The crystallisation of insight #JusticeforLB

I’m currently sat in a hotel room in Manchester thanks to the generosity of the #JusticeforLB crowdfunders, who smashed our initial target in August, thankfully, given this is the fourth time the tribunal have met to discuss Dr Valerie Murphy’s (un)fitness to practice. For anyone reading this blind Murphy is a psychiatrist specialising in learning disability, she was LB’s responsible clinician and she should have provided the clinical leadership when LB was in the STATT unit.

Up to six months after Connor died 

In the six months that followed Connor’s death an independent investigation was conducted by Verita. This investigation found that Connor’s death was preventable. To quote theVerita investigation:

‘The unit lacked effective clinical leadership and they operated a team-based approach in which no individual/s held the responsibility for ensuring that the care and management of Connor was appropriate and coordinated effectively. The impact of this was that standalone key safety decisions such as those pertaining to bath time observations were not validated by other professional colleagues’

To look at this further Verita asked Murphy about her knowledge of the observations set for bathing. Given that she was the consultant on the ward, the most senior member of staff and indeed the responsible clinician, and this investigation is being conducted in 2014 following Connor’s death, you’d think she would show some insight and remorse about what happened. At the very least you’d expect her to own her own actions and failings. So how did Murphy respond to the question about bathing:

She told us: “Observations I am involved with, in terms of level of self-harm or harm to others, would normally be recorded in the progress notes. Conversations and observations around bathing and around those kinds of everyday occurrences, I’m not usually involved in because it’s to do with everyday care. I know OTs were very involved in assessing his bathing and spoke to mum about his bathing and what he liked to do, so you’d have to ask them really. Observations from bathing wouldn’t be something I would ever have done for any patient ever.”

Responsible actions of a responsible clinician? Holistic care? Professional duty and insight on show? What about the recording practices of the lead clinician, over six months after a young man had died a preventable death under her care. Surely she’d be reflective about that?

We asked a number of our interviewees whether a single document captured the different involvement of the various professionals and how the objectives of their work were coordinated into a multi-professional care plan. S1 [Dr Valerie Murphy] told us: “What you’re asking me is if there is any central document where everything is put together; I don’t do that. I don’t sit down and write an entire document about what every other professional is doing because that wouldn’t be appropriate for me to do.

Concerned that Connor was not being challenged enough his parents raised their concerns in one of the weekly meetings. Verita discussed this:

The minutes from the CTM on 10 June say: “…mum is concerned that… [CS] is not challenged and that there are not enough activities for him…Mum said she was confused that [CS] was admitted to the unit for assessment and treatment, but where is the assessment and treatment? … Dad advocated increasing [CS’] timetable of activities [on the unit].”

When asked about it Murphy responded by saying “We were not a unit that ever forced anybody to do anything they didn’t want to do because he was a grown man”. Verita also explored the lack of person-centred planning in the unit, until a meeting initiated by Connor’s family:

S1 [Valerie Murphy] described the CPA meeting to us as: “Normally we would do it and we would run it and we would have a set format to be followed to make sure all the bases are covered but then, with this other organisation who were there with flip charts and stuff on the wall, it was just all a bit chaotic and I didn’t know who was in charge.” “… very difficult… I don’t think it was, in any way, helpful actually, that CPA. It stopped us doing what we normally would do in moving things forward. I thought it was very disruptive and I came out of that meeting thinking ‘what was that all about’… There were different people there; I didn’t know who was in charge, I didn’t know who was driving it. It was all very chaotic and it wasn’t helpful at all.” “We just then went back to our usual CTMs because everyone was just quite baffled about what that was all about and it threw us. It certainly threw me. It threw me out of my stride, I didn’t know what was happening and it took me a while to recover from it.”

What else was revealed about Murphy in the first Verita report:

We found little evidence of what role the consultant psychiatrist and medical staff played in Connor’s care and the clinical leadership of the unit. Their role appeared limited to being present at CTMs (which had a rotational chairperson), attendance at a meeting with the school staff and Connor’s mother on 16 April; responsibility for drug prescriptions and in putting in place some precautionary actions around Connor’s epilepsy as a result of the suspected seizure on 20 May.

Murphy goes on to say that she basically stepped away from providing any care because she didn’t feel Connor should have been in the unit. Close examination of the notes reveal there was no meaningful care provided in the first place, but this is what she said to the interviewers:

“As you probably picked up I wasn’t terribly involved towards the end because I didn’t see a role for psychiatry at that time. In fact, if you look at the number of meetings we had with mum at CPA [CTM], I mentioned a number of times I thought [CS] should have been discharged already. For whatever reason that couldn’t happen and that’s practical. “We wouldn’t normally have someone like [CS] for the length of time we had him and I said that in a CPA. I explained why because, as far as we were concerned, he was admitted to see if we could identify any psychiatric illness or any particular triggers of what was going on with him. As far as I was concerned we had done that and, as far as I was concerned, he was well ready for discharge.”

So here we have the responsible clinician, six months or so after Connor died, with zero insight into her own failings. She demonstrates no remorse or awareness, instead blaming Connor himself for not being the right type of patient, blaming Sara for organising a care planning meeting that she found confusing, suggesting nurses, OTs and physios were responsible for Connor’s care.

Two years and three months after Connor died 

Fast forward a couple years and in October 2015 a full two week jury inquest took place into Connor’s death. Murphy left Southern Health in June 2014. Surely by now, after two whole years, she’d have developed some insight and remorse. You can read all the tweets from LB’s inquest on the twitter account here, but I’ll give you a flavour:

Here Murphy is still claiming there was no evidence of seizure activity, this is at an inquest into the death of a young man who died from an epileptic seizure.

When asked about her duties as a responsible clinician Murphy is quick to distance herself, talking about interventions and disciplines, expertise but not acknowledging once her own role or responsibilities.

Dr Murphy’s arrogance was so extreme not only did she dismiss Sara’s knowledge of Connor, but she also dismisses the evidence of the court appointed expert in epilepsy, Professor Crawford. No insight, awarness or humility.

Later a barrister for one of the nurses asks Dr Murphy about Connor’s seizures again and whether she acted on Sara’s concerns:

When Adam Samuels pushes Dr Murphy further, she just doesn’t have it in her to admit that she might have been wrong and that Sara was right.

Later in the inquest the Coroner actually has to check whether Dr Murphy was suggesting Connor didn’t die from a seizure, such was her lack of acknowledgement:

Two whole years of reflective opportunity later, still nothing.

Four years and one month after Connor died 

Fast forward to the start of the MPTS tribunal when the GMC are acting to have Dr Valerie Murphy erased from the medical register in England. Murphy has already relinquished her licence to practice when she returned to Ireland in 2014. The tribunal sat for two weeks in August last year, you can read the tweets here. Another opportunity for Dr Murphy to show remorse, to hold her hands up about her failings and given that Sara had to give evidence in person, it was also an opportunity for her to apologise to Connor’s family face-to-face.

Except none of that happened. Dr Murphy admitted some of the allegations made against her at the start of the hearing, while still denying others. She continued to lay the blame on other people, colleagues, the systems and paperwork, the computer system and of course Sara and Connor’s family. Watching Sara be cross-examined by Murphy’s barrister was revolting. You can read about her experience here, suffice to say it’s been crystal clear since that it’s like some blood sport, attack the bereaved relative, because it’s been in no way relevant to what we’ve heard from Murphy since. She did of course sit throughout her brief’s questioning, the brief acting on her instruction.

In August Dr Murphy was in no way open about her failings, in fact she was as defensive and opaque as we’ve seen previously, when asked by the GMC Barrister Chloe Fairley whether she was the responsible clinician this was her response:

It took four attempts of the same question for Dr Murphy to admit she’d not seen Connor before the 8th April 2013. The first:

Second attempt

Third attempt

and finally

These are not the actions of a clinician full of remorse about their failings. After a two week hearing in August, some of which Dr Murphy couldn’t bring herself to attend, after all it had been very upsetting for her:

the tribunal reconvened over two weekends in November to make a decision on impairment. Again Dr Murphy did not attend. The decision of the tribunal was clear, the clinical failings of Dr Murphy were numerous and included:

  • failing to conduct risk assessments
  • failing to conduct appropriate mental capacity assessments
  • prescribing drugs without explaining benefits, risks and side effects
  • failing to assess Connor’s mental state
  • failure to formulate a diagnosis, aetiology or risk assessment
  • failure to make comprehensive or accurate records
  • failure to develop an adequate care plan or any treatment plans
  • failures in relation to Connor’s epilepsy including not taking a history, conducting risk assessments, making appropriate care plans or obtaining information from his family or neurologist

The tribunal noted the following in relation to Dr Murphy’s insight:

The Tribunal then considered the third question posed in Cohen as to the likelihood of repetition. The Tribunal considers that remediation in terms of a recognition of responsibilities, insight and overall fitness to practise is a critical element of remediation. Of concern is the fact that Dr Murphy has not demonstrated insight into the gravity of the findings of facts made against her. She has not availed herself of the opportunity to put any evidence before this Tribunal at the impairment stage to show that she has considered and reflected on the findings of facts made nearly three months earlier in August 2017 which could have demonstrated real insight. In her reflective statements of 2014 and 2015 Dr Murphy appears not to recognise the extent of her failings. Even at the beginning of these proceedings in 2017, she still appeared to be looking for excuses, a position from which she has not departed significantly to date. There is a clear reluctance to admit full responsibility for her actions, as she appears to have only accepted responsibility for those parts which cannot be denied. Furthermore, the Tribunal has noted that there has been an absence of apology to Patient A’s mother and an absence of remorse for the consequences. It considers that the remorse displayed was limited to the consequences these proceedings have had upon her.

Four years and seven months after Connor died 

So this week, we’re back in Manchester, over 4.5 years after Connor died. Dr Murphy bothers to attend on this occasion. She has had a blueprint of what to say, and how to demonstrate remorse, the MPTS tribunal told her what to do:

She has not availed herself of the opportunity to put any evidence before this Tribunal at the impairment stage to show that she has considered and reflected on the findings of facts made nearly three months earlier in August 2017 which could have demonstrated real insight.

What do you know, this week there is yet more evidence. Not disclosed publicly but more testimonials and another opportunity for Dr Murphy to give evidence. So on this occasion was she open and honest? Did she show real insight? First up was the farcical conversation when it became clear that Dr Murphy was off-sick, but driving a research agenda into a yellow card scheme to record patient information – no, no, no, not *the* yellow card scheme that has been around for decades, just an imitation one that has been trialled in a handful of Irish units. Chloe Fairley, the barrister acting for the GMC, tries to get to the bottom of Murphy’s involvement:

Trying to ascertain how this work happens and why the tribunal should take it seriously. Dr Murphy has an opportunity to be clear, open and honest, instead its only on cross examination that the truth emerges, that one of the colleagues in this work, that she’s driving, is actually her husband:

A blip perhaps. Let’s see how open and honest Dr Murphy is on another question. How much insight she has into her own insight. It takes Chloe not one, or two

or three, but four attempts for Dr Murphy to have the insight that she had no insight into her own failings in her reflective document

She goes on to claim that she had a revelation after Connor’s inquest, a sea change in her mind

When pushed by Chloe, the GMC Barrister, she is forced to admit that this crystallisation of insight only actually occurred in this tribunal process

I’d go as far as to say that there is no genuine insight or remorse still. Dr Valerie Murphy is only concerned about the impact on her. The tribunal also stated in November:

the Tribunal has noted that there has been an absence of apology to Patient A’s mother and an absence of remorse for the consequences. It considers that the remorse displayed was limited to the consequences these proceedings have had upon her.

What do you know yesterday, suddenly 1,692 days after Connor died, Dr Murphy suddenly decided that she should have apologised, I wonder why that is?

A non-apology, given to a tribunal, in a last ditch desperate attempt to save your own bacon. It’s about as low as it gets. I can not see how anyone who needs 4 years, 7 months and 16 days to crystallise their insight is fit to be a medical practitioner. I hope the tribunal reach the same decision.

I’ll be live tweeting the outcome, some time after 12:30pm tomorrow on @JusticeforLBGMC.

2 comments on “The crystallisation of insight #JusticeforLB”

JudyB says:

From my limited knowledge as a parent of an adult with newly diagnosed epilepsy. With diagnosed epilepsy you take all the precautions all the time as you have no way of knowing when someone will have a seizure. Which means not leaving someone alone in the bath. If on top of that you prescribe meds that lower the seizure threshold then you know a seizure is more likely. What was done elsewhere, what parents said or didn’t say is all totally irrelevant. The precautions to take were spelled out to me and my daughter in two minutes, so why a psychiatrist wasn’t completely aware of it is totally beyond me.

Alison says:

Not to mention that many drugs that are prescribed by psychiatrists are known to increase the likelihood of seizures.

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