Wednesday, September 28, 2005

Grieving family stress concern over smoking culture at KGV

• Doctors ‘not heeding mental patients as they should’ – claim parents

The parents of a 35-year old woman who died of lung cancer have alleged “serious shortcomings” in the care she received from the Gibraltar Health Authority (GHA), in particular during her time as a patient in the King George V mental hospital.

Mario and Violeta Apap said their daughter Geraldine became a chain smoker while she was a patient at the KGV.

They claim that she was encouraged to smoke as a way of passing time and, although there is no evidence that her cancer was caused by smoking, describe this as “a serious failing”.

In a letter to this newspaper, they also maintain that not enough credence was given to her complaints of pain because she was a long-term mental patient with a history of complex medical problems.

Between November last year and March this year, doctors carried out several X-rays and tests on Miss Apap. Early this year they diagnosed pneumonia but the cancer, one of the most aggressive types known, was only detected after Miss Apap’s condition deteriorated and a CT scan was carried out. She died on April 19th, just over a month later.

Mr and Mrs Apap believe their daughter’s life might have been prolonged, perhaps even saved, had doctors conducted the scan and detected the cancer at an earlier stage, as they had urged.

“We believe if she had been diagnosed with lung cancer earlier there would have been a real chance of her being treated successfully or living longer,” they write in today’s Chronicle.

“We further believe that if she had not been a KGV patient her complaints would have been listened to by the doctors more closely.

We therefore are firmly of the view that our daughter’s medical treatment suffered because she was a mental patient.

That is unacceptable and a situation that must never be repeated.”

The GHA, in common with other health authorities, does not comment publicly on individual cases. But an investigation into a complaint filed by the family of Miss Apap concluded that doctors and staff had acted properly throughout this case. In its response to the Apap family, the authority said that Geraldine had been urged to smoke less while she was at the KGV. It also highlighted that chest X-rays carried out late in November 2004 showed no abnormality in Miss Apap’s lung.

The GHA investigation also found that even if the CT scan had been carried out at an earlier date, the eventual outcome would have been the same. The initial reluctance to carry out a scan, the GHA added, was because of the high radiation dose that patients undergoing such tests are exposed to.

An independent medical source contacted by the Chronicle backed that assessment and said such scans would only be carried after other avenues of diagnosis had been exhausted.

Although the GHA has defended the actions of its staff in this case, there is an underlying acceptance of the need to improve many aspects of mental health services in Gibraltar.

In its response to the Apap family, the GHA said it was currently conducting a review of these services to move from an institutional approach to mental healthcare to a more therapeutic approach.

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