Oncologist Sent 'Inappropriate' Messages to 'Vulnerable' Patient, Tribunal Hears

Ian Leonard

September 08, 2021

Editor's note, 8 September 2021: This article was updated with additional information.

MANCHESTER—Leading oncologist Professor Justin Stebbing may have sent inappropriate messages to a vulnerable patient out of "kindness" and to "jolly her along" knowing her prognosis was poor, a medical tribunal heard.

Prof Stebbing, who's appearing before a Medical Practitioners Tribunal Service (MPTS) fitness-to-practice hearing, has admitted failing to maintain an appropriate degree of professional distance with the woman, known as Patient E.

The 47-year-old woman, who'd been diagnosed with rare ampullary cancer that spread to her liver, was treated by Prof Stebbing between November 2015 and July 2016.

The tribunal previously heard how they exchanged "flirtatious" messages, and he referred to her as LMT - or 'Little Miss Trouble'.

Many of the messages were accompanied with kisses, "love to LMT" or "good LMT". 

Prof Justin Stebbing

Not Wise

Cancer expert Professor Karol Sikora, who's appearing as a defence witness and is honorary professor of professional practice at the University of Buckingham, was questioned about the messages by Sharon Beattie, QC for the GMC.

He agreed with Ms Beattie when she said he "would haul them over the coals" if any of his foundation level doctors engaged in similar behaviour.

Prof Sikora said Patient E was "vulnerable" but also "manipulative" and commenting on the messages, he said:

"In a sense this was kindness, to keep it going towards the end."

"It's not wise to do it, I'll be the first to admit," he continued.

"But I've done it myself, now and again. Patients are all individual, if that's her way of expressing her feelings, as long as it doesn't go to anything else.

"As long as it doesn't involve a relationship a few emails with a few kisses on them probably doesn't do anyone any harm in the modern world."

Ms Beattie said he didn't seem to accept that the messages were inappropriate.

Prof Sikora replied that he did agree they were inappropriate but Prof Stebbing had been dealing with a dying and "very demanding" patient and he'd been "jollying her along".

Ms Beattie accused Professor Sikora of avoiding any criticism on Prof Stebbing's actions in a report to the tribunal but he claimed it was a "technical issue" that wasn't his area of expertise.
 

Patient D

Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, is accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017.

He faces 36 charges - 21 of which he's admitted - which include allegations that he inappropriately treated patients given their advanced cancer or poor prognosis, overstated life expectancy and the benefits of chemotherapy and continued to treat patients when it was futile and they had just weeks to live.

Earlier, the tribunal heard about another patient who was treated by Prof Stebbing, a 44-year-old woman known only as Patient D who'd been diagnosed with breast cancer which then spread to her liver and bones.

Although she'd had previous NHS treatment, by April 2016 her condition had deteriorated and medics at The Christie hospital in Manchester decided it would be inappropriate to carry on treatment.

Prof Stebbing then attempted to obtain private funding from the Grand Masonic Lodge so he could prescribe chemotherapy but his request was turned down.

Nevertheless, he went ahead with the treatment, with her father then having to pay the £3000 bill, but she died 2 days later.

Prof Stebbing is accused of failing to obtain informed consent for the chemotherapy and "inadequately" communicating to Patient D and her family the funding position for treatment.

Ms Beattie said there had been a clear "failure of communication" by Prof Stebbing who knew "there was a problem" with funding as a letter he sent to the Grand Masonic Lodge 3 days before the chemotherapy indicated it hadn't been authorised.

Prof Sikora said the Grand Masonic Lodge may have contacted the patient directly and the job of the doctor was to "make sure the patient understands where you're progressing to".

He said if he’d written the letter he would have imagined "there was a good chance of funding being provided in the circumstances".

This prompted an intervention from MPTS panel chair Hassan Khan who said it was clear there was no funding in place prior to treatment and Prof Stebbing "surely" should have informed the patient that was the case.

"That would be wise," said Prof Sikora.

"You would expect the oncologist [to do it] or even a junior member of staff or secretary to phone up and say they haven't got approval."

Risks and Benefits

Ms Beattie said Prof Stebbing's letter had claimed medics at The Christie "seemed to be taking an enormously long time" to make a decision on treatment, which wasn't correct, and he'd failed to check with the hospital.

Prof Stebbing is also accused of failing to discuss the risks and benefits of not having chemotherapy with the patient and failing to appropriately communicate the rationale for treatment and her likely prognosis.

Ms Beattie said these discussions "could not be underestimated" in Patient D's case given she'd had extensive previous treatment, the progression of her cancer, and her "bleak" prognosis.

She said the patient had the option of a "comfortable and dignified departure" and that should have been "spelled out" to her.

 But Prof Sikora argued that the patient had wanted to continue active treatment and there was a chance she could have got better and Ms Beattie was using a "retrospectocope" to look at the patient's outcome.

Ms Beattie said when doctors were faced with patients "who didn't want to hear the news" they had a responsibility to do so.

 "If you remove hope, you do it at your own peril," Prof Sikora replied.

But he admitted a conversation should take place before a joint decision was taken whether to go ahead with treatment.

Ms Beattie said there was a "slim or negligible" benefit from the chemotherapy prescribed by Prof Stebbing.

But Prof Sikora claimed there had been a "significant" chance of response to treatment - around 30% in his estimation - although Ms Beattie described his opinion as a "gut instinct" because it wasn't based on any medical evidence.

The hearing is continuing.

Prof Sikora comments on cancer issues for Medscape UK.

Ian Leonard is a freelance journalist experienced in covering MPTS hearings.

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