Multi Disciplinary Team (MDT) vanishing?

Royal Blackburn hospital’s HPB MDT team are a magical entity, that changes more often than the weather (sarcasm mode on).

Dad had three HPB MDT meetings to assess his care/treatment, two while he was in Royal Blackburn (ward C1), one after he was discharged.
Every aspect of these meetings has changed according to every member of senior Royal Blackburn’s senior staff and East Lancs Health Trust chairman Kevin McGee.
The Care Quality Commission (CQC) and the General Medical Council (GMC) have been offered written and recorded evidence of failings, but do not want to see or consider it.

HPB MDT meeting 1:
This took place on September 12th 2014.
Hospital notes show that nothing was discussed and notes returned to the ward not filled in (Mr David Chang, clinical lead of HPB MDT meetings is on record claiming “all meetings are recorded live” and it is required for the MDT meeting to be deemed quorate)
Nurses recorded that the outcome of this MDT meeting “needs to be chased up”.

Senior surgeon and clinical lead Mr David Chang claims “this meeting simply never took place, so there is nothing to discuss” – Written evidence shows Mr David Chang is telling the family lies, deliberately misleading and publishing false information.

HPB MDT meeting notes from the following week (19th September 2014) shows clearly that the diagnosis of terminal T4 stage cancer was made at the 12th September 2014 HPB MDT meeting.
These notes also show that an EUS FNA (cytology biopsy) was to be taken from dad and sent away for testing to confirm this diagnosis.
MDT update notes from the ward also show that various staff also knew about the “care plan” decided at the 12th September HPB MDT meeting (that Mr David Chang claims “never took place”) – Dieticians, ward consultant Dr Mansoor, ward doctors, nurses all recorded that an EUS FNA was to be done, all before Mr David Chang claimed it was decided at the 19th September HPB MDT.
The final damning evidence against Mr Chang’s claims, is that the doctor carrying out the procedure, Dr Kaushik, sits on the same HPB MDT team. He has confirmed on record that he was present at all three of dad’s HPB MDT meetings.
Written evidence shows that the EUS FNA procedure was carried out on the 18th September 2014… 24 hours BEFORE it was decided to be done at the 19th September HPB MDT meeting!

If Mr David Chang is to be taken seriously with his claims, then surely Dr Kaushik, sitting next to him at the 19th September HPB MDT meeting, would have informed Mr Chang that he had already carried out the procedure on the 18th September?
The notes from that meeting show that he did not. We have a copy of the email sent by the Critical Nurse Specialist (CNS) on the 22nd of September, advising Dr Mansoor (ward consultant) that dad would need an EUS FNA done.
Both Dr Kaushik and the CNS have stated on record that they were present at the 19th September HPB MDT meeting, so how/why did they know it had already been done?

East Lancashire health Trust chairman Kevin McGee confirmed in writing in November 2015 (yes, a full year to establish that an HPB MDT meeting DID take place) that the meeting of the 12th September DID take place, but dad “wasn’t discussed at this meeting as all the information/tests/results weren’t available” – more false and misleading information from Mr David Chang, as the same information/tests/results weren’t available for the 19th September HPB MDT meeting either!
In fact there are no notes from the 19th September HPB MDT meeting, all that is recorded is on these notes is what was discussed at the 12th September HPB MDT meeting, written evidence confirms this is accurate, despite Mr David Chang’s claims.

So why, despite overwhelming written evidence, does Mr David Chang continue to publish false and misleading information about the 12th September HPB MDT meeting not taking place for dad?

Could it be that the meeting did not meet the MDT quorum?

East Lancashire Health Trust chairman Kevin McGee and Mr David Chang have blocked the attendance records of the HPB MDT meetings from being released to the family.
Care Quality Commission, that should have access to the HPB MDT attendance records when inspecting hospitals, refuse to confirm or deny if these were provided when they inspected Royal Blackburn hospital.

The 12th September 2014 HPB MDT meeting at Royal Blackburn hospital did not meet the MDT quorum – we have written evidence of this.

That it did not meet the quorum is not irregular, that a diagnosis was made on dad and claims that his CT scans (showing pancreatitis) were over-ruled by more “expert” MDT senior staff, is highly irregular.
For a non quorate MDT meeting to over-rule test findings is very serious.
An MDT expert can over-rule, but if the meeting does not have the senior “expert” present then no decision is to be taken, it has to be referred higher up the expert chain, to a medical professional in that field more specialised.

Dad’s CT scans showed a small blockage at the head of the pancreas, as the radiologist Dr Oliver Nicholson is a very competent radiologist, he then examined further to establish if the blockage was invasive.
Dr Nicholson found “No invasion of the portal vein, splenic vein, SMA or coeliac” Dr Nicholson suggested it could be pancreatitis.

Mr David Chang and Dr Mansoor (ward consultant) have both claimed on record, that these findings were “over-ruled at MDT level by a more senior expert radiologist”
This is why we have asked numerous times to see the attendance records of whom this radiologist was, sitting at MDT level.
At the time, Dr Oliver Nicholson was Royal Blackburn hospital’s most senior radiologist, he was not qualified to sit on the HPB MDT team.
IF (and it’s a huge IF) he was called in to the MDT to give his opinion, are we seriously to believe that he over-ruled his own findings?

Written evidence provided by Royal Blackburn’s own senior staff, shows that no radiologist was present at the 12 September HPB MDT meeting.
Mr David Chang and Dr Mansoor (ward consultant) have both been making false and misleading claims, that more “expert radiologist over-ruled these findings at MDT level”
It is a serious issue that needs to be addressed, as dad’s diagnosis, that shaped his care pathway, was decided at this HPB MDT meeting.

East Lancashire Health Trust chairman Kevin McGee’s ever changing account of staff present at Royal Blackburn hospital’s HPB MDT meeting:

I can’t work out which is more inept.
That East Lancs Health Trust chairman Kevin McGee and RBH clinical lead surgeon Mr David Chang keep changing their account and numbers of “expert” staff present at the same HPB MDT meetings (publishing false and misleading information) OR that ELHT chairman Kevin McGee and Mr David Chang can’t see any issues of patient safety being affected by running HPB MDT meetings on care pathways and diagnosing patients, without the correct quorum of “expert” qualified staff being present?

Either way it does not look good, nor is it acceptable under any circumstances.
Who are these mysterious “more expert” MDT staff whom are over-ruling qualified test/scan results?
Are they qualified to over-rule?
What if they are wrong when they over-rule?
This could lead to misdiagnosis, wrong care pathways and treatments, dangerous to the patient when drugs administered come into play. It’s nightmare waiting to happen.
On the other side of this, is if the top brass are deliberately blocking release of essential information, where is the accountability?
How many more patients has/is this happening to?

I’ll end this post with something to reflect upon.
East Lancs Health Trust chairman Kevin McGee has now put in writing several different accounts of the professions that were in attendance at Royal Blackburn’s HPB MDT meetings for dad.
In November 2015 Kevin McGee wrote to the family stating,

“In attendance at the HPB MDT meetings were two consultant surgeons, one consultant gastroenterologist, two consultant radiologists, one consultant histopathologist, three consultant oncologists, an upper gastro-intestinal tract clinical nurse specialist and a MDT co-ordinator”

That’s eleven essential “expert” MDT core members.

In reply to the Information Commissioner’s Office ruling against them, East Lancashire Health Trust’s account had changed to (at least) eighteen “expert” MDT staff,

“We are able to advise that the following classes of staff would have attended each of the meetings :

  • Consultant surgeons
  • Consultant physicians
  • Consultant radiologists
  • Consultant histopathologists
  • Consultant cytopathologists
  • Consultant oncologists
  • Specialist nurses
  • Research nurses
  • Dieticians and administrative staff”

In reply to our MP Graham Jones and the junior Health Minister at the Dept. of Health, East Lancs Health Trust chairman Kevin McGee wrote,

“All three HPB MDT meetings had in attendance the following essential members;

  • A consultant surgeon
  • A consultant GI physician
  • A consultant radiologist
  • A consultant histopathologist
  • An upper GI nurse specialist
  • A consultant oncologist

The specialist palliative care team (read: MacMillan nurses) were not in attendance.”

There was only ever one consultant surgeon present – Mr David Chang (Reply 1 and 2 state minimum of 2 consultant surgeons – false)
There was only ever one upper GI physician present – Dr Kaushik (Reply 2 states there were more one present – false)
Radiologists present – Reply 1 and 2 claim more than one were present, reply 3 claims just one was present (written evidence shows that NO radiologists were present – false)
Histopathologist present – Reply 1 claims just one present, reply 2 claims more than one were present (even though only one sits on the HPB MDT) reply 3 claims there was just one present (written evidence shows that NO histopathologist was present at the first HPB MDT meeting where diagnosis was made and results were over-ruled – false)
Oncologists present – Reply 1 and 2 claims there were three oncologists present, reply 3 claims only one oncologist was present (written evidence shows NO oncologist was present – false)
Upper GI Nurse was present – Reply 2 claims “specialist nurses” there was just one (written evidence shows that just one upper GI nurse was present, but copies of emails show that the nurse who “was present” did not know that the EUS FNA had already been done, even though she was at the MDT meeting with the upper GI physician whom carried out the procedure), very odd.
Specialist palliative care nurses (read: MacMillan) – Reply 1, no specialist nurses were present, reply 2 specialist nurses were present, reply 3 it’s changed again to the specialist nurses not being present (even though this is a requirement of the MDT quorum!)
Research nurses – There was never any attendance by research nurses, we have no idea where this comes from in reply 2 – false information again.
Dieticians – again, no idea where reply 2 answer comes from, they simply were not in attendance at any of the MDT meetings and are not a core member of the MDT.
MDT co-ordinator/administrative staff – MDT co-ordinators have to be present and record events in real time. Written evidence shows they were not present at the 12th September MDT meeting, despite claims in reply 1 and 2 that they were present, in reply 3 reference to them being present has disappeared.

It’s hard not to conclude from the fabrications, false and misleading information coming from East Lancs Health Trust chairman Kevin McGee via Royal Blackburn hospital senior staff, that they have not one clue about what they are doing!
Publishing false and misleading information – whether by accident or knowingly – by any senior management of a public body, is a criminal offence!

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