Sunday, December 29, 2013

Burial Arrangements with Regard to Bacteria Etc

Burial Arrangements with Regard to Bacteria Etc

There is much public misunderstanding about particular bacteria often associated with hospitals and dubbed "superbugs" by the media. Multiply (or methicillin) resistant Staphylococcus aureus (MRSA) and Clostridium difficile (or C Diff) are probably the best known, and the subject of reporting and hospital targets. 

MRSA can cause problems, just like methicillin sensitive Staphylococcus aureus - wound infections, implant infections (artificial hips or heart valves for example) boils, etc. However, a large amount of the MRSA detected in hospitals is simply "sitting" on the skin of patients. It often lives in the nostrils, armpits and groins - warm, moist places. This is a concern because of the potential to infect wounds, but the presence of this microbe causes no harm as such. Some people colonized with MRSA may get rid of the bacterium without any treatment, and in others the bacterium will return after successful treatment. Their skin for various reasons is the ideal place for MRSA to flourish. Although MRSA may be acquired in hospital, the majority is acquired in the community, particularly in care homes. It is a consequence of widespread antibiotic use.

Clostridium difficile is a bacterium which is present in the large bowel of many people in small numbers. It is also present in soil, as are many other bacteria like Clostridium tetani (cause of tetanus) and Clostridium botulinum (cause of botulinum poisoning and source of Botox!*). Clostridium difficile only causes a problem when its numbers in the bowel grow - this is usually as a result of antibiotic treatment (particularly with a class of antibiotics known as cephalosporins) rather than by transmission from person to person. It then causes a difficult-to-treat diarrhoea. Thus the method of control is to restrict the use of the antibiotics most likely to cause this. Infection control is less important.

The relatives of a patient colonized with MRSA and suffering Clostridium difficile diarrhoea would not be particularly prone to problems from contact with their loved one. It is a wise precaution to prevent transmission, but it is transmission to other patients which is the main concern. 

In this context, it can be seen that the accounts of Deb Hazeldine about her mother make no sense. This may be a result of poor communication. Various sources say the same things, some as direct quotes:

"Ellen Linstead was admitted with bone cancer but died on December 13, 2006, from C.difficile and MRSA, hospital acquired infections that so ravaged the frail pensioner she had to be buried in a sealed body bag."


"When Mrs Linstead died in December 2006 her body was so badly infected with C. difficile that she had to be buried in a sealed body bag."#


"At the undertakers, her body was in a sealed bag covered in stickers warning it was highly contagious. We were allowed a few minutes, a few moments, with my mum. We saw her head protruding from a body bag. And we were allowed to spend a couple of minutes with her, just really to say goodbye. And what they said was 'we now have to put your mum's head back into the body bag and seal it because she is at risk of infecting the ground that she is buried in'."



"And even in death there would be no dignity. Ellen’s corpse was so riven by hospital-borne infections that no one was allowed to touch her body.
‘She was sent to the undertakers in a body bag with instructions that I couldn’t hold her hand or kiss her goodbye,’ she says. ‘I will never forget that.’"

 
This is medically nonsense. Clostridium difficile is present in the soil. The precautions required for various microbes are listed here in the Health Protection Agency guidelines for funeral directors: 

Clostridium difficile:
Body bag not required (unless there has been faecal leakage)
The body can be viewed
Hygiene and embalming permitted
MRSA:
Body bag not required
The body can be viewed
Hygiene and embalming permitted
So if there is no faecal leakage, no special precautions are required.


In fact, in some reports there is an acknowledgment that the funeral directors were misinformed about the management of the body:

"Furthermore, there was a mix-up at the hospital mortuary in which the undertakers were handed forms saying that Ellen's body was highly infectious, so people should not be allowed to see her.

In the end, Deb did see her - but only for a few minutes when she was in a body bag."


This clarification is omitted in most of the reports.

*Registered Trademark

Saturday, December 28, 2013

Julie Bailey – Fact or Fiction?

Guest Blog compiled courtesy of one of my Tweeps:
Julie Bailey – Fact or Fiction?

Julie Bailey has enjoyed lots of media exposure over the last 4 years in relation to her experience of Mid Staffordshire NHSFT.  In her interviews she recounts the ‘horrors’ of what her mother, Bella, had to endure at the hands of the staff there after being referred to Stafford Hospital by her GP in September 2007 with recurrent vomiting. Interview after interview brought out a catalogue of allegations against those in the hospital and indeed those who live in Stafford. 
The question arises whether all her claims are true.  There have been many who have argued that they are not, that there has been exaggerations and embellishments added.
I will allow the reader to make up their own minds as I present a timeline of Ms Bailey’s account.  I have taken only a couple of examples but there are many more contradictions in her statements over the years, far too many to put in this blog, so I have concentrated on the ones that come up time and time again.

April 14th 2009
David Cameron comes to Stafford to meet with Julie Bailey and Cure the NHS.  There is a video of the visit here:
You will hear Ms Bailey tell David Cameron “we looked after Mum, she was one of the lucky ones, it was the otherpatients who were suffering”

April 23rd 2009
Just nine days after Cameron’s visit Ms Bailey’s account changes.  In this video she claims “even being with my mum 24 hours a day, they still managed to kill her”

Francis 1 Enquiry June 2009
Ms Bailey is invited to give evidence.  From her statement to Mr Cameron, one would expect that there is not much to be said, but obviously Ms Bailey has had a ‘rethink’ and her mother is no longer  “one of the lucky ones” .
Here are some extracts from Ms Bailey’s testimony, the full account can be found here;

1.     “On Ward 10 she was left unattended for some time with another patient before a healthcare assistant arrived. Without saying anything, the healthcare assistant placed a tray of food on the table in front of the other patient, who was immobile and unable to reach the tray, and left again. She returned approximately 15 minutes later and collected the tray of untouched food”.

2.    “the patient’s daughter sign a Do Not Resuscitate (DNR) form and “He said: listen… the prognosis is very poor. He said:… her stomach has pushed up…she is going to die over the weekend and it is going to be a very painful death because what will happen is it can happen at any moment, any second now, it can turn, it can twist and she will die.”

3.    In Mum’s bay the woman in the next bed, she would sound the buzzer and it would just go off and off and off and then the same – it was the same thing, she would just call out for the nurse. When the nurse did come, she would be put on to the commode and it was obviously too late. The nurse would put her back into the bed, you could hear her – she would wait on the commode for half an hour and very often she would just try to make it herself and just go smack on to the floor. So you would have to go searching – if you couldn’t do it yourself, you would have to go searching, and I mean searching, for the staff. Very often you would just give up. I would just have to give up”.

November 2010 – Francis 2 Enquiry
Again Ms Bailey is given the opportunity to give her account under oath.  The first thing to point out before Ms Bailey recalls her previous statement the Chair acknowledges “I know also that you've made an addendum statement”.  Another rethink from Ms Bailey.
Taking the three statements from the Francis 1 report, we see Ms Bailey has expanded on her initial ‘evidence’.  The whole transcript can be found here,
It is worth a read – the contradictions are too many to blog here. and you will also see many points raised here that she had never mentioned before.
1.    Q. And I think that in relation to the lady who was there, there was a slightly distressing incident in relation to how her lunch was dealt with.
A. That's right.
Q. Again, just taking it shortly -- but this obviously impinged upon your experience later on and part of the complaints that were made by Cure -- I think you describe how her food was brought to her but she was unable to either feed herself or unwrap her food.
A. That's correct.
Q. Did the healthcare assistant who brought her food make any attempt to help her?
A. She didn't make any attempt at all. She didn't even speak. There was not a word said when she put the tray down and when she took the tray away.
Q. So what did you do?
A. I just said "She hasn't -- she hasn't eaten her food at all". And she just -- she just walked out the door, and as she was going she said "She never does".

2.    Q. We'll turn to the letter in a second, but after  this incident after you mum's collapse and your mum fortunately survived that, I think the doctor came and  had a discussion with you or a word with you about whether your mum should in fact in the future be resuscitated.
A. That's correct.
Q. Again, can you just tell us a little bit, please, about that?
A. I was just taken into a room. I was obviously upset. I wanted to see if my mum was okay. But there was pressure to go into the room with him, and what he said was that "Your mum -- it's a poor prognosis and it is likely that your mum will die over the weekend. It is going to be a painful death. She will die just like that", is the way he said it to me, "And we won't be resuscitating". I just couldn't believe how callous and the way he was speaking to me. So I asked my friend to come in, who was outside and I said "Please, just listen to what he's saying". I can't agree not to resuscitate my mum, you know. I was still in shock to be honest.  Felt as if -- I've never felt like that before.  I felt as if my head was ringing. I asked him -- he said "Well, it doesn't matter. We won't be resuscitating anyway".  So I walked out of the room and then another doctor came to see me, it was the doctor who had told me it was a poor prognosis after mum had had the endoscopy, and
 I understood completely what he was saying, but what I wanted to know if it was going to be such a painful death and it could happen any minute now, I didn't want to see my mum die in pain. And I just needed to know thatshe would be given medication.
 Q. All right.
 A. If anything was going to happen.
 Q. I think you did in fact over the course of the next few days see a consultant, or your mum saw a consultant, and there was discussion then about pain relief, and indeed about getting your mum back on her feet.
 A. That's correct.
 Q. All right.
 A. It was at that point that I made my first complaint.
 THE CHAIRMAN: Just going back to the doctor who talked about not resuscitating, can I just clarify one point.  Was he asking you to agree that that should be the policy, that she should not be resuscitated?
A. That's correct, yes, that's what he took me in the room -- he wanted me to sign a form. But then whenI said that I -- it wasn't -- that wasn't my decision, I had a family as well, then he said that it doesn't matter. That it wasn't up to me anyway. They'd already made that decision.
 THE CHAIRMAN: But he wanted you to sign the form?
 A. That's correct.
 MR KARK: And did you ever sign the form?
 A. No. But I -- I would have done.
 Q. You would have done if what?
 A. Once it had been explained to me what I was agreeing to, that, you know, it would be a painful -- you know, it would be an awful experience for mum to go through that, she was 86, then I would have signed, but it was just the way it happened.

3.    Q.  When you say you were able to help the patients in your mum's bay, what sort of thing were you having to do for them?
A.   Well, to help them out the bed or to pass them a drink.  It was mainly to take them to the toilet, if they wanted to get out to go to the toilet, or if you weren't able to get them out the bed, to go up to the nurses' station and to try and get some help for them. Then once they'd put them on to the commode, then they would be left there. You'd have to give them the buzzer, and then once they'd pressed the buzzer, they'd wait 20 minutes, and then I'd have to go up to the nurses' station to try and find a nurse to help them back into bed, because I wasn't going to lift anybody.


We see many changes to Julie Bailey’s version of events. The reason why they have been changed is debateable and will be covered in another blog!  However not content with leaving matters there, Julie Bailey then is courted by the press and we see her version of events change yet again.  The most astounding is this one by the Daily Mail; in it Ms Bailey appears not only to exceed herself with the events but paints herself as ‘The Saviour’.

Daily Mail interview, 15th November 2012


“During the next weeks, I found several patients lying on the floor,’ she recalls. ‘They’d struggled to go to the toilet after fruitlessly ringing their buzzers for so long. They’d tried to manage alone and they’d failed, so I helped them.”

“The room was grubby, cramped and windowless, and Julie Bailey had been summoned to it by a hospital doctor. He clicked his fingers to demonstrate how swiftly her mother’s condition could decline, warning that the end would not be merciful. ‘Your mother will die a painful death,’ he said. ‘It is best that you leave her here with us.’
She did not hear the medical explanation that ensued. She was mute with shock; confounded. Then the doctor slid a piece of paper towards her. It was a Do Not Resuscitate form. Quietly but firmly, he urged Julie to sign it. Suddenly she was alert, defiant. ‘Of course I will not allow my mum to die!’ she said, refusing to sign the form.”

"Patients sounded their buzzers in vain. Julie, unable to ignore the chaos, stepped in. ‘I emptied a bowl of vomit; scrubbed blood from walls; helped a patient onto a commode. I washed faeces from the hands of one elderly woman who had been left in the same soiled clothes for four days.
‘There was one confused patient who was so parched with thirst because she had no water that she drank stagnant water from flower vases.”

In another article, this time for the British Heart Foundation and things change again.


https://www.bhf.org.uk/heart%20matters%20online/january%20february%202014/my%20story/julie%20bailey/stafford%20hospital.aspx

One day a doctor said he needed to speak to me. He took me into this sort of cubby hole and said it was a very poor prognosis. I said: “Well, you haven’t helped.” He said: “It’s nothing to do with us, it’s the nurses.” He gave me a “do not resuscitate” order to sign. He said: “Your mum is going to die. The best thing you can do is leave her with us over the weekend. It will be a painful death but it will be just like that” – and he clicked his fingers right in my face. He kept pushing this piece of paper at me and asking me to sign it. I thought, ‘I can’t let her die in pain’. She was 86, but I didn’t want her to go like that.”

“We started to notice what was going on around us. Trays of food were being left by the bed but the patient needed help with eating. Sometimes food was left on the trolley and the patients had to go and get their food from the trolley. In some cases, confused patients were supposed to fill in a form to say what they wanted to eat the next day. I was asking why they didn’t have any food and I was told they hadn’t filled in a form. We were able to help three patients in Mum’s bay. We gave them food, gave them fluids, we got the commode for them.”

And finally, this video
“if it wasn’t for us helping them, they would have died long before”



So there we have it, from 2009 to the present day.  What a difference nine days can make!

FACT or FICTION – What do you think?

Journalism and truth

Journalism and truth

I think we're all accustomed to exaggeration and selection of facts by the media - there's a general cynicism in the UK. People still run with the narratives of the media when it suits them of course, but this is human nature. The totally unproven story about patients drinking from vases, and the story of the judicial review that never was, were both repeated by Julie Bailey to the House of Lords Select Committee on the Inquiries Act. Even the Telegraph had to print an apology when repeating the vase story, accepting that Francis had not heard any direct evidence about this and so came to no conclusion. The Independent showed its ignorance of both hospital wards and horticulture when it proclaimed today that patients were forced to drink from plant pots. Every gardener knows that plant pots have drainage holes, making drinking from them nigh impossible.

What is quite unfathomable are the remarks of Shaun Lintern, where he concedes that there have been inaccuracies in the national media coverage of Mid Staffs, but then goes on to say that the coverage was fair and justified! 


He also claims that actually the "sensationalist" reporting was not as bad as the reality (which brings into question Shaun's understanding of the term "sensational"). He also believes that factual reporting of details neutralizes the erroneous headlines. It's well recognized that this is not the case - the brain remembers information without remembering the source, and so the shrieking headlines become embedded in the mind as "fact".

  1. There was some sensationalist reporting which was silly as many things in the report were even worse.
  2. the whole thing was sensationalised. It's what the media does.

  3. is partly what the tsa proposals hinge on, reputational damage. Which points to agenda.
Shaun admits he has something of a reputation for being biased

He goes onto claim that the vase story wasn't even important.

It seems bizarre to suggest that the provenance and truth of the vase story was not important! It goes to the heart of the credibility of the worst allegations. Shaun Lintern seems to be suggesting that the vase story and 1200 deaths are unimportant details, and worse of all that people highlighting these inaccuracies are denying reality. This is a whole new definition of truth. It's one thing for journalists to distort the facts, another for them to justify it.

The truth is the plain truth - not embroidered, embellished nor embroidered!