Surgery under fire over ‘do not resuscitate’ row
Letter to people with life-limiting illnesses amid Covid-19 crisis causes upset:
A GP surgery which sent people with “significant life-limiting illnesses” a letter offering to complete a DNACPR (do not attempt CPR) form for them has come under fire.
Llynfi Surgery, in Llynfi Road, Maesteg, sent the letter to patients with serious health conditions such as incurable cancer, motor neurone disease, and untreatable heart and lung conditions, on March 27.
It said that people with these conditions are “unlikely to be offered hospital admission” if they become unwell with coronavirus and “certainly will not be offered a ventilator bed”.
The letter was sent to the Gazette’s sister paper, the South Wales Evening Post by a patient who wished to remain anonymous.
They said: “It not only greatly upset me but my family and close friends.
“It was like having my death warrant being sent by the grim reaper. It made me feel worthless. I’ve lived with cancer for eight years and I want to live another couple of years. I’m not digging my grave yet.”
The letter continued: “We would therefore like to complete a DNACPR form for you which we can share with the OOH [out of hours] GP services and which will mean that in the event of a sudden deterioration in your condition because of a Covid-19 infection or disease progression the emergency services will not be called and resuscitation attempts to restart your heart or breathing will not be attempted.”
Although people with underlying health conditions are more likely to die as a result of a Covid-19 infection, victims of the disease range in age and levels of health and fitness.
The surgery goes on to suggest that the “best option” for patients is to stay at home to be cared for by their family with “ongoing support from ourselves and community nursing services”.
People considered at highest risk from coronavirus, including those with serious respiratory illnesses and cancer patients, have been told to self-isolate for 12 weeks to “shield” them from coming into contact with the virus.
A number of “benefits” to signing the DNACPR form were also listed in the letter:
“Your GP and more importantly your friends and family will know not to call 999”;
”Scarce ambulance resources can be targeted to the young and fit who have chance of surviving the infection”, and;
“The risk of transmitting virus to friends, family and emergency responders from CPR (even chest compression alone) is very high. By having a DNACPR form in place you protect your family and emergency responders from this additional risk”.
The letter ends with “in an ideal situation” the conversation would be had in person but this could not be done because of the risk of GPs catching the virus from “asymptomatic carriers”. Patients will instead be contacted by phone this week, it says.
The final line reads: “We will not abandon you but we need to be frank and realistic about what the next few months holds for all of us.”
A spokesperson for Cwm Taf Morgannwg University Health Board said: “A letter was recently sent out from Llynfi Surgery to a small number of patients. We have been made aware that the letter has caused upset to some of the patients who received it.
“This was not the intent and the surgery apologise for any distress caused. Staff at the surgery are speaking to those patients who received the letter to apologise directly and answer any concerns they may have.”
Ogmore AM, Huw Irranca-Davies, and MP Chris Elmore said: “We were made aware of the letter by worried constituents. We immediately contacted the chair of the health board with our concerns.
“Following inquiries by the board, it was made clear that this was not a standard letter from the health board or Public Health Wales. We have also been given assurances that the board is now supporting the Llynfi Surgery in reaching out to those patients who received the letter, and to offer compassionate and sound advice.
“We are deeply concerned by the content of the original letter and the distress it has caused our constituents and their families.
“Vulnerable members of our community need to be provided with the best advice possible during the pandemic, ensuring they are treated with care and compassion and respect, and following the correct public health advice.
“We sincerely hope Llynfi surgery and the health board provide that reassurance quickly.”
Older People’s Commissioner for Wales, Helena Herklots, said: “The letter sent to vulnerable patients, many of whom will be older people, by the Llynfi Surgery in Bridgend has caused significant worry and upset and I’m shocked that it was even written, let alone sent out.
“Many of those who will have received the letter will no doubt have been left feeling worthless, that their lives do not matter, and will have felt significant pressure to sign a DNACPR form.
“This is shameful and unacceptable.
“While difficult and painful decisions will need to be made in the weeks ahead these must be taken on a case-by-case basis through honest discussions between patients, doctors, and their families that consider risks and benefits as well as people’s own wishes.
“At this difficult time it is crucial that we continue to protect people’s fundamental human rights. It would be completely unacceptable to abandon these rights in favour of taking blanket, discriminatory decisions.
“I welcome the fact that the surgery and the health board has apologised to the patients affected and I hope this awful situation will lead to stronger leadership and guidance, from health boards and the Welsh Government, to ensure that people’s rights are upheld and communication with vulnerable patients is handled in a far more sensitive way as we navigate the difficult path ahead.”
On March 31, an apology was sent to the patients who received the original letter, dated March 27. It said: “On review, our letter was poorly worded and did not properly articulate the care and commitment we have for our patients.
“We would like to sincerely apologise. We understand that many of you will be concerned about COVID-19. We want to assure you that as a practice we are here to support you.”