Accused Oncologist 'Lacked Insight' Into 'Realism of Events' for Terminally Ill Patients

Ian Leonard

September 23, 2021

MANCHESTER—World-renowned oncologist Professor Justin Stebbing has "lacked insight" into the "realism of events" after facing accusations over his treatment of terminally ill cancer patients, a medical tribunal heard.

Prof Stebbing is appearing before a Medical Practitioners Tribunal Service (MPTS) fitness to practise hearing accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017.

The 36 charges, 30 of which he's admitted, include inappropriate treatment of patients given their advanced cancer or poor prognosis, overstating life expectancy and the benefits of chemotherapy, and continuing to treat patients when it was futile.

The long-running tribunal, which began in January 2020, is approaching its final stages with both the GMC and the defence making their final submissions.

Prof Justin Stebbing

'Evasive'

Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, was accused of being "evasive" when giving his evidence.

Sharon Beattie, QC for the GMC, told the tribunal: "When Prof Stebbing was giving evidence you may feel he was evasive at points, that he could not recognise there were issues with some patients, even with matters he's admitted.

"He was not, unfortunately, straightforward in relation to many issues.

"You can see the areas of dispute and that his evidence was not accepted.

"Ultimately, it's up to you as a tribunal to decide whether or not you accept it, or if you think he was evasive at any points, that he lacked insight.

"Not in a Stage 2 [impairment] sense but actually as to what happened and the realism of events.

"Prof Stebbing was an unsatisfactory witness on matters of substance."

GMC Witnesses

Ms Beattie said Prof Stebbing had ascribed "personal and professional motives" to some of the witnesses in the case, including "jealousy", and the defence had questioned the credibility of experts for the GMC.

Prof Stebbing had adopted "a pattern" of labelling witnesses "incompetent" or "biased" against him, she said, but he'd not pursued the claims any further when they gave evidence.

He'd said he didn't want to "get into tittle-tattle" but the point was there was "no actual substance" to his accusations, Ms Beattie said.

She said GMC experts' view was the patients were "unusual" not because of their condition but the fact they had received treatment given the "expected trajectory" of their disease.

"Wherever these people come from, whatever their circumstances, whether they come by private jet or on the bus, the fact is they are patients who deserve treatment that is appropriate, and who deserve a standard of care that is appropriate," she said.

That included giving patients "dignity" at the end of life and using evidence-based medicine and clinical guidelines.

Defence Witnesses

Earlier, Ms Beattie called into question the independence and impartiality of expert evidence provided by defence witnesses Professor Karol Sikora and Dr Nick Plowman.

The defence, she said, had since "abandoned" Dr Plowman in relation to his "overall competence" and the GMC's view was he was an unreliable witness, and despite doing "all he could - in his words - to defend Professor Stebbing", he'd had to make concessions about his clinical practise.

Ms Beattie said independence was a "core issue" and a "necessity" for any expert witness and the same issues that rendered Dr Plowman "an unreliable witness" for the defence applied equally and "more immediately and obviously" to Prof Sikora.

"Neither are impartial experts," she said. "The GMC guidelines and the general standards of experts have not realistically informed their conduct and their opinions.

"And the GMC would submit they cannot be relied upon to provide the impartial, independent, and neutral opinion sufficient to enable the tribunal to be confident that their evidence is unbiased and can be relied upon."

She accused both Prof Sikora and Dr Plowman of acting as "advocates" for Professor Stebbing, with Dr Plowman "unapologetic" about his role.

Reports they had provided to the tribunal were "wholly uncritical", she said, and any reservations they had were either "not expressed" or "downplayed".

"Both had sought to defend a position," she said, with Dr Plowman commenting that "everyone deserves a defence" and that Prof Stebbing was "up before the beaks" and "in the dock".

"That was not the function of an expert," she said. "And for someone of Dr Plowman's seniority you may think that's a surprising approach to take and one that is concerning."

Similarly, when giving evidence Prof Sikora had stated that the "proceedings were unfair" and categorised both Prof Stebbing and himself as "crusaders", Ms Beattie said.

Prof Sikora had also claimed Prof Stebbing was being "pilloried" but he'd ignored admissions that had been in the case.

Ms Beattie said both experts had also failed to reference clinical guidelines because they were not "supportive" of their positions and made claims that GMC experts had "resiled" from their positions, which wasn't the case.

Letter

Prof Sikora and Dr Plowman had sought to "influence" the case by co-signing a later to former GMC Chair Dame Clair Marx, Ms Beattie said, and it was "concerning" they hadn't deemed it inappropriate when both were acting as expert witnesses.

Ms Beattie went on to highlight "inconsistent" evidence given by Prof Sikora about how he'd acquired documents relating to some of the patients in the case, forcing him to consult Medical Defence Union (MDU) lawyers.

She said Prof Sikora had claimed he'd been "confused" but that his answers to the tribunal had been "untruthful", so he couldn't be viewed as either "reliable or impartial".

In response, Mary O'Rourke, QC for Prof Stebbing, said her role wasn't to defend Prof Sikora and Dr Plowman.

She said she wouldn't comment on whether Prof Sikora had "told a lie", "changed his mind", or was confused about his evidence and wanted to focus on the patients.

Patient B

Prof Stebbing denies charges in relation to one patient - Patient B - who was allegedly given doublet chemotherapy beyond six cycles, despite evidence of impaired renal function.

And Ms O'Rourke pointed out that the patient had lived for two-and-a half years after treatment while the other 11 had all died within a month.

Ms O'Rourke said: "The issue is whether you rely on what Prof Sikora said on the subject of Patient B as being independent, impartial evidence that met the quality of an expert.

"In other words, was he qualified to say it, to know it?

"Did he genuinely hold the view he expressed? Was that view given in an impartial and independent way and not based on any favouritism or otherwise to Prof Stebbing?"

She said his independence was demonstrated by the concessions he'd made on four patients - D, E, H, and L - which led to admissions by Prof Stebbing.

Therefore, "he did not defend to the hilt" she said.

She described Prof Sikora as an "eminent expert" and the issue of "impartiality or bias" needed to be "taken in the round" given the concessions that had been made.

Ms O'Rourke claimed the GMC had "reversed the burden of proof" in relation to some of the allegations and put the onus on Prof Stebbing, while much had been made about his comments about witnesses.

Ms O'Rourke said she didn't pursue matters that weren't relevant to the case and had wanted to focus on the wording of the charges so she'd not cross-examined any witnesses for that reason.

The fact that some witnesses had been labelled "competitors" to Prof Stebbing had no relevance, she said.

Patient C

Ms O'Rourke also addressed some of the other charges denied by Prof Stebbing in relation to Patients C, L, and O.

In relation to Patient C, he's accused of failing to discuss with her and her family a realistic assessment of her prognosis, failing to discuss the risks and benefits of treatment, and failing to obtain informed consent.

But Ms O'Rourke said a letter from the patient's daughter had made it clear she was aware there was only a small chance the chemotherapy would have any benefit but she'd wanted to proceed.

Prof Stebbing has admitted a number of charges in relation to Patient L, who was given chemotherapy despite it being vetoed by his supervisors.

But Ms O'Rourke said he denied a charge of dishonesty, which included a failure to withdraw his prescription because he believed the treatment had already been given, so his actions had been "reckless" instead.

A charge of not obtaining informed consent to give combination chemotherapy to Patient O was based on the unreliable evidence of the patient's daughter, she said.

The tribunal is continuing.

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

Prof Sikora comments on cancer issues for Medscape UK.

Credits:
Lead Image: MPTS
Image 1: Kerry Elsworth

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