Significant failures in care of former neurologist Dr Michael Watt's patients, report finds

There were significant failures in the care and treatment of deceased patients of former neurologist Dr Michael Watt, a new report has found.

On Tuesday, the Regulation and Quality Improvement Authority (RQIA) published a report of the expert review of the clinical records of 44 deceased patients who had been under the care of the a former Belfast Health and Social Care Trust consultant neurologist.

The RQIA commissioned the Royal College of Physicians (RCP) to undertake the review in August 2020 at the direction of the Department of Health.

The panel highlighted concerns over clinical decision-making, diagnostic approach, communications with other clinicians, as well as poor communication with patients and with families.

More than 5,000 patients in Northern Ireland were recalled, the biggest ever in the region, when it was found that Dr Watt had misdiagnosed patients. Among conditions being treated were stroke, Parkinson's disease and multiple sclerosis.

The key findings from the review include:

• There was a lack of empathy and often a failure to consider patients’ needs holistically.

• There were concern over the assessment and initial management of patients; aspects of clinical decision-making; diagnostic approach; prescribing; the communications and engagement with other clinicians; and interactions with patients.

• The review team identified concerns or omissions and their potential to lead to harm in almost half of the cases examined, including that some of the treatments prescribed were unnecessary and invasive.

• In several instances, the review team believed patients had been denied holistic, supportive care that may have made their condition, and ultimately end of life care, easier to manage.

• In almost half the cases reviewed the team did not consider the diagnosis to have been secure.

• While in most cases, the review team did not identify any concerns with the recorded cause of death, they stated that in several instances the review of death certification, or referral to a medical examiner or coroner, was recommended.

• The review team concluded that more than half of cases were graded “poor care” or “very poor care” in terms of initial management of the patient, and that clinical decision making was “poor” or “very poor”.

• They found that more than half of cases reviewed there was “poor care” or “very poor care” in terms of communication with colleagues, and that there was little evidence that multidisciplinary team input into complex cases was sought.

The panel also reported that they were deeply saddened by the accounts provided by families. The Chair of the RQIA added that she commends "the courage and openness of all those families who came forward". Christine Collins said: "Family accounts starkly illustrate how failings by an individual practitioner, and by the system, led to deep human impacts and resulting harm, both to the deceased patients and to their bereaved families. “While this process has been difficult and may not have produced the outcome sought by some families, RQIA sincerely thanks every family for their patience, their personal commitment and the invaluable contribution they have made on behalf of their loved ones." She added: "As Northern Ireland’s independent regulator for health and social care, the Authority is committed to using its role and powers to ensure that the recommendations within this report are implemented.”

The RQIA is an independent health and social care regulatory body.

Their primary duties are to keep the Department of Health informed about the quality and availability of health and social care services, ensure regulatory compliance, and encourage improvement in the quality of services.

The expert panel produced two reports which examined the records of two groups of deceased patients.

The “Cohort 1 Report” included 29 patients whose families had contacted RQIA with concerns about the care and treatment of their relative.

The “Cohort 2 Report” focuses on 16 patients who had been included in the Belfast Trust’s Cohort 1 neurology recall, who unfortunately died before attending or completing their reassessment.

The expert panel excluded one patient from this group as there was no evidence in their records that they had ever been under Dr Watt’s care, thus bringing the total number of cases reviewed to 44.

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