Tribunal Ruling: Stebbing 'Still Not Convinced' his Actions were Wrong

Ian Leonard

November 16, 2021

Leading oncologist Justin Stebbing could be struck off after a medical tribunal found he had shown insufficient insight into his treatment of dying cancer patients and was "still not convinced" his actions were wrong.

Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, was found guilty last month of overtreating patients.

He had been accused of failing to provide good clinical care to 12 patients between March 2014 and 2017 and admitted charges of inappropriately treating patients given their advanced cancer or poor prognosis, over-stating life expectancy and benefits of chemotherapy and continuing to treat patients when it was futile.

He also admitted failing to gain informed consent for treatment from patients and keeping proper records.

A long-running Medical Practitioners Tribunal Service (MPTS) tribunal ruled on Monday that there had been misconduct in relation to all 12 patients and Prof Stebbing's fitness to practise was impaired.

The tribunal will now decide what sanction he will face, which could include suspension or being erased from the medical register.

Tribunal 'Not Satisfied' his Attitude Has Changed

In its determination on impairment, the tribunal identified a "a number of recurring themes," including consent issues, prognosis and treatment, poor communication with colleagues (and collaborative working), maintaining professional boundaries, and dishonesty.

Prof Stebbing’s "quality of understanding what went wrong together with his attitude to the underlying behaviour" had to led to a misconduct finding, the tribunal said, and were also measures of his insight.

MPTS panel chair Margaret Obi said he had given some aspects of his misconduct "more consideration than others," resulting in "a blurring of perspectives and insight towards the events."

She said Prof Stebbing had not always made a clear distinction between the rationale for his actions at the time and his current attitudes.

Although he’d apologised for his actions, Obi said, the tribunal, at times, was left with the impression he’d been forced to change his practise "but had yet to fully process why" and, on occasions, he had failed to explain what he would do differently in the future.

"The Tribunal considered that, at times, Professor Stebbing was still not convinced that, in what he still considered to be 'fine line' cases, his actions were not right," she said.

"The Tribunal observed that there was often a lack of detail in his reflection as to why and how he would change his practice in those 'fine line' cases other than a broad statement that he is now an 'overly cautious doctor'; in particular, there was a lack of detail regarding what changes would be made to his approach to prognosis, treatment, and informed consent. These issues raise ongoing patient safety concerns."

In relation to his prognosis and treatment of patients, the tribunal did not accept Prof Stebbing's assessment that his misconduct resulted from finely balanced decisions.

Although it acknowledged his "apologies, regret, and remorse" and recognised his commitment to remediating his conduct, it was not satisfied he had "fully demonstrated"  he understood "where he had gone wrong with regard to fundamental core principles and how he would address this concern in the future."

The tribunal criticised his explanations for failing to obtain informed consent from patients and was "not satisfied that his attitude to end-of-life care has changed."

Approach to End-of-Life Care went Against Guidance

It was also concerned that he still regarded not treating patients "negatively" and "it equated to giving up on a patient, whereas the end-of-life guidance makes it clear that giving a patient the opportunity to have a peaceful and dignified death is a legitimate and appropriate aim."

Although Prof Stebbing had shown a commitment to remediating his past misconduct, the tribunal concluded his insight was "incomplete" and was "not persuaded" failures wouldn’t be repeated.

Furthermore, it notes that he had made the "deliberate choice" to act dishonestly on four occasions but had attempted to "minimise" the seriousness of his wrongdoing and "shown a reluctance to accept the full extent of his dishonesty."

In a statement submitted the tribunal, Professor Stebbing said he had "considerable time to reflect and soul search" and could now see his actions in a different light.

"It has been a difficult journey for me and one in which I have had to confront some home truths about myself and my behaviour. I am deeply ashamed to have behaved in such a way and paid a heavy price," he said.

In oral evidence, he insisted he’d reflected on his past mistakes and had been on a "humbling"  and "chastening" learning experience.

He said he been wrong to treat patients, despite wanting to give them "a chance" or "hope," and was now a "very cautious, conservative doctor."

But the 12 patients, he said, had been difficult cases and he’d used his clinical judgment and "fallen the wrong side" of a fine line by opting to treat.

'Mistake' to not Admit Allegations Sooner, Stebbing Says

In a second statement, Prof Stebbing said he had initially believed his case was "defensible" and the GMC experts were "out of touch," not only in terms of clinical practice and a translational approach but also in terms of attitudes to patient care.

He said the support of cancer experts Prof Karol Sikora and Dr Nick Plowman, who were criticised by the tribunal for lacking independence and impartiality, influenced his initial approach to the case and they had encouraged him to defend all allegations.

It had been a "mistake" not admit allegations sooner, he said, and his eventual admissions had avoided additional trial costs and the "attendant financial burden" for supporters who’d contributed to a GoFundMe page, set up to help his legal costs.

But Sharon Beattie, QC for the GMC, accused him of having a "Damascene conversion" after 

he’d challenged the opinions of experts and criticised colleagues before admitting his mistakes at a later stage of the tribunal.

She disputed his claim that the 12 patients were "fine-line" cases and he had fallen "on the wrong side" of that line, describing his actions as "cavalier."

Finding of Impairment Required in Public Interest

Prof Stebbing’s QC Mary O'Rourke argued that the clinical matters were remediable, had been remediated and, as Professor Stebbing had demonstrated insight, they were unlikely to reoccur.

And she disputed 18 clinical factual findings which the GMC stated were "seriously below" the standard expected of reasonable competent consultant medical oncologist.

She submitted that they were only "below" the standard and, therefore, were merely negligent and did not amount to misconduct.

The tribunal rejected her claims that a large number of testimonials in support of Prof Stebbing showed that a finding of impairment was not required in the wider public interest. 

Given the nature and gravity of the concerns, it said a finding of no impairment would not uphold professional standards and undermine public confidence in the profession.

It concluded that, even if Prof Stebbing had fully remediated his past misconduct, a finding of impairment was required.

The MPTS has yet to announce when it will reach a decision on Prof Stebbing’s sanction.

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

Credits:Images: Kerry Elsworth

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