Case studies/ stats / figures Flashcards
Gillick competence
Victoria Gillick: leaflets in her local practice showed that contraception could be given to minors, she thought this would promote sex with minors and so took it to court.
This was ruled against her, and the Gillick Competence Guidelines were created.
Genetic engineering:
Lulu and Nana case: CCR5 gene resistant to HIV infection, cannot enter WBCs. In 2018 they were the first genetically engineered babies without consent, scientist sacked from Uni and given 3 years in prison, broadly condemned by scientific world. unclear what results are as they are still young and there are still ethical complications to disturbing their normal lives with testing.
Negligence: case, possible factors, improvements
Dr Bawa-Garba Case: 2011 peadatric registrar
Jack, 6 yr old with Down’s syndrome and AV septal defect, passed in Jan 2011, Nov 2015 Dr was found guilty of manslaughter on ground of gross negligence, x-rays not seen for hours after results, late prescription of antibiotics, 5 hour late reporting of blood tests, suspensions of all long term prescriptions without writing them on drug charts, confused a DNAR with another patient and stopped resus for 2 minutes.
Fall on Dr or understaffing, lack of availability of senior consultants’ failure to communicate availability of results.
Struck off initially, stress and workload taken into context, Dr is practising at a lower grade and with supervision now, UK gov published reforms.
Improvements: changes in hospital protocol, improvements in tech, discussion about stress and workload on doctors.
Vaccines: case, consequences
MMR Scandal:
Case study: Wakefield’s Lancet Publication, MMR leads to autism. Published by The Lancet and was incorrect and did not follow the scientific method, causing an increase in vaccine hesitancy and recurrence in MMR.
Measles Mumps and Rubella. Given to young children, 12 months first dose, combination of 3 vaccines reduced time until all diseases are vaccinated against.
Dr AJ Wakefield
Consequences: MMR vaccine coverage fell as low as 80% in 2003-4
Continued worried and doubts about vaccine safety, affecting uptake and reluctance.
Impacts those who have autism painting the condition as worse than even deadly diseases.
Obesity: uncontrollable case
Prader-Willi syndrome: loss of function of genes on chromosome 15, no paternal copies inherited.
Affects hypothalamus, leads to insatiable appetite that drives obesity, no direct cure.
Francis Reports Negligence: background, review, reports, recommendations, responses
Robert Francis QC Barrister specialising in Med Law, including Clinical Negligence claims.
Public Enquiry into poor care at Mid Staffordshire NHS Foundation Trust 2005-09.
Enquiry focused on organisations responsible for regulating and managing the trust did not spot problems before they were brought to light by the campaign group ‘cure the NHS’.
Report:
Exposed appalling treatment and high mortality rates at the hospital and concluded that an estimated 400 to 1200 people could have died unnecessarily between 2005-08.
Recurring problems such as:
Call bells unanswered
Patients lying in own urine/excrement.
Food and drink left out of reach of patients
Patient falls concealed from relatives.
Too few consultants and nurses.
Poor communication between staff and relatives.
Francis Reports:
1st:
2010 ‘historic understaffing’ of nurses as one of a number of reasons for poor care.
Wards re-organised without proper risk assessments compromising patient care.
Ratio of nurses to HCAs dropped to 40:60 (65:35).
Francis criticised the organisations obsessions to obtain foundation trust status instead of patient care.
Poor nursing care was at the heart of the Mid Staffordshire foundation trust.
2nd:
2013
Set up of the health and social care system in England can help or hinder nurses and other healthcare staff to deliver good care. It also focused on the culture of the NHS and its impact on staff voice.
Recommendations (over 200):
Staffing levels and skill mix
Protection of whistle-blowers
Eradication of the blame culture and bullying
Training and regulation of healthcare assistants
Recruitment training and standards of registered nurses.
Reponses:
GMC Oct 2013 included and insight into education safety in the practice environment and info sharing.
Government included actions for improving patient care, increasing openness and changes to regulations in hospitals.
NICE Created guidelines on staffing capacity to ensure safety in the NHS.
Dissolution of the NHS Trust
Shropshire maternity scandal: background, key patient, report, malpractice notes, impact
Nov 2019, report from an interim inquiry into failings at the Royal Shrewsbury and Princess Royal Hospital in Telford was leaked to the press.
Investigated deaths and injuries of babies at the two hospitals dating from 1979 to present, with the majority of cases occurring since 2000.
Midwife Donna Ockendon led the review, with more than 1800 cases examined after families were invited to contact the inquiry, from an initial 23 families, the hospitals were placed into special measures.
Obsessions with meeting targets for normal births lead to contraindicated vaginal births instead of c-sections. Also a complete lack of compassion including one mother who was told to ‘keep the noise down’ as her baby died in her arms. Ignoring sings of Strep B and leaving confidential information on post it notes around the ward.
Key patient: Stanton-Davies Family
Baby daughters death Kate in 2009.
Pregnancy was meant to be marked as high-risk and the mother should have never been on the unit in the first place, midwifes failed to monitor Kate’s condition.
Inquest made into Kates death ruling was it was avoidable.
Resulting review found systemic failings of the former head of midwifery and midwives who altered notes retrospectively.
Stanton-Davies family worked with a second family who wrote to the Health Secretary, Jeremy Hunt, who ordered an independent investigation.
Report:
Biggest maternity scandal in the history of the NHS, unchecked clinical malpractice for over 40 years.
250 Cases examined, at least 42 babies and 3 mothers died avoidably. 50 New-borns may have sustained avoidable brain damage.
Malpractice notes:
Repeated clinical errors were inadequately followed up, preventing reflection.
Bereaved families weren’t treated with respect, with staff referring to babies as it and one baby’s body left to decompose for weeks after a post-mortem.
Impact:
Trust ordered to repay 1 million initially given by NHS Resolution for good maternity care.
Two months after the payment in Sep 2018 CQC rated the maternity services an inadequate and placed under special measures requiring weekly reports.
Jun 2020 West Mercia Police began a criminal investigation into the deaths of babies at Shrewsbury and Telford Trust, to see whether there was evidence to support a criminal case, which is ongoing.
Aug 2020, new areas of concern identified at the Shrewsbury and Telford trust, failing leadership is perpetuating poor care, rated inadequate on every measure.
Charlie gard: background, potential treatment, result, ethics, key info
Born 4th Aug 2016, Charlie appeared to be a healthy child, after a month unable to support own head.
The weeks that followed Charlie couldn’t gain weight and was transferred to GOSH.
Later diagnosed with infantile-onset encephalomyopathic mitochondrial DNA depletion syndrome (MDDS), one of 16 known cases.
Charlies brain heart liver kidneys and his ability to breathe were severely affected. He also had congenital deafness and epilepsy.
Also suffered from severe progressive muscle weakness, couldn’t move limbs or breath unaided. He couldn’t open his eyes, which weren’t developing properly, impossible to tell if he was awake or asleep.
Potential treatment: nucleoside bypass therapy
Untested on humans with his specific condition but the Neurologist Dr Hirano claimed there was a ten percent chance it could improve the baby’s condition.
No evidence to suggest the treatment would be able to cross the blood brain barrier and resolve his brain damage.
Experts at GOSH feared it would only prolong his suffering.
Despite raising money to travel and fund the treatment the legal battle to continue treatment was lost and he died on 28th July 2017 11 months old after his life support was removed.
Ethics:
Protecting Best interests
Experimental treatments vs Distributive Justice
Autonomy
Charlie Gard’s parents are advocating for a change in the law, wanting judges to ask if the treatment would cause significant harm, if not they should be allowed to test their options.
The change would allow independent medical mediators to get involved in any disagreements as early as possible, which aligns with new advice for RCPCH.
Alfie evans: case, impact, ethics
Suffered from a degenerative neurological condition, admitted to hospital Dec 2016 after suffering seizures and remained a patient there.
His parents wanted to fly to Rome for further treatment but Alder Hey Children’s hospital described the decision as inhuman and futile
At 23 months old the courts ruled for his life supports to be removed.
Impact on NHS and UK Law:
49 000 children and teens suffer from potentially life limiting diseases, only expecting to rise as medical advancements allow unwell babies to live for longer.
Key:
Royal College of Paediatrics and Child Health RCPCH believes that such cases are traumatic and distressing leading to difficulties in recruitment and retention of vital NHS staff.
Ethical dilemmas to life sustaining treatment being withheld/drawn:
Autonomy: a competent patient refuses it.
Distributive justice: expected benefit is insufficient to justify public resources being used.
(30k or less per QALY) (Nucleoside bypass was estimated long term 150k for a shortened lifespan)
Quality of life for Charlie at 0.3 x 50yr life is 15 QALYSs , x 10% likelihood, 1.5 QALYs for 150k
However money was raised privately so this point is uncertain.
Treatment is not actually the best thing for the patient, in terms of trauma suffered to go through treatment.
Indi Gregory: case, result, ethics
Nov 2023, Gregory was the latest critically ill baby in a life support legal battle.
Died on November 13th 2023 brought to light the complex interplay between parental rights, medical ethics and judicial decisions in the UK.
The case involved the court agreeing with the NHS medical professionals’ recommendations to withdraw life-sustaining treatment from Indi despite objections from her parents.
Born with a life limiting Mitochondrial disease, treated at Queens medical centre in Nottingham in 2023
Indi’s parents appealed for other care pans including treatment in Italy and home care, however life support was withdrawn in a hospice on Nov 13th 2023.
8-and-a-half-month-old born in Feb 2023.
Italian gov granted Italian citizenship aiming to facilitate her transfer to a paediatric hospital in Rome however the UK court upheld their decision.
Ethics:
Best interests safeguarding for the patient
Exploration of treatment options (and transfer)
Distributive justice
Billy caldwell
Autism and Severe epilepsy
Was prescribed Cannabis oil by his GP in 2017 but was later refused due to THC.
Mother tried to get cannabis oil from Toronto but had this confiscated.
Billy was completely taken off the oil causing seizures.
Public outcry in 2018 led to special measures to use cannabis oil at a select trust.
Long commuting to the hospital described as hospital arrest.
Billy was later getting a private prescription from a neurologist in London, meaning he had to fly to England every few weeks to collect more oil.
In 2019, he was given a lifelong medicinal cannabis prescription on the NHS.
Alfie Dingley
Moved to Amsterdam to get cannabis for seizures, improving rate from 3000 seizures a year to 20.
Mother became first person to be granted a special import licence back into the UK.
Resistance developed and requiring a new strain and the hassle to import this would take months so they moved to Amsterdam to receive this strain.
Archie Battersbee: case, considerations
12-year-old boy passed away in 2022
Suffered traumatic hypoxic brain injuries following an accident at home. First allegedly participating in blackout challenge viral then putting a belt around his neck to experience a high before passing out.
Doctors believed him to be brain dead and to withdraw life support but his parents wished against it.
After a series of legal battles, life support was withdrawn on Aug 6th 2022 in the Royal London Hospital with his family bedside.
Considerations:
A recent court case ruled families do not need to seek a judges consent to remove a patient’s life support.
Brainstem death occurred in this case, the cessation of brainstem function including the ability to breathe independently, irreversible.
Harold shipman: case, improvements
Murdered at least 250 (upwards) of his patients of 15 years of practice, using lethal doses of heroin.
Testimonies from his colleagues and forensic evidence of the bodies, falsified medical records to cover his crimes.
Sentenced to life in prison with at least 15 years before possibility of parole.
Struck of GMC register and banned for life.
Unclear motivation possible narcissistic personality disorder and a lust for power and control.
Died whilst serving his sentence in prison in 2004 committed suicide
Improvements:
GMC given more power to investigate complaints about doctor’s conduct.
Introduction of a new system to track doctors’ prescriptions.
Creation of CQC to inspect and regulate healthcare providers.
Better training for doctors in ethics and patient safety.
Lucy Letby: case, ethics
Neonatal Nurse, Countess of Chester hospital.
Jun 2015/16 guilty of murdering 7 infants.
Injecting babies with air, force-feeding milk and insulin poisoning. (C-peptide levels low, insulin poisoning)
Doctors called into question her after 3 babies died within 2 weeks, yet this was ignored by hospital management.
Jun 2016 she was removed from the ward after a senior colleague raised concerns.
After being arrested on suspicion of murder in 2019 and again in 2020, One of the longest murder trials in the UK, over 10 months, guilty of 7 counts of murder and 7 counts of attempted murder.
An investigation led by a senior judge recently been launched to look into failures of hospital management.
Ethics:
Breach of patient trust: on duty for all seven infant deaths, to what extent is the role of hospital management and colleagues blamed?
Whistleblowing: What kind of hospital environment is required to allow people to raise concerns?
