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The MPTS hearing concerning the fitness to practise of Valerie Murphy, the psychiatrist who was the (ir)Responsible Clinician at STATT during LB’s (Connor Sparrowhawk’s)  time there, finished on Wednesday 21 February.

Having made a determination of facts in August 2017 and a determination of impairment in the November of the same year, the Tribunal reconvened on 19 February to deliver its decision on sanction.

It’s worth remembering that when Murphy appeared in person at the August hearings of fact, her attitude was the mixture of disdain and belligerence she had manifested at LB’s inquest.  She did not appear in person at the November impairment hearing. Questions were put to her counsel, Richard Partridge, who answered them as best he could in the absence of his client, which was not terribly satisfactorily, as it turned out.  There was quite a lot of ‘I will have to ask’ and ‘I will find that out for you, Madam’ from Mr. Partridge.  Some documentary evidence of her remediation was produced.  The Panel seemed to consider her moves towards insight and remedy pretty perfunctory:

Remediation

So three months later, Murphy’s counsel presented a bundle of additional evidence by way of mitigation, consisting of

• Emails regarding the ‘yellow card’ (actually an A4 form for recording details of epilepsy);
• An audit of Epilepsy In Psychiatric Inpatient Settings (a ‘baseline’ audit);
• An audit of the epilepsy ‘yellow card’;
• An email regarding epilepsy care;
• An email regarding Directions for Future Research; and
• Testimonials;
• A reflective statement, signed and dated 15 February 2018 (the Thursday before the sanction hearing began);
• A certificate of attendance at ePEX (An Electronic Computerised Record Keeping System) training;
• An ePEX Manual and Index;

The more I re-read the  tweets, the more sickened & disgusted I feel.  Murphy has never apologised to or shown any consideration for Connor’s family, but she has used his death to set herself up in southern Ireland as an expert on epilepsy in learning disability care.

She claims to have had an epiphany after Connor’s inquest & begun her ‘yellow card’ epilepsy recording scheme.  She says she was open with other health workers about her failures, in order to emphasise the importance of epilepsy care and the dreadful consequences of her failure to provide it.  But until the 19th of February, she hadn’t ever publicly acknowledged the full extent of her failings.   Even on Monday, she was giving deflective answers to questions about the extent of her responsibility for Connor’s death and skirting round her previous efforts to displace blame onto the nursing team.  How can she possibly have been honest with colleagues about her errors at a conference in June 2017, when in August 2017 she was stoutly refusing to be accountable for them?  From here, the ‘yellow card’ scheme and the conference look like something cobbled together as extenuation, just in time for the first MPTS hearing.

Murphy’s submitted email featured three other clinicians, showing, she claimed, that she was ‘driving the (epilepsy) scheme forward’.  I’m not sure you can call this bunch a steering group for the scheme, as the participants mentioned have never met as a group and there didn’t appear to be any formal agreement on working to ensure that the scheme is uniformly implemented.  In fact, it turned out that of 3 other people mentioned in the emails, she’s not seen one since 2014, and another since around 2015.  However, she said, she sees the third person frequently.  How frequently? asked the GMC barrister.  Oh, all the time, said Murphy.  (He’s her husband.)

Moving on to the ‘yellow card audit’ data provided, this came from Ireland’s Midwest health region.  The Midwest region, for those whose Irish geography is a little sketchy, is Limerick and its hinterland.  As it happens, the University of Limerick is where Murphy’s husband is based, as an Adjunct Senior Clinical Lecturer in psychiatry with an interest in research.  In fact, he is the one who appears to be running the whole Midwest ‘yellow card’ project.  Murphy did not make an upfront, public, competing interests disclosure about his involvement in the audit process.
The abstract of the poster presenting the Midwest audit says that the introduction of the ‘yellow card’, coupled with ‘an intervention to improve awareness of risks’, significantly improved documentation of considerations concerning assessment and risk assessment, but did not significantly improve documentation of PRN (as-required) epilepsy medication.

In Cork, no auditing was done because Murphy has been off work since August 2017.  She did, however, claim that “I’ve had verbal feedback that shows 100% use and completion of yellow card for a patient in the unit there, the feedback I get is that it’s working.”
I don’t see how such claims can be considered evidentially admissible in the absence of robust numerical data, especially if – as I suspect – this was oral, i.e. unwritten verbal feedback.  Murphy’s word for it was, at best, hearsay.  There was no way of verifying the accuracy of either her understanding of what was said or her transmission of that understanding.  She produced nothing to corroborate her story.

Having been castigated for failings over recording notes on STATT’s RiO electronic system, Murphy has taken a course on e-notation. She still doesn’t use electronic notes, but if she did, she would hand-write notes & then transfer them onto computer.  I can see more than a smidge of potential in that for transcription errors and omissions.

Murphy ducked directly answering questions about her failures in leadership , leading to dialogues like this:
GMC barrister: You just explained a moment ago this document was your reflection following (LB’s) inquest, is that right?
Murphy: Yes
GMC barrister: You outline leadership as one of the aspects.
Murphy: Yes.
GMC barrister: Do you accept you were trying to blame the nursing (staff) for deficiencies?
Murphy: This is a reflective document about my thoughts and feelings of why I struggled with leadership, this is very personal, part of reflecting on things was thinking what was stopping me, why, this was more a reflection of my difficulties with the environment.

Ah, that inconvenient, uncongenial environment.  Of course.

Chloë Fairley, for the GMC, pressed on:
Fairley: Do you accept that you don’t at any stage identify your own failings in this document?
Murphy: Yes.
Fairley: Do you accept you’re attempting to lay some of the blame on the nursing (staff)?
Murphy: No, someone has to take charge.  Sorry, I’ve got a bad headache.  It was the inquest that was helpful for me, for it to sink in that (the care system) was siloed and there was no-one tying it together, and it should have been me that was doing that.

Murphy claimed to have questioned Southern Health’s interdict on contacting Connor’s family.  I don’t doubt that Sloven imposed just such a prohibition on direct contact.  Yet  doctors have a duty of candour, so Murphy’s abiding by that embargo was dubious, to put it mildly.  Moreover, even after leaving Southern’s employment in 2014, she made no attempt to contact or comfort LB’s family.  Instead, Murphy continued to treat his mother in particular in a hostile and aggressive manner, via her legal representatives at both inquest and tribunal

She contradicted her own evidence: having previously claimed she was distracted by a multiplicity of clinical roles, she then admitted she was no longer doing them when Connor died.  She also made statements that contradicted the submissions made on her behalf by her counsel: she claimed to be a ‘young consultant‘  while her counsel talked of ‘a single clinical incident in a long career.’
Nobody acknowledged that the failings in this ‘single clinical incident’ had stretched out over a span of .

Finally, her counsel submitted for Murphy that she was ‘emotionally broken by these events’.  Given that plural, ‘events’, I don’t think it was Connor’s death that broke her.  I believe it is being held (repeatedly) to account, that she has found shattering.  Had Connor’s death affected her, she could not, would not, have countenanced her barristers hounding his mother as they did.  If she had come to realisation after the inquest, as she claimed, she would not have permitted the same specious attacks on Dr. Ryan to continue at the tribunal.  As with the Tribunal’s finding on impairment (page 15, paragraph 69) when it considered the extent of Murphy’s remorse,  the brokenness of Valerie Murphy seems ‘limited to the consequences these (Tribunal) proceedings have had upon her.’

Despite the dubiety of some of her evidence, despite being granted an extra seven months in which to work up a show of remorse that was still unconvincing, despite the bad faith she displayed in the way she allowed her lawyer to batter LB’s mother, despite the inapt-to-the-point-of-grotesque intervention of her witness Prof Ted, despite her inability to use health information technology, despite one-minute-to-midnight reflections extruded four years and eleven months after Connor went into STATT – her sanction is a 12-month suspension, (which may be extended at a further review before it expires).  The tribunal accepted Murphy’s assertion of a ‘sea-change’ in her attitude.  It even quoted her own marine-metaphor description of herself, verbatim.

I can’t give this change much credence and I really don’t know how anyone can ever place confidence in her again. Her character seems entirely unsuited to responsibility for or authority over disabled persons.  Its salient features appear to be cowardice and dishonesty.  Her behaviour towards Connor’s mother during his time in the unit reeks of both.  Murphy would neither confront Dr. Ryan with her own view of events, where her view and Dr. Ryan’s were in disagreement, nor would she keep Dr. Ryan apprised of what was actually happening to Connor.  After Connor died, Murphy didn’t act on her duty of candour and she made repeated proxy attacks on Dr. Ryan via her lawyers.

One of the reasons I don’t believe that Murphy has overcome either her cowardice or her dishonesty is embodied in this thread of live-tweets from the sanctions hearing.  Dr. Murphy explained she was honest with people about her learning before describing the ‘yellow card’ scheme.

Cork 100

What would ‘honesty about learning’ look like?  Well for a start, it would have to acknowledge the trigger for the learning: the death of Connor Sparrowhawk and Murphy’s responsibility for that death.  True honesty would have to be along the lines of the penitential act:

I confess…to you, my brothers and sisters
that I have greatly sinned
in my thoughts and in my words
in what I have done
and in what I have failed to do
through my fault
through my fault
through my most grievous fault…

So we come again to the ‘insight’ and accountability question: Did Valerie Murphy admit to the professional colleagues to whom she presented the ‘yellow card’ scheme, that, through her ignorance, arrogance and failure to fulfil her duties, an eighteen-year-old-boy for whom she had clinical responsibility came by his death under her care, drowned in a hospital bath?   I beg leave to doubt it.

The original article proposing the scheme, a letter to the editor of the Irish Journal of Psychological Medicinedated January 2017, doesn’t mention Murphy’s experiences at all.  Connor is expunged from the narrative.  What we have here is a detached, academic suggestion from our cogitative clinician, worrying about what appear to be non-specific risks of ‘higher mortality rates, particularly in those with recent seizures‘ and ‘psychiatric medication (that) may interact with anti-epilepsy medication‘ or ‘seizures could be mistaken for evidence of psychiatric illness‘ and – a real kicker here – the fact that ‘from a risk-related viewpoint, those with comorbid epilepsy have specic risks to consider including but not limited to areas such as bathing…
Every individual statement is neatly referenced, either to an academic paper, or to some other authoritative publication.  Far from presenting the ‘yellow card’ scheme as an act of atonement, Murphy is presenting herself as a paragon of farsighted benevolence who has sagaciously synthesised all this disparate observation into a coherent and philanthropic whole, to improve the welfare of the afflicted.  In the case of the risk consideration, Murphy has the gobsmacking neck to refer to the UK National Institute of Clinical Excellence epilepsy management guidance.  You know, that commonsense stuff about deep water and seizures that she fatally ignored when Connor entered her orbit.

Of course, Murphy would have needed to seek permission from his mother to talk about Connor.  She would have had to approach her humbly and frankly: “I realise I did a terrible thing – a series of terrible things – when your son was in my care and after he died.  I was neglectful towards him and I’ve been vile to you.  I am sorry, although I know mere words are not enough.  Nothing I can do will bring him back.  I wish beyond anything that I had done things differently.  I have had this idea for trying to help other doctors do things differently, I hope it might prevent failures like mine in future and avoid deaths.  May I send my ideas to you?  I won’t do anything without your agreement or approval….”

But it’s beyond Murphy.  She doesn’t have the guts, or the integrity, to go beyond mere remorse to contrite action.  She’s happy to wallow in regret, to which she now appears to have added a splash of guilt (I don’t believe the tribunal’s interpretation of her demeanour to mean that she is ‘wracked with guilt’, is correct.  Wracked with regret – for herself – sure; guilt-wracked: No.)   She has made no amends to Connor’s family.  She hasn’t even apologised to them for inflicting some of the deepest hurts one human being can cause another; she’s half-apologised – after prompting – to the Tribunal.

There comes a time when apologies and amends are no longer acceptable. They are too late to be credible.  I don’t know if Murphy has reached Connor’s family’s Too Late, although given that Murphy’s barrister harried Connor’s mother into breakdown and illness at the MPTS fact-finding hearing, I wouldn’t be surprised if their Too Late were last August.

On the other hand, I don’t foresee Murphy ever making true effort at apology.  As I say, she has, in my estimation, neither the backbone nor the probity for it.  She’s interested in (self)-justification.  Not justice.