Part 3 - Complaint against Medway Primary Care Trust (Medway) and West Kent Primary Care Trust (West Kent)
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Remedy for a former general practitioner who retired on health grounds as a result of the poorly handled investigation of a complaint against her
Background to the complaint
In August 2002 Mrs B took steps to register at the Practice at which Dr D worked. A ‘new patient’ check was required before registration could be completed and was arranged for 3 September. During that appointment an altercation took place between Mrs B and the nurse, which Dr D overheard. She advised the nurse to tell Mrs B that she would not be accepted for registration. Mrs B left the surgery, verbally abusing the nurse as she left. Dr D followed Mrs B into the street, and told her ‘You do not call my nurse a bitch, lady’. The same day Mrs B sent Dr D a letter of complaint, to which the Practice Manager replied setting out the Practice’s view of events.
On 6 September 2002 Mrs B wrote to the Chief Executive of Medway to complain about Dr D, apparently not having received the Practice Manager’s letter. Mrs B wrote to the Practice Manager on 8 September, having by then received her letter, explaining that she had complained to Medway. On 16 September Medway asked Dr D to respond to Mrs B’s complaint letter and informed Mrs B that she could request an Independent Review (Review) of her complaint if she was dissatisfied with the Practice’s eventual response. Mrs B replied that she had already received a response from the Practice, which she felt was unsatisfactory. Medway told Mrs B that she now had the right to request a Review, but did not say they had already asked Dr D to respond directly to her.
After Mrs B wrote back to Medway confirming her dissatisfaction with the Practice’s response, they treated her letter as a request to proceed to the second stage of the NHS Complaints Procedure. Responsibility for arranging a Review was delegated to Kent Primary Care Agency (the Agency) which operated under the management of the then Dartford, Gravesham and Swanley Primary Care Trust (now West Kent). The paperwork relating to the complaint got lost in a departmental move.
On 2 October 2002 Dr D replied personally to Mrs B’s complaint, apologising for the delay in responding, caused by her absence on leave, and setting out her view of the events of 3 September. On 11 November Medway realised that the Agency had not received the complaint documentation, and they forwarded the papers again; Dr D’s letter to Mrs B was not included. On 15 November Dr D wrote to ask the Agency if they had taken account of her letter to Mrs B when considering the Review request. She pointed out that she had never consulted with Mrs B. Two weeks later the Agency told Mrs B and Dr D that a Convener had decided that a conciliator might help resolve the complaint. They did not answer Dr D’s question about her letter to Mrs B, nor address her point that she had not consulted with her.
In January 2003 Mrs B and Dr D were told that the conciliation process had ended, and that Mrs B could still request a Review. She did so. The Practice Manager wrote to ask Medway and the Agency how a Review could be considered when Mrs B was not a registered patient. The Agency responded that Mrs B had the same right to complain as any visitor to the Practice. Medway wrote to Dr D in response to the Practice Manager’s letter; they said they understood that a Review Panel had been convened, but did not answer the question about whether Mrs B was entitled to pursue a complaint. In March Dr D’s representative wrote to Medway, repeating that Mrs B had never been a formal patient at the Practice.
The Panel met in June 2003 and partly upheld Mrs B’s complaint. They said that Dr D had not breached her Terms of Service for General Practitioners, because Mrs B had not been registered with the Practice. The Panel’s report noted that the complaint arose out of Mrs B’s attempts to register, but nonetheless said that ‘such a complaint falls within the guidelines of the Health Service’s Complaints Procedure’. Dr D’s mental state was such that the day of the hearing was her last day in general practice. She took sick leave and was admitted in September to a psychiatric hospital with bipolar disorder. She retired from general practice on health grounds in March 2004.
Dr D complained to the Ombudsman in August 2003, wanting an investigation into the process that had led to the Panel sitting at all. She felt she had been the victim of a ‘witch hunt’ and said that the Trusts’ mishandling of the complaint against her had cost her her career, and significantly disrupted her personal and family life.
What we investigated
- The management of the complaint against Dr D, and whether the resulting stress had led to the deterioration of her mental health and resignation from general practice.
- Dr D’s allegations that both Trusts had been biased against her in favour of Mrs B, had failed to treat her objectively, and had not properly supported her.
- The matter of the jurisdiction of Mrs B’s original complaint, since this was a factor in assessing the adequacy of the Trusts’ management of the investigations.
What our investigation found
- Key documents were not sent to Dr D in a timely manner.
- Medway did not inform Dr D that they had told Mrs B that she could ask for a Review, despite asking Dr D to provide a local resolution letter.
- Dr D’s letter to Mrs B was unreasonably dismissed throughout the investigation because it arrived very slightly late, despite valid reasons for the delay.
- The fact that a Review into the complaint had been arranged was inappropriately disclosed to Dr D as an aside in a letter.
- Both Trusts repeatedly failed to answer Dr D’s reasonable questions about whether they had considered her letter to Mrs B, and whether Mrs B was even entitled to pursue a complaint under the NHS Complaints Procedure.
- We made no finding, however, on the issue of Mrs B’s status as a patient with the Practice at the time of the incident, since the matter turned on technical arguments that could only be settled in a court of law.
- The Trusts’ investigation lacked a sense of perspective and proportionality. It was driven purely by process, with an absence of overall leadership and guidance to determine whether the progress and direction of the investigation were appropriate to the nature of the complaint.
- There was no evidence of bias against Dr D, or that the Trusts had given her insufficient support throughout their investigation.
We concluded our investigation in May 2007 and upheld Dr D’s complaint. The maladministrative handling of the complaint against her contributed to a significant change in the nature of a pre-existing psychiatric illness. There was extensive and persuasive medical evidence to indicate that that maladministration had led to Dr D’s retirement on health grounds.
Outcome
Both Trusts agreed to:
- pay the sum of £25,000 to Dr D to remedy the significant injustice to her;
- write personally to her to apologise for their failings;
and - use our investigation to inform a thorough review of their existing complaint handling procedures, and use the findings of that review to develop an action plan to be agreed with the Healthcare Commission (in its role as regulator).
