– in the House of Commons at 10:29 pm on 11th February 1997.
This is the sort of Adjournment debate that most hon. Members never like to introduce, simply because it involves deceit, lies, a cover-up and the unnecessary death of a young child.
Sally-Anne Messenger, my constituent, was born on 17 October 1992 and she was diagnosed as having Sandhoff's disease. The lifespan of someone with Sandhoff's disease is short, and they are usually expected to live only to late childhood or adolescence. In March 1994, Mr. and Mrs. Messenger took Sally-Anne to the United States of America to attend a hospital there that specialises in this disorder. It was confirmed there that Sally-Anne was suffering from mild symptoms and that she was coping particularly well with the disorder. Sally-Anne was due to return to the hospital in 1995, and it was hoped that she would be accepted to undergo clinical trials.
In 1994, Mr. and Mrs. Messenger purchased a holiday in Kos. The party consisted of Mr. and Mrs. Messenger, their two children and Mrs. Noble, the children's grandmother. At the same time, they purchased travel insurance through Intertravel Group plc. The insurance company was aware of Sally-Anne's condition before entering into the policy of insurance. The policy is quite standard and makes provision for the event of an insured person falling ill and requiring hospitalisation while on holiday. The medical insurers are Chubb Insurance, a member of the Association of British Insurers.
Before their departure, Mr. and Mrs. Messenger took Sally-Anne to their general practitioner, who confirmed that she was well enough to travel. The party departed on 8 October 1994 and arrived on Cos at about 6.45 on 9 October. They then had a long coach journey lasting about three hours. On Monday 10 October, Sally-Anne fell seriously ill. The Messengers took advice from a British doctor in the hotel and he gave them some medicine—but, quite honestly, it simply did not work, so Sally-Anne was taken to the local hospital. She was taken to the Kos hospital by taxi on the advice of the people named on the insurance claims form.
The doctors informed Mr. Messenger that Sally-Anne was dangerously ill and needed to go to Athens children's hospital. Mr. Messenger stated that he wanted to take her home to a UK hospital, but they told him that she would not make the journey. An Air Tours representative arrived at the hospital, and an aircraft was arranged to transfer Sally-Anne to Athens hospital.
Mr. Messenger returned to his hotel to collect his passport and money. Sally-Anne and Mrs. Noble went to Kos airport in an ambulance. Mr. Messenger met Sally-Anne at the airport. He was transported by the Air Tours representative. One can assume that the flight was arranged by agents appointed by the insurers. On arrival at Kos airport, Mr. Messenger asked the doctor who travelled with Sally-Anne in the ambulance how she was. He said that she had stopped convulsing and was now stable. Sally-Anne, Mr. Messenger and the doctor flew from Kos to Athens on Olympic Airways.
At Athens, an ambulance was provided to collect them from the airport and to take them to St. Sophia Athens district general hospital. There Sally-Anne was given medication, and an intravenous drip was set up. Mr. Messenger informed the hospital staff of her pre-existing condition. There was very little communication from them regarding her condition, and he was never asked to consent to any specific type of treatment.
Investigations were made. The emergency medical services may have been International Assistance Service or Athens Assist—it does not really matter. In any event, a representative from one of those agencies contacted Mr. Messenger and informed him that a doctor would be instructed to examine Sally-Anne on behalf of the insurance company.
Mr. Messenger contacted the emergency services to ask whether the rest of the family could join him in Athens so that they could be with Sally-Anne. He was informed that only the cost of his wife coming to Athens would be met by the insurance policy. Even though Mr. Messenger explained that Mrs. Messenger could not travel without her daughter because she was on the same passport, the insurance company was adamant that it could fund only the cost of Mr. Messenger travelling to Athens.
Sally-Anne was under observation in hospital. Mr. Messenger was not asked to take any decisions regarding her treatment. Sally-Anne's convulsions had been controlled and he understood that she was being treated for a respiratory tract infection.
On the evening of 14 October 1994, Mr. Messenger received a call from Athens Assist, informing him that he and Sally-Anne could now return to Kos and complete their holiday, or Sally-Anne could be repatriated to the UK to be admitted to a local hospital for further observation. Obviously—and sensibly—Mr. Messenger did not consider that Sally-Anne was well enough to travel to Kos to complete her holiday, and chose the safer option of having her repatriated to the UK and admitted to a local hospital for further observation.
Athens Assist arranged the flight. Mr. Messenger had no part in making any of the arrangements for Sally-Anne's repatriation, but was entirely in the hands of the insurance company. He was informed by the insurer's representatives that he would be leaving at midnight. He was not informed of any special arrangement that had been made.
Mr. Messenger telephoned his wife to inform her that they were leaving for England that night. He then informed the doctors who were on duty. They expressed surprise and did not appear to be aware that Sally-Anne was being repatriated to England. They asked Mr. Messenger whether he was going to have a medical escort. Mr. Messenger said that he did not know—no one had told him what the arrangements were. The doctors appeared concerned. They gave Mr. Messenger rectal valium and a syringe and advised him to use it if Sally-Anne had convulsions during the flight. It should not be forgotten that he had never administered that sort of treatment to his little girl before.
The story gets worse. One of the doctors then wrote out a letter in Greek and gave it to Mr. Messenger to give to the receiving doctor in England. Mr. Messenger and Sally-Anne were driven by car to Athens airport, as arranged by Athens Assist. They had to wait for one and a half hours at the airport before boarding the flight. Sally-Anne was clearly unwell. Although stabilised, she was unresponsive and very poorly. Mr. Messenger and Sally-Anne were allocated two seats on a charter flight—it was not a medical flight. The flight staff did not appear to know that they were carrying a sick, if not terminally sick, passenger until they saw Sally-Anne and expressed concern about how poorly she looked. On seeing her condition, one of the air hostesses offered Mr. Messenger additional seats so that Sally-Anne could lie down.
On arrival at Gatwick airport, Mr. Messenger and Sally-Anne had to go through customs in the usual way, even though she was terminally ill. Mr. Messenger had to ask a member of the airport staff to look after Sally-Anne while he collected his luggage. They were met by a car with a paramedic, and Sally-Anne was taken to Princess Alexandra hospital in my constituency. She was admitted to that hospital on 15 October. On 16 October, Sally-Anne began to have breathing difficulties. She was intubated and ventilated and then transferred to the intensive care unit. That same evening, she was transferred to St. Mary's intensive care unit in London.
On arrival at St. Mary's, Mr. Messenger contacted his wife to tell her to come home immediately, because Sally-Anne was critically ill. He also contacted IAS to inform the company of the situation. I shall not go into the details of the appalling problems that Mrs. Messenger had in getting a flight home. She got a flight home at 12.40 am. In the meantime, Mr. Messenger had been informed that Sally-Anne had severe neurological failure. A CT scan confirmed that she had a grossly swollen brain and raised intracranial pressure. Mr. Messenger was anxious for his wife to arrive and contacted IAS to find out when she would be arriving. During the telephone conversation, it became apparent that IAS had arranged for Mrs. Messenger to be driven to Princess Alexandra hospital in Harlow. Mr. Messenger explained that Sally-Anne had been transferred to St. Mary's in Paddington.
Despite aggressive treatment at St. Mary's, additional tests confirmed that brain stem death had occurred and that nothing further could be done. By the time Mrs. Messenger arrived, Sally-Anne was clinically dead. Obviously, that was extremely distressing. Mrs. Messenger had not been at the side of her dying child for a week, because of the insurance company's actions.
Initially, Mr. and Mrs. Messenger submitted a claim under their insurance policy for compensation for the curtailment of the holiday. The claim was met without dispute. However, as time went on, they began to ask questions. They wondered what could have happened to Sally-Anne, the little girl they loved and who had died. Investigations were made—at the expense of my constituents. I hope that they will forgive me for saying so, but they are not wealthy people. They are decent, ordinary people. Mrs. Messenger has pawned her jewellery. There is nothing on the walls in their house and they have no stereo, because they have spent all their money trying to find out what happened to their little girl.
I am coming to the most disgusting aspect of this case. The investigations showed that the system that is triggered on notifying the emergency number in the insurance policy appears to be that the IAS, which is based in the United Kingdom, appoints agents in Athens—in this case, Athens Assist—to obtain information and make any necessary arrangements, acting on instructions from IAS. IAS states that it has its own medical advisers based in the UK, who liaise closely with the doctors treating their insured before making any decisions about the insured's treatment or repatriation. IAS, in turn, takes instructions from its principal, Chubb Insurance, before committing any financial support. The bottom line is that any treatment or repatriation requiring expenditure under the policy must be authorised by IAS and Chubb.
In Sally-Anne's case, we understand that IAS instructed Athens Assist to deal with matters at the Greek end. Athens Assist in turn instructed a Greek doctor to liaise with Sally-Anne's treating doctors, to ascertain her condition and to report back. The doctor did not liaise with the hospital. We do not believe that there was ever any direct discussion between the medical staff at IAS and the treating doctors at Athens hospital. As regards the treatment that Sally-Anne received in Athens hospital, the House will appreciate that that is a different matter for litigation.
One must ask what requests for treatment were made to IAS. What instructions did IAS give regarding any request for treatment? It is apparent that a CT scan was never carried out. We do not know the reason, but it is possible that the treating doctors decided that a scan was no longer necessary, or that IAS indicated that it would not fund the cost. The CT scan was vital to assess Sally-Anne's neurological condition properly. If it had been performed earlier, treatment could have been available that might have saved the little girl's life.
We have obtained extracts from the medical reports, but I shall not go into the details: they are contradictory, if not downright fraudulent.
The little girl was repatriated to England. A number of questions must be asked. First, who made the decision that Sally-Anne should return to Kos? In the course of the investigations, the insurers disclosed copies of faxes that they received from Athens Assist. It is noteworthy that they did not disclose copies of the faxes detailing their instructions to Athens Assist.
It would appear that, on 13 October 1994, IAS received a fax from Athens Assist stating that Sally-Anne had been stabilised, that her spasms were due to her main disease—which is untrue—and that the prognosis was that she could be discharged in two days' time to continue her holiday on Kos island. On 14 October 1994, Athens Assist faxed IAS with the information that Sally-Anne remained on medication and required a further 10 days' monitoring in the hospital.
At the same time, Athens Assist requested instructions regarding repatriation. Mr. and Mrs. Messenger were informed orally by a member of staff at Athens Assist that a Dr. Hamid from IAS instructed that Sally-Anne should be discharged and returned to Kos. Those instructions caused concern, as further information received suggested that Sally-Anne was too ill to return to Kos and required further monitoring in hospital.
At some point, instructions were received via Athens Assist that Sally-Anne could be repatriated. We understand that instructions were given over the telephone, and not committed to fax. There must have been a breakdown in communication, as the message given to Mr. Messenger was that he could return to Kos with Sally-Anne or that she could be repatriated to a hospital in the UK. Confronted with such a bizarre choice and under terrible pressure, Mr. Messenger chose the safer option—for Sally-Anne to be repatriated to their local hospital and eventually that she should go to Paddington.
I will now deal with the mode of transfer to the UK. The decision was reached by IAS, which states that the decision was made by its medical advisers following close liaison with the treating doctors, but no evidence has been disclosed to us to support that. The implications are to the contrary, and the cynical conclusion that we must draw—we have it in writing—is that a decision regarding a dying child was reached on purely economic grounds, based on a false belief that Sally-Anne's symptoms were due to a pre-existing condition which was fatal in any event. The insurance company appears to have taken the view that the mode of transportation would make little difference to her condition.
In contrast, Athens hospital states that Mr. Messenger gave an assurance that the insurance company had arranged a special flight with a medical escort. That was not true. Needless to say, Mr. Messenger did not provide that information, but it suggests that there was no direct and meaningful liaison between the IAS and the treating doctors.
As to the decision to refuse to allow Mrs. Messenger and other members of the party to join Sally-Anne in Athens, the IAS simply states that no request was ever made. We understand that, if a patient is to be repatriated without a medical escort, the hospital must issue a fitness to fly certificate. Initially, IAS insisted that a certificate was issued. However, upon our pressing the point and requesting sight of the fitness to fly certificate, it eventually conceded that a certificate had not been issued.
It was then revealed that a discharge certificate had been issued by the hospital, presumably transferring the care of the patient, but no discharge certificate was among the records sent by Athens hospital or referred to in the records. Mr. and Mrs. Messenger were informed that the discharge certificate was sent to Chubb Insurance, together with the invoices and other documents relating to Sally-Anne's treatment at Athens hospital. Eventually, in the latter part of 1996, Chubb provided a copy of what it claims is the original discharge certificate. The copy is virtually illegible, and we suspect that the document is totally bogus.
It is not clear who signed the document, as the signatures cannot be distinguished. However, it is clear that Mr. Messenger is not on the certificate and, as such, he cannot be said to have consented to or authorised the discharge of his daughter into his care. Further investigations revealed that the discharge certificate was completed by a staff member at Athens Assist and signed by administrative staff at Athens hospital in 1995, months after Sally-Anne had died. Consideration was then given to the arrangements that were made with Princess Alexandra hospital in my constituency. The senior house officer on duty at the time has provided evidence that can only damage Chubb Insurance.
It has been put to the insurer that it has breached its obligations to the insured under the terms of the insurance contract. Despite the traumatic death of a tiny child, the parents' suffering and the total incompetence of the insurance company, the breach has been denied and the insurer has refused to offer compensation. Mr. and Mrs. Messenger, driven by the need to know what happened to their daughter and the need to ensure that insurance companies provide proper cover, have continued to try to discover what really occurred.
I could go on and on about what has occurred with the insurance company and with the insurance ombudsman. My hon. Friend the Minister will reply to the debate in a moment. He knows the facts of the case. He knows that the insurance ombudsman appointed a lady to deal with the case. She works four days a week and she is dealing with 50 other cases. She begins work at 10.30 am and finishes at 4.30 pm. The Messengers have put themselves in hock and into debt. They are decent, honourable people who are merely trying to find out what happened to the child they loved and who died. They have been put through hell.
I ask my hon. Friend the Minister to investigate what I always thought was a reputable insurance company. Most of us have Chubb locks in our homes: I thought that they were decent people, but clearly not. I ask my hon. Friend to investigate what happened with the ombudsman, who I am sure meant well. All the investigations were undertaken by my constituents, the Messengers; yet months elapsed and they were offered—not that money is important—£1,700. That is an insult.
No one could fail to be moved by the tragic case that my hon. Friend the Member for Harlow (Mr. Hayes) has brought to the attention of the House. We respect him for doing so, and for finding the time and the opportunity to present the case sensitively and forcefully.
Before responding to the points made by my hon. Friend on this sad and distressing case, I should like to extend my deepest sympathy to the Messenger family. To lose a child is terrible, but to do so in such circumstances and so far from home must be devastating. I must also declare straight away that I am unable to comment on some of the substance of the case because it remains unresolved and may be the subject of further legal action. I know that this will inevitably be frustrating for the Messenger family, and I am truly sorry for that, but I am bound by the constraints of law.
I have been in touch with the insurance ombudsman, and I have sought to establish the facts of the case. Since he first began to consider this case, he has received extensive evidence from both parties to the dispute, all of which has been taken into account. He has made a number of further inquiries in the light of evidence and the submissions that he received. On the basis of that evidence, he has made a number of decisions, some of which involve awards to Mr. and Mrs. Messenger. Those have been communicated to the couple.
No one is in any doubt that this has been a difficult and complicated case. The ombudsman has assured me that every effort has been made to bring the matter to a conclusion as quickly as possible. He has agreed with the Messengers that the repatriation of Sally-Anne to the United Kingdom was poorly handled. He has accepted that the child should have been accompanied by a qualified medical adviser, that the insurer's agents should have made Sally-Anne's medical notes available in English translation, and that the insurer made a number of administrative errors.
I cannot comment on the amount of compensation that the ombudsman has awarded, save to repeat what my hon. Friend said: no amount of money can make up for the loss of a child.
The ombudsman has also quite properly pointed out to Mr. and Mrs. Messenger that, because the case concerns the recollection of events most of which were very stressful, and because no contemporaneous record is available, it may be more appropriate to a court of law. In a court of law there is a process for discovery of documents, and witnesses must give evidence under oath and are subject to cross-examination. I do not want to add to the trauma and distress that Mr. and Mrs. Messenger have obviously experienced, but I believe that they should seek legal advice on that option, including the possibility of obtaining legal aid to pursue the matter further.
As my hon. Friend will be aware, Ministers cannot intervene in the grant of legal aid in individual cases, but I can bring the points raised to the attention of the Parliamentary Secretary to the Lord Chancellor, who can request a report on the case from the chief executive of the Legal Aid Board. My hon. Friend will also be aware that the Government are reforming the legal aid scheme to target resources at the most needy and deserving cases.
I should stress that Mr. and Mrs. Messenger are in no way bound by the ombudsman's decisions. Although his decision is binding on the insurance company, which must pay compensation if it is awarded, the policyholder still has the right to pursue any dispute through the courts if it is felt that the complaint has not been adequately addressed. I should also point out that the Secretary of State has no powers to intervene in individual disputes between a policyholder and an insurance company.
My hon. Friend has expressed concern about the time that it has taken to resolve the dispute. I appreciate his frustration, and that of the Messenger family, over the time that it has taken to reach decisions; nevertheless, it is clear that this has not been a typical case. Indeed, the ombudsman has stated that it is one of the most distressing and complicated with which he has had to deal. His office has received no fewer than 136 pages of submission and 39 telephone calls from the Messenger family.
The voluntary scheme has one major advantage over the courts or a statutory regime: it allows the ombudsman to take a rather broader view in arriving at a decision. He is not bound by the strict letter of the law; nor is he hampered by the prospect of judicial review. Because the scheme has the support of the vast majority of the industry, the ombudsman can take a common-sense approach, which, if anything, is biased in favour of the insured party.
Time does not permit me to respond to the points raised by my hon. Friend in all the detail that I would like, but perhaps I may be allowed to say this. No arbitration scheme can ever hope to resolve all disputes to the satisfaction of both sides. Nevertheless, I believe that the insurance ombudsman scheme is, in general, a very good scheme, which commands the support both of the public and of the insurance industry. However, nothing that the ombudsman or anyone else could do could make up for the distress that Mr. and Mrs. Messenger have so obviously suffered. My heart goes out to them in their sorrow, and I thank my hon. Friend for drawing the case to the attention of the House in such a sensitive and forceful way. I assure him that I have taken careful note of his comments.
Question put and agreed to.
Adjourned accordingly at one minute past Eleven o'clock.