CRITICISM has been levelled at the RQIA over its handling of a dead woman’s medical records.
Ruth Armstrong was a patient of the former Belfast Trust (BHSCT) neurologist, Dr Michael Watt, prior to her death in November 2002.
In May 2018, the Department of Health (DoH) commissioned the Regulation and Quality Improvement Authority (RQIA) to examine the medical records of all of Dr Watt’s former patients who died in the previous ten years.
However, the family members of those who died outside of this period were told, if they approached the RQIA, their loved one's medical records would also be looked into as part of the review.
In 2018, the RQIA received Ruth Armstrong’s medical records from the Business Services Organisation (BSO).
Correspondence sent to Mrs Armstrong’s son, Colin, by Emer Hopkins, currently the RQIA’s interim director of improvement, states that his mother’s records “were returned to the BSO as we did not require them at this point”.
However, an RQIA spokesperson told The Detail it was the absence of a “legal framework” for the review, which meant Mrs Armstrong’s records were not examined and were instead returned to the BSO.
The Detail was told that this legal framework was finalised in February 2020 “just prior to the DoH’s direction for RQIA to pause its programme of reviews” due to Covid-19. The DoH’s direction for RQIA to cease its reviews was rescinded on June 22.
We asked the RQIA to explain which piece of legislation allowed it to receive Mrs Armstrong’s records in the absence of this legal framework. The Detail was not initially provided with this.
Section 41 of the Health and Personal Social Services (Northern Ireland) Order 2003 states that the RQIA has the power to require health boards, trusts, bodies or service providers to provide it with ‘any information’ which it considers ‘necessary or expedient to have for the purposes of its functions’.
The legislation also states the RQIA has the power to do this ‘at any time’.
Despite this, when queried by The Detail, the RQIA spokesperson maintained that this section of the order is only relevant when the organisation is carrying out inspections and is therefore not applicable to the deceased patient review.
The RQIA spokesperson said: “Access to deceased patients’ records is governed by the Access to Health Records (Northern Ireland) Order 1993, which places strict limits on the disclosure of patient records.
“RQIA is not included in this legislative provision. Accordingly, a legal framework has had to be drawn up to enable the RQIA to access the relevant records for the purposes of the review.”
Mr Armstrong told The Detail: “They were able to contact the BSO to ask for my mother’s records.
“If the RQIA didn’t have a legal basis to do this, did it even obtain the records legally? If the RQIA did obtain the records legally, as I suspect was the case, why was there a need for a new framework?
“Without a new order or statute, which there hasn’t been, the legal framework would presumably have to operate within existing law, but if such law were already in place, why would the RQIA need a framework?
“The entire story doesn’t fit together. I do not find it plausible. It’s all very odd and has caused me great confusion and distress.”
Correspondence sent to Mr Armstrong by the RQIA's then chief executive, Olive Macleod, in May 2018, said: "We are currently finalising arrangements for work we will undertake regarding patients who have received neurology care and since passed away."
Mr Armstrong said this correspondence, along with the fact that the RQIA obtained his mother’s records in 2018, “suggests strongly” that, at that time, the organisation was aiming to begin the review. However, this did not happen.
Mr Armstrong has submitted a Freedom of Information (FoI) request seeking a copy of the legal framework. He is awaiting the response.
The DoH commissioned the RQIA to undertake this deceased patient review just after a Royal College of Physicians (RCP) report, which has never been publicly released and which examined Dr Watt’s actions, was finalised.
Mr Armstrong said: “I am concerned, almost two and a half years on, that there is simply a lack of will to begin this review.
“The words of the former Labour Foreign Secretary, Ernest Bevin, come to mind; ‘open that Pandora’s Box and all sorts of Trojan horses will come flying out.’”
This week, Mr Armstrong received correspondence from a DoH official saying it is expected the RQIA review will begin in the coming months.
“Given my experiences dealing with the DoH and the RQIA, to date, I will reserve my judgement on the significance of this correspondence,” Mr Armstrong said.
After Mr Armstrong’s assessment of the RQIA’s comments, The Detail went back to the RQIA.
A spokesperson then failed to address the issues we raised regarding the seemingly wide-ranging powers of Section 41 of the Health and Personal Social Services (Northern Ireland) Order 2003, but again referenced the Access to Health Records (Northern Ireland) Order 1993 which, we were told, legislates for “individuals” to receive their deceased relative’s records.
The spokesperson added: “Before any record can be released consideration has to be given as to whether it can be full disclosure or partial disclosure as set out in this legislation.
“In giving such consideration the holder of the record is required to seek advice from an appropriate health practitioner.”
The RQIA stated it contacted the BSO to “facilitate Mr Armstrong” to access his late mother’s records.
“It was on the basis that RQIA’s medical director was identified as a medical advisor by BSO for the purpose of reviewing the records before it determined what records would be released to Mr Armstrong,” the RQIA spokesperson said.
Now Northern Ireland’s deputy Chief Medical Officer, Lourda Geoghegan was the RQIA’s medical director at this time.
The RQIA spokesperson added: “For RQIA to retain these records for any other purpose would not have been appropriate.
“This legislation, however, does not provide RQIA with an appropriate legal basis to request records for the purposes of the review, and therefore a specific legal framework has had to be developed for this work.”
Mr Armstrong responded by saying he’s a visiting research associate in Queen’s University’s history department so he has a background in viewing things chronologically and assessing documentation, “and the RQIA’s further explanation of its actions doesn’t make sense”.
He added: “I have seen no prior evidence to support the claim that the RQIA only contacted the BSO to enable me to see my mother’s records.
“This is the first time, I have seen it claimed, that they were only accessing my mother’s records so Dr Geoghegan could view and redact them before sending them to me.
“In fact, when I informed the RQIA that I also contacted the BSO, they asked me if I would share my mother’s records with them if I got them first.
“Why else would the RQIA want to acquire my mother’s records from me if not for the purposes of beginning the review?”
Mr Armstrong then said it was “telling” that the RQIA ignored The Detail raising the seemingly wide-ranging powers of Section 41 of the Health and Personal Social Services (Northern Ireland) Order 2003.
He then showed The Detail correspondence, from the RQIA, dated September 4, 2020.
It states that the RQIA had, in its dealings with Mr Armstrong, on different occasions referenced multiple legal frameworks being required for various purposes.
Mr Armstrong said: “The waters have been muddied regarding this legal framework.
“It reminds me of Kellyanne Conway, Donald Trump’s former political advisor, when she spoke about ‘alternative facts’.
“I reiterate, without a new order or statute which there hasn’t been, the legal framework for the purposes of review would surely have to operate within existing law, but if such law were already in place, there wouldn’t be a need for a new framework. The RQIA has ignored this point.”
The only time that the review into the medical records of Dr Watt’s deceased former patients has ever been referenced in minutes from an RQIA board meeting was in November 2018. The minutes state that a ‘full-time solicitor is required for this piece of work’.
The RQIA informed The Detail that a member of the BSO’s legal services directorate has responsibility for advising on the review, but we were not told who this individual is.
We, therefore, sought this individual’s name from the DoH, which deals with media enquiries on the BSO’s behalf.
Likewise, the DoH also stopped short of naming the lawyer with responsibility for the review, but a spokesperson referenced Alphy Maginness, the leading legal figure for Northern Ireland’s health and social care system, as having an important role in the BSO.
Mr Armstrong said: “I would call on Mr Maginness, or another such appropriate person, to speak publicly about the status of the review and outline the legal framework which the RQIA said it had to establish.” The RQIA did not comment on this.
Another man whose wife was a Dr Watt patient and in her mid-40s, when she passed away in early 2018, also spoke with The Detail.
He wished to remain anonymous. The man said: “My life has been totally bent out of shape in these last few years. It is totally unrecognisable to the life I once led.
“My wife has died, I’ve had to move home and my career has been negatively impacted.
“On top of this, I have spent considerable time and money on a solicitor to try and get answers about what is happening with the RQIA review of the medical records of Dr Watt’s deceased former patients, of which my wife is one.”
However, it got to the stage where the man’s solicitor said he no longer felt comfortable taking his money “because he was getting nowhere” in his attempts to get answers from the RQIA.
The man said: “The solicitor was a good, genuine guy who was doing all he could but he was getting nothing from the RQIA.”
He also said there have been “empty promises” from the RQIA about how often they were going to contact him to update him about the status of the review, “but their communication has been abysmal”.
The man added: “I, and I’m sure others like Colin Armstrong, have been really badly let down by the lack of information.”
It was in 2017, when the scandal regarding Dr Watt was breaking, that the man’s wife became a patient of the former BHSCT neurologist.
The man said there was a six-month period during 2017 when his wife couldn’t get an appointment with the BHSCT neurology department when “she was abandoned”.
He continued: “It was terrible, as it is now trying to get answers from the RQIA about this review.”
Correspondence, seen by The Detail, sent by PSNI Detective Superintendent Jason Murphy to one of Dr Watt's former patients, in January 2020, states the RQIA review is important in "considering to what, if any, extent did the practices of Dr Watt impact on the deaths of some of his patients".
Mr Armstrong said: "The police officer's comments highlight just how critical the RQIA review is and why further delays are not acceptable. Pandora’s box again comes to mind.”
To read more about Ruth Armstrong’s case, please click here.