‘Death Pathway’: Veteran Josef Boberek died days after being admitted to hospital with a chest infection
Doctors at one of the country’s leading hospitals condemned a veteran to die on a notorious ‘death pathway’ after they wrongly decided he could not be saved.
Great-grandfather Josef Boberek was admitted to Hammersmith Hospital in West London with a chest infection, but died days later after doctors incorrectly told his family that he was at death’s door and deliberately withdrew his fluids and normal medication.
Now an official health watchdog report seen by The Mail on Sunday has revealed that the pensioner would have lived and returned to his normal life had he received proper treatment and not been placed on the discredited Liverpool Care Pathway (LCP).
Mr Boberek’s daughter Jayne, who fought a three-year battle to uncover the truth, said last night: ‘My father was condemned to an unnecessary early death by the doctors. They had no right to take his life, and him away from me.’
The damning report by the Health Service Ombudsman found a litany of failings at the hospital, including:
- Doctors claimed Mr Boberek was suffering from terminal heart and kidney failure when he was not;
- Although he was frail, he would almost certainly have lived if he had been properly treated;
- He was not suffering from dementia, as stated in his medical notes.
In what is believed to be the first time hospital chiefs have publicly accepted that the LCP had ‘killed’ a patient, the Imperial College Healthcare Trust told Miss Boberek that ‘if the failings had not happened, on the balance of probabilities your father would have survived and returned to his nursing home’.
Mr Boberek died in June 2013, months before the LCP – in which dying patients are sedated while treatment is withdrawn – was banned by the Government following claims it was being abused, although critics say it persists under other names.
HOW HOSPITAL TIRED TO JUSTIFY JOSEF’S DEATH… BUT WAS SLAMMED IN THIS BOMBSHELL REPORT
Part of the Trust’s letter to Mr Boberek’s daughter Jayne, who fought a three-year battle to uncover the truth
Miss Boberek did not commit her father (right) to the Liverpool Care Pathway. Nevertheless she found that registrar Dr Rather (left) had authorised the protocol, and he told her it was the ‘best thing’ for him
A passage from the Health Service Ombudsman’s report on the case
The 92-year-old, who fled the Nazi invasion of his native Poland and fought with the British Army during the Second World War, was admitted to hospital from his Ealing nursing home on May 29, 2013, suffering from a chest infection.
The father of two, a former engineer, had made several similar visits and his daughter had no reason to believe this one was anything but routine.
Mr Boberek was prescribed antibiotics for the infection and three litres of fluid from an intravenous drip because he was dehydrated, a common condition. His daughter said that, within a few days, the doctors considered him almost well enough to go home, but she had become concerned because he was not eating or drinking properly.
What she did not know until she examined his medical notes months later was that, for an unknown reason, her father had received only one of the three prescribed litres of fluids.
After five days in hospital, Mr Boberek was becoming drowsy and confused, but his daughter was reassured by doctors who said they would give him a further two litres of fluid – though she later found he had been given less than a quarter of that.
A week after his admission he was vomiting and, the following day – June 6 – Miss Boberek told the specialist registrar, Dr Arshad Rather, who was the most senior day-to-day doctor on the ward, of her concerns.
Later that evening a junior doctor told her that her father had developed a further infection and that his organs were failing, and gave her the strong impression that even if he recovered from the infection with another dose of antibiotics, his heart and kidneys were giving out.
Doctors at Hammersmith Hospital in West London incorrectly told Mr Boberek’s family that he was at death’s door and deliberately withdrew his fluids and normal medication
COMMENT: OLD SHOULD NEVER BE DENIED TREATMENT
Comment by Patrick Pullicino – Consultant Neurologist
Placing sick elderly patients who are diagnosed as ‘dying’ on end-of-life regimes – where they are deprived of fluids – is an ongoing scandal in the NHS and must not be allowed to continue.
The Ombudsman has just produced a report damning the failings of care in the case of Josef Boberek, who they admit would probably have survived but for the doctors’ erroneous interventions.
The importance of Mr Boberek’s case is that it is the first time an NHS trust has publicly acknowledged that they erred in making a diagnosis that a patient was ‘dying’. They also admitted they gave the patient inadequate fluids and that if they hadn’t made these errors, he would probably have been discharged alive. The failings in this case were the two main concerns of the 2013 Neuberger Report, which recommended the phasing out of the LCP: that there is no precise way of diagnosing if someone is dying and that patients should be supported with hydration and nutrition unless there is a strong reason not to.
These two lessons have not, however, been learned, since recent NICE guidelines continue to insist on diagnosing who is dying without providing any objective ways to do this. They also state that withdrawing fluids does not hasten death. Now that one of the top NHS trusts has admitted it was wrong to diagnose dying in Mr Boberek’s case and to withhold fluids, it is important that the findings are the impetus for ending the intentional dehydration of sick elderly patients in the NHS.
Elderly patients must not be intentionally dehydrated for any reason. A way to stop this is for NHS trusts to be required by the Care Quality Commission to report any instance of a patient not having fluids for more than 24 hours and to institute significant penalties. In addition, a diagnosis of ‘dying’ must never be allowed to be the basis for limiting care.
Otherwise, it is too easy to make a self-fulfilling prophecy in a patient who, like Mr Boberek, could be saved with more hydration and more care.
She was later told by the Ombudsman there was no evidence that her father had a new infection, let alone any serious decline in his heart or kidney functions.
She said: ‘It was presented to me as a dire situation, very bleak.
‘I later found out that by the time I was told this he had been 29 hours without oral fluids and three days without his prescribed IV fluids, and his usual medication for various conditions had been stopped.’
Miss Boberek reluctantly agreed to delay the antibiotics, which she was told could do more harm than good, but did not commit her father to the LCP. Nevertheless she found out the next day that registrar Dr Rather had authorised the protocol, and he told her it was the ‘best thing’ for him.
Mr Boberek, whom she described as looking exhausted, soon became unconscious and he died the following day.
Miss Boberek remained suspicious, however, about the claims that her father’s heart and kidneys had been in their worst-ever condition. She requested his medical notes and when they arrived after 60 days, parts were missing, obscured or inaccurate, such as a statement that he was suffering from dementia – but they did show his heart and kidneys had been worse eight months earlier.
In response to her questions, the trust said her father’s consultant Dr Edward Dickinson, now retired, had concluded that the treatment was ‘in line with the best principles of palliative care’.
She complained again, and in a second letter in January 2014 she was told by the trust the case had been reviewed by Dr Catherine Urch, the NHS London co-clinical director of end of life care.
The trust said: ‘Although the dying phase is not always clear, Dr Urch has specified that in your father’s case, sadly, it was clear.’
The report by the Ombudsman on June 29 this year told a very different story, concluding ‘there is no evidence to support the trust’s explanation that Mr Boberek was immediately dying on June 6’.
It added: ‘His hydration had been inadequate and there is no evidence he was encouraged to drink fluids… There is no evidence that his [heart and liver] had deteriorated to terminal levels… There is no evidence he needed any more antibiotics or that the clinical situation had changed on June 6.’
It added: ‘We cannot say how much longer Mr Boberek would have lived. However, in our view, if the failings had not happened, he would not have died at this time.’
In a letter to Miss Boberek earlier this month, trust chief executive Dr Tracey Batten admitted the trust should have provided more hydration and oral fluids. She said the trust was sorry it had made ‘a number of incorrect diagnoses’ and ‘incorrectly told you that your father was dying and placed him on the Liverpool Care Pathway’. She added ‘Please accept my unreserved apology that this happened and for the emotional impact that this has caused you.
‘Our complaint responses were not supported by evidence and, if the failings had not happened, on the balance of probabilities your father would have survived and returned to his nursing home.’
Miss Boberek, who has refused an offer of compensation, said: ‘Until recently I had a lot of rage in me, constant rage. I feel that has gone now that I have got some of the answers. But I do feel anger. I feel most of all I don’t want this to happen to others.’
Calling for all the doctors involved to be held to account, she added: ‘I don’t think it is relevant whether they did it on purpose or by accident or through incompetence or they just couldn’t care less. That doesn’t matter.’
A number of families at hospitals across the country have complained to the police that their loved ones were unnecessarily put on end-of-life regimes, though none of those cases has been resolved.