Revolting reminder yesterday of the complete lack of empathy and human kindness manifested by LB’s so-called Responsible Clinician, via her brief, at his inquest.
The psychiatrist, Valerie Murphy, is up in front of the GMC’s fitness-to-practice Panel this week and next. Confusingly, the GMC has decided to refer to LB neither by his name, Connor Sparrowhawk, nor his nickname of LB, but as ‘Patient A’. There’s probably a whole other blogpost in there about the effect and intentions of this depersonalisation, but right now I am busy with other things.
The full list of allegations runs to four pages (thanks and acknowledgement to George Julian for posting these).
On a first count, there are 55 separate allegations there, of which only the first does not allege misconduct. But the effect of 7 (i) and 7(ii a-c) is to multiply the accusations in 7(a)-7(f). Item 7 contains 24 separate allegations of misconduct, giving a grand total of 68 allegations of individual instances of Murphy’s care of LB falling below adequate standards.
Of those 68 allegations, Murphy has admitted 30, which are accordingly found proven, but contests the remaining 38. Looking at the matters admitted to, they are either procedural failings (not arranging a best interests meeting, inadequate record-keeping) or related to Connor’s epilepsy. The ones she is contesting are the mostly psychiatry-related ones: assessment, diagnosis, treatment and medication, including the whole of that multiplex Section 7.
The inference I draw from this is that she intends to assert that her treatment of Connor as a psychiatric patient was unexceptionable, that its poor documentation was down to faults in the system beyond her reasonable control, and that his physical health was not her responsibility.
At Connor’s inquest, she was already citing system chaos, for example on the morning of Day 6:
VM: I can’t remember what was seen or discussed at that meeting, but I remember it as quite chaotic..
11.05 AS asks who those minutes wld be sent to? VM: Wouldn’t know. AS: Do minutes of CTM meetings find themselves in patient’s medical records? VM: Yes, they would. AS: Would members of the team have a duty to ensure those records were accurate as medical professionals? VM: It depends, we were struggling w RiO, the Chair would read and confirm them.
(From @LBInquest tweets)
Now, I’m all for Southern Health management being made to shoulder their share of responsibility. It was painfully obvious at Connor’s inquest, that the detached and indifferent nature of Southern Health’s oversight of Oxford services was itself probably well over the line of neglectful, leaving staff demoralised and demotivated. But Southern’s flaws, however egregious, do not excuse a clinician failing in her direct duty to a patient.
The failure properly to treat Connor’s epilepsy is catastrophic on its own. Psychiatrists are medical doctors, and all medical doctors are required first to train as generalists before they specialise. Moreover, Murphy is a specialist in the psychiatry of learning-disabled people. Given that epilepsy is commoner among learning-disabled people than it is in the general population, she should have been well aware of epilepsy in general. And, given the information that came into STATT with Connor and the subsequent additions to that information offered by his family, she should have focussed on epilepsy as a difficulty of Connor’s in particular. Instead, she dismissed it, and continued to do so.
On Day 5 of LB’s inquest in 2015, she insisted that “there was no evidence of seizure activity during LB’s admission”, because “two instances that were explored as potential seizures….were ruled out”. This was in spite of clear and urgent warnings, both oral and written from LB’s mother that she had seen signs of seizure activity – drowsiness and a bitten tongue – while LB was in STATT. Now, it seems, Dr. Murphy has folded on the presence of epilepsy, in the face of the inquest findings, although she apparently continues to claim that its management was not her responsibility. Oddly, she also still appears to contend that she obtained a history of Connor’s epilepsy that included whether seizures made him tired and need to sleep. If she had done so, why did she then ignore that he was drowsy at unlikely moments?
My general feeling for the other contested allegations is that these are areas where it is possible for Murphy to argue that she did the things she should have done; it is merely her recording of them that is defective. Slap-on-the-wrist stuff, not striking-off material. Whether those arguments will seem plausible, is likely to be largely down to the credibility of Murphy herself. She needs to present herself as competent, knowledgeable and benevolent, but overworked and harassed.
Hence, no doubt, the utterly disgusting hounding of Connor’s mother in front of the Tribunal yesterday. The interactions of Richard Partridge, Murphy’s barrister, with Dr. Ryan, were not so much a cross-examination as an attempted crucifixion. He did everything he could to portray Dr. Ryan as incompetent, ignorant, uncaring, shiftless and vindictive, in order to improve his client’s chances of appearing the reverse. It was exactly the same strategy as the one used at Connor’s inquest by Murphy’s then-counsel, Alan Jenkins. It failed then and it failed this time, for the same reasons as before. Firstly, Dr. Ryan is a person whom it is difficult to impugn: she has always been shrewd, informed, capable, industrious and warm; and now she is showing tremendous courage in the face of loss and grief that would overwhelm most people. I don’t think a Panel with even a modicum of intelligence is going to fail to notice the discrepancy. The inquest jury certainly were not fooled. Secondly, and far more importantly, Dr. Ryan’s personal characteristics are completely irrelevant to the question of the adequacy of Murphy’s care of Connor. Whether Murphy found Dr. Ryan’s outspokenness uncongenial, difficult or even frankly insufferable, that was still no excuse to ignore the information she contributed about Murphy’s patient, Connor.
That both Murphy’s briefs have taken this line of personal attacks upon the patient’s mother, suggests to me that the initial steer in that direction comes from Murphy herself. It seems like a risky strategy. It’s going to be hard for her to come across as competent when she has so seriously misjudged Dr. Ryan as well as Connor himself; or as benevolent when she has allowed her barristers to stick so many unwarranted knives of sneer and innuendo into a grieving mother, and then twist them.
The nadir yesterday came when Partridge read out Dr. Ryan’s impression of Murphy as ‘dismissive, arrogant and distant’ and told her it was ‘very upsetting for Dr. Murphy to hear any patient’s relative describe her as such’. Dr. Ryan asked for a recess at that point:
Nevertheless, she returned to display the intellectual rigour that #JusticeforLB’ers have come to know and admire. Pursuing an irrelevant line of questioning on the blog, Partridge tried leading his witness: ‘The tenor of the blog was critical, in a neutral term’.
“I don’t think ‘critical’ is a neutral term,” rejoined Dr. Ryan. “The blog was an honest account of our experience.”
Partridge continued in a similar dismissive vein, referring to ‘the tongue-biting incident’. When told by Dr. Ryan that it was not an ‘incident’ but a seizure, he went DefCon1 on the patronisation: ‘I know that you feel it was a seizure.’
Dr. Ryan did not let him get away with that, either. “It was a seizure.”
I really don’t know what Murphy hopes to gain by permitting or requiring her counsel to act thus. If anything could confirm the accuracy of Dr. Ryan’s negative summation of Murphy’s character, it surely has to be such a display of tone-deaf, compassionless persecution. To ‘dismissive, arrogant and distant’, most observers would probably add, ‘egocentric, devoid of empathy, disrespectful and cruel’; in short, thoroughly unsuited to being a consultant psychiatrist.
An irresponsible clinician.