Stephen Cox's Blog, page 3

The Stars

A poem, after The Trees, by Philip Larkin

The stars are blooming on the Goodreads Page.

Reviewing is a kind of grief,

We wait with fear and hope and rage.

Each kindly word is sweet relief.

The readers measure, judge, and speak,

Our labours handed to their tender care.

Our ratings ebb and flow, then peak,

So tardy friends bring ripe despair.

We bookmark sites, and fearing death

Will come before our friends’ review,

We tap to see the stars anew.

Refresh, Refresh, Refresh

My coffee with an offender (2)

Professor B was accused of sleeping with youths and men in a country where homosexuality is illegal. Some were his patients and with some he paid for their education. Some were under the UK age of sexual consent.

I worked for the UK hospital which was his main employer. We suspended him, for actions not in our service, to investigate. His suspension soon posed considerable difficulty delivering some parts of the cardiac service, and of teaching his extremely important new treatment to other hospitals across the world. His work meant some children could have a procedure done by catheter, not by cutting open the chest.

Photo from Mohamad Azaam at Unsplash. (This is a stock photo and no-one in it is implicated!)

Our working theory was that our hospital wasn’t a great place to attempt anything untoward. He didn’t have much contact with patients during their stay. There wasn’t much privacy, there were too many nurses with child protection training around, and a British children’s hospital usually has parents around, even overnight. Making relationships to exploit later was far more worrying.

The tough choice was this. Already other clinicians could do many cases with his method, but at the cutting edge, there were patients who needed his pioneering skill for the best outcome. One case was considered inoperable without him and several would be riskier. We needed him to train new staff, even faster than planned, so the department and the world could do without him if the charges were proved.

The department organised a plan that would allow him to work, under severe restrictions.

The CEO looked at me and said, ‘So can we defend this in the media if we let him work?’

‘Yes,’ I said. ‘Giving our patients the best chance is what we’re here for. We just need the plan to be credible.’ I knew who would be doing the defending.

Fierce rules were put in place. The Professor was not allowed in a room with a patient without an additional senior member of staff, solely to watch him. This even applied in clinical procedures, where there were several other staff anyway and the procedure was routinely filmed. Watching him in the procedure room was to manage understandable parental anxieties, rather than to believe there was a serious risk. He was a smart man and he wasn’t going to do anything while he was watched.

When the news did break, we immediately activated a patient and family helpline. People affected needed to talk this through with someone. The public and media response was as good as could be expected. The media’s “serious questions” got serious answers – the bald truth. It had been the right call.

Misplaced loyalty

The degree of staff denial was extraordinary. The admirable senior staff – who felt personally betrayed – accepted there was an issue and friendship couldn’t get in the way. The evidence was strong. Even if all sexual accusations were lies, the Professor’s actions – inviting underage patients to sleep and shower in his rooms – were scandalous and indefensible. The leadership had to manage staff who just didn’t want to believe it, including those who thought the management had made it up. In a field which lives and dies by evidence-based medicine, some believe to this day that this able man was brought down by a conspiracy.

Even now, the Professor is invited to the odd prestigious conference.

Some staff said we shouldn’t collude with ‘wicked African homophobia’. This ignored the realities that he abused his power. There was no homophobia. The disciplinary investigation came across a couple of consenting relationships with adults who weren’t patients or relatives.  Those posed no professional concerns, so they were dismissed as irrelevant.

This curious self-deception occurs elsewhere. Daniel Carleton Gajdusek, a Nobel Laureate with a distinguished career, brought 56 boys from Micronesia to the United States and paid for their education. Some of them later accused him of sexual misconduct, and there’s a heart rending documentary. Gajdusek also wrote in diaries and clinical journals about sex with boys, and incest, which he defended. When the accusations broke, eminent figures were quick to accuse the boys of lying, then to shift to the wholly different claim that sex happened but that they consented, and that these relationships were culturally acceptable. Gajdusek served one year of jail in a plea bargain. As an SFF fan, it pains me to mention Arthur C Clarke and his life surrounded by boys in Sri Lanka, although the allegations were never upheld in a court.

Interesting that the documentary about Gajdusek, The Genius and the Boys, was directed by Swedish investigative journalist Bosse Lingquist. He also first exposed Paolo Macchiarini, (who I spotted was a grandstanding narcissist, if not a cruel and dangerous crook.) Macchiarini was defended by Sweden’s most prestigious medical organisation despite enough alarm bells to wake a city.

A verdict

In Greek tragedy, the hero has many good qualities but is brought low by their flaws.

Most of the accusations were confirmed and after a very deliberate and careful investigation, the hospital dismissed him. In due course even younger victims were identified from his time abroad, including horrifically the family of a French boy aged ten he touched inappropriately. The family decided to give him a second chance, and so they hadn’t reported his behaviour several years before.  

The UK regulator, the GMC, brought the Professor before a professional tribunal to permanently deprive him of the right to practice as a doctor. He simply refused to engage with the process. The case turned out to have wider implications.

Rogues deserve rights

The Professor was found unfit to practice – in layman’s term, banned from being a doctor – and his team appealed. The GMC as prosecutor had assumed that none of the boys, youths and men could possibly be brought to the UK to face cross examination because of the stigma and legal threats they faced in their society.

The defence argued that the principle of testing prosecution evidence is important for fairness. The court agreed. It ruled that the GMC should have thoroughly considered every possible option, including new-fangled videoconferencing, before they relied on evidence which could not be directly challenged. The system needs to be fair, even if the person probably did it. I agree with the court but I recognise the GMC had a difficult job to do.

The GMC had to re-prosecute the tribunal which still reached the same damning conclusion.

This test case, named after the Professor, now binds all such bodies. This shows why rights cannot be kept only for ‘good people.’ Sometimes, throughout history, it has been the defence of absolute rogues which lead to legal protections for everyone. Disappearing MP John Stonehouse who staged his death to defraud his insurers, ended up in a test case, defending the right of the jury to decide on facts.

The African authorities did not prosecute the European philanthropist. I recognise the enormous risk the victims might have been under if they testified. UK authorities investigated – the law had been changed to allow overseas offences to be prosecuted here – but nothing came to court. Maybe the victims would have welcomed their day in court.

The balance of probability

Criminal courts work to ‘beyond reasonable doubt’, or as juries are now instructed, ‘you must be sure’.   Employers and professional tribunals (and civil courts) work to ‘the balance of probability,’ which is ‘more likely than not’.

That’s why a hospital can fire someone and the professional tribunal remove them from the register, and yet the same case might lose in court.

For a doctor, our law says that a hospital must be allowed to fire them if there is a reasonable chance but not absolutely certainty that they pose a danger.

In addition, if a doctor repeatedly refuses to follow good safe practice, the employer need not wait until someone is actually harmed before they are disciplined.

This is a sad tale. I suppose I take comfort in the fact that no matter how well respected and important the man was, he was not considered more important than the safety of children and young people in his care. Survivors were believed and hopefully protected, and the important clinical work will continue. At a personal level, I’m pleased that the difficult decisions we made balancing safety and delivering care were accepted.

My coffee with an alleged offender

CW: While abuse is mentioned, it is neither described at all, nor shown in an image.

An old child protection case at the hospital I used to work at. What were the issues as Head of Comms when a respected and important figure in his field turns out to have feet of clay?

What’s it like when a story of alleged sexual misconduct hits an organisation?

I’m not writing this to take shots at the individual, over ten years ago, to brood or gloat. I do think it gives a little insight into these cases.

Note: I can only write about my previous work respecting patient and staff confidentiality and consent, for personal/professional ethics and legal reasons. I am only writing from memory and publicly available information. If I don’t respond to certain comments and questions, that’s why.

I was Head of Communications. The Chief Executive and I had talked through the latest drama, and I was walking back to my office, a little off site. Then I was called to come back. Had I done something wrong? Or one of my team?

The CEO, a confident doctor, looked like she’d had a bad shock. I was one of the first few people to be told that a head of department, a charismatic and internationally renowned heart specialist, had been accused of sexual misconduct in his charitable work abroad.

Luring Professor B away from one of the top European hospitals to head our department had been a coup. His work was genuinely innovative, reducing the need for invasive heart surgery in children. It offered new vistas of better treatment for young and old, and through us, he was teaching it to the world. (Unlike Paulo Macchiarini who was a charlatan.)

Accusations and scope of the crisis

The Professor regularly travelled to Africa with a surgical charity. Youths and men had accused him of enticing or pressurising them to have sex with him. Some were his patients or their relatives, for some he paid for their schooling. The abuse of power was obvious. Some were under the UK age of consent and homosexuality was both illegal and heavily stigmatised in that country.

The news was devastating. If true, two immediate questions. Were patients in our hospital at risk? And had we failed to safeguard them? Could the Professor have social relationships with UK parents and families – could he groom discharged patients? How many victims – how had he got away with it – were there warning signs missed? Had our own systems failed?

He was heavily involved in fundraising and publicity. He was articulate, he could explain things without jargon, he spoke four languages and as a hobby he was a talented musician. He didn’t overclaim – the sober accuracy of GOSH claims in our PR built credibility.

Our actions

We had to do the right thing. Incredulity as to whether this could be true soon turned to incredulity that he had been so bold and stupid. In Africa, he had not used the accommodation for other Western staff or the patients, but his own separate apartments elsewhere. He encouraged youths to bunk down with him. Jaw dropping, and it certainly convinced me we were going to part company with him.

A small team handled his suspension, the investigation, dealing with the regulators, and assessing the risks here and abroad. Everything had to be done by the book because that’s the only safe way to do it. No short-cuts or trying to massage facts. We would be under exceptional scrutiny – from government and regulators straight away and the public when it got out. You can’t succeed in this stuff by smarm. You need practical plans to ensure patients are safe.

With our disciplinary process, the medical regulator, and the law involved, we needed a holding statement for different groups affected, and an immediate helpline for families concerned about their own children, ready to go live at very short notice.

The management and the department were devastated at this possible betrayal. The two cardiac leaders involved considered him a friend. I watched their professional discipline fight their personal feelings, and win.

A knotty issue in cardiac. (An open rope knot forming a heart shape. Pixabay via pexels).

Why the coffee?

I had to go and talk to him, as I would any member of staff who might be approached by the media, to discuss handling. I had a duty of care. He denied everything, he agreed talking to the press was a bad idea, and I made sure he knew he could get independent media advice from his medical defence organisation. I was confident the advice I was giving him was in his best interests whether he turned out to be guilty or not – but there could come a point where he’d need his own team.

The Professor had trained in Italy and was a coffee buff. He was a little off his best, a bit shaken. He said the youths had been paid to lie. It was some sort of conspiracy to discredit him.

He wasn’t creepy; he was presentable, articulate and cultured. I remember thinking, he could have found any adult partner he wanted in London.

You “should have” known

Without warning signs, how are you supposed to know when you hire someone?

There is no blood test we could give staff for wanting sex with children or teenagers. Polygraphs were discredited by their inventor a lifetime ago. There had been no complaints at our hospital or the previous employer. Many people thought there was something creepy about Jimmy Saville. I doubt many people got further with the Professor than noticing he didn’t talk about a partner and that vague sense that he might be gay. Like lots of NHS staff are.

And before long, we had a hard decision. The department would struggle without him. Should we let him do (some) of his clinical and teaching work, knowing the shock that would cause among families and the media.

‘Can we defend him working?’ the CEO asked me. Everyone in that meeting turned to me. What did I tell the CEO and why?

NB. To this day, the Professor continues to deny all the allegations and the finding of the UK regulator against him. I may or may not be able to answer questions.

Continued shortly.

LONGER READ COMING

I’ll be publishing this week part one of a long read about allegations of misconduct against a Great Ormond Street clinician, when I worked there. The misconduct was outside our service. The grim story, a tragedy for everyone, ended up having implications for justice everywhere.

In preparation, here’s an older post about misconduct by an Italian clinician which Great Ormond Street got dragged into. I knew this gentleman was a bad’un.

https://stephencox.substack.com/…/bad-surgeon-love…

The best public relations is based on truth. Yes, the communications person may seek to sell a particular line, but I always held that fibs are both unethical and in the long run, bound to sink you.

Current events have shaken that view.

This is the new post

https://stephencox.substack.com/p/coming-soon-and-in-case-you-missed

Picture is Cadence of Autumn by Evelyn Morgan

A Recommendation

Recommendation – Our Child of the Stars/Our Child of Two Worlds

Here is what ruddy sucks about ai

(Hey this is a test, do contact me via the website contact form here if you like or dislike this feature for web-subscribers. I also have a newsletter.)

I have put a 6000 word short story on this website. It would break it up to use some nice illustrations. Particularly the superhero suit that George bought in a charity shop in Manchester, which works. Or him time-travelling.

The story is the top one on Free Fiction.

I can’t afford to pay for art on the website. What’s reasonable for someone to ask, what is fair for their time and talent, is not easily findable on less than minimum wage. Wish I sold a gazillion books, one thing I would do for sure is scatter it across artists.

There are good, ethical, free photo libraries (pexels, unsplash) and a website listing public domain art (artvee). And some oddities like Library of Congress. Often, they have something quite good. 90% of the time I manage.

I could spend ? ten minutes using an AI programme to generate something, not as I see it, but roughly enough. That would use a lot of energy and be using the product of deliberate, pre-meditated, knowing theft. AI is trained on real people’s work, with a vague idea that ‘we’ll use lawyers to sort it out later’. That is, steal the rights and force people to sue.

My experiments took time, and now I have a basic understanding of how these programmes work, Any more and I am not just sniffing the blood, I am dipping my hand in it.

I could hire a good artist to draw it, which would be a day or two at fastest and £100 at best. (Or I could trade if I knew anyone good and in appropriate style, and with free time. I will, swap art for novel reading, just saying.)

I could learn to draw, which is on my list of things I’d like to try. It would be ages before I would be good enough, and another creative – seated – not going for a walk -not finishing the book pastime is not what the doctor ordered.

I could steal someone else’s work directly.

So, I did without. But it shows the case use for AI as quick and cheap (ignoring the environment, the disrespect to skill, the lowering of career possibilities for artists.)

Latest newsletter: my books, my strategy

My writing priorities half-way through 2024

I’m sixty-something and I want to get the balance right between

getting my writing ready to share

getting it out there so you can read it

and you know, everything else important in life.

For reasons, I recently dipped back into Our Child of the Stars and it was oddly enjoyable. Writing is what I do now. Both books widely available.

Read and subscribe to my free newsletter

Avoiding the Sludge State, Using Feedback

My latest newsletter is out.

I commissioned some human art.

Fire Jays by Paul Humphreys, Inkycovers

A reminder

I have two novels out I am truly proud of. Our Child of the Stars and Our Child of Two Worlds. They are widely available including from me in the UK.

I have some Free Fiction on my website (Tab, free fiction). I also offer creative services – including MS assessment and media skills/confidence. (Tab, Services)

Bung me a question or comment. Post below or privately here. Is anyone interested in a Zoom chat on all things writing and fiction?

Sludge State

There’s a wonderful point in the creative life where you reach a flow state – maybe for minutes, maybe an hour, maybe a few days. In this state you write with ideas fizzing and the words (or worlds) flying onto the page.  It’s this state which means I could never write a book by hand, I could not write fast enough, and it would be illegible.

I think I have been in sludge state, where things move very slowly, and trying to speed up can just increase the resistance.

And I write about how to use feedback constructively.

Two recent posts

I ask whether I have become an AI Art Addict. In some ways, my little experiments have made me more pessimistic not less.

I also have a walk on part in the scandalous story behind Bad Surgeon: Love Under the Knife on Netflix. I have some insight on consent for emergency treatment, consent for publicity, and so on. My newsletter has details.

Happy New Year #1 – refilling the creative well

I am a very wordy person, but I’m not good making visual art. I like music but don’t create it. I have the same hopes every New Year, but one is to get out more. I think writers need to fill the well of creativity, and that means more than reading novels and watching TV.
I’ve taken a fortnight’s break from the novel, I’m progressing the novella instead, and I’ve also been exploring AI art in a sandbox. It’s kind of a know-the-enemy thing, a bit sleeping with the devil, but it is an interesting exercise in semi-creation. I’ll talk more in a future post. Before denouncing me, perhaps read my AI commentary here.

From today’s newsletter

My latest newsletter looks at a brilliant human creation – the work of Ethopian Elias Sime, mud huts, and why I don’t just stick to words in books.