My letter to Paul Bridge GMC has been added to Support Dr Myhill website.
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MA(Oxon) ACA
Email:
22 September 2010
Paul Bridge,
General Medical Council,
Regents Place,
350 Euston Road,
London, NW1 3JN
Dear Mr Bridge,
DR SARAH MYHILL IOP HEARING 7 OCTOBER 2010
I am writing to you with reference to the above. I am requesting this letter be submitted
as further evidence in Dr Sarah Myhill’s defence. I shall refer to the two complaints as
the ‘Website Complaint’ and the ‘B12 Complaint’. I trust that you will know the details
of these complaints without further explanation.
The restrictions placed upon Dr Sarah Myhill (SM) at the IOP Hearing of 29 April 2010
should be set aside for the following reasons. References to the Defence Document which is
to be submitted by SM are abbreviated to DD.
1. The B12 complaint contains in its actual text the phrase:
“On 24th March 2009 I had a further telephone conversation with the mother. I reiterated
that we had not agreed to administer, or train her to administer the injections.”
This statement is not true, as has been demonstrated in the DD. For example, in Patient
X’s medical notes there is a letter dated 4th March 2009 from Dr P of the Partners to the
district nurse at K Road Health Centre stating that:
“Dear Colleague, Please can Patient X’s mum be taught how to administer B12 injections.
Yours sincerely, Dr P.”
Therefore the B12 Complaint should be set aside given that it is based on an untruthful
statement.
2. The Website Complaint is not corroborated by an evidence base and the credibility of
the Website Complainant has not been established by the GMC.
Under GMC Imposing Interim Orders: Guidance for the Interim Orders Panel and
Fitness to Practise Panel April 2008 Annex 9 (see section 4.12) it is stated that:
“The Interim Orders Panel will make no finding of fact but the complaint must be credible
and backed by corroborative evidence.”
The arguments for this point are laid out in detail within the DD. Therefore the Website
Complaint should be set aside under application of the above mentioned Annex.
3. The GMC data records, both of the ongoing case against SM and also of previous,
subsequently dropped, cases are factually inaccurate.
These factual inaccuracies are detailed in the DD. There are also serious omissions of facts, also as detailed in the DD.
The cumulative effect of these inaccuracies and omissions is to render the case history of
SM’s involvement with the GMC, as presented to the IOP in this data record, to be so
materially deficient that the Hearing can only be concluded to have been unfair.
Therefore, all decisions and restrictions resulting from that Hearing should be set aside
on the basis of unfairness.
4. The Website Complaint is based on a false assumption arising from the Website
Complainant’s personal belief system.
The Website Complainant has a personal beliefsystem that NICE guidelines are in some way mandatory and that Doctors who do not
follow their guidance, in their entirety, represent a danger to the public. This is simply
not true. Once again the DD argues in detail with a firm evidence base that NICE
guidelines are not mandatory and that Doctors do have clinical freedom. This is best
expressed in the following quote from a letter from NICE, which can be found in the
Appendix section of the DD:
‘NICE clinical guidelines are recommendations about the treatment and care of people with
specific diseases and conditions in the NHS in England and Wales. Clinical
guidelines represent the view of NICE, and are arrived at after careful consideration of the
evidence available. Healthcare professionals are expected to take it fully into account when
exercising their clinical judgement. However, the guidance does not override the individual
responsibility of healthcare professionals to make decisions appropriate to the circumstances
of the individual patient, in consultation with the patient and/or guardian or carer, and
informed by the summary of product characteristics of any drugs they are considering.’
Since the Website Complaint is based on a false assumption it should be set aside.
5. Further to point 4, you will be aware of the concept of Patient Counter-Examples and
in a very real sense this is why NICE guidelines can never be mandatory. Patient
Counter-Examples are those patients for whom ‘conventional’ or ‘accepted’ treatments
for certain conditions are not efficacious. These patients deserve access to Doctors who
are willing, able and qualified to diagnose and treat on an individual basis rather than
merely follow these ‘conventional’ and ‘accepted’ treatment options. This is exactly the
approach SM takes and the IOP will be provided with many Patient Counter-Examples
to demonstrate this. In taking this approach, SM is not passing comment on NICE
guidelines in general; she is merely treating patients for whom such ‘conventional’ and
‘accepted’ treatments have been ineffective and she is doing so to the best of her ability
and knowledge. The fact that so many patients have sent letters and emails of support in
favour of SM shows that her methods are, at the least, providing a necessary service for
these patients. In fact, patient support runs much deeper than that: many of SM’s
patients, myself included, credit their improving health to her protocols. These patients
have almost always been failed by the ‘conventional’ and ‘accepted’ treatments laid
down in NICE guidelines.
I urge the IOP to consider this point very carefully.
Placing severe restrictions, of the kind which were imposed on 29 April 2010, on SM’s
licence to practise medicine is denying a large cohort of patients access to such
individualised treatments (which they surely deserve) and this does no service at all to
the reputation of the GMC.
6. As detailed in the DD both the Complaints were vexatious as defined by Criteria 8 of
‘Vexatious Allegations Guidance on the Application of Rule 4(3)( c) of the GMC
(Fitness to Practise) Rules 2004’ which states that:
‘8. Broadly, a complaint can be vexatious within rule 4(3)(c) in either its intrinsic nature or
in the manner in which it is brought and/or pursued: that is, if there are reasonable grounds
to believe that one or more of three criteria apply:
A. The complaint’s primary purpose and/or effect is to disturb, disrupt and pressurise the
doctor, the GMC and/or another organisation and/or individual.
B. The primary purpose and/or effect of the manner in which the complaint is brought is
to disturb, disrupt and/or pressurise the doctor, the GMC and/or another organisation
and/or individual.
C. The complaint is otherwise manifestly unreasonable.’
The reason why the GMC did not come to the conclusion that both complaints were
vexatious was because it did not properly carry out its procedures for filtering out
vexatious complaints. This point is also made and evidenced in the DD. Indeed, the
vexatious nature or otherwise of both Complaints was not even considered. Under its
own rules, the GMC should set aside both of these Complaints on the basis that they are
vexatious.
7. The independence of the Panel which sat on 29 April 2010 has not been demonstrated
in a transparent and accountable way. This has to be done, as noted in the DD, even if
retrospectively, for the public to have confidence in GMC procedures concerning this
IOP. The DD suggests the taking of suitable affidavits for this purpose and this would
seem a sensible way forward.
8. The GMC contravened certain procedural matters as follows:
• Discussion of the IOP sentence before the hearing of evidence
• Lack of fair notice period accorded by GMC to SM
• GMC Counsel revealed the identities of the Partners and also of Patient X
during the course of his public presentation.
• Full consideration by the Panel of the level of support for SM was not given
• Patient X’s notes were taken without their permission or knowledge A3D
• Hearing Proceedings were flawed and unfair in that neither cross examination
nor the calling of witnesses was permitted.
• The letter of instruction from Ms TS, GMC Legal Department to Professor
Bouloux is littered with factual inaccuracies.
• Professor Bouloux’s Expert Witness report does not follow GMC guidance on
Expert Witness Reports
Full discussion of these points is given in the DD. The cumulative effect of these
procedural contraventions is to render the IOP Hearing unfair to SM and so it should
be set aside on that basis.
9. Under the principle laid down in Bolam v Friern Hospital Management Committee
[1957] 1 WLR 583, SM has the right to be judged by her peers. A summary of this case
law is that it:
“ lays down the typical rule for assessing the appropriate standard of reasonable care in
negligence cases involving skilled professionals (e.g. doctors): it is known as the "Bolam
test". Where the defendant has represented him or herself as having more than average skills
and abilities, this test expects standards which must be in accordance with a responsible
body of opinion, even if others differ in opinion. In other words, Bolam test states that "If a
doctor reaches the standard of a responsible body of medical opinion, he is not negligent"
SM was judged by the Expert Witness, Professor Bouloux, who by his own admission,
has no expertise in the diagnosis and treatment of either chronic fatigue syndromes or
mitochondrial disorders. Indeed he states that he refers this group of patients to
specialists rather than treat them himself. Within the GMC case notes on SM there is a
piece of advice dated 16th February 2010 from an expert GP witness which states that:
“..did not have sufficient knowledge of CFS to be in a position to answer questions posed and
that in view of Dr Myhill’s background he feels that the GMC should instruct an expert not
just with mainstream knowledge of CFS but an expert with a special knowledge or interest in
CFS”
By instructing Profesor Bouloux who is neither expert in nor has a special interest in
CFS, the GMC has ignored its own expert advice. Indeed the GMC are confused about
the manner in which SM should be assessed and the standard against which she should
be judged. In his case notes, the relevant Case Examiner states that:
“Dr Myhill has provided opinions which would not be supported by the wider medical
profession.”
This is not the standard against which SM should be judged. It is a defence in law,
provided by Bolam, that if a doctor practises a technique which is generally accepted by
his peers, then that is sufficient. ‘Peers’ are defined not by reference to the ‘wider
medical profession’, as the GMC has done so but rather by reference to ‘a responsible
body of medical opinion’ as defined once again by the Bolam principle.
This Bolam test is passed even in the presence of others who ‘differ in opinion’. SM’s
peers are the group of doctors involved in the practice of allergy, environmental and
nutritional medicine. It is from within this group of doctors that the GMC should have
sought expert witness reports. These doctors certainly represent a responsible body of
medical opinion and are best placed to judge SM’s practising of medicine.
Since SM has not been judged by her peers, as required by Bolam, the IOP decision
should be set aside on the basis of unfairness to SM.
10. The GMC is acting outwith its remit and so its decisions regarding this IOP should
be set aside. In a letter to SM, dated 7th August 2006, Neil Jinks, then GMC Assistant
Registrar, stated that:
“It is not the place of the GMC to take a position on the correctness or otherwise of generally
recommended or of possible ‘cutting edge’ treatment…...”
Yet this is exactly what the GMC has done and so this is exactly why the GMC’s
decisions regarding this IOP should be set aside.
11. Even if restrictions were considered necessary on SM’s licence, a position which has
been argued very forcefully not to be the case both in this letter and the very many
other documents laid before the IOP, then the severity of those restrictions imposed on
29 April 2010 bears no relation to the supposed transgressions. No patient has been
harmed by SM’s action; in fact many have been helped. Surely this is the ultimate
arbiter of good medical practice? Do no harm. The DD contains many examples,
demonstrating the illogical and disproportionate nature of the restrictions placed on SM
compared with other recently decided GMC cases. When the IOP reconsiders SM at the
review IOP due on 7 October 2010, I urge them to take into account this factor and even
if they cannot accept that SM should have no restrictions on her licence to practise
medicine, I implore them to reduce the severity of the restrictions with particular
regard to the prescribing of BNF medication as it is this restriction which has caused so
much harm to the health of SM’s patients. The IOP will be presented with real life case
studies of where such harm has been directly caused by this particular restriction and
once again this does no service at all to the reputation of the GMC.
I hope that the IOP sees fit to take note of these many points raised in defence of SM
and will, at the very least, lift the restriction on her right to prescribe when the case is
reviewed on 7 October 2010. It is simply not the case the SM is a risk to public safety
and the way this case has been dealt with thus far has been a travesty.
Please acknowledge receipt of this letter by return.
Yours sincerely,