Another pod surgeon targeted by the HPC

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I see Mr Tollafield is the latest Podiatric Surgeon up before the HPC fitness to practice hearing. One does wonder who initiated this one, a member of the orthopaedic community perhaps, only speculation, but this is happening all to often. I admit i know nothing about the case, but given the grounds of the allegation i should imagine the patient has been prompted by another professional (mmm maybe an orthopod) or it will remain anonymous. Anyway having heard Mr Wilkinson speak about his turmoil with the HPC in the past, i should imagine the case will be found to be without evidence and thrown out and yet Mr Tollafield's name will still be smeared all over the web / media in relation to this allegation.

 

This hearing pertains to a patient treated in 2002!?!

Ridiculous.

 

All,
I have noticed an increase in this type of allegation.
Are there some political shananagins going on in the world of foot surgery?

CF

 

I recently spoke with a member of one of our state registrations boards (now disbanded into a national board) and they mentioned that the Board was starting to get more ‘complaints’ re adverse outcomes from surgical procedures. Adverse outcomes are not necessarily due to incompetence .... adverse outcomes happen! Looks like this could be happening with the HPC in the UK.

One would hope that he HPC panel is competent enough to distinguish between an unfortunate adverse outcome and incompetence. That is what happen here. A witch hunt dragged up a whole lot of adverse outcomes against a podiatric surgeon as the basis of a complaint of incompetence. They were all dismissed as adverse outcomes (if I understand what happened properly)

 

netizens

This is unfortuantley one of the issues which comes with a more litigious culture. It is not to say being under investigation is by itself confirmation of malpractice, far from it but only because we live in a more accountable world. (for good or bad).

toeslayer

 

There seems to be a good deal of misinformation posted about this case (concerning which I know nothing but the material on the HPC web site.) It states, for example, that Mr Tollafield was employed by the relevant private hospital. He was of course, using the hospital as a private practitioner, as all consultants do.

This seems to be another situation where the HPC is inappropriately dragging a registrant's name through the mud, whilst the registrant pays for the privilege.

Bill Liggins

 

I don't understand why the US (thank God) is the only country where we are able to be addressed as Drs? It seems the problem is the fact that in Canada (a fellow NYCPM graduate, Francois Alort, did a surgical program but in Quebec, his homeland, he is STILL not addressed as Dr and cannot perform any surgery), England and Australia, one is a podiatrists but not addressed as Dr. and therefore cannot perform surgery or even write presciptions. I really don't understand how the ball was dropped in these coutries regarding the lack of being considered physicians but behinds need to be kicked. No matter where you go in the world, dentists are considered doctors. These guys really have their act together and maybe we should start taking good notes as to how they turn around the entire profession in the last few decades and can name their own price without being beholding to thes medicare and other healthcare financial institutions SCAMS! If podiatrists in one of these nations want to perform surgeries without some low-selfesteem MD telling on him then he/she gotta change the title and simply stop being reduced to just Mr/Ms.

 

Dr Brooks,

the podiatrists in the UK can perform surgery, however we do have limited prescription rights. We do still come up against orthopaedic opposition though.

 

Hello

Just to clarify, all surgeons in the UK (and I think in Oz and NZ too) are called 'Mister'; this is historical in origin and I won't go into detail here. So whilst you may thank God to be a 'Doctor', it is to our advantage to be a 'Mister' even though many Podiatrists here hold a doctorate. However, you can be assured that Podiatric Surgeons - as we prefer to call ourselves - have been carrying out foot and ankle surgery for many years, have and do hold Consultancies within the NHS and have privileges within private hospitals. And yes, we even write prescriptions! This is also true for Oz and NZ. It is really just a matter of different systems in different countries. I do not know anything concerning the o/p case, but I'm perfectly willing to wager that an orthopaedic surgeon is involved somewhere along the line. I understand that this, at least, is a problem which we all share.

I do go along with you that all behinds of all leaders need to have a little shoe leather regularly applied with some force. In the UK as well as in the USA the dental surgeons (my grandfather and Uncle amongst them) foresaw the changes in society throughout the 40s/50s/60s and placed themselves accordingly with the result that they enjoy a high level of respect and income. Many UK dentists don't bother with naming themselves doctors though, they also prefer to be Mister!

All the best

Bill Liggins

 

In the UK litigation against orthopaedic surgeons is nearly three times greater than in other fields, the majority of cases being foot surgery.

Few of these cases ever go before the GMC, outcomes are not always as wished.
When litigation is successful it is not considered appropriate for 'fitness to practice hearings' to be a consequence.

The HPC seem to be on a mission; unless gross negligence and incompetence is proven in a civil court, such cases should not be within their remit.
I`m not even sure that it is !

 

Just for the record to close the loop on this thread

The HPC ruled that there had been no malpractice.
The exact quote from the panel on the day the case was heard 4/2/2011 reference FTP02361
"The panel decided the case against you was not well found. This means your case is now closed and your registration status is unaffected."

 

This last post by Tom Galloway is misleading.

There were 4 allegations in this case.

1. Did not provide a sufficient level of patient care to A namely that;

a. the surgery was inappropriate

b. the surgery was unusually aggressive

c. the surgery was not performed to a reasonable standard

2. Your behaviour as stated above amounts to a lack of competence

3. By reason of this lack of competence, your fitness to practise as a registered health professional is impaired.

Allegations Proved: 1(a) & 2
Allegations not proved: 1(b) & (c)
Grounds: Lack of competence
Fitness to Practise Impaired: No

It was considered that this was an isolated case and unlikely to happen again.

Clearly this brings up the question as to this case being brought in the first place, and after such a long period had elapsed. If these standards were applied to GMC registrants there would be tens of thousands awaiting judgement.
At the end of the day there is a very fine line between lack of competence and less than perfect outcomes.
This illustrates that the HPC is not fit for purpose and questions the wisdom of those collaborating with it !

 

Can't find the case on the HPC website. Any chance of a link?

Seems a strange thing to try to prove. On what basis was the surgery deemed inappropriate? An adverse outcome surely would not indicate that the surgery was inappropriate. I struggle to believe that this would not have been pointed out by Mr Tollafield or his advocate. Its both common sense and written in black and white on the consent form. On what basis then was the judgement made?

I would agree that the HPC is a pain in the hole and has handed down some odd decisions on some questionable complaints. Its also clearly bizarre to be going through the process 9 years after the event. However I think we must also beware of "tribalism". Mr Tollafield is obviously a very respected surgeon with great integrity and great knowledge. However it would be wrong for us to assume that he is incapable of making a mistake for that reason.

The HPC often cries "wolf" when there is no wolf, but that does not alter the fact that there are wolves out there. Without posession of all the facts we should probably not jump to judgement in either direction.

 

'On what basis was the surgery deemed inappropriate' ?

One reason would be misdiagnosis

'An adverse outcome surely would not indicate that the surgery was inappropriate'.

Absolutely correct.

'it would be wrong for us to assume that he is incapable of making a mistake'

Of course, we are all human. It is quite likely that litigation had taken place and concluded, but should we subsequently be brought before a Professional Conduct Committee every time a 'mistake' is made ?

 

Was that the reason here? I would not consider misdiagnosis to be neccessarily equitable to lack of competance.

An interesting question. When does accountability cease to be a healthy thing?

I suppose it partly depends on the nature and consequences of the mistake. To take your example of misdiagnosis, has someone made a reasonable judgement based on good clincial information or has one been lax in investigation and dived in with a scalpel without confirming the diagnosis? What was the missed diagnosis? Missing a bizarre and rare condition is understandable and, perhaps, acceptable. Missing a common one is less so. What were the consquences and risks of the surgery.

Let me flip the question. Litigation, pain in the backside though it is, cannot establish competance, not least because its generally easier and often cheaper to simply settle before the question gets to court. So without the HPC, what would stop a careless, incompetant or negligent surgeon from keep practicing? If there is no body to whom mistakes are brought for investigation, how will mistakes be deterred?

 

'I would not consider misdiagnosis to be neccessarily equitable to lack of competance'

Neither would I, but we are not the arbiters.


'lax in investigation and dived in with a scalpel'

That would suffice, would it not ?

'what would stop a careless, incompetant or negligent surgeon from keep practicing'

Referrals would dry up for a start, plus a whole raft of factors. Employers, insurance companies, peer review etc..................

My point, as I have said, is that I do not believe that the HPC is fit for purpose. Of course a regulatory body is advisable, Clinical Podiatry is so different from the other Allied Professions that a separate body would be more appropriate.

 

I'm unconvinced. Especially in the NHS where the lowest bidder is king for referrals. Peer review is in house and optional. Employers have little authority on clinical matters.

Here I agree. Although I still believe that body should have an external accountability. Its a small profession and the toes you tread on today (or the hearing you are asked to adjudicate) may be attatched to the feet you have to kiss tomorrow. I don't know that something entirely internal would be as robust as something with an external presence. I would certainly struggle to be objective if asked to pass judgement on a colleague I know personally and respected. Wouldn't you? I guess you for a surgeon Rosherville, if you were asked to comment on something your mentor had done, could you do so objectively and without fear of repercussion?

 

'I'm unconvinced. Especially in the NHS where the lowest bidder is king for referrals. Peer review is in house and optional. Employers have little authority on clinical matters'

Suggest you think again; there are eyes everywhere, waiting to pick up on your mistakes. In fact I encourage my theatre nurses to do just that, 'keeps you on your toes' !

'I would certainly struggle to be objective if asked to pass judgement on a colleague I know personally and respected. Wouldn't you? if you were asked to comment on something your mentor had done, could you do so objectively and without fear of repercussion' ?

No; have, do and will. It`s the only way to maintain standards. If you would struggle to be objective, it`s just as well you`re not a surgeon !

 

But are those eyes connected to mouths which would tell ears which would make a difference? And are those ears on either side of a brain which has the confidence and knowledge to call you on it?

Certainly it takes courage to state an opinion your colleagues may not like and to have the courage of your convictions to stand by that opinion in public where you will be judged on it by your peers. Especially senior ones.

Me, I tend to shy from disagreeing with senior colleagues as Dr Spooner Dr Otter Prof Rome and Prof Kirby will attest. Don't like conflict me. But having initiated more than one capability process with colleagues in the past I can attest that it is an unholy nightmare even when the case is cut and dried. In matters where it is a question of somebodies clinical judgement it is the devils own nightmare. When that someone is a podiatric surgeon, the top of the tree, it is well nigh impossible!

 

Just read through all the comments made here about the case, and had a thought about what Craig said. Does this mean the medical board get 10 times the amount of 'complaints' about adverse outcomes to lets stay with foot surgery, from Orthopods, because I know in my clinic I see some pretty horrific outcomes..

So as mentioned above, is the HPC and the newly appointed AHPRA in Oz best placed to regulate the profession of podiatry, or do we need our societies to stand up for its members and fight for a profession specific regulatory body?
Ive never looked into it but is there podiatry representation on these boards??

Col.

 

Yes, orthopaedic claims are several times higher for feet.

Yes, a separate regulatory body is the ideal.

The representation is very poor, the main involvement being by members who are paid well and therefore have an interest in its continuation !

 

That is a shame one works hard to build up a good reputation only for someon to smash it in minutes! The truth will vindicate you. Goodluck

 

Hello Ms Janari,
I cannot see you listed on the HPC register as a podiatrist/chiropodist so I am wondering what your interest is in this ?

Perhaps you could enlighten me?

Yours etc

Catfoot

 

I find it staggering that in 2011 a profession such as podiatry, who has been embraced highly by certain medical specialisms such as Rh/A and diabetes, vascular, are still being treated in the way we are. I dont know of any other industry where the specialists in that industry get treated with so little respect. I also don't understand how podiatry got to this stage and why we are still allowing ourselves to be regulated by a body who does not hold the growth of podiatry seriously but rather cause damage to the profession by entertaining these silly allegations/ complaints.

Sorry rant over lol
Col

 

We are being treated this way because we allowed it and individuals encourage it.

What other profession, after having protective legislation, would have allowed grandfathering of any Tom, Dick or Harry that self authenticated membership of that profession ? None that I can think of.

What other major professional body whose articles of association aimed at maintaining excellence, would change them so that Tom, Dick or Harry could join; so enhancing membership size ?

What professional, after their organisation had depricated the HPC at an AGM, would then collaborate with the HPC for money ?

The answer, I believe, is a collective who put their own self promotion ahead of their profession.

A cynical view maybe, but reason enough for the wider world not to hold us in any great esteem and for the profession to be on a downwards course !

 

Rosherville,
You sum it all up very neatly and almost as cynically as I would have done.

In addition, if we just cast our eyes around this forum and look at the absolutely asinine queries about treatment modalities that are being posted by some practitioners it is hardly surprising that we are having what little status we have eroded.

It's bad enough coping with outside negative influences but when our own colleagues "shoot themselves in the foot" (pardon pun) it is a pretty poor state of affairs.

Cynical Cat

 

Can you provide evidence for this statement?

I understand that all of my colleagues in podiatry who do not practice surgery will see a lot of post surgical complications - but are the majority of these coming from orthopaedic surgeons or podiatric surgeons? I accept that there are more orthopaedic surgeons than podiatric surgeons in the UK, but it would be interesting to compare complication rates of each as assessed by people (almost in some cases) outside of each department.

Internal assessments/ audit of complications will always have their validity questioned, but still have value (as long as those inputting data and providing reports remain professional and objective). External regulatory bodies with little or no understanding of the processes involved in delivering this type of care (eg. HPC) can have a considerably more negative outcome for practitioners and patients due to their ignorance.

I think we need to retain some perspective on complications. If you see consistent complications of foot surgery by your local podiatric surgeon or orthopod, have you approached them to let them know? They may be unaware that their surgery is just not working and if you let them know, they can learn from this and make necessary changes. Of course, we will all only generally see each other's poor outcomes anyway as all the good outcomes are getting on with life and staying away from our clinics. If we had absolute clarity on complication rates of foot and ankle surgery, we could improve training, etc... and outcomes for patients.

 

'Can you provide evidence for the statement' Orthopaedic claims are several times higher for feet ?

About 2 years ago figures from Medical Indemnity Companies showed that although foot operations comprised 10% of orthopaedic procedures, the claims for negligence accounted for 25% of the total.

 

Thank you very much, that is great info. Any idea how to access the current figures from the companies?

 

I guess from the annual reports of the Medical Protection Society and the Medical Defence Union.