Prof Trudie Chalder, ONE CLICK document dated 23 November 2003
http://www.php.nhs.uk/the-php1-team/mental-health-lead-professor-trudie-chalder.html
Professor of Cognitive Behavioural Psychotherapy Professor Trudie Chalder
Mental Health Lead Professor Trudie Chalder Professor Chalder is a specialist practitioner in Cognitive Behaviour Psychotherapy and International expert in Cognitive Behaviour Therapy. Professor Chalder is current Director of the Chronic Fatigue Syndrome Research and Treatment Service at SLAM NHS Trust.
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Note: The views and opinions expressed in the document below and the events reported are those of the author as supplied to ONE CLICK and published by the ONE CLICK Group.
From the ONE CLICK site files:http://www.theoneclickgroup.co.uk/documents/ME-CFS_docs/c_histories/Psychosocial Torture UK.doc
Name and address supplied
22 November 2003
Dear Linda,
I am writing to tell you what 1 know about Dr Trudie Chalder. She was consulted about the treatment of my son whilst he was in hospital. My son, who is 20 now, was admitted to a hospital in the District for rehabilitation with his ME. He was severely affected and bedbound and unable to care for himself. Since his discharge I have obtained the medical records and I can see that the consultant in charge wrote to Dr Simon Wessely for advice. I presume he referred the request to his colleague Dr Chalder. On my son's hospital file is a document, dated 07-03-01, a Draft Action Plan Proposal following consultation with Trudie Chalder which I attach. I find the action plan shocking, and I was particularly disturbed by the penultimate paragraph which states:
"We expect (name) to protest as well as the activity causing him a lot of pain. This may result in screams. .. . it may feel punitive. "
What I witnessed in the hospital was certainly punitive and I often saw him handled roughly and his skin marked.
This plan has never been discussed with me. I was unaware of it's existence, in fact when I spoke to the consultant asking where he was getting his advice about treatment for ME he refused to tell me. I never gave my consent to this action plan.
There was a parental meeting about physiotherapy being painful, and I was specifically asked whether I consented to this. At the time I understood the question to concern normal physiotherapy, and did not realise that I was being asked to consent to a painful psychological action plan,
In the file is a note by the physiotherapist stating that pushing into my son's contracted hamstring would cause pain. He was told "that is the point".
I believe this explains why my son was never offered pain relief; and although 1 asked for it several times I received no response, There were a number of painful incidents; he was found bleeding from the stomach in February 2001 and duodenal ulcers were detected in September 2001. He also had surgery in September 2001.
On 18 April 2001 I wrote to the consultant about the pain my son must experience in having a naso-gastric tube frequently inserted. I reported that it had been reinserted 11 times in the previous 7 weeks and asked if steps could he taken to avoid the frequency of such an invasive procedure. 1 have no record of receiving a reply.
The Action Plan also accounts far the diagnosis of "elective mutism" which was then applied to my son. This in itself has caused him great harm both before and after his discharge as everyone treats him as though he is refusing to speak. Community speech therapists have refused to work with him on the basis that he might "not be compliant or not in the mood". After three referrals one did visit him once but she appeared to have been warned by her medical director not to put anything in writing, for fear of challenging that diagnosis.
During his time in hospital all the other young people on the ward were continually told that my son could speak, and could move, but was choosing not to. They would frequently ask me why he chose not to speak. The nurses would say, "It's a lovely day, what a pity you're not out there", as though he could be if he wished. Day after day he was treated this way.
He was admitted to the hospital on 14 December 2000, initially for a three-month assessment. At the family meeting on 25 January 2001 it was stated that the final review would be on March 15 2001 and if there was no progress towards free communication a discharge plan would be agreed with the family. My son's lack of speech was clearly seen as the most serious of his disabilities.
In the file is the occupational therapy review dated 15 March 2001 recommending, "Team to debate the approach following recent consultation with ME specialist", which I presume refers to Dr Chalder. The occupational therapist then appeared to take on the role as lead therapist. There is a record of a confidential meeting on 31 May 2001, which agreed to continue with the behaviour programme. It states that, The Chronic Fatigue Service believe that this (exercise programme) is not to prevent contractures as (name) is moving and being moved enough to otherwise prevent this, but to pursue exercise to the point where he resists. The service referred to above is the one at Kings College Hospital.
At a team meeting on 28 June 2001 a provisional discharge date was set for August. In the event he was not discharged until 10 January 2002.
Until discharge the behaviour programme continued to be increased and I attempted to resist this. I wrote to the consultant and eventually complained that it was too much for my son. The response was to increase the programme further. The consultant stopped speaking to me on the unit. I then discovered that he had behaved unprofessionally because in a referral letter he stated my son was suffering from "pervasive refusal syndrome", which had never been said to me. I then realised I had been completely left out of the loop identifying my son's illness and his treatment, l complained to the Chief Executive of the hospital Trust. An investigation was promised but this never happened.
The hospital did not want to discharge my son home. They tried to refer him to two brain damage units who would not accept him, as they were not appropriate referrals. Finally a letter was written to the consultant from the House of Lords, urging him to allow my son home. Coincidentally he was discharged home soon after.
The issue of my son's consent is frequently referred to in the notes, and it is clear throughout that they did not have his consent.
This unfortunate history is a case study of what can happen when diagnosis and treatment are not discussed with the patient and his family. There was no consent to the "treatment" which caused pain and suffering. I believe that the action plan had the effect of making staff who carried it out indifferent to my son's pain and safety. He was treated with less and less respect the longer he was on the unit, not least because he failed to respond. The longer this went on the harder they tried to make him respond. By the end he was not being treated with any respect. I believe therefore that the action plan devised by Trudie Chalder was harmful and posed unacceptable risks.
There was no appraisal of evidence as to whether or not the programme was working. It is not in dispute that my son made no improvement at all during the 12 months spent in that hospital
I believe Dr Chalder has stated that
" parents... hold physical illness attributions resulting in them searching for a specific physical cause"
The implication is that to do so is both unhelpful and wrong. She must be asked to what she attributes the illness.
The approach of Dr Chalder and the Chronic Fatigue Service is diverging from Department of Health policies, like the expert patient programme, and the Report of the CFS/ME Working Group to the chief medical officer, which recommended that management should be undertaken in partnership with the patient, and should be applied flexibly in the light of their clinical course. Please note that she resigned early from the working group, as she did not agree with the findings.
An action plan, such as the one attached, is not respectful of the patient, could not be discussed with the patient, or carried out in partnership. It is not good practice to cause patients "a lot of pain", I question whether it is ethical, indeed it may be unlawful.
May I draw your attention to the controversy raging at which Dr Chalder is at the heart. She and colleagues published an article in the BMJ in September 2003, "Epidemiology of chronic fatigue syndrome and self reported myalgic encephalomyelitis in 5-15 year olds".
This has been followed by a stream of incandescent correspondence. (bmj.bmjjournals.com/cgi/eletters/327/7416/654#36770). Articles in the press, such as the recent one in the Times "Chronic Fatigue Syndrome : Tired or emotional? September 27 2003, echo the row going an in the field, Dr Chalder's position is extreme and I hope the Department of Health will consider carefully whether it wishes the Chronic Fatigue Service, of which Dr Chalder is a member, to have any role in proposals for new services for patients with ME.
Yours sincerely,
[Document ends]
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