Doctor admits ignorance of care pathway

Jean Tulloch's feeding tube was removed too early. Picture: contributed

Jean Tulloch's feeding tube was removed too early. Picture: contributed

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A TOP doctor has admitted that he and other NHS Lothian consultants did not know how to properly implement controversial guidance designed to improve care for dying patients.

Dr Mark Strachan, director of acute medicine at the Western General Hospital, revealed that he was unaware that the Liverpool Care Pathway (LCP), should only be initiated in the final 24 to 72 hours of life.

In a review of the case of Jean Tulloch, whose son Peter complained to police after she had a feeding tube removed without his knowledge, Dr Strachan added: “I suspect many other consultants in NHS Lothian were similarly unaware of this guidance.”

The LCP was used in hundreds of cases since being rolled out in the region in 2011, with NHS Lothian encouraging its use. However, it was dubbed a “pathway to death” in some quarters, largely because it allowed doctors to stop giving patients nutrition. The Scottish Government announced last month that it is to be scrapped, after an independent review raised concerns over “inappropriate use”.

Mr Tulloch, 56, today said the “explosive” admissions around his mother’s case raised concerns that other Lothian patients could have been placed on the LCP too early.

He said: “How many people have incorrectly been put on the LCP prematurely in NHS Lothian hospitals? How many would have otherwise survived?”

Mrs Tulloch, who passed away in March 2012 aged 83, had nutrition withdrawn for around 24 hours after being placed on the LCP. After Mr Tulloch raised concerns, the feeding tube was reinserted and she survived for another two weeks.

Dr Strachan concluded that while placing Mrs Tulloch on the LCP was “technically incorrect”, it “did not result in any material change in her management” and that the removal of fluids for 24 hours did not contribute to her overall prognosis.

The NHS Lothian findings contradict a report commissioned by a lawyer acting for Mrs Tulloch’s family, which said a “starvation diet” had “materially contributed to her death”.

The Crown Office today confirmed that following a police investigation into Mrs Tulloch’s death, a fatal accident inquiry would not be held.

Dr David Farquharson, NHS Lothian’s medical director, said it would be inappropriate to comment on Mrs Tulloch’s care, saying it formed part of an “ongoing legal case”.