‘MURDERED’ BY THE PATHWAY
Margaret’s doctors told her family she had terminal cancer, then put her on a death pathway that should have been scrapped. They continued to restrict her food and water even after they realised she DIDN’T have cancer . . .
MARGARET Hesketh took the news she was suffering from an aggressive terminal cancer with the same bonhomie which had characterised her life. When doctors told the 70-year-old former Lancashire mill worker she had only a few months left to live, she was still able to crack a joke.
One of the three large tumours ravaging her body, she was told, was within her pelvis. She quipped of being well past her baby- carrying days and therefore was definitely not pregnant.
Nevertheless, the news came as a shock as the mother- of-three had only been admitted to hospital to have treatment for an infected pressure sore and suspected pnuemonia. But medics assured her that death was imminent, and she was placed on a ‘pathway-style end of life palliative care plan’ shortly afterwards.
No doubt, for many, the words ‘pathway’ and ‘end of life’ instantly bring back memories of the notorious Liverpool Care Pathway (LCP).
It was phased out over the 12 months from July 2013 after a campaign by the Mail led to an independent inquiry, which found evidence of ‘shocking abuse’ of gravely sick and elderly patients.
Under the LCP, patients considered to be dying would no longer receive treatment to save their lives. Medication was stopped, food or water was limited, if not completely denied, and there was routine heavy sedation.
At its peak, the Pathway was involved in more than 130,000 hospital deaths a year — half of these patients hadn’t given their consent — and hospitals were offered cash incentives for those put on the plan.
During the inquiry, led by Baroness Julia Neuberger, more than 1,000 families were interviewed, many of whom told of relatives being knocked out with a ‘chemical cosh’ followed with death by dehydration and starvation.
But that was then. Surely, after the exposure of such a terrible scandal, hospitals wouldn’t consider using anything like the LCP on a dying patient. Would they?
The terrible case of Margaret Hesketh shows otherwise.
After her diagnosis, she was moved into a side room on the 32-bed Winstanley Ward, which specialises in cardiorespiratory problems, at the Royal Albert Edward Infirmary in Wigan. She was heavily sedated with morphine, and her water and food was restricted for her final six days, until she died on a cold November morning in 2014.
Worse was to come.
HER grieving husband Derek, 70, and three children prepared for the funeral of Margaret, an avid bingo player. Such was her positivity, that on waking every morning, she would say ‘each new day is a blessing’. Despite their sorrow, the children tried to remember their mother’s upbeat nature, her constant joy.
Imagine their horror when, so the family claim, they received a call from the coroner’s office a few weeks after her death to be told the shattering news a post mortem had concluded the pensioner had, in fact, died from pneumonia. There was no sign of cancer that was said to be ravaging Margaret’s body.
A second post mortem had the same result: the supposed tumours in her pelvis, throat and lungs did not exist. Margaret had been placed on an endof-life protocol unnecessarily.
Horrifyingly, doctors had realised their mistake four days before she died, but did not tell Margaret or her family and continued with their death plan regardless.
One shivers to think of such arrogance, such carelessness when dealing with matters of such import.
To make matters worse, this does not seem to be an isolated incident. Margaret is one of up to four patients whose deaths are being examined by Greater Manchester Police after they were put on end of life pathways at the same hospital — three in the same ward.
Their families argue what happened to their loved ones is tantamount to murder as they could well have survived if food, fluids and vital medication had not been withdrawn.
And, yes, these cases bear all the hallmarks of the Liverpool Care Pathway.
So why on earth, if the LCP has supposedly been abolished, does it seem that a very similar practice is still being carried out at Wigan?
Margaret’s only daughter Karen Masters, 47, is unequivocal; she believes, and said in court, her mother’s death was murder. ‘Mum was a bonny lady who weighed 14st when she went into hospital. When she died, she was like a bag of bones.
‘She only went in because she had an infected pressure sore and she came out in a box. How did that happen?’
Margaret, also mother to Kevin, 42 and Derek, 37, had suffered from a lung condition for 20 years, which had been managed with medication. But, critically, her tablets were stopped as soon as she was placed on her end-of-care plan.
Speaking from the terrace mill worker’s cottage she shared with her mother in Wigan, Karen adds: ‘Two weeks after she went to hospital, she was put in a side room and basically left to die.
‘Mum had no food or water. Even the tea trolley missed her out in this death room. We were told they were stopping her medication because they didn’t know how fast the cancer was spreading and there was no need for them any more.’
An inquest into Margaret’s death last year heard she was not a well woman who was a heavy smoker, and that two days after she had been placed on palliative care, hospital staff had a meeting after learning she did not have cancer.
But they didn’t tell the family of their findings or change their course of action — something the coroner criticised.
Today, Karen is fighting for a second inquest to challenge the verdict that her mother died of ‘natural causes’ from pneumonia.
She believes malnutrition should have also been recorded as a cause of death because of her mother’s dramatic weight loss and because, she claims, this is what the coroner’s officer told her.
Much to the family’s bewilderment, the coroner was satisfied that the treatment and care given to Mrs Hesketh, 70, did not amount to gross neglect or negligence.
The family say her mother was placed on palliative care a day after being admitted to hospital on October 31. The hospital say it was not until mid-November. Either way, the family want answers.
Unable to contain her tears, Karen, who works as a carer, says: ‘My mother was so heavily sedated on morphine she was unable to eat or drink. She was allowed to just waste away.’
Describing the moment the coroner’s officer revealed the cancer- free post mortem results, she explains: ‘I thought, oh my good God! We
have never known such devastation or felt anger like it. How despicable. How barbaric.
‘There’s nothing more anyone can do to me because they’ve done the very worst thing possible, they’ve killed my mother. They took her away from us. She didn’t need to have died. And they keep on washing over the truth. Well, I’m not going to let them.’
SUCH devastation is, unfortunately, not unique. Helen Prescott is similarly scarred, admitting she will be forever haunted by her 88year-old mother Hilde’s treatment during the final days of her life. Hilde was admitted to the Winstanley Ward in April for routine tests following a urinary tract infection. Doctors suspected she may have had a stroke after becoming drowsy and unresponsive.
But although tests came back negative, Hilde was still placed on an end- of-life care regime as her condition badly deteriorated. She died three weeks later.
Philosophy lecturer Helen, 63, from Horwich, near Bolton, was so horrified by what she witnessed she complained to police immediately. They have now agreed to examine the case.
The hospital say fluids were being administered with a cannula, but Helen disputes this.
‘For days my mother was crying out for water. You wouldn’t treat a plague-infested rat like that. I sat by her bed and nurses told me she couldn’t swallow so wasn’t allowed a drink. But tests while she was in hospital showed she could swallow. She wasn’t even terminally ill.
‘ She kept everyone on the Winstanley Ward awake night after night, crying out, begging for a drink. The other patients told me when I came to visit. The only time she was quiet was when she had fallen asleep exhausted.
‘I should have ignored the nurses and given her a drink, but they told me she would aspirate [take it into her lungs] if I did and instead to dab her lips with water. I bitterly regret doing as they asked, but they were quite forceful — and I’m no medical expert.
‘My mother was born in Germany. She survived the blitz and the firebombing of Hamburg which saw many of her relatives burn to death, only to be killed in an NHS hospital after being wrongly placed on what is basically the Liverpool care Pathway in a different guise. She was deliberately starved and dehydrated. It is a scandal.’
Indeed, Hilde was still leading a thoroughly full and happy life. A former chef, she had five children (tragically one, also called Helen, drowned in pond as a toddler 50 years ago).
A widow since her husband Arthur, a former member of the RAF and furniture maker, died 23 years ago from cancer aged 62, she was the epitome of spritely.
She enjoyed a tipple in her local in Ashton-in-Makerfield and she and Helen travelled widely together — indeed Hilde was looking forward to a trip to the Amalfi coast in May.
‘I believe my mother was murdered by Wigan Infirmary,’ says Helen, furious at her mother’s misdiagnosis as terminally ill. ‘The death certificate said she died primarily from kidney failure. But she was hardly given anything to drink so that’s not surprising.’
Police have also extended their inquiries to the case of Benjamin Bowdler, who died before the LcP was abolished in 2012 at the age of 63 after also being treated on the Winstanley ward. Benjamin, known as ‘Bob’, had been left in a vegetative state after a skiing accident in the Swiss Alps in 2011.
He was allegedly misdiagnosed with aspiration pneumonia and a blocked feeding tube. But his sister, Margaret Whalley, insists he was not terminally ill when placed on the plan. She spent four years trying to establish the truth behind his death until police finally agreed to review the case this month.
Margaret, 60, said: ‘If there is no accountability regarding the reasons nutrition and hydration are withheld and how these reasons are recorded then the most vulnerable are at risk.’
Wigan MP Lisa Nandy has written to Health Secretary Jeremy Hunt asking him to intervene in Bob’s case, suggesting they have been denied the truth behind the death.
The death of Winifred Brogan, 93, is also being examined by police. Earlier this month, her daughter Pat, 60, a former nurse, received an offer of £1,000 compensation after the Health care Ombudsman upheld her complaint that her mother was wrongly placed on the LcP in 2013.
Again, the initial health problems which sent Winifred, a widowed mother-of-five, to Wigan Infirmary were relatively minor. She was admitted on November 7, 2013 with a suspected urinary tract infection. A junior doctor then diagnosed her as suffering from pneumonia and sepsis, and she was treated with antibiotics.
While a decision was taken to monitor her for 24 to 48 hours, within just three hours of her diagnosis the same junior doctor had placed her on the LcP.
Her horrified family, backed by Winifred’s GP, objected so strongly doctors agreed to send her home — but, vitally, without antibiotics.
Winifred quickly deteriorated. She was readmitted to the hospital on November 13 and died the next day.
‘Somebody should be accountable. The junior doctor got off with a slap on the wrist and that’s not enough,’ says Pat.
‘She might have been in her 90s, but she still had a great sense of humour. She was so affectionate and adored her five grandchildren and 12 great grandchildren. Family always came first for Mum.’
Pat, who lived with her mother, says one of the hardest things to bear is the guilt that she could have saved her.
‘I constantly wonder how many people might have died on this pathway unnecessarily.’
Professor Patrick Pullicino was the neurologist who, in 2012, blew the whistle on abuses carried out under the LcP. Today he says the complaints emerging from Wigan expose how end-of-life care remains lethally flawed.
‘ Why, if the Liverpool care Pathway was abandoned in 2013, are we still seeing cases of enforced dehydration of the elderly?’
He goes on to say that these reports ‘confirm the replacement for the LcP is just as bad as it was’.
Since the axing of the LcP, there are now new end-of-life care guidelines, which are meant to provide a more individually-tailored approach, rather than the tick-boxing attitude of its predecessor.
However, Prof Pullicino says: ‘The culture of dehydrating those diagnosed as dying that came in with the LcP has not stopped when it was discontinued. It is unfortunate that a “group-think” mentality that this is acceptable care appears to have taken over in the NHS.’ Indeed, he believes that withholding fluids from patients has become dangerously routine.
To halt this callous practice, he says NHS Trusts should report every instance of withheld hydration to a patient that last for longer than 24 hours, as well as making sure there is a named consultant for every patient in hospital and for relatives to be listened to.
It is notable that, before the abolition of the LcP, nearly one in two hospital deaths in Wigan were on the discredited protocol — making it one of the most prolific users of the pathway in the country.
Greater Manchester Police would not comment on the individual cases, but a detective chief inspector is examining the deaths before deciding whether to launch a formal investigation.
Meanwhile Pauline Law, Director of Nursing for Wrightington, Wigan and Leigh NHS Trust [WWL], said that ‘Any corrective action recommended has also been addressed or implemented and all the families concerned have been invited to meet with WWL to further discuss any issues.’
She also said that they wished to reassure the public as end of life care services have continued to ‘significantly improve’, while also highlighting how a recent care Quality commission inspection rated such services as ‘outstanding [which is] the highest accolade a service can receive’.
BUT that doesn’t escape the fact that more and more families are asking police to investigate their relatives’ deaths. So are events in Wigan just the tip of the iceberg? Is the LcP back — albeit under another guise?
Many believe this is the case. Julie Hurst, 55, wants answers over the death of her mother, Betty Lythgoe, 85, also treated on the Winstanley Ward, in 2015.
In cheshire, officers have examined the medical records of pensioners Alice Johnson and Margaret Smart, who both died at Warrington General Hospital last year.
And the family of Margery Freeman have asked West Yorkshire Police to investigate their mother’s death at Pinderfields Hospital, Wakefield, in June 2014, after she was dehydrated over nine days.
A spokesman for Pinderfields Hospital said that, after receiving a complaint from the Ombudsman, ‘ we complied with all their recommendations and the case has now been closed’.
A spokesman for Warrington and Halton Hospitals NHS Foundation Trust said: ‘We work hard to support patients with the best possible care at all stages of their illness. In keeping with most other hospitals, at the time of Mrs Johnson’s death we were using the Liverpool care Pathway.
‘It is important to note that in our hospitals we had, and continue to have, an extremely strong programme of training and education to ensure that patients are supported with the best care possible based around their personal needs at the natural end of life. This is a principle we always work to at what can be a very difficult time.’
For Margaret, Hilde, Bob and Winifred and the other patients who may well have died unnecessarily, any investigation is too little, too late.
Their families, meanwhile, are united in their determination.
As Margaret’s daughter Karen says: ‘My mother loved life, but she was so terrified of dying. She always made us promise we would be there holding her hand. But she died before visiting hours, so even that was taken away from us.
‘I will not stop fighting until I have justice for her — and all the others who died in this degrading and inhumane way.’