Exclusive: Three year cover up of avoidable heart patient death at Epsom and St Helier Health Trust revealed at employment tribunal

Cardiologist Dr Richard Bogle admits trust should have told the coroner and the Care Quality Commission about the death at the time

Former consultant also says old X ray machines at Epsom Hospital put staff and patients at risk from radiation when they are fitted with pacemakers

Dr Richard Bogle, the former head of the cardiology department at the Epsom and St Helier University health trust, admitted to an employment tribunal that the trust should have reported the death of a 76 year old heart patient to the Coroner and the Care Quality Commission three years ago.

The doctor under cross examination from barrister Matt Jackson described the death as “tragic ” and admitted the trust should have informed both the coroner and the CQC. He said that although he was on ward duty he did not know anything about the patient and ” couldn’t have been expected to know about all the patients at St Helier hospital.”

The details came out at a recent tribunal hearing under Judge Anthony Hyams-Parish, brought by Dr Usha Prasad, a cardiologist who has been dismissed by the trust even though the General Medical Council has exonerated and re-validated her as “fit to practice” medicine. She decided to make two protected disclosures under the Whistleblowers Act after the trust covered up her findings on the death. You can read a series of previous articles on this blog about the battle Dr Prasad has had with senior staff at the trust.

The disturbing case of patient Mr P

The patient known as Mr P was admitted in August 2018.Dr Prasad’s witness statement said :”He died of heart failure on 5 September 2018 having been previously admitted from 5 to 15 of August to Ward 6 which is a ward run by cardiology and respiratory medicine at St Helier hospital. Mr P had been admitted with breathlessness and diagnosed with pneumonia. However, an echocardiogram had been ordered by Dr Foran (Cardiologist) which showed evidence of “severely impaired left ventricular systolic function…. [with a] drop in left ventricular function since last scan, previously mildly impaired.” The echocardiogram was performed when Dr Richard Bogle was assigned to the ward and the results could not have been known by Dr Foran. The pneumonia was successfully treated by the respiratory physicians and Mr P was discharged after about 10 days. The echocardiogram had shown signs of severe left ventricular failure but the results were not recognised by the chest physicians or cardiologists on the ward. The patient was discharged after having largely recovered from the pneumonia during his first admission and then was readmitted on 4 September with severe left ventricular failure from which he died shortly afterwards on 5 September 2018. The certified cause of death was heart failure.”

Dr Usha Prasad

Dr Prasad was assigned by Dr James Marsh, the medical director to write up a report on the patient’s death. Her conclusion was that it was a Serious Untoward Incident Level 5 – that is the hospital caused severe harm to the patient leading to his death. This would lead to a report to the coroner and the CQC. The coroner could look at how the patient died and the issues surrounding it to help prevent other deaths.

What followed were attempts by other senior consultants to water down the report and delay its completion which Dr Prasad refused to do. Those involved in this exercise included Mr Karim Bunting, the quality manager at the trust and Dr Simon Winn, Clinical Director for Acute and General Medicine, She was asked to make the report in her words “inaccurate” and Dr Winn drafted an alternative version. He accepted that a serious mistake had been made by not recognising the result of the echocardiogram but put the emphasis on the lack of communication between the respiratory physicians and the cardiologists. He did not accept it as an avoidable death.

It is not known whether the patient’s relatives were properly informed about the circumstances of the death or which version of the report they have been shown if any. There is a duty of candour if someone has died.

Epsom hospital Pic credit: Epsom and St Helier University NHS Trust

The second disclosure of failings at the hospital that came out at the tribunal concerns serious radiation risks from old X Ray machines at Epsom Hospital – which are used when pacemakers are inserted into patients. This puts staff and patients at risk.

Dr Sola Odemuyiwa, consultant cardiologist at Epsom Hospital from 1994 until 2016, He disclosed how an audit by Dr Abhay Bajpai, – specialist in pacemaker devices and electrical rhythms, appointed to take over pacing at Epsom in addition to his other duties – revealed stark contrasts in radiation levels between Epsom and St George’s hospitals. Using a dosimeter, he compared radiation insertion of a similar number of devices at St George’s. With similar average screening times, the total radiation received was substantially higher (up to a hundred times greater) at Epsom than at St George’s.

He says in his witness statement: “When I saw the histograms – the Micrograys of radiation from Epsom a skyscraper beside which the values from St George’s, looked slipper thin, (I attach the relevant data) my heart drummed against my ribs out of apprehension and angry self-reproach as I recalled with dismay how for twenty years I may have been gorging my organs on X-rays. My anxieties ballooned when I learned that Abhay’s readings came from Libra, the more modern of the two machines and that I was often given the older Endura machine, which emitted even higher levels of radiation.”

“Drs Yousef Daryani and Abhay Bajpai, my colleagues on the Epsom site continued to press the Trust over the safety of the X-ray machines. In February 2016, Abhay presented his audit data again at a meeting between Cardiology and Radiology departments. He thought the machines should be replaced. The senior radiographer said she could not change the past but that the machines were working properly.”

He then sought figures for radiation doses he had received during his career at Epsom Hospital.. “The Radiation Protection department at George’s were most helpful and sent me dose records from 2005 to 2008. Where are the data from 1995 I asked. They said they could not retrieve the data from the archive of the Mirion Technologies Dosimetry Services Division.”

The trust itself is adamant that there is nothing wrong with the machines. A long e-mail trail between the consultant and trust officials ended with the Trust insisting that the machines are safe and regularly checked.

Sally Lewis ” our image intensifiers are old and due for replacement “

Sally Lewis, a radiologist and medical examiner at the trust, wrote to Daniel Elkeles, then chief executive of the trust, saying there had been confusion about the reporting of the differing level of doses at Epsom and St George’s using different methods. She said if they had exceeded safety levels it would have triggered an alert.

She admitted; ” We are well aware that our image intensifiers are old and due for replacement … newer machines will with new technology produce lower dose readings which is something we always strive for.”

Dr Odemuyiwa disputes her findings. He said: “The manager misunderstood the report from the Radiation Protection Service. The absorbed dose of radiation, the amount of energy deposit in a small volume of tissue, and the equivalent dose, the impact that dose has on that tissue are numerically the same. The former is measured in mGy and the latter in mSv or milliSievert. Colon and prostate are more sensitive than the head for example.”

A year after leaving the trust he was diagnosed with prostrate and bowel cancer.

He explained to me in an interview: ” When you are fitting a pacemaker you are lying over the patient and are very close to the imaging equipment. If you are going to receive too much radiation the most sensitive organs to cancer are the prostrate and the bowel.”

Dr Odemuyiwa: ” When you are fitting a pacemaker you… are very close to the imaging equipment”

Since he announced his support for his colleague, Dr Prasad, Epsom and St Helier University Trust have declined to revalidate him so he cannot practice medicine.

The trust were contacted about what they intend to do after these revelations but have not responded.

Epsom and St Helier University Trust say on their pinned tweet on Twitter: “We put the patient first by giving outstanding care to every patient, every day.” Draw your own conclusion.

A second blog will look at what the hearing revealed about the issues surrounding the treatment of Dr Usha Prasad. The tribunal is expected to issue its findings in the New Year.

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Exclusive: General Medical Council investigation exonerates Dr Usha Prasad of any medical failings

Dr Usha Prasad

Dr Usha Prasad, the cardiologist currently appealing against her dismissal from the Epsom and St Helier University Trust, has been exonerated by General Medical Council of any medical failings or putting patient safety at risk.

The decision by the GMC not only rejected a dossier of complaints from the trust but decided that the issue was closed and will not be re-opened again by the GMC.

The decision is part of a long running saga that has been going on for nine years and heightened by an anonymous letter sent by Dr Perikala, a staff doctor, who made the patient safety allegations in an anonymous letter to the General Medical Council, Care Quality Commission, Daniel Elkeles, the chief executive of the trust and Jeremy Hunt, then the health secretary in 2015.

The GMC initially declined to investigate Dr Perikala’s anonymous complaint but the trust has persisted in pursuing her at the GMC.

dr james marsh pic credit: Epsom and St Helier University Health Trust

I understand Dr James Marsh, the trust’s medical director, and Dr Richard Bogle, the lead cardiologist at the trust, compiled a dossier of no fewer than 43 cases which they claimed should be investigated. The GMC narrowed it down to seven cases and sent them for review to a very distinguished consultant at the James Cook Hospital in Middlesbrough whose career has spanned work at Papworth Hospital and Addenbrooke’s Hospital in Cambridge. The very detailed report came back completely exonerating her of any failings. She has also received glowing references from Pinderfields Hospital where she is currently working as a cardiologist after the Epsom trust dismissed her.

Dr Richard Bogle pic credit:www.richardbogle.com

The GMC’s decision comes just as an internal inquiry into her appeal is under way. This is being heard by Claire McLaughlan   an independent consultant, and Associate Director of  the National Clinical Assessment Service with an interest in the remediation, reskilling and rehabilitation of healthcare professionals. The case was also being followed by Dr Zoe Penn, Medical Director NHS England ,London Region and Lead for Professional Standards. She is sitting on the panel with Claire McLaughlan. Ms Mclaughlan runs a private business with her husband in Hampshire.

The fact that the hearing is taking place now is questionable since Professor Stephen Powis, national medical director of NHS England, told health trusts NOT to hold such hearings when the NHS is under pressure from the pandemic. I checked with the press office of NHS Resolutions and they have supplied me with the guidance for such hearings. They really should only be held if there is an absolute necessity and immediate risk to patient safety. Now with the GMC deciding there is no current and immediate risk to patient safety in Dr Prasad’s case – this makes the hearing even more questionable.

Officially the GMC will not comment on personal cases but they did confirm her clean bill of health entry on their public register which is reproduced below. All entries on this register have to be kept up to date on a daily basis. The saga continues but the case being made by the trust looks pretty weak after this decision by the GMC.

There are three earlier blogs on this issue.

They are: A bizarre tribunal hearing on the treatment of Epsom’s health-trust’s sole woman cardiologist

Top cardiologists back Usha Prasad’s fight against ” badly behaving ” health trust

Botched internal inquiry hearing into Dr Usha Prasad at St Helier Hospital as doctors fight death from Covid- 19


Since this blog was published I have had this strong message of support from Justice for Doctors. Here it is:

Dear Mr. Hencke, you are doing an excellent job by highlighting the problems with our NHS and how splendid doctors like Usha Prasad had been treated. It was very courageous of Usha to challenge the wrongdoings and the harsh decisions by our health institutions at a time when the GMC are calling retired doctors to rescue the overstretched NHS.

Without dedicated and committed doctors like Usha Prasad, our NHS will crumble and collapse. The misleaders and bullies will remain to demolish what goodness is left in our NHS. Unfortunately, most doctors retire or change location whenever they were unfairly challenged. Moving away will not solve the problem but encourage bullies and harassers to thrive and do more damage.

In our view, Dr. Prasad has won the moment she decided to stand firm and challenge the discrimination, the harsh and unfair decisions. We congratulate both of you for raising awareness about what goes on in our hospitals and congratulate Usha for her courage and conviction.
Thank you
On behalf of Justice for Doctors

Botched internal inquiry hearing into Dr Usha Prasad at St Helier Hospital as doctors fight death from Covid- 19

Dr Usha Prasad

Epsom and St Helier University Hospital Trust has hit the headlines by allowing the Times (behind paywall) access to their intensive care unit to see the heroic work of doctors and nurses fighting to save people’s lives from the scourge of Covid 19.

This highly commendable act brings home to the public the work of the NHS saving lives and the heartbreak caused by the Uk’s appalling death toll from the pandemic.

Yet while all this was going on the trust chose to hear an appeal by Dr Usha Prasad in the very week when Covid 19 admissions are expected to peak taking away highly skilled consultants away from the front line caring for patients not only fighting the scourge of Covid 19 but from other life and death surgery involving heart, kidney and liver disease. They also tried to take away consultants working for other trusts and a private hospital to bolster their case against her.

Professor Stephen Powis Pic credit: NHS Improvement

The timing of the appeal hearing appears to go against advice from the top of the NHS as prescribed by NHS Resolutions and by Professor Stephen Powis, national medical director of NHS England, NOT to hold such hearings when the NHS is under such pressure.

I checked with the press office of NHS Resolutions and they have supplied me with the guidance for such hearings. They really should only be held if there is an absolute necessity and immediate risk to patient safety.

  The guidance says: “We recommend that serious consideration should be given at this time as to whether alternatives to exclusion or substantial restrictions on clinical practice can be considered, so that the practitioner is not removed from the workplace at a time when there is such immense pressure on clinical staff. “

In Dr Usha’s case there was no immediate risk to patient safety as she is currently a locum cardiologist at Pinderfields Hospital in Yorkshire. There have been no complaints there, quite the opposite, and neither have the General Medical Council ruled she is not fit to practice.

Yet the trust decided to rush ahead with this hearing and not surprisingly, in the current situation, came to grief.

The original plan was for a one day hearing with five witnesses for the trust in the morning and for Dr Usha Prasad’s witnesses in the afternoon. The hearing was organised by Bevan Brittan, a law firm ( more taxpayers money for lawyers). The chair was Claire McLaughlan   an independent consultant, and Associate Director of  the National Clinical Assessment Service with an interest in the remediation, reskilling and rehabilitation of healthcare professionals. The case was also being followed by Dr Zoe Penn, Medical Director NHS England ,London Region and Lead for Professional Standards. She is sitting on the panel with Claire McLaughlan.

It went wrong from the beginning. Instead of starting in the morning, it didn’t start until the afternoon. Two of the five witnesses didn’t attend because, unsurprisingly, they had urgent clinical duties in the middle of a pandemic. None of Dr Prasad’s witnesses were heard as there was not enough time and there will have to be another day set aside for the hearing.

Dr Richard Bogle cardiologist: Pic credit; richardbogle.com

The five people who were due to attend for the trust were extremely busy. They are Dr Richard Bogle, cardiologist at Sr Helier and St George’s ( see CV here):Dr James Marsh, medical director for the trust; Dr Peter Andrews. clinical director and renal specialist; Dr Yousef Daryani, a cardiologist from Ashtead Hospital; and Dr David Fluck, medical director, from the Ashford and St Peters NHS Foundation Trust. The last two did not attend.

Dr James Marsh: medical director. pic credit: Epsom and St Helier University NHS Trust.

Who is missing for the trust is Dr Perikala, the more junior doctor, who made the patient safety allegations in an anonymous letter to among others, Jeremy Hunt, then health secretary presumably expecting he should rush down to St Helier Hospital and put a stop to Dr Prasad immediately. His letter – the subject of three employment tribunal hearings – for some reason does not factor in this hearing.

Altogether I find as a layman this is an extraordinary state of affairs- petty bureaucracy run riot. The tragedy is that this is happening when thousands of NHS patients are dying and medical staff are completely stretched. It undoes all the commendable work the trust has done to bring public attention to how the NHS is doing its best to help people in their direst hour of need.