§ 12.33 a.m.
§ Mr. Charles Loughlin (Gloucestershire, West)
I wish to raise this morning the case of the late Mr. Geraldus Green, who was a constituent of mine living at Staunton near Coleford in the County of Gloucestershire, and who died in Standish Hospital on 9th December, 1971. I wish to make it absolutely clear from the beginning that there is no criticism of any kind of the hospital and its staff. Indeed, the family of the late Mr. Green can find nothing but praise for the care and attention that was lavished on him during his stay in the hospital.
The burden of my complaint is against the two general practitioners who treated Mr. Green before his entry into Standish Hospital. I charge them with culpable negligence and of being incompetent. The names of the two doctors concerned are Dr. Wallis and Dr. Hodson.
For some time I had had a lot of complaints about the medical services in Coleford and, as the Minister well knows, in particular about Dr. Hodson, who is a complete law unto himself. A large number of his patients are so afraid of him that they have now got to the point of not calling him out even when they are seriously ill. They know from bitter experience that if they protest against what they consider to be his callous treatment of them they will be struck off the list. It might be argued that they can always get another doctor, but there is only one practice in Coleford, of which Dr. Hodson is one of the three partners, The other doctor concerned in the case, Dr. Wallis, is also a partner. It is essential to bear in mind the attitude of the doctors and the state of mind that has been created among the patients in Coleford in relation to the specific case of Mr. Green.
Gerry Green lived in my village and was a personal friend of mine. He was a really good man. An ex-miner, he was very intelligent and well-read, and had a philosophical turn of mind. He brought up six children, five boys and a girl. He had 45 years' married life. He brought his family up as a very nice family unit. But he was not a man who devoted his entire efforts to his own family. He devoted a great deal of his time to the service of the community. He was for 216 many years a member of the parish council, a chairman of the parish council, a member of the rural district council and a trustee of the only local charity. He was a man who gave service to the community and was entitled to service when he required it, and that service was not forthcoming. I believe that had it been forthcoming Gerry Green would be alive today and we should not be having this debate.
He was taken ill on 22nd October. His brother called at my house on Saturday, 23rd October, asking me to go to see him as he was very ill and had refused to have a doctor. When I saw him I asked him whether he had sent to the doctor. He replied—I paraphrase what he said, "No. You know what Hodson is like. He will not come, and if he does there is only trouble." In a subsequent conversation he told me that he was bothered because his wife was not too well—she has not been too well for a long time—and he wanted to safeguard her position should he need to send for Hodson for her. It is a tragic situation for a man to be in, to be sick himself and not want to send for the doctor because of the atmosphere created by Hodson against his patients. Gerry Green was certainly not a man to see bogys where they did not exist.
I went home immediately and rang Hodson's number. I received an Ansafone message, and consequently rang Dr. Wallis. I told him who I was and asked him to pay a visit to Mr. Green. His first reaction was to argue that Mr. Green would not be as seriously ill as I suggested. When I insisted, he said, "This is a fine time to call me out." That was at about one o'clock at a Saturday lunchtime. If that is a bad time to call him out, how much worse would it be if it were two o'clock in the morning? Anyway, he made a visit. He diagnosed bronchitis, left a prescription and never paid a single visit after that. Nor did he inform Dr. Hodson that he, as stand-in doctor, had treated one of his patients.
I was tied up with work on the Saturday following that weekend and consequently was not able to go to Mr. Green's home until the late Sunday lunchtime. I did not stay long upstairs, where Mr. Green was lying, for to me it was obvious that he was dying. I asked Mrs. Green downstairs when the doctor had paid his 217 last visit, and she told me that no further visit had taken place since the initial visit. Indeed, she said that Dr. Hodson had refused to attend. I went back home and telephoned his number. I received again an Ansafone message saying that late callers in any case of emergency should ring again at 2.30 p.m.
I do not want to exaggerate but I think I had to wait a little over 20 minutes, as it was close to 2 p.m. when I made that call. In any case, let us just imagine the significance of that 20 minutes in a case of emergency. It could well have been a matter of life and death. I believe that this Ansafone system when a doctor is on stand-by is a breach of his terms of practice. I rang again at 2.30 p.m. and as a result of what I said to the doctor he paid a visit to Mr. Green, who was taken to Standish Hospital on the following Tuesday on the instructions of Dr. Hodson.
I return now to the refusal of Dr. Hodson to pay his visit. One of Mr. Green's sons, Michael, has, as the Minister knows, since I told him privately, a very responsible position which for good reasons I do not want to refer to in the House. But it is a position of such a nature that he would not be likely to panic or become hysterical.
On Saturday, 30th October, Michael Green, who is married and lives some miles away, called to see his father and was shocked by his condition. He telephoned Dr. Hodson, explaining who he was and saying that his father was seriously ill. He asked him to visit him. Dr. Hodson refused, but said that if Michael attended the surgery he would give him some tablets for his father. Michael attended the surgery and after 20 minutes or so was handed some tablets or capsules by the receptionist. He asked to see the doctor but was told firmly and bluntly, "No." On leaving the surgery, however, he saw the doctor through the hatchway to the dispensary and spoke to him. He again described the condition of his father and implored Dr. Hodson to visit him. He was told bluntly that Dr. Hodson had no knowledge of Dr. Wallis's visit, that in any case Dr. Hodson was not available that weekend, that he was not likely to be available until the following Tuesday and that he would if he could pay a visit on Tuesday, although he could not promise.
218 The significance of that is that if I had not known Mr. Green's son, and if Mr. Green's brother had not come to me in the first place, no doctor would have attended that man from the initial visit until that Tuesday. It was only because they knew me and because I was prepared to go to the doctor and tell him that he had better come out that he did come out. But an enormous number of my constituents, faced with a similar situation, had no opportunity of seeing me or would not dream of coming to see me about it. It is a pretty nasty situation when a doctor has a responsible person pleading with him to attend to his father but refuses to come out because it does not suit his convenience.
I say that Dr. Wallis was guilty of negligence in his failure to inform Dr. Hodson of the serious nature of Mr. Green's illness and in his failure to say that he had made a visit to one of Dr. Hodson's patients. Both doctors apparently diagnosed bronchitis. It is true that Mr. Green had a very heavy chest condition but he was also spitting what in the circumstances can be described as large quantities of blood. When admitted to Standish his condition was diagnosed as pneumonia which is of course symptomatic of some other condition.
If the doctors had paid the visits which they ought to have done in the first week they would have been able to see that the man had something much worse than bronchitis and would probably have diagnosed pneumonia much sooner. Mr. Green was given oxygen on the way to Standish Hospital and when he arrived it was impossible for tests to be carried out. Only the post-mortem disclosed that he had died from peritonitis due to a perforated carcinoma. It is significant that one of the hospital staff told a member of the family that if Mr. Green had gone into hospital a week earlier they could possibly have pulled him through.
Why did Dr. Hodson send this man to Standish Hospital, which is a specialist chest hospital? He was travelling from Staunton to Standish, passing the Dilke hospital far beyond the two hospitals in Gloucester and he could have sent him to Lydney. He was so incompetent that he assumed that it was bronchitis and sent a dying man on journeys he 219 need not have undertaken. The death of Mr. Green is a sorry tale of incompetence, indifference and culpable negligence.
The Minister might argue that the proper steps to take in such a case is to ask for a hearing before the Medical Services Committee of the Executive Council. I so advised the Green family. A request for such a hearing was dated 3rd January. Bearing in mind that Mr. Green did not die until 9th December the application was within six weeks of his death, but the bureaucratic mind of the Executive Council fastened on the dates of the visits and the failure to visit, to challenge the right to a hearing. The Secretary of the Executive Council was informed that the man had been in hospital for five weeks and had died. Anyone with the slightest semblance of sympathy for a human being would have accepted that illness as being within the terms of the exceptions under which late applications can be made.
I have tried to handle this case as tactfully as I could: I have seen the Minister to try to get some improvement in the service and I have deliberately avoided publicity, because I did not want further to erode the confidence of the patients in the doctors. I have now reached the stage when I cannot honestly say that I have any confidence in the issue being resolved in that way.
I am beginning to think that I have been at fault in trying to deal with it in this way. Time and again I have advised patients of Dr. Hodson to apply for a hearing to the Executive Council. I have run up against this brick wall of fear. People fear that if they take action against him it will have repercussions against them and their families. It is essential that the Minister should now undertake a complete investigation into the medical services in the Coleford area. I tell the Minister that this is not the last case of death that he will hear of because of this doctor's failure to act. The sooner that a full investigation takes place, the better it will be for everyone concerned.
Mr. Green's case apart, it is essential that people who are patients of this man should have the confidence to be able to bring him out when they are really sick. I do not want people to be for ever at 220 the door of the doctor's surgery. I do not want to claim any privileges. But, when a person is ill, it is essential that his relatives have the right to insist that the doctor should make a visit, and that the doctor should not argue that it is not convenient for him and put off the visit for five days when he has been told specifically by a responsible person that his patient is virtually dying. If a doctor takes that attitude to a person like the son of Gerry Green, bearing in mind the position that he holds, heaven help the ordinary man or woman who has not the sagacity of Mr. Michael Green.
§ 12.50 a.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)
One of our more rewarding jobs as Members of Parliament is to concern ourselves with the personal problems which crop up for our constituents. I may say that my own experience of the record of the hon. Member for Gloucestershire, West (Mr. Loughlin) in this regard has left me with a great respect for his zeal and tenacity.
The circumstances with which we are concerned tonight are extremely distressing and, through the hon. Gentleman, I offer my sympathy and that of the whole House to Mr. Michael Green and the rest of his family on the sad death of his father. I am sure that the hon. Gentleman will convey our condolences.
In the course of my remarks I hope to persuade the hon. Gentleman that the door which he first considered, namely, the statutory complaint procedure, is a useful one, and one which will open readily to his touch. I refer to the procedure known as the service committee procedure, established under the National Health Service (Service Committees and Tribunal) Regulations, 1956. I am sure that the best advice I can give the hon. Gentleman is that the events which he has described should be brought within the ambit of this procedure and that the procedure should be allowed to operate.
Perhaps I might elaborate. The procedure exists to facilitate complaints that practitioners have failed to comply with the terms of service which form part of their contract with the local executive council. The committee of the executive 221 council which carries out such investigations—the service committee—includes both lay and professional members, and a hearing is usually arranged where prima facie grounds of complaint exist in the opinion of the service committee.
Before the hearing, both parties usually present written evidence and at the hearing both parties are normally present and can call witnesses. The service committee reaches a conclusion on whether or not the practitioner was in breach of his terms of service—and if the conclusion is that there was a breach, can recommend sanctions, including the withholding of remuneration.
The service committee's report and recommendations go to the executive council, whose decision is notified to the practitioner, to the person complaining, and to my right hon. Friend. Both parties have a right of appeal to my right hon. Friend against a decision adverse to them. I would only add at this stage that it is, of course, a serious matter for a practitioner to be found in breach of his terms of service.
I should like to turn now to the facts of the complaint. I have explained that my right hon. Friend fulfils an appellate function under the service committee procedure, and as Mr. Michael Green may pursue his complaint under that procedure, I must make it quite clear that it would be wrong if I were to express any view on the merits of the complaint.
On 31st December, 1971, Mr. Green wrote to the Gloucester County and City Executive Council stating that he wished to lodge a formal complaint against the two general practitioners who had attended his father, as he felt that they had failed to comply with their terms of service. Mr. Green's father was taken ill on 22nd October, 1971, and on either 23rd or 24th October, at the initiative of the hon. Gentleman, one of the two doctors attended him. Mr. Green alleges, however, that during the ensuing week no follow-up action was taken by either of the two doctors and that on 30th October, in spite of Mr. Green's several urgent requests, one of them refused to visit his father. The doctor did, however, make a visit on 31st October at the request of the hon. Gentleman, and the patient was admitted to hospital on 2nd November. I am sorry to say that he died on 9th December.
222 Mr. Green's letter was received in the offices of the Executive Council on 3rd January. The letter was studied to see whether it contained an allegation that either or both of the doctors mentioned in the complaint had failed to comply with their terms of service.
It was noted that there was an allegation that one had refused to visit and treat the patient on 30th October, which would imply a breach of paragraph 7(6) of the terms of service for general medical practitioners. It was also noted that this alleged failure occurred just two months and one day prior to Mr. Green's putting his complaint in writing. The clerk of the executive council wrote to Mr. Green, therefore, to ask him to confirm that his complaint was based on this allegation, and drew Mr. Green's attention to the time limits for making such complaints and the circumstances in which a complaint made outside those time limits may be considered.
The clerk pointed out that Mr. Green's complaint had been made outside the time limits, and in accordance with the regulations he asked Mr. Green to give his reasons for the delay, indicating that without such information the council's medical service committee would be unable to determine what action to take in the matter.
In a letter dated 7th January, Mr. Green replied to the clerk saying that he had placed the matter in the hands of the hon. Gentleman. So far as the service committee procedure is concerned, the matter can be taken no further until Mr. Green gives his reasons for the delay in making his complaint.
I shall return to this matter shortly but, having said that Mr. Green's complaint was not made to the executive council within the time limits described in governing regulations, I think it will be helpful if I say a little more about these limits. Normally a complaint should be made to the executive council within six weeks of the event which gave rise to the complaint. There is a practical reason for this, as the longer the delay between the event complained of and any investigation of it the more difficult it becomes clearly to establish the facts. It is also easier for the complainant to remember the facts, as it is his own case, than for the practitioner who is treating many people every day. Clearly, therefore, there 223 must be some limit to the time during which practitioners can be asked to account for their actions on a particular occasion.
However, there will inevitably be occasions when, with the best will in the world, a person is unable to make a complaint within this period of six weeks and it would not be right to impose an absolute bar at this point. The regulations provide that the medical service committee of the council may also investigate a complaint against a general practitioner which is made within two months after the event giving rise to it, provided the committee is satisfied that the delay in lodging the complaint is due to illness or other reasonable cause. Furthermore, a complaint which is made outside two months may still be investigated if, in addition to the committee's being satisfied with the reasons for the delay, the consent of the practitioner is obtained, or—failing that—my right hon. Friend consents to an investigation.
Returning to Mr. Green's complaint, the hon. Gentleman wrote to me on 19th January saying that he understood from Mr. Green that the executive council's decision was that his complaint was rejected. I replied to that letter on 10th February, and apart from explaining the time limits as I have just now done again, said:I should make it clear that the Council have not rejected Mr. Green's complaintand… Mr. Green should reply at once to the Clerk of the Executive Council's letter of 5th January and explain the reasons for the delay in lodging his complaint.Of course I added then, as I have to add now, that executive councils are independent bodies and it is up to the medical service committee of the Gloucester Council to decide whether, if it is satisfied that the complaint was not made within the time limit because of 224 illness or other reasonable cause, it should go on to seek the consent of the practitioner—or failing that, of my right hon. Friend—to an investigation. But to return to the analogy with which I began, I think the hon. Gentleman will more likely than not find the service committee procedure door will open if he advises Mr. Green to reply to the letter of 5th January.
If the hon. Gentleman is disappointed by this reply I would refer him to some words of his own when he was standing at this Box replying to an Adjournment debate which involved a case where a service committee had gone further than it has in relation to Mr. Green's complaint and decided that delay in making the complaint had not been occasioned by illness or other reasonable cause. Then he said thatThe service committee procedure is the statutory method of investigating complaints and the regulations governing the procedure leave the matter to the opinion of the Committeeadding that though his Minister was a sympathetic and understanding person,the reason for the disappointing reply was solely that he had no power to go outside the regulations".In conclusion, therefore, I can only repeat that the hon. Gentleman should advise Mr. Green to reply as soon as possible to the executive council's letter of 5th January in order that the statutory procedure for dealing with complaints such as he has made can proceed. As I hope I have made clear, there is no direct action that I or my right hon. Friend can take in this respect, but there is every likelihood that if Mr. Green replies, as he was asked to do, sympathetic consideration will be given to his explanations as to the delay.
§ Question put and agreed to.
§ Adjourned accordingly at one minute past one o'clock.