One of the recommendations of the report into the fact that 28 doctors have committed suicide while under investigation by the GMC is the institution of an ’emotional resilience’ training scheme for those subjected to its disciplinary processes. While this has been welcomed by the Chairs of the BMA and RCGP – and it is clearly a good thing that the GMC is at least recognising that a problem exists – there does seem to be a suggestion that the fault lies with the doctors (not ‘resilient’ enough) rather than with the GMC’s own procedures.
To be fair, there are other recommendations too, including the fairly startling statement that doctors should be made to feel that they are innocent until proven guilty – startling because the author of the report clearly felt that it needed to be said, thus confirming the impression of many doctors that the regulator tends to assume the opposite when complaints are made against them.
Of course, some doctors do come before the GMC’s disciplinary panels (or, more accurately, the Medical Practitioner Tribunal Service panels, which are supposed to operate at arm’s length from the GMC) as a result of mental illness. This may predispose them to thoughts of suicide, and it must be right to ensure that they have the appropriate support not only to get them through the disciplinary process, but to address their mental health issues and enable them to return to their careers. However, mentally ill or not (and most are not) any doctor subjected to disciplinary procedures will find themselves experiencing dark moments of the soul – especially when they are innocent of the charges brought against them, and even more so when panel hearings are beset by unnecessary delays, dithering and incompetence.
At the risk of boring those who have already seen my previous blog on the issue, I’ll use the case of Derek Keilloh as an example, because the timeline is instructive.
1. September 2003. The date of the alleged offence: failing to recognise signs of ill treatment of a detainee in the heat of battle in Iraq.
2. July 2007. A complaint is made about Dr Keilloh to the GMC. They wish to wait for the outcome of the public inquiry into the Baha Mousa case before deciding whether to investigate, and in the meantime he carries on working with the threat of proceedings hanging over him.
3. October 2008. Baha Mousa Enquiry opens.
4. September 2011. Enquiry report issued. Over four years since the initial complaint, and despite the fact that the report does not accuse Dr Keilloh of lying, the GMC decide to instigate proceedings.
5. June 2012. After another nine month delay, the MPTS hearing begins. After six weeks, in mid-July, the panel decides that they have run out of time, and postpone the hearing.
6. December 17, 2012 after another three months of agonised waiting for the Keilloh family, the hearing resumes, and lasts for a week.
7. December 21, 2012. Four days before Christmas, and with his excited young family looking forward to the festivities, the MPTS inform Dr Keilloh that he is being struck off the register, and no longer has a career. He has 28 days to decide whether to appeal, with many of those days blighted by the official inactivity which accompanies Christmas and New Year holidays.
8. In January 2013, a depressed and exhausted Dr Keilloh decides that he can’t subject himself and his family to the trauma of an appeal. In any case, he has no job and no support from his medical insurers to cover the considerable costs of such an appeal.
I’ve talked about the injustice of the GMC’s verdict and sentencing of Dr Keilloh elsewhere, and won’t go over it again now, but I think the outline of his case, involving five years of constant and increasing anxiety, may explain why so many doctors appearing before the GMC have been reduced to taking their own lives. It is to his credit that, after selling the family house and accepting the loss of the career which he loved and for which the country had trained him at great expense, he has managed to rebuild his life. It wouldn’t have been surprising, though, if at some point in the sorry course of events outlined above he had begun to wonder if it was worth going on. He was fortunate in having the support of a strong and loving family and of his patients, who continue to lobby for his reinstatement. It is easy to imagine how much worse it would be for a doctor going through the process without that support structure.
And Dr Keilloh’s case is not an isolated one. Colleagues called to give evidence before one of these panels have told me of the capricious way in which hearings are cancelled or rearranged at the last minute – in one case, when all those attending were already on their respective trains to London. A hearing was also held up when it transpired that one of the panel members had not read the papers relating to the case.
There is little doubt in the minds of most doctors of my acquaintance that the GMC is a dysfunctional organisation which fails either to protect patients or to ensure fair treatment for doctors appearing before its disciplinary panels. Paying a compulsory annual subscription of £400 for the sort of treatment received by Derek Keilloh and others does not seem like a good deal, and I for one would far rather take my chances before a properly constituted and publicly-funded quasi-judicial body than face the lottery of an MPTS hearing.
In his response to the report on suicides, Niall Dickson, Chief Executive of the GMC said:
‘we want to handle complaints as effectively as possible and ensure our processes are as quick, simple and as low stress as we can make them. We have made some progress on this but we have more to do.’
You do indeed, Mr Dickson, you do indeed.