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More than 170 Jersey patients wrongly given powerful drugs

More than 170 Jersey patients wrongly given powerful drugs

Thursday 03 August 2023

More than 170 Jersey patients wrongly given powerful drugs

Thursday 03 August 2023


Over half of rheumatology patients prescribed powerful drugs which suppress the immune system and can make individuals more susceptible to infections did not meet the accepted criteria for the treatment, an records audit has revealed – and the finding may be symptomatic of other serious problems in Health.

However, the department said that it was "too early" to establish whether anyone had suffered harm as a result as it released the initial findings of its audit this afternoon.

The audit was carried out by Health following an investigation by the Royal College of Physicians in response to concerns raised about the department.

The audit involved checking the past treatment and diagnosis of a group of 341 rheumatology patients – all of whom who were prescribed a group of drugs known as ‘biologics’ in the period before January 2022.

"Too early to determine whether anybody's been harmed"

Biologics are a group of powerful drugs derived from natural sources such as human, animal, fungal or microbial cells. These drugs work by suppressing the immune system and disrupting the inflammation process that leads to joint pain. 

However, they can make patients more susceptible to life-threatening infections.

shutterstock_1805310514.jpg

Pictured: Rheumatology deals with arthritis and several other conditions that affect the joints, tendons, muscle, ligaments.

Preliminary findings from the audit indicate that over half of the 341 patients receiving biologic therapy did not meet the accepted criteria for starting this treatment.

The Health Minister said that it was "too early to determine whether anybody's been harmed by [the inappropriate prescribing of biologic agents]".

"Serious problems"

The preliminary findings of the audit also indicated that there was insufficient evidence in the patient case notes to confirm the diagnosis of around one-third of patients who were first diagnosed with a rheumatological condition in Jersey.

However, this may not necessarily mean patients were misdiagnosed. Some of these patients may have been accurately diagnosed but their patient records may not have adequately recorded the reasons for their diagnosis.

The Minister for Health and Social Services, Deputy Karen Wilson admitted that these "serious problems" around the diagnosis and treatment of rheumatology patients may also extend into other areas of healthcare.

Health Minister Karen Wilson.jpg

Pictured: The Health Minister, Deputy Karen Wilson admitted that these "serious problems" may also extend into other areas of healthcare.

Expanding on these comments, Deputy Wilson explained that "when you get findings like this, it sorts leads to an additional line of inquiry to see whether or not there are any other patients who are affected".

The Health Minister confirmed that the care and treatment of a wider group of patients, including other rheumatology patients, will now also be reviewed.

She added: "Findings like this can cause concern and it's my job to make sure that we cover all bases so that patients can be assured that there is no cover up and that we're being open and transparent about what needs to be done."

"Working with what they had at the time"

The Chair of Jersey Arthritis Society, Maureen Parris, described it as "reassuring to note that Jersey’s rheumatology service is now being run by a specialist Consultant Rheumatologist on the General Medical Council’s Specialist Rheumatology Register".

When asked why this wasn’t previously the case, the Health Minister admitted that the Rheumatology Department had been "working with what they had at the time". 

"I think any specialist area of practise should have people with specialist knowledge and expertise," she said. "What I'm really pleased about is that we've managed to secure that for the [rheumatology] department now."

The Health Department hired a new full-time Head of Rheumatology last month with the appointment of  Dr Sofia Tosounidou, who trained in the Medical School at the University of Ioannina in Greece.

The final report of the Royal College of Physicians review is expected in the autumn of this year and Deputy Wilson confirmed that this will be made public.

Review of wider group of patients

Patrick Armstrong, Medical Director at HCS said: “This audit clearly indicates that some of our rheumatology patients on biologic drugs may not have been properly diagnosed or properly treated in the period before January 2022.

"I am satisfied that in recent months these HCS patients have been reviewed by specialist rheumatologists, but the audit suggests we now need to review the care and treatment of a wider group of patients including our other rheumatology patients. We will be doing this as quickly as possible.

Patient.jpg

Pictured: "The audit suggests we now need to review the care and treatment of a wider group of patients including our other rheumatology patients."

“HCS will be starting this further review immediately and if there is a need for any patient to be seen in person they will be contacted directly. In the meantime, patients should continue to take their medication as prescribed and attend their hospital and doctor appointments as normal.”

Any patient requiring further information about this matter can contact the HCS PALS information service by email on pals@health.gov.je or by telephone on 01534 443515.

READ MORE...

New Rheumatology Head after review finds "inappropriate" prescribing

Review suggests "inappropriate" prescribing of medication for rheumatology patients

“Rheumatology patients deserve better” - records to be audited

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Comments

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Posted by Guy de Faye on
The problems identified for nearly 200 rheumatology patients represents the "tip of the iceberg" for misdirected treatment offered by our "Health professionals".

The shortcomings seem to stem from a failure to properly use IT systems, which leads to the administering of inappropriate drugs.
I am aware of a patient facing two serious medical conditions being prescribed powerful drugs by the relevant consultants, which quickly resulted in traumatic episodes such as mental instability and nightmares. It soon became apparent that the consultants were not aware of the other drugs that had been included in the overall prescription, which was adjusted accordingly, solving the sudden crisis. Proper use of IT should have prevented this incident from happening.

One of the original concepts behind investing huge sums of money in Health IT kit was to provide immediate notification to all involved medical staff of a patient's immediate and historical issues including their drug treatment - to ensure their fundamental safety. It is critical to know if a patient has a pre-existing condition, such as diabetes, if new medicines are to be applied.

My guess is that money spent on hospital IT equipment cannot be far off £40 Million over the last 15 years.
Rather pointless expenditure if accurate data is not entered into the software and those that should consult the information don't bother. I further understand that the new hospital infrastructure is to be fully equipped with brand new IT at a rumoured cost of £50 Million - that's at current prices.
I am sure that could be money well spent if the technology is used correctly and to its full extent. Unfortunately, the health department track record on IT does not fill one with confidence on any measure.
Posted by EdWilliams4 on
The keyword in the latest PR spin is 'MAY. They MAY have been wrongly diagnosed, the finding MAY be symptomatic of other serious problems in Health. It is a scaremongering blown up of proportion before the final report of the investigation by the Royal College gets completed. It looks like a personal vendetta against the former rheumatology doctors. There is no proof provided that any of the patients audited suffered as a result of the potential misdiagnosis or use of biologic medications outside of the established criteria. Biologics are the most advanced and the most powerful drugs used in rheumatology and other specialities dealing with autoimmune and chronic inflammatory conditions. They are highly selective, targeting specific immune pathways involved in these conditions. While they do carry a risk of serious infections - they are often much safer than the other powerful, older drugs which act more like bazookas. One of the reasons why biologics are used in advanced diseases when nothing else helps is their high cost, the other is the fact that they were first tested in these late stages. Specialists are allowed to use drugs 'off label' as long as they document it appropriately, as they respect contraindications and interactions and the funding gets provided. Let's wait for the final report to see if anyone got harmed by the actions of the former rheumatologists. The big question now is WHO was responsible for ensuring regular audits of biologic medications and the oversight of the medical documentation in rheumatology. Who was responsible for providing the necessary resources to ensure both the regular audits and the quality of the medical records? Was it the Chief Officer of Health or the Head Nurse - the two top female executives sacked in late March? The Minister prefers to avoid asking this obvious question and tries to deflect the blame towards the hard-working, remaining doctors suggesting that similar problems might exist in other departments. This unbelievable transparency of the early findings from the audit contrasts with the secrecy around the state of the waiting lists - not published since the 1st of March.
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