THE 2008 FIASCO
In Dec 22, 2007, after having been told, for 7 years, that I was suffering from a 'frozen shoulder'; having 6 months physiotherapy which did nothing but increase the pain & going to the Royal Orthopaedic Hospital Pain Management Clinic who could do nothing for my condition but tell me to keep taking the painkillers, my new family doctor heard the cracking sound in my shoulder only once and immediately referred me for an X-ray at a local NHS hospital - which took place on the 22nd December 2007.
JAN 7th - I saw my doctor for the results and he told me that I had VERY severe arthritis in the shoulder and indeed it might collapse altogether soon if left. I asked that he refer me to a local private hospital, at my own expense, to see an excellent surgeon there. This he did and on Jan 22nd, I had a consultation with the surgeon. My husband came with me to hear exactly what was said. Despite the fact that there had been 3 weeks between making the appointment and seeing this consultant, my X-rays had not been obtained, nor looked at, by him - despte the fact that he actually works at the hospital I had them taken at. He said he would get them and give me the results in two days time. Nevertheless he diagnosed me as needing a shoulder resurfacing operation. I told him specifically at that consultation, that I had been turned down for various procedures at the local NHS hospital due to my weight; whereupon he weighed me and told me that there was NO problem with operating on my shoulder at that particular hospital.
I mentioned at that time that to have an operation I would have to cancel a holiday we had booked in April but this would take precedence if he was sure I could have it done. He said yes, he could not see why there would be a problem. However, he did make a note that I was to have one of the 'High Dependency' beds at the hospital, just in case of post-operative problems, which he said was MORE than sufficient for my needs. He even gave me the scrubs with which to disinfect my shoulder on the day of the operation and explained other procedures I should use to help with ensuring the area was as sterile as possible. He mentioned at the time that I would also see an anaesthetist before the operation but at no time did he indicate that this anaesthetist could or would veto the operation and gave me the impression that this was just a formality to determine how much anaesthetic would be needed.
He asked me to phone his secretary the next day, to get a quote for the operation and make an appointment for it to be done. This I did but she said she could NOT give me a quote without consulting the private hospital coding system. She nevertheless booked me in as a private paying patient at the hospital for the operation to take place on the 12th April.
By Jan 25th I had still received no word re the X-rays OR the quote for the operation I rang the consultant’s secretary to ask why; she said she would ask him on the following Monday. On Jan 28th I received an email from her with a quote for the operation. No word about my X-rays or reply from him personally. I rang her AGAIN to request these. On Jan 29th, I finally received a reply by email from the her – the sum total of which was that 'he had seen my X-rays, has decided that I need a shoulder replacement and the price of the op had risen another £1100'! I contacted her to ask WHY it had risen; was this because I needed a bigger and more serious operation? I commented that if so, then I would need to see him again to discuss this as I wanted to know what was involved. 20 minutes later I got a phone call from the secretary again, this time to say that there had 'been a mistake', the operation WAS the original one as we had discussed with him at the consultation and the price WAS also the original one also. My husband and I felt this was VERY odd and NOT very reassuring but the secretary blamed the 'mistake' on the private hospital’s coding system recently being ‘changed’. I was so anxious to have the operation that we kept the date on but we were FAR from satisfied with the service at that time.
We then mulled things over and I discovered, on the web, that the hospital was part of the NHS 'Choose & Book' scheme that states that patients can choose the hospital (providing it is part of the NHS - which this particular private hospital IS) and the date for the procedure that they want. I checked everything on the website and there was nothing to indicate that I would not be eligible and having already been accepted for the operation I asked my doctor if he would refer me as an NHS patient for it, which he agreed to.
In their replies to my complaints, much has been made by the hospital about whether or not my family doctor should have ever booked me onto the Choose and Book Scheme but it must be remembered that:
I therefore eventually received the necessary documentation for the Choose & Book appointment and emailed the surgeon's secretary to tell her that I was changing from a private patient to an NHS one. She told the consultant, who said this was not a problem and asked me to ask for him specially when I rang Choose and Book for an appointment. I then attempted to use the password and username supplied on the Choose & Book website. It would accept neither and after 3 attempts locked me out of the system completely. I then rang the Choose & Book telephone line and gave them the details plus the request from the surgeon to be asked for specifically. I explained that I had already had Xrays, also a consultation with the consultant AND booked the operation, I merely now needed to know if this could be taken over by the NHS.
They were extremely curt, telling me that I couldn't choose who I saw or where or when (THIS is a CHOOSE and BOOK scheme?) and that my surgeon had no RIGHT to be asked for. She said I HAD to see him again as that was 'part of the process' (what a GROSS waste of public funds!) and that if I wanted to see him in particular I should call his secretary to try and get a consultation date and they would TRY to fit in with it. So I called the consultant’s secretary AGAIN. She gave me a date of 13th February for the consultation. I rang back Choose & Book with the details. They said, NO - I couldn't have that date because it wasn't on their computer! They offered the 20th February so I took that just to keep things moving; I didn't want to lose the operation date of 12th April that was already booked.
On the 6th February, the hospital called to tell me that the surgeon was not DOING a clinic on the 20th and would I attend on the 13th please!? I said, yes, because that's the date I originally wanted ANYWAY and had been told was not possible! When I got to the hospital they asked me for 'the forms I was sent'. I told them I didn't have any forms and they looked somewhat disbelieving. I was given a set of very long forms to fill in - some before the consultation and even more afterwards.
I then had the 2nd consultation with the same consultant, with the same results as the first one. During the consultation I ONCE AGAIN specifically raised the subject of my weight and the safety of the operation as this was worrying me considerably - as I am only too aware that at my weight, any operation could kill me, due to the anaesthetic. ONCE AGAIN he told me that he was confident that everything would be fine and that I should 'leave the worrying to him'. He said that he was completely happy to keep on the original date of the operation and that he would see me then. At no time did he indicate that this was subject to further review by the hospital or anyone else and I got the total impression that HIS word was final.
The following day, I finally received confirmation the appointment for the night before and all the forms I should have filled in. According to the date on the envelope, they were only POSTED ON THE DAY OF THE CONSULTATION. The Director of the hospital later apologised for the letter for my appointment not arriving on time but says that this would have been sent out automatically etc. However, when I received my medical records, they indicate in an email, that it does not look as if my case was the first time that mail was not sent out in time to reach patients in time for their consultations!
I was VERY surprised therefore when on the 22nd February I received a letter from the Choose & Book Scheme reminding me that I had yet to make an appointment to see a consultant as their records showed I hadn’t done this yet! I rang them to say that, not only had I made an appointment THROUGH THEM, but it had subsequently been changed by the hospital and I had attended it some NINE DAYS before! They said that nobody at the hospital had told THEM about any of this, hence their writing to me and said that they would then remove me from their lists in that case. I asked if this might affect my operation date in April and they said ‘NO, if you have been accepted for the operation on that date, it will be fine’.
Just to be sure however, I rang the hospital as well to check - for my own peace of mind. They passed me through three departments over some 20 minutes, none of which could help but one lady did say that ‘if the surgeon had booked me in for the procedure then I could be SURE that it was on and that they would eventually confirm all the arrangements approximate one month before the operation’. I then rang the consultant’s secretary herself as well, to check that the operation date was definitely arranged and she said, yes, the operation WAS booked - NO PROBLEM. At NO time did anyone mention that the operation was subject to further discussion or veto by ANYONE.
On the 11th March I was shocked therefore to get a letter from my family doctor enclosing a letter to him from the hospital which states: 'We have reviewed the notes and are unable to see this patient due to medical grounds because her BMI is 46 etc. THAT WAS THE FIRST THING I KNEW ABOUT ANY SUCH EXCLUSION. I later found out from the records of my case that the hospital supplied, that in fact the hospital DOES have discretion to operate on patients with a higher BMI but at NO time was that told to me - in fact at one point I was told on the telephone specifically that the hospital does not operate on patients over a BMI of 40.
Having had two months of stress with the operation looming and not knowing what the outcome might be, I was extremely distressed to find that it was all for NOTHING and immediately rang the hospital to complain. I was assured that someone would call me back. By the afternoon of the FOLLOWING DAY I still had not heard from the hospital so I immediately wrote to the Chief Executive of the hospital group and (as the hospital were leading me to believe that they were bound by a ruling of the NHS) emailed my MP and the local press who said yes, they were VERY interested in covering the story.
On the 13th MARCH my MP replied immediately to say he was referring the matter to the Department of Health. The Hopsital CE’s office contacted me to say that they were very concerned to hear my story and would be asking the Director of the hospital to look into it - who would contact me direct.
I rang the hospital to complain once more and was told that the hospital was bound by the ruling set down by the NHS.In fact IN ALL THE PHONE CALLS I HAD WITH THE HOSPITAL AT THIS TIME I WAS LED TO BELIEVE THIS WAS THE ‘FAULT’ OF THE NHS – they knew that I believed this and did not ONCE tell me that this was an arrangement that their individual hospital had with the NHS and was NOT a general ruling. I firmly believe now that this was merely to deflect my anger away from the hospital and onto the NHS. When I told them I would be speaking to the press about NOT being told about this at ALL for the past two months, I was asked if I was also going complain about my family doctor as ‘he should have known about this before referring me’! I did NOT appreciate this attempt to implicate someone who had done NOTHING but try to help me and SAID SO in NO uncertain terms.
On the14th MARCH I got another phone call from the hospital Director, who promised me that everything would be thoroughly investigated and on the 20th March I received a letter from saying that they would investigate my complaint within 20 working days. Incidentally, they constantly ignored the fact that I first complained on MARCH 11th, NOT THE 14TH OR THE 18TH AS THE HOSPITAL SAY. This fact is confirmed however in details in the medical records I requested.
On the 31st March, the surgeon returned from holiday, contacted me immediately and made an appointment for the following day at the local NHS hospital, where he also works. I was under the impression that this would be to talk about what had happened, explain to me WHY it had happened and maybe get a well-deserved apology. However, when we got there, nobody at reception knew anything about the appointment – nor did they even know the consultant’s name, or which department he worked for! Once we did, finally track him down, I was surprised to find however, that he was not interested in discussing the problems I had had at all, despite the distress caused, nor was an apology forthcoming. The ONLY comment he made about what had happened previously was to reiterate that when I had consulted him on the two occasions, he had been totally unaware of any exclusions there due to weight – either as a private OR NHS patient. I felt I was being pushed to have an operation at a hospital I did NOT want to go to and also without vitally needed information. I said that before I could make a decision about having the operation done at ALL now, I needed to talk to an anaesthetist so I could be fully informed as to exactly what the risks were of the operation and whether these were acceptable – as these had been deemed too great for the private hospital to cope with. He agreed to arrange this and told me that this would be on the following Monday and would be treated as urgent. A few days later they rang to say that it might be the actual Monday morning before they could tell me what time to arrive that day - I said that was fine.
I then got a phone call from the Director of the private hospital who said she would contact me around the middle of the following week/Wednesday (9th April) to see what was happening regarding my operation. I pointed out that for two months I had been under the strain of knowing I was going to have what was for me a potentially fatal operation, had given up my holidays, had bought special clothing for after the operation and that people had made arrangements with their work and booked hotels in order to be stay my husband on the weekend of the operation as he would be understandably upset and worried. I also pointed out the already numerous administration blunders that had taken place at the hospital, asked WHY I had not been told about any limitations due to my weight before I was, and made it clear that so far as I was personally concerned, whether I was going to have the operation was only part of my complaints and worries. I told her I did not feel up to having an operation ANYWHERE until my complaints about what had happened had been brought to a satisfactory conclusion. She assured me that all my complaints were being looked into and that she would contact me shortly.
The following Monday I waited in for the hospital to ring but, despite waiting in for the rest of the day as instructed, I didn't get the expected phone call until the next day and then only to be told that the first appointment was, in fact, 15 days later on the 23rd April!
The promised call on Wednesday from the Director of the private hospital ALSO did not happen until late on the Thursday night, wasting me another two days waiting in. She said she was hoping to hear about my appointment with the anaesthetist before making any comments. I pointed out that as the private hospital weren't going to treat me ANYWAY, no matter WHAT the outcome of that consultation, it was totally irrelevant insofar as my complaints about the hospital were concerned and really none of their business and I wanted my complaints ANSWERED PLEASE! I told her that I had had enough waiting as it was already over a month since the cancellation of the operation and I was going to talk to the press immediately.I got the distinct feeling, despite their protestations to the contrary, that the private hospital were hoping that if I got an op booked SOMEWHERE I would then forget everything that has happened and be content. I had to tell her that, FAR from a positive ending to my problems - as I really didn't WANT to be treated at the NHS hospital it was only the start of more worries for me and my decision to go to the press stood.
All of a sudden next morning I got another phone call from the NHS hospital, saying they can give me an appointment the following Tuesday at 10.30 to see the anaesthetist.
On the 14th APRIL I had major, long interview with the local paper about all this. One of their FIRST questions was ‘Haven’t you been offered ANY compensation for all this mix up?' and of course I had to say NO.
I finally saw the anaesthetist at the NHS hospital and she said I could go ahead with an operation there though she warned me that there were significant risks in having it. She put me into the system for pre-op tests there though to be honest I felt pressured into this and eventually I decided that I was, as I had always said, NOT prepared to be operated on at that hospital as I felt that the odds of something going wrong were too high - this is something that SHOULD have been told to me RIGHT AT THE START BY EVERYONE!
On the 16th APRIL I got a letter from the Director of the private hospital, admitting, more or less that I have been ‘caught up in a lot of complex issues and she fully appreciated my distress and frustration with the system and process issues that have resulted in the situation I now found myself in.’ She seemed, in the letter, to admit many things had gone wrong and that steps were necessary to ensure that they do not happen again. This was all well and good but I had to ask - exactly how DOES THIS COMPENSATE US for months of stress and distress that both I and my husband had gone through - to say nothing of arrangements that were made by friends to come and visit, the loss of our holiday and other financial losses incurred?
The journalist from the Sutton Coldfield News rang me to say that he had spoken to the NHS who informed him, after all this, that there is NO blanket ban on people over BMI 35 after all! In every phone conversation I had had with the administration at the private hospital, I had been given the impression that ‘their hands were tied by the NHS ruling’ and I believe that they let me go on believing this to deflect my anger onto the NHS and away from the hospital. These are obviously individual arrangements made by the private hospital with the NHS and ones that were NOT been made clearly enough to my GP at that time, despite their protestations that they were recorded on the system, nor obviously had they make such limitations known to their consultant surgeons!
The journalist was also contacted by the hospital who merely stated that they take their decisions in the best interest of the patients.... and that they won't go into details because of patients confidentiality. My comment back to that was – yes, I fully appreciate that if they do not have the facilities to cope with operations on the overweight, they do not do them and that that is in the patient’s best interests. However, if this is the case, they should adequately inform GPs and their own consultants about this – not book patients in for operations and then leave them with all the stress that that entails for two MONTHS before they tell them!
It also begged the question, where was this concern for confidentiality when they were waiting on the results of my private consultations at ANOTHER hospital as an excuse for not replying to my complaints?
I also found from my records, that while, in every letter and phone call I was being told that there was NO WAY the hospital could (or would) operate on me, behind my back, in emails internally in the hospital, they were using phrases like ‘I presume that she is not coming back to us’ and ‘hopefully she will have her surgery there (the NHS hospital). If she comes back to us, then any admission would be subject to anaesthetic review here by the consultant‘s private anaesthetist’! This was certainly NEVER mooted to me as a possibility by anyone from the hospital!
21st APRIL. I wrote a long letter to the director, expressing how disgusted I was, that they couldn’t even ANSWER my complaints properly and asking, why, if they have to put SO much right at the hospital, can't they admit that things were WRONG for me and at least offer a little compensation for the distress & strain they had put us through + financial loss caused by the cancellation of the holiday, purchase of clothing and other items?. I also wrote AGAIN to their Chief Executive to tell him how disappointed I was with the result of the hospital’s investigations and mentioned that I was prepared to take the complaint further if they refused to offer any compensation.
On the 22nd of April I got a letter from their ‘Customer Services’, telling me that if I am not satisfied with their complaints procedure then I should write to the Healthcare Commission. I wished to ask someone there questions about this – however the Customer Services letter doen't even carry a telephone number or email - how can a hospital provide decent ‘customer service’ if the patients cannot even SPEAK to someone there?
23rd APRIL. I got a letter from my MP, enclosing a letter from the Minister of State, Dawn Primololo (representing the NHS) who says also that there IS NO rule regarding BMI requirements on the Choose & Book Scheme and that it must have been a local issue with that particular hospital. I contacted the journalist who was anxious to update my story into the local newspaper and on the 25th APRIL the story came out in the Sutton Coldfield News. I received an amazing amount of support from friends all round the world via email and my website.
On the 7th May I received a letter from the hospital which once again did not even BEGIN to address any of my complaints. It mentioned that a new liaison officer had been recruited who will be working with GPs to ensure that they fully understand the ECN restrictions and the reasons for them. She also said that the consultant would have told me that his anaesthetist would have to determine whether I was safe to be treated there – NO HE DID NOT. As I have already said, I would not have cancelled a much-needed holiday unless I was SURE that the operation was ON. I fully understand that a patient needs to be checked before an operation to ensure that they are not sick and that their condition has not deteriorated since seeing the surgeon etc. HOWEVER, at NO TIME was it made clear to me that my case was subject to review and possible veto by ANYONE.
The letter acknowledged that the ‘administrative process had not gone smoothly’ but blamed it all on the fact that I had had one private consultation with the surgeon and then changed to the NHS Choose & Book Scheme. I fail to see why such a simple administrative process should cause such problems, especially considering the fact that the Choose & Book Scheme insisted that I did everything ‘by the book’. I had started treatment privately three times at at this particular hospital in the past and then gone on to complete it under the NHS – none of which caused the slightest problem under the previous administration. If the hospital is to continue as both a private and a NHS hospital it is surely not unexpected that they will have to cope with moving patients from an initial private consultation (that many patients have to save waiting time) to a final operation on the Choose & Book scheme in the future and surely this can be achieved without the mess that I faced happening? It is after all, only a case of good records being kept and efficient communication between departments at what is a VERY small hospital!
Then comes the most annoying remark of all and the one that has caused me, ultimately to take the matter to the Healthcare Commission.
She says: “I have acknowledged that the particular circumstances of your referral pathway resulted in a situation that is not idea but not that you have suffered as a result…
I do not feel therefore that compensation is due for any inconvenience experienced by the administrative process not going as smoothly as intended…. “
I find THAT thoroughly insulting and lacking in any kind of professional understanding of a patient’s situation. It is like saying that as long as someone apologises and promises not to do it again, they can damage someone’s health and cause them distress, inconvenience and financial loss, with impunity! There are times when an apology is simply NOT enough! I replied to this, expressing my feelings about these comments and also contacted the Sutton News to let them know of the decision and they were only too pleased to write a follow up article.
I also wrote to CE of the hospital group, about the whole situation, offering to wait while they reconsidered their decision, before escalating this whole matter to a complaint to the Commission. I then requested copies of all my files under a 'Subject Access Request'.
On the 15th May, I received a letter back, in which the Chief Executive dug his heels in, in support of the hospital’s comments and says ‘I am aware from your letter to me, received on the 12th May, that you intend to escalate your complaint to the Healthcare Commission…. Under the circumstances therefore, it would not be appropriate for me to prejudice or influence the investigation of the Healthcare Commission by offering compensation." NICE ONE. That is NOT what I had said and I felt it was a deliberate misinterpretation of my words. I had said I was giving them time to reconsider making a decent gesture of compensation before I decided whether to make a formal complaint. I thought that once they had fully understood the degree of stress that had been caused by the hospital’s shortcomings, he would make the only moral and ethical decision possible – to offer SOME compensation. I was simply giving him time to do this. I wrote back immediately to make that position clear.
On the 17th Mary, I then got a letter which is enclosed – which more or less accused me of trying to get them to give me compensation just to stop me complaining to the Commission. I found this incredibly insulting. I wrote back immediately to explain that I was not trying to ‘bribe’ them into giving me compensation; I was merely trying to give them time and opportunity to come to an ethically and morally decent decision regarding compensation.
Neither the administration of the hospital or it’s CE seem to have ANY concept of the degree of stress caused when a patient is waiting, for months on end, for an operation that could well be fatal – it is a terrifying thing to live through, even if, at the end of it, the operation goes ahead. To go through it for NOTHING is NOT acceptable, especially when the reasons for it not going ahead so obviously should have been picked up at my very first consultation there (an opinion which seems to be backed up by members of the hospital administration in the enclosed documents). I believe that a gesture of compensation is the very LEAST this hospital could have done after all the stress and upset that their ineptitude has caused.
This site © Rosie Hardman 2009