Declan Lawn investigates problems at the Royal Victoria Hospital's Accident & Emergency department and hears the experiences of some of those affected.
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Today, in a statement to the Assembly,
Health Minister Edwin Poots
was talking about solutions to problems
in the Royal Victoria Hospital in Belfast. He promised
more staff, better oversight and an improved system for patients.
But he said that real change will take time.
Tonight on Spotlight, we speak to some of the families
for whom time has already run out -
families whose loved ones died in remarkably similar circumstances
-ten months apart.
-His clothes were covered in blood,
his overcoat was absolutely drenched in blood.
He had bled a lot.
She had some bruising to her face
and, clearly, needed treatment.
We hear from a doctor, who says that change
is not happening quickly enough.
I would say that the clinical staff of the minute
don't have faith in the management team and that
the only way that faith can be restored
is if positive changes are made very quickly.
And we reveal disturbing new evidence which suggests that,
as recently as three weeks ago,
patient safety was still being compromised.
Today, the Minister said it's important that the public still has
confidence in the emergency medicine system,
but neither he nor the Health & Social Care Board
nor the Belfast Trust would agree to be interviewed for this programme.
This is a story of how systemic failings in the emergency department
of the Royal Victoria Hospital
affected some patients and their families.
It's also an investigation into what's still going wrong.
Last month, Spotlight investigated the care being provided to patients
in the emergency department of the Royal Victoria Hospital in Belfast.
We revealed that last year five serious adverse incident reports
at the hospital involved deaths where waiting times
may have been a factor.
It came as a shock to many.
Last night's BBC Spotlight programme
highlighted the cases of five patients.
In that programme, we asked the Chief Executive of the Belfast Trust
whether the families involved in two of the incidents had been informed
that waiting times played a part in the deaths of their relatives.
I'm not aware of the detail of both, but I know one of the families had.
-You would expect that a family would want to know...
..if the system played some kind of part in their loved one's death?
-So, will you be looking into informing the other family, if...?
If they haven't been informed? Of course, yes.
It soon emerged that in three out of five cases
families had been not informed that there were failings
in how their loved ones were treated. The Health Minister
quickly announced that all of the families that did not know
something had gone badly wrong would now be told.
The treatment and care that those five people had may well have
fallen short and, therefore, we will have
an appropriate investigation of that matter.
Two days after the Spotlight programme was broadcast,
we were contacted by Grainne and Bronagh Boyle.
A year earlier, their grandfather Charlie Patterson
had died in the Royal.
As far as his family were concerned, he had received the best treatment
he could have, until Grainne received a call
from the Royal Victoria Hospital that would devastate her
and the rest of the family.
It was the day before Valentine's Day - the 13th, the Thursday.
And at ten to five, my phone rang.
There had been a report into my grandfather's death
and they would like for us, as a family, to come and speak to them
about that report.
When five deaths may have a contributory factor...
'An hour after, I sat down to watch the news'
and then the full enormity really kicked in and, as I was
watching these people speak, in my mind, I was thinking,
"That is us. That's our family."
And that is shameful. By anyone's standards, that is shameful.
That was the first time that we had known anything about
what had occurred.
Charlie Patterson was 86.
He lived his life surrounded by a close and loving family.
Our granda was amazing. He was everything that your granda could be.
He was our best friend.
We were like the Three Musketeers, always together.
Always together. You never seen one without the other two.
It was unusual for us not to be together
and every single day, we would go up to granda's in the evening
and all have our meal together and it was very important,
at the end of each evening, that we sat together and talk about our day.
Charlie Patterson had some health concerns associated with old age,
but he was still very active and went out walking every day.
It was after attending Mass on 27 January, 2013
that Charlie fell and hit his head. An ambulance was called.
He arrived at the emergency department
of the Royal Victoria Hospital at 7.10 in the evening.
He was bleeding from a head wound, but his family were not informed.
Charlie would lie on a trolley for the next seven hours alone.
That's something his family find difficult to deal with.
Personally I'm angry, because he was never alone.
He was an incredibly social man and to think of him
sitting there dazed and confused
and on his own is quite upsetting.
The details of what happened to Charlie Patterson that night
are contained in here.
This is an incident report, compiled not long after he died.
This wasn't even shown to his family until just a few weeks ago,
three days after the Spotlight investigation was broadcast.
But it goes into great detail about the shortcomings in the care
he received from the moment he entered the emergency department.
The first problem was at the triage stage.
Charlie was seen by a nurse 20 minutes
after arriving in the department.
She noted that he was confused, but he was able to tell her
that he was on the blood-thinning drug, warfarin.
Elderly patients on warfarin are at risk of profuse bleeding
and haemorrhaging and the report says it would have been appropriate,
at this point, for Charlie to have been given another drug,
to reverse the effects of the warfarin.
But he lay on a trolley for five hours before he was given that drug.
It almost defies belief, in a way,
that this could happen in a busy casualty department.
The report reveals other significant problems with delays.
A doctor should have examined Charlie within an hour.
He didn't see one until three and a half hours into his wait.
He should have received a CT scan soon after arrival
in the emergency department. That didn't happen for four hours.
For all of that time, he lay on a trolley alone,
growing more and more unwell.
His family had no idea he was there.
It's just the fact those few hours would have been valuable,
to say goodbye, to let him know that he wasn't on his own,
that he didn't need to be afraid -
the things you imagine you would do for the person you love.
To bring him his little bits of comfort, like his rosary beads,
or having his glasses.
The small, stupid things that weren't probably done for him.
He would have been confused, as to what was happening around him
and, undoubtedly, he would have been afraid and I find that just,
for someone who was so loved, I find that very difficult to reconcile.
All in all, this report outlines a litany of errors,
but what runs through it is the problem of delays.
The reason given here for the delays is that the system was
under pressure because a large number of patients
who were in the department that night needed to be admitted
to hospital and there were not enough beds for them to go to.
The emergency department was simply log-jammed.
Eventually, at 2.00am, Grainne and Bronagh
were informed that their grandfather was seriously ill
-in the emergency department.
-As soon as I arrived,
I was immediately taken into a family room,
but I was brought through the waiting area
and it was chaos. The trolleys were just everywhere.
It was like a Third World country, almost.
It was like walking into a war zone.
It had been only 12 hours since they had last seen their grandfather
alive and well and on his way to Mass.
Now, they were deeply shocked at what they saw.
He was covered in blood and his clothes were covered in blood.
He had bled a lot.
A very nice, but very junior young doctor come in and she explained
to us that the outcome was likely to be fatal.
She was very upset. She seemed, sort of, visibly upset.
As Grainne and Bronagh were shown in to see Charlie,
other staff seemed upset, too.
One of the nurses was crying and she had said to us,
"I'm so sorry, I'm so sorry." We just assumed
she was sorry because he had died and the end of any life is sad,
but perhaps now, she was sorry
because he had been treated so poorly.
Gareth Martin is the union rep for the Royal College of Nursing.
He told me that far too many patients,
particularly the elderly, are suffering because the system
just isn't working. You say old people
are waiting in an environment that is not fit for purpose.
What do you mean, that the emergency department
at the Royal is not fit for purpose?
Absolutely. When there's pressures of patients waiting to be admitted
and you are hearing of large volumes of patients waiting six,
eight, ten, 12 hours and longer,
so the ability to provide dignified care is certainly compromised.
This report explains why the department was overstretched that night.
But it doesn't really answer the question of how an elderly man
could have spent hours lying alone in a busy emergency department
becoming more and more unwell,
and not get the attention that he needed.
I think there are numerous reasons he wasn't a priority.
He sat in the corner quietly.
He didn't cause a fuss.
Although the Belfast Trust didn't want to be interviewed
about Charlie Patterson's case, they did send us this statement.
They say that what happened was a matter of deep regret to them
and they say that Charlie's case was fully investigated
and that they've learnt lessons.
They also say that their policies and procedures about being open with
families were not followed in this case and for that they are sorry.
This statement leaves a lot of unanswered questions,
particularly for the Boyle family, but because the Trust have decided
not to do an interview we won't be hearing the answers.
No-one will ever know for sure whether Charlie Patterson might have
survived if he had got the treatment he needed in a timely fashion.
The only thing that is clear is that he didn't get it.
All the signals were there, all of them.
And they were missed and they weren't missed once,
they were missed time and time again.
There are various opportunities where intervention
may have had a different outcome,
but time and time and time again, they just passed.
What upsets Charlie's family more than anything else
is that the hospital didn't see fit to inform them
that so many mistakes had been made until a year after he had died.
And only then, after the Spotlight investigation had revealed
details of the five deaths.
We specifically said to them, had this not broke in the media,
would you have contacted us? And there was a non-response.
It wasn't even an apology. They moved on to the next question.
How did you feel about the fact that you hadn't been told,
that you were shown this comprehensive report
a year after he died?
Angry. You feel resentful
and disbelief that had the media not broke this story,
that you would never have been any the wiser.
We asked the Trust a direct question -
had they discovered other families who haven't been informed
about serious, adverse incidents involving their relatives?
They sent us this statement
and it says they're satisfied in the vast majority of cases
families have been informed, but that they have identified a number
of cases where the level of involvement
is not what they would expect.
Now, that sounds like a yes.
And we would have pressed the Trust on that point in an interview,
but because they won't meet us face-to-face on camera, we can't.
This is Peter Walsh.
Based in London, his charity, Action Against Medical Accidents,
lobbies for patients' rights in the NHS.
He's one of the leading patients' advocates in the UK,
representing about 3,000 patients and their families every year.
We asked him to come to Belfast to review Charlie Patterson's case
and some of the others that have come to light.
I'm really shocked by the circumstances,
not just of Mr Patterson's death, but the way that the knowledge
of a whole series of errors was kept from the family
following his death. It's scandalous
that this family had to wait over a year to hear
for the very first time that something went wrong
with Mr Patterson's treatment.
Peter Walsh spent years campaigning for what is called
a legal duty of candour in England, which would force hospitals to admit
mistakes to families of people who have been harmed.
This year, new legislation in England will make that a reality.
But there are no plans to introduce it here.
He's now written to the Health Minister
asking that it be introduced in Northern Ireland
and demanding an independent inquiry into the Royal's emergency department.
Bronagh and her aunt Anne wanted to meet Peter
to discuss what happened to Charlie,
and for privacy reasons, we agreed not to film that meeting.
What really strikes me about what I have learnt about
what's happened in Belfast so far
is the very clear similarities with the root causes of the problems
that we learnt so much about at Mid-Staffordshire, the big hospital scandal in England.
The key ingredients of that scandal, that led to it,
were a lack of good leadership,
a failure to listen to staff
and also a culture of denial.
That's a toxic cocktail.
In our experience, a hospital that fails to be open and honest
is likely to be a dangerous hospital.
The Health Minister, in his statements following the revelations
about the five deaths, took a very different view.
Five people dying in hospital of 80,000 being treated
is not a crisis.
The Minister did say that he had asked all Trusts to report to him
on serious adverse incidents going back three years,
and tell him in how many cases families had not been informed.
We asked the Department of Health about what that review had found so far.
They said it's not yet complete.
I also asked the Minister for an interview about the new information
that is now emerging, but just as with the first Spotlight programme
on this subject, he declined to be interviewed.
Charlie Patterson's death raises other serious issues too
and that's because it wasn't unique.
Now that's significant, because this report into his death
is about how lessons were learnt and new practices put in place
to prevent anything like it ever happening again.
But it did happen again. And in remarkably similar circumstances.
This is Colette Mac Ruagain.
Five months ago, her mother Brigid, who was 81, was admitted to
the emergency department of the Royal Victoria Hospital.
It was ten months after Charlie Patterson's death.
Brigid, too, had fallen and hit her head.
One of her daughters came to the hospital with her.
When Collette arrived soon afterwards, it was obvious
that the department was under pressure.
When I arrived, it was extremely busy.
A lot of people just sitting along the corridor. It was extremely busy.
Brigid had sustained bruising to her face
and seemed to have hurt her arm.
We thought it was a minor injury.
We weren't aware of the extent of her injuries at that time.
In fact, Brigid was bleeding from a haemorrhage inside her head,
but it wasn't spotted.
The bleeding would have been made much worse,
because, like Charlie before her,
Brigid was on the blood-thinning drug, warfarin.
She should have quickly been given a drug to reverse
the effects of warfarin, but that didn't happen for six hours.
Her family thought there was nothing seriously wrong.
She was clearly very uncomfortable
and she had some bruising to her face. I mean, she was clearly unwell
and clearly needed treatment, but nobody was alerting us
that there was anything major
or anything that we really needed to worry about.
Over the next few hours, Brigid began to deteriorate.
She became confused and disorientated.
She was seen by a doctor after four hours and a CT scan was ordered.
But it wasn't carried out for a further hour and a half.
And when the results finally came, it was very bad news.
The sister in A&E had said that there was something serious
that had shown up on the scan,
and she said to my sister, "We're going to have to go to resus,"
and she knew then that something terribly was wrong.
By now, Brigid was unconscious.
Things escalated very quickly after that.
The neurosurgeon came down and had viewed Mum's CAT scan,
and explained just how serious things were and the extent of her injuries,
of her brain injuries at that time.
It was obvious to the family that something had been missed.
They began to ask questions
and staff admitted that Brigid had waited too long.
She was rushed to the neurosurgery ward, but it was too late.
Three days later, Brigid died.
Her family felt angry.
Staff at the hospital had already admitted that Brigid had not
received the care she should have,
so now the family asked the Trust what exactly had gone wrong.
They had done investigations, a review into mum's care in A&E
and outlined and acknowledged the mistakes that they had made
and told us that they had put significant measures in place
to ensure that this wouldn't happen again.
Of course, it wasn't the first time the hospital had said that.
In fact, they had said it ten months previously in this report
into the death of Charlie Patterson, another elderly patient
also on warfarin, who had also waited too long, but incredibly,
these aren't the only two cases with very similar characteristics.
That's because Brigid's family were given this document after she died.
This is a learning letter,
which is distributed after serious adverse incidents.
And this says that just a few days before Brigid died,
yet another elderly patient who was also on Warfarin
died after waiting too long for treatment.
So, how many incidents like these two, ten months apart,
are down to the department being overwhelmed and under-resourced?
Spotlight has seen documents obtained
under Freedom of Information legislation.
They record that 720 incidents of all types occurred in the Royal's
emergency department in 2012 and 2013,
although the vast majority were low or medium risk.
But significantly, 265 of them,
over a third, were attributed to staffing and resources.
We wanted to ask the Belfast Trust and the Health Board
about whether this suggests that the emergency department suffers
from chronic short staffing
and whether that is leading to harm for patients.
But once again, we couldn't, because they would not be interviewed
for this programme and the statement
they gave us doesn't address that issue.
The big question, of course, is
whether among all of this adverse publicity and embarrassing
revelations about patient safety, that the situation is now improving.
Spotlight has been given some information which suggests that
if that is happening, it isn't happening
quickly enough for some senior doctors.
Today, Edwin Poots outlined a range of measures
that have already been implemented
to improve conditions in the emergency department of the Royal.
We are appointing 40 additional nurses to the emergency department
and that goes back to a report last summer,
so many of the nurses are actually already in place,
or being appointed as we speak.
So, there's courses of work that is happening
and actions are being taken to ensure
that we can meet the needs of the public.
In terms of what we are doing, we are responding to the problems
that are being identified and we are dealing with the issues.
But last week, BBC Newsline revealed that just three weeks ago,
another elderly patient died in the emergency department
and she too may have waited too long.
The Belfast Health Trust is investigating the circumstances
surrounding the death of an elderly patient.
The Belfast Trust says that waiting times
did not play a role in this woman's death,
but Spotlight understands that waiting too long may have
affected the comfort and dignity of her final hours.
But we have uncovered disturbing new documentary evidence
about what was happening in the emergency department
on the weekend this death occurred.
This is an e-mail chain dating from the weekend of 22nd February,
when the death occurred.
It includes e-mails from three senior consultants
on duty that weekend.
These e-mails describe a litany of serious concerns about
patient safety and dignity during the weekend in question.
All of it recorded meticulously by the consultants
and sent up the line to their management.
Colm Donaghy, the Chief Executive of the Trust, is copied in.
How can it be that during a period of intense public scrutiny
and concern about patient safety at the Royal
that right up until three weeks ago,
some consultants still thought that the department was unsafe?
Now, even if there are no quick fixes,
as the Health Minister pointed out today, these e-mails depicted
a department that was simply overwhelmed
and that needed immediate and comprehensive action
to put things right immediately,
at least on this weekend in question.
Now, those are all questions we would have put to the Trust,
but they have decided not to do an interview,
so in this programme, we won't be hearing the answers.
We have also uncovered questions
about the number of serious incidents
that occurred last year and whether that number could in fact rise.
In the last Spotlight programme we asked
the Chief Executive of the Trust, Colm Donaghy,
how many serious adverse incidents
there had been in which waiting times had played a part.
Well, it's difficult, but it would be single figures.
We have been told that it could be nine.
No, it's not as high as nine, no. I think at this point it's about four.
But I don't have those figures in front of me.
In how long - in the last six months, the last year?
No, no, that would be over the last couple of years.
In fact, it was five deaths in one year.
Spotlight has now been told that there may be further cases
currently pending, which could become serious adverse incidents,
though not all involve deaths.
Yet that would mean there may be more
than five serious adverse incidents with waiting times as a factor.
That's not including the death from three weeks ago.
Again, we put this to the Trust
and they say they're not aware of any such incidents.
We showed our evidence to Peter Walsh.
Given that this information is coming out in a piecemeal fashion,
what do you think needs to happen now?
It underlines even more there needs to be an independent inquiry
into how this has been allowed to happen,
and we must have a legal duty of candour.
Last week, it was revealed that one consultant in the Royal,
and a patient, are now suing the Belfast Trust for negligence.
Their lawyers said they have evidence of a toxic environment
for staff and patients and they're calling for a full public inquiry,
because they say the hospital has failed in its duty of care.
Two weeks ago, I wrote to every consultant in emergency medicine
at the Royal Victoria Hospital.
I asked them to do on-camera interviews, either as a group,
or as individuals.
But some of those consultants did talk to us off-camera.
They said they couldn't speak out publicly,
because they feared for their jobs.
That's despite the fact that in the last Spotlight programme
on this subject, senior health managers said that they should.
At the moment, people are scared
to speak out, both doctors and nurses...
-They shouldn't be. It's as simple as that.
-But they are.
But they shouldn't be. They have an obligation to do so.
If you look at their professional obligations,
they don't have a choice.
So, what is the problem?
Well, the medical and nursing staff we spoke to say that
the reality is they would suffer for speaking out.
They say they're operating in a climate of fear
and that blowing the whistle could destroy their career.
Even when it comes to patient safety.
I spoke to a nurse this morning who said to me,
"There are so many things I'd like to tell you about what
"I have seen and what I'm still seeing, but I can't do that,
"because they will get me in the long grass."
Those were the words she used.
That is a dangerous and unacceptable situation, isn't it?
It absolutely is. That's very disturbing to hear a nurse say that.
It speaks volumes of the culture. That's unacceptable
and needs to be challenged.
Medical and nursing staff...
One doctor did agree to a tape-recorded interview.
We have reconstructed that interview using an actor
to protect his identity.
It will be done in a subtle way, OK?
They won't necessarily come to you
and say, "You've spoken out, so I'm suspending you."
The fear is they'll get us in the long grass.
We showed this interview to Peter Walsh, who has campaigned
on behalf of patients involved in
some of the biggest hospital scandals in England.
What we are now learning about the failure to listen to or even
possibly the bullying of whistle-blowers
and the failure to be open and honest with patients and their families
when things have gone grievously wrong -
we need a shock to the system.
We need a statutory legal obligation to be open and honest,
with serious repercussions for organisations who don't follow
that line to make things better.
Last month, preliminary findings of the regulator, the RQIA,
talked about allegations of bullying and harassment
at the Royal Victoria Hospital.
Added to that now are the voices of doctors,
who fear if they speak out publicly, they'll be victimised.
Serious questions for the Belfast Trust,
and once again, questions we would have put to them
in the interview they've declined to give.
On 8th January this year, a major incident was called
in the Royal's emergency department to deal with congestion.
It led to intense public scrutiny.
Spotlight has been told that the term "major incident" won't be used
again to deal with congestion, to avoid raising public concerns.
This is simply a rebranding to protect reputation.
This doesn't help protect patients in any way, because we have had
circumstances as bad as the night in question,
since the night in question,
and there has simply been some rebranding.
They are papering over the cracks.
That corresponds to information in the consultants' e-mails
regarding the weekend of 22nd February.
In those e-mails,
two of the consultants say
that in their opinion, conditions were so unsafe at points
that a major incident should have been called.
But that didn't happen.
Last week, Colm Donaghy, the Chief Executive of the Belfast Trust,
resigned his position to take up a new post in England.
Fixing what appears to be a broken system
will now be a problem for his successor.
The families involved say it can't come soon enough.
These are human beings,
human beings with families, with lives, they're loved.
They are not just numbers or categories. They deserve better.
They really do. We all deserve better.
You just put so much trust in the medical establishment
that once you enter a hospital,
you are going to be treated properly.
You don't expect to be left on a trolley to die.
There are now serious questions for the Health and Social Care Board,
the Minister and the Belfast Trust, about the real extent
of the problems at the Royal Victoria Hospital.
They chose not to answer them in interviews for this programme.
The question now is whether somewhere, at some point,
they are going to have to.