David J. Black

The ‘little people’, as ‘Queen of Mean’ the late Leona Helmsley once termed them, would appear to have finally won the day, as would, inter alia, the victims of the infected blood scandal – or those among them who survived. But can we be so sure when agreed settlements are endlessly delayed and the principle of accountability routinely frustrated? How many of the perpetrators of this mega-injustice will be seeing the wrong side of a prison door? One shouldn’t hold one’s breath.

There are other instances which may have escaped our notice. The General Medical Council describes itself as ‘the independent regulator of doctors in the UK’, though since that same body is paid for by the very doctors it’s meant to be regulating the claim should probably be taken with a pinch of salt. Richard Smith, former editor of the British Medical Journal, is certainly not alone in criticising the GMC culture of putting ‘fairness to doctors ahead of patient protection’

One of the most notorious GMC faux pas occurred in 1975, when it was discovered that a local GP in Todmorden, West Yorkshire, was found to be a pethidine addict. He was arrested and convicted on eight charges of illegally obtaining controlled drugs by forging prescriptions in the names of his patients, and ordered to attend a drug rehabilitation clinic on the cognisance of two psychiatrists.

A police report sent to the GMC was for some mysterious reason not filed. The detective inspector who’d planned to testify that the doctor was a danger to the public and should be struck off attended the disciplinary hearing, but was not called. The GMC panel looking into the case sent their offending colleague a wrist-slapping letter and a pamphlet on the hazards of drug misuse. This was an unfortunate outcome, given that the doctor concerned was Harold Shipman, the biggest serial killer in UK history. His eventual estimated victim count would be between 250 and 400.

In the case of the Lucy Letby baby killings, consultants at the Countess of Chester Hospital who communicated their concerns to hospital director Ian Harvey were ordered to apologise to her in writing at the height of her killing spree. Harvey was referred to the GMC after Letby’s trial, but the case was closed nearly four years later after a purported ‘thorough’ investigation by the watchdog authority.

This response was described as “completely inadequate” and “a pretty sad indictment of the GMC” by one of the whistleblower consultants concerned. Anthony Omo, director of fitness to practise and general counsel at the GMC, offered a terse defence: “In 2018 we received a complaint about Ian Harvey which we promoted for a full investigation – our senior decision makers considered all of the evidence and decided that the case did not reach the threshold for referral to the Medical Practitioners Tribunal Service for a hearing.”

Both cases above, of course, occurred in England. Scotland’s National Health Service is the responsibility of the Scottish government and its ministers. The non-devolved GMC, by contrast, operates out of Euston Road, London while retaining an Edinburgh office under Nicola Cotter, whose career has mostly been in the private sector “in leadership and management”. One place is reserved on its London HQ council for a Scot, though Scots currently represented include GMC Chair Professor Dame Carrie MacEwan, who is, among other things, a consultant ophthalmologist for NHS Tayside; Vanessa Davies, a former senior civil servant in the Foreign office, and a barrister; Professor Paul Knight OBE, associate medical director for NHS Greater Glasgow; and former chartered account and Scottish Water chief executive Douglas Millican.

This ample input by Scots may suggest that Scotland should have had a high level of protection against rogue practitioners, but that is hardly well demonstrated in, for example, the case of disgraced Dundee neurosurgeon Sam Eljamel. He was first reported to the GMC in 2001 – or so it would transpire after it was forced to release data by the Information Commissioner’s Office in September 2023.

Eljamel had removed himself from the GMC register in 2013 prior to fleeing to Berlin, Connecticut, where he set himself up as an expert in “general, stereotactic, and functional neurosurgery”. He later moved to Mistrata, Libya. The truly concerning point about the Eljamel case is that he had worked for Tayside Health Trust for 18 years, latterly as head of Ninewells’ department of neurosurgery, and was an adviser to the Scottish government.

Ninewells is one of the few institutions anywhere which still carries out de facto lobotomies, though this is officially denied, and a more benign terminology is preferred – NMD (neurosurgery for mental disorder), stereotactic anterior capsulotomy, cingulotomy, amygdalotomy, rostral leucotomy, ablative neurosurgery, and psychosurgery, for example. Since, on the whole, the objective is little different from that of the old brain-butchery – the irreversible destruction of brain tissue - the word lobotomy would seem to be still very much in point, even if it happens to benefit from such modern techniques as MRI guided laser ablation.

“NMD is not lobotomy – the techniques used today are very different” declares the website of mental health charity Mind. On the other hand a January 2018 British Journal of Psychiatry paper Status of neurosurgery for mental disorder in Scotland states “all modern neurosurgery for mental disorder involves the ablation, or disconnection, of ventral and medial prefrontal cortical areas”. Given that the latter paper was co-authored by “disgraced surgeon” Sam Eljamel and published five years after his suspension by Ninewells, and 17 years after he was first reported to the GMC, it’s difficult to know which of these opinions can be trusted.

Precisely what damage and distress Eljamel may have inflicted on the 111 Tayside patients who have raised complaints about him is far from clear, but in Scotland, there is a further complication. Under Holyrood’s 2000 Adults with Incapacity Act it became possible to carry out these surgical interventions without a patient’s permission, despite a 1991 United Nations declaration that psychosurgery and other intrusive and irreversible treatments should only be carried out “where the patient has given informed consent”. Ninewells claims to operate a system based on consent, though whether such patients always have the mental capacity to give consent is something of a grey area.

Another interesting ‘live’ case which the GMC has recently declined to investigate concerns a report from psychiatrist in the west of Scotland which could reasonably be described as an ad hominen attack on its subject – a patient detained in another part of the country whose future was about to be adjudicated upon by a mental welfare tribunal.

Such bizarre imputations as the patient’s illness arising from an “adopted identity, a lifestyle choice, (or) a species of camp exaggeration” while urging the reader to “think of Proust in his cork-lined room, or how Trollope’s work fell off when he started riding to the hounds” seemed to warrant some investigation into the investigating doctor in question. It turns out the doctor was himself a former psychiatric patient who had at one point triggered a police search after he had absconded from a psychiatric hospital. The GMC’s disinterest in the matter could perhaps be described as perverse.

Given that section 1(a) of the 1983 Medical Act states, inter alia that “the over-arching objective of the General Council in exercising their functions is the protection of the public” it rather beggars belief that in this somewhat alarming case the GMC “don’t feel that these are issues that would warrant further GMC action being taken”.

Not all doctors are in receipt of such privileged protection, however, Dr Sarah Myhill being a case in point. In her 2017 book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis she describes the persistent harrying she was subjected to “as the most investigated doctor since the GMC started keeping records – since 2001 I have been subject to 30 separate investigations - (all) had come either from other doctors or from the GMC itself – not a single patient had complained about my practice. No patient had been harmed, indeed no patient had been put at risk. All investigations were eventually dropped.”

Her offence seemed to be that she favoured “novel” treatments and was deemed “idiosyncratic” by the GMC’s complainants. If an internal GMC memo of February 10 2006 is to be believed, the over-riding concern would seem to have been that none of her patients would support the attacks on her. Even the GMC appeared to concede that her treatments actually worked; viz

My main concerns with all the Myhill files are that all of the patients appear to be improving and none of them are likely to give witness statements or have complained about their treatment.

The traducing of Sarah Myhill was not unconnected with the fact that her remedies for Myalgic Encephalitis/Chronic Fatigue Syndrome threatened the hegemony of a body of influential psychiatrists whose ‘biopsychosocial model’ was rooted in the belief that the condition was the outcome of ‘unhelpful false illness beliefs’ and ‘maladaptive behaviour’ rather than, say, a viral trigger, and could be best addressed by such techniques as cognitive behavioural therapy and graded exercise therapy, both of which have since been downgraded in NICE guidelines.

Her critics could be vicious, one damning her as “a pill peddling quack” who’d “lulled patients into a dangerous world of make-believe pseudo-science”. Dr Myhill, who was clearly succeeding where her psychiatrist adversaries were failing, was slammed with a year long interim ban and ordered not to prescribe any drugs for 18 months, subject to GMC review. She was also instructed to remove material from her website. Some months later the chairman of the GMC panel lifted Dr Myhill’s one year ban and she was free to practice once more.

Sarah Myhill wasn’t alone in attracting the venom of her detractors. In 2017 the distinguished paediatrician Nigel Speight was disciplined by the GMC after they upheld an unspecified anonymous complaint. No reasons were provided for the resultant decision to prohibit him from carrying out work on ME/CFS, though he was re-instated on appeal.

Given the above somewhat speckled track record, the question naturally arises; Is it ethically appropriate that the GMC, which is funded by its members, should be acting as the profession’s regulator? It might also be asked in the context of Scotland, why it is that, when the NHS is fully devolved, and the writ of the National Centre for Clinical Health and Excellence (NICE) doesn’t actually run north of the border, the GMC ‘regulates’ Scotland’s doctors (or, in the case of neurosurgeon Sam Eljamel and the aforementioned anonymous psychiatrist from the west of Scotland, manifestly fails to regulate them) from London NW1?

The dramatic possibilities of the deliberations of the General Medical Council will never equal the page-turning horrors of the Post Office Horizon scandal, the crimes of Harold Shipman and Lucy Letby notwithstanding, so we shouldn’t anticipate a TV spectacular. Mind you, given that the biographical profile of GMC chief executive Charlie Massey includes an intriguing reference to his “leading work on Royal Mail and the future of the Post Office network at HM Treasury” perhaps we shouldn’t relax our vigilance too much, while bearing in mind the quis custodes, ipsos custodiet injunction – who, exactly, should be regulating our regulators?