The Death Protocol: Whistleblower Nurse Says “One Medical Blunder Cost Thousands of Lives.”
Whistleblowing nurse Lesley Roberts has highlighted one “devastating blunder” that she believes led to thousands of avoidable deaths during the Covid pandemic, the NG163 ‘end of life’ protocol “It should never have been considered. People who were not at the end of their lives were brought to the end because of those drugs. If they had breathing difficulties then their breathing was being suppressed even further by the drugs and it was this that then killed them, not Covid.”Source
The Scottish Daily Express reported the story which has been the same story that freelance Journalist Jacqui Deevoy has been “pitching” to the English newspapers for almost three years!
Do Not Resuscitate.
As an infection control link nurse with NHS Greater Glasgow and Clyde at the start of pandemic as well as a workplace health and safety rep for Unison, Lesley Roberts has been an outspoken critic of the decisions taken by ministers and healthcare officials at the time, according to the Ben Borland from the Scottish Express.
She has repeatedly highlighted the increased use of “Do Not Resuscitate forms,” especially around elderly or vulnerable patients with what she says was “Covid-19.” and has reported the Scottish Government to Police Scotland and is calling for Nicola Sturgeon and Jeane Freeman to face corporate homicide charges. Source
Lesley Roberts, is speaking out despite receiving a “Restriction Order” from the Scottish Covid Inquiry that would prevent her from disclosing any of the evidence or documents she has submitted to the probe. Ms Roberts says she fears the impact will be to stop her and other campaigners from criticising the Scottish Government.
Now – with the threat of a ‘gagging order’ looming from the inquiry – she wants to discuss what she sees as the most explosive part of the vast array of evidence she has gathered over the past three years. Source
End of Life Protocol
The NG163 ‘end of life’ protocol from NICE, the National Institute for Health and Care Excellence had been issued to doctors and nurses across the UK on April 3, 2020 and remained in place until March 21, 2021.
According to Roberts and other healthcare campaigners, NG163 essentially told medics to prescribe a deadly cocktail of powerful drugs to people in hospital and elsewhere who had been diagnosed with an “advanced case of Covid-19.”
Lesley Roberts said: Just like the catastrophic decision to move elderly patients from hospitals to care homes, either without testing or sometimes even after they had tested positive for coronavirus, NG163 was controversial right from the start.Source
‘Silence Me’ Drugs’
Speaking to the Scottish Daily Express, Ms Roberts said the decision to ignore these and other warnings about the NICE guidance should play a central role in both the UK and Scottish public inquiries.
“They were called ‘silence me’ drugs,” she said. “I don’t believe any nurse wants to watch their patients die but I’m afraid that is what happened as a result of this Covid care protocol.”
Her evidence around NG163 forms a key part of both her submission to the Scottish Covid Inquiry and her witness statement provided to Police Scotland detectives from Operation Koper, the long-running investigation into Covid deaths in Scottish care homes.
A Good Death?
Similarly freelance journalist, Jacqui Deevoy launched her own a personal investigation into euthanasia in the NHS in 2021 that resulted in her producing the shocking documentary ‘A Good Death?’ with Ickonic Media. Within the documentary there are heartbreaking stories from people who lost loved ones to fatal doses of morphine and Midazolam.
Please watch the documentary which can be seen here
“Each year, tens of thousands of elderly and terminally ill patients are quietly euthanised in NHS facilities. In hospitals, care homes and hospices, behind closed doors, their deaths are hastened in what appears to be a caring and humane way. But how has this practice of euthanasia – illegal in the UK and carrying a life prison sentence – become so widespread and acceptable? And why are people who are nowhere near the end of their lives being given killer ‘cocktails’ of drugs that are used in many US states for executions?” say Ickonic Media
Hancock Ignored Advice From Experts?
Jacqui says that Matt Hancock, the then Health Secretary was the first to come up with NG163 (the Covid protocol, which she says is “reminiscent of the abolished Liverpool Care Pathway that was used to treat the elderly and those presenting with respiratory issues in hospitals and care homes.”
In an article authored by Jacqui in Unity News in March 2023 titled, “Matt Hancock ignored 11 experts’ Advice on Deadly Covid Protocol” and the just as Nurse Lesley Roberts has, points out that Hancock was presented with advice in early 2020 from nine doctors and two professors. These were 11 of the UK’s most senior consultants in palliative care medicine – all of whom were familiar with end of life care procedure, including Barry Laird, from the University of Edinburgh and St Columba’s Hospice.
The experts, after studying the protocol said they were “concerned that uncritical use of NG163 may create unintended risks for people with suspected or actual COVID-19 infection” The doctors said that, with regards to the old guideline, the evidence base was so poor that specific dosages were not recommended. They seemed confused by the fact that dosages recommended in NG163 were so specific. https://unitynewsnetwork.co.uk/matt-hancocks-ignored-11-experts-advice-on-deadly-covid-protocol/
They suggested that the new guideline that replaced NG31, which detailed how to deal with people dying of cancer, should not be implemented.
The palliative care specialists also warned of the danger of the potent combination of “opioid, benzodiazepine and/or neuroleptic” drugs recommended by NICE. “It takes great skill and experience to use palliative sedation proportionately so that extreme physical and existential distress are palliated, but death is not primarily accelerated,” they said. “NG163 states: ‘Sedation and opioid use should not be withheld because of a fear of causing respiratory depression.’
“If Covid-19 infection were uniformly fatal, this would be an acceptable statement. But for people not previously known to be at the end of life, there is potential risk of unintended serious harm, if these medications are used incorrectly and without the benefit of specialist palliative care advice.”
The Most Frightening Line Ever
Jacqui said that this major concern of the panel” is probably the most frightening line ever to be written into a NICE guideline as it’s telling nurses not to be put off giving the prescribed drugs due to a fear that the patient’s breathing will dramatically slow down. They’re being told to disregard any concerns and administer the drugs anyway.”
“Doctors prescribing the meds – and many of the nurses giving them – KNOW that using Midazolam and morphine together will slow down breathing (to the point of death if it’s administered continuously via a syringe driver) but this very clear instruction is telling them not to worry about that!” exclaims Jacqui Deevoy
“How many medics administered this killer cocktail of ‘end of life drugs’ to patients, not all of whom were presenting with respiratory symptoms – or, in some cases, appearing to have nothing more than a positive result from a non-diagnostic, not fit-for-purpose PCR test – knowing it was going to kill them?”
“Some doctors and nurses have since admitted wondering about the potentially lethal effect of this combination of benzodiazepines and opioids and knew that the doses they were giving were way too high (something else that was a point of concern in the letter), but very few spoke out and the vast majority just continued to follow orders.” Jacqui Deevoy
The Letter From The Real Experts
The eminent experts, led by Professor Emeritus Sam H. Ahmedzai, wrote to the British Medical Journal to flag their concerns. the letter, published on April 20th 2020, point out that “while NG163 states ‘Note that symptoms can change, and patients can deteriorate rapidly in a few hours or less’, there is no counterpoint that most patients without the preconditions above will eventually recover.” Other quotes from the letter - ’There is potential risk of unintended serious harm’, “We are concerned that uncritical use of NG163 may create unintended risks for people with suspected or actual Covid-19 infection.” https://www.bmj.com/content/369/bmj.m1461/rr-1
They were ignored as was the fact that the guidance was based on previous NICE advice “aimed at care of people who were likely to die in the coming hours and days“. despite the fact that “Many people in the UK who are suspected of having Covid-19 will not have advanced cancer or be dying from another existing terminal condition.”
Dear Editor
We read with great interest the summary of NICE guideline NG163: COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community.[1] NICE is to be congratulated on producing a series of guidelines for the COVID-19 crisis in such a short time. The letter from Dr (Lieutenant Colonel) Rajesh Chauhan et al,[2] detailing their concerns around the recommendations for codeine, and the response by Dr Paul Chrisp,[3] Director of the Centre for Guidelines at NICE, illustrate the inherent problems associated with producing UK national guidelines for a global problem.
We fully understand why shortcuts to the normal NICE guideline procedure were necessary, in order to produce COVID-19 guidance rapidly. But we are concerned that uncritical use of NG163 may create unintended risks for people with suspected or actual COVID-19 infection.
Under ‘General advice for managing COVID-19 symptoms’, NG163 recommends: “3.2 When managing key symptoms of COVID 19 in the last hours and days of life, follow the relevant parts of NICE guideline [NG31] on care of dying adults in the last days of life. This includes pharmacological interventions and anticipatory prescribing.”
The earlier NICE guideline NG31 (2015) for symptom management at the end of life was based on studies carried out in people who were mostly in the advanced stages of cancer.[4] However, in NG31 the evidence base was so poor that it did not publish detailed recommendations for drugs and doses.
We are unaware of more recent high-quality research evidence that NICE could have used to produce such specific drug and dosing recommendations now for COVID-19 patients.
NG31 was aimed at care of people who were likely to die in the coming hours and days – usually from advanced diseases, from which recovery was deemed most improbable. Many people in the UK who are suspected of having COVID-19 will not have advanced cancer or be dying from another existing terminal condition.
The accumulating global evidence shows that the case fatality rate reaches >50% in those needing mechanical ventilation, over 80 years and with serious underlying health conditions including congestive heart failure, chronic kidney disease and lung cancer.[5]
So it is worrying that while NG163 states “Note that symptoms can change, and patients can deteriorate rapidly in a few hours or less”, there is no counterpoint that most patients without the preconditions above will eventually recover. In contrast, NICE guideline NG31 emphasised the importance of how to recognise whether someone was dying, but also to keep open the possibility for recovery by ‘monitoring for further changes at least every 24 hours’.(5)
Compared with advanced cancer, COVID-19 is a condition that very few practitioners will have sufficient confidence to prognosticate on. For no doubt good intention to provide ease from distress, patients may be started by inexperienced practitioners on potent medications with detailed advice on how to escalate doses, but not on monitoring daily or more frequently, and how to wean off medication if the patient stabilises and recovery becomes possible.
We have further specific concerns. NG163 recommends codeine and morphine for the management of cough and breathlessness. (Codeine, is of course, a pro-drug converted to morphine by a process dependent on common pharmacogenetic variations which can lead to little or no effect in some patients, or severe opioid toxicity in others.[6]) Although morphine is recommended in several places, only once is there mention of switching to oxycodone “if estimated glomerular filtration rate (eGFR) is less than 30 ml per minute”.
We doubt if most practitioners in the community will have access to daily renal function results to know when to make that switch.
Given the propensity for COVID-19 to lead to acute kidney injury in 4 – 31% of cases,[7] we would suggest that oxycodone could be considered as an alternative first-line drug for symptoms of COVID-19 (including pain), especially for those at risk of renal impairment or in the older population. Although small compared to the literature on morphine for breathlessness, the evidence for oxycodone is growing.[8]Moreover, the effect of renal impairment on morphine pharmacokinetics leading to adverse neurotoxic effects including acute delirium is well established.[9] Thus focusing on morphine in NG163 might lead to increased use of lorazepam, midazolam, haloperidol or levomepromazine for sedation. Such a situation could potentially be avoided if oxycodone were used instead.
With respect to drugs used for sedation, the neuroleptics haloperidol and levomepromazine are recommended if midazolam alone does not work. There is no mention of the potential pharmacokinetic or pharmacodynamic drug interactions between the antibiotics that could be used for bacterial pneumonia in the community (e.g. clarithromycin/erythromycin, ciprofloxacin/levofloxacin) [10,11] and opioids or neuroleptics. For people who are not on antibiotics this will be of no consequence; but for those who are, it could lead to opioid toxicity including prolonged QTC interval.[12,13,14]
The combination of opioid, benzodiazepine and/or neuroleptic is used in specialist palliative care settings for symptom control and for ‘palliative sedation’ to reduce agitation at the end of life.[15]
It takes great skill and experience to use palliative sedation proportionately so that extreme physical and existential distress are palliated, but death is not primarily accelerated. NG163 states: “Sedation and opioid use should not be withheld because of a fear of causing respiratory depression.” If COVID-19 infection were uniformly fatal, this would be an acceptable statement.
But for people not previously known to be at the end of life, there is potential risk of unintended serious harm, if these medications are used incorrectly and without the benefit of specialist palliative care advice.
Another concern is that the recommended doses for morphine and midazolam are sometimes higher than current guidelines state for non-specialist use; and moreover there are inconsistencies between the maximum doses recommended by the oral or subcutaneous routes.
In summary, we welcome NICE’s rapid production of practical guidelines to help community practitioners prescribe medication to ease the distress of people with serious COVID-19 infection. However, as current or retired consultants in palliative medicine, we respectfully suggest that some recommendations in NG163 should be revised to prevent inadvertently adding to that suffering.
Professor Emeritus Sam H Ahmedzai, The University of Sheffield
Dr Andrew Dickman, Liverpool University Hospitals NHS Foundation Trust
Dr Amara Callistus Nwosu, Lancaster University
Dr Barry J A Laird, The University of Edinburgh and St Columba’s Hospice, Edinburgh
Dr Catriona R Mayland, The University of Sheffield
Dr Ashique Ahamed, Manchester University Hospitals NHS Foundation Trust
Dr Sophie Harrison, Manchester University Hospitals NHS Foundation Trust
Dr Donna Wakefield, Consultant in Palliative Medicine, Newcastle-Upon-Tyne
Professor Mari Lloyd-Williams, University of Liverpool and LCCG / Liverpool Health Partners
Dr Jason Boland, Hull York Medical School, University of Hull
Dr Sam Fingas, Sheffield Teaching Hospitals NHS Foundation Trust
Source – https://www.bmj.com/content/369/bmj.m1461/rr-1
This really should have stopped the protocol altogether. Hancock clearly thought he knew better and continued on and recommended the deadly protocol.
Euthanasia in the Pandemic
The Fight Continues
A group called The People’s Care Watchdog is also campaigning about the “unlawful end of life protocols” brought in as a result of NG163. It argues that many Covid deaths in care homes and hospitals “could and should have been avoided”. The group adds: “Many people lost family members during ‘lockdown’ and the clinical guidance produced by NICE in April 2020 demands public scrutiny to understand the impact it had on deaths in care homes and hospitals.”
Jacqui Deevoy has a crowdfunder for her new groundbreaking documentary “Playing God” although the filming is completed funds are needed for the editing and final costs. https://www.crowdfunder.co.uk/p/playing-god-final-phase.
“The stories we’ve heard from our contributors whilst filming have been both heartbreaking and horrifying but they’ve finally spoken out and there’s no going back. Their loved ones have all been victims of blatant medical democide and they’re all seeking justice.
‘Playing God’ gives a voice to the previously voiceless, a platform to those who’ve been fighting the system in order to get to the truth of the horrors that have befallen their families. The film aims to expose the government for what it really is. These stories MUST be heard.”
The teaser can be seen here
The Whistleblower nurse, Lesley Roberts has been successful in at least getting her truth seen in a Scottish national newspaper. We wish her lots of luck in her fight.
The mainstream newspapers in England, however, have continued to ignore Jacqui Deevoy. but, the horrendous actions from the top down who were and continue administering the deadly cocktail, needs exposing and the Scottish and English governments and particularly Matt Hancock needs Jailing.
They knew what they were doing yet continued on with the death protocol along with many others, as Jacqui rightly says:
“Sadly, as we know from the Nuremberg Trials, the excuse of “just following orders” does not stand up in court. And, whether they knew the dangers of what they were doing or not, court is where many of these obedient ‘angels of death’ will end up.” – Jacqui Deevoy
This article has been archived for your research. The original version from The Exposé can be found here.
