In July 2006, Debbie Westwick, a 43 year old nurse, was diagnosed with cancer of her left breast. She was treated at the Kent & Canterbury Hospital, where she worked, by oncologist Howard Smedley and surgeon David Jackson. Unbeknown to her, Dr Smedley was subject to ‘supervision undertakings’ imposed by the GMC for reasons that they refuse to reveal. Mr Jackson was suspended in the middle of her treatment, subsequently sacked and referred to the GMC.Westwick had surgery, (a lumpectomy, with lymph node sampling), in July 2006. The histology revealed 4 out of 7 nodes sampled were cancerous and that there was tumour left behind in two of the margins of the breast wound. She needed an urgent mastectomy and node removal but instead was given chemotherapy and radiotherapy. Debbie realised she needed more urgent surgery but her surgeon was now suspended and mastectomy and reconstructive surgery were delayed until September 2007. There were four fundamental failings in her treatment, all of which breached national guidelines: performing a lumpectomy rather than a mastectomy for a multi focal tumour; not removing the breast when the initial surgery failed to fully remove the cancer; not clearing the axilla of lymph nodes; giving radiotherapy when a mastectomy was indicated. The GMC was supervising Dr Smedley so why wasn’t this picked up?
Debbie took legal action in 2009 and the trust settled for £155,000 without responding to the allegations. Westwick knew her time could be limited – she now has metastatic disease and is terminally ill – and was far more interested in understanding how her care could have failed so badly despite clear national guidelines in treating and auditing breast cancer care. Had other patients received substandard care? And why hadn’t the NHS and regulators acted promptly to protect patients from avoidable harm – particularly given that Smedley and Jackson were on the GMC radar?
Prompt is not a word to feature much in the NHS complaints’ procedures or the GMC and CQC lexicons. Stage one complaints were lodged in May 2009, but a review of whether East Kent trust breached regulations in cancer care and held adequate multi-disciplinary team meetings to pick up and act on serious failures has yet to be published. Westwick complained to the GMC about Dr Smedley on 7th August 2009. After expert review, case papers were served in July 2010. In November, the investigation was halted for reasons which could not be revealed. Nor could any indication be given of when the investigation might recommence. In June 2011 Dr Smedley was referred for a public hearing by a Fitness to Practice Panel. In August 2011, the hearing was listed to start on 5th March 2012. No details could be given of the charges until 28 days before the hearing.
In September 2011 the GMC approached Debbie to interview her as a witness. Unfortunately this coincided with her cancer returning. By the time she was fit to proceed, as of November 2011, Dr Smedley had applied for voluntary erasure. This was refused in January and a hearing was set for March 2012. The GMC then applied for a postponement as there was not enough time to investigate and serve the charges. Debbie complained about not being consulted and was told the GMC had no duty to do so as she is not a party to the proceedings. The GMC has now listed the hearing for 7 June – over 3 years since the original complaint. There is no guarantee that it will go ahead or that Debbie Westwick will still be alive if it does. But at least the care she now receives at Kent and Canterbury hospital is competent and compassionate.
Meanwhile, Mr Jackson’s GMC proceedings, (unrelated to Debbie’s case), have still not been heard. He faces 75 charges relating to his treatment of 16 patients between 1989 and 2007. In response to the Eye, the GMC said ‘Our procedures are designed to protect patients by making sure we stop unsafe doctors from practising.’ But suspending and striking off doctors, often years after patient harm has occurred and in such a secretive manner, is of no help in understanding how poor care can be allowed to carry on for so long unchecked, and it’s no help to harmed patients. If the Mid Staffs Inquiry does nothing else, it must ensure the NHS complaints system and regulators serve patients rather than destroy them.
Nick Fairweather represents Debbie Westwick and others treated by Dr Smedley and Mr Jackson.