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Blind eye to complaints allowed psychiatrists to abuse patients

BMJ Clare Dyer legal correspondent

An NHS culture of turning a blind eye allowed two psychiatrists to get away with sexually abusing scores of vulnerable women patients through the 1970s and 1980s. This was the conclusion this week of the report of an independent inquiry commissioned by the Department of Health.

Concerns and complaints about William Kerr and Michael Haslam were never acted on by the NHS, and they were allowed to retire in 1988. They were also allowed to remove themselves voluntarily from the medical register, avoiding disciplinary action by the General Medical Council.

Complaints were ignored, consultants were seen as "all powerful," and colleagues were reluctant to raise concerns about fellow professionals, concluded the inquiry’s panel, which was chaired by Nigel Pleming QC.

Haslam, 71, was jailed in 2003 after he was convicted of four counts of indecently assaulting patients. A conviction for rape was later quashed by the Court of Appeal.

Kerr, 77, who has a brain wasting disease, was convicted in his absence of one count of indecent assault in 2000. He was given an absolute discharge but placed on the sex offenders’ register.

"Patient complainants largely got nowhere, professional complainants often fared worse, attracting blame, criticism and a degree of professional ostracism that deterred others from following their lead," the report said.

Professionals were reluctant to take any action against consultants out of "a misguided sense of loyalty and fear of confrontation," and administrators devised mechanisms to protect themselves rather than patients.

The inquiry heard evidence that Kerr, who worked at Clifton Hospital in York from 1965 until his retirement in 1988, was guilty of "sexualized behaviour" with at least 67 women. Some had come forward only during the inquiry, but 38 claimed to have made disclosures at the time, not one of which was investigated.

Haslam, who was appointed a consultant at Clifton Hospital in 1970, gave rise to at least 10 complaints of sexual advances, but it was only after a complaint of sexual assault that he was "allowed, perhaps even encouraged," to retire from the NHS. He continued to work in private practice and was later appointed an honorary NHS consultant in York and a non-clinical medical director in Durham.

In chapter 29 (p 593) the report reproduces a letter Haslam wrote to the BMJ in July 1992, in response to an editorial on sexual contact between doctors and patients. He said he knew of 20 "liaisons" between colleagues and patients and "would not dream" of reporting them to any official body. Any doctor who did report such a liaison without the consent of the parties would be in breach of medical ethics, he said.

The inquiry report said that many of the NHS staff involved were "committed and caring" but that "no matter how committed and caring they may have been, many nevertheless ignored warning bells or dismissed rumours and some chose to remain silent when they should have been raising their voices.

"It is also a story of management failure, failed communication, poor record keeping and a culture where the consultant was all-powerful.

"Above all this is an account of psychiatric patients, many in number, whose concerns and complaints fell on deaf ears."

A nurse, Linda Bigwood, tried to raise concerns "over a period of almost five years involving the most senior NHS managers," but no investigation happened, and Kerr retired "with a letter of thanks for his ‘valuable contribution’ to the health service in the Yorkshire region." Ms Bigwood, in contrast, suffered "professional detriment" for raising the issue of how the complaints were dealt with.

The report conceded that much has changed within the NHS but made 70 recommendations for further action, centred on three "core concerns."

Firstly, health and social care professionals must be left in no doubt that the breach of professional boundaries with regard to their patients was unacceptable and must always be treated as harmful. Secondly, patients should have a clear and well publicised point of contact for raising concerns. And thirdly, all mental health patients who make a complaint must be offered appropriate support and assistance.

The chief medical officer, Liam Donaldson, said: "The recommendations will feed into the programme of work currently under way to review a number of issues in light of the findings of the Shipman Inquiry."

The Kerr/Haslam Report is available at www.dh.gov.uk (series number Cm 6640).