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The Regulation and Quality Improvement Authority (RQIA) published a report this week, saying that there were “significant failures” in the care and treatment of patients by former Belfast consultant neurologist Dr Michael Watt.
The RQIA had the Royal College of Physicians (RCP) take on an expert review of the clinical records of 44 patients who had been under the care of Dr Watt and who had died.
The expert panel said there were concerns over Dr Watt’s clinical decision making, diagnostic approach, communication with other clinicians and poor communication with patients and their families.
2018 patient recalls
Concerns were initially raised by doctors about Dr Watt’s treatment plans and diagnoses. This resulted in a recall of 2,500 patients in May 2018 and a further 1,044 patients in October 2018. The second recall included people discharged back to their GP and then referred back to neurology services, some of whom were prescribed epilepsy medicines.
The recall showed around one in five people were misdiagnosed, as they later received a different diagnosis. For the majority, a new treatment had to be prescribed as the original was not deemed appropriate and could have led to harm.
‘Very poor’ care
The new review from the RQIA found that in the 44 patients who had died, there was ‘poor’ or ‘very poor’ care in around half. Additionally, around half the people were not considered to have a ‘secure diagnosis’. This means that they potentially did not have an appropriate diagnosis and associated care planning and treatment.
The review report found that Dr Watt failed to properly assess patients’ conditions and request appropriate or timely investigations to determine the diagnosis. The report said this was a recurring theme in cases where Dr Watt diagnosed epilepsy. The records for four people diagnosed with seizures (epilepsy) had no evidence to support this diagnosis, such as an EEG or a description of the events.
The panel found there was lack of empathy and a failure to consider patients’ needs as a whole. It also found concerns or oversights that had the potential to lead to harm in around half of the cases, including some unnecessary and invasive treatments.
This included prescribing epilepsy medicines to a patient without confirming their diagnosis. There was also a lack of evidence to suggest he spoke to a female patient with epilepsy about issues with epilepsy medicines and the possibility of sudden unexpected death in epilepsy (SUDEP).
The panel also concluded that in some instances, patients had been denied care that would have supported them in managing their condition or appropriately planning end-of-life care.
Tip of the iceberg
Carla Smyth, Epilepsy Action Northern Ireland services and projects manager, said: “The shocking findings in the report are only the tip of the iceberg given the extent to which so many patients have been subjected to significant harm and distress at the hands of Dr Watt. We understand that the findings will be distressing for the families involved.
“In particular, we are very concerned at how many patients were wrongly diagnosed with epilepsy without sufficient evidence and diagnostic tests, and the avoidable harm they experienced as a result.
“It is vitally important that lessons are learned and that the concerns of patients and their families are addressed and duty of candour is discharged. We urge the Regulation and Quality Improvement Authority to conduct further investigations into those who received an epilepsy diagnosis, given that thousands of people were affected by Dr Watt and the significant failures in patient care that have occurred.
“We thank all the affected families who have spoken out about their situation.”
The report sets out specific recommendations for the RQIA. In the short term, it said the RQIA should consider what these findings mean for other cases included in the recall where patients have died.
The authority will also need to consider specific cases in terms of harm arising from the findings of the report and in terms of responding to the concerns with respect to the recorded cause of death for patients and discharge Duty of Candour.
In the medium and longer term, the RQIA is recommended to consider whether more attention should be given to groups of patients who were diagnosed with epilepsy and neuropathies by Dr Watt and who have died. The report also urges the RQIA to consider making it mandatory for clinicians in Northern Ireland to send a copy of outpatient clinics letters to patients, and to consider how to address the implications of a clinician working in isolation.
In the Independent Neurology Inquiry report launched earlier this year, it was revealed the General Medical Council (GMC) had given Dr Watt a five-year warning in 2006-7 but this was never communicated to his line managers.
The report said the GMC should disclose all the information about a doctor to their Responsible Officer so they can revalidate (evaluate a doctor’s fitness to practice) appropriately. It added that the GMC should hold doctors who fail to report concerns to account.
The GMC responded to the findings of the Independent Neurology Inquiry Report, saying it supports the focus on creating a culture where doctors feel able to raise concerns and learn from mistakes. They said they will assess whether they can make guidance on raising concerns more effective and will review their revalidation guidance.
Charlie Massey, Chief Executive of the General Medical Council, said:
“Mr Watt’s patients and their families have suffered harm due to his unacceptable practice. We could, and should, have done more to help identify and put a stop to it much earlier. We are determined to learn from what has happened and make improvements to guard against anything like this happening to patients and their families again.
“We are committed to taking forward the Inquiry’s recommendations for us, in collaboration with others, to better protect patients.
“In particular we fully support the Inquiry’s focus on creating a culture within the Northern Ireland Health and Social Care service where doctors feel able to raise concerns. It is through strong and effective leadership that organisations develop cultures that support staff to speak up and openly learn from mistakes.”
The full report is available on the RQIA website.