How can we eradicate fear in the NHS when a junior doctor is treated as a criminal for trying to do his job?
Margaret McCartney is right to highlight the lack of wisdom associated with the decision by the Crown Prosecution Service (CPS) to place Dr. Dharmasena in front of a criminal court (1). Although the director of public prosecutions has tried to justify the decision to prosecute and the associated waste of public money, the fact the jury dismissed the case in less than thirty minutes tells us everything we need to know about the case. McCartney also rightly flags up the failure of the CPS to prosecute cases where female genital mutilation has actually taken place. However she does not comment on how the system has failed the junior doctor involved. Having been suspended from clinical practice for over a year, been through an internal trust enquiry and now a criminal trial, Dr. Dharmasena to my knowledge is still suspended and awaiting a GMC fitness to practice hearing. He will have suffered the triple jeopardy of being tried three times for the same “offence” despite there being widespread agreement that he acted entirely reasonably.
We hear much about the desire for an open and “transparent” NHS, where it is safe to highlight possible problems so they can be corrected. The Berwick report talked about fear being “toxic for patient safety” (2). Yet – this junior doctor acted in the best interests of his patient as he saw it at the time. After reflection, he discussed the case with his supervising consultant, as he was concerned that his management had been appropriate. We all know the outcome. What is the message of this case to junior doctors or indeed to anyone working in the NHS?
Other than transparency, another quality that is essential for an organization to function properly is accountability, ensuring that those working in public, private and voluntary sector organisations are answerable for their actions and that there is redress when duties and commitments are not met. Well - Dr. Dharmasena is certainly being held accountable for his actions. However what about the hospital staff who thought this case warranted referral to the police and subsequently the CPS? What of the CPS and the DPP whose prosecution was thrown back at them in thirty minutes? What of the GMC and the decision to suspend? When Dr. Dharmasena is finally found to have no case to answer as he surely will, who will he be able to hold to account for the impact this case has had on his career, the financial loss, and the stress he and his family must have been under? The treatment of Dr. Dharmasena is demonstrably unfair and can only have served to bring the regulatory structure in the UK into disrepute.
1. McCartney M. Female genital mutilation: a wise doctor and a foolish prosecution. BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h815
2. Berwick review into patient safety. A promise to learn – a commitment to act: improving the safety of patients in England. Department of Health.
Last accessed 25th January 2015
Competing interests: No competing interests