Well policed statutory duty of hospitals to report negligent staff to regulators would save lives

15th April 2013

And how do I know this? Well, many of our clients have been damaged by poor quality health care professionals who had been allowed to bounce around the NHS for years from hospital to hospital without being reported by those hospitals to their regulating body. Why? Because there is no statutory duty for the hospitals to do so that is rigorously policed. More often than not it is left to the patient to complain. Also hospitals are sporadic in their sharing of employment history data with other hospitals. This is a fundamentally flawed system.

I give you the example of 2 clients of ours who underwent vasectomy procedures on the same day in July 2011 performed by Mr Marek Krolupper. Mr Krolupper was acting as a locum consultant at the Eccleshill Medical Centre in Bradford. He was there for only one day, during which he performed 5 vasectomies. The Trust has admitted already that with one of our clients Mr.Krolupper was negligent in not ‘snipping’ the correct tubes in the operation, instead just cutting into fatty tissue. We have evidence he made exactly the same mistake with our other client. Our clients have had unnecessary pain and suffering in the most tender of areas for subsequent years as a result. So, we have independent medical evidence to show that on that one day he was negligent in operating on at least 40% of his patients. That was only one day. Mr.Krolupper worked as a doctor from 1988 until the GMC stopped him carrying out vasectomies in 2011. That is 23 years as a doctor! He was registered to work in this country in 2009.

The problem with relying on patients to report doctors to the regulator is that in an operation such as a vasectomy involving a very personal area of the body, patients are often embarrassed to come forward and find it difficult to talk about this sensitive subject. Over and above this, even when patients do report the alleged negligence to the hospital there is no statutory duty for them to report it to the regulator. The patient must report it directly. Working out how to do this, for a patient who is already traumatised, is a huge task, and often felt not worth the hassle. This creates a system in the NHS where negligent doctors keep working, and damaging innocent patients, for years going from one hospital to the next without the regulators getting wind of them.

I urge any of Mr Krolupper’s previous patients to contact me in confidence if they feel that they have suffered in a similar fashion.

Proposed Solution:

There should be a threshold number of alleged negligent acts by a health service professional that triggers an alert within a Hospital Trust. I would urge an ‘x strikes and you are out’ rule . That is after ‘x’, for illustration 3, allegations of medical negligence involving serious patient harm that are fairly and squarely against the medic, and not system related, there would be a statutory duty on the hospital to send the health service professional’s details to the relevant regulator. For example, for doctors it would be the General Medical Council (the ‘GMC’).This of course is in addition to any action the Trust itself may take. An extension of this idea would be the doctor being suspended from working in that area of surgery/treatment/care until the GMC have reviewed the individual’s situation and reported back.

As I say, this is just an idea but the larger issue is unpicking the culture of cover up and denial in the NHS which is as old as the health service itself.

The senior doctors I talk to tell me that historically they were actively told by their superiors not to tell patients when they had made an error, so those superiors were hard-wired to cover up blunders and the idea of voluntarily reporting negligent acts to the GMC, or relevant regulator, totally alien. More than just remnants of this culture still persist in the NHS.

There has never been the openness that Robert Francis states is essential within his report for doctors and nurses to admit mistakes and blunders to patients or their managers. Historically therefore these medical accidents have been covered up at source, so not reported to managers. At every level there was an incentive not to report up the line. So, even if there was a duty to report negligence to the regulator, the culture in the health service of finding a culprit and reprisal that permeates every level of the NHS, is going to take years to change. So there is neither the rigorously policed statutory duty for hospitals to report negligent doctors to the GMC, nor the culture within the hospitals to encourage such reporting.

Wholescale adoption of the Francis report recommendations is an excellent starting place to turn the tide.

A link to the programme, in which I appear at 25 mins and 50 seconds is as follows

BBC5 Live Radio Link

Ed Fletcher

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