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The Sick Doctor Defence Apart from assessing sick doctors, the Health Procedure has many other functions. It is a convenient and secretive procedure � useful for many other covert purposes � to protect the establishment. We examine the role of the use and abuse of mental health within the GMC procedures. The material below is based on various interviews and communications with people at the General Medical Council and doctors who have faced various hearings. For many years, the medical defence unions in the United Kingdom have also used the “Sick Doctor Defence” on behalf of doctors facing the conduct procedures at the General Medical Council. This is roughly similar to the criminal law pleading/defence of “ Diminished Responsibility”. According to many sources, the defence unions have used this defence as an idealistic alternative to being “struck off “or perhaps as an alternative to the conduct proceedings. To any doctor facing the conduct proceedings, the idealistic and pleasant image presented by defence unions may well be palatable – but the stark and shocking reality of health procedures is not widely known. The defence unions will usually say “Well, you are likely to be struck off but if we manage to get a psychiatrist to question your fitness to plead then you will be shunted down the health route – where you can be reviewed once or twice and return back to practise”. Life is really not that simple. This really is an elaborate version of the common “ sickie” used frequently by seen in school children that play truant. THE HUNTING GROUNDS Rumour within the medical profession cites a doctors only web forum as a hunting ground for GMC Screeners and GMC Assessors. Prowling the Internet forests of the forum is on occasion a full time occupation for these GMC doctors. Vulnerable doctors speak openly of their anguish, distress and matters affecting their lives within the confines of a private Internet chat group. The provision of companionship away from the outside world leaves many doctors to seek solace and comradeship from their fellow doctors. Comradeship always has a price. Little do they know that a number of GMC committee members actively seek doctors to “ fit up–. From our investigations many committee members are members. of the doctors only web site. It makes their work so much easier. Information travels to the GMC in someway - through meetings in toilets, through whispering campaigns and through memos and telephone calls. Some sick doctors seeking support may well find themselves inadvertently within the Health Procedures. Other alternatives within the hospitals are a group called the “Three Wise Men” developed by the Department of Health and based within each Trust. These provide a informal reporting mechanism to the GMC itself. One such man identified as a GMC Assessor and also a member of the northern Three Wise Men panel is Dr David Goodhead Consultant Psychiatrist Doncaster NHS Trust. These systems are relatively unknown to the average doctor. The reputation of the Health Procedures though is this “Once you are in there, you never come out”. It appears to be a cul de sac for doctors, a dark tunnel with no way out. The Health Procedures are reputed to be draconian with repeated assessments by specialists to assess Fitness to Practise that can potentially go on forever. The process takes so long that doctors often become deskilled. The GMC does not function as a rehabilitation programme for doctors – it functions as an assessment for “ fitness to practise”. The doctor has the option of voluntary compliance or the GMC can force a doctor to comply under the Medical Act. Most doctors feel obligated to comply. GETTING LOST – AN EXAMPLE Dr A once got lost while trying to find a patient’s house during a GP visit - was considered to have “ Possible cognitive problems” and referred to the GMC. The doctor was obliged to comply – and through the procedures see one psychiatrist after another. The doctor has remained within the procedures for almost five years. There has been one assessment after another, which has found no abnormality, but medical assessors state, “she needs to be reviewed and monitored”. The initial complaint on Dr A was two fold – firstly she had got lost once when new to the practise and secondly she had problems using EMIS a complicated GP computerised system (without any training). Dr A went onto pass ECDL ( the European Computer Driving License) without any problems. I jest not – this is the logic of many GMC assessors who clearly have no comprehension of “ real life”. These days “ getting lost “ is a health matter much like writing websites and challenging the medical establishment. THERE MAYBE TROUBLE AHEAD The other function of the Health Committee really is to shunt troublesome doctors – doctors who challenge the establishment. These include juniors who make complaints against seniors are automatically cited as “possibly intemperate and probably paranoid or stressed”. It happens within Trusts and many other medical establishments. THE TALE OF BILL Dr William Stevenson, Consultant Radiologist once stated the following ”Someone phones someone else and fixes whatever they want to fix. Then they can say to anyone "can you prove that such and such an arrangement was made?", and of course you can't, because they do it privately. This is how an organisation dedicated to it's own ends behaves. This idea of claiming that anyone who is troublesome and a thorn in the flesh of some official (and officious) body is mentally ill is not a new one- the Soviet Union operated it successfully for some years. In my case it was not the GMC who claimed that I was mentally ill, but the Medical Director of the teaching hospital Trust in Aberdeen. He made the claim to the Medical Director of my then employer, West Wales General Hospital. This was to cover up some errors on their part- I thought I had them 'on toast' on the grounds that it would be difficult to find anyone less mentally ill than me, and I complained to the GMC, looking forward to slaughtering the said Medical Director and exposing the original problem that I'd been going on about. The problem then was that the West Wales Medical Director, Dr Denholm (who subsequently lost his job as Medical Director, having re-applied for it) then refused to give any evidence to the GMC- i.e. refused to state the truth which was that he had been telephoned by the Aberdeen Medical Director who suggested that I was mentally ill- he stated that he had 'been given legal advice which prevented him from making a statement'. Wow! legal advice not to tell the truth- can this be true? This was after I had already incurred £300 legal costs initiating the proceedings that I would have won- £300 wasted. Wasting money on legal fees is something the GMC is very adept at, except in that case it's someone else's money, and when they run out, they just put up the fees. That's some deal, that Deal 22! Therefore the complaint to the GMC could not go ahead. This will all these wheeler-dealer types have fixed all over the phone, and it's impossible to prove how it was done. When these people think they're going to lose, they will do anything they have to 'shut it down'. No wonder people hate the GMC- we know its devious and incompetent ways. Since then there have been numerous cases demonstrating it's incompetence, but each time they claim 'it's all different now'. It will never be any different. Here I am 13 years later, still not showing any sign of mental illness and still campaigning against NHS 'crapness' in all it's forms” SPECTRE OF MENTAL ILLNESS The advantage of this for the senior is this - it raises the spectre of mental illness and discredits any concern raised by that person. The GMC then spends copious amounts of time mocking the concerns or not taking them seriously. Mind you – why would a GMC clerk question a consultant GMC Assessor? The directives really are from doctors who are usually from well to do backgrounds, who have no understanding of “real life” and who find themselves in the position to abuse their power. Most sit in judgment gloating that there will be no repercussions. The GMC allows them to do this by the sheer lack of accountability. It should be noted that the GMC refuses to investigate screeners or GMC Assessors. Complaints are dropped from that hotplate. To accept a complaint regarding a screener would mean to discredit his or her own. The above happens to whistleblowers, junior doctors and anyone else who is considered a threat to the medical establishment. A close-knit world of doctors – with the sole aim of deviating attention from negligent practise simply by shunting doctors down the health procedures. Its clever, its subtle but it is a clear and present danger and a method not obvious to the naked eye. A prime example of this behaviour is shown by Dr B – Dr B an Asian junior doctor told one of the Royal Colleges that their procedures and policies were discriminatory. The President of this Royal College decided to report the junior (whom he had never met) for a “ health assessment”. By doing this, the concentration of the GMC workers deviates to the junior but lets the President (a consultant) off the hook. This results in questions over the doctor’s conduct sent to his Trust etc and the GMC workers much like drones – missing the motivation of the initial complaint but following “Procedure” blindly. The more this doctor writes in an “ intemperate” fashion – the more ammunition the GMC has to “collect information questioning his mental health”. This method of career assassination of junior doctors has sounded a code of silence throughout the profession. The aim of these seniors is to “maintain the status quo of the medical establishment” . Once you are at the GMC defending your sanity –the perception really is this “Well, the GMC questioned your sanity therefore there must be some truth in it”. The more agitated a “ normal person” becomes in defending himself or herself, the worse the situation appears to the GMC Assessor”. The junior then finds himself or herself in a defence vacuum having to justify each and everything. The law provides very little in terms of a solution and the junior finds him or herself trapped. The spectre of mental illness is a powerful one – staining your character with a stigma that you have to defend for the rest of your life. BLESSINGS FROM THE ROYAL COLLEGE OF PSYCHIATRISTS A normal reaction for the average person is to complain about inadequate treatment received by the assessor or the GMC. You are then faced by an irritating organisational silence and injustice – so you make the effort to complain again. These are the actions of an average human being. The GMC with the direction of their GMC Assessors and Screeners may well consider these complaints as “vexatious” subtly use the diagnosis of Querulous Paranoia seconded by the Royal College of Psychiatrists to discredit the complainant. It should be noted that the all GMC Screeners and Assessors are high in the evolutionary scale of the Royal College of Psychiatrists. These psychiatrists are often fond of “ diagnosing on paper” (against Good Medical Practise) and they often have a taste for playing God. I often wonder whether these highflying psychiatrists have ever looked at themselves in the mirror and considered whether their actions could be construed as possibly psychopathic or even personality disordered. The common person on the ground uses the word “ control freak”. I can safely say I have never come across a psychiatrist in the higher echelons of power (i.e. the prime movers and shakers at the Royal College) that has been an honest and decent human being. Most wish to pigeon hole each individual into the only way that people should behave or react. Anything deviating from that is apparently “Abnormal”. The rest practise the art of “ silence” when you start a debate on these issues. Dr Tony Zigmond Vice President of the Royal College of Psychiatrists is very good at the art of silence. The GMC with the Royal College are happy to manipulate the use of mental illness as a method of discrediting juniors. It has been self evident in Stalinist Russia and is currently gaining momentum in the UK. Harris HHJ in his judgment called the GMC a “totalitarian regime”. Technically though the doctors involved in the case should be labelled as “propagating the totalitarian regime”. Dr Sheila Mann Consultant Psychiatrist Clacton on Sea was solely involved in the protection of what she perceived to be a “threat to the medical establishment”. Faced with the report verifying the whistle blowing concerns initially raised (and ignored), Dr Mann had no comments to make on the issue. The Royal College of Psychiatrists and particularly its Vice President had no comments to make regarding the above issue either. There is no doubt whatsoever that GMC Assessments are “big money” and who would place that in jeopardy to do what is right? Top Psychiatrists have always been motivated by the draw of money. I have failed to meet one who isn’t. Forget truth or justice – what is of course important to these people is their bank balance and the protection of it. All good links between the General Medical Council and the Royal College of Psychiatrists are paved with gold. Royal College of Psychiatrists have never provided a policy to the General Medical Council to ensure that the issue of mental illness is not abused. The issue was brought to the Royal College of Psychiatrist’s attention three years ago but they chose to overlook it. It is interesting to note that they ran an “Anti Stigma” campaign in the public domain but support the use of mental illness to shut down any complainants. They published a piece of flawed research on Querulous Paranoia and supported their colleague Dr Francis McManus who attended a International Law Conference recently. He was given the go head to dub all “complainants to have an element of Querulous Paranoia”. This prompted the Lord Chief Justice to smear all LIPs and complainants with the stigma of mental illness in the Independent newspapers. The important factor of injustice never occurred to the Royal College of Psychiatrists who remain two faced - practising the art of hypocrisy as opposed to Hippocrates. I question the real Stalinist regime – is it the General Medical Council or the Royal College of Psychiatrists? It should be noted that their own ex President Mike Shooter was mentally ill and admitted this in the BMJ sometime ago. He suffered from depression. That of course seems acceptable to the Royal College of Psychiatrists but they seek to support the victimisation of atypical junior doctors who are not mentally ill. Lack of action is identical to silence. The Royal College assumes that the issue will disappear into an ether while they decide to ignore it. When Dr Mike Shooter is mentioned to the General Medical Council or the Royal College of Psychiatrists – there is a deadly silence. Indeed, neither organisation have any idea why they participate in stigmatising juniors for an illness they do not have but seek to accept their brotherhood comrades (with a mental illness) with open arms – free of the stigma of mental illness. The irony is this – the real people with the mental illness usually reside within the Royal College of Psychiatrists. I could name many doctors with a real and diagnosed mental health problem. We therefore question who the real “fruitcake is”? (quoted from a reference on a medical website used by respected medical professionals). This phrase should not be used for mentally ill people in general. It is derogatory and insulting but exhibited here to show the manner in which doctors view mental health. THE DARK HEALTH TUNNEL – NO WAY OUT The Health Procedures is affectionately known as the “Health Gulag”. I have dubbed it “ The black hole”. One cannot be totally unfair with the Health Procedures and the Health Panel because they probably do some good work for doctors who are seriously mentally or physically ill. Of course, there are rumours of doctors who have committed suicide because the GMC procedures are simply too insensitive or traumatic. The main criticism is that it lacks the arm of rehabilitation. The other quality about the Health Procedures is this – it has never been in the public forum and all hearings have been held in secret. Who knows what happens behind these closed doors? Dr J Coleman a previous GMC Committee member stated recently “I have no time for their Health Procedures, doctors get stuck in them and then dispatched eventually”. In the end, doctors are so deskilled that they are asked to voluntarily erase themselves. Faced with the wrath of the General Medical Council, we suspect very few doctors would choose to go down the conduct route. Access to the health route for doctors facing questions on their conduct is a temptation. It also revolves around a subtle form of deception that turns on the use or abuse of the mental health card. A clever twist of words done by the collusion between a tame psychiatrist and the defence union lawyers combined with the use of a blunt instrument like law. Psychiatry is one of those subjects where “ anything goes” if it is backed by the title “ Professor” or “ a raft of degrees” – a psychiatrist can say “ anything”. There is no accountability afterall. THE LOCKED SECRET The vault of the health side of General Medical Council is difficult to penetrate. The sick doctor defence is a locked secret – one that no one speaks of, one that is covertly hinted at. Rumours have been propagated that doctors have been sectioned and left incarcerated in a mental health units. A committee member suggested that “if they don’t know what to do with a doctor, they are taken out of the way”. There is no evidence to verify this either way. The conclusion though remains that the health procedures are something to be avoided if a doctor is not mentally ill. Undercurrent influences within the GMC are numerous. It is now ingrained and accepted culture that juniors stepping out of line will be silenced by the abuse of the mental health spectre. So it seems that in summary there are a number of reasons doctors are marched off into the darkened tunnel of the Health Procedures. The reasons are as follows 1. Serious illness and impaired fitness to practise DR DAVID JARMAN – TAKING A “ SICKIE”. One infamous case is that of Dr David Jarman who made an application to the GMC for voluntary erasure on grounds that he had a “ fear of the GMC”. A Oxfordshire General Practitioner who managed the impossible – he got away from being held accountable to his regulatory body by pulling a very elaborate “ sickie”. This is Oxfordshire wrote on the 21st February 2001 “During a High Court judicial review last year it was claimed that the child suffered from glycogen storage disease and went into a hypoglycaemic seizure on October 9, 1993, at the family's home in The Lane, Gangsdown Hill, Nuffield, near Wallingford. Dr Jarman, of Wallingford Medical Practice, was called to the house to examine Wilfried.Mr Toth claimed the GP failed to treat the child's condition with glucose and instead gave him sedative drugs. He took his son to the casualty department at the JR, in Headington, where Wilfried died a week later” His tale is one of spectacular collusion between Psychiatrists, Defence Unions and the General Medical Council. The beauty of psychiatry is simply this – it is not an exact science. As we will see, the subject is manipulated to suit all circumstances for the right amount of money. The psychiatric assessment of Dr David Jarman is rather interesting. In 1999, he was reviewed by Dr Janet Boakes who stated that Dr Jarman had no known illness. He had also told her “If he is ever forced to go before the GMC - he would rather resign than face the GMC”. We can assume that his motive (with the assistance of his lawyers at the Medical Defence Union) was to take voluntary erasure if he was forced to face a conduct hearing. Following Dr Janet Boakes there were other reports that were never disclosed. Rumour has it that they all stated that Dr Jarman had been well. Finally in 2002. Dr Adrianne Reveley Consultant Psychiatrist provided a report stating that he had a phobia related to the General Medical Council. This is Oxfordshire on the 26th April 2004 wrote “But Harley Street psychiatrist Dr Adrianne Revely said that he had a fear of the GMC and was unfit to attend the hearing” . Interestingly, Dr Adrienne Reveley did not acknowledge anxiety as a psychiatric disorder in Evans v SMG Television Ltd & Ors [2003] EWHC 1423 (Ch) (26 June 2003. Dr Reveley also admitted that she did not have read Dr Jarman’s previous psychiatric reports. In the meantime, Professor Malcolm Weller for the opposition stated that he had mild anxiety and would be well with a short course of treatment. If the diagnosis of “ fear related to the GMC” was accepted by the GMC then every doctor facing the conduct hearing could cite his or her “profound fear of the GMC”. In colloquial terms “Sorry Guv, can’t attend the hearing at the GMC cause I am frightened of them”. By accepting this defence, the GMC set a precedent to all doctors to “take a sickie when the going gets tough” and “ duck the procedures”. All the doctor has to do is gibber away at the very mention of the GMC and bingo the ideal defence is made. This means Dr Shipman could have jumped the conduct procedures by stating he was “ fearful of the GMC”. Dr Shipman had not though been as clever as Dr David Jarman and his legal team. As This is Oxfordshire pointed out “Dr Jarman, who is suffering from generalised anxiety disorder, is appealing for voluntary erasure from the medical register, so he does not have to go through the conduct hearing” Dr Jarman provided the defence that he was not fit to plead. This is Oxfordshire quoted Mary O'Rouke as stating "he was too ill to instruct his legal team or attend the hearing, even though he had the "right to be present and participate effectively". The Medical Defence Union ( MDU) stance was that he was not able to instruct his legal team. Interesting though, all documentation stated(in writing) that the MDU solicitors had indeed been instructed by their client. Dr Jarman had gone to his trusted GP Dr Parker who noted “he was aware his solicitors have put forward something to the court that was untrue". While he was apparently too unwell and unfit to plead or instruct his solicitors - Dr Jarman was up to many things. He was able to go on holidays to India, USA and Wales, run a business, able to attend clinic, was advise PCT on computer equipment. He attended numerous surgeries to discuss information technology. Information Technology Advisor. He was there fore able to do everything – apart from face the General Medical Council. The issue of Fitness to Plead should be examined again in detail. Larkin et al Medical Journal Review 1989 Jan;29(1):26-32. stated that “this study support earlier work which has suggested that psychiatrists have a poor understanding of the issues surrounding fitness to plead and criminal responsibility”. Unfitness is most significantly associated with symptoms affecting comprehension and communication. The fitness criteria could be simplified without loss of power. These results, predominantly concerned with mental illness, may not generalize to the mentally impaired. (Psychological Medicine - 2001 Jan;31(1):139-50). Dr Jarman’s activities clearly implied that he had no problems in communication and comprehension. Dr Jarman was successful in his application for voluntary erasure. This is Oxfordshire stated “Dr David Jarman, of Wallingford Road, Cholsey, became the first doctor to duck allegations of serious professional misconduct under new regulations for "voluntary erasure". Dr Jarman failed to give Wilfred Toth a potentially lifesaving injection after he suffered a diabetes-type fit in 1993. The boy later died”. There was never a hearing or an investigation of the issues surrounding the death of Wilfred Toth. Dr Jarman was voluntarily erased with a full pension and not a worry in the world. He has absolutely no stain on his character. Dr David Jarman may return to medical practise at any time he wishes. The GMC failed to comment. Dr Rita Pal Note Mary O'Rouke Barrister MDDUS and Ralph Shipway of Radcliffes Le Brasseur can be seen in glorious Technicolor performing in the case of Dr Sushant Varma. The issue of Fitness of Plead arose there as well - raised by Mary O Rouke. Interestingly enough Dr Varma has three GMC Assessor reports certifying him mentally fit. Professor Blueglass has a different view while representing the MDDUS. Transcripts are available on request from Mr Mark Ellen LAWYER LINKS Profile
of Mary O'Rouke Profile
of Mr Ralph Shipway DEFENCE UNIONS ENGAGING IN THE SICK DOCTOR DEFENCE 1. Medical Defence Union RELATED LINKS Referring a sick doctor to the GMC Fitness to Plead Shipman Inquiry – Health Procedures WILFRED TOTH COLLECTION Oxfordshire News Declared Conflict The author has been involved in a direct challenge and litigation against the GMC in R Pal v GMC - the first libel and case for breaches of HRA and DPA to succeed at strike out hearing. The hearing was won on a wild card and was the most unpopular win in the history of the media and the medical profession. The author was a whistleblower wrongly advised by Radcliffes in 1998. Moreover, GMC screener Dr Sheila Mann – prime mover and shaker at the Royal College of Psychiatrists made attempts to discredit problems in patient care by questioning the authors mental health – ie shooting the messenger. In 2005 the report disclosed from the Trust into these concerns of substandard patient care verified the issues raised to the GMC by the whistleblower in the year 2000. In 2005, the GMC finally acknowledged that author did not have a possible mental health problem. The author was also a friend of Dr Sushant Varma and was aware of the health card suggested by Mary O Rouke, Radcliffes and Mr Shipway ( Dr Varma’s legal representatives). One presumes there was an effort to repeat history.
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