Failings in the treatment of deceased patients under the care of a doctor at the centre of the North’s biggest NHS recall led to “deep human impacts and resulting harm”, an expert review has found.
Medical records of 44 former patients of retired Belfast consultant neurologist, Dr Michael Watt, were examined and bereaved relatives were interviewed as part of the review first ordered by the Department of Health in 2018.
Published on Monday by the health watchdog, the Regulation and Quality Improvement Authority (RQIA), the report on “certain deaths” over a 10-year period highlights “significant failures and concerns” in relation to the medic’s “clinical decision-making, diagnostic approach, communications with other clinicians, and poor communication with patients and with families”.
In five cases, the certified cause of death is questioned “in light of the stated diagnosis” and the review’s authors recommend that the RQIA should consider “review of death certification” or refer them to a coroner. Concerns about the diagnosis of epilepsy in patients is also detailed, while the need to tackle clinicians’ working alone and ensure patients have direct access to doctors’ letters are among other recommendations.
Dr Watt was based at the Royal Victoria Hospital in Belfast for more than 20 years and also ran an extensive private practice. He removed himself from the medical register last year ahead of a tribunal hearing.
Safety fears about his work led to the unprecedented recall of 2,500 patients in May 2018 after a whistleblower GP contacted Dr Watt’s employer, the Belfast Trust, 18 months earlier.
To date, more than 5,000 of his patients have been reassessed. Misdiagnosis of conditions such as multiple sclerosis and Parkinson’s disease were investigated as well as incorrect prescribing of medication and unnecessary invasive procedures.
In June, a public inquiry into the circumstances that led to the recall concluded there was a “catalogue of missed opportunities” by the Belfast Trust to act on earlier alerts.
The expert panel from the Royal College of Physicians – which included experienced neurologists – was commissioned by the RQIA to review the clinical records of “certain deceased patients” under Dr Watt’s care “with the intention to understand his clinical practice, to ensure learning for others and to help make care better and safer in the future”.
It produced two reports on separate groups of patients who died between 2008 and 2018.
The first included 29 patients whose families had contacted the RQIA with concerns about treatment of their relatives. Concerns “or omissions” relating to the care of these patients had “potential to lead to harm”, with some of the treatments prescribed “unnecessary and invasive”, according to the panel.
“Across the 29 cases, not one case was considered to have represented good practice in terms of the overall quality of neurology care provided,” the review found. “In several instances, the review team believed Dr Y’s [Dr Watt’s] approach had denied the patient holistic, supportive care that may have made their condition and ultimately end-of-life care easier to manage.”
In almost half the cases, experts did not consider the diagnosis “secure” while care was graded as “poor” or “very poor” in terms of the initial management in more than half those assessed.
The second group of 16 patients were those who were asked to attend a recall by the Belfast Trust but who died prior to assessment or before completion. The RQIA set up a dedicated family liaison team to engage with relatives who wished to describe their experience of care provided to their loved ones, which was then considered by the panel.
“The most upsetting aspect of the families’ concerns related to Dr Y’s interactions with patients and family members,” according to the review. “Failures by Dr Y to effectively communicate with patients and family members were most evident where family members had unresolved questions over their loved one’s diagnosis and the potential genetic impact.”
RQIA chairwoman Christine Collins commended the “courage and openness” of families who took part in the review.
“Family accounts starkly illustrate how failings by an individual practitioner, and by the system, led to deep human impacts and resulting harm, both to the deceased patients and to their bereaved families,” she said.
“As Northern Ireland’s independent regulator for health and social care, the authority is committed to using its role and powers to ensure that the recommendations within this report are implemented.”
