Cost cutting eye surgery of elderly patients

The request was successful.

Dear Moorfields Eye Hospital NHS Foundation Trust,

It appears that the Moorfields Eye Hospital NHS Foundation Trust has a policy of ignoring what are otherwise medical emergencies when it comes to the elderly.

The public have a right to know why the elderly are apparently being left feeling discriminated against.

Please supply the number of patients between the age of 50-60, 60-70, 70-80, 80-90, 90-100, 100 and above, who were operated on for
1. Cataracts in one or both eyes
2. Retinal Detachments or tears
3. Laser

every year for the last 5 years and the length of time they waited for surgery.

Please provide the number of patients who died whilst waiting for the above 3 operations before the date of the operation from primary (infections, haemorrhages) or secondary causes (loss of sight)
Yours faithfully,

lotus

Dear Sir

Thank you for your request for information. Your request was received on 12.02.13 and we are dealing with it under the terms of the Freedom of Information Act 2000.

In some circumstances a fee may be payable and if that is the case, we will let you know the likely charges before proceeding.

If you have any queries about this letter, please contact us. Please remember to quote the reference number above in any future communications.

Yours sincerely,

Heather Wilcox
Freedom of Information Team

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Dear foi,

Please provide details of the list of charges made and how these are calculated.

Also provide details of the FOI requests refused by Moorfields Eye Hospital NHS Foundation Trustsas a result of non-payment of your FOI charges.

What is the average cost of FOI requests where charges have been required before processing FOI requests.

It appears that you are denying FOI requests to those who cannot afford to pay your fees.

Yours sincerely,

lotus

2 Attachments

Dear Sir

 

The Trust has now completed its search for the information which you
requested on 12.2.13.

 

We note and disagree with your opinion set out in paragraphs 1 and 2 of
your email but this does not appear to specifically request any
information.

 

In answer to your questions, please find below activity data as requested.
Please note that the figures for 2012-13 are for the period April 12 to
Jan 13.

Waiting times are based on the clinical decision to admit (DTA), and the
date the patient is admitted into hospital.   It should be noted some
patients choose to delay surgery for personal reasons.

Laser treatment is generally completed in an outpatient setting and not
generally subject to a wait specifically for the procedure, hence no
waiting times are provided.
We do not record cause of death among patients who are waiting for
treatment.

 

 

If you are unhappy with the way the Trust has handled your request, you
may ask for an internal review.  You should contact Ian Tombleson –
Director of Corporate Governance 0207 566 2490 if you wish to complain.

 

If you are not content with the outcome of the internal review, you have
the right to apply directly to the Information Commissioner for a
decision.  The Information Commissioner can be contacted at:

 

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

SK9 5AF

 

If you have any queries about this letter, please contact us.  Please
remember to quote the reference number above in any future communications.

 

Yours sincerely,

 

Heather Wilcox 

Freedom of Information Team

Moorfields Eye Hospital

 

 

ACTIVITY

 

Cataract

 

Age Band
Financial  Grand
Year 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 100 + Total
2008-2009 1479 3464 5475 3448 373 10 14249
2009-2010 1412 3398 5213 3063 299 4 13389
2010-2011 1595 3602 5296 3019 359 2 13873
2011-2012 1552 3568 5175 3053 359 2 13709
2012-2013 1154 2758 4074 2541 248 3 10778
Grand Total 7192 16790 25233 15124 1638 21 65998

 

 

Retinal detachment or tears

 

Age Band
Financial 
Year 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 Grand Total
2008-2009 24 18 21 19 2 84
2009-2010 164 219 138 58 4 583
2010-2011 129 164 111 51 7 462
2011-2012 465 643 447 156 10 1721
2012-2013 470 606 357 133 20 1586
Grand Total 1252 1650 1074 417 43 4436

 

 

Laser Procedures  

 

Age Band
Financial  50 to 80 to 90 to Grand
Year 59 60 to 69 70 to 79 89 99 100 + Total
2008-2009 1851 2747 2882 1637 245 43 9405
2009-2010 1833 2523 2741 1359 214 29 8699
2010-2011 2239 2965 2790 1494 202 15 9705
2011-2012 1754 2370 2344 1302 192 18 7980
2012-2013 1976 2579 2114 1103 177 13 7962
Grand Total 9653 13184 12871 6895 1030 118 43751

 

 

 

AVERAGE WAITING TIME (DTA to procedure) IN WEEKS

Cataract

 

Age Band
Financial  Year 50 to 59 60 to 69 70 to 79 80 to 89 90 to 99 100 +
2008-2009 7.45 7.51 7.78 7.81 8.45 5.70
2009-2010 7.31 7.45 7.58 7.74 7.93 8.00
2010-2011 8.61 8.89 9.09 9.29 9.19 1.50
2011-2012 8.66 8.92 9.30 9.89 9.90 11.00
2012-2013 6.60 7.39 7.51 7.78 8.23 10.33

 

 

Retinal detachment or tears

 

Age Band
Financial  80 to 90 to
Year 50 to 59 60 to 69 70 to 79 89 99
2008-2009 3.95 4.19 2.15 4.12 7.00
2009-2010 3.15 3.84 3.76 4.73 4.00
2010-2011 3.12 3.69 4.25 3.85 4.43
2011-2012 3.24 4.05 4.96 5.52 6.33
2012-2013 5.15 4.48 4.57 5.26 2.27

 

 

 

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lotus left an annotation ()

Clearly it is unacceptable that retinal detachments are not being carried out immediately as per the NHS stating it is a medical emergency. The waiting time of several weeks will result in retinal tears becoming total retinal detachments with the macula coming off, reducing the chances of regaining sight after surgery.

The Moorfields Eye Hospital being a national centre for eyes, this is a very poor quality service.

Given that the elderly population percentage has increased over the years, the number of cataract surgeries are expected to increase in time, not decrease. This suggests, the number of elderly patients requiring cataract surgery but not receiving it at Moorfields has increased.

Dear foi,

The figures are not provided in a sufficiently clear format to make any statistical analysis with the naked eye.

The issue is not properly dealt with since the question was aimed at identifying the number of surgery's identified but not carried out.

The response implies that all diagnosis made for cataracts and retinal tears and detachments were dealt with. Yet my personal experience has been that most of the elderly patients requiring emergency retinal surgery have been denied or refused surgery by the hospital.

Please provide the number of patients identified as having
1. cataracts
2. retinal tears or detachments

who were denied or refused surgery in the same time and age groups as the FOI request and the grounds for the denial or refusal.

Please provide the number of complaints received that patients surgery was
a) delayed,
b) denied
c) refused
with age groups of patients.

Yours sincerely,

lotus

Dear lotus,

Thank you for your request for further information. Your request was received on 16.03.13 and we are dealing with it under the terms of the Freedom of Information Act 2000.

In some circumstances a fee may be payable and if that is the case, we will let you know the likely charges before proceeding.

If you have any queries about this letter, please contact us. Please remember to quote the reference number above in any future communications.

Yours sincerely,

Heather Wilcox
Freedom of Information Team

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Dear foi,

The response is long overdue, please respond as soon as possible.

Yours sincerely,

lotus

Dear Sir

 

The Trust has now completed its search for the further information you
requested in relation to your FOI request:

 

In answer to your additional questions:

 

1. It is Moorfields Eye Hospital's policy that all patients who are likely
to benefit from treatment are offered it as soon as feasible and
convenient to the patient.

 

2. Patients presenting with recent onset retinal detachment are offered
surgery and are given priority irrespective of age. Specifically patients
with "macula on" detachments are operated on the same day or within 2 days

 

3. There is no evidence that patients with macula off retinal detachments
suffer worse outcomes by waiting up to a week.

 

4. Patients with retinal detachments are largely treated as day cases.
Patients presenting acutely are therefore sent home if they cannot be done
that day and brought back within days.

 

5. We do not collect data on patients who decline surgery or die whist
waiting for surgery.

 

If you are unhappy with the way the Trust has handled your request, you
may ask for an internal review.  You should contact Ian Tombleson –
Director of Corporate Governance 0207 566 2490 if you wish to complain.

 

If you are not content with the outcome of the internal review, you have
the right to apply directly to the Information Commissioner for a
decision.  The Information Commissioner can be contacted at:

 

Information Commissioner’s Office

Wycliffe House

Water Lane

Wilmslow

Cheshire

SK9 5AF

 

If you have any queries about this letter, please contact us.  Please
remember to quote the reference number above in any future communications.

 

Yours sincerely,

Heather Wilcox

Freedom of Information Team

 

Before acting on this email or opening any attachments you should read the
Moorfields Eye Hospital NHS Foundation Trust's email disclaimer available
at

[1]http://www.moorfields.nhs.uk/Home/emaild...
 

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Dear foi,

I do not consider the data you hold is correct. I know of a case where a partial retinal tear was ignored by the Medical Retinal Team, Uveitis Team and the Glaucoma Team of the Moorfields Eye Hospital between 23 July 2013 and 20 August 2013 which led to total detachment by October 2012. No surgery was done at the hospital and this person's statistic is fraudulantly omitted from your data.

The 80 year old was left with total blindness without any surgery despite the NHS stating that retinal detachment is a medical emergency. You wrongly state that it doesn't matter whether a patient waits 2 days or a week for surgery, so why was this gentleman denied surgery and his statistic concealed from public scrutiny. How many other elderly patients are denied surgery and are fraudulently not in the statistics you quote?

Yours sincerely,

lotus

Dear Lotus

 

In light of your comments the Trust has re-checked the data given to you
in response to your original request for data on numbers of patients
operated on, by age band, for the last 5 years and can confirm that it is
accurate.  We can also confirm that we do not hold or record the cause of
death for patients waiting for treatment as we are not always informed
that patients have died.

 

In your latest request you state that you know of an 80 year old patient
who was left to go blind without treatment and this is probably why they
did not appear in the statistics that we gave you, as your request was for
details of patients that had been operated on.  If you are willing to let
us have details of the patient (and they have provided their permission),
we would be happy to investigate the claims made by you in your recent
follow-up request which you have posted on the What Do They Know website.

 

We are very unhappy with the posting on the website as we are believe the
statement to be untrue and certainly not a reflection of the way the
hospital treats its patients and would be grateful if you could arrange
for the posting to be removed immediately.

 

Yours sincerely

Heather Wilcox

Freedom of Information Team

 

Before acting on this email or opening any attachments you should read the
Moorfields Eye Hospital NHS Foundation Trust's email disclaimer available
at

[1]http://www.moorfields.nhs.uk/Home/emaild...
 

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[Name Removed] (Account suspended) left an annotation ()

I find the handling of this request alarming. Firstly, a legitimate request for information has received a data dump which is not easy to follow.

Secondly, it is unreasonable to ask that comments be removed. It cannot be claimed the incident did not occur simply because the Trust does not hold the relevant information. If however the Trust can provide contrary proof, on this site, then a request for removal is reasonable though not mandatory.

This request highlights the need for an internal review of the Hospital's data capture procedures.

Dear foi,

Please see below the letter sent by the late patient referred to above who died totally blind in March 2013. Despite this letter, the Moorfield Eye Hospital NHS Trust shamelessly failed to provide a remedy, leaving the patient totally blind, nearly run over twice, it is self explanatory except Mr Parvesio's promised letter was blocked by Moorfield Eye Hospital NHS Trust denying him private surgery at Benenden Hospital:-

"From Mr Ved Chaudhari
30 October 2012
Chief Executive & Directors
Moorfield Eye Hospital NHS Trust
City Road
London

John.Pelly@ moorfield.nhs.uk, Declan.flanagan@ moorfield.nhs.uk, Tracy.luckett@ moorfield.nhs.uk, Charles.nall@ moorfield.nhs.uk, Peng.khaw@ moorfield.nhs.uk, Ruth.russell@ moorfield.nhs.uk, Mike.anderson@ moorfield.nhs.uk, Rob.elek@ moorfield.nhs.uk, Sally.storey@ moorfield.nhs.uk, Ian.tombleson@ moorfield.nhs.uk

Ref: Ved Chaudhari DOB 1932 Age 80 Hosp No 0261807
Formal Complaint: 1. Maladministration; 2. Moorfields diverting NHS Trust funds to outside NHS trusts, 3. Misdiagnosis and 4. Denial of cataract surgery since 28 July 2012 .

On 13 September 2012, Mr Mandeep Sagoo in Thursday Medical Retinal OPD at Moorfields, refused cataract surgery in the right eye and wrongly and inappropriately advised a full body CT scan at St Bartholomews Hospital, where he works the rest of the week, to “rule out any cancer in the body that may have spread into the right eye” despite extensive scans to the contrary.

On 02 October 2012, Professor Garway-Heath in a Glaucoma OPD clinic, made an informed decision that a cataract operation may improve my sight in my left eye and could be safely performed. He undertook to put this in writing, as soon as possible, to Benenden Hospital to enable them to conduct the operation privately but no such letter has been sent to date.

On 11 October 2012, Miss Parul Desai, in the Thursday Medical Retinal OPD clinic, obtained a second opinion from Mr Pavesio in Uveitis OPD, who made an informed decision that cataract surgery was not contra-indicated in the right eye. A letter was requested to be sent to Beneneden Hospital to enable them to carry out the cataract operation in both eyes.

In a letter dated 25 October 2012 from Benenden Consultant Mr Nils Molander, it is apparent, that Moorfield hospital consultants Mr Sagoo, Professor Garway-Heath and Mr Parvesio have contradicted the assurances they gave to us.

The PALS officer, who is also the complaints officer, Marie Burke, as well as all the secretaries for the above Consultants, have failed to resolve the above simple issues despite many attempts. I would be grateful for a prompt resolution and a full investigation in the public interest into maladministration, wastage of public funds and a failure to perform its statutory public service of acceptable quality.

Yours sincerely

Mr Ved Chaudhari
Copied to info@ normanlamb.org.uk, anna.soubry.mp@ parliament.uk, howee@ parliament.uk, daniel.poulter.mp@ parliament.uk,
c/o Houses of Parliament
c/o PALS & Complaints Officer mary.burke@ moorfields.nhs.uk"

Yours sincerely,

lotus
follow me on twitter @lotusprincess4u
remove space after @ for public servant's emails in public interests

Dear Moorfields Eye Hospital NHS Foundation Trust,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Moorfields Eye Hospital NHS Foundation Trust's handling of my FOI request 'Cost cutting eye surgery of elderly patients'.

The FOI Officer is being denied the proper statistics of all patients diagnosed with retinal tears and detachments by the Moorfields Eye Hospital NHS Foundation Trust. The FOI officer has admitted that those patients who are diagnosed with retinal tears and retinal detachments, who are denied surgery are not documented in the statistics. This defeats the object of transparency & accountability and constitutes misrepresentation of facts to the public and the Trustees.

This review determines the number of patients who were denied surgery once diagnosed as requiring urgent surgery, those who died as a result of the denial of surgery, those who were denied private surgery by the Moorfields Eye Hospital NHS Foundation Trust by interfering with clinical decisions made by the Consultants named.

This review also determines the number of patients requiring surgery who were denied surgery who underwent a full body CT scan under Mr Sagoo and whether they were diabetic on Metformin and whether the Metformin was stopped for 3 days before the CT scan as required and if not, whether the patient died of renal failure and what was the cause of death documented in patients who died after a CT scan and the length of time between the CT scan and death.

It appears that the full body CT scan is being carried out without stopping the Metformin for 3 days leading to renal failure and death within weeks of the CT scan. The fact that this patient who was a diabetic on Metformin, which was not stopped for 3 days before the CT scan, and was unable to walk, talk or eat immediately after the CT scan and thereafter suggests that there was an overdose of the CT scan given on top of the reaction between the radioactive iodine and Metformin.

The public are being exploited for their vulnerabilities such as age, sight, diabetes, to end their life prematurely, despite all Trustees being formally notified by the patient and failing to remedy the situation before the unnatural death.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/c...

Yours faithfully,

lotus

Dear Lotus

 

FREEDOM OF INFORMATON ACT 2000 – INFORMATION REQUEST APPEAL (FOI 1626)

 

Further to your request data 15 September 2013 and in accordance with the
Trusts Freedom of Information Policy an appeal chaired by Ian Tombleson,
Director of Corporate Governance has reviewed your request and the
information provided.

The request for information under the Freedom of Information Act has run
over many months and a summary of events is attached below for ease of
reference. 

 

The Trust has spent a considerable amount of time dealing with this
request and feels that it has more that complied with the spirit of the
Act.  Having made further enquiries into the case example given by you we
can confirm that this particular case was investigated under the Trusts
complaints procedures and a formal response was sent to the patient, from
the Trusts Chief Executive, on the 31 October 2012. 

 

The patient, accompanied by his daughter, when offered further tests as
part of his treatment, declined the offer, it was also made clear in the
response that cataract surgery was unlikely to improve vision in that
particular case.

The patient did not receive an operation and that is the reason why the
patient would not have been included in the data supplied to you in
response to your original request.

 

If you are dissatisfied with this response you may request the Information
Commissioner to investigate.  The contact details are:

                Information Commissioner’s Office

                Wycliffe House

                Water Lane

                Wilmslow

                Cheshire

                SK9 5AF

 

                Telephone:  08456 30 60 60 or 01625 54 57 45

 

                [1]www.ico.gov.uk

 

Yours sincerely

 

Heather Wilcox

Freedom of Information Team

 

Summary of Events

 

12 February 2013 – Original request for data:  number of patients, by age
band, who were operated on for cataracts, retinal detachments or tears and
laser treatment for the last 5 years and the length of time waited.  Also
to provide the number of patients who died whilst waiting for the above
operations.

13 February 2013 – Request acknowledged

7 March 2013 – Data supplied as per your original request.  The Trust
informed you that it does not always have, or record, the cause of death
of patients waiting for treatment.

16 March 2013 – You feel that the data supplied does not answer the
question about surgery identified but not carried out and request further
clarification of the data supplied and also further data:  cataract and
retinal tear or detachment patients who were denied or refused surgery, in
the same time and age groups.

15 May – The Trust responds to your additional request for information,
although delayed, and states that all patients who are likely to benefit
from treatment are offered it as soon as feasible and convenient to the
patient.  Patients with retinal detachment are offered surgery and are
given priority irrespective of age.  Patients with ‘macula on’ detachments
are operated on the same day or within 2 days.  The Trust again informed
you that it does not collect data on patients who decline surgery or who
die while waiting for surgery.

18 June – You inform the Trust that, in your opinion, the data supplied is
not correct.  You give an example of an ’80 year old left with total
blindness without surgery despite the NHS stating that retinal detachment
is a medical emergency ‘ and ‘why was this gentlemen denied surgery and
his statistic concealed from public scrutiny’.

11 September – The Trust responds to your statement that the data is
incorrect by re-checking and also explaining that your original request
was for patients that were operated on and that the 80 year old, given by
lotus as an example, did not receive treatment and therefore would not
have been included in the data of patients receiving treatment.   The
Trust asked for further details of the 80 year old patient (with the
appropriate consent) so that it could be investigated further.

The Trust also asked that the posting on the ‘What Do They Know’ website,
of details of this FOI request, be removed as the statements made are
untrue and not a reflection of the way that the hospital treats it
patients.

12 September – The Trust receives details of a late patient referred to
above  from lotus  in the form of a letter that was sent to the Trust in
October 2013 about a patient who died totally blind in March 2013.

15 September – The Trust receives a formal request from lotus for an
internal review of the Trusts handling of her FOI request ‘Cost cutting
eye surgery of elderly patients’.

 

 

 

Before acting on this email or opening any attachments you should read the
Moorfields Eye Hospital NHS Foundation Trust's email disclaimer available
at

[2]http://www.moorfields.nhs.uk/Home/emaild...
 

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Dear foi,

I am entitled to an internal inquiry and it is not a justified excuse that you have spent so much time in trying to mislead the public about the services you should provide and are not providing.

For example, when you state above in May or June,

"1. It is Moorfields Eye Hospital's policy that all patients who are likely
to benefit from treatment are offered it as soon as feasible and
convenient to the patient."

You imply that someone has assessed who is likely to benefit from treatment unilaterally without involving the patient and the only time the patient is involved is to assess when it is "convenient". Surely, the patient has a right to determine if it is going to benefit him or her. I mean, we are talking percentages here so even if there is a 1% chance of success, a patient may well go ahead with it, if it means they have a some chance they can get through their day without relying on someone.

The information you have been provided about the patient is misleading. The patient had a retinal tear with macula on which was ignored by A&E and by 3 different Consultants and even when the 80 year old blind patient begged for surgery it was denied to him contrary to your stated policies for "macula on" - which means that there is a big chance of success. Mr Mandeep Sagoo bizzarrely suggested that the patient should have a full body CT scan instead of the emergency eye surgery which was denied to him for several months until he went totally blind.

The eye A&E doctor at Whipps Cross Hospital refused the surgery in Feb 2013 despite the patients' forehead going numband insisted on following Mr Sagoo's advice on the CT scan.

It is no coincident that there is a lethal interaction causing death from kidney failure from radioactive iodine injection in diabetic patients on Metformin which this patient was known to be on. The Metformin was not stopped for the CT scan as it should have been.

Your policies are being manipulated to end the lives of elderly patients exploiting their vulnerabilities to put them on Liverpool Care pathways and premature deaths.

The above responses you have provided are evidence of statistical manipulations to conceal mass crimes against the most vulnerable members of the public.

The NHS is not about keeping jobs, it is primarily to provide a public function beyond expectations not beyond scrutiny.

This is theft of public money to deny a service and keep Consultants in jobs to ensure that public services are denied. This is formal notice to the Health Ministers and Health leaders to step down from their public positions or ensure that the patient is at the centre of all health services, and NHS staff are at all times acting in the patients' best interests regarding their wishes at all times. No public servant may back another when the patient is in dispute, they must back the patient in a dispute or they all step down, Mr Sagoo, Mr Green, Mr Smith, Mr Garway-Heath, Mr Parvesio, the Barts NHS Trust Chief Executive and Directors, etc. etc.

It is unacceptable that you wish to use your own failings as an excuse to deny the public the scrutiny of those failings to keep the budget dead horse on his feet. Without public service, there is no NHS, profit or not!

Yours sincerely,

lotus

lotus left an annotation ()

Please follow me on twitter @lotusprincess4u

Please visit my website at www.icj13.webs.com

Dear Lotus

The Trust has responded to your request for information under the Freedom of Information Act and has provided the information.

The Trust has also responded to your request for an appeal. If you are still not satisfied with the way the Trust has dealt with your requests then please contact the Information Commissioners Officer, details of which were included in the appeal response.

If you have any other complaint about services offered by the Trust then you can make a compliant by sending a letter to our complaints manager at the address below, or if you wish to discuss the issue then call the complaints team on 020 7566 2054, during working hours:

The Complaints Manager
Moorfields Eye Hospital NHS Foundation Trust
162 City Road
London
EC1V 2PD

Yours sincerely

Heather Wilcox
Freedom of Information Team

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