Daily Insight: The high price of truth

In legal fees and compensation, the Macanovic case cost Portsmouth Hospitals University Trust nearly £700,000.

That’s a fair old whack for an organisation, which, like every other hospital trust, is hard pushed to make savings.

To give a contemporary example it would pay for 155 consultant strike cover shifts.

But that’s not the most disturbing part of a case that saw the consultant nephrologist subjected to “a campaign of harassment” after pointing out that patients had come to harm because of a controversial technique.

Internal emails disclosed during her employment tribunal case showed the trust was proud of the “buttonholing” process, presenting at conferences and similar events.

Jasna Macanovic believed a patient had died as a result and others had been harmed, and said so.

This set off a long chain of events culminating in her dismissal five years ago, legal victory last year and the disclosure of the trust’s costs, reported today. The judge at Dr Macanovic’s costs hearing firmly rejected any suggestion she had contributed to her dismissal.

He said: “Where she believed that risks were being downplayed she did not hesitate to describe this as a cover-up or an act of dishonesty”.

The tribunal heard the trust’s Dignity of Work policy was for a whistleblower to be assigned a trust non-executive director to support them through the process. The NED in question was Melloney Poole and the proceedings were told she never got in touch. Ms Poole is now the trust’s chair.

NHS England South West said they had received no complaints about Ms Poole and the lack of support Dr Macanovic had received.

Dr Macanovic was also told by the then nursing director and current medical director during the trust disciplinary process that she could still resign and leave with a good reference.

No one knows how many staff are out there in trusts with good references that are in fact settlements of this sort, offered instead of a difficult process? Not all of them are going to be principled whistleblowers, as in this case.

The process also showed up how weak the Care Quality Commission can be in its role policing care quality.

The CQC assigned a surgeon from a different specialty to look into Dr Macanovic’s concerns about patient safety. Then it wrote to the unit whose practice was complained about and asked for its opinion. Then the CQC reported back; it’s fine, as far as we can tell.

It took a second complaint about patient safety for the CQC to re-open their review, this time consulting with a nephrology specialist. The CQC said in a statement: ”On the advice of that nephrology specialist we asked the trust for further assurances about the arrangements for always ensuring informed consent from patients prior to undergoing a buttonholing procedure”.

It added: ”The trust went on to seek input from an independent external reviewer and took action to strengthen the consent process to ensure safety”

It is not clear if that report is the one Portsmouth is now witholding claiming legal privilege.

In November the regulator opened a second phase of its own inquiry into how whistleblowing cases were handled. This follows the CQC’s unfair dismissal of one of its own clinical advisors for whistleblowing, who subsequently won his employment tribunal.

In one of the emails to his boss, the whistleblowing medic suggested he was expected to act beyond his expertise on an inspection, by assessing the trust on a whole range of surgical specialties from a medical perspective, when he was only qualified to do this in a limited way

In emails between her and Portsmouth colleagues, Dr Macanovic pointed out that in one case where she believed a patient had died as a result of buttonholing, a post-mortem might have proved it. One was never carried out because the work was not classed as a clinical trial. Why not?

Since losing the case the trust has commissioned a report into the “lessons learned” from the case, and its brief told the judge its finding has been shared internally.

When HSJ asked for a copy of the report, Portsmouth refused, saying it constituted legal advice and was thus exempt from disclosure.

It’s not clear what changes to the policies, procedures or rules in a publicly funded body could constitute “legal advice”. And you might assume Portsmouth would be keen to show that, indeed, lessons have been learned.

Either way, this is all quite difficult to square with the trust’s stated “commitment to transparency”.

 

Bribes for sales

A theatre manager has been found guilty of theft, fraud and bribery offences after a seven-week trial.

Hasan Abusheikha, 47, who used to work at St Albans City Hospital in Hertfordshire, was accepting money in return for his trust to procure medical equipment from particular companies.

Two men who worked as suppliers to the trust have also been convicted. NHS Counter Fraud Authority told St Albans Crown Court the total value of offences between the three men was more than £600,000.

Elmo Emanuel was found guilty of bribing Mr Abusheikha. He was chief executive officer of two companies – Implants International Ltd and Xtremity Solutions Ltd – that were both supplying medical equipment to the hospital.

The companies said in a statement: “The evidence shows that the trust, NHS and the taxpayer made significant savings using products supplied by IIL”.

A second supplier, Jawid Khan, already pleaded guilty to one charge of bribing Mr Abusheikha. He was a director of TSI Med Ltd, which is now dissolved.

The three men are due to be sentenced at a later date.

 

This story was amended at 15.19 on Thursday March to reflect that the CQC ordered a second review when contacted again about patient safety, and their second review included a nephrologist.