Unfit for Purpose: The NHS appeal panel that upheld the sacking of Dr Usha Prasad

Earlier this month the appeal panel set up by the Epsom and St Helier University NHS Trust under Mrs Claire McLaughlan rejected the appeal by Dr Usha Prasad, the cardiologist, against her sacking. She is said to be ” unfit for purpose”. For many the verdict was thought to be inevitable given the enormous lengths the trust had gone to dismiss her, but the findings are worth highlighting because it is a perfect example of why this internal system is in disrepute and needs to be scrapped.

The unwieldly nature of the Maintaining High Professional Standards Appeal system set up in 2003 by the NHS is itself “unfit for purpose” as illustrated by an enlightening article in the Health Services Journal by Alastair Currie, a partner with the law firm Bevan Brittan.

“No sane NHS manager would use MHPS”

He wrote: “MHPS is a calamitous mess of a document,” and goes on to say:

“MHPS, at 59 pages, is a bloated mixture of inconsistent policy verbiage and labyrinthine procedure. It seems designed to promote High Court debate … and so it often does. There is a devastating trail of case-law left by MHPS, each case involving a doctor or dentist and their employer becoming miserably entrenched in MHPS for years before landing in the courts.”

“No sane manager wants to touch MHPS, let alone use it frequently or to intervene early in borderline bad practice. It is well known that any attempt to use MHPS risks years of disputes and litigation.”

So it is a supreme irony that the law firm Bevan Brittan is the very company that facilitated the MHPS hearing on the Usha Prasad case. While Alastair Currie denounced the system in the most colourful language, his colleague Tim Gooder, was fixing up the arrangements for the hearing. Still never get between a law firm and their business to make money. I wonder which ” insane” manager from the trust engaged them.

Now to the hearing itself. The report begins with a desperate defence that the three main members of the panel are independent. Claire McLaughlan emphasises that she is a non practising barrister. What she should have said, I am told, is that she is an unregistered barrister because she has never worked for a law firm and never completed any pupillage. The analogy which she should know is that a qualified doctor is not properly qualified until he or she has worked in a hospital.

Dr Zoe Penn has a high flying job as a medical director and lead for professional standards at NHS England and Improvement (London region). She, I understand, has refused to communicate any explanation of the decision hiding behind the “labyrinthine procedure” of MPHS.

And Ms Aruna Mehta, a former banker and non executive director of the trust, I gather was appointed to the trust without any competition for the post.

The panel could not find that Dr Prasad was ” not fit to practice” because she has been both exonerated and revalidated by the General Medical Council. They didn’t even bother to read all the detailed expert findings in the GMC report. So citing the bad relations in the hospital trust between medical colleagues they decided that Dr Prasad was not fit for purpose.

Back of an envelope decision

The relevant paragraph said: “The GMC were concerned with Dr Prasad’s fitness to practise whereas the MHPS panel were concerned about Dr Prasad’s fitness for purpose. The Panel are fully cognisant that these are two different considerations, with different tests, thresholds, processes and outcomes. Fitness to practise distinguishes behaviours which are not in keeping with GMC requirements on good medical practice and therefore may have an impact on a doctor’s licence or registration from behaviours which are not in keeping with a doctor’s ability to carry out a particular professional role. Although the latter do not breach the threshold for GMC action it does mean that a doctor is not fit
for purpose.”

Yet nowhere are these different tests and thresholds explained nor how a human being rather than a system or faulty goods can be classified as unfit for purpose. It is as almost Mrs McLaughlan made the concept up on the back of the envelope just to find anything to attack her. And also safe in the knowledge that the MHPS protects her from explaining herself.

Certainly there are purple passages slamming Usha Prasad’s perceived failings: “Dr Prasad made mediation unviable, refused to participate in a behavioural assessment, made a placement impossible, refused a sabbatical, did not engage with the Trust’s MHPS investigation, responded antagonistically throughout and submitted multiple grievances as a result of any challenge. She appears unable to accept help from her peers but sees everything through the prism of victimhood.”

Yet this is at total odds with reports from Pinderfields Hospital near Wakefield where has received glowing tributes for being able to work there with colleagues while on a placement from St Helier – the report seems to suggest that she is a Jekyll and Hyde figure.

The report does not exonerate other senior figures in the cardiology department. Dr Richard Bogle, who was head of the cardiology department, is criticised: “The Panel were concerned about some of Dr Bogle’s actions and non-actions while clinical leader and how little leadership he demonstrated. He displayed little empathy in relation to the anonymous letters. As the departmental leader he could have undertaken an investigation himself into the relationships within the department.”

Also the inquiry has to admit that the way the trust collected evidence against her to send to the GMC was dubious. “The 43 cases do appear to have been gathered in a haphazard, rather than properly random, fashion. This could be construed as a hunt for evidence rather than a proper audit of clinical care against known gold standard best practise which is properly comparative with others i.e. benchmarking.”

This sorry saga has ended with a popular and competent cardiologist dismissed from the trust and declared to be ” unfit for purpose” as a human being. The truth, as I see it, is that it is the system that judged her that is ” unfit for purpose” not Dr Prasad.

THE USHA PRASAD FILE: PREVIOUS STORIES

 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

https://davidhencke.com/2021/03/10/exclusive-general-medical-council-investigation-exonerates-dr-usha-prasad-of-any-medical-failings/

https://davidhencke.com/2021/04/21/hidden-justice-in-the-nhs-profile-of-claire-mclaughlan-a-doctors-career-terminator-and-rehabilitator/

Professor Jane Somerville; Pic credit: World Heart Foundation

Professor Jane Somerville, a distinguished cardiologist , who took part in the first heart transplant in the UK, has put up this comment on the situation:

This story highlights a serious problem within the National Health Service which needs urgently to be addressed by the Department of Health. The number of new whistleblowing scandals is steadily increasing. It is concerning when dismissal of a senior doctor following a “whistleblowing” event (as in this case) occurs at a time when insecure young doctors and new consultants are worrying about what sort of National Health Service has employed them – and in the middle of the worst pandemic for 100 years! In David Hencke’s excellent factual reports, a BAME consultant, easily bullied by the Trust despite being found by our regulatory body (the GMC) to be ” fit to practice” has lost her livelihood on grounds of not being “fit for purpose”. This interesting phrase does not appear in English Employment Law, and when used applies to services or goods. Perhaps the Trust wishes to show she is as useless as a cardboard box!

Why does the Department of Health or NHS England allow hospital Trusts to do this, to fight whistleblowing staff but fail to address their original concerns or even pay any lip service to them, using vast sums of taxpayers money (>£700k going on £1m in the case of Dr Chris Day, see @drcmday on Twitter) which the “little person”, the doctor under fire, cannot hope to match? In an exercise of gross imbalance of power and taxpayers’ money Trusts respond to whistleblowers by using panels of seemingly prejudiced and dubious panellists and often expensive lawyers.

These bullying Trusts have too much power and no one seems to be able or willing to control their excesses. This is not a unique case. There have been several very prominent examples in the national press over the past 2 decades. The Department of Health should be concerned about the oppression of their vital professionals, unequipped to fight back and often not helped by representative bodies (such as the BMA), or seniors who may themselves be too frightened of a Trust’s retribution. This cannot be a fair outcome for whistleblowers whose primary motives are to preserve and maintain patient safety, often requesting simple as well as fundamental changes and fair but thorough investigation of underlying problems. A Trusts’ response to whistleblowing often seems corrupted by internal bias. The Department of Health turns a blind eye or does not care. Sir Robert Francis QC was asked to report (2010 and 2013) on failings of Mid Staffs management and avoidable loss of lives. He made many (290) recommendations and introduced the Freedom To Speak Up Guardian. Only a few of 290 recommendations were adopted and FTSU process is not functioning as intended. The Dept of Health should be ashamed of ignoring its responsibilities to the NHS, its doctors (and nurses) and the British electorate. Not to mention the huge sums of taxpayers money expended to save face and cover up the initial problems as well as the labyrinthine process itself.

Professor Jane Somerville

Hidden justice in the NHS: Profile of Claire McLaughlan – a doctors’ career terminator and rehabilitator

Claire McLaughlan. Pic credit: Linked In

The National Health Service has a largely hidden system of justice when a health trust is involved in a dispute with a doctor. It holds internal inquiries and appeals in private to decide whether a doctor should be dismissed.

The people who chair and sit on the inquiry are drawn from a list that a health trust can choose. The same people are also chosen and paid by trusts to build up a case against a doctor. The people who get onto the list normally have had a career in the NHS but are now running their private businesses in Claire McLaughlan’s case offering rehabilitation to doctors who have fallen foul of their own health trust.

I have chosen Claire McLaughlan as an example because she has been and is involved in three high profile cases where doctors have challenged decisions by health trusts to dismiss them. They are Dr Raj Mattu, who won a spectacular £1.2 million settlement after being unfairly dismissed for warning about patient safety in a cardiology department; Dr Chris Day, who is still fighting his dismissal for warning about patient safety at an intensive care unit at Woolwich Hospital, and as readers of this blog will be familiar, Dr Usha Prasad, a consultant cardiologist at the Epsom and St Helier University Health Trust, who is currently awaiting an internal inquiry appeal over her dismissal from the trust.

I did offer Claire McLaughlan an opportunity to comment but have received no reply to my request.

From Royal Navy nurse to clinical assessment services

Claire McLaughan’s nursing career started in the Royal Navy before she became Head of Fitness to Practise at the Nursing and Midwifery Council and then moved to the now renamed National Clinical Assessment Service (NCAS) becoming, an Associate Director. There she developed the NCAS Back on Track Services for doctors, dentists and pharmacists between 2008 and 2014. 

She also did obtain a law degree and was called to the Bar but as far as I could ascertain never practised as a barrister despite calling herself a non practising barrister. Certainly the Law Society do not appear to have any records of her working for chambers.

She left NCAS and set up her own business which offers a huge list of services which are listed on her Linked In page. It begins “Claire provides bespoke, holistic services and access to resources relating to performance management, revalidation, remediation, reskilling and rehabilitation for health professionals and the organisations they work in.”

Her company CC McLaughlin Services ( website here) which appears to be run according to the website from their home in Stockbridge, Hampshire, ( though it has a registered office in Winchester), which they purchased according to the land registry for £600,000 in 2010.

The latest Companies House accounts for the firm show that she and her husband, fellow director, Charlie ,have a thriving business. Latest company returns show it made a profit of £137,000. Both directors pay themselves in dividends rather than salaries which is more tax efficient.

While working in the private sector she holds a number of NHS posts including Chair for NHS England’s Performers List Decision making panels( they decide the internal inquiries) She is also an Invited Review panellist for the Royal College of Paediatrics and Child Health and an appointed lay member of the Royal College of Veterinary Surgeons.

Given this stellar series of appointments it is rather surprising that in two cases she has been subject to criticism- and in one case had to apologise.

The first case involved Raj Mattu, a cardiologist with the University Hospitals Coventry and Warwickshire NHS Trust. He was dismissed after he warned of serious patient safety problems at Walsgrave Hospital. He lost his court battle but won an employment tribunal and was awarded over £1m damages in 2016.( see here).

Claire McLoughlan, who appeared for the trust, was criticised by employment judge Pauline Hughes for an important omission in her evidence. The extract in her judgement says:

Her second case was highlighted by Chris Day. She was paid by Greenwich and Lewisham NHS Trust to investigate his claims of patient safety concerns at and was working with M J Rhoddis Associates. They were paid over £40,000 for the work.

Dr Chris Day; Pic credit: Twitter

In a recent letter to the Care Quality Commission Mr Day said that he came to a meeting with them to explain the circumstances of his concerns – only to find afterwards that the record of what happened had been completely altered, important points were left out, his views were distorted and comments attributed to him which he never said.

He got an apology from Mrs Mclaughlan and the record was altered.

Now at the moment Mrs McLaughlan is about to issue her verdict as chair of an internal inquiry on the fate of Dr Usha Prasad, who has already been exonerated by the GMC, so there can no question of patient safety being at risk. There is the question why this appeal is being heard while we still have a pandemic and St Helier hospital has been hit badly by it. It goes against NHS guidance to have it now and Mrs Mclaughlan as chair of the NHS England Performers List should know. Obviously she has not followed NHS guidance in this instance.

Is it a chumocracy?

These internal NHS hearing are areas where journalists rarely investigate but to my mind raise a lot of questions which need answering. Is this rather closed system open to chumocracy? How curious that people can glide between the public and private sector running a successful business on the proceeds? How independent are these people if they are paid by the trust which obviously in all three cases wants to get rid of the doctor concerned?

And most importantly whatever findings come out – they can ruin the professional careers of doctors – and should that be left to a secretive system to decide their fate? And why is all this taxpayers’ money going on these long and drawn out proceedings which are money making troughs for all the lawyers concerned?

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.

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.