S T A N D I N G C O M M I T T E E O F T Y N W A L D C O U R T O F F I C I A L R E P O R T
R E C O R T Y S O I K O I L B I N G V E A Y N T I N V A A L
P R O C E E D I N G S
D A A L T Y N
PUBLIC ACCOUNTS
MEDICAL STAFF INVESTIGATION
HANSARD
Douglas, Wednesday, 5th December 2012
PP163/12 PAC-MS, No. 1
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Published by the Office of the Clerk of Tynwald, Legislative Buildings, Finch Road, Douglas, Isle of Man, IM1 3PW. © High Court of Tynwald, 2012 STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
Members Present:
Chairman: Mr A L Cannan MHK Mrs B J Cannell MHK Mr C G Corkish MBE MHK
Clerk: Mr J D C King
Mr D M W Butt MLC and Mr L I Singer MHK declared an interest and took no part in the proceedings.
Business Transacted Page
Procedural...... 3
Evidence of Mr D Killip, Chief Executive, Department of Health and Mrs B Scott, Hospital Manager, Department of Health ...... 3
The Committee adjourned at 4.30 p.m.
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Standing Committee of Tynwald on Public Accounts
Medical Staff Investigation
The Committee sat in public at 3.30 p.m. in the Legislative Council Chamber, Legislative Buildings, Douglas
[MR CANNAN in the Chair]
Procedural
The Chairman (Mr A L Cannan): Good afternoon and welcome to this public meeting of the Public Accounts Committee. I am Alfred Cannan MHK and I chair this Committee. The other members of the Committee are Mr Geoff Corkish MHK and Mrs Brenda Cannell MHK. 5 Please switch off your mobile phones and do not just put them on silent – they interfere with our recording equipment. Also, for the benefit of Hansard, I shall be making sure that we do not have two people speaking at once. In February 2012, the case of Dr Dirk Hoehmann was referred to the Social Affairs Policy Review Committee by Mr Alex Downie MLC. Tynwald and its Committees cannot comment on 10 matters which are the preserve of the judiciary, i.e. decisions made in relation to an individual case; however, it is within the Public Accounts Committee’s remit to look at a case to see what lessons arise for the efficiency and effectiveness of the public services more generally. Dr Hoehmann was appointed by the Department of Health in March 2005. On 15th November 2010, he was arrested and charged with obtaining a pecuniary advantage by deception, which is an 15 offence under the Theft Act 1981. He was immediately suspended from work. In April 2011, he resigned from his post at Noble’s Hospital. In November 2011, his criminal trial ended. He was acquitted of the offence charged in the Isle of Man, but re-arrested and returned to the UK to face proceedings for extradition to Germany under a European Arrest Warrant. In referring the case to us, Mr Alex Downie MLC highlighted, firstly, the cost of keeping Dr 20 Hoehmann on remand for a year; secondly, the cost of finding a replacement stand-in consultant; thirdly, why it was not left to the GMC to pursue a prosecution. In March 2012, the Social Affairs Policy Review Committee referred the case to the Public Accounts Committee, which decided to investigate.
25
EVIDENCE OF MR D KILLIP AND MRS B SCOTT
Q1. The Chairman: I am pleased to welcome two representatives of the Department of 30 Health, and I would like each witness to state their name and job title. Perhaps you would like to start, Mr Killip.
Mr Killip: Thank you. David Killip, Chief Executive, Department of Health.
35 Mrs Scott: Barbara Scott, Hospital Manager, Noble’s Hospital.
Q2. The Chairman: Thank you very much. When were you appointed, Mr Killip?
40 Mr Killip: I was appointed to the Chief Executive post in the Department of Health when the Department was conceived following the Government restructuring in the early months of 2010,
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specifically 1st April 2010. However, prior to that I was the Chief Executive of the Department of Health and Social Security from 2nd June 2003.
45 Q3. The Chairman: Thank you. Mrs Scott?
Mrs Scott: April four years ago… yes, it will be.
50 Mr Killip: 2008.
Mrs Scott: Yes, 2008.
The Chairman: April 2008 you were appointed. Okay, thank you very much. 55 Mrs Cannell.
Q4. Mrs Cannell: Thank you, Mr Chairman, and good afternoon. I am just going to go straight into the dates. I just want to clarify the dates and the sequence of events as they occurred. As I understand it, it was on 10th March 2005 that Dr Hoehmann was 60 interviewed. Is that correct?
Mrs Scott: Yes.
Q5. Mrs Cannell: Okay, and then on 13th March of the same year, Dr Hoehmann filled out 65 his fitness to practice form, which failed to declare any previous convictions. Would that be correct?
Mrs Scott: Yes.
70 Q6. Mrs Cannell: And then it was on 15th March that the Department of Health formally offered the post to Dr Hoehmann. My first question is he was interviewed and three days later he filled out his fitness to practice form, which failed to declare previous convictions, and two days following that you actually offered him the post. Why the rush? 75 Mrs Scott: He was interviewed on 10th March, (Mrs Cannell: Yes.) so you would normally offer a post within that timescale, because he had been interviewed and offered the job.
Q7. Mrs Cannell: What date was it that he accepted the post? 80 Mrs Scott: Very shortly afterwards. He had already verbally accepted at interview.
Q8. Mrs Cannell: Okay. It was not until 2008 that the criminal records check arrived, but it had failed to show up any of Dr Hoehmann’s convictions. What I am trying to get my head round, 85 having read all the evidence that we have submitted – and we have got quite a bit on this – it seems rather odd to me that good practice was not followed, in terms of waiting and offering the job to this doctor subject to his police checks, his previous criminal convictions if there were any, and all of those relevant checks that are normally done as part of the good practice before engaging a consultant to work here. Why wasn’t that done? 90 Mr Killip: I rather think it was.
Mrs Scott: It was.
95 Mr Killip: In due course, I will make a comment about the criminal record check in 2008, but perhaps before we get to that point it might be easier to follow the chronology, so I will ask Barbara to speak about the recruitment process.
Mrs Scott: Yes. The recruitment process is obviously a fairly long process from advert and the 100 Royal College has to approve the job description before the post is advertised. Once the advert closes, the closing date, the short-listing takes place and obviously the interviews then take place. The offer is made to the person subject to all those checks, and it states that in the letter. So that is ______4 PAC-MS STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
standard practice, that you make an offer to whichever person you wish to appoint, subject to references, police checks, whatever checks need to be done for that post. 105 Q9. Mrs Cannell: That is how we understand it, but it would appear that did not, in fact, follow in this particular case, did it? I am just going and looking now at the cross-examination of you, yourself, Mr Killip, by Lord Carlile QC, in terms of the matter, the legal case that was pursued, where you admitted under oath that there was a real possibility that the critical form had 110 not been received by the Department of Health at the time the job offer was made; and if it was, the envelope might not have been opened; and if it had, the form could simply have been filed by a clerk, rather than being read and its contents noted. That suggests to me, having read that evidence, that there was uncertainty as to whether or not the critical form that contained the previous convictions just seemed to disappear and that nobody became aware of it until it was way 115 down the road. It was, what, 2008, three years later?
Mr Killip: No, it was not. Let me respond to your comment about the court case, but then I think matters would be helped if Barbara continued with the chronology. What I said to Lord Carlile in response to his questions is essentially that it could not be proven that the form was 120 received in time, because bear in mind the standard of evidence required in a criminal prosecution is very high. So it is not a case that necessarily what you describe did happen; it is just that it could not be proven that it didn’t happen.
Q10. Mrs Cannell: Why couldn’t it be proven? 125 Mr Killip: Because I do not necessarily think that at every step in the process those matters were necessarily recorded, that something happened on a particular day at a particular time.
Q11. Mrs Cannell: In correspondence with the Public Accounts Committee, you have 130 indicated that all the relevant checks were good in respect of the appointment of Mr Hoehmann and there was nothing thrown up in that, but then you later went on to say in an e-mail that there was no obligation for the Isle of Man to follow good practice anyway. So my other question is going to be, in terms of the National Health Service (Appointment of Consultants) Regulations Good Practice Guide, dated January 2005 – this has been in place in the UK for a considerable 135 amount of time – were these Regulations in place here at the time of the appointment of Dr Hoehmann?
Mr Killip: The good practice regulations for NHS… recruitment regulations for consultants, or recruitment best practice is followed at Noble’s Hospital and was followed in this case, as I think 140 Barbara can explain in more detail, having been involved in the recruitment of this particular individual. But those two things that I said to you are not in conflict with one another. What happened here is that an individual who had criminal convictions in another jurisdiction, which is a matter of fact and for which he continues to serve a custodial sentence, did not declare those convictions in an application that he made for employment with the Department. It is not that he 145 did declare them and they were not spotted or that he did declare them and the data was lost; he did not declare them. Now –
Q12. Mrs Cannell: Can I just ask you to pause there? You have admitted in a letter to Public Accounts dated 24th May this year, and I quote: 150 ‘The following checks are normally carried out in respect of a doctor being appointed to Noble’s Hospital…’
– and then you listed the various checks that are done. You then went on to say:
155 ‘With regard to the police check, this was not carried out on Dr Hoehmann at the time as these were not a mandatory requirement at the time of the appointment.’
This is why I am asking you about the UK regulations.
160 Mr Killip: I do not think police… at the time of his recruitment… and again, I am going to defer to Barbara, because this is more –
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Q13. Mrs Cannell: I would rather you would not, Mr Killip, because this is in respect of information that you have submitted to Public Accounts. 165 Mr Killip: Which I am willing to comment –
Q14. Mrs Cannell: I would like you to justify it.
170 Mr Killip: I am willing to comment and I will certainly justify it, but I think Barbara’s technical knowledge of these matters will help the Committee further understand the topics. As I understand it, a CRB check at the time of Mr Hoehmann’s recruitment in 2005 was not a mandatory check for all medical appointments.
175 Q15. Mrs Cannell: But hang on, you have just said that Noble’s Hospital does follow the National Health Service (Appointment of Consultant) Regulations good practice guidelines.
Mr Killip: Yes, and at the time I do not think that those guidelines required there to be a CRB check for every medical appointment at a hospital, either in the Isle of Man or in the UK. 180 Q16. Mrs Cannell: Mr Killip, can I just point out page 11, and it is paragraph 5.7 under ‘Employment’, and it states:
‘Good practice is formally to offer the post in writing to the successful candidate, subject to the results of checks on 185 professional qualifications, criminal record check and health clearance, within two working days of the decision to appoint.’
Mr Killip: Yes.
190 Q17. Mrs Cannell: That is what is done elsewhere. You said that is what Noble’s Hospital follows. I am just wondering then why it was not done.
Mr Killip: If you read to the foot of the paragraph from which you have quoted, it refers to a particular circular, (Mrs Cannell: Yes.) and it is therefore indicating that that circular addresses 195 the issues raised in that paragraph. That circular, which I concede I am not an expert on and do not know verbatim, but as I understand it, that circular indicates that a criminal record check should be undertaken… Bear in mind this good practice dates from 2005 and the circular dates from 2002. At that time, as I recall, the circular recommends that a criminal record check is undertaken for a medic or a doctor who has unsupervised access to children – and the origins of that 200 recommendation, I think, were the Beverly Allitt case – or, I think, in some circumstances if they might have unsupervised access to vulnerable adults. It does not, to my recollection… Neither this good practice nor the relevant circular at the time did not require a criminal record check for each and every doctor, and that –
205 Q18. Mrs Cannell: Are you suggesting therefore that HSC 2002/008, the circular number, is limited in its application?
Mr Killip: It is limited in its application where referring to the requirement for criminal record checks. 210 Q19. Mrs Cannell: But that is your interpretation of that because you have not supplied Public Accounts Committee with this circular, but you did supply a copy of the good practice guidance.
Mr Killip: I feel sure we can provide a copy of that circular if you would like to see it. Indeed, 215 I would venture to suggest that Barbara will be able to either confirm or modify what I have just said, because I suspect that Barbara’s familiarity with these documents is more forensic than mine is.
Q20. Mrs Cannell: But I was addressing you because you were the person who wrote to the 220 Committee.
Mr Killip: Yes, and as I said a little earlier, when you get round to asking Barbara I think she will be able to put more colour into that. ______6 PAC-MS STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
Q21. Mrs Cannell: What you are saying then, if I am to be clear – and correct me if I am 225 wrong – is that your interpretation of this particular circular is limited in its application. Therefore, can I suggest that if you are correct in that interpretation that you do employ and engage with consultants and doctors and do not do police checks on them unless they are going to be working with young children or vulnerable people… Is that what you are saying?
230 Mr Killip: That is my understanding. First of all, I would ask you to modify your comment my interpretation of this –
Q22. Mrs Cannell: Well, we have not got the facts –
235 Mr Killip: – because I –
Mrs Cannell: – because we have not got the circular before us, Mr Killip.
Mr Killip: It is not for me to interpret it. It is my – 240 Mrs Cannell: Sorry, you are –
The Chairman: Sorry, no.
245 Q23. Mrs Cannell: Through Mr Chairman – sorry, Mr Killip, you have not supplied us with a copy of it, so we are dealing with your interpretation of a document which you have not got at the moment and we have not got.
Mr Killip: It is not for me to interpret that document, because I am not involved in the 250 recruitment of hospital consultants. I think a more appropriate word would be my understanding of the content of that circular. But yes, what you have just said is correct. At the time, that circular was limited in its application where it refers to the requirement for criminal record checks.
Q24. Mrs Cannell: So your reading and your understanding of it, the way it is printed then… 255 and I take it these guidelines are still in practice. They are only dated 2005, so they are not terribly dated, so –
Mr Killip: They may have been modified. I am sure Barbara can clarify that for us.
260 Q25. Mrs Cannell: But what you are suggesting therefore is that good practice in checking criminal record checks and health clearance and professional qualifications… they are not all required. Obviously the professional qualifications will be and health clearance is an obvious one, but what you are saying then is that the norm is not to ask for a police check.
265 Mr Killip: The norm in 2005 was not to ask for a police check –
Q26. Mrs Cannell: And now?
Mr Killip: – and it may be the case now. 270 Mrs Scott: It is now, yes.
Q27. Mrs Cannell: When did you start to apply that practice?
275 Mrs Scott: In 2008.
Mrs Cannell: In 2008.
Q28. The Clerk: I think the expression ‘It is now’ was ambiguous. Could maybe Mrs Cannell 280 ask the question again about what is happening now? Or maybe I could ask it, because I did not understand the answer. Is it the case now that you do a criminal record check on all doctors?
Mrs Scott: Yes.
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285 Q29. The Clerk: Whether or not they are involved with children or vulnerable adults?
Mrs Scott: Yes.
Q30. The Clerk: When did it change? 290 Mrs Scott: In 2008.
The Clerk: Thank you.
295 Q31. Mrs Cannell: What was the reason for applying that in 2008? Was there a particular reason?
Mrs Scott: We would normally follow risk-assessment checks on each practitioner, whether it is a medic, a nurse or whatever. So a medic back in 2004-05, who had access to children, 300 underwent a CRB check. That was standard. In 2008, it changed following risk assessments when all staff were CRB checked as standard practice in hospitals as guidance has changed.
Q32. Mrs Cannell: How far do you go in terms of a previous criminal convictions check? What is the method by which you seek that information about an individual who might be engaged 305 at the hospital?
Mrs Scott: It is via the Police. We do not –
Q33. Mrs Cannell: By the local Police Force? You ask them to do the check? 310 Mrs Scott: Yes, it is a standard form.
Q34. Mrs Cannell: Okay. So this all came to light after Dr Hoehmann… We always called him Mr Hoehmann, previous patients of his. 315 Mr Killip: It is usual for a surgeon to be referred to as ‘Mr’ as a matter of courtesy, (Mrs Cannell: Yes.) and Mr Hoehmann was a surgeon, so to refer to him as Mr Hoehmann is technically correct.
320 Q35. Mrs Cannell: I knew it was, but everything that I read before is all saying Dr Hoehmann, which is rather curious, given his particular expertise. He was, was he not, a very good surgeon? He was very good at his job.
Mr Killip: I am not qualified to comment on that, though I am not aware of any clinical 325 failings in his surgery.
Q36. Mrs Cannell: Were there ever any complaints about his workmanship?
Mr Killip: Not to me. 330 Mrs Scott: Yes, to the hospital.
Q37. Mrs Cannell: There were, okay. It was in 2008, three years after he had been appointed, that the criminal record check was 335 carried out, and it is ironic, is it not, that the Police, from 2008… Mrs Scott, you say the Police are asked to do a police check on what would be employees, but in fact the same year the criminal record check that was carried out failed to show, did it not, Mr Hoehmann’s previous convictions?
Mrs Scott: Yes. 340 Mr Killip: Can I make an observation concerning that?
Mrs Cannell: Yes.
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345 Mr Killip: I would invite the Committee to follow this up independently, as what I am saying to you now was an observation made to me by a police officer, which I do not doubt to be correct but which I have no documentary evidence of. One of the officers involved in the prosecution of Mr Hoehmann observed in a conversation with me that when he absconded from Germany the German authorities notified the police forces 350 in other jurisdictions through the usual channels concerning the international arrest warrant, and that such a notice, or whatever form it takes, was sent by the German authorities to the Serious Organised Crime Agency in the United Kingdom, which is the body that receives such submissions. The local police officer went on to say to me that, for some reason or other, the Serious Organised Crime Agency had not recorded the German details on the UK Police National 355 Computer, which is why a criminal… a PCB check came back negative. I am happy to provide you with that observation, but I cannot provide you with documentary evidence that it is correct, but it is a remark that was made to me.
Q38. Mrs Cannell: It is a very interesting remark, but of course unless it is backed up with 360 evidence as such it is not an area that we can really pursue.
Mr Killip: Well, you may seek to see if you can clarify it with the local constabulary. That is a matter for the Committee.
365 Mrs Cannell: That is all for the moment, Mr Chairman.
The Chairman: Mr Corkish.
Q39. Mr Corkish: Thank you, Chairman. 370 Hello, both. Irrespective of the checks that happened here, or did not happen here, you mentioned before, Mrs Scott, the Royal College. I think I read in the report of the GMC, and possibly the BMA… What reliance, or what contact would you, as an employer, have with them before contracting, in this case, Mr Hoehmann to the job? And if we did, how much would we rely upon that information supplied? 375 Mrs Scott: On the Royal College? If I talk about the Royal College –
Mr Corkish: The Royal College and/or the GMC.
380 Mrs Scott: Yes, I will do them all. There is the GMC, the Royal College and the BMA. Did you –
Mr Corkish: The BMA.
385 Mrs Scott: Yes, of course, I will do them all. The GMC – it is standard for the human resources department to check the application of a doctor, to check the registration number and to print us out a copy of the registration of that doctor so that we are fully aware that the doctor is registered with the GMC, that they hold specialist registration, if that is what is necessary for the post, and that we are able to appoint them on that 390 basis. In Mr Hoehmann’s case, we had that information.
Q40. Mr Corkish: And if we had done that, and we did do it, would we be a little bit more relaxed perhaps in the appointment, that we think that the GMC, BMA, Royal College had done their part of the background information? 395 Mrs Scott: The GMC, in order to register a professional, require the professional’s credentials with regard to their training, their experience, their exam results, that sort of thing, and that is how they register somebody with the General Medical Council. So that was all done; there was no problem with that. 400 The Royal College of Surgeons… We would always have the job description checked and approved by the Royal College before we can go out to advert for the post. The Royal College then appoint an independent assessor to the appointment panel, to the Appointment Advisory Committee, who will then sit on the shortlisting panel with us and sit on the interview committee with us. They look at each application and they ask questions at the interview, and they then tell
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405 us, at the close of the interview, whether the person is appointable or not. They check there is research, they check where they have worked, that sort of thing. So that was done in this case.
Q41. Mr Corkish: So that practice was still maintained, (Mrs Scott: Yes.) but will be more robust now? 410 Mrs Scott: It is the same.
Q42. Mr Corkish: Were there any add-ons on to that that –
415 Mrs Scott: No, it is the same. The main thing with appointing a doctor is about self-declaration and that they are up-front and honest in their application and any issues or problems or challenges that they face in their career.
Q43. Mr Corkish: Even though you now know that they do not always fall into that category? 420 Mrs Scott: Yes.
Q44. Mr Corkish: So have there been any alterations, additions, added robustness to the way that we appoint a doctor, consultant? 425 Mrs Scott: There has not been in Noble’s because there is not any need to do anything. I think –
Mr Killip: Other than, of course, the fact that criminal record checks are now universal since 430 2008.
Mrs Scott: Yes, so we have –
Mr Killip: As we have previously discussed, in 2005 they were not. 435 Mrs Scott: But I think there may be more learning to come from the GMC, because that hearing is still ongoing with regard to Mr Hoehmann.
Q45. Mr Corkish: So, following that, will the GMC be… You would be in touch with them, 440 they would be in touch with you, (Mrs Scott: Yes.) to further what could happen?
Mrs Scott: Yes.
Q46. Mr Corkish: I heard you say a little bit earlier on, Mrs Scott, that there had been 445 complaints within the hospital regarding Mr Hoehmann.
Mrs Scott: From patients, yes.
Q47. Mr Corkish: From patients, not staff. From patients? 450 Mrs Scott: From patients, yes.
Q48. Mr Corkish: On professional…?
455 Mrs Scott: Yes, on professional issues. That tends to be…
Q49. Mr Corkish: And at what period of time would this be after his appointment?
Mrs Scott: A couple of years after his appointment. I do not think there were any that I can 460 recall early on, but I have not brought that evidence today. I am sorry, I did not realise we would be asked about that.
Q50. Mr Corkish: So there was some doubt as to his professionalism?
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Mrs Scott: It tends to be normal to have complaints made against medical staff in lots of areas. 465 That is the world we live in, so it is not that… His level of complaints was not above average or anything different to another professional.
Q51. Mrs Cannell: Through Mr Chairman can I just clarify then, although complaints were made, was there ever a formal complaint made through the formal complaints procedure? 470 Mrs Scott: Yes.
Mrs Cannell: There were?
475 Mrs Scott: Yes.
Q52. Mrs Cannell: Have you an idea of how many and what the outcomes were?
Mrs Scott: No. It would be wrong for me to give you an estimate off the top of my head. I 480 would need to look at the numbers. They were not exceptional numbers.
Q53. Mrs Cannell: No, but you cannot recall whether or not any were upheld or dismissed?
Mrs Scott: They were all investigated. I know that one definitely went to the IRB and was 485 upheld, which was a complaint that we would… that ran its course, that would be normal, but there were not any exceptional complaints.
Q54. Mrs Cannell: Mr Chairman, if I could just continue a little bit. Just looking at the referees for Mr Hoehmann, it is ironic, is it not, that one of them actually 490 came from the Director of University, the Ear, Nose and Throat Department in Germany, and you actually had a… Presumably you saw copies of all of that. Was it a dated reference, or was it a current date?
Mrs Scott: Yes, they are all dated. 495 Q55. Mrs Cannell: It was a current date?
Mrs Scott: Yes.
500 Mrs Cannell: Okay.
Q56. Mr Corkish: Sorry, Chairman, could I just come in there? Just a point on that. I think part of the criteria for the appointment of this, with regard to referees, was that one of the referees must be the last person who employed him. That person, one would think, would know that there 505 would be problems with this individual already.
Mrs Scott: You would think so, yes.
Q57. Mr Corkish: So that person is culpable as well. 510 Mrs Scott: Yes.
Q58. Mrs Cannell: Just returning to the General Medical Council, are you aware, Mrs Scott, what the criteria is for considering the new registration of a surgeon who is coming in from outside 515 of the British Isles, overseas, as it was in this case? Do you know what the criteria is? Is it merely just that they check the professional, the medical qualifications, or do they go deeper?
Mrs Scott: It tends to be the professional qualifications, the passport, the identity, that sort of thing. 520 Mrs Cannell: Right, okay, so they would not –
Mr Killip: Possibly language check.
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525 Mrs Scott: Your language checks, that the spoken English is good.
Q59. Mrs Cannell: So they would not necessarily ask for some sort of a previous criminal conviction check, police check?
530 Mrs Scott: They do not do that.
Q60. Mrs Cannell: They do not?
Mrs Scott: As I said earlier, it is self-declaration because the duties of a doctor… It is about 535 honesty and probity and all of those things.
Q61. Mrs Cannell: So, had you not become aware of the fact that there were outstanding matters back in Germany, the likelihood is, if I am correct, that probably he would still be engaged today, would he not? 540 Mrs Scott: Quite possibly, yes.
Q62. Mrs Cannell: We were interested in a letter from you, Mr Killip, dated 24th May this year, where you say that the total costs of employing locum consultants throughout this time – and 545 this is the time of the suspension and then subsequent departure of Mr Hoehmann – were £226,507.32. Could you give us a little bit more breakdown on that? What period of time is that covering precisely, and how many locums are we talking about in the intervening period?
Mr Killip: I would, with your agreement, Chairman, invite Barbara to comment on that, as this 550 information will have come to me from Barbara and I am not aware of whether there was a single locum. I believe there probably was, but I think perhaps Barbara can answer that question more fully than I can.
Mrs Cannell: Okay. Mrs Scott. 555 Mrs Scott: The locum was employed more or less from the time when Mr Hoehmann was arrested. A replacement was found and the locum worked until a substantive appointment was made. It was, as far as I can recall, one person for that time.
560 Q63. Mrs Cannell: What period of time are we talking from here?
Mrs Scott: From the November until an appointment was made, which was last year sometime.
Mrs Cannell: So November which year? 565 Mrs Scott: November 2010.
Q64. Mrs Cannell: Until the appointment, which was?
570 Mr Killip: Mr Hogg’s appointment.
Mrs Scott: Yes, I am just trying to think when that was.
Mr Killip: About nine months ago? 575 Mrs Scott: Yes, end of last year.
Mrs Cannell: December? November?
580 Mrs Scott: It could be. I will…
Q65. Mrs Cannell: Could you provide the Committee with the precise dates, please –
Mrs Scott: Yes, of course I can. 585 ______12 PAC-MS STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
Mrs Cannell: – so that we can actually work out what it has actually cost – part of the costs of this whole affair.
Mr Killip: Of course, following… The Department was in a position of having to put a locum 590 into place when Mr Hoehmann was arrested because from that moment onwards there was no ENT consultant available. Of course he resigned from his post in the early months of –
Mrs Scott: April 2011.
595 Mr Killip: Thank you, April 2011. So, even if he had not been arrested in the November, following his resignation we would have had to put a locum into post, if you see what I mean, so the Department… I understand the point you are making, but the Department, of course, could not have the hospital functioning without an ENT consultant.
600 Q66. Mrs Cannell: We are not suggesting for a moment that we would expect the hospital to function without a surgeon to fill in. It is just that the wording in your letter of 24th May this year says locum consultants, which suggests there was more than one.
Mrs Scott: Sorry. It would be to cover annual leave of the other consultant. So there was one 605 that was employed for the long term, so it is –
Q67. Mrs Cannell: Right, okay, for that period of time?
Mrs Scott: Yes, so it is – 610 Q68. Mrs Cannell: And whilst he was off, someone else would fill in. So we are talking about two then, aren’t we?
Mrs Scott: Yes. 615 Mrs Cannell: Yes, okay. Thank you.
Q69. Mr Corkish: Thank you, Chairman. Could Mr Hoehmann have got a job in the UK under the same criteria as he did here? 620 Mr Killip: He did so. As I said, he worked in the… This, of course, will be… One imagines this will be of interest to the GMC in the review that they are presently undertaking into this case, such as was referred to by Barbara a few minutes ago, because Mr Hoehmann was indeed employed by a UK NHS trust before he came to the Isle of Man. 625 Q70. Mr Corkish: He worked in the UK, he came here, we had – if I can use the term in this context – a good bill of health regarding Mr Hoehmann. We relied upon the GMC, BMA, Royal College. Why, when the end of the line came, could we not have had Mr Hoehmann dismissed, sacked, whatever, and returned to the UK without any cost to the Isle of Man? 630 Mrs Scott: We have to follow a certain procedure. In this case, we have to await –
Q71. Mr Corkish: But we had been misled and wrongly employed this person.
635 Mrs Scott: Yes. We had to wait for legal confirmation from the Police as well that the Police case had completed and therefore we could enter into our internal procedures at that time, and that the internal procedure could conclude, if that was possible, prior to the conclusion of the Police case being heard in court. Once that permission was granted, we then proceeded into our own internal disciplinary investigation and then on to a hearing. Mr Hoehmann decided to resign prior 640 to the hearing being concluded.
Q72. Mr Corkish: Is that what is meant in the report where it says that… or the disciplinary process, that ‘we were eventually permitted to proceed’?
645 Mrs Scott: Yes.
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Q73. Mr Corkish: You could not do anything beforehand?
Mrs Scott: Yes, and quite often we have to wait for the Police case to actually conclude in 650 court before we can enter into our own internal procedures, but as the two cases were separate we were allowed to continue.
Q74. Mrs Cannell: I am sorry, if I could just clarify – who gave you advice in respect of that, that you had to wait before your own internal check was done? Who advised you (Interjection by 655 Mr Corkish) that that was the lawful position?
Mrs Scott: A law firm who –
Mr Killip: Yes, there was legal advice and I think that was supplemented by advice from the 660 HR people. We can check by whom and when.
Q75. Mrs Cannell: Okay, so you did not check with the Attorney General’s Chambers, then?
Mr Killip: I think that was done. 665 Mrs Scott: Yes, and they advised us to go to a legal firm.
Q76. Mrs Cannell: And that you had to wait?
670 Mrs Scott: No, we had to wait until at some point we could begin our internal disciplinary procedures, but quite often we have to wait until the actual conclusion, but not in this case.
Q77. Mrs Cannell: Okay, so you were advised through the Attorney General’s Chambers then that they could not deal with it and that you had to engage with your own private advocate? 675 Mr Killip: Correct.
Mrs Scott: Yes.
680 Q78. Mrs Cannell: Can we ask you who you engaged?
Mr Killip: Was it Dougherty Quinn?
Mrs Scott: No, it was John Aycock. 685 Mr Killip: Mr Aycock. That is Mann & Partners. Yes, Mr Aycock, Mann & Partners.
Q79. Mrs Cannell: Mann & Partners, okay. Did you have a budget for that cost?
690 Mr Killip: No. We do not specifically have a budget for retaining legal services.
Q80. Mrs Cannell: Had you expected the Attorney General’s Chambers to give you the appropriate advice? Did it come as a surprise that you had to engage an outside advocate?
695 Mr Killip: I think we have been aware for a while that there are very significant pressures on the AG’s Chambers, and I think it was not unique for Chambers to say, ‘Could you please secure legal advice from a private law firm?’
Q81. Mrs Cannell: May we have details of what that has actually cost you? 700 Mr Killip: Yes.
Mrs Scott: Yes.
705 Q82. Mrs Cannell: If we could have that. While we are sticking with the criminality, or the legal aspect of it, I take it that in preparation for the criminal trial you would have submitted a statement of case. ______14 PAC-MS STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
Mr Killip: Yes.
710 Q83. Mrs Cannell: Yes, and may we have a copy of that statement of case, now that the trial is concluded?
Mr Killip: I believe you would have to secure that from the court. I think the evidence of the criminal proceedings is a body of material that is vested in the court. 715 Q84. Mrs Cannell: Well, it is sensitive whilst the case is continuing, but our understanding is that once it has concluded, the fact that it was your piece of work, it is your document…
Mr Killip: I think that is the point, Mrs… I am not splitting hairs with you. I do not think it is a 720 case of sensitivity. I think it is a case of ownership, that my statement, my witness statement does not belong to me. It belongs to the court. I do not immediately have a copy of it, to be frank, but I do not think it is for me to provide it to you, actually. I do not think –
Q85. Mrs Cannell: Through Mr Chairman, we will need to check that out with our own legal 725 advice in respect of that. We are advised slightly differently, but we will double-check that. I am sorry, I am going to hand over to Mr King to actually clarify this position, please, if you would, though Mr Chairman.
The Chairman: A point of clarification. 730 Q86. The Clerk: Thanks, Chairman. Mr Killip wrote in his letter:
‘…where a Police investigation is ongoing and a court case pending, we are asked not to proceed with an internal 735 investigation. In Dr Hoehmann’s case we were eventually permitted to proceed as the 2 cases were for different “charges”.’
We have heard quite a lot about what the criminal case was about. What was the disciplinary case, and in what way was it different? 740 Mr Killip: By all means add your own views. The criminal case, as we heard from the chair earlier, was a prosecution for fraud – pecuniary advantage through fraud. The disciplinary case related to the breach of the recruitment procedure and was consequently misconduct, for want of a better word, through having falsely represented 745 his background when applying for the post. So, whereas one was criminal, the other was a disciplinary matter in respect of his personal conduct – if that is an adequate description.
Mrs Scott: His failure to declare his criminal convictions was the basis of our internal investigation. 750 Q87. The Chairman: When did you become aware that there were these 44 outstanding warrants in Germany, or 44 charges in Germany?
Mrs Scott: When he was arrested in November. 755 Q88. The Chairman: As soon as he was arrested, yes?
Mrs Scott: Or very shortly afterwards.
760 Mr Killip: Or maybe even shortly before. The fact of his criminal convictions… Two germane facts were brought to our attention: one was that he had criminal convictions in Germany; and the other was that he had absconded from custodial sentence.
Q89. The Chairman: Sorry, I need to… Did you have clear evidence that this was the case? 765 Was that provided to you by the Police or by a third party?
Mr Killip: By the Police.
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Mrs Scott: By the Police. 770 Q90. The Chairman: So at that stage then, the Police had clearly told you, and you had no reason to disbelieve them, that there were 44 outstanding warrants or charges for Dr Hoehmann. So actually, as far as you were concerned, he had lied on his recruitment forms, on his application forms. Really, that should have been an automatic dismissal for misconduct. 775 Mr Killip: The advice from our HR colleagues, I am pretty sure, is that the established disciplinary procedures had to be followed.
Q91. The Chairman: Did you want to sack…? Who was dealing with this? You, Mr Killip? 780 Were you?
Mr Killip: No, the Hospital Manager.
Q92. The Chairman: Mrs Scott, did you want to sack Dr Hoehmann at that point? 785 Mrs Scott: Yes.
The Chairman: Yes?
790 Mrs Scott: Because there was no way I would employ –
Q93. The Chairman: Do you think HR and the lawyers were overly cautious in their advice to you? Were you frustrated by that decision?
795 Mrs Scott: No, not at the time, because… If I could just go back on what you were saying, we were provided with the list of offences at some point following his arrest, and it was quite some time afterwards – I would have to check the date on that – so we could not actually… the actual physical evidence did not become ours until some time later. (The Chairman: Right.) So at that point, yes, I wished to then move on to proceeding to a disciplinary hearing. 800 Q94. The Chairman: But it became a long, drawn-out, protracted process for you; and in fact had Dr Hoehmann not voluntarily resigned his position, he would have carried on being paid until well after his criminal trial had finished.
805 Mrs Scott: No, because we stopped paying. His pay ceased when he was arrested.
Q95. The Chairman: Sorry – so he wasn’t paid from that point?
Mrs Scott: No. I was very clear that someone under those circumstances should not receive 810 pay.
Q96. The Chairman: So you stopped his pay?
Mrs Scott: Yes. 815 Q97. The Chairman: But he was retained, for all effectiveness, on the personnel –
Mrs Scott: He was, yes.
820 The Chairman: Okay, right.
Mrs Scott: And he was suspended from the GMC as well at that point, so it is –
Q98. The Chairman: It is a very strange set of affairs that you have stopped someone’s pay, 825 that he has been suspended from the GMC, and he has not been formally dismissed. I find that very difficult to put together, but that is as may be. Just going back to a point earlier that was brought out from Mrs Cannell, you said that it was standard practice, and I presume still is standard practice, to offer subject to references and
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criminal checks, but in this case the individual started before those checks were completed. Is that 830 correct?
Mrs Scott: No.
Q99. The Chairman: But there was a check outstanding, was there not? 835 Mrs Scott: No. No checks outstanding.
Q100. The Chairman: Everything had been received?
840 Mrs Scott: Yes.
Q101. The Chairman: As far as you were concerned, no criminal check had taken place at the first stage?
845 Mrs Scott: No, because at that time they were not –
Q102. The Chairman: And you had had all your references back?
Mrs Scott: Yes. 850 Q103. The Chairman: Clearly then, if that is the case, something went wrong somewhere with those other references. Do you have a view on what went wrong with those other references, in terms of failure to identify?
855 Mrs Scott: I assume that the person in Germany was fully aware of the convictions and did not declare them in the reference. It is not something that I can take up to find out.
Q104. The Chairman: Was the person in Germany whose reference was sought… Were they working at the same hospital as Dr Hoehmann? 860 Mrs Scott: It is in the same health authority, yes.
Q105. The Chairman: What changes to practice have you brought about as a result of those references? Because it would seem to me that you were always running the risk that you were 865 writing to somebody who may well have been a friend of Dr Hoehmann’s and was prepared to lie on his behalf – or perhaps not lie, maybe just not give the information. So, have there been any alterations to the reference process, other than giving named individuals?
Mrs Scott: No, because we would always seek the employer and make sure that we get a 870 reference from the employer.
Q106. The Chairman: But are you still writing to individuals who are named by the applicant?
875 Mrs Scott: Yes, unless I am unhappy with… that they are not the employer, and then I ask for a further reference.
Q107. The Chairman: I accept you have got to write to the employer. Do you not think that, rather than writing to the name that you have been given, you should write directly to the hospital 880 or surgery, or wherever the individual has come from, without specific reference to names, or to the chief executive directly, or to the head of human resources directly, rather than to a name given by an applicant?
Mrs Scott: It is very difficult, because you expect a doctor to be honest, and in this case it 885 would not have really mattered, I do not think, whom I had written to because we did write to others in Germany and had the same reference, as in that there is nothing… Nobody declared anything against Mr Hoehmann. No matter what we did, we would never have uncovered this, I do not think, because the failure appears to be in the UK.
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890 Q108. The Chairman: Well, I am not sure I entirely agree with you. I think that all aspects need to be reviewed, and perhaps that is something that you might want to consider and take away with you. Can I just ask my fellow Committee members whether they have any further questions, please?
895 Q109. Mrs Cannell: Yes, I would just like to… Again, for the sake of clarity, can you explain what ‘CRB’ check stands for?
Mrs Scott: Criminal Records Bureau.
900 Q110. Mrs Cannell: Criminal Records Bureau, okay. Because in this letter from Mr Killip, 24th May 2012, the Criminal Records Bureau check was undertaken but it was the police check that was not undertaken. Is that correct? That is what it stated in the letter.
Mr Killip: What I said was… On the second page of the letter to which you refer, I have listed 905 a number of things and I have said:
‘The following checks are normally carried out in respect of a doctor being appointed to Noble’s Hospital…’
I have begun that list with ‘CRB Check’, because as we have heard earlier in this conversation, 910 they have been uniform since 2008. So writing this letter in 2012, the CRB check of course is part and parcel of what is done, but you will see that I have continued that paragraph by saying:
‘With regard to the police check…’
915 – by which I mean the CRB check, so I apologise if that is confusing –
‘… this was not carried out on Dr Hoehmann at the time as these were not a mandatory requirement at the time of the appointment…’
920 – which we discussed at the outset of today’s meeting. I then said in the letter:
‘However, this was completed in 2008 for Dr Hoehmann.’
Mrs Cannell: Quite. 925 Mr Killip: And as we have also heard in this conversation, the 2008 CRB check identified no concerns about him because there was no record of criminality in the United Kingdom system, and –
930 Q111. Mrs Cannell: Okay, can I just clarify then, in your mind is a police check and a Criminal Records Bureau check one and the same, or are they two different processes?
Mrs Scott: The same.
935 Mr Killip: They are alternating terms for the same thing.
Mrs Scott: If I can just clarify, originally, back in the early 2000s, it was called police vetting and we followed the Isle of Man Government police vetting policy, which was… I think it was Corporate Guidelines on Police Vetting for Employment Purposes. So that is why they were 940 referred to as police checks. They then became CRB checks.
Mr Killip: Though they are –
Mrs Scott: One and the same. 945 Mr Killip: – undertaken by the Police.
Mrs Scott: Yes.
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950 Mr Killip: But in the letter to which you have just referred, as I have just commented, in the paragraph at the top of page 2, I have referred to a police check, and then in the list of items appearing beneath that paragraph I have referred to a CRB check. I mean the same thing, though if that is not clear I apologise.
955 Q112. Mrs Cannell: Well, it is very unclear.
Mr Killip: It might have been helpful if I had said in the paragraph… In the narrative, it might have been helpful if I had said ‘CRB check’, which is the term I have used beneath, but at the risk of clouding matters yet further, a CRB check is undertaken by the Police. 960 Q113. Mrs Cannell: Okay. So it more or less one and the same, but the way in which it is worded it gives a completely different suggestion here. When it was done in 2008 it did not throw anything up of any significance?
965 Mr Killip: It did not throw anything up, (Mrs Cannell: No.) and as we discussed (Mrs Cannell: Subsequent.) a little earlier, apparently because of the failure to record it.
Q114. Mrs Cannell: If I could just ask you to pause there. Subsequent to it not showing anything up and then all of this coming to light and Mr Hoehmann being arrested and then you 970 being provided with the list of charges etc, did you then go back to our Police here and say, ‘Well, you did the check – why didn’t this come up?’ Did you formally write to ask for an explanation from the Department of Home Affairs here, in terms of ‘Why didn’t this get picked up?’
Mr Killip: I did not write to the Police in the manner you have just described, for the very 975 reason I mentioned earlier: the Police were then in possession of knowledge of why the CRB check had failed, and we became aware of that knowledge when Constable Moore shared that information with me about there being no data on the UK system.
Q115. Mrs Cannell: But this was informal information that was shared with you, wasn’t it? 980 You had not got –
Mr Killip: Well, it was shared conversationally, yes.
Q116. Mrs Cannell: So really, in theory, it is hearsay, because you have not had it confirmed 985 in writing that in fact this whole thing could have been prevented had whoever the crew were in the United Kingdom that held this information not filed it in the correct way.
Mr Killip: That is true. With deference to Constable Moore, I take your point that it was hearsay inasmuch as it was not contained in any formal communication, but I think it would be 990 proved to be reliable data, coming as it did from a police officer involved in the case. But in terms of establishing how this error had come about… because you are right – had the 2008 check thrown up the information about Mr Hoehmann, then the Department could have taken action at that point. But in terms of establishing how it was that that information was not contained on the UK system, it was clear that the Manx Constabulary were aware of it, and as it was a police 995 procedure, I would anticipate that they would follow up on that as part of their investigations. I do not think it was for the Department to challenge SOCA.
Q117. Mrs Cannell: I am not suggesting that one would challenge, but one would literally seek confirmation formally as to how events led up to this, bearing in mind that you say that you 1000 had followed the proper procedures. You see, what I still cannot get round is that he was appointed and he was practising, and three years later the police check was undertaken and it did not throw anything up. Again, I question why was it left until 2008 before the CRB check was undertaken?
Mr Killip: Do you want to comment on that, Barbara? 1005 Mrs Scott: Yes, I was going to say… It is probably in the court evidence that, in 2008, the Medical Director at Noble’s was informed by the Royal College of Surgeons’ representative who had interviewed with us for Mr Hoehmann’s post, that he had been told that Mr Hoehmann had convictions outstanding against him, and he contacted us to tell us that this is what he had heard. 1010 Mr Upsdell interviewed Mr Hoehmann and asked him was this the case, and Mr Hoehmann denied ______19 PAC-MS STANDING COMMITTEE, WEDNESDAY, 5th DECEMBER 2012
this and I then suggested a CRB check was then undertaken, because if there were convictions we would then be made aware of them and could then take action.
Q118. Mrs Cannell: I understand that. I do understand that, Mrs Scott, but what I cannot ratify 1015 in my own mind is why you waited so long to do it. I fully accept that you did not adopt the good practice guidelines until some time later – it was in 2008 – but the very fact that they had been in existence in the United Kingdom since 2005, and one tends to follow good practice… I still cannot get round the idea of why you did not actually do a check, particularly on a surgeon coming in from abroad, and make sure that everything was as it should be. 1020 Mr Killip: Forgive me – if I have correctly understood what you have just said, I think you are confused by something and we would like to try and dispel that confusion. No CRB check was undertaken on Mr Hoehmann at the time of his appointment in 2005 because, as we discussed a little earlier, mandatory blanket CRB checks on medical practitioners were not required by the 1025 good practice or by the circular document to which we earlier referred –
Mrs Cannell: No, I am not –
Mr Killip: – at that time. 1030 Mrs Cannell: I am not confused, Mr Killip.
Mr Killip: The two –
1035 Mrs Cannell: I am not confused.
Mr Killip: Well –
Q119. Mrs Cannell: It may not have been a mandatory requirement, (Mr Killip: Yes.) but 1040 good practice would suggest that you would do it anyway, wouldn’t you?
Mr Killip: I think that is the point: the good practice did not require it for medics at that time unless the individuals had unsupervised access to children or, in some circumstances, unsupervised access to vulnerable adults. So the good practice of the day would have been 1045 completely content with the way that Mr Hoehmann was recruited, and as I understand it, subject to my technical colleague, what the Isle of Man did is what a UK NHS trust would have done – clearly did do, because Dirk Hoehmann was employed within the UK NHS before us. In your remarks of a few moments ago, I thought that you said you were confused as to why the Department had waited until 2008 before doing – 1050 Mrs Cannell: I am not confused, Mr Killip. I am never confused.
Mr Killip: Well –
1055 Q120. Mrs Cannell: I said I just cannot ratify why you did not automatically do a check. You have explained there was not a mandatory requirement to do it, (Mr Killip: Correct.) but ignoring whether there was a mandatory requirement or not, just being a good prospective employer, I would suggest you should have made a check. After all, this particular surgeon was dealing with children and babies and operating on them. 1060 Mr Killip: Not in the unsupervised way described in the… I will have to –
Q121. Mrs Cannell: Possibly not, but I would have thought, if I was the employer, I would want to make sure that doctor, not only did he have all the qualifications, but that he had a good 1065 record. I would not merely take it on face value that he had declared no previous convictions and you just accept that.
Mr Killip: I do not think the Department did take it on value. The –
1070 Q122. The Chairman: I am not sure we are achieving anything here.
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Mrs Cannell: No, well, we are not. We are at different –
The Chairman: We are clearly at loggerheads on this. 1075 Mr Killip: Sorry, Chairman, can I just check that the reasons behind the 2008 CRB check –
The Chairman: I think you have already clarified that.
1080 Mr Killip: – as described by Barbara. We are content that that is clear, thank you.
Mrs Scott: Can I just add something?
The Chairman: Sorry, I just want… Mrs Cannell, have you got anything further? 1085 Mrs Cannell: No, I think I have pretty much got what I wanted, thank you.
The Chairman: Mr Corkish.
1090 Q123. Mr Corkish: Chairman, one very last… It was obviously a very difficult time for Noble’s Hospital and the Department, but for comfort of many, if a doctor or consultant should be considered for appointment within Noble’s Hospital any time in the future, would that procedure proceed the same as it has in the past? How different would or could that be now?
1095 Mrs Scott: I think all of us are more acutely aware of what has gone on in the past and how we could be, whether knowingly, misled.
Q124. Mr Corkish: Would there be more collusion with the Police, for instance, now?
1100 Mrs Scott: I think we research people more and make sure that we know who they are before we interview them.
Q125. Mr Corkish: So, far more robust now?
1105 Mrs Scott: Yes.
Q126. Mr Corkish: And there have been lessons learned?
Mrs Scott: Yes, most definitely. 1110 Mr Corkish: Thank you, both.
The Chairman: Thank you very much. This hearing is now closed. Thank you to both witnesses for their time this afternoon. 1115 The Committee adjourned at 4.30 p.m.
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