Law in Action asks: Legal aid changes: long overdue reform or denial of justice?

Radio 4's Law in Action asks: Legal aid changes: long overdue reform or denial of justice? I listened to this programme today. There isn't an iPlayer version available unfortunately, but the programme will be repeated on Thu 23 Feb at 20.00 on BBC Radio 4. ""The single biggest attack on access to justice since the legal aid system was introduced". That's the view of the Law Society on the government's controversial proposals to reform the civil justice system. But the government argue that the legal aid system has become unaffordable and along with no win no fee has helped create a litigious society. They say the current system is a boon for lawyers, while draining resources from organisations like the NHS and leaving many small businesses in fear of legal action." It is clear that the intended changes to the legal aid system will have a disproportionately harsh effect on medical negligence victims and their families, who are already abysmally and inhumanly treated by the NHS and their scandalously futile Complaints System. I constantly wonder why Kenneth Clarke (Justice Secretary) is so astonishingly hard on medical negligence victims. I remember he was of the same mind when he was Health Secretary over 20 years ago. His bluff, faux-reasonable style cuts no ice with me.

Why does it never occur to anyone in government that the best way - incomparably the best way - to reduce the costs of medical negligence, both the financial costs to the victims and their families and to taxpayer funds, and the terrible cost in pain and suffering to the damaged victims, is to reduce the ever-increasing incidence of clinical negligence? - And the best way - incomparably the best way - to accomplish that is make health professionals ACCOUNTABLE for their negligence.

Thousands of deaths caused by clinical negligence in the NHS

The Telegraph reports on the latest statistics about thousands of deaths caused by clinical negligence in the NHS. "The figures cover some of Britain’s worst hospital scandals including up to 1,200 people dying because Mid Staffordshire NHS Trust put Whitehall targets and cost-cutting ahead of care."

Until death because of negligence by NHS staff is appropriately punished, after trial of the negligent individuals in a criminal court, clinical negligence will continue as a prominent feature of NHS 'care'. The present scandalous unaccountability of NHS healthcare professionals naturally does nothing to discourage negligence.

Ash Wednesday

Ash Wednesday is the first day of Lent, the Christian season that is customarily a time of reflection, repentance and self-denial. It symbolises the 40 days in which Jesus fasted in the wilderness and was tempted by the Devil. He withstood the three tests and banished the devil with the words, "Get thee behind me, Satan."

It was on Ash Wednesday years ago that the then Bishop of Sheffield, David Lunn, came to see me in my home.

I had been seeking his help in my endeavours to put an end to the appallingly cruel treatment being meted out to some patients at the Charles Clifford Dental Hospital in order to cover up sustained clinical negligence. See the account of my personal experience of this. He had not wanted to help, but had not wanted to admit that he did not want to help. He had made several excuses first. Then at last he had had me to see him at the Bishop's Palace. I was shown into the library there, and waited a little while there, on my own, until he came into the room. I found it a forbidding room, with its daunting collection of commentaries on St Paul. I'd have felt happier with books about Jesus.

He had already checked up on me with Professor Eric Wilkes, whom we both knew and respected: checked that I was a person who told the truth, and Prof had assured him I was. I had told Prof that I was seeking the Bishop's help. At that meeting in his library, I left some further information with him and he later wrote to me arranging the Ash Wednesday visit.

He arrived in his purple bishop's cassock and stayed a long time - I forget how long. He said he would need some of the lords in the House of Lords to help him to deal with the matter. I had asked him to ensure that patients with agonising toothache, needing dental help, would not be told at that dental hospital (or indeed any other) that they were not in pain and were 'just depressed', without properly examining the patients' teeth! and to give the dentists a statutory duty to examine the patients' teeth. Mr Reg Dinsdale, the negligent consultant dentist who did me the most harm, had told me he was not going to 'indulge' me by having necessary X-rays done! (I have written about him in my short story, Long in the Toothache.)

So I set about getting some lords to help the bishop. I was already in contact with the secretary of a society - I think it was called something like The Human Rights Society. I had already helped her to help a guy in the North-East who had been so atrociously treated in his dealings with the NHS and was so sick of being ignored or insulted (but never helped) by the useless NHS Complaints Procedures, and by his MP, that he had gone to London to the Houses of Parliament and had nailed his hand to a door there! to try to get someone to do something about all the NHS cruelty. - He still didn't get any help... - I had talked about him on local radio, and sent him a recording of the interview, and it had lifted his spirits to know that his shocking treatment was at least no longer completely ignored.

I asked that secretary if she could help me. She said the society was only small and not very active, but it had several lords among its membership. She asked these lords if they would help and they said they would, but that the Bishop would have to introduce the matter in the House of Lords and then they would support him in the matter. When the Bishop had left me that Ash Wednesday, he had said to me that in approaching anyone about the matter after that day, I could quote him at any time and in any context (I remember those were his exact words) that he had investigated the matter and knew that I was telling the truth and he would support me in the matter. I asked him to write me a short note to that effect and sign it but he said that that would not be necessary; I could trust him to keep his word.

Excitedly, I wrote to him to tell him that there were these lords happy to support him in the House of Lords. I never heard from him again!

I wrote to him again. He did not reply. I rang him. His newly-appointed secretary had clearly been told by him that I was a nutter, and she spoke to me as though I was half-witted. Neither she nor he answered my letters and he refused to speak to me on the phone. I can only surmise that he had supposed that I would be unable to get any lords to back him up in the House of Lords and so had felt safe in assuming that his promise to speak on the matter would never need to be kept. And he had most shamefully lied to me when he had told me that I could quote him at any time and in any context that he had investigated the matter and knew that I was telling the truth and he would support me in the matter

AvMA, a charity, is inviting signatures to a petition

AvMA, Action against Medical Accidents, a charity, is inviting people to sign a petition to urge the Government to reconsider proposals to remove clinical negligence claims from the scope of Legal Aid and to further restrict access to justice by changing the rules that govern making claims under a condition fee ('no-win no-fee') agreement.

This Telegraph article may help you to decide whether to sign it. I agree with every word of Mr Jonathan Sinclair-Wilson, as quoted in the article. The proposed removal of legal aid would certainly increase the incidences of clinical negligence and avoidable suffering ,and would therefore not save any money at all.

Only a snowball's chance in Hell remains for civil cases against pharmaceutical companies in England and Wales to obtain legal aid from the government

Only a snowball's chance in Hell remains for litigants in civil cases against pharmaceutical companies in England and Wales to obtain legal aid from the government in order to pursue a case of clinical negligence or personal injury, as investigated by Radio 4's File on Four this evening.

I cannot urge you strongly enough to AVOID taking prescribed pharmaceutical drugs if you possibly can! The drug companies have long histories of criminal negligence, corruption and giving misleading information about their drug products. They have teams of highly-paid corporate lawyers well-versed in all the technical dodges to secure a favourable outcome for their shady clients.

The programme will be repeated on Sun 23 Jan 2011 at 17:00 on BBC Radio 4.

Long In The Toothache - Short Story by Margaret Wilde

Long In The Toothache

"These Fat Depressives: they’re always complaining of pain; they’re never happy unless they’re moaning." The consultant was musing to himself. He was a very important man. He hadn’t much time to spare for this silly woman.

He glanced at the notes. She’d complained of an acute abscess to her dentist nearly a year ago and then come afterwards to the Dental Hospital with the same complaint. Well, clearly she couldn’t have had it all that time. She couldn’t have put up with the pain.

True, she’d kept going back to her dentist. But that was the way with Depressives: obsessive about health, always wanting attention. The dentist hadn’t pandered to her, sensible fellow. He hadn’t taken any X-rays. As he’d told the woman last summer when she’d had her breakdown, that proved the ‘pain’ was just her nerves.

Coincidence that she had, after all, developed an abscess on that tooth, and it must have been there a while or the bone wouldn’t have rotted so far. Still, it would have been chronic. Lots of people had so little discomfort from chronic abscesses that they were only discovered in the course of other dental treatment. The pain of acute abscesses was of a different order of magnitude altogether, though they all become chronic if left untreated.

He knew how to deal with Depressives: Shock Treatment. It never failed. Let them know you’ll stand none of their nonsense. They needn’t whine to you for sympathy. If only everyone would treat them in the same way. They’d soon snap out of their silly behaviour then. He prided himself on his decisiveness.

She entered his room nervously. Her eyes were puffy. She appeared tired and confused. Of course, she was on Librium and amitriptyline.

"You Fat Depressives!" he greeted her. "You grind your teeth, don’t you?"

"No," she replied, and started to cry.

"All Fat Depressives on amitriptyline grind their teeth."

"Well I don’t." The silly woman was weeping copiously and blowing her nose. What a mess she looked! No wonder no-one had ever wanted to marry her.

"The last three Fat Depressives I had all ground their teeth. Why should you be any different?"

"I’m not a Fat Depressive; I’m a person. And I’ve got a lot of toothache. My mouth is a sheet of pain."

"A bit of sensitivity: we all get that as we get older. Don’t be childish. The fact is you grind your teeth while you’re asleep and that makes them hurt a bit."

"But I don’t sleep! That’s the point! I’m in too much pain. That’s why I had the breakdown. I’m so desperately tired."

"Rubbish, Woman! Of course you sleep. You just think you don’t. Pull yourself together!"

“And I’m very concerned about my work. I have a good honours degree and a distinction in teaching – but how can I give of my best to my pupils when most of my concentration is focussed on this excruciating pain and I’m so tired I can’t think properly?"

Ah that was it! She needed something to blame for poor performance in the work situation! – A classic example of neurosis!

He raised his voice to drown hers: "It is no good being hysterical with me, Young Woman. You’ve got to learn to be quiet and listen. You Neurotics are fond of the sound of your own voices."

"Tell me, Mr Lambert, don’t ‘Depressives’ ever get toothache? I have had an acute abscess left untreated for nearly a year; I have had a just-detected cracked cusp which has been painful for almost as long, one tooth just filled because it had decay and another still awaiting treatment. There are sympathetic pains all over my mouth. I am in torment."

"Stop exaggerating. - You Fat Depressives are all the same. You eat oranges and drink fizzy drinks all day, don’t you? I know these fad diets."

She looked bewildered at the change of direction of his questioning. "I don’t eat oranges. My teeth hurt too much. I never drink fizzy drinks. And I’m not normally fat. The amitriptyline holds water in my body and has caused me to gain two stones. – But what has any of this to do with the abscess, the decay and the cracked tooth?"

"Fat women always claim they never eat. - I’ll make you a bite-guard to wear at night to stop you from grinding your teeth."

She realised the advantage to the Dental ‘Mafia’ of covering up gross diagnostic errors over such a long period, but surely a consultant would have had a greater allegiance to truth and scientific exactitude than to negligent incompetents, professional colleagues or not. Surely he must realise that it was stretching credulity and coincidence too far to maintain that an abscess, a cracked tooth and two decayed teeth had all appeared by magic on the day that, fighting her appalling weariness, she had made a scene and insisted that her ex-dentist write a note for the Dental Hospital to have another look at the abscess!

The interview was at an end. He had not looked at her teeth, of course. You didn’t need to, with Depressives. The diagnoses were always the same: tooth-grinding, ‘target teeth’, acidic foods, sugary drinks, imaginary pain and exaggeration.

Well, he’d do the operation to remove the abscess and the rotting bone in June. At the same time he’d excise the scar from a previous mouth operation as it had healthy nerve tissue trapped in it. There was no urgency. She was a healthy woman in no pain and could wait four months.

He informed her doctor that she was just a Depressive. It wasn’t possible to have pain in so many teeth. "We have a Pain-Prone Neurotic here, Doctor. If I were you I’d treat any pain she complains about with a pinch of salt. These people waste a lot of our time."

The day of the operations came. He had not told her what to expect. She lived alone and would have made suitable preparations had she known how ill the operations would make her, how long they would take, how much blood she would lose. She was in ghastly pain in some other teeth. They had been treated at last, but the trouble had gone on so long before they were treated that they were taking months to ‘settle down’. Her tongue was exquisitely sore from contact with rough edges of temporary crowns and from encountering oil of cloves – balm for aching teeth but corrosive to tongue and gums. She was desperate, absolutely desperate – genuinely suicidal because of the continual pain, tension and lack of sleep. - She forced herself to remain calm. Some relief was at hand.

He had a student to assist him. He talked ‘at’ the patient. - It was only a local anaesthetic despite the operations lasting well over an hour. She had her mouth open and the scalpel and aspirator in it. Blood and saliva were removed as they appeared. She was unable to reply even if she had wanted to.

"Well Miss – Er -, you will have followed the Falklands Campaign. Brave men. They know what genuine suffering is."

As he cut through the gum during the apicectomy he accidentally cut deeply into the dentine of the perfectly healthy tooth next to the abscessed one. – God! - That’d be painful when the anaesthetic wore off! Rather her than me! Still, she’d be in shock today and it wouldn’t be absolute agony till tomorrow. It’d do her good to have some real pain for a change, anyway.
She was, after all, extremely fortunate to get the services of so eminent a dental surgeon on the National Health!

The following day, after a night of sitting upright to keep the swelling to a minimum, she was amazed to discover its actual extent. Her nostrils were splayed out to either side far wider than the outer corners of her eyes. The space left was too narrow for breathing. She had to breathe through her mouth. Blood and saliva ran down her chin. The upper lip was so swollen that it extended right over her lower lip, touched her chin and turned up at the bottom so that the inside was on the outside, so to speak. She strongly resembled the snouted Trolls she had once seen in a performance of ‘Peer Gynt’.

All was stiff – stiff as a board, she started to think, but realised that if a board were pressed, its rigidity would resist. If this stiffness were to be pressed, what would happen? The blood-gorged flesh would surely tear internally? She must try to keep very still and not touch it or stretch it.
But it was necessary to eat and drink to restore her strength after the loss of blood.

This was not only painful; it was extremely difficult. Her lips did not make a seal, since the upper was so much bigger than the lower. To drink in the normal way was impossible, as the upper lip was unusable. She had to introduce a small spoon into her mouth and ‘pour’ a little liquid from it into the bottom of her mouth and then bend her head backwards for it to reach her throat. It was a messy, immensely slow business.

She had not believed her ordeal could worsen so much. The healthy tooth which had been damaged by the surgeon’s carelessness astonished her by being the most harrowing of all the teeth. The scar excision had proved a much bigger operation than she had been led to expect. Painful throbbing extended from her mouth, up the side of her nose and as far as the outer edge of her left eye.

Her mouth was to her the very jaws of Hell.

The sweet focus was her TONGUE.

How deliciously sensitive the tongue to delight! – How agile a member when all had been well with her mouth! But for three months now it had been constantly chafed by the temporary crown and sticking-up point of the tooth which had been cracked. She had been embarrassed at school by having to use chewing gum to cover the sharp point. This was effective but it had to be continually chewed in order to function. If just left on the point without chewing, it went flaccid and soft in the heat of her mouth and slipped its mooring.

But how was she to chew? – With the great need for inactivity for healing to take place and the swelling to subside?

Unhappily, there proved to be no choice. The tongue’s demands were the most strident. She chewed all day – and all night, since the pain from the tongue would not allow her to sleep. In sleep the chewing gum would leave the tooth, the tongue would relax onto the point and the pain would wake her from that tiny sleep.

How could this torture have been allowed to happen? If an I.R.A. prisoner had been made to suffer as she had, Amnesty International would have intervened. But she was allowed no advocate. Her torturers were the prosecution, judge and jury.

She could feel the tight flesh tearing as she chewed. She could feel the stitches tugging through the delicate skin. She knew that she was doomed.

Lack of sleep. Horrendous pain.

She had the stitches out a week later and begged that the sharp point be ground down. It was, a little, but the remaining tooth tissue had to be conserved at all costs, apparently, even the possible cost of her sanity. She had no strength to argue and her tongue did not permit much speech.

Three days after this the migraines began. She took paracetamol and embarked on a futile expedition to find and purchase a glue to stick the chewing gum into position. She obtained some, but the glue remained in position and the gum slid off! Then the next shopkeeper told her that the glue was poisonous.

The fifth migraine in a day – she had not believed so many were possible in a day – attacked her on her way home. It was the end. No-one would help her. No-one understood her wretchedness and it increased when she sought to explain it. since this involved moving her tongue. So many teeth hurting; gums throbbing; face painful; head pounding; eyes aflame and unseeing.

As a stumbling, purblind, weary, yet supremely lucid and logical act, in order at last to end the pain and blessedly to go to sleep, she stepped in front of the approaching car.

………………………………….

Notes.

Every word I have put into the mouth of the surgeon in talking to me is what Mr Reg Dinsdale (I have used a pseudonym in the story) actually said to me, but there was more than this, of course.

I have telescoped two ghastly interviews into one.

Much of what ‘she’ says in the story was actually written for the surgeon, as I was far too ill to speak much.

He did look in my mouth actually, to see if an apicectomy on the Upper Left 2 would be feasible. But this was only after he had made his ‘diagnosis’ – of Depression and Tooth-grinding!

The car stopped (end of story). I felt contrite that I had frightened the driver – though it was not a pre-meditated act. I went to Dr Hazel Radley and told her I had just attempted suicide. – Please would she help me to get the dental treatment I needed? – Coldly she told me not to be silly. – I was not in pain, she assured me.

Margaret Wilde

Doctors 'must own up to blunders' says Steve Walker, chief executive of the NHS Litigation Authority (NHSLA)

Doctors 'must own up to blunders'

Extract from The Observer:

"Doctors have been told to own up and apologise if they make mistakes, in a bid to reduce the £613m in compensation paid each year to victims of blunders such as wrong diagnoses, botched surgery and delays during childbirth.

A new culture of honesty and openness should see such patients receive a personal apology from the doctor concerned and a detailed explanation of what went wrong, a senior official said.

Steve Walker, chief executive of the NHS Litigation Authority (NHSLA), said that patients and their families can feel hugely frustrated when hospitals are reluctant to acknowledge and explain cases of negligence. He believes that a more candid and speedy response could reduce the £613m paid out in damages each year. He made his comments in the week that Leslie Ash was awarded £5m in damages after contracting MSSA, a variant of the MRSA superbug.

Negligence lawyers say that the main reason a number of victims take legal action is to obtain more information.

'The message to doctors is: if you're aware of an error, or a shortfall in what's been delivered, you should feel free, indeed you should feel under an obligation, to tell your patients and to apologise and to explain, either verbally or in writing, even if the patient is likely to sue,' he told The Observer. 'The explanation bit is really important to many, many claimants. It doesn't matter if it heads off a claim or encourages a claim, people as human beings and patients are entitled to this and they should be getting it."

I think the culture of lying, evasion and cover-up of clinical negligence by doctors, along with collusion by the Department of Health and the Health Authorities, and partiality from the criminal justice system, has been allowed to go on too long for any meaningful change to come about without employing legal sanctions...)o: - And the uselessness of the GMC and similar bodies in protecting patient safety, rather than doctors' reputations, is well-known and notorious... - Routinely, when patients or their relatives complain about clinical negligence they are given further distress rather than a scrap of help or any sincere words of regret, apology or explanation.

Patients experience very little benefit despite huge increases in cash for the NHS.

Patients miss out as NHS cash floods in

Extract:

"Billions of pounds of taxpayers' money pumped into the National Health Service has gone on improving the salaries of GPs and consultants and paying for increased pensions rather than on improvements in patient care and frontline services.

A damning report by the highly respected health think-tank, the King's Fund, reveals that productivity in the health service has actually declined, despite the huge injection of cash.

The report reveals that only 30 pence in every pound of the Government's record NHS budget has been aimed at directly improving patient care. As well as salaries, the rest has gone on a growing bill for clinical negligence payouts and rising drug costs."

Patients seem to come last in importance for the NHS. Doctors' pay and drug company profits seem to be the priorities.