Is the UK’s most famous children’s hospital sometimes more concerned about its reputation than patient care?

I was interested to read this week a news piece in the British Medical Journal concerning the senior paediatric consultant Dr Hilary Cass [1]. Dr Cass used to work at Great Ormond Street children’s hospital in London. In 2007, she objected to planned cuts in the number of junior doctors at the hospital. She subsequently filed a grievance claim against the hospital managers, and then launched a claim for constructive dismissal.

She ended up leaving Great Ormond Street hospital in 2009 to take a post at another London hospital. However she and Great Ormond Street struck a deal to enable to train in palliative care (care focusing on the relief of suffering and pain, usually in terminally ill individuals) at the hospital. This was, apparently, so that she could set up a palliative care service at her new hospital.

Documents obtained via the Freedom of Information act reveal, though, that Dr Cass’s training was contingent on her signing a gagging clause, which forbade her making “any statements derogatory of GOSH [Great Ormond Street Hospital].” According to the piece in the BMJ, Dr Cass signed the agreement “under duress.” The agreement stated that Great Ormond Street hospital could cease to provide the agreed benefits, including the palliative care training, if Dr Cass raised “any existing protected disclosure with any third party.”

This, to my mind, is a sorry state of affairs, especially in light of recent news stories in the UK about ‘whistleblowing’ in the health service. What has become clear is that some doctors and other health professionals are fearful of raising concerns about patient care lest they are treated badly and suffer personally and professionally.

Part of the reason I am writing about this story is because it reminded me of an exchange I had last year with Great Ormond Street’s then Head of Communcations, Stephen Cox. He emailed me about a piece I had written here. The story concerns the tragic death of a child which was initially put down to child abuse, but in fact turned out to due to rickets (bone disease caused by vitamin D deficiency). The rickets had been missed by doctors at Great Ormond Street. Stephen Cox’s email asked me to amend my piece, essentially claiming that the doctors were not at fault by failing to spot rickets on the X-rays. He included an amendment from the BBC website (which I think Great Ormond Street had drafted), and suggested I do the same.

I emailed one of the lawyers closely involved in this case (he had acted for the parents) to seek his opinion. In short, he claimed that the doctors simply missed the diagnosis, and this was perhaps they were trained at a time was rickets was thought to be a thing of the past.

I felt the right thing to do was to leave the post as it stood, and I heard nothing further from Great Ormond Street’s Head of Communications.

Subsequently, the child’s parents were cleared of any crime, and a child who had been taken into care was returned to them. The judge who presided over the case, Mrs Justice Theis, criticised Great Ormond Street hospital for what she described as sub-optimal care.

At the time, I felt that Stephen Cox’s email to me was little more than a damage limitation exercise. Reading about Dr Cass’s experience with Great Ormond Street only helps to strengthen this idea in my mind.

References:

1. Great Ormond Street Hospital gagged doctor who raised safety concerns BMJ 2013;347:f4253

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5 Responses to Is the UK’s most famous children’s hospital sometimes more concerned about its reputation than patient care?

  1. Vanessa 5 July 2013 at 12:06 pm #

    All part of the big picture I guess – along with nobody producing research that pin-points problems with certain drugs, vaccines and so on (or non-profit making ways of treating disease) because the funding will be cut. Sorry state of affairs we have at the moment.

  2. Mark Struthers 7 July 2013 at 11:29 am #

    John: thank you for posting this piece, which raises a number of hugely important issues.

    I suspect that infantile scurvy, vitamin D deficiency and rickets, are quite difficult to diagnose in babies and I therefore have some sympathy for the offending paediatricians and radiologists at GOSH. However, in the dreadful case of alleged ‘Shaken Baby Syndrome’ (SBS) you refer to,

    http://bit.ly/ZKlpKR

    … rickets was diagnosed at post-mortem. Despite this, the police, CPS and the ignorant, ‘think dirty’ brigade from GOSH, pressed on with a criminal prosecution and a murder trial that took place more than two years after the baby had died. Fortunately, the young couple were eventually acquitted of murdering their baby after sixty ‘specialists’ had put their various and conflicting medical opinions before a jury over six weeks at the Old Bailey. The whole spectacle was simply obscene.

  3. Mark Struthers 7 July 2013 at 11:46 am #

    John: I suspect the lawyer you contacted was Bill Bache. He wrote a letter to ‘The Times’ in the aftermath of this despicable trial:

    “Sir, I was the solicitor for Rohan Wray during the course of the criminal proceedings against him in which he was alleged to have murdered his four-and-a-half-month-old son Jayden (report, Apr 20).

    At University College Hospital, London, and later at Great Ormond Street Hospital, as soon as fractures had been detected the immediate reaction of the health professionals was that my client and the child’s mother were abusive parents. They were treated thereafter as though they were criminals.

    As a result of the intervention of the police they were prevented from seeing their son or being at their son’s bedside when he died. They were not present at the death. The early assumption that there was abuse distracted those who should have known better from seeking out the real reason for his illness. As a consequence it is likely the treatment that might have saved Jayden was overlooked.

    All the official attitudes were obviously inspired by the so-called ‘shaken baby syndrome’ theory. The triad of retinal haemorrhage, subdural haemorrhage and brain swelling was present in this case.

    It is high time the shaken baby syndrome theory was discarded. It is becoming increasingly discredited. There can be many other reasons for the triad which have nothing to do with abuse. Slavishly assuming that the triad is strong evidence of abuse will result in yet more inappropriate prosecutions and worse, inappropriate convictions. It will lead to more loving families being torn apart for no good reason.

    The only worthwhile scientific truth in these situations is that the best experts simply do not know what really causes some of these deaths. To embark on legal proceedings on the basis of what is still only a theory will continue to lead to untold misery. The Director of Public Prosecutions should revise his guidelines on the subject.”

    WILLIAM BACHE
    William Bache & Co

  4. Mark Struthers 7 July 2013 at 12:14 pm #

    I should point out that Hilary Cass is now president of the Royal College of Paediatrics and Child Health (RCPCH), so her career has not obviously been damaged by her whistle-blowing activities at GOSH. Dr Cass followed Professor Terence Stephenson as president last year. Stephenson is one of those that Bill Bache refers to as “slavishly assuming that the triad is strong evidence of abuse”. Stephenson has also strongly professed his ignorance on vitamin D deficiency and rickets,

    http://www.telegraph.co.uk/news/uknews/1581407/Has-Sally-Clarks-case-changed-attitudes-to-infant-death.html

    And Stephenson, a stout defender of Professor Sir Roy Meadow, has made it clear that he is more concerned for his own reputation and livelihood than in properly protecting children.

    http://www.bmj.com/content/341/bmj.c3672

  5. Mark Struthers 7 July 2013 at 5:00 pm #

    Archie Kalokerinos was an interesting Greek born doctor from the outback in Australia. Professor Terence Stephenson could learn a thing or two from Archie – on rickets, infantile scurvy and the metabolic mechanisms that involve vitamins C, D & K. And Archie could teach the professor a few things about how to protect children properly. It was Dr Kalokerinos who blew the whistle on the uselessness of the medical establishment and their misguided love affair with vaccines. He was ignored of course – and vilified – like all those who blow the whistle on the medico-pharmaceutical establishment.

    In 2008, Archie Kalokerinos wrote a book called, ‘Shaken Baby Syndrome: an abusive diagnosis’:

    http://www.beyondconformity.org.nz/_literature_100424/Archie's_book

    It’s a very useful read and should be very widely read. In it he wrote:

    “While the vitamin C recommended daily allowance might be sufficient to avoid a pre-morbid state called “scurvy”, it bears no relationship to the amounts required for the body to effectively manage essential biochemical processes brought into play after vaccines, toxin exposure, malnutrition, illness or stress.”

    And:

    “I found that the whole vaccine business was indeed a gigantic hoax. Most doctors are convinced that they are useful, but if you look at the proper statistics and study the instance of these diseases you will realise that this is not so.”

    Dr Archie Kalokerinos died last year.

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