TWENTY months after being instructed to review medical records of Dr Michael Watt’s deceased former patients, the RQIA still cannot confirm the number of cases it’s examining.
Even though the Department of Health (DOH) commissioned this review back in May 2018, the RQIA (Regulation and Quality Improvement Authority) admitted to The Detail it is still determining which cases fall within its scope.
When asked if it has a duty to the loved ones of the suspended neurologist’s deceased former patients and the wider public, the RQIA responded: “This is a highly complex matter and RQIA is sensitive to all those who have lost a loved one during this time period and may have concerns.”
The DOH was due to publish an outcomes' report on the Belfast Trust's neurology patient recall in June 2019, but its publication was postponed.
It was eventually published last month. The report referred to 17 former patients, who were "under the active care" of Dr Watt at the time when the recall commenced, who "were known to have died" before the process began on May 1, 2018.
The report also stated that a separate 12 patients, who did form part of the recall, died before their cases were reviewed.
An additional 15 patients, who were recalled and had their cases reviewed, were reported to have died in the time between when they were reassessed and May 7, 2019.
From the RQIA’s correspondence with us, it is still unclear the number of further cases (if any) that it's looking into in addition to those referenced in the DOH report.
The PSNI's Detective Superintendent (DS) Jason Murphy previously told us that the police are awaiting further material from the DOH before taking an "informed view" and assessing "how best to move forward" which he anticipated would take some time.
However, The Detail has seen correspondence sent by DS Murphy to one of Dr Watt's former patients, dated January 13, 2020, which states the RQIA review will be important in "considering to what, if any extent, did the practices of Dr Watt impact on the deaths of some of his patients".
DS Murphy also wrote that it's unclear from the DOH outcomes' report alone if criminal offences had been committed, adding that police are "therefore awaiting consideration of other reports... before being able to take a holistic and professional view of potential criminal culpability".
Lyndsay Eccleston, a former Dr Watt patient, said she was pleased that the PSNI had acknowledged there's the potential for criminal investigations, arising from the cases of the deceased individuals.
She told The Detail: "The police have specifically named the RQIA review as an important element in the decision making process.
"We hope to provide valuable insight to assist police in their inquiries."
However, Lyndsay, who also leads a neurology recall patient support group, added that a "lack of communication" on the part of the RQIA, doesn't give her much confidence in its review.
She added: "The fact that the scope of the RQIA's review hasn't been established yet is worrying.
"It's deeply upsetting to those family members of patients who have died and it's only added undue stress and worry to them."
On January 15, 2020, Lyndsay's group requested a meeting with the newly appointed Health Minister, Robin Swann. The minister hasn’t, at this stage, responded to the request.
"It has been dreadful"
Colin Armstrong's mother Ruth became a patient of Dr Watt's in February 2001. She remained on his books until her death in November 2002, aged 78.
Ruth was diagnosed with a terminal brain tumour, but her son doubted the reliability of the assessment after seeking the opinions of doctors in England, prior to his mother's death, who reached different conclusions.
The revelations about the neurology patient recall have led Colin, in recent months, to also question the validity of Dr Watt's decision to diagnose his mother with epilepsy.
In April 2018, a final version of a report by the Royal College of Physicians, which raised concerns about Dr Watt's work, was sent to the Belfast Trust.
Just after this, in May 2018, the DOH commissioned the RQIA to review the medical records of all of Dr Watt's former patients who died in the previous 10 years.
However, Colin Armstrong was initially informed by the RQIA that if family members – of those who died before this period – approached the body, then their loved one's medical records would also be looked into as part of this review.
Correspondence sent to Colin in May 2018, signed by the RQIA's chief executive, Olive Macleod, said: "We are currently finalising arrangements for work we will undertake regarding patients who have received neurology care and since passed away."
After receiving this correspondence, Colin was then later told by Olive Macleod and Dr Lourda Geoghegan, the RQIA's director of improvement and medical director, that their organisation was aiming to start looking at the medical records of Dr Watt's deceased former patients – including Colin's mother's – in September 2018.
"I initially found them to be helpful," Colin added.
However, the RQIA has admitted to The Detail it is still in the "designing and planning" stages of this process and has yet to establish which patients fall within the scope of the review.
Colin said: "It has been over a year and a half since the RQIA was commissioned to undertake this review, how can it still be working out the scope?
"The RQIA has been completely ignoring my correspondence about these issues since August 2019 and I try to get in touch with them regularly. It has been dreadful.
"Do they not realise they are dealing with someone who's trying to get answers about their dead mother?"
The Belfast Trust recalled over 3,500 neurology patients for case reviews, due to concerns about their treatment.
Individuals on whom Dr Watt carried out epidural blood patches (EBPs) accounted for a significant proportion of those who were recalled by the Belfast Trust.
When we asked the RQIA specifically about the number of EBP patients of Dr Watt who have since died, it replied that it "does not have any information on this matter at this time".
Before going to the RQIA about this, The Detail asked the Belfast Trust if it could tell us the number of Dr Watt's EBP patients who have died. It also said it doesn’t hold this information.
This is despite the following:
- The RQIA being tasked, in May 2018, with reviewing the medical records of all of Dr Watt’s former patients, not just the EBP patients, who died in the 10 years prior.
- The DOH having produced an outcomes' report on the neurology patient recall.
- The Royal College of Physicians having produced a report which raised concerns about Dr Watt’s work.
- The General Medical Council investigating the situation.
- The PSNI confirming it has engaged with senior DOH officials regarding the neurology recall.
The Independent Neurology Inquiry, chaired by Brett Lockhart QC, has also been established.
Its remit is to review the recall of neurology patients by the Belfast Trust.
The Permanent Secretary of the DOH, Richard Pengelly, established this inquiry in May 2018 – the same month when his department commissioned the RQIA to carry out a review into Dr Michael Watt’s deceased former patients’ medical records.
By December 16, 2019, the inquiry panel had met on 102 occasions and heard from 171 witnesses – this includes 105 medical personnel, 34 non-medical personnel and 32 members of the public.
It had also, by this point, received 62,500 pages of evidence in addition to 196 responses to its questionnaire.
An inquiry spokesperson told The Detail it has scheduled in a number of witnesses for the months ahead and "continues to follow lines of enquiry".
Given the level of work the inquiry panel has already undertaken, we asked it if it could tell us the number of Dr Watt's former patients who died in the 10 years prior to May 2018 and the number of these deceased individuals on whom he performed EBPs.
However, the spokesperson replied by saying this is "outside the terms of reference for the inquiry" and referenced the RQIA being tasked with "taking forward an expert review" regarding these matters.
As the Independent Neurology Inquiry is of a non-statutory nature, it doesn't have the power to compel any individual to provide evidence, including Dr Watt.
Lyndsay Eccleston, who received EBP treatment from Dr Watt in September 2016, said this could make the inquiry a "waste of public money".
Epidural blood patch (EBP) spike
No more than 10 EBPs were carried out, per year, in the Belfast Trust in the period from 2008 to 2013. After that, however, there was a spike in EBP treatment in the trust.
In 2014, 19 EBPs were performed, in 2015, 72 were, in 2016, 92 were and in 2017, 29 were.
It was in December 2016 that concerns about potential misdiagnoses by Dr Watt were formally raised by a G.P working in Northern Ireland.
The Belfast Trust told The Detail that “treatment decisions” taken by Dr Watt account for the increase in the performance of EBPs.
When asked, the trust stated that it isn’t aware of the EBPs being performed for the purposes of “research, studies or for an experiment”.
Dr David Bogod is an anaesthetist at Nottingham University Hospitals Trust and is a Royal College of Anaesthetists council member.
The Detail asked Dr Bogod if he knew of any non-anaesthetists who perform EBPs.
He told us: “I have never heard of it being done by anyone other than an anaesthetist.
“Since anaesthetists do far more epidural needle placements than any other specialty, they are best placed to carry out this procedure." Dr Watt is a neurologist.
Dr Bogod added that EBPs are used to treat a “very specific condition” called post-dural puncture headache (PDPH) which is a recognised complication of spinal and epidural injections, including lumbar puncture.
He continued: “It is not effective for other forms of headache.”
Lyndsay Eccleston did not have PDPH – she had spontaneous intracranial hypotension (SIH) – which is a spontaneous leak of spinal fluid.
We therefore asked Dr Bogod if he had heard of EBPs being performed to treat SIH or if he knew of any protocols on the subject.
He replied: “I am not aware of any guidance on the subject and I don't know of any anaesthetists who do this.”
On hearing this, Lyndsay Eccleston told The Detail: “To find out that a council member from the Royal College of Anaesthetists is saying that ‘well actually, blood patches should really only be performed for PDPH’ is devastating, it’s shocking.”
Despite Dr Bogod's comments, the Belfast Trust has maintained that EBPs are a “recognised therapeutic treatment in neurological practice” and can be used to treat SIH.
The trust did, however, acknowledge that "no national neurological guidelines" for the performance of EBPs exist.
When asked what guidance or policies it has for the circumstances in which EBPs can be performed, the trust said that it’s only recently that a “neurosciences local guideline” has been implemented. It did not say how recently this was put in place.
"How many deceased patients are there?"
Nichola Mallon, the deputy leader of the SDLP and recently appointed Minister for Infrastructure, was due to meet with RQIA officials on December 18, 2019 regarding its review into the medical records of Dr Watt's deceased former patients.
However, talks to again get the Northern Ireland Assembly and Executive operational meant she had to postpone this planned meeting with the RQIA. The meeting has now been rearranged for February 21, 2020.
Nichola Mallon told The Detail: "These people have gone through a traumatic experience. They have lost a loved one.
"They were promised a review. Now, over 18 months on, it's still not exactly clear if that review has started and, if so, how far on it is.
Nichola Mallon also said the "poor communication" with the family members of Dr Watt's deceased former patients has been a hallmark of the entire experience for all those impacted by the neurology recall.
Aside from the Independent Neurology Inquiry, which she feels has been open in its engagement with people, the SDLP's North Belfast MLA said it has been "next to impossible for patients and their families to obtain information and regular updates".
Nichola Mallon continued: "We need to understand, why is the review taking so long?
"How long is it going to take? How many deceased patients are there and how is the RQIA going to communicate with their loved ones and keep them updated?
"These are all questions that we need to get answers to. I'll be urging the RQIA to learn from the mistakes made by the DOH and the Belfast Trust in terms of poor communication with patients.
"The loved ones of the deceased patients, they are at the heart of this, and they should be kept as informed as is possible."