Medical Negligence

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In Memory of Robbie Powell
By Will Powell

This article is dedicated to a little boy called Robbie Powell. His family's perseverance and dedication throughout their long fight for justice are an inspiration and example to us all.

Robbie Powell died at the age of ten on the 17th April 1990 of a treatable condition called Addison's disease which, unknown to his parents, had been suspected four months before his death, when he had been an inpatient at Morriston Hospital, Swansea. The test to confirm the diagnosis was ordered by the hospital consultant but not performed. Addison's disease invariably results in death without treatment; however, if treated the patient can live a full and normal life. The hospital had informed the GPs of the suspicion Addison's disease and requested immediate referral if Robert had a recurrence of, amongst other things, vomiting and/or abdominal pain. Between the 2nd and 17th April Robert was seen by five GPs from the Ystradgynlais Health Centre on seven separate occasions [i.e. 2, 6, 11, 15, 16 and twice on the 17]. In the 2 weeks leading to Robert's death he had been vomiting [a characteristic symptom of Addison's disease which had led to his initial hospital admission], was so weak he couldn't walk unassisted, had excessive weight loss, dilated pupils and central cyanosis when he regained consciousness after fainting on the day he died. In the light of these symptoms and the several earlier consultations the GP refused hospital admission on her first visit of 17th April 1990. On her second visit the GP again refused hospital admission but eventually agreed following a heated argument. However, the Powells' request for an ambulance was refused. On arrival at the hospital, Mr Powell watched his youngest son take his last conscious breath. Robert was declared dead shortly after.

The Powells were refused an inquest and the coroner did not have any preliminary inquiries notwithstanding medical negligence had been alleged by the family. It came to light that the pathologist, employed by the health authority that would later admit liability for Robbie's death, withheld from the coroner that Robbie had been suspected of Addison's disease, that the test to confirm the condition was ordered, but not performed, and that had it been Robbie would not have died. The pathologist also misrepresented Robbie's external appearance in the post mortem report by stating he was a well-nourished child. Following a several year campaign and a Court Order from the Attorney General, the Swansea coroner was forced to open an inquest in December 2000. The jury at the inquest found in April 2004 [14 years after the child's death] that Robbie died of 'natural causes aggravated by neglect'. The verdict was based on falsified medical records and the coroner denied the Powells the opportunity to call witnesses to prove that the medical records were not authentic. Had the jury known the full truth I believe that the only verdict that would have been open to them would have been one of 'unlawful killing'. The doctor who attended Robbie on arrival at hospital on the night he died gave evidence at the inquest that he had the appearance of a child from a concentration camp, which was, in direct contrast, to the pathologist's record that Robbie was a well nourished child.

The senior partner at the health centre refused Mr Powell's request for an investigation into Robert's death. The doctors subsequently falsified Robbie's medical records to evade the consequences of their gross negligence and did so with the knowledge that Mr Powell and a witness had examined and noted the original documents.

The Powells had no other option but to complain to the appropriate Family Practitioners Committee. A Medical Service Committee in December 1990 exonerated 4 of the GPs and found one to be in breach of her terms of service - she was given the minimum reprimand. Mr Powell appealed to the Secretary of State for Wales. A subsequent appeal hearing at the Welsh Office in 1992 collapsed because of alleged maladministration, which the Welsh Office vigorously denied for three years in the light of evidence to the contrary. However, even when the Powells were vindicated, and the Welsh Office was forced to admit the maladministration, the Powells were still refused their statutory right to a fair and honest investigation into Robert's death and did not even receive an apology. However, seven years after the collapse of the Welsh Office appeal the Parliamentary Ombudsman accepted, in 1999, after initially refusing to investigate the case in 1993, that it was the Welsh Office's maladministration that caused the collapse of the appeal. Mr Powell was awarded £500 for the injustice and hardship he had suffered. The Parliamentary Ombudsman did not recommend that the Welsh Office should now have an inquiry into Robbie's death and has to date failed to explain why he initially refused to investigate the Powells' MP's complaint in 1993.

A complaint to the local police force in 1994 resulted in a 2-year investigation. However, the CPS decided in 1996 that there was insufficient evidence to prosecute any of the GPs. It later came to light that the GPs under investigation had been providing a police surgeon service, to the investigating force, for the past 20 years. An outside police force subsequently found that the police investigation was so flawed that it demonstrated 'institutional incompetence'. An independent criminal investigation, by an English police force, between 2000 and 2002, found that there was evidence of criminal offences and submitted a file to the CPS in York. The CPS informed the Powells in March 2003 that there was sufficient evidence to prosecute at least two of the GPs for forgery and attempting to pervert the course of justice. However, they would not be prosecuted, because to do so, would be an abuse of process [i.e. because of the passage of time, because the police failed to adequately investigate the case in 1994-96 and because the police had informed the GPs in writing in 1996 that no further action would be taken against them].

The Powells were forced into a civil action for negligence hoping that the truth would be established. However, that wasn't to be. In 1996 West Glamorgan Health Authority admitted liability for Robert's death with the same information that was available on the night the child died [i.e. Addison's disease should have been diagnosed]. £80,000 was paid into court, which the Powells initially refused, and the GPs successfully had the case struck out against them as doctors had no duty of care to tell parents the truth about the circumstances of a child's death nor to refrain from deliberately falsifying medical records.

The Powells' legal advisers and a representative from the Legal Aid Board informed them that if they did not accept the compensation from the health authority they would have their Legal Aid Certificate forthwith discharged and would not be in a position to appeal to the Court of Appeal against the High Court judgment. The compensation was therefore accepted by Mrs Powell and secured by the court pending the outcome of the appeal. The appeal failed, as did the Powells' subsequent Petition to the House of Lords and the compensation was completely absorbed in legal costs - there was also an Order for costs against the Powells and the appeal judges told them that there is no more that they could do. The case was then submitted to the European Court of Human Rights but was deemed, on the 4th May 2000, to be inadmissible. This was because the Powells could not claim to be victims under Article 2 of the Convention as they had accepted £80,000 compensation in civil proceedings and had withdrawn from the Welsh Office appeal. The Parliamentary Ombudsman's report confirming that it was the Welsh Office's maladministration that had caused the collapse of the appeal was disclosed but not taken into consideration. By accepting the compensation in the civil proceedings, it was claimed that the Powells had denied themselves the opportunity to have a full adversarial hearing on their allegations of negligence in the court, to subject the doctors concerned to cross-examination under oath and obtain discovery of all documents relevant to their claim. The European Court also considered that the Powells could have made their grievances about the medical records a live issue before the court and that there is no reason to doubt that this would have dominated the pleadings. The European Court failed to take into consideration that the Powells had been forced to accept the compensation because of the restrictions of public funding in Britain [see above]. It was therefore erroneous of the European Court to say that the Powells denied themselves the opportunity to a full adversarial hearing as the decision to accept the compensation was taken completely out of their control by the British Justice system. Furthermore, a year later, several of the same European judges ruled, in Jordan v UK that civil proceedings did not fulfil the State's obligation under Article 2 as these proceedings are initiated by the bereaved relatives.

The Law as it stands today - below is the last paragraph of page 15 of the European Court of Human Right's judgment:

"Whilst it is arguable that doctors had a duty not to falsify medical records under the common law (Sir Donaldson MR's "duty of candour"), before Powell v Boladz there was no binding decision of the courts as to the existence of such a duty. As the law stands now, however, doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even to refrain from deliberately falsifying records."

In response to this astonishing judgment the British Medical Association stated [GP Magazine 11/7/97]:

"GPs could now put a gloss on the cause of death without fear of litigation."

It is interesting to note that there is a law to protect the privacy of the Prime Minister's children but there is no provision in law for parents to know the truth when their child dies as a result of a doctor's negligence.

It is the view of the Powells, and that of many others, that the NHS complaint procedures are conveniently structured to protect the medical profession. Furthermore, the NHS complaints procedure and medical negligence litigation will be compromised until such a time that doctors have a legal duty of care to tell the truth and are precluded by law from falsifying medical records. There is also no current mechanism to address impropriety and the abuse of power by individuals within the NHS investigating authorities and government. The absence of a deterrent not only breads complacency but encourages individuals, with a conflict of interest, to cover up medical mistakes. The Powells have taken their complaints to the Prime Minister on several occasions. However, the complaints are referred straight back to the individuals complained against and the complaints are again brushed under the carpet of deceit. It is the failure of the government to address public concern that leads to such atrocities as the Bristol Heart Babies and many others.

The Powells are now calling for a public inquiry into Robbie's death and the post death cover up and would very much appreciate your support. You can help by completing the form below and sending it to the Evening Post. The First Minister of the National Assembly for Wales is currently considering whether there should be a public inquiry into Robbie's case and your support may make the difference.

Please print and return the form below, or click here to fill in the form online.

Resources

All you need to know about Addisons Disease
Addisions Disease Self Help Group
Medline Plus on Addisons Disease

Stop This Witch-Hunt
Family Of Tragic Girl Back Robbie Inquiry
Robbie Powell - New Southwales
First Minister Urged To Order Death Probe
Lessons Must Be Learned
Help Expose Cover-Up
Tragic Family Call For Public Support
Morgan May Order Inquiry On Robbie
Calls Mount For Robbie Death Probe
Couple's Courage
Boy Died After A 'Gross Mistake'
Robbie Gp Negligent Says Medical Expert
Death Case Gp Rejects Criticism
'I Would Have Taken Robbie To Hospital'
Inquest Resumes On Tragic Robbie
New Delay In Death Probe On Robbie, 10
Boy's Inquest Resumes After Seven Weeks
Boy's Inquest Is Delayed By Absent Expert
Doctor Expected A 'Less Sick' Child
Mum Regrets Hospital Delay

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