File on Four

 

On 3 November 2015 the treatment of Sunil featured on the BBC's File on Four programme. The programme was investigating the use of locum staff in the NHS and any related issues in the quality of care. 

 

http://www.bbc.co.uk/programmes/b06mfwcn

 

The response to the programme can be found here.

 

An excerpt of the programme can be found below. Featured are Alan Urry (BBC), Sahil Sinha, Matthew Waite (Irwin Mitchell), Niall Dickson (GMC),

 

URRY: Is that what happened at a hospital in Kent, where a man who was supposed to be recovering from a routine operation instead bled to death on a surgical ward?

Video played
SINHA: Here you have some footage from a wedding only a few years past, both sides ….

 

URRY: Oh, this is him here, isn’t it?

 

SINHA: Yes.

 

URRY: But I mean, he’s the most vigorous dancer of the lot up there.

 

SINHA: Yes. Unfortunately we were all doing the same thing and he wasn’t, didn’t get the memo on that.

 

URRY: Sahil Sinha reflecting fondly on his dad’s dancing, seen in a family video.

 

SINHA: He was the first person to encourage people to get involved.

 

URRY: He looked like he enjoyed life and he had fun.

 

SINHA: Oh, very much so.

 

URRY: But there was a lot more to Sunil Sinha than an enthusiasm for dancing. Born in India 60 years ago, he came to England as a young man to get qualifications at the London School of Economics and the School of Oriental and African Studies. Later he became a notable development economist in the UK, working to reduce poverty abroad. In February this year Sunil was in Maidstone Hospital, having a small tumour removed from his bowel by keyhole surgery. A screening programme had picked it up early and his family say they were told his chances of a full recovery were good. The operation was a success, albeit that Sunil had a bleed during the procedure, something which is not uncommon. Then he was admitted to a surgical ward, where his recovery could be

 

URRY cont: monitored. According to his son, Sahil, he was expected to do well, but two days later he was dead.

 

SINHA: They were quite open about the fact they were very surprised at what had happened. What I was told on the phone initially was massive heart attack.

 

URRY: So at what point did you become concerned that matters weren’t as straightforward as they appeared to be?

 

SINHA: I think from the post mortem was the beginning of triggering concerns. The consultant in question phoned us because he’d managed to send his registrar along to the post mortem and therefore knew what the results were going to be well before the coroner sends the paperwork through. And he phoned up and was quite clear on the phone that he thought failures of care may have been involved in my father’s death, because what had transpired is that he had clearly bled to death in the hospital, and if anyone sits back and thinks about it, how does someone in a hospital bleed to death without anyone noticing? Questions certainly start being asked from that point.

 

URRY: So who should have noticed? That’s a question the Sinha family’s lawyer is wrestling with, but one of those in a position to have done more was a locum doctor. According to hospital paperwork obtained by solicitor Matthew Waite, the junior locum became involved when the 60 year old patient, who was being monitored by nursing staff, went into crisis during the first night.

 

WAITE: It looks to be the case that around two in the morning on the fifth of February, Mr Sinha had some alarming signs and symptoms. His blood pressure was very low and the hospital scoring system in place demonstrated that this was very high risk.

 

URRY: And this is a procedure they have, isn’t it, which is called patient at risk score, and the higher the numbers the more serious this is. So what is it scored on this?

 

WAITE: It’s scored as six or seven, and any score of five or more dictates that a doctor must be informed immediately and the patient to undergo a senior review within thirty minutes.

 

URRY: I can see it here in big letters in a big red box. The patient may be critically ill.

 

WAITE: It’s obviously a very concerning symptom and it needs to be appropriately managed.

 

URRY: The nurses did the right thing and contacted the junior locum who was on duty at the ward. Now it was down to him to decide what to do next, but he didn’t seem all that certain, and according to Matthew Waite, overlooked an important protocol - calling in a more experienced doctor to find out the underlying cause of the problem.

 

WAITE: He determined a management plan following discussion with the nursing team, and the reports suggest that he was asking the nurses how he should manage the patient. What then happens is that he takes some vital signs, the blood is taken and he ends up having a blood transfusion some time later. The family’s concern is whether the review was by an appropriately senior clinician and whether there was a missed opportunity at that point in time to intervene earlier, with a suspicion that there could be a bleed, a haemorrhage, something to explain the low blood pressure and the high patient at risk score that Mr Sinha had.

 

URRY: And he did ask, as you say, nurses what he should do, which might be cause for concern in itself, but they did tell him, didn’t they?

 

WAITE: Yes, it’s evident from the report in front of me and it clearly says, ‘Locum doctor asked nurse what he should do,’ and the nurse advised him to contact the senior on call. From what we have to date, we can’t see that that did actually take place.

 

URRY: Like other cases we’ve looked at, there are complicating factors to take into consideration here. The hospital’s own internal report findings suggest intra and postoperative care could have been improved. Handovers across teams affected continuity of care, and that bed management may have played a part. Was
Mr Sinha on a surgical ward because there were no places in intensive care or a high dependency unit? Although the locum doctor’s not named in the report, our investigations show he’s a Professor called Laurentiu Belusica, a Romanian medic who describes himself as a surgeon, head physician, senior lecturer and doctor of medical sciences. It sounds impressive.
I’ve got a copy of Professor Belusica’s CV here, which lists his work and achievements going back to his university graduation in 1986. It says that, whilst based at a hospital in Bucharest, he advanced through medical and teaching ranks all the way up to head surgeon, and that he’d been teaching 3rd and 4th year medical students. There are pages of lists of his contributions to surgical textbooks, scientific papers, lectures at conferences and membership of research teams. His UK work experience though is rather more modest. Doing locum shift work as a senior house officer which, despite the name, is actually a junior position. He was on duty at hospital surgery wards somewhat sporadically between 2010 and this year, including two sessions for the Trust which runs Maidstone Hospital. One, for the month of August last year and the other his four day stint in February this year, when Mr. Sinha died.
The hospital incident report also records worries about this man’s grasp of the English language. Nurses were concerned about that, according to the paperwork we’ve seen. And it notes he was unfamiliar with hospital, ward and team procedures. But the Professor didn’t want to answer any questions from File on 4. When we contacted him to ask for his version of events, he told us he didn’t want to say anything at this time and referred us back to Maidstone and Tunbridge Wells NHS Trust. They declined to speak up directly on his behalf, telling us instead they believed no one individual or service was at fault. They offered sincere apologies and regret about Mr Sinha’s death and they accepted that some of their care did not meet their own high standards. They say they’ve learned lessons from some of the weaknesses they’ve already identified. To have worked at their hospital, Professor Belusica would have needed a licence to practice, issued by the GMC. It’s a legal requirement. So I asked Chief Executive Niall Dickson if that itself is an assurance of quality.

 

DICKSON: No, it is not, and I think people need to be really clear about what a GMC licence to practice means. First of all there are doctors who have had a licence to practice over a considerable period of time and they may not be as good as they once were. Secondly, we still have a major gap in our regulatory defences in relation to Europe, because we are not allowed to check the competency of these doctors. They can still come into this country and there is nothing we can do. So a GMC stamp is not good enough for anyone to say, ‘Oh that’s all right I don’t need to do anything.’ There are responsibilities that agencies have and employers have.

 

URRY: No checks on the competency of doctors from other parts of Europe sounds worrying. Professor Belusica hails from Romania, and the locum in the Peter Ross case has English as a second language. So if the GMC can’t cover everything through their licensing system, what are the agencies doing to ensure there are proper checks? In one case we’ve looked at, they were actually cheating the NHS.