A Tale of Two Wakefields
Compare and contrast this colonoscopy risk consent form from the Wakefield Clinic in Adelaide, Australia with this consent form from Andrew Wakefield.
Both are consent forms for colonoscopies. The first one clearly explains what the alternatives are and advises patients of potential hazards, including,
3. Perforation of the colon
A perforation is when a hole or tear is made in the colon by the colonoscope. This is rare, occurring in 1 in 500 – 1000 cases. If it occurs, then it would be likely that an operation would be required to repair the damaged area. This would involve a stay in hospital for approximately 1 week.
4. Bleeding from the bowel
Small amounts of blood are not uncommon after biopsies or polypectomy (removal of polyps). In 1 in 100 cases of polypectomy the bleeding may be sufficient enough to require transfusion.
The second one is from Andrew Wakefield’s clinic at the Royal Free in London when he was researching the possible connection between entercolitis and autism. It describes colonoscopy procedure thus. There is no mention of any risk for this procedure or for the lumbar puncture that would be performed straight afterwards while the child was still under sedation.
At least one family has cause to rue this omission. According to the Daily Mail
An autistic boy has won a £500,000 payout after a hospital at the centre of an MMR scandal carried out an operation that was “not clinically justified”. Jack Piper, then five, was left battling for life after the procedure, which his parents claim was carried out to establish links between his condition and bowel problems. His bowel was perforated in more than 12 places during surgery at the Royal Free Hospital in Hampstead, North London.
The court approved a cash payment of £482,300 by the Royal Free Hampstead NHS Trust which may still be liable for further costs of £1 million depending on Jack Piper’s lifetime care needs. They admit to negligence in carrying out the colonoscpy, which caused Jack to suffer
multiple organ failure, including kidney and liver problems, a swollen brain and neurological problems. He has also developed epilepsy and suffered stomach ulcers. The botched operation “significantly increased” his dependence on others. Now aged 14, Jack needs round-the-clock care.
Because of the settlement some serious claims will not now be tested in the courts.
High Court papers alleged the colonoscopy procedure performed on Jack in 1998 was “not clinically indicated or justified”. They also claimed the “principal reason” for the surgery was to further research into links between autism and bowel conditions rather than Jack’s clinical needs. The documents also claimed that Jack’s parents were not warned of the risks of the procedure or the “controversial and uncertain” link between autism and bowel conditions. This meant the surgery was performed “without lawful consent” and was an “assault” on Jack.
These are similar to some of the charges laid against Dr Simon Murch, the doctor who recommended Jack Piper’s colonoscopy, by the General Medical Council. So we may eventually see a resolution to these concerns. Meanwhile, the Piper family, quite reasonably, have chosen to safeguard Jack’s future. Having sacrificed him once in the name of research it would be unreasonable to expect them to jeopardize his financial settlement in order to prove a point of law.
Comment by i jones | December 10th, 2007
Very pertinent. Congratulations. Is the Wakefield Clinic in Adelaide connected with Dr Andrew Wakefield in any way other than the name?
Jack Piper was assaulted. So were the other children who went through the Royal Free procedure. But it was the Legal Services Commission that funded and ordered those tests to be carried out as part of the MMR litigation; and it was the claimants’ lawyers that sent the children to the Royal Free; and the procedure and results were presented to court in the MMR litigation and were viewed by several judges, none of whom commented on the ilegality involved!
Comment by Mike | December 10th, 2007
No there is no connection between the two, unless the authorities in Adelaide named the street after Andrew Wakefield!
You are right about the role of the LSC in agreeing to fund the “research” which cost the taxpayer millions and was so badly flawed that the case never came to court.
Comment by notmercury | December 10th, 2007
Raising an autistic child can be challenging enough. I’m trying to imagine the extra hardship this family has been forced to endure as a result of these procedural complications.
An award well deserved, as far as I’m concerned.
Somewhat ironic that this resulted from a search for evidence to help with a lawsuit for damages caused by a medical procedure.
Comment by laurentius-rex | December 12th, 2007
What is incredible to me, is not so much that the procedure was allowed, but that it was so incompetently carried out by a supposedly qualified gut surgeon.
Our NHS has got a lot to answer for. I think a certain medical school has a lot to answer for, If you can furnish me off line with further details that would stand up in court I would be happy to pass those on to the Dean of the medical school.
I might even do that in person as this guy ‘operates’ in a hospital half an hours walk away.
Do those who call for more research into diet and gut issues really know what it involves ethically and the risk?
Comment by abfh | December 12th, 2007
Mike, I’ve tagged you for a blogging award.
Comment by ACB | December 16th, 2007
House of Lords
Questions tabled for written answer
12 December 2007
Lord McColl of Dulwich to ask Her Majesty’s Government whether they have any plans to investigate the decision-making process by which the measles, mumps and rubella and measles and rubella vaccines litigation received legal aid funding. HL975
Lord McColl of Dulwich to ask Her Majesty’s Government whether the Legal Services Commission, in accordance with its press statement of 1 October 2003, has sent to the Medical Research Council research paid for by legal aid in connection with the measles, mumps and rubella and measles and rubella vaccines litigation. HL976
Lord McColl of Dulwich to ask Her Majesty’s Government whether the legal aid funding of the measles, mumps and rubella and measles and rubella vaccines litigation was an appropriate use of public money. HL977
Lord McColl of Dulwich to ask Her Majesty’s Government whether the payment of legal aid fees in excess of £1 million in connection with the measles, mumps and rubella and measles and rubella vaccines litigation to Augustus Ullstein QC, Simeon Maskey QC and Jeremy Stuart-Smith QC was an appropriate use of public money. HL978
Lord McColl of Dulwich to ask Her Majesty’s Government what plans they have to recover fees paid for research funded by legal aid in connection with the measles, mumps and rubella and measles and rubella vaccines litigation. HL979
Comment by Mike | December 16th, 2007
Those are good questions ACB.
The answers should be very interesting.
Comment by Moggy | December 20th, 2007
That’s horrifying! I can say as someone that did need colonoscopy repeatedly as a kid that it’s total bulls**t that it’s painless! It was one of the most painful things I’ve experienced — and I’ve hiked on a broken kneecap & gotten peritonitis twice from ruptured organs — in part because (as is alluded to) it’s often done to kids by holding them down without anesthetic, and only give meds if they physically can’t control the child. Even without physical damage, it does some serious long-term psychological harm, as you might imagine. Grr…
I also came over to let you know that there’s currently a very receptive audience of nondisabled NTs in a discussion at SFGate.com (as well as probably elsewhere) about the Judge Rotenberg Center “shocking kids over a prank call” scandal… Since you wrote brilliant posts about the JRC, I thought you might want to make use of the opportunity to do a little educating & make some allies for us. Please do spread the word if you will, since I’m out of touch with the advocacy world these days.
Here’s the link: http://tinyurl.com/2xpzkc
I’m betting that there are a lot of similar conversations from shocked citizens out there that have never heard of the JRC, incidentally. I’m going to look around and perhaps post links to my blog (perhaps here to you or similar blogs), but you might want to as well if you have time.
I hope all is going well for you — and I apologize for rambling, it’s just that kind of day for me language-wise. (I can’t edit well when my receptive-language skill is wobbly.)
Comment by cole | December 30th, 2007
Dearest Mike,
I haven’t been by in a while but keep you on my blogroll. I admire your commitment and drive to bring attention and insight to autism and the spectrum disorders. I have been hearing about hyperberic oxygen therapy for autistic children…what do you know of it?
x Good luck with your new site.
Comment by stapler | January 2nd, 2008
FYI
The Independent 31 December 2007
Letters
Legal aid harms NHS
Sir: Further to recent items, our legal aid system is not only the most generous in the world but has caused huge damage to our health service, propagating dangerous myths about the safety of childhood vaccines, and funding unsustainable cases against hospitals and doctors. Lawyers are rewarded for bringing speculative cases, thus diverting resources from patient care to legal pockets; it is amply borne out by the dismal success rates in clinical negligence and pharmaceutical litigation, where lawyers are too often the only beneficiaries. Legal aid reform is long overdue.
DR ANTHONY BARTON
SOLICITOR & MEDICAL PRACTITIONER, London N1
Comment by pigeon | January 8th, 2008
House of Lords
7 January 2008 Written Answers column 163
Health: MMR Vaccine
Lord McColl of Dulwich asked Her Majesty’s Government:
Whether they have any plans to investigate the decision-making process by which the measles, mumps and rubella and measles and rubella vaccines litigation received legal aid funding; and [HL975]
Whether the legal aid funding of the measles, mumps and rubella and measles and rubella vaccines litigation was an appropriate use of public money; and [HL977]
Whether the payment of legal aid fees in excess of £1 million in connection with the measles, mumps and rubella and measles and rubella vaccines litigation to Augustus Ullstein QC, Simeon Maskey QC and Jeremy Stuart-Smith QC was an appropriate use of public money. [HL978]
7 Jan 2008 : Column WA164
The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Hunt of Kings Heath): Decisions about funding in civil cases are entirely a matter for the Legal Services Commission (LSC). As such, Ministers do not intervene in or comment on decisions made about the grant of funding in individual cases. The LSC makes individual funding decisions in accordance with the governing legislation.
Lord McColl of Dulwich asked Her Majesty’s Government:
Whether the Legal Services Commission, in accordance with its press statement of 1 October 2003, has sent to the Medical Research Council research paid for by legal aid in connection with the measles, mumps and rubella and measles and rubella vaccines litigation. [HL976]
Lord Hunt of Kings Heath: The Legal Services Commission has not sent the research in the MMR/MR vaccines litigation to the Medical Research Council (MRC). It was proposed to release the research to the MRC. However this can only be disclosed with the consent of the clients, or the solicitors acting on their behalf. I understand that such consent has not so far been forthcoming.
Lord McColl of Dulwich asked Her Majesty’s Government:
What plans they have to recover fees paid for research funded by legal aid in connection with the measles, mumps and rubella and measles and rubella vaccines litigation. [HL979]
Lord Hunt of Kings Heath: The Legal Services Commission (LSC) has no plans to recover legal aid fees paid for research in the MMR/MR vaccine litigation.
Comment by andy @ compensation advice | October 31st, 2009
Although I can relate to your article I can also see how the ‘No Win No Fee’ policies have developed. The certainty with No Win No Fee doesn’t need to exist with our qualification for Legal Aid.
Comment by Solicitors | October 31st, 2009
FYI
The Independent 31 December 2007
Letters
Legal aid harms NHS
Sir: Further to recent items, our legal aid system is not only the most generous in the world but has caused huge damage to our health service, propagating dangerous myths about the safety of childhood vaccines, and funding unsustainable cases against hospitals and doctors. Lawyers are rewarded for bringing speculative cases, thus diverting resources from patient care to legal pockets; it is amply borne out by the dismal success rates in clinical negligence and pharmaceutical litigation, where lawyers are too often the only beneficiaries. Legal aid reform is long overdue.
DR ANTHONY BARTON
SOLICITOR & MEDICAL PRACTITIONER, London N1
Comment by sheldon101 | June 10th, 2010
A few comments. First, I love the consent form. I’ve had colonoscopies in Toronto from the late 1980s. The consent form wasn’t as detailed as the one here — but it always included a consent for emergency surgery. So Wakefield’s a joke.
Second, about the pain. That depends. The first time was by a cretin who didn’t give me anything for the pain. Later ones were done under drugs, but I was awake and they were still painful. The latest one had an anesthesiologist (change in billing codes made that possible). I was drugged in the room and woke up half an hour later in recovery. Totally painless.
Comment by sheldon101 | June 11th, 2010
Hey Mike, see http://www.huffingtonpost.com/ken-reibel/is-wakefield-losing-his-b_b_595303.html?show_comment_id=50080486#comment_50080486
According to this fruitcake, neutralground, I’ve violated your copyright etc. by not doing something or another.
Because it bothers it so much, I’ve decided to come here and apologize profusely. But I don’t know what for, I didn’t claim the work was mine and I gave you credit.
Anyhow, I’ll include a link back to here in my response at Huff-Po.
Comment by Mike | June 11th, 2010
Hi Sheldon,
Fair usage in my opinion. Keep up the good work.
I followed your link and agree that the Daily Mail is a poor source of information - witness its constant stream of MMR scare stories and its support for Andrew Wakefield. However on this occasion it got it right. Judges in the UK get very fussy if you lie about what happens in their court rooms.
From the law firm that represented Jack Piper.
Jack Piper v Royal Free Hospital (QBD, London) [2007] – acted for the claimant in a bowel investigation on an autistic child – issues included parental consent and the scope of information to be given in quasi-experimental setting – settled before trial and approved.