Laura Booth’s inquest started this week after four long years. I’m not going to write much here*, I’m too enraged and upset for her parents (and for the families who have had similar experiences). Laura’s death (aged 21) was originally labelled as natural causes. Her inquest came about after Jayne McCubbin intervened.
The inquest is being live tweeted by George Julian. Following a now familiar route of a reputation obsessed NHS Trust instructing a well practiced barrister who draws on a bag of grubby tactics (parent/patient blame, witness coaching/discrediting, obfuscation, etc…) with no apparent regard for the devastated family sitting in front of him.
[While revolting, it’s evidence of some change as these deaths were pretty much ignored with no inquest or scrutiny before 2015. A legacy of #JusticeforLB and George’s fortitude, expertise and kindness.]
This week Laura’s parents listened to their daughter reduced to an ‘unstable and complex case’ with ‘a mental age of 18-24 months’. Too complex to feed while an anecdote of noshing a bit of mashed potato and peas was repeatedly shoehorned under the coroner’s nose to try to discredit weighty evidence of malnourishment.
She ate mashed potato and peas.
Ma am, I want to make sure this witness who wasn’t here yesterday is aware evidence has been given she ate mashed potato and peas.
Laura was starving.
So many questions raised by witness testimony carefully obscured by the work of the Trust’s barrister. Double take moments lost in ‘moving on swiftly’ sleight of hand activity. A medic who claimed an abbreviation in medical notes always confused him. A nutrition supplement not stocked by the Trust only sourced a week later despite copious notes that the patient hadn’t eaten for weeks. No feeding charts kept because, because ‘the parents’.
We’ve seen across the live tweeted inquests that coroners are often ill-equipped to understand and respond to the deaths they are examining. However well meaning or enlightened they may be (and many aren’t), they face the likes of Paul Spencer (or Peas as he is now in my mind) and other regular state funded barristers. Families don’t have recourse to funded legal representation and don’t know they need to. The years (decades) of work these barristers have in cementing relationships with coroners and the trusts they work for is pervasive. I was struck earlier when Peas told the coroner to make a note about a particular point. Evidence of chummy ease and privilege dripping across the coronial system while Laura’s parents sit traumatised.
Various Trust staff gave evidence this week, meithering about Laura’s lack of nutrition while doing crap all about it. An uncomfortable witnessing of buck passing, of trying to duck out of responsibility, claims of lack of ‘specialist knowledge’ alongside claims that the best care possible ‘in the circumstances’ had been provided.
Laura was starving.
There were drops of sense and brilliance. I remain in awe of these drops of sense and brilliance [I know I shouldn’t]. The piecemeal yet rock solid set of allies. This time Prof Sam Ahmedzai, a retired palliative consultant who became friends with the Booth family, especially Laura with whom he had a lovely relationship. He described how:
Earlier, Dr Patel an expert gastroenterology witness took the stand. A shift in the shape and tone of evidence. Dr P was baffled by illogical evidence. You try and feed patients, he said. The risks involved in not feeding patients are obvious. Staff didn’t engage with these obvious risks and yet there was email discussion about the risks of stopping nutrition. Dr P said no one gets better by continuing to ‘try harder’ which is what the records were suggesting and this emphasis places responsibility on patients to get better. Which is wrong. He said [bleary screen] Laura’s parents had tried as hard as they could to help her. Medical intervention was essential.
Storm clouds must be gathering in Trust towers in the face of this unassailable sense, knowledge and expertise, I thought, reading the tweets. Dr P couldn’t be dismissed as a ‘biased’ family friend.
An adjournment was immediately requested.
Ma’am I’d like to invite you to adjourn to enable me to take instructions from my team here, I’ve received lots of instructions…
I can imagine the maelstrom Dr Patel generated with his openness and honesty. We witnessed it during Connor’s inquest. Footy match type cheers when a witness ‘scored’ for the Trust and agitation/mobile phone activity when sense was spoken. Virtual inquests are different in terms of the visibility of these reactions though the distress experienced by the Booths was obvious as it was mentioned by the coroner.
Cross-examination restarted and the barrister kicked off with a question around how complex Laura was. Previous witnesses had expanded their complexity claims under questioning to the point she was the most complex patient in the whole, wide world. Dr P said, yes, Laura was unique and robustly deflected clunky attempts to place the blame on her (and her parents). Peas immediately turned to the speed with which Dr P had written his expert report.
The inquest has been adjourned till Tuesday. Leaving Laura’s parents and family in a liminal space of further brutalisation with more to come. The actions of Trust barristers are deliberate, calculated, cruel, practiced and formulaic. It’s becoming possible to anticipate the direction questioning will take. We’ve faced the same barrister (and colleagues from his chambers) in various proceedings as have other families.
The archive of live tweets George has been creating since 2015 is now a substantial evidence base which enables the identification of similarities and patterns underpinning the preventable deaths of people with learning disabilities, and the practiced response of the state to these deaths. A starter for ten:
People are denied basic health care and dying of starvation, drowning, scabies, constipation with little comment.
Medical (or even public health) knowledge is erased when health professionals come into contact with patients with learning disabilities.
No one takes responsibility for the patient’s health care. Action is punted into the next week/never never without scrutiny.
There’s a collusion around this abdication of responsibility. An acceptance that doing nothing is fine. No one asks ‘why?’
This, in turn, is underpinned by a belief/acceptance or even desire that the patient will die early.
State funded response:
Protecting the Trust’s reputation is key.
Winning is key. There is no low too low to sink to in terms of winning points.
The patient is non human and therefore irrelevant. Their family are non-human by association.
The coroner is a sitting duck in terms of schmoozing with fake charm and too often oven ready to be swayed by othering techniques.
I hope the Booths are able to find some peace this weekend. And hold onto the moments of the inquest which were about love. Laura, her mum and dad. Prof A. Love and social justice. Dr P. George Julian. Jayne McGubbins. And everyone following, retweeting or engaging with the live coverage.
*Sorry, wrote more than I expected.
The thing about this bit:…
‘You try and feed patients, said. The risks involved in not feeding patients are obvious. Staff didn’t engage with these obvious risks and yet there was email discussion about the risks of stopping nutrition.’
…was that the Trust staff appeared hugely reluctant even to *start* nutritional support for Laura, UNTIL they had a plan in place for subsequently weaning her off it. Like, you’re only allowed to be dependent on feeding support, Miss, if we can be sure it’s not going to be a long-term commitment? (If the intent WAS to avoid a long-term nutritional support commitment, one has to say that the strategy worked out perfectly.)
Meanwhile, Laura’s risks of refeeding syndrome grew with every day that she continued to be undernourished. That’s not just cart before horse, that’s a whole herd of eighteen-handers massed around… well, a wheelchair, when you face facts squarely, wasn’t it?
Which, one can’t help suspecting, may well have been the reason that the obscuring equines were so eagerly embraced.
I’m revolted by the lack of “basic care”. If a patient has difficulty with communication, it’s ok to just not “do”. Not wash, not feed, not speak with, no engage with.
This could be any of us or any of our loved ones.
The NHS is in dire straights in terms of care standards and the only thing keeping it afloat is the expert legal teams they have fighting the negligence claims.
Private care is no better. Just more expensive. Problem lies with a sociopathic government.
Problem surely lies with bureaucratic Stockholm Syndrome i.e. staff come to believe the institution is more important than the service, its ‘procedures’ more important than their own observations. The seeping away of personal initiative. Something to do with our education system?
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