Appraisal causes disaster.

 

I’ve written repeatedly here about appraisal and revalidation, and vowed to myself on a number of occasions that I’ve now exhausted the subject, and I’ll put it to rest.

And then along comes another horror story.

This one concerns a doctor who started working in an NHS post in 1991 as a haematologist, who carried on working into his mid 80’s by simply informing his employers that he had made a mistake with his date of birth, and “updating”. He did this more than once until it was noticed that his latest update would have made him just 8 years old when he qualified from medical school.

He duly appeared in front of the GMC, was found guilty of dishonesty and his registration was suspended for twelve months, after which he was restored to the register.

Prior to his suspension he had accumulated a number of adverse incidents relating to his work, no doubt related in part to his advanced age. You would have thought that the Trust involved would have taken steps to ensure his retirement but no. Unbelievably they gave him his job back and he returned to work.

So let’s just summarise

He had a string of adverse incidents

He had a GMC conviction for dishonesty

He was 85 years old

And his Trust gave him his fucking job back!!! With the full acceptance of the GMC!!!

So what happened next should not surprise anyone.

A patient of this doctor required bone marrow sampling and he chose to obtain it by sternal puncture using the device featured in my recent mystery object post. This is a simple procedure and very safe if properly done. DZ himself performed it a number of times as a houseman in the 1970s. It requires some physical force to penetrate the front of the sternum and it is absolutely crucial that the adjustable collar on the needle is securely set at the correct distance from the tip to prevent the operator from “following through” and coming out of the back of the sternum. The correct distance is usually just a few millimetres.

Reading between the lines either, the collar was removed, the collar was not set at the correct distance, or it was not properly tightened. The result was that the doctor went through the sternum and penetrated the heart causing rapid death from haemopericardium and cardiac tamponade. The patient was in her 40s, and was accompanied by her husband, who witnessed the entire debacle.

Naturally the police were involved and the doctor found guilty of criminal negligence. He has been sentenced to three years in jail.

The GMC, and the Trust involved undoubtedly failed in their duty of care to the patient. But they also have a duty of care to the doctor. In restoring his registration, and reemploying him they clearly failed in that duty too. He should have been quietly and gently informed by both that he was being retired, not just for the benefit of his patients, but also his own. As a result of their abject failure a woman died, and the doctor will spend what is almost certainly the rest of his life in prison.

So where does appraisal and revalidation come in here. Well obviously he has successfully navigated these since 1991. Had he not he could not have been revalidated and reemployed. So this is not just yet another case of the process not working in weeding out an unfit doctor. It is far worse. This is a case in which the appraisal and revalidation process actually facilitated the return to work of someone unfit.

Nice one boys.