Intimate Examinations

December 2001

The GMC regularly receives complaints from patients who feel that doctors have behaved inappropriately during an intimate examination. Intimate examinations, that is examinations of the breasts, genitalia or rectum, can be stressful and embarrassing for patients. When conducting intimate examinations you should:

Explain to the patient why an examination is necessary and give the patient an opportunity to ask questions.
Explain what the examination will involve, in a way the patient can understand, so that the patient has a clear idea of what to expect, including any potential pain or discomfort (paragraph 13 of our booklet Seeking patients’ consent gives further guidance on presenting information to patients).
Obtain the patient’s permission before the examination and be prepared to discontinue the examination if the patient asks you to. You should record that permission has been obtained.
Keep discussion relevant and avoid unnecessary personal comments.
Offer a chaperon or invite the patient (in advance if possible) to have a relative or friend present. If the patient does not want a chaperon, you should record that the offer was made and declined. If a chaperon is present, you should record that fact and make a note of the chaperon’s identity. If for justifiable practical reasons you cannot offer a chaperon, you should explain that to the patient and, if possible, offer to delay the examination to a later date. You should record the discussion and its outcome.
Give the patient privacy to undress and dress and use drapes to maintain the patient’s dignity. Do not assist the patient in removing clothing unless you have clarified with them that your assistance is required.

Anaesthetised patients

You must obtain consent prior to anaesthetisation, usually in writing, for the intimate examination of anaesthetised patients. If you are supervising students you should ensure that valid consent has been obtained before they carry out any intimate examination under anaesthesia.

You may find some hospitals don't get the proper consent and if for instance they were to give you pain relief by way of a suppository while you are under sedation if they do they must get your permission in writing before you are sedated or the doctor may be struck off for assault. A lot of Hospitals use Midazolam (versed) for sedation during minor operation like a hernia and by the rules they must tell you the risks.

One of the risks is it can make you forget which you may think is a good thing but some people don't want to forget. You may be given a pain relief Voltkol which is given as a suppository if they haven't told you about this and obtained your permission in writing as per the above GMC rules then you can complain to the GMC or look for compensation for sexual assault. The problem is because of the Midazolam you may not know they did this you would have to apply for your medical records to see. You don't need this pain relief you can have tablets and according to the rules they must explain this to you and give you the chance to opt out.

The Leighton hospital was condemned by the Health Care Commission in January 2006 See the full report here

Health watchdog finds that failings at the Mid Cheshire Hospitals NHS Trust led to unacceptable levels of care for older patients Published: January 24th 2006 Serious lapses in the care of older people at Leighton Hospital have been identified in an investigation report published today (Tuesday) by the independent healthcare regulator the Healthcare Commission. The investigation followed the conviction in 2004 of Ward Sister Barbara Salisbury on two counts of attempted murder.

The conviction related to incidents that occurred at Leighton Hospital in 2002 and involved the inappropriate administration of diamorphine, a powerful opiate analgesic, to patients. The aim of the investigation was to look at whether there were failings in systems to protect patients in the trust in 2002, and to assess whether these failings were still a problem. The investigation found that the trust failed to meet adequate standards of care.

This, together with poor leadership and management, staff shortages and a lack of learning from complaints, resulted in the safety of patients being compromised. Patients were often not assisted to take their medication or helped with eating and drinking. The Commission found that the general lack of attention by staff sometimes prevented patients from getting to the bathroom or using the bedpan in time, adversely affecting their dignity, morale and health.

Healthcare assistants reported having no time to shave patients or answer buzzers, and there were numerous examples of drug rounds being late and tablets being left on tables out of reach of patients. Following the conviction of Barbara Salisbury, many nurses and some families reported serious misgivings that patients were not receiving adequate pain relief. Marcia Fry, Head of Operational Development at the Healthcare Commission, said: “There is no excuse that allows for the care and dignity of patients to be compromised in this way. “This report has highlighted serious problems, some of which go right up to the most senior level at the trust.

We are pleased that the trust has already taken some urgent action to improve the service for patients. It must continue on this path and make every effort to implement all of the recommendations in this report. It must do everything in its power to build a service that staff, patients and their families can rely upon. “As performance manager and commissioner of services of the trust, the local strategic health authority and primary care trust must share responsibility and work with the trust to improve the situation.

“The Healthcare Commission will keep a close watch on the trust over the coming months to make sure that the necessary improvements are made.” In order to address the concerns identified in the investigation the Healthcare Commission has made the following urgent recommendations:

* Recruit additional frontline nursing staff to provide an acceptable and safe standard of care

* Improve governance and management of the medical directorate

* Investigate and address the cause of poor clinical outcomes in the medical directorate, including apparently higher than average mortality rates in recent years

* Review management and accountability arrangements in the trust In addition, the trust must also:

* give greater priority to the care of older patients in line with the national service framework for older people

* provide care that puts the needs of patients first and treats them with dignity and respect

* review its arrangement for providing patients with appropriate pain relief

* take action to address poor care when it is identified through complaints and/or reporting

* develop action plans in response to serious complaints and ensure that they are implemented and monitored Mid Cheshire Hospitals NHS Trust have developed a detailed action plan to address the recommendations in the report.

A number of these actions have already been put in place including a high level review of the trust’s management arrangements. The trust is reviewing its risk assurance framework; they are also reviewing arrangements for governance and management particularly in the medical directorate. In addition to this, the trust, which is under the leadership of a new acting chief executive, has recruited 44 new nursing staff, and introduced a new approach to handling and learning from complaints. An audit of the care of older people has been launched. Cheshire and Merseyside Strategic Health Authority and the Healthcare Commission regional team will closely monitor progress made against the action plan.

TRUSTS TOLD TO IMPROVE

09:56 - 09 October 2007
The organisations running the ambulance service and Leighton Hospital have been told to improve how they handle complaints.An audit carried out by the Healthcare Commission has revealed that North West Ambulance Service (NWAS) NHS Trust and Mid Cheshire Hospitals NHS Trust are not meeting the basic standard to ensure patients, their relatives and carers are not discriminated against when complaints are made.

The audit also revealed that NWAS Trust's complaint system needed to be more accessible in terms of registering formal complaints and feedback on the quality of services.

The healthcare watchdog launched the audit after becoming concerned about how patients' complaints are handled locally.

The trusts were two of 32 chosen for inspection because of concerns that they were not meeting Government standards.

The basic standard requires trusts to make complaint procedures accessible, ensure complainants are not discriminated against and act on concerns and make changes where appropriate.

The Healthcare Commission said that trusts should do more to make it easier for people to raise a complaint.

Mid Cheshire Hospitals NHS Trust, which runs Leighton Hospital, received 288 complaints in 2006/7 - a drop on the previous year's figures of 300 - and has received 147 complaints this year to date.

Officials reacted to the Healthcare Commission's findings by forming Matron Forums for staff to discuss complaint handling.

A spokesman said: "A thorough audit of complaints has taken place and systems have been implemented to ensure staff are trained in dealing with complaints."

A NWAS spokesman said: "North West Ambulance Service NHS Trust treats complaints very seriously and welcomes the findings of the audit to ensure best practice is achieved across all areas.

"Following the audit on complaints handling within the former Mersey Regional Ambulance Service NHS Trust, areas for improvement were noted by NWAS and included in the trust's action plan.

"NWAS immediately reviewed and amended its new complaints policy and stated its intention to provide information on staff attitudes, staff support and emphasised the issue of not discriminating against complainants of the services it provides.

"The Healthcare Commission acknowledged the swift action the trust has taken in response to the findings.

"The trust remains committed to ensuring all its staff are fully aware of the trust's complaints policy and procedures."

Have you lodged a complaint with one of the trusts?

Mother Dies in Leighton Hospital from Superbugs

Nov 7 2007

A BEREAVED son whose 86-year- old mother died after contracting two superbugs has accused Leighton Hospital of failing her and her family.

James Carter, 61, of Congleton Road, Sandbach, has lodged an official complaint against the Mid Cheshire Hospitals NHS Trust following the death of his mother, Hettie McKenna, on August 26.

Mrs McKenna, lived alone at Highfield Drive in Nantwich and was fiercely independent before she was admitted to the Crewe hospital on May 25 after a minor fall.

The cause of death was recorded as clostridium difficile (C. diff) – an infection which can lead to ulceration, bleeding from the colon, peritonitis and death.

Mr Carter said: ‘She recovered quickly from her fall but was treated for a urinary infection. When they suddenly moved her to another ward I asked why and was told there had been an influx of male patients. But this wasn’t true and I eventually found out she had contracted MRSA.

‘She was then moved to the Discharged Ward and we were told she was well enough to leave and that her bed was needed quickly. However, a visiting care-home manager correctly said she was too ill to leave.

‘On subsequent visits, we became concerned about the bouts of diarrhoea she was suffering and eventually asked if it was C-Diff. Only then were we told it was. She died two weeks later.

‘I deserve answers because the trust has failed my mother and my family. Why were we not told she had caught these bugs? Why was she being prescribed antibiotics when we were told that they were what was causing the C-Difficile?

‘Why was her nightwear – thickly covered in faeces – left for us to wash when we had not been told what precautions to take whilst laundering them?’

In total there were 2,157 reports of C. diff across the North West among patients aged 65 and over between April and June this year, a decrease of 19% compared to the previous quarter.

Five Leighton Hospital patients died after catching the infection between April 2006 and April this year.

A spokeswoman for Mid Cheshire Hospitals NHS Trust said: ‘The trust would like to express its sincere condolences to the patient’s family.

‘The trust is taking the concerns of the family seriously and is undertaking a review of the advice and care the patient and her family received, in line with the NHS complaints procedure.

‘Once that process has concluded, the trust will share the findings of the investigation with the family.’

Leighton Hospital A&E

I attended Leighton Hospitals

A&E with a patient who had a suspected broken leg /knee. After a 2 hour weight we saw the doctor who asked the patient to jump up on the bed. The patient was crying as it was with pain sitting in a wheel chair. When I pointed out the fact the patient was small and couldn’t jump up on the bed if she was fit the doctor said I am not bending down to look at the knee. The patient was then crying with extreme pain forced to try and climb up on the bed. If the leg was broken it could have pushed the bone through the skin.

After x-ray it was decided that it was badly strained and swollen. The doctor offer the crying patient pain relief and asked are you allergic to anything who replied yes Paracetamol and it will be on my notes.

The patient was then given tablet containing Paracetamol which if she had taken could have been fatal even a child would not have given these tablets knowing she was allergic.

Is the Doctor that gave the Paracetamol totally incompetent or was this a deliberate act as this patient has a complaint against the hospital. If this was the case then its a very serious case but its hard to see why when she was told of the allergy and its on the notes she still gave what could be a fatal medicine.

The Healthcare Commission report on discrimination against people who have complained says

The organisation could not demonstrate that systems had been in place to make sure that patients, relatives and carers did not suffer in their care or treatment as a result of making a complaint.

What does this mean to you?

If you are concerned about the possibility of being discriminated against as a result if making a complaint, check what written assurance the organisation has given in the information about complaints which they make available to patients. All trusts have action plans in place where they said they did not meet or could not be sure whether they met this standard.

This means this patient may have been discriminated against because she had complained

Use the file a complaint to put your views and stories on the site

Nurse gets five years for seeking to kill two patients but was she innocent?

Nurse gets five years for seeking to kill two patients

Ward sister weeps at verdicts after trial that heard of her ruthless desire to free beds by causing elderly to die

Helen Carter
Saturday June 19, 2004
The Guardian

A senior ward sister was convicted yesterday of attempting to murder two elderly patients under her care because she was motivated by a ruthless desire to free up beds at a Leighton hospital which was in the throes of a bedblocking crisis.

Barbara Salisbury crossed the line between humane nursing and callous dispatch of patients at Leighton hospital in Crewe by administering diamorphine or lying them on their back so they would drown in their own secretions. She was jailed for five years after being found guilty at Chester crown court of the attempted murders of May Taylor, 88, and Frank Owen, 92, in March 2002.

Article continues
Salisbury, 47, from Pontybodkin, north Wales, wept as the guilty verdicts were read out. Sentencing her, Mr Justice Pitchford said: "Your duty and your trust was one of care towards your patients, and under the direction of the doctors, the respect for and preservation of human life. The jury has found that in the case of two elderly patients who were nearing their end, you broke that duty and abused your trust by attempting to hasten death."

He added: "It is impossible for me to fathom what it was to cause you to act as you did. You chose to exercise control over life and death of patients whose time had not quite come."

Salisbury had faced four attempted murder charges. But she was cleared of any unlawful involvement in the deaths of James Byrne, 76, and Reuben Thompson, 81.

Two years ago, the Cheshire Leighton hospital which serves a community with a large number of elderly people, was in the middle of a bedblocking crisis, which has since eased. The court heard that when she arrived back on the ward after six days off sick, she saw Mr Owen, who had been a patient for three months, and asked: "What's he still doing here?"

The prosecution said she had been constantly pressing for him to be discharged to a nursing home, despite Mr Owen needing a drip. She told her colleagues to lie him on his back "so his lungs will fill with fluid and he will die".

Despite colleagues telling her that Mr Owen was not in pain, she gave him two injections of diamorphine. The former mechanic died five minutes after she finished her shift. One witness described her actions as "callous and unprofessional". Later, she was asked if his death was peaceful. She replied: "Yes, thanks to me."

Salisbury had lied to doctors to ensure Mrs Taylor, a widow, was given excessive doses of diamorphine. When challenged, Salisbury had replied: "Why prolong the inevitable?"

She had been accused of telling James Byrne, who had suffered a minor stroke: "Give in, it's time to go," as she gave him diamorphine.

When she appeared in the witness box, Salisbury repeatedly denied hastening patients' deaths, but admitted using the phrase "It's OK to go now" to those close to death, in an effort to be soothing.

The prosecution claimed Salisbury had arrogated to herself the right to decide when patients should die and attempted by her actions to shorten what remained of their lives. But she said: "I have probably said, 'It's OK for you to go now.' It's a term I often used to use in intensive care, meaning it's OK, you can leave this life," she told the jury. "I said it in a gentle way to let them know there was somebody there." She could not remember any of the four patients.

Unpopular

Salisbury was said to have been unpopular among her colleagues on the ward because of her brusque manner. Many of the nurses were traumatised by what they witnessed, while others were bullied into obeying her orders. Following the death of Mrs Taylor, nurses Katherine Darby and Alexandra McNally were so appalled by her treatment at the hands of Salisbury that they complained to their managers.

There were other incidents involving elderly people. Nurse Annie Denson said that on Christmas Day 2001, Lila Hillyer, 86, was nearing death. She had left her on her side aided by an oxygen mask so she might survive until relatives could see her. Then Salisbury came into the side room and said: "Lose the oxygen and lie her flat." The nurse ignored the instruction and the patient survived two more days.

Salisbury's barrister, Peter Birkett, said in mitigation that she had no criminal record and suffered from depression, for which she was treated in hospital from August 2002 to July 2003.

Salisbury, a mother of two, had been a nurse for most of her working life. Born in Liverpool, she began training in 1975 while in the RAF. She went on to qualify as a state enrolled nurse and a registered general nurse and worked at hospitals in Peterborough and King's Lynn, principally in intensive care. In 1993, she moved to Leighton hospital. She had risen to the rank of Grade E staff nurse and three years later she was promoted to a Grade F ward sister.

She worked on Ward 5, a general medical ward with a number of geriatrics, until 2000, when she transferred to Ward 4. The following year, the trust's chief executive, Simon Yates, presented her with a Learning to Be a Leader award.

"She had a pretty good reputation with the management," said a source at the Leighton hospital. "They looked upon her as being efficient. But the people who worked with her had no time for her at all. They certainly didn't like her attitude and she upset and offended an awful lot of people."

For more than a year, a team of detectives from Cheshire police were based at the Leighton hospital as part of a lengthy investigation led by Detective Chief Inspector Adrian Wright. Salisbury was eventually charged with the attempted murders in June 2003. The inquiry team examined 20 deaths of elderly patients at the Leighton hospital over a five-year period. A hotline set up for concerned relatives received more than 100 calls in its first few weeks.

In a statement, the Cheshire and Merseyside Strategic Health Authority paid tribute to the whistleblowers. "We are grateful to the Leighton hospital staff who first raised their concerns with the trust for bringing the matter to the attention of the police," it said. "We have agreed with the trust that the SHA will commission an independent investigation to look into the issues surrounding this case."

A statement from Salisbury's husband Derek said: "My wife is a devoted nurse, who has dedicated herself to the care of the sick. Always she has put the interests of patients first. We do not accept this jury's verdict. We know her to be innocent of any crime. This is a tragic day for her, for us her family, and for the nursing profession."

Case of the month

If you have been abused or sexually assaulted by Health Care workers the site above may be able to help. Fill in our form and make your views known Here

Join our campaign to stop sexual assault in Leighton Hospital. Many women and some men have complained about what they see as sexual assault by this they mean they have gone for an operation and had their underwear on and then woke up from the operation only to find their underwear has been removed without their consent and often they have been buggered by having a suppository given without consent.

For many this has been a traumatic experience with long term effects and nightmares and any Muslim women would be mortified if this happened. It comes down to a simple failure of Leighton Hospital to communicate with patients and being totally arrogant that they can do what the hell they like. People are not being told enough information for them to make and informed decision and thus give informed consent.

If you go in for an operation and they explain before you are put to sleep and you give consent and remove your own underwear then there is no problem. If you turn up in theatre a sleep and with your knickers on then it’s clear you haven’t given consent for them to be removed and being a sleep can’t give consent. Removing your own knickers is one thing but when a group of people do it for you its like a gang rape attack. Often people take this in even if a sleep.

We asked that they simple ensure that no one removes any ones knickers if they are a sleep unless it’s an emergency and that patients are checked before they have any pre med to ensure knickers are removed if needed or to confirm the patient’s wishes that they are not removed. The cost of this is zero but Leighton Hospital doesn’t want to know.

The Health Services Ombudsman has now ruled on a case and found it’s not acceptable to remove knickers and give suppositories without consent. We hope this ruling will force changes to Leighton Hospital and as some people want to press criminal charges of sexual assault against staff this may bring the message home.

Its down to lack of communication you may give consent to an operation but have know idea that this entails having you knickers removed, you may even give consent to a suppository and they be shocked when it happens as many people don’t know that this entails someone sticking their finger up you backside. You must ensure that patients understand what you mean saying a suppository is like saying an endoscopies people just don’t know what they hell your talking about

Nurse and Doctors don’t seem to have any comprehension of dominant role. If you are upset afraid and vulnerable in a state of undress and a person in a uniform towers above you this is a very dominate position and you may fell forced to comply because of this. If they came down to the patients level then this effect is reduced and again doesn’t take a genius to work out.

Webmasters Notes This case has shaken the Hospital to the extent that they have employed high power lawyers to harass the patient and family who are witness in a GMC case and they have attempted to have my sites removed by threats to ISP's all of which have failed and resulted in me putting more sites up all over the world.

Leighton Hospital have in this case totally failed in there duty of care in this case.

The failed to obtain informed consent as the GMC have identified that the doctor taking the consent couldn't give enough information for informed consent so technically the whole operation was assault.

The failed to assess her anaesthetic needs which resulted in her nearly dyeing and being in extreme pain.

The gave 10 mg of Midazolam in one dose as shown on her records which is potentially fatal.

They gave 900mg of local instead of 400mg and didn't give adrenaline which was nearly fatal.

She was sexually abused by having her knickers removed when she had expressly forbidden it.

She was sexually abused by them giving a suppository when she had said no.

They failed to take care of her pain relief.

What is worse when they complained they failed to find anything wrong and cover up what had happened. After the GMC HCC and Ombudsman have found all the problems its hard to see why Leighton Hospital didn't find anything wrong but put further patients at risk from the surgeon another potential Barbara Salisbury. They are refusing to name the nurses who sexually assaulted this patient we know that Tracy Smith, Professor Aluwihare and Dr Anmed were in attendance at the operation but the others haven't been named. Witness are helping to fight this case and the people who did this will be brought to justice.

Assaulted during Hernia operation

I am a housewife.

On 30 June 2005 I attended the Day Ward of Leighton Hospital for an out-patient appointment as I had been diagnosed with an umbilical hernia and I was aware that I needed surgery to repair it.
I understood that the reason for the out-patient appointment was so that I could be assessed as to my suitability for surgery as the hernia was getting bigger and bigger. I had assumed that I was going to see Mr Cade, the Consultant to whom I had been referred by my General Practitioner. However, I was not seen by him when 1 attended the appointment.

At the appointment I was given a Hernia Assessment Questionnaire by reception and was asked to fill it in. 1 did so and was then seen initially by a nurse who took my blood pressure and checked that I had filled in the form correctly. The nurse told me that I would be given pain relief after the operation and it was usually given as a suppository. She explained that if I did not want a suppository then I should make it clear so that I could be given an oral painkiller instead. I told this nurse that I did not want a suppository. The nurse then left the room and took the Hernia Assessment Questionnaire away with her.

This doctor discussed my weight with me. At that time I was around 22 stone and this affected the operation that I needed. The doctor explained that it would be better if I could lose some weight but that my weight should not cause any problems and the operation could still take place. He told me that I would be awake throughout the operation as this would be safer for me. I understood that he meant that it would be safer for me to have the operation under local anaesthetic rather than general anaesthetic because I was overweight and may not wake up if I was given general anaesthetic. I was also informed by him that this operation would normally take half an hour but because I was overweight it would take three quarters of an hour to an hour.

During the appointment, the doctor also examined me and felt and prodded at my stomach as part of the assessment. During my time at the Leighton hospital on 30 June 2005 I did not see Professor Aluwihare at all.

I attended Leighton Hospital on 11 November 2005 for my operation, anticipating that I would be there for a couple of hours and I therefore did not take any overnight clothes with me.

I waited in a waiting room for a couple of hours and I recall that I saw a young female Asian doctor first, although I cannot now recall her name, and she went through the consent form with me. I remember that this doctor told me that the operation would not take long to complete, that it would take about an hour, I would need an hour to recover and then 1 would be allowed home. She did not mention any of the risks or complications of this operation or offer any alternative forms of anaesthetic, she didn’t say that there would be no anaesthetist present. As a result of this I don’t believe I gave informed consent had I known the full facts I would have had a different form of pain relief. At the end of our conversation, the doctor asked me if I had understood everything and she then left the waiting room. The doctor was with me for no more than five minutes I felt under pressure to sign as I was petrified alone and vulnerable waiting for the operation.

At some point whilst I was waiting I was asked to change into a gown which I did. I specifically told the nurse who was running the reception area that I wanted my knickers to be kept on and she said that this was fine.
I waited for what seemed like another couple of hours and then Professor Aluwihare came to see me. This was the first time that I had met Professor Aluwihare. He asked me to lift my gown up and I did so, at which point he commented that the hernia area was a purpley grey colour and asked me if I knew why. I said that 1 didn't know why and I remember that he said that he didn't know why either.
Professor Aluwihare asked me, at that point, if I understood what the operation would involve and I said that I understood roughly. He then told me that he would be putting a plug into the hernia and then a mesh over the top of it to make it extra secure.

Professor Aluwihare then asked if I had any questions and checked that I had signed the consent form.
Following my conversation with Professor Aluwihare, a nurse called Tracy Smith came to and introduced herself to me and took me to the anaesthetic room. Once there, Tracy asked me to get on the trolley bed that was in the room and attached monitors to my chest and to my finger.

I remember that Professor Aluwihare then came into the room and Tracy tried to find a vein in my arm with a needle and I assumed that this was so that I could be injected with either a sedative or something that would take any pain away.
Tracy could not find the vein in my arm and I remember her saying that this could have been because it was cold in the anaesthetic room and because I was nervous.

Professor Aluwihare then tried to get the needle into the vein in my arm but he could not do so either. I then remember that someone else in the anaesthetic room informed Professor Aluwihare that there was someone next door who may be able to help. At this the Professor said that she was 'the expert' and she was the person that he needed.
At this point there were four or five people in the anaesthetic room and one of them went to get the lady they had been talking about. I assume that this lady was a doctor and she came in and found the vein in my arm first time. This lady was only in the room for a couple of minutes and, after inserting the needle into my arm, she left. I still do not know the identity of this lady.

At no time up until this point did Professor Aluwihare say that he thought that I ought to have a general anaesthetic instead of a local anaesthetic.
I assume that medication was then inserted into the needle to my arm but I cannot really recall this and do not know who administered it as there were a few people in the room at that time. I do recall that Tracy then placed a large cold wet patch onto my leg but 1 don't know what this patch was. After the patch was put on I do not recall anything else until I awoke during the operation and was looking up at the
theatre lights. I am aware that I woke up in theatre but I do not recall being transferred to theatre or the first cut to my skin.

When I first awoke I found myself looking up at the theatre lights, I felt quite calm and it was interesting to watch what was happening. Although I was lying down I could see what was happening in the reflection on the surface of the theatre lights. For a few minutes I didn't feel any pain at all.

I must have passed out again because I woke up with an oxygen mask over my nose and mouth and I do not remember anyone putting this mask onto my face. I was also in excruciating pain 10 times worse than having a baby. I clearly remember that I was crying and screaming out in pain shouting stop. I was trying to get the oxygen mask off so that I could wipe my eyes because I had my glasses on and I remember not being able to wipe my tears away.

I know that Professor Aluwihare heard me crying and shouting because he looked at me and asked the nurse if I was alright or if 1 was just a little tearful.
At this time, I could see the cut to my stomach and my innards which looked like red blobs in the reflection of the theatre lights above my head. I could not see the cut and my innards by looking down because I was lying down and I couldn't sit up.
I remember at one point 1 managed to get the oxygen mask off and screamed out in pain again. I specifically recall that Professor Aluwihare told me that it was not hurting, it was just a 'pulling' sensation that I could feel and that he had nearly finished the operation.

At no point did Professor Aluwihare say that he was going to stop the operation but I recall that he did ask someone in the room to see if there was an anaesthetist around who could assist. This makes him no better than a torturer and the most cruel and in human surgeon even though he knows the pain I went through he hasn't even had the courtesy to apologize. I am unsure whether anyone went to find an anaesthetist because at this point I started to feel very strange.
I felt like I was fainting and that my heart was slowing down and then stopping. I remember the staff seemed to panic at this point as there was an urgency in their voices and I heard Professor Aluwihare shout something about my heart although I cannot now recall exactly what he said. I honestly thought that I was going to die and I was absolutely petrified.

At this point, I passed out again and when I woke up there were only two nurses, one of whom was Tracy, in theatre with me and they were cleaning up.
Suddenly the other nurse, whose name I do not recall and have been unable to find out, came over to me and said, 'I've just got to give you this', lifted one of my legs up and inserted a suppository into my anus.

Just after the suppository was inserted I recall having strange thoughts of a sexual nature again and I now understand that this can be caused by Midazolam which I think is one of the drugs that I was given during the operation.

There are a lot of complaints about the use of this drug as you forget what has happened but your subconscious mind can still react to what happened see http://ideas.4brad.com/archives/000100.html. It is also used as a date rape drug and this means you cant remember being raped but your mind will react to what has happened. This makes things worse as you don’t know why you are having strange feelings.
Its often used as a Date Rape drug and a male nurse got 7 years for using it
Midazolam can lead to the patient experiencing daydreams with a sexual content.
For more info see

http://versedbusters.blogspot.com/2005/12/introduction.html or

http://www.askapatient.com/viewrating.asp?drug=18654&name=VERSED
I was never told anything about the drug to be used or its effects or risks like it could stop my heart.
At no point on 11 November 2005 had anyone mentioned giving me a suppository and I was not given a choice by the nurse who inserted the suppository I believe this was an assault of a sexual nature as I felt I had been violated by this women totally without my consent. A similar case http://www.bmj.com/cgi/content/full/310/6971/43 an anaesthetist was struck off for the same thing.

At this point I was not aware that I did not have any underwear on but it became clear that I didn't when I was wheeled into the Day Ward on the trolley bed. As I was sitting up, 1 could see that I wasn't wearing any underwear and asked Tracy where my knickers were. Tracy told me that my knickers were in a bag under the trolley and that they had been taken off to avoid getting iodine on them she refused to give me them back this meant I was to be wheeled through the hospital without them then forced to get onto beds etc showing everything private I had and this was the most humiliating act. I believe that it was this Tracy Smith who sexually assaulted me by removing my knickers and her forcing me to go through the hospital without any underwear one was some sort of bizarre act. She was also present when the nurse gave the suppository but during questioning no one will admit removing the underwear or giving the suppository. If it was all above board and not a deliberate sexual act on their part why wont they face a disciplinary hearing?

We will hunt Down Tracy Smith and this other nurse and do anything LEGAL to bring them to justice and have them pay for their crimes.

I was worried about how my knickers had been taken off as I did not remember it happening I still do not know who took them off without my consent. All I remember is having a dream of being forcible stripped by a room full of strangers and dreaming I was to be gang raped it appears that some of this wasn't a dream but was actually happening to me. People should be told that the Midazolam is a DATE RAPE drug and you could have anything done to you without remembering. This makes things ten times worse as people who have been raped cant remember but subconsciously their mind show the effects but they dont know why.

I had no idea how long I had been in theatre at that point although 1 knew I had been there for some time as the operation began at around 2 - 2.30pm and when I came out of theatre there was no one waiting in the Day Ward and it was dark outside.
I was then wheeled into a waiting area on the trolley. I was then told that 1 was to stay in Leighton hospital overnight and that they were waiting for a bed to become available on the ward.
1 asked the nurses if anyone had contacted my partner to tell him that I was staying in Leighton hospital overnight and they told me that they did not know.

I still had not been told why I was being kept in overnight and I had no idea of what had happened during the operation as no one had explained anything to me. I did not see Professor Aluwihare again whilst I was in Leighton hospital.

I ended up staying in Leighton hospital for two days, after which time I discharged myself. During my time in Leighton hospital I was told by the nursing staff that the operation had been bigger and more complicated than they had at first thought.

The day after the operation (Saturday 12 November 2005) a doctor came to see me. This doctor did not tell me anything about my operation but he looked at my drain, saw that there was blood in it and told me that they wanted to keep me in longer to see if any more blood drained.
The nurses told me that they were unable to tell whether the blood in the drain was old or new because they could not take the drain apart. However, on Sunday 13 November 2005, my partner insisted that I see a doctor and when the doctor came he told me that I was fine and told the nurses that I could be discharged. The nurses then took the drain apart, as they had been able to do all along, and 1 went home.

Since the operation I have asked Leighton Hospital to provide me with copies of my medical records which I have now received. As a result, I am now aware of the length of the operation and that I was given 10 mg Midazolam all in one go as shown on my medical records instead of incrementally, as it should be given. I was also given a massive overdose of Local anaesthetic as the maximum should have been 400 mg and they gave me 900mg. An international expert believes this caused my near death experience.

I would also like to say that 1 was terrified of going into Leighton hospital prior to this because of terrible experiences in the past but this experience has made it much worse for me. I am very withdrawn now and find it very difficult to talk about and still have nightmares 2 years later.

We complained to the Leighton hospital straight away
Main points from the Leighton hospitals replies

Dr R Okell, Clinical Director Anaesthesia has answered these questions
Had the patient been given a general anaesthetic, she would have certainly experienced less pain but as I advised you in my previous letter, this carried a greater risk to the patient because of her weight. Professor Aluwihare did ask for an anaesthetist during the procedure but none was available although one was present at the beginning of the procedure and helped to get the line in. If one had been available, they may have been able to increase the efficiency of the sedation, which would have reduced the likelihood of the vasovagal episode and the fluctuation in pulse and BP might have been less.

Dr Okell tells me that he does not know how surgeons acquire training in the use of Midazolam

The patient says during the operation she was in so much pain she was screaming the place down and crying. You ask if we can confirm that she was screaming and for how long.

Professor Aluwihare tells me that he cannot remember The patient screaming at all. She had discomfort from time to time and articulated this quietly or briefly cried very quietly. He tells me he could see The patient face and was very aware of the need to control her pain.

We then complained to the Health Care Commission
Main points from the Health Commission reply

The independent clinical adviser comments that it was predictable that this would probably be a difficult and long operation. A general anaesthetic was not contraindicated due to the high BMI of 54, but would present significant risks. However, the technique using local anaesthetic reduced the risks of general anaesthetic, but carried risks associated with local anaesthesia. The independent clinical adviser clarified that the clinical records showed the amount of local anaesthetic used was lidocaine (2%) 400mg, marcain (0.5%) 100mg and lidocain (0.5%) 400mg.

In the clinical adviser’s opinion the maximum amount of plain local anaesthetic would have been in the order of 3 x 138 (weight of patient) = 414mg. He states that it is surprising that so much local anaesthetic was used and that adrenaline was not added.

The patient was therefore possibly at risk from the dose of local anaesthetic. However, having an anaesthetist present would have reduced the risks as the anaesthetist would have been able to monitor, administer appropriate drugs, and resuscitate in the event of vomiting and aspiration which was essential in such a patient (with a BMI of 54 and weight 138kg).

The clinical adviser recommends that the trust formulate a policy concerning the presence of an anaesthetist, especially when a patient receives large doses of local anaesthetic, for abdominal procedures and patients with a BMI of 54.

My expectation is that Mid Cheshire hospitals NHS Trust will contact you in writing within the next 25 working days in order to set out the steps that it will be taking in response to the recommendations for further action that I have made. I would also expect you to be informed in due course of the outcome of that action, and I will be asking the trust to copy the Healthcare Commission in on the relevant correspondence. The letter was sent on 21 December but the Leighton hospital has not complied with the above order in the time stipulated.

We were not satisfied with the report and complained to the Health Ombudsman
The Ombudsman's report
The Ombudsman has completed their investigation and found the HCC failed to identify that the removal of a women's knickers after she had said they couldn't be removed and giving a suppository without consent must be reinvestigated as soon as possible.

The GMC after a year investigation have referred to a Fitness to practice panel the surgeon Professor Aluwihare and we are hoping he will be in court very soon.

An overdose of local or sedation can cause the heart to stop and we believe this is what happened due to their negligence this experience is life changing.

Professor Aluwihare the surgeon responsable

The surgeon Professor Aluwihare if you have any complaints about this man let us know as the GMC would like to know

Battery is defined

A battery is the willful or intentional touching of a person against that person’s will by another person, or by an object or substance put in motion by that other person. Please note that an offensive touching can constitute a battery even if it does not cause injury, and could not reasonably be expected to cause injury. A defendant who emphatically pokes the plaintiff in the chest with his index finger to emphasize a point may be culpable for battery (although the damages award that results may well be nominal). A defendant who spits on a plaintiff, even though there is little chance that the spitting will cause any injury other than to the plaintiff's dignity, has committed a battery.

Assault and battery has a 6 month custodial sentence and a £5000 fine at Magistrates Court.

Experts Opinion

1. We sent Steve Bolsin BSc, MB BS, FRCA, FANZCA, MRACMA, MHSM, DLitt (Hon)
Director of Perioperative Medicine, Anaesthesia & Pain Management
The Geelong Hospital Geelong Victoria 3220 the notes and asked for his comments which are

I have reviewed the notes that you have sent and certainly there is evidence of a large overdose of lignocaine and an inappropriately high dose of midazolam in the first instance. However there are other more systemic issues relating to the planning and anaesthesia for such an operation. For example it might have been safer to undertake the procedure on a patient weighting 135 Kg under general anaesthesia to anticipate and prevent some of the potential problems that arose during the procedure. Who undertook the anaesthetic assessment for the patient? What type of block was used for the surgery? What factors led to the operation taking 2 hours? Why was the atropine given? (Presumably for bradycardia). What was the cause of the bradycardia? Why did the surgeon proceed with any operating while the patient was in pain? This would imply withdrawal of consent for the operation at that time and under those circumstances and may be an assault.
The specific answers to your questions are:

Yes it is far too much midazolam in one dose and is evidence of lack of experience with the drug and the technique of sedation.

The local could drop the heart rate but if the patient could not breath then there may be more significant reasons such as hypoxia followed by bradycardia.
The local dosage is a large overdose and inappropriate in the circumstances.
You need to find out who altered the chart and for what reason? If the bradycardia was due to hypoxia the saturations must have fallen. If there was no fall in saturations then the bradycardia was due to the local anaesthetic overdose and is still very significant.
Yes the operation should be pain free.
Hyperthermia for long operations can be easily prevented by warming blankets. these usually blow hot air over the patient and should have been used for any operation taking more than 20-30 mins.
I hope this brief assessment helps you.
Steve

Effects of the operation

An open letter to nurses and doctors

Special note here the patient express her personnel feeling of what happened during an operation she was sedated for some of the experience with a drug known to give sexual daydreams.

I went into Leighton hospital for a simple hernia operation as a day case and before the operation I told the nurse I didn’t want my knickers removed. She said as I was 21st they were not in the way and that was fine I also told her I didn’t want a suppository. I was taken into the anaesthetic room and given a massive dose of Midazolam 10mg all in one go according to my medical records.
I then started having a terrifying dream of being gang raped I was in a room full of people and they were removing my knickers in the most dirty, vile filthy and perverted way I feared for my life. I was unable to stop them doing these vile things to me and I was totally humiliated being stripped in public in this way it was the most terrifying experience of my life.

Midazolam is know to enhance sexual feeling and lots of cases of people having these feeling that's why it popular as a date rape drug. My knickers were removed for none medical reasons they claim so they wouldn’t get stained. Any women would prefer to loose a 50p pair of knickers instead of being forcible striped by complete strangers. I don’t know if it was done so people could look at my private parts in order to get sexual pleasure or what. As it’s a criminal offence of Assault and Battery which can have a 6 months custodial sentence I wouldn’t think anyone would do it without they got pleasure out of it. To ask a women while awake to remove her own knickers is one thing but to forcibly strip someone is a totally different thing As I was coming around from the operation I was awake when a nurse lifted my legs and buggered me.

Both the things were done totally without my consent and expressly against my wishes I don’t care how good a reason you had you did it totally without consent and for that reason its sexual assault.

It has now been nearly 2 years since this happened and I still wake in the night from horrendous nightmares screaming and trying to cover my self from the sexual assault my heart rate goes through the roof and I cant breath. My life has changed I am dirty and can never be clean again I have been sexually abused just the same as if I had been raped but its worse than that as I was helpless and had no way of stopping the attack, I couldn’t even fight back. I cant have any sort of sexual relations as I am unclean and cant stand the thought of anyone touching me. I have been buggered and deeply humiliated without my consent has taken place and once again I was unable to stop this happening to me. I feel that some perverted women has had her wicked way with me and once again it was done against my wishes and without my consent.

What makes this worse is the hospital refuse to sack this woman or name her so she can be brought to justice. She has no excuse for what she did its her job to ensure she obtains consent before she touches anyone and simply asking if its ok and explaining what she wanted to do is all it took but she didn’t do any of these things just simply buggered me. As she didn’t seek consent I can only conclude that she is a lesbian and obtains great sexual pleasure from this act of sexual abuse. No decant caring nurse would do this terrible thing without first obtaining consent.

In the last 2 years I have lost over 11st in weight due to this incident. If I go out and see a group of people it can bring on panic attacks were I think they are going to strip me again my heart races and I cant get my breath. The attacks can happen watching television if there is anything similar to what happened to me. My life is a total mess I am depressed and often go into a world of my own for a week at a time. I cant talk about what happened without getting flash backs.

The hospitals attitude is once you give consent to an operation they can do what the fucking hell they like to you. For senior management to refuse to give the names of the perverts that did this is unbelievable. The senior management at the hospital refuse to answer any emails and have not bother to even apologise for the sexual assault they claim it was all done above board but if you bugger someone and remove their underwear without consent there is no grey area its assault. The GMC have ruled that these things were done without consent so there is no doubt that in the eyes of the law a crime has been committed but still the hospital refuse to name or discipline the nurses who have done this to me.

I want all doctors and nurse to read this and I hope they will then think before they do anything to a patient without first obtaining consent they must remember that people are not just pieces of meat but have feelings and fears and are very vulnerable. Maybe reading this they will understand what effect their actions can have on someone. To them removing underwear is nothing but to many this has the effects that I have described. Many modern women might not mind but there are thousands who feel like I do.

I noticed my time in hospital that most don’t ask consent or explain what they intend to do they think they are gods better than the rest of us and can abuse patients and get away with it. I believe that most of the violent attacks on staff are because they don’t explain what they are doing and don’t seek consent. It take a second to say I want to take some blood is that ok.

I do accept that the whole incident was done for all the right reasons and nothing untoward happened but this doesn't make any difference to what I felt and what I still feel a lot of the feeling I believe are enhanced by the drug Midazolam that they used and it show they have considered the side effects of this drug. Midazolam can lead to the patient experiencing daydreams with a sexual content.