In The Death of Stephen O’Neill I suggested his doctors, like soldiers in an army, simply by dint of following orders were capable of doing horrific things.
At his inquest, the doctors from the Bluestone unit in Craigavon, where Stephen had gone for help, issued this astonishing statement.
Southern Trust Health and Social Care Trust response to Healy
Senior clinicians working in the Trust reviewed Professor Healey’s report and would like to provide a response to a number of points raised by Professor Healey.
The Consultants who reviewed the report are as follows; Dr McMahon – Associate Medical Director, Mental Health and Disability Directorate; Dr McFarland – Chair of the SAI; and Dr Chada – Consultant in the Home Treatment service.
As clinicians working in a HSCB Trust we endeavour to provide the best care possible to patients presenting to our service.
We make the following points
- We work to nationally agreed guidelines such as those recommended by NICE and Up-to-date
- Anti-depressants prescribed for both anxiety and depression have been approved by the rigorous (world renowned) medication approval system in the U.K., the MHRA (Medication & Healthcare Regulations Authority). The drugs prescribed have also been approved by the FDA. They were prescribed within BNF guidelines. (British National Formulary).
- Medication prescribed was carefully monitored and when it appeared there was a possible reaction to one of the SSRis (Sertraline), this was discontinued. This demonstrates that the Senior Clinician was aware of the potential side effects of the SSRI and acted on it.
- There are no specific cautions about the use of Buspirone and any potential suicidality in the current BNF guidance. It was prescribed in keeping with recognised indications and within the prescribing guidelines noted above.
- There have been a number of meta-analyses carried out in relation to the risk/benefit of using antidepressants both in children and adults. The meta-analyses clearly indicate that the benefit in adults aged over 25 significantly outweighs the risk as reflected in the National Guidance.
- As we are following regionally approved guidelines and the standard met by other similar Doctors and Clinicians, we refute the Trust is putting people at risk;
- We would agree with Professor Healy that there was no evidence of negligence, nonetheless we will share some of the learning highlighted in his report;
I hope this is helpful. Thank you.
Dr P McMahon Consultant Psychiatrist
There are two astonishing things about this.
The first intriguing feature is that this McMahon statement is almost identical to responses I later had from the Northern Irish, English and Welsh Governments in response to a letter I sent about the O’Neill inquest to Michelle O’Neill – the Deputy First Minister in Northern Ireland – see Overture to Michelle O’Neill.
The response from Vaughan Gething in Wales is given in full here because it follows on an earlier letter to him and response from his office – I Recognise these Constraints – and it leads deliciously to the next step in the saga (next post). All 3 government responses can be downloaded from Richard Pengelly N. Ireland, Leigh Smale England, and Vaughan Gething. They are strangely similar and very like the McMahon statement.
Gething to Healy December 10th
Dear Professor Healy,
Thank you for your e-mail of 26 November regarding the inquest into Stephen O’Neill’s death following him taking prescribed anti-depressants.
I note the previous letter that you sent on this matter on 2 September which you copied to me. I must clarify that I did not respond to your letter as it was directed to Michelle O’Neill. However, I did share it with Welsh Government officials to consider the points you raised and what action may need to be taken.
In Wales, we take an evidence-based approach to deciding which treatments should be routinely available in the NHS. To do this, we rely on the expert advice of the National Institute for Health and Care Excellence (NICE) and our own appraisal body, the All-Wales Medicines Strategy Group (AWMSG). NICE and the AWMSG recommendations are based on the best available evidence.
NICE’s evidence-based recommendations developed by independent committees, including professionals and lay members, and consulted on by stakeholders. We rely upon this robust process to assist health care professionals, patients and their carers’ decisions about appropriate treatment and health care.
We also rely on the work of the Medicines and Healthcare products Regulatory Agency (MHRA) which is responsible for ensuring that medicines and medical devices work and are acceptably safe.
May I suggest that you write to both the Chief Executive of NICE, Sir Andrew Dillon, and the MHRA, Dr June Raine, to address any concerns you may have in regards to their processes.
Vaughan Gething AM
Minister for Health,
Welsh Assembly Government
Healy to Gething Dec 11th
Re Ghostwriting and Public Health
Dear Mr Gething
Many thanks for the response to my recent letter. I have followed your advice and written to Andrew Dillon, copying you in. I will copy him into this letter.
It’s not the job of NICE to police the medical literature. I would imagine pretty well everyone would figure it’s up to physicians to do the policing. Given that journal editors and bodies like Cochrane are failing to do so, it falls to me to tell you of this risk – hence my previous letter. I wrote to NICE about these issues after giving a lecture in the Welsh Senedd building last December.
I assume, given your reply didn’t quibble with what I wrote, that senior physicians in your Department have not suggested that Healy is entirely wrong. They might well be interested in any response from NICE – but this is passing a buck they seem to know about.
At the end of the day I can try to look after the safety of patients in my care, by rarely paying heed to NICE Guidance. But most doctors across Wales will not feel able to do this and will give their patients treatments that risk harming them because to do otherwise would fly in the face of what they perceive to be NICE Guidelines with a consequent risk of losing their job if their practice is reviewed by Medical Directors in Welsh Health Boards. Everyone can pass the buck here – you, the Medical Directors, NICE, MHRA and doctors.
A JAMA article this week indicates life expectancy has been falling in the US for 5 years. In recent weeks there have been similar reports from the Health Foundation and Public Health England. And an ONS report last week said babies born in the UK now will live 3 years less than previously expected. A strong case can be made that polypharmacy is a contributor to these figures, driven by Guidelines like NICE’s, and that this outcome was almost inevitable if Guidelines are based on a Fake literature.
But these issues are not just about patient safety. You (not Pharma) are paying for screening staff, auditors and managers to deliver services that essentially are about getting people to take drugs – as for instance osteoporosis services and lately the children’s mental health services a recent Minister of Health called the greatest point of failure of the NHS.
I remain happy to discuss any aspect of these issues with you or your department before I leave this job and the country early next year.
Professor David Healy MD FRCPsych
cc. A Dillon (NICE).
Two More Astonishing Things
First, it might just be worth noting that McMahon concedes Stephen O’Neill had a toxic reaction to Sertraline and then goes on to mention NICE and MHRA but NICE have no guidance on how to treat SSRI toxicity and MHRA have licensed nothing for treating SSRI toxicity.
Second, another remarkable feature of the McMahon input to the inquest is that you’d expect politicians like Vaughan Gething to say just what they said – what is a politician faced with a query from the media, patients, or Healy on an issue about drugs going to do except say that we are not doctors – we are advised by the regulator and the guideline makers.
Politicians aren’t doctors. But doctors it seems, if not politicians, are people who know no more about how to practice medicine than politicians.
This goes right to the vacuum at the heart of medicine that the Covid Pandemic exposes. Back when I trained, before we had respirologists, physicians with an interest in chest problems were experts in physiology. They relished unexpected clinical twists and the challenge to work out what was going on.
Then they became people who dished out inhalers and LABAs – always the latest, all guideline approved and regulator approved. And they now stand paralysed in the face of Covid. They have no idea how to deal with the unexpected.
The point here is that anyone who wants to pigeon-hole Stephen O’Neill’s death as just one of those weird mental health things is now facing exactly the same thing play out on a Global Technicolor Screen.
Our drugs are more dangerous than germs and our doctors have forgotten this. You should be very scared.
Its time for our so called marvellous health services and frontline workers to stop adhering to guidelines that based on a Fake Literature are getting in the way of seeing and hearing and helping the patient right in front of us.
Orders from Nowhere have no place in Healthcare.
To be continued with The NICE before Christmas.