Book Reviews - Murders/Suicide at WHF

[-Harters-]

It would be less than accurate to assume that medical note are always accessed, let alone digested, and ensuring that a patient FEELS cared for goes a long way in the healing process. I still feel it unacceptable that a gp who had no knowledge of her patient saw fit to countermand the advice of a gp who did and who subsequently presented it to the patients consultant as a fait accomplis..........and on that note I'll wish you a pleasant evening and say good-night.

Again, I'm not seeing a problem, either by coincidence or by qualified diagnosis, Dr Wilkinson prescribed exactly the dose that the specialist consultant stated should be given.

The continuity of care was provided by her medical notes and also the fact that Wilkinson reported to Sheilas regular GP, who clearly felt the care given was appropriate.

I know what you are all trying to say, but it doesn't work, it's the old chicken and egg scenario.

You want to say that Sheila had an episode/relapse on the night in question, the reasons for this being that her medication was incorrectly lowered. You're alluding to her episode/relapse as evidence that her medication was inappropropriately reduced.

My problem in the first instance, is that we have no evidence that Sheila had an episode/relapse, only the word of a convicted multiple murderer.
The next problem I have, is that regardless of forum members views, three qualified medical professionals all agreed that the dosage of medication and level of care was appropriate. Their expert opinion cannot simply be dismissed, and so the reduction of medication cannot possibly be blamed for causing something which there is no evidence that it even took place.

[mertol22]

Even if that was true there remains a issue , why was Sheila more or less silent on the drive up that day ?

[Bridget]

Good morning -The Jam-

Patient treatment is a two way thing: professional giving and patient taking ie accepting and complying.

Dr F: "She was always a difficult and erratic patient failing to keep appointments, heed advice or take
         medication".

-The Jam - "Point taken about missing appointments".

                 "However it remains the case that she was appropriately treated for her condition, there is
                  nothing which indicates otherwise".

Sheila received appropriate advice and medication but she failed to keep appointments, heed the advice given and take the medication prescribed. As a result of Sheila's non-compliance her treatment was inappropriate for her needs.

(- = top of members list. Accident of design?)

Morning Egap

Is the bit in red your opinion or did one of the doctors say that (I'm getting confused!)? If it's your opinion, in what way do you think her missing some appointments etc affected the appropriateness of her treatment?

[susan]

Morning Bridget  nice to see you thought you and Patti had run away

[lebaleb]

I must disagree with you Jam, There is evidence. Sheila was behaving strangely as indicated by Pamela Boutflour's statement that she spoke with Sheila who just answered yes or no and then left without saying goodnight. June then expressed concern over Sheila's health and was trying to persuade her to go for a 'holiday' in a home in Bornemouth.
I have personal experience and know that the use of these drugs is a fine balancing act, changes in levels of medication can trigger psychotic episodes. Doctors are not infallable. Patients need to be monitored closely and frequently have their medication adjusted.

[Jane]

Again, I'm not seeing a problem, either by coincidence or by qualified diagnosis, Dr Wilkinson prescribed exactly the dose that the specialist consultant stated should be given.

The continuity of care was provided by her medical notes and also the fact that Wilkinson reported to Sheilas regular GP, who clearly felt the care given was appropriate.

I know what you are all trying to say, but it doesn't work, it's the old chicken and egg scenario.

You want to say that Sheila had an episode/relapse on the night in question, the reasons for this being that her medication was incorrectly lowered. You're alluding to her episode/relapse as evidence that her medication was inappropropriately reduced.

My problem in the first instance, is that we have no evidence that Sheila had an episode/relapse, only the word of a convicted multiple murderer.
The next problem I have, is that regardless of forum members views, three qualified medical professionals all agreed that the dosage of medication and level of care was appropriate. Their expert opinion cannot simply be dismissed, and so the reduction of medication cannot possibly be blamed for causing something which there is no evidence that it even took place.

Good Morning Hartly, I hope you are feeling rested. My own take on what you say is as follows:-
Paragraph 1 & 2
Dr f. didn't advice the 100mg dose. He concurred with aprocedure already set in motion. Dr A. suggested 150mg. He, undoubtedly would have concurred with that, too
Dr W. reported back to Dr A. AFTER she had countermanded her decision.

Paragraph 3
Hartly, it may surprise you to know that when I first noted the adjustment of meds, my immediate thought was "No! Not again." I know somebody with a scizophrenic son. Reduction in his meds has led to him forgetting to take any meds, going missing, attacking his mother. At this point it is NOT just about Sheila. These things happen. My genuine belief is that whatever "episode/relapse" Sheila suffered, it did not start at WHF. It started the moment the decision was hake to halve her meds. From that moment, there was a question mark about her future.

Paragraph 4
You are correct. Like many other factors surrounding this tragedy, there is no proof. I agree that "three qualified medical professionals" agreed the dosage and level of care was appropriate, but it was said AFTER the event.

In a world inhabited by humans, mistakes occur. In a world in habited by medical professionals, mistakes can have disastrous consequences. They can be fatal. I'm not saying that THIS is what occured. I'm saying that this is what MAY have occured, and incidentally, had Sheila been a member of my own family, on discovery of what had been done with her meds, I would have made enough noise to make those concerned sit up and take notice.

[Bridget]

Morning Bridget  nice to see you thought you and Patti had run away

Morning Susan, nice to see you too

[Bridget]

Good morning Bridget

They are indeed my own words  .  If a patient fails to keep appointments, heed advice or take prescribed medication, non-compliance will affect the appropriateness of the treatment plan.  It will be either less or totally ineffective otherwise why would the medical professional provide the advice and prescribe the medication in the first place? 

I agree that it may affect the approriateness, but it's not automatic. Sheila was taking the prescribed medication for schizophrenia, it was administered by injection.

I agree with Hartley's chicken and egg analogy, there is no evidence that Sheila had an 'episode' that night at all. It just doesn't work for me to start with the assumption that Sheila must have killed her family, deduce from that that she must have had an epsiode, and then find reasons for why she must have had an episode - that's back to front to me!

[-Harters-]

Good morning -The Jam-

Patient treatment is a two way thing: professional giving and patient taking ie accepting and complying.

Dr F: "She was always a difficult and erratic patient failing to keep appointments, heed advice or take
         medication".

-The Jam - "Point taken about missing appointments".

                 "However it remains the case that she was appropriately treated for her condition, there is
                  nothing which indicates otherwise".

Sheila received appropriate advice and medication but she failed to keep appointments, heed the advice given and take the medication prescribed.  As a result of Sheila's non-compliance her treatment was inappropriate for her needs.

(- = top of members list. Accident of design?)

Morning egap,

I understand what you are saying, but I don't see it that way. It's argumentative at best and pure speculation at worst.

It's also a marked change of view from the original suggestion that Sheilas care was inappropriate due to the lowering of her medication by a qualified medical professional.

I'll go further by saying that you have no idea what, if any, repercussions were caused by missing appointments or not heeding advice. You are certainly unable to arrive at any conclusion from the contents of these witness statements alone.

On the other hand, Sheila was assessed by a GP who administered her medication and sent her on her way. I would suggest that it would be fair to conclude that this GP had no concerns over the appropriateness of Sheilas care, nor have either her regular GP or specialist consultant expressed any concerns. In fact the complete opposite could be concluded (i.e. the care given was entirely appropriate and even successful) from the unanimous decision to reduce her medication.

[Jane]

I agree that it may affect the approriateness, but it's not automatic. Sheila was taking the prescribed medication for schizophrenia, it was administered by injection.

I agree with Hartley's chicken and egg analogy, there is no evidence that Sheila had an 'episode' that night at all. It just doesn't work for me to start with the assumption that Sheila must have killed her family, deduce from that that she must have had an epsiode, and then find reasons for why she must have had an episode - that's back to front to me!

Because there is no evidence of Sheila having suffered an episode that night, it seems to me as if complacency has set in. Because the doctors say her meds and care were adequate, ergo, they were. Had these been ANY other circumstances, I think people would have been shouting about it from the rooftops, and if Jeremy hadn't been part of the equation, I suspect an attempt would have been made by someone, maybe Colin, to exonerate Sheila's responsibility in it.

[-Harters-]

Because there is no evidence of Sheila having suffered an episode that night, it seems to me as if complacency has set in. Because the doctors say her meds and care were adequate, ergo, they were. Had these been ANY other circumstances, I think people would have been shouting about it from the rooftops, and if Jeremy hadn't been part of the equation, I suspect an attempt would have been made by someone, maybe Colin, to exonerate Sheila's responsibility in it.

Although quite clearly, there is absolutely nothing to suggest that her medication and care were inadequate. Nothing at all.

I don't see Sheilas apparent lethargy and quietness as evidence that she was 'acting strange', I think it's a fair conclusion that it was due to the side effects of the higher dose of Haloperidol, the very same reason that Sheila requested that her medication be lowered.

[lebaleb]

Her dose had been lowered because she didn't like feeling lethargic. In my experience becoming withdrawn is a classic phase of a psychotic episode. Jam, have you ever witnesses a psychotic episode?

[-Harters-]

Her dose had been lowered because she didn't like feeling lethargic. In my experience becoming withdrawn is a classic phase of a psychotic episode. Jam, have you ever witnesses a psychotic episode?

In three qualified medical professionals expert opinion, it was due to the dosage of Haldol being too high.

I'm not sure that their expert opinion can be dismissed on a whim.

[andrea]

Her dose had been lowered because she didn't like feeling lethargic. In my experience becoming withdrawn is a classic phase of a psychotic episode. Jam, have you ever witnesses a psychotic episode?

Withdrawal isnt always a classic symptom of psychosis.

[-Harters-]

I agree that it may affect the approriateness, but it's not automatic. Sheila was taking the prescribed medication for schizophrenia, it was administered by injection.

I agree with Hartley's chicken and egg analogy, there is no evidence that Sheila had an 'episode' that night at all. It just doesn't work for me to start with the assumption that Sheila must have killed her family, deduce from that that she must have had an epsiode, and then find reasons for why she must have had an episode - that's back to front to me!

That is pretty much the point that I was trying to make.