Success: Medicines and Healthcare products Regulatory Agency to review all Enalapril Maleate Package Information Leaflets

By Dr Helen Bright


Every medicine pack includes leaflet (PIL), which provides information on using medicines safely.

PIL needs to be read several times, but even after doing that some will be puzzled.

In the course of investigations into the case of Dr Hadiza Bawa-Garba I discovered that PILs varied in different countries and that it would be difficult for patients and carers to understand what action they need to take at times when it really matters.

For example, it would be difficult to know exactly what is meant by severe diarrhoea and bad vomiting. It would be both offputting and nearly impossible to measure such fluid loss outside hospital environment even if precise definition was there. The context of diarrhoea and vomiting such as in sepsis can define prognosis further.

It is best to consult with doctor at once regarding further administration of medication if there is vomiting or diarrhoea while taking Enalapril Maleate. This could save lives.

Following communication of disparities in PILs Medicines and Healthcare products Regulatory Agency will review all PILs for Enalapril Maleate in UK.

MANY DOCTORS' DEATHS BY SUICIDE IN UK

It has been reported that over 430 doctors killed themselves by suicide in the last four years in UK.  That is about 108 on average per year. In USA which has five times larger population of doctors, and people about 300-400 kill themselves each year.

There is nothing very surprising about it. Doctors4Justice investigated suicides in doctors and also suicides in lawyers who were subject to their regulator's investigations. Dr No calculated twenty times higher mortality rate when compared to normal population of this particular group.
Photograph of Professor Clare Gerada in Pulse

Labour government, in particular, was keen to reduce doctor's status by introducing New Ways of Working in NHS although, of course, this as purpose was denied. Instead, of a waiting list per Consultant doctor in NHS many waiting lists were made by other professionals in the team. Many patients died because of the failure to recognise which cases have to be priority for treatment that doctor would have no problem deciding. New referrals would be seen by nurses, and others in the team.

New Ways of Working was just one of the policies that was a killer for doctors and patients. Another one was the assumption of guilt and doctors who harmed no patients whatsoever would have to undergo four days performance assessments by regulator. Those who refused were struck off medical register eventually. Order to undergo psychiatric educational supervision - invented by Dr Gwen Adshead, Forensic Consultant Psychiatrist, who is, hey, a member of the Trustee Board of The Royal College of Psychiatrists would be used if doctor complained that junior doctors needed educational supervision during inspection by The Royal College of Psychiatrists. How can intelligent doctors trust psychiatrists when they protect corruption in their midst? Please.

If doctor complained about something wrong in the way clinical practice was done at a national or local level, then false allegations of mental illness, poor conduct or professional competence would be made by psychiatrists paid by regulators. While it is true that not all doctors working for GMC are corrupt some are. Enough of them to destroy more than one life. When good doctors are removed in UK more patients die including doctors. Doctors4Justice would therefore, advise doctors to seek Internet support from abroad and if it is not appropriate to their needs they should be told and agreement to this effect made and recorded. If you cannot trust the locals look elsewhere. Now you can.

DEATH BY HUMILIATION

Anyone who has read a bit of history would know how people killed themselves as the result of humiliation for thousands of years. Some have killed themselves in advance to avoid it, for example,  if captured as prisoners of war.

In addition, in humiliated individuals there would be a higher chance of death from other causes such as cardiac arrest.

What happens today to doctors is humiliation on a global scale in comparison to ancient history, and as never seen before.  It is not just the regulators who publish their "Findings" on the Internet but so do irresponsible individuals with nothing to lose. There is some merit in defamation, for example, in some cases being a criminal offence which it is not in UK.

Even doctors who have never done any harm to any patients, and in fact, are whistleblowers, will be demolished by the UK's courts, Employment tribunals, medical regulators, Internal investigators and anywhere they turn to help because UK is a failing state. The state apparatus is there to rule but it is abused.


KILLING DOCTORS THROUGH SELF - REGULATION

There are countries where justice is valued but this is not so in UK. The system is outdated.

Doctors and patients need proper independent, investigative court. Investigation, punishment and compensation all done at once, and in one place. At present, patients are sent from pillar to post over many years. Patients are afraid of risking their house to pay legal fees, for example, to fight the case against doctor in court. So, they opt for the free version of humiliating doctor through complaints procedure which does not give them compensation from medical regulator at all.

At present what we see is so called "state-capture" phenomenon in UK institutions. This occurs in failing state.

In democratic society who earns what, where and how is determined by state and is supposed to depend on merit.

In prehistoric times it was within family that relationships determined allocation of resources. Later on relationships within tribes determined the same.

What we see in doctors and patients situation is "relationships" used to get to the resources at the regulators. When there is no relationship guilty doctors quite simply become part of the regulation as fitness to practice panellists and no action is ever taken by the regulator against them even when they have much evidence against them from many unrelated sources.

There is political, religious, sexist and racist bias which kills both doctors and patients and those who are known to have a problem with such issues are protected.

Some guilty doctors are actually, protected by regulators. Sometimes, these doctors  work for them, or have previously done so. One managed to work regulating no less than eighteen professions and yes, he is a psychiatrist. GMC let him work for three terms although their regulations said two maximum and he had a bundle of complaints against him never, ever acted on.

In other cases, quite simply, regulator fixes tribunals which will be biased such as religious tribunals.
They are relied on to do as told.

WOMEN DOCTORS AND SUICIDES

Overall, in general population, i.e. when looking at all the suicides, men kill themselves four times as often as women.

Women doctors attempt suicide far less frequently than members of the general population but when they do attempt it they are usually successful just like the male doctors in that they chose lethal means. The same numbers (rate) of women doctors as male doctors complete suicides.

American doctor who collected suicides to investigate them reported in Washington Post that men were eight times more common in her register in 2018. This is interesting, but it may reflect her sampling.

Some research has indicated that in medicine, it is women who somewhat outnumber men in suicides but this only arises when one starts making standardised mortality rates and comparing doctors to the general population or other populations such as scientists.

WHY DOCTORS MAY AVOID HELP

Lack of trust
Trust is of fundamental importance in medicine.
There are doctors who think they would be reported to the regulators (and many were) if they seek help from psychiatrists.

Refusal of medical insurance and professional indemnity
For doctors without experience of law it can be overwhelming experience to be hit with malice as well as refusal of help. Ethnic minorities are more at risk. It is bewildering and some are like rabbits standing in the middle of the road as car approaches.

Too tired
Burnout can lead to symptoms of depression and with it lack of energy. Doctors work very hard and for many more hours than anyone can see. This is not always appreciated.

Sleep deprivation can lead even to psychotic symptoms and this could be the final straw for those who do not know it.

Lack of control
Increased demands from patients and through regulation leading to the sense of hopelessness could lead to suicides.

There is a lot to be learned from military who although exposed to high stress have lower suicide rates.

Dislike for arguments
Doctors dislike arguments but in real life it is essential to resolve problems. Too much of "we all love each other". Well, we do not. In fact, some doctors loathe others and would stop at nothing to ruin them with the help of the state institutions and medical regulator.

The same applies to some patients who are loaded with hate also by their religion such as Church of Scientology, so, all psychiatrists are killers for them who should be shown no mercy. At least, one Scientologist got a job as Fitness to Practice Panelist at GMC. Prosecution of psychiatrists increased many fold.

During religious governments regulators get loaded from religious groups participants even more. The effects last for many decades later.

Bystander mentality
Medical profession continuously employed bullies, manipulators and corrupt individuals amongst them. Have you ever heard of medical board walking out in protest against bad company?

Knowledge about the reality
Doctors are intelligent and can work out the likely outcomes in corrupt system like in UK where state capture has taken place already by interested groups at The Royal College of Psychiatrists, for example.

Lack of legal tools
Doctors lack basic legal protection. They have no contract with patients on complaints procedure that is signed by patient and doctor.

The list of things doctors lack control over would include for NHS;
who they work with
management
who comes to see them
how many come to see them
and a little bit more.

Justice crumbs - The real dark side of Dr Bawa-Garba's case by Dr Helen Bright

http://www.mediafire.com/file/y58id59enrlttzm/Struck-off_Dr_Hadiza_Bawa-Garba_wins_appeal_to_work_again_-_BBC_News.pdf/file

                                        Photo: BBC, Click on the photo to read their article

Dr Bawa-Garba has won her appeal in English Court of Appeal (Civil) against the decision made by the High Court following application by The General Medical Council (GMC) that she should be erased from the GMC's medical register following the death of  a sweet, little boy age 6 who suffered from Down's Syndrome and died (according to reports and judgements) very quickly from sepsis due to her alleged negligence on 18th February 2018. Dr Bawa-Garba was convicted by Crown Court of criminal negligent manslaughter.


VIRUSES

The case is of interest to much wider public because all judgements before Court of Appeal (Civil) are faulty, in my opinion, and paid no attention to the fact that there was failure to test for viruses post-mortem which can cause rapid death in even healthy strong man very quickly.

It has been known since 2009 that Influenza virus causes 335 fold (that is 335 x 100 = 33, 500%) increase in Down syndrome deaths compared to normal population. If the judges were told this then their instructions to jury would be very different.

British did not vaccinate vulnerable children until 2013. No expert told jury in Crown Court or Court of Appeal (Criminal)  judges about that, as far as I was allowed to know (coroner refused to disclose post-mortem report or expert evidence), or the fact that Influenza virus was discovered in 1933 and that the first vaccine was made shortly after. So where was it for Downs syndrome children in 2011 when patient died? By 2011 more sophisticated vaccines would have been made already.

Apart from influenza other viruses can cause fast death, even ordinary cold, in immuno-compromised people by precipitating secondary bacterial infection leading to sepsis. Again, judgements do not mention investigations for that aspect in post-mortem. There is mention that Jack Adcock was prone to colds, but there is no testing at all mentioned for any viruses. Only Strep. Group A as cause of sepsis is mentioned in judgements but this is usually harmless bacteria in many people until something else happens as well to trigger sepsis. Many people are asymptomatic carriers.

VACCINES AGAINST STREPTOCOCCUS

There is no mention that England had vaccine in 1920's against Streptoccocus bacteria causing maternal childbirth deaths from Puerperal Fever (belongs to the same group as Streptococcus Group A). Vaccine was used in East London, by St. Bartholomew's Hospital midwifes.

I could not find medical history chronology of how human negativity destroys because vaccine was attacked in British Medical Journal with claim that prevention did not matter as much as treatment.  There were protesting and astonished voices from a couple of doctors that BMJ, actually, published.


CORONERS' STANDARDS

The coroner in this case refused to cooperate with me as did GMC by refusing to send me redacted copy of the expert evidence. I am entitled to this as per relevant law. Justice is public and has to be seen to be done. Additionally, experts have to be truthful. They have to tell court about the limits of their opinion.

Because of the cover ups in my opinion, it has not been possible to see what this case was really about: Bad practice on a larger, much larger scale leading to many deaths unnecessarily.

What we have seen from media reports is just two women (mother and doctor) pitted against each other, medical doctors protesting about NHS conditions while the big picture is that those who were paid to do their work have not done it for decades.

Good investigation is the key to successful litigation. So law books say.

MONEY IS NOT EVERYTHING

When there is shortage of public money in NHS there is need for openness. If parents are told honestly that there are vaccines they could have obtained them elsewhere.

 My guess is that Jack Adcock parents just did not know better.

MENTAL SUFFERING

Jack Adcock parents had enormous amount of grief, I imagine. Did anyone ever tell them they can ask for new techniques to be used to find out what virus/agents were present at the time of death. Sometimes it is a mutant virus that has never been detected before. There should be retained tissues that can be analysed.

Little Jack Adcock was a vulnerable person for many, many reasons to do with his Down Syndrome which causes many immune problems as well as difficulty breathing due to the anatomical features of the face in Down Syndrome (small midface, with little nostrils and mouth too small for normal size tongue). Mouth breathing misses on the immune defences in the nose as air goes directly to pharynx. Thus bacteria can move more quickly to lungs to cause pneumonia.

TEMPERATURE AND AIR POLLUTION

I looked at the temperature records in February 2011.  Most of the time it was a couple of degrees above zero Centigrade. It was a cold February in 2011. The air would be dry. It is known dry air decreases functioning of the immune system further. Wearing scarf over mouth helps to moisten air.

 There are about 60,000 deaths annually in UK related to air pollution (particulate matter).  Leicester has poor quality air in third place after London, and another city, especially in winter.

If one looked for all different factors in Jack Adcock's death one would not find it in judgements. So, how can judge or jury do the right thing if expert evidence is not there or did they ignore it?

DRESSED TO KILL

British Empire traditionally does not care about ethnic minorities doing things harmful to themselves such as wearing clothes that lead to lack of trust and confidence in wearer even if it is linked to English people's deaths.

Those who have money can avoid Dr Bawa-Garba when mistrust, or lack of confidence occurs without a word to her or anyone, but most people would feel stuck with her in NHS and take risks such as perhaps, Jack Adcock's mother did when she gave the boy his usual pill (Enalapril) even though Dr Bawa-Garba quite rightly stopped it. This drug dramatically reduces blood pressure and can cause heart attack in the setting of dehydration and sepsis.

It is legitimate to notice differences between us and others whatever their looks without it assuming significance of prejudice or hostility in legal terms.

What is wrong in law (wilful blindness) is that UK government commissioned and knew of the research since 1998, at least, which showed clergy is more likely to be attacked physically than any other profession. They just ignored it. Doctors carry twice as high risk of violence compared to the average risk. When one adds religious dress the risk of attacks increases.

I imagine in many situations, including the courts, and amongst staff Dr Bawa-Garba has not enjoyed trust. It is likely nobody cared to tell her for fear of causing offence.

Certainly, her hospital policy was unlawful as it ignored mentally ill and their needs when it comes to the wearing of religious uniforms. Trust is of fundamental importance in medicine.

In circumstances such as medical setting (and in emergency situation even more so) there is no time for patients' or carers' exploration of their doubts about the doctor, self-searching questions, historical study of other people's clothing, political and psychological implications research, or any lengthy battles through administrative state institutions. Yet, trust and confidence is of fundamental importance in medical profession. Both General Medical Council and  UK governments just continued to live in denial attacking those who raised the issue of religious dress as a substitute for real justice, disregarding the deaths and injuries at home as well as evidence from abroad (such as murders of nuns in USA and elsewhere). Similarly, there have been attacks on those wearing hijab and other forms of ethnic clothing some claim to be Muslim, religious requirement, while others protest such claims including Islamic scholars.

MORE DEATHS FROM SEPSIS YET TO COME

In 1970's a substance called Pro-Calcitonin was discovered. It is a natural precursor of a hormone in humans and by 1990's it was recognised that it could be better at diagnosing sepsis than tests in use.

In UK, even today, it is not used although result would be available in 20 minutes and it is superior to the current tests used for sepsis and monitoring of treatment. Dr Bawa-Garba did not have this available to her. Years after the event, and in her geographic area of Leicester, England, Europe, the opinion for years was that it was as good as CRP (C reactive protein Test) which she did use. Well, it is not.

Thousands of people die in UK from sepsis because UK is as it is, a negative place where there is no social justice or culture that aims for quality.

RELIGIOUS TRIBUNAL AT GENERAL MEDICAL COUNCIL

The standard of proof in criminal setting is beyond reasonable doubt. Crown Prosecution Service in Leicester had doubts about going ahead against Dr Bawa-Garba to Crown Court. Criminal trial took place with much delay and it may have had effect on how Dr Bawa-Garba was judged by medical experts because medical diagnosis of sepsis was changing (international criteria).

Something happened and eventually, CPS went ahead with prosecution despite their initial reluctance.

I do not know the court medical experts in Dr Bawa-Garba's case and I do not know Dr Bawa-Garba. I do have experience of GMC and I sincerely doubt that they have any intention whatsoever to deal with how they have for many years allowed their own religious tribunals to cause so much damage.

In Dr Bawa-Garba's case, Medical Practitioners Tribunal (part of GMC) that suspended her medical registration, was in my opinion, religiously biased. In rush, they appeared ready to just accept findings from the criminal courts without looking at the whole case critically. Some people may say, well, this is what you can expect from the religious, lack of critical thinking. The translations of disciplinary panel members names are Leader of Faith (Islam), Garden of the one who judges on religious matters. The third member is Elizabeth Daughters a member of Women's organisation that accepts feminists who are Muslims. Many feminists would say it is impossible to be a feminist and a Muslim in the same time. However, these feminists have their own interpretation of Islam. It does matter that tribunal is perceived as being fair and unbiased.

In USA it would be perfectly acceptable for lawyers to question jury members regarding their religious belief extent in the selection process. At GMC nothing like that is ever checked with respect to Medical Practitioners' Tribunal panellists. Extremism and harm slide into disciplinary committee from time to time causing injury to doctors and deaths to patients.

I had an NHS exorcist doctor judge me, then a doctor, a sister of a Catholic nun who failed to declare she was also a preacher, a political lobbyist for religious rights and others in a case where their religious attitudes mattered a lot. One (preacher) was involved in cover ups not just of faulty policy but faulty actions by experts sitting in the Royal College executive that advises government on what would be desirable to help mentally ill.

Some religious views of those with mental illness and learning disability is that they are possessed by demons. Doctor exorcist who judged me certainly described such view as his in his book: Hard Questions and Answers.

Most religions, being patriarchal do not favour women. Dr Bawa-Garba was to be made happy to eat her justice crumbs (suspension from medical register). There was no concern for the suffering of the parents who could have been helped by full understanding of what really happened. Did anyone give them the list of all the medical, social, political and environmental factors that lead to death of their much loved son? I think that is unlikely. Modus Operandi of the system is: be secretive, they will never know better.

MEDICAL TESTS LACTATE

It took years before blood lactate levels in paediatrics were actually published since their description in adults as markers of sepsis, and it was months after Jack Adcock died that a paper was published in India.

Even in 2017 it has been maintained that serum lactate cannot be relied on in paediatric practice.

Boris Johnson is right! Burkas should be outlawed

https://news.sky.com/story/boris-johnson-told-by-tory-chair-to-apologise-for-burka-comments-11464276

Recently, the attacks on Boris Johnson, outspoken British Member of Parliament have been reminiscent of similar persecutions of professionals from English judges to psychiatrists and sociologists who think the same, try to do something about it and have the system descend on them lawlessly and with vengeance.

So, Boris, get yourself some data on mortality. In Harrow, Labour council's social services employed a uniformed Catholic nun to work as social worker in mental health. Harrow in the period she worked there they had excess of eight deaths above average from known suicides. Once she left her job after four years mortality dropped to their usual average for suicides. Religious uniforms form a barrier to trust and confidence. When services cannot be trusted, some patients die. Look at he case of Dr Bawa-Garba where mother administered medication that Dr Bawa-Garba rightly stopped for her son. He died.

Boris, learn about inferiority complex and why women with poor self-esteem wear burkas. It is a form of discrimination described previously and used by the wearer in order to get special treatment. Why not kneel before them? Not a good idea, of course, as cure for poor-self esteem is different.

Boris, you could win your case in European Court on Human Rights, Article 10 if you lose your job but........
Well, Hungarian judge from Supreme Court won his case when they sacked him because of his criticisms of the new laws.

Men have been wearing veils to protect themselves from the elements of hot dry air.

Even today instinctively hijab becomes protective against air pollution in Teheran although some prefer surgical masks:

At some point what has been ethnic cloting became identified by some as symbol of their religion.
But Islam doe snot ask for burka or hijab. Their requirement is modest dress both for men and women.

Other religious groups also wear veils for decorative purposes.

Religious dress has been used to isolate and kill Jews in middle age and later: different hats, capes, applications to the cloth.

There are men who protest against veils using burkas as these in Afganistan:

And here is a cowboy ready to put face veil when it is dusty

Some men value beauty and are ready to be judged . Here is a serious woman judge for male beauty contest:

and men waiting to be judged:

There are men who refuse to allow their women to be veiled by veil themselves:

And this male beauty had to run because he was not veiled and was attacked by jealous males:

We already know that Equality Commission screws up on this issue so Boris Johnson will not get any help from that lot.

Slobodan Milosevic's lawyer murdered, Lawyers on strike in Serbia from tomorrow

Yesterday a high profile lawyer , Misa Ognjanovic was killed in Belgrade in front of his home and his son was wounded.

In the last several years a number of lawyers were killed and a number of murderers never caught.

Lawyers chambers have announced one week strike.

Recently murdered lawyer,  is second from left and was defending Slobodan Milosevic

Theresa May, Dominic Raab and Winston Churchill

Winston Churchill said something like; tact is having the ability to send someone to hell on a trip they are looking forward to. 

Chemical Weapons in Syria

This report in New York Times in 2016 is about 52 chemical weapons attacks by ISIS in Syria.
https://www.nytimes.com/2016/11/21/world/middleeast/isis-chemical-weapons-syria-iraq-mosul.html

ISIS helped themselves to the chemical weapons in Iraq and took it to Syria.

Dr Bawa-Garba's and responsibilties of many people

Photograph: Daily Mail. 

Dr Bawa-Garba is a Paediatrician who has worked in Leicester Royal Infirmary Hospital.

The Uniform and Dress Code Policy in University Hospitals of Leicester NHS at the time clearly recognised purposes, and principles of the policy one of which is:

"Ensuring that the individual promotes a clean, smart professional appearance, building public trust, confidence and promoting a positive image for the Trust - First Impressions Count as stated in the Caring at its Best standards and UHL Values."

Many doctors, in many medical disciplines, do not wear uniforms at work because uniforms decrease trust and rapport with their patients.

In mental health setting, for example, research has shown that wearing of uniforms (including religious) is associated with with poorer compliance with medication, increased violence, unauthorised absences from the hospital and more deaths from suicides.

However, Department of Health refused, now for twenty years,  to make a national policy on workwear and left it to the local NHS trusts to create them. This led to loss of many lives.

The Uniform and Dress Code Policy in University hospitals of Leicester NHS (2010):

"7.8 Female members of staff who for religious reasons need to cover their hair and neck by the wearing of a dark coloured scarf are permitted to do so. The material must be able to withstand a 60 degree mechanical wash".

The medical regulator, the General Medical Council, condemned research by Dr Helen Bright on approachability of social worker wearing religious uniform (Christian) in mental health setting as serious professional conduct. The research has been published HERE.

Dr Bawa Garba had unblemished record until 18th February 2011 when she returned from maternity leave to her work as Registrar in Paediatrics. Her department was understaffed: short of two doctors and a nurse, IT did not work, and staff did not inform her when some of the results of investigation arrived.

A child, Jack Adcock, who had Down's Syndrome, was admitted following illness lasting two days. He had vomiting, diarrhoea, and difficulty breathing. His GP prescribed only one medication Enalapril following cardiac surgery in the past. Dr Bawa-Garba wisely stopped it. Enalapril has serious potential side effect i.e. cardiac arrest. This fatal side effect is more likely to occur when patient is already hypotensive and/or having abnormal levels of electrolytes in his blood.

Down's syndrome causes many impairments in the immune system, and has much higher susceptibility to death from sepsis. The most common infections in this syndrome are those of the lower respiratory tract. These are more severe and frequent than in normal population.

Additionally, there is evidence of greater sensitivity to some drugs leading to increased mortality rate.

In the case of Jack Adcock, it was claimed by experts, there was evidence of sepsis and changes in blood biochemistry that demanded faster response.

Enalapril can cause electrolyte abnormalities such as raised potassium which can be fatal causing heart attack. This means that even if there are staff shortages the chances of successful resuscitation are very much diminished unless it is recognised.

There is description of one successful resuscitation hyperkalaemia case in scientific literature which involved haemodialysis, but patient was not on Enalapril and did not have Down syndrome. There is no public information of the details of what "crash team" decided to do when cardiac arrest occurred. Because Enalapril was given by mother without Dr Bawa-Garba prescription there would be no medical record of it on the prescription chart when resuscitation team arrived. In other words, there was no record and it was not because Dr Bawa-Garba had poor record keeping skills..

In review of this case hospital found numerous failings in the system and some in Dr Bawa-Garba. About 90 recommendations were made.

After criminal proceedings, GMC's tribunal imposed on Dr Bawa-Garba a suspension of her registration for a period of one year. This sanction was overturned by the High Court on GMC's application for the sanction of erasure.

Crown Prosecution Service was reluctant to prosecute initially. But experts at coroner's inquest claimed there was a case of manslaughter by Dr Bawa-Garba. Coroner stated that Enalapril played part in the death of Jack adcock. A two year prison sentence was imposed on Dr Bawa-Garba and suspended for one year. Her appeal was unsuccessful.

During the sentencing process it was stated that Dr Bawa-Garba had a child with autism, a condition of high heritability.

  It has been suggested in one theory that autism may stem from problems with prediction.

" In Ayaya’s telling, her autism involves a host of perceptual disconnects. For example, she feels in exquisite detail all the sensations that typical people readily identify as hunger, but she can’t piece them together. “It’s very hard for me to conclude I’m hungry,” she says. “I feel irritated, or I feel sad, or I feel something [is] wrong.  Information is separated, not connected.” It takes her so long to realise she is hungry that she often feels faint and gets something to eat only after someone suggests it to her."

In the same article later on an experiment is described on how autistic person reacts to change:

"Last year, for example, Lawson and her colleagues brought two dozen people with autism and 25 controls into the lab. They played a high or low beep, showed a picture of a face or house, and asked participants to press a button for ‘face’ or ‘house.’ At first, a high tone presaged a house 84 percent of the time, then a low tone did, then tones had only a 50-50 relation to image type, and so on. The controls slowed down whenever a run of violated expectations convinced them that the rule must have changed, but the participants with autism responded at a more consistent rate, which was slightly slower overall. The researchers concluded that the participants with autism responded as if each deviation — a house when the tone augured a face, say — signalled a change of rule, whereas typical people were inclined to write off the first few deviations as probabilistic happenstance".

In her evidence Dr Bawa-Garba said that normally blood results are on computer screen and abnormal results show in red. The day Jack Adcock was admitted IT system failed and she eventually got results over the telephone and although she wrote them down she did not quite realise their significance. The rule what is normal and what is not in blood results does not change based on the system of delivery. Of course, it is possible to mishear but that was not the claim. The reference range for each result has to be checked if not known by heart. Dr Bawa-Garba with two other doctors looked after patients on six wards and four floors. She had to keep calling the lab for all patients' lab. results.

It was alleged that she did not pay adequate attention to blood results such as raised  serum lactate. However, and more importantly, there was no scientific evidence on blood lactate levels and its correlation to  mortality in children at the time of Jack Adcock's admission. It was a contraversial and unsettled issue. It was only in April 2011 (about two months after patient's death) that Kama Ran Jat et al. study on the subject was published in Indian Journal of  Critical Care Medicine with title:
Serum lactate levels as the predictor of outcome in pediatric septic shock

They found that child's arival to the unit with a lactate level of 45mg/dl or more was actually a predictor of death.

" Nonsurvivors had higher blood lactate levels at admission as well as at 12 and 24 h. A lactate value of more than 45 mg/dl (5 mmol/l) was a good predictor of death."

It is not clear from the information in the public domain on what scientific evidence Dr Bawa Garba was judged because no actual data was included in determinations or judgements, There is no mention on what evidence expert could claim with any degree of confidence how likely Jack Adcock was to survive. There was no such data at the time of patient's death according to the above paper. The coroner's inquest was in 2013 when two experts blamed her for the Jack Adcock's death despite the fact that following her initial treatment of him patient recovered enough to be fully alert and even smiling.

Corrected punctuation errors in judgement from Court of Appeal make significant difference in the meaning. Enalapril as well as Down Syndrome can cause coughs, colds and resulting breathlessness:

4. The case concerns the care and treatment received by Jack Adcock, a six year old boy (born on 15 July 2004), who was diagnosed from birth with Downs Syndrome (Trisomy 21). As a baby, he was treated for a bowel abnormality, and a "hole in the heart" which required surgery as a result of which he required long-term medication called enalapril. and He was more susceptible to coughs, colds and resulting breathlessness. In the past Jack had required antibiotics for throat and chest infections, including one hospital admission for pneumonia. However, he was well supported by a close family, local doctors and learning support assistants and he was a thriving little boy, who attended a mainstream pre-school nursery and then a local primary school. He enjoyed playing with his younger sister and was a popular and energetic child. 

Enalapril manufacturer produces Patient Information Leaflet. It was mother's duty to follow it and she did not. It states that in case of diarrhoea it should not be given without consultation with doctor. Why was there assumption by patient's mother that Dr Bawa-Garba did not prescribe medication to her son competently? Lack of trust, and/or prejudice?

The fact that Dr Bawa-Garba confused Jack Adcock at the time of his resuscitation with another child who had cardiac arrest earlier in the day is not a reflection of her incompetence but grief. Visual hallucinations are known to occur in normal people in grief situation. She quickly, within seconds, corrected herself and it had no impact on the outcome of the case.

Doctors are exposed to the high degree of psychological trauma. One of the consequences is re-experiencing of the traumatic event when reminder occurs.

Whistleblowing - report by Sir Anthony Hooper to General Medical Council (GMC)

Carol Kinsey Goman reported in a survey of more than 500 employees that 67% said their senior leaders lied to them and 53% said their direct supervisors lied. 

One of the justifications for dishonesty in human beings arises in so called situational ethics.

Situational ethics is a concept describing human behaviour depending on the situation so that dishonesty is OK. In an experimental situation it involved monetary incentive to cheat in game against a partner.

In a University of California, San Diego laboratory experiment to test people’s willingness to lie to a partner in a game, 14% of people always chose to be truthful, even if lying would have benefited them, and 14% chose to lie whenever they stood to gain, according to a team. The rest reacted in variable ways to incentives, sometimes lying and sometimes not (situational ethics), except for one participant who always lied, regardless of circumstances.

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In 2014, GMC (General Medical Council, regulator of medical profession in United Kingdom, Europe) commissioned an independent report from Sir Anthony Hooper, a retired Court of Appeal Judge, to review medical whistleblowers' treatment by GMC. In 2015, GMC published the report.

As published by GMC the terms of reference for the report by Sir Anthony Hooper have been:

 "To conduct a review of how the General Medical Council handles cases involving individuals who regard themselves as whistleblowers and who have appropriately raised concerns in the public interest. These are individuals: 

• whose fitness to practise is being investigated or determined under the General Medical Council (Fitness to Practise) Rules 2004; or 

• who have reported such a concern to the GMC.” 

There is no definition in the report of what is appropriately raised concern using law to define it or anything else. 

 

 Instead, whistleblowing is defined:

"3. Whistleblowing is the raising of a concern, either within the workplace or externally, about a danger, risk, malpractice or wrongdoing which affects others."  

This definition is somewhat problematic as whistleblowers can raise a number of concerns in short period of time leading to their persecution. The same whistleblowers can also make a number of very successful complaints that are not public at all and well before persecution in a particular, for example, political environment that grips the state institutions. Concerns can be raised within the workplace, within the workplace and externally or just externally. Concerns can be about criminal matter(s) (such as patients dying due to institutional neglect- corporate manslaughter). Of course, this is not convenient for some medical directors and they report whistleblowers to GMC when they sense danger for themselves. Labelling whistleblowers as inappropriately raising concerns is great escape for some doctors who even managed to get employed by GMC for many years for their services to the faulty political party. One managed to get three terms as GMC's Fitness to Practice panellist.

In point 6 of the report:

"6. It is sometimes said that a whistleblower is a person who raises concerns externally, that is with persons other than his or her employer. That is not right". As in his point 3 it could be.

The law recognises that there are whistleblowers who raise concerns in different ways including externally only because they have to do so. Various sections of Public Interest Disclosure Act 1998 deal with that aspect. 

Here are some examples:

43DDisclosure to legal adviser.

A qualifying disclosure is made in accordance with this section if it is made in the course of obtaining legal advice.

43EDisclosure to Minister of the Crown.

A qualifying disclosure is made in accordance with this section if—

(a)the worker’s employer is—

(i)an individual appointed under any enactment by a Minister of the Crown, or

(ii)a body any of whose members are so appointed, and

(b) the disclosure is made in good faith to a Minister of the Crown.

43GDisclosure in other cases.

(1)A qualifying disclosure is made in accordance with this section if—

(a)the worker makes the disclosure in good faith,

(b)he reasonably believes that the information disclosed, and any allegation contained in it, are substantially true,

(c)he does not make the disclosure for purposes of personal gain,

(d)any of the conditions in subsection (2) is met, and

(e)in all the circumstances of the case, it is reasonable for him to make the disclosure.

(2)The conditions referred to in subsection (1)(d) are—

(a)that, at the time he makes the disclosure, the worker reasonably believes that he will be subjected to a detriment by his employer if he makes a disclosure to his employer or in accordance with section 43F,

(b)that, in a case where no person is prescribed for the purposes of section 43F in relation to the relevant failure, the worker reasonably believes that it is likely that evidence relating to the relevant failure will be concealed or destroyed if he makes a disclosure to his employer, or

(c)that the worker has previously made a disclosure of substantially the same information—

(i)to his employer, or

(ii)in accordance with section 43F.

(3)In determining for the purposes of subsection (1)(e) whether it is reasonable for the worker to make the disclosure, regard shall be had, in particular, to—

(a)the identity of the person to whom the disclosure is made,

(b)the seriousness of the relevant failure,

(c)whether the relevant failure is continuing or is likely to occur in the future,

(d)whether the disclosure is made in breach of a duty of confidentiality owed by the employer to any other person,

(e)in a case falling within subsection (2)(c)(i) or (ii), any action which the employer or the person to whom the previous disclosure in accordance with section 43F was made has taken or might reasonably be expected to have taken as a result of the previous disclosure, and

(f)in a case falling within subsection (2)(c)(i), whether in making the disclosure to the employer the worker complied with any procedure whose use by him was authorised by the employer.

(4)For the purposes of this section a subsequent disclosure may be regarded as a disclosure of substantially the same information as that disclosed by a previous disclosure as mentioned in subsection (2)(c) even though the subsequent disclosure extends to information about action taken or not taken by any person as a result of the previous disclosure.

43HDisclosure of exceptionally serious failure.

(1)A qualifying disclosure is made in accordance with this section if—

(a)the worker makes the disclosure in good faith,

(b)he reasonably believes that the information disclosed, and any allegation contained in it, are substantially true,

(c)he does not make the disclosure for purposes of personal gain,

(d)the relevant failure is of an exceptionally serious nature, and

(e)in all the circumstances of the case, it is reasonable for him to make the disclosure.

(2)In determining for the purposes of subsection (1)(e) whether it is reasonable for the worker to make the disclosure, regard shall be had, in particular, to the identity of the person to whom the disclosure is made.
Although, Hooper whistleblowing report does not state exactly that state bureaucracy hates media spotlight on them he does acknowledge that there could be reprisals against whistleblowers of serious nature and would agree probably, that media attention is hated. 
The Hooper report does not state what scientific methodology he used in sampling of whistleblowers. We presume it was enough for whistleblower to be struck down by prejudiced, biased, and even fixed tribunal of some sort in order to be excluded by GMC and therefore by him as inappropriate. Tribunals label whistleblowers as non-whistleblowers or in the case of GMC. whistleblowing doctor is labelled as mad when not mad, or as cases of serious professional misconduct when there is no misconduct at all. The same psychiatric experts that GMC employed to defend paedophile doctors were used to attack whistleblowing doctor(s). Sir Anthony Hooper will be aware of them as he also wrote a report for GMC on Dr Morris Fraser, a paedophile and criticised those expert witnesses. Why is there no recommendation that these experts are checked over by GMC or referred to the courts? It would be novel, perhaps. There were complaints to GMC about these experts even before Sir Anthony Hooper ever got the job to write any reviews for GMC. We wonder if he ever got this information. Our guess is that he did not, but we could be wrong. Sir Anthony Hooper although respected for his expertise in court does not write in the style of an expert witness by listing all the documents provided to him. He is not in court and no court rules apply to him as an expert witness at GMC. He can have secret conversations with whistleblowers as well.

Sir Robert Francis report "Freedom to speak up" recognises ethnic minorities and injustice done to other groups of doctors, on page 10, paragraph 19:"It was also clear from the evidence that there are some groups who, for different reasons, are particularly vulnerable including locums and agency staff, students and trainees, BME groups and staff working in primary care". 
We tried the search tool for word "women" and found no results in Francis report. Scientific evidence is that women whistleblowers have worse outcomes in courts. In Hooper report on whistleblowing for GMC, again search tool for words women and female get zero results although he acknowledges that there are women whistleblowers as would Sir Robert Francis.

Hooper report does try to help GMC investigator by suggesting a bit of comparative methodology in investigative stages. This may help some cases of discrimination to be uncovered. We can only say that GMC sometimes does it and sometimes not. They have certainly done that in the cases won by some of their ex council members who had allegations against them brought to GMC. The case of Professor Wendy Savage is one. She and her private solicitors did take on the issue of discrimination against women and won. However, medical defence unions do not care about women and ethnic minorities to the same extent as others so they do not ask the right questions when they should. Women's rights would be pushed back during authoritarian regimes when religions of patriarchal nature are promoted as was the case with GMC during the last Labour Party governments. The right to speak up for women? Certainly, not. GMC website page link on Sir Francis report is there on GMC website (not on Hooper's report page). Some links in the Hooper report references have not been found. For example, reference 4 link. We recommend GMC IT department use different method for linking of website pages so they do not go missing. They need a permanent bank of documents which are linked to the articles on their website.
Although Sir Anthony Hooper recommends to GMC investigators to  ask questions of organisations when they refer doctor to GMC if they raised concerns about patient safety or integrity of the system, we do know that some medical directors would lie endlessly and that GMC is partial to them whatever facts are documented at the hearings later on. This brings us to the start of this article: money talks. In English culture complaining is something some people even apologise for. For example: " I am not complaining, but..." Yes, English apologise from breakfast to dinner and beyond in their dreams, probably. For some people complaining has negative connotations. So, according to GMC patients and relatives complain but institutions make referrals to them.
In his report Sir Anthony Hooper refers to complaints from patients but referrals from organisations. Similar to organisations some patients can be malicious if they sense they have been caught by doctor in some wrongdoing such as criminal, fraudulent or manipulative behaviour for the purposes of housing, for example. They can also join forces with medical staff in mega mobbing attacks on whistleblowers. We do not think GMC provided Sir Anthony Hooper with the data they have on mobbing attacks. Mobbing attacks can go on for decade or longer.

Sir Hooper still has confidence in the system when he writes that good record keeping could save whistleblowers. Well, when there is excellent record courts ignore it, in our experience. Truth and evidence of truth do not necessarily conquer prejudice, hate or monetary inducements such as promotions for tribunal members. See situational ethics above. That is why Doctors4Justice warmly recommends financial penalties for those who beat up whistleblowers. Science is on our side not faith. Because human beings have different capacity for empathy we realise some are never going to be moved by evidence. Please, see again
Somewhat usefully, Sir Anthony  Hooper suggests that investigators at GMC should consider if referring organisations have procedures in place to deal with complaints. Well, they do not care about those doctors who have little power (eg locums) and do not bother making procedures when Department of Health themselves have led the way of lawlessness, for example, recommending different justice for locum doctors such as lack of job reference and the absolute requirement for the reference from the last job. Ha, ha, ha. Political masters are wilfully, blindly followed by agitated and incompetent NHS medical directors who refer whistleblowers with false allegations to GMC. Had Sir Anthony Hooper had the courage to speak to Doctors4Justice his report would have been more interesting from legal perspective and the number of laws that actually apply to GMC. There is more to life than Medical Act 1983 and GMC Fitness to Practice Rules 2004 which themselves have not been compliant with law for example Article 6 of Human Rights Act.. Sir Anthony Hooper is silent on the deficiencies of GMC 2004 rules with respect to European Convention on Human Rights, the period his whistleblowing cases cover, and which Good Medical Practice Rules he is referring to because over the many years there have been different rules. He appears to be quoting  the more recent Good Medical Practice rules which again are not compatible with law. It would have been helpful to the mere mortals if he stated the relationship between the rules and the law and where the discrepancies exist. Law trumps GMC rules, is that not good to know? For example, GMC guidance states what one must do but does not recognise that it may be unnecessary to ask others for advise if one knows the law: "If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or us. If you are still concerned you must report this, in line with our guidance and your workplace policy, and make a record of the steps you have taken.^{14,16" 
Reporting to GMC their Fitness to Practice Panellists is a complete waste of time in our experience. Evidence does not matter. It does not matter how clever you are or how many other professionals (for example, lawyer, brilliant mathematician) have made complaints about the same doctor lacking integrity. Spitefully, GMC will stick to their guns defending their own because they know they have easy, very easy time in High Court.}

Hooper report correctly identifies some of the risks for the whistleblowers such as:
56. Although the risk of taking retaliatory action against a doctor who has raised concerns may arise in the context of a complaint, it is much more likely that it will arise in the context of a referral from an organisation. I shall therefore concentrate on referrals from an organisation. Complaint is what patients write and referrals is what organisations write.  These are all complaints or all referral, we think. Doctors are also members of the public so one can presume that whistleblowing is in their interest too. We mentioned this because some guidance issued to doctors states that when patients complain it is about wrong inflicted to them while whistleblowing doctors are concerned about others. The reality is that whistleblowing doctors are also afected if working with bad doctors or other professionals involved in wrongdoing.
While we would like justice to be swift NHS organisations take years to disclose essential information to GMC because they are hiding what they did wrong in the case of whistleblowers. GMC allowed that. Hooper quite rightly recommends more speed and he would know what law is there to assist GMC.
Hooper tries to advocate resolution through mediation and suggests it even though government rejected it. Well, we find nothing wrong there.  Mediation could save many lives, money and many reputations. There are some good legal points made on refusal of mediation and this not being used for further retaliation.
Of course, as a legally trained person Sir Anthony Hooper is somewhat reluctant to recommend family therapy for dysfunctional management and dysfunctional doctors. At least 30% have significant issues with mental health. Contrary to GMC allegations of madness in whistlblowers reserch has shown them to be healthier people. GMC hate swearing in whistleblowers but it is healthy. It is not serious professional misconduct. All that offends is not professional misconduct. And on this healthy note this article ends.