Hospital trust prosecuted for not supervising junior doctors
BMJ

Clare Dyer legal correspondent

A UK hospital trust faces a potentially large fine after pleading guilty to failing to properly supervise two junior doctors whose gross negligence led to a patient�s death. The judge overseeing the case, thought to be the first of its kind, said that it had implications for the whole NHS. It heralds a new concern for NHS managers because many untoward incidents in hospitals involve a degree of system failure as well as individual negligence.

Southampton University Hospitals NHS Trust admitted that it had not adequately managed two senior house officers, Amit Misra and Rajeev Srivastava, who were working at Southampton General Hospital in June 2000 when Sean Phillips, aged 31, died of staphylococcal toxic shock syndrome.

A spokesman for the Crown Prosecution Service (CPS) said that he believed it was the first time that an NHS trust had been prosecuted under the Health and Safety Act for the way junior doctors were managed. Prosecutions of doctors for manslaughter increased from the early 1990s after the CPS took a policy decision to prosecute cases of manslaughter at work more vigorously.

Mr Phillips, who had been admitted for a routine knee operation, developed a bacterial infection, which the two doctors failed to diagnose and treat. They were working in the trauma and orthopaedic department.

The two were convicted of gross negligence manslaughter at Winchester Crown Court in 2003 and given 18 month prison sentences suspended for two years. In 2005, the General Medical Council suspended Dr Misra, now 35, for a year and Dr Srivastava, aged 40, for six months.

Last week at Winchester Crown Court, the trust pleaded guilty to an amended charge concentrating only on the supervision of the doctors, in a plea bargain which avoided a costly six week trial. The prosecution agreed to drop other allegations of failing to take up a reference for Dr Misra, failing to implement a system of ward rounds, failing to have proper handover meetings for staff, and failing to encourage nursing staff to report concerns.

Judge Michael Brodrick said, "I would not want it thought that confining the indictment to this particular aspect there was not a need to conduct a wide examination of what went wrong and put matters right in the future." He said that the case had implications for the whole NHS but that any fine would have to be taken from patient care. Sentencing will take place on April 10.

Hywel Jenkins, prosecuting, said that the trust had made improvements, including a warning system for nurses to summon doctors when patients� conditions deteriorate. The trust said in a statement that it would explain in detail on 10 April the action it had taken after the death. It added, "Although the issue to which the trust has pleaded guilty was identified following the tragic death of Mr Sean Phillips, the trust�s plea of guilty is on the basis that this issue did not cause his death."

Ian Martin, lead clinical coordinator for the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), said, "Not all patients need to be seen by a consultant, but it is the responsibility of the consultant to ensure that trainees only work within their own level of competence and know when to seek the advice of a senior colleague.

"These problems cannot be addressed by individual doctors, but require careful planning by clinical teams, trusts, and in some cases strategic health authorities. It is to be hoped that the prosecution of an NHS trust under health and safety legislation will encourage all trusts to review their operational policies, and hopefully implement NCEPOD recommendations."