Map of life expectancy at birth from Global Education Project.

Thursday, June 21, 2018

Dr. Evil

Occasionally, medical professionals turn out to be serial killers. There have been a few cases of nurses who have had a hobby of murdering patients here in the U.S. Offhand I can think of a single physician who not only murdered several patients but who tried to feed his colleagues poison doughnuts, among other unpleasant acts. (Sorry, I can't remember his name and I don't feel like searching for it. I wrote about it here at the time, several years back.)

In the UK, Harold Shipman was a small town GP who murdered as many as 250 patients. He killed himself in prison without ever explaining why he did it. They were mostly elderly, but not terminally ill. He gave them overdoses of heroin.

Now our former colonizers have a case that is perhaps more disturbing, and quite weird. Not just a single doctor, but an entire hospital ward killed something on the order of 450 patients with heroin overdoses. (I should point out that the drug we call heroin is called diamorphine in the UK and is used medically in situations in which morphine would be commonly used in the US.)

A bit of context is needed here. There is some debate about it, but it is generally considered ethical to give terminally ill people who are in severe pain doses of opioids sufficient to relieve their suffering even if death might be hastened as a consequence. You're supposed to compartmentalize and keep in your mind that it is not your intention to cause death. However, the patients at Gosport hospital were not in pain, or had only relatively mild pain that could have been treated safely. Nor were they necessarily terminally ill. So it would not have been immediately obvious that something really wrong was going on if you saw a lot of old people in intensive care with infusion pumps pushing in opioids, and ending up dead.

However, in this case nurses and family members complained about it, the police investigated several times, and yet it continued for 12 years. Doctor Jane Barton was responsible for overseeing prescribing on the wards, but others were aware of what was happening. Barton was eventually found to have been deficient in her care of 12 patients by a medical tribunal, but she was never prosecuted.

The investigation has not provided much insight into why and how this happened. But it does seem to be an exemplar of how a group  mentality or workplace culture can form in which people collectively go off the rails. There is still a great deal about this that's mysterious and I hope we'll learn more.

As a footnote, there is something very odd in the reporting. One of the nurses says that until she got to Gosford, she had never heard of a syringe driver. That doesn't make any sense. These devices -- more commonly called infusion pumps in the U.S., I believe -- are commonplace. They deliver a continual slow trickle of medication, often an opioid. When I had surgery back in 1991, they put me on a morphine infusion. I didn't like it and asked them to stop it after a day or two. Of course my dose was not at a dangerous level.

Anyway, this is a very weird outlier story and it shouldn't deter you from getting a morphine drip if you really need one. But still . . ..

1 comment:

Don Quixote said...

Can the asshole-in-chief be sent to this hospital?