David Southall: anatomy of a wrecked careerBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3377 (Published 16 May 2012) Cite this as: BMJ 2012;344:e3377
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The GMC must learn from the Southall tragedy, but there are few signs that the organisation has done so-or indeed intends to.
With the perspective of time, it is clear that the Bristol, Alder Hey and Shipman cases of the 1990s and early 2000s led in turn to a febrile atmosphere among the media. This led to political pressure for the GMC to act and look tough, aided by some 'left field' judgements in relation, for example, to the right of a complainant to have their complaint heard in public.
A sort of institutional McCarthyism prevailed where suspicion trumped common sense; the result was a steep increase in complaints and public hearings. In this context the current GMC chief executive is quoted approvingly that more doctors are likely to report eachother.
What we have now is a regulator that habitually over-reacts, and appears to think that it is right to do so. The GMC not infrequently facilitates its own use as a tool between Trusts reporting doctors, and doctors reporting doctors. Doctors appearing before the Interim Orders Committee commonly face sanctions with far reaching ramifications based purely on the prima facie case-not on the veracity of the facts themselves. In the meantime, a fitness to practice hearing may take a year, two or more to come to fruition or be summarily dropped.
In the meantime, a doctor's life may disintegrate and their practice destroyed, suffering reputational damage and family breakdown-not to mention suspension from the employing Trust or other organisation. Even if charges are not found, they all too commonly find it difficult to function again.
Let me be clear that it is in nobody's interest to protect bad or dangerous doctors. Nor do I seek to suggest leniency for those whose practice has genuinely fallen below an acceptable standard. But there again, neither does a system serve patients well if justice is delayed and excessively cumbersome. Why, for example, should a GMC process take longer than many criminal prosecutions?
For the GMC to learn from its mistakes, it could do worse than to set up an independent appraisal of cases that came to a public hearing-by inviting both the complainants and the complained against to feedback their experiences. Whilst not quite a 'truth and reconciliation' commission, insights and experiences might well surprise the GMC. And even-heaven forbid-inform the future direction of travel of this confused organisation.
Competing interests: No competing interests
David Southall's wrecked career as described by Claire Dyer is a tragedy. Unfortunately all judicial systems (which includes GMC Fitness to Practise procedures) have their imperfections. When an NHS or university-employed Consultant has to spend time defending himself in judicial proceedings on account of actions taken during his work for the NHS and/or his university, this must surely be considered as a component of his job. Doctors have to recognise that the process of determining contentious issues will often cause them personal stress but we need to accept that when this occurs it is part of our role. When all of these proceedings conclude with an acquittal or the absence of any case to answer it is surely wrong for the doctor then to suffer financial penalties. The profession should strongly support David Southall in taking proceedings against the GMC to recover his probable financial loss, and the organisations of the profession, such as the BMA, his Royal College and willing donors, and hopefully his defence organisation, should join in financing such proceedings. Of course, he may prefer to walk away from his nightmare but I would hope that he would consider making such proceedings the apotheosis of his academic contribution to child protection by holding the authorities to account.
Competing interests: I am not sure whether or not the following would be considered as competing interests: (1) Member of GMC Fitness to Practise Panels, 2006-2009 (2) Deputy Chairman, BMA Consultants Committee, 1997-2002
PACA Response To Clare Dyer – David Southall: Anatomy Of A Wrecked Career
We fully endorse Clare Dyer’s excellent account of the ordeal that Professor Southall suffered, particularly through the offices of the GMC .
However, it should be emphasised that the way these matters were handled by the employing Trust, Regional Health Authority, Department of Health and the GMC impacted on not only David Southall.Others also underwent "prolonged suspension, traumatised personal lives, multiple GMC hearings, loss of income, career destruction and repeated vilification in the press" . While their stories were not so newsworthy, the effects on the units they worked in, their families and ultimately their patients was striking.
For example, Martin Samuels, a close colleague of Dr Southall, underwent a 20-month suspension from work in 1999-2001, while David Southall, Martin Samuels and Andy Spencer were all absent from the University Hospital of North Staffordshire for 3 months in 2008 whilst they attended a Fitness to Practise Hearing at the GMC. In the UK, research and child protection work have suffered long term
adverse consequences [2-4].
In her opening account, Clare Dyer states that she will describe “what steps have been taken to make sure no other doctor has to go through such an ordeal.” Judge Pearl has been appointed to lead the new Medical Practitioners’ Tribunal Service and the GMC is shortly to issue guidance on how doctors should conduct themselves in child protection cases. In our view, however, it is the GMC that needs to learn how to conduct itself in child protection cases.
We recommend that:
• the GMC take notice of previous enquiries by the doctor’s employer and other agencies: the Morris case had been fully considered and dismissed by 3 senior paediatricians years before.
• any charge that is brought before a Fitness to Practise Panel should be of sufficient severity to warrant serious sanction. No competent assessor could believe that the reporting a suspicion of child abuse to the police, as in the Clark case, or writing a letter to an unnamed colleague, or not asking a parent suspected of abuse for permission to pass on child protection concerns could possibly be thought to suggest impaired fitness to practise. Such actions confirm the poor competence of assessors who consider allegations against doctors working in child protection. Assessors’ decisions appeared driven by the emotional intensity of cases rather than by concerns of misconduct.
• the actions of the doctor are analysed from the point of view of the intended benefit to the child - this would be helped by the appointment of an advocate for the child in the proceedings. If the hearings involving David Southall had included such advocates, he would not have been censured. The Children Act states that the welfare of the child is paramount and the courts in this regard have clearly defined the doctor’s duty.
• all members of Fitness to Practise Panels should have training in the basic principles involved in professional practice in this complex field.
• the GMC must be more careful about its choice of experts: not all of them would be accepted as genuine experts by others.
• the GMC should be wary of the motives of complainants, particularly when there are multiple complaints.
• the GMC must have courage to resist unreasonable demands from politicians and the media.
The practice of child protection will suffer until the GMC shows that it wishes to do better.
1. Dyer C. David Southall: anatomy of a wrecked career. BMJ 2012;344:18-22.
2. Modi N, McIntosh. The effect of the neonatal Continuous Negative Extrathoracic Pressure (CNEP) trial enquiries on research in the UK. Arch Dis Child 2011;96:500-504.
3. Wright T. The Stoke CNEP saga - how it damaged all involved. JR Soc Med 2010;103: 23-28.
4. Mathews B, Payne H, Bonnet C, Chadwick D. A way to restore British paediatricians' engagement with child protection. Arch Dis Child 2009;94: 329-332.
Competing interests: No competing interests