AT 6.30am on April 5 2020, I received a text from my 88-year-old aunt saying ‘am on the floor’. I called 999 for an ambulance and set out to drive 90 miles to her home.
I found her sitting up, alert but masked, and I was told by the first responder that an ambulance would be called for hospital admission. ‘All her obs (sic) are fine’, I was told, ‘I only want her to go in because she can’t support her weight on her walking frame’. Much persuasion and coercion then ensued and we assured my aunt that the hospital would discharge her in a few days ‘to make room for the Covid patients’.
On my way home several hours later, I received a phone call – as next of kin – from the consultant who told me that my aunt had ‘swabbed negative’ but that they were going to ‘run a test to rule out the virus’. The only things that were mentioned were that her kidney function was ‘below par’ and that she had agreed to a DNR (which I was not au fait with at that time).
When I rang the hospital for an update 30 hours later I was told my aunt was in the Covid ward, having ‘tested positive’. This is where she remained until the end of April when she was transferred to the Dragon Heart hospital (the field hospital set up in the Principality Stadium, Cardiff) for ‘rehabilitation’ or physiotherapy in her case. Only 46 patients were ever admitted here.
At first the only complaint we made was regarding a brand-new pair of slippers which I had packed for her hospital admission. They were still in the packaging and went missing within the first 48 hours, when no members of the public were being allowed into hospitals.
Following my aunt’s discharge, we requested her entire medical notes, since we could not fathom how she could have caught the virus. When I asked her about agreeing to a DNR she was most indignant and denied that she had done so. She may be frail and riddled with arthritis but she has all her mental faculties.
As I have previously written, we complained to the Cardiff and Vale health board about the DNR, later taking it to the ombudsman, but were told that as a legal document it cannot be changed, only ‘reviewed’ upon any future hospital admission.
The hospital notes state early on, ‘worsening inflammatory markers . . ? progression of Covid? consolidation consistent with bacterial pneumonia’. I am no ‘Covid denier’, but the facts of the case are contradictory at best given what we now know about the incubation period, therefore it is my belief that my aunt caught pneumonia or Covid once admitted.
It was only months later that it came to my attention that journalist Jacqui Deevoy was researching the drug midazolam and that many people believe that their loved ones had been administered this drug as an end-of-life ‘care pathway’, similar to the Liverpool Care Pathway in England which was allegedly phased out around eight years ago. Upon hearing this, I returned to my aunt’s notes and indeed found this drug in her PRN (Pro Re Nata or list of anticipatory medications) along with morphine (although at the top of the triage notes, it clearly stated, ‘allergies – morphine’) and 50 mg of cyclizine, an anti-sickness drug.
According to MHRA guidelines midazolam, a benzodiazepine, should not be co-prescribed with the opioid morphine unless there is no other alternative because of the risk of potentially fatal respiratory suppression. So why would these drugs be prescribed in the PRN of a patient who is suffering a respiratory illness? Cyclizine, too, can have unpleasant side effects. Concomitant use of all three drugs would surely have been a deadly cocktail for a small, frail 88-year-old. These facts have been communicated to me by medical researcher Stuart Wilkie, who shockingly lost both parents to this drug several years ago. We noted that my aunt had actually had morphine administered to her.
I set about asking questions. My first email to the Cardiff and Vale health board was ignored and so I repeatedly sent this until I received a reply. However, the reply was addressing not the midazolam question but the earlier concern about the DNR. We decided to involve the Public Services Ombudsman once again and in their response via the PSO, the health board stated that after having consulted with the GP they were ‘now aware’ of my aunt’s morphine allergy. So much time had elapsed between communications – with me having to send one particular email four times before I got an acknowledgement, that I believe the health board had forgotten that we had the full medical records in our possession. I duly pointed out to them that this was patently untrue because it was clearly at the top of the triage notes. This resulted in my aunt being offered a £250 payment for this ‘error’.
Much obfuscation regarding midazolam then followed.
In May 2022, the Ombudsman’s decision letter stated: ‘I also found that the complaint response overlooked the question of whether the prescription of midazolam and morphine together was against MHRA guidelines, particularly given that [my aunt] was 88 years old and had respiratory issues. This question had, in fact, also been raised previously with the Ombudsman, at which time an agreement had been reached for the Health Board to provide a response. I find it disappointing that further intervention from this office has been necessary, given that complaint handling had already been highlighted as sub-standard during our consideration of that previous complaint.’
The health board was given one month to address the contradictions in the complaint response and to address also the clinical implications of MHRA guidelines on co-prescribing Midazolam with morphine. It didn’t end there, however.
Within one month there arrived a response which referred to morphine, cyclizine and hyoscine but strangely evaded mentioning midazolam. Once more it was necessary to recontact the Ombudsman to say that the response was insufficient. In the interim period I enlisted the help of my Member of the Senedd, Paul Davies, who wrote to the Cardiff and Vale health board to request a response be sent to my aunt and me.
We finally received a response on October 14, 2022. It was satisfactory in that it referred to the fact that ‘these medications’ (without referring to them specifically by name in the relevant paragraph) were prescribed for my aunt, ‘to ensure her comfort had her condition deteriorated and it was thought she would not survive from Covid-19’. To me, this was a roundabout way of admitting an end-of-life ‘care pathway’. Still it made no reference to MHRA guidelines.
The response still maintained that my aunt’s condition was ‘significantly deteriorating’ on April 11, when her clinical notes for that day indicate otherwise. They state that she was sitting up in bed and did not necessarily feel any worse. She was even offered physio on this date. Yet curiously this was the date on which the lethal combination of drugs was written into her PRN under the guidance of her consultant (who is a clinical pharmacologist and a toxicology consultant).
Had my aunt passed away during this hospital stay in 2020, she would have become another ‘Covid death’. Had I not known about the many questions surrounding the PCR testing, I would not have requested the hospital records. Had I not requested the records, I would not have found the list of anticipatory medications and learned about the midazolam stockpiling in March 2020. I urge anyone to request and scrutinise hospital records of your loved ones and do not accept any diagnosis or cause of death at face value.
Meanwhile, my quest for a straight answer for my now 90-year-old aunt (who has declined all flu and Covid jabs and is doing just fine) continues. Watch this space.