Trial by Kangaroo Court

Denise McKenna

Sixteen years ago my sister, Jane, who was 31, died from a massive drug overdose given to her intravenously by a doctor at the Royal Marsden Hospital in London. Eight months prior to her death Jane was diagnosed with cancer of the cervix. She had radiotherapy at the Royal Marsden and a hysterectomy in Greenwich Hospital. Since both hospitals had thought the other was responsible for her aftercare, or so they later claimed, this, and the fact that her GP was a misogynist, meant that Jane was given virtually no follow up care. So, eight months later when she visited a Well Woman Clinic in desperation, she was found to have a recurrence of the cancer: a Ďtumour the size of a grapefruití. She was rushed to the Royal Marsden for chemotherapy. Her GP visited her - anxious - since in the preceding eight months he had refused to examine her, dismissing her various symptoms, which included extreme pain and a large lump, later found to be her bladder which was displaced by the tumour, as being psychosomatic and telling her to stop visiting him and get some counselling instead.

Jane returned home a day or two after the chemotherapy but her condition soon took a drastic turn and, on her immediate readmission to the Royal Marsden, my family and I were told that Jane had mistakenly been given the wrong dose of chemotherapy. Since the effects were irreversible, we were told she would die in a matter of days, although they said that they could prolong her life by about 6 - 8 weeks if they put her on a kidney dialysis machine but they would have to amputate one of her legs. (She must have overheard them talking about this in the Intensive Care Unit because she thought that her leg had been amputated). We decided against this course of action as she was, by now, in an appalling condition. We decided to let her go. Amazingly, the doctors told us that palliative care would be minimal as there would be an inquest into her death and any additional drugs which could contribute to her death might implicate them further. Jane died an horrendous death one week later.

The coroner at the inquest was Dr Paul Knapman, currently notorious for having removed the hands of the Marchioness disaster victims. In Janeís case, however, he was incisive (no pun intended). All of the doctors questioned lied, even the pathologist who carried out the post-mortem. Her GP had "lost" all of her notes and could only "vaguely remember" having ever seen her. Dr Knapman easily cut through their lies (again, no pun intended) and, one by one, they admitted to the truth, all except her GP who remained amnesiac throughout. ĎDeath by misadventure due to an accidental drug overdoseí was the recorded verdict. Although Janeís death wasnít front page news, it was widely reported in the national and local press. The Sunís headline read, "Docís Deadly Blunder".

Years later, in 1997, I was a voluntary patient in the Jim Birley Unit in the Maudsley Hospital where I was given ECT. Both myself and my mother were told that I had over-convulsed during my tenth and final treatment. As a side effect of the ECT I became wildly manic. Despite mania being an acknowledged side-effect of ECT the hospital, remarkably, failed to identify my problem. I was sectioned and transferred to the high support area on the ward. There was a male user in this area whom I had apparently spoken to briefly whilst I was being "escorted" by the Emergency Crash Team to my room. I have a very hazy recollection of speaking to him, I never learned his name and thought nothing of him until, a couple of days later, while I was still on close observation, he beat me up. My close observation nurse intervened in a very courageous way but he still managed to do some damage to me. It was ages before they could get him off me. And the verbal abuse was something else. That continued for months after the assault, both in the hospital and in the street, in fact, every time he saw me. I didnít take legal action against this guy, I thought, "I didnít come into hospital to get beaten up and Iím sure he didnít come into hospital to get a criminal record". The hospital hadnít been a safe place for either of us. Meanwhile, the hospital blocked my contact with the Victim Support Agency out of "respect for my confidentiality" although the Victim Support Agency were accused of lying about this by my doctor when they later mentioned it. I was desperate to speak to them. I was desperate to speak to anyone.

Manic and distressed; I was crying and shouting and making a lot of noise. The nurses took to frog marching me to my room, medicating me and locking me up. They wouldnít allow me to talk about the assault as they couldnít talk to be about anything that involved another user out of "respect for his confidentiality". There was no one I could speak to. My relationship with the nurses deteriorated into one of abuse. They abused me, I retaliated, in a deranged way. A few of the nurses treated me with kindness, but I was abusive to some of them too, it was like a genie that was out of the bottle and I couldnít get it back in.

Eventually, I was moved to another ward, ES3, where the abuse from the nurses had to be seen to be believed. I was aware of only one nurse showing me any kindness on that ward. They made it clear that my level of distress wasnít wanted on their ward. They frog-marched me all over the place, medicated me, threatened me, e.g. I would be locked in an empty room indefinitely; I would be denied visitors, etc., if I didnít "behave". They wouldnít give me my Ventolin for my asthma when I needed it. I was trying to tell them I couldnít control my behaviour but they thought I was just a bastard although it was clear they knew I wasnít completely compos mentis because some of them were openly laughing at me. They spoke to me with undisguised contempt and, assuming I was Ďout of ití, they dropped all semblance of civilized behaviour. It was like something out of "Lord of the Flies". Latterly they took to dragging me the length of the ward by my arms and legs, once one of them had me by my hair.

When my mother Ďphoned to speak to me on the ward, the user who answered it said, "Is that Deniseís mum? For Godís sake come and get her, theyíre dragging her around the ward and treating her like shit". My mother did come and get me. I was traumatized for about a year following the assault. On one outpatient appointment the nurse who had been kind to me on the second ward came over and said to me, "I just want to let you know that I thought it was terrible the way they treated you when you were on the ward".

I made a complaint to the hospital both about the fact that, whilst being detained there against my will, they had been unable to secure my safety and about the abuse from nurses which I was forced to endure. I was also aggrieved about the number of lies my doctor was telling. Although no one could deny that I had been assaulted, the nurses and doctor involved lied about everything else. Even some nurses who werenít involved lied to corroborate the lies of others. They focused on my behaviour and, eventually, I came to believe that I was responsible for everything: the assault; the mania; the abuse. I was just rotten through and through. After a while I found an advocate (Dr Jo Nash, from POPAN - Prevention of Professional Abuse Network) and got it together to ask to see my medical notes. Some of my notes were missing and it was denied that I had ever over-convulsed or that either my mother or I had ever been told that I had. So, as well as the Victim Support Agency being liars, my mother and I were also liars and my sister, Fiona, was also accused of being a liar over some evidence she had given.

Crazy efforts were made on the part of the hospital to "resolve" the problem. My being beaten up was deemed to have been "inevitable" since both my assailant and I have "strong personalities" and it was suggested that we meet, in the presence of our consultant (we shared the same consultant) to "resolve our differences". What differences? This man was a complete stranger to me. Besides, he was threatening other users. He clearly had a problem that had nothing to do with me.

Their initial response to my complaint was absolutely off the wall, and very slow in coming. I rejected this. The next stage was the Complaints Convenor who was a non-executive Director of the Trust. I told him my story and he asked those involved (not any of my witnesses, of course) if it was true. They said, "No", so he wrote to me and told me my story wasnít true, that I had lied. They were the professionals; I was mad; there was more of them than there was of me. In other words, an everyday scenario on an acute psychiatric ward. But the Convenor did tell me that he was struck by how concerned those questioned were for my welfare!!

Throughout it all, my "bad" behaviour was emphasized. I was bad, bad, bad. The fact that I was manic, thanks to the ECT, had been violently assaulted, was locked up with the man who had assaulted me and who was continuously shouting abuse and threats at me across the length of the ward unchecked by the nurses who could clearly hear him and who were laughing and joking with him, punished for my distress, punished for being manic, physically and emotionally abused by nurses, unable to use my Ventolin for my asthma and lied to by my doctor, all of these things apparently could not account for my behaviour. The cause of my behaviour was within me. I was just a bastard. In a way, this is one of the primary criticisms of psychiatry. The things we experience and the meanings we take from them do not account for our behaviour. Its genetic, its biochemical, its because weíve got rotten personalities. Our behaviour is decontextualized. It wasnít till I finally met with the Victims Support Agency that I realized that my response to what had happened to me was explicable, even normal. I was behaving appropriately!

In the event, there was no real investigation into my complaint, it was all a sham. I kept hearing the term, "local resolution" which means donít involve the outside world. Like in the abusive domestic set-up where it's all kept in the family. The Complaints Department (I believe they now call themselves the Customer Relations Department) exists to nip potential litigation in the bud or at least for the Trust to be forewarned about any litigation. I agree it must be awful to be in a job where any mistakes you make at work can leave you open to litigation, after all, we all make mistakes, thatís the view I took when Jane died. In Janeís case one doctor wrote the wrong number down by mistake - she wrote the number 2 instead of 1 (incidentally, a mistake Jane herself would never have made) - and that was enough to kill Jane. The recommendation at the inquest was that there should be put in place a system whereby all medications prescribed at the Royal Marsden should be checked by another person to prevent errors. Its unbelievable that such a system was not always in place.

One thing which struck me was how much my visible behaviour determined how I was treated, there was no regard for what I might have been experiencing. They didnít want to talk to me about it. They abused me simply because they found me to be obnoxious and I couldnít get it together to make a coherent defence, it was spiteful abuse. Due to the ECT, I didnít have the social skills which are usually available to me. So now I know how they treat people they donít like and who arenít able to look them in the eye and say, "I see what youíre doing and I know what it means". Thatís how it is for children who are abused, they are less understanding of what is happening to them so the abuser assumes that the abuse isnít being assimilated and will therefore be forgotten or will never reach the childís full consciousness. But assimilation can be done at a later date. Hence child abusers are often taken by surprise years later when the adult child turns round and accuses them. You go over what happened again and again, peeling away the layers. I guess thatís what recovery is all about.

Abuse is always an option where there is an imbalance of power. We know from the behaviour of child abusers that people who want to abuse others seek out situations where there is such an imbalance of power. Why should psychiatry be any different? If the abusers are in senior positions, they can set the tone of a whole ward. I think that in my case the less experienced nurses went along with what was happening because they thought that if others were doing it, then it must be OK. Not all of them went along with it, some of them were great, and I try to hold on to those good experiences.

Looking at the investigation in a court of law into Janeís death in comparison with the investigation into my complaint to the Maudsley, I can see how appallingly amateurish the Maudsleyís efforts were. But that doesnít matter, the complaints system is just a front for what is effectively a litigation quashing exercise. In the end, however an investigation is conducted, the medical profession is untouchable but there is something to be said for the truth coming out, even if nothing can be done about it, especially if you are seeing things through an ECT mist. In the end, after three years of regurgitating the complaint and arguing about the minutiae of the complaints procedure, I became tired of being at war with the hospital. In addition, I didnít want to jeopardize my relationship with my new care team so I agreed to accept any old apology, and thatís exactly what I got - brief, vague and evasive, although it did acknowledge, for the first time, that the ECT had caused me to be manic. Sadly, it will be recorded by the hospital as a complaint that reached a satisfactory resolution.

Would I complain again? No, I donít recognize the Trust as having a complaints system and I would never collude with their bogus set-up again. Instead, I would contact the police, the local press, my MP, the CHC, my User Group - in fact anyone who wasnít part of the Trust - because the Maudsleyís complaints system is a kangaroo court. Strangely enough, although the staff questioned were shockingly cynical, I donít think the Complaints Convenor was. He just seemed to be unbelievably gullible -

I guess thatís why they use him. g