TheNorthStaffordshireWhistleblower

Part 1 Blowing It.

It'sbeenalmost 13yearssinceDr RitaPal madethesingletelephonecall that changedthecourseof
her medical career, andshe'sstill dealingwiththefallout fromthat brief conversation.
She began work at North Staffordshire NHS Trust in August 1998, a medical student from
University CollegeLondoneager toget startedonher Pre-RegistrationHouseOfficer (PRHO) year.
Theyear would be spent working three-month stints in four different departments, offering rookie
doctors a broad grounding in the ways of hospital medicine and culture, and Rita was looking
forward to it. She didn't realise there would also be an unofficial extracurricular crash course in
workplacepolitics, taught by exampleonanadhocbasis.
Her first lesson, delivered by awell-meaning senior colleaguealmost as soonas shearrived at the
Trust, was anobliquewarning tokeepher headdownandavoidthepolitical issues that supposedly
plaguedtheTrust if shewantedtodowell. Mystified, Ritaagreed shewasn't interestedinpolitics,
shejust wantedtobeagooddoctor.
Shewas delightedto receivecongratulations fromher colleagues andseniors onajobwell doneat
theendof her first three-monthpost, but her secondpost didn't look quiteso promising. Almost as
soon as Rita arrived at Ward 87 - an outlier ward marooned in the middle of a car park some
distanceaway fromthehospital proper respiratory consultant Dr MonicaSpiteri madeapoint of
tellingher that it was pronetolitigationandthat all junior doctorswererequiredtoenter bloodtest
resultsinabookimmediately after theywerereceivedfromthelab.
The ward's litigious character didn't surprise Rita. Now she thought about it, the ward was a
frequent destination for on-call junior doctors summoned to cardiac arrests. They grumbled about
thecombinationof distanceandregularity amongst themselves, but nowthat shewasactually based
there, Rita saw that these issues were just the start of Ward 87's problems. In short, it was in
disarray anacutewardwithabsolutely nothingacuteabout it.
Her first day oncall inher newjobwastobespent at theMedical Assessment Unit (MAU). Before
headingfor MAU, shecalledinat Ward87to seeif anythingrequired her attentionthere. Shewas
horrified to find one patient with extremely lowblood pressure, ahigh fever and no urine output.
Thepatient hadbeenmoribundall night, andno observations hadbeendone, soRitarushedtofind
theobservations equipment anddidthemherself.
Appalledat theway this patient hadbeenneglected, sheset about tryingtocorrect matters. Thefirst
step was to infuse fluid and antibiotics into the patient a simple enough task, assuming that the
required equipment (aspecial needlecalledavenflon, andadripset) was available. It wasn't. This
supposedly-acuteward didn't have the equipment to administer this most basic, routine (but, right
now, vital) treatment.
Rita's first thought was to sendsomeoneto another ward for theequipment, but shewas toldthere
was nobody available to go as Ward87was already critically short-staffed incredibly, therewere
no nurses on duty at all, just care assistants. At 10:10 AM, she recorded in the patient's medical
notes, Still no givens sets available asked to go and obtain set from 61 as short staffed. No staff
available to help on ward.
Goingherself wouldtakeseveral minutes andwouldmeanleavingapatient onthebrink of cardiac
arrest under the tenuous supervision of care assistants. All junior doctors were trained to call for
helpif they got into difficulties, andRitawas professional enoughto knowthat sheneededbackup
now. But fromwhere? Several minutes' frantic telephony revealed that her immediatesuperior, the
firm's Senior HouseOfficer (SHO), wasaway onstudyleave. Their boss, theRegistrar, wasrunning
achest clinic elsewhereintheTrust andtheConsultant wassimply... unavailable.
Clearly, if anythingwasgoingtobedone, Ritawasgoingtohavetodoit herself, and, at 10:30AM,
sherecordedinthepatient's medical notes, Having to go to 61 to obtain connection sets. This she
did, returning as quickly as shecouldwiththeborrowedequipment to begin treatment. Oneof the
risks of infusing fluids is that the patient becomes short of breath, particularly if the procedure is
carried out by an inexperienced, unsupervised junior doctor, and that is exactly what happened in
this case.
With some considerable effort, Rita managed to stabilise the patient, and then once again sought
urgent help, this time froma passing SHO fromthe Dermatology department who had no official
connection withher firm. Without any discussion with senior doctors officially responsible for the
patient, and, most significantly, without anydiscussionwiththepatient's relatives, theSHOcasually
marked the patient as Not For Resuscitation and went on his way. No questions haveever been
askedof himabout this incident.
Later that same day, Rita, still shocked by the whole experience, was told by the senior nursethat
staff shortages, lack of equipment andabsenceof senior support werelongtermissues onWard87.
The same nurse encouraged Rita to contact senior management by telephone to request more
equipment andstaff for theward asimpleenoughrequest, madein goodfaithwiththeintention
of preventingfurther patient neglect, andyet it wastobringRitanothingbut troublefor manyyears.
During the telephone call, management vehemently denied the existence of any such problems on
Ward 87. The very next day, Rita was summoned to her Consultant's office and ordered not to
discuss her concerns or disclose the ward's all-too-obvious problems to anyone. She was also
promised a transfer away fromthe ward, although the transfer never materialised and the promise
waslater denied. Fromthat point onwards, thingsbecameverydifficult for Rita.
One week later, she was once again on call at MAU. While she was there, a cleaner back at the
ward suffered aneedlestick injury fromaneedlethat hadbeenimproperly disposedof inaregular
rubbish bin rather than in the special sharps bin set aside for this purpose. The potential for
serious injury and/or infection fromany oneor moreof theunpleasant agues that might bepresent
onausedneedlemadethis seemingly trivial incident averyseriousmatter.
So serious, infact, that it fell within thepowers of criminal investigationgrantedto theHealthand
Safety Executive under the Health and Safety at Work Act 1974. Despitehaving been away from
thewardat MAU for most of theday, despitenot havingusedany needleswhenshehadvisitedthe
ward much earlier in the day, and despite first hearing of the unfortunate event long after it
happened when she returned to the ward after her stint at MAU, Rita quickly found herself the
prime- andonly - suspect.
As the investigation ground on over several months, and it became apparent that several nurses
wereprepared to swear that Ritahad admitted to improperly disposing of the needle, Ritaquickly
learned who her friends were approximately nobody. Colleagues looked narrowly at her and
avoided her, seniors who had been friendly and encouraging were far less willing than they had
beentosupport her, andbeforelongRitarealisedtherewasonly onecourseleft opentoher.
Pausingonly todropher bleepoff withher manager, snatchanillicit photocopy of thepatient notes
that proved what had happened onWard87and obtain aglowing referencefromtheRegistrar she
had worked for in her first post, Rita left the Trust intending never to return. Unfortunately, Dr
Colin Campbell, her postgraduate tutor, had other ideas. He telephoned her at home and told her
that other juniors hadexperienced problems onWard87, but that nothing hadbeendone. Promises
of apost ingeneral practise, away fromtheallegations andrumours at thehospital, alongwiththe
needtoearnalivingandpressurefromher family finally persuadedRitatoresumeher training.
But things weren't that simple. Her pay was cut inhalf, and, onhearing theallegations against her,
University College London's Professor David Brenton forbade her fromundertaking locumwork.
Burdenedby student debtsandunabletomakeanyreal moneyfromher work, Ritawasonthepoint
of financial collapse.
Despitetheseproblems, Ritagrewto likeandtrust thegeneral practitioners shewas working with,
andeventually shetoldoneof themwhat hadhappenedat thehospital to necessitateher transfer to
general practise. Later, documentsobtainedfromtheDepartment of Healthshowedthat this GP had
subsequently made unfavourable comments about her, demonstrating yet again that a medical
whistleblower shouldnever confideintheir colleagues.
Meanwhile, Rita'sweekly meetings withDr Campbell weretakingadisturbingturn. Withahearing
into the cleaner's needlestick injury looming, he was becoming insistent that she should plead
guilty somethingthat Ritawasdeterminednot todo, as shehaddonenothingwrong. Dont raise
this issue outside the hospital, we will deal with it, he said sternly. Professor Elder, too,
acknowledged that therehadlongbeenunresolved problems onWard87. Heofferedher asurgical
positionunder his supervision, but refusedtorespondtoher lettersor confirmwhat hadbeensaidin
his office.
Ritabecameawarethat theTrust was keentolaunchdisciplinary proceedings against her inrespect
of the needlestick injury, to run alongside the investigation being conducted by the Health and
Safety Executive. But it could only do so if she remained in its employ hence, she assumed,
Professor Edler's offer of a surgical position and Rita resolved to find work in another Trust
without delay.
She applied for a surgical post at City General Hospital, Birmingham. Although initially keen to
employ her, theConsultant changedhis mindafter speakingtoNorthStaffordshireNHSTrust. Rita
later foundthat hewas agoodfriend of Dr JohnGreen, NorthStaffordshire's Clinical Director. By
this time, Dr Green was also refusing to signoff onRita's successful completion of her first three-
monthpost at theTrust, asrequiredby theGMC, andrefusingtoprovideher withareferenceonthe
basis so he said at a meeting that she was to blame for what had happened. Finally, even Dr
Bowling, amanwhohadgivenher anA as amedical student, declinedtogiveher areferencefor
locumwork.
It was clear that theTrust wantedto keepmatters inthefamily, toensurethat shedidn't raiseher
concerns or circulatetheissues outsideof theTrust. Theintentionwas to disciplineher, blameher,
and refer her to the GMC, then end her ability to work in medicine. By doing so, their
misdemeanours in relation to patient neglect would go unnoticed, while maximum attention
focussed on the whistleblower. But why should an NHS Trust go to such lengths to discredit
someonewho, after all, hadonly triedto improvepatient care? Theanswer may lieintheTrust's
ambitious and potentially lucrative plans to obtain University status. Bad publicity was the last
thingtheTrust wanted, or needed, at that time, andit reactedswiftly toprotect itsposition.
Towards the end of January 1999, Rita was summoned to Professor Temples office. He, too,
insisted that she not disclose her experiences to the media, promised to arrange a new PRHO
post in Birminghamfor her and gave her contact details of a counselling service (which she
threwaway), asdid LondonDeaneries duoFionaMossandElisabethPaice.
Ritanever understoodwhy counselling thewhistleblower shouldbeaviablesubstitutefor anin
depthinvestigation into substandardpatient care. Correspondence between Dr John Green and
Dr Colin Campbell shows they wereaware of staffing and supervision deficiencies within the
Trust, Professor Brenton deduced their existence fromRita's experiences and, to a greater or
lesser extent, Professor Temple, Professor Paice and Fiona Moss were all aware of Rita's
concerns. Yet, a March 2002 report by the Commission of Health Improvement (CHI) of a
Clinical Governance Review at North Staffordshire NHS Trust described the same serious
shortcomings in the supervision of junior doctors that Rita had complained about in 1998.
Clearly, the approach of prescribing counselling to doctors who raised concerns was not an
entirely effectivesolutiontotheunderlyingproblem.
Back to 1999 and the interview at the Health and Safety Executive. The Medical Protection
Society (MPS) felt that the best way to present Rita's case was to omit any mention of her
raising concerns about poor conditions on Ward 87 . Rita privately disagreed, and before the
hearing she carefully packed all the evidence she had into a bright pink folder, which her
solicitor assumedtocontainmakeup.
Theinterviewroomwas airless andgrim,withonly atiny windowfacing thesky inacorner of
theceiling. Two mensat oppositeher andexplained about taperecordings under PACE (Police
andCriminal EvidenceAct). Luckily, despitesomeferociousquestioning, theHealthandSafety
Executive investigators were prepared to listen to her answers. As the going got tougher, Rita
produced her pink folder - I want to show you something this is the evidence of patient
neglect, I am being scapegoated. Ignoring her solicitor's advice, she explained what had
happened. After theinterview, oneof theinvestigators quietly revealed that they hadfoundher
evidencetobeat least plausible. A fewmonths later, shewas informedby letter that all charges
weretobedropped.
Unhappy with the language of this letter, which implied that the Health and Safety Executive
hadaprimafaciecaseagainst her but haddecidednot toprosecute, RitaaskedtheMPS toclear
her name, but their advicewastolet sleepingdogslie.
Havingfailedto set therecordstraight vialawyers, Ritaherself sought further disclosures from
theHealthandSafety Executiveand, eventually, wrotealetter beforeclaim, offeringto litigate
against the Executive. The Health and Safety Executive subsequently backed down and wrote
her the requested letter of clearance, some 7 years after the events in question: This letter
confirms that no charges were laid by the HSE against any person, particularly Dr Pal, in
respect of the incident of 12 November 1998, and that therefore no person can be said to be
guilty of any offence under the health and safety law in connection with that incident.
Although it had taken a long time to obtain, this acknowledgement was important to Rita
because documents obtained fromthe Trust and the Department of Health showed that they
both still attributed the needlestick injury to her, despite the HSE's decision not to prosecute.
Even today, bothorganisations haverefused all requests to correct this inaccurateinformation,
longafter theHealthandSafetyExecutivespositionhasbeenmadecrystal clear.
By February 1999, Rita had started work at Selly Oak Hospital. Her consultant wasnt happy
about it, but tried his best to be fair. Rita had developed awful anxieties about venflons and
needles, repeatedly checking their disposal, and taking extra carein writing up medical notes,
soasnot tohaveanyquestions raisedabout her performance.
Management set her to work on multiple endless waiting lists, which had to be done without pay.
Clearly, the hospital felt that her goodwill could be misused and abused - she was, after all, a
desperate whistleblower with nowhere else to go. An entry by the Postgraduate Deanery noted:
There have been no major problems although there was an issue about her clerking a large
number of patients that came in a waiting list initiative under a locum consultant. This caused a bit
of friction within the directorate but she appears to have full support from her own consultant and
this is now being resolved.
Even so, the transition to becoming fully registered with the GMC was problematic. The hospital
completedtheforms for every doctor andsent themtotheGMC - except for Rita's, whichwereleft
lying around awaiting completion. In the end, she addressed the problemherself, instigating their
completion and sending themoff so that she was fully registered Human Resources were most
surprised!
After atumultuousPRHOyear, Ritawascoughedout of her trainingwithout proper support, or any
proper encouragement to stay in medicine. She had learned a lot about hospital politics and the
power of rumour, andshedecidedthat, helpful astheyhadbeen, shecouldnot rely onany reference
fromSelly Oak Hospital. Instead, sheundertook aperiod of locumwork, beginning in the Isleof
Wight. Having finally securedareference(andagoodreferenceit was, too!) that wasn't taintedby
the whistleblower stigma, sheset about rebuilding her career as a permanent locum ajob that
gaveher freedomfrommanagement andvictimisation, and, incidentally, offeredher theopportunity
togainclinical experienceinmorediverseenvironmentsthanmost doctorscouldever dreamof.
Part 2 The Discreet Inquiry
Despite her growing workload as a locum, the events of Ward 87 were never far from Rita's
thoughts. She had written to Frank Dobson, the then Health Secretary, setting out her concerns
about the poor standards of care at the Trust, but had received no reply. Refusing to accept this
injusticeintheNHS, shedecidedtobreak her silenceandapproachedmedia.
This resulted in an article in the Birmingham Evening Mail, about the problematic care in all
hospitals overseenby theWest Midlands Strategic HealthAuthority. Thearticlewas calledDoctor
Quit Nightmare of Ward; People put their trust in hospitals and that trust is Sometimes being
abused [2000]. At that time, West Midlands Strategic HealthAuthority was responsible for both
NorthStaffordshireNHS Trust andthenow-infamous Mid StaffordshireNHS FoundationTrust (as
it isnowcalled), whichbecamethesubject of aPublic Inquiryintopoor careandpatient neglect.
Ritawas never very surprised whenconditions at Mid Staffordshirecameto light, sheknewhow
badthingswereat NorthStaffordshire, andhadnoreasontoassumethey wouldbeany better at any
other Trust within the same Strategic Health Authority. Had anyone paid serious attention to her
concerns, the problems at West Midlands Strategic Health Authority, and the Trusts it governed,
might haveemergedmanyyearsearlier, savinganawful lot of lives.
As it was, theEvening Mail article was largely ignored, andRitadecided that wider exposurewas
calledfor. Her next attempt wasanational pieceby twojournalistsfor theSundayTimes thefront
page article, backed up by an undercover investigation, was called Elderly Helped to Die. The
journalists interviewed her in aStokeonTrent hotel, insisting that, in order to runthe article, Rita
must reportthematter totheGMC.
Rita feared further victimisation, but the journalists promised to support her and run follow-up
articles that wouldmakesuchvictimisationmoredifficult, and, eventually, Ritaagreed. Shegavean
interview focussed largely on poor standards of care. Unfortunately, the spectreof mass murderer
Dr HaroldShipman loomed largein thejournalists' minds, andapassing referenceto diamorphine
abuse seemed to capture almost all of their attention. Even though approximately 95% of the
article was about substandard care and lack of resources, diamorphine was the aspect that
everyone includingtheauthrorities pickedupon.
The article, published in early April 2000, induced panic in the medical establishment. Questions
wereasked in the Commons, and in the Lords, theDepartment of Health was frantically trying to
decidewhat linetotake, andtheGMC commissioned Professor RodGriffiths, Regional Director
of Public Health, toinvestigate.
Summoned to a meeting at the GMC on the 27
th
April, 2000, to discuss the matter, Professor
Griffiths' beganby castingaspersions onRita'sprofessional competenceandmatters went downhill
from there. Despite having access to two internal investigations carried out by the Trust which
largely upheld Rita's concerns about patient neglect, Professor Griffiths eventually reported to the
GMC that her allegationswerebaselessinJanuary2001.
Rita knewnothing of any of these investigations, or their results. However, in the year 2000, just
after the Sunday Times article, a GMC committee member suggested that she should leave the
GMC to their own devices as their aim was to edge her towards the health procedures - a
reference to the GMC's procedures for dealing with doctors who wereno longer fit to practise by
reasonof ill-health.
Althoughshewas unsurehowfar to trust this tipoff, theGMC certainly hadapersistent interest in
meeting her during that period, ostensibly to discuss her allegations (although Rita had already
provided themwith everything sheknew), and shefelt it wiseto keep her distance. In frustration
andannoyanceat thesituation, Ritawroteanumber of intemperateletters to theGMC andDonald
Irvine - the then President of the GMC before suggesting that the GMC should conduct its
investigationswithout anyfurther involvement fromher.
Meanwhile, Rita's locumwork was going well, but her past seemed to be catching up with her.
Persistent rumours about theGMC's interest in her mental health werecirculating on adoctors-only
website, andoccasionally spilledout into thereal world. This speculationbecamesoproblematic that
shebegancarryingaletter fromher GP, confirmingthat shedidnot have, andhadnever had, mental
healthproblems. Eventually, anumber of memoscametolight, originatingfromahospital shehadnot
workedfor, thatenabledher topinpointthesourceof therumours.
Thesememos and other material led Ritato question theGMC, and, eventually, theGMC admitted
that theyhadwrongly disclosedinformationabout her tothehospital inquestion. Convincedthat there
wasmoretolearnabout theGMC's interest inher, Ritabeganmakingrequests for informationunder
theDataProtectionAct andFreedomof InformationAct. Shewaslividatthelevel theregulatorybody
shehadalways respectedhadstoopedto, andshewasdeterminedtodiscover what elsetheyhadbeen
upto.
When shefoundout, shewas shocked, horrified and, finally, downright furious. Amongst thepapers
sent to her by the GMC's ever-helpful Mark Ellen was a collection of memos between GMC
employees Mr Peter Lynn, Ms Sara Bedwell and an unnamed Screener (eventually, and very
reluctantly, identifiedby theGMC asDr SheilaMann), inwhich, over aperiodof many months, they
questionedher competenceandher mental health, anddiscussedwhether they shouldinstituteformal
actionagainst her under theHealthProcedures. Evenworse, theScreener hadconductedaDiscreet
Inquiryintoher backgroundwithoutanyformal authorisationtodoso.
Bythis time, Ritahadset upacontroversial website, aimedat exposingproblems withintheNHS, and
theGMC's Peter Lynn hadset about printing out reams of material fromthesite, including personal
details suchasRitabeingafanof theauthor, StephenKing. This intensescrutiny into everythingthat
shehadwrittenwasaninvasionof her privatelifethat Ritawasnot preparedtotolerate. It wastimeto
takeastandandfight for her rights, if onlytopreserveher employment prospectsandprevent yet more
unfounded rumours leaking out into her workplace. Besides, Ritawas disgusted to seehowlittlethe
GMC caredabout theconsequencesof theconcernstheyraised, howtheyhadfocussedtheir attention
onher, whilethemajority of peopleresponsiblefor theawful conditions onWard87escapedwithout
any accountability, andhowtheGMC refusedtoevenconsider acomplaint about Dr Mann's conduct
incarryingout her Discreet Inquiry - therewasasensethat it wasstandardpractiseat theGMC, that
theyhaddoneit tolotsof doctorsanddidn't seeanythingwrongwithit.
Andnow, thankstotheGMC, shehadtolivewiththestigmaof mental illness, eventhoughshedidn't
haveoneand never had. Shehadbeenworking as apsychiatrist for sometime, surroundedby other
psychiatristseverydayof her workinglife. Surely, if shehaddevelopedamental illness, atleast oneof
theseexpertsinthefieldof mental healthwouldhavespottedit?
Rita decided that, as a first step, she would simply ask the GMC to remove these offensive and
wrong documents fromher files. Despite numerous letters and emails, the GMC first refused to
comply withher request, andthenignored her correspondencecompletely. Therewas no longer any
alternativebuttolitigate.
Noneof the427solicitorssheapproachedbelievedher plancouldwork, andsoRitabeganresearching
the legal arguments she would need herself. After all, understanding of the law comes fromlaw
books if lawyers couldreadthem, so couldshe! SoonshehaddraftedandservedtheParticulars of
Claim, focusingonbreachof humanrights, harassment, defamation, breachof theDataProtectionAct
and anything else she could think of. The GMC's legal teammade an application to have the case
struck out at the earliest possible juncture, and then took refuge in cunning plans like serving
documentsat thelast possibleminute, possibly hopingthat their litigant-in-personopponent wouldnot
havethetimetoreadandunderstandthem.
At thefirst hearing, inFebruary 2004, Ritamadeanapplicationfor full disclosureof documents, and
soughtanadjournment until therequesteddocumentsweremadeavailable. Thejudge, MacKennaHHJ,
refused her application and awarded the GMC almost 3000 in costs as a result. Undeterred, Rita
continued with the hearing, following along as best shecould as the judgeand the Counsel for the
GMC tiptoedthroughthelegal arguments. It wasn't long, however, beforesherealisedthat theGMC's
legal advisors had madeamistake they had served threewhole bundles (to which they werenow
referring) solatethattheyhadfailedtoreachher intimefor thehearing
Shequietly pointedout this breachof court rules to thejudge, who simply put his headinhis hands,
knowingthatanadjournment wasnowinevitable. Althoughshehadsuccessfully representedherself in
court before, andwon, Ritaknewthat shewouldneedlegal adviceif shewas to succeedat thenext
hearing, and sheset about finding first asolicitor, and then Queen's Counsel, who wereprepared to
takethecaseoninthethreemonthsbeforethenext hearing.
Her luck was in, and having located a solicitor, (Mr Richard Price, then of Howells Solicitors) she
instructedhimto findaQC, preferably agoodlookingone, to represent her. Again, her luck was in,
and, after having rejected Keir Starmer QC, now Director of Public Prosecutions, and causing Ben
EmmersonQC tosit downrather suddenly whenheheardthat someonehadbeenrashenoughtosue
theGMC as alitigant inperson, shecameuponRobert Jay QC. Jay was suave, confident, and, most
importantly, hadagapinhis schedulehavingjust settledacasethat hadbeenexpectedtotakeweeks.
Hewoulddo!
As thehearing loomed, andRitasought toeducateher lawyers intheways of theGMC (neither had
dealt withthembefore) shefoundherself facinganewGMC investigation. Someone adoctor had
taken offence at something she had written about them on her website, and, instead of taking
appropriateactionthroughthecivil courts, hadcomplainedtotheGMCthatRitahaddefamedhim.
Ritawassurprisedthat theGMC hadtakenupsuchacomplaint, asshehadtriedtomakeoneinvery
similar terms against doctors who hadcirculateduntruerumours about her onadoctors-only website,
onlytobecategorically toldthattheGMCdidnotdeal withcomplaintsof defamation.
Sheassumedthat, withahearingimminent, theGMC hopedtodistract her fromthepressingbusiness
of suingthemby takingupthis complaint they didn't yet knowabout her legal team. Unfortunately,
thecomplainant had been an activeparticipant in the aforementioned doctors-only website, and had
made a number of online comments that were clearly unbecoming of a doctor. Overnight, Rita
produceddetailedrebuttalsof theallegationsagainst her, together withacomprehensiveexplanationof
whytheywerebeyondtheGMC'sremit, andincludedanextensivecounter-complaint inrespect of the
complainant's conduct on the doctors-only website, before returning to the far more interesting
businessof beatingtheGMC incourt. It isprobably fair tosaythat theGMC werebothsurprisedand
downcast to receive, by return, in excess of 60pages of submissions in responseto acomplaint that
oughttohavekeptRitadistractedfor weeks.
Hearingdaycame, tofindtheGMC'sCounsel, whohadonly learnedthat Ritawasnowrepresented
byaQC, noless thedaybefore, squealingfor thesamekindof adjournment thatshehadrefusedRita
3months earlier. Ritawas in no moodfor further delays, and thrust her feebly protesting legal team
intocourtinfrontof her, ignoringtheir well-meaningwarningsaboutcosts.
Therequestedadjournment wasnot granted, asRitahadknownit wouldn't be theargumentsshehad
given to her QC in favour of holding the hearing that day were pretty sensible. But still the GMC
barrister complained! JudgeMacKennahadmysteriously vanished shortly after hearing that Ritahad
obtainedleadingCounsel, andtheGMC didn't want tohavetopresent theentirety of their caseagain
tothenewjudge, HarrisHHJ.
Unperturbed, theever-suaveRobert Jay QC quickly persuadedthejudgethat it wouldn't beany great
hardship for theGMC to represent their arguments, and, pretty soon, Ritafoundherself engulfed by
their tedious bleatings for a secondtime. But, onthis occasion, they weren't having everything their
own way. On the subject of Rita's mental health, Miss Collier, for the GMC, struggled to persuade
Harris HHJ that there was any reason to question her sanity, while he, in turn, likened the GMC's
attitudetothat of aStalinist regime. Thehighwater mark of mental ill healthpresentedby theGMC
wasatypographical error [ 0600hrsinsteadof 0900hrs].
The judge suggested an amicable, mediated resolution, but Ms Collier insisted that that could only
happenwiththeblessing of theChief Executive, who could not befound. For all her valiant efforts,
judgement wasinRita'sfavour, withasuggestionthat therebeapausefor mediationbeforethematter
proceededtofull trial. Later, bizarrely, theGMC claimedthat it wouldhavewononappeal if it had
appealed. AsRobert JayQCpointedout, theydidn't appeal, and, inanyevent, theylost.
Although they eventually entered into mediation, theGMC resisted acomplete settlement for many
months, until SahotaSolicitors took thecaseto completion on Rita's behalf. TheGMC removed the
memos, issued a letter stating that there were no concerns about her fitness to practise, signed a
chequeand, eventually, droppedthecomplaint fromtheallegedlydefameddoctor.
Despite this successful outcome, Rita feared that her medical career could not survive the GMC's
attitude towards her indefinitely. The Shipman Reforms were coming, and her days as a footloose
locumdoctor, freeof stigmaandrumour, wereshort. Databases intendedto track problemdoctors as
they moved around the NHS would monitor theprogress of a whistleblower just as effectively, and
beforelongtheGMCwouldalwaysknowwhereshewasworking. Itwasjustamatter of time.
Part 3 Never Ending Story
As her case against the GMC progressed, Rita became increasingly disgusted that Professor Rod
Griffiths' so-called investigation into her allegations hadresultedinfindingsthat werediametrically
oppositetothoseof theTrust's owninvestigations, andoutragedthat hehadpersuadedtheGMC that
therewas no basis to her concerns, and even suggested to themthat therecould be some concerns
abouther health.
Shedecided that enoughwas enough, and madeaformal complaint to theGMC about his conduct,
withparticular referencetohisinvestigationintoher allegations, andwaitedtoseewhattheywoulddo.
She was not at all surprised when the GMC rejected her complaint out of hand. In fact, she had
expected it, and had planned for thecontingency by obtaining an expert report into her experiences
fromthewell-knownwhistleblower, Professor SteveBolsin, of Bristol Inquiryfame.
Armedwiththis, RitainvokedRule12of theGMC'soperatingprocedures effectively, areviewof a
decisionmadeby theGMC inlight of newevidenceor procedural flaws. Professor Griffiths enlisted
the aid of the Department of Health's solicitors, whose tortuous submissions sought to conceal
inadequacy withverbosity, but tonoavail. Rita's arguments left theGMC withlittlealternativebut to
reversetheir earlier decisionandbeginaformal investigationintotheDirector of PublicHealth.
After several years of legal wrangling between Rita, the GMC and Professor Griffiths' legal team,
during which Professor Griffiths retired, the GMC finally arrived at something approaching a final
decisioninthecase, althoughsovagueweretheir findingsthat Ritawonderedwhytheyhadbothered.
The GMC response dated the 6
th
February 200 stated As an experienced practitioner, Professor
Griffiths will be aware of the guidance in paragraph 47 of the GMC publication Good Medical
Practice. In future he will wish to ensure that comments about colleagues are not misinterpreted as
unfounded criticism.
It is accepted that the specific case of Mrs EP may have involved a standard of care that was sub-
optimal, as Dr Pal has alleged. Professor Griffiths conclusion that there was no evidence of lack of
medical care for patients (including Mrs EP) is not supported by an examination of Mrs EPs medical
records, nor by the Report of the extended investigation into the allegations made by Dr R Pal in
November 1998 conducted by North Staffordshire NHS Trust. The Case Examiners accept, therefore,
that Professor Griffiths view about the care provided to Mrs EP was inaccurate.
Dr Pal had to leave a critically ill patient to go to another ward in order to find a drip set (a
means of administering intravenous fluids). That this is unsatisfactory is not disputed. The letter of
17/1/05 from his [Professor Griffiths] representative to the GMC responding to the allegations
stated: An alternative available to the complainant was to call a crash team herself and not leave
the patient. The crash team would have had a drip set and would have provided more experience
The statement is inaccurate and, so, misleading. It is noted that the statement was written in response
to the options identified by Dr Pal when she said I was obliged to leave a medically untrained care
assistant in charge of a seriously ill and rapidly deteriorating patient with instructions to summon a
cardiac arrest team in the event that the patients condition became worse before I could return with
the equipment. Crash teams at North Staffordshire NHS Trust did not routinely carry drip sets. It is
acknowledged that it would have been inappropriate for Dr Pal to call the team for a patient who did
not require immediate resuscitation.
Finally, after so many years, anacknowledgement that thesituation onWard87, as presented to the
GMC by Professor Griffiths, was inaccurate, andthat thepatient whoselifeRitahadtried so hardto
saveoneautumnday in1998did, indeed, receivesubstandardcare! But what didtheGMC intendto
doaboutProfessor Griffiths' conduct?Nothing. Notathing.
Furiousthat, evennow, theGMCwasunwillingtomakeanykindof amendsfor their previousactions
by imposing even a minor sanction upon Professor Griffiths, Rita sought to initiate judicial review
proceedingsagainst theGMC'sdecision. However, by astonishingcoincidence, nosooner hadRichard
Price Solicitors issued a Letter BeforeAction on Rita's behalf than the GMC took up a new and
utterly ludicrous - complaint against her with a determination that had been sadly lacking in their
approachtothecomplaint against Professor Griffiths. Ritaandher newly reconstitutedlegal teamwere
forced to abandon their challenge to the Griffiths decision and concentrate their efforts on the
allegationsmadeagainsther.
And the nature of these allegations, that the GMC seized upon with such gusto and clung to so
tenaciously in the face of overwhelming evidence that they were, in fact, unsustainable? On this
occasion, the GMCs legal teamdecided to investigate a link fromone of Rita's websites to a
publicly availabledocument (originally createdby theBritish Psychological Society) onathirdparty
website, andthetitleusedbyRitainaletter intendedtosavethelifeof TheLowickOne - previously
featuredbyPrivateEye andelsewhere.
Geoffrey Monks, formerly the landlord of the Snooty Fox in Lowick, had been mistreated by the
prison service. His medication, previously withheld, had been made available to him after Ritas
intervention. In the letter, written quickly in an emergency, Rita had signed herself off as a
Psychiatrist, which, in fact, shewas. On hearing what theGMC had done, Geoff Monks wroteto
Rita in the following terms: The Letter was a private letter written out of genuine and informed
concern for me. It was both very kind and extremely appropriate. You wrote it not as my Psychiatrist or
Doctor but simply out of astute concern for my medical safety. I remain extremely grateful. All of your
voiced concerns were proved to be entirely accurate. Indeed, I can speculate that I may even owe my
life to the small reaction that it may have raised in the establishment.
HealsowrotetotheGMC, demandingthat theyceaseprocessinghispersonal datafor thepurposesof
pursuingthisblatantly ridiculouscomplaint against Rita. TheGMCrefusedtocomply withhisrequest.
Meanwhile, IT news websiteTheRegister summarisedthelink aspect of thecomplaint as follows:
A mental health doctor is headed for a showdown with the General Medical Council (GMC) in the
High Court because she is accused of breaking confidentiality by posting a link on her blog. Dr Pal
was forced out of her locum job at Worcestershire NHS Trust in early May after managers got wind
that she was being investigated by the GMC over the link. The GMC is the statutary body responsible
for regulating doctors in the UK.
Interestingly, while Rita lost her job, her references and her ability to work in the NHS, and the
GMC insisted in taking the matter forward, an identically worded complaint concerning a second
doctor, Dr Aubrey Blumsohn, who hadpostedaidentical link tothesamematerial onhis blog, was
rejected out of hand: We have carefully considered the information you provided and understand
your reasons for writing to us. However we have decided that this is not a matter that justifies
action under our procedures, as the doctor's profession is incidental to the issue you have raised
with us. You have suggested that Dr Blumsohn has breached confidentiality by including a link on
his website to another website containing information related to the BPS hearing. It would appear
that in these circumstances any breach of confidentiality has been committed by the owner/operator
of the website on which the information appears. In any case, the information posted on the website
does not relate to a patient of Dr Blumsohn and is therefore outside our guidance on
confidentiality.
Quiteso. And, indeed, thesewereexactlytheargumentsthatRitahadput totheGMC inrelationtothe
identically worded complaint against her. However, in her case, theGMC's legal teamtried to argue
that RitaowedaRight toPrivacy totheBritishPsychological Society under Article8of theEuropean
ConventiononHumanRights, asenactedintoEnglishlawbytheHumanRightsAct 1998. Ritaslegal
teampointed out that Dr Pal was not an authority, as required by theHuman Rights Act 1998, and
thereforecouldnotowesuchadutytoanyone.
UnlikeDr Blumsohn, Ritawas subjected to a traumatic 6-month investigation. Each of her referees
referredtoher asaPsychiatrist, theGMC hadreferredtoother junior doctorsintheir pressreleasesas
psychiatrists and theDepartment of Health referred to Junior Psychiatrists regularly. Shewas an
affiliate member of the Royal College of Psychiatrists a position which can only be held by
Psychiatrists. Therewas, andcouldbe, no doubt shewasentitledtocall herself A Psychiatrist. And
yet, inher case, theGMC chosetoinvestigate until eventheycouldnot twist rationality any further
beyond breaking point, and they were forced to concede that, in respect of both of the allegations
against her, Ritahaddonenothingwrong.
Bythattime, however, Ritahadlosther job, hadbeensubjectedtoneedlessinvestigationandhadspent
countlesshourspreparingrebuttals totheGMC'sincreasingly spuriousreasons for carryingontheir
investigation. Worse, shewas nowin apositionwhereshecouldnot truthfully answer No to the
inevitable question Are you, or have you ever been, subject the GMC's Fitness to Practise
proceedings? which is a routine element of job applications in the NHS. The locumjob market is
highly competitive, and, given the choice between two otherwise identically suitable applicants, no
reasonably cautious Trust couldbeblamedfor selectingthecandidatethat wasabletosay theyhadn't
beeninvestigatedbytheGMC.
Realising that her hard-woncareer as alocumdoctor hadeffectively beendestroyed, Ritadecidedto
continueher legal challengetotheGMC's decisiontotakeupthecomplaint inthefirst place if she
could show that the GMC had acted unlawfully in doing so, at least some of the damage could be
reversed. Unfortunately, thewheels of justiceturnever moreslowly, andby thetimethematter came
before Mr Justice Collins (featured previously in Private Eye for his various links to the medical
profession) shehadbeenforcedtofindandinstruct anewsolicitor andlocateaQC willingtotakethe
caseon.
This shehadmanagedto do, only to watchher carefully preparedarguments founder ontherocks of
Collins J's indecisionandmisunderstanding. Inajudgement out of linewithprevious andsubsequent
caselaw, Collins J redefinedproceedings inthecontext of regulatory bodies liketheGMC to refer
onlytohearings, andnot totheentireprocessof allegation-investigation-hearing, despitetheexistence
of precedent tothecontrary. Heimpliedthat misconduct couldbeappliedtoanyconduct (suchas
linkingtoadocument), rather than, ashadbeenlongsettled, conduct impinginguponadoctor'sfitness
to practisemedicine(as theGMC ruledin theBlumsohncomplaint). Heruledthat theGMC hadno
needtoconsider theimpact of aninvestigationonadoctor's employment prospects, and, whenshown
theBlumshondecision, insistedthat it was perfectly OK for theGMC toreachdifferent decisions on
caseswithidentical facts.
Beforeandduringthehearing, theGMC argued presumably by way of avoidingany allegations of
damagetoher career - that Ritahadresignedfromher employment, yet all thedocumentsshowedthat
she had, in fact, been fired. This position was supported by an opinion fromleading Employment
Tribunal Chairman, Oliver Hyams, whereastheGMC reliedonwitness statements fromRitasseniors
(themost senior of whomhad acloseprofessional relationship withthe GMC), who could offer no
documentary evidence of the alleged resignation. Rita complained to the GMC about the witnesses'
conduct, andthey remain subject to theGMC's Fitness to Practiseprocedures at thetimeof writing.
Strangely, during the investigation, theTrust lost Ritas personal file, which may haveshed some
lightonthesituation.
RitacontinuestochallengetheGMC's decisiontotakeupthesepatently ridiculous allegations, andits
apparent right tovarythecriteriafor takingupanallegationatwill (see RvGeneral Medical Council
Ex ParteRemedy UK for another caseinwhichthemeritsof different tests areexamined). Although
sheno longer practisesmedicine, sheis still actively involvedinseekingafull andopeninvestigation
intotheappallingstandardsof carethatshewitnessedonWard87.
TheGMC'sacknowledgement of poor care, basedontheTrust'sinternal investigations, wasawelcome
step in that direction, but those investigations were founded on a very small data sample of just a
handful of patients. Rita believes that the death rate on this ward was routinely high, and that a
thorough investigation is required to determine exactly how many patients died needlessly. As a
whistleblower, Rita was denied important documentation to defend her position. She subsequently
spent nearly 10yearsmakingrepeatedDataProtectionAct andFreedomof InformationAct requests.
Finally winningaFreedomof InformationandDataProtectionAct appeal against NorthStaffordshire
NHS Trust in 2005, Dr Pal was still only allowed to view a redacted copy. All requests to higher
authorities including 10 Downing St have resulted in a outright refusal to provide the unredacted
version.
Unfortunately, themajority of her efforts so far have met with failure. The local Coroner refusedto
investigateEPs death, claiming that Ritahad no right to report thematter. TheHealth Commission
wasn't interestedbecause, it claimed, it wasn't withinitsremit totakeupwhistleblower'sconcerns. The
CareQuality Commissionacknowledges that mortality rates werehighat theTrust intheyears before
2003/ 2004, but claims that any investigation wouldnot nowbepossible. Needless to say, theever-
resourceful RitaPal still hasafewshotsleft inthelocker, andsomeformof inquiryisn't asunlikelyas
itmight seem.
Ward 87 closed in 2005, and while this may have gone some considerable way towards improving
mortalityratesat theTrust, it doesnothingtoholdaccountablethedoctorsandnurseswhoallowedthe
appallingconditionstheretocontinueover aperiodof several years. Someof themhaveleft medicine,
but many moreremainintheNHS, and, for thesakeof their past andpresent patients, they shouldbe
madetoanswer for their actions. Ironically, thebuildingthat wasWard87becameofficesthat housed
noneother thanNorthStaffordshire's most infamous paediatrician, Dr David Southalls colleagues
perhaps there is something to the idea that a building can be cursed, after all! The local television
stationoftenreportsfromthesiteof Ward87ontheissuesof DavidSouthall. Littledotheyknow the
real scandal at theTrust was never uncovered quiteas well as it should havebeen. It was now the
ForgottenGrave.
There is no doubt that being a whistleblower, and resolutely refusing to back down in the face of
substantial opposition fromthemedical establishment, destroyed Rita's career beforeit had properly
begun. Her jobwasforfeit, her friends(if youcouldcall themthat) disappearedandher futurebecame
a constant quest to makea living while avoiding the repercussions of her past. Rita is much, much
happier outsidethemedical profession than she was within it, ever sincetheday she had the nave
temeritytopickupthetelephoneandaskfor moreresources.
Whistleblowing isn't a career move that she'd recommend to any doctor today. Their inherent
unpopularity hasn't changed, and the desire to punish themthrough trumped up complaints is as
strongasever, but theopportunities todosopresentedby post-Shipmanreforms andwider regulatory
powers are greater and more numerous than ever before. There is a distinction between what is
advertisedbythemediaandwhat isactually doneby themedical establishment. After 10years, Dr Pal
managedtovindicateherself duetothepersistent efforts tounearthdocumentationthat requiredletter
after letter tobewrittenonadaily basis. TheGeneral Medical Council wasperfectly happy toplay a
part indiscreditingDr Pal as mad, bad or quite sad. Eachandevery authority hasbeenobstructive
andunhelpful. Dr Pal isnowavindicatedwhistleblower, noonewasheldaccountablefor theatrocities
committed on Ward87. Ward 87 is nowshut and this is the way theestablishment deals with poor
care out of sight, out of mind. Thepatients whohavediedarelargely forgotten. Noonequestions
what went wrong and each authority refuses to informtheir relatives. No one has learned fromthe
mistakes of thepast and no MP wishes to correct theoriginal issues raised in Parliament. Thereis a
distinct establishment reluctancetoaddressthefactthatRitawasactuallyright.
Of course, everyone will recognise BirminghamStrategic HealthAuthority as being involved in the
MidStaffordshireInquiry thesecondhospital affectedafter repeatedwarnings hadbeenissuedmany
years beforeby Dr Pal. Fewpaid attention, few corrected its failings and this lack of accountability
resultedinfurther loss of life. Therearemany Ward87s intheNational HealthServiceandcurrently
theDepartment of Healthrefuses to monitor localised mortality rateandthereis no way of detecting
poorcareinaisolatedwardwithoutrelyingonthegoodwill of awhistleblower.
That said, conditionsintheNHSarecertainly nobetter thantheywerein1998, andtheymayevenbe
considerably worse on some wards. Thereare, without doubt, doctors out therewrestling with their
conscience, trying to balancepersonal commitments withtheir duty to do their best for their patients,
and coming to the conclusion that whistleblowing is the only way to go. For them, Rita has the
followingadvice: Stop. Think. Do you really need to do this, or can you resolve the situation another
way? If not, if a whistleblower you are determined to be, plan ahead. Gather your evidence in the form
of documents, tape recordings, photographs etc., before you shoot your mouth off, because you'll be
amazed how much will change or vanish altogether the minute you say anything. Be sure of your legal
position; research is key, and you MUST take the trouble to read important documents instead of
hoping your lawyers will do it for you. Learn how to obtain documents using the Data Protection Act
and the Freedom of Information Act, and don't be afraid to do so it's your right, after all. Always
have a contingency plan, because sooner or later something will go wrong. Be prepared for a 10 year
battle to extract information to vindicate you. You never know what lies beneath the NHS.