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Monday, 29 January 2018

A Child Dies. A Junior Doctor is Struck Off the Medical Register. What are the implications for Conventional Medicine?

A junior doctor has been struck of the medical register by the GMC, and its decision has now been supported by the High Court. The decision has caused controversy and consternation within the ranks of the conventional medical establishment. The Medical Protection Society, which represented the doctor, has warned that the case would have "worrying implications for doctors". The medical community is, indeed, angry, with over 800 doctors writing to the GMC about the dangers of 'criminalising' clinical errors.

Note that the concern is about 'criminalising' clinical errors, not a concern about clinical errors, per se!

The Health Secretary, Jeremy Hunt, has tweeted his concern, saying that he was "perplexed" that the GMC acted as it did, and adding that "patient safety must be paramount". He said on the BBC Radio 4 Today programme that doctors needed to be able to express themselves freely about mistakes in order to keep patients safe.

The chief executive of GMC said that this was a "tragic case" - because a family lost their son in terrible circumstances, and a doctor has lost her career. Yet it is important to note that much of the concern has been about the processing of the case.
  • The doctor was a registrar at the Children’s Assessment Unit at Leicester Royal Infirmary in February 2011, the most senior doctor on duty when a six-year-old child with sepsis died. 
  • The doctor was subsequently convicted of manslaughter by the Crown Court in November 2015.
  • The Medical Practitioner Tribunal Service, who investigated the case, decided in June 2017 that striking the doctor from the register would be ‘disproportionate’ and instead recommended a 12-month suspension.
  • The GMC overturned this decision, and accordingly they struck her off the register.
  • The doctor appealed the GMC decision, and the High Court has now confirmed it.
There is partial recognition that the decision is far more significant than a matter of process. It concerns whether doctors should function within what has been called a 'learning environment', where doctors can admit their mistakes and discuss them without the threat of losing their careers. One doctor has been quoted by the doctor's e-magazine, Pulse, as saying:

               "When considering whether a doctor is fit and safe to practise every case must be assessed on its own merits and should not be solely determined by the criminal sanction handed down by the court. Gross Negligence Manslaughter cases are usually complex, involve systems failures, and are devastating for all concerned. A conviction should not automatically mean that a doctor who has fully remediated and demonstrated insight into their clinical failings is erased. 'This appeal decision may jeopardise an open, learning culture in healthcare at a time when the profession is already marred by low morale and fear. We are considering all options in the interests of our member and the wider profession."

This is the second dimension to the case. Doctors do make mistakes, patients do die, and it is important that learning takes place. If a doctor realises that admitting a mistake will lead to dismissal they will not admit the mistake.
  • People do die, it is part of life - the final part.
  • People die who should not die when they are not given appropriate medical treatment at the appropriate time.
It is distinguishing between these two deaths that has been raised by this case. The public was to be protected, not from the inevitability of death, but from death through the lack of appropriate medical treatment. 

Yet there a third dimension to this case which has not been discussed in relation to this case, and many others.
  • Conventional medical treatment is inherently dangerous - and it is dangerous its own, without any help from illness or disease,. It kills millions of people every year who should not die.
So has this doctor been struck off the medical register because of the seriousness of the illness, or a deliberate or reckless failure to provide appropriate treatment, or because the treatment she gave the child was inherently dangerous? Does the doctor represent an ongoing risk to patients because of her incompetence, or because of the dangers of the type of medicine she practiced?

So is public confidence in conventional medicine best served by striking this doctor off the medical register, thereby endangering open discussion and learning, or by allowing her to continue practicing her trade, which is inherently dangerous?

Jeremy Hunt has said that doctors all over the world are always going to make mistakes, and for patients to be safe they need to be able to reflect to discuss such cases openly and freely. Whilst this may be true, such discussions take place amongst a medical profession that fails to recognise the inherent dangers of the medicine they practice. It believes without question or doubt that the treatment it offers is the most effective, and the safest available. It is not! And the safety of conventional, drug-based medicine should be part of the debate in this case.

If open discussion is really required, if patient safety is really paramount, then the value of safer and more effective medical therapies need also to be involved in those discussions.

Certainly the involvement of alternative medical therapies in an open and honest debate in this case would have been useful. It would have discovered that there were alternatives to the conventional treatment of sepsis. Treating sepsis is something that homeopaths have been doing for decades, and for which there is considerable clinical testimony, and 'scientific' evidence too.

Frass M, et al. 
Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit. 
Homeopathy. 2005, 94, 2, 75-80. 

              "In this study, 70 people admitted to an intensive care unit suffering from severe sepsis were treated either with individualised homeopathic treatment or placebo. On reviewing the signs of sepsis, organ failures, need for mechanical ventilation and other parameters at 180 days after beginning treatment, 76% of the patients using homeopathy met survival criteria versus 50% of those on placebo."

Such evidence is routinely dismissed by the conventional medical establishment, as can be seen in this dismissive and deeply unscientific article about this research. 

So if there are 'open' discussions amongst doctors these are closed to conventional medical practitioners,. Alternative medicine is excluded. If there are safer and more effective treatments for sepsis they will not be discussed, leave along offered to patients, even if that means that a 6-year old child has to die.

So if this doctor had not been struck off the medical register it is unlikely that she would have learnt about the homeopathic treatment of sepsis.

Secrecy already abounds within the NHS, and this will be reinforced by the High Court's decision to support the BMC. Yet people are dying unnecessarily on a regular basis, not just because of the failure of an individual doctor, but because conventional doctors practice a form of medicine that is inherently dangerous. There will be no real learning which conventional medicine has a monopoly within the NHS. Indeed, secrecy is a necessary tool for the conventional medical establishment - they need to practice behind closed doors in order to cover up just how dangerous drug-based medicine is.

This judicial decision will probably made little difference to this. Certainly the safest, and probably the most effective treatment for sepsis will continue to be excluded from the NHS, denied to patients. Learning is not happening within the NHS, and patients are not properly or fully protected from the harm caused by both negligent doctors, and by a form of medicine that is inherently dangerous.