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This website provides information on how Atos runs its business, extracts from the Contract between the DWP and Atos including the MEDICAL CONDITIONS that mean a face to face medical assessment is not always necessary, ASSESSMENTS AND POINTS, the breaches of Contract that occurred in my case, my unsound medical report and the correspondence showing how difficult it is to obtain justice or advice.
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The medical advice (ESA85) supplied by Atos Origin written by a "doctor" whose grasp of ability to read and write English is somewhat limited and certainly not up to the standard set in the contract between the DWP and Atos Origin.
The printed report was scanned as images, converted to text and sensitive information removed. There have been minor format changes to improve the layout. This is a true copy of the actual report.
Each page contains the following:
Report on ... completed by Dr Ludmila Semetillo on 24 July 2009 Ref: ...
Surname ...
Other Names ...
National Insurance Number ...
Date of Birth ...
Time Examination and Interview Started 16:13
Time Examination and Interview Ended 17:53
Time Report Complete 18:06
Date of Examination 24 July 2009
Place of Examination HIGHGATE MEDICAL EXAMINATION CENTRE
Healthcare Professional's Name Dr Ludmila Semetillo (Registered Medical Practitioner)
Client Interview Medical Conditions and Treatment 1. Medical Conditions Conditions Medically Identified Brain Tumour Cardiovascular Problem Other Conditions Reported Client states no other problems 2. Medication Levetiracetam 500 mg Atenolol (for blood pressure taken regularly. Ramipril (for vascular disease) taken regularly. Simvastatin (for cholesterol) taken regularly. 3. Side Effects Due to Medication The client experiences drowsiness as a result of their epilepsy medication. 4 Description of Functional Ability Having considered whether the condition is likely to vary during the average week and if the function can be carried out regularly and repeatedly taking into account, fluctuation, pain, fatigue, stiffness, breathlessness, balance problems etc, the description of functional ability is as follows: Condition History Brain Tumour The condition started 8 years ago. He was unconscious for 20 minutes, he had grand mal fit with big pain. Last admitted to ... hospital 3 months ago. Stayed in hospital for 10 days. He was put in stroke unit with symptoms of stroke. Has had MRI scan for Brain Tumour and the result confirmed an abnormality. Since October 2008 he had 4 fits including 4th in April when he was admitted to hospital. I past 6 months 3 fits.
Description of Functional Ability He had to submit his driving license. She suffers with fits, cramps, problem with walking, balance, shaking, visual problems, tiredness, migraines and anxiety. He was put on anticonvulsive treatment. Currently attends the neurosurgeon out-patient clinic at ... hospital every 3 months. The treatment started 3 months ago. He was offered immediate surgery, watch and see or biopsy with radiation. They decided to wait and see. He had another MRI scan 10 June and there was no change. He is referred to neurologist. Sees GP at the surgery for this condition. Cardiovascular Problem The condition started 8 years ago. It has been getting worse over the last 3 years. Troubled by headaches and lightheadedness which happens most days. Sees GP at the surgery every 1 month for routine check up for this condition. Social History The examination was carried out in an examination centre. Came by tube here today, which took about 119 minutes. Came to the examination centre alone. Lives with their wife. Lives in a house. Occupational History Last occupation: IT manager. Stopped work 10 months ago. The main reason for leaving work was redundancy. Not currently working or studying, The client is right-handed. Description of a Typical Day Client states that: Usually gets up at about 6 am. Usually sleeps well. Usually needs to lean on something to get out of bed due to pain and stiffness. Usually goes to bed at about 10 pm. Poor sleep at night causes moderate fatigue and napping during the day. Has no problems in the bathroom. Has no problems with dressing. Often needs someone's help to make meals due to weakness and poor concentration.
4. Description of Functional Ability
Usually able to use kettle, use oven and use microwave.
Usually able to do housework for about 15 minutes.
Climbs and descends the stairs every day by holding on to the rail.
Always unable to go to the local shop, alone or with someone else because of weakness,
poor balance and blackouts.
While taking the anticonvulsive medicine 1 hour later as a side affect he feels
extremely tired.
Able to walk 100 metres at a slow pace to the shops occasionally.
Can travel as a passenger without significant difficulties.
Experience no difficulties queueing.
Usually has difficulty using a computer for web surfing due to their poor concentration.
Listens to music most days.
Reads books most days.
Usually finds taking part in leisure activities such as watching TV difficult,
due to their problem with mood disturbance.
Usually has difficulty doing light gardening due to their poor balance.
The client speaks to their friends most days,
Has no difficulty communicating with others.
Is usually able to use a mobile phone for keeping in touch with others.
Always unable to deal with own correspondence due to upper limb problem and poor dexterity.
Requires help from wife.
Always able to begin and continue to complete getting washed and getting dressed
without any help.
Has not suffered any serious accidents or near misses recently.
Does not drink alcohol.
Is able to manage any changes in their daily routine and continue their day to day activities.
Experiences no difficulties finding their way to both a familiar and unfamiliar location.
Medical Opinion - Physical I have considered the possible ESA activity outcomes and my advice is that the following apply: Lower limb - Activity Outcomes Activity 1 - Walking with a walking stick or other aid if such aid is normally used We - Cannot walk more than 200 metres on level ground without stopping or severe discomfort Activity 2 - Standing and Sitting Sg - None of the above apply Activity 3 - Bending or Kneeling Bd - None of the above apply Lower Limb - Supporting Medical Evidence 5. Prominent features of functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Has no problems with dressing. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Climbs and descends the stairs every day by holding on to the rail. Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. Able to walk 1OO metres at a slow pace to the shops occasionally. Usually has difficulty doing light gardening due to their poor balance. 6 Behaviour Observed During Assessment Client was able to sit on a chair with a back for 65 minutes. The client rose twice from sitting in an upright chair (with chair arms) without physical assistance from another person. The client was able to bend to the floor and get up again to pick up an item without assistance. Stood independently for 5 minutes without difficulty. The client walked 35 metres normally to the examination room.
6 - Behaviour Observed During Assessment Gait observed to be broad-based and I found this consistent. Was able to get onto the couch without assistance, Did not appear to have any difficulty using a step to get onto the couch. 7. Relevant Features of Clinical Examination Abnormal Findings: Relevant Normal findings: Right Leg Power in the right leg was slightly reduced Reasons for loss of function: Pain, Stiffness, Neurological Problem Blood Pressure Slightly raised sitting blood pressure Other findings: No other significant findings from the lower limb examination noted. No other significant findings from the cardiac examination noted. No other significant findings from the vascular examination were noted. 8. Summary of Functional Ability Examination findings suggest mild disability due to functional loss of the lower leg, which is consistent with the typical day and observations.
Upper Limbs - Activity Outcomes Activity 4 - Reaching Re None of the above apply Activity 5 - Picking up and moving or transferring by the use of the upper body and arms Pd None of the above apply Activity 6 - Manual Dexterity Mj None of the above apply Upper Limbs - Supporting Medical Evidence 9. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Has no problems with dressing. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. 10. Behaviour Observed During Assessment Had difficulty with removing coat but was able to manage unaided. 11. Relevant features of Clinical Examination Abnormal Findings: Relevant Normal Findings: Right Upper Arm Neck Muscle power in the right arm is significantly No neck tenderness reduced No grating felt on neck movements Reasons far loss of function: Pain, Stiffness, Can touch chin to front of chest Neurological Problem Full upward neck movement Can look over left shoulder Can move left ear towards shoulder Can look over right shoulder
11. Relevant features of Clinical Examination Can move right ear towards shoulder Left Upper Arm Left shoulder turns outwards normally Can put left hand fully behind neck Left hand can reach fully behind back Can raise left arm away from side as normal Can fully bend left elbow Muscle power in the left arm was normal Right Upper Arm Right shoulder turns outwards normally Can put right hand fully behind neck Right hand can reach fully behind back Can raise right arm away from side as normal Can fully bend right elbow Muscle tone in the right arm was normal Left Forearm Left wrist turns inwards as normal Left wrist turns outwards as normal Left wrist bends backwards as normal Left wrist bends forwards as normal Left hand - thumb and index finger grip normally Left fist grips normally Right forearm Right wrist turns inwards as normal Right wrist turns outwards as normal Right wrist bends backwards as normal Right wrist bends forwards as normal Right hand - thumb and index finger grip normally Right fit grips normally Other Findings: No other significant findings from the upper limb examination were noted. 12. Summary of Functional Ability The client's Brain Tumour is mild. They have seen a specialist for this problem. The medication used is average strength.
Vision, Speech, Hearing - Activity Outcomes Activity 9 - Vision including visual acuity and visual fields, in normal daylight or bright electric light, with glasses or other aid to vision if such aid is normally worn Vg None of the above apply Activity 7 - Speech SPe None of the above apply Activity 8 - Hearing with a hearing aid or other aid if normally worn He None of the above apply Vision, Speech, Hearing - Supporting Medical Evidence 13. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Has no problems in the bathroom. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Usually has difficulty using a computer for web surfing due to their poor concentration. 14. Behaviour Observed During Assessment Had no difficulty negotiating doorways and furniture within the examination centre. Had no difficulty reading small print on medicine label and a letter. 15. Relevant Features of Clinical Examination Visual acuity was 6/6 using both eyes with glasses. Visual field testing was normal in both eyes. 16. Summary of Functional Ability There was no evidence of significant physical disability affecting vision from the condition history, typical day history, physical examination findings, observed behaviour and medical knowledge of the condition.
Continence (Other than Enuresis) - Activity Outcome Activity 10a - Continence other than enuresis (bed wetting) where the person does not have an artificial stoma or urinary collecting device Ch None of the above apply Continence - Supporting Medical Evidence 19. Summary of Functional Ability Client has no problem with this activity.
Consciousness - Activity Outcome Activity 11 - Remaining conscious during waking moments Fc At least twice in the six months immediately preceding the assessment, has had an involuntary episode of lost or altered consciousness, resulting in significantly disrupted awareness or concentration Consciousness - Supporting Medical Evidence 20. Prominent Features of Functional Ability Relevant to Daily Living Client states that: Always unable to go to the local shop, alone or with someone else because of weakness, poor balance and blackouts. Has no problems in the bathroom. Able to walk 100 metres at a slow pace to the shops occasionally. Had to give up driving due to problems with fits. 21. Relevant Features of Clinical Examination Neurological examination revealed moderate weakness in the right leg. 22. Summary of Functional Ability The customer's fit result in infrequent episodes of altered consciousness during waking hours, which result in significantly disrupted awareness or concentration. They have seen a specialist for this problem. The medication used is average strength. The client's medication does improve their level of function.
Medical Opinion - Mental, Cognitive and Intellectual Function Understanding and Focus - Activity Outcomes Activity 12 - Learning or comprehension in the completion of tasks LTf None of the above apply Activity 13 - Awareness of Hazard AHd None of the above apply Activity 14 - Memory and Concentration MCc Frequently forgets or loses concentration to such an extent that overall day to day life can only be successfully managed with pre-planning, such as making a daily written list of all tasks forming part of daily life that are to be completed. Activity 15 - Execution of Tasks ETe None of the above apply Activity 16 - Initiating and sustaining personal action IAe None of the above apply Understanding and Focus - Supporting Medical Evidence 23. Prominent features of Functional AbiIity Relevant to Daily Living Client states that: Has no problems in the bathroom. Usually able to use kettle, use oven and use microwave. Usually able to do housework for about 15 minutes. Always able to begin and continue to complete getting washed and getting dressed without any help. Has not suffered any serious accidents or near misses recently. Experiences no difficulties finding their way to both a familiar and unfamiliar location. Usually has difficulty using a computer for web surfing due to their poor concentration. Always unable to deal with own correspondence due to upper limb problem and poor dexterity. Requires help from wife.
24. Relevant Features of Clinical Examination Abnormal findings: Relevant Normal Findings: Appearance Looks tired Behaviour Was restless Cognition - General Needing prompting at interview Poor concentration on examination 25. Summary of Functional Ability Mental state examination suggests the client's Brain Tumour causes mild disability with their concentration, which is consistent with the condition history, typical day history and medical knowledge of the condition.
Adapting to Change - Activity Outcomes Activity 17 - Coping With Change CCd None of the above apply Activity 18 - Getting About GAe None of the above apply Activity 19 - Coping With Social Situations CSd None of the above apply Adapting to Change - Supporting Medical Evidence 28. Summary of Functional Ability Client has no problem with these activities.
Social Interaction - Activity Outcomes Activity 20 - Propriety of Behaviour with Other People IBg None of the above apply Activity 21 - Dealing with Other People DPg None of the above apply Social Interaction - Supporting Medical Evidence 31. Summary of Functional Ability Client has no problem with these activities.
Exceptional Circumstances Non-Functional Descriptor The Non-functional descriptors were not considered for this case as curtailment applied.
Limited Capability for Work-Related Activity 34. Evidence to support the opinion that the person does not meet any of the descriptors for limited capability for work-related activity Terminally Ill: There are no conditions reported that are likely to result in death within 6 months. Chematherapy: From the available evidence, the client is not receiving or recovering from chemotherapy administered via an intravenous, intraperitoneal or intrathecal route. Pregnancy Risk: Male client. Substantial Mental or Physical Risk: There is no indication of any condition that would lead to a substantial mental or physical risk if the client were found capable of work related activity. Watking or moving on level ground: Although the client has some limitation walking, the history, examination, observed behaviour and medical knowledge of the condition suggest they would be able to walk more than 30 metres. Rising from sitting and transferring from one seated position to another; The evidence does not support that the client has a significant problem rising and transferring, therefore they should be able to rise from sitting and transfer themselves independently. Picking up and moving or transferring by the use of the upper body and arms, reaching and manual dexterity: The evidence does not support that they suffer from a physical condition severely affecting the trunk or upper limb function. Therefore, they should be able to use a star-headed tap, reach up to the top pocket of a coat or jacket, pack up and move a O.5 litre carton full of liquid and pick up a £1 coin or equivalent. Continence where the client does not have an artificial stoma or urinary device: The evidence does not support a significant continence problem, therefore it is unlikely the client would lose control every week of full bladder emptying or full bowel evacuation. Maintaining personal hygiene: The evidence indicates that the client's physical and mental function is at a level which would allow them to clean the front of their own torso independently. Eating and drinking: The evidence does not support that the client cannot eat and drink independently. Learning or comprehension in the completion of tasks and personal action:
34. Evidence to support the opinion that the person does not meet any of the descriptors
for limited capability for work-related activity
The evidence does not support that there is either a severe mental health problem or
impairment of cognitive ability which would prevent the client being able to learn
or understand how to undertake a simple task, or to initiate and sustain basic
personal action.
Communication:
There is no evidence to support that the client has significant difficulty interpreting
or using any of the usual forms of communication.
Prognosis 35. Expected Change Functional Problems: I advise that a return to work could be considered within 6 months. 36. Reasons for the Opinion Given The client's level of disability would be expected to improve with time and appropriate treatment.
Medical Examination Findings The information contained in this section uses medical terminology and is intended for a reader with medical training. All relevant findings are explained in non-technical terminology in the appropriate sections earlier in the report. 37. General The details of the physical examination were explained to the client, who gave consent for the process to proceed. 38. Lower Limb Lower Back Spinal Curves: Are normal Palpation: There is no tenderness or muscle spasm Forward flexion to: Mid shin Squat and rise: Is Full Left Leg Hip flexion is: 130° (normal) Knee flexion is: 120° (normal) Knee extension is: Full External hip rotation: 45° (normal) Tone: Normal Power: Normal Straight leg raising is: Normal (more than 70°) Right Leg Hip flexion is: 130° (normal) Knee flexion is: 120° (normal) Knee extension is: Full External hip rotation: 45° (normal) Tone: Normal Power: Slightly Reduced Straight leg raising is: Normal (more than 70°) Reasons for loss of function: Pain, Stiffness, Neurological Problem No other significant findings from the lower limb examination noted. 39. Upper Limb Neck Neck tenderness: None
39. Upper Limb Neck crepitus: None Chin to chest: No gap Neck extension: 80° or more (normal) Left Neck rotation: 80° or more (normal) Left Ear towards shoulder ; Yes Right Neck rotation: 80° or more (normal) Right Ear towards shoulder: Yes Left Upper Arm Shoulder external rotation: 70° (normal) Hands behind neck: fingers overlap mid-line Hands behind back: finger to mid scapula Shoulder abduction: 170° (normal) Elbow flexion: 130° (normal) Power: Normal Right Upper Arm Shoulder external rotation: 70° (normal) Hands behind neck: fingers overlap mid-line Hands behind back: finger to mid scapula Shoulder abduction: 170° (normal) Elbow flexion: 130° (normal) Tone: Normal Power: Significantly Reduced Reasons for loss of function: Pain, Stiffness, Neurological Problem Left Forearm Wrist pronation: 70° - 80° (normal) Wrist supination: 70° - 80° (normal) Wrist dorsi-flexion ; 30° or more Wrist palmar-flexion: 30° or more Pinch-grip: Normal (thumb to index finger) Power-grip: Normal Right forearm Wnst pronation: 70° - 80° (normal) Wrist supinatian ; 70° - 80° (normal) Wrist dani-flexion: 30° or more Wrist palmar-flexion: 30° or more Pinch-grip: Normal (thumb to index finger) Power-grip: Normal No other significant findings from the upper limb examination were noted.
40. Cardiac, Respiratory, Vascular General Cyanosis: Absent Clubbing: Absent Face Arcus Senilis: Absent Xanthelasmata: Absent Malar Flush: Absent Butterfly Rash: Absent Plethoric: Absent Hands Nicotine Stained: Absent Temperature: Normal Sweaty: Normal Tremor: Absent Splinter Haemorrhages: Absent Radial Pulse Pulse Rate: 65 bpm Rhythm: Regular Left Radial Pulse: Normal Volume Blood Pressure Sitting: 140 / 100 Arm Used: Left arm used Left Leg Peripheral Circulation Ankle oedema: None General Appearance: No evidence of significant peripheral vascular disease Dorsalis pedis pulse: Normal Popliteal Pulse: Normal Capillay return: Normal Bandaging: Absent Arterial Ulcers: Absent Scarring: Absent Hairlessness: Absent Venous Ulcers: Absent Varicose Veins: None Pigmentation: Absent Varicose Eczema: Absent Thrombophlebitis: Absent Lipodermatosclerosis: Absent Temperature: Normal
40. Cardiac, Respiratory, Vascular Right Leg Peripheral Circulation Ankle oedema: None General Appearance: No evidence of significant peripheral vascular disease Dorsalis pedis pulse: Normal Popliteal Pulse: Normal Capillary return: Normal Bandaging: Absent Arterial Ulcers: Absent Scarring: Absent Hairlessness: Absent Venous Ulcers: Absent Varicose Veins: None Pigmentation: Absent Varicose Eczema: Absent Thrombophlebitis: Absent Lipodermatosclerosis: Absent Temperature: Normal Heart Sounds Character: Normal Lung Sounds Crackles amount: None No other significant findings from the cardiac examination noted. No other significant findings from the vascular examination were noted. 41. Vision, Speech, Hearing Visual acuity was 6/6 using both eyes with glasses. Visual field testing was normal in both eyes. 42. Consciousness Neurological examination revealed moderate weakness in the right leg. 43 Continence
44. Mental State Appearance Tired: Looks tired Build: Average build Grooming: Well kempt Dress General: Casually dressed General health: Well Tremulous: Present Increased sweating: Present Complexion: Looks flushed Behaviour Activity Rocking: Absent Facial expression: Normal Activity General: Restless Coping at Interview: Some difficulty coping at interview Arousal: Tense Rapport: Adequate Eye Contact: Adequate eye contact Speech Amount: Was talkative Rate: Rapid Volume: Normal Content: Normal Mood Ideas of Self Harm: No ideas of self harm Demeanour: Confident Thoughts Delusions: No delusions Ruminations: Does not ruminate Obsessions: None Perceptions Illusions: Does not experience illusions Depersonalisation: Experiences no depersonalisation Derealisation: Experiences no derealisation Hallucinations: None Cognition - General Orientation: Orientated in time, place and person Prompting: Needed Prompting General Memory: Adequate
44. Mental 5tate Concentration: Poor Insight Insight: Good Awareness of Danger: Adequate No other significant findings from the mental state examination were noted. 45. Observed Behaviour Lower Limb & Back Client was able to sit on a chair with a back for 65 minutes. The client rose twice from sitting in an upright chair (with chair arms) without physical assistance from another person. The client was able to bend to the floor and get up again to pick up an item without assistance. Stood independently for 5 minutes without difficulty. The client walked 35 metres normally to the examination room. Gait observed to be broad-based and I found this consistent. Was able to get onto the couch without assistance. Did not appear to have any difficulty using a step to get onto the couch. Upper limb Had difficulty with removing coat but was able to manage unaided. Sensory Had no difficulty negotiating doorways and furniture within the examination centre. Had no difficulty reading small print on medicine label and a letter.
Declaration This form has been completed by a healthcare professional approved by the Secretary of State for Work and Pensions. I have completed this form in accordance with the current guidance to ESA examining healthcare professionals as issued by the Department for Work and Pensions. I can confirm that there is no harmful information in the report other than indicated. Healthcare Professional's Name Dr Ludmila Semetillo (Registered Medical Practitioner) Approved Disability Analyst Date 24 July 2009