Kent to Leeds: a mercy dash too far

It took 10 hours and 200 miles to get Malcolm Murray to hospital. Was it NHS cuts, or just someone's incompetence? Liz Hunt reports

When the brain cavity starts to fill with blood after a head injury there is a crucial four-hour period after which the chances of any meaningful recovery fall steeply. Malcolm Murray, the patient flown more than 200 miles from Kent to Yorkshire in search of a hospital bed, never really had a chance.

He suffered his injuries after being hit by a van at Orpington late on Monday night. Ten hours elapsed before surgeons were able to remove the massive blood clot pressing on Mr Murray's brain. His death at 4.15pm on Wednesday afternoon at Leeds General Infirmary came as no real surprise to the surgeons who had performed the intricate seven-hour operation.

Nor were they surprised that Mr Murray's death immediately became the subject of frantic buck-passing and political point-scoring which had, by last night, forced the Prime Minister to comment on the case.

Was Government policy - which is closing intensive care and specialist beds in London as part of its reorganisation of the capital's health care - a contributory factor in Mr Murray's death, as opposition parties claimed? Or was his death due to a combination of incompetence - a communication failure that failed to identify emergency beds closer to London than Leeds - and bad luck?

Mr Philip van Hille, a consultant neurosurgeon at Leeds, chose to fuel the furious row that erupted by breaking away from the usual non-committal expressions of sympathy issued in cases such as these. Mr Murray might well have died anyway, he said, "but a delay like that does not do any good at all".

That delay is now the subject of intense inquiry by Queen Mary's Hospital in Sidcup, Kent, where Mr Murray was first admitted, and the South Thames Regional Health Authority. They are poring over telephone logs trying to find who was ringing whom and at what time, in an effort to find an intensive care bed at a hospital with specialist neurosurgical facilities.

Both the hospital and the health authority yesterday refused to comment until the inquiry is complete, but already it is clear that worrying failures of the system have been exposed. Eleven hospitals in London and the South- east were contacted and did not have beds, but other specialist hospitals in Oxford, the West Midlands and Nottingham - much closer to London than Leeds - were not even contacted about Mr Murray.

Malcolm Murray's last journey began late on Monday night outside the Artichoke Pub in Orpington, Kent. According to reports, he was involved in a fight in the street and minutes later was hit by a Transit van which was allegedly driven at him. Onlookers called an ambulance and he was rushed to Queen Mary's Hospital in Sidcup, where he was admitted to the accident and emergency department at 11.35pm.

A brain scan revealed that Mr Murray was in urgent need of specialist neurosurgery. The first-choice hospital was the Brook Hospital at nearby Woolwich, the regional neuroscience unit that serves Kent and Sussex. But the Brook was in the grip of a gastric flu outbreak and its intensive care and neurological wards had been closed to new admissions since Monday afternoon.

A senior neurological registrar advised doctors at Queen Mary's on treating Mr Murray but neither he or anyone else at the Brook was involved in helping to find a suitable bed elsewhere, despite the fact that they would have better knowledge of what was available in the area and whom to contact.

Professor Douglas Miller, vice-president of the Society of British Neurological Surgeons, said yesterday he found this action by the Brook "very odd". He added: "There are about a dozen neurosurgical units in and around London. When I first heard about this, when colleagues were discussing it yesterday, I found it almost unbelievable that they couldn't find a bed."

Graham Hayter, director of the London Emergency Bed Service, which co- ordinates available hospital beds in London and the South-east, also said that it would be normal practice for the Brook to assist Queen Mary's. A spokeswoman for the Brook insisted yesterday that it was solely the responsibility of Queen Mary's to find Mr Murray a bed.

A junior doctor at Queen Mary's was in charge of the phoning around to find a bed, using a booklet called Guide to Emergency Care Centres of Britain. The Royal London Hospital in Whitechapel, where the boxer Gerald McClellan underwent neurosurgery for a similar injury to Mr Murray's two weeks ago, insists it was not contacted, despite claims by Queen Mary's that it was called at 3.42am.

Judith Payne, spokeswoman for the Royal London, said the neurosurgical registrar on duty in the early hours of Tuesday was not contacted "and I don't know anyone else at the hospital who was". A consultant, who asked not to be named, said yesterday: "If they didn't contact the London, you begin to wonder who else they didn't contact."

Mr Hayter, at the London Emergency Bed Service, was also doing some wondering yesterday. The service logged a call from Queen Mary's at 2.30am but according to its records this was a general inquiry about availability of intensive care beds. He says a specific patient with neurosurgical injury was not mentioned. If he or she had been, it would have prompted a different response. "We get those kinds of general inquiries all the time," Mr Hayter said.

The Atkinson Morley Hospital at Wimbledon was contacted but did not have a bed, while the Maudsley Hospital at Denmark Hill refused to comment last night. The National Hospital for Nervous Diseases was also unable to offer Mr Murray a bed. But the Radcliffe Infirmary in Oxford says it was not contacted.

Eventually a suitable bed was found for Mr Murray in Leeds and an RAF helicopter was scrambled from Wattisham, Suffolk, through the Rescue Co- ordination Centre at Plymouth at a cost of around £5,000. The only available helicopter in London, at the Royal London Hospital, does not fly at night for safety reasons.

The RAF helicopter arrived at Queen Mary's early on Tuesday morning and Mr Murray, whose condition had by this time been stabilised, was accompanied by nursing and medical staff for the hour-long flight to Leeds General Infirmary, arriving a little after 8am.

But in the West Midlands, where there are several major neurosurgical centres, including the Midland Centre for Neurosurgery and Neurology at Smethwick and the Walsgrave Hospital in Coventry, hospital managers were yesterday bemused as to why they had not been rung by Queen Mary's. Alastair McIntosh, neurosciences manager at the Walsgrave, said: "Whether or not we would have had a bed is a matter of conjecture but we did wonder why we weren't contacted when we heard about this case."

At the Queen's Medical Centre in Nottingham, another specialist neurosurgical centre, a spokesman confirmed that no approach was made about Mr Murray and that this was "surprising". At the Royal Hallamshire Hospital in Sheffield, managers were unable to confirm whether or not they were approached for a bed.

Health ministers are demanding the results of the inquiries into Malcolm Murray's death "as soon as possible". But there are already fears that a junior doctor has been earmarked to take the blame and to save Virginia Bottomley, Secretary of State for Health, from further political embarrassment about the health service. According to the watchdog body London Health Emergency, the pressure on specialist beds is increasing: six intensive care units and three specialist neurological units are currently threatened with closure. The danger is that more cases like Mr Murray's will follow.

Additional research by Anne Heron.