For those of you who like Breaking Bad, this the third in the Persecution Murder Mystery series. Without giving away the plot, it jumps right to last week. It has been adapted from a letter to members of the House of Commons committee on harassment in the NHS. The second part of the letter will feature later in the week – Harassment: From Rolf Harris to James Coyne and Doctor Who. Click on the image to read the text.
The many ways in which NHS staff can be harassed if they express concerns about patient safety have only recently begun to be recognized. The GMC however do not appear to have mechanisms in place to manage their potential role in this.
The GMC initial assessment process has a prejudicial default. It is calibrated on a scale from neutral to significant complaint, when the scale should run from harassment through neutral to complaint. The fact that GMC’s procedures self-evidently do not do this makes them wonderfully fit for the purpose of harassment.
In any reasonable universe, faced with such a blatant case of harassment in the materials they received from me four weeks ago, which will be posted over the next few weeks, the GMC should consider taking an action against someone in BCUHB.
If this is not what happens and GMC indicate they plan to investigate me, the question as to what is going on, a question that currently applies to BCUHB, will apply to GMC also, and will scream that larger forces are at work.
In such circumstances, do nothing and my fate lies in the hands of people who have proven themselves capable of considerable malice.
I cannot ask GMC’s advice on how I might “constructively” not participate as GMC do not seem to have a policy on or procedure on how to do what I am proposing.
Some might say wait till the current GMC process runs its course and concludes in my favour but if the GMC process goes on to the next step this will have been a mistake. It seems better to act now in mid-stage rather than wait on GMC.
Anyone contemplating how GMC might come up with a procedure to manage situations like this are going to be better placed to come up with the right answers if faced with the issues more clearly in real time than if contemplated in retrospect when the urgency is removed from the situation, damage has already been done, and goodness only knows what other forces have muddied the waters with what other material.
In cases like this, GMC are always going to have to make a judgement under uncertainty or else concede it is impossible to have a procedure that enables them to avoid being used as an unwitting accomplice to a harasser’s agenda.
The situation parallels the sexual harassment and abuse cases from Rolf Harris to Max Clifford that we have seen linked to the BBC in particular over the last year. GMC like BBC have hitherto been relaxed about the problems.
If they are going to have a procedure they need to forge it now in the white heat of a moment like this.
Meanwhile in another part of town
Meanwhile ‘forgeries’ on the BCUHB side appear to be coming thick and fast. Staff in the mental health team where both Tony Roberts and I work have been told to notify management about everything that might form the basis of a possible complaint against Dr Roberts or myself.
Some weeks ago, a letter to me addressed private and confidential was opened and almost immediately put into the hands of an individual previously involved in marching staff out of jobs here on spurious grounds, and other egregious breaches of natural justice – see POVA.
This commandeering of private correspondence has led to an investigation about the inquiry the letter contained that I only found out about by accident. The private correspondence was about a misunderstanding. I may well put the entire correspondence up on this post, but for the moment the key point here is the pressure that I, and other colleagues, are operating under.
A recent death kick-started an SUI – serious untoward incident – investigation, even before the person was buried. The problem with SUIs in BCUHB is that investigation panels selected by management regularly come to conclusions without bothering to interview the clinician or others involved in the care. They send all kinds of conclusions to coroners or the GMC, KGB or FBI without the person at the center of the case being aware of anything – even that there has been an SUI.
In this case, the person who died hadn’t been seen by me for almost two years – but that’s no guarantee the panel in their wisdom won’t forward a complaint to the GMC.
Weirdly beyond SUIs, it seems that BCUHB managers have access to material from confidential discussions – for instance with ACAS – that they should not be privy to.
There is no way I can be certain that GMC processes are immune to the reach of BCUHB, until the basis of that reach is established. This is something GMC will likely shrug off but should not.
Whatever uncertainty GMC think they are facing on these issues, and stress it might cause them, this is minor compared to the uncertainty that Anne Ward and Shyam Kishto and Tony Roberts and pretty well everyone in Hergest are operating under.
Despite two years of trying to sort the problems out, the malignancy at the heart of what’s going on here – which will be laid out in full details over the next few weeks – is alive and dangerous.
Betsi Cadwaladr: A health board scared of its patients and staff?
I am asking GMC to break new ground, but there is another novelty worth putting on the map. It would not surprise anyone here if some of the managers were to plead that they are being bullied. Indeed they might use posts like this as the basis for their complaint. Being in the light is “traumatic”. This case is so full of novelty it’s almost to be expected.
Staff here have all had fliers through during the last year for courses educating managers on how to avoid being bullied or intimidated by staff refusing to do as ordered.
There is other correspondence that fit this template.
Most interestingly in December 2013, there was a strange HIW (Health Inspectorate Wales) review of the Hergest Unit. Against a background in which the review team failed to note that there were thirty-five whistle-blowing nursing staff and failed to spot the use of POVA in an egregious breach of employment law, the final report states that:
Management do not feel empowered to initiate change and bring leadership to the unit – the reasons for this must be fully explored and strategies to resolve it must be implemented.
When the notes behind these reviews become available, under Freedom of Information requests, it appears that comments like this in HIW reports are close to simple transcriptions of what management says to HIW without any critical assessment as to whether management are the problem.
The report is consistent with a de facto HIW view that whistle-blowers need to be silenced. This may be a Welsh Government view.
This December 2013 HIW report was followed by what to most staff seemed an inexplicable directive from somewhere in Welsh Government to close the Hergest Unit down.
To the last syllable of recorded meaninglessness
It is essential to underline the motivation that staff such as Anne Ward, Shyam Kishto and the rest of my nursing and medical colleagues have had that has led us to stick our necks out and put our jobs and reputations on the line by raising concerns over an extended period. We have been trying to put right system problems that have serious safety and quality of care implications for patients. Our collective activity should be a clear safety signal.
We have been distressed at management responses that do little but tick a box again and again and again to the last syllable of recorded meaninglessness.
It’s hard to believe but the fundamental problem seems to be that BCUHB management is scared of its staff and patients:
- The one group of people who could tell Betsi where services have slipped up – families – have no input to SUIs.
- Only staff selected by management have input in HIW reviews – and HIW is not independent of Government.
- The Betsi Board believe everything they are told by CPG management – they have no interest to hear from the rest of us.
- The Betsi Board was dissolved recently, the CEO and Chair let go, with one of the criticisms being that the Independent Members of the Board were non-functional – they still seem to be non-functional.
There is no possibility of real feedback, of engagement, and the sense of common purpose that might come from that.
This disconnect from reality must be what gives rise to a palpable sense from the Board down through CPG management of semi-psychosis. There are many other elements that maintain the paranoia, such as diktats from Welsh Government, the fact the Health Board is all but bankrupt, the fact that management comes with salary perks, but it is difficult to weight these from outside the bunker.
Seems like they find their staff and patients revolting.
I don’t think the bureaucrats are mad, just ruthless and corrupt. In the Emperor’s New Clothes the courtiers are not really mad or delusional they just know what to say. Is the Emperor himself mad? The Emperor’s problem is that people just tell him what he would like to hear, so he ends up stupider than a small child. People need personal myths in order to preserve themselves. Generally speaking the Emperor needs to believe that his being Emperor is of universal benefit, and everything must be done to disguise the fact that it isn’t.
Of course, with the GMC there are no rules at all and they will find things if it suits them – and if they can get away with it – which are plainly impossible. Some of it might get cleared up to no practical purpose in the High Court years down the line. This stuff is awful, and so familiar.
I think there is a new element in this– that takes us into territory not covered by fables and myths–
Friday– in a leading U.S. Newspaper, the CEO of a ‘family/corporate health care system’ makes a plea for the creation of “a cabinet level agency” that will step up to the plate with adequate funding to support — what he calls “a behavioral health emergency”. Just so happens, his ‘health care organization’ has taken proper account of the crisis and has sprung into action:
“… we needed to centralize and coordinate behavior health into a specialized *autonomous and empowered team* (my *’s) whose goal is to TAKE A HOLISTIC, LONGITUDINAL VIEW OF THESE PATIENTS.”
This is a CEO asking for ‘government’ to respond to his assessment of crisis and his ‘word’ that his organization is probably the most deserving of this new source of funding.
I am caught in this health systems struggle to fund behavioral health. I know that the CEO has no direct input from frontline staff , struggling to deal with poorly staffed units– now overrun with inexperienced ‘cheap labor’. and systems problems that are continually ignored.
I know that department/nursing/unit management is truly autonomously operating outside the guidelines for patient safety set forth by local regulatory/licensing agencies AND violating even minimal guidelines for resolving reported incidents on the units set forth in the contract with our nursing union.
Should be obvious. This is the set up for management to dispose of anyone who can expose THEM.
This is not a tale of the weaknesses and flaws. inherent in human nature. It is a deliberate enacting of the very antithesis of what it means to be *human*,that is; the willful disengagement from any attempt at *rational* inquiry!
Persecution and exploitation of vulnerable people is not an ‘oops, sorry’ situation. Intent matters and premeditation evokes the most severe punishment for murder.No wonder the cover ups are becoming the major focus of management, administration, regulatory agencies— even government??
And while the CEO of a leading American health care organization is telling the public he hopes to deal with the marginalization suffered by the mentally ill and drug addicted members of society by forcing the government to create a separate agency that will fund his *team’s* holistic approach to *these patients*– I think he is merely banking on government responding to the need to warehouse the *dregs* of society.
WHO amongst us knows how little consideration has been paid to the safety, well being– even the health of the patients locked up on *behavioral health wards*?Pretty much a no-brainer– right?? Seek out the frontline staff, patients, families– right?
WHO wouldn’t employ such a simple, direct, caring approach??
Thank you Sinead for the fight you’re putting up — and letting us know about it! I heard about the for-profit “Steward Healthcare” chain a few years ago when the Nurses Union went to Wall Street to protest their buyout of a nonprofit Catholic hospital group. Steward is owned by a private-equity fund called Cerberus Capital Management. (Yep, Cerberus, the three-headed hound who in Greek mythology guarded the entrance to Hell. He’s a very fitting mascot for the Fund.)
Now it looks like they’re heavily investing in psych facilities to supply what they think the insurers selling policies under the Affordable Care Act will want: psych care that’s streamlined, low cost and standardized in every detail. They’re hoping to cozy up to the Medicaid program for the poor as well. This Business Week article gives a pretty good breakdown:
http://www.businessweek.com/articles/2013-08-29/private-equitys-hospitals-a-business-model-for-the-obamacare-era
The fight you’re waging is really the same one David Healy’s been trying to push forward on this blog — and the one he & his colleagues are facing now in North Wales. This model means replacing care for human patients with “algorithms” — and in particular, replacing people with pills. That’s true across the board in health care, but nowhere more than in psychiatry.
As a psychiatric inpatient 30 years ago I got a fair number of pills — but I was also able to be hospitalized in a well-staffed unit with activities. Three times. It was far from perfect, but it kept me alive. Today almost no patient in my shoes would have that chance. I think it’s one big factor driving doctors to prescribe these paralyzing “cocktails” of five and six drugs, especially antipsychotics, to more & more patients. Drugging the patient to the gills begins to look like the only way to keep them safe — or at least keep your own ass covered, should they not be safe.
Sure looks like Hades to me.
Johanna, your experience as a patient on a well-staffed unit with activities supports my observations as an nurse, noting better outcomes for patients who are receiving treatment and care– also a reduction in the use of drugs, seclusion and restraint, when patients are in an environment that provides them with what I call, *signals of care*.
If you then consider the compelling evidence for reducing the use of psychotropic drugs, it follows that the best care and treatment for patients on an inpatient psychiatric unit would center on staffing– quality and quantity.
Here’s the *mystery*– How do we explain management practices that do not reflect care that is proven to be the best for the patients? Keeping in mind that there are managers with nursing background on the first tier of this group- advanced nursing degrees are usually required. These are the nurses one expects to be aware of *compelling evidence* for changing trends in patient care/safety. And, of course, we all should be able to expect that the psychiatrists are staying abreast of any specific dangers inherent in the treatments they prescribe. So, how do we come to grips with management practices that de-stabilize an inpatient psychiatric unit?
Is there some reason why the majority of inpatient psychiatric units STILL subscribe to the philosophy that psych drugs ARE the treatment– the more, the better?
Any for- profit behavioral health care *business* is certainly going to aim for the management practices that promote psych drugs as the main attraction. There is no profit to be gained from providing the care that will best meet the needs of the patients. AND, this needs to be addressed as *criminal*,[imo]– exploitation of a vulnerable population that the service providing business is harming — for financial gain. That is a crime.
But, what if academic medical centers providing inpatient psychiatric services are no better in managing their units? What if the same philosophy of treatment =psych drugs prevails where we should be able to expect even greater vigilance over potential harmful practices? How do we begin to understand, what now amounts to, deliberate negligence of hard scientific evidence on the part of academic/teaching hospitals ?
The big profits to be made in the business of behavioral health come from pharmaceutical companies. Period. No mystery there— and a *warehousing* approach to behavioral health care will definitely ensure that psych drugs will be the *proven* means for keeping the unit *safe*.
I would imagine that an academic setting, beholding to financial contributions from pharmaceutical companies might actually be the model for an enterprising, business-minded doctor. Or so it seems in the case of the CEO of Steward Health Care.
I was on the Nevada State Board of Psychological Examiners for 8 years (1990 to 1998). Our primary responsibility was protecting the public from incompetent or unscrupulous practitioners, a responsibility that is similar to what I imagine the GMC is charged with. We were earnest in carrying out our responsibilities but occasionally someone would file a frivolous or malicious complaint with the board following an undesirable legal outcome, for example in a child custody case. In such a case, the complainant was sometimes trying to use the Psychology Board to punish a professional in a disputed legal case, even though the practitioner had performed professionally and competently. We, as a board, were determined to not let ourselves be used to inappropriately extract revenge for an undesirable legal outcome when a professional behaved appropriately in a court of law. After reviewing all complaints carefully, the board would sometimes conclude that the complaint was not supported by the available evidence and therefore dismissed it. I hope the GMC will also not let itself be used by the pharmaceutical industry to punish legitimate industry critics with frivolous complaints. That would indeed be a tragedy. The GMC hopefully will realize that the goals of such critics and those of the GMC are aligned in protecting the public.
David Antonuccio, Ph.D.
Professor Emeritus of Psychiatry and Behavioral Sciences
University of Nevada School of Medicine
Reno, NV
Dr. Healy:
It was just a matter of time. Good luck and God bless you, my friend!
Clark Baker
OMSJ