A devastated husband is calling for answers after his wife died in QEQM Hospital on Christmas Eve following a positive test for covid which the family believe she caught while on the ward.
Alan Barker, 64, says he has complained to the hospital trust about pressure placed on the family over applying a do not attempt resuscitation (DNAR) decision, lengthy waits for pain relief and, he says, a lack of systems to reduce covid transmission inside the wards. He says he will raise the issues when an inquest into Lorraine’s death is held.
Mum-of-two Lorraine was just 52 when she died. She had been battling health problems associated with having Crohn’s -an inflammatory bowel disease – and was due for an operation at King’s College to remove part of her liver due to a tumour.
Lorraine, who ran an exhibition stand production business with Alan, had been in QEQM between October and November before being discharged with the referral to King’s for a liver biopsy.
A decision was made to carry out a liver resection operation at Kings in December.
But Lorraine fell and was unable to get up on November 28 and eventually ended up back in QEQM as an inpatient.
Alan says this was when he believes she contracted covid after being moved from a ‘secure’ area on one ward to an open section on another. A week later a positive covid result was confirmed.
Alan, who lodged a request for post mortem in his bid to get answers, said: “About now Lorraine should be recovering from liver resection surgery at Kings College Hospital instead of dying from the effects of catching Covid-19 just days after transferring from a secure “bubble” in one ward to an open section of another.
“I and the family also wish to have details to back up the claims by doctors attending her suggesting she was dying and no more could be done for her, ruling out ITU provision and making the automatic imposition of a statement of DNR specifically against a notice in writing having been submitted by myself.
“The decision was made due to her co-morbidities (existing health conditions) and problems with infection but despite my letter they refused to take it off. Instead I was bombarded with meetings about it and some of what was said was horrific. I was told CPR would be like them jumping up and down on my wife until her sternum broke.”
Alan, who first met Lorraine in 2000 when her children Tom and Emily – who both live with autism – were three and five, says there were also issues with pain relief being ‘on request’ rather than scheduled which sometimes resulted in waits of up to five hours before medication was received.
He also says he believes a simple screening of beds on the open sections of wards could have helped reduce transmission of covid, particularly when people are on general wards directly after admission.
He said: “There are so many ways that people could have been protected, even by creating ‘bubbles’ around the beds by keeping screens closed.”
Alan was with his wife when she died and says in the run up there had been issues with getting Lorraine in the right position to accept input from the CPap (breathing) machine, problems getting a response to requests for help and an insensitive “parking of a replacement bed ready to bring into use once Lorraine had passed away.”
Alan says the death of his “wonderful best friend and partner” has left him and her family devastated.
He says he promised Lorraine he would always care for Tom and Emily and is currently trying to help them through their loss, setting Emily a project to find photos of the many times spent on the couple’s much-loved Disney holidays.
He added: “Lorraine and myself had been completely inseparable since meeting in 2000. We lived together and worked together since 2006 when we took over Premier. My mother in law described us as two peas in a pod.
“We instinctively knew what each other was thinking. A smile could say a thousand words, a holding of a hand brought a smile and a whispered “I Love You”.
“She had been through so much pain, having had 25 lots of surgery, 20 of those n the years we have been together. Despite all that she had said yes to her surgery planned for Kings to resection her liver without hesitation.
“She was the strongest person I have ever met. There can never be another person so kind, willing to put other people first, she even advised fellow patients in QEQM during her first stay how to claim PIP and other support systems for those with similar medical issues. Many of those people have sent their condolences.
“That is how my wonderful best friend and partner was. Her life has been cut short by Covid-19 and issues at QEQM.
“It is hard but I am hoping we will get answers and better ways of handling covid infection controls in hospitals put in place.”
A spokesperson for East Kent Hospitals said: “Our thoughts are with Mr Barker and his family after the death of his wife.
“While our staff had regular meetings with Mr Barker to discuss and agree his wife’s care in line with his wishes, we are sorry he has concerns about her treatment and would welcome the opportunity to discuss these with him directly.”
Use of do not attempt to resuscitate process
A court judgement in 2014 over the process of DNAR use in hospitals in relation to cardiopulmonary resuscitation found in summary, a duty; that staff must consult patients in relation to DNACPR decisions, unless the clinician believes that the distress that will be caused by the discussion will harm the patient.
In the circumstances when staff avoid the consultation because they believe that harm will be caused, they must document their reasons for this belief. If the patient lacks capacity, they must take reasonable steps to involve the patient’s family in the discussions that lead to a decision as to whether or not it is appropriate to attempt cardiopulmonary resuscitation.
An East Kent Hospitals’ document says: “When someone is coming to the end of their life as a result of an advanced, irreversible illness, and the heart and breathing stop as part of the natural process of dying, CPR will not prevent their death.
“If CPR does restart the heart and breathing in these circumstances it can leave a dying person with more distress or worse health in the last hours or days of their life. For others, receiving CPR would deprive them of dignity during the very last moments of their life.
“A decision not to attempt CPR is often called a ‘Do Not Attempt CPR’ or ‘DNACPR’ decision. Many healthcare teams will try to discuss with individual people their wishes about CPR and to record when CPR would still be wanted, as well as when it is not wanted or would not work.”
In 2015 the Trust admitted breaching the Human Rights of a 51-year-old disabled man after two Do not Attempt Cardiopulmonary Resuscitation (DNACPR) orders were placed on his medical records in 2011, giving his disability, ‘Down’s Syndrome’ as one of the reasons for its imposition, without the knowledge of his family. The man died in 2015 due to health matters unrelated to the DNACPR.
Patients being treated for covid at East Kent Hospitals
As of January 5 there were 460 beds occupied by patients with covid in East Kent Hospitals Trust’s general sites at Margate, Ashford and Canterbury. Of those patients, 26 were on mechanical ventilation.
The Trust has recorded 936 deaths of patients who have died in its hospitals and have tested positive for COVID-19 since the beginning of the pandemic.
My heart goes out to you and your family for your lose of your beautiful wife and mother. Heart broken reading it I’m so sorry for you lose
What a terrible sequence of events with such sad and tragic consequences.
I hope your family gets the full support that it needs and the EKHT/QEQM are clear and honest in their explanations of what went so very wrong. You need a good advocate/lawyer to help you through this. You must take your experience to the Care Quality Commission, especially Damian Cooper, Inspection Manager, Care Quality Commission South East Hospitals Inspection Directorate
Heartfelt condolences to you Alan Barker and your family.
After weeks of being bedridden in QEQM, denied visitors, and finally contracting Covid, Lorraine Barker could only have infected her in QEQM.
Her husband, Alan, was informed that the Trust has a policy to impose DNR on all patients not in ITU who have Covid-19, and after three days without improvement, then automatic transfer to the Liverpool Care Pathway, a “pathway” that a Public Inquiry found to be abhorrent. Across the country, the Liverpool Care Pathway was discontinued in 2013/14, but it persists at the QEQM. Alan had multiple discussions with Hospital staff about this, and they in turn still used the phrase “Liverpool Pathway” despite the fact that documentation shows that there are currently guidelines to avoid that term and to use another one (which is in truth the same pathway under a different name). She and Alan refused repeated requests to put her on a ‘palliative care’ programme which in this context was going to be the Liverpool Care Pathway. Effectively, these policies would appear to amount to a death sentence. Hospital-acquired Covid-19 flooded her lungs. Even then, Lorraine’s wish to live never dimmed.
At no point was Lorraine ‘proned’ onto her stomach, a technique which has been found to be incredibly important in increasing the likelihood of successful outcomes for Covid-19 patients in hospital. I have been told, independently, that all Covid-19 patients should be proned. Apparently that technique is available in ITU, but she was refused admission to ITU because she was ‘too sick’, this despite the fact that the time of her admission to the QEQM for a preliminary liver biopsy, her London consultant at Kings regarded her as fit to survive a liver re-section operation that was scheduled to take place before Christmas. Alan was not allowed to visit her at all during the weeks she was in hospital until two days before her death. He asserts that no patients were proned in any wards at the QEQM.
Alan was able to sustain and greatly enhance her breathing when he was able to help her, through squeezing her hand to stimulate and encourage her during her last few days of life when he was finally allowed to see her, but whenever there was no one in constant attendance, her vital stats plummeted. On at least two occasions, Alan saw her asked by a hospital administrator to remove her cpap mask so that she could answer questions that could easily have been answered by asking her to blink. On the first occasion, the mask then fell apart, the administrator didn’t know how to fix it, and there were no replacements to hand as her oxygenation level plummeted. Afterwards, Alan managed to get her back on track by squeezing her hand to encourage her to make the effort to breathe. On the second occasion, her vital signs again plummeted but once more she rallied while Alan was there. In the end, she died within seconds when her mask was again removed for the last time.
QEQM did not provide her with one life-giving means to support her as her lungs filled up with fluid: an ECMO device that takes ‘black’ deoxygenated blood, fully enriches it with oxygen, and returns that now red blood back into a patient’s circulatory system, effectively doing what healthy lungs do. Had they done so, Covid-19 would have run its course, and Lorraine would have stood a very good chance of recovery, as high as for non-Covid patients (https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30581-6.pdf). Her lungs meanwhile could have been effectively treated with altogether more proactive and continuous support in an ITU setting instead of receiving only sporadic attention by nursing staff who have far too many patients to deal with concurrently in non-ITU wards at the QEQM.
Nursing attendance remained sporadic in her case, and it generally remained so even during his visits. Exhaustion from long-delayed pain medication could have been attenuated, too. As the Prime Minister’s own experience clearly shows, constant and pro-active nursing attendance is needed if patients are to survive full-blown Covid-19.
According to QEQM, I understand, the cause of death is Corvid Pneumonia, cancer of the liver, and acute kidney injury, crohns disease. It remains to be seen what the Coroner decides, and whether a full Inquest will be held. I hope it will.
Lawyers apply a “but for” test to determine torteous or criminal liability, but when doing so also have regard for another consideration: was there a “Novus Actus Interveniens” (a new intervening act). Her London Consultant expected her to recover from her impending Liver Resection. Her Crohns Disease did not kill her although it undoubtedly weakened her as did her compromised but treatable liver. The Novus Actus Interveniens in her case was hospital-acquired Covid, acquired in an environment controlled and monitored by those who owed a duty of care towards their patients.
It remains an obvious question whether this death was caused by inadequate and defective management of this patient (Clinical Negligence, a civil liability, to be determined on the balance of probabilities – “more likely than not”), and if so did it constitute Gross Negligence Manslaughter (a criminal offence, to be determined ‘beyond reasonable doubt’) and these serious questions should be a matter for the Courts, not self-serving hospital administrators or clinicians.
This is not the first case of hospital-acquired Covid-19 at the QEQM that I’m aware of, and in not one of those cases has the QEQM accepted responsibility for the transmission of the disease to those in-patients.
At the very least, a grieving husband should be entitled to the pursuit of Justice and appropriate remedies so far as those may be possible. To “Save the NHS” we ALL need to stay safe, follow the guidelines and save lives, not tolerate bad or negligent practices and unnecessary premature deaths.
One member of staff told Alan, “the risk of catching covid in hospital is higher than outside” due to the number of Covid-19 patients in wards or being moved from ward to ward. The son of another friend who survived hospital-acquired Covid-19 while at the QEQM following a heart attack told me that a member of staff said, “Covid has been found in every ward at the QEQM.”
Thank you so much for that full, and sensitive explanation, it takes courage to express so complicated an experience of what happened in this case. My father was put on a Do Not Resuscitate regime following a massive internal bleed, in 1988. Because he was on Warfarin, any surgery to stop the bleed meant he would not heal, so the surgeons were damned if they did, and damned if they didn’t!
They couldn’t let my father just bleed to death, so they operated, and put him in an induced coma, which they said to me as the eldest son, meant he would probably die within 3 or 4 days. In the event as a D-Day veteran, he lasted 8 days! I arranged for a member of the family to always be at the hospital during this terrible time, except for my mother, who was unaware my father would not be coming home!
Dumpton, that depth of tragedy in that story is infinite.
Never forget the smile of Lorraine…