Author Archives: DougRead

Reflection on “Reflection to the GMC”.

Reflection on “Reflection to the GMC”.

Today, 13th May 2016, nearly 2 years after that Reflection of 29 June 2014, I write a further reflection on those issues on another auspicious occasion. Last night saw the birth of my granddaughter, Florence Fiona, to my eldest son and his wife.

The intervening years have allowed some sort of coming to terms with the behaviour of the Trust and the subsequent involvement of the GMC.

I can see that it could be straightforward, at least in principle, for the investigation of a complaint from a patient, a member of the public, with regard to an alleged injury at the hands of one or more employees of the NHS. The case itself may be exceedingly complex and its investigation demanding, but in principle it involves an allegedly injured party seeking compensation.

The difficulty arises when there is no injured party, no morbid or mortal consequences to an alleged failure to comply with Good Medical Practice. This in itself would not be so difficult to deal with by Trust and GMC were the complaint manifest by a member of the public. The doctor subjected to that complaint could be supported by members of the Trust both in substance and in spirit in surviving the necessary investigatory process without risk to health and well being.

The problem arises when a doctor is similarly accused of such malpractice, without evidence of accompanying morbidity or mortality, by a senior medical practitioner in that Trust who has authority over the that same troubled doctor. The consequence of such a scenario is that the word of the senior must be taken preferentially by all sections of medical and general management within the Trust while the views of the accused are at best ignored and at worst dismissed out of hand. No member of management or of the Trust Board can step out of line, reject the disciplinary demands of the higher status accuser and be seen to support the unfortunate subject of the allegations.

The accused is therefore totally isolated from all support within the organisation and if the attitude and actions of the accuser are in any way vindictive and excessive, the situation the troubled doctor can find themself in can be dire.

When such a situation presents to the GMC, the Council has a duty to support and protect the accused individual if it is to be seen as more than a prosecuting authority against members of the medical profession. The situation can be invidious, with overtones of bullying, harassment, intimidation, isolation and exclusion – and no one in a senior position in the Trust, or even in the GMC perhaps, can raise their head above the parapet in support of the accused because it smacks of disloyalty to a close colleague, the accuser.

Mental health issues and even suicide could be on the cards here for the hapless situation of the accused. Isolated, ostracised, and intimidated – even former friends in management and Trust Board dare not support, sympathise or even contact the individual at the centre of the storm. Hence you can understand why no one from the Board or senior management sent condolences on the death of my daughter Fiona.

I have some understanding here, of human frailty – both mine and of others.

Reflections on referral to GMC

It is early morning on the 29th June 2014. My daughter Fiona would have been 30
today, but died on 10th April this year.

In her final years she witnessed her father, former Professor of Psychiatry, referred to
the GMC for practice outside the Guidelines of Good Medical Practice. This referral
had occurred in September 2012.

The South West Yorkshire Trust had written a letter to the GMC which I could sorely stand to read – even now I have not read it all in one go. The allegations were of a substance designed to provoke the maximum alarm in the GMC without recording any complaints or any morbidity or mortality as a result of the supposed poor practice.

After a 35 year practice in Psychiatry in Learning Disability and with only 2 complaints
during that long period – each of which was resolved without disciplinary actions, the
referral came as a profound shock. What had I done that was so wrong?

The referral itself arose from a request for help I had made to the Drug and
Therapeutics Committee regarding a small number of patients – a few of whom were
taking high dose antipsychotics. I was suspended – yes! suspended. I was cast adrift,
a process known as Exclusion, and prevented speaking to any member of the Trust, or
entering any Trust premises other than a small bare office in a hospital 30 miles from
my home. My computer was shut down, my office raided by managers and any and
every attempt made to humiliate me and ruin my reputation before my peers and all
other staff. An investigation ensued. The 5 cases were examined in a detail unheard
of in the Trust, including a interrogation of myself of 350 written questions. A report
of 48 pages was produced. There was no substantial finding against my practice.
During this time, I appeared before the Interim Order Panel of the GMC. On this first
occasion, the most notable comment was made by the Medical Member of the
Committee who asserted that it was “a matter of differing opinion” and the Trust had
been “heavy handed in suspending me”.

When the Report of the Inquiry was produced, I again attended a hearing of the IOP
and again the committee turned down the request for Restrictions on my Practice.
The GMC had produced its own report, based on further evidence provided by the
Trust, and the Expert Opinion on this evidence was discredited as being from an
expert outwith the subject or the Specialty.

The search began by the GMC to find an expert within the specialty who would
condemn me. They did so and the condemnation came as one particular case alone,
enough perhaps, for a re-referral to the IOP and an application for fitness to practice
conditions.

On the third hearing, the IOP finally gave in and imposed the mildest condition. I was
to discuss practice with a Consultant Colleague every month, and he or she was to
report back to the IOP after 6 and then 12 months.

Although requested to do so, the Trust refused to assist in finding such a mentor.
Indeed it prevented the most appropriate Consultant from doing so by effectively
removing indemnity and isolating him too. It was at this stage that the MPS defence
solicitor threatened to report the Trust Medical Director to the GMC.

No! A mentor was found in the private sector, by myself, and discussions commenced.
It was during these final events, that Fiona died after a short illness. What, perhaps,
hurts most of all is the utter silence and complete indifference to this event shown by
the Executive Management Team and Trust Board.

People I had worked with closely for 15 years during the inception of the organization
and its approval as a Foundation NHS Trust.

I had been Chairman of the Medical Staff Committee for 6 years as the Trust moved
towards and was offered Foundation Trust Status. I had been Associate Medical
Director for Education and Training for 6 years and worked closer with the Medical
Directorate in providing a comprehensive, high standard CPO programme. I had been
appointed as Named Doctor for children by the Trust because of my work with the
Learning Disability Children’s Team in Kirklees. I was also Chairman of the Research
Committee. I had completed a programme of research into risperidone that had
taken 12 years by publishing a third and final trial in violence and self injury in
learning disabled children. The series of 3 clinical trials, one International and two
Investigator Instigated, indicated the Safety and Efficacy of risperidone in treating
these violent and self injurious disorders in the learning disabled and improving the
Quality of Life enjoyed by them in so doing.

I am now at the point where the Trust is liable to refuse to sign off my Appraisal. So
far I have been successfully appraised until this referral to the GMC. I have always
been in Good Standing with the Royal College, including this last year 2013. I have
always produced the CPD points required. I have arranged my training as required.
In discussion with my mentor, it is difficult to explain why the Trust has done what it
has. I have always been hard working and loyal. I have spent the first 15 years of my
Consultancy in West Yorkshire itself, essentially preparing people with a learning
disability in long stay hospitals for relocation in the community by reviewing medical
and psychiatric treatment. I have in this way contributed to the relocation of more
than 800 patients from 4 long stay hospitals which have all subsequently been closed.
The second half of my career has been spent in preventing these and other patients in
the community from going back to similar hospital places in the private sector.

In the light of this incomprehensible behaviour by the Trust, I am in a quandary as to
how I am expected to react. This is where the death of my daughter becomes
relevant and not just a distraction. She was brilliant.

The Trust is concerned with process – managerial process – governance.
I am concerned with brilliance. I have led a brilliant, but minor career in the field I
have chosen.

The Trust is concerned that I am outlying i.e. not totally within their control by the
means of their process or governance protocols. The Trust is scared about indemnity
and scared I might be a rogue: it is fear of litigation which drives them. There is no
trust in the Trust.

I am not. I have published extensively. I have practised in an exemplary fashion. I am
an experienced and effective clinician. I make extensive consultations with carers,
relatives and colleagues.

Interestingly, I have a profoundly and multiply learning disabled daughter, and am carer
myself and fight the carers and parents battles too!

I have worked on the National and even International scene, and despite its budget,
the Trust is an organisation with a limited horizon.

Let us take these issues, then, to the GMC and see that they are not reassured that
there is, here, at the heart of the matter, a failure in communication and that I
remain a dedicated, hard-working, safe clinician, researcher and teacher who has
been inappropriately referred.