Doctors sign letter expressing worry over criminalisation of surgeon
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Version 0 of 1. More than 300 doctors and other medical staff have signed a letter voicing their disquiet at the criminalisation of a surgeon operating in a private hospital who was held responsible in the courts for the death of a patient. David Sellu, a colorectal surgeon, was found guilty of gross negligence manslaughter and sentenced to two and a half years in jail in November 2013. James Hughes, 66, suffered a perforated bowel while undergoing a routine knee replacement operation at the Clementine Churchill hospital in north-west London, owned by BMI Healthcare. It is vital that the focus is not just on the individual doctor but equally on the system they are working in The court found that Sellu, the surgeon given the case, failed to act when it should have been clear that Hughes’ condition was very serious. By the time Hughes underwent an operation to repair the damage, he was gravely ill and did not survive. Sellu’s appeal against his conviction will be heard this autumn. His supporters say that police investigations, which are focused on blaming individuals, are not appropriate in healthcare, where teamwork and system-wide safety procedures are vital. Some of Sellu’s friends and colleagues say there are serious issues around the capacity of private hospitals to deal with emergencies. In the last four years, 800 patients have died unexpectedly in private hospitals, where many people choose to go for treatment thinking standards are higher than in the NHS. In reality, they say, not all private hospitals are set up to deal with emergencies. Often it is the NHS that has to pick up the pieces when things go wrong. They also warn that police investigations and the criminalisation of doctors for mistakes will lead to doctors feeling fearful and reluctant to take on difficult cases. “Criminalising doctors sets a dangerous precedent,” said Roger Kirby, medical director at the Prostate Centre, who is one of the signatories of the letter to Clare Marx, president of the Royal College of Surgeons. “I personally have been called in to deal with emergencies in private hospitals in the middle of the night. The situation can be very challenging. If surgeons become paranoid about taking on these cases under the prospect of personal prosecution should the patient die, lives will be put at risk as fewer patients will receive the operations they urgently need.” The letter, which the doctors will circulate to all the medical royal colleges, says the Crown Prosecution Service is increasingly investigating doctors for alleged negligence over patient deaths – there have been four cases in the last year, they say. “All responsible doctors want malpractice to be rooted out of the profession. However we are adamant that individual doctors, who are readily blamed in circumstances where mistakes and delays have culminated in a patient’s death, should be given a fair trial,” they write. “The reality is that unexpected deaths in healthcare more commonly result from a chain of events rather than one individual doctor’s gross negligence. We are concerned that jailing doctors allows systemic failures, which commonly provide the context in these cases, to recur which may then result in further unexpected deaths.” The letter calls on the royal colleges to set up a review of expert witnesses in cases brought against medical practitioners, which would work with the lord chief justice and chief coroner’s office, to ensure future trials are fair. They say they are worried about the quality of the evidence in complex cases that is put forward in the courtroom. It has been signed by 313 medical staff, mostly consultants, from a wide range of disciplines, including 16 professors. Kirby says doctors are increasingly worried that the police and the courts are becoming the route for redress when things go wrong, rather than inquiries that lead to everybody learning from mistakes. There have been at least four criminal investigations against medical staff launched in the last 18 months. One involved a doctor who wrongly confused a boy with Down’s syndrome with another who had a “do not resuscitate” order. She and two nurses were charged with manslaughter. Two more doctors, and their hospital trust, were charged following the death of a woman after a delayed caesarean section. “The more the police are involved the less likely people are to learn the lessons and for the system to improve,” he said. In the Sellu case, there were a number of errors, he said. “Junior doctors didn’t give the right messages, it was hard to get the CT scan, it was very hard to get an anaesthetist and the hospital didn’t have an on-call system for anaesthetists. “The whole system could improve. Just locking David up is not going to improve the system and it has devastated David’s life and made other doctors paranoid about being prosecuted themselves.” A spokesperson for the Royal College of Surgeons said: “Any death of a patient is clearly devastating for everyone involved, and can be life-changing for surgeons and other health professionals involved in that person’s care. At present it is rare that a healthcare professional is struck off or prosecuted for clinical negligence; criminal prosecutions for negligence manslaughter are even rarer. “Where an unexpected death occurs, regulators and the judicial system need to weigh up all of the evidence. It is vital that the focus is not just on the individual doctor but equally on the system they are working in. We will look carefully at the doctors’ recommendations and undertake to discuss them with other relevant parties.” A spokesman for BMI Healthcare said: “The safety of our patients is paramount and is protected by all the same checks and balances that apply to NHS hospitals, both those set out in legislation and those issued by regulators (the Care Quality Commission, Healthcare Inspectorate Wales and Health Improvement Scotland). “In terms of the standard metrics used to measure patient safety – including returns to theatre and the rates of hospital-borne infections – while we are never complacent and constantly seek improvement, there is evidence that our hospitals are at least as safe as NHS facilities. Patients are often admitted with multiple, complex conditions and rarely – but sadly – some patients do die in our hospitals or following treatment in our hospitals, just as they do in or following treatment in NHS hospitals.” The Clementine Churchill has an intensive care unit, he said. Following the death of Hughes, it had asked all surgeons to supply the names of four anaesthetists who could work with them if required. If there was no appropriate anaesthetist, an emergency case would be transferred to another hospital. |