Maverick practitioners who do harm

The overwhelming majority of healthcare practitioners go to work to give their best to those receiving their care despite sometimes testing situations due to limited resources or other constraints. However, the Letby criminal case has challenged us to consider that there may be a healthcare practitioner somewhere in the NHS whose motives are malevolent and their whole practice might be based on deception. Beverly Allitt and Harold Shipman were similarly convicted of murdering vulnerable patients under their care.

It is clear that it is not easy to identify and secure convictions of malevolent practitioners because much healthcare practice takes place hidden from view, even within hospital settings. A rise in hospital mortality may be explained away as just a random statistical variation which occurs occasionally with A ‘blip’ of increased mortality in patients. This may be due to a rise in the number of patients who had entered hospitals being particularly sick and succumbing to their conditions despite the best efforts of those involved in their care. Hospital patients receive care from multiple doctors and nurses and so, working out if the deaths are associated with a particular practitioner is hugely challenging. Even then, having identified a possible association between an individual practitioner and a patient death to secure a prosecution, the act of commission has first to be identified, and then proven beyond reasonable doubt in a jury trial to meet the legal benchmark for a criminal conviction.