Ireland Medical Council
November 2002
Statement on the Fitness to Practise Committee Inquiry
concerning Dr K C M Woods
Introduction
The Medical Practitioners Act 1978 requires the Medical Council to examine all
complaints in relation to the conduct of a doctor. When a complaint is
received, complainant and doctor are asked to comment, following which the
Fitness to Practise Committee makes a decision on whether an inquiry should be
held. Inquiries are normally are held before a team of five members of the
Committee. The Registrar - who presents the evidence - and the practitioner are
legally represented and the standard of proof is usually beyond reasonable
doubt.
The Medical Council initially received a complaint in 1992 in relation to the
management by Dr. KCM Woods of alleged child sexual abuse cases and made a
decision in 1995 that an inquiry should be held. Following protracted
proceedings in the High Court, the Medical Council was in a position to proceed
with the inquiry in 1999. The Fitness to Practice inquiry team heard 43 days of
evidence from 60 witnesses and issued its report to the Medical Council in
2001. The inquiry process was subject to rigorous confidentiality measures
imposed by the High Court. The Medical Council was granted permission to
publish the findings of the inquiry provided that the anonymity of the children
and parents involved would be suitably preserved.
It is the view of the Medical Council that in assessing and treating children
Dr. Woods was obliged to follow basic and well-recognised medical principles
and to ensure that the process of differential diagnosis was followed. In
certain cases, Council found that Dr. Woods failed to show and apply the
standards of clinical judgement and competence required of a doctor in her
position. Specifically, the Fitness to Practise Committee found that Dr. Woods
failed to gather all the available evidence and/or did not follow the protocols
established by SATU and/or failed to review additional information received
after preliminary findings had been reached. Dr. Woods faced 55 charges of
which 13 were found to have been proven.
In January 2002, the Medical Council accepted the finding of professional
misconduct made by the Fitness to Practise Committee. The Medical Council
censured Dr. Woods and imposed conditions on her registration.
Background
In March 1984, the Department of Health issued a
circular letter to all acute hospitals dealing with reports alleging inadequate
treatment for victims of rape. Between May and June 1984, informal discussions
between the Department of Health and the
In October 1984, a Working Group was established with membership from the
Department of Health, the
• Establish a Sexual Assault Treatment
Unit at the Rotunda Hospital
• Report on the operation of the Unit
after six months
The first meeting of the Working Group agreed that doctors working at the SATU
would be employed by the Rotunda Hospital and would operate under the direction
of the Master of the hospital. The SATU began work in January 1985; its work
was envisaged as undertaking the forensic examination and medical treatment of
adult victims of suspected sexual assault in the EHB area.
Little consideration was given to the possibility of the treatment or
examination of children within the unit. Within a month of its establishment,
the issue of the treatment of children was considered at the third meeting of
the Working Group. That meeting considered that a children's unit would be
required with special expertise and training and that relevant children's
hospitals should be consulted about establishing such a unit. Such units
ultimately came into being in 1988.
Between 1985 and 1988, the SATU found that the numbers of children being
treated increased rapidly until they represented the vast majority of those
attending the unit. Thus a situation evolved where very substantial numbers of
children were being examined in a unit which had originally been established
for the purpose of examining adult victims of sexual assault.
|
Year |
Number of children examined |
|
1985 |
190 |
|
1986 |
530 |
|
1987 |
600 |
Once the SATU was established it continued to operate almost independently of
the
Dr. Woods had been engaged in limited general practice from 1979 to 1985 and
had, around the same time, worked in
The diagnosis and management of sexual assaults involving children was not a
well developed area of medicine in the 1980s, in
Procedures were established within the SATU for the diagnosis and management of
children, influenced by work carried out in other countries. The SATU was
subjected to very substantial work pressures within a short time, but with very
limited resources.
It is noteworthy that SATU did not have access to in-patient facilities and
could not therefore admit children to a hospital setting. This limited the
options for the investigation and management of these cases.
However, the weight placed by the Courts and Health Boards on reports issued by
SATU was substantial and significant decisions regarding children and their
families were based to a certain extent on these reports.
Medical
Council Concerns - Management
and doctors
Patients are entitled to expect and receive safe, competent care from doctors.
When children or their parents receive care which is inadequate, as in this
case, doctors must take responsibility for not meeting the standards set by
their peers and which can reasonably be expected to apply in those
circumstances.
However, those who plan, fund and oversee medical services have separate
responsibilities to the doctors whom they employ. Medical Council disciplinary
proceedings have no authority to investigate management structures in Irish
medicine. Nonetheless, where management structures appear not to have fully
played their part, it is essential that a distinction be drawn between the
responsibilities of individual doctors and the responsibilities of the agencies
for which they work.
It is now well recognised that Clinical Governance sets out the
responsibilities of employers and service providers to create a safe and
effective working environment for patients and health carers. Although the
terminology was not in use in the mid-1980s, it is clear that a range of
Clinical Governance issues have not been addressed in this case.
1.
The role of supervisory structures / bodies
Although a high level Working Group and links to the
The training and professional background of staff selected to work at SATU
should have been of paramount importance when the service was being
established. Dr. Woods was employed without formal training or experience in
the management of paediatric victims of sexual assault. While other qualities
may have made Dr. Woods the right candidate for the post, her relative
inexperience should have alerted management to the need for supervisory
structures. This would have been particularly important when Dr. Woods' role
changed dramatically to focus on children who had been abused.
2.
Role and resource allocation in the establishment of services/ The inappropriate use of services
The SATU was established with a specific purpose - the care of adult women.
Within a short time, it found its work dominated by the care of children, a
role for which it was unprepared. This change in focus was apparently quite
unexpected. Management in turn should have been highly conscious of the
implications of the change and should have identified and obtained the
personnel and resources needed to meet these demands.
Services constructed for one purpose which then expand into other roles, always
face the potential to grow beyond the expertise and capacities available. No
real changes appear to have occurred in the profile of SATU after its role
began to be dominated by children, rather than women. The appropriateness of
services established in an adult setting for the care of children must be
questioned.
3.
The difficulties facing doctors when there are few or no peers practising in
Maintaining standards in very specialised areas
The innovative and rapidly evolving service provided at SATU should have
alerted all involved to the need for audit and review structures linked to best
practice overseas. While individual links were established - mainly by Dr.
Woods - no systematic assurance was offered to the public of the standards in
use at SATU. Without equivalent services or colleagues in this jurisdiction,
the difficulties facing Dr. Woods and her staff in maintaining competence
should have been obvious to all. Structures to assure competence may not have
been commonplace at the time but were essential given the unique service
involved at SATU.
4.
Significant legal decisions based on the views of an unsupported doctor
The Court decisions resulting from SATU reports were of great significance for
many children and their parents. Dr. Woods was operating in an environment
perhaps unique to Irish doctors, in which prompt and dramatic change could
affect entire families based on her clinical decisions. In retrospect, it would
have been appropriate to introduce validation procedures and to cross-check
even a sample of cases.
S.
Multi-disciplinary working
The development of current multi-disciplinary services
to deal with child sexual abuse clearly acknowledges the need for such
components within a functioning service.
It is clear that towards the end of the period in question,
a range of dedicated paediatric facilities was being established, involving a
multi-disciplinary approach. It is not clear what measures were taken to
establish communication and collaboration between these services and
disciplines in relation to provision of service, audit or training issues.
Conclusions
The Medical Council issues this report to ensure that a matter of significant
public importance is brought to the attention of the public, profession and
those responsible for Clinical Governance.
It is clear that many lessons can be learned from the setting up of SATU in
relation to the establishment of new clinical services. While doctors have a
fundamental role in such services, lessons should be learned from the wide
range of governance issues which appears not to have been addressed.
Doctors must at all times be responsible for their behaviour in caring for
patients. However, if a doctor works in an environment which is underfunded, poorly staffed, without relevant expertise and
not under the management of a proper supervisory body, then responsibility for
incidents of patient harm should be shared by all involved.
The problems identified in SATU have the potential to recur. Isolated,
specialised or reactive health agencies may be established without the planning
or resources needed to ensure that they remain within the mainstream of
clinical quality assurance systems. It is the responsibility of all involved in
running these services to ensure these issues are addressed.