11 The Patients Charter
Where a patient isn't capable of making a decision on his own behalf the courts can step in to make the decision on the patient's behalf..
The court will insist on the fullest possible disclosure of information before attempting to decide what treatment to agree or refuse...
Unfortunately, a competent UK patient is expected to decide what to do about his own treatment without the benefit of such detailed and comprehensive information.
What Doctors Dont Tell You Volume 4 No 11 Paul Balen
In September 1992 I decided to find out exactly what was in my medical records, especially the ultrasound report, and I tried to get in touch with the local Community Health Officer. I telephoned her office twice within one week but was not answered. I wrote. She had been on holiday. Eventually she got in touch with the local hospital and they wrote on 28 September.
Dear Mrs Nomark
I believe that you have tried to make contact with the hospital and Mrs Gasbag of the Community Health Council regarding your desire to inspect some parts of your medical records.
Can I inform you that under the Access to Health Records Act 1990, you are required to make a formal application for this. Please find enclosed an information sheet which will help you in this.
You will note that people who apply for access to health records may be charged a fee. This is minimal and is only in order to recover the administration costs in making the records available to you.
If you wish to request access to your records, I would be grateful if you could complete the attached form and address it to the General Manager at he above address.
I hope this is helpful to you.
Your sincerely
A J BRESLIN
Director of Nursing
A 3 page application form was attached stating "Fee (£10) received/not appropriate". £10 might be a "minimal" amount for Mr Breslin on his fat Director's salary but to me on the dole it was a hell of a lot for a couple of sheets of photocopied notes. When was the fee "appropriate"?
I tried to find out.
In the local library I found that a book called the "NHS A-Z" said that no fee could be charged for merely looking at a record so on 23 October I wrote for further information to the authors, the Help for Health Trust.
The reply came from Healthwise and was dated 29 October. It said:-
Your letter dated 23 October and addressed to Help for Health Trust has been passed to us as we provide health information for the region.
On page 110 of the NHS A-Z you will find that it states that "no charge can be made for inspection of the record but a fee can be charged to cover photocopying and postage costs if you want a copy." I presume that the charges you have been quoted fall into that category. I think that the only way to avoid charges would be to ask to inspect the records on site rather than requesting copies.
If you do experience difficulties in obtaining your rights under the NHS your local Community Health Council (CHC) will be able to offer help and advice.
And he gave me the address of my local CHC office and concluded:-
I hope that the above information is of help to you.
Yours sincerely
Andrew Mackey
Project Manager
I did not find being quoted back the exact passage that I had referred to in my original query of the slightest bit of use. Especially since I later found it to be quite incorrect! When I had found out about medical record charges I wrote and told Mr Misinforming Mackey what I had discovered. I hope he found it illuminating.
On 20 November I wrote to the NHS Executive.
Dear Mr Nichol
With reference to access of medical records
The NHS A-Z produced by the Help for Health Trust states on page 110 that "no charge can be made for inspection of the record but a fee can be charged to cover photocopying and postage costs if you want a copy."
"When I applied for my health records the Royal hospital sent an application form along with a demand for £3.80. Helton hospital sent a demand for £10 along with a 3 page application form including a CERTIFICATION section which was certainly not present on the double sided single sheet received from the Royal.
I would like to know:-
1. Am I legally entitled to free access to my medical records and if so how do I get it.
2. Why does Helton have such a ridiculous section on their form and if it is necessary why doesn't the Royal have it.
3. Why does Helton charge more than twice the amount that the Royal does - after all you can only see records from the last year, hardly archival material. Are they less than half as efficient as the Royal.
Hoping to hear from you shortly.
Yours sincerely
Pamela Nomark
The reply was dated 23 December 1992.
Dear Ms Nomark
Thank you for your letter of 23 November addressed to Mr Nichol concerning access to medical records. I have been asked to reply and am sorry that staff shortages due to illness and an unprecedented level of work has prevented me from doing so before now.
The Access to Health Records Act came into force on 1 November last year and provides that patients will have statutory access to their own medical records complied on or after that date, subject to certain safeguards. The Act allows for a fee not exceeding ?10, to be charged, but only where the record for which access is being sought has not been added to in the 40 days prior to the application for access being made. Otherwise, no charge can be made to the applicant.
Access under the Act may be afforded in one of two ways. Either the applicant may be allowed to inspect the actual record (or the relevant part of it), or he may be entitled to inspect an extract setting out such part of the record as he is entitled to see. In either case the applicant is entitled to be supplied with a copy of the record or extract. Where such a photocopy is supplied, a fee may be charged, but only to cover the cost of making the copy and, where applicable, the cost of any postage.
Doctors continue to enjoy the discretion to open those manual records compiled before 12 November 1991. Records have not always been made with the possibility of patient access in mind however, and it is for this reason that any decision to grant access to these records will need to be taken by the holder of the records, where appropriate, in consultation with the health authority on whose behalf he or she is holding the record.
It is worth mentioning that if your medical records are held on computer then you already have the right of access to them under the Data Protection Act 1984.
I hope this letter is helpful in explaining the position.
Yours sincerely
STEVE GILT
Health Care Division
This was a lot better than Healthwise or the elusive Help for Health Trust but there were still some things I was still unsure of so I wrote again on 4 January 1993.
Dear Mr Gilt
Thank you for your letter of 23 December. I am sorry to be adding to your workload but have found that there is a general lack of information locally.
You did not mention the certification section on the application form for medical record access from Helton Hospital. Can I take it that hospitals make up the form and can include anything they want - like permission required from your parents or a blessing needed from the Pope?
Also you have stated that a fee may be charged if the record has not been added to within the last 40 days. Does this mean that if I have an X-ray or blood test at the local hospital I can get free access to ALL my records there back to November 1991, regardless of who wrote them? Or would episodes of attention from different people be considered as different records?
Does this mean that GP's cannot charge a fee to patients who have seen them, or even had a repeat prescription, within 40 days of asking to see their records?
Finally I changed GPs recently and am informed by my new GP that she has no computer records of mine. As the previous practice definitely used computers should my computer record have been sent to her as a computer summary, as I was told by the local FHSA? If so how do I get it?
Yours sincerely
Pamela Nomark
Mr Gilt replied on 11 January.
Dear Ms Nomark
ACCESS TO HEALTH RECORDS ACT 1990
Thank you for your further letter of 4 January concerning access to medical records.
It might be helpful to answer your questions in the order in which you raised them.
1. There is no Government directive on how an application form for access to records should be constructed. The Department's guidance on the Act includes at Appendix 1 a model form which the Helton hospital has followed closely. I attach a copy of our guidance for your information.
2. Separate episodes of patient care and treatment should be contained within the patient's main file and should require only one application for access under the Act.
3. On changing GPs all your medical records would have been forwarded to the appropriate FHSA to retain until receiving notification of your new GP. If your current GP does not hold all your records you should make enquiries of the FHSA in the first instance.
I hope this letter and the guidance booklet help clarify the issues you have raised. Please do not hesitate to contact me again should you need further advice.
Yours sincerely
STEVE GILT
Health Care Division
The enclosed NHS guidelines were not only quite understandable but also seemed to positively encourage patient information.
In the meantime I wrote to the Royal about getting access to my medical records. I received a letter dated 13 October 1992 from the Medical Records Officer demanding only £3.80 for my records. As they also had a copy of the ultrasound report it seemed a bargain. I sent them a cheque.
I received an invoice dated 28 October along with some photocopied sheets.
But no ultrasound scan report.
I wrote to the Medical Records Officer pointing out that I was particularly interested in the ultrasound scan and would they please send me a copy of it. The reply, dated 18 November, stated:-
Dear Mrs Nomark
Re: Access to Medical Records
Thank you for your letter of 6 November 1992, concerning the above.
It is noted that you require a copy of an Ultra Sound Scan taken at Helton Hospital. In this respect, you will need to request a copy of the scan from Helton Hospital direct, as the original scan is kept there.
Yours sincerely
Mrs P I Thomas
Legal Services
What had my ultrasound scan got to do with "Legal Services"?
On the 20 November I wrote back to the legal eagle.
Dear Mrs Thomas
Re: Access to Medical Records
Regarding your letter of the 18 November. When I filled in your application form, more than a month ago, I specified that I wanted whatever information was gleaned from my previous appointment at Helton General, which apparently is merely an ultrasound report mentioned in a letter ASG/BD/13785888N as follows:-
"We managed to get a copy of the ultrasound report from Whiston which confirmed the presence of a fibroid uterus."
No investigations were done on me at the Royal - a four month old ultrasound scan apparently being considered enough. Since it should now be a part of your records I want a copy of it.
If I don't get it, or a reasonable explanation, within two weeks I shall complain to the Chief Executive.
Yours extremely sincerely
Pamela Nomark
Mrs Thomas' reply was dated 27 November.
Dear Mrs Nomark
Thank you for your letter dated 20 November 1992.
With regard to the second paragraph of your letter, I would inform you that a copy of the Scan was not actually received here at the Hospital. The Ultra Sound Report information was contained within a letter dated 30 July 1992, sent by Mrs J Languid, Consultant Gynaecologist & Obstetrician, to Mr A Curry, Lecturer in Gynaecology.
As stated previously a copy of that Ultrasound Scan has not been received at the Royal. This Ultra Sound Scan is the property of Helton General Hospital and in view of this fact, you will have to contact them direct to receive a copy.
If you write to their medical records department, I am sure they will be able to give you this information.
If I can be of further assistance to you, please contact me on the above extension.
Yours sincerely
Mrs P I Thomas
Legal Services
What on earth was she going on about? I was referring to a medical scan - not a complex, copyrighted, literary production. Moreover Godly's letter had clearly stated that they had got "A COPY OF THE ULTRASOUND REPORT". Was Godly lying? Or just "mistaken"? Whatever form the ultrasound information was in I wanted it. Dr Curry had said he would get a copy of it. He had written for a copy of it. Godly had clearly stated that they had a copy of it. Why was the hospital denying all knowledge of it? When I later found that the ultrasound report stated that my ovaries appeared normal, while Miss Godly had declared that she couldn't be sure just going on ultrasound that the mass wasn't ovarian I began to seriously wonder if she was deliberately trying to stop me getting the scan information. I knew that the Access to Information Act still allowed doctors to hide information from patients - though only in the patients interests, of course. But who was to say what was in their interests - why the doctor, naturally. And the health service was to back up their lies. Was I becoming paranoid?
On 8 December 1992 I wrote to the Chief Executive of the NHS.
Dear Mr Nichol
In October I requested my records from the Royal University Hospital, specifically asking for whatever ultrasound information had been gleaned from the scan done in April this year.
Dr Godly's letter (enclosed) states that a copy of the scan report had been received though Mrs Thomas's letter (enclosed) states that the scan information was contained in a letter.
Personally I don't care if it was in a report, a letter or on a postcard it represents the sum total of investigative procedures performed on my tumour. It is - or should be - part of my record at the Royal. I have requested it THREE times, paid for it and want to see it.
I am therefore complaining to you about being denied access to this medical record.
Yours sincerely
P Nomark
On 19 February 1993 I wrote again to the NHS.
Dear Mr Nichol
Although it is more than 2 months since I wrote to you (copy of my letter enclosed) complaining about not receiving part of my medical record from the Royal Hospital I have received neither satisfaction nor even a reply.
I have since been told that there is no procedure for dealing with complaints and that I should apply to the local County Court if I want the record in question. If I hear nothing within the next week I shall conclude that the much vaunted Patient's Charter is no more substantial than a clapboard movie set, allowing health professionals to do what they like. It would seem that I have to see a solicitor or perhaps my local M.P. to get anything done.
Yours disgruntledly
P Nomark
The reply was dated 23 February.
Dear P Nomark
Thank you for your letter of 19/2/93 to the Chief Executive.
Your correspondence is receiving attention and a full reply will be sent to you as soon as possible.
Yours sincerely
I Nicholls
Chief Executive's Office
Well it was nice to know that I was receiving attention but by June my patience was wearing rather thin and on 14 June 1993 I wrote again to the NHS.
Dear Mr Nichol
I applied to the Royal Hospital in October 1992 for my medical records. When they came the ultrasound report from Helton hospital was missing. When the hospital refused to give me it after 3 further letters I complained to you, in December 1992.
It is now 8 months since I applied for my records and 6 months since you received my complaint. I have received a note from your department dated the 23 February stating that a full reply would be sent "as soon as possible". Do you have any idea how much longer that "soon " is going to be?
Yours sincerely
Pamela Nomark
A letter dated 18 June arrived.
Dear Ms Nomark
Thank you for your letter to the Chief Executives Office dated 14 June.
Sir Duncan Nichol has today asked his official Mr D Broadhead to investigate your correspondence and to reply on his behalf.
Yours sincerely
I Nicholls
Chief Executive's Office
And sure enough Mr Broadhead wrote on 29 June.
Dear Ms Nomark
Thank you for your letter of 14 June to Duncan Nichol about your attempts to obtain your medical records from Helton General Hospital. I am sorry that you have not had a reply before now.
As this is a local matter I have written to Mr S Yates, Chief Executive of Helton General Hospital NHS Trust, asking him to look into the matter and reply to you direct.
I hope this is helpful.
Yours sincerely
David Broadhead
Corporate Affairs -
Intelligence Unit
If Mr Broadhead was an example of the level of intelligence to be found in the NHS I felt it was no wonder that it seemed to be in such a mess. I thought that Mr Pinhead would have been a more suitable name for him, or possibly Mr Dickhead. I wrote back, steaming mad, on 2 July 1993.
Dear Mr Broadhead
Thank you for your extremely unhelpful letter of the 29 June 1993. I'm sorry my letter of the 14 June was obviously unclear and that you have apparently lost my correspondence of 8 December 1992, the date of my complaint.
As you will see from the further copies enclosed my complaint is against the ROYAL UNIVERSITY HOSPITAL, who took my money and then declared that they didn't have a copy of the ultrasound report I was particularly interested in.
Last July I was asked if I would give permission to get the ultrasound information from Helton as presumably nobody at the Royal wanted to be bothered to do a more up to date scan. Both the ultrasound scan report and the letter from Mrs Languid SHOULD have been in my record. I asked SPECIFICALLY for the ultrasound scan when I made my original application to the Royal. If they had NO INTENTION of giving me this information then they should have said so.
When I saw the Helton gynaecologist, Mrs Languid, on 18 February this year she confirmed that a copy of the scan report WAS sent to the Royal. Miss Godly's letter to my GP confirmed that this copy was received yet Mrs Thomas of the Royal in letters of the 18 and 27 November states that the scan report information was in a letter. Either she or both gynaecologists were lying. I should like to know which it is and why.
I should like point out that this scan is the sum total of all investigations or treatment of my large abdominal mass. Though I have been told that if I would like to proceed directly to amputation of my reproductive system the hysterectomists of the National Hysterectomy Service will be only to glad to oblige.
According to Dr Goldfarb in his book "The No-Hysterectomy Option Your body, Your choice":- Careful observation of the progress of that fibroid may be all that is necessary, particularly in a woman who is having no symptoms or who is nearing menopause. In my patients who fall into this category, I perform a baseline vaginal ultrasound, and then monitor them with pelvic exams every 6 to 12 months to follow their symptoms and any significant change in the growth of the fibroid.
This is because, although rare, sarcomatous change of fibroids is possible. Schwartz et al recommend that the largest myoma be closely monitored during conservative treatment. It is now 16 months since my brief, abdominal ultrasound scan was performed.
Miss Godly has said of the mass "it was probably uterine but one couldn't be 100% certain just by going on ultrasound reports." So that shows you just how much confidence she has in NHS radiology.
Miss Godly's associate Dr Curry raised the possibility of the mass being an ovarian cyst and therefore quite possibly malignant.
MALIGNANT OVARIAN CYSTS HAVE A LOW 5 YEAR SURVIVAL RATE. Even if the mass is fibroids there still remains the possibility of sarcomatous change.
However 16 months after the original scan I find that not only do the NHS hysterectomists make no attempt at basic conservative care, dropping you completely if you won't let them proceed to quick, simple and convenient mutilation they don't do an adequate investigation in the first place and refuse to give you the inadequate information they DO have.
And when I complain to the NHS my letter is ignored for SIX MONTHS, in fact until I wrote again. And then a letter is sent to the WRONG HOSPITAL. Well I suppose this delay, disinterest and incompetence is exactly what I should expect given my experience so far. If you want to be butchered the National Hysterectomy Service can do it. Anything else - forget it. You'd be better off in Russia, where conservative surgery IS provided.
I enclose a copy of the information I have gleaned about fibroids and their treatment and should like to finish with 2 more quotes from Dr Goldfarb:-
However, if a woman is 40, the chances are overwhelming that she's not going to have problems after myomectomy because the menopause will intercede. (I am 45)
The number one job of the gynecologist is to address the patient's needs and desires, and put into perspective for her within the context of those needs and desires what her chances of success will be when availing herself of any particular plan of care.
I DO NOT DESIRE TO HAVE ANY PART OF MY REPRODUCTIVE SYSTEM REMOVED.
This message was delivered to both Languid and Godly. Mrs Languid's registrar told me I should have a hysterectomy and I should come back when I had decided to be mutilated. Miss Godly was VERY OBVIOUSLY only interested in mutilation. Do you know of any competent gynaecologists as defined by Dr Goldfarb operating within the NHS? Or is the mutilate them all line NHS official policy?
Yours sincerely
Pamela Nomark
The NHS Executive resides in splendour at Quarry House, Leeds, a magnificent "Peoples Place", as the locals have dubbed it. A £55,000,000 ediface paid for entirely by a NHS apparently increasing unable to provide the basics of medical care for punters but willing to lavish thousands on specially commissioned murals, a handwoven, designer made, silk carpet and framed prints galore to tart the corridors of the mighty. Not to mention the fully equipped gym, squash courts and swimming pool.
The plebs who pay for this luxury are, of course, barred from the building and when the crew of the TV program "Here & Now" came to the door to have a look security rushed out to get them to stop filming the hallowed portals.
Even the stationery from these exalted regions is quality, watermarked material, superior to mere hospital paper.
As I heard nothing save contemptuous silence from the gods of the NHS on 14 August 1993 I wrote to my M.P.
Dear Mr S Elm
In October 1992 I applied for, and paid for, copies of my medical records from the Royal University Hospital. When they came the ultrasound report, which Dr Curry had sent for from Helton hospital, was missing. I asked for it a further 3 times and was told that the Royal didn't have a copy in spite of the fact that the letter sent by Miss Godly to my GP, Dr Amicable, stated quite definitely that a copy HAD been received.
I complained in December 1992 to the NHS about being denied this record as according to the much publicised Patients Charter I was supposed to have access to my records. They ignored my complaint for 6 months and then an incompetent by the name of Mr Broadhead wrote to the wrong hospital.
I enclose copies of most the correspondence I have about this and would like to know to whom do I complain about the incompetence and inaction of the NHS Executive.
Yours sincerely
Pamela Nomark
Mr S Elm reply was dated 26 August.
Dear Ms Nomark
Thank you for your letter of the 14th August 1993 and copies of correspondence that you have had with the Royal University Hospital. This does seem to me to be a case of maladministration and incompetence by the N.H.S. and accordingly I have sent the file to the Ombudsman for Health for him to consider taking the matter up with the Hospital.
You will probably hear from him directly if he agrees that there is maladministration in this case, within his jurisdiction.
Yours sincerely
Gordon S Elm.
The next letter, with enclosures, was dated 24 September.
Dear Mrs Nomark
Mr S Elm is currently abroad on parliamentary business. However, to ensure that there is no unnecessary delay I am sending the reply that he has received from the Health Service Commission (Ombudsman) direct to you, together with the pamphlets they enclosed.
I am returning the papers you sent to Mr S Elm as the Commissioner has taken copies of these.
Yours sincerely
Ms Dot Willig Secretary to: Mr S Elm
The Commissioner's letter was dated 22 September 1993.
Dear Mr S Elm
Thank you for your letter of 26 August, with enclosures, about the complaint of your constituent, Mrs P Nomark. I am replying because Mr Reid, who holds Office as both Health Service Commissioner (HSC) and as Parliamentary Commissioner for Administration (PCA), is away at present. Mrs Nomark is complaining about the difficulties she has experienced arising out of an application she made to obtain a copy of an ultrasound scan taken at Helton General Hospital in April 1992, and about the Department of Health's handling of correspondence relating to the matter. I was sorry to hear of your constituent's concern.
I enclose a (brown) leaflet about Mr Reid's role as HSC. In that capacity he can consider certain complaints about NHS authorities, including trusts. Your constituents's main concern is to obtain disclosure of the scan report, but the Access to Health Records Act 1990 provides in section 8 that it is for the courts, not HSC, to determine whether there has been a failure to comply with any requirement of the Act. In considering such an application, the courts will satisfy themselves that all such steps as may be prescribed by regulations to secure compliance have been taken (my understanding is that those regulations have not yet been introduced). The essence of this is that HSC has no power to assist Mrs Nomark with her primary objective.
Although Mrs Nomark has not provided all the background papers, it seems that the issue in dispute is whether the Royal University Hospital received a copy of the test report, as distinct from merely a letter from the Helton General Hospital giving information based on such a report. I can see why she would wish to establish the facts in that respect before contemplating the effort and, presumably, expense of making an application to the Court. In his capacity as ASC Mr Reid has to be satisfied that a complaint has been put to the relevant NHS body before he can consider whether he should investigate. If it is her contention that she is being misled, I suggest that your constituent should first write to the chief executives of the Royal University Hospital NHS Trust and the Helton General Hospital NHS Trust. It is possible that that will resolve the apparent difference, enabling Mrs Nomark either to obtain disclosure or to make an application to the court without recourse to what might otherwise be fruitless time and effort. Whether, after those further local enquiries have been made, HSC would decide to investigate any prima facie evidence of maladministration by either hospital I cannot say at this stage. I would only ask that Mrs Nomark makes any further approach to him as soon as possible.
With regard to the Department of Health's part in the matter, that falls in principle within Mr Reid's jurisdiction as PCA. Mrs Nomark points to "delay and incompetence" in the actions of the NHS Management Executive (which is part of the Department of Health). PCA would certainly not condone such shortcomings but, before deciding whether he should investigate a complaint, PCA needs not only to be shown evidence of fault but also to be satisfied that there is a reasonable prospect of a worthwhile outcome to an investigation by him. Given your constituent's main purpose - disclosure of the test result - and that she has made her feelings clear to the Department in no uncertain terms I doubt whether, in view of the course of action I have suggested earlier, an investigation into the Department of Health's handling of the correspondence would be of any real help to her. The enclosed (green) leaflet giving more explanation about the PCA may be useful in that regard.
I hope that this is of some help. I enclose a further copy of this letter, and the two leaflets, in case you wish to send them to your constituent. I also return your enclosures, copies having been taken for the Commissioner's file.
Yours sincerely
R A OSWALD
Deputy Health Service Commissioner
I was unaccountably reminded of the inimitable Lady Bracknell who, in "The Importance of Being Earnest", declares that, while she concedes that her nephew has behaved abominably to Mr Worthing in masquerading as his brother, alienating the affections of his ward and consuming all his cucumber sandwiches, she has decided, in view of the size of Miss Cardew's inheritance, to absolutely forgive him.
I was not so forgiving.
I wrote to Mr Oswald on 6 October 1993.
Dear Mr Oswald
I have received a copy of your letter of 22 September to my MP, Mr S Elm, about my complaint regarding my attempts to get my ultrasound report from the Royal University Hospital. I have no complaint against Helton General.
I enclose a copy of Dr Godly's letter of 17 August 1992 which states "We managed to get a copy of the ultrasound report..." This is the letter referred to, and enclosed, in my original complaint to the NHS of 8 December 1992. As I said in my letter of 2 July 1993 I saw Mrs Languid on 18 February at Helton General when she stated that a copy of the report WAS sent to the Royal. Yet Mrs Thomas in her letter of 27 November states that the ultrasound information was in a letter. I also enclose a copy, obtained from Helton General, of the letter from Mrs Languid dated 30 July which accompanied the ultrasound report. This is ANOTHER document which should have been given to me as part of my medical record at the Royal but which was with-held along with the ultrasound report.
My primary objective now is not getting a copy of the ultrasound but to establish WHY the Royal did not give me the report and Mrs Languid's letter of 30 July when I requested, and paid for, my medical records in October 1992. Why was I told to apply elsewhere for documents which had been requested and sent to the Royal? As stated previously no tests or investigations were done at the Royal, nor was a proper physical examination made. Major, mutilating surgery was suggested presumably on the basis of the ultrasound report which was then with-held from me. I should like to know why.
Is the patients much vaulted right to access of their own records just another bag of hot air?
The right to access to health records is number 6 in the Patient's Charter which has been sent, I believe, to every household in Britain. I enclose a copy of page 19 which states that anybody being denied their Charter right should write to Mr Nichol. It does not say that Mr Nichol and his department will thereafter completely ignore your letter, though this is apparently exactly what happens. Does this mean that the entire population of the British Isles is being deliberately mislead by the Department of Health and that the only practical use for the Patient's Charter is as toilet paper?
In 7 months Mr Nichol's department did nothing - not even inform me that the only way of possibly getting your records was to go to court. And when I reminded them that I had NOT forgotten my complaint they wrote to the wrong hospital. And I have heard nothing from them since. No explanations, no apologies, just ignored completely as an unimportant old ratbag.
What a lot of fruitless time has passed while the NHS Executive did absolutely nothing.
It is now nearly a year since I applied for my records from the Royal thinking that I would soon see my scan report and know exactly what my physical condition was. How wrong I was!
And now you think I should go back to the drawing board and write to the Chief Executive of the Royal, asking them if Miss Godly was lying when she stated that she received a copy of the ultrasound report or whether Mrs Thomas was lying when she wrote that the ultrasound information was in a letter only!
Is this correct?
Yours sincerely
Pamela Nomark
My reply from the Commissioner was dated 4 November.
Dear Mrs Nomark
Thank you for your letter of 6 October, with enclosures, further to the complaint made on your behalf by The Right Hon Gordon S Elm PC MP.
You say that you have no complaint against Helton General Hospital and that it is not your primary objective to obtain a copy of the ultrasound scan report taken at the hospital in April 1992. However, you wish to establish why the Royal University hospital did not give you the report, together with a copy of a letter dated 17 August from one of their consultants, Miss A Godly, when you requested - and paid for - a copy of your medical records in October 1992, in accordance with the Access to Health Records Act 1990.
I enclose for ease of reference a further copy of the booklet about my work. In his letter of 22 September to Mr S Elm, my deputy explained that, before I could consider a complaint about the Royal University Hospital, the matter would have to be put in writing to the chief executive of the Royal University Hospital NHS Trust (which is responsible for the administration of the hospital). You ask whether you have been given the correct advice. You have. The law provides that I cannot consider any complaint until the health authority (or NHS Trust) concerned has first been given a reasonable opportunity to look into the matter and reply, and that I need to see all the background papers. This is explained in section 3 of the booklet. There is nothing in the correspondence provided so far to indicate that your complaint, as it now stands, has been put to the Trust. Furthermore, I have not been provided with a copy of your letter of 6 November 1992 to the Royal University Hospital, and only now have you sent me a copy of Miss Godly's letter of 17 August to your GP.
However, on the basis of the information now provided, I do not believe that I can help you. Mr Oswald explained that the Access to Health Records Act 1990 provides for the courts - and not for me - to determine whether there has been a failure to comply with any requirement of the Act. As I see it, the matter which concerns you is an alleged failure by the hospital not to make a full disclosure and, for the reason shown in section 6(a) of the booklet, I cannot investigate it. I should add that, while you say that you have no complaint against Helton General Hospital, the ultrasound report originated there and the Royal University Hospital might argue (whether with justification I express no opinion) that the report - and more particularly its contents - was not theirs to disclose, at least without authority from Helton.
Turning next to that aspect of your letter which concerns the NHS Management Executive (part of the Department of Health), in my role as Parliamentary Commissioner for Administration I have already noted your understandable complaint. As my deputy explained in his letter of 22 September to Gordon S Elm, I do not condone poor administrative performance, such as a failure to reply to correspondence, but for the reasons previously given in Mr Oswald's letter to Mr S Elm I am not persuaded that an investigation of this aspect of your complaint, in itself, would serve a useful purpose now.
I regret that I cannot be of further help to you, but I hope the explanations in this letter will be of use.
Yours truly
William Reid
As I had stated it was Mrs Languid's letter of 30 July which the Royal had withheld along with the ultrasound scan. It was because they HAD sent me a copy of Miss Godly's letter that I knew (unless their consultant was lying) that the Royal HAD received a copy of the report.
Moreover Mr Oswald had stated that "HSC has no power to assist Mrs Nomark" in my attempts "to obtain disclosure of the scan report" as "it is for the courts, not HSC, to determine whether there has been a failure to comply with any requirement of the Act." And Mr Reid said that he "cannot be of further help" to me. And yet he was pedantically moaning that I had not sent him a copy of my letter of 6 November letter to Mrs Thomas when the HSC had "no power to assist" me.
The phrase used by Mr Reid, "I am not persuaded that an investigation of this aspect of your complaint, in itself, would serve a useful purpose now" was very similar to the official reply, "I do not really feel that there is any useful purpose to be served in pursuing this matter further" which is translated by R T Fishall in Bureaucrats: How To Annoy Them as meaning, "Get stuffed".
I wondered what was the "worthwhile outcome" which Mr Reid had to expect before even considering a complaint against the NHS Executive. Presumably it was not ensuring that the Executive promptly inform other complainants that they were totally powerless to enforce the "Access to Medical Records Act" and that if patients wanted satisfaction they would have to take the matter to court.
The amusing Mr Fishall writes of an Ombudsman that he "has as much real power as a raspberry blancmange, and even when he comes down in favour of the victim (as he often does), nothing ever happens."
And I was quite mistaken about the Patients Charter. It was printed on thick and shiny sheets and was, therefore, of no use whatsoever - even as toilet paper.
The grinding bureaucracy was wearing me down and it wasn't until after Christmas, on 27 December, that I finally wrote to the Chief Executive of the Royal:-
Dear Sir
Over a year ago I was seen by Miss Godly at a gynaecology clinic held at the Royal University Hospital. In autumn 1992 I requested the medical records from this consultation and after sending a cheque was sent a number of papers. These did not include the ultrasound report for which Dr Curry wrote to Mrs Languid. When I asked again for this report I was informed by a Mrs Thomas that the Royal did not have a copy of the ultrasound report, in spite of the fact that Miss Godly's Letter to my ex GP Dr Amicable states quite clearly that she HAD received a copy.
In February this year I saw Mrs Languid who confirmed that both the ultrasound report and a covering letter had been sent to the Royal University Hospital. As both these documents, the scan report and the letter, should have been in my records can you tell me why I was not only not given them but was told that the Royal did not even have the scan.
I enclose copies of the letters I received from Mrs Thomas and the letter from Miss Godly.
Yours sincerely
Pamela Nomark
Their reply was dated 18 January 1994.
Dear Mrs Nomark
Please accept my apologies for the delay in responding to your letter of 29 December 1993 with regard to your request for a copy of your ultrasound scan taken at Helton Hospital. I have now made further enquiries into this matter.
I wish to confirm that the Royal University Hospital has never in fact received a copy of the ultrasound scan and a copy therefore is not included within your Royal University Hospital casenotes. Had it been so included, it would have been released to you in response to your previous request to access to your medical records,.
I note from the previous correspondence sent to you by Mrs Thomas that it is stated clearly the ultrasound scan has not been received at the Royal University Hospital and that, since the ultrasound scan is the property of Helton General Hospital, you will have to contact that hospital direct in order to receive a copy. I also note from Mrs Thomas' letter of 27 November 1992 that it was explained to you that the ultrasound report information was contained within a letter dated 30 July 1992 sent by Mrs Languid to Mr Curry.
A further review of your Royal University casenotes has confirmed that the scan report is not contained therein. I regret, therefore, that I cannot assist you further with regard to this matter.
Yours sincerely
Mrs D.M. Mercer
Director of Quality, Nursing and Patient Services
c.c. Mrs. P.I. Thomas, Legal Services
When I had mentioned to the Ms McD, of the CHC, that I hadn't been given my scan report she said casually "Oh, the Royal is always losing records". I was finally convinced that there was no conspiracy to withhold records from me - they'd just been lost, a common bureaucratic bungle. Yet the Royal was determined to label their consultant a liar rather than admit that they'd lost a scrap of paper. I decided to take them at their word and on the 26 January I again wrote to the chief executive.
Dear Sir
I have received a letter, dated 18 January 1994, from Mrs D.M. Mercer, Director of Quality, Nursing and Patient Services.
This states that the Royal University Hospital has never received a copy of the ultrasound scan report requested by Dr Curry in July 1992, in spite of the fact that Miss Godly, consultant gynaecologist at the Royal, wrote to my GP on 17 August 1992 that "We managed to get a copy of the ultrasound report from Whiston". I would wonder why the Royal employ people of dubious honesty but since Mrs Languid, consultant gynaecologist at Helton, clearly told me, in February 1993, that she had sent a copy of the report with her letter to the Royal it would seem that duplicity is par for gynaecology consultants at least. I find this lack of veracity on the part of women licensed to hack you open extremely alarming.
I am especially concerned since Miss Godly did not even bothered to examine me, nor did she have any diagnostic tests or investigations done, relying solely upon the ultrasound report, which she apparently never even saw, from Miss Languid. As far as I can make out Miss Godly wanted to perform major, mutilating surgery (hysterectomy) on me on the basis of what Mrs Languid (a newly appointed and presumably relatively inexperienced gynaecologist) SAID about an ultrasound scan.
I do not think this adequate medical attention and have been in contact with the regional medical officer about it.
Also as you DID get Mrs Languid's letter about the ultrasound scan this should be part of my medical records and I have not, so far, received my copy of this. I would be obliged if you would finally send me this part of my medical record, though of course how much reliance I can place on the ramblings of a gynaecologist is very much open to question.
Yours sincerely
Pamela Nomark
The reply of 14 February 1994 was again from Mrs Mercer.
Dear Mrs Nomark
Thank you for your letter of 26 January 1994 with regard to your application for access to your Royal University Hospital casenotes.
I wish to make it clear that the hospital has copied to you all of your casenotes and that, indeed, the Royal University Hospital would have no reason whatsoever not to do so.
May I suggest, with the greatest respect, that you make application to Helton Hospital for a copy of the letter from Mrs Languid which you still require.
Yours sincerely
Mrs. D. M. Mercer
Director of Quality, Nursing and Patient Services
c.c. Mrs P.I. Thomas, Legal Department
I thought it very suspicious that the legal eagle had to have copies of all letters. Those taking legal advice are usually either trying to to get information or trying to conceal it. It was 12 March before I got the spirit to reply.
Dear Mrs Mercer
Thank you for your letter of 14 February in which you state that I have been sent all my case notes. However as the letter of which I wrote, dated 30 July 1992, was that sent by Mrs J Languid, Consultant Gynaecologist & Obstetrician, to Mr A Curry, Lecturer in Gynaecology, and concerned my ultrasound scan the Royal University Hospital should have it in my notes.
This letter was sent in response to the letter written on 20 July 1992 by Mr Curry requesting a copy of the report of the ultrasound scan done in April 1992, and a copy of Mr Curry's letter was sent to me. However I have not received a copy of Mrs Languid's reply, which is referred to by Mrs Thomas in her letter to me of 27 November 1992.
Can I take it that the Royal University Hospital has, in fact, lost this letter since it seems unable to produce it?
Yours sincerely
Pamela Nomark
On 27 April I wrote again reminding Mrs Mercer that I had had no reply and enclosing a copy of my March letter. As there was still no response I wrote again to the Royal in June, this time sending my letter by recorded delivery and addressing it to the chief executive.
Dear Mr Stamp
Nearly 2 years ago I was seen by Miss Godly at a gynaecology clinic held at the Royal University Hospital. In autumn 1992 I requested the medical records from this consultation and after sending a cheque was sent a number of papers. These did not include the ultrasound report Dr Curry had requested from Mrs Languid, which was what I wanted to see and why I had asked for the records. When I asked again for this report I was informed by a Mrs Thomas that the Royal did not have a copy of the ultrasound report, in spite of the fact that Miss Godly's Letter to my ex GP Dr Amicable states quite clearly that she HAD received a copy.
Mrs Thomas had written that the ultrasound information was contained within a letter dated 30 July sent by Mrs J Languid to Mr Curry but I hadn't been sent a copy of this letter either. When I wrote in December 1993 about my records a Mrs Mercer, Director of Quality, Nursing and Patient Services, wrote on the 14 February that I had had all my casenotes (as the Royal had never had a copy of the ultrasound and both gynaecologists were lying when they said one had been sent and received) and suggested that I write to Whiston for a copy of Mrs Languid's letter to Dr Curry. I wrote to Mrs Mercer on 12 March and enclose a copy of the letter. As I received no reply I wrote again on 27 April but have still had no response.
Dr Curry's letter asking for the ultrasound scan was sent to me - but not the reply. I don't see why I should be referred to other hospitals to get documents that should be part of my record at the Royal. The patients' official watchdog, the Association of Community Health Councils, has said that when trying to see their medical records patients find their rights whittled down by small print, high charges and doctors' decisions. I can't complain about the Royals charges which were much less than my local hospital wanted to make but when records are withheld and I am told to apply elsewhere and pay their charges as well this makes the process of getting actual information even longer, more expensive and extremely irritating.
I should like an answer to my question of why I have not been sent the letter from Mrs Languid. Has it been lost or deliberately withheld, and if withheld - why.
Yours sincerely
Pamela Nomark
The chief executive had changed and the reply, dated 12 June, went:-
Dear Mrs Nomark
Thank you for your letter of 11 June 1994 relating to your request for a copy of a letter dated 30 July 1992 sent by Mrs J Languid, Consultant Gynaecologist and Obstetrician, to Mr A Curry, Lecturer in Gynaecology, relating to your ultrasound scan.
Your Royal University Hospital casenotes are currently in the possession of Miss A Godly, Consultant Gyneaecologist and Obstetrician, having regard to the transfer of Gynaecology services from the Royal to the Obstetrics and Gynaecology Trust. Miss Godly's secretary has been requested to again examine your casenotes to ascertain if a copy of Mrs Languid's letter is enclosed within. I have no objection whatever to releasing a copy of the letter to you and I shall write to you again when the above mentioned search is complete.
Yuors sincerely,
K A Haynes
Chief Executive
In fact I had not asked for a copy of Languid's letter. I had asked for an explanation of why I had not been given a copy of the letter.
On 22 June I received a copy of the letter in question from the chief executive who wrote:-
Please find enclosed, a copy of the letter, which was indeed located within the Obstetric and Gynaecology Trust.
On 8 July 1994 I wrote again to Mr Haynes.
Thank you for sending a copy of the letter sent by Mrs Languid to Dr Curry on 30 July 1992. However, I did, in fact, get a copy of this letter 18 months ago from Helton hospital. As I wrote on 11 June I am interested in why I was not sent a copy when I asked for my medical records nearly 2 years ago - and why I was told to go elsewhere to get a copy of it. And why my last two letters to Mrs Mercer about it were ignored.
I also find the sending of copies of letters to Legal Services deeply suspicious. I get the distinct impression that the letter and the ultrasound report, which I am convinced Mrs Languid DID send, were deliberately withheld and that the Association of Community Health Councils were perfectly correct when they wrote that patients find their rights whittled down by small print, high charges and doctors' decisions when trying to see their medical records.
My impression from reading Mrs Languid's letter was that she is incapable of performing conservative surgery on the womb and is what I would term a hysterectomy technician. I also feel that she deliberately arranged for me to be seen by her registrar so that he could bludgeon me into having a detested, and unnecessary, mutilation. I enclose a copy of the registrar's letter to my GP of the time. It makes quite clear that I am to have only mutilation, the full mutilation and nothing but the mutilation and I am to return only when I have agreed to it.
When I saw Miss Godly at the Royal she was perfectly aware of my antipathy to mutilation but tried to get me to agree to it and was mightly put out when I didn't. She made no effort to investigate my lump and made untrue assertions about myomectomy. When an adequate ultrasound scan was done at Manchester the mass turned out to be a very large fundal fibroid 15 cms in diameter. It was removed on 13 June in a procedure described by the operator as "technically uncomplicated" and by Professor Tizzy as "technically easy".
I do not know whether Miss Godly is also a hysterectomy technician, incapable of performing conservative surgery, as my request for information about the number of myomectomies she has done was ignored, but I do know that she has the utmost contempt for female organs and thinks that they should all be exterminated with no attempt to perserve them, whatever their owners may feel. This is a very common medical attitude and one from which a friend of my sisters, 10 years younger than myself, is now suffering. She has been told that her fibroid womb (at 16 weeks size much smaller than mine was) should be excised. She has not had even a basic ultrasound scan, so without any information on the number, position or size of the fibroids involved she has been told that she can't have a myomectomy, presumably because she has also been referred to a hysterectomy technician.
In the foreword to the book "Fibroids" Professor Campbell of King's College Hospital, London, writes that "there is also growing acceptance among gynaecologists that a woman's attitude to her body, and to her fertility, must be respected whatever her age. She is entitled to the treatment which she feels is right for her". But not here or in Helton, where they will get excision only.
As you may know I complained about Miss Godly to the Regional Medical Officer but from my experience with the NHS I know that I might as well complain to the Man in the Moon. After all it's taken 18 months to get a bare letter out of the Royal, with no explanation of why it wasn't given in the first place and a continuing blanket denial that the Royal ever had a copy of the ultrasound scan in spite of the fact that both gynaecologists (or hysterectomy technicians) said that it was sent and received.
Yours sincerely
Pamela Nomark
Mr Haynes did not reply.
writings
>>
womb
>>
chapter 11