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Widower in legal fight with hospital 
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A widower is suing a hospital trust and the Health Secretary over his claims that doctors twice put “do not resuscitate” orders on his wife’s medical notes without her consent.
David Tracey is taking legal action following the alleged use of the orders while his wife, Janet, was treated at Addenbrooke’s Hospital in Cambridge. Doctors cancelled the first order after she objected to it, only to put on a second one, he claims.

Mrs Tracey, 63, a care home manager, had been diagnosed with terminal lung cancer but died at the hospital 16 days after breaking her neck in a car accident.

Her widower is taking action against Cambridge University Hospitals NHS trust, which is responsible for Addenbrooke’s, and the Department of Health, which he claims acted unlawfully by not having a standard policy on resuscitation decisions.

“My wife cared for the elderly all her life and her treatment at Addenbrooke’s caused unnecessary suffering to her, our daughters and me,” said Mr Tracey. “She would have taken great pride in seeking a change to the system which would mean future patients and their families are not forced to endure the same experience.”

Alison Noeland, one of Mrs Tracey’s daughters, said: “We believe mum’s experience is a consequence of the lack of clear policy on decisions relating to end-of-life care. A clear and national policy is needed.”

Mr Tracey is taking action under the 1998 Human Rights Act. He alleges that his wife was denied the right to life and was subjected to degrading treatment while he was denied respect for his personal and family life.

There is national guidance on “do not resuscitate” instructions for health professionals but the NHS in England leaves official policy to local health trusts.

A Department of Health spokesman said: “Decisions on Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) must be clinically appropriate for the individual involved, weighing up the possible benefits of CPR against any burdens or risks associated with the treatment.

“Because clinical judgment is so important in these decisions, it’s our view that guidance provided by a responsible body of professional opinion, based on direct experience of the complexity and sensitivity of these circumstances, is more appropriate than the setting of national guidance by the department.”

A spokesman for Addenbrooke’s hospital said it did not agree with the family’s account. “Our clinicians followed the DNACPR policy, which remains in place.”

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Sat Aug 27, 2011 11:00 pm
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Addenbrooke's and Andrew Lansley sued over 'do not resuscitate' rule
The husband of a woman who died in one of Britain's best-known hospitals is taking its management and the health secretary Andrew Lansley to court, alleging an illegal use of "do not resuscitate" orders.

David Tracey claims doctors at Addenbrooke's hospital, Cambridge, twice put such orders in his wife's medical notes, cancelling the first after she objected to it only to put in a second three days later without her consent or any discussion with her.

Tracey alleges the hospital's actions deprived his 63-year-old wife Janet of the right to life and subjected her to degrading treatment, while he was denied respect for his personal and family life.

He is also seeking to force the coalition government to draw up a policy for England on the use of Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) instructions, and claims the present system of local policies is open to abuse.

The case is likely to ignite a public debate over whether patients should have the final choice over their life and death, or whether doctors ultimately "know best" on when such treatment might be futile.

Thousands of "do not resuscitate" instructions are added to medical notes each year. There is UK-wide guidance for health professionals, but the NHS in England leaves official policy to local health trusts, although there are moves at regional level to harmonise approaches. Scotland has a countrywide policy.

Solicitors have lodged a claim for David Tracey and the estate of his wife Janet, the manager of Trent Lodge care home for older people in Enfield, north London, with the high court, alleging breaches of the 1998 Human Rights Act.

It wants a judicial review of the actions of the Cambridge University Hospitals NHS trust which is responsible for Addenbrooke's, and the Department of Health, both of which deny they have acted unlawfully.

In February Janet Tracey, who had four daughters and seven grandchildren and had recently been diagnosed with terminal lung cancer, was admitted to Addenbrooke's after breaking her neck in a car accident. She died 16 days later.

Her husband alleges the trust acted illegally by not having an appropriate policy on resuscitation decisions – and that the health secretary had not issued any "clear policy or guidance" which told patients and their families of their "rights and legitimate expectations".

David Tracey claims the lack of a standard policy is liable to create a system that is "arbitrary, variable between hospitals and open to abuse" – and, in the case of his wife, failed to offer "a minimum degree of protection" of her human rights.

Tracey said: "My wife cared for the elderly all her life and her treatment at Addenbrooke's caused unnecessary suffering to her, our daughters and me. She would have taken great pride in seeking a change to the system which would mean future patients and their families are not forced to endure the same experience."

Alison Noeland, one of her daughters, said: "We believe mum's experience is a consequence of the lack of clear policy on decisions relating to end-of-life care. A clear and national policy is needed. It should not be the case that there is a different policy from area to area. This just does not make sense."

Noeland and her sister, Kate Masters, have also made formal complaints to the hospital. But the hospital has told them it will not respond to these until the legal action is concluded.

Tracey's solicitor Merry Varney, of Leigh Day & Co, said: "The use of DNACPR orders are widespread, yet patients and their families seem often to be unaware of the decision-making procedures, the meaning of the term and even their use.

"The fact that under current policy, treatment with the potential to sustain life can be withheld without the consent or knowledge of a fully capacitated patient raises real risks of gross violations of an individual's basic human rights, and appears perverse considering the current law regarding assisted suicide and the right to die.

"Janet's medical notes clearly stated that prior to her death she was unaware of the DNACPR on her file, which reinforces that the current system is open to abuse and can disregard patient choice. We hope to bring an end to this and seek coherent national guidance giving full information on a patient's right to choose and be informed, and what to do if a dispute arises."

Addenbrooke's hospital told the Guardian: "We do not agree with the account given by the family, but we cannot debate the issues involved because we are subject to ongoing judicial review proceedings.

"Our clinicians followed the DNACPR policy, which remains in place." The hospital sent the Guardian a copy of its policy, but said it did not have a patient information leaflet.

The Department of Health said in a statement: "Decisions on Do Not Attempt Cardio-Pulmonary Resuscitation must be clinically appropriate for the individual involved, weighing up the possible benefits of CPR against any burdens or risks associated with the treatment.

"Because clinical judgement is so important in these decisions, it's our view that guidance provided by a responsible body of professional opinion, based on direct experience of the complexity and sensitivity of these circumstances, is more appropriate than the setting of national guidance by the department."



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Sat Aug 27, 2011 11:02 pm
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Having worked in hospital for four years now, this is something that boils my piss.

A lot of people have misconceptions about "Do Not Resuscitate" or DNR (aka DNAR). All it means is that if your heart stops beating, a crash team don't come running and try to restart it. It does not mean you cannot have treatment, such as antibiotics for infection, or fluids if dehydrated.

There is also a lot of misconception about CPR. Even with best situation (young patient, otherwise fit and well), CPR is about 15% effective, so you can imagine the chances of a 90 year old with pneumonia and a whole host of other problems. The other thing is about after CPR. Even if the 90 year old could be successfully resuscitated, the quality of life is likely to be poor (eg hypoxia leading to brain damage meaning they're likely to be bedridden/dependent).

In the article, the widower states the doctors denied the right to prolong life. This is incorrect - no one has the "right" to prolong life. You have the right to refuse treatment, and you cannot demand anything eg if I have a chest infection, I want all antibiotics no matter what the situation. Doctors often don't discuss the DNR status with patients, often if it may distress them, if they have no capacity (eg cannot understand what they're being told), etc. Often it's because the patient is confused/unwell and waiting until they get better isn't an option. They may well have no family/next of kin present. It can also be insensitive to ask - imagine if your mum or dad gets unexpectedly admitted, and you get asked if you want them to be resuscitated.

What really needs to be done is that DNR and CPR need to be campaigned to the public to help them understand what it means. A video of CPR (showing the outcome of both successful and unsuccessful CPR) in my opinion should be mandatory.

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Sat Aug 27, 2011 11:20 pm
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While I agree with you, CW, I do think that in this case, if the woman had seen that she had a DNR and had said that she wanted it removed from her records, they should have complied and not snuck it back on when she wasn't looking...

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Sun Aug 28, 2011 6:49 am
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big_D wrote:
While I agree with you, CW, I do think that in this case, if the woman had seen that she had a DNR and had said that she wanted it removed from her records, they should have complied and not snuck it back on when she wasn't looking...
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The doctors should use their judgement, but if the patient has specifically told them to not to apply DNR, then that it what should happen.

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Sun Aug 28, 2011 7:08 am
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You cannot demand treatment, and that includes CPR.

There should have been a good discussion but this isn't always the case. Some people have unreasonable expectations. TBH in this situation, even if she didn't have a DNR form in place, realistically she would have received two rounds of cursory CPR (lasting max 15 mins) and then declared deceased. If successful, the CPR could have left her paralysed below the neck depending on the type of neck injury.

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cloaked_wolf wrote:
You cannot demand treatment, and that includes CPR.

There should have been a good discussion but this isn't always the case. Some people have unreasonable expectations. TBH in this situation, even if she didn't have a DNR form in place, realistically she would have received two rounds of cursory CPR (lasting max 15 mins) and then declared deceased. If successful, the CPR could have left her paralysed below the neck depending on the type of neck injury.

Yes but with her broken back it would have been very problematic. The problem is that they went about this in the wrong way. If they had spoken to both about this and said if she had a problem requiring CPR that it would have been dangerous to continue. It seems that the consultants were too arrogant to even mention the problems to the couple. That is the problem with many consultants now. They have lost all empathy with their patients. So the outcome is that the hospital will now probably lose more than half a million pounds fighting a legal action that was completely avoidable. They might win but they will still be seriously out of pocket for incompetence.

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Sun Aug 28, 2011 12:58 pm
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I agree they went about it the wrong way, but it was the right decision. She could object all she wants but if a treatment is deemed unsuitable, she won't be offered it.

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cloaked_wolf wrote:
I agree they went about it the wrong way, but it was the right decision. She could object all she wants but if a treatment is deemed unsuitable, she won't be offered it.

But why didn't they make that clear? With her broken spine she would have been paralysed as a result. Was that made clear to the family? If not, then they deserve the lawsuit.

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Sun Aug 28, 2011 3:53 pm
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Unless the patient has specifically requested a DNR, I think doctors should administer CPR in all cases.

Allowing doctors to decide whether someone should be "DNR" is very, very wrong.

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another case of someone dies and the family wants to blame someone

sorry, terminally ill cancer, then she brakes her neck, she was going to die one way or another. Plus, CPR could of killed her, if theres nothing a doctor can do, or if the treatment will kill them, why waste money and time, and if they did revive her, she would of been in all sorts of more pain.

why cant people just accept that people die.

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Linux_User wrote:
Unless the patient has specifically requested a DNR, I think doctors should administer CPR in all cases.

Allowing doctors to decide whether someone should be "DNR" is very, very wrong.


I completely disagree. Have you read my previous posts? 12-15% success if you're young, fit and healthy. It drastically cuts down the older you are and the more co-morbidities you have. You're talking about essentially assaulting a human body with a tiny chance of success. That tiny chance may well end in someone remaining comatose or severely impaired for the rest of their life. Like all medical treatments, it should be applied in specific circumstances to suitable patients only. Performing CPR on a 90-year old with dementia and poor quality of life (eg bedridden, can't do much other than sip water, has carers 24/7) is entirely inappropriate and probably unethical.

As I've said before, most of you have no idea what CPR entails and what the outcomes are.

What would you do to the 90-year old I've described, with no DNR in place? Would you resuscitate her? What about when she crashes again ten minutes later? What about when she goes into cardiac arrest the third time? Where would you draw the line?

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Sun Aug 28, 2011 5:06 pm
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bubbles wrote:
why cant people just accept that people die.

I think it's down to three things:

- advances in medical science mean we can treat/prolong life in people either in primary care (eg GP starting patients on blood pressure treatment to lower their risk of a heart attack or stroke) or in secondary care (CPR, life support, advanced treatments).
- a change in society's expectations and consumerism where we "demand" or "expect" to live healthy, perfect, problem-free lives.
- blame culture/lawyers. The entire notion that nothing is an accident and blame must be apportioned somewhere.

Humans have been dying for tens of thousands of years. It can be painful. It can be difficult. There's always someone looking to blame some one or some thing.

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Sun Aug 28, 2011 5:12 pm
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cloaked_wolf wrote:
Linux_User wrote:
Unless the patient has specifically requested a DNR, I think doctors should administer CPR in all cases.

Allowing doctors to decide whether someone should be "DNR" is very, very wrong.


I completely disagree. Have you read my previous posts? 12-15% success if you're young, fit and healthy. It drastically cuts down the older you are and the more co-morbidities you have. You're talking about essentially assaulting a human body with a tiny chance of success. That tiny chance may well end in someone remaining comatose or severely impaired for the rest of their life. Like all medical treatments, it should be applied in specific circumstances to suitable patients only. Performing CPR on a 90-year old with dementia and poor quality of life (eg bedridden, can't do much other than sip water, has carers 24/7) is entirely inappropriate and probably unethical.

As I've said before, most of you have no idea what CPR entails and what the outcomes are.

What would you do to the 90-year old I've described, with no DNR in place? Would you resuscitate her? What about when she crashes again ten minutes later? What about when she goes into cardiac arrest the third time? Where would you draw the line?

Hey if you ask me then it's about what the patient wants, not what the doctor thinks is best.

For example, I'm sure there are a few cases floating around where doctors have declared someone brain dead and recommended pulling life support only for the person to come around later.

If the patient doesn't recover after administering CPR you haven't lost anything. But to me the idea of denying CPR to someone when they want it is abhorrent.

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Linux_User wrote:
If the patient doesn't recover after administering CPR you haven't lost anything. But to me the idea of denying CPR to someone when they want it is abhorrent.


Depends on how you see things. Administering (advanced) CPR takes staff, equipment, time and money. At night time, the crash team may consist of no more than 4-5 staff and that means being pulled from other patients. And how long do you spend on CPR? I've been in a crash call where we tried over an hour for a young kid. How long would you expect to spend on anyone?

In my opinion, CPR is medical treatment. You don't give morphine to someone just because they want it. You don't perform an operation just because they want it. You don't perform CPR just because they want it.

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