‘Hospital placed a do not resuscitate order on my partner without my permission’
WHEN Celia Jones received a call from the Royal Gwent Hospital in Newport she couldn’t believe what she heard.
While driving to the hospital along Cardiff Road on the evening of September 27, 2017, she was told she was too late, and that her partner of almost 30 years was dead.
She thought those words would be the most shocking she would ever hear, but nothing could have prepared her for what was to come in the days, months and years ahead.
The revelations surrounding Brian Boulton’s death are so devastating they’ve left Celia thinking about little else five years on.
Celia discovered eight months after his death that doctors made the decision not to resuscitate Brian without asking him, Celia, or Brian’s brother, and placed a Do Not Resuscitate (DNR) form on his files seven days before his death by aspiration pneumonia.
Even more shocking, the form states that Brian, 69, had no known relatives alive, despite Celia attending the hospital regularly.
“I think some of them really didn’t know who I was,” Celia told the Western Mail from her home in Newport.
“Sometimes they called me daughter, sometimes wife, sometimes girlfriend. I don’t know why I was never consulted about the DNR and I’ve never received an answer.”
The couple first met in 1986 and they were reunited again in the early ’90s when Celia returned from a couple of years working in Australia.
They had lived together since 2000.
“Brian had been a very fit person until he fell ill with COPD (chronic obstructive pulmonary disease) in 2016,” she said.
“He played a hell of a lot of tennis until his 60s and he was a coach too in his spare time. He was a lovely, laid-back and pleasant man.”
But despite Brian’s fitness, Celia – a former NHS nurse with the Cardiff and Vale health board – claims a “catalogue of errors” led to his rapid decline, including a missed cancer diagnosis, and incorrect and unnecessary medicine which she believes contributed to his sudden death.
In July 2019, when reading through Brian’s post-mortem notes, she found that he had been suffering with oesophageal cancer.
“I couldn’t believe it,” the 68-yearold said. “I think it’s really shocking that wasn’t picked up. The size of it was like a tennis ball.”
Celia was so dumbfounded she called for a public inquiry and the ombudsman investigated Brian’s care in the days before his death.
They upheld her official complaint against the health board regarding the care delivered relating to the scans.
The ombudsman’s report said: “The CT scan showed evidence of oesophageal cancer and indicated that the cancer had spread to the lymph nodes in the surrounding area. These findings should have been reported and an urgent cancer referral made.”
Celia accepts that a diagnosis of cancer might not have greatly prolonged Brian’s life but she said: “At the time the cancer should have been found a stent should have been fitted. If that had happened he wouldn’t have got aspiration pneumonia.”
She also claims that Brian was given potentially harmful medication needlessly by nurses two hours before he died.
Nurses gave Brian fluphenazine medication, which Dr Mark Burgin of the Medical and Forensic Expert Witness Services determined “could have caused decreased respiration”.
The ombudsman’s report reads: “I have been advised that there was no clinical evidence to suggest that the fluphenazine medication caused [Brian’s] acute deterioration.
“However, the health board has acknowledged that the fluphenazine should not have been given to [Brian] as the CPN had determined that due to his poor physical condition there would be no clinical benefit.”
Celia claims she was restricted from visiting the hospital regularly, which contributed to the fluphenazine being given by nurses.
She says she was restricted to one hour visiting time on a Tuesday and one hour on a Thursday over concerns she was giving Brian unprescribed furosemide medication.
Celia maintains the medication was prescribed and Brian was selfmedicating.
Celia says the accusations against her and the impact on her not seeing Brian as often as she could have before his death still sticks with her. “It was awful,” she explained.
“I was taken out of making funeral arrangements. The doctors told Brian’s brother that I had given Brian unprescribed medication before his death, but I hadn’t. It’s terrible and I do live with it every day because I was not there when he died and I should have been. I still feel so guilty that I wasn’t there.
“On Monday 25th I walked in and within minutes I was called in to see the doctor who accused me of giving him furosemide.”
The ombudsman’s report suggests that Celia was restricted from visiting the hospital due to poor behaviour in the ward which nurses said was distressing patients.
“I wasn’t,” Celia said. “I am a timid person generally and I genuinely don’t wish to make waves.
“It was often like a pub there. They would call time and try to kick you out and it was horrible and really upset me.
“Brian had been in the hospital a year before and it had been nothing like that. I had open visiting. I was a nurse and so I knew how it worked.”
Celia is also devastated that she was not able to be at her partner’s bedside when he died, having received a call warning her he was dying 10 minutes before he did.
Nursing records show that his deterioration had been obvious to medics an hour before this.
She admits she has gone further than the ombudsman’s report on social media with her accusations against the health board.
It has led to the health board reporting her to the police.
“I felt intimidated by the police’s visit to be honest and it has worried me,” she said.
“I am speaking out because I don’t want this to happen to others.
“I do still feel angry. I still feel as though there has been no accountability for any of it, and that makes me feel as though I can’t move on. I want them to say sorry about the unprescribed medication allegations against me, but that has never come.”
A spokesman for the Aneurin Bevan University Health Board said: “We have offered our apologies to Ms Jones and we are very sorry for those elements of her late partner’s care that fell below the expected standard, despite the best efforts of our staff. Our thoughts remain with his family and friends.
“We have already fully co-operated with a Public Services Ombudsman for Wales’ Office inquiry and provided information to aid their independent investigation. We accepted the recommendations outlined in the ombudsman’s report, a number of which we have already addressed in response to the original complaint from Ms Jones in 2017.”
A spokesman for Gwent Police said: “We’re investigating reports regarding an allegation of malicious communication. Several people have been contacted by officers to assist their inquiries and the investigation is ongoing.”