Two weeks before Annie Mulholland died her family compiled a shocking account of her care
A health board has apologised to the family of an inspirational cancer campaigner who spent three days in hospital without a proper bed as she lay dying.
Annie Mulholland, 63, of Pontcanna, Cardiff, died in May five years after being diagnosed with ovarian cancer.
She moved to London and rented a room after being denied the drug Avastin by the Welsh NHS.
She campaigned for earlier diagnosis and access for cancer patients to a wider selection of drugs.
Two weeks before she died, Annie and her family compiled a shocking account of her experience of accident and emergency care at the University Hospital of Wales in Cardiff.
This is the family’s account of May 7 this year:
Early morning: “On May 7 Annie suffered from symptoms including Deep Vein Thrombosis (DVT) in her leg, rapid swelling and sharp shooting pains.
“Following the phone advice from George Thomas Hospice and Marie Curie, Annie and her husband attended A&E at University Hospital of Wales.”
9am: “Upon arrival Annie explained her existing condition, and she had been advised by existing services that she should attend A&E as a matter of urgency, as we suspected it was DVT.
“Annie was seen fairly quickly for an initial assessment and progressed for blood tests, CT scan and x-ray within an hour of seeing a doctor.”
3pm: Annie was then moved to the waiting area, with TV, assessment unit.
6pm: “Annie plus family were still waiting for results from the blood tests. We were moved to another waiting area in the assessment unit.
“Annie advised she needed to take daily medication, including morphine, to manage pain. Her family were concerned that she was also in a huge amount of pain and needed somewhere to lie down to rest. We were told the unit faced a difficult situation due to a lack of hospital beds.”
10:30pm: “Annie was moved to a curtained area in the assessment unit and provided with a trolley so she could lie down.
“We were told that Annie needed to stay overnight to receive intravenous heparin. We asked whether we could administer this at home in order to keep Annie as comfortable as possible.
“We were advised this was not possible. They also advised Annie needed a Doppler test, which was not available at the weekend, so it was likely that Annie would need to stay in hospital until Monday.
“Annie spent from Saturday May 7 at 10.30am to Monday May 9 at 6.30pm on the assessment unit. Her family discharged her due to concerns about her levels of distress, lack of sleep, and an inability to source the right advice on the level of drugs to treat her DVT condition.”
The issues she encountered during Annie’s 72-hour stay in the A&E assessment unit included:
- No access to a working shower or place to wash;
- No proper pillows or bed sheets to make her comfortable (in the end the family brought these in from home);
- Continued noise during the night that prevented her from sleeping including staff talking throughout the night, staff laughing, making meals in the microwave, and wearing shoes that made a ‘clip clop’ on the floor throughout the night;
- Two nurses kissing at the nurse station at the end of their shift.
During the night things got no better:
Annie observed during the night there were no systematic checks or rotations from nurse staff to ensure each patient was comfortable and not in pain.
“Twice she had to shout for nursing assistance to support patients in neighbouring trolleys who had got their leg stuck in the bed, and started vomiting.
“These instances could have been either avoided or dealt with quickly and quietly if staff regularly checked patients in the assessment unit.
“There was no ownership of patients, while six nursing staff spent a lot of time chatting amongst themselves rather than checking and reviewing patients.
“Annie reported her concerns to the designated member of staff dealing with complaints in the ward.
“Annie was keen to emphasise as part of this discussion that junior staff alone were not to blame. There was a systemic management failure to address these issues or lead by example.
“The senior consultant on call throughout the night shift wore shoes that did not meet hospital regulations and made a noise. Junior staff require more senior staff to lead by example both in their approach and efficiency to deal with patients.
“If the assessment unit in A&E needs to be regularly used as an overnight facility to support emergency admissions to hospital and bed shortages, then the conditions of this ward need to meet the same standards as a regular overnight ward.
“Patient comfort, care, and medical support need to be priority at all times. Annie and her family were deeply distressed and upset by the conditions Annie was subjected to. She left hospital in a worse condition than she entered, having had no sleep or rest in 72 hours.
“The support we have since received at home has been excellent and very quick to address Annie’s needs. Patients clearly marked as requirting palliative care require prompt and sensitive support to ensure their end of life care is as high quality as possible.”
What a campaigning politician thinks about her treatment:
Labour MP Ann Clwyd, who has campaigned on health issues for years and was sent a copy of Annie’s account, said: “Annie Mulholland was an exceptional woman, who I first met in 2014.
“She spoke to me a few days before she died on the phone.
“Her wish was always to improve the treatment and care for patients generally and her family have asked that her last letter should be published.
‘Nothing has changed since you first made your own complaints’, she said. “I just want you to know that what you said was true. I’ve experienced it myself.”
What the hospital had to say:
Ruth Walker, executive director of nursing at Cardiff and Vale University Health Board, said: “We are very sorry to hear of Annie’s family’s concerns.
“We have the utmost respect for her work, courage and passion for improving cancer care.
“The assessment unit is designed for short term care but we know that patients can be there for longer periods before a decision is made to admit them or send them home safely.
“That is why we are listening to patient feedback and looking at all steps we can take to make their time in the unit more comfortable.
“We will be contacting the family to discuss their concerns in detail and apologise directly.”