Monday, July 31, 2006

The High "Cost of Courage" in the UK

A while ago, the Pittsburgh Post-Gazette published a series called The Cost of Courage about physicians threatened with punishment or who lost their jobs because they complained about quality problems at their hospitals.

Now there is a UK version of this. The Guardian just reported that Dr Otto Chan, at the Barts and the London NHS Trust, was fired after he complained about a huge backlog of unread x-ray films.

from 2000 the number of films started to accumulate in the Royal London. 'At first it was just few packets from outpatients and inpatients but gradually they built up. By 2001, it was 10,000 packets of film (each packet contains up to eight images) and by 2002, it was up to 15,000 packets. They were stuffed into boxes and kept in the corridor.

'One day I turned up and they had all disappeared. I tracked them down to a storeroom which had been locked, and it transpired that the inspectors from the Commission for Health Improvement [now the Healthcare commission] were coming round on a visit.' Managers at the time said that the move was taken to protect safety of patient records.

These films were finally read at the end of 2002 after Chan demanded action, and threatened to go public with it. But the hospital administration then allowed a second backlog of another 15,000 packets of film to build up between 2003 and 2004. This time, there was no agreement to read all of them. Apart from chest X-rays the second pile of films was never checked by radiologists.
Dr Chan, 49 and a father of six, was suspended 18 months ago, and then dismissed last month - a decision he is now fighting. 'I believe I was sacked because I was marked out as a whistleblower and a troublemaker, and that's because I refused to accept that thousand of films lying jumbled up in a corridor constituted good patient care,' he said.

In January 2005, Chan was suspended and accused of professional misconduct. The trust, under threat of legal proceedings from Chan, appointed an internal investigation panel headed by a QC which took 12 days of evidence about the saga, and which included other doctors' accounts of the piles of films. The findings of the panel remain confidential but it is understood that in April this year, they concluded that although there were 'serious deficiencies' in his behaviour towards managers, he had made a 'very substantial contribution' to the trust, and they should consider re-employing him under a different structure.

Chan was therefore shocked to be told on 7 June that he was 'summarily dismissed'.
Amazingly, a hospital leader seemed to admit the existence of the x-ray backlog, and that many x-rays were never read.
In a statement last night, Dr Charles Gutteridge, medical director of the trust, said: 'It is true that at times in the past our radiology service experienced considerable pressure, due to the volume of films and a national shortage of qualified radiologists and radiographers. It should be emphasised that the images concerned were from patients with the lowest clinical risk. Patients with the highest clinical risk have always been reported urgently.'
He denied that Chan was fired because of his whistle-blowing:

The panel concluded that there were grounds for dismissal. The dismissal was in no way connected with issues with our radiology processes in the past.
However, the Mirror reported that Chan
was accused of bullying and racism towards his junior doctors but colleagues said that far from being a bully, Dr Chan was 'a delight to work with'. One said: 'It's an utter disgrace. The public are being deprived of a doctor who can help save lives. His skills are irreplaceable.'
Furthermore, the Guardian noted
Charles Blakeney, a radiologist at the Royal London who worked for years with Chan, said: 'The way in which he [Chan] has been victimised is to my mind, disgraceful. He raised the issue of the unread films because it mattered to him that patient safety was being compromised. I was shocked beyond belief, as were many others, when he was dismissed.'
And it gets considerably worse. The Mirror reported that the practice of suspending UK doctors and nurses who questioned management or complained about quality is widespread. A spokeswoman for a nurses' group, Campaign Against Unnecessary Suspensions and Exclusions, charged, "People are being excluded on the basis of unsubstantiated allegations and often within days of them highlighting an area that could cause embarrassment. Put simply, it's the quickest and easiest way to get whistleblowers to shut up."

Examples cited by the Mirror included,
One senior consultant was sent home for 'not being a team player' and a radiologist for 'an unauthorised audit'.

And increasing numbers of staff claim they are suspended for raising concerns about poor practice or patient safety.

Some doctors and nurses claim they have been banned from work just because of personality clashes with their managers.

They are forced to stay at home while trusts conduct investigations into alleged offences such as 'bullying' or 'harassment'.

A highly qualified mental care nurse claims she has been excluded for more than two years for raising concerns about the safety of elderly patients. Another nurse has been suspended for nearly six months after she complained of being sexually harassed by a lesbian senior colleague.
It seems that the "cost of courage" in the UK is as high as it is in the US. Furthermore, some in the UK seem to have borrowed the tactics frequently employed by academic administrators in the US, accusing those who question their leadership of politically correct charges such as "bullying," "harassment," or "racism." (See the FIRE web-site, and the ACTA online blog for other US academic examples.)

Quality health care will not long survive such a totalitarian mind-set on the part of its organizational leaders.


Claire said...

and if you're a patient who dares to complain then heaven help you.

Anonymous said...

Sort of unrelated, but nice to see ACTA and FIRE mentioned.

These are fine organizations. I've donated a little money to F.I.R.E. before, because after returning as an adult to get a college education, I was shocked at the way dissenters in academia are treated. Professors do not get tenure, and students are made to feel as if they don't belong there.

If that same climate of intimidation exists in healthcare, then I pray I never get sick!!

Dr Grumble said...

Dr Grumble once complained about that a service he was responsible for was unsafe. The management response was to threaten closing the service altogether. This would not have been in the best interests of the patients so Dr Grumble was effectively silenced. This sort of thing is common.

Dr Rant also has an account of the Otto Chan affair.

Anonymous said...

Well said,i applaud your blog, mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it's Zyprexa product causing my diabetes.--Daniel Haszard

Anonymous said...

I worked with Otto for 6 years as a trainee. I think the way he has been constructively dismissed by Bart's and the London NHS Trust is a disgrace and his consultant colleagues who have been involved in this fiasco should be deeply ashamed of their behaviour.

Anonymous said...

A total disgrace of Medicine in London and Barts.

Anonymous said...

I worked with Otto for years, if he's so worried about patients why would he ignore his trauma bleep while having lunch in the pub? The hypocracy of that man made me sick.

Anonymous said...

Dr Gummble rather one sided account don't you think? Otto Chan LOST all six counts in the high court. He was NOT suspeneded for raising concerns about unreported scans but for gross misconduct. He is one of the most unpleasent and biggotted doctors I have ever known. The NHS is a much better place without him. If he was innocent the high court would have overturned Bart's decision to suspend him, but the court applauded Bart's for making the right decision.If the moderator is not an "otto chum", I would hope this is published as the account given is plainly factually wrong.