Medical Negligence

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The death of Dirk Ooms: NHS mistakes and cover-ups
By Jan Ooms (Dirk's son)

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In a world of authorities and abuse of power, Jan Ooms a articulate, logical and intelligent man attempted to seek the truth. To the lay observer, the events described in this article may be surreal but for those who have experienced it, it is reality. The reality that the life of a person should be valued so little that those in higher authorities will "lie" to save face. Lying is indeed a strong word but the memory of a dead man deserves the truth. For patients with little or no medical experience, the authorities attempt to gloss over the "facts". Afterall, who would know? Jan Ooms though researched his father's condition and has challenged the system for a long time. This is a simple story made complex by the conduct of the NHS Complaints Procedures, the NHS Ombudsman and finally the General Medical Council. Jan Ooms shares his grievances regarding the General Medical Council with many others. His piece regarding the GMC will contribute to their revalidation.

This is written in memory of Mr Dirk Ooms who deserved a better standard of treatment than he was provided with. Even after his death, the authorities have not had the respect to admit the truth. This is a story by Jan Ooms.

My father, Dirk Ooms, died in Victoria Hospital, Kirkcaldy following a 3-day illness in January 1998. The illness, at post mortem, was identified as epiglottitis. During subsequent years, I identified a catalogue of errors from:

• The GP who visited him at his house the evening of 11/1/98 before his catastrophic collapse,
• The ambulance crew who transported him to hospital on 12/1/98,
• Staff and procedures at the hospital where he collapsed and subsequently died.

I struggled for years to get all the information and during that time I experienced unsatisfactory complaint procedures of the NHS, Ombudsman, and GMC. The Procurator Fiscal did not wish to pursue the matter other than to remind the hospital to report all sudden and unexpected deaths. Various MPs and MSPs that I contacted did not get me any further. I also contacted the Health Committees in both Parliaments but both responded that they could not get involved with individual cases. I petitioned the Scottish Parliament to review the NHS complaint procedures. I participated in the public consultations of the Scottish Ombudsman Bill and Scottish NHS Complaint Procedures. I joined the Patients Association and AVMA but neither helped. I was expected to ask for Judicial Review and pay for it in order to contest what I regarded to be unsatisfactory and biased investigations by both the Ombudsman and GMC.

My father's sudden and unexpected death was from an illness that could and should have been treated. I have pursued the matter as far as I can go so I am now telling the story so that others will know that the mistakes have been concealed and covered up.

This is not meant to be an attack on the NHS. My grievance is about the circumstances of my father's death and also about the way that my complaints were dealt with by the NHS Complaint Procedures, Ombudsman, and GMC (All these institutions are undergoing or have since undergone changes). In recent years I have learnt that my experience is not unique and that cover-ups of medical mistakes/negligence seem to be more common than I realized.

My father's illness

My father was 73 years old, had always been in good health, and up to that point had suffered no serious illness (despite 28 years in the tropics), rarely visited doctors, and had last been in hospital in 1961 and 1964 for appendix and hernia operations. It was, therefore, an indication of the severity of his condition that he agreed to his first ever home visit by a GP on the evening of Sunday Jan 11, 1998. His symptoms, over the previous 2 days, were an initial earache followed by a painful throat that prevented him swallowing or speaking normally, elevated temperature, and difficulty breathing in any other position than an upright one.

Dr. A. Dunn, an out-of-hours Fife GP, visited him at his home and made a cursory and ineffectual physical examination that failed to see any sign of throat infection, ignored my mother's account of his clinical history, then confidently but incorrectly dismissed his illness as a viral infection, refused his insistent request for antibiotics, provided no treatment whatsoever, and left him, after her 10 minute visit, with nothing to alleviate his pain and discomfort. The following morning his own GP had to be called to the house and he arranged for immediate admission to Victoria Hospital, Kirkcaldy with suspected quinsy and with instructions that he should be kept upright. My father was able to walk into the ambulance but en route to hospital was given oxygen to ease his breathing. On arrival at A & E the oxygen treatment was withdrawn and he was taken to the reception desk in a wheelchair where admissions forms were completed and then to an examination 'cubicle'. My mother was in attendance during this time. There was no triage and no one read the GP's referral letter. The ambulance crew neglected to tell the hospital staff that they had given him oxygen. No one seemed concerned about his abnormal physical signs - R.R.36, B.P. 220/130, pulse 132, Temp 38.4 C, tripod posture, inspiratory stridor (It was later suggested that staff may have interpreted his high B.P. to anxiety!). It was in the cubicle that a nurse noticed that he was having difficulty breathing and she and the SHO ENT took him in the wheelchair to the Resus room.

What happened from then on is unclear since my mother, who had been in attendance up to that point, was escorted to the waiting area. The story goes that in the Resus room he was helped onto an examination trolley whereupon he started gasping and then stopped breathing. This was followed almost immediately by respiratory and cardiac arrests. This occurred within 30 minutes after arrival at the hospital and about an hour from leaving his home. He was intubated with some difficulty and resuscitated and admitted to ICU but never regained consciousness. Life supports were withdrawn 3 days later on the 15th and he died.

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