What’s wrong with me!

by Captain Walker

Categories: Health, Humanities

Oh yes – that’s what I am forced to ask myself because others will no doubt wonder after reading some of this blog.

How crazy am I?

Much of today Saturday 02/12/2023 was taken up reading details the case Prof Marjan Jahangiri. It is in the public domain. I can imagine some will be going, “Who that? Never here of them before“. Well FYI Professor Jahangiri was the first woman to be appointed Professor of Cardiac Surgery in the United Kingdom and Europe, receiving her MBBS from UCL in 1988, according to Wikipedia – and if you don’t trust Wikipedia then disbelieve it!! I don’t know the woman from proverbial ‘Eve’ and I couldn’t care less if you’re not convinced. Leave now if you’re that type.

Well wha’everrr – I was satisfied spending time digging up truckloads of references and analysing them. Why? It is just one of the biggest debacles in the NHS, but you may not have seen it in mainstream or lesser media because it would have been covered by other big stories.

The debacle

What’s the debacle – you wonder. I’ll let Prof Jahangiri tell it to you in her letter to The Times. The letter alludes to her professional experience of being witch hunted by St Georges Hospital and sent to the GMC.

Sir, The Lucy Letby case focuses attention on what happens when concerns are raised by hospital doctors. Bogus internal investigations are frequently set up and conducted by investigators who are both unqualified and inexperienced. The outcomes of these investigations are often predetermined by hospital managers. The person who has been the subject of the concerns is encouraged to then raise a grievance against the complainants. For the doctors to progress, they have to apologise or else their registrations with the GMC will be threatened. Often straightforward clinical concerns are unnecessarily turned into team issues, following which the hospital chooses and directly employs external mediators at vast expense. The hospital managers then threaten the clinicians with referral to the GMC or, in certain instances, they actually do so alongside additional threats of not revalidating the doctor and thus interfering with their ability to practise.

Although this case represents a set of exceptionally tragic consequences that might have been mitigated but for hospital management’s prevarication, the seriousness of the case demands legislative reform around the procedure and accountability for NHS investigations. Clinicians are accountable through their respective regulators — it is surely time that NHS managers experienced similar levels of scrutiny.
Marjan Jahangiri, FRCS
Professor of cardiac surgery; chairwoman, speciality advisory committee, Surgical Royal Colleges

Some of the details that preceded the GMC referral in 2020 was in the judgement of the High Court in 2018. You don’t have to read it – and take a flying leap if you expect me to summarise the whole thing for you to a 5 second read.  Pick it up from The Daily Mail: Leading heart surgeon in whistleblower row wins fight to work again after headless doll and dead animal were sent to her home.

A sample of documents gathered from among a bigger list:

  1. Joint Public Statement from St George’s University Hospitals NHS Foundation Trust:
  2. Search Results for Professor Marjan Jahangiri GMC Referral Details:
  3. Independent Mortality Review of Cardiac Surgery at St George’s University Hospitals NHS Foundation Trust (PDF):
  4. Coroner’s Report – Regulation 28: Report to Prevent Future Deaths by Dr. Fiona J Wilcox:

Summary

The following is a tight summary of thousands of pages.

The case involving Professor Marjan Jahangiri at St George’s University Hospitals NHS Foundation Trust is a multifaceted and significant event in the UK healthcare sector, encompassing various reviews, legal proceedings, and professional evaluations. Here is an impersonal narrative summary that outlines the key developments in this case:

Initial Concerns and Reviews

  • NICOR Alerts and Internal Reviews (2017): The Trust received alerts from the National Institute for Cardiovascular Outcomes Research (NICOR) indicating increased mortality rates in cardiac surgery. This led to internal reviews and a mediation event in December 2017 to address the concerns.

Professor Mike Bewick’s Review

  • Commissioning of Bewick Review (April 2018): Following a second NICOR alert, the Trust commissioned Professor Mike Bewick to conduct a review. The Bewick Review, published in July 2018, found issues of division among cardiac surgeons and a ‘persistent toxic atmosphere’ in the unit.

High Court Ruling

  • High Court Injunction (August 2018): Professor Jahangiri sought an injunction against her exclusion from work, leading to a High Court ruling. The court scrutinised the Trust’s procedural actions, particularly the handling of the exclusion and the disciplinary process against Professor Jahangiri.

NHS England’s Influence and GMC Referral

  • Referral to GMC (2020): At the request of NHS England-London, Dr. Richard Jennings, on behalf of the Trust, referred Professor Jahangiri to the General Medical Council (GMC) in 2020. This referral was in connection with the findings of the Independent Mortality Review (IMR) of Cardiac Surgery at the Trust, commissioned by NHS Improvement in November 2018.

GMC Investigation and Outcome

  • GMC Investigation (Closed December 2021): The GMC concluded its investigation into Professor Jahangiri, finding no evidence of failings in her care. The Council determined that there was no case to answer regarding her fitness to practice.

Unresolved Issues

  • Underlying Surgical Problems: Despite the GMC’s findings, the case leaves unresolved questions about the root causes of the surgical problems identified in the various reviews. The NICOR alerts, internal reviews, and the Bewick Review pointed to systemic issues within the cardiac surgery unit, including team dynamics and the working environment. However, the specific factors contributing to the increased mortality rates and the extent of individual versus systemic responsibility remain areas of ongoing discussion and analysis.

What’s next?

Nothing – you go away and whatever you wanna do, if in the odd chance you got this far. I will continue digging deeper over the next two weeks, in order to create a massive scoop at my professional blog. And if you don’t know where that is, tough! I’m not linking it here again.


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