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A summary of the case of Robbie Powell - by Will Powell

Robbie Powell died at the age of ten on the 17

April 1990 of a treatable condition calledAddison’s disease which, unknown to his parents, had been suspected four months before hisdeath, when he had been an inpatient at Morriston Hospital, Swansea. The ACTH test toconfirm the diagnosis was ordered by the hospital consultant [Dr William Raymond Forbes] but not performed. Addison's disease invariably results in death without treatment; however, if treated, the patient can live a full and normal life. The hospital informed Robbie’s GPs of thesuspicion of Addison’s disease, by letter, and requested immediate referral if the child had arecurrence of, amongst other things, vomiting and/or abdominal pain.Between the 2

and 17

April Robbie was seen by five GPs from the local Health Centre onseven separate occasions [that is, on 2

[Dr Elwyn Hughes], 6

[Dr Nicola Flower], 11

[Dr Mike Williams], 15

[Dr Paul Boladz], 16

[Dr Keith Hughes] and twice on the 17

[Dr Nicola Flower]. In the 2 weeks leading to Robert's death he had been vomiting [acharacteristic symptom of Addison's disease which had led to his initial hospital admission],was so weak he couldn't walk unassisted and had excessive weight loss, due to severedehydration. On the day he died the child had dilated pupils and central cyanosis when heregained consciousness after fainting, while his mother assisted him to the toilet. In the lightof these symptoms and the several earlier consultations a GP [Dr Nicola Flower] refusedhospital admission on her first visit on the day of death. On her second visit she again refusedhospital admission but eventually agreed to do so following a heated argument. However, thePowells' request for an ambulance was refused. On arrival at the hospital, Mr Powell watchedhis youngest son take his last conscious breath. Robert was declared dead shortly afterwards.The hospital reported Robbie’s death to the Swansea Coroner [Mr J R Morgan] and a pathologist [Dr Susan Williams] employed by the health authority that would subsequentlyadmit negligence and liability, for Robbie’s death in 1996, in civil proceedings, was instructed by the Coroner to perform the post mortem. The pathologist omitted from the post mortemreport that Robbie had been suspected of Addison’s disease, the previous December, and thatthe test to confirm the disease had been ordered by the hospital consultant but not carried out – had it been Robbie would not have died. The pathologist also misrepresented Robbie’sexternal appearance by stating that he appeared normally nourished when his condition onarrival at hospital was subsequently described by the doctor, who treated him, as being like achild from a ‘concentration camp’. Robbie had suffered two heart attacks because of criticaldehydration – the second being fatal. Robbie didn’t die because he had Addison’s disease - thechild died because the GPs, in the days leading to his death, failed to recognise a child withcritical dehydration notwithstanding they recorded weight loss.The Coroner failed to have preliminary inquiries notwithstanding the Powells alleged medicalnegligence and had formally requested an inquest. Based solely on the flawed post mortemreport the Coroner decided that Robbie’s death was natural causes and the Powells’ requestfor an inquest was refused. It took the Powells ten years of pressurising the Coroner and a

Fiat

from the Attorney General before the Coroner agreed to open an inquest. The inquest wasopened and adjourned in December 2000 pending the conclusion of a third criminalinvestigation by an independent police force. The inquest did not take place until January2004 [see below]. On the day the inquest was open and adjourned, this being almost 11 yearsafter Robbie had died, the Coroner, Mr J R Morgan, asked Mr Powell if he had anything tosay. Mr Powell responded, “Has the circumstances of Robbie’s death changed in any waysince the night he died?” Mr Morgan said, “No”. Mr Powell then said, “Thank you”.

It is the Powells’ contention that if the Coroner had adequately performed his duties the truthabout the negligent circumstances, leading up to Robbie’s death, would have come to light atthe inquest, which should have taken place in 1990. Furthermore, had the Coroner adequately performed his duties and forthwith secured Robbie’s original GP and hospital medical recordsthey would not have been subsequently falsified in the way that they were.On the 20

April 1990, three days after Robbie’s death, the Powells were informed by theCoroner’s office that Robbie had died of Addison’s disease. Dr Keith Hughes came to thePowells’ home to explain in more detail the result of the post mortem. Mr Powell wasdevastated to learn, after reading Robbie’s GP medical records, that Addison’s disease had been suspected the previous December and that it was falsely claimed the parents had beentold that an ACTH test was necessary – this test would have confirmed that Robbie hadAddison’s disease and he would have received the appropriate treatment that would havesaved his life by preventing the subsequent critical dehydration. A further letter also statedthat the GPs should re-refer Robbie immediately back to hospital if he had a recurrence of vomiting and abdominal pain and the GPs had clearly failed to do so. Mr Powell was soconcerned about this information and particularly the pre-death suspicion of Addison’sdisease, and the GPs’ failure to carry out the consultant’s instructions to re-refer Robbie, thathe asked his closest friend to witness and contemporaneously note the GP medical records.Mr Powell took the view that the GPs, in the light of this information, had no defencewhatsoever to their negligence. Mr Powell was advised by his friend to ask someone whollyindependent and, as a consequence, the local vicar agreed and the relevant content of Robbie’sGP medical records were witnessed and contemporaneously noted six days after Robbie’sdeath.It was established that only one GP had actually read Robbie’s GP medical records. This GP[Dr Mike Williams], on the 11

April [six days before death], informed the Powells that hewould refer Robbie immediately back to the hospital. However, he failed to do so, and theletter was typed post death and backdated. It was later accepted [by the police and the CPS]that this letter was backdated to mislead the reader into to believing that the referral had beenmade and the content of the letter was also fabricated.It was also established some years later that the GP’s consultation notes, regarding the day of Robbie’s death, were not written until weeks after the child’s death and were later establishedto be forgeries. The GP [Dr Nicola Flower] admitted under police caution that the notes werenot written until approximately 8 weeks after Robbie’s deathThirteen days after Robbie’s death the Powells made a formal complaint through the NHScomplaints procedure because the senior partner [Dr Keith Hughes] of the health centre hadrefused Mr Powell’s request for an investigation. A Medical Services Committee [‘MSC’]found nine months later that four of the GPs had not been in breach of their terms of service, but that the GP who had seen Robbie twice on the day of death had been. Dr Nicola Flower was told to conform to her terms of service in future, which was the minimum reprimand. The proceedings were a complete whitewash and the evidence of the Powells and that of their witnesses was completely ignored. The Powells’ allegation regarding the post deathfalsification of Robbie’s medical records, which was subsequently accepted by the police andthe CPS, was also ignored. The MSC members, as well as the Chairman [William Glyn Rees -a Magistrate] when shown evidence by the police in 2001, regarding the falsifying of Robbie’s medical records agreed that the GPs had deceived them in 1990.

The Powells made several very serious complaints to the Health Service Ombudsman but itwas claimed that the complaints were outside his jurisdiction. When Mr Powell requested allthe documents related to his case, under the Data Protection Act, from the Ombudsman’soffice, in 2000, he was shocked to find out that derogatory comments had been made abouthim. For example it was stated that I do not tell the truth, that I withhold information, that Iam vindictive, an alley cat, caveman, bully, aggressive and loud. Although the thenParliamentary Ombudsman, Sir Michael Buckley, declined to comment on these inappropriatecomments about me I received a personal and a written apology from his successor. AnnAbraham stated in a letter dated 26

October 2004,

“The comments made about you personally ain the files by some of the Ombudsman’sofficers were highly judgmental, inappropriate and entirely unacceptable. I can offer youmy sincere apologies for that. In my view they demonstrated a deplorable lack of sensitivityand understanding by those concerned, all the more so given the very difficult and painful circumstances which had led to your complaints.”

The Powells appealed to the Secretary of State for Wales against the MSC’s decision and ahearing was listed for three days in March 1992. However, due to lack of time, the appeal wasadjourned for six months. At the reconvened hearing it was established that Robbie’s GPmedical records had gone missing from the Welsh Office and had been tampered with by theaddition of further medical notes, which originated from the respondent GPs, but had not been present or disclosed to either the Powells or their legal team previously. As a consequence of the appeal chairman’s refusal to adequately investigate this matter or call in the police thePowells were forced to withdraw from the appeal as they had lost all confidence in itsindependence. Although the Welsh Office had received Robbie’s GP records, by recordeddelivery, directly from the Powells’ forensic document examiner, a week

before

the appealhearing started in March, the Welsh Office denied receipt, and continued to do so for threeyears. Furthermore, the Secretary of State for Wales falsely denied receipt of the GP recordsin a Parliamentary Question in 1995. The receipt of the GP medical records was only acceptedafter the Powells submitted irrefutable evidence. It came to light subsequently that therespondent GPs and/or their legal team had at least one clandestine discussion with one or more of the appeal panel in March 1992.Following the Powells’ withdrawal from the appeal they complained about the WelshOffice to the Parliamentary Ombudsman, via their MP, but were told that a complaint of maladministration against the Welsh Office was outside his jurisdiction. However, five yearsafter the appeal the Parliamentary Ombudsman agreed to investigate the Powells’ MP’sfurther complaint that the Secretary of State for Wales [John Redwood] had falsely answereda Parliamentary Question. Seven years after the actual withdrawal from the appeal the WelshOffice was found guilty of maladministration and criticised for causing the collapse of theappeal. The Powells were awarded £500 compensation and the Welsh Office was ordered toreimburse the Powells legal costs, which were substantial. However, the Welsh Office refusedto reconvene the appeal hearing claiming there was no provision in law to do so. As with theMSC members the Welsh Office panel also subsequently informed the police that they had been deceived by the GPs.As a consequence of the cover up by the NHS investigating authorities the Powells, in April1993, with the support of public funding, issued writs against both the health authority and theGPs for negligence and causation.