Robbie Powell: how one crucial document may hold the key to a young boy’s unnecessary death [PART ONE]

Steve Topple

The death of a 10-year-old boy more than 26 years ago is once again being investigated, amid claims of a cover-up by medical professionals. These claims by the boy’s father also imply the NHS, police, the Crown Prosecution Service (CPS), the Welsh Office, the Independent Police Complaints Commission (IPCC), the General Medical Council (GMC) and other public bodies may have been involved.

Robbie Powell from Ystradgynlais, Powys died a preventable death in 1990. Dyfed Powys police and the CPS conducted the original investigations between 1994 and 2000 and found no evidence of criminal wrongdoing. But following an independent police investigation between 2000 and 2002, the CPS agreed that numerous individuals could be charged. But they never were. So now, his grieving father is once again fighting for justice.

Note: All evidence cited in this article has been seen by The Canary.

A treatable illness

Robbie was suffering from Addison’s disease, a serious but treatable condition. But numerous chances to diagnose and then save his life were missed. After two weeks of illness, he died in Morriston Hospital, Swansea – just hours after his parents were refused an ambulance to take him there. Addison’s disease didn’t kill him; the severe dehydration that it causes resulted in a massive drop in Robbie’s blood pressure, causing two heart attacks. The second one was fatal.

As The Canary previously documented, when Robbie was first taken to hospital by his parents, on 5 December 1989, he was suspected of having Addison’s disease. The test to confirm this was ordered but not carried out. While the hospital never informed his parents of any of this, they did tell Ystradgynlais Health Centre, a practice of seven GPs where Robbie was a patient. And they instructed the GPs to refer Robbie back to hospital immediately if the child became unwell again. When Robbie did fall ill again, he was seen by five different GPs on seven different occasions, who all missed the boys life-threatening illness, right up to his death. Altogether, nine opportunities to save Robbie’s life were missed; seven by the GPs and two by the hospital.

An independent criminal investigation between 2000 and 2002 found that four of the doctors were grossly negligent. Two of them and a secretary had committed forgery of medical records. And these same three attempted to pervert the course of justice. But an inquest jury in 2004 returned a verdict of death by natural causes, aggravated by neglect. So far, no one has been prosecuted over Robbie’s death.

But at the heart of this story is the mystery surrounding one document in particular. A letter sent by Morriston hospital to the GPs charged with Robbie’s care vanished from the boy’s medical records. And it is this piece of missing evidence which holds vital clues to the alleged cover-up surrounding the death of the 10-year-old boy.

The ‘Addison’s letter’

Three days after Robbie had died, on 20 April 1990, Dr Keith Hughes visited the Powells’ family home. He was one of the GPs responsible for Robbie’s care, and was later found to be grossly negligent by an independent medical expert.

It was at this meeting that Mr Powell claims he witnessed the existence of what he calls the “Addison’s letter”. Robbie’s consultant at Morriston hospital, Dr Forbes, or one of his team, had sent the letter to the GPs at Ystradgynlais Health Centre, after the boy had been under his care in December 1989. Robbie had been an inpatient for four days and had been critically ill with 25% weight loss caused by dehydration. The child had suffered a life-threatening Addisonian Crisis.

According to Mr Powell, the letter stated that Robbie needed an ACTH test, to see how his adrenal glands were functioning. It stated that the boy’s parents were informed of this. The letter also referred to a hormonal imbalance and Forbes’s suspicion of Addison’s disease. In addition, there was another letter that Mr Powell and an independent witness hadn’t seen before, originally a half-paged letter dated 18 January 1990. It was now on A4 sized paper. Jointly, the two discharge letters made it perfectly clear that Addison’s disease had not been discounted and that the GPs should refer Robbie immediately back to hospital if he became unwell.

But the Powells, at the time, knew nothing of the contents of these letters. The coroner had just told Mr Powell the cause of Robbie’s death was Addison’s. This was the first time the father had ever heard of the rare disease. Additionally, at this meeting at the Powells’ home, Hughes allegedly admitted that Robbie could have been saved. Mr Powell signed the medical records directly under the last consultation note as proof he had viewed the original documents.

The Reverend Thomas

Immediately after Hughes’s visit, Mr Powell walked into his kitchen and relayed the Addison’s letter to his family and later to two friends. He said words to the effect of “the f*cking b*stards had suspected Addison’s disease”. One friend, Sid Herbert, gave a written statement to the police. Another gave a statement to Mr Powell. And both confirm that Mr Powell informed them of the existence of this letter. Mr Powell’s family claim that before Hughes’s visit he appeared calm and balanced. But after seeing the letter, Mr Powell became loud and visibly upset. This was owing to the fact he had never seen its contents before. Herbert advised Mr Powell to get an independent witness to observe the letter’s content.

Mr Powell approached his local vicar, the Reverend Thomas, to bear witness to the Addison’s letter. He did this on 23 April at the Powell’s’ home. Thomas also took notes on the Addison’s letter and the half page letter dated 18 January 1990. The Reverend’s original notes are available to this day. But he later had his character attacked by the GPs, in what Mr Powell believes was an attempt to undermine his credibility as an independent witness.

A crucial meeting

In April 1990, Mr Powell was invited by Forbes to attend Morriston hospital to discuss Robbie’s death. Mr Powell asked Forbes to confirm in writing any information he had about the boy’s care, which Forbes declined to do. But a meeting did take place on 25 May at which Mr Powell was accompanied by his wife. With the knowledge that Robbie had been suspected of Addison’s and the ACTH test requested, which would have confirmed the diagnosis, Mr Powell went with the intention of asking Forbes a series of questions. His original note, which is still available, states:

  • Do you feel that Robert had to die of Addison’s?
  • Did you suspect Addison’s or any other hormone disease when Robbie was in hospital?
  • Did you give all the necessary tests?
  • Why didn’t you, and why was this test not discussed with me or my wife?
  • You told my wife at the appointment in January that you couldn’t believe Robbie’s progress and the weight he had put on. As far as we were concerned, you had given Robbie a clean bill of health and all the results of tests were OK.
  • What were the dates you were on (annual) leave? When did you receive the letter from Dr Williams?

But when they met with Forbes, and before Mr Powell could ask any questions, the consultant immediately admitted that he had suspected Addison’s disease, and that he wished he had done the ACTH test. When Mr Powell asked Forbes why the family hadn’t been informed, he said the GPs should have informed them. Forbes had Robbie’s hospital medical records present at the meeting, and referred to them during the appointment. Forbes also said that he sent all the information relating to Addison’s to the GPs. He then brought the Addison’s letter to Mr Powell’s attention, not knowing that he and the Reverend had seen this very same letter a month earlier in the GP medical records.

Intentional deception?

Mr Powell handed Forbes a five-page typed document, which he had submitted to the Powys Family Practitioners Committee the day before as grounds for a complaint against the GPs. The document set out the chronology of events that led to Robbie’s death. It listed the seven consultations that Robbie had with the five GPs in the last 15 days of his life. While reading the letter, according to Mr Powell, Forbes was shaking his head in disbelief, and said “you just can’t trust anyone”. At this point, Forbes was obviously under the impression that the GPs had received and shared the Addison’s letter. So he would have worked on the assumption that the document had been read by them and that they were still on notice of this potentially life threatening disease.

Dr Elwyn Hughes made a request to Forbes on 25 June for a copy of the hospital medical records and was provided a copy and an accompanying letter dated 5 July. In the letter Forbes offered to meet the GPs.

It’s been accepted there was at least one secret meeting between Forbes and the five GPs. And also that both parties were in possession of the original GP and hospital medical records. Mr Powell believes this gave them the opportunity and the means to alter the discharge documents. Mr Powell believes they did this by removing the originals and substituting them with less incriminating documents to create a defence to his complaint.

Troubling records

When questioned, under oath, Forbes could not remember any of the discussions in the meeting with the GPs, as he kept no record. This was in complete contrast to the previous meeting Forbes had with the Powells, where he kept a detailed note which he placed in Robbie’s hospital records. But Forbes accepted that it would have been good practice to have sent a letter resembling the Addison’s letter. Yet in Robbie’s case, he claims he hadn’t done so. It is interesting to note that the documents Mr Powell and the Reverend claimed to have seen and read, with no medical experience or knowledge of the content of medical records, is exactly what should have been in Robbie’s medical records.

Mr Powell attempted to secure copies of both the GP and hospital records from the appropriate authorities in September 1990. But they refused his requests. Also, Dr Keith Hughes wrote to Forbes on 5 October, requesting permission to use Robbie’s hospital records at the forthcoming hearing. Forbes responded on 11 October and provided Hughes with a second copy of Robbie’s hospital records. It would appear that, while Mr Powell was unable to have copies of his own son’s medical records, that had not been the case with the GPs.

The GPs were relying on both the hospital and their own records as evidence at the forthcoming Medical Services Committee hearing. West Glamorgan Family Health Service Authority (FHSA) therefore saw the records, and they, in turn, gave them to Mr Powell on 22 November 1990. It was at this point he noticed the absence of the Addison’s letter from both sets of records. Furthermore, Mr Powell observed that other documents had also been tampered with. The half-page letter of 18 January 1990 had turned into A4 sized paper. He immediately phoned the FHSA and informed them that documents were missing. He also informed Forbes’s secretary, and requested that his telephone calls be recorded and kept as a matter of record, and they were.

A breach of regulations?

Mr Powell immediately visited the local health centre and requested to see the original GP records. But they informed him that they had sent them to the FHSA two to three weeks prior. Another GP charged with Robbie’s care, Dr Boaldz, gave Mr Powell a letter, following a request to do so, confirming this. Under the GPs’ terms and conditions of contract, the original GP should have returned the records six months earlier and no later than 17 May 1990.

It begs the question, why GPs would blatantly breach regulations, when they could easily retain photocopies for the same purpose. This brings into question whether they did so to alter the originals. Forensic evidence shows that the consultation notes regarding the day of death were entered into the GP records after the date the originals should already have been with the FHSA. Mr Powell then telephoned the FHSA, requesting to see the original records, and they gave him an appointment for the following day.

On 23 November 1990, in the company of his sister, Mr Powell was able to view the records. Mr Powell also requested a second copy of the GP and hospital notes, and for the FHSA to sign and date each document. He could compare the copies of the GP records with the originals that were in the custody of the FHSA. Powell could also compare the photocopies of the hospital records that the GPs had provided to the FHSA. So he established that he had received copies of all the records the FHSA possessed. It was now clear that the Addison’s letter was missing from the original GP records. It was also missing from Morriston Hospital’s records, which the GPs gave to the FHSA.

Vanishing documents

After finding out the Addison’s letter was missing from both the GP and hospital records, Mr Powell went back to Ystradgynlais Health Centre where Robbie had been a patient. He accused Dr Keith Hughes, who brought the original records to the Powell’s home on the 20 and 23 April 1990, of falsifying the records by removing and substituting the Addison’s letter. There was now no record in the GPs notes that Addison’s disease was ever suspected. But there was now a mention of adrenal insufficiency. But this was a vague diagnosis and doesn’t necessarily point to Addison’s disease, as it could be caused by hypopituitarism.

On 26 November 1990, Mr Powell, accompanied by his friend Herbert, attended Morriston hospital, without an appointment, to compare the photocopies of the medical records provided by West Glamorgan Family Health Service Authority (FHSA) with their originals. Herbert made contemporaneous notes of what took place. It became apparent that the Addison’s letter had also been removed from the original hospital records. There were also other anomalies within these records including the disappearance of the GP’s referral letter regarding the day of death, and the discharge notification. Mr Powell also noted that there were original documents in the hospital records that had not been disclosed to him.

But as Part Two of this article will demonstrate, the absence of the Addison’s letter from the GP and hospital records was just the beginning of an even more complex possible cover-up.

The Canary has seen all the evidence cited in the article.

The Canary will be working with the Powell family on a further investigation into Robbie’s tragic death. You can read Part Two of this article here; Part Three here; and all other articles in The Canary’s series here.

This article was updated at 11am on Saturday 26 November to reflect typographical errors.

Get Involved

– Read more on Robbie’s tragic story.

– Write to your MP, asking them to intervene in the case.

– Support the family on Facebook.

Featured image via the Powell family

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