Hundreds Killed in Gosport - Those Responsible Must be Held to Account
More than 450 patients were killed after being given powerful painkillers for no medical reason at Gosport War Memorial Hospital, The Report of the Gosport Independent Panel has found. The report reveals that during the 1990s at least 450 people, and probably more like 650, had been killed as a result of a policy of attaching them to syringe drivers pumping diamorphine.
Diamorphine is an extremely potent pain killer and is usually only indicated when a patient is in the severest pain or is terminally ill. If large doses over a short period of time are given without the patient having built up a tolerance to it, it leads to respiratory failure and death. (It was the chosen method of the serial murderer Dr Harold Shipman in killing his patients).
(Diamorphine is usually administered via a syringe-driver, a device which slowly introduces the drug into the body over a number of hours or days. The time period over which the drug enters the body is essential as too much over too short a time can have lethal effects – which is precisely what happened as Gosport War Memorial Hospital. Where the diamorphine would usually enter the body via syringe driver slowly over a 24 hour period, instead many patients were receiving the drug in as little as an hour. It is the rapidity of the drug intake which caused death.)
Back in the 1990s nurses attested to the fact that it seemed many patients were not receiving diamorphine for any medically indicated reason. An auxiliary nurse, Pauline Spilka told the police: “It appeared to me then and more so now that euthanasia was practised by the nursing staff.”
She went on to mention a “difficult” patient whose life was apparently ended for this offence: “I remember having a conversation with one of the other auxiliaries… we agreed that if he [the ‘difficult’ patient] wasn’t careful he would ‘talk himself onto a syringe driver’.”
Shortly afterwards, this patient was put on a syringe driver, and subsequently died.
There are a number of personal testimonies like this in the report. And the report concludes that there were 456 patients were killed as a result of the administration of opioids without appropriate clinical justification. That is to say, 456 patients were given a substance known to cause death with little or no medical justification for it in the first instance
This horrendous affair started almost 30 years ago and the truth about the extend of the scandal is only becoming apparent now.
In summary, the report found there was a "disregard for human life and a culture of shortening the lives of a large number of patients” from 1989 to 2000. There was an "institutionalised regime" of prescribing and administering "dangerous" amounts of a medication not clinically justified at the Hampshire hospital, the report said.
Another way to state the report’s conclusions would be to say that ‘there was a culture of killing patients’. This of course sounds more radical (which is presumably why the euphemism “shortening the lives… of patients” was used), but it nevertheless accurately reflects the reality of what happened.
As a number of commentators have pointed out, there is concern that this is not an isolated incident. But there is no simple bureaucratic solution. Indeed, it was, in part, the failure of the various bureaucratic systems in place which led to the deaths. A significant part of this scandal, and cause of much distress to the families of the victims, is the fact that the hospital management, healthcare organisation, Hampshire Constabulary, local politicians, the coronial system, the Crown Prosecution Service, the General Medical Council and the Nursing and Midwifery Council, did not take their complaints seriously (or at least seriously enough).
More safeguards and systems are unlikely to help as there were already a number in place which were not adhered to.
In accord with many of the families whose loved ones were killed at Gosport War Memorial Hospital, “those implicated must now face the full rigor of the criminal justice system. Accountability must take precedence here. These horrifying, shameful, unforgivable actions need to be disclosed in a criminal court for a jury to decide…”
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Gosport War Memorial Hospital: Justice Must be Done for Victims and their Families