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Pontifications on Poison

Being some ramblings on events associated with poisonous plants.

Saturday 16th July 2011

It is far too early to know what has happened at Stepping Hill Hospital in Stockport where police are investigating three deaths and eleven other possible cases of poisoning via contaminated saline. There are reports that insulin was the contaminant which is not a plant based poison but has been used before as a murder weapon. 

Digitalis, foxglove

In 2006, Charles Cullen, a nurse who worked in New York and New Jersey hospitals, was convicted of killing 29 patients with an overdose of either insulin or digoxin, the heart medication derived from foxgloves, plants in the Digitalis genus.

He was suspected of involvement in another eleven cases but, with those, the authorities felt they could not prove that it was Cullen who killed the patients rather than the condition for which they were hospitalised. And that will, of course, be something to consider for the police in Stockport.

But I mustn’t over speculate on the current case. That wasn’t why I decided to write about it for today’s blog. My interest is because, sooner or later, we’ll start hearing cries of ‘How could this happen?’ and ‘Why didn’t the hospital’s controls on medication prevent this?’

And that brought me to the most famous case of murders committed by someone with access to pharmaceuticals from the 20th century; Doctor Harold Shipman. In his case, the weapon of choice was morphine derived from Papaver somniferum, the opium poppy. I wrote about this on the 7th July and discussed the idea that ‘Lessons have been learned’ is not always true. But, this new case, sent me off to look at the inquiry held after Shipman’s conviction on 31st January 2000.

Papaver somniferum, opium poppy

The Shipman Inquiry, under the chairmanship of Dame Janet Smith looked into all aspects of the Shipman affair and produced a total of six reports. The first, published in July 2002, set out what the inquiry had found out about the number of Shipman’s victims and how and when they were killed. The sixth, published in January 2005, returned to this aspect in order to take account of new information arising after the first report was published.

The fifth report is the one of interest in this context. It is titled ‘Safeguarding Patients: Lessons from the Past - Proposals for the Future’ (Crown copyright Command Paper Cm 6394, published 9 December 2004)  and looks at not just how another Shipman can be avoided but at the broader topic of patient safety. It’s an 1178 page document so I won’t try and summarise it. My interest in it, today, is because it makes fourteen references to lessons being learned.

This is not in the complacent sense that people sometimes say ‘Lessons have been learned’ and then go on in the old way. Most of the references are to the need to ensure that systems make proper provision for lessons to be learned. Dame Janet Smith gives detailed consideration to the matter of how complaints, from members of the public or from NHS employees, should be treated. Her comments are directed at complaints of all sorts and not the narrow, and, thankfully, rare, cases where deliberate harm is suspected.

It is interesting, then, that in the week when the Stepping Hill Hospital deaths came to the attention of the police, Private Eye has a special report entitled ‘Shoot the Messenger’ written by Dr. Phil Hammond and Andrew Bousfield. This report details a number of cases where whistleblowers in the NHS have been bought off or discredited in order to avoid their complaints being dealt with in public.

It remains to be seen whether any concerns had been raised and ignored at Stepping Hill but, I suspect, once the matter is fully investigated and any criminal proceedings completed we will be assured that ‘Lessons have been learned’.

Incidentally, in the 7th July blog I gave the figure of 282 murders committed by Shipman. In the sixth and final report of her inquiry, Dame Janet Smith stands by the figure of 218 identified victims but accepts that 250 is a realistic figure for the total number of people killed by Shipman.