Mother of anorexic girl killed by train criticises care failings after inquest

The mother of a severely anorexic 15-year-old girl who died after stepping in front of a train has said that failings in her daughter’s care “from beginning to end” resulted in her death.

Pippa “Pip” McManus was granted home leave from the Priory hospital in Altrincham, Greater Manchester, ahead of completion of the formal discharge process, in December 2015.

Five days later, after a family row, she walked to Gatley station in Stockport and was hit by a train. She was pronounced dead at the scene.

A jury at South Manchester coroner’s court concluded on Wednesday that Pip had taken her own life, but said that the lack of support provided to her family and the delay in implementing a care plan when she arrived home could have been contributory factors in her death.

The court was told that Pip’s parents had reservations about their daughter’s release, as they believed she remained in danger of self harming but felt they had no option but to go along with the decision.

Reading a statement outside the court after the verdict, Pip’s mother, Marie McManus, said her daughter’s death had caused a “tear in the thread of our family [that] will never be mended”.

“Anorexia has the highest mortality rate attributed to any psychiatric illness, with as many as 40% of deaths [of those with anorexia] due to suicide,” she said. “Too many of our children are dying from this terrible illness. Effective treatment is needed more quickly and if this had been available to our beautiful daughter, maybe she would still be alive. Maybe we would not have needed this inquest.”

Jim McManus, Pip’s father, said that throughout the three years of his daughter’s illness there were many more failings than that of not creating an adequate plan for her discharge from the clinic. “From start to finish there were many hurdles, which we felt we were failed on,” he said.

The court was told that Pip talked to her mother about suicidal thoughts on many occasions and that once, the family had found goodbye letters written to her family, dog and doctor. One note read: “I do want to grow up and have a life; at the moment I don’t have one. I can’t fight anorexia any more. I have tried so very hard, but it has won me.”

A medical report made a week before the teenager died judged that absconding, suicide and deliberate self-harm were not “current risks” in Pip’s case. Janet Walsh, a consultant adolescent psychiatrist who was in charge of her care at the Priory, told the inquest that 40% of people with the teenager’s condition relapsed.

“She would still have risks with eating habits and exercise, it’s whether they could be managed,” she said. “There are going to be ongoing issues. You don’t get a young person at discharge without significant problems.

“It is about whether you can get a young person to a stage where it is reasonable to do a trial at home. I was concerned she might end up back in hospital, but it is an important learning process. My fears were about long-term hospitalisation. She had been in a long, long time and she was getting frustrated.”

The jury in Stockport decided that the decision to send Pip home had been appropriate, “as this was deemed to be the lowest risk option”. The jury foreman said: “The planning for discharge was not carried out in a timely manner. This resulted in not all necessary support packages being in place at the time of discharge.”

The jury also concluded that Pip’s parents had not been adequately warned of “the statistically increased risk of suicide in the first week following discharge”.

Pip was formally diagnosed with anorexia at 13, before a deterioration in her mental and physical health led her to be detained by the private hospital in Altrincham in September 2014 under section 3 of the Mental Health Act. When she arrived at the facility she weighed 27kg (4st 3lbs), which Dr Walsh said was “probably the most severe case” she had seen.

Responding to the inquest verdict, Paula Stanford, director of the Priory hospital in Altrincham, said: “Our heartfelt sympathies are with Pip’s family and we will now carefully consider the findings of the jury.”

Deborah Coles, director of the charity Inquest, said Pip’s death had exposed serious failings in the mental health system in relation to the discharge of a highly vulnerable child. “Her terrified family knew there was huge risk,” she said.

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

Mother of anorexic girl killed by train criticises care failings after inquest

Scurvy cases reported in Australia reveal modern diet failings

Scurvy, an 18th century disease caused by a lack of vitamin C, appears to have made a surprise comeback in Australia.

Historically associated with sailors on long voyages, scurvy has been detected in a number of diabetic patients at Westmead hospital in western Sydney.

Prof Jenny Gunton from the hospital’s centre for diabetes, obesity and endocrinology said several of her patients with long-running unhealed wounds had been cured by a simple course of vitamin C.

A lack of vitamin C in the body results in the defective formation of collagen and connective tissues, which can cause bruising, bleeding gums, blood spots in the skin, joint pain and impaired wound healing.
When the patients were asked about their diet, some were eating little or no fresh fruit and vegetables. The rest ate fair amounts of vegetables but were over-cooking them, which destroys the vitamin C.

Gunton fears the problem could be much more widespread.

“Human bodies cannot synthesise vitamin C, so we must eat foods containing it,” she said.

Most Australians don’t meet World Health Organisation standards for vegetable consumption.

Research by University of Sydney PhD candidate Reetica Rekhy, recently published in the journal Nutrition & Dietetics, found that while almost one in two Australians ate the recommended two serves of fruit daily, only 7% of adults consumed the recommended serves of vegetables.

Her research found most of the 1,000 respondents did not have a good understanding about specific nutritional benefits of most vegetables.

“If we are not eating what we are meant to eat, it will have a reflection on our health and there will be all these conditions [like scurvy] that will emerge or re-emerge,” Rekhy said.

Common foods that are high in vitamin C include oranges, strawberries, red and green peppers including capsicums, broccoli, kiwi fruit and grapefruit. Overcooking any food is likely to destroy the vitamin C.

The Australian Guide to Healthy Eating recommends people eat two to eight serves of vegetables and legumes each day, based on age, physical activity levels and body size.

One serve is described as about one cup of uncooked or half a cup of cooked or canned vegetables or beans.

Potatoes are not considered vegetables for the purposes of the requirements but tomatoes, although officially a fruit, are.

Scurvy cases reported in Australia reveal modern diet failings

Serious failings in medical care led to man"s death, inquest finds

The NHS has apologised after a coroner criticised “serious failings” in medical care that led to a man dying hours after an ambulance crew failed to diagnose his heart attack and take him to hospital.

Gary Page, 54, died at home in Essex in February, 12 hours after the senior member of the crew of a private ambulance working for the NHS dismissed the pains in his chest and arm as possible signs of heartburn, indigestion or a pulled muscle.

The East of England ambulance service offered its condolences to Page’s family and “a formal apology for not providing the patient with the care which was expected”.

A spokesperson said that after discussion of the case with Ambulance Service Limited, the private contractor whose crew responded to the 999 call, “it was identified that the seriousness of Mr Page’s condition was not recognised and further advice not sought”.

Caroline Beasley-Murray, who presided over the inquest into Page’s death at Chelmsford coroner’s court on Tuesday, recorded a narrative verdict. She found that his death was preceded by “serious failings of medical care” provided by the private ambulance service.

The inquest heard that Lauren de la Haye, the emergency medical technician on the ambulance, misread an electrocardiogram and wrongly concluded that Page was not in the early stages of a heart attack.

She ignored the concerns of a more junior colleague, Darren Rudge, who believed the ECG reading meant Page needed to be in hospital. Page died at home early the next morning despite efforts to save him.

Stephanie Prior, the solicitor representing the Page family, said: “Gary’s death has been life-changing for [his widow] Kim Page and it is clear today, as endorsed by the coroner, that his death was contributed to by negligence of the private ambulance service personnel and clearly could have been avoided.

“She has suffered and continues to suffer significant anguish knowing that more could and should have been done to treat him and that her husband’s death could and should have been prevented.”

A serious incident report commissioned by the East of England ambulance service found a litany of failures, mostly involving De La Haye. “Service delivery problems” revealed by the death included the lack of a fully trained paramedic on the ambulance; “complacency” by De La Haye in not acting on her colleague’s concerns about her diagnosis; and her wrongly advising Page that he was well enough to stay at home.

De La Haye’s “incorrect analysis of the patient’s ECG and presenting signs and symptoms” was the “root cause” of Haye’s death, the investigation concluded.

De La Haye has been retrained in the correct reading of an ECG and the private contractor’s performance monitored more closely than before as a result of the death.

Serious failings in medical care led to man"s death, inquest finds

Welsh hospitals report reveals "appalling" patient care failings

The Trusted to Care report named into question the ‘short-phrase economic planning’ in place across the NHS in Wales. Photograph: Cate Gillon/Getty Images

Frail elderly sufferers had been forced to endure chaotic, degrading and occasionally harmful situations, a extremely essential independent assessment into two Welsh hospitals has revealed.

Medicines had been administered in an inappropriate way, households complained their vulnerable loved ones had been left without having sufficient foods or drink and sufferers have been informed to go to the toilet in bed. Nurses and physicians felt a sense of helplessness and there was a shortage of certified staff, particularly at night.

1 female patient confided to a member of the evaluation group sent in to investigate the Princess of Wales hospital in Bridgend and the Neath Port Talbot hospital: “I am in hell.”

The review crew concluded that above a variety of years the Abertawe Bro Morgannwg University Health Board (ABMU), which runs the hospitals, appeared to be driven by the “quick-term fiscal organizing” that it said was in area across the NHS in Wales.

Their report, entitled Trusted to Care, explained: “The question should be asked about no matter whether this kind of a relentless concentrate on monetary delivery yr-on-12 months prompted by the nationwide program is distracting NHS boards from a proper concentrate on good quality and patient safety.”

It additional: “No 1 should be in any doubt that there are factors of the care of frail older folks which are basically unacceptable and need to be addressed as a matter of urgency via action by the board of ABMU and by the Welsh government.”

The Welsh overall health minister Mark Drakeford ordered an quick overview of the care of elderly patients across the nation. He mentioned there would be a series of unannounced spot checks by a ministerial group of experts to examine specifications of care for elderly individuals at district common hospitals in Wales. The spot checks will emphasis on the delivery of medication, hydration, evening time sedation and continence care.

Drakeford stated: “This review does not make straightforward reading through it will be specifically tough for all concerned with the care of older folks in these hospitals. I give my unreserved apology to those individuals and their households whose care has fallen brief of what they may well anticipate from the Welsh NHS. I have been shocked by some of what I have read through in this report.”

The findings have been instantly seized on by opponents of the Labour-managed Welsh government, whose well being record is continually attacked both at the national assembly in Cardiff and at Westminster by the prime minister, David Cameron.

The Welsh Conservatives’ health spokesman, Darren Millar, mentioned: “The startling severity of this review’s findings is almost unimaginable. It is clear that individuals have suffered appalling and unforgivable lapses in care that apologies will do little to put right. Not simply shocking – this evidence is horrific in the severe.”

The investigation, which was led by authorities from the Dementia Companies Development Centre and The People Organisation at the request of the Welsh overall health minister.

It was launched right after the case of Lilian Williams, 82, whose loved ones explained she endured appalling neglect at the hospitals and suffered a horrible death. Her son Gareth has named for a total public inquiry.

Amid the most striking components of the report had been direct testimonies of investigators, individuals and family members. 1 member of the assessment crew mentioned: “My 1st impression was of a chaotic environment. Workers appeared stressed and not in control. They informed me that they had been 6 senior workers down, with a single suspended and one particular on sick depart. There were individuals calling out and 1 lady mentioned to me: “I am in hell.”

They added: “Personnel have been not assured about caring for baffled men and women. Newly certified personnel weren’t getting supervised and junior physicians came and went with really minor interaction with the nurses. The noise and clutter was overstimulating, with TVs on but not being watched, and an ambiance in which there had been also a lot of people – doctors, cleaners, nurses, all in the patient area at when.”

An additional assessment member stated: “The chaotic atmosphere increases the chance of drug mistakes. Individuals that almost certainly have dementia have been being prescribed antipsychotics without a appropriate risk assessment. The inappropriate use of sedation for ‘aggression’ was observed.”

Sufferers have been given prescribed medication but not observed taking it. The assessment stated the way drugs had been administered in some circumstances was “unacceptable and hazardous”.

There was also worrying testimony from patients’ households. 1 relative stated: “They left him with the cloth and a bowl to wash himself. I located dried excrement on his legs.” An additional advised the investigators: “We couldn’t seem to the nurses to care for mum. They had no power. They could not get a doctor when we required 1. They couldn’t get medicines in excess of the weekend. My mum had no medicine or food or water for days.”

The report said employees appeared not to know about ameliorating the frequent difficulties in care of frail older individuals, such as management of continence, delirium, mobility, nutrition, dementia, hygiene, and worry.” It highlights failings in medical professionals, nurses, pharmacists and managers.

Looking at problems affecting the NHS in Wales in common, the assessment said: “It is not also great a stretch to see current muddled management structures, lack of clinical cohesion and failures to have sufficiently experienced and oriented workers functioning in frontline settings, as being straight traceable to an overemphasis on brief-phrase operational and economic delivery.”

The ABMU board apologised to individuals and their households or carers.

It accepted some care had been very poor and vowed to place it correct. The chair, Andrew Davies, mentioned: “This report was very uncomfortable to read but we are determined to emerge as a health board where all our hospitals give excellent, patient-centred care.”

Ten nurses have been suspended from Princess of Wales Hospital as element of a police investigation into alleged record-retaining anomalies.

Welsh hospitals report reveals "appalling" patient care failings

NHS believe in apologises for care failings in excess of youngsters with severe heart defects

The families of sixteen young children born with severe heart defects did not acquire the compassion, empathy and assistance they needed from personnel at Leeds educating hospitals believe in and in some instances felt pressured to have terminations, an NHS investigation has found.

Leeds, exactly where children’s heart surgical procedure was temporarily suspended last yr in excess of fears that death rates had been too large, was provided a clean bill of health for its clinical efficiency.

But the damning report into paediatric cardiology at Leeds standard infirmary outlining the experiences of sixteen families who complained of poor care at the unit has prompted apologies from the two NHS England and the Leeds educating hospitals NHS trust, which runs the hospital.

Dad and mom felt they were currently being pressured to have terminations when the heart defect was detected in pregnancy, and had been left alone and in distress soon after the diagnosis.

After the births, some say they were not told that doctors believed the little one would die. One particular couple waited 3 many years for an operation only to uncover that their little one was not on the waiting record. Of the youngsters concerned, six are identified to have died.

The evaluation of the families’ complaints about Leeds was carried out by the independent case reviewer, Professor Pat Cantrill. The complaints associated to care among 2009 and 2013.

The mom of a child called Tom informed Cantrill: “They did the scan and then I went into a space exactly where there was a medical professional and a nurse. I was told my child had half a heart.

“There was no compassion. I cried. The medical doctor explained that the recommendation was to have a termination. I asked if there have been other options and I was informed I could go to complete term and have the baby and then it would die or have the little one and then have surgical treatment but that was not advisable. I was given a booklet and two days to make a selection.

“I was advised not to search items up on the world wide web. I was sent to the antenatal clinic and waited from 2 o’clock until finally five o’clock. I was exhausted. My father went and asked for somebody to see me. The personnel had not been informed about me.

“Then a doctor rang me at home on the Friday for my decision. I said I did not want a termination. I was told it was the largest mistake of my daily life.”

The households had been occasionally provided leaflets to take house but felt they did not have ample info to make a selection. “Some have been left waiting in a distressed state, or in rooms on their personal, and in 1 case left in a corridor,” the report explained.

The mother of yet another baby, Aziz, was urged to consider about termination. “They seemed against me continuing with the pregnancy. As a Muslim I feel that abortion is incorrect. They did not seem to understand,” she advised Cantrill.

Soon after the birth, some mentioned there was no program for the care of the kid.

John, who was breathless, sweaty, blue and slept most of the time, “was on the ‘wait-and-see/as-and-when-required’ path. Alarm bells commencing ringing when a consultant at our local hospital questioned why no care prepare was in spot when John was so poorly,” said on of his mothers and fathers.

Several had been distressed by the lack of distraction when essential tests were carried out. The mom of Sally mentioned: “When they took blood it was awful. They would hold her down. They had 12 attempts to get blood by 4 various doctors. She was so distressed and so were we.

“At the other hospital it could not have been far more various. They have a distraction space and they perform videos while they are taking blood. She can cope with it now.”

Some dad and mom said they have been not advised that the heart could not be repaired and any treatment was only palliative – to relieve symptoms.

“We have been waiting to get a letter for Shona to go into hospital for her heart surgical procedure. I was a nervous wreck,” mentioned a mom. “She commenced to deteriorate. I contacted the hospital. They created me feel as though it was me and that I was becoming above protective and that I would just have to wait.

I stated that we necessary to see someone and eventually we saw the cardiologist. The scan did not demonstrate anything distinct. We had waited for three many years for her surgery but when we saw the physician she told us that Shona was inoperable and that she was not on the waiting list.”

A single mother was known as by the children’s hospice with out understanding the hospital had referred the little one. Families told of delays to their children’s treatment method, which they believed produced it significantly less very likely to be productive.

Some talked of a lack of support after their little one had died. “After Tim died the shutters appeared to come down. There need to be counselling offered for mother and father who have misplaced their child,” mentioned a parent.

Not all the experiences have been negative, the families acknowledged, but some said care from the cardiology support that had been excellent had deteriorated in excess of the years.

The stories she heard, mentioned Cantrill, “were all heartfelt, moving and sincere. All the households have been saddened to locate themselves in a position in which they had lost self confidence in the care supplied for their young children and for them as a family. They want the services for kids with congenital heart conditions each nationally and locally to learn from their encounter. They want companies for children and their households to increase.”

She created a series of suggestions for the believe in, other heart units and NHS England.

The trust apologised to the households and explained it had currently made adjustments, but the deputy director of NHS England, Mike Bewick, warned that lessons have to be realized by all people concerned in the care of this kind of vulnerable youngsters.

“This kind of experiences are not able to be defended,” he stated.

Julian Hartley, chief executive, and Yvette Oade, chief medical officer at Leeds educating hospitals believe in said they have been glad the children’s heart unit had been discovered to be risk-free and running effectively. “We are very sorry however, that the sixteen households who shared their stories with [the evaluation] felt we did not give the care they had a appropriate to anticipate … we sincerely apologise to individuals households and will of course, make sure we understand from what they had to say and enhance our providers as a outcome of this.”

The report was published by NHS England on the day that Sir Ian Kennedy – who chaired the inquiry into failures in babies’ heart surgical procedure at the Bristol royal infirmary more than a decade ago – met families whose young children with heart defects died at one more hospital in the city, the Bristol Royal Hospital for Kids. Kennedy is assisting to set up an inquiry into their concerns, at the request of Sir Bruce Keogh, NHS England’s health care director.

“I have to say that I really feel a wonderful sense of sadness that I discover myself right here in Bristol – 13 years after my first report – hearing after once more the anger and distress of mothers and fathers,” stated Kennedy. “The families want a robust independent procedure. We have made very good progress in obtaining the way forward and there is still more work to do. We hope to get issues moving with some urgency.”

Four inquests on children who have died following heart operations in Bristol have exposed failings in care, breakdowns in communication and, at times, an apparent lack of empathy with mother and father when they flagged up considerations about remedy.

The parents of two of the youngsters, Luke Jenkins, seven, and Sean Turner, 4, who died in 2012 within a month of each and every other at the Bristol royal hospital for Youngsters, have strongly expressed the belief that employees did not consider their concerns seriously.

Faye Valentine, the mother of Luke, stated she and her companion, Stephen, had been manufactured to really feel as if they have been a nuisance when they flagged up fears about their son’s recovery.

“We weren’t currently being listened to,” she stated. “They considered we had been currently being above-anxious and asking too a lot of concerns. They ignored us. We weren’t asking stuff for the exciting of it. We had significant issues and they ignored us.”

The mother and father of 4-12 months-old Sean Turner, who like Luke was taken care of in ward 32, the children’s cardiac ward, said there had identified a “lack of leadership, accountability and communication” at the hospital.

The believe in insists that it has produced basic modifications to the way both kids and their parents are cared for on ward 32. Dad and mom are now asked frequently if they have considerations – and any worries are noted and what actions taken to address them recorded. In addition mother and father can write their views into the official patient information. Up coming to each child’s bed is data about how they can increase concerns formally.

NHS believe in apologises for care failings in excess of youngsters with severe heart defects