THE ABRUPT cessation of a Medical Council fitness to practise hearing last Friday took many observers by surprise. The case, taken against two paediatric surgeons from Our Lady’s Hospital for Sick Children in Crumlin, centred on the wrongful removal of a healthy kidney from a six-year-old boy in March 2008. With another witness still to give evidence and the committee yet to hear a summary from both legal teams, the chairman said it had decided to invoke section 67 of the Medical Practitioners Act 2007. This allows the committee, as a final determination, to request the doctors under investigation to undertake not to repeat the conduct complained of and to carry out remedial action to improve their competence.
This section is unique to the 2007 Act and it is unclear whether its invocation must be approved by a meeting of the full Medical Council. But the late use of section 67 in this case has had the effect of appearing to pre-empt the conclusion of a hearing that has important implications for patient safety. This may lead to the unfortunate impression that the medical profession was protecting two of its own. However, one of the major changes introduced in the 2007 legislation is a declaration that the majority of members of the Medical Council fitness to practise committee are not medically qualified. Therefore the decision to invoke section 67 in this case must have obtained the support of a majority of non-medical members of the committee.
Given the level of remorse shown by both surgeons, it is possible the sanctions imposed by the committee would not have differed significantly if the hearing had run its course. Nonetheless, the evidence did reveal a lack of acceptable operational policy in the conduct of the child’s surgery. Research has defined clearly the minimum acceptable procedures required for safe surgery, including the need for all on the team to voice their agreement that the right operation is being carried out on the correct organ. Certainly, last minute decisions to replace one surgeon with another should trigger a “time-out”, with a reaffirmation of roles and responsibilities among the reconstituted operating team. And mechanisms must be found to allow patients or their guardians to express concerns in a way that will be transmitted to the team as they prepare to operate.
Lessons from the aviation industry suggest “blaming and shaming” individuals does not improve safety. But procedures to flatten cockpit hierarchy have worked and must be replicated in medical practice.