Inquiry finds ‘catalogue of missed opportunities’ by health trust to act on concerns about neurologist

A damning inquiry has found a “catalogue of missed opportunities” by a health trust to act on concerns about a consultant at the centre of Northern Ireland’s biggest ever patient recall.

Delivering his findings into the circumstances that led to more than 5,000 former patients of Dr Michael Watt being invited for reassessment, inquiry chair Brett Lockhart highlighted a “culture which discouraged the escalation of concern”.

At the “heart of the problems” was a “medical culture” in which doctors were “apprehensive in raising a concern about the practice of a colleague” – and where “aberrant practice was happening in plain sight”.

Safety fears about the neurologist’s work led to the unprecedented recall in May 2018 after a whistleblower GP contacted Dr Watt’s employer, the Belfast Trust, 18 months earlier.

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Misdiagnosis of conditions such as multiple sclerosis and epilepsy were investigated as well as incorrect prescribing of medication and unnecessary invasive procedures.

Patients wept on Tuesday as it emerged there were 12 “specific occasions” between 2011 and 2016 when other GPs, registrars, a nurse and consultants from outside the trust raised the alarm – but no action was taken.

The case of a pregnant woman diagnosed with epilepsy and prescribed medication by Dr Watt “when the evidence suggested she should not have been diagnosed” was raised in 2013 by a registrar. Another medic complained about “various aspects” of his work in the same year but this never escalated.

“Were patients let down? The Inquiry Panel believes that they were,” Mr Lockhart said.

“Were opportunities missed over a period of years to identify a problem with Dr Watt’s practice? Again the answer is ‘Yes’.

“Would earlier intervention have made a difference? The Inquiry Panel believes that it would have done.”

“What the inquiry found, prior to November 2016, was a catalogue of missed opportunities, systems that did not work effectively, and a culture which discouraged the escalation of concerns.”

The 1,000 page report describes the trust’s failure to learn from complaints as “one of the most disturbing aspects” of its investigation.

Complaints about Dr Watt outnumbered those of other neurologists “by some measure”, it said.

“His response was almost invariably to justify the position he had taken…The sober reality is that the complaints system within the Belfast Trust was inadequate in terms of identifying patient safety concerns.”

Dr Watt was based at the Royal Victoria Hospital in Belfast for 20 years and also had a large private practice.

He removed himself from the medical register last year ahead of a separate public hearing into his clinical work by the Medical Practice Tribunal Hearing.

The report also documents concerns about the “truly extraordinary” increase in a highly invasive blood patch treatment carried out by Dr Watt “in plain sight of his colleagues” – after it emerged the majority of patients did not have supporting evidence for the procedure.

A total of 76 recommendations are made, which extend beyond the Belfast Trust as criticism is also made of other oversight bodies including the Department of Health, the General Medical Council and the private sector.

Mr Lockhart said it is “the fervent hope” of the inquiry that each of the bodies “will recognise the urgency of the situation and review current practice with the aim of enhancing patient safety”.

Reacting to the report, Belfast trust chief executive Dr Cathy Jack accepted the organisation had “let down” patients who “suffered avoidable and unnecessary harm”.

“Whether that was through being given a diagnosis that was not correct, receiving incorrect treatment or medication, or having a procedure you did not need. For that I am truly sorry.

“That is not what the Belfast Trust wants for its hundreds of thousands of patients, cared for in a wide variety of ways by a dedicated staff. It is why that I, and my executive team, are determined to continue to work to improve the governance systems that we have in place to reduce, as far as we possibly can, the risk of something like this happening again.”