Are you ready to go to prison on a manslaughter charge?

Mr Sellu was convicted for manslaughter caused by his gross negligence to his patient. To warrant a conviction, a healthcare professional’s breach of the duty of care to the patient has to (i) have been so grossly negligent AND (ii) show such a disregard for the life and safety of others, as to be worthy of criminal conviction. In addition, the test for proving gross negligence is much harder to pass than the test for “regular” negligence. Furthermore, the legal standard of proving gross negligence is “beyond all reasonable doubt” and not the lesser “balance of probabilities” used in civill negligence cases. Proving manslaughter by gross negligence is a very tall order. Also, the law under which Mr Sellu was convicted is not new. For all these reasons; (i) healthcare professionals are rarely convicted for manslaughter by gross negligence and (ii) the Sellu case is notable for its rarity, not its novelty. The Judge’s sentencing remarks are available online are are worth reading. DSU

The judges sentencing remarks make chilling reading! https://www.judiciary.gov.uk/Resources/JCO/Documents/Judgments/r-v-sellu-sentencing-remarks.pdf.
Whatever actually happened, and there appear to be many discrepancies, David Sellu appears to have contravened a fundamental tenet of medical practice in that there was a lack of documentation of the care provided. As is well known, “if it isn’t written down it didn’t happen”, and therefore the failure to adequately document his visit and instructions in this critically sick patient was incomprehensible.
Prof Kirby’s suggestion that the patient died due to the lack of availability of an anaesthetist is interesting as there was no mention of it by the judge. Delays were probably due to the failure of the surgeon to recognise the severity of the condition and his decision to order a CT scan. He should have been looking for an anaesthetist on Thursday evening and not some 18hours later.
The decision not to suspend the sentence does however appear to be unnecessarily harsh and I suspect he has been used by the judiciary to send a message to the medical profession.

Even across the miles this is indeed worrying . Clearly it highlights the need to accurately document all steps in the care of a patient . Obviously delays in assessing and operating on an acutely unwell patient in unacceptable. In this courts eyes , if that contributes to the death of a patient it is deemed grossly negligent and now worthy of a prison term. Obviously this is a major concern for all surgeons who may not always be in a position to acutely assess a patient if they are performing another procedure. Obviously this highlights the need for defensive strategies including adequate documentation in notes , having a low threshold to investigate out of hours ( including calling in radiologists, surgeons or physicians as required ) , ensuring prioritisation and full assessment of any unwell patient before any routine scheduled elective surgery ,and I suspect now ensuring adequate consultant cover in case an emergency aries when a surgeon is not immediately available to assess a patient . I would agree incarceration is an extremely harsh penalty and may well make anyone considering a medical and in particular a surgical career , reconsider their career choice.

What a shocking sentence for this surgeon. There have only been 3 custodial sentences in the last 100 years or so involving similar cases. BUT… Doesn’t look good if you read the RCS document and judges sentencing.
The key learning points seems to be poor communication, lack of urgency, terrible lack of documentation and lack of openness and honesty due to changing his story.
Ironically if he was in an NHS hospital then the CT and antibiotics probably would have been sorted by the team. Privately there isn’t that backup. Maybe he should have just been transferred that first night. The P-POSSUM score for peri operative mortality may well have resulted in the predictive score for survival dropping significantly due to the delay.
He failed to recognize the seriousness of the situation and react accordingly but was probably reassured given the history of a knee operation that serious bowel pathology was unlikely.
He didn’t ask for the referral to him and probably could have done without it that night but having seen the case had a duty of care to the patient and unfortunately had a heavy schedule the next day. Working alone privately in this situation is highly stressful in these circumstances.
Much to learn from and take note of but hopefully most of us would be able to react differently. However jail really seems a step too far.

We all make mistakes and if it results in harm to the patient we never forget it & learn. Our feelings of guilt are punishment in itself. We do not know enough about this case to make any judgement to know if the punishment was fit for the crime, but one thing is for sure, the surgeon will have felt great remorse. A fine example of how surgeons feel when things go wrong is in Henry Marsh’s book DO No Harm, published by Orion books ISBN 978-0-2978-6987-0, I commend it to you. It tells of the experiences of a neurosurgeon. What I have learnt over the years is to be very honest and say sorry as soon as possible.

It would be terribly easy to be sanctimonious about this case, without knowing the details. The bottom line is that if someone has been found to have acted in a negligent manner, one has to accept the consequences. In this instance, the judge has sentenced the surgeon to a prison sentence, which was obviously considered to be the appropriate sentence. I think that the fact that the surgeon has been sent to jail is catastrophic for the person involved and the consequences for him are serious and far-reaching. If the deceased patient’s family decide to take a civil suit against the surgeon or physician, this is a potential end-point.

There, for the Grace of God, go the rest of us…..for the moment. This could happen to any one of us at anytime. In the same way that we may cause a fatal motor accident. We do not set out to do these things that may bring us down. They happen. On reflection we may have wished we had done things differently, We are all very busy with too many strings pulling at us and we have to prioritise timings. There are no winners here,: not for the patient, not for the family and not for the surgeon. There are only losers. It is important that the implications of this case are widely disseminated through educational fora to all of us who practice medicine and surgery. It is likely that we will see more rulings like this. We all need to be vigilant in preventing such catastrophes and we need ongoing education and infrastructures and pathways to ensure that we have done all we can do to prevent disaster. Even with that, disaster will happen. The judgement, however, may be different if we have had such education, infrastructure and have adhered to validated pathways of care. God bless us all.

This is a truly tragic case for all concerned and perhaps one of the most surprising features is the very limited amount of comment there has been about this in the medical and lay press.
This case may have some impact on the management of patients in the NHS but it should have a really significant impact on private medical practice. It should be compulsory reading for all private hospital CEOs.
There are virtually no protocols for the management of the emergency patient in private hospitals (where such cases usually occur as the result of complications of another elective operation). Not all private hospitals have planned out of hours rotas for anaesthetists and radiologists and sometimes there can be difficulty in accessing emergency theatres at night.

I completely agree with the comments of others that we have to get better about making daily timed records in all private patients notes and that these notes should be extremely detailed in all occasions where complications occur.
We need a low threshold for transferring private patients to an appropriate NHS facility if high dependency care is not available and I suspect there are many hospitals where the level of middle grade support falls far below that which we take for granted in the NHS.

Writing as a layperson aware of our over-crowded prisons, what is the point of a custodial sentence? Surely there are better options?

Good article in this month’s MPS magazine about David Sellu. Sarah Redston seems to have made one of the best observations. Prison is a scary prospect for middle class professionals and his sentence brings to mind Admiral Byng failing to do his utmost in 1757 and being shot. Voltaire commented that the purpose was to “encourager les autres” It all contributes to a less enjoyable and more defensive medical life which is expensive medicine. Would I be guilty of manslaughter for not admitting dying patients to ITU if I thought it inappropriatebut an expert witness disagreed?

Reading this site it seems that there is much interesting disagreement about this case. As to concluding that Mr Sellu lied. I doubt that very much indeed. I wonder how many of us when at the mercy of a system determined not to be found wanting, and the whole process Mr Sellu went through when he was singled out against a likely backdrop of a series of systems errors would find that our words could be deemed lies if we had made any small unintentional errors. I wonder. The lesson here is do not seek to judge this and look very carefully at the circumstances……….

There are rumours, which I do hope are true, that an appeal is being considered on behalf of David Sellu. I agree entirely with the view expressed above by Matt Dunkley: David made errors, but so did others. The sad end result was the result of an error chain in which David Sellu was only a single link. I would hope that an appeal would lead to his release from a prison term that is really serving no useful purpose for society and costing us all money. Below is a photograph of David and his family reproduced from the Sunday Times article: “Surgical Removal”

I’m in my final year of a law degree and my dissertation includes a consideration of the elements of gross negligence manslaughter. I have read an article in the sunday press from last August which suggests that the David Sellu’s patient had a 40% mortality risk in any event.
If that was so, then on the basis of the earlier case law at least, i cannot see how causation was proved by the crown. Can anyone shed further light on this aspect? Since there was no appeal, a formal law report of the trial is unavailable, so the submissions of the expert witnesses are not readily available.

Thank you for your interest in this case and your comment on the blog. The bowel problem was a completely separate pathology and not an injury, but most likely a perforated diverticulum of the sigmoid colon resulting peritonitis (I haven’t seen the detailed medical details of the case). The development of a second illness when a patient is in hospital recovering from a knee operation can cause diagnostic difficulties, and the symptoms could well have been masked by the pain-killers given for the orthpaedic procedure. Perforated diverticular disease has a very significant mortality with or without laparotomy, but it is true that the delay in getting the CT done and the operation performed certainly did not improve the patient’s chances of survival.

For all of those interested in this important issue there is an upcoming “Doctor’s and Manslaughter” meeting in London. Do take a look at this link:
https://www.doctorsandmanslaughter.org.uk/
and register for a modest £25. A very worthwhile investment if it keeps you out of prison!

Hi Roger, what are the accepted mortality statistics for perforated diverticular disease please?

I have spoken to Professor Sina Dorudi about the mortality from perforated diverticular disease (the presumed diagnosis in this case). He pointed out that this would depend on whether there was a septic peritonitis or a faecal peritonitis: the latter being more hazardous.
For those interested in this case and the issues surrounding it, there is another blog running on the http://www.trendsinmenshealth.com website: https://trendsinmenshealth.com/clinical-negligence/#comments

I am a solicitor who acts for patients in pursuing negligence claims against doctors and hospitals and as such it may be thought that I can be expected to have limited sympathy for Dr Sellu`s plight. But that is far from being so. I have very considerable sympathy. In fact this case troubles me every bit as much as it clearly troubles everybody else who has contributed to this blog. I do not see what possible public interest can be served by criminalising and imprisoning doctors simply for making mistakes that lead to an unintended outcome – however tragic that outcome may have been. To be guilty of manslaughter in this context a person must make a mistake, which is “grossly” negligent and which also causes death. But the distinction between “gross” as opposed to “ordinary” negligence is in reality meaningless and whether or not the error results in death is a matter of chance.
I am sure that, aside from a Shipman scenario (where there was no “mistake” because the harm was intended) no doctor causes harm to a patient just for the fun of it. It happens because everybody (including judges!!) makes mistakes everyday and always will. Most of our mistakes of course have no consequences or are easily rectified. Few mistakes result in the tragedy of a death (although it does happen). Precisely the same mistake can easily result in very different outcomes (e.g, no harm at all or death) and yet the culpability is the same. So what is the public policy justification in making one a serious offence justifying imprisonment and the other no offence at all. The only difference between the cases is the outcome, which is a matter of chance. Making one a criminal offence certainly does nothing to reduce the likelihood of other doctors making other errors in the future.
Regrettably however I fear that the political climate is against this view because I have a sense that these prosecutions are happening more often. For example, I understand that an anaesthetist at Tunbridge Wells NHS Trust is currently facing a manslaughter charge after the death of a patient and that the Trust itself is also facing a corporate manslaughter charge; although I know nothing about the case. Neither do I know what can be done to stop this trend.
My only other thought is that reading the Judge`s sentencing remarks, he seems to have decided that a custodial sentence was appropriate because David Sellu gave a false (or at least a different) account of what happened to the internal investigation. If so this is yet another example of a bad situation being made very much worse because of an attempted cover up. Speaking as a lawyer my strong advice is that if confronted with a seriously threatening situation such as this, seek immediate help from your medical defence organisation, give them a complete and honest account of what happened and then follow the advice that is given.

And yet another recent manslaughter charge against medical professionals:
Doctor and nurse appear in court charged with manslaughter of six-year-old Jack Adcock.
“A doctor and a nurse appeared in court recently charged with the manslaughter of a six-year-old boy at Leicester Royal Infirmary.
Dr Hadiza Bawa-Garb and ward sister Theresa Taylor pleaded not guilty at Nottingham Crown Court to the manslaughter by gross negligence of Jack Adcock at the hospital on February 18 2011.
Dr Bawa-Garb (38) of Watkin Road, off Upperton Road, Leicester, and Theresa Taylor (55), of Henley Road, Western Park, Leicester, were granted unconditional bail.
Staff nurse Isabel Amaro (47), of Balmoral Court, Manchester, did not appear in court due to ill health”.
There does seem to be little doubt that manslaughter charges against members of the medical profession are becoming more prevalent. How should this change the way we practice?

Read more: https://www.leicestermercury.co.uk/Doctor-nurse-appear-court-charged-manslaughter/story-26425441-detail/story.html#ixzz3cMDcJ9sN

Letter to the President of the Royal College of Surgeons from Peter Taylor

15 July 2015

Miss Clare Marx CBE, DL, MBBS, PRCS
President
The Royal College of Surgeons of England
35-43 Lincoln’s Inn Fields
London WC2A 3PE

Dear Miss Marx,

You will no doubt be aware of the increasing incidents of doctors being investigated by the Crown Prosecution Service (CPS) with a view to bringing charges for Gross Negligence Manslaughter following an unexpected death of a patient. Regrettably the CPS cannot confirm this increase as they claim not to record the occupation of individuals suspected of criminality. However we are concerned about a possible increase in criminal investigations over the last 18 months, with at least four cases reported in the media during 2015 alone. Over the same time there has been a notable increase in the number of times police have been called in to investigate hospital deaths.

All responsible doctors want malpractice to be rooted out of the profession. However we are adamant that individual doctors, who are readily blamed in circumstances where mistakes and delays have culminated in a patient’s death, should be given a fair trial. This means ensuring that the evidence given to judge and jury should properly, and accurately, reflect the facts as known to the doctor under the particular circumstances in which they were making decisions affecting that patient’s care. The quality of evidence given by expert witnesses is variable and may be heavily biased. We are concerned that retrospective analysis of evidence may produce unfair trial outcomes and will do nothing to uphold patient safety.

The reality is that unexpected deaths in healthcare more commonly result from a chain of events rather than one individual doctor’s gross negligence. We are concerned that jailing doctors allows systemic failures, which commonly provide the context in these cases, to recur which may then result in further unexpected deaths.

We are also concerned about a climate of fear enveloping healthcare in this country where unrealistic expectations are placed on doctors. As the population gets older, has more chronic co-morbidities and takes increasing amounts of medication, doctors will be reluctant to take on high risk patients for fear of being prosecuted in the event of a death.

We are similarly writing to each president as it is our firm view that the Royal Colleges should:

1. embark on a process of reviewing, registering and overseeing the quality and training of expert surgical witnesses to both coroners’ and criminal courts. This would be in the best interests of patient safety and the future of the profession;

2. form a working party to review the quality control of expert witnesses. The working party, together with the Lord Chief Justice and the Office of the Chief Coroner, should be safeguarding fairness in future gross negligence manslaughter trials involving doctors;

3. establish a process of nominating expert witnesses from suitably qualified individuals to prevent expert witness “shopping” by either prosecution or defence;

4. suggest to the Attorney General that the CPS should begin to compile data on the professional occupation and ethnicity of those it chooses to investigate. Ethnic monitoring is now essential to ensure fair treatment irrespective of background. There is evidence to suggest that there are excess successful prosecutions of and disproportionate charging of doctors from black and ethnic minorities (Quick et al 2015). This will do nothing to encourage diversity within the profession.

All doctors need to have full confidence in the Royal Colleges. As a collective body we would like to see them show how high a value they place on probity within the criminal justice system insofar as it affects the profession.

Yours sincerely,

Peter R Taylor Ex President of the Vascular Society of Great Britain and Ireland.

CRIMINALISING DOCTORS LEAVES PATIENTS’ LIVES AT RISK SAY SENIOR MEDICAL PROFESSIONALS

In February 2010, a highly-regarded and experienced Consultant Colorectal Surgeon David Sellu operated on a patient with a perforated bowel at the Clementine Churchill Hospital. Despite David’s efforts the patient died two days later. There followed a sequence of extraordinary events that led to David being tried and convicted of Gross Negligence Manslaughter in November 2013.

In the wake of David Sellu’s conviction, senior medical colleagues continue to speak out over their concerns that five and a half years on from this incident, patient safety continues to be compromised as hospitals’ systemic failings are yet to be addressed. 800 people have died unexpectedly in private hospitals in England during the last four years[1].

Professor Roger Kirby, Medical Director at The Prostate Centre says:
“Criminalising doctors sets a dangerous precedent. I personally have been called in to deal with emergencies in private hospitals in the middle of the night. The situation can be very challenging. If surgeons become paranoid about taking on these cases under the prospect of personal prosecution should the patient die, lives will be put at risk as fewer patients will receive the operations they urgently need.”

Research suggests the average Briton may go through 7 surgeries during his/her lifetime[2]. Complications are said to arise in 8-13% of cases, half of which are believed to be preventable through systemic improvements.

Mr Sellu is currently appealing his conviction at a hearing this Autumn. Meantime, between them, many medics supporting him have the following concerns and observations:

– As a direct result of the prosecution of David Sellu (following the death of his patient from complications after a routine operation), surgeons are increasingly adopting defensive medical approaches to complex surgery in the private sector. There is a risk that some may even refuse to operate on higher-risk patients. This unnecessarily limits the outcomes for patients with challenging medical histories.

– A culture of openness is of paramount importance for patient safety. Medical practitioners need to be transparent about their mistakes but in a no blame environment. If they fear the hospital prefers to make individuals culpable, and likely subjects of criminal investigation when errors occur, this will not happen. All hospitals, whether NHS or private, should adhere to a standard mechanism for unexpected deaths. This must include a transparent and thorough overhaul of their own systems and processes that led to the unexpected death or serious incident occurring.

– Over the past 18 months, doctors claim anecdotally that there has been a notable increase in the number of times police have been called to investigate hospital deaths and an increase in CPS charges against medics. However the numbers cannot be verified as the CPS claims not to hold data on the professional occupation, or ethnicity, of individuals charged. Doctors are also concerned at what appears to be a disproportionate number of successful prosecutions against black and ethnic minority doctors. They acknowledge that the overall prosecution numbers are small, but nonetheless are concerned about the emergence of a growing trend.

– Patients opting for elective surgery in a private hospital are not routinely made aware of the consequences of private hospitals’ failure to institute emergency oncall rotas. Should complications arise, delays can be caused to emergency surgery with sometimes fatal consequences if no anaesthetists can be found to allow the operation to proceed.

– There is no standardised consent required from those NHS patients whose elective surgery is passed to the private sector.

– There is no formally recorded data of the 6000 private patients referred annually to the NHS following surgical complications arising in the private sector. The Department of Health should collate and publish the nature and cost of these referrals.

– The significant cost of these emergency referrals is currently being born by the over-stretched NHS, rather than being the responsibility of the private healthcare companies.

– Private hospitals should be required to report safety incidents along exactly the same lines as NHS hospitals are currently required to do, as part of a requirement for CQC registration. Currently, patients who die in an NHS hospital following referral from a private hospital, are listed under NHS mortality and morbidity statistics, and not under those of the referring private hospital. This means no reliable audit can be made of patient safety in private hospitals.

A number of supportive senior doctors have today lent their name to a letter (copy available) written to Claire Marx, the President of the Royal College of Surgeons calling for the College to ensure that the quality of evidence given by expert witnesses at trial is consistent and properly reflects the knowledge of the medical professional making the decisions at the time. They are particularly concerned that retrospective analysis of complex medical evidence, in the sterile environment of a court room, may produce unfair trial outcomes and will do nothing to uphold patient safety.

Mr Ian Franklin, Consultant Vascular Surgeon and representative of the Friends of David Sellu Campaign, says:

“Unexpected deaths in healthcare more commonly result from a chain of events rather than one individual doctor’s gross negligence. Bringing charges against individual doctors, which the CPS is increasingly doing, does not make patients safer as there is no incentive for the organisation in which the mistakes occurred to address their systemic failings. One crucial safety factor is for private hospitals to have an anaesthetic rota to deal with emergencies. Some private hospitals have done this but in many, emergency rotas are still non-existent.”

Responsible doctors are calling for a review of the way private hospitals investigate and report unexpected deaths and serious untoward incidents (SUIs). It is woefully inconsistent across the sector. Another immediate step should be the requirement to introduce emergency anaesthetic rotas in those hospitals that still fail to provide them, to improve patient outcomes following surgery in private practice. These demands are rightly put on the NHS so there is no reason not to have similar expectations of the private sector, particularly given the growing numbers of patient referrals from the NHS.

[1] https://chpi.org.uk/wp-content/uploads/2014/08/CHPI-PatientSafety-Aug2014.pdf (Exec Summary)
[2] https://chpi.org.uk/wp-content/uploads/2014/08/CHPI-PatientSafety-Aug2014.pdf (para 47)

Read this article in the Guardian about David Sellu’s forthcoming appeal against his manslaughter prosecution
https://www.theguardian.com/society/2015/aug/06/doctors-sign-letter-expressing-worry-over-criminalisation-of-surgeon

And another case for those following this sorry saga:
https://www.dailymail.co.uk/news/article-3276076/Doctor-denies-manslaughter-primary-school-teacher-Mrs-Coffee-died-giving-birth-emergency-Caesarean-section.html

A surgeon whose jailing for manslaughter over a patient’s death at a private hospital caused widespread alarm among doctors has won permission to appeal against his conviction.
Three judges at the Court of Appeal in London granted colorectal surgeon David Sellu, 68, leave to appeal after a short hearing.
Sellu, a senior consultant surgeon with a successful 40-year career in the NHS, was sentenced to 2 ½ years in prison in November 2014 for contributing to the death of James Hughes in February 2010 at the Clementine Churchill Hospital in Harrow, north London[i]. He was called in after Hughes, 66, a retired builder, developed abdominal pains in the wake of a routine knee operation.
Sellu operated on Hughes just over 24 hours after he first saw him, but he died from a perforated bowel. An internal investigation by the hospital found “systemic failures” but the report was not disclosed at Sellu’s trial and he was blamed for a catalogue of delays.[ii]
More than 300 doctors, including professors of surgery, signed a letter to the president of the Royal College of Surgeons noting that “unexpected deaths in healthcare more commonly result from a chain of events rather than one individual doctor’s gross negligence”.
Sellu’s lawyers were given permission to appeal on the ground of fresh evidence showing, first of all, that Hughes’ risk of death at the time Sellu first saw him was much higher than the 2.6% put forward by the prosecution. Secondly, his lawyers argued that the significance of the fact that Hughes had been given dabigatran, a new generation oral anticoagulant, was not fully appreciated at the time.

And a related article in Trends about a vascular surgeon who was charged with manslaughter after an intra-operative death of a patient: https://trendsinmenshealth.com/wp-content/uploads/sites/13/2015/11/Surviving-prosecution.pdf

Another fatal error:
https://www.bbc.co.uk/news/health-35403822
We shall see if it is NHS 111 or the clinicians who get the blame for this.

Frances Cappuccini Caesarean death trial halted
Frances Cappuccini died at Tunbridge Wells Hospital in October 2012
A doctor and hospital trust have been cleared of the manslaughter of a woman who died hours after a Caesarean birth, following a landmark trial’s collapse.
Mr Justice Coulson halted the trial of Dr Errol Cornish and Maidstone and Tunbridge Wells NHS Trust, saying it would be “unsafe and unfair” to go on.
Frances Cappuccini, 30, died after suffering a haemorrhage at Tunbridge Wells Hospital on 9 October 2012.
It was the first prosecution of an NHS trust for corporate manslaughter.
Dr Cornish, 67, of Holmbury Park, Bromley, south-east London, a consultant anaesthetist, had denied manslaughter by gross negligence.
The judge told the court there was little or no evidence he had done anything wrong that had contributed to Mrs Cappuccini’s death and, likewise, there was no evidence of systemic failure at the trust.
“I am firmly of the view that it would be unsafe and unfair to everyone, including Mrs Cappuccini’s family, to leave this case to the jury,” he added.
“Her unexpected death can only properly be described as a tragedy.”
He told the court Dr Cornish had taken actions that were “as far removed from a case of gross negligence manslaughter as it’s possible to be” and he and the trust that employed him had “no case to answer”.
The Crown Prosecution Service (CPS) said it had “carefully considered” Mr Justice Coulson’s judgement and decided not to appeal against his decision.
It is still deciding whether to continue proceedings against anaesthetist Dr Nadeem Azeez, who was not on trial because he had left the country.
Following the conclusion of the trial, it emerged Mr Justice Coulson had ordered the Health Secretary Jeremy Hunt to delete a tweet he posted on the second day of proceedings which said it was a “tragic case from which huge lessons must be learned”.
In a statement following the collapse of the trial, Maidstone and Tunbridge Wells NHS Trust said “no outcome from these proceedings could bring any consolation to the family” adding its sympathies were with them.
“The allegation of corporate manslaughter has been consistently denied by the trust and now also comprehensively rejected by the court,” it continued.
“The trust regrets that the Crown Prosecution Service saw fit to pursue the charge in the first place, given the additional stress this will have caused all involved.”
Dr Cornish said he was relieved with the judge’s verdict and thanked “family, friends, legal team and all those who supported me through this difficult time”.
“I would like to pay tribute to the family of Mrs Cappuccini for the restraint and dignity they have displayed throughout this trial,” he added.
Jurors had been told Mrs Cappuccini lost more than two litres of blood when she gave birth to her second son Giacomo by Caesarean.
She was taken back into theatre for surgery for postpartum bleeding but did not regain consciousness.

Mrs Cappuccini’s final hours:
Mrs Cappuccini is admitted to Tunbridge Wells Hospital in the final stages of labour on 8 October 2012
Her son, Giacomo, is born by caesarean section at 08:28 GMT the following morning
At 11:35 GMT she is taken back into the operating theatre after suffering a haemorrhage
Dr Azeez removes her breathing tube at 12:30 GMT
Half an hour later Dr Cornish is called to assist when Mrs Cappuccini encounters difficulties breathing
She suffers a cardiac arrest at 15:16 GMT and is pronounced dead just over an hour later
The prosecution claimed the Dr Azeez, who was the anaesthetist, and consultant anaesthetist Dr Cornish failed to ensure Mrs Cappuccini safely came round from surgery.
It was the first time an NHS trust had been accused of corporate manslaughter since the charge was introduced in 2008.
The prosecution also claimed if one or both doctors were found to be grossly negligent then the trust could be said to have employed someone it knew or should have known was not suitably qualified or trained for their role.

The rise and rise of defensive medicine:
https://www.theguardian.com/society/2016/jan/29/doctors-avoiding-risky-operations-due-to-prosecution-threat-survey-finds

Two GPs have appeared before a judge at Cardiff Crown Court accused of the manslaughter of a child patient.

The doctors, Lindsey Thomas, 42, of Copper Beach Drive, Tredegar , and Joanne Rudling, 45, of Blackberry Way, Pontprennau , Cardiff , each entered a not guilty plea to an allegation that they unlawfully killed 12-year-old Ryan Morse “on or about” December 8, 2012, by gross negligence.

No further details of the child’s death were put before the court during Monday’s short hearing.

The plea hearing was held before Recorder of Cardiff Judge Eleri Rees who granted both women bail until their trial takes place on May 3.

The prosecution was represented by John Price QC and both Thomas and Rudling also had leading counsel acting for them.

Ryan lived with his family at Brynither, Abertillery, and the doctors are understood to have been working in the Gwent town.

The child’s mother is expected to be called as a witness during the trial, which is expected to last about three weeks.

WalesOnline

FEBRUARY 9, 2016

Here is the link to a new website created by Dr Jenny Vaughan and Ian Franklin and others which focuses on the issue of gross negligence manslaughter (GNM): https://www.manslaughterandhealthcare.org.uk/
Do take a look.

Two GPs in Wales are now on trial for gross negligence manslaughter for failing to recognise that a child was seriously ill with Addison’s disease. Follow this link to read the details:

https://www.itv.com/news/wales/2016-05-10/doctors-manslaughter-trial-boy-would-have-survived-with-emergency-treatment/

A GP was today cleared of killing a 12-year-old boy by gross negligence after he died from Addison’s disease.

Dr Lindsay Thomas, 42, had been on trial for two weeks for causing the death of schoolboy Ryan Morse after he died from the rare condition.

Her colleague, Dr Joanne Rudling, 45, is charged with manslaughter and trying to pervert the course of public justice, after she also received a call from Ryan’s mother, and then allegedly manipulated his medical records days after he died.

But Mrs Justice Judge Nicola Davies today dismissed the charge against Dr Thomas by directing the jury to find her not guilty of manslaughter.
The judge said: ’In law, on the charge of gross negligence manslaughter, there is no case to answer.

‘I direct that a verdict of not guilty be entered by you, the jury.’

Dr Thomas was charged after schoolboy Ryan died in his home in December 2012, from Addison’s Disease – a condition which includes progressive anaemia, low blood pressure, weakness and discolouration of the skin.

His mother had called Dr Thomas at Brynithir Surgery in Aberystwyth, West Wales, 24 hours before her son died for advice about his condition.

The prosecution said the GP should have realised the schoolboy was dying, and should have called for an ambulance or gone to visit the boy herself.

But Judge Davies told the court Dr Thomas’ actions didn’t amount to manslaughter.

Outside the court Dr Thomas, from Tredegar, Gwent, read a short statement saying she was ‘very pleased’ at the outcome.

She said: ’I would like to thank family, friends, patients and my legal team for their support.

‘Once again I offer my condolences to Ryan’s family.’

Dr Rudling, of Pontprennau, Cardiff, denies manslaughter and trying to pervert the course of public justice.

The trial continues at Cardiff Crown Court.

Another manslaughter case against a clinician – this time a psychiatrist whose patient hacked a victim to death. The judge said that the doctor was blind to the risk.
https://www.theguardian.com/world/2012/dec/19/france-europe-news

Dr David Nicholl (@djnicholl)
Add your signature to this petition please:
Open letter to the Academy of Medical Royal Colleges & Dept of Justice on the use of Gross Negligence Manslaughter

Joanna Pallister Durham
Why would anyone join the medical profession?
I read with dismay the short article (In the Independent) on the optometrist jailed for failing to spot a life-threatening disease.
Whilst this is an appalling tragedy and my thoughts are with the boy and his family, our ability as a nation to see humans for what they are, human and fallible, and therefore too desperately seek blame, horrifies me. Why would anyone want to put themselves in a position where your employers are threatening constant cuts, privatisation (as in this case) and personal liability? We are creating, or actually running headlong to, a less caring, more selfish society.

Why become a Doctor?
Please allow me to recommend this series: https://www.bbc.co.uk/programmes/b07q3k8g/episodes/player
There’s a very topical episode 3, dealing with Gross Negligence Manslaughter (GNM), and featuring an insightful contribution from Ian Barker of the MDU. Well worth listening to.

Our letter in The Times https://t.co/E05oqGGdGn @vaughan_jenny #justculture #manslaughter #patientsafety pic.twitter.com/gVxBpYlW2v

— Dr David Nicholl (@djnicholl) August 27, 2016

Judgement has been reserved after the appeal of David Sellu against his conviction for gross negligence manslaughter. We await the decision of the judges with some trepidation! A new piece of evidence was put forward by Mark Ellison QC: it transpires that James Hughes, the patient who died, had been prescribed the platelet-inhibiting anticoagulant dabigatran, which at the time had no antidote. If Hughes had been operated on during the period that Sellu was accused of being grossly negligent for not operating, the presence of dabigatran created a very high risk of catastrophic surgical haemorrhage, carrying a significant risk of death.
The new evidence is crucial because, for a manslaughter conviction, the prosecution must prove not only that the doctor was grossly negligent but that this negligence caused or significantly contributed to the patient’s death.

More good news.
The prosecution have (very sensibly!) decided not to apply for a retrial!
The ordeal is finally over for David and his family.

The appeal judges said the trial judge did not give the jury adequate legal guidance on what gross negligence meant.
Speaking after the conviction was quashed, Mr Sellu said there was a range of factors which contributed to Mr Hughes’s death, including problems with the whole system at the hospital.
“I think for the sake of that poor man and his family justice has not really been done,” he said.
“It has been retribution, but I don’t really believe that they’ve been served as well as they should have been.”
Mr Hughes became ill after a routine knee replacement carried out by another surgeon.
Mr Sellu later carried out surgery to repair a perforated bowel, but there had been delays in that carrying operation. Mr Hughes died two days later.
The Crown Prosecution Service has decided not to seek a retrial after David Sellu’s conviction was quashed
The original case against Mr Sellu, of Hillingdon, was based on the standard of his care over about 25 hours.
Mr Sellu argued he knew Mr Hughes needed an urgent operation, but an anaesthetist was not available for several hours and it was not safe to move the patient to the nearby hospital.
“It really was another routine day. A busy day of course, but I’d been used to working in this sort of way for many, many years,” Mr Sellu said.
Mr Sellu’s medical licence was suspended when he was convicted and would only be reinstated after a General Medical Council (GMC) hearing.
The Crown Prosecution Service has decided not to seek a retrial.
In a statement, Mr Hughes’ family said the doctor had “served his sentence”.
“Our father’s suffering was not prioritised as the emergency it so clearly was,” they said.
A spokesman for Clementine Churchill Hospital said the “original prosecution was a criminal case led by the Crown Prosecution Service and the police”.

Professor Sir Norman Williams says prosecutors are becoming ‘energetic’ in prosecuting and convicting surgeons:

https://www.dailymail.co.uk/news/article-3959052/Doctors-scared-save-lives-case-hauled-court-NHS-adviser-s-warning-surgeon-cleared.html#comments

Another interesting piece relating to David Sellu’s quashed conviction: https://thejusticegap.com/2016/11/poor-bad-truly-atrocious-directing-jury-gross-negligence-manslaughter/

In addition this website set up by the outstanding Dr Jenny Vaughan has a great deal of up-to-date information about these issues: https://www.manslaughterandhealthcare.org.uk

Check out this editorial in Trends: ‘Justice at last’
https://trendsinmenshealth.com/article/editorial-justice-at-last/

Judges considering prosecutions against doctors for gross negligence manslaughter would not view a lack of NHS resources as a defence against clinical negligence, James Badenoch, a barrister who specialises in medical law and clinical negligence said at a recent meeting at the Royal Society of Medicine.

At a conference on litigation against doctors at the Royal Society of Medicine, James Badenoch QC said that he was often asked whether judges would take into account “the impossible conditions in which some doctors work.”

“The answer, to be relatively frank with you, is no,” he said. “

Here are the videos from our meeting at the Royal Society of Medicine on the 21st of April. It includes David Sellu’s “Mistake or Manslaughter” and some other great talks: https://videos.rsm.ac.uk/specialties/urology-section. Do take a look.

As followers of this blog will know, there has been a recent rise in the range of healthcare workers charged with “manslaughter by gross negligence.” Although prosecutions are still rare there is widespread concern that staff cannot learn from errors or near misses in a culture of blame or under threat of criminal charges. However, the GMC duty of candour tells healthcare workers to be open and honest, when things go wrong. This anonymised survey will take you no more than two minutes of your time to fill out and is being done to get a sense of your views.
If you wish you can also follow the final link (qu11) through to a very important consultation being done by the sentencing council (closing date 10/10/17). Without amendment of their proposals, healthcare workers could be facing new jail time of 12 years in the most ‘severe’ cases. There have been two recent successful appeals which have shown that both convictions for Surgeon David Sellu and Optometrist Honey Rose were unsafe. The results of this survey are anonymous but will be presented to the Crown Prosecution Service so they are aware of the impact of criminal prosecution on patient care.
Survey link https://www.surveymonkey.co.uk/r/MK85BHR