Management blamed over consultant's malpracticeBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7249.1557 (Published 10 June 2000) Cite this as: BMJ 2000;320:1557
A government inquiry has blamed poor management within the NHS for allowing the serious malpractice of consultant gynaecologist Rodney Ledward to continue for 16 years. Powerful constraints against “telling tales” and a culture of treating consultants as gods also contributed to the conspiracy of silence surrounding his poor surgical performance.
Some 160 women patients gave evidence to the inquiry, many of whom had been scarred physically and emotionally as a result of their treatment.
Mr Ledward was struck off the medical register in 1998 after managers at East Kent Hospitals Trust finally agreed to investigate long standing concerns of general practitioners, fellow consultants, and others. These included allegations that he pressurised NHS patients to have private treatment and asked them to bring cash with them when they were admitted for surgery.
The report states that several of Mr Ledward's private patients seem to have been subjected to repeated and unnecessary surgical procedures. In one case, Mr Ledward said that he would carry out a pregnancy termination only if the patient agreed to be sterilised at the same time. She agreed and was admitted for both procedures.
His manner and attitude to patients was also criticised. One patient described how he had arrived in “a dusty sweater and jodhpurs” and told her that she did not have cancer after she had already undergone “deforming surgery” at his hands. Several patients told the board of inquiry that he did not explain their treatment or subsequent complications. While operating on a woman with an advanced gynaecological cancer, he tore both ureters and then attempted to reimplant them without the help of a urologist.
The inquiry was set up in 1999 and was chaired by Jean Ritchie QC. It found that although Mr Ledward bears the greatest responsibility for the failures of his practice “better NHS management should have picked up the problems earlier.” The report details how as early as 1986 senior management was aware of Mr Ledward's high complication rate and his cavalier manner. The inquiry heard that he advised a patient to have a hysterectomy saying: “Oh my dear you need a vaginal hysterectomy—it's on its way out anyway down there.”
John Denham, the health minister, said: “We are working with the GMC to make sure that action can be taken more swiftly against bad doctors and that when they are struck off, apart from exceptional cases, it is for life.”
The trust offered sympathy to the women who had suffered as a result of Mr Ledward's practice at the William Harvey Hospital, Ashford. David Astley, the chief executive, said: “It took months of exhaustive detective work to piece together sufficient hard evidence to get Rodney Ledward struck off, and only after that had been achieved did the vast majority of his victims come forward.”
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