This letter of 16th September 1997 was from a Hospital Consultant to the GP who had wished to admit my Mother unnecessarily for a blood sample, and the same GP who had threatened me with legal devices if I stood in the way of the ambulance.
"You had noticed bruising of her limbs and had advised hospitalisation. Although the patient supported this, the son who stays with the patient had refused the admission.
Mrs. Stewart is dementing, and has a history of hypochondriacal and probably manipulative behaviour. The son with whom she stays, is "difficult" from a hospital staffs viewpoint. He questions staff intensely and seems often dissatisfied with his mother's care. Despite joining various societies and reading avidly his grasp of priorities and illnesses remain poor. One gains the impression that one can never reassure him.
On examination the patient was bedfast. Her legs were contracting. She was shouting "leave me alone". She was calling her son "Simon" although Ian is his name. When I asked her how she was being coped with she said that "maids" looked after her. She did however remember my name. There was no acute illness. There was no bruising of her hips or shoulders and no sign of fracture. Examination was difficult because at times the patient voluntarily refused to communicate. The right leg was bandaged apparently because of a skin tear. I did not remove the bandaging. There was a tear which had been steristripped on the right upper arm. There was bruising and haematoma formation on the right forearm. The left arm had bruising on the back of the hand.
In addition to any dementing process, Mrs. Stewart has further behavioural problems. This may be manipulative or even psychotic. The son was unshaven and unkempt. He looked agitated. There was no sign of drink or drugs in the house."
"The son again refused to consider the patient's admission to hospital or to a nursing home to give the above care. He asked what a hospital could do that he could not do if he received the necessary assistance. He also pointed out that his mother had been in hospital frequently in the past and never liked it there. He felt that doctors sent people in to hospital to make life easier for themselves."
"The son's request for help to keep his mother at home was certainly plausible. However during my home visit I was by no means reassured. I could not get him to address the various issues which he is facing. He would digress to other and irrelevant issues. A subsequent phone call from the visiting district nursing sister indicated that she had offered the son help some weeks before. Moreover some nurses had expressed concern that he "stands close" when they visit and locks the door behind them. Adjacent to the patient's bed there were no hard surfaces in which she might have bruised herself. However if up sitting on a chair or commode it is quite possible that she would fling her arms around causing her bruising. The son denied all knowledge of how the bruising occurred."
"I note that numerous professionals have seen or are involved with the case ie psychogeriatrician, CPN, district nurses, physiotherapists, and occupational therapists. I know that the patient has been referred to social work in the past. Later on the day of my visit I referred the case to social work requesting an emergency assessment of the patient's care aimed at:
co-ordinating the current input;
achieving adequate nursing care in the home;
providing nursing care probably in a nursing home if:
the above cannot be achieved;
the son's behaviour prevents this;
there is a real suspicion of non accidental injury.
I have no experience of the legal steps necessary to admit a patient for her own safety if opposed by that patient and her relatives. My understanding is that the Mental Health Act would not apply. However I have asked Dr....'s advice on this. The only pertinent legislation might be social work's National Assistance Act."
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