Grandfather Joins Irwin Mitchell In Calling For Lessons To Be Learned
A dad left permanently disabled after a hospital wrongly flushed food into his lung has called for lessons to be learned from his case.
Michael Moy had liquid administered into his right lung instead of his stomach on at least two occasions after staff did not check the position of his feeding tube before commencing his feed. Under Department of Health guidelines such an incident is classed as a ‘never event’ – something the NHS says simply shouldn’t ever be allowed to happen.
The 58-year-old was subsequently diagnosed with pneumonia and an abscess in the lung following the incident at Queen’s Hospital, Romford. He had previously undergone surgery.
Michael now has permanent lung disease which is expected to deteriorate, has a shortened life expectancy and has been forced to retire from his job a railway emergency planning manager on health grounds.
Michael, of Basildon, Essex instructed expert medical negligence lawyers at Irwin Mitchell to investigate his care under Barking, Havering and Redbridge University Hospitals NHS Trust.
He has now joined his legal team in calling for the NHS to do more to reduce the number of never events and crucially to be open and honest when these incidents occur.
It comes after Irwin Mitchell secured an admission of liability and an undisclosed settlement to cover his future care, medical treatment and loss of earnings.
Latest NHS figures found there had been nearly 300 never events in the past six months. These included 14 incidents where food was administered through a gastric tube which was in the respiratory tract.
Expert Opinion“Never events are classed as such because they should not happen but sadly we continue to see the effects they have on patients.
“The consequences of liquid or food reaching the lungs are extremely serious and can have long-term health implications including serious disease of the organs.
“What happened to Michael has had a profound effect on him and his family. It would have been easily avoided if the hospital had carried out basic checks to establish the position of the tube.
“While nothing can make up for what has happened we are pleased to have secured the settlement for Michael which will provide him with peace of mind regarding his future.
“The number of never events that the NHS is continuing to record is worrying. As with Michael’s case, every time a never event occurs, it is vital that they are thoroughly investigated and that information is shared across the NHS so that they can eliminate such issues.” Richard Kayser - Senior Associate Solicitor
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Michael has a long term partner, Marcie (59). He has two children and four grandchildren.
In the autumn of 2014 he was diagnosed with a brain tumour. Michael underwent successful surgery at Queen’s Hospital on 16 October, 2014.
Following surgery a feeding tube was inserted. The tubes were regularly replaced. On each occasion a check X-ray should have been undertaken but was not.
Between 21 and 23 October food was flushed into Michael’s right lung on two occasions.
Late on 23 October Michael began coughing up blood. Following examinations the error was spotted.
Around a week later another tube was discovered in Michael’s lung.
Over the next month he underwent 14 X-rays which showed an expanding abnormal area of the lung.
He was diagnosed with pneumonia and a lung abscess. Michael remained in hospital until January 2015.
He was diagnosed with emphysema and bronchiectasis, a condition where the lungs become abnormally wide, leading to a build-up of mucus that can make them more vulnerable to infection.
Michael suffers regular coughing fits each day and suffers from lung infections, some of which have required hospital treatment.
NHS policy means that staff should check the position of a feeding tube before administering food.
A root cause analysis report by Barking, Havering and Redbridge University Hospitals NHS Trust found that tubes were not checked prior to food being given.
Michael is also no longer to enjoy many of hobbies. He used to regularly run 15 miles and cycle.
He said: “My life has totally changed following my lung problems. I enjoyed working and going running and cycling as well as many of the things people just take for granted. However, all that has now gone.
“Even day-to-day tasks such mowing the lawn is now a struggle. I had not really needed to have to go to hospital for 50 years but it seems like I’m there regularly now.
“The last few years and trying to come to terms with what happened has been incredibly difficult for all of us.
“This event has changed my life from an adventurous 50 something who was active in all aspects of my daily living into a person who finds it difficult to catch my breath doing simple tasks and paranoid with any future medical procedures.
“I’m anxious about what the future holds and what it will mean for me and my family. I try not to think about it but it’s difficult and it’s also difficult not to feel angry at what has happened.
“I just hope that by speaking out more is done to improve patient care. I appreciate that doctors and nurses face an incredibly difficult job but it’s unacceptable that so many never events are still happening. It seems like many of these could be avoided by a few simple checks.”
The NHS recorded 277 never events between 1 April and 31 October 2019.
Never Events are classed as serious, largely preventable patient safety incidents that should not occur if healthcare providers have implemented existing national guidance or safety recommendations.
Incidents in the time period included 143 cases of ‘wrong site surgery’ such as the wrong testicle being operated on, the wrong patients receiving procedures such as laser treatment and a lumbar puncture as well as a cervical biopsy being carried out instead of a colon biopsy and the wrong eye being cut.
There were also 57 occasions when foreign objects such as surgical wire, swabs and forceps were left inside a patient as well as incidents of drugs being incorrectly administered.