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By Tony Dawe, Readers Digest
Dr Geeta Nargund, a fertility specialist, was frustrated at the lack of support from bosses for her understaffed clinic at St George's Healthcare NHS Trust, south London. She also objected to the promotion of a doctor involved in a mix-up over embryos.
In October 2002 the hospital trust suspended Dr Nargund, on full pay, and closed down her centre, accusing her of running a "badly organised and chaotic unit". Outraged, she lodged a formal complaint and sued the trust for libel. This summer she won substantial damages and costs, plus a public apology. Her suspension lifted, she has still not been allowed back to work.
Dr Nargund's case is not isolated.
Dr Pamela Harper, a consultant geriatrician, was suspended for five years by Perth and Kinross Healthcare Trust, following allegations about her personal and professional conduct. The trust eventually offered her a new post, which Dr Harper declined, as a demotion. She has now launched legal proceedings.
Pioneering breast surgeon Briony Ackroyd was suspended for three years from Walsgrave Hospital in Coventry following concerns about her performance. The General Medical Council cleared her and in March, Dr Ackroyd resigned, after reaching a negotiated settlement.
Thirty years ago one or two doctors were suspended in Britain each month. Today it's one or two a week. Right now, around 100 doctors and consultants are prevented from working in our over-stretched health service. Many have been off work for more than a year, banned from even entering their hospitals. Yet, when investigations are finally over, research shows that four out of five doctors will have been cleared.
The cost is astronomical. At a time when the Government is pouring money into the NHS to improve it, hospital chiefs are wasting some £50 million a year paying specialists not to work, hiring replacements and funding investigations into often trivial complaints.
Few suspensions follow complaints by patients—just six per cent, according to one study. Most seem to be punishment for whistle-blowing or related to petty jealousies, rows over money and private practice and arguments with colleagues or managers.
"Some doctors are not good at interpersonal skills," admits Dr Jane Fenton-May, a BMA representative in Cardiff. "They can be a bit bossy and shout at people. They are suspended at once and sometimes managers start to look into their clinical records in the hope of finding a real reason to justify the suspension."
"Managers seem to have no idea of what constitutes a serious offence that justifies draconian action," says Dr Peter Tomlin, who runs a support group for suspended doctors at the Society for Clinical Psychiatrists. A trust manager can suspend a doctor on little evidence—and as long as that suspension contin-ues, he doesn't need to prove anything. "Individual trusts can do what they like," Tomlin says, "and in law the Government cannot interfere unless it takes over the whole trust."
No better example exists of a trust throwing its weight around than the University Hospitals of Coventry and Warwickshire NHS Trust, at the centre of three high-profile suspensions.
The most recent case concerns Dr Raj Mattu, one of the world's top heart specialists, who in 2001 was alarmed by the high death rate for heart bypass operations at the trust's Walsgrave Hospital in Coventry. Mattu blamed this on a shortage of vital equipment and lack of managerial support. He particularly abhorred the practice of putting five patients into bays equipped for only four. At least two patients died, he says, because beds lacked essential equipment. Frustrated by the hospital's denials, Mattu spoke out publicly.
He was suspended. Not for any clinical mistakes, nor officially for blowing the whistle, but for allegedly bullying a junior colleague.
Thousands of local people—patients, politicians and clergymen—concerned by the apparent injustice and the impact on waiting lists for heart treatment, called for his reinstatement. The trust has ignored them. Dr Mattu has been suspended for 20 months.
Frustratingly, misuse of suspension continues despite
mechanisms to prevent it. The Public Interest Disclosure Act came into
force four years ago with the aim of protecting whistle-blowers, yet
reports of victimisation continue.
When a consultant at Derriford
Hospital, Plymouth, quit and blew the whistle on waiting-list fiddles, Dr
Rhona MacDonald, an editor on the British Medical Journal, revealed she'd
interviewed 50 doctors and nurses at the hospital. "I was told there were
bullying tactics going on," she says. "On at least four occasions people
were told that they had to go on "gardening leave"—a euphemism for
suspension—for weeks or months, before they knew what they were accused
of."
Two years ago a new body, the National Clinical Assessment Authority (NCAA), was set up by the Department of Health to prevent costly long-term suspensions. Hospital trusts were asked to consult the authority before suspending doctors—but the number of suspensions is still unacceptably high. "The NCAA has no teeth," says Peter Tomlin. "It cannot make a trust reinstate a suspended doctor."
Patients' associations, doctors and consultants want an end to the scandal. Proposed solutions range from genuine safeguards for whistle-blowers to tough financial penalties for vindictive managers to immediate exclusions of no more than two weeks.
The Department of Health insists it is revising the processes for the exclusion of doctors—but is unable to tell Reader's Digest when.
Will any of these proposed solutions be implemented? There is hope. The National Audit Office, the parliamentary spending watchdog, is issuing a damning report attacking the waste of public money and the Department of Health's inability to get a grip on suspensions.
"This report signals a breath of fresh air," says Dr Gerard Panting, communications and policy director of the Medical Protection Society, which represents many suspended doctors. "It is now up to MPs to force through changes. We need a transparent system of recording suspensions, we need ways to speed up the process—and we need to remind everyone that the priority of NHS managers is the patient."
