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Consular Support

Volume 483: debated on Tuesday 18 November 2008

It is a pleasure to serve under your chairmanship, Mr. Key. I want to raise the issue of the consular assistance that was provided to one of my constituents in relation to her brother, who tragically died in the Pertamina hospital in Jakarta while he was on holiday in Indonesia. The case revolves around the refusal of the hospital to treat Mr. Nord until he provided a cash payment to the doctors who were on duty that evening. This was not about paying for treatment through a credit card or cheque. It was a demand for money—American dollars—to be paid up front before the hospital would consider any treatment. In the event, Mr. Nord died. His death was entirely preventable. My constituent, his sister, believes that the consular assistance that was provided was inadequate to say the least.

Mr. Dale Nord was taken ill on Friday 4 January. He spent the whole day in bed in his hotel room. He was persuaded to go to hospital that evening. His condition had deteriorated to such an extent that by the time he arrived at hospital, he was unconscious. From that point on, he never recovered consciousness. When presented with Mr. Nord, the hospital refused to treat him until his companion had provided $1,700 in cash.

Mr. Nord received no treatment for several hours until his companion was able to contact friends to raise part of the money. As it turned out, his friends raised $700. After that, the hospital began to consider treating Mr. Nord. I want to point out that, contrary to what the Foreign Office has been told and to the information that it provided in our exchange of correspondence, up until that point no treatment, be it good, bad or indifferent, had been given to Mr. Nord. In a letter—admittedly not written by my hon. Friend the Minister—the Foreign Office said:

“Our records show that at no time was medical treatment withheld from Mr Nord”.

That is not the case; medical treatment was withheld until Mr. Nord’s companion could produce a cash payment in US dollars to the doctors on duty in the hospital.

Mr. Nord’s companion, his girlfriend Anna, was an Indonesian national. Obviously, she could speak the language. She was well aware of what was happening at the hospital, of what was being demanded and of the fact that Mr. Nord was not being treated. She did not have the money available to her, and so she contacted April Nord, Mr. Nord’s sister and my constituent, to ask for her help. April Nord then contacted the embassy, through the embassy’s emergency telephone line, and spoke to Mr. Golding, the officer on duty that evening. Unfortunately, Mr. Golding responded by saying that it was not his day job, and that he was not used to doing that type of work. He said that he did not want to go to the hospital that evening because he did not have an interpreter and he did not have the required language skills. He said that he would not go to the hospital until 7.30 the following day.

Why was an emergency duty officer on duty that weekend in Indonesia when he did not have the requisite language skills or the skills to deal with the situation? Mr. Golding said that such work was not his day job, which one takes to mean that he had been seconded into the job of duty officer without any experience.

Throughout the time, the hospital was pressurising Mr. Nord’s companions for cash payments. It said that it could not put Mr. Nord in intensive care, which is what it said that he required, until the money had been paid. It was made crystal clear to Mr. Nord’s companion that he would not be moved until money had changed hands.

My constituent, April Nord, had a number of conversations with Mr. Golding throughout the course of the evening. She was anxious to get money to the hospital to pay for any treatment that her brother required. During her conversation with Mr. Golding, she was told that everything in Jakarta works on bribery and that the request for $1,700 was probably a request for a bribe. By this time, things were becoming a little frantic to say the least. The companion of Mr. Nord and Mr. Nord’s sister were told that Mr. Nord was in a diabetic coma and that he had suffered multiple organ failure, neither of which turned out to be true. It was suggested that a credit card payment might be acceptable. That suggestion came from Mr. Golding himself and not from my constituent, as has been suggested in the correspondence with the Foreign Office.

Unfortunately, the hospital refused to take a credit card payment on the basis that it did not have sight of the credit card—it was Mr. Nord’s sister’s credit card and she was in the UK. By the same token, the Foreign Office refused to guarantee or loan any money in accordance with the Foreign Office consular advice. Therefore, there appeared to be no way in which money could be paid to the hospital to obtain treatment for Mr. Nord. Yet all the time the doctors kept saying that he was in a diabetic coma, that he was suffering multiple organ failure and that he required intensive care.

After Mr. Nord had been in hospital without treatment for several hours, a friend provided $700, which had been collected from friends. At that point, the hospital agreed to begin some assessment of Mr. Nord’s condition. However, at 5 am, Mr. Nord allegedly suffered a cardiac arrest, and later that day, he died. All of that happened between 1 o’clock in the morning and 3 o’clock in the afternoon, Indonesian time.

Throughout the whole of the period that he was in hospital, Mr. Nord had been unconscious. Even if the man had had insurance, a credit card or cash with him, he could not have communicated that information to anybody; he was unconscious. He could not say whether he had funding available. The Foreign Office provides clear consular advice. A person in those circumstances could be any one of us; incapacitated and unconscious and unable to communicate with the hospital. The hospital would not provide treatment until a payment was made, but the situation was such that it was impossible to provide that payment. I find it strange that the embassy staff, faced with a situation involving a clear demand for money, which the individual concerned had difficulty in meeting, could not have done more to provide assistance to him. I appreciate that the guidelines state that no financial assistance is available, but by the same token it is strange that the Foreign Office was willing simply to stand by and allow the man to die for the want of $1,700.

To make matters worse, when Mr. Nord’s body was returned to the UK, the West Yorkshire coroner undertook a post mortem examination of the body and the medical notes from the hospital were referred to specialists in West Yorkshire, for an analysis of what had happened to Mr. Nord while he was in hospital. Mr. Nord had no history of diabetes and there was no diabetes in his body. There was no question that he had been in a diabetic coma. He had not suffered any cardiac arrest. Nor had he suffered multiple organ failure. The consultant’s conclusion was that the

“heart and kidneys were unremarkable.”

The conclusion reached by the specialist was that Mr. Nord had been suffering from something known as ketoacidosis or, in layman’s terms, dehydration. Had he been given fluids he would easily have been resuscitated. That raises the question why that treatment was not given. Probably, Mr. Nord, being on holiday in Indonesia, had drunk too much and not looked after his diet as he should have done, and developed a severe case of dehydration, which led to his death. That death, according to the specialist, was entirely preventable.

Several questions about consular assistance to individuals abroad are raised by this case. I repeat my question: if a person is incapacitated and cannot speak or is unconscious when admitted to hospital—even if they have insurance or money—what assistance can or should be provided to ensure that the individual is not put in Mr. Nord’s situation and left to die? Why was the consular officer on duty that evening, by his own admission, so badly equipped to deal with the situation? He mentioned that it was not his day job and that he required an interpreter before he went to the hospital. In the end when he found out that Mr. Nord’s companion was Indonesian and could interpret, he visited the hospital. The officer mentioned that he knew that the country operated on a system of bribery. Why does the Foreign Office not have protocols or procedures in place, so that if it is known that there might be a request for a cash payment in advance of medical treatment an attempt can be made to get round the situation and assist an individual? Obviously it is not the easiest matter for the Foreign Office to make reference to another country’s being corrupt. However, it happens. There are countries where a level of corruption is acceptable, when it is not here. There should be some system to get round situations in which a bribe or some such payment could be anticipated.

Even if there was no request for a bribe, and even if the hospital was the best in Jakarta and had, in the words of the Foreign Office,

“the highest reputation within Indonesia”,

why was Mr. Nord allowed to die while embassy officers and doctors stood and let him? Surely there is something wrong with the system, no matter how good the hospital and its procedures, when a man is admitted to hospital and dies in this way in 12 hours. There is something wrong with the system and we need to consider it again.

I appreciate that the Foreign Office goes to great lengths to publicise its consular guidance and make individuals aware that there is no financial assistance and that there are no medical payments or guarantees. However, surely there must be a system that allows for a situation such as the one I have set out, and in which a person can be given some assistance at least to prevent a tragic outcome. If the Foreign Office takes the view that the guidance is sound and there is no reason to change it, surely the information that is provided must go further, and include such situations. Individuals should be alerted to the fact that they could be asked for cash payments, with no question of insurance or credit cards being used. The people in Mr. Nord’s case were not asked for insurance or a credit card payment. They were asked for 1,700 US dollars—not sterling or Indonesian currency. It was quite specific. Surely some reference should be made in the guidance to the fact that there are countries where such a demand will be made.

The version of events in the correspondence that I exchanged with the Foreign Office does not equate to the version in statements provided by people who were present at the hospital. I question why the Foreign Office has chosen to accept its version of events in the light of clear evidence that some information given by the doctors on the fateful night was absolutely wrong. The man in question did not receive treatment, and was not asked for payments in the normal course of private treatment. He was asked for a cash payment up front.

I accept that the Foreign Office consular guidance is clear and that consular officials are not medically trained and should not be required to give medical advice. However, I am sure that I and the British public expect a better service from our consular staff abroad than was provided to Mr. Nord on the day he died.

I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on securing this debate, on behalf of his constituent, about the Foreign and Commonwealth Office’s consular assistance policy and, more specifically, the handling of the case of Dale Nord who, as he has said, tragically died in Indonesia in January. I know that the issue has greatly concerned my hon. Friend, who has pursued it vigorously. I would like to take this opportunity to express my condolences to the Nord family. I can only imagine how hard it must be to lose a member of one’s family in such circumstances. This is a particularly poignant time as the first anniversary of Dale Nord’s death approaches.

There has been much correspondence between Mr Nord’s sister, April Nord, and the FCO about the events on the day of Mr Nord’s death and I fully appreciate the family’s need to know as much detail as possible about the circumstances. Consular staff in Jakarta and London have tried to provide Ms Nord with as much support and information as we can. I regret it if discrepancies between our records and Ms Nord’s have added further to the family’s distress. I know that Ms Nord does not agree with aspects of the version of events that our duty officer in Jakarta recorded. As we have made clear to her, that is simply a record of what the embassy duty officer was told at the time and the action he took.

My hon. Friend has said that Ms Nord feels she received inaccurate information on the medical condition of her brother from our duty officer. I do not think that it is appropriate in this forum to go into the detail of the information relayed about Mr. Nord’s medical condition, but I reiterate what we have said in previous correspondence: our duty officers are not medically trained personnel; their role in such situations is to relay information between the various parties. They cannot and should not interpret medical information. Any diagnosis and decisions on treatment are made by the relevant medical staff. If there was a misdiagnosis of Mr. Nord’s condition—I do not know whether that is the case—our duty officer in no way contributed to it. He was simply passing on the information that he had been given. I must say that, in the circumstances, I do not see what other course of action was available to him.

My hon. Friend also said that the West Yorkshire coroner, who has opened an inquest into Mr. Nord’s death, has concerns in relation to this case. As my hon. Friend knows, in addition to the documents from the hospital that the coroner requested, we have provided him with a statement from the embassy officer who was on duty at the time of Mr. Nord’s death, which records the information that the duty officer was given and the actions that he took, and a statement from the vice-consul in Jakarta, whom the duty officer had consulted. The coroner has not expressed to the FCO any dissatisfaction or reservations about those statements, nor has he asked for any further evidence from the two individuals concerned. I understand that there is one outstanding request from the coroner for information from the hospital itself, which our staff in Jakarta are trying to obtain on his behalf. I hope that we can achieve that outcome.

Clearly, a particularly distressing issue for Mr. Nord’s family is their belief that treatment was withheld from Mr. Nord until such time as the hospital received payment. Hospital treatment in Indonesia is not free and requires either a deposit or a confirmed undertaking to pay from an insurance policy, so it is not unusual that the friends who were with Mr. Nord would have been asked for an initial payment. However, it is our clear understanding from what Mr. Nord’s friend said to the duty officer at the time that in fact, the hospital did not withhold treatment from Mr. Nord until it received the payment that it had requested.

Our belief is that Mr. Nord was treated by the hospital throughout that night and he was certainly being treated when the duty officer from the embassy arrived. Our understanding is that, on his arrival at the hospital at 1.50 am, Mr. Nord was moved to the intensive care unit. Further, the hospital log shows that treatment took place at 3 am and the duty officer from the embassy was first contacted at 3.35 am. That record certainly demonstrates that Mr. Nord had received treatment before the duty officer from the embassy arrived.

One of the main concerns that my hon. Friend and Ms Nord have raised with us is why the FCO could not guarantee payment of Mr. Nord’s medical costs. My hon. Friend has also said that he believes that the FCO should have procedures in place to assist British nationals who need funding in medical emergencies such as this. However, I must say that I do not agree with that view. Unfortunately, a huge number of British nationals end up in hospital overseas each and every year, needing treatment. Indeed, there have been almost 3,000 cases already this year that we have been notified about. The UK Government cannot pay the medical costs of those individuals, nor can we provide financial guarantees on their behalf.

The FCO has invested substantial resources in making it clear to British nationals who are travelling or living overseas that they need to have full travel insurance. Our consular directorate’s “Know before you go” campaign was launched in 2001 to encourage British nationals to take the necessary precautions to ensure that they have safe and trouble-free travel abroad. The need to obtain comprehensive insurance is one of the campaign’s key messages, and a wide range of methods and partnerships are used to promote it. The FCO’s travel advice on its website includes suggestions about what a travel insurance policy should cover, and what the real cost of medical treatment could be for those who travel without insurance.

As my hon. Friend is probably also aware, in 2006 the FCO published a booklet, “Support for British Nationals Abroad: A Guide”, which clearly sets out what we can do and, just as importantly, what we cannot do for British nationals overseas. Page 16 of that booklet explicitly states:

“We will expect you to have full travel insurance for your trip, or health care and other appropriate cover if you are living abroad. The Government cannot cover medical costs”.

With regard to this specific case, our duty officer was therefore correct in saying that he could not guarantee payment of the medical bills on the Nord family’s behalf. I must say that if we were to make such an undertaking in individual cases, we would have to do it in every case, the cost of which would be colossal, and I believe that the resulting burden on the taxpayer would be both unreasonable and unaffordable.

As my hon. Friend knows, the duty officer at the embassy went to the hospital where Mr. Nord was being treated and he tried to facilitate a credit card payment by Mr. Nord’s family, but I understand that that payment was refused because the hospital’s standing instructions required its accounts office to see the original credit card. Of course, I understand the additional distress that can be caused when funds are needed in an emergency and that any time delay in the transfer of funds adds to that distress. Although it will bring little comfort to the Nord family at this time, they may want to know that the FCO is examining the possibility that in some emergencies where British nationals are in urgent need of funds, we will be able to take card payments ourselves directly from friends or family in the UK, and thereby, in situations such as this one, quickly facilitate payment to a hospital overseas.

Ms Nord has also expressed reservations that the person on duty at the embassy, who was not a consular officer, may not have been best placed to provide assistance to her brother and herself; indeed, those concerns have also been expressed by my hon. Friend this afternoon. I must point out that duty officers deal with all inquiries to an embassy’s out-of-hours emergency number, many of which are not about consular issues. In this case, although the duty officer was not working in a consular position in the Jakarta embassy, he had previous consular experience. He also spoke to the vice-consul at the post to brief him on the situation and on the actions that he had taken. The vice-consul confirmed to the duty officer that he was following consular guidance in dealing with this situation.

Although I again appreciate that it will not alleviate the Nord family’s distress at their loss, the FCO is reviewing how we deal with out-of-hours calls to our missions overseas and examining how we can ensure that we have as consistent and professional a service as possible out of hours, as well as during the working day. As I have said, I appreciate that that does not help Ms Nord and her family, but I hope that the House will note that we are continually looking for ways to improve the consular service that we offer to British nationals overseas, particularly those in serious distress.

Having said all that, I genuinely understand the concerns of relatives when, as in this case, someone dies tragically thousands of miles away in a situation that the relatives feel they have no influence over. It is a tragic situation; this incident was a tragic accident. However, nothing will bring Mr. Nord back. Nevertheless, if it would help I am happy to meet my hon. Friend and his constituent to explain as fully as possible our actions and those of our consular staff, and our understanding of exactly what took place. Sometimes, such a meeting can be a better forum within which to discuss these matters than an Adjournment debate in the House.

As I said at the beginning of this debate, I genuinely and deeply regret that this tragic situation has been made worse for Mr. Nord’s family by their belief that he was treated neither promptly nor correctly by medical staff at Pertamina hospital, and by their dissatisfaction with the assistance that the duty officer at our embassy in Jakarta provided. However, I am satisfied that the duty officer provided the appropriate consular assistance. Much as we might like it to be otherwise, it was not in his power to guarantee payments for Mr. Nord’s treatment, nor was it in his power to interpret any medical diagnoses. I simply do not think that either of those actions would have been possible in the circumstances. Nevertheless, the offer that I have made to meet my hon. Friend to discuss this case is a genuine one, and I will happily meet him if that is what he wishes to do.