Editor Jaimie Kaffash argues that non-white doctors facing tribunal are experiencing unconscious discrimination
Reading the judgement from the recent tribunal hearing for Dr Redouane Lammali left me aghast. If you haven’t read it, you might not think it is real. The Algerian-born emergency medicine locum was working at Lincoln County Hospital and was accused of lying to a healthcare worker about having asked the patient if they had taken paracetamol before attending A&E. The patient was then put on IV paracetamol, which the healthcare worker claims was prescribed by Dr Lammali.
The tribunal found that there was no evidence for any of this. There was no evidence Dr Lammali administered the IV paracetamol – it was likely done by an agency nurse – or prescribed it. There was no evidence a conversation along those lines had taken place with the healthcare worker, who didn’t mention it until hours after Dr Lammali’s shift had finished (and this alleged conversation didn’t form part of the Trust’s initial investigation).
There are some snippets throughout the ruling that make for interesting reading: the healthcare worker (referred to as ‘Ms H’) described Dr Lammali as ‘very obstructive and rude’; it was a particularly busy night in A&E; and the patient has described the care he received from a doctor as exemplary.
With all this in mind, I can’t fathom a reason why this case was brought to tribunal. It seems like there was no attempt by the Trust or the GMC to determine whether the healthcare worker was accurate – a quick look at the rotas would have strongly suggested her recollection was inaccurate. A quick look at the prescription chart would have told them he hadn’t administered or prescribed the IV paracetamol.
But I’d say there is an even more important point here: even if all the allegations were correct, this still wouldn’t warrant a tribunal. This was a drug error, there was never any issue of potential overdose. It was a busy A&E. And it seems there was a personality clash between Dr Lammali and Ms H. Such matters could have been dealt with at a line manager level. Instead, we have a stressful tribunal hearing, and Dr Lammali hasn’t worked another shift at the Lincoln County Hospital since. And he was in limbo, waiting for the hearing, three years after this non-incident.
This is not the first egregious example of pointless tribunals. You might remember the case of Dr Manjula Arora, the GP accused of dishonesty after telling her IT department she had been ‘promised’ a laptop. Or, of course, the suspension of Dr Hadiza Bawa-Garba, which – although a tragic case – resulted in a huge backlash from the medical profession for holding an individual doctor responsible for systemic failings.
It is impossible to ignore the elephant in the room when discussing these cases: these are all non-white international medical graduates. And – although I expect backlash for this – I am going to say something I believe with all my heart: none of these cases would have got to this stage if these doctors were white and UK-born.
This is not to say white UK-born doctors do not face spurious complaints, or don’t have to go through ordeals way out of proportion. But the checks and balances are more likely to click into gear – at one of the pre-tribunal stages, someone will point out that ‘rude and obstructive’ is likely to really be ‘stressed and overworked’; that a ‘dishonest’ action is more likely to be a mistake or an irrelevant white lie (excuse the unfortunate term); and that escalating to tribunal is wildly disproportionate.
The figures back this up – the GMC’s seminal report on this found that 1.1% of BAME doctors were referred to the GMC by employers 2012-17 compared with 0.5% of white doctors. They are more likely to be face fitness-to-practise hearings, too.
I am not smart enough – nor have enough time – to go through what leads to non-white doctors facing this unconscious discrimination. Solving this is not easy, and it is in my opinion a societal issue first and foremost – the disproportionate number of complaints from employers and the public suggest this.
But the regulator can do itself a favour and all parts of the organisation need to think carefully before escalating cases such as Dr Lammali’s. Because at the moment, it is impossible to escape the feeling that race is a factor.