Consultant who called junior doctor ‘bad girl’ and grabbed her waist struck off after tribunal says he ‘treated women like sexual objects’

Dr Velmurugan Kuppuswamy — known as Dr Vel — was erased from the medical register after the Medical Practitioners Tribunal Service (MPTS) found he carried out a pattern of sexually motivated behaviour towards two junior doctors, Dr A and Dr B, between August and October 2021.

The tribunal said his conduct “fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to serious misconduct”, and imposed an immediate suspension while erasure takes effect.

Waist‑grabbing, wrist‑squeezing and ‘bad girl’ comment

The tribunal found that at a staff accommodation party in September 2021, he hugged Dr A, touched her back, and “squeezed [her] waist”. He then grabbed her wrist, squeezed it, pulled her towards him, smirked, winked, and told her she was a “bad girl” after she joked about smoking being unhealthy.

In her evidence to the GMC, Dr A said she “felt exposed” and that his behaviour “felt so wrong”. She told police she tried to pull away and told him he was hurting her.

The tribunal accepted her account, noting she was a junior colleague and that the power imbalance made his behaviour even more serious.

‘Sexy dancing’ comments and touching near groin

The panel also found he stared at Dr B while she danced, told her to “keep doing that sexy dancing for me”, and later put his hand on her thigh before squeezing near her groin area.

He followed a group of female colleagues around the party and stared at them while they danced.

During a game of ping‑pong, he told the two women they should “use their chests as paddles” and said being “well‑endowed” was an advantage.

The tribunal concluded the behaviour was sexually motivated, saying:

“His behaviour, which involved multiple instances of unwanted physical touching, was sexually motivated.”

Tribunal rejects his claim of a conspiracy

Throughout the hearing, Dr Kuppuswamy insisted the allegations were fabricated as retaliation for what he described as “whistleblowing” about another doctor’s performance.

But the tribunal rejected this entirely, stating:

“The GMC evidence has firmly disproved that this had any relevance whatsoever… The Tribunal was satisfied that the Allegation was not a conspiracy.”

It also criticised his attempts to undermine the women’s credibility, calling his claims “unreliable, speculative” and “false”.

The panel noted he repeatedly referred to the junior doctors as “girls” and was “reluctant to accept” the power imbalance between a consultant and junior staff.

Previously struck off for dishonesty

The hearing heard that his name had been removed from the medical register once before, in 2012, after findings of dishonesty. He was restored in November 2020 — less than a year before the sexual harassment took place.

An apology letter submitted to the tribunal did not accept wrongdoing, instead apologising if anyone had “misinterpreted” his actions. The tribunal said this fell far short of demonstrating insight or remorse.

‘Failed to act with integrity’

In its final determination, the tribunal said:

“The public ought to be able to trust doctors to conduct themselves with integrity… [His] behaviour represented a significant breach of professional boundaries.”

It concluded he “failed to act with integrity” and that erasure was the only sanction that could protect public confidence.

He will be able to apply for restoration in five years.

Health board response

Hywel Dda University Health Board said it could not comment on individual staff but added:

“We have robust policies and procedures in place to ensure the safety of both staff and patients… We are committed to providing a safe, supportive environment.”

Revealed: Hospital doctors are the top target for the NHS Resolution Practitioner Performance Service

Following my blog on the secret process using NHS Resolution to help hospital managers discredit whistleblowers I decided to ask the advisory body a series of questions on its operations using the Freedom of Information Act.

What emerged was extremely revealing. NHS Resolution hides in its annual report how many hospital doctors are involved by lumping them together with dentists and pharmacists. But the breakdown revealed through FOI reveals it is almost exclusively targeting doctors to advise trusts on how to handle them.

It shows that in the last financial year it advised in cases involving 1168 doctors in England, Wales and Northern Ireland. And the number of cases would be higher – as a number have multiple complaints from managers against them. This compares with 53 dentists and under 5 pharmacists. Indeed the pharmacists involved are so few – it won’t give me an exact number for fear of identifying individuals.

The PPS was last audited in 2019 and the organisation says it was then considered to be adequate and. effective. A more recent review in July this year by Dr Penny Dash looked just at the patient safety and learning role of the organisation and not wider issues.

Nor does NHS Resolution check whether it is given accurate information by managers. It said:” our role is to provide impartial and expert advice which is aimed towards supporting the local management and resolution of performance concerns. We are not a decision-making or an investigative body – in all cases, any decisions about the ongoing management, employment or contractual status of the practitioner rests solely with the healthcare organisation.”

In other words it is there solely to support health managers – who have no duty of candour – and it tries to include doctors by saying managers should tell them about their request for advice. In fact managers can and do ignore this as there is no requirement for them to say anything to the doctor they are investigating. So without hearing the doctor’s case it cannot be genuinely impartial. Also should a practitioner object to the partial advice given by a health manager they are ignored and the body continues to deal with the health manager.

NHS Resolution has not carried out any audit on the effect on doctors who are subject to complaints but it does do occasional research into problems arising on a very small scale. One example in its Insight Publication series last year was looking at whether ethnic minority doctors were badly treated in the NHS.

Involving just 11 doctors it said:”Most participants felt discriminated against based on their ethnicity and/or where they qualified. They felt this was reflected in the way their cases were handled by both their employer and Advice, and the higher rates of concerns raised against practitioners from ethnic minority backgrounds.”

Not surprisingly there was a lot of ignorance of how NHS Resolution’s advice service worked – given that health managers needn’t tell them about it. Again NHS Resolution’s solution was to give advice to managers which they need not take up. The full report is here.

Then there is the question of the phrase, performance. Is it a misnomer? NHS Resolution advice service does not look into the question of performance by doctors – relying on hospital manager for that – and it does not employ people qualified to do so. Many are solicitors, human resources staff and employment law experts and are not qualified to know when say a complex heart operation went wrong or the details of paediatric care. Indeed from doctors who have contacted me the trust often cites uncooperative behaviour and not working well with colleagues as part of its case.

Taken with earlier articles on the role of the General Medical Council a disturbing picture emerges which shows the hospital doctor is always at a disadvantage while the responsible officer – usually the medical director – holds all the cards – using NHS Resolution for advice and reporting the doctor to the GMC. Yet neither body is necessarily equipped to handle this and in NHS Resolution’s case, it is toothless to influence decisions by trusts. It can help to easily ruin a doctor’s career and even ban him or her for life for continuing their careers.

There seems to be a wholly unregulated sector covering NHS Resolution, the GMC and the trusts themselves and certainly no accountability. Patients have no idea how this is handled -yet their safety should be paramount in the NHS. And while NHS Resolution says it works under the direction of the Department for Health and Social Care my research shows it is not clear who regulates them.

If ever there was a case for reform of both systems, now is the time for something to be done.

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Are there flaws in the new guidance for General Medical Council investigations?

Reforms without addressing core issues may lead to persistence of key flaws  or omissions in any future changes with risks to patients

Last month I wrote about the government proposing the first major reforms for 40 years in the running of the General Medical Council. My blog was meant as a warning to ministers to scrutinise the changes very carefully because I was sceptical, after talking to a number of doctors, that there were flaws in the changes. You can read the blog here.

Now the GMC has published its new guidance by Dr Andrew Hoyle, an assistant director in the GMC’s Fitness to Practise Team He is both a doctor and a barrister.

In a high minded piece on Linked In and in a blog ( see the article here) he promises greater clarity and consistency .. and fair, flexible and compassionate fitness to practise processes. He also emphasises the GMC’s duty under the 1983 Medical Act to protect, promote and maintain the health, safety and well being of the public, promote public confidence in the profession and promote and maintain professional standards and conduct by doctors.

Now from the patient’s point of view how is this being enacted by a change to one simple process?

The first point is drawing up guidance for the decision makers on whether to proceed. There is a comprehensive list of issues to consider for the decision makers whether to start an investigation into a doctor. But the response to the concern raiser, the guidance does not specify who the decision makers are. Are they fully competent in the field or even sub-field of medicine practised by the doctor to make a sound judgment  about clinical matters? I have heard from some doctors that this is not always the case. On the question of accountability should it not be made public who made the decision and their qualifications to do so. This would reassure the public and the patients that it had been properly investigated.

The current process’s most crucial step, the  “initial triage and closure of concerns” relies on the “opinions” of the GMC postholders who in turn rely on managers. There is no mandatory requirement to immediately investigate serious harms or near miss issues that may have led to consequences to that or other patients.

This is particularly relevant as there is also the issue of the seriousness of the concern. The guidelines suggest that if there is evidence of repeated bad practice this should be relevant to striking off doctors. But there is a second flaw in this process. How does the GMC know about a bad doctor? The answer is because he or she is reported to the GMC by the responsible officer – normally the medical director or chief medical officer of the trust or far less by patients and or colleagues who are more in the know of bad practices but are fearful of consequences. See article in the Lancet.

Therefore the issue the GMC knows about may not be the first one and the GMC cannot verify it with the current approach neither can the complainant know of all issues. 

From earlier blogs I have found this process to be flawed – either because the responsible officer has targeted a doctor who has raised whistleblowing issues – whether patient safety or fraud – to discredit a perfectly good doctor – the case of Usha Prasad, a former cardiologist at St Helier and Epsom hospital is a current example – or covered up bad practice to save the reputation of the trust or private hospital.

The most egregious example of the latter is the case of Mr Ian Paterson, a breast and general surgeon, now serving a 20 year prison sentence after performing unnecessary operations on hundreds if not thousands of unsuspecting patients until a lawyer brought a civil case against him.

The public inquiry into his practice concluded “They were then let down both by an NHS trust and an independent healthcare provider who failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice.”

It went on: “The recall of patients did not put their safety and care first, which led many of them to consider the Heart of England NHS Foundation Trust and Spire were primarily concerned for their own reputation. Patients were further let down when they complained to regulators and believed themselves frequently treated with disdain.”

Imagine how different the outcome for hundreds of patients if this had been first reported by a responsible officer to the GMC – life changing needless operations would have been stopped rather than covered up. What the GMC should demand is that the management of NHS trusts and private hospital groups have to sign a ” duty of candour” putting them on par with doctors who raise complaints. This would require them to notify the GMC about the practices of the doctor involved and meet the legal requirement that the GMC has to protect patients and promote higher standards in the profession. Otherwise the assessment of a serious repeated bad practice is a hollow gesture in many cases.

 However if the GMC has been and appears it is continuing to rely on the Responsible Officers to provide a response can the GMC’s decisions be evidence-based  and safe for public. Even if a small minority of doctors are unsafe or dishonest,  the impact on the patient and profession must be the core of decision.

The third point is when a doctor acts inappropriately or unsafely that can be investigated by the GMC personnel but who are potentially not being regulated by any one and via a process built on reliance on an RO and in at times without transparency or evidence verification and opinion based decisions are taken that can affect lives This does not appear to be a safe approach as multiple scandals continue to occur; suggesting concerns are not really reaching the GMC due to its current system or are being ignored.

The current concern management requires a complete overhaul and not just superficial tweaks

Since I started looking at this issue I have been contacted by doctors across the country about the GMC and I intend to follow this up in a future blog.

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Will health minister Karin Smyth spot the need for more radical reform of the General Medical Council to protect clinicians and ultimately patients?

The new Labour government is embarking in the first reform of the professional regulation of the General Medical Council for 40 years. This welcome development comes after the GMC extended its scope to cover physician and anaesthesia associates at the end of last year. In theory it will allow the GMC more flexibility to change its rules and allow less adversity among fitness to practice cases involving doctors thus avoiding referrals to the overloaded and often unfair employment tribunals. It also abolishes an arbitrary rule that prevents it looking at cases that are more than five years old.

From my observations of recent complaints against doctors who raise patient safety cases and conversations with doctors who are concerned about referrals to the GMC the whole process needs a radical overhaul. It is also an overhaul that requires some political intervention.

How the GMC handles individual complaints against doctors is by no means transparent. Nor is the GMC directly accountable for their failings and omissions and its workings can be manipulated by individual health trusts. I am about to give you two different examples,

Many doctors think the complaints system is flawed because of a practice of referring the case to the so called ” responsible officer ” to handle it. The responsible officer is often the person who has brought the complaint in the first place – the chief medical officer of the trust. Now the chief medical officer is not what the public might think – the ultimate person protecting medical standards on behalf of patients. He is part of the trust’s management team whose main purpose is to protect the reputation of the trust which may not be in the interest of patients. So surely this is a conflict of interest?

NHS Managers labelled one doctor ” too passionate about patient safety”

There was also an extraordinary experience of a whistle-blower who was a warned by local managers against being too “passionate about patient safety.”

And does the GMC do a thorough job when it investigates.? Doctors are sceptical. In one example it appears the complaints about serious safety issues, were closed at the first step and  not even seen by GMC clinician. The bald reply from the GMC confirmed that to be the case; neither the team had nor did they seek any advice or expert opinion.

The GMC’s current practices enable its staff without clinical knowledge to close clinical concerns in such manner or only with hospital managers’ response, even when the concerns about the said managers are known to the GMC. In one example it appears the complaint was not even seen by fellow clinicians.

Given the whole point, according to many of the doctors who have raised patient issues, is the worry that either patients have already been harmed or more are left  at risk of being harmed by such poor medical practice,  these do not appear to be safe concern closure processes for a regulatory body.

There is another side and here I can quote an actual case – as it came up in an employment tribunal – the removal of cardiologist Dr Usha Prasad from the then Epsom and St Helier NHS Trust ( now merged with St George’s Hospital in Tooting, south London.)

Here the GMC faced with 41 complaints from the trust who wanted her removed did do a thorough investigation and checked with very senior cardiologists and exonerated her -including revalidating her working for the next five years.

But the trust’s chief medical officer, Dr James Marsh , refused to accept this, making the fatuous statement that the trust’s medical standards were ” higher than the GMC’s “. This is also ironic as the doctors from that organisation are being revalidated by, no one else but the GMC.

Where a doctor is revaluated the rules should be changed so in those circumstances the GMC’s decision is binding and final and this requires a politician to intervene to make sure this happens. An individual chief medical officer should not have the power to wreck a doctor’s career if their complaint to the GMC is utterly rejected. and not formally appealed against.

I would be very interested to see if other doctors have had similar experiences in both these areas and doctors can contact me on my website  ie either concerns were dismissed without due consideration or the GMC decision was ignored by the managers.  All contact will be treated in confidence unless the doctor wishes to go public.

This is a once in a lifetime reform and we need to get it right for both the benefit of the doctors and the safety of patients who entrust their lives to the NHS.

Karen Smyth, the minister of state for health, has a huge list of responsibilities from this area to cancer care and hospital car parking. The list is here. She needs to focus on this and ask pertinent questions.

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#departmentForHealthAndSocialCare #doctors #GeneralMedicalCouncil #KarinSmyth #medical #patientSafety

Today is an opportune time for the UK’s #GeneralMedicalCouncil & #RoyalCollegeOfPhysicians to educate & inform relevant medics on the treatment of #pwME and specifically those of us with #SevereME following #NICEGuidance #NG206.

No more deaths in #NHS hospitals due to #ignorance &/or #iatrogenesis!

#SaveCarlasLife #ExposeMENow #BringMillieHome

https://youtu.be/cnvA3oT_ZyQ?si=Czx2BKd-z5bdDNRF

As recently as 30 years ago, the GMC (the UK's medical regulator) was still investigating gay doctors due to their sexuality. The GMC is finally apologising.

https://www.theguardian.com/world/2024/feb/22/uk-regulator-to-apologise-to-gay-doctors-struck-off-because-of-sexuality

#GeneralMedicalCouncil #GMC #LGBTrights #Doctors #GayRights #MedicalMastodon

#PhysicianAssociates aren’t #doctors and shouldn’t be regulated as such, says #BMA

Union says government’s plans for #GeneralMedicalCouncil regulation diminishes role of doctors and could confuse #patients
https://www.theguardian.com/society/2024/jan/18/physician-associates-arent-doctors-and-shouldnt-be-regulated-as-such-says-bma
#ToryPoliciesInAction #NHS #NHSEngland #BreakThenPrivatise #IdeologyBeforePeople