Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Getting the facts straight for once
- Penny Mellor (3 August 2001)
-
Revisiting Stoke
- Mark Struthers (4 August 2001)
-
Don't blame the CMO too much
- Gordon Pledger (4 August 2001)
-
An Immodest Proposal
- Frank Arnold (5 August 2001)
-
Where's the evidence?
- Brian Morgan (5 August 2001)
-
What about the victims of medical error?
- Gurli Bagnall (6 August 2001)
-
My earlier response edited without consultation.
- Brian Morgan (7 August 2001)
-
End of term report for CMO
- Donnelly (9 August 2001)
-
Safety and well-being of doctors
- Donnelly (9 August 2001)
-
Mistakes in the practice of Public Health Medicine
- Donnelly (9 August 2001)
-
Let readers decide who has their facts straight
- Edmund Hey (16 August 2001)
-
Applying the no-blame culture to corporate failure
- David Hall (17 August 2001)
-
Re: Let readers decide who has their facts straight
- Mark Struthers (18 August 2001)
-
Complaints should not have come as a surprise.
- Brian Morgan (23 August 2001)
|
|
|||
|
Penny Mellor, Child Advocate Home 6 Coven Mill Close Coven WV9 5HX
Send response to journal:
|
Fact: The GMC do NOT have any juridstiction in criminal matters and can NOT investigate criminal complaints. Fact: Staffordshire police are still consulting an outside force barrister on the issue of forged consent forms. Fact: No parent who has made an allegation has been informed officially or unoffically that their complaints are no longer being investigated. Fact: Staffordshire police have the consent forms locked up under strict security and have not released any consent froms for any forensic testing. Fact: Hey and Chalmers are wrong and in printing this so are the BMJ, how sad that the parents are yet again derided by the medical profession who seem unable to establish what is in fact the truth and how like an MSbP allegation this is. Perhaps you would like to explain why the BMJ have not published the following, except that the consultation paper on MSbP leaves the reader in NO doubt as to what the suspended paediatrician failed to do during his time an North Staffordshire and makes for uncomfortable reading for all his supporters, not least of which because no credence is given to any of David Southall's work at North Staffordshire Trust, leaving the reader to wonder why. Press release: reference 2001/0345 Thursday 26th July 2001 CONSULTATION LAUNCHED Draft guidance for the protection of children for whom illness is induced or fabricated by their carers Draft guidance is published today to help protect children in whom an illness is induced or fabricated by their parents or carers. The guidance is intended to provide a national framework within which agencies and professionals at a local level - individually and jointly - can draw up and agree their own more detailed ways of working together to address this issue. The need for further direction was identified following the publication of the report of a Review of the Research Framework in North Staffordshire Hospital NHS Trust, which recommended the development of guidelines to properly identify children who had illness fabricated or induced by their carer. A multi-disciplinary panel was set up to assist the Department of Health in drawing up the guidance. Launching the consultation, Health Minister Jacqui Smith said: "This is a highly complex and sensitive area. We need services which are able to successfully identify cases and which will focus on securing the best possible outcomes for children. The guidance highlights the shared responsibility of services, professionals and the wider community for safeguarding children in whom illness is fabricated or induced by their carers and promoting the welfare of these children." "The publication of this document is an important part of the overall Government effort to strengthen protection for children and to improve the support provided to vulnerable children and families." It is intended that the guidance will be issued as supplementary guidance to Working Together to Safeguard Children. The consultation period will end on 31 October 2001 with final guidance due to be published in Spring 2002. Notes to editors: 1. The guidance is issued jointly from Department of Health, Home Office and Department for Education and Skills. It is available at www.doh.gov.uk/qualityprotects/index.htm. 2. Responses should be submitted to fabricated-induced- illness@doh.gsi.gov.uk. 3. The guidance is addressed to those who work in the health and education services, the police, social services departments, the probation service and others whose work brings them into contact with children and families. It is relevant to those working in the statutory, voluntary and independent sectors. 4. Media Enquiries to the Media centre on 020 7210 5375/5315. |
|||
|
|
|||
|
Mark Struthers, GP Leighton Buzzard, Bedfordshire,
Send response to journal:
|
Hey and Chalmers use the publication of the report into the Bristol inquiry as an excuse to pick again at the festering sore that is Stoke. One wonders what they are trying to achieve with their specious argument and further attempts at discrediting the Griffiths inquiry. It would surely be better for everyone if they left it alone. The question of forgery is a police matter and even now does not seem to have been resolved; there is in any case more than one allegation of forged consent. The suspension of paediatricians at Stoke had nothing to do with the Griffiths inquiry; they took place well before the report was published. "Learning from error, rather than seeking someone to blame" doesn't seem to apply when attacking 'civil servants' even if they have medical qualification and experience. Hey and Chalmers would be better using their influence to ensure that the police and the GMC complete their investigations expeditiously so that all the doctors involved can get back to work. Conflict of interest: filial relationship to lay member on Griffiths team. |
|||
|
|
|||
|
Gordon Pledger, retired Director of Public Health
Send response to journal:
|
Iain Chalmers and Ed Hey should not blame the CMO too muc, as he is only having to fit in with a culture in GOvernmane managers (senior civil servants and ministers) that errors are never admitted. For an example outside the NHS you only have to look at the 1994 Mull of Kintyre Chinook helicopter crash in which 25 senior army and security officers and 4 crew were killed. Two professional civil servants in effect overrode the findings of an RAF Board of Inquiry and of a Scottish Fatal Accient Inquiry and found the dead pilots to be guily of gross negligence, for reasons which may be winkle out at a forthcoming HOuse of Lords Select Committee. The curent top-down culture in the NHS has resulted in cowed managers and compliant professionals, which may suit our governors in the short- term, but which is sowing seeds of long-term disaffecton and apathy. |
|||
|
|
|||
|
Frank Arnold, Founder director, Unicorn Hospital Communications 231 Kings' Rd, Reading
Send response to journal:
|
Editor In their cogent open letter to the chief medical officer, Chalmers and Hey (1) demonstrate that while Professor Donaldson has repeatedly endorsed a departure from the blame culture which pervades the NHS, he and his civil servants are acting in ways which tend to perpetuate it. In part, this contradiction arises from the fear on the part of Department of Health officials that to admit mistakes is to be attacked and hurt for having made them. The very people who attempt to treat the illness suffer from it themselves, as do we all in varying degrees. There is a simple answer to this problem. It is one that will not be at all simple to implement. In order to rectify and prevent mistakes, it is first necessary to recognise, then understand them. There is often a high personal cost to the kind of painful reappraisal required. If the further price of honesty exacted by employers, government and the press (suspension and vilification) is too high, honest correction of errors will tend to occur belatedly if at all. If DoH public servants were to admit that they were wrong on some or all of the points raised by Chalmers and Hey, they would be performing a public service of great value. In this event, they would deserve praise, not blame (though some victims might understandably cheer through gritted teeth.) This would be salutary for the NHS. It might even start an astonishing trend: Evidence based politics, anyone? Frank Arnold doctor and NHS patient 14 College Road Reading RG6 1QB arnold_frank@hotmail.com 1) Chalmers I, Hey E. Open letter to the chief medical officer. BMJ 2001; 323: 280-1. (4 August) Competing interests: I am a medical practitioner and have been an NHS patient. |
|||
|
|
|||
|
Brian Morgan, Freelance Journalist Cardiff
Send response to journal:
|
Chalmers and Hey say this: "The worst accusation levelled at the doctors and nurses in Stoke was that some research consent forms had been forged, an allegation that received very wide publicity, including an editorial in the BMJ.14 The General Medical Council has now ruled that these allegations were entirely false.15 . . . If the Department of Health and managers at the NHS Trust really "valued and supported" the nurses and doctors in Stoke, they would have ensured wide publicity for this finding by now." The existence of ruling of this nature by the GMC, indeed that any investigation had taken place let alone been completed, was news to me. The article referred to at 15 in their open letter makes no claim of this nature, nor does the adjudication by the GMC which the same article refers to - of which I have a copy in front of me. I spent much of Friday after reading the Chalmers and Hey letter trying intermittently to get a comment out of the GMC relating to the Chalmers and Hey claim - without success. Staffordshire Police were more helpful - yes they knew about this claim but could not provide me with a source - and they were still waiting for legal advice as to whether they should be involved in investigating allegations of forgery as well as the GMC - suggesting some lack of closure on the issue. |
|||
|
|
|||
|
Gurli Bagnall, Patients' Rights Campaigner
Send response to journal:
|
Much has been said in the last year or so about the handling of medical error and the consensus seems to be that each incident should be used as a learning experience (with which most would agree), and that blame should not be apportioned (with which most outside of the profession would disagree). If iatrogensis occurred in 1% of all cases the latter might be a reasonable proposition, but since reported medical error is in the vicinity of 33.3%, accountability is long overdue. Taking into account the unreported cases which are frequently misdiagnosed, we have a situation where the medical profession is creating its own business. Embarking upon "learned" dissertations about the "etiology" of iatrogenisis as the BMJ did some months ago, suggests that this is an infectious disease beyond the control of the physician. In using such language, the profession distances itself yet again, from responsibility. As a patients' rights campaigner, my concern is that the victims in these cases, are hardly, if ever, considered. The message they receive, is that responsible physicians must be protected at all costs, while the lives, health, careers and financial security of their victims, are not even worthy of a mention. Worse, once the damage has been done, patients typically find that rather than being offered the help that they need through no fault of their own, the profession turns its back leaving them to struggle alone with enforced poverty and lack of medical help and equipment. Medical "error" goes hand in hand with incentives from drug manufacturers to prescribe specific drugs, just as it goes hand in hand with political lobbying and contributions to party funds. In the United States, "Drug company lobbying for the first half of 2000 reached $US42.9million" and it was "predicted that the prescription drug industry would spend $US230 million during the election". Certainly the current most influential man on earth, George W. Bush, had no qualms about allowing the industry to contribute $US1.7 million towards his inauguration celebrations. (British Medical Journal 27.01.01). Sums such as these, are not contributed without the promise of a pay-back. Roche had a cunning plan about thirty years ago, where the payback was to corner the market in addictive benzodiazepine drugs. They"....had been supplying hospitals with Valium and Librium free of charge. This not only blocked the competition, it also contributed to dependence.... in response to the Monopolies Commission enquiry, Roche ceased this practice in 1972. In the same year, Dr. Anthony Clift published his seminal report on hypnotic drug dependence, in which he estimated that about one in five of his patients had started their hypnotic habit in hospital." ("Power and Dependence - social audit on the safety of medicines" by Charles Medawar) Benzodiazepines have to date, been one of the greatest medical scourges of all time. How many of those who suffered the effects of addiction, and long-term or permanent neuronal damage, appear in the medical "error" statistics? Where are the statistics regarding the floppy baby syndrome? Where in the records, does it specify how many of those babies were later subdued with Ritalin? And where in the statistics are the iatrogenic birth defects such as cleft palates, recorded? In her article "The big tranquillizer cover-up" published in "What doctors don't tell you", June 2001, Margaret Bell described how her friend and benzodiazepine victim, died. "My friend Simon died last year at the age of 36 after 15 years of painful [post] withdrawals. Over six feet tall, he weighed only six stone. His post mortem showed swelling and marked pallor of the entire brain..... he also suffered from an atrophied heart, artherosclerosis, oedema, congestion of the lungs, liver damage, stomach bleeding and multiple gastric erosions. The pathologist diagnosed death due to multiorgan failure...." In life, Simon's GP had diagnosed anxiety. A cover-up, indeed. "Mistakes" such as these and the denial of them, have eroded the public's confidence. The profession is itself the author of the public's cry for accountability. It would be a mistake indeed, to continue to ignore it. Gurli Bagnall New Zealand |
|||
|
|
|||
|
Brian Morgan, Freelance Journalist Cardiff
Send response to journal:
|
My earlier response entitled 'Where's the evidence?' was cut to less than half its length without consultation. The section removed gave two examples of allegations of forgery of consent forms during the CNEP trial at Stoke, I stressed that these concerns would not disappear and that parents were entitled to an investigation. Chalmers and Hay produced no evidence that this investigation was undertaken by the GMC, and on further reflection I wonder where the remit of the GMC actually permits this kind of wide scale investigation of alleged malpractice by a number of individuals at a trust - some of whom may not even be doctors. |
|||
|
|
|||
|
Donnelly , career break Durham
Send response to journal:
|
Chalmers and Hey raise some concerns with the CMO and other concerns were raised at the BMA ARM in the context of how the profession was being "led" and how it was being "supported" in the aftermath of isolated instances which have affected the medical profession's standing in the media, the eye of the public and society in general. Perhaps Professor Michael Clarke might now be commissioned to provide a similar report to that which he recently published on the Secretary of State. The CMO is an important link between politicians and the profession and the profession should assess his performance in this regard. |
|||
|
|
|||
|
Donnelly Durham
Send response to journal:
|
The anaethetist at the centre of the Bristol Heart cases reported that he was not able to get another post in the UK and had to go to Australia. The possible mechanisms of what might amount to "blackballing" need to examined as well by the CMO, as this serious allegation may have deprived a shortage specialty but may have been to Australia's gain. |
|||
|
|
|||
|
Donnelly Durham
Send response to journal:
|
Mistakes and errors in the practice of the CMO's specialty of Public Health Medicine rarely come to the attention of the profession, let alone the public. That may change and the CMO should take a lead and give an example to other specialties by setting up and publishing reviews of such instances. Given the nature of the specialty the methodology would have to be robust but could be of use to other specialties. |
|||
|
|
|||
|
Edmund Hey, Retired Paediatrician Newcastle
Send response to journal:
|
Once again Penny Mellor has her facts wrong. Since some readers may assume that the absence of any rebuttal means that none is possible or appropriate, and since nobody else seems motivated to correct this continuing misinformation, perhaps I had better do so. The North Staffordshire Hospital NHS Trust will no doubt address most of the issues raised by this latest letter in the not too distant future, once they have completed the investigations they have been undertaking for 30 months now. However, it is palpably false to assert that the recent issue of a consultation document by the Government on how to handle suspected fabricated or induced illness in children is yet further evidence that such cases were being mishandled in Stoke. The call in the report of the Griffiths inquiry for an "interdisciplinary panel which review [sic] methods of identification, including the use of covert video surveillance within the framework of the Government's interagency guidance on child protection" gave the misleading impression that nothing like this existed already.[1] Even though there was a paediatrician on that panel he does not seem to have checked to see if guidance already existed. That impression has been further perpetuated by the referral back to the Griffiths inquiry recommendation in the Ministerial letter which was issued with the consultation document on 26 July.[2] In fact such guidance had been in existence for years. Not only was it being followed by the Stoke clinicians - they had actually taken the lead in shaping many of the guidelines. I invite readers to look a few of the documents for themselves.[3-6] They will then see that there is very little difference between what is now being presented as a new initiative by the Government and what was already standard practice in London and Stoke eight years ago. What is more those guidelines had received the official approval of the Department of Health as far back as 1994.[7,8] [1] NHS Executive West Midlands Regional Office. Report of a review of the research framework in North Staffordshire Hospital NHS Trust. Leeds: NHS Executive, 2000. (Griffiths report) www.doh.gov.uk/wrmo/northstaffs.htm (accessed 13 August 2001) [See paras 4.5.2 and 12.4.1] [2] Department of Health, Home Office, Department of Education and Skills. Safeguarding children in whom illness is induced or fabricated by carers with parenting responsibilities. London: Department of Health, 2001. www.doh.gov.uk/qualityprotects/index.htm (accessed 13 August 2001) [3] British Paediatric Association Working Party. Evaluation of suspected imposed upper airway obstruction. London: British Paediatric Association, 1994. [4] North Staffordshire Hospital Trust, Staffordshire Social Services, Staffordshire Police. Guidelines for multi-agency management of patients suspected or at risk of suffering from life-threatening abuse resulting from cyanotic-apnoeic episodes. J Med Ethics 1996;22:16-21. [5] Shinebourne E. CVS and the principle of double effect: a response to criticism. J Med Ethics 1996;22:26-8. [6] NHS Executive, Northern and Yorkshire Office. Working Group of the Specialist Advisory Committee in Paediatrics (Northern). Covert video surveillance in the management of induced illness syndrome. Newcastle, 1998. [7] Department of Health. Protocol of videoing children in hospital. Children Act News 1994;12:5. [8] Middleton C. Controversy ...in the best interests of the child!!!... (with a commentary by J Wynne). Child: care, health and development 1995;21:271-85. |
|||
|
|
|||
|
David Hall, professor of community paediatrics Sheffield University
Send response to journal:
|
EDITOR, Re: letter from Hey and Chalmers – BMJ 2001; 323: 280-1. “Open letter to the Chief Medical Officer” Hey and Chalmers (1) express concern about the Griffiths Report and the prolonged suspension of two paediatricians at North Staffordshire hospital. I share their concerns. Of course, I cannot predict the outcome of the current extensive investigations into Professor Southall’s child protection work or his research, though in my view both are original, thorough and important; however, the recent reinstatement of his colleague and collaborator, Dr Samuels, is most welcome. The Griffiths Enquiry faced several difficulties. First, few researchers, however meticulous, can instantly produce all the relevant data and records from projects completed some years earlier. Second, the resources and range of expertise needed to conduct such a complex investigation were (and still are) seriously underestimated. Third, Griffiths’ team was not ideally qualified for such a complex task. Fourth and most important, there was no framework of good practice to guide them – unfortunately, this is still the case. Perhaps the responsibility for corporate systems failures is more widespread than implied by Hey and Chalmers. Politicians, the civil service, NHS management and the health care professions had all failed either to recognise the speed of change in public expectations regarding quality, safety and transparency in public services or to implement a system that could respond appropriately to complex complaints – and in particular to serial, orchestrated allegations of misconduct or incompetence (2). The Chief Medical Officer does understand the need to implement a “no -blame” culture (3). There are encouraging signs that the Secretary of State does too. Could we apply the no-blame principle to the North Staffordshire saga? We might – if two lessons, one general and one specific, are learned. The general lesson is that procedures for investigating complaints and conducting enquires must be better planned from the start, with appropriate membership, resources and procedures, so that just one investigation is undertaken, instead of the series of reviews that was needed at Stoke. The specific lesson is that complaints in respect of child protection work are different from other NHS complaints. Procedures must be re-examined in the light of North Staffordshire. “Working Together” rightly requires health and social services to work together, so they share responsibility for problems and it would be sensible for complaints to be investigated jointly. David Hall, 1.Hey, E., Chalmers, I. “Open letter to the Chief Medical Officer: learning from Bristol – the need for a lead from the Chief Medical Officer”. BMJ 2001; 323: 280-1. 2. Marcovitch, H. Diagnose and be damned. BMJ, 1999, 319: 1376. 3. Department of Health, 2001. A commitment to quality, a quest for excellence. |
|||
|
|
|||
|
Mark Struthers, GP Leighton Buzzard, Bedfordshire,
Send response to journal:
|
Would Dr Hey care to answer Penny Mellors' other and main assertion that ran contrary to those stated in his open letter to the CMO? Both he and Sir Iain were very clear that " The worst accusation levelled at the doctors and nurses in Stoke was that some research consent forms had been forged... and that "The General Medical Council has now ruled that these allegations were entirely false." Penny Mellor and indeed Brian Morgan both refute that the GMC has made any such ruling and in any case were not in a position to do so. The reference in their letter does not appear to support of this statement either. The lack of a rebuttal on this point could lead some readers to assume that none is possible and this may of course be an injustice. The readers ought to know who has their facts straight and the evidence should be made clear. There should be an end to misinformation. It occurs to me that this new letter from Dr Hey is really just a smokescreen to distract the readers from the dishonesty that went on at Stoke so long ago. There is someone at Stoke who is still waiting for the axe to fall over these allegations and it is only fair for them and of course for the parents that this matter is investigated and resolved and soon. |
|||
|
|
|||
|
Brian Morgan, Freelance Journalist Cardiff
Send response to journal:
|
It should not have come as a surprise to the academic team based at North Staffordshire Hospital that one day they might just have to account to people other than their peers for their research and child protection work. Professor Southall has said in the past that he welcomed an inquiry. Excerpt from transcript of 'You and Yours', BBC Radio 4, Wednesday 15th June 1994 Interviewer: "Would you welcome an enquiry into your methods?" David Southall: "I have no problem with any enquiry into the methods and into our work and into the cases we have diagnosed." There were sufficient safeguards to ensure that clinical, research and child protection work were well performed provided these guidelines were adhered to - The Royal College of Physicians had perfectly adequate guidance at least as far back as January 1990, and Working Together guidelines for use with the then new Children Act 1989 came into force in October 1990, replacing previous Working Together guidelines. The doctors at North Staffordshire (greater in number than just the two focussed on) were not required to 'instantly' produce their data and records - there should have been sufficient material in the personal medical records of the patients recruited for much of the investigation required - for example the consent forms, data collection sheets, patient or parent information sheets and nursing notes. LREC minutes would have been available. And in any event concerns about the CNEP trial existed from as early as mid 1997 and Griffiths was not convened until 1999. Nothing instant about that. Then there's the responsibility of other agencies where child protection is concerned - I sense a slight element of shifting some of the blame for what happened to Social Services - and on this I agree entirely with Dr Hall. There is in my opinion a framework for investigating major local concerns where the public interest is involved and this would be a Part 8 Case Review under Working Together. Whilst Part 8 is most often used in cases where a 'looked after' child has died it also includes '....a child protection issue likely to be of major public concern....'. Reviews are conducted by each agency within the Area Child Protection Committee and then a composite review prepared. Perhaps there have been Part 8 reviews, if so we should be told. Brian Morgan |
|||