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 McLaughlin   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 McLaughlin.

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.

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

Dr Usha Prasad

Just before Christmas I carried a blog on a tribunal held in Croydon looking into allegations of sexism and racism brought by Usha Prasad, the sole woman cardiologist employed by the Epsom and St Helier University Health Trust. The case centred round an anonymous letter by a junior doctor who believed she put patient safety at risk and sent it to the chief executive, the Care Quality Commission, the General Medical Council; Jeremy Hunt, then secretary of state, and one of her patients.

She lost the case at a bizarre hearing presided over by employment judge Katherine Andrews which would only discuss whether the letter was racist or sexist.

But now two very eminent cardiologists Professor Jane Somerville and Dr David E Ward, have come forward to speak out in her defence – and raise much wider issues about how our National Health Service is being run and how trusts are using taxpayers’ money to pay large sums to lawyers to silence people who raise uncomfortable issues they would rather brush under the carpet.

Professor Jane Somerville, now 87, is one of the country’s leading cardiologists. She recently was awarded the World Heart Federation Award for Outstanding Contribution to Cardiovascular Health for defining the concept and subspecialty of grown-ups with congenital heart disease (GUCH) and being chosen as the physician involved with Britain’s first heart transplantation in 1968.

David E Ward has recently retired as a cardiologist at St George’s Hospital, in South London.

Jane Somerville: Pic Credit: World Heart Foundation

This is Jane Somerville’s detailed comment:

“There are many serious problems that are illustrated from this sad report of the ruining of a young doctor’s career as a cardiologist. She was an obvious target for bullying, harassment, and victimization by management at all levels. Why? Because she was Asian (foreign), small and female. This is such easy picking for those in charge to establish a continuous stream of it as indeed is shown over years.

“What is of more concern is the failure of the regulatory bodies and support services on which we have been brought up in medicine to believe they will be there for us to help give advice and support when in need. Just to name a few involved in this case: BMA, legal representation, GMC, MPA or MDU and indeed, the civil law itself. This is particularly important as the offending trust can afford on taxpayers money to engage the best advisors and the young doctor cannot afford to enlist such help.

questioning integrity and fairness of the judiciary

“Now from this case, one is forced to question the integrity and fairness of the actual judiciary. This is something one hopes in a civilised country one would never need to do. However in this case it is clear to assume that what has been reported is true, that the judge was biased against Dr Prasad with more than one example and did not allow relevant evidence (letters) to be shown.

  “It is clear from the beginning of this case which started with simple complaints related to poor bureaucratic and system management which was influencing safety and comfort of patient management and continuing a few months later with acceptance from the trust with anonymous letters from her junior colleague and unacceptable behaviour in contacting one of her patients, that the trust was not interested in being even handed to her and worse, wanted to get rid of her.

bullying trusts

 ” In these current times of enormous difficulty and pressure in the NHS where it is clear that junior staff and nurses are needed and should be valued and cared for, that one must wonder why anyone would want to work in this trust or other trusts who have shown similar behaviour, victimising a young useful doctor. Despite what claimed, doctors who draw attention to something wrong for patients or staff safety (whistleblowing), have little or no protection in the bullying Trust.

The Department for Health with all its talk needs to address this matter urgently and stop just giving lip service to the excellent recommendations (Sir Robert Francis QC) that have been made to them. They must be made responsible for this bad behaviour by trust managers which alas is not unique to Dr Usha Prasad.

Dr David E Ward

Dr David E Ward commented earlier on my blog as aceofhearts44. He is now happy to repeat his view in his own name.

“I know Dr Prasad as friend and colleague. I and a senior eminent British cardiologist have been supporting her cause for sometime. It is astonishing that what was initially an anonymous complaint has led to a chain of events culminating in the dismissal of a small, female doctor of Asian descent. It smacks of bullying, victimisation and other behaviours doesn’t it?
Something is seriously amiss in this story. It needs to be exposed. It’s heartening that a respectable journalist has taken an interest (we tried unsuccessfully to get others involved). Let’s hope justice is done. Sadly I’m not optimistic. We will continue to support Dr Prasad in any way possible.”

Something seriously wrong in the NHS

These are not the only people who are concerned. I have had a number of people contact me – some in confidence – who are raising similar behaviour elsewhere – and want me to look into other cases. Since this is not a mass circulation blog – with the exception of the campaign I have backed for justice for the 1950s born women who are having to wait another six years for their pensions – it suggests to me that there something seriously wrong in the NHS and needs a thorough investigation. Otherwise I would not have such a strong response.

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

Dr Usha Prasad.

Dispute could last a decade

Last week by Zoom I attended a tribunal hearing – just one in a long running saga between the Epsom and St Helier University Trust and their former consultant, Dr Usha Prasad.

This dispute which is by no means over – she has already had one employment tribunal, one employment appeal tribunal, a reference back to the original employment tribunal – and has still to go to a General Medical Council hearing and an another tribunal over her unfair dismissal claim.

The hearing took I attended just one day but it felt to me that I had just stepped into an unreal world of interminable hospital politics. The issue goes back to 2012 and won’t be settled until 2022. And all this, by the way, is being funded by the taxpayer using NHS funds.

Dr Usha Prasad is a well qualified cardiologist who has been popular with patients but ran into difficulties with staff at the trust and complained she was subject to gender and racial discrimination, bullying and harassment. There are also whistleblower issues which are yet to come out at another hearing.

Three years ago she featured in the current trust’s chief executive’s report for receiving a Patient First Gold Badge award for giving ” a wonderful extra five years of life” to an 81 year old patient suffering heart disease. She is pictured here with chief executive Daniel Elkeles.

Dr Usha Prasad with the trust’s chief executive Daniel Elkeles at the award ceremony Pic credit: Epsom and St Helier University Trust

Behind these happy scenes however all was not well. Usha felt she was not being treated well by some of her fellow male colleagues and relations between her and her junior doctor Dr Aran Kumar Perikala were strained.

Anonymous letter sent to Jeremy Hunt

The centre of her complaint surrounded an anonymous letter which turned out to have been sent by him in 2015 to Daniel Elkeles, the chief executive, the Care Quality Commission, the General Medical Council, and to Jeremy Hunt, then health secretary and to one of her patients. It was signed as representing the entire cardiology team at St Helier Hospital and made very serious allegations that Dr Prasad was putting patient safely at risk.

Jeremy Hunt.

She saw this attack by a fellow Indian doctor as sex discrimination and also as racist. It went to an employment tribunal headed by employment judge Katherine Andrews (more about her later) and her complaint was rejected. She appealed to an Employment Appeal Tribunal who upheld three of the letters but said that sending an anonymous letter to a patient and to Jeremy Hunt was going too far. The EAT ordered it to be referred back to the employment tribunal which held a hearing last week.

The hearing was unbalanced from the start. The trust was represented both by a barrister and a solicitor at enormous public expense. She appeared as a litigant in person ( funding herself) but was helped by Philip Howard ,a part time consultant at St Helier, who acted as Mackenzie friend, a pro bono role.

The part time judge, Katherine Andrews -a solicitor – was appointed as an employment judge by Chris Grayling when he was Lord Chancellor in 2013. Coincidently Grayling is also the Tory MP for Epsom and Ewell and is familiar with the workings of his local health trust.

Judge rules clinical judgement is irrelevant

From the start the judge brusquely limited the hearing to the contents of the letter and nothing else. Two other consultants at St Helier, Dr Sola Odemuyiwa, and Dr Ranjit Shail, a consultant physician, who wished to testify about Dr Prasad’s abilities were ruled as ” irrelevant” by the judge as they had no detailed knowledge of the letter. She ruled as ” irrelevant” any discussion about the clinical judgement of Dr Prasad. An issue that her brother in law, Dr Anand Kamath, working as a NHS dentist had committed suicide after being bullied by a primary healthcare trust over a complaint about his record keeping ,when this started, was also deemed to be ” irrelevant ” by the judge.

This left Philip Howard a very limited role to help defend her. His description of the circumstances of Dr Perikala writing the letter were illuminating. He told the hearing that he wrote the letter while all the other consultants were on holiday, did not consult them about it and paid a ” rare” home visit to one of her patients without her knowledge. He was only unmasked when the chief executive thought the entire cardiology department were of that view and other consultants objected. He told the tribunal that the patient had received excellent treatment and had no objections.

You would have thought that he would be the key witness that should be cross examined about why he acted alone and what his motive was. But the hospital trust’s lawyers did not call him and the judge ruled that as it was his belief it didn’t matter whether he was right or wrong. In other words the man can say anything he liked to a lot of important people and as long as he believed it, it didn’t matter a jot.

Not a level playing field

The trust has taken the matter to the General Medical Council where his behaviour could be questioned and certainly the issue of clinical judgement will not be brushed aside there.

The judge ruled against her but she has asked for the whole matter to reconsidered because she has received new information. Some of the time was spent arguing that she had missed legal deadlines to present new information. Given one side is using full time professional lawyers – and she is having to bring a case while still working elsewhere for Mid Yorks Health Trust – on loan from Epsom and St Helier University Trust. – it is hardly a level legal playing field.

Since the first tribunal hearing in 2017 she has effectively been suspended by the trust on full pay and faced losing her job. There are still two hearings to go.

One has to ask why the Epsom and St Helier University Health Trust is spending so much time and taxpayers money on this protracted dispute rather than using the cash to treat patients. When I earlier raised this with the trust they said they didn’t discuss issues about individuals working for them. They have also refused to give me details of how much taxpayer’s money they are spending on disputes.

This story is not over and I shall return to it when there are more developments.