‘Oxford hospice where neglect caused death of our daughter should be shut down and staff sacked’ say grieving Letchworth family of Emily Bushaway
- Credit: Archant
The parents of a 21-year-old girl from Letchworth who died when staff botched the assembly of her breathing apparatus say they want the hospice where she was cared for temporarily shut down and culpable staff struck off.
Mark and Lisa Bushaway also want proper training for all hospice staff across the UK so the kind of tragedy their family suffered can never happen again.
An inquest into the death of their daughter Emily Bushaway at Oxford Coroner’s Court on Wednesday last week, heard how her family had entrusted her to the care of Helen and Douglas House Hospice in Oxford, so they could spend five days decorating her bedroom to finish renovating their Letchworth home.
But hospice nurse Katie Philips changed the flexi-tubing on Emily’s ventilator and accidentally threw away part of the machine’s ‘whisper valve’ so her body was not able to expel carbon dioxide.
Emily later suffered a cardiac arrest and died.
The inquest ruled Emily’s death in May last year was accidental but contributed to by neglect.
Police investigated to determine if Ms Philips would be charged with manslaughter by gross negligence or if the hospice would face a corporate manslaughter charge, but the Crown Prosecution Service determined there was insufficient evidence to secure a conviction.
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But the family’s lawyer Tim Deeming, who is a specialist in criminal negligence, says the family will seek a civil case for compensation and will press the CQC and the Nursing & Midwifery Council to do everything in their power to make sure the hospice is brought to book.
Mr Bushaway told the Comet: “I know the hospice is needed but I think it should be shut down and re-staffed with new managers appointed.
“The hospice never apologised to us. We got one phone call from a guidance councillor on the Sunday after her death and that was it.
“They reassured us three or four times that they could look after our daughter. Our nurses at home spoke to them at length on the phone about how to operate the ventilator and everything seemed fine.
“When we took her to the hospice we spent time doing a handover and I kept saying to them about the different parts of the machine. Then to go and pick her up and find her in the state she was in was just so terrible.
“It’s just awful, you can never move forward and we’ve not been able to talk about it until now because of the criminal investigation.
“We couldn’t have the funeral until August 8 because of the investigations.
“To listen to oral evidence at the inquest and hear about how bad it really was really really hard.
“To find out nobody was trained and didn’t known what they were doing is just awful. They lied to us and told us their staff were trained but they weren’t.
“How do you live with that?” he said.
Mr Deeming says he will put pressure on the CQC and NMC to take steps to discipline and train the necessary staff and to ensure that Helen Douglas House and other hospices are safeguarded against similar circumstances.
Mr Bushaway said: “What I would like is for the nurses to be accountable and to be struck off and for the place to be re-staffed and re-managed because it’s a vital place for people to go.
“We want to make sure proactive steps are taken to make sure it doesn’t happen to anyone else at this hospice and in others in the UK.
“Emily had 21 years of fantastic care at home and supportive nurses all of whom had done the required training.
“There have been a catalogue of failures and no formal apology from the hospice.”
Coroner Darren Salter said he would also write to the Medicines and Healthcare Products Regulatory Agency to see if changes can be made to the ventilator to ensure the same mistake cannot be repeated.
Helen & Douglas House is well known in Oxfordshire and attracts patients and fundraising support from across the county and beyond. Its is comprised of two hospices, Helen House – for children – and Douglas House for those 16 and above. It opened in 1982 and sprang from the friendship between founder Sister Frances Dominica and the parents of a seriously ill little girl called Helen, who lived at home with her family but required 24-hour care.
On its website the hospice states it provides medical, emotional and practical support helping families deal with the implications of living with a child who will die prematurely, so they can make the most of their time together.
It says it costs more than £5.5m a year to run its two hospice houses and provide outreach.
CQC inspected the hospice in December last year and graded it ‘inadequate’ for safety in its report published in February 2017. The previous inspection report published in June 2016, but carried out prior to Emily’s death, rated it ‘good’ for safety and stated the service was safe.
The report said: “Staff were trained to protect children and young adults from abuse and harm and knew how to refer to the local authority if they had any concerns.
“Medicines were managed in accordance with current best practice and where specific advice was received from professionals this had been reviewed with a pharmacist.
“Risks had been appropriately assessed as part of the care planning process and staff had been provided with clear guidance on the management of identified risks.”
A spokesman for Helen & Douglas House said following the inquest: “We acknowledge fully and respect the findings of the Coroner’s ruling. We were privileged to look after Emily for over two years prior to this tragic incident. Our thoughts are with Emily’s family at this very difficult time and we would like to reiterate our deep and sincere condolences for their loss.
“Following the incident last year we conducted an immediate review of clinical procedures. We want to assure patients and families that the safety and care of patients is our priority. We have taken action to ensure that this type of incident won’t happen again and we will continue to review our clinical practice with patients’ safety at the heart of our decisions.”