Touche - How I Lost Laura to a Private Health Fiasco
11/02/2002
Thank you to everyone involved in my case. I never dreamed of such an outcome and you have made such a long and difficult case seem easy and bearable.
Nigel, Derbyshire
Peter Touche writes for the first time of his wife's death after giving birth, and his fight to find the truth
Last Wednesday was my twin sons' third birthday. Their mother was not there to celebrate, nor to see Charles and Alexander's excited faces as they opened their presents. Laura, my wife, died nine days after the boys were born.
Some hours after the birth - by caesarean section - Laura suffered a brain haemorrhage, due to high blood pressure. The gravity of her condition was not realised until far too late because medical staff failed to carry out the most basic post-operative checks.
We were not in the poverty-stricken backwoods of the Third World, but in one of the most famous private hospitals in Britain. The entrance to the Portland hospital has become a familiar backdrop for celebrities such as Victoria Beckham, Zoe Ball and Patsy Kensit showing off their new babies.
We didn't choose the Portland for its celebrity cachet, but we did think that in paying for Laura's treatment we would get at least the standard of care available in the NHS, if not better. My wife, being American, was used to a system whereby one obstetrician takes charge of a woman's care in pregnancy, sees her at antenatal appointments and supervises the birth.
At the NHS Chelsea and Westminster hospital, which we first attended, that could not be guaranteed. Instead, we opted for Ursula Lloyd, an obstetrician recommended by friends, who only practised privately at the Portland.
I did not know then that private hospitals were regulated through the 1984 Registered Homes Act, putting them on a par with nursing homes, and under no obligation to match the clinical standards of the NHS. Indeed, 90% of private hospitals are unable to provide adequate intensive-care backup.
I did not know that, at night, private hospitals are under no obligation to have anyone more senior than a junior doctor on site and that many of the nurses working in private hospitals are unused to dealing with emergencies.
If I had known then what I know now, would Laura still be alive? Laura's caesarean was booked for Tuesday, February 9, 1999. However, her waters broke the previous Saturday evening and we headed for hospital. The babies were born shortly before 10.30. Laura and I took turns at holding them as we telephoned our family and friends.
The midwife came in and out of Laura's room, chatting and advising on breastfeeding. In the NHS, a woman's blood pressure is checked, as minimum, every 15 minutes for the first hour, half-hourly for the second hour, then hourly for the next three hours. Laura's was not checked at all.
At 1am, Laura suggested I go home and get some sleep. When I called to say goodnight and see how she was at about 1.30am, she said she had the worst headache she'd ever had and I told her to call a doctor.
At 4am, the hospital rang and told me to come in as my wife was feeling unwell. By that time she was having fits down her left side and slurring her words. She was rushed to the Middlesex hospital and then to a specialist NHS neurology hospital, but never recovered.
Trying to get at the truth of what happened has taken me three years, but my belief that Laura's death was completely unnecessary was confirmed at an inquest last month. The jury found that Laura had died of "natural causes contributed to by neglect".
I had to take legal action to get an inquest, which was at first denied on the basis that the death was "natural". I was determined that the full facts of the case would be aired in public, and lessons learnt. I wanted to know how and why this could happen in an established private hospital in a First World country at the end of the 20th century.
The day before Laura died, her parents and I had a meeting with the obstetrician and anaesthetist who treated her. The meeting was amicable and professional and we came out feeling relieved that there was nothing to worry about in terms of the medical care that Laura had received.
It was suggested that what had caused the ultimately fatal brain haemorrhage was something congenital, and that it could have happened at any time. Even then, we had no idea that Laura would die. She was in intensive care at the National Hospital for Neurology and Neurosurgery and we were quietly confident that she would recover.
I had visions of giving up work to look after her and the children but eventually looking forward to a relatively normal life together. I know the Portland consultants now regret not telling us of the lack of monitoring. This was, I believe, a fundamental breach of doctor-patient trust.
When Laura died the next day, a report was made at the coroner's office, including the statement that there was no evidence of neglect nor complaint from the family and that no post-mortem examination was required. Ironically, because we had been led to believe that the probable cause had been congenital and were therefore worried about the rest of the family, we requested a post-mortem.
The results of this, when they emerged in June 1999 were, inter alia, that they could find no congenital weakness in terms of an aneurysm (a weak blood vessel in the brain) and that the site where the haemorrhage occurred was typical of a site secondary to hypertension (high blood pressure).
The coroner's original decision, given that there was no apparent evidence to suggest that neglect had contributed to Laura's death, was unassailable. But one must ask what actual medical records he had to support his conclusion. I suspect none. I requested Laura's medical records from the Portland hospital.
Maternal death is now such a rarity that I could not attempt to comprehend what had happened without knowing every single detail of the chain of events. I started the process with a completely open mind. I was medically illiterate but gradually I became more familiar with medical terms and procedures.
The medical records were accompanied by a letter from the director of clinical services stating that "we do not have a standard operating protocol for caesarean sections". My request had been for a copy of the protocol for monitoring after a caesarean section - a much narrower question. Obviously I wanted to check with an official internal document that the procedures had been carried out.
Within the medical records there was a complete absence of any notes between the hours of 11pm and 1.35am (the boys were born at 10.24pm and 10.25pm). I wrote back to them to confirm that I had all the records.
I discussed this with Laura's father and clearly there was something very wrong. Some time later I spoke to Laura's obstetrician over the telephone and asked if it was right that there were no observations taken. To her credit, she admitted there weren't.
An internal meeting at the Portland concluded that "everything that could have been done was done". There was no mention of the complete absence of post-operative observations for 2 hours, described at the inquest as "inexcusable" and a "gross failure". I decided to consult solicitors.
I wrote to Dr Stephen Chan, the coroner, to request an inquest in the light of the evidence that had emerged. This failed, as did requests from my solicitors. There is no easy right of appeal against a coroner's decision. The only option was to take him to judicial review.
We ended up in the High Court (two judges) in June 2000. The crux of the matter was whether or not the coroner had reasonable cause to suspect that her death was "unnatural". The judgment came a week later concluding that there should be an inquest and that the coroner was wrong in his interpretation of the law. On the last permissible day, the coroner appealed.
His objections focused on the facts that my wife had been cremated and that he thought the "floodgates would be opened" in terms of inquests that would have to be held following the judgment; and an issue as to costs as I had been awarded the costs of the case, which apparently went against precedent.
Given that I might never get an inquest, I issued legal proceedings against the Portland hospital in the civil court. The proceedings were conducted honourably and honestly, culminating in an out-of-court settlement in October 2001 and a meeting with personnel from the hospital. This meeting was a very welcome part of the process in terms of learning that they had changed procedures since Laura's death. They did not have to do this and I am grateful that they did.
In the meantime the Court of Appeal (three judges) in March 2001 unanimously dismissed the coroner's appeal. A jury inquest date was set for January 2002 with Dr Susan Hungerford presiding. She had a total understanding of the issues of public and private importance and the proceedings were conducted with sensitivity and thoroughness.
The greatest satisfaction so far for me has been hearing that various families of victims have been granted an inquest on their loved one. For example, the father of an 11-year-old boy who had been left untreated in the accident and emergency department of their local NHS hospital only to die of meningitis a day later. This father had been requesting an inquest and the judgment in Laura's case has enabled him to have one.
Laura's case is just one of several private sector horrors that have come to light in recent years. The government is trying to address this by way of the Care Standards Commission, which will come into being on April 1. It will bring in new regulations for private hospitals but they will still not be subject to the rigorous standards of the NHS.
I appreciate that most operations performed in the private sector are routine, but we would not accept different levels of safety standards between public and private railways. At a time when the NHS is contracting out operations to the private sector and a secret blueprint for health that apparently suggests using the private sector "to the full" is being discussed by Labour policy makers, what is the common standard of care and how will it be policed?
The inquest on Laura heard that even when the medical officer on call was alerted to her condition, the drug necessary to treat her could not be found on the ward. I would like to see private hospitals graded and licensed to carry out only those procedures for which they can prove they have suitable staffing and NHS backup.
I would like to see league tables published, as they are in the NHS, so that death rates and success rates become public. Standards need to be established for the investigation of complaints, adverse events and an early warning system for near-misses.
The political system needs to understand that private healthcare should be regulated in the same way, at least to the same standard and under the same body, as the National Health Service. I can only hope that the health secretary (of whatever party) ensures that he/she is in charge of the health of the nation and not just the National Health Service.
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