An MDU GP member describes how it felt to be subjected to a complaint, claim, NHSE investigation and GMC investigation after the death of a patient. The process took more than five years to resolve. And while he was obviously relieved to be exonerated at the eventual conclusion, he believes cases like this could drive doctors from the profession.
Multiple jeopardy
Multiple jeopardy is a term used by the MDU and others to describe the many different and separate ways a doctor can be called to account by different organisations after a single clinical incident.
Depending on the circumstances, one event could lead to a complaint that potentially progresses to the ombudsman or a claim for clinical negligence, a disciplinary inquiry into a doctor's clinical performance or conduct, an NHS or GMC investigation, a coroner's inquest/fatal accident inquiry (FAI), and even a criminal investigation. Any of the above can also result in media intrusion.
While a complaint or claim can be hugely stressful on their own, doctors in this situation typically experience unrelenting pressure from all directions over many years. Even if one investigation finds they acted appropriately, their ordeal won't be over until all the processes are completed.
A member's story
That was the fate of a one MDU member, a GP partner and trainer at a large practice in England, when a bewildering succession of medico-legal blows threatened his career and livelihood. As he explains, the experience took its toll on his mental wellbeing - but he was grateful to have the MDU by his side every step of the way.
"When the patient died from cancer, their family complained to the practice", he remembers. "We responded explaining what had happened, and at first we thought they were satisfied. It was a surprise when they later went to a 'no win, no fee' solicitor and made a claim for clinical negligence against me, along with a practice colleague, the hospital and another consultant.
At that time, before the introduction of state-backed indemnity, the MDU handled the claim and the claims handler was able to deal with the case in a supportive way. The claim was not successful. The doctor explains:
"After five years, the family dropped their claim, but then they made a complaint about me to the GMC, and the GMC informed NHS England. Because NHSE asked me for a response and closed its case within a week, I wasn't too worried about the GMC initially, so I was really shocked when they [the GMC] decided they needed to look into my practice. It took a long time - another five or six months - for them to complete their investigation."
What made the GP's predicament more upsetting was that he was one of several doctors the patient had seen. "I was actually the one who had recognised there was a cause for concern and requested tests," he observes. "Why was I singled out when so many others were involved?"
The GMC investigates
The GMC investigation progressed to the point where allegations were put to the doctor under formal heads of charge - the Rule 7 stage. By that stage the GMC investigators had spent months gathering information, including comments from the GP and statements from his colleagues. While the GP found the process stressful, with the advice and support of his MDU adviser and the MDU-instructed solicitor, he was able to provide a response to the allegations that included convincing evidence that he was conscientious, reflective and well-regarded by his peers and patients.
"I showed them the reflections I had written, evidence of all my reading, the courses I'd completed, my appraisals, feedback and also my work as a GP trainer. In fact, I used this case as an example when talking about diagnosing cancer in tutorials although I never thought it would come back to bite me like this. I was also very happy that my practice partners and trainees wrote very supportive testimonials - and of course, the MDU were always there for me throughout, which really helped."
I had been trying to carry on as normal, but it was always at the back of my mind
Unsurprisingly, the GMC found no concerns about the GP's fitness to practise and notified him that it was closing its investigation with no action. "I was so happy. It was like a load had been lifted from my head," he remembers.
"I had been trying to carry on as normal, but it was always at the back of my mind, and I'd think about it 15-20 times during the day. I used to worry about how I would pay the mortgage and support my family if the worst happened and try to come up with a Plan B. I did tell my wife, but I didn't say much. I knew she and the rest of my family would be upset and I'm quite a private person, so I never spoke to anyone about what I was feeling.
"In general, I think I'm a strong character who doesn't give in that easily, but the situation definitely affected me. I felt angry inside and I felt I was losing my temper more easily. I'm normally thorough, but I was conscious of being extra careful with everything I did because I felt like I had another pair of eyes watching me. It was a very, very rough time."
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Facing the future
Despite being cleared, the GP remains upset that the case cast a shadow over his life for so long. "I didn't expect things to unfold the way they did, and my practice colleagues were astonished it went that far," he says. "It felt a little bit like revenge when the family went straight to the GMC after they found they were unable to win a claim for compensation. I was also surprised that the GMC had to investigate, rather than it being dealt with locally by NHS England.
"It's very easy for people to go online and make a complaint to the GMC. But as a doctor it's very scary to be the subject of a fitness to practise investigation, and after everything I went through, it's still the thing I worry about the most."
While he had been unfamiliar with the concept of multiple jeopardy before, he believes it's an apt description for his own protracted ordeal. "I had a mortgage to pay, but otherwise I wouldn't have bothered because it was so stressful," he says. "Who would want to be subjected to all these investigations? Sadly, I think doctors who have experiences like mine could easily feel they've had enough and leave the profession."
Interview by Susan Field.
The MDU adviser's perspective
"We never forget the stress caused to our members when they are undergoing investigations. We can signpost them for support, as well as offering advice on preparing a case to get the best outcome.
"It was a pleasure to help this doctor, along with my colleagues in the claims and legal departments, to keep doing what he loved and did well - looking after patients. He listened to our advice and did lots of reflecting and relevant CPD. The testimonials from the doctor's colleagues were heart-warming to read, and I am sure all of this helped him to get a good result.
"We would encourage any member dealing with such matters to contact us at the earliest opportunity. We always aim to make what can be a very stressful and difficult experience more manageable, so our members can see the light at the end of the tunnel and are able to get back to their chosen profession."
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