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DEATHS
SPARK PRIVATE HOSPITAL ALERT
The
Sunday Times (London) July 21 1985
By
Brian Deer
BRITAIN'S
biggest independent hospital group, Nuffield
Hospitals, called this weekend for the government to
lay down national standards of private care and new
complaints procedures after an investigation by The
Sunday Times into incidents in which private patients
have died or been seriously injured.
Our
inquiries have revealed flaws in the organisation of
many private hospitals, which the present legislation
on the supervision of nursing homes has failed to
correct. These include the frequent absence of
doctors, shortages of essential equipment and
operations hurried to save doctors' time.
* A
fatal accident inquiry in Glasgow heard last month
that a boy, seven, died after an operation went wrong
at Ross Hall hospital, run by American Medical
International. The hospital's intensive care unit was
shut, and when the boy was eventually transferred to
an NHS hospital Ross Hall staff had difficulty
starting its ambulance.
* In
March, two doctors working at AMI's Harley Street
Clinic in London agreed to pay £280,000 to a Saudi
Arabian boy who suffered severe brain damage a few
hours after non-urgent surgery. The doctors pressed
ahead with the operation though the boy, aged four,
had a high temperature.
*
Last month, the independent St Theresa's hospital in
Wimbledon, south London, was, with one of its
doctors, ordered to pay £36,000 to a woman whose
newborn baby died after being taken to Charing Cross
NHS hospital. A court heard that St Theresa's was
ill-equipped for complications which arose in this
birth, and the anaesthetist was an hour late.
Each
of these cases involves particular circumstances from
which it would be dangerous to generalise. But they
have prompted investigations which reveal gaps in
private provision only now coming to the fore because
of the recent rapid growth of the £1bn independent
private health sector.
More
than half of the 190 private hospitals have no
doctors on the premises at night and almost none have
resident anaesthetists. NHS hospitals generally have
"crash teams" of a senior doctor, an
anaesthetist and two junior doctors on 24-hour
emergency call.
Even
private hospitals with heart units and doing major
surgery, such as the Princess Grace in London, manage
emergency cover with only one doctor and nursing
support. But providing for resuscitation with this
number is condemned because an anaesthetist is needed
to put up drips, insert tubes and administer drugs in
the few minutes available to save life.
"It
is very hard to handle a patient single-handed,"
said Dr Peter Nixon, a consultant heart specialist at
Charing Cross hospital. "You could dispense with
one of the people, just as you could dispense with a
wheel on a four-wheeled car."
Although
big London private hospitals have some of the most
sophisticated medical equipment in the world, many
others lack the technical backup regarded as standard
in a district general hospital. Mobile X-ray units
and fully-stocked 24-hour pharmacies, for example,
are often lacking.
These
facilities can be crucial in emergencies, such as a
cardiac arrest, but there is additional anxiety about
the heavy workload of consultants, who are often also
employed by the NHS on full-time contracts. This can
lead to operations being hurried by what one senior
private medical manager called "a new generation
of wallet-motivated doctors".
Such
difficulties are caused less by the manner of
financing private hospitals than by the economics of
their small scale. Although about 65 private
establishments have opened in the past five years,
they will commonly have only 20 or 30 occupied beds,
compared with 10 times that number in a typical
district general hospital.
The
difficulties imposed by size were admitted this
weekend by Nuffield Hospitals, which said that it
would sometimes recommend that patients use NHS
facilities if the case was complex. The group's
general manager, Oliver Rowell, called for the
government to safeguard standards in the private
sector.
At
present, there are no specific controls on private
hospitals, but Rowell said that the market was big
enough for regulation. "I accept that the
private sector is small, but it is larger and more
mature than it was 10 years ago. It should now move
into an arena where we should accept some broad
standards.
Nuffield
is also to press the government for a consumer
watchdog to be set up to handle patients' complaints.
Under present arrangements, if internal mechanisms
fail to resolve a dispute, patients outside the NHS
have recourse only to lengthy and often impracticably
expensive action in the courts.
The
sensitivity of anything that might add to the cost of
private medicine, however, prompted cautious
reactions to our inquiries from doctors. Although Dr
Nixon of the Charing Cross Hospital backed the
general medical opinion that full crash teams were
essential, he hung up the telephone when the
emergency provisions in private hospitals were
broached.
Dr
Brian Lewis, an anaesthetist and deputy chairman of
the British Medical Association's consultants'
committee, said doctors could drive to private
hospitals in a few minutes. "Your readers don't
want to know about this," he added. "They
want to know about the problems in the NHS"
AMI
said this weekend that the standards of its medical
care and technical backup were completely adequate
for the cases it handled. "AMI hospitals are
fully equipped to do the operations that we advise
our doctors we are capable of doing," said John
Cassell, an AMI director. "We provide the best
and most appropriate level of care."
| brian deer |
Copyright,
Times Newspapers Ltd. All rights reserved. No portion
of this article on deaths and negligence in private
hospitals may be copied, retransmitted, reposted,
duplicated or otherwise used without the express
written approval of the copyright owner. Responses,
information and other feedback are appreciated - via
Brian Deer's homepage.
