ULTRA VIRES, AND VISITING RIGHTS – LINCOLNSHIRE PARTNERSHIP TRUST PLEASE NOTE
With heavy restrictions still in place extended incorporating Xmas, Lincolnshire Partnership Trust clearly are not up to date with the law – see below:
Visiting Report December 2023
It is all very well and good to go down the legal route and ban visitors but in the event of this, what should be in place is an alternative. Yes LPFT or any other Trust should provide alternative arrangements/somewhere else where Elizabeth can meet myself or any other family members if they are not allowed onto ward premises .
I am now banned for a further two weeks, given only 1 hour supervised only on Xmas Day, total breach of Art 8 and even Xmas Day and religion is not respected under LPFT. Another unsigned letter came via email attachment stating the restrictions would be continued agreed by the MDT and I would say to LPFT they need to rewrite their whole policy as they are clearly out of date with everything. I am sure the law has changed in this respect and I will write about this another time. No longer can the Bolam test be applied.
I am actually now thinking more and more that I myself am a victim of ultra vires acts and therefore I would be justified to take out a Judicial Review.
I reassured Elizabeth I would go to any lengths to do what is necessary to bring about accountability and look at the way staff are acting ultra vires whilst the Trust do nothing to intervene. They have done nothing but completely abuse the law and in particular MHA, MCA and HRA law.
Important Case Law on Denying Patients the right to order food and have food parcels externally
The other day Elizabeth told me that she was refused ordering food by Elizabeth, a nurse on the ward. She was starving hungry as she has once again been missing meals on Castle Ward and a ban was in place as punishment for being hostile, meaning she could not go out at all. It is important for members of staff to know about the law and that the following is all about denying patients the right to have food parcels and to order food from outside. If Elizabeth is allowed to miss meals she is not going to feel her best what do they expect! On the first occasion it became evident I was banned I had brought a meal for Elizabeth to make up for not being allowed out to the Carlton Centre with myself and a friend. I was told quite clearly that there was no way food could be allowed onto the ward as staff did not know where it ha come from and this could have been proven of course. Not only did ill-informed nursing staff turn away the meal I brought as a consolation for missing her s17 leave, they did not have a clue about the law and here it is below – Here is another interesting piece for LPFT to study and to review their whole policy in line with the latest or they could have to bear the consequences.
L v Board of State Hospital (2011) CSOH 21; 2011 SLT 233 - the hospital had been ultra vires in denying patients the right to have food parcels and to order food from outside.
A consultation argument succeeded in the unusual case of L v Board of State Hospital [2011] CSOH 21; 2011 SLT 233 where a decision of the board of the state hospital placing restrictions on patients’ food and drink fell to be reduced as the board had failed to consult the patients as required in terms of the Mental Health (Care and Treatment) (Scotland) Act 2003 s.1. Limitations arose from the nature of the hospital, but only did so because they were justified in terms of the European Convention on Human Rights 1950 Art.8(2): the loss of control over those aspects of life which would otherwise be under a person’s sole and direct control were all concominants of the justifiable deprivation of liberty which followed on imprisonment or detention in the state hospital.
The board decided that visitors would no longer be allowed to bring food parcels for patients, and patients would no longer be allowed to order food from outside sources, other than one take away meal a month. The ultimate reason for recommending the changes related to patients’ health, and issues with obesity. L sought reduction of the decision on the basis that the board had failed to consult the patients as required in terms of the Mental Health (Care and Treatment) (Scotland) Act 2003 s.1, and, it being a public authority for the purposes of the Human Rights Act 1998, the decision constituted a breach of L’s rights under the European Convention on Human Rights 1950 Art.8. The board relied on the notification of changes to the availability of snacks and refreshments at a single meeting of the Patient Partnership Group (PPG), attended by 12 patients, and an email from the hospital’s lead dietician (D) referring to the response of patients when asked about the nature of items they purchased from the hospital shop, and the reason for their purchase.
L submitted, inter alia, that interference with his right to choose what to eat and to restrict what had otherwise generally been available to him was an interference with his right to respect for his private life and home, and the exception based on the protection of health and morals did not entitle the board to act as it had, as that referred to action necessary for protection of public health in general.
Lady Dorrian decided that the board had not been entitled to reach the decision.
(1) From such consultation as had taken place, it appeared that patients had been opposed to restrictions on external purchasing but their views had not been recorded or presented to the board prior to its decision. Moreover, it had been recorded that patients felt that visitors should continue to be able to bring in parcels.
(2) There was no indication that D had advised patients of the proposals which were being considered, or that she had asked them to give their views thereon.
(3) The PPG meeting had failed to have an opportunity to consider the actual proposals made to the board in relation to visitors. The recommendation put to the meeting was simply that visitors should not be allowed to bring food into the hospital, and the rationale for that was said to be infection control and storage space, which was an explanation that played no part in the board’s decision. Further, it appeared that the issues discussed on external purchasing related to limits on spending rather than an outright ban.
(4) It was highly questionable whether even such feedback as was obtained was properly put before the board and, in any event, such consultation did not enable patients to consider and to comment on the three options eventually put to the board regarding visitors. The option selected by the board in relation to purchasing did not appear to have been put before patients at all. Accordingly, the board had failed to consult as required by the legislation, and its decision fell to be reduced.
(5) The opinion was expressed, that (a) although the state hospital was L’s home, it was not and could not be treated as equivalent in all respects to a private home, and while limitations did arise from the nature of the place, they only did so because they were justified in terms of Art.8(2). The loss of control over those aspects of life which would otherwise be under a person’s sole and direct control were all concominants of the justifiable deprivation of liberty which followed on imprisonment or detention in the state hospital, R. (on the application of G) v Nottinghamshire Healthcare NHS Trust [2009] EWCA Civ 795, [2010] P.T.S.R. 674 considered; (b) a person’s right to choose what they ate and drank was a matter in respect of which Art.8 was engaged, and the general restrictions which applied in the state hospital prior to the board’s decision were justified.
Thus, the additional restrictions which the board sought to impose had also to be justified, but it was unnecessary to pass further comment on the matter with regard to the views expressed by the court on the lack of consultation, except to say that a health reservation under Art.8 did not have to refer to public health. In general, it was perfectly capable of applying where one particular section of the community which required protection had been identified.
MISSING MEALS
I complained about this two weeks ago and still it continues on a regular basis. Tonight Elizabeth told me she had not had either breakfast or lunch. She suffers extreme tiredness and has no quality of life thanks to LPFT. She also told me about the prone restraint and this is life threatening by either 3 or four men. I am quite disgusted. She then spoke about the CTR and that there were two ladies who concluded there and then she is in the right place in hospital. I asked Elizabeth to find out who these two ladies were as it would appear that the CTR has not been carried out correctly as it was finally done in Enfield and that is the reason why no-one in the family was invited. Her advocate from Voiceability was there but how comes they could put words in my daughter’s head and say “Castle Ward is the right place for her to be” or words to this effect. In my opinion it is the wrong place for anyone to be as there is nothing done correctly in terms of procedures, in terms of law, guidance and even their own Policy.
Research on Missing Meals:
“The researchers continued to fast mice for up to 24 hours, and then reintroduced food. The cells hiding in the bone marrow surged back into the bloodstream within a few hours. This surge led to heightened level of inflammation. Instead of protecting against infection, these altered monocytes were more inflammatory, making the body less resistant to fighting infection”
This should tell the clinicians at the PHC that missing meals is very bad for people with psychiatric disorders, however they were originally induced. Not that they listen!
Note heightened levels of inflammation again:
We already know that inflammation in the brain not only causes psychotic symptoms by interfering with neurotransmitter pathways but that it can block the receptors targeted by neuroleptic medication.
Missing meals also causes blood sugar fluctuations that can also cause psychotic symptoms. This, along with Elizabeth’s already established P450 deficiencies will create havoc with her state of health and with the ability of the drugs to work at target sites.
“The researchers continued to fast mice for up to 24 hours, and then reintroduced food. The cells hiding in the bone marrow surged back into the
bloodstream within a few hours. This surge led to heightened level of inflammation. Instead of protecting against infection, these altered monocytes were more inflammatory, making the body less resistant to fighting infection”
Clinicians at the PHC need to be aware that missing meals is very bad for people with psychiatric disorders, however they were originally induced.
Note heightened levels of inflammation again. We already know that inflammation in the brain not only causes psychotic symptoms by interfering with neurotransmitter pathways but that it can block the receptors targeted by neuroleptic medication. Missing meals also causes blood sugar fluctuations that can also cause psychotic symptoms. This, along with Elizabeth’s already established P450 deficiencies will create havoc with her state of health and with the ability of the drugs to work at target sites.
The practice of constantly giving her prn medication while allowing her to miss meals is ridiculous. If she was properly fed and hydrated this would probably not be necessary at all. Any nutritionist will tell you that missing meals interferes with the body’s ability to function and any pharmacist who is aware that the patient is not properly nourished will take that into account when advising on medication. They presumably are not bothering to tell the pharmacist that she is not eating.
The P450 cytochromes are activated or induced by food. A patient who is not eating will become a poor metaboliser. Elizabeth already is a poor metaboliser of the medications they are giving her, missing food can make that worse. Then in their usual ‘style’ instead of tackling the problem the attack the symptom with more prn. It is beyond foolish to allow a psychiatric patient to go under nourished. They should ensure that she consumes food at sufficient levels in every 24 hour period.
Cytochrome P450 induction properties of food and herbal-derived compounds using a novel multiplex RT-qPCR in vitro assay, a drug–food interaction prediction tool
Xue Fen Koe,1 Tengku Sifzizul Tengku Muhammad,2 Alexander Shu-Chien Chong,1,3 Habibah Abdul Wahab,1,4 and Mei Lan Tan1,5
Drug–food interactions or drug–nutrient interactions are gaining much attention recently as such interactions have the ability to influence patient outcome. These interactions need to be recognized, understood, predicted, and then managed as necessary as drug–drug interactions (Boullata ). Drug–food or drug–nutrient interaction is considered clinically significant if it alters therapeutic drug response and/or compromises nutrition status (Boullata and Hudson ; Boullata ). The severity of drug–food interactions can vary the same manner as drug–drug interactions. Specific food and nutrients are known to elicit changes in drug absorption, distribution, metabolism, and elimination (ADME) properties, often through specific mechanisms, and affecting the components of drug metabolism enzymes is common. For example, furanocoumarins from grapefruit juice such as bergamottin can cause irreversible inhibition of the cytochrome P450 enzyme, CYP3A4, mainly in the small intestine (Lown et al. ; Pirmohamed ).
Fasting-Induced Changes in Hepatic P450 Mediated Drug Metabolism Are Largely Independent of the Constitutive Androstane Receptor CAR
· E. M. de Vries ,L. A. Lammers,R. Achterbergh,H-J Klümpen,R. A. A. Mathot,A. Boelen,J. A. Romijn
Hepatic drug metabolism by cytochrome P450 enzymes is altered by the nutritional status of patients. The expression of P450 enzymes is partly regulated by the constitutive androstane receptor (CAR). Fasting regulates the expression of both P450 enzymes and CAR and affects hepatic drug clearance. We hypothesized that the fasting-induced alterations in P450 mediated drug clearance are mediated by CAR.
Impact of fasting followed by short-term exposure to interleukin-6 on cytochrome P450 mRNA in mice
Martin Krøyer Rasmussen a, Lærke Bertholdt b, Anders Gudiksen b,
Henriette Pilegaard b
, Jakob G. Knudsen b
The gene expression of the cytochrome P450 (CYP) enzyme family is regulated by numerous factors. Fasting has been shown to induce increased hepatic CYP mRNA in both humans and animals. However, the coordinated regulation of CYP, CYP-regulating transcription factors, and transcriptional co-factors in the liver linking energy metabolism to detoxification has never been investigated. Interleukin-6 (IL-6) has been suggested to be released during fasting* and has been shown to regulate CYP expression
Prone Restraint given by several Men 15.12.2023
Apparently Elizabeth refused the Clopixol depot today so 3-4 men pinned her face down to inject her. This is supposed to be her “treatment” under the MHA but what about the rest? Only a fraction of the quantity of drugs were prescribed under previous area and therefore no need to forcibly inject other drugs on top such as Procyclidine. Then on top of this are frequent rapid tranquilisations. Take a look at the article below. I have specifically asked CQC to check on the RT CP11 log. Also I do not think proper monitoring is going on.
A Questionable CTR
Elizabeth told me she had a CTR a couple of days ago but it sounded nothing whatsoever like a CTR. It was supposed to have an independent Chair and Elizabeth was supposed to have independent support. None of this was given. A nurse from the MDT was involved in supporting Elizabeth but at one point she told me she was just given a piece of paper to write on. Not one single member of the family were included and that would be my replacement NR who happens to be my younger daughter. Why wasn’t she invited at least. The conclusion of the CTR was that it was concluded that the best place for Elizabeth was on Castle Ward however this is even more questionable when every law has been abused by them and nothing has been followed correctly. Elizabeth told me CQC were on the ward but what are they doing about all of this – you never get to hear the outcome unless an institution is closed down because of total malpractice but this is what I see is going on under LPFT and it is all well and good the message being given “we take your complaint seriously”. Well how comes then this dreadful situation has gone on for over two years now under this DREADFUL area.
Whatever they think of me there is still such a thing as Duty of Care:
Here are just some of the NMC’s (Nursing Midwifery Council) guidelines/code of practice:
- Treat people as individuals and uphold their dignity. To achieve this you must Supervised calls/visits/banning visits??? (even when instructed why isnt this questioned?)
1.1 Treat people with kindness, respect and compassion. (Not kindness to punish someone by telling them you can no longer go to the shop in the grounds)
1.5 Respect and uphold people’s human rights (no-one has a clue about human rights yet continue to carry out their “duties” of a very questionable nature but for not wanting to challenge and no doubt the consequences under an area where there is no accountability.
3.4 Act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care. Poor practice is rife under LPFT and discrimination also rife and yet this has been going on for over two years now without any question.
4.4 Tell colleagues, your manager and person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care How many would dare to do that under LPFT where I have received nothing but bullying but I suppose this may be an explanation as to why several male nurses stepped in to forcibly give the depot today under prone restraint. I very much doubt they even bothered to check for blood oxygen levels or vital signs. This was the clopixol depot and Elizabeth had refused it on this occasion. Why though are other drugs being administered on practically a daily basis with several “nurses” pushing her up against a wall. The other drugs are not part of the treatment under the MHA. To think CQC SOAD agreed all of this well if the effect is that Elizabeth is too tired to move to get out of bed for breakfast and for lunch something needs to be done and the CQC SOAD need to look at the whole picture and come back and do something about this as this SOAD is clearly not taking into account Elizabeth’s physical health.
5.5 Share with people, their families and their carers as far as the law allows the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand. A CTR should have included family members or at least the NR but not under LPFT. The Tribunal also went on in secret. It is the worst experience of my life and I have seen at first hand how carers are treated if you dare to raise concerns which I did not do for a very long time.
16 Act without delay if you believe that there is a risk to patient safety or public protection to achieve this you must:
16.1 raise and if necessary escalate any concerns you may have about patient or public safety or the level of care people are receiving in your workplace or any other health and carte setting an use the channels available to you in line with our guidance and your local working practices. Not sure whether anyone bothers to raise concerns apart from me and several other patients at the former hospital of Ash Villa. If things go wrong I can visualise staff sticking together to protect one another.
16.3 tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of concern if you can
17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse. I have not seen anything other than supporting each other to protect one another as in MDT where over 30 people are invited.
20.2 Act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment this must be difficult to implement in an area where I myself have experienced ruthlessness and if you say or do something they do not like they use punishment.
24.1 Keep to the laws of the country in which you are practising
Treat people in a way that does not take advantage of their vulnerability or cause them upset or distress to take away a vulnerable’s person’s phone so they can no longer listen to their music, to deprive her from seeing photos of her cat and two weeks punishment for supposedly being hostile - it has caused distress without any doubt.
never allow someone’s complaint to affect the care that is provided to them. Now this is an interesting point as I feel that the punishment dished out is aimed at me inflicting upon Elizabeth – how on earth can it be good for any vulnerable person to be cooped up on a ward 24/7 that is noisy, no psychological input and no encouragement to venture outside of what I can only call a prison.
Below is an interesting piece about Nursing staff mistreating vulnerable people – this seems to go on a lot and especially under the MH where a vulnerable patient can be drugged for no reason other than the convenience of nursing staff and when inspectors go onto the ward the first thing they should check is the CP11 RT log and go and speak to the patient instead of listen to a group of professionals who will stick together in the event of any adverse occurrence no matter what.
There has been substantial abuse to my vulnerable daughter over a period of over two years now and nothing whatsoever has been done about it. It makes you wonder how the current section can possibly be lawful by the way my daughter has/is being held. With such heavy restrictions it is no wonder patients ask to go to prison. If Responsible Clinicians do not know the law and decide that they will go down the legal route and use this as a form of punishment then this is impacting on a vulnerable person’s wellbeing and this is what I wish to contest. It also has a knock-on effect on the physical health of the family involved who have trouble getting through on the ward.
Unless very bad reasons for banning the person who has ultimate responsibility should know the law and be aware of human rights law and weigh up the benefits of such restrictions.
The Responsible Clinician in this case states that Elizabeth is a free thinking person so from that they secretly recognise that Elizabeth has capacity but in order to control her and make decisions they have to rely on three completely flawed not fit for purpose capacity assessments done for another court case that was not even relevant. These were all done dishonestly so as to take control of Elizabeth’s life and try and send her the other side of the country so they can sever contact as I suppose this is a stepping stone in the severance of contact and completely unlawful.
There are so many other cases like mine where Xmas this year will be a very sad occasion and this is why I want to get the word out there to everyone affected that a few days ago this paper has come into effect:
Visiting Report December 2023
Just to reflect this has been the “appropriate care” provided under LPFT of practically daily injections and prone restraint by several men and missing meals evident at Ash Villa too, as well as banning visits and taking away the phone. It is not just the Oliver McGowan training they need but also on the MHA, the MCA and HRA and also medical ethics.
5 institutions – one out of area: namely Charlesworth Ward, Ash Villa, Cygnet Durham, Ward 12 and now Castle Ward.
Here are the Doctors employed/were employed under LPFT:
Dr Ismail
Dr Shahpasandy
Dr Ismail again
Dr Kumar
Dr Islam
Dr Suleman
Dr Greenall
Dr Memons This Doctor employed by Cygnet spoke nicely to me and seemed concerned for physical health
Dr Khokhar
Psychiatric Abuse UK 