https://www.dailymail.co.uk/health/article-11204547/Why-medical-regulator-pursuing-one-worlds-leading-cancer-specialists.html

By JOHN NAISH FOR THE DAILY MAIL

PUBLISHED: 22:38, 12 September 2022 | UPDATED: 14:58, 13 September 2022

When Professor Karol Sikora, one of Britain’s most eminent cancer experts, was asked to defend an equally distinguished oncologist, Professor Justin Stebbing, against being struck off by the General Medical Council (GMC), he robustly challenged the claims being made against his colleague.

The brilliance of the world-renowned Professor Stebbing had earned him a professorship at Imperial College London before the age of 40.

His fall from grace began in 2017, when an anonymous whistleblower sent a dossier to the GMC, alleging that he had unnecessarily tried to save dying patients in a manner that was ‘fundamentally inconsistent’ with their best interests.

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The allegation was that he had tried too hard and gone too far. Arguably, this was precisely why some of his patients had sought Professor Stebbing’s care in the first place, after their own doctors had told them there was no more that could be done.

But last November, at the end of the disciplinary hearing, the GMC’s Medical Practitioners Tribunal Service (MPTS) panel ruled that Professor Stebbing’s behaviour had breached ‘the very core of the Hippocratic Oath’, and that his fitness to practise was impaired.

Professor Sikora, 74, is the founding dean of the University of Buckingham Medical School and a former clinical director of cancer services for Hammersmith and Charing Cross

This was despite the fact that hundreds of supporters — families and patients whom Professor Stebbing had treated either on the NHS or privately, and eminent colleagues — rallied to his cause, arguing that this verdict was unjust and testifying to his life-saving work.

The MPTS panel suspended Professor Stebbing for nine months, so he was unable to care for his 150 patients. The GMC had wanted more — it had pressed for him to be struck off completely.

And now the GMC has put Professor Sikora under threat of being struck off, too. He and another expert oncology witness who testified in Professor Stebbing’s defence have been served with notice from the GMC that they are now under investigation. The GMC will not tell them why.

‘Three months after the hearing had ended, I and the other defence expert received letters from the GMC saying our fitness to practise is under investigation,’ Professor Sikora told Good Health.

‘There’s been no hint of what we’d done wrong. They only sent 5,000 pages of transcript from Professor Stebbing’s disciplinary hearing.’

Professor Sikora, 74, is the founding dean of the University of Buckingham Medical School and a former clinical director of cancer services for Hammersmith and Charing Cross.

He has also been a member of the UK Health Department’s Expert Advisory Group on Cancer and the head of the World Health Organisation’s cancer programme. Described as a world expert on cancer, he has published more than 300 scientific papers and written or edited 20 books.

‘It’s the first time in my life I have ever been in trouble with the GMC,’ he says.

The GMC’s letter says: ‘On the basis of the information currently available, we’ve identified areas of good medical practice that have been called into question. We need to find out more information to see if this is correct and, if so, whether your fitness to practise medicine is potentially impaired. Our investigation will involve gathering more information about the allegations that have been raised and your practice as a whole.’

Dr Max Pemberton, a Daily Mail columnist and a full-time NHS psychiatrist, knows only too well how the GMC can subject innocent practitioners to lengthy, stressful investigations that are entirely unjustified. ‘I was referred to the GMC by a patient who made an incredibly serious allegation that I had assaulted them while assessing them in A&E,’ he says

A GMC spokesperson told Good Health: ‘We are unable to provide further information about any cases unless or until they are referred to a full hearing.’

Professor Sikora feels, however, that he knows why he has been put under investigation.

‘The MPTS disciplinary panel didn’t like what I told them. I had an argument with the chairman,’ he says. ‘I had reasonably suggested that the GMC investigation had cherry-picked 12 cancer patients’ cases out of the many hundreds that Professor Stebbing had successfully treated.

‘I pointed out that those 12 cases were a selected sample of patients who all did badly. But the chairman insisted that was not true. He actually shouted at me at one point. I was accused of misleading the tribunal.

‘But as a witness I was simply exercising my right to express my sincerely held, honest belief,’ Professor Sikora adds.

During the hearing, Professor Sikora admitted to mistakenly telling the tribunal he’d obtained summaries of three of Professor Stebbing’s patients’ records himself. In fact, lawyers had provided Professor Sikora with the summaries four years before and Professor Sikora had forgotten this (blaming a ‘lapse of memory’).

He has complied with the GMC demand that he send them details of all his current paid work.

‘The GMC then wrote to all my employers telling them that I am under investigation,’ says Professor Sikora. ‘Of course they are all worried that I’ve done something wrong. How can giving tribunal evidence possibly affect my fitness to practise medicine?

‘This is witness intimidation and in a criminal court it would be illegal.’

That might sound like a strange thing for the GMC to do — and why does this matter to patients?

Critics of the GMC claim that it has a record of persecuting good doctors, while allowing bad and even dangerous practitioners to continue treating patients.

For example, in another recent disciplinary case the council has been publicly lambasted by medical leaders for prosecuting a doctor in an overzealous manner.

In May, Dr Manjula Arora, a Manchester GP, was suspended for a month after ‘dishonestly’ claiming she’d been promised a laptop. The GMC tribunal heard that Dr Arora had requested a laptop for work and been told by her employer’s medical director that no laptops were available, but that they would ‘note [her] interest when the next rollout happens’.

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The stress of undergoing lengthy, potentially career-threatening GMC disciplinary proceedings is borne out by the fact that the regulator’s own statistics show that 29 doctors died while under investigation or monitoring between January 1, 2018 and December 31, 2020 — 20 from natural causes, six from ‘external causes’ (of which five were suicides) and three from ‘unspecified reasons’ [File photo]

Dr Arora subsequently told an IT department colleague that she’d been told she could have a laptop ‘next time [one was] available’, adding that she’d been ‘promised’ one. Despite the tribunal acknowledging her ‘dishonesty was confined to the use of a single word on a single occasion’, and that the case involved no risk to patients, it was deemed that her actions constituted ‘serious misconduct’.

The ruling sparked outrage. The British Medical Association (BMA) called the decision to suspend her ‘incomprehensible’. Its then chair, Dr Chaand Nagpaul, said it was ‘no wonder those three letters — GMC — instil terror in doctors’.

Amid widespread protests, a month later the GMC admitted the suspension was wrong and has taken steps to restore Dr Arora’s full registration.

The Royal College of General Practitioners said: ‘We will be asking for answers as to why the case was allowed to get through the GMC’s screening processes and end in a fitness-to-practise hearing and a sanction.’

A spokesperson for Doctors’ Association UK, which represents frontline British medical staff, said that while justice had been served, ‘this does not discount the unnecessary stress to Dr Arora and the message sent to thousands of doctors that their regulatory body does not think twice before unjustly suspending them’.

Dr Max Pemberton, a Daily Mail columnist and a full-time NHS psychiatrist, knows only too well how the GMC can subject innocent practitioners to lengthy, stressful investigations that are entirely unjustified.

‘I was referred to the GMC by a patient who made an incredibly serious allegation that I had assaulted them while assessing them in A&E,’ he says.

‘The GMC investigation process took 11 months — despite the fact that two police officers were present throughout the assessment I’d performed; two other members of staff also accompanied me; and there was CCTV of the entire encounter which showed I didn’t even touch the patient, let alone assault them.’

Dr Pemberton says that during the investigation his sleep suffered and he lost so much weight ‘colleagues thought [he] was ill’.

‘Everyone who knew me and worked closely with me in my team knew it was ridiculous, but the management were more concerned and I was lucky to have a boss who stuck his neck out and insisted that I be allowed to continue to work unsupervised, as normal, despite the allegations and investigation.’

After months of silence, the GMC wrote Dr Pemberton a letter saying that it did not find evidence and that the case had been dropped. ‘No apology was given,’ says Dr Pemberton.

The stress of undergoing lengthy, potentially career-threatening GMC disciplinary proceedings is borne out by the fact that the regulator’s own statistics show that 29 doctors died while under investigation or monitoring between January 1, 2018 and December 31, 2020 — 20 from natural causes, six from ‘external causes’ (of which five were suicides) and three from ‘unspecified reasons’.

Dr Karen Ellison, a medicolegal consultant at the doctors’ indemnity organisation, the Medical Protection Society, told Good Health: ‘Day in, day out we see the psychological impact GMC investigations have on the doctors involved.

‘We also see the impact it has on their families, their pay, their reputations and their careers.’

She says that fitness-to-practise investigations ‘often take several months — and sometimes years — to conclude’. It took four years for the GMC’s disciplinary system to investigate Professor Stebbing, during which time he was suspended by HCA Healthcare, a private health firm for which he worked.

Lengthy investigative procedures might be justified if they resulted in the GMC protecting patients’ safety. However, recent evidence suggests otherwise.

In June, a public inquiry report criticised the GMC for wrongly reassuring a hospital trust that a neurologist it employed was safe to work with patients, when in fact he was misdiagnosing them and treating them incorrectly.

In 2018, Michael Watt, a consultant neurologist at Belfast Health and Social Care Trust, was at the centre of the largest ever patient recall in Northern Ireland. A review of more than 5,000 patients found that nearly one in five of his high-risk patients had received a diagnosis described as ‘not secure’.

Concerns about Michael Watt’s practice had been voiced back in 2006, but the inquiry concluded that a vital opportunity to stop him was missed in 2012 when the GMC, following an ‘inadequate investigation’, decided to take no action on a patient’s complaint against him.

Thus the trust, wrongly reassured of Michael Watt’s safety, let him continue to practise, said the inquiry chair, Brett Lockhart KC.

The GMC’s chief executive, Charlie Massey, said: ‘We acknowledge that during our investigations we could and should have done more to act on clinical concerns sooner and to share information more effectively with other organisations.’

 In fact, five years ago the MPTS tribunal heard fresh allegations about Michael Watt’s fitness to practise. But after evidence that he had been thinking of suicide, the tribunal allowed him to remove himself from the medical register without a hearing.

The Professional Standards Authority, which oversees healthcare regulators, challenged the decision at the High Court in Northern Ireland, but a judge decided that the decision was not open to challenge.

Other lenient responses include the case of Dr Satyen Singhai, who a GMC tribunal heard was rushed to hospital in January 2019 after bingeing on cannabis, cocaine, whisky and the tranquillising drug diazepam, which he had not been prescribed.

He fell down the stairs, prompting his neighbour to call the police. When officers arrived they had to handcuff him due to his agitated state.

Dr Singhai was taken to A&E at St Helier Hospital in Carshalton, South London, and the consultant who treated him referred him to the GMC. At the hearing last October, he was told: ‘This conduct does not meet with the standards required of a doctor. It risks bringing the profession into disrepute and it must not be repeated.’

But he was only issued with a warning and was allowed to keep his job.

Dr Singhai’s representative told the GMC tribunal that Dr Singhai was dealing with ‘extreme’ stress and bereavement at the time and that he was an ‘excellent’ doctor.

Meanwhile, in May Dr Jigarkumar Dave, who had been suspended for nine months for beating his wife, was given permission to practise again.

At a criminal court in November 2019, the former cardiologist was convicted of assault, made subject to a community order and fined £331.

In July 2021, Dr Dave was suspended by a GMC tribunal. But in May, Paul Moulder, chair of the tribunal, allowed him to return to practice, saying: ‘The tribunal determined that the risk of repetition was extremely low and hence there was no risk to the health, safety and wellbeing of the public.’

He added: ‘The tribunal was satisfied that an ordinary member of the public, appraised of the facts of this case, and having regard to Dr Dave’s considerable insight and extensive remediation, would not be shocked or surprised to learn that Dr Dave was to be allowed to return to unrestricted practice.’

Meanwhile, Professor Sikora remains under the shadow of an inquiry that he believes focuses on the considered professional opinion he was asked to give at a GMC tribunal.

‘My professional indemnifier [i.e. insurer] is taking it very seriously and thinks that I will be put up before a disciplinary tribunal,’ he says.

‘The GMC desperately needs reforming. We need good people to feel wanted in the NHS, not hounded out on spurious grounds at great expense to the taxpayer.’

His opinion is echoed by Dr Nagpaul, who is calling for an independent review into the GMC to address the ‘systemic flaws’ in its disciplinary processes.

Professor Sikora adds: ‘I feel let down by the GMC. It has totally lost its way.

‘If I am hauled before a tribunal, the current pace of GMC investigations means that it won’t be held until 2026 at the earliest. I’ll be 78 then. It’s a bizarre thing to do at this stage in my career.’