Terminally ill woman not consulted before 'do not resuscitate' notice was placed on her medical records, judge rulesGrandmother Janet Tracey, 63, objected when she found note
Judge Nicola Davies says consultant wanted to 'avoid conversation'
Mrs Tracey had terminal lung cancer and broke neck in car crash
07:37 GMT, 20 December 2012
Doctors placed a do not resuscitate order on a patient’s notes without her knowledge or consent, a High Court judge said yesterday.
Grandmother Janet Tracey, 63, had terminal lung cancer when she was admitted to hospital with a fractured neck following a serious car accident.
Despite her poor prognosis, her family say she ‘wanted to have every minute of every day’ and told doctors she wanted to be included in conversations about her care.
Patient: Janet Tracey, pictured with her husband David, did not consent to having a DNR notice put on her medical records
So she was ‘distressed’ to discover
in March last year that a Do Not Attempt Cardio-Pulmonary Resuscitation
(DNA-CPR) order had been placed on her notes.
When Mrs Tracey objected, it was
cancelled by staff at Addenbrooke’s Hospital, in Cambridge, only to be
reinstated three days later.
Mrs Tracey died two days after the second notice was issued.
Yesterday, Judge Nicola Davies said
she did not accept the evidence of Dr Andrea Lavinio, a consultant on
the neuro-critical care unit, that he had discussed the first order with
Mrs Tracey but forgot to record it in her medical notes
In written findings, she said: ‘There is nothing in the records which suggests any agreement to DNA-CPR by Mrs Tracey.’
She said Dr Lavinio may have kept Mrs
Tracey in the dark to ‘spare her a conversation which he knew was
likely to cause distress to a suffering patient’.
Legal battle: Mr Tracey stands outside the Royal Courts Of Justice with his daughters Kate Masters (second from right) and Alison Noeland (right) and solicitors Sophie Turner (left) and Merry Varney (second left)
Mrs Tracey received treatment, and died, at Addenbrooke's Hospital in Cambridge. She was terminally ill and had been involved in a car crash
But the findings will reignite the
debate over whether patients have the right to decide whether they are
resuscitated, or whether the doctor always knows best.
Fears: Mrs Tracey told her family that staff 'wanted to get rid of her'
Clinicians are not required by law to
gain the consent of patients, but hospital policy states they should
discuss it where possible.
The Tracey family claim their
mother’s human rights were breached and that Cambridgeshire University
Hospitals NHS Foundation Trust acted unlawfully when they ignored her
They will find out tomorrow whether
the case can proceed to a judicial review, where they can challenge the
trust’s policy and the national guidelines set down by the Secretary of
State for Health.
The family’s QC, Philip Havers, told
London’s High Court: ‘When the case is a matter of life or death, it is
not good enough for a trust to have a policy that is confusing.
‘There is a real problem out there and this is not a hypothetical or academic issue.’
Judge Davies said: ‘Amongst
clinicians responsible for the care of Mrs Tracey, there was unanimity: a
DNA-CPR order was appropriate in order to protect her from an
undignified and cruel procedure which was of no clinical benefit.’
Mrs Tracey’s four daughters,
including Alison Noeland who attended court yesterday, say they were
given graphic accounts of resuscitation to pressure them to agree to a
Daughter Kate Master told the hearing: ‘They said they would jump up and down on mum’s chest.
‘They would burn her with electrodes, they would break her ribs that weren’t already broken.’
Lord Faulks QC, speaking on behalf of
the hospital, said: ‘Whether or not to give CPR in circumstances like
this is a matter for the clinicians, ultimately.’