I have been asked to provide a comment on the current ongoing case of the GMC v Dr H Webberley. The Tribunal hearing is being held at the Medical Practitioners Tribunal Service (MPTS).
Firstly, this blog is an opinion on matters as they proceed, and I have no part in the case. I am merely viewing aspects from the outside, like many others. I am preparing this in a non-professional capacity, but I do have some experience in giving expert evidence at tribunal over many years. I am getting updates from ‘live Tweets’ from the hearing provided by the Tribunal service and will see if I can get a press update as well. I am also thankful to @truesolicitor for their updates on this case.
In this case, and current tribunal hearing, Dr Webberley (Dr W) is accused of practising medicine outside the rules and regulations of the General Medical Council (GMC) during the period March -November 2016, A failure to hold a proper safeguarding policy, and (2018) a failure to be registered as a practice in Wales. But there is more to it than that.
Today’s update is from day 11 and is brought to you by running backwards. I was going to wait a few days and review a longer period before preparing part 3. However, I had suggested Day 10 (Friday) was quite a strange day. Well, Day 11 (Monday) became stranger still. Even, "curiouser and curiouser" as Alice would have said.
Today was supposed to be about the questioning of a key witness in this matter and one taking the stand for the GMC (The red team).
The key witness, Dr H, had compiled THREE key reports into the operations of Dr W. As such, it was likely Dr H would be in the witness stand for some time.
A key piece of background here.
Some of the allegations against Dr W and her ‘malpractice’ were when she was employed by an online prescription practice known as Dr Matt limited. This practice was subject to a short notice CQC inspection and report in, or about, April 2017. Dr W no longer works for this practice. The practice no longer trades. That is important as will be seen.
Don’t forget, the CQC inspection was AFTER the period that the alleged offences took place and, arguably, isn’t relevant information. They may infer the practices in 2017 were the same as 2016 but can’t really prove that fully.
The day started well for the red team. Dr H was sworn in and SJ started his line of questions, to ‘establish the facts’ Initially, he was endeavouring to establish that Dr W had prescribed incorrectly and without due consideration and/or appropriate record. SJ was showing that information had been missed and this had created the errors from Dr W. Particularly surrounding patients C & D.
IS (the blue team) was given his chance to question the witness, and to explore the arguments and find holes in his statement.
This he quickly did, and this then led to the red team looking for the handbrake and reverse. It was established that the records seen by Dr H in compiling his THREE reports were incomplete. Woefully incomplete in fact.
Why? You ask
Well, several reasons.
The CQC (Care Quality Commission– the government review body) Report was incomplete in that not all the information from it had been passed on. It is understood not all the right information was requested at the time of that inspection and, it seems not all the report information passed to the consultant.
The records from Dr Matt Limited, had been passed to another ‘secure’ organization (Etail*) when Dr Matt Limited ceased trading. It transpired that those records had been destroyed by Etail within a few months of receipt. They suggested the data had been passed to DMC (the parent Co) but those records are not with DMC.
This is not good.
*Etail is an online e-commerce web management company.
Some admin records exist, but these contain very little medical information. Any assumptions drawn from that information by Dr H (or others) is on shaky ground. The background information to any ‘transaction/prescription’ is not on the admin record.
The issue here is what information Dr H had access to when he compiled his report(s). This is a turning point in this matter as IS questioned Dr H.
IS asked Dr H to look at an email from the patient where the patient states that Dr W had asked for more information. Dr H stated he had NOT seen that email before. The email made it clear that in prescribing the increased dose of medication, Dr W HAD asked the patient for more information beyond what the patient had already given. The point being, Dr H formed his opinion as to the practice and procedure of Dr W on the basis of incomplete information and, importantly, when the full facts were presented, that conclusion has now to be cast into doubt. This, therefore, affects ALL the other similar conclusions Dr H had come to.
It’s a bit like driving with only the driver’s side windscreen wiper working. You might think you can see the road ahead and be clear, but really you can’t, and a lot is not in view. That, like this, is dangerous.
The other question is where are those records?
It seems most likely that they have been destroyed when they shouldn’t have been, or not without safeguards as to a proper archive having been made first.
Dr W had passed on some other records and notes, which it seems, wasn’t passed to Dr H. Again, how can his three reports be considered sound and robust if they are based on incomplete evidence and information. The wheels are starting to gain traction and skid the red waggon to a stop.
It was also established by IS that the GMC only made a request for the clinical notes on 28th May THIS YEAR. Why? When they have had FOUR years to prepare the case.
Dr H was being run through information and the on-screen process, but he seemed a little unfamiliar with it. At this point SJ stepped in to help. He however strayed from establishing facts to ‘giving evidence’ in that he was explaining how it worked rather than question its process as advocate for the GMC. IS quickly intervened and stopped this. Dr H admitted that with only a limited view of the system he couldn’t comment. At that point SJ pulled on the handbrake and attempted a J turn, looking for the exit.
In this case, the detail of information is very important. As it involves prescriptions, changes to prescriptions and reasons for change. Who knew what and why, are important factors here.
Patients had to fill out on-line forms giving information for the online doctors to make their decisions on prescriptions. Just like a face-to-face consultation, but all carried out online in the virtual world. Without ALL the information, it cannot be certain the conclusions drawn by Dr H are sound. With the records likely destroyed for good, information is sparse. The email from the patient clearly showed in that instance, Dr W had done much more than Dr H suggested she had done, which changes the course of his opinion.
It is presumed, Dr H was asked to review one or more records and establish if the procedures followed were safe and robust. This aspect had partially come from the later ‘unsafe CQC review’. (Although in some parts of that review elements of the practice were considered satisfactory.)
So, Dr H has produced statements, that he has accepted are true, that are now easily established are based on incomplete information. In addition, the information that is/was available and should/was passed to Dr H may have led him to a different conclusion in one or more aspects of his statement.
From this, it can be seen, the time at the witness stand, by Dr H is likely to now be limited.
There is one issue that remains outstanding and does get a reference from time to time. The statement from Dr W is not fully prepared/presented to the tribunal and the red team. As such, when the completed document is prepared/issued, some of the witnesses may need to be examined to revisit previous statements/facts that may be either upheld or contradicted by the statement of Dr W. Of course, if you remember, IS was stating clearly last week that much of the information he should have been provided with was not provided until the last minute. The red team both complain they haven’t received the full statement, whilst not disclosing or being (very) late with their own information.
The panel tried to find new witnesses to fill the space, but none were available at such short notice.
The hearing is now adjourned to the public until Thursday (12th August). Matters will continue behind the scenes (in Camera) while the red and blue teams decide with the acceptance or otherwise of the Chair what information cannot be admissible (permitted) and what is inadmissible (not permitted) There are specific rules on this process and acceptance or otherwise.
What do we know?
There is a pattern emerging so far. That is there is a woeful lack of clarity of the red team’s case in many respects, and that the coordination and presentation of information for and too the tribunal thus far by the GMC (the red team) is frankly shambolic.
How the blue team fair, is yet to be seen.
If it is established that information that needs to be relied upon has been destroyed, that will cause serious ramifications in this matter. How, may depend on why the records were destroyed and perhaps by whom.
It may also yet be established that the red team (the GMC) should or could have collected that evidence before it was destroyed (as this case is for matters from 2016 AND was commenced in 2016, then it will seriously undermine the credibility of the red team, and perhaps the protocol of the GMC.
Additionally, if it is established that reports and statements have been prepared with missing information THAT WAS and SHOULD HAVE been made available, then the conclusions of those reports (expert or not) have to be drawn into question. That is the equivalent of pulling the rug out from under the feet of this case.
The in-camera hearings could be to decide if the reports and evidence to be given by key red team witnesses may be so flawed as to be unacceptable. The same could be for the blue teams witness statements, but that remains to be seen, and may depend on who knew what when and who had what information at the time or since. This is probably less likely on what has been seen so far.
With the boxers now resting and the referees considering the next few rounds, we wait until Thursday. New witnesses (presumably), old witnesses (perhaps), and more questions (probably).
Don’t forget, this is only the first stage to establish facts and see what ‘allegations (if any) can be taken forward to the main part of the hearing.
To be continued…../
Authored by Nicola Rose @Nicola2019