When people are hit by a really devastating disaster, it often seems to happen that instead of giving in to sadness, they elect to feel angry, to become almost consumed by a furious determination to uncover all of the causes of the disaster which has struck them and to punish all of those who were responsible.
Sometimes, this is merely an emotional reflex – anger being more tolerable than misery – but there are other times when this kind of rage for justice is a uniquely powerful tool for exposing scandal. Think of some of the relatives from the Lockerbie disaster or the Marchioness or the Herald of Free Enterprise, who simply will not give up their quest for the truth. Will Powell has this kind of anger.
The doctors and Government officials against whom he has aimed it, say he has simply succumbed to the emotion and lost all sight of the truth. He does not accept that. He says he has got his grip on a real scandal and he says that he would have proved his case long ago if the Government had not systematically boarded up the windows which once allowed the public to look in and see how their health system was being managed. He says he will never give up, not while he has the police and the Government investigating his claims of corruption, not while the anger lasts.
Will Powell’s journey to disaster began in the weeks before Christmas, exactly five years ago, when his youngest son, Robbie, who was then ten, fell ill at their home in Ystradgynlais in South Wales. He was throwing up and complaining of stomach pain and he looked so bad that his mother, Diane, phoned the health centre, and Dr Elwyn Hughes came out and called an ambulance to take him to Morriston Hospital 12 miles down the road on the outskirts of Swansea.
Now, Powell was very close to his boy. He loved his two older sons just as much, but Robbie had always clung to his side, full of infant pride about his dad. He was always asking people: “Do you know my dad? Willy Jock they call him. Do you know him?” Powell had thrown in his work as a motor mechanic to become a plasterer and it was always Robbie who hung around and watched him work. Powell was a keen fly-fisherman in those days – he was in the Welsh national team – and he would come back from a fishing trip and throw himself down on his bed and again, it was Robbie who would come and lie down beside him to hear all about how he had got on.
So when Powell saw him lying there in the hospital bed, all groggy with his eyes sunk in his head and his arm wired up to a drip, he simply cried with fear of losing him. And then, four days, later when the doctors said Robbie could go home, it was just a bout of gastroenteritis, probably brought on by a throat infection, Will Powell was a happy man. They had a good Christmas together. And three weeks later, on January 18, Diane took him back to the hospital for a check-up, and the paediatrician said Robbie looked so much better that he hardly recognised him. He agreed that it had probably just been a nasty bout of gastroenteritis.
It was April 1 when Robbie became ill again. He said his jaw hurt and his throat was sore. The next two and a half weeks were a blur of doctors: seven different sessions with five different GPs at the health centre in Ystradgynlais; Robbie repeatedly saying he was weak and unwell, being sent home from school, chucking up his supper, lying limp on the sofa in the front room; the GPs offering different solutions, different suggestions; one saying he would get him back into hospital; another saying he would start him on anti-biotics; another saying he would test his blood sugar except that his kit was out of date; all of them offering reassurance. Then, on April 17, at about 3pm, Robbie collapsed upstairs in the bathroom at home.
His mother, Diane, screamed and ran to cradle his head. Powell sprinted downstairs and called the health centre. The last doctor who had seen Robbie, just the day before, had said Robbie should go straight to hospital if he vomited or deteriorated but 30 minutes later, it was a different GP who arrived, Nicola Flower, and she suggested that he had a throat infection which had gone to his chest. She thought he had probably fainted because he was weak from spending two days in bed.
Powell was now deeply worried. He called the hospital and spoke to one of the nurses on the ward where Robbie had been treated in December, but she said they must trust their GP. By 5.30, Robbie was complaining of stomach pains again and, once more, Powell called the health centre. Dr Nicola Flower arrived again and after a passionate argument from Powell, she agreed that Robbie should go to hospital if only to put Powell’s mind at rest. He wanted an ambulance, but Dr Flower believed it was not necessary. Powell and Diane drove their aging Talbot Sunbeam to Morriston Hospital as fast as they could, trying to keep Robbie awake while he sprawled along the back seat with his thumb in his mouth.
It was just before seven when Powell walked through the doors of the hospital, with Robbie lying limp across his arms. His eyes were dilated, rolled up into the back of his head, his lips were blue. When the hospital staff saw him, their alarm was so obvious that Diane collapsed and had to be taken out. Powell tried to tell them that the GPs said there was nothing seriously wrong but, as he watched, he saw Robbie had stopped breathing. He was told to leave the room but he could still hear the crashing and banging of the resus team at work. A doctor came and asked questions. A nurse came and told him Robbie was really very ill. Powell saw some tears in her eyes. It was several hours before a young doctor came and told them that he was sorry but their boy had died.
They went in to see their young son where he was lying still on the bed in the Intensive Care Unit and they held him in their arms and told him how much they loved him and how much they would miss him always. Powell was crying desperately but even then, at the height of his grief, there were questions he had to ask. Couldn’t any of these doctors have done more? Why had it taken so long to get him referred to hospital? Did Robbie have to die?
It was three days later, on April 20, when Powell first felt the flame of rage inside him. One of the GPs from the health centre, Keith Hughes, came round to see him to tell him about the post-mortem. He explained that Robbie had been killed by a rare condition called Addison’s Disease, which meant basically that his adrenal glands had ceased to function and had stopped pumping vital hormones around his body. Powell hardly understood a word of it.
“All I want to know is – did my Robbie have to die?”
“No,” said the doctor.
Powell felt sick with sorrow. He saw the doctor had Robbie’s medical notes with him, so he asked if he could have a look, and as he slowly turned the pages, he saw several things which started to make him feel curious. One of them, dated back in December, mentioned Robbie needing a test, an ACTH test.
“What’s this then?”
“It’s from the hospital,” the doctor said. He explained that it was a test for hormones, though the detail passed Powell by.
He had never heard of this ACTH test. No such test had ever been done in December or any other time. It had never even been mentioned. Yet the notes seemed to say that Robbie’s parents had been told about this. Then he saw something else, a reference to hormonal imbalance, and to two words he had never heard before this day.
“What’s this about Addison’s Disease?”
“The hospital should have told you. They suspected Addison’s.”
“What!” Powell shouted, so loud that Diane in the kitchen was frightened. “They suspected my boy had this fucking Addisons Disease? And they didn’t do anything?” That was when the anger came.
Will Powell was about to be transformed. This was a man who had left school a few days before his 15th birthday, who had never passed an exam in his life and who had never even written a letter for 20 years. But he liked to say that though he might not be educated, he was not daft either. He had a tough streak, something to do with growing up in a rough patch of Glasgow before his parents moved to Wales and having to start a milk round when he was only 12 to buy himself clothes, and he had spent long enough as a motor mechanic to have learned to be methodical.
Later that evening, when the doctor had gone, he started to think. It was the beginning of a process which would see the man who did not write letters become a prolific source of letters and briefing papers and legal arguments, all of them clear and concise, all of them tapped out on the keyboard of a cheap computer which he bought for his fight; and which would see the man who had never passed an exam educate himself in all the complexities of the hormonal feedback system that linked the adrenal glands to the pituitary gland and the hypothalmus. To him, it seemed simple. It was just like the inside of an engine: switches came on, switches came off, the fuel went round. His whole life was about to become one long quest for answers.
On that first evening, as he absorbed the implications of the doctor’s visit, it occurred to him that if he had been working on a man’s car and he had failed to report some kind of deadly fault and then there’d been an accident, well, he might feel a bit nervous about the truth coming out. He had no reason to think that the doctors were dishonest but, just in case anyone got any funny ideas, he decided to make sure of his facts. So he asked Dr Keith Hughes to come back and see him again and, this time, he arranged for a local vicar to be there with him.
So it was that three days later, on April 23, Rev DG Thomas, heard Dr Hughes confirm that Robbie need never have died and, when the vicar took Robbie’s medical file, he heard the doctor say: “I don’t know if this is a wise thing I am doing. Have to be careful what I say.” And, with the file on his knee, Rev Thomas wrote : “Clinical Summary Sheet dated December 1989. Detailed long letter on back page. Headed ‘Information: Needs ACTH Test. Parents Informed.’ Mentions hormone imbalance – possibility Addisons.” He also noted a second letter, the size of a half page, dated January 18, when Robbie had returned to the hospital for his check-up, in which the paediatrician had asked to see the boy again if there was any recurrence of his symptoms.
Now the questions were bigger. If the hospital had suspected this deadly illness, why hadn’t they done the ACTH test that would have confirmed its presence? Why hadn’t the doctors said anything about the test being needed? And if the hospital had passed all this information to the GPs, why hadn’t they sent Robbie straight back to hospital when he became ill again?
Powell recalled that in one of their seven meetings with GPs during April, one doctor – Mike Williams was his name – had told them he was definitely going to send Robbie back to hospital. That had been on April 11, six clear days before Robbie died. So what had happened? Powell asked Mike Williams directly and he confirmed he had sent off the referral letter. So Powell went to the hospital, where the paediatrician who had dealt with Robbie, Dr Forbes, was equally clear that he had never received any such letter from Mike Williams. Powell was not sure what to make of it.
However, he did find the answer to one mystery. Dr Forbes explained that although he had suspected Addisons Disease back in December, his colleague at the hospital had disagreed with him and thought that Robbie was suffering from nothing more than gastroenteritis. It so happened that Dr Forbes had been away on the day that Diane asked for a diagnosis, and so it was that no one had ever told them that their son might be suffering from a life-threatening condition nor that his paediatrician wanted to check by giving him an ACTH test. And, somehow, this danger had passed the GPs by.
By now, Powell had decided to file an official complaint with the Family Health Service Authority. Some months passed before, at the end of July, the various GPs at the health centre replied to his complaint in formal statements. One point leapt from the pages: four of the five GPs who had dealt with Robbie in April said that for one reason or another they had never read his medical notes, so they had never seen any of the warning signals which had been transmitted by the hospital. Powell could hardly believe it. And the one GP who had read the notes – Mike Williams – said he had not been too concerned. He reckoned that the child had shown no signs of Addisons, such as vomiting, and so he had referred him to hospital without any special urgency.
The more he read the GPs’ statements, the more puzzled Powell became. Their recollection of events kept clashing with his. For example, he and Diane had a clear memory of Robbie chucking up his food and of himself and Diane taking Robbie to Mike Williams the next day and telling him. Yet Mike Williams not only denied there had been any report of vomiting but also made no mention of the drug which Powell believed he had prescribed to deal with it. Powell even remembered its name: Dioralyte it was called. Powell recalled that one GP, Paul Boladz, had told him Robbie might have glandular fever while the others had given him no diagnosis at all. But, in their statements, two of the GPs said they had diagnosed a virus and Mike Williams added that Mr and Mrs Powell had told him this. Powell remembered no such thing, nor did he remember being advised to give his boy Calpol and paracetomol to deal with this virus, as the GPs now recalled.
Will Powell decided to do a little digging. He started by trying to prove that Mike Williams, contrary to his recollection, had prescribed Dioralyte for Robbie. He searched the house for the packet, but they had thrown it out. He went to the chemist who had supplied it but he said he had wiped his records when Robbie died. He contacted the Prescription Pricing Authority in Cardiff, but they refused to speak to him because he was not a doctor. Finally, he contacted the FHSA and, disguising his real interest, he asked them for all of the records of all the precriptions which had been supplied to Robbie. And he got them – and there was the Dioralyte, just as he remembered. So Dr Mike Williams’ statement was wrong.
He did a little more checking. He confirmed that Dioralyte was often used to stop vomiting. And if the GP had know Robbie was vomiting, Powell reasoned, then surely he should have seen the danger of Addisons and referred him back to hospital urgently. Tying down his facts, Powell now made a series of phone calls to the hospital paediatrician, Dr Forbes, and finally persuaded him to confirm in writing that he had received no referral letter from Dr Williams before Robbie’s death.
However, just as he thought he was beginning to win, Powell discovered he had lost his biggest weapon. For seven months, he had been waiting to receive copies of Robbie’s medical files so that he could refer to the letters from the hospital which had first sparked his anger. According to the rules, the GPs were supposed to hand over their records within a month. When they finally reached Powell, on November 22, he had a shock. The crucial letter for which he had been waiting – the one which said that the hospital had suspected Addison’s Disease – was not there. He was dumb with confusion.
He felt sure that it had been typed on the back of the Clinical Summary Sheet which was produced when Robbie was discharged from hospital in December. The vicar was equally sure – he had written it down in his notes. Yet, here was the Clinical Summary Sheet, with its back completely blank. And there was something else. Powell and the vicar both recalled seeing a half-page letter from the paediatriciain, Dr Forbes, dated January 18, when Robbie had gone to hospital for a check-up. The file did contain a letter with that date, but it was on a full page and, instead of giving the GPs a clear warning to send Robbie back to hospital if he showed any signs of hormone deficiency, as Powell recalled, it contained a weak warning about hormones and added that he was suffering from gastroenteritis.
Even odder, in Powell’s eyes, there was an envelope in the file, addressed to the Appointments Officer at Morriston Hospital. Its top was torn open and, inside, there was a referral letter, asking the hospital to look at Robbie Powell. It was signed by Mike Williams and dated April 12, the day after he had seen Robbie. Alongside it in the file was another, loose copy of the same letter. Powell could now see how the GPs might say that Mike Williams had written his referral letter on April 12, put a copy in the file, and put the top version in an envelope addressed to the hospital, which had then been lost in the surgery until it was found and torn open and placed in the file. But, if that was true, the copy of the letter would have been in the file when he saw it at his home on April 20, three days after Robbie’s death, and, again, when he saw it with the vicar. And Will Powell was sure that it had not been there.
Powell went to the health centre, saw Dr Keith Hughes, who had brought the file to him and who had shown it to him again in front of the vicar. With some passion, Powell told him he wanted him to confirm in writing that that letter had not been in the file on either of those visits to his home. Dr Hughes complied. Powell reckoned he now had made a very visible hole in the doctors’ version of events. Two weeks later, the hole became even bigger when the GPs produced a new statement, made by one of the secretaries at the health centre.
She explained that she had typed the referral letter for Mike Williams – not on April 12, as it was dated, but on April 19, two days after Robbie’s death. She had been away, she said, and so the typing had been delayed , and when she had finally got round to it, Mike Williams had instructed her to back-date the letter “for the record”. Powell was staggered by the shifting story. And, for him, it still did not explain why the copy of this letter had not been in the file when Dr Hughes visited him on April 20 and 23, nor why Mike Williams and all of the other GPs had submitted formal statements in July in which they all said that Robbie had been referred back to hospital and in which none of them mentioned that the referral had been delayed until the boy had been dead for 48 hours. And if no-one typed the letter until 48 hours after his death, what on earth was the point of putting it in an envelope and addressing it to the hospital? And why on earth would they then tear it open and put it back in the file with their copy?
Powell could not help thinking that if he had not pursued this, he would simply have accepted the GPs’ bland statements that his son had been referred to hospital. Convinced that the doctors had tried to mislead him, Powell now tried to make sense of the other medical notes he had been sent. What had happened to “the Addison’s letter”? If he and the vicar had not simply imagined its existence, the only possibility he could think of was that somebody had disposed of it. The more he studied the notes, the more convinced he became that someone somewhere had tampered with them.
The Clinical Summary Sheet, on whose reverse he believed the Addison’s Letter had been typed, had no doctor’s signature on it and no typist’s initials. When he compared it to the hand-written original, it contained half a dozen errors of detail. He trawled through his familiy’s medical records and found no other Clinical Summary Sheet without a doctor’s signature, a typist’s initials or that varied from its hand-written original. He speculated that the original summary sheet had been destroyed along with the Addison’s letter on its back and that the surviving document was a forgery. In their present form, the notes contained no reference at all to Addison’s Disease. If they were genuine, he reasoned, there was no way that the vicar could have written “Addison’s suspected” when he copied their details into his notebook.
There were other possible signs of tampering. Next to the one surviving reference in the notes to Robbie needing an ACTH test, someone seemed to have added a question mark. Someone had added the word “gastroenteritis” to a hospital document recording Robbie’s illness when he was in hospital in December. He could not say that any doctors had done any tampering, but he felt pretty sure that at some level in the Welsh medical establishment, someone had decided to intervene to weaken the evidence that his son had been suffering from Addison’s in December 1989.
It was December 1990 by now. The hearing into his official complaint was due to start. Powell believed he could prove that four of the GPs had failed to read his son’s medical history; that Mike Williams had prescribed a drug which was commonly used to stop vomiting even though he had failed to mention this in his statement; and that all five GPs had stated formally that his son had been referred to hospital and that none of them had mentioned that he was already dead when this was done.
But against him, the records appeared to show that even if the GPs had read Robbie’s medical files, instead of seeing the clear hospital warning of Addison’s which Powell believed he had read, they would have seen instead that this boy had had a simple history of gastroenteritis with only the weakest hint of the possibility of hormonal problems. The notes also appeared to confirm that, contrary to Powell’s understanding, the GPs had diagnosed a virus in April, advised the Powells to give him Calpol and paracetomol, that Robbie had not vomited or shown any other sign of Addison’s Disease, and that Mike Williams had done his best to refer him to hospital.
For Powell, the hearing was a disaster. He felt ill-at-ease from the outset, making his complaint to the very same heirarchy which was responsible for hiring the doctors and which stood to lose face if his complaint was upheld. He felt out of his depth, a layman pitted against medical experts. The GPs had a union to pay for their lawyers; the only advice he had was from his friend, Sid Herbert, who ran an ice cream parlour and who had agreed to come with him to lend him support. Throughout the hearing, he found himself at odds with the chairman, unable to make the points which he considered vital. When the FHSA published their report, they entirely exonerrated four of the GPs and found that Dr Flower alone had failed to react effectively on her first visit to Robbie on the day that he died. They admonished her, the mildest possible punishment.
But Will Powell was still angry. He took out a mortage on his house, hired lawyers, filed an appeal, won a new hearing in front of the Welsh Office, whose start was repeatedly delayed until March 1992, when it opened and was then adjourned after three days without hearing all the evidence. When it re-opened in September 1992, Powell was fired up and ready to win. Then something odd happened.
Powell’s barrister was trying to explain that one suspicious feature of the document which was supposed to have had “the Addison’s letter” on its back was that it carried no block stamp to mark its arrival at the health centre. This was consistent with its having been forged at a later date. The barrister had already explained all this at the hearing in March. Now, when he rose to repeat the point, he suddenly discovered that the document, which he had handled repeatedly in the past, had precisely the kind of block stamp which he was describing, firmly stamped on its back. There was uproar.
The documents had been in the care of the Welsh Office but when an official was called to the stand, he said that he had had only half of them. He did not know where the others had been. Each side accused the other of tampering with them. Powell and his barrister wanted the police called in. The chairman of the hearing refused. Powell and his lawyers then retired to a local hotel and decided that they no longer had any confidence in the hearing and refused to take any further part in it. It cost Will Powell some £35,000 in legal fees. He had to mortgage his house to pay.
At that point, so far as the system was concerned, the fight was over, but Will Powell refused to accept defeat. He lodged a complaint with the Welsh Health Service Ombudsman about the GPs, but the Ombudsman said that was outside his remit. So he made a complaint about the FHSA hearing, but the Ombudsman said that, too, was outside his remit. Undeterred, Powell complained about the Welsh Office hearing, but the Ombudsman said he could not investigate the Welsh Office unless he was asked to do so by an MP. So, Powell contacted his MP, but the Ombudsman said he could not investigate a complaint from an MP about the Welsh Office if it dealt with personnel who were responsible to a Minister – such as doctors.
Drawing deeper on funds he did not have, Powell decided to sue the FHSA for negligence and, in the meantime, he continued to write to the Ombudsman who now said he could not investigate any complaint which might be the subject of legal action. Powell still did not give up, but the Ombudsman then explained that he could not investigate a complaint which was so old and, in any event, even if he did have the power to investigate, he still had the discretion to decide not to.
This year (1994), Powell went to Dyfed Powis police and provided them with 20 pages of tightly-argued summary. He explained his case to two MPs, Jonathan Evans and Rhodri Morgan, and this summer, the Welsh Office agreed to set up a formal inquiry. Last month (Nov) the police sent a report on the case to the Crown Prosecution Service, and the doctors announced that they would not give evidence to the Welsh Office inquiry.
The GPs have refused to discuss Will Powell’s claims but their lawyer issued a statement on their behalf, declaring that they would answer him in court in the action for negligence. “All Mr Powell’s allegations, both relating to Robert’s treatment and to the records, are absolutely denied by my clients and the reasons for that denial will become fully apparent from their evidence to the court in due course.”
Will Powell is still running on anger. But he has never worked since Robbie’s death, he no longer cares to go fly-fishing, he has trouble sleeping and sometimes during the day, he just shuts himself in his bedroom and thinks his way back to that hateful day when Robbie went away from him and then, for all his anger, a horrible sadness still creeps over him..
