A POTENTIAL legal claim against the Hospital’s rheumatology department is gathering pace after it emerged that hundreds of patients were given drugs they did not need or were misdiagnosed.
Law firm Viberts yesterday confirmed it was dealing with over 110 inquiries from patients – including some who have reportedly suffered “serious” complications – after a damning review of the service found the standard of care was “well below” what would be considered acceptable.
Health and Community Services has said it will be contacting some of the affected patients “over the coming weeks” and would also be seeking legal advice on “an appropriate approach to compensation”.
The issues were unearthed following a review by the Royal College of Physicians, of 18 case records of patients who received rheumatology care between January 2019 and December 2021.
The college’s long-awaited report, published yesterday, highlighted several concerns about the way patients were being diagnosed and prescribed powerful drugs.
Its findings included that there was “no evidence” of standard operating procedures for most aspects of routine rheumatological care and, in some cases, “no evidence of clinical examinations”.
It found that there had been incorrect diagnoses and wrongly prescribed drugs, describing the standard of care as “well below what the review team would consider acceptable” for a contemporary rheumatological service.
“For example, the review team found in several cases patients were diagnosed with AS (ankylosing spondylitis) and started on medications without a magnetic resonance imaging (MRI) scan having been conducted to confirm the diagnosis,” the report stated.
It also raised concerns over limited “and often absent” handwritten evidence of clinical interactions with patients.
“The professional opinion for each case was documented in a typed letter. These letters were brief and generally uninformative. They often failed to mention the diagnosis, rarely mentioned any relevant clinical findings and lacked therapeutic information, past or current. Due to this, the review team found it difficult to understand the clinical decision-making,” the report continued.
The review also raised concerns about staffing within the rheumatology department, which was being run by two doctors who were not on the specialist register for rheumatology. Both of the rheumatology doctors involved in the review “alleged to have no job plans and ever-increasing workloads”.
Job plans were requested for both consultant rheumatologists. However, these were not provided to the review team.
One doctor – who was described as being “very patient-centred” and “a popular figure” – described his own practice as “old fashioned”, with his prescribing practices being personally tailored towards patients’ lifestyles and his interpretation of the latest literature.
The other doctor – who has since left the Island and now works for the NHS in Scotland – said that he found it difficult to challenge processes and decision-making by leadership in the rheumatology service in Jersey.
The review was commissioned by HCS medical director Patrick Armstrong, following concerns raised by a junior doctor in January 2022.
It sparked an audit of 341 patients on biologic drugs to ensure their diagnosis was correct.
Biologics are powerful drugs derived from natural sources such as human, animal, fungal or microbial cells. They work by suppressing the immune system and disrupting the inflammation process that leads to joint pain.
However, they can make patients more susceptible to life-threatening infections.
The audit found that, in over half the records reviewed, clinicians were not able to identify sufficient evidence to support the patient’s diagnosis. Approximately one in four of the patients reviewed had their biologic drugs discontinued because these drugs were not felt to be necessary.
The college’s report noted that: “Despite a lack of clear diagnosis, biologic agents were prescribed, with frequent and multiple changes. For example, a case was reviewed where a patient had been diagnosed with inflammatory arthritis although an ultrasound scan had shown no evidence of active synovitis. Despite this, the patient was started on treatment with biologics.”
In the majority of cases reviewed by the RCP, patients were often started on biologics and switched therapies frequently – which the report states did not give “adequate” time to determine whether they were effective.
“In some of the cases patients were treated with five or more biologics within a short period of time and in many cases prescribing was outwith both UK and European guidance,” the report added.
In light of the concerns, HCS also carried out a wider review that included over a thousand patients on disease-modifying anti-rheumatic drugs. Of those patients, over 45% had their diagnoses changed as a result, while nearly a third stopped receiving the drugs.
Chris Bown, the chief officer for Health and Community Services, said: “What has emerged from the RCP review and our own additional work, is a picture of a rheumatology service that none of us at HCS could be proud of. The people of Jersey deserve better, and we are deeply sorry that we did not provide a service that staff, patients and our community could be satisfied with.”
He continued: “A number of patients have had changes to diagnoses or medications as a result of the work we have undertaken and it is inevitable that some of these patients will have been harmed clinically, emotionally and/or economically by their earlier diagnosis or treatment. We expect that in most cases the level of harm will be minor or negligible but, of course, any level of harm is completely unacceptable and over the coming weeks we will be contacting any patient where we think harm may have been caused and we will be discussing with lawyers an appropriate approach to compensation.”
He added that HCS was making process on the development of “more robust clinical governance”, including the appointment of a new specialist rheumatologist to lead Jersey’s rheumatology service.
Mr Bown said: “We have made it clear that clinicians must now follow certain additional, key clinical guidelines such as the National Institute for Health and Care Excellence guidelines.
“Our task now is to make the improvements recommended by the RCP and to ensure that HCS becomes a beacon of good governance, not just in rheumatology but across the full spectrum of our health and care services.
“Finally, I want to commend the junior doctor who originally raised concerns and our medical director Patrick Armstrong, who commissioned the RCP review. It’s very important that healthcare staff feel free to speak up when they see something they think is not right. And when a junior doctor or anyone within HCS raises concerns about the practice of another colleague – even perhaps a senior and well-respected doctor – it is vitally important these concerns are taken seriously, fully considered and thoroughly investigated. That is what we have tried to do in this case.”
In a statement, law firm Viberts said: “Viberts is dealing with over 110 enquiries, of which we anticipate that the vast majority will be instructing us to progress with a claim against the rheumatology department. We expect this number to increase.
“Health and Community Services have acknowledged that it is inevitable that some patients will have been harmed clinically, emotionally and/or economically by their earlier diagnosis or treatment.”
The firm added that it was currently in the process of meeting the patients individually.
“They have suffered a range of complications and side-effects, from relatively minor to the most serious. For some, the impact on their lives has been devastating and irreversible,” the statement added.
Mr Bown said he could not comment in detail regarding any potential payouts, but said: “Patients have been harmed and they require compensation – and the Jersey Law Office is working to deal with that situation.”
Commenting on what concerned patients should do, Mr Bown added: “At present there is no need to do anything. We have already reviewed the care of thousands of patients to ensure they are now being treated in the most appropriate manner.
“If we need to contact any other patients we will do so directly. If you do have any concerns about your treatment, you can always contact our Patient Advisory Liaison Services (PALS) by email at PALS@health.gov.je or telephone on 443515.”
