HC Deb 21 December 1956 vol 562 cc1703-11

3.34 p.m.

Mr. Airey Neave (Abingdon)

The subject that I want to raise has a different emphasis from that raised by the hon. Member for Erith and Crayford (Mr. Dodds), and I shall give the Parliamentary Secretary to the Ministry of Health the fullest possible time to give me an explanation of the death of one of my constituents, Mrs. Ethel M. Gill, who died in September, 1953.

The hon. Lady well knows the reason for the delay in raising the matter. It is that Mrs. Gill's husband sued the Radcliffe Infirmary, the convalescent home at Weston-super-Mare to which she was sent, and the doctors—I need not name them—who were concerned with her treatment at the time of her death. That action being pending over a considerable period—it has now been settled—it was not possible—I quite understand the situation—for the Ministry to make any announcement about its investigations into the case.

The legal aspect of the matter has dragged on for some time, but it is clear from the fact that I wrote to my right hon. Friend the then Minister of Health, in October, 1953, asking him to investigate the case, that the circumstances were gone into at that time. I came to the conclusion—I think the hon. Lady will have reason to say this, too—as a result of the fact that the action was settled with considerable damages to the husband, that it was a serious case of neglect.

It is always a difficult type of case to raise, as my hon. Friend will agree, in view of the devoted work of the hospital service, and, indeed, of her admirable contribution to its administration, but that does not mean to say that when a case of this kind comes to light a proper explanation should not be given of the action taken to prevent such things in the future. It is also disagreeable to criticise the Radcliffe Infirmary in a case of this kind, or the convalescent home at Weston-super-Mare, but something went very seriously wrong in this case, and I want to raise the facts so that my hon. Friend can, say what she wants to say about what happened, about what action was taken at the time, and about what precautions have been taken to avoid such things happening on a future occasion.

The defendants to the action were the Governors of the United Oxford Hospitals and the Weston-super-Mare Hospital Management Committee. The action was taken by the husband, Mr. S. B. Gill, my constituent. There is one point that I want to raise before I go into the facts about the settlement of the action. It is not very clear, from the order made in the High Court, whether liability was admitted by the United Oxford Hospitals and by the Weston-super-Mare Hospital Management Committee, but that matter is the subject of further action by Mr. Gill at present, and, indeed has been referred to the Law Society. Therefore, I need not go into that complication in raising the medical side of the matter.

Mrs. Gill was admitted to the Radcliffe Infirmary on 1st August, 1953. The diagnosis was that she was suffering from a strangulated hernia, and an operation was performed on her. There is some dispute as to the facts, as to whether it was said at the time that there was no danger to her, but the operation was performed, and the result of it was that she remained in the Radcliffe Infirmary until 13th August, no X-ray examination having at that time been taken of the swelling of her abdomen that resulted, and a certain number of other symptoms.

Indeed, when she left on 13th August, the operation wound, according to the Minister's letter to me, was well healed. Mrs. Gill left for the convalescent home at Weston-super-Mare. She told her husband, according to a statement which he made to me, and which was, of course, communicated to the defendants, that the wound had broken open, but that is a matter on which the evidence is disputed. The question does, however, arise as to whether she should have been discharged in view of what was subsequently discovered as to her condition at that time. She was discharged, according to the husband, as having been cured. Clearly, she was not cured; no doubt, that fact is admitted, in view of the settlement of the action with considerable damages to the husband in the case.

She remained at the convalescent home until 28th August. On 26th and 27th August it was noticed that her left leg and thigh were painful and swollen. There is some dispute as to the facts here. The Minister in his letter to me said it was "a little swollen". When she was declared fit to travel the next day to Oxford and was seen by her husband on Oxford station, he noticed that the leg was so distended that it showed over her shoe. In my submission on the facts of the case, she clearly was in no condition at all to travel. Indeed, when one considers what was discovered in the post-mortem after her death only a few days later, that must obviously be right.

When I wrote to my right hon. Friend the Minister of Health about this case, I drew his attention to the fact that the doctor who had seen her before she was discharged from the convalescent home thought that all this trouble of pain she was suffering from was rheumatic; he sad that the lessons had been learned. I would rather like to know what lessons had been learned. What records were sent from the Radcliffe Infirmary to the convalescent home, in view of the fact that, as I understand it, it was made known to the convalescent home that constant medical attention would be required in this case? How did it come about, in the view of the hon. Lady's Department, that Mrs. Gill was discharged?

It may be a matter for medical judgment. There are cases in which want of care and skill by a medical officer may result in legal action. None the less, my hon. Friend may think it is the duty of her Department to say something about a case of this kind which resulted in this lady's death which, in my submission, should never have occurred at all.

I have already mentioned the legal aspect of the matter, and I need not go further into the question of the exercise of medical judgment, save to say that when the Minister wrote to me, I having asked him what he had to say as to why the medical officer had discharged the lady from the convalescent home, he said that it was a matter of the exercise of medical judgment, adding: Whether the doctor was justified or not in coming to this decision, I am really not in a position to say. This was after the husband had recovered £2,000 damages in respect of the negligence of the staff of that convalescent home.

I feel we ought to hear about this, and it is a duty laid upon my hon. Friend's Department to say much more about it. Although this is not in any way intended to be an attack upon the services provided by these two particular hospitals, it is a case in which a much better explanation ought to have been given.

Mrs. Gill arrived unaccompanied back at Oxford in this very serious condition, as it turned out. She was met by her husband, and was then so ill that within 48 hours she was back in the Radcliffe Infirmary. The facts of the matter are not in dispute at all. It was found when she got back to the Radcliffe Infirmary that she was suffering from thrombosis of the left leg—this was provisionally diagnosed before her death—and also a pelvic abscess, the existence of which became clear before her death. The post-mortem showed matters which one would have thought ought to have been cleared up before.

It is plain that this is a matter of medical judgment, and it is perfectly true that medicine is not an exact science. Equally, it is plain that it is unfortunate that my hon. Friend's Department did not, in view of the clear case of negligence involved here, as shown by legal action, say a little more to the husband and in response to my inquiries as to whether any action has been taken to supervise cases of this kind in order to ensure that people are not discharged from hospital to a convalescent home, on the one hand, until they are cured, or to ensure that they do not, on the other hand, leave a convalescent home in a condition of this kind.

The post-mortem dated 8th September showed that in Mrs. Gill's leg there was a widespread septic thrombo-phlebitis, and it also revealed a pelvic abcess of a kind which may or may not have been expected. What is perfectly clear, without medical knowledge, is that she was very seriously ill at the time she was discharged from Weston-super-Mare. The conclusion of the post-mortem was that a small focus of infection remaining in the pelvis after the operation for hernia gave rise to the pelvic abcess.

If certain lessons have been learned and if, as the Minister states in his letter to me of 4th June, it is true that by these lessons being learned, Mr. Gill's object has been achieved, in view of the circumstances of the case, I should like to know what lessons have been learned, and what has been done. It seems to me important that the matter should be raised from that point of view. My hon. Friend may tell me that the doctors made a mistake in this case; indeed, I understand that that is the position by the admission of liability—taking it only as far as the defendants in Weston-super-Mare are concerned.

Is there not a little clearer answer to be given, however, as to how it is that patients are allowed to leave the Radcliffe Infirmary in a condition which, at the time, one would have thought was noticeable? If my hon. Friend is satisfied that on a reasonable interpretation of the facts no doctor would have seen anything wrong with this lady at the time she left the infirmary, what is the position with regard to the convalescent home? Whose responsibility is it to see that patients do not leave in a condition as serious as this lady's must have been? A closer examination of the postmortem shows a wide degree of sepsis and a degree of thrombosis of a kind which one would have thought was of long standing.

Had this matter come to court that would have been some part of the plaintiff's case. Is my hon. Friend satisfied that everything has been done to avoid this kind of thing in future? Is she satisfied that something more than lessons have been learned, in the sense that some kind of administrative action has been taken? I hope that I have not taken up too much of my hon. Friend's time, and that she will be able to give me a reply on these points.

3.48 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)

This is one of those unhappy cases where the process of law has been invoked on a matter which is always difficult to decide—that of a medical diagnosis. Medical diagnosis is not an exact science and, using all the skill and knowledge available, and with the best treatment, occasions arise when some symptom or condition evades the penetration of the medical officer.

In this case the proceedings have been long drawn out, over three years from 1953 to 1956, and because of the recourse to law my right hon. Friends the former and the present Minister could not comment upon the various points raised because the matter was sub judice. My right hon. Friend has, however, asked me to offer his deep sympathy on the tragic loss that Mr. Gill sustained in the death of his wife.

As the hon. Member has outlined, Mrs. Gill was admitted to Radcliffe Infirmary on 1st August, 1953, with a strangulated hernia, and was successfully operated on. In the ordinary way, she would have been discharged on the seventh or eighth day after that. As, however, she was thought by the surgeons to be rather a frail woman physically, they decided to send her for convalescence to Weston-super-Mare. That convalescent home could not take her until 13th August, and so she was not discharged from hospital after eight days. Because it was considered advisable not to send her home before convalescence, the Radcliffe Infirmary retained her for a further five days. She then appeared to have made a good recovery. The hospital therefore showed the patient every consideration, and there is no question of negligence there.

On 13th August, Mrs. Gill was transferred from the Radcliffe Infirmary to the convalescent home at Weston-super-Mare. At that time, the wound was well-healed apart from a quarter-inch stitch abscess which was superficial and in no way necessitated a further stay in hospital. Mrs. Gill had been up and about for some days before she left the Radcliffe Infirmary. The matron of the convalescent home was informed that there was still some discharge from the wound of the operation, mostly serum and some thickening of the tissues, and that dry dressing would be required. During her stay at the home, Mrs. Gill was able to take daily walks and enjoy the same activities as other patients. She was in fact up and about.

On 26th August, the day before Mrs. Gill was due to be discharged, she was seen by Dr. Kelly, the medical officer, who noted that she had gained some weight and had made satisfactory progress, and he decided that she was fit to travel and for discharge on the following day. A hospital car was arranged to meet the train at both ends. The hon. Member tells me that in fact Mr. Gill picked his wife up, but the record of the Oxford ambulance service shows that an ambulance car was at the station to meet her at the other end.

The discharge of the lady on that day was an exercise of medical judgment, and whether the doctor was justified or not in coming to that decision the Minister is not in a position to say.

As regards absence of prior notification to Mr. Gill of his wife's return home, which the hon. Member has raised in correspondence, it was assumed that as she was at the convalescent home for a fixed period of fourteen days he would be aware that she would leave on 27th August, 1953, and that no reminder to him of the fact by the hospital was necessary.

Before she left the hospital, Mrs. Gill was advised to see her own doctor on arrival at her own home. On 28th August, Mrs. Gill was readmitted to the Radcliffe Infirmary. A pelvic abcess was suspected. She was correctly and adequately treated and there was no delay which could have any bearing on the outcome. There will, unfortunately, always be some cases where the hest judged treatment will unhappily fail to save life. There was no delay in her admission to the Radcliffe Infirmary; in diagnosing her suspected condition which subsequently proved to be a correct diagnosis, and in giving her immediate treatment for the pelvic abcess.

I would like to emphasise that a suggestion that the existence of a pelvic abcess noted post-mortem caused surprise, which was mentioned in a letter, was in fact due to a misunderstanding of the medical terms used. So far as the records of Radcliffe Infirmary show, there was no delay in suspecting this case, proving the diagnosis and providing the correct treatment for it.

The hospital services were made fully available at all stages of this unhappy case. The only doubtful issue concerns the fitness of Mrs. Gill to undertake the return journey from Weston-super-Mare to Oxford, and, as already said, this was an exercise of medical judgment. The Minister, as he has said in correspondence to my hon. Friend, feels sure that any lesson to be learned by the particular practitioner has indeed been learned in this case and to that extent Mr. Gill's object has been achieved. But an error of judgment is not the same as medical negligence, and I want to make that point clear to the hon. Member. As he knows, Mr. Gill brought proceedings against the two doctors, and from those two defendants he accepted an amount in full settlement of his claim.

As is customary, the other defendants, the Oxford Board of Governors and the Weston-super-Marc Hospital Management Committee, approved the settlement of the proceedings but they were not concerned in the payment of damages. They had never been in communication with the plaintiff's solicitors and never at any time admitted neglect or liability. This case was settled out of court on payment of £2,010 damages.

That Mrs. Gill received full care and treatment at the Radcliffe Infirmary is not. I think, in question. What is questionable is whether there was an error of judgment regarding Mrs. Gill's fitness to travel. In such a matter, the layman, cannot decide: and indeed after a lapse of three years, and with all the medical records, it is even more difficult to assess the error of judgment. What has not been proved, nor has it been tested in the courts, was whether there was negligence, which if proved would have involved the employing authorities, the hospitals, concerned.

Mr. Neave

I cannot possibly accept that. This was an action for negligence against the Weston-super-Mare Hospital Management Committee, settled for £2,000 damages, in which the Committee clearly admitted liability.

Miss Hornsby-Smith

I have not time to repeat what I have said, but the hon. Gentleman will read it tomorrow in HANSARD. I can only affirm that this matter was settled by the Medical Defence Union for the two doctors and, as is the normal form, in order to avoid duplication of cases, the other defendants were associated with the settlement although at no time were they in contact with the solicitors, and they have never accepted liability. Nor do they accept any claim of negligence.

The issue was not tried, and the Minister cannot assume negligence such as would merit the request which my hon. Friend has made for an official reprimand to the hospital. In such a matter as this, where there is doubt as to the medical judgment of one of the doctors, the protracted proceedings and the final settlement cannot have failed to be well registered in the minds of the staff and the authorities of the hospital.

I would again, in this most unfortunate case, like to express our deep sympathy with Mr. Gill in his bereavement and our regret that he should still feel anxiety in the matter.