When a government abuses its power, it does so generally by using an excess of it, to suppress the truth or to crush the opposition or simply to get its own way. In the sad, strange case of the death of Robbie Powell, however, you can see quite clearly how governments are equally capable of abusing their power simply by refusing to use it.
It is more than seven years now since Robbie Powell died on the evening of April 17 1990. He was aged ten. He was killed by Addison’s Disease, a relatively rare illness which meant that over a period of months, his adrenal glands had ceased to function and had failed to pump vital hormones around his body. His death followed two bouts of severe and unexplained illness, neither of which had been properly diagnosed.
During the first bout, in December 1989, Robbie had been taken to Morriston Hospital in Swansea where doctors told his parents that he was suffering from gastro-enteritis. He was discharged and when he returned for a check-up five weeks later, the paediatrician at the hospital declared that all seemed well. During the second bout, in April 1990, Robbie was taken on a total of seven occasions to see five different GPs at the clinic in his home town, Ystradgynlais, about half an hour’s drive from Swansea. The five GPs said variously that he was suffering from a throat infection that had gone to his chest or from glandular fever or that he needed anti-biotics. None of them said anything about Addison’s Disease.
Robbie’s parents, Will and Diane Powell, might have considered that their son was the victim of nothing more than bad luck had it not been for the kindness of one of the local GPs who agreed to come to their home three days after Robbie’s death to show them his medical file. In the file, Will Powell found two letters that made him pulse with fury. They had been written by the hospital paediatrician who had treated Robbie during his first bout of illness: in the first, he said he suspected that the boy was suffering from Addison’s Disease and needed a special blood test; in the other he said the boy must be referred back to hospital immediately if he was ill again. Both of these letters had been written more than twelve weeks before Robbie died. And yet nothing had been done to save him.
The distraught Will Powell set out to discover how doctors could suspect that a child was suffering from a fatal condition and yet do nothing to treat it. More than seven years later, he has been failed and frustrated by every limb of government to which he has turned and he has uncovered a scandal of official chaos, dishonesty and mismanagement which now embroils two of the most senior members of the Conservative Party – William Hague, its new leader, and John Redwood, its new spokesman on trade – both of whom personally dealt with the case when they were Secretary of State for Wales.
Will Powell is a man of unusual tenacity. Although he was in no doubt about what he had read in the letters in Robbie’s file, he took the precaution of inviting the local Anglican vicar to come round to examine the file himself. The notes which Revd DG Thomas wrote at the time confirm Powell’s memory in some detail. This turned out to be most important: the file went back to the GPs; Powell made an official complaint about his son’s treatment; and eight months later, when the GPs produced a photocopy of their file for the hearing of the complaint, there was no trace of either of the letters which Powell and the vicar remembered. One had apparently vanished. The other had apparently been re-written. There was no longer any mention anywhere in Robbie’s file of Addison’s Disease.
By then, Powell had uncovered something else. One of the five GPs who had examined Robbie, Dr Mike Williams, had decided to refer the boy to hospital. This was six days before Robbie died and yet the referral did not seem to have happened. Dr Williams assured Will Powell that he had asked for the referral. In a written statement, he confirmed this. In a joint statement, all four of his colleagues did the same. In the file which the GPs now produced, there was even a copy of the referral letter, dated April 12 1990, the day after Dr Williams had examined Robbie, together with the top copy which, curiously, was inside an envelope which had been addressed to the hospital, sealed and then torn open. That looked like the answer: Dr Williams had written the letter which must then have been lost in the clinic until it was too late to be worth sending. But Will Powell knew that wasn’t the truth. If that letter had been written on April 12, then the bottom copy would have been in the file ten days later when he and Revd Thomas examined it. And it hadn’t been there.
Under pressure from Powell, Dr Williams admitted that, in truth, the letter had not really been written until two days after Robbie was dead. He said he had dictated the letter on April 12 but the typist had been away and when she had finally got round to it, he had asked her to backdate it. So why hadn’t Dr Williams said that in the first place? Why had he and all four of his colleagues made written statements confirming that Robbie had been referred to hospital without mentioning that he had been already dead when this was done? And why – two days after Robbie had died – had someone bothered to put the letter in an envelope, address it, seal it, tear it open and then file it? Powell believed there had been a deliberate attempt to deceive him. And he still wanted an answer to his most important question: why had no one done anything to treat his son’s illness?
When the Family Health Service Authority considered his complaint, Powell got nowhere. He produced his evidence that one crucial letter in his son’s file had vanished; another had been rewritten; and a third had been forged. He heard four of the five GPs confess that they had never even read Robbie’s file when they treated him. He produced further evidence to suggest that someone had tampered with the file. All of the doctors denied that they had done anything wrong. The FHSA exonnerated all of them, save for one of the GPs, Dr Nicola Flowers, who was admonished (the mildest level of discipline) for failing to take more action when she visited Robbie on the day that he died.
Will Powell refused to give up. He appealed to the Welsh Office and, after several false starts, the hearing resumed in September 1992. And an odd thing happened. Somebody interfered with the key bundle of documents, the photocopies of Robbie’s GP records: one of the documents which had previously been one-sided now had material on both sides; several new documents had been added. Each side blamed the other and Powell said the police should be called in. The chairman of the appeal refused. Powell and his lawyers decided that they no longer had any confidence in the appeal and refused to take any further part in it.
When Powell tried to discover who had interfered with this bundle of documents, something even stranger happened. The Welsh Office claimed that Powell had had the bundle himself, implying that if anyone had interfered with them, it must be him. For three years, Powell peppered the Welsh Office with letters in which he ridiculed their position. The person who had interfered with this bundle of photocopies had added extra documents, so they must have had access to the originals. How could it possibly be him? Anyway, the interference didn’t help him: it helped the GPs. He insisted that the bundle had been with the Welsh Office when the appeal opened and so it must be them and/or someone acting for the GPs who had interfered with them.
For three years, the Welsh Office told Will Powell he was wrong. John Redwood personally wrote a long and emphatic letter and answered a parliamentary question to this effect. He even claimed to have conducted an internal inquiry on the subject. When William Hague took over, his head of health services told the same story. And then, on October 16 1995, in the teeth of a detailed and substantiated letter from Will Powell, William Hague finally admitted that the Welsh Office had been misleading him all along. The truth was that they had had the bundle. He apologised. Powell was vindicated, but he still wanted to know who had interfered with it.
Hague appointed an independent barrister, Mrs Elizabeth Elias, to investigate. Powell had high hopes that she would confront the GPs and the Welsh Office and force someobody to admit that he or she had got hold of the bundle and intefered with it. His hopes were not fulfilled. First of all, Mrs Elias threw the balance of guilt back towards Will Powell by suggesting that his lawyers might have accidentally scooped up the bundle and taken them off with them at the end of a hearing – a suggestion which Powell’s lawyers dismissed as “surpising and illogical”. Then she admitted frankly that she could not say who had interfered with the documents. Months later, Powell was furious to discover that although she had grilled him at length, she had never interviewed a single one of the GPs. She said it wasn’t in her terms of reference.
Powell was not about to give up. He had become a human pinball, ricocheting from one government department to another in search of justice for his dead boy. He went to the Parliamentary Ombudsman in London who said the problem was outside his jurisdiction. So he went to the Welsh Health Ombudsman in Cardiff with a complaint about the GPs; he said he could not investigate GPs. So Powell went back to him and complained about the FHSA instead; he said he could not investigate the FHSA. So he went back to him again and complained about the Welsh Office hearing; he said he could not investigate that unless an MP made the complaint. So he got his MP to make the complaint; he said he could not investigate that because the complaint dealt with doctors. Powell decided to sue the health authority for negligence and when he went back once more to the Welsh Health Ombudsman, he told him he could not investigate a complaint that might be the subject of legal action. Powell went back again; this time, the ombudsman told him he could not investigate a complaint which was so old.
Powell went to Dyfed Powys police. They set up an inquiry to find out whether any of the doctors was guilty of manslaughter and whether anyone had tried to pervert the course of justice by tampering with documents. They interviewed all of the key people but failed to get their own medical expert to advise them on their approach and to review the doctors’ behaviour. On the basis of what they had found, the Crown Prosectuion Service said there was insufficient evidence to prosecute anyone. After more pressure from Powell and his lawyers, the police then agreed to consult a medical expert. They went to the top of the profession and chose Professor Charles Brook, consultant paediatrician and director of endocrinology at Great Ormond Street Hospital in London. His response was devastating.
He considered the behaviour of Dr William Forbes, the hospital paediatrician who had dealt with Robbie during his first bout of illness. Professor Brook said that Dr Forbes was “medically grossly negligent” in dismissing the suggestion of Addison’s Disease without doing any tests. “It is clear that the diagnosis was entertained in December 1989 and January 1990. Not to have pursued it constitutes practice of an unacceptably low standard. Had the diagnosis been made, Robert Powell would not have had a further collapse in April and he would be alive to this day.” This was another vindication for Will and Diane Powell, but the Crown Prosecution Service declined to change its mind. There would be no prosecution. Powell went to his MP, Jonathan Evans, who complained with some force. He dug out newspaper stories of apparently similar cases where doctors had been prosecuted. The CPS would not move.
Will Powell pursued the truth through the civil courts, suing the health authority and the GPs. In May last year, on the eve of the court hearing, the West Glamorgan Health Authority, which had been spent six years denying that there was any truth in any of Powell’s allegations, admitted liability for its doctors’ failure to diagnose Addison’s Disease during Robbie’s first bout of illness. They offered their unreserved apology. They then added: “You should be advised that the authority considers that no individual clinician was to blame.” Powell did not accept that. He also wanted to know the truth about Robbie’s second bout of illness and the apparent efforts that had been made by someone to tamper with the paperwork which he and Revd Thomas had seen. However, he was now trapped by the rules of the civil courts.
He could no longer pursue the doctors in the first bout of illness because the health authority had paid £80,000 into court. If he continued his case and failed to win an award of more than £80,000, he would be liable to pay a crushing bill for the legal costs of both sides. If he accepted that the first group of doctors had been negligent, he could not then claim that the GPs had been negligent in their handling of Robbie. The only avenue that remained was to sue them for causing emotional damage to himself and his wife by concealing the truth after Robbie’s death. At least, he thought, he and his lawyers would have a chance to confront the GPs with the evidence of tampering with the paperwork which he and Revd Thomas had seen.
The GPs appeared to be willing to tell their story in court. During Powell’s battle with the Welsh Office, John Redwood had tried to set up an informal inquiry into Robbie’s death, but it had collapsed when the GPs refused to co-operate because they would tell their story during the civil action. Now, however, their lawyers went before Mr Justice Butterfield in Cardiff and asked for the action to be struck out on the basis that even though doctors might be under a moral obligation to tell the truth after a patient’s death, they were under no legal obligation to do so. Mr Justice Butterfield agreed with them. The case was killed.
Powell tried to find another way through by going to the coroner in Swansea to question his original decison not to inquire into Robbie’s death. The coroner said he didn’t hold an inquest because Robbie had died of natural causes. Powell said that was not the whole story and he wrote back and asked: “If it came to light at an inquest that a child died because of the gross negligence of a doctor, would a coroner give a verdict of natural causes?” Probably not, said the coroner: “The more likely verdict would be accident or misadventure or possibly, in an extreme case, one of unlawful killing.” In that case, said Powell, could he please have an inquest? No, said the coroner: “Robert died of Addison’s Disease, which is a natural cause. In my view, that natural cause is not made unnatural by a failure to diagnose and/or treat.”
Even now, Powell continues to fight. He has appealed to the High Court in London against Mr Justice Butterfield’s decision to strike out his civil action. He is contemplating taking out a private prosecution. He has been given free backing by London’s most expensive libel lawyers, Peter Carter Ruck, to sue the GPs for a notice which they displayed about him in their surgery. He wants to know the truth. Sooner or later, he plans to finds somebody somewhere in government who will use their power to find it.
