CASUAL WORKER, CASUAL JUSTICE

Self-employed doctors who worked as locums had a lot of bad experience and some agencies now realize they lost a lot of the best doctors through casual administration of justice at the government level, GMC, MPS and MDU.

Some are now actively negotiating alternatives ie independent legal advice (insurance) and other measures. At present medical agencies are doing well, but not so well many doctors, and their patients.

The Lauffer case

Hospital Doctor presents largely a one sided view of the Gideon Lauffer case. Nevertheless, it is well written and can be read here. As a brief introduction, this is what Hospital Doctor recently said

"A consultant surgeon dismissed by his trust has won a high court battle to set aside the dismissal and force his employer to hold a full investigation and hearing into its allegations against him.

Barking, Havering and Redbridge University NHS Trust dismissed Mr Gideon Lauffer, on 25 June 2009, after claiming to have lost trust and confidence in him.

Mr Lauffer, with the Medical Protection Society’s representation, took the trust to the high court and on 10 August was granted an interim injunction.

The court decided that the surgeon’s dismissal breached contractual disciplinary procedures and ordered the trust to continue treating him as an employee.

The judge, Mr Justice Holroyde, said that by not following the proper procedures set out in Maintaining High Professional Standards in the Modern NHS (MHPS) the trust had arguably unfairly denied Mr Lauffer the opportunity to respond to criticisms and the chance to clear his name"

The Daily Mail has a different spin on the situation. This is what they say

A surgeon alleged to have botched operations on patients over a 10-year period - resulting in at least four deaths - is under investigation by the General Medical Council.

Last night a lawyer representing relatives of one of the dead expressed fears that many more patients may have died or been harmed after surgery by consultant Gideon Lauffer.

The GMC suspended him last month after the deaths of two patients last year and is understood to be preparing to review operations stretching back many years.

Read more here.

So essentially things aren't looking great for Gideon. Nevertheless, the Medical Protection Society is hell bent on supporting him. It is a shame they failed to show that level of kindness to those who did not end the lives of patients.

Anyhow, the landmark judgment can be downloaded from here. We are one of the only publications to host this judgment. Please feel free to circulate and download. In the interim, we hope innocent doctors make use of this judgment.



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[2009] EWCA Civ 789 - Kulkarni v. Milton Keynes Hospital NHS Foundation Trust

The judgment for this case can be downloaded here.

The summary of this case according to Old Square Chambers is as follows

The Court of Appeal today handed down judgment in the case of Kunal Kulkarni v. Milton Keynes Hospital NHS Foundation Trust. Kulkarni was successfully represented by Mr Jonathan Davies led by John Hendy QC, both of Old Square Chambers.

The judgment was highly significant for two reasons:

· it establishes that doctors and dentists employed by the National Health Service are entitled to legal representation at internal disciplinary hearings to determine serious disciplinary charges made against them;

· it strongly suggests (albeit obiter) in relation to all employees of public bodies that internal disciplinary proceedings which may result in dismissal in circumstances where, as a direct consequence of that dismissal the dismissed employee is effectively prevented from ever practising his profession again, must comply with Article 6 of the European Convention of Human Rights.

Read the full article here.

VOLUNTEERS TO TAKE PLACE OF PSYCHIATRISTS

There are now many soldiers returning from Afganistan (and Iraq veterans) who are committing suicide at the alarming rate. There are many others who suffer brain damage too. The need for psychiatrists is impossible to meet and US government is recruiting thousands of volunteers to help instead. In UK, there has been little said about these men who suffer terribly and their families too. One of the symptoms of post-traumatic stress disorder is anger and with increased irritability there is increase in marital discord and violence. Without help children become traumatized witnessing what goes on at home when parent is unable to cope.
Losing temper as a result of post-traumatic disorder means poor working ability.
Distressed men are more likely to offend and a startling number are in prisons and on probation. Twice as many as serving on the front! These are UK data. Neglect of these men is quite astonishing.

Meanwhile, there are unemployed psychiatrists in UK who are not allowed to work because regulatory authorities have been too preoccupied defending religion or incompetent NHS management instead of good medical practice. In other words whistleblowers cannot work while soldiers returning from the front are killing themselves.

Graduates Poorly Prepared to be doctors

A new study has criticised the training of junior doctors. The Telegraph presents an interesting summary.

"A study by Catherine and David Matheson of the University of Nottingham's Medical Education Unit said junior doctors were not prepared in eight of 11 topic areas.

Interview with specialist registrars and consultants said new medics were especially unprepared in "clinical and practical skills and the more challenging communication skills".

The research was published in the Postgraduate Medical Journal.

The conclusions are as follows "Overall, F1s in the study were not well prepared either to perform the tasks that await them or in terms of most of the specific background knowledge and skills necessary for the successful execution of those tasks. The level of preparedness raises important issues about medical training and transition from medical graduate to first year doctor. Further research is needed to determine whether this situation exists in other regions of the UK."

This raises further future questions about appraisals, the rate of referrals to the General Medical Council and revalidation. How many doctors are going to have their license revoked in the future. This raises further questions about the effectiveness of Modernising Medical Careers [MMC] Clearly, the microscope should be placed on this training system. Remedy UK has long argued that the MMC has placed patients at risk. They now appear to be right. The architects of the MMC are directly responsible for creating a system that is clearly failing doctors and patients.

Related Links

Medical News Today.

Saha v General Medical Council [2009] EWHC 1907 (Admin)

Source - Penningtons.co.uk

As the purpose of fitness to practise proceedings is to protect the reputation and standing of the profession, rather than to punish the practitioner, factors of personal mitigation carry less weight

This involved an appeal against the decision of the General Medical Council's Fitness to Practise Panel (FTPP) that the doctor's fitness to practise was impaired by reason of misconduct and ordering his erasure from the register.

The appellant surgeon had a contagious medical condition. NHS guidance required healthcare workers with that condition to undergo tests and to refrain from work in certain circumstances.

The GMC became aware that the appellant had undertaken tests other than through formal NHS screening procedures (as required by the NHS guidance). The GMC made a number of requests of the appellant to provide information as to his current and past employers, but he failed to do so That failure was found by the FTPP to have constituted misconduct, leading to a finding of impairment of fitness to practise and his erasure from the register. The appellant appealed on several grounds:

1. Although it would have been 'better' if the FTPP had indicated distinct consideration of the two issues of 'misconduct' and 'impairment', there is no requirement in all cases for there to be a formal 'two stage' process.

The court held that 'the requirement under the Act is that there are two 'steps': the panel must consider whether there has been misconduct and further whether that misconduct is such as to impair fitness to practise. Whilst misconduct is about the past, impairment is an assessment addressed to the future albeit made in the context of past misconduct'. It was held that the FTPP had considered both issues and found, broadly, that one and the same facts gave rise to the misconduct and the impairment. The approach was not erroneous as a matter of law.

2. It was held that 'impairment' is not only an 'elusive concept', but is essentially a matter of overall value-judgement, as well as being a matter of professional judgement. Further, the court noted the concept of impairment in the fifth Shipman report, where one of the four possible bases of impairment cited by Dame Janet Smith is where the practitioner has, 'breached one of the fundamental tenets of the profession'. The FTPP finding of impairment was upheld.

3. It was held that the FTPP is essentially concerned with the reputation and standing of the profession, rather than with punishment of the doctor, and thus factors of personal mitigation carry less weight. The court held further that particular regard should be had to the special expertise of the FTPP, being the body best qualified to judge what measures are required to maintain the standards and reputation of the profession. The court did not accept the appellant's argument that either a short period of suspension or the imposition of conditions would have been an appropriate and sufficient sanction. The court held that the FTPPs 'decision of erasure was proper and should be upheld'.

Download the case here.

Professor Nutt

Ferret Fancier has exceeded himself recently. None of us are very happy about the government's treatment of Professor Nutt. It is a sad fact of life that the Labour government wishes to control everything including scientists. We conclude that either scientists and doctors toe the party line or they are ousted from their jobs. We all think David Nutt is absolutely great.

Ferret writes

"Alan Johnson accused Professor Nutt of becoming political with his statements, in fact what he said prior to his sacking was simply a well rehearsed and well researched scientific argument that was backed up by solid evidence. All of Brown and Johnson's comments on drugs have merely shown an immense lack of understanding of the evidence and a pathetic tendency to appeal to the lowest scaremongering sections of the tabloid press.

Skunk is not 'lethal' as fat Gordo stated, in fact by Johnson's logic Brown should resign as he is clearly straying into the scientific domain with this political statement. Johnson is just as bad as Brown with his illogical statements that he has released in order to justify the unjustifiable.

This is a simple issue and it comes down to the government having no balls. Brown is a weak incompetent leader who will do anything, no matter how wrong or dishonest, to win a few votes. Brown has routinely ignored experts on issues of which he and his fellow morons in power have no clue, he is too stupid to have any insight into his own lack of knowledge, he is a first class buffoon. This affair is not going away, it is about important principles, the resignations continue and I sincerely hope that it has done some good in exposing the rank stupidity and arrogance of those leading our country"

Related Links

Google UK News.

So you want to be a doctor.

Professor Rubin is desperately trying to be a man of the people. The problem is he isn't being very successful. He recently did a interview for the Guardian on encouraging doctors from the lower socioecomic classes. Strangely, the lower socioeconomic class hardly read the Guardian. They have more exciting papers to read. To having targeted the affluent intellectuals in the form of Guardianistas, Rubin expects to encourage poverty stricken teenagers into medicine. Rubin is dubbed The Count for obvious reasons. Having destroyed good doctors through the GMC, he seeks to find more new blood. His fangs are certainly out for the next innocent desperate poverty stricken teenager who is desperate enough to sacrifice themselves to the world of the GMC.

The GMC Register once had 300,000 doctors. It has now dwindled down to 185,000 practicing doctors. So a mere 185,000 doctors now try and help a population of 61.4 million. Doctors are unhappy with the General Medical Council. The option of revalidation otherwise dubbed the "harassment" of doctors isn't going down well. Given this shortage of doctors in general, Rubin is trying to persuade the lower social classes into entering the esteemed medical profession. Is it esteemed anymore? Or is it an imprisonment of genuine people who would otherwise be free? Rubin tells the world that he was from a atypical background. He flaunts his father's personal history to tell us all " if I can do it, you can". The point here is this :- do we really want to be like Prof Rubin? Does any spotty teenager want to be a bald man with large ears who knows nothing about the real world.

"Research by the British Medical Association (BMA), the doctors' trade union, shows that just one in ten medical students comes from the three lowest socio-economic groups, far less than the 30% from such backgrounds in higher education overall. It estimates that by next year the average debt incurred by a graduate of a five or six-year medical degrees will rise to an average of £37,000 by next year, with those in London paying as much as £67,000"

So instead of campaigning for a change in culture ie less judgmental medical school staff, Prof Rubin asks that richer students pay more tuition than poorer students. Rubin assumes this to be "equal opportunities". Rubin makes the assumption that all rich students are funded well by their parents. In reality, not every parent funds their child. This view will create discord and resentment between the two groups. Rubin fails to understand that the entire system of university education should be changed. The whole system is encouraging those from a higher social class into education. We are becoming a generation where education is only given to those who can afford it - a system that was in place in the 18th Century. It isn't just medicine that is in trouble, all students are in dire straits. There is no such thing as equal opportunities. It is time to scrap tuition fees, reinstate the full grants and ensure students from their GCSE years are provided with support and additional funding [ topped up EMAs] in order to work towards their aspirations. Each student should be judged equally - grades should not be lowered for poorer students nor should they be funded by their richer counterparts. The system in the UK used to believe in education for all. It certainly doesn't anymore. Rubin therefore fails to understand the that this issue is a global problem in UK education. The solution isn't to insult poorer students by offering them beggar funds. The solution is to equalise opportunity by ensuring all students are able to study - whether they are rich or poor. If the basic grants were of a decent amount, no one would need extra funds.

One of the GMC blessed programmes encouraging those from a so called "lower social class" is the Extended Medical Degree Programme. This extended medical degree programme has recently been criticised by its students. The programme has been accused of being insulting to minority students by implying they are in some way a special needs section of medical school. Students were given psychometric tests to show if the experiments in social mobility were working.

Medical Students were subjected to the draconian processes as implemented by the General Medical Council. Again, Prof Rubin believes that any person in their right mind would opt to choose a profession where every segment of you is scrutinised.

What to expect from the GMC.

This is what he says about Revalidation

"Rubin will certainly leave a major footprint in the sand of UK healthcare. His top priority is implementing the revalidation of all those 185,000 doctors. Although he describes it as "the biggest change to medical regulation since the GMC was established in 1858", revalidation has so far generated little controversy outside specialist medical publications – despite significant suspicion towards it among doctors. It will involve every doctor undergoing an annual 360-degree appraisal – with input from colleagues and patients – to prove their skills are up to scratch, and having to acquire, every five years, a fresh licence proving that they are fit to practice"

This is what the Telegraph said about GMC Style hearings for medical students.

The issue was highlighted at the British Medical Association's annual representatives meeting after student Drew Kinmond said the numbers graduating with black marks against their name has increased from three per cent in 2006/7 to one in ten last year.

He told the conference in Liverpool: "Students are not doctors, we are still in training. There has to be a period of time where students can be students and learn what it takes to be a doctor. There has to be a period of time where we can make some mistakes.

"That is why students are not in charge of patient safety."

He said he supported disciplinary action in serious cases such as assaulting a patient or dealing drugs, but urged the rules to remain in proportion.

The General Medical Council has issued guidance on disciplinary matters at medical school in an attempt to standardise rules that apply to behaviour before graduation.

The guidance states: "Students must be aware that unprofessional behaviour during their medical course, or serious health issues that affect their fitness to practise, may result in the GMC refusing provisional registration.This is the case even if the circumstance in question occurred before or early on in medical school."

The medical schools can set their own rules and hold hearings when they are breached.

Students have been warned they face action for skipping bus fares, setting off fire alarms, damaging carpets and floors, playing loud music, being impolite, not filling out forms on teacher feedback, parking violations, and attendance.

Of course, Rubin fails to inform the general public about the oppression that exists in medicine.You could successfully get into medicine and one night out may end your career. There are very few good things to say about medicine. Rubin implies that doctors earn a great deal. For the hours they do, they earn practically nothing. By the time you pay your student loans off and living expenses, MPS fees, GMC fees etc you will probably have as much in your pocket per week as someone working at the checkout in ASDA.

Professor Rubin also misses out the fact that hundreds of doctors are prevented from working due to the GMC's draconian Interim Order Panel. Having got rid of the usual good doctors in the NHS, Rubin wants to get in new blood. Well, one cannot expect any less from the man referred to as Count Rubin.

WHISTLEBLOWER TRAP

Chief Medical Officer Update Autumn 2009 newsletter issue 49 just informed me that NHS has independent NHS Whistleblowers Helpline (Public Concern at Work-PCaW). How could I resist calling: 020 7404 6609? Chief Medical Officer said they were independent yet authorised by the Department of Health to provide whistleblowing support to the NHS in England until 2011. Wow, a man who likes to be in control. There must be a long line of people waiting to kiss him. So dependable he is.

When I telephoned Public Concern at Work I found they are not really independent in the sense that they have contracts with NHS Trusts.

They protested that I did not understand that they really do provide independent advice.

It seemed reasonable to test them.

On the famous telephone help line for whistleblowers I said I was a consultant psychiatrist who raised the issue of the inappropriate wearing of religious uniforms in mental health setting and took one example of mentally ill patients who were raped. Specific example would be of men raped by clergy when they were children. I said they would not be able to trust Mother Superior working as a Social Worker with their history of abuse. Giving history to a health professional / social worker is the first step in that setting (NHS, Social Services). PCaW wanted to know if it was against the policy to wear religious uniforms. I said there was no policy but there is professional ethics: doctors do not wear white coats in psychiatry and nurses do not wear nursing uniforms in psychiatry. Social workers do not wear uniforms. I explained I did speak with the managers who said they would do something about it, but did nothing. Eventually, I went to the press.

PCaW told me I was asking for trouble by going to the press. They added; "You have to go with them (managers) even if you do not agree with them". Helpfully, the spokesman added: "They probably dismissed you with a good reason". Also he told me that at that time "PIDA was not in place in 1999". I pointed that it was. PIDA is Public Interest Disclosure Act.

Naturally, PCaW are confident that they have been able to help other people raise their concerns.

They tried absolutely everything they could to fob me off. They told me my concerns happened too long ago. When I pointed this was still my concern as religious uniforms were still worn whenworking with mentally ill I was told I held strong views.

I explained that I lost everything, Health Ministers changed (resigned), Prime Ministers changed, but that Department of Health still would not issue a policy about not wearing religious uniforms in mental health.

Eventually, I was told to contact Humanist Society. Well, at least there was a recognition that my concerns had something to do with human beings. When I called them they told me:"Well, I am not sure this is something that we would"...

Department of Health has been informed numerous times they are in breach of Human Rights e.g.

Article 9 Freedom of thought, conscience and religion

1 Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief and freedom, either alone or in community with others and in public or private, to manifest his religion or belief, in worship, teaching, practice and observance.
2 Freedom to manifest one’s religion or beliefs shall be subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others.

Department of Health told me that they will not respond to me but that they will log my letters.

It is the response that is required. The policy on the wearing of uniforms in mental health is faulty, but it can be corrected.

What is responsibility? One way to define it is the ability to respond. According to that definition there are some people in the Department of Health who appear to lack that ability.

Meanwhile, of those raped men who suffer with post-traumatic stress disorder, some would kill themselves and some would kill others.

Post-traumatic stress can cause violence in extreme form.

I am a doctor who raised my concerns appropriately, at the right time to the right people in the authority and discovered an awful lot of irresponsible people. When I read about the recent shooting at the largest military base in USA I wondered if the faults were made because of "political correctness".

My impression of military psychiatrists is that one has to be the darling of establishment to do the job. In UK, the rate of PTSD is about ten times less than in USA in military personnel. Do we really, think that British man is the strongest in the world? Or do we think some of the British psychiatrists are the weakest in the world? Diagnostic criteria are international. Human Rights are international too but it is the application that matters.

The Royal College of Psychiatrists has refused to issue the guidance on the wearing of religious uniforms in psychiatry and they have Spiritual Section contrary to their own regulations. Psychiatrists are very well aware on how they can limit the power of the patients and also how to keep status quo in their own interests. Traumatised people guarantee good business for many generations of psychiatrists to come, assuming public continued to maintain them. But the public will not do so. It already has cheaper options to use.

Laws are of no importance, I conclude, in the case of the wearing of religious uniforms because British judges are not willing to protect the whistleblowers and are not acting independently of religion or government.

Meanwhile, the government funded PCaW help line will be just another window dressing exercise. PCaW supports the government, not whistleblowers or the patients or the public.

Justice in Health Network (JIHN)

Of late, we have all been puzzled as to why Justice In Health Network had failed to invite a number of people to their meeting in the Houses of Parliament. Another meeting dated 23/11/09 is due to be held. Anyone wishing to attend, should make contact with the individuals below. Justice in Health Network kindly issued an invite to a member of Doctors4Justice. Doctors4Justice is taking this opportunity to extend this invitation to the wide public and members of the health profession.

An outline of Justice in Health Network (JIHN)

The Justice in Health Network is an independent, non-party political, grouping bringing together patients, service users, family carers, voluntary sector organisations, and others with knowledge and experience in health matters, social care, and other relevant fields.

We desire an efficient, sedulous, and well run, NHS that is both democratic and accountable, and to bring about beneficial change in medical services, and social care.

We endeavour to facilitate an independent, informed, and coordinated, voice on health policy issues.

From time to time, we hold conferences to promote debate on issues relevant to a wide cross section of health service users, and to encourage and inform public involvement.

We wish to support positive action to improve health services, but will be critical where that is appropriate. We endeavour to do this from an informed viewpoint, to propose possible solutions in a spirit of engagement and co-operation, and to do no harm.

In addition to general networking and other activities, we are currently :-

a) Opening and developing a lines of communication and dialogue between the Network, members and participants, and the health unions, regulators, and other influential bodies.

b) Exploring opportunities to bring about a co-ordinated approach on health issues.

Adrian Delemore,
Project Organiser
Justice in Health Network, March 2009
Justice in Health Network
Park Cottage, Portsmouth Road, Esher, Surrey KT10 9JF
Tel: 07973 834 012 Email: justice_in_health@yahoo.co.uk