Hearing follows announcement by GMC to quash its earlier decision not to investigate ten doctors in related inquiry
On Tuesday 13th October the High Court will hear a Judicial Review against the General Medical Council (GMC) over alleged failings to investigate the actions of Professor Sir Bruce Keogh, the NHS England Medical Director.
The Judicial Review is being brought by Nina Ali, clinical negligence partner at Hodge Jones & Allen, on behalf of Dr. Sheila Adam, former Deputy Chief Medical Officer of NHS England. Counsel is John de Bono QC of Serjeants’ Inn.
It is alleged by Dr. Adam that the GMC failed to follow its own statutory regime for the investigation of misconduct allegations against Sir Bruce Keogh and 10 other clinicians in relation to the care of a 19 year-old man at the Royal Brompton Hospital (RBH) in London. However, despite now backing down and agreeing to investigate the ten other clinicians, the GMC is still refusing to follow the statutory regime in respect of Sir Bruce Keogh and open an investigation.
Nina Ali of Hodge Jones & Allen says: “The Francis Report into the failings at Mid-Staffordshire emphasised the duty that doctors have to raise safety concerns and that colleagues must act on such concerns. Yet here we have an account of a doctor doing exactly that only for her concerns to have been ignored.”
John de Bono QC adds: “Dr Adam raised serious concerns over patient safety in London with Professor Keogh. When he failed to respond she reported him to the GMC and was entitled to expect that the GMC would investigate. This case raises important questions about the willingness of the GMC to hold the most senior clinicians in the NHS to account in the wake of the Francis Report.”
The misconduct allegations relate to the care of a patient, BL, at the Royal Brompton Hospital in 2010. BL was known to have a giant coronary artery aneurysm following the diagnosis of Kawaski Disease in 1993 when he was aged three. This is a recognised complication which significantly increases the risk of a coronary occlusion from thrombus (clot) in childhood or young adulthood.
Following this diagnosis in 1993, Dr. Adam agreed, on behalf of BL’s parents, an “open access” agreement with RBH to provide emergency care for their son.
Upon attending the RBH on 14th August 2010 at 6am with heart attack symptoms, staff initially told BL that the hospital did not provide emergency care, and refused to admit him. After his admission there were delays in making the diagnosis, and further delays in instigating thrombolytic (clot-dissolving) treatment, despite his parents explaining to medical staff the need for urgent investigation and the treatment required. His parents were then told that cardiac surgery was needed because the clot had not dissolved. However, surgery was potentially avoidable if earlier delays had been minimised.
BL’s parents complained to the hospital about failures in their son’s clinical care, however, the hospital declined to conduct a rigorous review of BL’s care, and continue to defend their clinical practice.
BL’s parents then escalated their concerns to NHS London’s Medical Director, Dr. Andrew Mitchell. Despite a letter to the parents from Dame Ruth Carnall, CEO of NHS London which said “…you raise issues of a potentially serious concern both about the RBH and NHS London which I am satisfied merit further investigation,” but this did not happen. The parents then made contact with Dr. Adam, now semi-retired, who also approached Dr. Mitchell, but he did not intervene effectively.
On 5th December 2011 Dr. Adam contacted Sir Bruce Keogh, then NHS Medical Director at the Department of Health. His office responded on his behalf, saying that he had “…indicated that it is not appropriate for him to discuss an individual case.”
Dr. Adam contacted Sir Bruce again via email on 22nd December 2011, stating: “…I realise that, in your role, you cannot get directly involved in investigating clinical concerns or complaints. However, I believe that as medical director for the NHS, you do have a locus in ensuring that such concerns are properly investigated. This may be via the complaints process, but as the Mid-Staffordshire inquiries show, this can be a blunt instrument. Moreover, if an NHS body is aware of concerns about clinical care they should take action whether or not there is a complaint…I am putting this on record, as a I believe it is my responsibility as a registered doctor with the GMC…” she did not receive a response.
Nina Ali says: “The NHS has failed at every level to investigate the concerns raised about BL’s care. No effective action has been taken to protect the cohort of young patients with Kawasaki Disease, despite acknowledged problems in the clinical care of at least one further patient.”
When the NHS declined to investigate, Dr. Adam had no alternative but to take her concerns to the GMC in line with her duties as set out in Good Medical Practice of any registered medical practitioner to address concerns about the practice of a colleague. Initially the GMC declined to take the referral until Dr. Adam directly contacted Chief Executive, Niall Dickson. The GMC eventually established investigations into other doctors involved, but refused to investigate Sir Bruce. They argued that he “…is too far removed from the point of care to be accountable.”
In 2014, Stephen Dorrell, then Chair of the health select committee, also brought the concerns of BL’s parents to Jeremy Hunt, Secretary of State for Health, consistent with the actions he later set out in the Learning not Blaming Review, but he declined to take any action.
It is hoped that the hearing will result in the GMC following their own statutory regime and opening an investigation into Sir Bruce Keogh’s failure to investigate Dr. Adam’s concerns.