Summary of the events following the death of Robbie Powell – Part 2

3 July 2015

Summary of the events following the death of Robbie Powell – Part 2

Summary of the events following the death of Robbie Powell – Part 2

If you have not already done so please read the summary of events that led to Robbie’s negligent death on the 17th April 1990. You can access the article at:

http://www.mistreatment.com/news/article/robbies-law-25-years-in-the-making-275/#.VXltgvlViko

Please also read Part 1 at:

http://www.mistreatment.com/news/article/summary-of-the-events-following-the-death-of-robbie-powell-part-1-276/#.VXlqEPlVikp

17th April 1990: Robbie died of Addison’s disease a treatable condition that invariably results in death without treatment, which was suspected four months before the child’s death. The test to confirm the disease was ordered by the paediatrician but not carried out. The parents were unaware of either the suspicion of Addison’s disease or the need for the ACTH test until after Robbie had died.

20th April 1990: Dr Keith Hughes, the GP who had spoken to the pathologist and had also examined Robbie, the day before his death, came to our home to discuss the post mortem result. Dr Hughes accepted that Robbie should not have died.  I was devastated to learn, after reading Robbie’s thin GP medical records that Addison’s disease had been suspected and the ACTH test, which would have confirmed the diagnosis, had been ordered but not done. It was erroneously claimed that my wife and I had been informed of the test. The discharge documents [i.e. Discharge Notification and Clinical Summary Sheet] from Morriston Hospital, which were sent to the GPs, following the 4 day in-patient episode, 4 months earlier [December 1989], confirmed the following:

·  Robbie had a hormonal imbalance;

·  Addison’s had been suspected in December 1989;

·  The ACTH test had been requested;

·  The parents had been informed about the need for ACTH test, which was untrue; and

·  There would be an outpatient appointment arranged for January 1990.

The letter of the 18th January 1990, which was sent by Dr Forbes, following the out-patient appointment, confirmed:

·  The earlier suspicion of Addison’s disease;

·  That Robbie had gained a stone in weight;

·  That the ACTH test had not been carried out; and

·  Robbie should be readmitted immediately to hospital if he had a recurrence of the symptoms of Addison’s disease [these are vomiting - weakness - weight loss - dehydration - abdominal pain - low blood pressure - low blood sugar -hyperpigmentation of the skin].

It was obvious to me and would have been, to any other parent that, in the light of this crucial information, Robbie should have been readmitted immediately to Morriston Hospital when he became unwell two weeks before he died. In that two weeks Robbie had been seen by no less than 5 GPs on 7 separate occasions with symptoms of a sore throat, lethargy, weight loss, loss of appetite, vomiting, weakness so extreme he couldn’t stand unassisted, severe dehydration, low blood pressure, low blood sugar and a loss of consciousness, on the day of death, when the GP actually refused hospital admission on her first visit but agreed to do so after a heated argument on her second visit. She then refused our request for an ambulance. When we arrived at Morriston Hospital, just 30 minutes later, Robbie took his last conscious breath and subsequently died.

The only GP to read the crucial medical records 6 days before Robbie died, Dr Mike Williams, said to my wife and I that he would re-refer the child immediately back to hospital. However, unknown to us at the time, he had failed to do so. Dr Keith Hughes was fully aware that his partner had failed to initiate the referral but he intentionally suppressed this grossly negligent failure from us.  Dr Keith Hughes also refused my formal request for an inquiry into what had gone wrong with the medical care, or lack of it, provided by the Ystradgynlais Group Practice.

Because of Dr Keith Hughes’s comment that Robbie need not have died and his refusal to investigate what had gone wrong I was suspicious that there may be a cover up. I informed my closest friend, Sid Herbert, of exactly what I had read in Robbie’s thin GP medical records and he agreed that it was paramount that the discharge documents were independently witnessed and contemporaneously noted. Sid declined my request for him to do this simply because he was my best friend. However, we jointly agreed that I should ask the Reverend Thomas, who lived three doors down from me. The Reverend Thomas, who knew Robbie, agreed.

22nd April 1990: Dr Mike Williams attended my home to visit my wife who was in bed following the shock of Robbie’s death days earlier. I asked Dr Williams in the presence of my wife, and later in the presence of my father-in-law, if he had referred Robbie back to hospital, as had agreed to do on the 11th April, and he said “Yes”. This turned out to be a blatant lie.

23rd April 1990: I invited Dr Keith Hughes to my home and requested that he brought Robbie’s GP medical records with him. Dr Hughes was surprised to learn that the Reverend Thomas was already waiting in the front room for him to arrive. As requested, the Reverend Thomas had a note book and pen. Dr Hughes again accepted that Robbie need not have died but then said that he would have to be careful about what he said in the presence of the Reverend Thomas. I requested the medical records from Dr Hughes and handed them to the Reverend Thomas who then noted the content of the discharge documents, which corroborated what I had read three days earlier. My request for a copy of Robbie’s GP medical records was subsequently refused.

30th April 1990: I made a formal complaint about the 5 GPs to Powys Family Practitioners Committee [“FPC”] not knowing that Dr Keith Hughes was actually a member of that Committee.

17th May 1990: Under a GP’s terms and conditions of service, original GP medical records, regarding a deceased patient, should be returned to the FPC by no later than a month after death – this being the 17th May in Robbie’s case. Furthermore, in the light of my complaint about Robbie’s death, on the 30th April, the General Manager, Mr Gwynne Phillips, should have immediately requested the original GP medical records, from Dr Hughes, which he failed to do. In fact, the GPs were inappropriately permitted by Mr Phillips and others to keep possession of the original GP medical records, for six months, when photocopies would have served the very same purpose unless, as we now know, the GPs intended to falsify the consultation notes, fabricate a referral letter and remove and substitute the original discharge documents from both Robbie’s GP and Morriston Hospital medical records.

25th May 1990: My wife and I met Dr Forbes at Morriston Hospital. He informed us that he had suspected Addison’s disease and that he now wished he had done the test. When I challenged him about the fact we had not been told about the suspicion or the need for the ACTH test he claimed that the GPs should have told us. When I informed him Robbie had been seen by 5 GPs on 7 occasions, with deteriorating symptoms, as mentioned above, in the last 15 days of his life, he shook his head in disbelief and said, “You just can’t trust anyone”. Dr Forbes identified the hospital discharge letters that I had already read in the GP medical records, 3 days after Robbie’s death, stating that he had sent all the information to the GPs. It was obvious by his demeanour that he was outraged by the GPs’ failure to re-refer Robbie immediately back to hospital in the light of the information he had sent them.

When I asked Dr Forbes the date he had received Dr Mike Williams’s referral letter, as confirmed to me and others on the 22nd April, by Dr Williams, he said he hadn’t received any such letter from him but had received a telephone call the day after Robbie died.

Dr Forbes made a record of our meeting and placed it in Robbie’s original Morriston Hospital medical records. However, when Dr Forbes subsequently had at least one clandestine meeting with the 5 GPs, when both he and the GPs had inappropriate possession of Robbie’s original hospital and GP medical records, no record of these meetings were taken. Dr Forbes could remember nothing about what had been discussed at these meetings when subsequently cross-examined at the 1992 Welsh Office appeal. Having custody of the original GP and hospital records gave them the means and the opportunity to remove and/or substitute original documents.

1st June 1990: Mr Gwynne Phillips, who was obviously, at the very least, an associate of Dr Keith Hughes, decided to refer my complaint to West Glamorgan FPC because Dr Hughes was a member of his Committee. Mr Phillips stated in his letter that my complaint should be investigated “beyond the suspicion of bias”.  However, not only did Mr Phillips forward the complaint to West Glamorgan FPC he also breached rules and statutory regulations by inappropriately sending Dr Keith Hughes my statements of complaint with the knowledge that the GPs still had unlawful possession of Robbie’s original GP medical records and the means therefore to falsify them.

At this stage, both the Coroner and Powys FPC had failed to secure Robbie’s original GP medical records to ensure their authenticity. It was later confirmed that West Glamorgan FPC also failed to secure the original GP medical records and permitted the GPs to have possession until November 1990, 7 months after Robbie had died and 6 months longer than they should have had them by law. When the original GP records were eventually secured by West Glamorgan FPC there was no accompanying letter from the GPs, the original records were not cipher date stamped on receipt, as was appropriate, and there was no letter sent from West Glamorgan FPC to the GPs, acknowledging receipt. All very convenient if you are attempting to conceal impropriety and/or a conspiracy to cover up a child’s needless death.

20th July 1990:  The 5 GPs responded to my formal complaint in individual statements and also provided a combined statement signed by all 5 GPs in support of each others’ untruthful defence. 

         2nd April consultation: Dr Elwyn Hughes claimed (a) he had diagnosed “a minor self-limiting ailment”, (b) he told me to bring Robbie back if and when necessary and (c) he had advised analgesics. However, none of this was true as he said he could find nothing wrong with Robbie at the consultation and that was the very reason Robbie was sent back to school. Notably he didn’t read the medical records or provide a prescription for the analgesics notwithstanding Robbie was entitled to free prescriptions or explain to me what analgesics actually were. He later stated that he had diagnosed a viral illness and that he had spoken to my wife even though she wasn’t present at the consultation.

·  6th April consultation: Dr Flower falsely claimed she had (a) diagnosed a viral illness and (b) advised Calpol when she had said at the consultation she could find nothing wrong with Robbie. She also claimed that Robbie had abdominal pain, which is a symptom of Addison’s disease. Notably she didn’t read the medical records or provide a prescription for the Calpol.

·  11th April consultation: Dr Mike Williams falsely claimed (a) that my wife and I had told him about the previous viral illnesses diagnosed by Drs Elwyn Hughes and Flower, (b) he had diagnosed a viral illness and (c) he denied Robbie had been vomiting. Dr Williams made no mention of the prescription for Dioralyte [normally given for vomiting] and claimed Robbie had been referred back to Dr Forbes, which was contrary to what Dr Forbes had told us on the 25th May and was proven subsequently to be untrue. Dr Williams admitted to have read the medical records and was therefore aware of the suspicion of Addison’s disease and the need for the ACTH test. He later claimed that, as well as being aware of the suspicion of Addison’s disease, he had also suspected leukaemia and yet failed to make an immediate referral back to the hospital notwithstanding Robbie’s life was in obvious danger.

·  15th April consultation [Easter Sunday]: Dr Paul Boladz agreed with most of our version of events. He had suspected Glandular Fever and prescribed Amoxicillin, ordered blood tests for the following Tuesday and that I had informed him that Dr Williams had referred Robbie back to Dr Forbes. Notably Dr Boladz made no mention of the history of vomiting, which we had communicated to Dr Williams and him, which was the reason given for the referral. He made no mention about his 3 partners’ previous diagnosis of viral illnesses, simply because we had no knowledge of this concocted diagnosis until after Robbie’s death. Dr Boladz later accepted that no mention was made of his partners’ previous diagnosis of viral illnesses. Furthermore, Dr Boladz prescribed Amoxicillin, which is medication containing penicillin and contrary to a diagnosis of a viral illness.

·  16th April consultation [Easter Monday]: Dr Keith Hughes agreed with most of our version of events. Robbie was vomiting, he wanted to test his blood sugar but his test kit was out of date and that he delayed the blood tests, ordered by Dr Boladz, from the Tuesday to the Wednesday. He stated that we informed him that Robbie had been referred back to Dr Forbes by Dr Williams. Notably Dr Hughes made no mention of the previous history of vomiting, as communicated to Dr Williams and him – this being the reason given by Dr Williams for the referral back to Dr Forbes. He made no mention about his 3 partners’ previous diagnosis of viral illnesses, simply because we had no knowledge of this concocted diagnosis until after Robbie’s death. Dr Hughes later accepted that no mention was made of his partners’ previous diagnosis of viral illnesses. Dr Hughes did not stop the administration of Amoxicillin, which again supports that there was no mention of viral illnesses.

·  17th April consultation [Easter Tuesday]: Dr Flower, regarding her first visit, denied everything that incriminated her and in particular (a) that Robbie had fainted, (b) the child had dilated pupils and central cyanosis, (c) that he was seriously ill and (d) that the was critically dehydrated and close to death. On her second visit Dr Flower denied the same and also claimed that we had not asked for an ambulance and therefore hadn’t refused one. Dr Flower claimed also that she had subsequently telephoned the hospital to enquire about Robbie, which was proven to be untrue.

·  The 5 GPs’ Combined Statement: the GPs supported each others’ individual statements and claimed on numerous occasions that Dr Mike Williams had referred Robbie back to Dr Forbes.

Some of my actions post receipt of the GPs’ statements in response to my complaint

·  I responded in further statements setting out the evidence I had in my possession to substantiate that the GPs were being untruthful and went about securing further evidence in an attempt to establish the truth and expose the obvious cover up.

·  I formally requested, in writing, copies of Robbie’s GP and Morriston Hospital medical records. My requests were refused.

·  I contacted Dr Forbes for confirmation as to when he apparently received Dr Williams’s referral letter. NB: Dr Forbes had informed us [my wife and I] on the 25th May 1990, a month after Robbie’s death, that he hadn’t received a referral letter from Dr Williams but had received a telephone call from Dr Williams the day after Robbie’s death [18thj April]. Dr Forbes responded in writing stating that he had not received a referral letter dated 11th April 1990, this being the very date Dr Williams informed us that he would make the referral and 6 days before Robbie died. Where did Dr Forbes get this date from? Also, his response did not answer my simple question as there may have been a referral letter received with a different date.

I contacted Dr Forbes again requesting confirmation as to whether he had received a referral letter from Dr Williams and if so when. Dr Forbes then claimed, again in writing, he had not received a referral letter prior to Robbie’s death, which suggests, at the very least, a referral letter was received after his death. However, if this was true, then the letter was received more than a month after Robbie had already died.

I contacted Dr Forbes for a third time and reminded him that he had informed us on the 25th May 1990 that he had received no referral letter from Dr Williams. I asked Dr Forbes to confirm the date he received Dr Williams’s referral letter. However, Dr Forbes did not respond.

·  Because Dr Williams had denied in his statement that Robbie was vomiting and omitted the prescription for Dioralyte, which is prescribed specifically for vomiting, I attempted to secure a copy of the prescription. I first went to the local chemist, Mr E W Richards, who had dispensed the Dioralyte on the 11th April. He informed me that he had erased all Robbie’s records from his computer and claimed he had no written records of any of the prescriptions he dispensed.  I asked Mr Richards what he had done with the prescriptions that I had given to him and he replied, “I’ve sent them away”. I then asked, “Where have you sent them” and he responded, “The Prescription Pricing Authority Cardiff” [“PPAC”]. “Will you please telephone them I asked” and Mr Richards said, “No”, but gave me the number for me to telephone them when I got home. 

·  When I telephoned the PPAC they refused to talk to me because I was a member of the public. I was advised to request the prescriptions via West Glamorgan FPC as they were dealing with my complaint. After doing so I subsequently received all three prescriptions, including the Diaoralyte, which had been dispensed, by two different chemists, on the 11th, 15th and 17th April 1990. I was asked if I wanted to submit the prescriptions as evidence for the forthcoming Medical Services Committee hearing and I said, “No”.

22nd November: I received copies of Robbie’s GP and Morriston Hospital medical records in advance of the December 1990 Medical Services Committee hearing. The original discharge documents that I had read 3 days after Robbie’s death, and witnessed by the Reverend 3 days later, had been removed and substituted with less incrimination documents – there was now no mention of Addison’s disease. On receipt of the falsified records, I immediately telephoned the paediatrician’s secretary at Morriston Hospital and West Glamorgan FPC and complained that the discharge documents had been falsified. I insisted that the telephone calls be noted, which they were and are now a matter of record.

I visited the Health Centre to examine Robbie’s original GP medical records, as I was unaware of the afore mentioned statutory obligation, at that time. I was informed that the original records had been sent to West Glamorgan FPC some weeks earlier. I insisted that this was confirmed in writing.

As mentioned above, the GPs were under a statutory obligation to return Robbie’s original GP medical records to Powys FPC by no later than the 17th May 1990. I now had written evidence from Dr Boladz that the GPs unlawfully kept the original GP medical records for an additional 6 months when photocopies would have served the same purpose if they were not going to be falsified and/or altered.

Also contained amongst the disclosed GP medical records were copies of two identical referral letters, dated the 12th April 1990, and an envelope addressed to the Appointment Officer at Morriston Hospital. The envelope had been previously sealed and torn open and one of the referral letters had been signed by Dr Mike Williams. The letters were addressed to Dr Forbes. The presence of these two referral letters established that, contrary to the GPs claims in their statements, Robbie had not been referred back to Dr Forbes. The letters also contained several untruths and anomalies. The following points are what appear to be the most significant regarding the cover up:

·  The letter falsely stated that Robbie had not been vomiting and omitted the prescription for Dioralyte when the reason given for the re-referral back to Dr Forbes had specifically been the vomiting, which Dr Forbes had warned the GPs about.

·  The letter claimed that Dr Elwyn Hughes, Dr Flower and Dr Williams had diagnosed viral illnesses when they hadn’t done so. However, these false assertions supported their untruthful statements.

·  The letter stated that Dr Williams had seen Robbie yesterday supporting the purported authenticity of the dictation of the letter as Robbie had been seen by Dr Williams on the 11th April.

·  There was no reference on the letters, which suggested they were typed by the junior secretary who did not reference the letters that she typed on behalf of the GPs. Any letters typed by the senior secretary would have been referenced with her initials “LS”. The senior secretary also omitted her reference from the GPs’ statements, which were in response to my formal complaint and contained false assertions that Robbie had been referred back to Dr Forbes.

23rd November: I examined the original GP medical records at the offices of West Glamorgan FPC and established that the photocopies that were provided to me the day before corresponded with the originals now in the GP records and that they had obviously been falsified. I subsequently requested a second copy of the medical records requesting that each page be signed and dated to avoid any future misunderstandings regarding the content of the originals.

I visited the Health Centre again and accused Dr Keith Hughes, who had initially brought the medical records to my home on the 20th April, of falsifying the discharge documents and in particular the reference to Addison’s disease. I informed Dr Hughes that a copy of the referral letter was not in the GP records when he called at my home, after Robbie’s death, on the 20th and 23rd April but obviously should have been, had the referral letter been typed on the 12th April, before Robbie had died. Dr Hughes accepted that a copy of the referral letter was not in the records and confirmed this in writing at my request.

I asked Dr Hughes who had typed the referral letter and he confirmed that it was the junior secretary. I formally requested that Dr Hughes provide a statement from her as to the circumstances in which the referral letter had been typed.

26th November: I called at Morriston Hospital to examine Robbie’s original Morriston Hospital medical records. I was shown the records by Dr Forbes who I had met on the 25th May with my wife. After examining the records it was now obvious that the original discharge documents had been removed from both the hospital and GP medical records and substituted. Notably there was not a referral letter in the hospital records from Dr Williams to Dr Forbes, the Discharge Notification was missing and other documents including Dr Flower’s referral letter, regarding the day of death, was also mysteriously missing suggesting collusion between the hospital and the GPs. I asked Dr Forbes to locate the letter referring specifically to his suspicion of Addison’s disease, which I had seen on the 25th May 1990, but he was unable to find it. In the presence of a witness, I accused Dr Forbes of falsifying Robbie’s medical records. I subsequently requested a copy of the hospital records directly from Dr Forbes.

In the absence of a referral letter from Dr Williams, within the hospital records, it is difficult to understand, and very suspicious, in my view, as to why Dr Forbes would send me two letters suggesting that a referral letter actually existed in the hospital records. It is believed that Dr Williams’s referral letter was placed in the hospital records when all 5 GPs secretly met Dr Forbes following Robbie’s death when they also removed and substituted the discharge documents. However, when I challenged Dr Forbes three times subsequently and reminded him he had stated, 4 weeks after Robbie’s death, that he had not received a referral letter from Dr Williams, it is believed that he gave the referral letter back to the GPs, thus the reason why there are now two referral letters in the GP records and a sealed envelope.

The second concocted story may have been that the sealed envelope, containing the signed referral letter, had been misplaced at the health centre and therefore not sent, without the knowledge of the GPs, at the time, the GPs’ provided their statements claiming that Robbie had been referred back to Dr Forbes. However, if the second concocted story was true, then the copy of the unsigned referral letter, dated 12th April, would have been in Robbie’s GP medical records when the Reverend Thomas and I examined them on the 20th and 23rd April.

5th December 1990: I received a signed statement from the senior secretary admitting she had typed the referral letter seven days after Robbie’s death and not the junior secretary as claimed by Dr Keith Hughes. The senior secretary had been on annual leave before and during the Easter Bank Holiday and therefore could not have typed the referral letter on the 12th April. She was now claiming that the referral letter was typed two days after Robbie’s death and only backdated to keep Robbie’s medical records chronologically correct. However, if this was true:

·  Why did the GPs claim on numerous occasions, in statements typed by the senior secretary, dated 20th July that Robbie had been referred back to Dr Forbes, if they were going to admit subsequently that the letter was typed after death, backdated but not sent?

·  Why did the senior secretary backdate the referral letter if she was aware that it was only typed for the record and would not be sent? 

·  Why did the senior secretary omit her reference from the referral letter to make it look as if the junior secretary had typed it if there was no intention to deceive anyone?

·  It came to light subsequently that the senior secretary had initially asked the junior secretary to say she had typed the referral letter. However, when I called at the Health Centre and accused Dr Keith Hughes of falsifying the medical records, on the 23rd November 1990, it was overheard by health centre staff, which resulted in the junior secretary telling Dr Hughes that she would not be lying about being the typist of the referral letter.

·  Why did the GPs put two referral letters in Robbie’s medical records, one signed and an envelope addressed to the Appointment Officer Morriston Hospital, if the letter was only typed for the record and would not be sent?

·  Why was the envelope sealed and then torn open?

·  Why did the senior secretary omit her reference from the GPs’ statements if there was no intention to deceive me and others with regards to the referral letter?

·  Why did Dr Forbes feel compromised in confirming, in writing, that he had not received a referral letter from the GPs if one did not actually exist at the time he was responding?

It was my intention to raise all the above anomalies and untruths at the forthcoming Medical Services Committee hearing, which was arranged for the 13th December 1990.

To be continued.

Will Powell

NHS Adviser for Mistreatment.com