Doctor blew the whistle and
suffered a reign of terror

Stoke Mandeville is one of Britain's most famous hospitals, but when a doctor in A&E warned about a consultant she was ignored - then the anonymous threats began.

David Rose
Sunday January 27, 2002
The Observer

For Alison Gammon, doctor in charge of Stoke Mandeville Hospital's renowned accident and emergency department, the letter was the final straw.

Over the preceding months, she had received threatening phone calls and letters. All had been sent via the hospital's internal mail, suggesting they must be the work of a colleague. The police had launched an investigation and had warned Gammon that she and her family might be at risk of physical attack.

Now, just before the end of 2000, she stood in her office, discussing the threats with Rodney Hill, Stoke's director of personnel. Cradling the receiver between her neck and shoulder, she opened an envelope as they spoke. Hill heard her gasp. Inside was another threatening message - words culled from newspaper headlines, pasted on paper: 'whistleblower,' 'failure,' 'going down'.

Within days, Gammon - who is not the source of any of the documents on which this article is based - had gone on sick leave, suffering from stress and depression. More than a year later, although judged fit three months ago, she has yet to return.

An Observer investigation has revealed the anonymous campaign against Gammon is part of a saga of mismanagement and interference by Ministers which has brought Stoke Mandeville to its knees. Its chief executive and chairman have been wrongfully removed, on the basis of claims now proven as false, and its future is in doubt.

A lesson in how not to run a hospital, the story suggests that, far from raising the health service to continental standards, some government policies risk destroying the best of what exists.

Gammon's 'crime' was to tell Stoke's management about the concerns she and her fellow A&E staff had about another consultant, Kimon Bizos. They believed his apparent lack of skills and experience, and his allegedly aggressive and petulant behaviour when colleagues pointed out his mistakes, made him a possible danger to patients.

The lesson of the Bristol babies heart surgery scandal is that 'whistleblowing' disclosures of this kind should be encouraged in the NHS. (In the Bristol case, Stephen Bolsin, the anaesthetist who tried to draw attention to the surgeons' high death-rate, was forced from his post and had to emigrate to Australia.) Yet today, Bizos still works at Stoke Mandeville, and Gammon is absent from the department she turned into one of the best in the country.

A management plan, in response to the complaints, which said Bizos should be allowed to treat Stoke patients only under rigorous safeguards designed to ensure a 'safe working environment', has been scrapped, without explanation.

This month, an employment tribunal condemned the treatment meted out to Gammon. It said hospital managers had wrongly regarded her disclosures as 'a personal grievance', the product of a personality conflict with Bizos, rather than 'a complaint of a lead clinician for and on behalf of the department'.

The tribunal said Gammon was entitled to compensation which could run into six figures. Accepting these comments, the Stoke Mandeville Hospital Trust admitted liability and promised an inquiry - not into Gammon's allegations, but into how they had been handled.

Reluctant to damage the hospital she has served for almost 10 years, Gammon has elected not to ask for compensation. 'All I wanted was a fair hearing,' she said yesterday, 'and to get back to work.'

Stoke Mandeville is best known for its spinal injuries unit, the beneficiary of millions of pounds raised by Sir Jimmy Savile. However, it is also a busy general hospital.

By the time Bizos joined the A&E department as its second consultant in 1997, Gammon had made it officially rated among the top 10 in Britain. It was Bizos's first consultant's post and he was expected to take time to settle in.

However, two years later, there was widespread concern about his performance. In a series of meetings with Stoke's managers, Gammon tried to communicate these fears. In August 1999, Dr Andrew Tudway, the hospital's medical director, asked her to submit a written report. She enclosed a dossier of nine alleged incidents involving Bizos.

They include cases where he was said to have given dying patients the wrong drug; to have missed the fact that a car crash victim had a broken neck; and to have caused young children pain and distress by his inability to set up intravenous lines. He was said to have lost his temper frequently, once throwing a scalpel in the resuscitation room.

At least 12 nurses and junior doctors submitted reports. The Observer asked Bizos to comment on the alleged incidents. In a statement issued through the Medical Protection Society, he said there was 'no evidence that my clinical practice was unsafe', adding that during a secondment in Oxford after Gammon and her colleagues submitted their reports, he was told his work was 'highly valued by doctors and nurses alike'.

The trust sent Bizos on extended study leave and set up an inquiry, conducted by a Stoke consultant and two external specialists. It spent only two days at the hospital and failed to speak to any of the other A&E staff who had written reports.

Before the inquiry began work, the team held a meeting with Tudway. He said its main purpose, instead of examining the claims against Bizos, was to find 'a means of resolving the conflict between the A&E consultants'.

Some of the evidence behind the department's concerns was inescapable. The inquiry team interviewed the former chief A&E nurse, who said Bizos 'lacked confidence and leadership skills,' was prone to shout at colleagues, 'throwing tantrums' and 'physically stamping his feet'. She feared he was 'not properly trained as an A&E consultant', and that his clinical performance was 'erratic'.

The inquiry report, in March 2000, said there was 'insufficient evidence of clinical incompetence' by Bizos to justify disciplinary action, although some had said he was 'less than professional'. But it was clear that the relationship between Gammon and Bizos had 'irretreviably broken down'. 'Personal conflict' was to blame.

In its comments this month, the employment tribunal was scathing about the inquiry. Its report was 'not based on the evidence given to it', while there was a 'quantum leap' in its conclusions. In the words of a briefing to the trust board by the then chief executive, Ken Cunningham, 'it was apparent that key staff, including the general manager and the nurse in charge, had in effect lost confidence in Mr Bizos as a clinical leader'.

Yet this had 'not been considered material' by the inquiry. As a result, any move 'which prejudices his employment' would be open to legal challenge.

Tudway and some of his colleagues still believed they needed to sort out personal differences between Bizos and Gammon, not find out whether he was clinically safe. The trust managers asked the Tavistock Institute in London to 'mediate'. In May 2000 it also produced a report - described by the employment tribunal as 'at the highest, wishy-washy' - suggesting the A&E problems were down to a failure to communicate.

Its solution was to punish Gammon: to downgrade her from lead clinician and bring in an outside A&E 'director'.

At the beginning of August, the hospital's medical staff committee advisory council held a meeting attended by several senior consultants, the trust's executive directors and many A&E staff. The minutes record a succession of senior nurses describing Bizos as a 'bully,' whose high-handed practices had placed their professionalism 'on the line'. One, a 25-year A&E veteran, said he 'pooh-poohed clinical protocols', the strict procedures for treatment and the giving of drugs by which all staff are bound.

Another nurse alleged that in one incident he refused to answer a call to treat a 16-year-old boy who had suffered a cardiac arrest, saying he could not attend because his daughter was ill and his burglar alarm was broken. The boy died.

Yet the trust board, chaired by Gillian Miscampbell, a long-standing Tory councillor who had been involved with the NHS for 20 years, still faced a dilemma. Its legal advice was that the original, 'skewed' inquiry report meant it could not take action against Bizos. Finally, in September 2000, it agreed to establish an 'A&E review group' to draw up strict protocols and practices, aimed at creating 'a safe working environment'.

Bizos would not be allowed to return to Stoke Mandeville until after this review was complete and he had signed up to the protocols. Seven months later, in April 2001 - before the review had been written, much less endorsed by Bizos - he returned to Stoke A&E.

By then, after dozens of threatening phone calls, letters and skulls and crossbones through the internal post, Gammon was on sick leave: 'It had got to the point where I feared I might make a mistake because of the stress and that I couldn't live with.' There is no suggestion Bizos was responsible for the harassment campaign.

How could this have happened? The answer lies in a further twist to this saga: the unjustified sacking, at the behest of Ministers, of Miscampbell, the suspension of Sue Nicholls, the acting chief executive, and the resignation in protest of three of the four non-executive members of the trust board. The hospital reinstating Bizos was under new man agement - which seems barely to have noticed what had happened before.

On 23 January last year - four months before an expected general election - the hospital discovered some patients had been waiting more than 18 months for operations for non-life threatening conditions, in breach of government targets.

Within days, Nicholls and Miscampbell were summoned to a meeting with the NHS South-Eastern Region. Its chairman, William Wells, told Miscampbell she had two options: resign or be sacked, while Nicholls would have to step down immediately.

On 13 February, a small team of civil servants spent six hours at Stoke, interviewed 12 people, and the following day wrote a report for Ministers, claiming there were at least 160 'long waiters'. They had found 'collusion in mismanagement at the highest level' and 'manipulation of the waiting list'.

Miscampbell was not allowed to see the report, but Wells told her there was evidence of 'fraud', for which she was 'personally responsible as chairman of the trust board'.

The affair provoked a media furore. One consultant told The Observer : 'Suddenly we were being portrayed as a failing hospital. GPs tell me their patients ask not to be referred to us.' Stoke's future is doubtful: it may be forced to merge with a hospital in Wycombe, 20 miles away. Only now is it apparent, following an inquiry by the district auditor, that the upheaval was unjustified.

There was no 'fraud' or 'collusion' and these allegations have been withdrawn. Nor were there 160 'long waiters'. Instead, it has been established that a junior manager wrongly 'suspended' between 15 and 20 from the waiting list - 0.19 per cent of the 22,000 treated at Stoke for non-emergency conditions.

Next month, Nicholls faces her own disciplinary tribunal. It is understood she intends to contest her dismissal fiercely.

Fiona Wise, the new acting chief executive, refused to tell The Observer why the new trust board, which took office last March, had allowed Bizos to return to work without signing the 'protocols' the old board had envisaged. She referred all questions to the new chairman, Anthony Woodbridge, a solicitor. He said he had been assured there were 'robust procedures' in place to assure patient safety.

The Observer asked what they were. 'I don't know the details of what those arrangements are,' he replied, 'but I am satisfied that the robust arrangements which have been put in place are sufficient.' He was asked about the campaign of harassment against Gammon. He said he knew nothing about it.

And what of the nine alleged clinical incidents in the original reports by Gammon and her colleagues? Woodbridge said: 'I was not aware of the detail of those nine alleged incidents at the time I made the decision [that Bizos should return to work]. I think in view of what you've told me, it would have been appropriate to know a little more.'

Last spring, Gammon filed an official grievance, for which Woodbridge - as trust chairman - was responsible. It was the trust's failure to deal with this grievance which forced her to go to the employment tribunal.

This, Woodbridge said, had cost Stoke Mandeville 50,000 in legal fees. It had spent almost 350,000 on providing two locum A&E consultants in the absence of Gammon - in all, more than two-thirds of the 583,000 deficit the hospital reported at the end of November.

'I feel so sad for the hospital and angry for all those talented and committed people with whom I worked for so many years,' Miscampbell said last night.

Gammon said there were vital lessons for the NHS. Most people found it hard to take action which might threaten their livelihood: 'Until we can develop a truly non-punitive culture, in which people can have the confidence to raise their concerns, there will continue to be a failure properly to identify, manage and resolve clinical risk.'


Disclaimer: HiddenMysteries and/or the donor of this material may or may not agree with all the data or conclusions of this data. It is presented and reported here 'as is' for your benefit and research. Material for these pages are sent to HiddenMysteries from around the world. If by chance there is a copyrighted article posted which the author does not want read, email the webmaster and it will be removed. HiddenMysteries and/or the donor of this material does not offer or provide any medical opinion, medical endorsement and/or medical advice as would be defined in law, legal code, legal policy, administrative rules and regulations.