of doctors in their letter to The Times in August 2010.

I have met no doctor who takes a contrary view.

Is it possible that Dr Hunt also was of this opinion by the time he had finished his examination at the scene and the post mortem on 18^th/19^th July 2003 might that be why at the opening of the Inquest by the Oxford Coroner, Mr Gardiner, on 21^st July 2010,  Dr Hunt gave another cause of death (perhaps overdose in the light of the empty packets of coproxamol)?

We do not know what “evidence” was given at the opening of the Inquest but we do know from Mr Gardiner that Dr Hunt subsequently wished to change his opinion.  In a letter to the Department of Constitutional Affairs in August, Mr Gardiner wrote:

“The preliminary cause of death given at the opening of the inquest no longer represents the view of the Pathologist and evidence from him would need to be given to correct and update the evidence already received.

As you will know, a coroner has power to compel the attendance of witnesses. There are no such powers attached to a Public Inquiry. If I do adjourn under Section 17(1), I would be unable to resume, if at all, until after the Public Inquiry has been concluded and thus would not be in position to assist Lord Hutton, should any assistance be needed in that respect.

In matters of this sort, I need to be scrupulous in following the provisions of the Coroner's Rules, and I have in mind in particular Rule 16 (Adjournements in a Formal Manner) and Rule 19 (Obligation to Notify Family).''

In my opinion Dr Hunt was probably awaiting the toxicology to confirm his initial conclusion of overdose or at least a non-haemorrhagic cause of death.  However the toxicology did not explain the death.  There was no support then for his initial conclusion.   He would have been obliged to find an alternative cause of death and, at the resumed inquest hearing on 14^th August 2003 about which the public was unaware Dr Hunt gave haemorrhage as his primary cause of death.  Meanwhile on the same day media attention was focused on the evidence Lord Hutton was hearing in London.

Dr Hunt, against his inclination, gave haemorrhage as the primary cause of death.  The coproxamol “ingestion” and coronary atherosclerosis were merely ancillary.

When challenged on his opinion last year,  Dr Hunt sought to support his conclusion by telling The Sunday Times about “big thick clots of blood inside the sleeve which came down over the wrist”.  This new “evidence” emerged 7 years after his involvement.  It was not part of his account to Lord Hutton.  Moreover, despite Dr Hunt saying to The Sunday Times “I noted it in my report”, when the report was subsequently disclosed by the Ministry of Justice, there was no such note to be found.

Lord Hutton was effectively obliged to accept the evidence on the cause of death from Dr Hunt because it had been determined by the coroner in private and registered by the Registrar of Deaths 5 months earlier:

If I am correct, the change from his first opinion as to the cause of death (which in the circumstances could not be maintained) and more particularly the delayed “beefing up” of the evidence of blood loss, throws further into doubt on the cause of death.

Dr Michael J Powers QC

31st May 2011

The investigation of death is supposed to make us all feel safer in life.  Whether it is learning lessons from fatal accidents or understanding why medical treatment went wrong, the coronial system should provide us with explanations, accountability and hope for a better future.


We all recognise that coroners are underfunded.  


The Prime Minister is to be congratulated for undertaking to bring the Military Covenant into law.  The debt owed by our Nation to our service men and women extends beyond their deaths on active service.  It is a disgrace that public money is spent by the Ministry of Defence on lawyers to defend its own interests in the ensuing inquests whilst bereaved families are denied publically funded legal representation.  Section 51 of the dormant Coroners and Justice Act 2009 should be brought into force immediately to rectify this iniquity.


It has been the failure properly to have a full, open inquiry into the circumstances of the death of the late Dr David Kelly which has provoked so much concern.  This highly respected government scientist is also owed a duty to ascertain exactly how he came by his death.  An informal inquiry, evidence not taken on oath, witnesses not being compellable to give evidence such as was undertaken by Lord Hutton is no substitute for a properly conducted inquest where the rigours of cross examination will often elucidate the truth.


Openness is the answer to most anxieties giving rise to suspicions of conspiracy and cover-up whether in medical treatment failures or unnatural deaths where prominent individuals loose their lives in highly unusual circumstances.


There are those who dismiss the call for a proper inquest into the death of Dr Kelly as being driven by "conspiracy theorists".   Dubbing this call in such a way is an attempt to dismiss consideration on the merits.  Let us not throw the baby out with the bath water; there is a real and justifiable concern about the adequacy of Lord Hutton's inquiry in respect to the cause of Dr Kelly's death.