Hearing of any death from appendicitis always brings back horrible memories to The Witch Doctor because her elder son some years ago had an acute gangrenous appendix with septicaemia followed by weeks of several complications any of which could have proved fatal. Fortunately, this young man’s mother was a doctor and well capable of being a belligerent one at that. As a result the consultant in charge was given an earful and within the hour had propelled her son into theatre instead of being sent home the day after admission as had been decided at the ward round.
Appendicitis is a serious disease if not managed promptly.
It cannot be accurately diagnosed by telephone.
A medical practitioner needs to examine the patient properly and consider the differential diagnosis carefully.
The Cockroach Catcher is highlighting the case of a six year-old boy who died because of a gangrenous appendix.
It involves Penrice Hospital, St Austell and the out-of-hours service run by Serco.
Looking at the Royal Cornwall Hospitals NHS Trust website it appears that the Royal Cornwall Hospital Truro is the only one with a major A and E Department open 24 hours a day. The West Cornwall Hospital in Penzance also has a 24-hour emergency service but only covers a range of conditions – the more serious patients being transferred to Truro.
The Penrice Hospital in St Austell does not have and A and E department. It does, however, have a minor injuries unit but it is not clear whether it is open 24 hours a day. This type of service may be nurse led. If so, they were correct not to be involved in the diagnosis of abdominal pain in a child. What then was a doctor-less team supposed to do?
In the case of the little boy who died, it seems they may have followed some sort of protocol advising that the father phone the out of hours service run by Serco. It was in the early hours of the morning.
What happened thereafter was bizarre.
Or was it just normal practice?
The father did as he was told and phoned the out-of–hours service from the hospital’s car park.
He was triaged.
By some kind of “Competent Clinical Decision Maker”
In this case, the Competent Clinical Decision Maker was a nurse. Lets assume it was a female nurse but it may have been a male.
“Triage” such as this is common practice nowadays and The Witch Doctor believes it is WRONG, WRONG, WRONG. Triage is being used in the wrong context within the NHS throughout the country.
The Triage Nurse apparently asked the father, on the phone, to examine his son’s abdomen in the hospital car park in the early hours of the morning.
This seems bizarre.
But is it?
To give the nurse some credit she seemed to realize that the child should have his abdomen examined by somebody, somewhere, sometime and she couldn’t do it through a telephone line. She may also have realised that nurses are not qualified to examine a child’s abdomen and to make a diagnosis of appendicitis or anything else for that matter.
But neither was the father.
The nurse then gave the wrong advice. According to Serco, it seems she failed to ask enough questions.
So it’s all the nurses fault then…….
Of course. That is the way of The Protocol.
“She told the coroner the nurse had been put under six months’ close supervision and the organisation had brought in new guidance on dealing with abdominal pain in children.”
If there was a need to bring in enhanced protocols for handling illness in small children, then it clearly was not all the nurses fault.
So whose fault was it?
Well perhaps, but only because they have allowed themselves to be sucked into the crazy system that exists within the NHS up and down the land.
It is a system that puts obstacles between patient and doctor.
It is system that puts obstacles between patient and accurate diagnosis.
It is a system that is governed by probability. The probability that most people most of the time are either well or have self limiting diseases and so mistakes will neither be too frequent nor conspicuous. The death of a six year old from acute appendicitis is conspicuous whereas the death of a seventy year old from the same condition might not have been.
It is inevitable that people will die if the basic principles of good medical practice are ignored or diluted down to save money i.e. the practice of a medical practitioner taking a full medical history and hands on examination are ignored.
And furthermore, it is a system that is rubber-stamped by the medical profession itself.
The Cockroach Catcher ends his post by quoting Bob Dylan.
“Yes, how many deaths will it take till he knows
That too many people have died ?”
Some interpret the lyrics of Dylan’s “Blowin’ in the Wind” are about the indifference of the human race towards its own.
Perhaps the triage nurse is not to blame for the death of the this child, nor Serco, nor “systems failure.”
Perhaps the blame lies within the medical profession itself.
The blame of indifference.
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