Case can proceed against doctor who discussed patient’s details on train, say judges

BMJ 2013; 346 doi: (Published 29 January 2013) Cite this as: BMJ 2013;346:f614
  1. Clare Dyer
  1. 1BMJ

The NHS trust that runs Broadmoor secure hospital can go ahead with disciplinary action against a consultant forensic psychiatrist who discussed a patient’s medical report with a colleague on a crowded train, three Court of Appeal judges have ruled.

The judges quashed a High Court injunction stopping West London Mental Health NHS Trust from convening a disciplinary panel to hear allegations of breach of confidence against Dr Chhabra.

Judge Jeremy McMullen granted the injunction in the High Court last June after ruling that it would be a breach of Chhabra’s contract to allow the disciplinary panel to be convened. The case investigator appointed by the trust had accepted Chhabra’s explanation that she had not appreciated that her actions, which also included dictating two patient reports on the train, had breached patient confidentiality.

Given that the doctor had accepted the allegations against her, McMullen ruled, the trust was contractually obliged to deal with the concerns under its “fair blame” procedure for less serious misconduct.

But Lord Justice Pill, delivering the leading judgment in the appeal court, said, “Patients’ right to confidentiality is fundamental in the health service and must be respected by doctors and other staff.”

He said that the case manager who had to decide whether to go ahead with the disciplinary process after receiving the case investigator’s report was entitled to regard breaches of confidentiality by a consultant at Broadmoor as a potentially serious offence.

Broadmoor is one of three high security psychiatric hospitals in England, most of whose patients have been referred there by the criminal justice system.

The appeal judges heard that the main allegation was that Chhabra had the patient’s report on her lap and was discussing it with a colleague when the two doctors were passengers on a train from Sunningdale in Berkshire to Waterloo in London in November 2010. Opposite them happened to be sitting the head of secure services policy at the Department of Health, Jo Leech.

Leech did not speak to the doctors at the time but later wrote a letter to Broadmoor, which was passed on to the trust, outlining details of the incident. She said that the patient’s name was clearly visible.

Chhabra admitted reading the patient’s notes on the train but said that she had not realised that his name could be seen. After a secretary expressed concern about train noises on a dictation tape, she also admitted dictating two reports on the train in one week when she had felt pressured by work, but she said that she believed she had ensured no other passengers were close by.

Lord Justice Pill said that pressure of work and a “glowing personal reference” might provide mitigation if it came to a sanction. But the alleged breaches were such that a decision to convene a disciplinary panel was justified. “The court should not in my view intervene to prevent it.”


Cite this as: BMJ 2013;346:f614