THE callous treatment of
the elderly in NHS hospitals has been exposed by a doctor who claims
patients are denied life-saving treatment, are grossly neglected and
are given drugs which hasten death.
A doctor who ordered the withdrawal of life-saving medication of
a dying patient after stating that the hospital needed beds.
Rita Pal, 28, a junior doctor, was so disturbed by her
experiences that she is leaving the profession. This week she will
submit a dossier to the General Medical Council (GMC) detailing the
cases of abuse that she saw.
"I have witnessed doctors who want to keep beds clear by
withdrawing treatment or actively assisting in death to the point
where it becomes involuntary euthanasia," she said. She wants the
government to set up an independent inquiry. Among the cases which
Pal witnessed were:
A diabetic patient in her nineties who was deprived of basic
medical attention after a nurse commented, "She will die anyway."
Critically ill patients whose lives were cut short after being
given "unnecessary" doses of diamorphine, which is commonly known as
A doctor who, when told about a patient dying from a liver
complaint, said, "Well, he is over 60", and made no effort to
administer medical attention.
Pal, from Sutton Coldfield, West Midlands, trained at University
College London. She joined North Staffordshire hospital in 1998 and
worked on two general medical wards - each with about 40 patients.
In her first month, a senior doctor ordered the medication to be
withdrawn from an 89-year-old stroke victim who was critically ill
and could not speak because he had a plastic tube down his throat.
"This man was actually conscious and could hear us," said Pal.
"The doctor said, 'We need the bed - stop all his medication'. He
obviously didn't think he was going to live. I thought: we are
killing someone because we want the beds.
"They stopped the medication and at about 9.30pm he started
getting short of breath. I held his hand and said, 'You will be all
right'. I was sickened by the whole episode."
Pal disobeyed the doctor and gave the patient drugs to help him
breathe. He was transferred to another unit, but later died. The
doctor, whose name is known to The Sunday Times, declined to comment
Last week one of the man's relatives said: "I think the NHS is
atrocious. I don't think they care about old people."
Another elderly woman, who was diabetic, was also allegedly
neglected after being admitted in November 1998. She was in danger
of dying if her blood sugar went too high, but the nurses failed to
monitor her properly. "She was incontinent and they wouldn't even
clean her up properly," she said. "I must have asked the nurses at
least 10 times to monitor the blood sugar. One nurse said, 'She will
In January 1999, Pal took up a new post at Selly Oak hospital.
Although she said ward conditions were better, she was disturbed at
the liberal use of diamorphine, which eases pain and is used to
treat heart conditions but can also hasten death.
In one case she was so convinced a dose of diamorphine she had
been ordered to give would be fatal that she injected it into the
When another doctor saw that the patient was alive the next day,
he said: "Oh, she is still alive - didn't you start her on
diamorphine?" The patient, suffering from pneumonia, later recovered
and left hospital.
"The doctor ordered that she be given the drug without examining
her and I felt his decision was based on her age," said Pal. "I
think diamorphine would have killed her because it would have
reduced her respiratory rate. The doctor thought she was going to
die anyway, but days later I saw her sitting up and putting on her
Pal also encountered alleged abuse of diamorphine at North
Staffordshire. On one occasion a female patient died after being
given what Pal considered an unnecessary dose. "She was dying, but I
think this was speeded up," said Pal. "This was involuntary
Her disillusionment with the NHS grew after she failed to save
the life of a patient admitted to Worcester Royal Infirmary with
internal bleeding after being discharged prematurely. She feared the
patient was bleeding to death as he lay on a trolley in accident and
emergency, but none of the staff available had the necessary
expertise to treat him. The patient started to vomit blood, but
there was no intensive care bed available.
When she contacted a senior member of the medical team, the
doctor said: "Well, he is over 60." The patient was subsequently
given the necessary treatment but died after being transferred to
Pal is now studying to be a barrister. "I have lost faith in
medicine," she said. "There is a code of silence and it's the
hardest thing to stand up and say something."
One doctor who worked with Pal said she had raised legitimate
concerns about the use of diamorphine. "It's the question of where
you draw the line between relieving pain and terminating life," he
Dr Michael Irwin, vice-chairman of the Voluntary Euthanasia
Society, said: "My main concern is that diamorphine is being used
without consulting patients or talking to relatives.
"That is involuntary euthanasia and although we know it happens,
we don't know the extent - there are probably thousands of cases
Dr Nigel Sykes, a consultant in palliative medicine at St
Christopher's hospice in London, said: "I have seen patients
overdosed with diamorphine so it certainly happens, but I don't
believe it is done wilfully."
The cruelty and inhumanity of treatment meted out to some elderly
patients in the NHS was exposed two weeks ago by The Sunday Times.
An undercover investigation by a reporter in two hospitals revealed
that patients were not receiving proper medical attention, were left
in soiled clothes for long periods and were routinely neglected. The
article prompted a deluge of letters from readers.
Pal's most serious allegations are made in the context, she said,
of a health service which is in "disarray" and routinely failing its
Pal, who was regularly working 16-hour days, admits her own
supervision was so inadequate that in November 1998 she nearly
killed one patient who was suffering from a serious gall bladder
After failing to contact more senior doctors, Pal gave the woman
a drip because of her falling blood pressure. The young doctor was,
however, so inexperienced that she gave the patient too much fluid
too quickly which "tipped" her into heart failure. The woman
recovered, but died days later.
Last week North Staffordshire hospital said Pal's allegations
will be "taken seriously and fully investigated".
Andrew Reid, medical director of University Hospital Birmingham
NHS Trust, which includes Selly Oak hospital, also said Pal's
allegations would be investigated if she provided further details. A
spokesman for Worcester Royal Infirmary said the liver patient Pal
saw had been discharged "inappropriately" but, when readmitted,
received the specialist treatment he required.