Target:
Academy of Medical Royal Colleges & Department of Justice
Region:
United Kingdom
Website:
www.manslaughterandhealthcare.org.uk

The successful conviction of optometrist, Honey Rose, for gross negligence manslaughter has added to the increasing concern that the Crown Prosecution Service is taking a much harder line against health-care professionals. For the avoidance of doubt, none of us would support neglect of our patients, however we remain very concerned that the CPS' approach will set back years of effort to encourage transparency when things go wrong in healthcare.

The Francis report highlighted the importance of a duty of candour when errors in healthcare occur. The Academy of Medical Royal Colleges (AoMRC) report 'Choosing Wisely' focuses on waste in healthcare and the risk of harm from over-investigation http://www.aomrc.org.uk/quality-policy-delivery/healthcare-policy/choosing-wisely/

We, the undersigned, remain very anxious that the current approach in the UK of the use of gross negligence manslaughter risks causing harm to patients by:
1. discouraging duty of candour and also
2. increasing the risk of defensive medicine and over-investigation.

The purpose of our letter is get the AoMRC and the Department of Justice to review the use of gross negligence manslaughter charges against healthcare workers and the use of expert witnesses. We will submit this letter to a national newspaper on the day in which Honey Rose is sentenced. I would like to confirm that the lead author has no conflict of interest or relationship to the plaintiff but has spent several years trying to highlight the importance of neurological examination, including assessment via ophthalmoscopy (references 1-5). Optometrists are mandated by law to conduct an internal examination, for them ophthalmoscopy is a core skill. It is also a skill which all doctors should have some skill in at qualification (ref 4). My concern is that competent physicians will in effect be scared off from maintaining these skills and this will have an (even more) adverse effect on patient care (ref 1-3,5).

Regards

Dr David Nicholl PhD MBChB FRCP FHEA
Consultant Neurologist, City Hospital Birmingham (writing in a personal capacity)

References
1. http://www.bbc.co.uk/news/uk-england-birmingham-20713587

2. http://www.rcpe.ac.uk/journal/issue/journal_42_4/nicholl.pdf

3. http://jnnp.bmj.com/content/early/2014/05/29/jnnp-2013-306881

4. http://www.theabn.org/media/Undergraduate%20Document%20May%202015.pdf

5. https://www.researchgate.net/publication/269770358_Are_the_skills_of_neurological_assessment_in_need_of_resuscitation?ev=prf_pub


We write with concern regarding the increasing use of the charge of gross negligence manslaughter to criminalise healthcare workers in UK courts. Today sees the sentencing of an optometrist, Honey Rose, who was convicted of gross negligence manslaughter for a missed diagnosis of papilloedema in a child, Vinnie Barker, who died suddenly 5 months later.

The death of any patient, especially a child, is extremely distressing - especially where there could have been a missed diagnosis. However the current adversarial system of justice in the UK fails to take account of system errors that may have contributed. We would urge the Department of Justice and the Academy of Royal Colleges to review urgently the use of gross negligence manslaughter in healthcare workers. We believe the current approach will make a duty of candour impossible when analysing error. All of us, even healthcare workers, make mistakes.

It is vital that we learn from mistakes to improve healthcare, rather than live under a culture of fear, which results in defensive medicine and risks harm from over-investigation.

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