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BBC Radio 4, 'You and Yours',
broadcast on October 27, 1999
Photo: Simon Hervey,
with kind permission of
RECORDING OF PM TONY BLAIR: Looking at some of the key issues that we've just ducked [drugs]. All governments for far too long in this area...
MARK WHITTAKER (MW): The drugs Tony Blair is referring to, of course, are all illegal. Drugs some people consume despite prohibition. There are though, thousands of people in Britain with problems caused by legal drugs. Ones which, far from being proscribed by the law, are actually prescribed by family doctors, but their effects too, can be petrifying. A combination of such medicinal drugs led to the death of 28-year-old Simon Hervey. He died earlier this year, leaving a father who doted on him with just photographs and memories
ADRIAN HERVEY (Simon's father): That's him as a baby, he was a happy little lad, that's him with his two cousins at the beach. That's him and my mum at... (showing photographs).
MW: By all accounts, as a little boy growing up in Northumberland, Simon was always popular, but as a young teenager he made no secret of the fact that he was gay. That was when the bullying began – and the drugs.
ADRIAN HERVEY: When he was 14 a doctor put him on Valium because of the bullying, because he had acne, because he was 'making a lot of noise' – and he was on that for the next 14 years of his life.
MW: Throughout those years, Simon kept a diary. His medication was a frequent topic.
ACTOR: March the 14th, 1994: The thoughts I'm having now are so random, yet seem so important when they're forgotten. I am becoming more manic and I'm aware of it.
MW: Simon chronicled his own growing sense of despair right up to the time of his death. On March 8th this year his dad, Adrian popped round to see him after coming off his night shift.
ADRIAN HERVEY: At half past seven in the morning I went to his flat and I could see the bedroom light was on, so I went in. He was sitting up in bed, reading his book and he had a bag of crisps as well. I started talking to him and then I realised, he wasn't answering me back – he was dead.
MW: At the inquest into Simon's death, the coroner recorded an open verdict. The post-mortem examination was carried out by Dr Nigel Cooper, a pathologist at Newcastle's Royal Victoria Infirmary.
DR COOPER: There were a variety of medications present in Simon's body and my conclusion was that the cause of death was a combination these various medications. They were all drugs prescribed by family doctors.
ADRIAN HERVEY: He died from prescription doses, not from overdoses. I know he didn't commit suicide because I spoke to him five hours before I found him in his flat. He monitored what he was taking every day. He would put his little dishes out and his pills in the different dishes so that he didn't have to make a mistake. [sound of pills falling as Simon's prescription drugs are poured out] These are the dishes he used.
MW: There's a small pharmacy in here isn't there!
ADRIAN HERVEY: Oh yes, I've got the lot here, yes, I could set myself up as a drugs baron.
MW: So just what were the drugs Simon had been prescribed and which seem to have been doled out in such liberal quantities? Well first there was the Valium. Rob Kerwin is Professor of Neuropharmacology at the Institute of Psychiatry. Does he think that Valium is a suitable drug to give to a schoolboy who's being bullied and has acne?
PROFESSOR KERWIN: No, not to a teenager at school, not least because one of the side effects of Valium is that it impairs memory. To give an amnesia-inducing drug to any schoolboy or student is not a sensible thing.
MW: What about the idea then, of being left on that drug for 14 years – effectively for the whole of your adult life?
PROFESSOR KERWIN: Well I think that you'll know that this is nothing short of a national scandal that many practitioners know about. There are very many patients in the UK, (I think it was about 70,000 at the last count), who are 'stuck' on Valium.
ACTOR: I'm confusion personified today, more than ever, my brain is like a 'blender'. I can't hold onto one thought for more than a moment – till it's gone. It's driving me crazy.
ADRIAN HERVEY: The side effects of it can be suicidal tendencies, agoraphobia, panic attacks, nightmares, sweating, even fits. The more side effects that kicked in with Simon, the more different drugs they stuck, (in conjunction with the Valium), into his body.
[sound effect of pills falling]
MW: Drugs such as Heminevrin are described by doctors 'You and Yours' have spoken to as either an old fashioned sleeping draught for the elderly, or an occasional, highly intoxicating substitute for severe alcoholics undergoing detox. And yet Heminevrin was the second prescribed medicine Dr Cooper discovered in Simon's body.
DR COOPER: The level was into what is potentially toxic, it's more than you would expect for somebody taking a prescribed dose of that drug.
MW: Would you say that finding Heminevrin in a case like Simon's would give cause for concern?
DR COOPER: It surprised me, yes.
MW: But what's particularly surprising is the dosage of Heminevrin prescribed to Simon – and the time he spent on the drug.
ADRIAN HERVEY: The makers recommend a time limit of not more than 9 to 12 days, on the drug. Simon was kept on it for 18 months – 4 tablets, 4 times a day, for 18 months.
PROFESSOR KERWIN: 16 tablets, which is four tablets again over and above the maximum possible dose that you would want give in any aspect of medical practice, that is day one of a very heavily addicted alcoholic.
MW: And yet he was neither very old, nor very alcoholic. Does that strike you as strange?
PROFESSOR KERWIN: Yes
MW: Not least, given Heminevrin's published side effects.
PROFESSOR KERWIN: Well, the most important side effect, which is stated in the drug's product licence state that when Heminevrin has given at higher than recommended doses, for other than recommended indications, over prolonged periods of time, physical dependence, tolerance and withdrawal reactions have been reported.
ADRIAN HERVEY: It was giving him blackouts, he was falling over and when we told the psychiatrist about it, what was happening with the blackouts, he prescribed a drug called Epilim, which is given to epileptics and Simon wasn't epileptic. So he was on three massive cocktails of muscle relaxant drugs.
PROFESSOR KERWIN: Epilim is the drug sodium valproate. It's a very good and useful drug for epilepsy, for controlling fits.
MW: A drug designed for epileptics – would you countenance giving it to someone who's not an epileptic?
PROFESSOR KERWIN: Sometimes, it's given, very rarely, under expert supervision, for people who are catastrophically angry, but I don't see any of that sort of thing here.
MW: Would you give it to someone who was already on Valium and Heminevrin?
PROFESSOR KERWIN: No that is illogical because the drug is an anticonvulsant and both Valium and Heminevrin are excellent anticonvulsants in their own right. He would have basically, with the Valium and the Heminevrin, a mega-dose of anticonvulsants on board already so I can't see a rationale.
[Sound effect: paper bag emptied of pills]
ADRIAN HERVEY: That's a big bag full of benzodiazepines which he didn't take. I've got Seroxat tablets, I've got pain killers – as much Heminevrin as you could desire – if you took one of those now, you wouldn't get back to London tonight, you'd be completely out of it.
DR COOPER: You very rarely come across somebody who has apparently died from medicinal drugs, having only taken maybe slightly too much of one or the other or altered his own medication to a degree.
PROFESSOR KERWIN: Sadly, I don't think it's very unusual at all. Two or three years ago I may have said that this was a strange and unusual situation, but I think it's widespread and in urgent need of investigation.
MW: Was Simon aware that he had a drug problem, and by drug problem, (I use the phrase advisedly), that a drug problem more or less had been created for him?
ADRIAN HERVEY: Very definitely, yes, yes. Over the last two years of his life, I think he must have approached every agency known to man on this planet – for help, but the help isn't there, it isn't there for people like that. I've got nothing against the drugs if they're used properly but this is severe abuse of the drug, under a legal system which says it's OK to do it.
MW: What have his doctors said to you – the people who prescribed these drugs?
ADRIAN HERVEY: There's been a deafening silence from the medical profession. I haven't had a call from anybody, I haven't had an apology note or a letter saying we're very sorry, nobody came to the funeral – just nothing – it's as though he didn't exist.
ACTOR: (Reading from Simon's diary): February 9th, 1999: I'm depressed, more suicidal than ever – help me...
[sound effect: pills falling onto surface]
MW: The case of Simon Hervey who died on March 8th this year, aged 28, due to the interaction if drugs prescribed to him by doctors.
'You and Yours' approached the Newcastle Upon Tyne NHS Trust for some answers regarding Simon's medication, not least why he was prescribed Heminevrin, (a drug for the elderly and alcoholics) and Epilim, (a drug for epileptics). Why he spent 14 years on Valium, when the Committee on Safety of Medicines advises against its continued use for periods of more than 2 to 4 weeks. We asked if there was, or would be, an investigation into Simon's death? Would any of his doctors be suspended pending an investigation?
We received two lines by way of a faxed reply which said merely: "The Trust has a policy of not discussing individual cases to protect patient confidentiality. We therefore decline the invitation to answer these questions."
Patient confidentiality – remember the patient in this case is dead and these are questions his closest relative, his father, wants answering, but which the NHS Trust is refusing to give any answers.
We also approached the General Medical Council, the British Medical Association and the Royal College of GPs. The answer was more or less the same – no comment. If you didn't know any better you'd think someone somewhere was hauling up the drawbridge.
Well joining us in the studio we have two people who hopefully are prepared to talk. Dr Phil Timms is a Consultant Psychiatrist at Guys, Kings and St Thomas' Hospital in London and Judy Clements is from the mental health charity MIND. Dr Timms first of all: Simon Hervey was already on large doses of Valium and Heminevrin when a psychiatrist prescribed Epilim to him. Is that standard practice?
DR TIMMS: I would say that standard practice, as recommended by the GMC and the NHS Executive is that when a GP refers a patient to a specialist, they should include all the relevant information to the specialist including the medication that patient is on. When it works the other way round, if a specialist prescribes medication, he should immediately, or as soon as possible, inform the GP as to what medication he has prescribed and whether he or she expects the GP to continue prescribing it.
MW: So there should be some cross-reference?
DR TIMMS: There should be, but given the administrative chaos in the NHS, that quite often happens, doesn't happen or happens with some delay.
MW: So it could be an administrative 'cock up' if you like, but a post mortem examination has revealed that Simon died as the result of drugs prescribed to him. Isn't it extraordinary that now there should be no official investigation into how this could have happened in the first place?
DR TIMMS: I don't know if there isn't one – all we know, is that we don't know. In the Trust in which I've worked, when something like this happens, there is a what's called a 'serious incidents inquiry', which is an internal investigation, it's not open to family or outside agencies. This is where the Trust, members of the Trust Board and a consultant psychiatrist and members of nursing and other staff form a panel and ask for reports from all the people involved and conduct an inquiry.
MW: So it's an internal inquiry. You're saying that there may be an inquiry going on in Newcastle at the moment that we're not aware of?
DR TIMMS: Maybe.
MW: But Simon's father is going out of his mind with worry, he can't grieve yet, because he doesn't know what happened to his son, and he wants answers.
DR TIMMS: I think this betrays a real problem that many of us in the psychiatric services have with families and patients. There's the notion of confidentiality around the patient, but, what about the family? – that's not very clear. What is clear is that families often want to know and they're often not told. They often want to know with the permission of the patient themselves – about facts about treatment, about diagnosis about medication and that information is not forthcoming, which is why the Royal College of Psychiatrists has recently published a series of question and answer sheets both for patients and their relatives, to use to ask the relevant professionals a whole series of questions about the treatment and what they can expect.
MW: Judy Clements from MIND. it seems to me, that Simon was the victim of sort of 'I know an old lady who swallowed a fly' kind of scenario – that the only answer these various doctors had for the drugs he was already on was to prescribe still more. Also at no stage were there any warnings of side-effects, either about the drugs themselves, or a possible interaction – does that strike you as strange?
JUDY CLEMENTS (MIND): It is strange, but it isn't unusual. Common sense would dictate that people ought to be given information, ought to be warned about side-effects, ought to be involved in their own treatment. Sadly, we hear from about 80% of people who do not get information, 75% of people tell us they're never even told about side-effects. If they raise it with their doctor, 45%, the doctors were unhelpful.
MW: So it's not a unique case then? What about clinical monitoring – because I know that this is something Simon's father has been worried about – why Simon's progress on these drugs was never monitored at any point? He was falling over and having blackouts and even at the post-mortem, he had bruises on him.
JUDY CLEMENTS: Clearly clinical monitoring did not take place, otherwise we might still have Simon with us. Again, all too often we hear from people who are saying their treatments are not being monitored, the side-effects are not being monitored. 44% of people on combinations of different powerful drugs – drugs do have a place in the treatment of mental illness, no doubt about that, but that has got to be a safe place. People are being over prescribed, being given dangerous combinations and there are not inquiries when these deaths take place and there should be.
MW: Do you think that we have too much of a drugs culture? (I don't mean the kind that Tony Blair's been talking about), but a drugs culture in doctor's surgeries?
JUDY CLEMENTS: Yes I think we do and we have too little alternatives available. Drugs do have a place, alongside other things as well and sadly we don't see those other things. We never heard whether Simon was offered any counselling, any talking treatments, ant other support. He was clearly going through turmoil as an adolescent, and all he got was pills, pills, pills.
MW: Well apparently the only advice he got, from the various agencies he approached was that he was referred to his GP – the very people who'd actually prescribed the drugs in the first place.
JUDY CLEMENTS: If he was on medication, people are always reluctant to say 'don't take the medication' so they would refer him naturally back to the GP, but the GP should have been taking more interest, giving more advice, giving information on the medication he was taking and instead he ended up on a combination which proved fatal.
DR TIMMS: I know sometimes the GPs battle on with patients where they're not clear what the way ahead is and sometimes don't ask for a specialists' opinion soon enough. Certainly, if somebody's falling over with their medication, it might be an idea to get them into hospital.
MW: One of the phrases Professor Rob Kerwin mentioned in that report was: 'expert supervision'. It doesn't seem that there's been any 'expert supervision' here does there?
DR TIMMS: It's very difficult to, when you're changing somebody's medication, (as an outpatient), it's very difficult to really supervise that unless you're seeing them, or one of your deputies is seeing them, on at least a twice weekly basis.
MW: In a word, is there anything that Simon's father can do now, he's come up against brick walls all the way along – probably not?
DR TIMMS: Well I think he ought to continue to approach the Trust, because one thing that has been emphasised over the last few years is (by bodies like the Medical Defence Union if no others), is that doctors have a duty to communicate with patients and their relatives. They have a duty to explain and a duty to lay out the facts of what's happened.
JUDY CLEMENTS: I think you should raise it with the Minister for Health because this is a serious national issue that it highlights and you should raise it with the Minister.
MW: Judy Clements and Dr Phil Timms, thank you very much for joining us.
After this programme was broadcast, the issues surrounding Simon Hervey's death were raised with the Minister of State for Health.
'You and Yours', BBC Radio 4
Broadcast on October 27, 1999
Presenter: Mark Whittaker
Producer: Claire Burnett
Simon Hervey's Story: Little boy lost, Guardian, August 15, 2000
Letter to Secretary of State for Health. Follow up to 'You and Yours' programme, Radio 4, broadcast on 27.10.99 following the death of Simon Hervey.
Some of the issues surrounding Simon Hervey's death were raised with The Secretary of State for Health. The following are extracts from the letter and the reply:
Extract from letter to the Minister of State for Health, November 15, 1999:
There are two matters which I feel urgently require your attention: One is regarding warning the public of the dangers of prenatal benzodiazepine exposure and the other is the subject of a recent Radio Four programme, 'You and Yours', broadcast on Wednesday 27th October (copy enclosed).
Simon Hervey, the young man whose death was investigated by 'You and Yours', contacted me as a result of a Radio 4 programme last year. He was desperate for help with the drugs he had been prescribed, in particular diazepam. He had tried all official avenues but specialist help is not available. The only advice he got was to go back to his GP – which he did and possibly died as a result.
Three of the drugs he was prescribed; – diazepam (Valium), chlormethiazole (Heminevrin) and sodium valproate (Epilim) were all prescribed outside of their licence (off label) and contrary to guidelines. Warnings of interactions between these three drugs are given respectively. The cause of death stated at the inquest was respiratory depression caused by the combination of diazepam and chlormethiazole.
Alarmingly, prescribing in this way is not unusual, and is reflected in the calls I receive from all over the country. A substantial proportion are from people whose doctors have prescribed outside of the guidelines and/or outside of the product's licence. Few deaths are brought to public attention, but I am frequently contacted by those whose health has been damaged as a consequence.
There is no help for people damaged in this way and the procedures for complaint are inadequate.
The findings of the Health Select Committee on 'Procedures Related To Adverse Clinical Incidents And Outcomes In Medical Care' (HC5491), to be published on Tuesday 23rd this month will hopefully cover this area.
It seems that at the root of this problem is "doctor's clinical judgement" and consequent lack of accountability. The area of prescribing is particularly open to abuse and the question must be asked, what are ABPI data sheets, The BNF, Medicines Resource monthly bulletin and the Committee on Safety of Medicines for, if a doctor's "clinical judgement" simply overrides them? The death of Simon Hervey illustrates what can happen when warnings are ignored.
Extract from Reply from the Department of Health:
Department of Health
133-155 Waterloo Road
London SE1 8UG
Your second point deals with the prescribing of medicines outside of their licensed indications. Clinicians are responsible for prescribing the treatment they think their patients require, taking into account the professional knowledge, knowledge of the drug and information about the individual patient. Clinicians may, if they wish, choose to prescribe medication on the NHS which has not yet been licensed for use in this country (with the manufacturer providing supplies on a "named patient" basis); or is not licensed for a particular indication for which they wish to use the product. Clinicians do this in the knowledge that they bear the full legal and clinical responsibility for the patient's condition in relation to that treatment. Professional standards for doctors are the responsibility of the General Medical Council.
The Medicines Control Agency, an executive agency of this department, monitors the safety of all medicines, whether or not the medicine is being used outside of its licensed indications. New safety issues are communicated to health professionals by strengthening the product information, or through the drug safety bulletin "current Problems in Pharmacovigilance", or if the issue is urgent, by sending a letter to all doctors.
Susan Bibby: Letter on Benzodiazepines
to Alan Milburn MP, Secretary of State for Health (full text).
Doctors urged to end drugs menace,
Newcastle Evening Chronicle, June 7, 2001.
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