1151 actions which were fought more than anything else.
General Medical Council
Council, Sir Robert
Kilpatrick, takes office just as one of the GMC’s lay members, Mrs Jean Robinson, has unleashed a stern indictment’ of the GMC’s performance as a protector of the public. Mrs Robinson, who was for three years in the chair at the Patients Association and who has served for many years on the Oxfordshire Community Health Council, was nominated by the Association of Community Health Councils as a lay member of the GMC, on which she has now sat for nine years. Her experiences have led her to conclude that the GMC interprets "serious professional misconduct" meriting disciplinary action as meaning behaviour so grievously detrimental to patients that many complaints against doctors have been given far too little weight and the public is not being protected from dangerous doctors. She would like to see the GMC threshold lowered by the deletion of "serious" (the Nursing Council deals simply with alleged "professional misconduct") and by the introduction of a lesser alternative charge of "unacceptable conduct", as was embodied in the unsuccessful Private Members Bill introduced in the Commons in 1984. When the GMC receives complaints of inadequate clinical care in the NHS, the complainant is advised to consult the NHS complaints system; and Mrs Robinson holds no punches in condemning what she see as the GMC’s use of referral to the NHS as a barrier to the advancement of claims that a doctor’s conduct should be investigated. "If you write to the GMC saying that your doctor had sex with you, talked about your illness in the comer shop, or had a favourable article written about him in the local paper, your complaint is likely to reach the Preliminary Screener if your letter can be understood. If, however, you write with a much more serious allegation that a doctor in the NHS was so negligent that he killed your child, the complaint will not get that far. In effect you will be told by the staff to take your complaint to the health authority." If the NHS inquiry finds the complaint justified, the GMC may then investigate. The public, Mrs Robinson fmds, is puzzled by this referral to the NHS; and she quotes from the GMC’s Blue Book (Professional Conduct and Discipline: Fitness to Practise) the impressive and reassuring passage about a doctor’s responsibility to patients. Impressive and reassuring that is, until the reader seeks the help of the GMC by lodging with it a criticism of a doctor’s standards of care.
Up to three-quarters of complaints to the GMC were rejected by the staff or the President (as Preliminary Screener) without reaching the Preliminary Proceedings Committee. Council members, Mrs Robinson continues, were not told what was in rejected complaints. The doctors most likely to be brought before the GMC were those who had already been investigated elsewhere. When Mrs Robinson tried to investigate two complaints about hearings in the Professional Conduct Committee of the GMC, she was not allowed to see the transcripts. It had been decided that if the doctor was found not guilty a transcript was no longer made. The GMC, prompted by the Department of Health after the introduction of the Private Members Bill, set up a working party to look at its disciplinary procedures. The working party has been proceeding, Mrs Robinson observes, at such a leisurely pace that the status quo will largely survive the life of the present Council, which ends it five-year term next year.
Complainants, she maintains, have certain legitimate needs: In
cases of serious injury, or the death of a loved one, they justice-not the same thing as retribution. Their lives have been devastated and the severity of what has occurred should be formally recognised. Otherwise their suffering or loss appears to
have been brushed aside as of no account, and unresolved bitterness is added to their burden. They need information about what happened and why, and opportunity to discuss and assimilate it. Full and open access to would
who wanted peace of mind
explanation of how this will be done. They want a genuine apology. They often need further medical treatment ("surprisingly often neglected") and sympathetic care. Sometimes they need or want money. Mrs Robinson has never met a complainant.who wanted only money and was not
Strictures Fall on the GMC
They want an assurance that steps will be taken to see that the same
THE new President of the General Medical
also concerned about the other issues. Many who did not set out wanting money ended up sueing for compensation because they were blocked from other forms of action. In Mrs Robinson’s view, no medical profession in the developed world could have had a body of patients who were more docile and grateful than the British since the formation of the NHS. Those who became aware sooner than others of the powerlessness of consumers in the system and tried to do something about it were working against the grain of British society. Attitudes began to change not because of bad care but because of the defensive and sometimes dishonest reactions of doctors and health authorities after complaints were made. In the end, consumer organisations did not have to work hard to convince the public that something was wrong-the doctors and their representatives were doing the job for them. "How can doctors, most of whom are intelligent and kind, collectively be so dim?" Mrs Robinson believes it was the very strength of the defences the medical profession had built around themselves which prevented constructive change. The highly paid, high-powered defence lawyers, the skilful drafting of rules and regulations, the power of the profession in getting the kind of Medical Act and NHS complaints system they wanted, prevented the emergence of underlying truth and constructive action. 1. A Patient Voice
the GMC. Available from Health
344 South Lambeth
Road, London SW8 1UQ. £4.95 (plus 55p postage). See: Gruneberg AL. The disciplinary function of the General Medical Council. Lancet 1984; i: 1287-89.
Medicine and the Law A
PATIENTS who have a diseased organ removed rarely give any thought to what will become of it. But what if the organ contains potentially valuable biological properties which are later patented? A long-running dispute in California over the ownership of a valuable cell-line’ gives cause for thought. LOS ANGELES CASE
In 1976, Mr John Moore had hairy-cell leukaemia. Dr David W. Golde (University of California, Los Angeles) removed his spleen, which was grossly enlarged, and the patient rapidly improved. Golde used a sample from the spleen to set up an immortal cell-line capable of producing a variety of products including granulocyte-macrophage colony-stimulating factor (GM-CSF). In 1979, Golde, with the University of California, took steps to patent his discovery, and in 1983 the university applied for a patent, naming Golde and his research assistant, Shirley Quan, as inventors. The patent was granted in 1984.1 In the meantime, the patient had moved to Seattle but he returned to consult Dr Golde every six months. He might never have known about the cell-line had Golde not told him that he had "mis-signed the consent form" (ringing "[I] do not" [rather than I do] grant the University all rights in any cell line". The patient consulted a lawyer, and in September, 1984, proceedings began against the University of California, Golde, Quan, Genetics Institute Inc, and Sandoz. At first the claim was struck out as disclosing no cause of action but this decision was reversed in July, 1988, when, by a majority of two to one, the California Court of Appeals held that Moore was entitled to bring an action. (An appeal has been lodged.) The appeal court concentrated on "conversion", a tort of strict liability ie, it requires neither knowledge nor intent on the part of the defendant). 1. Annas GJ Whose 1988 Oct Nov
waste is it
of John Moore.
Hastings Center Rep