Widow hits out at hospital care

James Paton, 69, of Flackwell Heath, High Wycombe, died in March 2000 from a massive stroke after his internal organs were ravaged by a bacterial infection contracted after an emergency operation for a burst stomach ulcer.

It is believed he most likely caught the deadly infection from a drip tube inserted into his neck. Hospital tests revealed the tube showed traces of MRSA a form of infectious bacteria resistant to some antibiotics and especially dangerous to patients with deep wounds, catheters or drips.

At a three-day inquest into his death at High Wycombe Magistrates this week, Mr Paton's wife, Pauline, broke down as she described the final weeks of her husband's life. She claimed doctors and nurses looking after her husband seemed unresponsive, badly trained and unable to provide essential day-to-day care.

Mrs Paton described hygiene procedures on Wycombe Hospital's Ward 2A as extremely lax and inadequate to deal with MRSA.

Jury members heard huge amounts of complex medical evidence as successive witnesses, including a surgeon, four doctors, two microbiologists, two nurses and a professor, pieced together the story detailing how Mr Paton, a retired Fleet Street journalist, went from an initially successful post-operation recovery to being infected with MRSA and then dying, in just over a month.

Barrister Dr Peter Ellis, representing the Paton family, grilled a number of hospital staff members over family concerns that the drip tube found to be infected with MRSA was not immediately removed from Mr Paton's neck after advice to do so from Wycombe Hospital's microbiology team.

He also questioned why doctors failed to diagnose a heart infection which probably led to Mr Paton's stroke as it was only discovered during the post mortem examination.

Professor Gary French, a leading expert who is heavily involved with the Hospital Infection Society, addressed the inquest on a number of concerns raised by the family.

Referring to issues of hygiene raised by Mrs Paton, he said: "I believe what Mrs Paton said and I think the issues she raised should be addressed."

But he added: "I honestly don't think that this particular issue [hygiene] made any difference to Mr Paton's outcome."

He described Mr Paton's death as a series of terrible tragedies.

He said proper infection procedures that met national guidelines had been carried out at the hospital and he was sure staff did all they could to care for him.

Doctors and nurses were also probed over why daily nursing and medical notes seemed to be incomplete and therefore in breach of guidelines issued by the South Bucks NHS Trust which runs the hospital.

Dr Ellis further revealed a number of factual inaccuracies in various medical reports and notes drawn up by the trust and its staff.

On Wednesday, Mrs Paton offered jurors damning evidence heavily criticising alleged standards of cleanliness and medical treatment at the hospital.

Before reading her statement out, Mrs Paton said it centred "on hygiene issues which I feel have contributed to James's death and put other persons within the hospital vicinity at risk".

She told the inquest that ward nurses regularly left full urine bottles by patients' food on bedside tables, failed to wear gloves designed to cut risks of passing on infections and appeared to be poorly trained in basic tasks such as changing intravenous drips.

"I witnessed nurses connecting several other intravenous drips. Only one of these nurses was wearing gloves, the others used their bare hands. They did not appear confident in what they were doing, triple checking everything."

The mother-of-four claimed her husband, who at the time was suffering from attacks of diarrhoea, was once left for some time in a bed he had heavily soiled and that on another occasion she watched as he pressed his bedside alarm 27 times without any response.

Mrs Paton added she had tried to complain to doctors on the ward on a number of occasions but explained they had "a wonderful way of blanking me".

On March 15 Mr Paton was moved into a side room because he had diarrhoea but Mrs Paton said: "He was left bare-chested with a flimsy nightgown and his sheets were not covering his body properly.

"There was no air-conditioning in his room. The pains in his neck were so obvious it seemed as though several doctors and nurses were ignoring him."

Both doctors and nurses told the inquest, however, they could not recall Mrs Paton making any complaints directly to them.

Mr David Cairns, consultant general surgeon at Amersham and Wycombe hospitals at the time, read out a detailed chronological report of Mr Paton's treatment under his team in Ward 2A, until his stroke, when he was transferred to the hospital's intensive care unit.

Jurors heard how Mr Paton was admitted to Wycombe Hospital on February 21, 2000, suffering from severe abdominal pain.

Mr Cairns explained he carried out an emergency operation to 'over-sew' a perforated stomach ulcer which was leaking into Mr Paton's abdomen and would have killed him without surgery.

Towards the end of February, Mr Cairns and his team thought Mr Paton to be recovering well and there was "a good chance he would be out of hospital in a few days."

By the beginning of March and throughout the weeks up until his death, however, Mr Paton's condition worsened with frequent attacks of diarrhoea and signs of serious infection in his abdomen and of the blood.

On March 7 it was decided a feeding line would be inserted into Mr Paton's neck to rest his bowels and encourage his abdomen to heal. However, Mr Paton's condition failed to improve and on March 20 he suffered a stroke.

He was immediately moved to intensive care where he deteriorated further, suffering from multiple organ failure.

He died at 8.18pm on March 26 when treatment was withdrawn after scans showed he was brain dead.

Dr Chris Graham, anaesthetist at Wycombe Hospital's intensive care unit, told jurors: "In Mr Paton's case we certainly did everything we could until there was no possibility of recovery."

During a cross-examination of Mr Cairns by Dr Ellis, jurors heard how Mr Paton was first confirmed MRSA positive on March 15 after microbiologists processed the results of blood tests taken on March 14.

Consultant microbiologist at Wycombe Hospital, Dr Mary Lyons, later told the inquest she thought the neck line was the "more likely" source of the infection and confirmed she had advised Mr Cairns' medical team to remove it on March 16.

On March 17 Dr Lyons told the medical team the line "must be removed" after she found a blood culture taken from the neck tube was growing MRSA. She had also noticed skin on Mr Paton's neck around the line's insertion point was red and tender but the tube was not removed until a matter of hours later.

Asked by Dr Ellis whether "time was of the essence" in removing the tube, Dr Lyons said: "Whether a few hours could have made a lot of difference, I think, is impossible to say."

Microbiologists are responsbile for setting guidelines as to how MRSA is controlled in hospital.

But Dr Lyons told the inquest it would be impractical to screen every patient that came into the ward because the system would grind to a halt.

She said the guidelines are exactly that. "They are to guide you. But this is not mandatory, it is not law to do them."

She added: "We are very ward-based. We do try to make sure that every day we go to the ward and see patients."

Dr Lyons said the inquest could not be certain when Mr Paton contracted MRSA but she agreed that tests carried out on February 21 and March 7 showed he did not have it, but from March 14 onwards he definitely did.

She added: "We try very hard to limit any spread of MRSA from patient to patient. At the time on Ward 2A we had no other patient we were aware had MRSA."

Her colleague Dr David Waghorn said MRSA was now endemic throughout every hospital in the UK and the Western world.

He said it is most prevalent in the south east of England but more prevalent in inner London. In 1999 South Bucks NHS Trust had about half the rate of the average for the south east.

He said Mr Paton was: "extremely unfortunate to develop this infection... but it must be remembered that he was admitted in an emergency with a severe life-threatening condition."

Dr Ellis, representing the family, asked if hygiene conditions could have contributed to the MRSA.

Dr Waghorn said it was impossible to comment on the conditions that Mrs Paton had observed but as a microbiologist, he considered general cleanliness was obviously important.

He said that he accepted that as a general criticism things could be better, pointing to resources and staffing.

He ageed with Dr Lyons and said: "I think on balance the most likely way Mr Paton acquired his MRSA was through the central line [in his neck]."

Dr Ellis asked if there had been improvement made to the ward since Mr Paton's death.

Dr Waghorn said there were more nurses and more resources made available after 2000.

He added: "It has been mainly in the last year to 18 months. It was some time after Mr Paton's illness and stay in hospital that there had been this improvement."

A postmortem examination of Mr Paton's body, performed by Dr Adam Padel, consultant pathologist at Stoke Mandeville Hospital, also showed he had been infected with the MRSA bacterium but Dr Padel said he "couldn't say" at what point this had happened.

Asked by Dr Ellis whether MRSA could be put as the cause of Mr Paton's death, Dr Padel answered: "No, I don't feel I have conclusive proof to that effect."

Dr Ellis asked each of the doctors and nurses called as witnesses whether they thought that procedures of medical note-taking and hygiene, including hand-washing and the specific care given to Mr Paton, had been good enough on Ward 2A.

Dr Ellis repeatedly suggested that the redness and tender area on Mr Paton's neck could have been spotted earlier by raising doubts over whether nursing staff had checked the drip entry-site daily, as guidelines recommend, because of a lack of written notes.

Sister Glenys Newton, who managed the team of six nurses which looked after Mr Paton, said: "I do admit the documentation is not as good as it could be.

"The pressure we had on that ward was tremendous and I think something has to go either nursing care or documentation and I think in this case it was documentation."

She added that she was satisfied that the correct procedures were carried out in Mr Paton's case, even if they were not documented.

Mr Cairns and his junior house officer at the time, Dr Hugh Matthews, both told the inquest they could not remember shortfalls in nursing care in Mr Paton's case.

However Mr Cairns did explain morale and funding on the NHS were a problem and added: "If there was more funding, everybody could do their job better."