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Port Agents: Medical Duty of Care

Volume 662: debated on Thursday 20 June 2019

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

Before I call Alec Shelbrooke, I just say that we recognise that your family are here today and that this is going to be a difficult time.

Thank you very much, Mr Deputy Speaker. For transparency, I make the House aware that I have declared a relevant interest with the Table Office.

On 13 February this year, Gordon Hoyland Spencer passed away at the Sue Ryder Wheatfields Hospice in Leeds. He was a beloved husband, father, grandfather, and also my much cherished father-in-law. This did not need to happen.

Gordon Spencer was a hard-working entrepreneur who, with his wife Jackie and family, built a large and successful enterprise. Gordon and his wife Jackie started life in the back streets of Leeds, working on the shop floor in the industrial and textile mills. However, both of them had an indomitable entrepreneurial spirit and, coupled with a hard-working ethic, this led to them building two large and successful businesses in facilities management and property. Their facilities management company started out as a window-cleaning round that Gordon bought to earn some extra income in order to buy a carpet for their cottage some 60 years ago. Their son, daughter, daughter-in-law and grandson all work in the business, making the companies a truly family enterprise. Combined, these companies today now employ over 11,000 people in the UK and it is one of the largest privately-owned facilities management companies in the country—a true facilitator of the northern powerhouse.

Gordon was also instrumental, as part of a group of Leeds-based landlords, in contributing to the Housing Act 1988, which brought in protection for both landlords and tenants through the shorthold tenancy agreement. He wanted to ensure not only that landlords would be able to receive the rent that they were owed but that tenants had protection from unscrupulous landlords.

Gordon and Jackie were married for 62 years—something quite unheard of these days. They have three children and two very adored grandchildren. Gordon was very much a family-oriented man and loved nothing more than spending time with his family. He was a devoted dad, husband and grandfather. In their retirement, Gordon and Jackie enjoyed travelling and had undertaken several world cruises, but two destinations had always eluded them: the cherry blossoms in Japan for Jackie and the Taj Mahal in India for Gordon. On 5 January this year, Gordon and Jackie set sail on a four-month world cruise with Cruise & Maritime Voyages that would take them to these last two bucket-list destinations.

Shortly after the cruise started, Gordon became unwell with a chest infection and cough. Jackie took Gordon to see the ship’s doctor, who diagnosed double pneumonia and high blood pressure and started treatment with antibiotics. Through an ECG, it was diagnosed that Gordon had a left bundle branch block, which causes an irregularity in the heartbeat but is not considered pre-emptive to a heart attack. The doctor also performed troponin tests and categorically confirmed that Gordon had not had a heart attack. Troponin is an enzyme that the heart emits. A higher level of troponin is the indication of myocardial infarction, or a heart attack. Despite the high blood pressure and the left bundle branch block, because Gordon’s troponin tests were negative, there was not sufficient evidence to suggest that Gordon had had a heart attack or was at risk of having a heart attack. This is a very significant point, in relation to the actions that happened next when Gordon and Jackie were disembarked in Barbados and where they consequently were sent for medical treatment.

Bridgetown is the capital of Barbados and is home to the Queen Elizabeth Hospital, which is the island’s primary acute medical care facility and provides extensive care in a wide array of medical specialties. A report in 2013 entitled “Caring for Non-residents in Barbados” by the Medical Tourism Research Group outlined the medical arrangements in Barbados. It states:

“Within the Caribbean, Barbados is regarded as a favoured destination for regional patients, particularly for those from smaller islands lacking advanced diagnostic and treatment facilities and the capacity to offer to treat high-risk patients…BFC, the Sparman Clinic, Island Dialysis, and Bayview Hospital all attract private regional patients; however, according to our interviewees, the public Queen Elizabeth Hospital is the primary health care destination for regional patients.

The Queen Elizabeth Hospital serves as the main referral hospital for the entire Eastern Caribbean…Consultants at the Queen Elizabeth Hospital…have the ability to admit private patients such as ill vacationers not covered by the island’s public system”.

On Friday 18 January, with a major hospital available just two miles from the port for an 86-year-old man with double pneumonia—who, according to the ship’s doctor, was improving at the point of medical disembarkation—the port agent in Bridgetown decided to send Gordon to the privately run Sparman clinic, some three miles from the port. The clinic is owned and operated by Dr Alfred Sparman, and is advertised as a heart specialist clinic. The ship’s doctor’s notes and lab results, which clearly stated that Gordon had not had a heart attack, were given to the Sparman clinic on Gordon’s arrival. However, the medical notes made by Dr Sparman afterwards state that Gordon was admitted to the clinic with double pneumonia and having had a heart attack, which was not the case.

On arrival at the clinic, Jackie was asked to pay US$10,000 before the clinic would admit or treat Gordon. Jackie maxed out her credit cards to pay the up-front costs, which left her without funds to find accommodation while in Barbados. On Monday 21 January—I emphasise that I am speaking about this year—Gordon’s children arrived in Barbados to assist their parents. At that point, Gordon was on a nasal cannula and an antibiotic drip, but had received no further treatment during the three days since being admitted to the clinic. He appeared to be weak and short of breath, but was able to sit up in bed, was eating, and was fully coherent.

Jackie had been sleeping on the couch in the observation room, because she did not have the funds to procure other accommodation. The Sparman clinic is actually a doctor’s surgery with a waiting area, one small operating theatre where most cardiovascular surgeries are performed, and an observation room which doubles as a patient bedroom and intensive care unit and contains mostly wooden and soft furniture.

Dr Sparman met the family to discuss Gordon’s prognosis in the clinic’s conference room, which contained a cracked board table held together with gaffer tape and several broken and cracked leather chairs. In addition, client records were strewn across the floor and piled high in boxes. I mention the dilapidated state of the entire clinic because, given that a state-of-the-art hospital was less than half a mile away in Bridgetown, it is difficult to understand how this clinic was deemed appropriate to offer any level of suitable healthcare to a critically ill patient with double pneumonia.

During the meeting, Dr Sparman advised the family that Gordon was very ill and had suffered a heart attack as a result of the strain that the pneumonia had put on his heart. He suspected that Gordon also had a blockage in one of his arteries, and therefore needed an angioplasty and an angiogram. He ended the meeting by stating that once the surgery was completed, Gordon would feel much better—better than he had felt for years —and that the family would be able to fly him home via a commercial airline by the end of the week. However, the medical report received from the clinic after Gordon was released clearly shows that at the time of the meeting with Dr Sparman, Gordon’s troponin levels, while now showing positive for the enzyme, were still well outside the parameters that would indicate that a heart attack had occurred or was likely to occur.

In the days leading up to the operation, Gordon’s condition began to deteriorate. He was in a highly agitated state. He lacked the strength to move his position in the bed, and was offered little assistance from the nurses, which led to great discomfort for him. Moreover, the air conditioning in the observation room, where Gordon was staying, was not working, which resulted in uncomfortable temperatures in a Caribbean hospital—so much so that Gordon had struggled to sleep since his arrival at the clinic, and was now exhausted. Despite several requests from the family for the unit to be mended, the clinic never repaired it. Gordon was clearly weakening. By the day of the operation he had been refusing food for more than 24 hours, had developed spasms that wracked his entire body, and had begun vomiting.

The operation finally took place six days after Gordon had arrived at the clinic. This was a man who had been able to walk, talk and eat just a few days earlier, but who was now visibly declining in front of everyone. This was due to a combination of lack of sleep because of the broken air-conditioning unit, lack of nutrition because Gordon was not placed on a protein drip until several days after he had stopped eating, considerable discomfort from his lack of strength to move position, and no aid offered and an overall general lack of proper nursing care.

Yet there were still more delays, not least when the family were then presented with a bill for $45,000 and advised that Dr Sparman would not perform the surgery without the money first. The family came up with the money and, despite Gordon’s severely weakened state, Dr Sparman proceeded with the surgery.

If Gordon had been admitted to the general hospital in the first place it is highly likely that he would have received pre-emptive treatment much earlier and would not have had to wait six days for a corrective procedure had he needed it. He most likely would have been making a full recovery, but at the Sparman Clinic there were continuous delays and a general lack of care.

According to the lab results, half an hour before the operation a troponin test was conducted. At this point, Gordon’s troponin levels had elevated to a point that showed that a heart attack was imminent. The family was not aware of this, but Dr Sparman would have been. Within half an hour of the operation commencing Dr Sparman returned to the family and said he had been unable to perform the procedure as Gordon had started going into cardiac arrest, so the operation was aborted.

After the operation Gordon began to deteriorate rapidly and within 24 hours he was under sedation and had been placed on tracheal intubation. A ventilator did the breathing for him, which was strapped to Gordon’s face using string. His blood pressure was now dangerously low, his body was still racked with spasms and he now also had kidney failure.

Gordon was initially sedated using Valium, but after he came round twice and tried to pull the tube from his mouth Dr Sparman changed the sedation to diazepam and tied Gordon’s hands to the bedframe. The diazepam worked in terms of ensuring that Gordon did not come round again and it also stopped the spasms; however, Gordon never fully regained consciousness after the drug was administered. For the remaining three days that Gordon spent at the clinic under sedation and intubated his body position was never moved once by the nursing staff and his family were not permitted to move him.

At this point, a member of staff at the clinic—who would prefer to remain anonymous—advised that Gordon should be airlifted out of the clinic as soon as possible. It was implied that he was not going to get better at the Sparman Clinic. The family immediately started to arrange a medical airlift back to the UK. At this very stressful time, the family were presented with another bill, for $11,000.

I hope I have managed to describe to the House the utter lack of care that Gordon received, and that the primary motivation appeared to be to delay the correct and proper treatment that Gordon needed in order to extract more money from the family.

The family were now working fastidiously with a medical flight team to repatriate Gordon to the UK. However, after speaking with consultants in the UK it was deemed that Gordon was too ill to endure the flight and needed to have an angioplasty and angiogram prior to repatriation, but it was also advised that in Gordon’s present condition this operation was high risk. Gordon was critically ill, and the risk factors associated with either the operation or the flight carried great life-threatening consequences.

Dr Sparman made it clear that the decision to have the surgery was entirely up to the family. I must reiterate this point: Dr Sparman placed life-threatening medical decisions in the hands of Gordon’s family, who had no medical training whatever. At a loss to know what choice to make, the family consulted the head cardiologist at the Queen Elizabeth hospital, who advised them to remove Gordon from the Sparman Clinic immediately and bring him to the hospital as soon as possible, and not to go ahead with the surgery. The family began making plans to move Gordon, but Dr Sparman advised them that he was too ill and would not make the journey and now began pressuring them to go ahead with the surgery.

In desperation, the family sought further advice from a relative in England who is a doctor. Based on the information that Sparman provided to the relative, it was advised that the surgery should go ahead. So the family had no choice but to put their faith in Dr Sparman.

At this point, the family were presented with another bill, for a total of $70,000, of which the family had already paid $56,000. The family were advised that the surgery would not go ahead without the balance being paid, so they had no choice but to once again come up with the money. It would appear that, in response to the threat to move Gordon out of the clinic, Dr Sparman was determined to now go ahead with the surgery, putting immense emotional pressure on my family and presenting more bills, in case he lost “the business.”

Gordon came out of surgery with only a 10% chance of survival according to Dr Sparman and two days later he was deemed stable enough for the medical evacuation. Dr Sparman arranged the medication to be administered during the medical flight, and this was given to the flight team—in a fast food bag. The sedative he provided for Gordon for the flight was once again diazepam. The air medical team queried the use of the drug as a sedative, saying that such a high quantity as had been prescribed to Gordon was not administered in the USA because it took far too long to disperse through the system in patients with that level of critical illness and especially patients with kidney failure. The absolute failure to care for Gordon’s wellbeing, coupled with a wholly inappropriate drug for his age and state of illness and in a quantity that was beyond irresponsible, placed a constant strain on his heart.

I must emphasise that we would never have been in this position had Gordon been sent to the main hospital and properly treated for the pneumonia the moment he arrived.

I interrupt my good friend to ask something I have been waiting to hear. Who made the decision to send Gordon to Sparman rather than the hospital? Was the decision taken on board the ship? Was there some kind of cosy arrangement or deal? Does he know?

I am most grateful to my hon. and gallant Friend. I will come to that in my speech, but it was not the decision of the cruise liner; it was the decision of the port agent.

In the 11 days Gordon spent at the Sparman clinic, he received limited nutritional care and substandard nursing that gave rise to horrific first-degree bed sores that visibly shocked the medical staff at the Leeds General Infirmary and was placed in a poorly air-conditioned room, which led to his exhaustion. This all led Gordon to have much higher levels of anxiety, fear, pain and rapid health deterioration, which put increased pressure on his heart, at a time when he should have been able to rest, be properly hydrated and nutritiously fed, and so continue the recovery from his pneumonia that the ship’s doctor said he was comfortably making without any heart issues at that time.

Gordon was repatriated to the UK and admitted to the Leeds General Infirmary early on Tuesday 28 January. On inspecting the report from Dr Sparman, the consultants could not understand why Gordon was still so critically ill. The medical reports implied that he was and should be in recovery. They were also very concerned at the gravity of Gordon’s bed sores, which were first degree and had resulted from his position not being changed whilst he was in the Sparman clinic. I re-emphasise that not only did the nursing staff refuse to move Gordon, but Dr Sparman had tied his hands to the bed and prevented the family from moving him. These are basic nursing practices. Anybody in the medical profession knows that patients left in the same position will develop bed sores. I emphasise again that the staff at the Leeds General Infirmary audibly gasped when they saw the state of my father-in-law. They also questioned the prolonged use and high dosage of the drug diazepam that was administered.

Sadly, after the consultants at the LGI had performed their tests on Gordon, it was determined that his heart had greatly deteriorated and was in a much worse condition than had been reflected in Dr Sparman’s notes. In fact, the prognosis was not good. In addition to chronic heart failure, Gordon had kidney failure and brain damage from lack of oxygen. Despite his being taken off the diazepam sedation on arrival at the LGI, Gordon’s kidneys were not able to dispel the drug, and that, coupled with his now having multiple organ failure and brain damage, meant that Gordon never properly regained consciousness. Thirteen days after being admitted to the LGI, the family, with very heavy hearts, had to admit defeat and Gordon’s life support was stopped. He died on 13 February, leaving behind a devastated and traumatised family.

Owing to the circumstances around Gordon’s death the post mortem is still ongoing as the Coroner’s Office considers it to be a very complex case, which means we have been unable to get the final pathology report and still await his final death certificate.

My family paid approximately $200,000 in total for the barbaric treatment my father-in-law received in Barbados and the subsequent medical repatriation to the UK, and they have nothing to show for that money other than traumatic memories of the tragic and painful death of Gordon. After the horrific treatment and trauma my father-in-law had been through, we did not think we could be hit with anything else, but we were. It was only after returning to the UK that the family started doing simple Google searches on Dr Alfred Sparman, and they highlighted a horrifying picture.

In 1986, Sparman was convicted of the offence of disorderly conduct, to which he pleaded guilty. In 1991, he was convicted of the crimes of sexual abuse in the first degree and unlawful imprisonment in New York and sentenced to five years’ probation. In January 1996, Sparman was registered as a sex offender in Florida, but in June he applied for licensure to practise medicine in Florida. The state of Florida revoked his medical licence in 1997. In 1999, Sparman received a licence to practise medicine in Tennessee, but this was revoked in February 2001 owing to

“unprofessional conduct; a previous felony conviction for sexual abuse in New York, and false statement on medical application.”

In June 2001, he was again registered as a sex offender in the state of Florida.

It was in 2001 that Sparman went to Barbados and opened his clinic. In 2004, he had his board certification in internal medicine suspended by the American Board of Internal Medicine, but he continues to this day to advertise himself as an “American Board-Certified Physician”. In 2005, he was reregistered as a sexual predator and offender in the state of Florida. In 2010, he was reregistered as a sex offender in the state of Tennessee, and the register also contains a list of Sparman’s aliases: John W. Freeman and Alfred W. Eversley.

On top of the crimes for which he has been convicted, Sparman has advertised himself as a “Board-Certified Cardiologist” but never passed the board certification cardiology exams in the USA. He has also advertised himself as a Fellow of the American College of Cardiology but the FACC has no record of his being a fellow. He was reprimanded by the Medical Council of Barbados and asked to remove “FACC” from his letterhead. He advertises himself as an interventional cardiologist but has no specialist training in interventional cardiology. He has had a number of complaints made against him to the Medical Council of Barbados. He has also tried to poach paying cardiology patients—that is, tourists—from the Queen Elizabeth Hospital. All this information can be found in a simple online due diligence check. In addition, there are countless stories online of other people who have suffered at the hands of Dr Sparman.

So why was Gordon sent to the clinic of a supposed doctor who was stripped of his licence to practise medicine in the US, who is a registered sex offender, who has numerous speculations surrounding him regarding his conduct and who has blatantly lied about his accreditations? Why was Gordon sent to a heart clinic in the first place when he was diagnosed with double pneumonia, rather than being sent to the Queen Elizabeth Hospital? We will never know the answers to those questions.

A representative of Cruise & Maritime Voyages has confirmed that it was the port agent who determined where my father-in-law was taken for his medical care once he was disembarked. The port agent is governed by maritime law. A port agent is the designated person or agency held responsible for handling shipments and cargo and the general interest of its customers at ports and harbours worldwide, on behalf of ship owners, managers and charterers. Quite frankly, the decision that the port agent made to send Gordon to the Sparman clinic, instead of to the main hospital, killed him. And to add a final insult to all the injury, instead of Gordon visiting his “bucket list” destination, the Taj Mahal, with his beloved wife, Jackie instead laid his ashes there.

I ask the Minister and her Department today to seek a change to international maritime law, by lobbying the International Maritime Organisation, regarding the duty of care and due diligence, through a fit and proper persons test, that a port agent must carry out when identifying and commissioning onshore medical facilities and practitioners for those who are disembarked for medical emergencies. The international conventions for the safety of life at sea of 1974 and 1988 have been used to bring in the highest standards of health and safety for those at sea, whether they be crew or passengers. These provisions were amended in 2004 through the international ship and port facility security code after the security concerns raised after 9/11, and I would argue that this shows that the wellbeing of seafarers carries on within the port, not just on the vessel.

Gordon was always proud of the work he did in bringing about changes to landlord law to achieve the protection and standards required, especially for tenants, and although this will never bring him back, it would be a final fitting tribute to his life to know that, even in death, he was able to try to make the world a better place, to ensure that this never happens to anybody else.

I must start by passing on my deepest condolences to my hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) and his family on the tragic death of Gordon Hoyland Spencer. I had the privilege of meeting Mr Spencer’s family earlier today and saw their grief and despair. My hon. Friend gave a powerful, brave, emotional speech, and it was incredibly difficult to digest such a long list of tragic incidents that should just not have happened. What makes Mr Spencer’s death all the more heartbreaking is that it could so easily have been prevented by prompt and correct treatment and good quality care. Quite understandably, my hon. Friend wants action to prevent any other families going through a similar agony.

Under the International Labour Organisation’s maritime labour convention, ships carrying 100 or more persons and ordinarily engaged on international voyages of more than three days’ duration shall carry a qualified medical doctor who is responsible for providing medical care. Ships’ doctors, like any other doctor, have a duty of care to their patients governed by ethical responsibilities. That would usually include discharging sick patients into what they consider appropriate medical care facilities ashore, in compliance with the code of medical ethics in their country of registration or licence. In doing so, a ship’s doctor may liaise with an assistance company appointed by the passenger’s insurer, which should be able to advise on appropriate care providers ashore.

According to my hon. Friend’s account, it would appear that Mr Spencer received appropriate care and treatment while on board the vessel and was recovering—we must note that. However, the facilities available on board were not sufficient to further Mr Spencer’s recovery and a decision was made that he should be medically discharged in Barbados. I understand that the port agent facilitated the transfer of Mr Spencer to a cardiology clinic rather than to the general hospital.

The port agent’s role is primarily to help facilitate the ship’s transit through the port, and the engagement and choice of an agent is at the shipping company’s discretion. A ship’s agent may, if asked, provide the details of local medical facilities, but the responsibility remains with the ship’s doctor to discharge sick passengers into what they consider to be an appropriate medical facility ashore. My hon. Friend has requested that international maritime law should be amended to place a duty of care and due diligence on a port agent, through a fit and proper person test, when they are identifying and commissioning onshore medical facilities for those who are disembarked for medical emergencies.

Port agents are required to comply with relevant domestic law and the port statute, but they are not regulated by international maritime law. However, considering the case that my hon. Friend has presented today, I will ask the officials at the Department for Transport and the Maritime and Coastguard Agency to consider whether such regulation would fall within the remit of the International Maritime Organisation or whether it would be appropriate for another international body. I will also write to the Cruise Lines International Association, the international trade association for the industry, to highlight the issues that this incident has raised in order to highlight its duty of care and responsibilities with regard to port agents.

Furthermore, I will raise the case directly with the IMO, and, considering how personal the case is for my hon. Friend, I wonder whether he could bear to share his experiences again. I know that this will be emotional and difficult for him, but I respectfully ask him to join me for a meeting that I will convene directly with the IMO’s secretary-general so that my hon. Friend can share his experiences and make representations to see whether we can lobby and obtain a change in the law.

I am most grateful to my hon. Friend for that offer. I wonder whether the invitation could be extended to my family, who were in Barbados at the time and experienced what happened at first hand.

That would be absolutely fit and proper. I accept it, and we will do what we can as soon as we can.

We have heard this afternoon of the tragic and preventable death of Gordon Hoyland Spencer. I share my hon. Friend’s commitment that, although nothing can be done to reverse what happened, Gordon’s death should act as a call for action to the maritime industry. Passengers should be cared for to the highest possible standard, particularly when they are most in need, and the Government will play their part in helping to ensure that no one has to repeat the painful experiences of Gordon and his family.

I believe the Minister is shortly to finish, but I wonder what the heck is going to happen to this so-called Dr Sparman. How can we allow this man to continue his work in Barbados? What can the British Government do to stop it? Are we going to report the man to the Barbadian Government? And are we going to complain about how the port agent dealt with this case? I believe that practical step might prevent another family from going through the hell that the Shelbrooke family have been through.

Absolutely. The fact this has been raised on the Floor of the House will be reflected by all Government agencies, and I do not doubt for a moment that this message will reach Barbados, especially once the meeting takes place with the IMO.

I commend my hon. Friend the Member for Elmet and Rothwell for bringing this debate to the House, Once again, I express my profound sympathies to him, to Gordon’s widow Jackie and to the entire family. I look forward, if I can use that word, to working with my hon. Friend to campaign on this incredibly important issue and to ensuring that we do all we can to prevent another incident like this one.

Question put and agreed to.

House adjourned.