Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. In other words, it’s your body’s overactive and toxic response to an infection.
It is the third largest cause of death in the UK and kills more people than bowel, breast and prostate cancer combined.
There were over 250,000 cases of sepsis in 2018 according to the UK Sepsis Trust and at least 46,000 people die every year as a result of the condition.
Some people are at higher risk of developing sepsis because they are at higher risk of contracting an infection. These include the very young, the very old, those with chronic illnesses, and those with a weakened or impaired immune system.
But it can affect anyone at any age, even those in good health – and recovery can be a long and difficult journey for those fortunate to survive.
In severe cases of septic shock, the most common cause of death is multi-organ failure due to a loss of blood pressure. To combat this, a range of drugs called vasopressors are administered. These have the effect of constricting the blood vessels in the arms and legs, redirecting the flow to the major organs. Approximately 40% of critical care patients with septicaemia require vasopressor administration. Unfortunately, this necessary regime has serious complications with life changing consequences for many patients.
The primary complication is a condition called disseminated intravascular coagulation (DIC), which occurs when trapped blood in the constricted arteries in the arms and legs, coagulates (or clots) and blocks the vessel. When the drug regime is discontinued and the blood flow returns to the limbs, these clots impair the re-vascularisation and gangrene occurs. Many of these patients then undergo limb salvage and amputation, often in multiple limbs – with mid-calf and above-wrist level amputations not uncommon.
Currently there is no NHS treatment for DIC induced ischaemic and gangrenous limbs other than salvage surgery.
In 1999, Tom and Nicola Ray were newly married and expecting their second child when, almost overnight, their lives were thrown into turmoil. Tom developed sepsis following a dental procedure and within a day of onset, he slipped into a coma. He was 38 years old.
When he woke up five months later, Tom discovered he had undergone quadruple amputations to both hands and feet, with additional facial amputations as a result of sepsis. He couldn’t remember who he was and didn’t recognise his family. During his coma, Nicola gave birth to their second child, but their difficulties were far from over.
Tom and Nicola lost the business they were running together and had to sell their house and move out. There followed several years of reconstructive surgery..
“I had to go through several years of extremely painful facial reconstruction operations to get a cosmetic nose and to make me look not so ugly. But the surgeon at the London Hospital gave up in the end – he is the best in the world but he said there was nothing more they could do about my face. I never understood why but apparently it was too difficult.”
Last year, an extremely moving film detailing Tom’s journey to recovery was released at the Edinburgh Film Festival. It should be seen by everyone.
When Scottish businesswoman Corinne Hutton from Lochwinnoch, fell ill at age 43 in June 2013 after suffering acute pneumonia and sepsis, surgeons were forced to amputate both her hands and her legs below the knee. Prior to her illness, Corinne was a busy small business owner, devoted Mum and regular fitness fanatic, setting herself challenges like running marathons, cycle rides and climbing expeditions to raise money for worthy causes. Earlier this year, Corrine underwent a double hand transplant and is presently recuperating, but like Tom and Nicola, she has since devoted herself to raising awareness of sepsis and its devastating complications and helping those who have lost limbs. Brave and amazing people all.
Five months ago, I wrote about the experience of a friend, Alan Bowell, from Blackpool who contracted sepsis last September and was gravely ill on admission to hospital. Alan had recently started taking medication for Crohn’s Disease – an immunosuppressant called Azathioprine – and was nine days into the course when he became disorientated and shivering uncontrollably.
He wasn’t made aware that immunosuppressant therapy can be a contributory factor in sepsis cases – and consequently, remained ignorant of the clinical signs and symptoms of the disease. Alan thought he was coming down with the flu and didn’t seek any medical help until the following morning when his condition deteriorated significantly. His last memory before he fell unconscious was being helped into the ambulance at home.
Ten days later, when he regained consciousness he discovered gangrene was already established in both feet and the fingers of his right hand and the prognosis was poor. Alan had undergone a colon resection a few days after admission and had a stoma fitted, but a surgeon advised he would require further operations to the gangrenous limbs, before a stoma reversal could be considered.
In cases of vascular insufficiency, with accompanying tissue necrosis and gangrene, a demarcation line is often found encircling the affected limb. This represents the boundary between the truly viable and dead or dying tissue. In limb salvage the level of amputation is determined by the demarcation line to ensure healing takes place.
Three weeks after regaining consciousness, the demarcation line in both Alan’s legs was mid-calf and in his right arm, just above the wrist.
From the previous post you will have read that Alan started a course of hyperbaric oxygen treatment when he was discharged home the following week. I wasn’t aware that he was ill until six weeks after he was admitted – and a month after he regained consciousness. When I visited him on 24 October, I was shocked by his appearance. We’d played guitar together late August and enjoyed a meal and drink. He was in great form.
Within just two months he looked dreadful, lost over two stones and dwarfed in the standard issue NHS high backed chair. It took a bit of time to adjust – just thinking about what he had gone through and what he was now facing. I’m not sure if I was in that position – the very real prospect of losing hands and feet – if I could even face it for a day. But here he was. Knackered, confused, frightened, angry but very determined. At that point, I’m not that sure I understood why.
As he told me what he knew had happened – falling ill, coma, abdominal surgery with bowel resection and stoma – and gangrenous fingers and toes (with established demarcation), I remembered something vaguely similar in the past and mentioned it to Alan.
When the ward doctor called in, we asked him about the possibility of starting hyperbaric oxygen treatment, but he hadn’t heard of it. Nor had any of Alan’s other doctors he was to subsequently see. The vascular and plastic surgeon he was referred to told us there was no evidence that HBOT helped limbs affected by vasopressor administration, but nor did they think it would do any harm.
So, the following week, when he was discharged from hospital, Alan started a seven-day course of HBOT at ‘A Breath for Life’ near Lancaster. After the first one-hour session, he reported feeling ‘tingling and pins and needles’ in both feet and his right hand. By the end of the course the demarcation lines in all three limbs had disappeared and pulses were present again in both feet.
Over the following three months, some recovery of necrotic and gangrenous tissue was established and new skin has since formed. Alan finally underwent salvage surgery in March this year to remove the putrefied tissue of his right forefoot, the apex of three toes on the left – and the tips of two fingers on his right hand.
He is making a good recovery and is hoping the stoma reversal will be scheduled in the very near future. Two weeks ago, he played his first gig since last August and it was a privilege to watch him perform.
I’m not a sepsis or vascular specialist, simply a podiatrist that recalled a similar case a few decades ago and assumed – wrongly, as it turned out – that pressurised oxygen treatment was already playing an important role to play in restoring circulation to limbs affected by vasopressor administration in sepsis management.
To discover that this is not the case in the NHS was astonishing. It certainly worked with Alan, which we are all grateful for – although I can’t help wonder how much more of his limbs could have been saved had the HBOT been started much earlier. Time is the critical factor – once the tissues and blood vessels degrade past a certain point, they are unrecoverable.
But when one considers just how many other patients are facing a similar prospect and prognosis currently, it seems inconceivable that they should be left with no other option than the surgeon’s knife.
Until very recently, I had no idea how HBOT worked in these cases. When I searched for articles online, I discovered no published articles reporting or supporting its use in preventing limb loss in sepsis recovery patients.
However, there were numerous articles on limb loss from vasopressor induced ischaemia following septic shock – and these explain the mechanisms that cause the loss of blood supply and tissue necrosis. The blockage of arteries by clots of coagulated blood – DIC – resonated with me when I read the first article. It is the same mechanism of injury that occurs in severe frostbite – and I’ve known a few people over the years climbers and patients that have lost fingers, toes and limbs from prolonged exposure to the cold.
When searching for DIC in frostbite gangrene – I found several prominent articles citing the use of HBOT for the treatment of frostbite, which explained in detail how pressurised oxygen helped re- vascularise limbs affected by cold induced DIC – even with established high level demarcation and gangrene.
It appears that the mechanism of injury – the coagulated clots in the blood vessels that impair the return of the blood flow – and subsequent tissue death – are the same in severe frostbite and those recovering sepsis patients. In the former, it is extreme cold that closes down the circulation – in the latter it is the drugs used to combat the loss of BP and multi-organ failure in severe septic shock management.
Subsequent searches on different medical and scientific databases have revealed numerous articles citing the use of HBOT for frostbite – many as the ‘gold standard’. Pressure chambers are now installed in most scientific stations in the Artic and Antarctic – as well as various sites in the Himalaya – specifically for that purpose.
Scientists and medics from Norway, Denmark, Russia and Canada use the HBOT chambers in the Artic – and all reports/papers demonstrate favourable outcomes and a considerable reduction in limb/tissue loss.
Recent papers cite a combined regime of HBOT, thrombolytics and manual physiotherapy/massage initiated as soon as possible following injury provide the best outcomes. If this works for frostbite, it may prove beneficial in sepsis care to prevent limb loss.
As Alan remarked, “It seemed like a good positive thing – and what did I have to lose, except the obvious?”
So, although I am no longer in practice, I thought it might be a good idea to report it to someone, especially as it seemed no-one in the NHS had even heard of HBOT, never mind its use for these patients. In January, I wrote to my MP and asked him to notify somebody in the Department of Health and two months later they replied saying following a recent review, HBOT was only now commissioned for decompression sickness in diving injuries and before they’d consider it further, they’d need a detailed proposal from a relevant specialist.
There are no HBOT facilities in the NHS and most of the private/charitable centres use multi-person chambers we are all familiar with. However, single use units for intensive care are used in many other countries. They are inexpensive and simple to operate and take up no more space than a hospital bed.
I’ve since written 98 emails to various people I think might be vaguely interested – the editors and presenters of news programs every time sepsis is mentioned, which is fairly regular these days. Same with newspaper health and medical correspondents who write regularly about tragic cases like Tom and Corinne – and other sepsis patients. To Ministers, shadow Ministers and other politicians – and even places like the Sepsis Trust and other charities.
Unfortunately, I have yet to receive an acknowledgement never mind a response from any one. You’d think I would know better by now….
I’m publishing this now in the hope it gets shared through social media, text or word of mouth – so that those of you who may one day find yourself in a similar predicament and told, like Alan, that nothing that can be done – might now be able to offer a suggestion to the medical team that could be very worthwhile.
You will encounter scepticism if not opposition; the majority of NHS doctors will search internet and find no evidence – and that’s what forms their opinion today – but if you are the victim or relative or friend, please persist and cite this post and the attached articles as evidence.
Hopefully someone else will join up the dots very soon. Of the 200,000 plus survivors of sepsis every year in the UK, a not insignificant number of people will require salvage surgery and amputations as a direct result of the drugs given to save their lives. It really shouldn’t be one or the other.
This may well prove to be a low-cost, simple, safe and evidenced solution for a tragic, horrific condition that the NHS is simply ignoring and leaving to deteriorate without intervention.
Please share if you think it useful or appropriate, thank you.
A 65-year-old man develops systemic peripheral gangrene (SPG) following hospitalisation for acute septicaemia and pneumonia. On admission, it was established that he was ten days into a course of Azathioprine, an immunosuppressant used in the management of Crohns Disease. Ischaemic changes to all limbs were noted one day after admission, consistent with disseminated intravascular coagulation (DIC).
He is kept in an induced coma for ten days, but on recovery, discovers necrotic and gangrenous changes to all hands and feet. At an initial a surgical consult, he is advised that it is likely he will require both feet and hands to be removed. He remains in hospital under observation for a further three weeks, at which point, the demarcation line is mid calf and above wrist in the respective limbs. A further surgical consult confirms bilateral BK and above wrist amputations, but surgery is delayed until he makes a full recovery from the sepsis.
On discharge from hospital, he commences a seven-day one-hour course of Hyperbaric Oxygen Treatment (HBOT) at 2.2 atmospheres of pressure with 100% oxygen.
At the conclusion of the seven-day course, re-vascularisation of all limbs was achieved and over the following month, there was rapid sloughing and granulation to many areas of gangrenous and necrotic skin.
Three months after discharge, there remains dry gangrene to the right forefoot, and the end of the three middle toes on the left foot. The terminal phalanx of two fingers on the right hand are also unrecoverable. His surgical prognosis, is however, substantially improved, with only the right foot requiring salvage beyond the toes.
There isn’t any published literature that details the use of HBOT for SPG following acute systemic infection like sepsis or meningitis, but I recall being told of a similar case over four decades ago following an abdominal puncture wound to a diver during sub-sea installations in the North Sea. Subsequently he developed septicaemia with resulting ischaemia and SPG in all limbs.
He remained in decompression during his treatment and rapidly made a full recovery with no limb or even tissue loss.
Over the last four decades, the use of HBOT in a variety of medical conditions is becoming more widespread, particularly with ischaemic conditions such as cerebral palsy, strokes, diabetic and neurovascular foot and leg ulcers, where increased blood flow and oxygen perfusion can improve outcomes significantly.
Whilst I appreciate that n=1 is no basis to claim vascular recovery can be achieved in all cases of SPG by commencing a course of HBOT at the earliest opportunity, it is surely worthy of consideration.
The gentleman referred to in this post was not a patient, but a friend of mine – a very good blues guitarist from Blackpool, who thankfully will be able to play again sometime soon – and drive himself to gigs. For others, the road is much more daunting.
So, to any vascular or sepsis specialists out there with responsibility for managing someone with SPG following septicaemia or meningitis, it may be worthwhile considering HBOT as a preferred option for limb recovery in these tragic cases.
Dad was born in the mining village of Cardenden on 15th October 1937, the first of two children to Jack and Mary Russell His father was a miner at the local pit and it’s reasonable to assume that Dad’s early childhood was not one characterised by luxury, not least because of the hardships that were to follow during and after the second world war, which started a month before his second birthday.
He spent many days during his formative years with his maternal grandfather, who introduced him to the art of fly-fishing, but only after he had learnt to tie his own flies and to cast properly, which he practised on the football pitch at the side of the River Ore. He knew of all the good pools on the river – and on the Fitty, down the ‘Meedies’ and every other bit of water in Fife – treasured information passed down from generations – something he put to good use.
I was with him many years later, in a reversible role, when he hooked an enormous brown trout at the ‘meetings’ – where the Fitty joins the Ore at Glencraig and it took nearly ten minutes to land. It was a monster, almost 5lbs, dark brown with big hooked jaw and I was too scared to go near it. I was only nine or ten at the time, but I remember him telling me about the pool and that his granddad once told him about the fish that were to be had under the branches of the trees on the opposite bank.
He was a creature of habit and kept to a fairly rigorous routine, something that was evident from an early age. His little sister, Irene, remembers Dad taking her to the village cinema where they used to sit in the same two seats every week. Woe betide anyone having the temerity (or stupidity) to sit in them before they arrived. There would be no reasoning with him. Thrawn wasn’t the word for it!
As a teenager, Dad attended Auchterderran High, where his prowess on the sport’s field outshone his academic achievements by a margin. That is not to say he was lacking in the classroom – far from it – but it was his athleticism and skills on the football field that were to combine into something truly remarkable. He made his first appearance for Dundonald Bluebell – the local Junior team – when he just turned fifteen and soon gained a reputation for being a fearsome tackler with a great turn of speed on the wing.
It was 1953. In March, he was selected to play for East of Scotland -v- Sunderland in the senior schools competition at his favourite position of right back. The inside right for Sunderland was Robert Charlton, better known, of course, as Bobby – and the pair were to meet again a few months later at Filbert Street in Leicester in the Schools Home Internationals. Bobby went on to be one of football’s greatest ever players – and whose goals will live on in the memory of everyone that ever loves the game, far beyond Manchester. But he didn’t score in either match back then. “I didnae let him” was the only boast I ever recall Dad making.
Dad played against Wales the following week and the young Scots went on to win 2:1 – then went on for trials with Liverpool and Hearts but a change in circumstances at home following his parents’ divorce took him in a different direction. A career in football then didn’t provide the security in the game today. Bobby (Charlton) trained as an electrician and Tom Finney (who was a patient of mine many years later) as a plumber – something to fall back on if they didn’t make it or were injured. As the new breadwinner at home, Dad didn’t have this latitude – so he gave up football and instead started a sales job in the Cooperative Shoe Shop in neighbouring Lochgelly, where a young girl by the name of Anna MacDonald worked in the ladies section. They were soon an ‘item’ in today’s parlance and one that was to endure.
The following year saw Dad enlist in the army as part of his National Service, which he served with 2 Para in the Middle East – first in Egypt during the Suez Crisis and then in Palestine. During his ‘square bashing’ at Aldershot, he was ‘volunteered’ as the Foot Orderly for his troop – an essential role to combat the crippling damage inflicted on squaddies feet during route marches from the army issue boots.
Blisters were soon his forte. It was, in hindsight, an unlikely apprenticeship and the start of another journey – one that would last for many years and lead him into a career, where he would continue to provide relief and comfort to many others that sought his skills and care.
In September 1960, John and Anna were married at St Andrews Church in Lochgelly and the following year, he opened his first chiropody surgery in the Main Street next to the Cross. I made my appearance a few months later and was a regular visitor in the practice by all accounts and some of my earliest memories are of Dad sitting in front of an old lady’s feet, the black Bakelite telephone with the two buttons and an overpowering smell of Dettol and TCP.
In 1966 the local Council introduced a chiropody scheme for old folk and Dad was asked to join the team, which was headed by Jim Ivers, a chiropodist from Northern Ireland. The following year, the NHS took over the service and Dad started work at the newly built Rosewell Clinic in Lochore and closed the Main Street surgery. But he kept his private practice running in the evenings, doing home visits most days after work and on Saturday mornings too. His services were always in great demand. Football would have been a gamble, but chiropody provided Dad with everything he needed and ever wanted – security, respect and the satisfaction of doing a good job.
We were all fortunate as a result. In April 1965, Mum arrived back from Kirkcaldy one afternoon carrying a tightly wrapped bundle with a shock of blonde curls at one end and suddenly I had a wee sister to entertain and play with for a year before I started school. A few months after Susan was born, we moved from a shared rented cottage in David Street to a brand new council house in Stewart Crescent, where we grew up and where Mum and Dad would spend the rest of their lives.
Our childhood was idyllic – a strange thing to say all things considered. Lochgelly was different back then – a working-class mining village for sure, but proud, ambitious and hopeful too. Dad’s job provided us with not only the staples, but also many of the luxuries he could only dream of as a child – holidays all over Scotland and everything we needed at home. His first car was a Hillman Minx followed by a run of Austin Maxi’s, which he loved. This was mostly down to the fact they could accommodate everything Mum would take on holiday with us – which was most of the house bar the furniture.
Oban was a favourite destination and became a regular haunt twice a year during the summer and autumn holidays. Dad had a patient that owned the caravan site in Benderloch and we spent many enjoyable weeks there. During the really hot summer in 1976, Dad took a notion to climbing Ben Cruachan after a day trip to the hydro scheme at Loch Awe. A few days later, we were sitting on the summit looking down on Loch Etive under clear blue skies.
It was a special day – the first of many in the mountains for both of us. The next few years would tick off many Munro’s all over the Highlands and what started as a holiday adventure, soon became a regular weekend feature.
Dad joined Lochgelly Bowling Club in 1960 and with both Mum’s parents they soon became regular names on trophies and club championships. He played at Lochgelly for 48 years until Mum’s death in 2008 and was regularly selected to play for the county team over the years. But he was modest and an intensely private man too. He didn’t like a fuss and certainly didn’t crave the limelight.
I only found out about his football history when I was a teenager and went rooting one Saturday afternoon in the attic and opened an old suitcase I hadn’t seen before. The first thing I saw was his Scottish Cap – then a pair of leather-studded football boots and horsehair shinguards – and not for the last time thought, “who is this man that’s called, Dad?”
When I played football for the school team, he would come to every game and stand quietly on the touchline and only make comment afterwards, if at all, but when he did, it seemed to make sense. But I had no idea. He was a season ticket holder at Dunfermline for a few years and used to take me to the home games on the supporter’s bus. It was the era of Willie Callaghan, Alex Edwards, Jock Stein – we watched many great games at East End Park and internationals at Hampden and he’d dissect the game on the way back home in the car or on the bus and I just used to sit and smile. What the heck did he know about football, after all?
That’s just how he was. After nearly two decades at Rosewell Clinic, Dad was promoted to District Chiropodist in Dunfermline where he worked in Carnegie Clinic managing the chiropody team in West Fife, until his retirement from the NHS in 1997. He kept his private practice running for another decade though and continued to ‘do the feet’ of many in Lochgelly, including some that first visited him in the Main Street shop almost half a century before.
With Anna, Dad found his perfect partner – they really were a beautiful couple in so many ways – and they complimented each other in every respect. It was an enduring romance but like all good relationships, the ending was always going to be hard to bear. When Mum was diagnosed with MND in 2007, Dad found it hugely difficult to accept, which is not in the least surprising. When she passed a year later, a big part of Dad left too – and that set the scene for the remainder of his journey.
Dad liked Soor Plooms and Barley Sugars. He whistled tunes that sounded like the Clangers and clucked his tongue like Skippy the Kangaroo. He loved music though, especially The Corries and he was a life-long Nationalist, long before it became fashionable. A brilliant smile and an avid reader throughout his life. His favourite story was Geordie – about the young boy who won a Gold Medal at the Commonwealth Games in New York.
I wonder why?
On Tuesday 15 May 2016, Philip Ralph Batten was found guilty at Guilford Crown Court of 42 offences including gross indecency, child cruelty, serious sexual assault and indecent assault on a child. Batten had been a teacher at the Royal Alexandra and Albert School in Surrey where the offences occurred during the 1970s and 1980s.
He was sentenced to seventeen years imprisonment. In his summing up the trial judge, HH Neill Stewart remarked:
“There is no sentence I can pass that can reflect the impact this has had on the victims.
“Your victims were particularly vulnerable because of the age disparity. Some were children of service personnel stationed overseas, and others had troubled backgrounds.
“Your entering their dormitory was akin to entering the child’s home. On occasion you acted with other adults, and you used alcohol and drugs on occasion.
“We have heard that there was also filming involved on some occasions.
“This was an exceptionally grave breach of a high degree of trust which was placed in you. You had the responsibility of a parent to safeguard and nurture these children. Instead, you groomed and manipulated them.
“You truly were a sexual predator, and for 30 years or more you tried to get away with it. The court cannot undo the grotesque harm you have caused.”
These offences went unreported at the time and Batten moved to other schools where the assaults continued. He was eventually dismissed and convicted of sexual abuse to children on 21 April 1989. A decade later, on 5 March 1999, Batten was found again guilty of nine charges of indecent assault and sentenced to three years imprisonment. He was placed on the Sex Offenders Register for life.
It appears that during his incarceration, Batten enrolled in the Prison Service education programme and undertook a correspondence/distance learning course in chiropody and was sent a certificate on completion. After release in 2001, Batten and his wife moved to the small village of Stogumber near Taunton in Somerset and despite being on the SOR, he commenced a visiting practice from his home in Wood Lane.
In 2001, health regulation was in flux – the old regulator, the CPSM, still had statutory responsibilities until the HPC emerged in 2003, but Batten would not have been compelled to apply for registration anyway.
It seems that Batten never joined any professional bodies or associations and didn’t apply for grandparenting onto the statutory register when the newly formed Health Professions Council opened the scheme in 2004. Had he done either, his previous conviction and SOR entry would have been discovered and the authorities could have liaised with the Police to restrict and monitor his activities. That didn’t happen.
According to press reports, the Battens quickly became a fixture in the local community. He immersed himself in the local church – and his new business as a chiropodist – which he ran as a visiting practice from his home in Wood Lane. Batten didn’t have a practice website and probably didn’t have to advertise much save for few business cards in the local shop to get him started. However, there are a few business directory entries online, where he promotes himself as a podiatrist and specialist in sports medicine, which presumably brought him into contact with children from time to time.
Philip Batten remained in practice as a chiropodist until his arrest in 2015.
Readers of this website will recall that it is now ten years since I first wrote to Marc Seale, the Registrar of the HCPC – and reported a deficiency in their legislation that could allow something like this to happen. I was concerned that an individual could use an unprotected title like “Foot Health Specialist” and practice without any vetting or scrutiny – posing a real predatory risk to the public if they were so inclined.
Batten didn’t use an unprotected title. He called himself a chiropodist and podiatrist and did so quite openly, even though he never registered with the HCPC or any professional organisation. On the face of it, he was breaking the law and given his history, he should have been prosecuted and warning notices issued.
However, as we now know from the evidence heard during both my prosecutions, that might not have been the case after all. Batten’s “qualification” in chiropody predates the legislation and providing he made it absolutely clear to the public and his patients that he was not registered, then he would be lawfully permitted to use either title. Even with his previous conviction.
The discovery that one of Britain’s most prolific paedophiles had been practising as an unregistered chiropodist, completely invisible to regulatory scrutiny, for fourteen years up until his arrest in 2015, is shocking enough. But when you think that the regulator responsible for public safety had been repeatedly warned that such a scenario could occur – then prosecuted the individual raising the concerns in an attempt to conceal the regulatory failings, the whole matter takes on a different hue.
Why would the HCPC spend up to £400,000 to prosecute someone who was simply highlighting a glaring and serious weakness that allowed someone like Batten to practise as a chiropodist with impunity?
We are about to find out.
Over the last eighteen months, with the help of my constituency MP, Mark Menzies, we have established a number of astonishing facts about the HCPC and Department of Health that shines a new light on this affair.
As a result, my conviction has now been referred to the Criminal Cases Review Commission, who will review the prosecution and papers over the coming weeks, before making a submission to the commissioners by the end of May. With the new evidence provided, I hope that justice will finally prevail in the near future – and when it does, the government and Health Secretary in particular, will face some difficult questions indeed.
Separately from the above and following advice from the Crown Prosecution Service in January, a formal complaint was lodged with Lancashire Police who will now investigate the circumstances of my prosecution to determine whether any offences occurred, specifically in regard to:
• deliberate non-disclosure of evidence in a criminal trial
• misconduct in public office
• fraudulent misrepresentation.
I had intended to update readers to this blog when some progress had been made in the concurrent investigations, however the fact that someone like Batten has indeed exploited this deficient legislation changes matters significantly.
The Prison Service is one of the largest purchasers of online and distance learning courses as part of their educational programme for inmates. Batten secured a certificate in chiropody during his incarceration in 1999, but now courses offer certificates in “Foot Health” where prisoners can legally call themselves a Foot Health Professional on release – and join the growing ranks of unregistered and unregulated ‘practitioners’, who remain completely invisible to the authorities.
A review of health regulation is urgently required together with an assessment whether any other ex-convict has access to vulnerable adults and children as a result of a qualification gained whilst serving a custodial sentence for offences against either group.
A separate inquiry should also be established to determine whether Batten re-offended during his 14 years in practice as a chiropodist to provide some reassurance to the people of Somerset who may have been exposed to this monster, in the belief he was someone they could trust. Those of you familiar with an earlier essay will appreciate why this is important to me.
I have written today to the Chair of the Health Committee, Dr Sarah Wollaston MP, to alert her to this matter. I have also written to the Health Secretary (again) via my MP.
Recent correspondence is attached below.
If you feel strongly enough that individuals like Batten should not be able to work in a health/caring capacity without any form of vetting or scrutiny, please share this post with your friends and MP and ask them to make some noise, please.
After ten years, my voice is getting just a little hoarse.
Well, well. Just like buses – you wait ages for one coming then all of a sudden, half a dozen appear at the same time! I’ve just been passed another case involving an “unregistered chiropodist” – this time in Liverpool.
Yvonne Thomas called herself a chiropodist to gain entry to old folk’s homes where she assaulted, injured and stole money from her “patients”.
Jailing her, Judge Alan Conrad, QC told Thomas: “You are a persistent and predatory burglar. You have previously served custodial sentences for house burglaries.
“In this case you have targeted victims who are extremely vulnerable due to their age and or their disability.”
(First published 7 October 2015)
I was nine years old the first time I remember visiting a hospital. It was late 1970 and my maternal grandmother just had an operation on her right foot to remove a painful bunion, something my father explained, was a lump on the side of her foot. She had the procedure carried out at the Bridge of Earn Orthopaedic Hospital, a familiar landmark to many, its wartime single storey buildings situated just east of the M90 motorway as it crosses the River Earn, just south of Perth. The hospital was constructed at the beginning of the Second World War to deal with the expected casualties from the fighting and opened in 1940 with space for 1,020 patients. Early admissions came mainly from neighbouring military camps, and the lack of expected air raids led to beds being used by three British General Hospitals, patients with tuberculosis and prisoners of war. The busiest time for the hospital came in 1944, initially from casualties of the V1 and V2 bombing of London, and then the Normandy invasion. Following the war in 1947, an orthopaedic unit from Larbert was transferred to Bridge of Earn and it was predominately for this discipline that the hospital gained its reputation until it finally closed in 1992.
My grandmother had a part time job as a home help and was a fit, healthy woman in her early fifties at the time of the procedure. Her foot had been troublesome for a number of years and it was becoming increasingly painful, especially during her sporting activity, lawn bowls, for which she held a great passion. My father, a chiropodist with the NHS, had spoken to the family doctor, and he arranged an appointment with the surgeon and the bunion was duly removed as an in-patient procedure some time later. I cannot recall much of the visit to see her recovering from the operation other than the smell on the ward of antiseptic, which was quite different to that in my father’s surgery or even the local dentist – and the nurses, who looked pristine in their starched white uniforms. My grandmother was sporting a below-knee plaster cast on her right leg and only her toes were visible and I remember being asked to count them in case any were missing. None were, but she had gained something extra! The operation was a simple arthrodesis; a procedure that corrects the position of the great toe and involves having part of the joint removed and a steel pin or wire inserted through the end of the toe down into the long metatarsal. This pin and the plaster cast would hold the toe in the correct position until the surgery healed in around six weeks and where the pin protruded from the end of the toe, it was capped by a small cork and it was this that held my attention for the duration of the visit. She remained in hospital for a week then returned home to convalesce until the pin and plaster cast were removed around a month later. The operation was deemed a success and a few months later she resumed her bowling with renewed enthusiasm, going on to win a number of championships and trophies in the following years. The operation was carried out on her leading foot as she was right-handed, and as such, the toe joint remained straight with the foot flat on the ground when she released her bowl. By contrast, the great toe on her trailing, left-foot was fully bent back or extended when she released and had the problem occurred on this foot and she had undergone the same procedure, then it would have been much more difficult for her to be able to return to the game she loved so much and in that respect, on this occasion, she was fortunate.
Four years later she was back in hospital for another operation. This time she was in the relatively new Victoria Hospital in Kirkcaldy – a general hospital encompassing the whole gambit of medical specialisms, but this time it was not for a minor joint problem but something altogether more serious. What she would not be aware of at the time was that this episode of ill-health would herald the circumstances of her death a dozen or so years later through a number of simple but completely avoidable mistakes by those she entrusted with her care.
Agnes Wilson was born on 2 October 1916 in the small mining village of Lochgelly in central Fife, midway between Dunfermline and Kirkcaldy. It is a date that would have some significance in my own life some ninety nine years later and is just one of a number of quite remarkable coincidences you will learn about in due course. It was a time of turmoil and slaughter in the middle of the Great War; the Somme Offensive in northern France was entering its bloodiest phase with many casualties from fighting in the Battle of Thiepval. In the collieries and pits of central Fife the outlook was just as grim. Desperate working conditions and real hardship with a dark sense of foreboding saw thousands of young men heading south to help the war effort, leaving behind families struggling to put the basics on the table – a task made even more difficult with the loss of their sons to the battlefield rather than the coalface. The coming decade at the end of the war saw little improvement in their prospects and with so many sons and fathers killed in action the future must have seemed devoid of hope for those left behind. By the time she was thirteen, Agnes had left school and was in work at the Jenny Grey Pit washing and separating coals and rubble at the pit-head where she worked for three years. She was one of five children; two sisters and two brothers and perhaps the only remarkable thing about their formative years was that they survived through into adulthood during times of high infant and child mortality arising from the poor sanitation, not to mention malnutrition and work related injuries down the pits, which were often horrific. By sixteen she had left the pits and went to work ‘in service’ in Edinburgh – cleaning mostly in some of the grand Georgian houses in the New Town where she lived in servant’s quarters before returning home to Lochgelly on her days off. Sometime during the next few years, she met my grandfather, Tom MacDonald, an apprentice blacksmith and a romance started and they were married soon after in 1938 and moved into a ground floor two-roomed tenement next door to the West School in the town. Two years later their first child appeared – my mother, followed two years later with another girl, both born at home with the doctor in attendance.
It is difficult to imagine today what living conditions were like in this working class mining village during either War when both my parents and grandparents were born. From the stories I have heard over the years it must have been unrelentingly arduous; outside toilets, food rations, freezing winters without any heating other than the coal fire – and yet these times are remembered in good terms and with fond memories. The family lived in these sparse conditions throughout the war and beyond until the incredibly harsh winter of 1947 when they moved into a brand new prefab on the edge of the village opposite the golf club. Perhaps unsurprisingly, they endured the usual childhood illnesses of the time – chicken pox, scarlet fever, mumps, influenza were all unwelcome visitors at some time or another, yet I cannot recall my grandmother or grandfather telling me of a time when they were struck down with anything that required a visit to the doctor, never mind a hospital. Until the bunion started to hurt.
I had just started secondary school in neighbouring Cowdenbeath when she started to feel unwell. It was 1973 and we had just returned from a family holiday near Oban where she had experienced several bouts of abdominal pain over the fortnight. I suspect she consulted the family doctor on her return as her first appointment with the hospital consultant coincided with my first day at Beath Junior High. It was ‘woman’s troubles’, my father explained later. And she was to have another operation.
It was over a decade later before I discovered she had ovarian cancer and that the operation was, of course, a hysterectomy, but at the time it was just another mysterious illness attributed to the fairer sex under the guise of ‘woman’s troubles’. Whispered quietly, it was a subject that was to be acknowledged but not discussed and therefore completely misconstrued. An approach that my father took quite regularly whenever a topic came up that he was uncomfortable with. A few days after her operation, I went to visit her again with my mother and father. This time she was on the seventh floor of the new tower block at Kirkcaldy’s Victoria Hospital, which seemed quite a contrast from the wartime buildings at the Bridge of Earn where she was four years previously. I can recall spending most of the visiting time looking out of the window with its panoramic views over the town rather than speaking with my grandmother, but then what thirteen-year-old boy would do otherwise? Besides, she looked in great health and not unwell in the slightest, sitting up in bed and castigating my mother for making a fuss of her. I cannot say I had any worries for her.
There were a number of follow-up appointments at the hospital; check-ups every now and then, but she made a remarkably quick recovery and by the time the following Easter arrived, she was back on the bowling green and as bright and enthusiastic as ever. There wasn’t anything to warrant any concern as far as I knew. In the years following her hysterectomy she attended the outpatient department at the hospital perhaps once or twice a year. Occasionally, I would accompany her, taking the bus down from Lochgelly through Cardenden to arrive at the hospital forty minutes later for the appointment with the doctor. She was always the epitome of great health, always smiling and always unfailingly respectful and grateful with every doctor that she consulted. And they were always content with her, with good reason, as her progress back to full health was excellent and there didn’t appear to be any recurrence of whatever ‘trouble’ she had that required the operation in the first place. On each visit to the hospital she saw a different doctor, whoever was on rotation at the time in the out-patient department she attended, but the result was always the same – “very happy with your progress and we’ll check you again in six or twelve moths time” – and off she would go until the next visit.
Eleven years pass and the operation was a distant memory. I had left school then taken a year out before starting Podiatry College in Edinburgh, graduating in 1983. My first post was based at the same Victoria Hospital in Kirkcaldy where my grandmother had undergone her hysterectomy and where she still visited very occasionally for her ‘check-up’. She was sixty-seven years old now but still full of the energy and vitality she always exhibited – and still winning competitions at the bowling green. Life was good.
Shortly after I started to work in the September I took her down one evening and showed her my new surgery in a wing of the hospital that had been recently built. The Whyteman’s Brae complex consisted of five specialist wards for psychiatric, psychogeriatric and geriatric patients and several clinics for physiotherapy, podiatry and the other professions allied to medicine that were applicable in such a unit, such as speech and language and occupational therapy. I had been very fortunate as my surgery was pristine and fitted out with the latest equipment and I remember the look of pride not to say amazement when my grandmother walked through the door.
“You’re in a lovely place” she remarked “and if you can look after your patients they way I’ve been looked after here, then you will do very well indeed.” Six months later she started to feel “off colour” and by the time the bowling season resumed that Easter she barely had the energy to play the opening tie. But there was other trouble on the horizon. A week or so before the Bowling Green opened the National Union of Mineworkers called a National Strike and the miners’ walked out of the pits and collieries in protest at the proposed closure program by the NCB under Ian MacGregor. My grandfather, had been retired for five years, but had been through the previous National Strike in 1974, which had been quite traumatic. He was, strictly speaking, not a miner but a blacksmith on the surface and responsible for, amongst other things, the heavy steel cables that raised and lowered the pit cages down the shaft and as such he was permitted to undertake essential maintenance work by the Union, but it was not a comfortable situation for him crossing the picket line every day, albeit with his fellow miners grudging consent. If they were fighting for their jobs, some would have to ensure they had a safe pit to return. Ten years later, these bitter memories were reignited against a different background.
A few days after the bowling season started properly in early May, Agnes visited her GP as she was becoming increasingly tired and exhausted by the slightest effort. A blood test was done and a few days later she was in another hospital for a transfusion. Milesmark Hospital in Dunfermline had a couple of medical wards similar to the geriatric unit at Whytemans Brae and it was here she had her first units of blood. I was unaware of these events at the time and only discovered she had been in hospital a few weeks after the transfusion after I returned from a holiday in Ireland. “It was nothing to worry about”, she said, dismissing my questions. “Just needed a little top-up”.
I don’t know if she knew what was really wrong or whether a diagnosis had been made at that stage, but should that have been the case, it would have been so characteristic of her to play things down. I don’t recall hearing any complaints about her health, ever. Even over the coming months.
During the summer of 1984 and again with a backdrop of a National Strike, Agnes was in Milesmark another three times for more blood; the tiredness and exhaustion returning increasingly and more obvious as the weeks passed. More worryingly, just before her final admission, she began to bruise quite readily and in addition, there were several areas of what looked like pin-prick sized spots on her arms and legs. I had assumed, until then, that her malaise was simply because she was anaemic, but I was wrong. The day after she was admitted at the beginning of October, my father telephoned to say that the consultant had requested a meeting with my mother, aunt and grandfather and the news was not good. She had developed acute myeloid leukaemia and it was unlikely that she would make a recovery this time. By the time I reached the hospital that evening she was already heavily sedated and barely able to speak, but still managed to smile. The following morning she slipped into a deep sleep and four days later, she died.
It was the first close relative to me that had died. Both my maternal grandparents were a huge influence in my life, but my grandmother – or Nana – especially. They lived in Gordon Street a hundred yards from our house and I spent much of my childhood with them. I was the eldest grandchild; my sister four years later then our cousin two years after her. My grandfather, being an engineer and blacksmith, had a fabulous wooden garage he built himself, stuffed full of every imaginable tool and implement for all sorts of jobs; a workbench made from railway sleepers and shelves overflowing with jam jars full of screws, nails and three-in-one oil in copper pourers. I used to stay over most Friday nights and on the Saturday morning I helped wash and polish his car – an Austin 1300 – before we started on a job in this magic den of his. He made me my first ice axe from a miners pick welded on to a tubular metal shaft with a bicycle-handle grip to protect bare skin. He was a short, stocky man with a head of bright, thick, white hair lightly bisected with a nicotine-orange streak in his later years. I can still see him standing at his bench in dungarees – an Embassy Red with two inches of quivering, curving ash hanging impossibly above the heavy vice before him. He managed a full cigarette once, the whole ashy length hanging in flaccid surrender whilst he planed some wood. I doubt he even noticed. He was everything you imagine a miner would be; tough as nails, strong as an ox with a dour Fife personality through and through. There is a photograph of the two of us at the stile in the path above the east sands in St Andrews when I was three years old. It provokes both morbid and sobering thoughts when you realise that after the passage of half a century, you have become the same age as your grandparents in faded family photographs.
But if my grandfather gave me my love of taking things apart and finding out how they worked – a practical influence – it was my grandmother’s inspiration in so many other ways that I still treasure to this day. She was a calm, sagacious woman and although she only travelled out of Scotland on a handful of occasions and never further than York or Blackpool, her outlook was anything but parochial. She was the one person I could tell anything to; an absolute confidante and on the one occasion I did run away from home aged eight (my father first giving me a hand to pack my suitcase) I made it no further than her back door. As I write this, it is thirty years since she died and there is rarely a day that I don’t still think of her, but at the time of her death I felt strangely unemotional and disconnected. Perhaps it was the relative suddenness of it all – I had just a few days to prepare for the inevitability yet it still didn’t seem to sink in even on the day she died. It was a surreal feeling and not uncommon, as I discovered subsequently with surviving relatives who experience sudden death of a loved one. In the blink of an eye she was gone and you are thrown into the aftermath of things to organize and people to call so that the time to allow grief to have the time to form properly is deferred. That is how it seemed in hindsight, but at the time it was as though I had become a spectator in a drama witnessing the incomprehension of my grandfather to the inconsolability of my mother and aunt and realizing immediately that the guiding insipration that was needed at this time was not there anymore.
Four months later, on a Friday afternoon, I had an out-patient clinic running at Whyteman’s Brae in Kirkcaldy when I noticed my penultimate patient of the afternoon had the same name as my grandmother, however her address was in one of the small fishing villages in the Neuk of Fife. But when I collected the patient notes from the front office, I discovered that the records office had sent the wrong notes and had inadvertently sent those of my grandmother instead. Thirty-years ago it took some months to close patient records, especially where care was spread over different hospitals and all the correspondence and ward notes were gathered and filed manually – and it wasn’t uncommon to receive a number of wrong records in any clinic, but it still came as something of a shock when I noticed the address on the front label. I took it back to my room with the rest of the bundle and sat down and began to read.
The first set of notes were from the Bridge of Earn Hospital about her foot surgery fourteen years earlier including the referral letter from her General Practitioner in Lochgelly, Dr Roy Blues, his illegible handwriting immediately recognisable. I could just make out ‘bunion’ and the name of the surgeon, but that was about it. The surgical and nursing notes followed, then the paperwork changed to the Victoria Hospital and her operation for her ‘woman’s troubles’ – the ovarian cancer. This was my first surprise. Even after the passing of the years and her death, I still hadn’t known that her hysterectomy had been performed for underlying pathology so the notes from her gynecologist, Dr Hill were a revelation of sorts. There was a letter to Dr Blues shortly after her hysterectomy informing him that the operation was a success and that she would be put on a maintenance regime of cyclophosphamide and reviewed in six and twelve months time. This was followed by a series of out-patient records that coincided with her annual or bi-annual check-ups before the final tranche of records from Milesmark leading up to her death. But it was the final piece of correspondence that really stopped me in my tracks. It was a letter from a Consultant Haematologist to the doctor in charge of her care at Milesmark during her final weeks. It was a single piece of A5 white hospital notepaper, neatly typed with two short paragraphs; the first, thanking the doctor for asking him to review my grandmother’s case and the second, informed him that she had “developed acute myeloid leukaemia which will be refractory due to the prolonged exposure to cyclophosphamide.”
I hadn’t heard the term ‘refractory’ before, but could easily make an informed guess as to what it meant, given the eventual outcome. Nor had I heard of cyclophosphamide and why she was on such a regime in the first place. There was no internet and no quick answers then, so it had to wait until the end of the clinic and a visit over the road to the hospital library before I found what I was looking for.
Cyclophosphamide is a drug that was commonly used as an adjunct therapy in the treatment of some cancers, including ovarian tumours. One of its actions is as a bone marrow suppressant in particular to the formation of T lymphocytes, a form of white blood cell that are thought to increase the risk of further cancer developing. The literature went on to state:
“Cyclophosphamide is used for the treatment of numerous malignant processes and certain autoimmune diseases. Goals of therapy are prompt control of the underlying pathological process and discontinuation or replacement of cyclophosphamide with less toxic, alternative medication as soon as possible in order to minimize associated morbidity. Regular and frequent laboratory evaluations are required to monitor renal function, avoid drug-induced bladder complications, and screen for bone marrow toxicity. Cyclophosphamide has severe and life-threatening adverse effects, including acute myeloid leukemia, bladder cancer, hemorrhagic cystitis, and permanent infertility, especially at higher doses.”
I re-read her notes again and couldn’t locate a specific entry for the proposed length of the course she had been recommended after her hysterectomy. The letter from her gynaecologist to Dr Blues was the only mention of the drug and that she was due to be reviewed in six and twelve months time, but that was it. Even on her subsequent out-patient reviews there was never mention of the drug again – most of the entries simply noting that she looked fine and had no problems before suggesting a review at some future point, usually twelve or eighteen months time. I then read through her later notes from Milesmark and found a hand-written entry from her first visit the previous year when she received her initial transfusion, made by a ward doctor following a telephone call with the haematologist. Underlined, it read simply, “discontinue cyclophosphamide immediately”. At the time she had been on the drug continuously for eleven years, but I couldn’t find any information regarding recommended treatment courses so I had no way of determining if this was normal or otherwise, but the ‘prolonged exposure’ was sitting uncomfortably in the back of my mind by that stage and I had an inkling that something was not quite right.
I took her records home with me that evening, in contravention of hospital policy, of course, but I needed to find out whether anyone else I the family was aware of this. They weren’t; at least according to my father. Nor did he know anything about cyclophosphamide or its ability to cause AML or what her recommended course was. Rather he was dismissive. “What do you want to know that for?” he asked, with not a little menace in his voice.
It is worth remembering that the issue of medical malpractice was very much under the radar until a relatively short time ago. In the early 1980s, it was generally accepted that mistakes could sometimes happen, but the apportionment of blame and liability for such a concept was entirely foreign in the National Health Service. I have heard my grandmother say on many a time that accidents occur for any number of reasons but providing there was no intent to harm, there should be no blame or recriminations (most usually when waiting for a confession and explanation of any number of misdemeanors by myself) – and so it seemed a likewise philosophy was similarly adopted by my father as he contemplated what to say. He was by then, a district chiropodist, employed by the same NHS Board in Fife as I was and any thought about raising any concern over an incident like this would not have even entered his head. The Health Service was very much regarded as a big family; a close knit organization with a proud tradition in Scotland but with a definite hierarchical structure and it would, with hindsight, have been a formidable prospect for someone even in his position to challenge established medical practice, especially over something he would have little, if any, authoritative knowledge about. “How do you know she was on it for too long?” he asked. And of course, he was right. I didn’t know that for certain. Perhaps she needed to be on a maintenance regime of the drug for that eleven years and it was just an unfortunate consequence that she went on to develop AML, but it was the prolonged exposure that still sat firmly in my thoughts later that night as I pondered what to do.
On the Monday morning I looked through the hospital directory until I found the number for the Consultant Haematologist, Dr John MacCallum, whose office was located in the main hospital block. I wasn’t at all sure what I would say to him or what his reaction might be. I was twenty-three years old and only been graduated for around eighteen months and I remember being extremely nervous when I eventually dialed his extension. His secretary answered and I asked her if it would be possible to see him about a patient later that day. She suggested after his ward round at 11.30am.
Dr MacCallum was a quietly spoken and extremely courteous man who had taken up his consultant’s post a year earlier and welcomed me into his office with typical grace. “How can I help you?” he asked. My hands were shaking as I passed him my grandmother’s records and opened them at his letter.
“I was wondering if you could tell me what this means?” I said, pointing to his second paragraph. He read the letter then looked back at the previous pages then said, “This patient died last year. What is your interest in this exactly?”
“She was my grandmother.” I went on to explain the circumstances of my discovery, courtesy of the patient record department.
“I see.” He said, before he filled in the gaps. He informed me that he had asked to review my grandmother’s records the previous year, shortly after she had her first blood test in the weeks after the opening of the Bowling Green when she started to feel unwell. Her blood test showed abnormally low numbers of both platelets and white blood cells and he had flagged the result up for further clinical investigation. The transfusion she had was not for haemoglobin for anaemia as I suspected, but for platelets. She had a bone marrow aspiration carried out, which again I knew nothing about at the time, and this fuelled his suspicions that she was starting to develop a form of leukaemia. It was at that point he recommended discontinuing the cyclophosphamide. Later, when she began to exhibit the bruising and the pin-prick haemorrhages on her arms and torso, which he called thrombocytopenia, he made the final diagnosis of AML.
“How long should she have been on it?” I asked, acutely aware I was on difficult ground.
“I would think between six and eighteen months.” He replied. “But that would depend on the diagnosis at the time. I’m not sure what happened here with your grandmother, it was possibly an oversight or a mix-up with her prescription, but she had been exposed to this for quite some time and that wouldn’t have helped.”
I tried to take in what he was saying and thinking how to reply when he said; “I’m sorry you had to find out like that and I’m really sorry for your loss.” And I could tell that he was genuine with it. He handed me back the notes and suggested I return them to the medical record department and that was that. I didn’t find out any more. There was no investigation to determine who knew what or why. I’ve no idea if my grandmother was even aware that it had been the chemotherapeutic drug she had been prescribed all those years that was the likely cause of her death. She may have been informed, I forgot to ask, but if she had, it was probable that she would have kept the information to herself anyway, that being the measure of the woman she was. She certainly wouldn’t countenance a fuss.
Trying to determine what might have happened is simply conjecture. The failure, if that is the correct term, could have been in several areas. There was no computerisation then and medical notes were anything but contemporaneous and standard clinical practice was more of a verbal art form handed down from senior consultants to their protégées than in published guidelines and protocols. Certainly someone should have realised that she had been taking the drug for much longer than usual, but who and when? The environment wouldn’t have helped; the continual merry-go-round of registrars, house officers and trainee doctors through the various specialisms in the hospital set-up provides an obvious impediment to continuity of care where records may not be as detailed as they could be. There was no forward review of her medication written up in the notes for guidance in future consultations, just a record of how she presented and how she felt. It was, in all probability, a simple administrative error; an oversight, as the consultant had suggested; an unfortunate error but one with significant and avoidable consequences.
I returned her notes to the records department later that day and filed the slip with the other Agnes MacDonald’s podiatry treatment from before the weekend in the correct patient file. That was the end of the matter. There was nothing else I could have done and even if there was I don’t know if I had the capacity to take it any further and whether it would have done any good. The philosophy was different then and it was generally accepted that the Health Service, as with most of the institutions of the State always acted in the best interests of the individual and where the outcome was not as expected and someone went on to suffer loss, injury or life, it was seen, from my perspective at the time as a tragic mistake; something to acknowledge and learn from rather than apportion blame or liability. Hospital management was simply administrative and supported clinical practice whose principal oversight was through the various consultant committees. However, changes were on the horizon with the recent publication of Roy Griffith’s report on general management in the NHS but his recommendations would take time to filter through, but even then it is doubtful if they would identify simple failings of the kind that compromised my grandmother’s care.
I am being careful with my words as I do not seek to apportion any blame; I do not find the concept helpful in the slightest as we understand in its current lexicon and I think I still share my grandmother’s philosophy too in that providing there is no intent to harm there should be understanding and a learning rather than retribution and punishment, but I am only too well aware such a view is not in fashion much these days. The pendulum has very much swung in the other direction since my grandmother’s death and after the likes of Shipman, Alder-Hey and the countless other ‘scandals’ in our State Health Service, there is an entire industry devoted to medical malpractice with enormous attendant costs. Countless Public Inquiries with armies of barristers, solicitors and traumatised relatives pouring over endless evidence of failings in care has achieved little more than promoting a defensive culture riven with fear and intimidation, not least because of the enormous liabilities the NHS is accruing from an equally expanding battery of claimants. Such are the times we are in, but it would have seemed absurd, even wrong to seek financial compensation or bring someone to task for a simple oversight that had inadvertently contributed to someone like my grandmother’s death, even though such an approach would not be out of the norm today and probably even encouraged. Especially by the industry geared up to profit the most out of it – our legal profession and in particular those concerned with regulation and compliance.
Thirty years ago I was a new entrant into our National Health Service – a lowly foot soldier, as it were, but nonetheless very enthusiastic about my profession and its prospects. It seemed a time of great promise and hope as I was instilled into a great institution founded on tremendous principles – and there was another more personal connection closer to home. The wife of Aneurin Bevan, the architect of the NHS, was Jennie Lee, later Baroness Lee of Asheridge, was born in Lochgelly and very much one of my grandfather’s favourite people and the subject of many a tale. She was ten years his senior and he could well remember her firebrand style supporting the miners through their various struggles in the years before she became a prominent Member of Parliament in her own right. The prospect of a career in the Health Service was something really I looked forward to. It seemed worthwhile and exciting. It was also set in a time of great innocence and naivety, for me at least. But the coming years were about to change all that.
It would take decades and a completely different set of circumstances before my views about ‘great’ institutions of State and their responsibilities and functions were challenged again and another two decades after that before that any lingering confidence in them finally dispelled.
(First published 3 November 2013)
There is always a danger, when looking back over one’s childhood, of succumbing to nostalgia and remembering only the happy events – those joyful times that leave an indelible mark in our memories to cherish when we get old.
Growing up in Lochgelly during the 1960s and 1970s offered plenty of opportunities to add to the collection. A proud, working-class mining village set amongst the beautiful scenery of central Fife, perched high on its own little hill with panoramic views over the Braes towards the Meadows and Benarty and Lomond Hills, then out along the East Neuk before turning south over the Loch that gives the village its name. But it wasn’t all Utopian bliss. And sometimes the real horrors lie hidden for years.
Like many youngsters in the town, I enjoyed a number of jobs that would help supplement the weekly pocket money allowance from my father. Picking tatties down at Ernies, doing the shopping for elderly neighbours and bagging the monthly one-ton coal delivery at my grandparents. Grandad’s job as a blacksmith with the NCB came with regular extras, but my steady job was as a paper-boy with Dougie Dickson who ran the newsagent on the corner of Auchterderran Road. The early rise could be a real pain at times, especially if I had been reading under the covers the previous night or when the alarm sounds alongside a thunderous cacophony cascading down from the heavens onto the tiles above my head. But it was also a joy – walking into the sunrise down Auchterderran Road then over to Cooper Ha’, along Launcherhead Road and up the Auld Guige on a warm spring morning with the hedgerows teeming with birds before anyone else was up and about was a great place to cultivate a fertile imagination. Most of the time we just delivered the papers and magazines, but for a short time in 1973 we had to collect the money too, so on a Friday, after school, it was out with the bike and a bag of change and round the doors for a second time that day. We had a small rise from Dougie to compensate for the extra round, but the novelty and pay rise soon wore off and it became a chore.
A Friday collection round during November that year took a sinister turn. My ‘home leg’ was MacGregor Avenue, which used to look out over the Plantin (short for Plantation or Planting – which I have never been able to determine). I lived one street up in Stewart Crescent so I had only a few calls left when I turned the corner by the water tank that looked out over the second green on the golf course – and into the west end of the Avenue. A short way down I stopped to collect the paper money from a house, left my bike at the gate and walked the sort distance to the red door. I was about to knock when it opened and Mr King was waiting for me. He was a familiar figure – a regular on the golf course, he would often give the young boys some advice and coaching. Short, stocky with thick arms and legs – he looked like a celtic Gene Hackman. Whilst the coaching was always welcome, there was an edge to him and he had a quick temper and tongue and was never gracious when playing behind, always the first to shout “out the way” if he wanted to play through.
I hadn’t really spoken with him directly though and certainly never one to one, so I was a little apprehensive when he announced, “Come on in, I’ve got something for you.”
At a time when adults were to be respected and trusted it didn’t cross my mind to refuse, so I walked past him into the hallway as he closed the door behind me. Perhaps what unnerved me most was his attire – a short, grey, toweling dressing gown – and as he climbed the stairs I had a good view of his thick hairy calves. “I’ve seen you on the golf course” he said without looking back, “I’ve got some golf magazines for you, come on up..”
The layout of the house was the same as my own and he turned at the top of the stairs I realized he had gone into the front bedroom. His head appeared round the corner and he smiled and said “Come on – you can carry them down.”
When I reached the top of the stairs and turned around he was waiting by a dressing table just inside the doorway. There was a pile of black and white magazines on the table and he gestured towards them. “That’s them there” he said ‘you’ll get lots of good tips from them.” He picked them up and handed them to me, then he leant down and opened the top drawer of the dressing table and pulled out another magazine. This one was in colour and had a half-naked woman on the front cover. I recognised it from one of the top row collection Dougie had in the newsagent shop. “What dae you think of this?”
As I stared at it, he put it down on the table next to a vanity mirror and brush set – the same as my grandmother’s – then he reached round and grabbed me by the back of the neck. “Have you seen one of these before?” he asked, as he reached inside his dressing gown with his right hand and pulled out his semi-erect penis and started to stroke it.
I was transfixed with fear and couldn’t move – for a second or two – then I lurched back and broke his grip before turning and fleeing down the stairs and out the front door. When I was halfway down the garden path he shouted after me, “Tell anyone and I’ll fucking kill you.”
I was a long way down the road when I bumped into a friend of mine, also collecting paper money and I told him what had happened. “What are you gonna do?” he asked. “You going to tell your dad?”
“No way” I replied.
I had forgotten about this incident. Completely. If ever the topic of paedophillia came up, I would have an opinion, of course, just the same as anyone, but I would always qualify it be stating that I was very fortunate and hadn’t experienced anything remotely like it in my life. Like most, I find the practice abhorrent. Like most, in an abstract, detached way. Or so I thought.
One Friday evening in late may during 1998 I was visiting my parents after returning from London for the weekend. I parked my car outside their house at the foot of Boyd Place and started to gather my things. As I opened the door and looked up, an old man was walking towards me on the pavement and as he passed he looked down at me and our eyes met. In that instant a scene started playing in my head, just like a film – and immediately I was back in his bedroom twenty five years earlier. Again I was transfixed and couldn’t move but this time with shock rather than fear. As he walked past me he turned and glanced back and I sensed the look of recognition in his face.
I cannot clearly recall the next few moments but I remember my mother standing at the window looking out with a smile and waving and then I was walking down the road towards him. I pulled up a few paces behind, keeping up easily as he tried to increase his pace. I didn’t say anything for a minute or two – I was still engrossed at what I was seeing in my mind’s eye. Everything had such incredible clarity – as if it was occurring concurrently with the present time. Out of one eye I was watching an old man walking down a pavement and in the other he was standing over me, masturbating. It was the eyes that made the connection.
“You’re Jimmy King” I said. More of a statement than a question. “Do you know who I am?” I asked. “Of course you do.” I answered for him. “I’m your paper-boy – remember me?”
For the next five minutes until we reached his front door I kept at him, asking about what had happened that Friday in November; what he was doing. What he was thinking. He said nothing. Just kept on walking with a studied determination. By the time we reached his house in MacGregor Avenue he was exhausted and shaking like a leaf. “You just fucking keep away frae me.” He said as he reached his door. I had paused as I reached the gate, unwilling to cross the threshold into his garden; his space, again. I looked at him as he walked through the familiar red door and as he turned, I said to him, “If I find out you’ve did that to anyone else, I’ll be back.”
I couldn’t think of anything else to say. It was a bit pathetic, but it was the only thing I could pluck out of the thousands of other thoughts that were racing through my mind at that second. I did raise my voice a little though, which helped. As I walked away I could see another figure walking across the living room to the door. Someone else.
The remembrance of the incident shook me up for quite a few weeks. Let me be clear. The magnitude of the ‘abuse’ was nothing compared to what we know now after the likes of Savile and the explosion of serious sexual abuse cases that have flooded the media in recent times. I wasn’t hurt physically, merely witnessed at close quarters, the infallibility and weakness of the human spirit. A sordid act, for sure, but nothing physically harmful in the strictest sense. What troubled me most was that I had completely erased the memory in the intervening years and it had only returned – with incredible clarity – when visually triggered by a casual encounter with the protagonist. What else may I have hidden away?
Experiences like this are not that uncommon. Spontaneous recall or memory reinstatement often occurs from a trigger stimulation – smell, sound, sight of an entity closely associated with the original memory. With me, it was the look in his eyes.
After a few weeks I reconciled my thoughts a little and was reasonably content there were no other monsters hiding in the cupboards of my deep memory and soon I had largely relegated the experience to an occasional consideration and by and by, other things took over.
Two years later I was in Fife again, this time during May at a Sunday league football match in Cupar watching my two sons play in the last match of the season. It was pouring with rain as both teams chased a sodden ball en masse up and down the pitch to howls of encouragement from the watching parents. Sometime during the game, a woman came across to me and asked how I was. “Not seen you in years” she said and she started to tell me about her son who was playing in the same match. After a minute or two I interrupted her and confessed that I didn’t know who she was, giving the usual excuses of rapidly advancing senility and incompetence. She had been at the same primary school she explained – in the same class – and once she told me her name I could remember her fine. But not quite the same way as I had with the old man.
We were chatting for a good while when we got round to asking about our parents. “I don’t see mine anymore” she said, as a matter of fact. “Haven’t seen them since before I got married about nine years ago.”
“Why not?” I asked, always curious to hear the unusual.
“Well when I was about eight, my mum and dad got a job at Andrew Antennas but on different shifts. Sometime though they would get swapped over and I used to have to stay with my aunt and uncle if they were working nightshift together. When that happened I used to get raped by my uncle and that kept happening until I was about sixteen. When I was going to get married, I told my mum and dad what had happened because they were going to get invited to the wedding. I didnae want them there. But my mum and dad didnae believe me. Didnae want to believe me. So me and Brian did the wedding ourselves and nobody from my family came and I haven’t spoken them since.”
I was at a loss for words but managed to ask what happened to her uncle.
“Nothing” she said, “he’s still in Lochgelly.”
“You’re kidding” I replied. “Where about?”
Long after the game had finished and the kids were sitting in the car I finished telling her about my encounter with her uncle all those years ago – and more recently. “What are you going to do?” she asked. I just shook my head in reply.
I didn’t return to London after the weekend, instead I stayed on in the Holiday Inn in Leslie for an extra night and sat up most of the night just thinking about what I had learned.
The following morning dawned cloudless and still – a beautiful day in prospect as I looked out over the ‘Cut’ – that long straight section of the River Leven that runs from the loch towards Auchmuir Bridge, on the road between Leslie and Lochgelly. I parked my car on the south side of Loch Leven and walked up Benarty from Vane Farm – the RSPB reserve – up the long incline to the top and as I reached the summit and Lochgelly came into view, I decided then what I was going to do.
An hour later I walked through the ‘close’ – the alleyway or gunnel, between the house with the red door and its neighbour on MacGregor Avenue. It was just after ten o’clock in the morning and most of the residents were in their back gardens making the most of the pleasant weather. On one side, a woman was hanging her washing whilst her husband was preparing the lawnmower. In the garden that concerned me stood Jimmy King, trimming some plants with secateurs in his hand. His wife was by the garden shed and it was she that saw me first. There was a cast iron and wooden garden seat at the back door and I sat down and waved her across.
“Can I help you?” she asked. “Yes, I think you can.” I replied and patted the seat beside me. She sat down and I introduced myself to her. “Do you remember me?” I asked. “I used to be your paper-boy many years ago. I lived just up in Stewart Crescent. Do you remember? My dad was the chiropodist.” I added as an afterthought. There was a vague look of recognition, but perhaps this was only out of politeness. She said nothing. I went only speaking quite slowly and slightly louder, “I was just wondering, Mrs. King, if you knew your husband was a paedophile and child abuser.” It was not the kind of question that would elicit a conversational response, but I did expect something back from her, but instead she just looked at me with a dread, a fear in her eyes that said everything. She knew. I told her what happened. Then I told her about her niece..
By now the neighbours had stopped and were listening and looked just as shell-shocked as the woman next to me. Jimmy came down towards us, brandishing the secateurs and shouting at me to get out. I waited until he was at arms length then with a calmness I didn’t know I possessed, I took the instrument from him quickly and grabbed him by the throat with my left hand all in one movement then lifted him off the ground.
He was an old man by then, probably late seventies but still quite stocky and muscular. He had worked on the railways and the golf had kept him in reasonable condition, but that morning, with my weaker arm, I managed to lift him clear of the ground then walked him down to the close on an outstretched arm, without even thinking about it. Once I got him there I held him up against the wall and came up close to his face. I could see his eyes reddening and beginning to roll and I realized then I was suffocating him and I squeezed ever so slightly harder. “How does it feel, Jimmy?” I asked “How does it feel to be on the receiving end for a change?”
I held him for a few seconds more then released by grip slightly and lowered him to the ground. In these few seconds I thought about what I was doing and quite calmly and detachedly I debated what I should do. I didn’t have an answer. Instead, I said to him very quietly, “I’m going to tell you something Jimmy. You won’t know when or where, but I’m going to come back for you. Maybe when you’re coming out from the golf course one night, maybe when you’re getting your messages or digging your garden. And I’m not sure yet what I’m going to do to you, but I am going to think of something quite memorable. Every night when you go to bed, and every morning when you wake up. I want you to think about that first and last. You got it?”
I dropped him and he fell to the ground and there was some shouting and some threats as I left and got into my car. As long as he lived then I was reasonably confident the police wouldn’t be involved. Not if Jimmy had anything to do with it.
I was left with a sense of disgust by the whole episode – not just for this man’s behavior and the trauma he had inflicted on one of my classmates from many years ago – but strangely enough for my own. Not the threats or the unpleasantness at the house that day, but in the few seconds that I had held him by the throat against the wall I realized then in that instant that that I was using that horrific power – of overpowering someone who is much weaker – in the same way that he had done against me, only without the sexual element – and that appalled me as much as anything else.
I never returned again to MacGregor Avenue and Jimmy King died a few years ago. I don’t know how. I do hope he thought about me from time to time – and his niece too – but sometimes these people just don’t. They have no conscience or guilt – or if they do, they keep it locked away somewhere deep in their innermost recesses. Like we all sometimes do with unpleasant memories. Just kept in a locked room waiting for something or someone to open the door.
Almost three decades have passed since the Lockerbie disaster and we are still a long way from discovering what actually happened that dark December night, never mind who was responsible for the atrocity in the first place. Time itself is proving the greatest handicap as many of the individuals involved in the case have since died and we have to resign ourselves that we may never know the true version of events and ensure justice is carried out for the victims and their families, which will be little consolation to the likes of Dr Jim Swire who has campaigned relentlessly for a new independent investigation, but to little avail. In an interview some years ago, Dr Swire descried the “wall of silence” in the government and media whenever he tried raising the issue – a practice that has become increasingly fashionable in the intervening years.
A week after my 40th birthday I was working in St Albans for the NHS when news began to break of a tragedy in America. Two commercial airplanes had crashed into the Twin Towers in New York and hundreds of people were trapped at the top of the skyscrapers above the impact sites. At lunchtime, we were told that all clinics had been cancelled for the rest of the day and I headed back home to Birmingham and listened to the developing situation on the car radio. Like most people throughout the world I suppose, I spent the next 24 hours after I arrived, glued to the television set, not quite believing what my eyes were telling me. It seemed absolutely impossible that two enormous buildings could collapse so comprehensively when it appeared that the fires that had engulfed the skyscrapers following the impact had largely burned out. Yet collapse they did – at what seemed an incredible rate.
It is worth remembering that in 2001, the Internet was in its infancy. There was no Facebook; no YouTube and no live news sites. Although media coverage was extensive for many months afterwards, most of the focus was on the personal tragedies and the political developments as the USA geared up for retaliation. We were left in little doubt who the perpetrators were – nineteen Arab fundamentalists instructed by Osama Bin Laden – whose guilt was unquestionable following the 9/11 Commission Report a few years later. The case was simple; four planes were hijacked in mid-air, two were flown into WTC 1&2 in New York, one into the Pentagon and the other into a field near Shanksville PA, after passengers overpowered the hijackers in a courageous fight to the death.
In Manhattan, fires from the kerosene aircraft fuel weakened the steel structure of the buildings and caused the top section of the towers to fall onto the building below, where it caused a gravity-driven collapse, pulverising the entire structure into pile of dust and twisted metal with the loss of over three thousand lives. The destruction of each building took less than twelve seconds and it was the manner in which the towers fell that transfixed this individual, perhaps to the point where I failed to register anything else that day. Like the destruction of another New York skyscraper later that afternoon. At 5.20pm EDT, World Trade Center 7 also collapsed from fires caused by falling debris after the towers fell.
It seemed irrelevant at the time. No one was killed as the building had been cleared hours before. It just fitted into the pattern that day – damage from the airplane crashes caused fires, which weakened the building structures causing them to collapse. It was the only explanation offered at the time – and one that was subsequently confirmed by the 9/11 Commission Report and the NIST (National Institute for Standards and Technology) investigations some years later. It is a position that has been steadfastly adopted by every US administration and its allies ever since.
September 11th 2001 became the pretext for a “war on terror” that is still being exercised today – sixteen years later. The official explanation of what actually happened that fateful day does not, however, bear close scrutiny.
Modern hi-rise buildings don’t collapse from fires thankfully. That is not to say they are ‘safe’ places to be in an emergency – as Grenfell so tragically illustrated recently. But it is worth noting that the London building did not collapse, even after an intensive fire that raged for over 16 hours. Neither did the Torch skyscraper in Dubai, which caught fire for the second time just last week. Of course, neither building sustained an airplane crash – but then again neither did WTC 7.
NIST is the US government agency responsible for investigations following major structural failures in buildings and up until the 9/11 atrocity, enjoyed an exemplary reputation for diligence and accuracy. However its conclusions into the failures of the three Manhattan skyscrapers are incomprehensible.
On the twin towers, NIST claims that a weakening of the connecting floor trusses from the kerosene fires resulted in the top sections of both buildings becoming unstable causing them to crash down onto the top of the structure below. This gravity-driven collapse then pulverised the remaining buildings into a pile of dust to the point where only a few sections of the outer walls at concourse level remained standing – at most a couple of hundred feet.
Whilst this seemed plausible on first reading, the explanation for WTC 7 did not. NIST claimed that fires from office furniture had substantially weakened just one support column (of 58) and when this failed at 5.20pm, the entire building then collapsed. However, at a press conference following publication of their report, NIST admitted that they really weren’t quite sure how WTC 7 had collapsed in the way it did, but they were sticking to their story regardless.
In time, when the details of the Pentagon and Shankville incidents were released, even more doubts surfaced about the official explanation. We are asked to accept that both aircraft mostly vaporised after crashing with only a few fragments of fuselage recoverable from both sites. No passengers were identified at either site – not even through DNA analysis – as they too vaporised on impact.
If we are to believe the official position that a passenger aircraft can fly at 560mph a few feet above the ground whilst approaching one of the most secure buildings in the world, knock down five lamp-posts with its wings en route and can still manage to crash a neat twenty foot hole through reinforced walls, then I guess it’s fairly safe to assume than none of the passengers would survive the collision. But parts of them would – enough to conduct DNA analysis for identification – only in this instance, it appears not.
The same with Shankville, where Flight 93, immortalised by Holywood, crashed into a field before reaching its intended target. Here too, the aircraft and passengers were vaporised, leaving only a smoking crater and a handful of fuselage fragments for investigators to look at and scratch their heads.
Why is this impossible?
In every other aircraft tragedy, crash investigators and recue personnel have always managed to recover substantial parts of the aircraft – and passengers. Following Lockerie, much of Pan Am 103 was recovered over a huge radius in the Scottish Borders and painstakingly reconstructed for forensic examination in an aircraft hanger in England. Part of a timer circuit in the bomb that exploded that evening was recovered on a hillside many miles from Lockerbie and became of critical in the subsequent criminal trial in Camp Zeist as the manufacturer’s name and serial number were still readable. All of the passengers on the flight were recovered, some of the bodies remarkably unmarked, despite the rapid descent in an aircraft blown up at 34,000’ whilst travelling at over 500mph. The black box was intact. Nothing vaporised.
Even Malaysian Airlines MH17, which was destroyed by Bulk surface to air missile whist flying at 33,000’ over east Ukraine in July 2014 gave up its ghosts five months later, when Dutch forensic investigators announced on 5 December they had identified 294 out of the 298 passengers and crew that were on board after a major recovery operation in an extremely hostile environment. Much of the aircraft was recovered too. Little, if anything was vaporised.
Of course, there has been no explanation as to why the 9/11 airplanes and passengers simply vaporised leaving no trace behind. There can’t be as it would be even more ridiculously implausible that the reasons offered by NIST for the WTC 1,2&7 building collapse in New York.
As tragic as all those events were on 9/11, New York remains paramount in emotive recollection – not least because of the violent deaths of over three thousand innocent victims – and it is here where demands for Pandora’s Box to be finally prised open will become irresistible. Only now, a decade and half later, are all the long-term health implications for Manhattan citizens being fully understood and realised. Many of the conditions were triggered by the inhalation of the toxic dust cloud that enveloped lower east side following the collapse of the towers. What was in the dust that proved so debilitating and fatal to those that were exposed? Could it offer any clues why the buildings collapsed in the manner they did?
If Isaac Newton had been around today, then this mystery could have been solved at the outset. All he would have done was to direct our attention to his Third Law and say “go figure”!
Of course, I have no experience of building construction and regulation and can claim no authority in that field. I’m just a simple podiatrist, but the same Newtonian principles apply in my area of expertise and I would be grateful if you can permit me an analogy.
Imagine one of the athletes competing in the long-jump in London this weekend took his final attempt, but on landing, screamed in agony and was rushed off to hospital. On admission his legs are x-rayed and the films show multiple compound fractures of all lower extremity bones – femur, tibia, fibula and all foot bones and joints completely destroyed into small fragments.
If the radiologist’s report came back diagnosing “multiple compound fractures resulting from abnormal impact stress”, then it’s a fair assumption said radiologist would be facing a Fitness to Practice hearing by my old friends at the HCPC in the near future, not that it would solve much – but that diagnosis is simply not possible, unless there was some other pathology present like osteogenisis imperfecta (brittle bone disease) or extensive bone cancer. We can calculate the forces present in our bones and we can determine how much stress can be applied to these structures before a fracture occurs – but common-sense dictates that a healthy athlete doesn’t sustain that kind of injury doing something he has does on a regular basis unless his bones were badly diseased. Newton’s Third Law is again the applicable principle; for every action, there is an equal and opposite reaction.
Just as in the example of the athlete, it is perfectly possible to calculate the forces present in the WTC building collapse when the top section of the towers fell onto the structure below and from this, an accurate model of damage could be ascertained. But simply applying the principles of Newton’s Third Law renders such calculations unnecessary.
Much argument is focussed on whether kerosene fires could actually weaken steel support columns or floor trusses to the point where they failed completely – but let’s assume for a minute that they suffered the same fate as the aircraft and passengers and simply vaporised. Ten floors of both towers vanished instantly into thin air and the top sections plummeted down 120’ on top of the building below. Applying Newtonian physics to this scenario, one would reasonably expect a fair bit of destruction to occur to the top sections and the buildings below, crushing several floors equally in the impact. But the energy expanded in crushing these floors reduces the force in the falling block decelerating its descent until the resistance from the lower section halts its progress completely. Unless the top section of the building had a mass many times greater than the lower section, the very most that could have been destroyed in the collapse is half of the top section and a corresponding number of floors in the intact building below.
For the WTC buidings to collapse within a second of freefall speed, all three must have been compromised from the basement up. That means they were subjected to controlled demolitions – which doesn’t really square with anything our governments have told us. It doesn’t suit the narrative. But whatever was used to demolish those buildings it is likely that it has contributed to the toxicity of the dust breathed by all those who were present that day and now struggling with the consequences.
I don’t normally recommend YouTube for research, but this short video is worth a watch. Peter Ketcham was a senior NIST investigator and scientist until last August 2016, when he finally concluded his organisation was covering up a major crime and decided to speak out. He is just one of many courageous individuals who have decided the wall of silence must finally be broken.
Not before time.
” It wasn’t just Kensington and Chelsea’s culpability for the way the tower was reclad in flammable material, or the repeated warnings from residents that were either ignored, or astonishingly, greeted by threats of legal action.”
Jonathan Freedland – Guardian 16.6.17
“It seems that one of the things about what happened in this disaster is that the warnings and concerns that had been voiced weren’t being listened to by those who held power and I think that if anything is going to come out of this is that we must listen to those people who don’t always get heard by people in positions of authority and this is a terrible and horrendous wake up call – but it’s got to be a wake up call so that never again can the voiceless be ignored by those who are power – and let us hope that some lessons are learnt and that procedures put in place so that never again do we have to sit here and say: “What more does it take for those people to be listened to?”
Rachel Reeves MP. – Any Questions BBC Radio 4
The same question is directed to the following:
# Marc Seale. # Jeremy Hunt. # Sarah Wollaston MP. # Elaine Buckley. # Alan Shillabeer. # Jonathon Jones. # Tan Ikram. #Jacqueline Beech. # Professional Standards Authority. # Health & Care Professions Council. # Nursing & Midwidery Council. # Bar Standards Council. # Liz Truss MP. # Sir Oliver Heald MP. # Lydia Barnfather. # Theresa May MP. # Richard Langley. # Society of Chiropodists & Podiatrists.