Bloodgate physio free to practise again

Posted by Nell Mead at 15:18 on 14 Jun 2011

The debate continues over the striking off of "Bloodgate" physiotherapist Steph Brennan.  As I blogged before, Steph was struck off the physiotherapy register by the Health Professions Council (HPC) in September 2010 when he pleaded guilty to helping the rugby team for whom he was head physiotherapist, Harlequins, cheat by providing a fake blood capsule to one of the players on the pitch.  By this time, he had already been banned from working in rugby for two years.  In contrast, the pitchside doctor (who cut the player's mouth to "prove" that he had been injured) was deemed fit to continue practising by the General Medical Council. 

Steph - by all accounts a superb clinical physiotherapist - appealed to the High Court against his striking off.  The High Court agreed that he had grounds to appeal to the HPC; and last month the HPC (after initially claiming that the High Court had no jurisdiction) revoked its decision, imposing instead a five-year "caution period".

Since the HPC initially struck Steph off, there has been hot debate among physiotherapists as to whether striking off was the correct action for the HPC to take or whether it was excessive.  Some have taken the view that Steph failed to maintain the "high standards of personal conduct" which form a part of the HPC's regulations and that he therefore deserves all he gets.  My own view is that it was excessive: that Steph clearly made a stupid mistake to put Harlequins before his profession and his morals; but that the public (whom the HPC exists to protect) is not better served by banning this man from practising.  He has also shown very public remorse and has clearly been reflecting on his actions, having undertaken a series of lectures to physiotherapy students on the importance of medical ethics.  I am therefore very glad that the HPC has overturned its own decision.

However, I'll leave the last word to Steph, who feels that his case has highlighted not just the pressure that is faced by physiotherapists working in elite/professional sport but also the importance of withtanding that pressure and keeping a cool head under fire: "I want the profession, and most importantly sports physiotherapists, to learn from my mistakes.  Sports physiotherapy is a very different role for the physiotherapist than any other job in public or private health, but that should not mean we forget our standards of ethics and practice."

Bloodgate physio wins high court appeal

Posted by Nell Mead at 16:00 on 3 Feb 2011

Moving back to the theme of HPC sanctions, do you remember Bloodgate?

On 12 April 2009, Harlequins rugby player Tom Williams was taken off the pitch by the team physiotherapist, Steph Brennan, with blood pouring from his mouth.  As he approached the Harlequins' bench, Williams grinned at his teammates, arousing such suspicion in Quins' Heineken Cup opponents, Leinster, that the Leinster team doctor requested to see the injury at the end of the match.

The problem was that there was no injury: Brennan had carried a fake blood capsule onto the pitch and Williams had bitten it in order to fake an injury which would allow him to be benched in favour of another key player.  In a panic, Williams approached the Harlequins' team doctor, Wendy Chapman, and asked her to cut his lip, so that he would have an injury to show the Leinster doctor.  Initially, she turned down his request but eventually gave in to the pressure and made a cut with a scalpel, as requested.

Following an investigation, the Rugby Football Union discovered that there had been four other incidents in which Brennan had facilitated the fake blood injuries.  He was banned from working in rugby for two years, while the chairman Dean Richards was banned for three years and the player, Tom Williams, for 12 months, reduced to four on appeal.  

Chapman, the doctor who had deliberately cut her patient, was initially suspended by the General Medical Council (GMC) but the suspension was lifted in August 2010 when the GMC decided that her fitness to practise was not impaired.

In contrast, Brennan, the physiotherapist who had facilitated cheating but who had not injured a patient and whose physiotherapy expertise was not in doubt (at the time of the scandal, he had been about to take up a post with the England rugby team) was struck off by the Health Professions Council (HPC), meaning that he could no longer work as a physiotherapist. 

As I'm sure you can imagine, this was pretty controversial, certainly within the physiotherapy community - a super-hot topic of debate on online physiotherapy forums.  Some felt that striking off served him right for cheating; more felt that the rugby ban was enough of a punishment in itself and an online petition asking the HPC to reconsider has so far gained 1175 signatures.

I think I agree with the petitioners.  Steph Brennan was clearly wrong to provide Tom Williams with a blood capsule, so the ban from rugby is fair; but his actions were not in any way dangerous.  The HPC's own Indicative Sanctions Policy states that a sanction such as striking-off is not to be used to punish wrongdoing, but to protect the public.  I'm not sure how striking off an experienced and well-regarded - albeit misguided in this instance - physiotherapist who has done no harm, is a move towards public protection.

Last week, Steph Brennan's lawyers successfully argued that his actions had not merited a sanction of such "gross severity" and Mr Justice Ouseley at the High Court ordered the HPC's Conduct and Competence Committee to reconsider the case.

Currently, the HPC are refusing to do so, saying that the striking-off order is not open to legal challenge.

So, should Brennan have been banned altogether from practising his profession - or just banned from rugby?  It's an interesting debate - what do you think? 

Trust me, I'm a doctor...

Posted by Nell Mead at 12:00 on 20 Jan 2011

I was going to demonstrate a simple exercise for back pain today, but I've just seen this article in the Daily Mail online and it's taken priority.  Normal service will be resumed very soon!

To summarise, it seems that this chap "Dr Charles Ahme" - a 50-year-old football referee with an online first aid qualification - set up a "physiotherapy and sports injuries practice" in Levenhulme, Manchester.  Wearing a white coat, he asked female patients to strip naked and then massaged them, in some cases indecently.  He wasn't investigated until a GB athlete visited his practice for treatment and realised that his practice wasn't exactly standard.  She reported him and he is now apparently "facing a lengthy prison sentence".  Good.

OK, so where do I start?  How do you choose a physiotherapist, or in fact any healthcare practitioner?

• Word of mouth is a sensible place to start.  Ask around: if your friend or colleague has seen a really good practitioner, the chances are that they may be able to treat you well, too.  Most of my patients come to see me because one of their friends has recommended me.
• Check their website - most good practices have one these days, and you should be able to get a feel for what's available: does the therapist offer services you think you will need, and do you like the tone of the site?  If you like what they write, the chances are that you will like the therapist.  Good rapport between patient and therapist is an excellent first step to successful treatment, as if you trust your therapist, you will relax and the treatment will be more beneficial.  Most websites will also include testimonials from past patients and, provided that these are genuine, they will also give you an idea of the therapists' areas of particular expertise.
• Chartered status is no guarantee of quality, but it does at least mean that the therapist has been received the training that they say they have, and that their insurance and qualifications are up to date!  You should check that your therapist is registered with the Health Professions Council.  Physiotherapists should also be registered with the Chartered Society of Physiotherapy; any private physiotherapist registered here or here is a CSP member.
• Instinct is possibly the most important thing.  Don't automatically trust the therapist who wears a white coat!  We are programmed to do this, but as Stanley Milgram showed in his famous experiment, someone who wears a white coat (or other uniform or clothing that denotes professional status) is not necessarily what he seems.  The therapist should greet you, make you feel at home and always explain what they are about to do to you, what you are doing and why they are doing it.  You should always be able to ask questions, and if you feel uncomfortable at any time, tell them so and they should stop what they are doing immediately and discuss it with you, modifying any treatment so that you are comfortable with it.  If they don't, or if you are not happy with the treatment in any way, let them know; and if you're dissatisfied with their response, you are perfectly within your rights to raise your concerns to the Health Professions Council who will investigate.

Please don't get taken in by a bogus therapist!

For an appointment with Nell (a totally genuine Chartered Physiotherapist with years of experience treating musculoskeletal injuries!) please contact us or send her an e-mail.  She is available at The Foundry on Mondays and Tuesdays, and at The Back Shop on Wednesdays and Thursdays.