Original subtitles

"| would like your assurance any other member of the medical team be tested immediately.

"| had an operation at your hospital last year. | demand an immediate blood test...”

Anaesthetists with HIV or AIDS are at liberty to continue to practise

since our work does not involve invasive procedures

which might be a risk to patients or staff,

specifically the use of sharpened instruments inside body cavities.

| have volunteered to keep away from patients

until the hospital receives the official guidance of the Director of Public Health.

You know | will receive her full support.

Now, following the albeit reprehensible disclosure of your diagnosis,

| fear you're being wilfully naive not to expect repercussions.

Against the hospital, you mean, from rabid journalists and ignorant councillors.

| will not be an apologist for hysteria.

Then stop acting like one.

I'm sure everything will be all right, Phil, but | mean, at a time like this,

| mean it might have been wise if you'd had private insurance after all...

— Oh, Andrew. Unfortunate news. — What's that?

The inquest has been brought forward.

James.

You know, with you being, you know, have you ever where | was concerned?

What?

Have you ever had thoughts where | was concerned?

— What? — Have you ever fancied me?

Rest assured, I'm one of the few people in this country

who has never taken a passing interest in your backside.

Good. Hang on.

How come? If | got on as well with a girl as | did with a mate,

she'd have to be a right tugboat for me not to fancy her.

Raj, it's Jackie. WiLL you look after her?

Yeah, sure.

— Hiya. — Raj.

It's my daughter.

She's got an abscess on her bottom.

Nasty abscess, that. Looks like we're gonna have to cut off your whole bottom.

Not quite.

It's a perianal abscess.

| reckon we can tee up surgery for some time this arvo.

Don't forget to tell the anaesthetist about her asthma.

| won't, Jackie.

Try to stop being a nurse and just be a mum.

Sorry. | know she's in good hands.

(Laughs) See ya.

See you, Sharon. See you.

| see the hospital are being their usual soft touch over sick leave.

(Sighs) So much for this crap about macho doctors not accepting their own illnesses.

It's more like no one else will let you accept it.

They only every granted a sickie to one of the juniors,

and then only on account of her being dead.

(Laughs)

— See you. — See you.

He must think that | was born yesterday,

not to notice he'd taken a blood test from my son.

| could have him charged with assault, you know.

— Scissors. — Mm-—hm.

Those useless med school lectures will be fresher in your memory than mine.

The inheritance of blood groups.

lf her father is,

let's say blood group AB...

His children's blood group would be A or AB.

Or B, but not 0?

— | thought so. — (Phone rings)

Thanks.

Ward L. Staff Nurse Dalton.

Thanks. Theatre's sending for Sharon Landers.

Her sats are dropping like a stone.

— Get help. — Atropine and sux.

— (Monitor beeps rapidly) — (Laboured breathing)

| mean, what bothers me most is that I've stopped being a person

— and I've become an issue. — Hm.

We need an anaesthetist in theatre.

Sorry, not me.

She went into laryngeal spasm after the first incision.

— OK, OK, OK. Back to 100% oxygen. — (Monitor beeps rapidly)

She had .6 of atropine and 50 of sux.

You did the right thing. No one ever died from not having a tube,

only from not having enough oxygen.

Her sats are coming back up.

(Monitor beeps steadily)

OK.

Together.

It's all right, you've had a scare, Nick, but no harm done.

Sorry for desterilising your theatre.

Now, Sister, you know she's in very good hands.

— Sharon's fine. — (Sighs)

— Did you get involved? — I'm glad you did.

Me too. We're taking her to HDU just as a precaution.

OK.

They've got you now, my boy.

(Docherty) | feel very sorry for the lad.

Easily one of the more capable members of that shower that call themselves anaesthetists.

I'm grateful to be leaving this bizarre setup,

where the mice have begun to run the experiment.

A grateful valediction indeed, Isobel.

— In my day, management... — Enough.

Ernest, I've no wish to share in a dotage of

"if only", “what might have been", or “the good old days".

Either you accept the fact that your time is past or you stay and you fight.

| know for which I'd respect you more.

No, of course | don’t want to go back to being someone's assistant.

— | take it my protest has been noted. — (Knock at door)

Thank you.

Come in.

Paul

| know how busy you two are, so I'LL get straight to the point.

This administration cannot afford

for tomorrow's hearing to become an inquest into how this hospital is run.

It should be Dr Kirkby, guilty or not guilty.

Oh. Lone assassin.

Hm.

I'm sorry, Barry?

An unbalanced individual acting alone, no shot from the grassy knoll.

A single bullet ricochets halfway round Dallas before embedding itself in the president's head.

No conspiracy there, that's for sure.

Oh, come on. You're doing it again.

Making a scapegoat of Phil Kirkby.

I'm sorry, I'm having no part in it.

— Now, Barry... — No, Graham. I've...

I've heard enough.

(Door closes)

Phil is a good lad.

He's worked well for me these six months.

I'm sure he'll see reason.

Either he falls or he's pushed. He takes a dive.

Oh, my God, Graham.

| thought | came here to get outpatients seen on time.

James.

Mr Docherty.

May | say how pleased | am to learn about your change of heart.

One moment, Mr Tennant.

I'm merely willing to reconsider my position vis—a—vis retirement.

There is one condition.

Name it.

James Mortimer.

You leave him be.

— Hi. — Hi.

| checked on the ward and he's taken the result. Yes. Thank you.

— That's OK. — Anything that stops Adrian DeVries

from finding out that Steven really is his son has got to be worth it.

Anyway, | think that one bastard in the family is quite enough.

Sit down, Phil

| expect you're nervous about tomorrow.

Don't be. It's all taken care of.

Now, these...are the notes...

of Mr Mcintyre.

The patient who died due to your error.

| would like to draw your attention to the last entry in your hand.

"Discussed with Dr Turner.

"Advised to continue.”

It was Christmas Day.

I'd partaken of one sherry too many, perhaps.

Possibly | wasn't communicating with my normal clarity,

and so you misunderstood.

We expect you to admit responsibility for Mr MclIntyre's death

owing to your ineptitude.

We expect you to deny that long hours or incomplete training

contributed to your error.

Well, I-I hope you'll forgive me not liking the sound of your plan.

Our "plan"? No.

If there is a financial settlement, the health authority will pay under NHS indemnity.

If you do this thing for us, Phil,

it won't go unnoticed.

We will see you right for all the plum jobs.

We promise you, no one will touch you for this.

But if you don't, you'll have to pick up the pieces without our help.

Not a good position for a young doctor to be in.

But | know you trust us, Phil.

| know because you're one of us.

So what are you gonna do with your life now?

(Laughs)

Goodness knows.

Well, tomorrow I've got, erm,

a meeting with some people who recruit former doctors.

You mean conscientious objectors, bed-—wetters, losers and wasters.

So you don't regret leaving?

| believe that medicine can help people.

| believe in the National Health Service.

| just hate the runts who run it.

(Laughs)

So, what do you regret, then?

| wonder if Charlotte and | should have had children.

| swear by almighty God that the evidence which | shall give be the truth,

the whole truth and nothing but the truth.

— (Woman) You are Dr Philip John Kirkby? — Yes, | am.

Speak up, please.

Yes, ma‘am, | am.

In what capacity did you attend Geoffrey Mcintyre

on the evening of December 25th, Christmas Day?

| was the house officer on call.

| was asked to give Mr Mcintyre his chemotherapy.

How long had you been on duty?

Just 36 hours.

And with what amount of break time?

None.

— No sleep? — No.

— This is normal practice? — Yes.

So after 36 hours of being on duty,

with no breaks, no opportunity to rest,

you went ahead and made up Geoffrey Mclntyre's chemotherapy?

Yes, ma‘am.

This was one of your usual duties?

No. The, erm...

junior doctors are only expected to make up the chemotherapy

if it needs doing out of hours.

What training have you had in this procedure?

None.

Were you fully confident of what you were doing?

Erm...

— Not quite sure, ma‘am. — Did you ask anyone

to corroborate that you were following correct procedure?

No. Hospital policy forbids the nurses from checking chemotherapy.

Examination of the materials and fluids you used when mixing the chemotherapy...

(Mobile phone rings)

. suggested that an incorrect dilution had been made.

Do you dispute this evidence?

No.

We will hear written testimony from a number of sources

who assert that an injection of such an over—concentrated solution could prove fatal.

| am Mary Withers.

| was the duty pharmacist on December the 25th.

Dr Kirkby asked me to come to the hospital to perform a task

which is excluded by my job description.

...have the written statement of my head of department.

This document has been supplied to all interested parties and is not contested.

| admit it in evidence under rule 37.

It states that the reconstitution of chemotherapy

is not considered an appropriate on-call duty.

Dr Kirkby has informed us

that the doctors receive no formal training in handling chemotherapy.

— Do your — Yes, ma'am. | have.

What safety equipment is provided for you when you work with chemotherapy drugs?

We have a FlowGuard cupboard to protect us from fumes...

(Inaudible)

visors, gloves.

To your knowledge, is this equipment provided for the doctors when they handle chemotherapy?

No, ma‘am.

All efforts at resuscitation were...

unsuccessful

and | pronounced Mr Mcintyre dead at, erm...

8:55pm.

Thank you, Dr Collin.

In your testimony you stated that Dr Kirkby contacted you for advice.

Yes, ma‘am.

In my recollection, Dr Kirkby omitted this detail from his own testimony.

You may step down, Dr Collin.

| would like to recall Dr Kirkby.

Dr Kirkby, may | remind you you remain under oath?

Did you seek advice from senior colleagues in the case of Geoffrey Mcintyre?

Well, yes. In the...

first instant, | contacted Dr Collin,

the senior house officer...

er...

who was himself unfamiliar with chemotherapy,

and he suggested that | contacted the pharmacist.

Did you speak with Dr Collin again before you went ahead with the chemotherapy?

No.

Did you contact anyone else?

Well, who might you have contacted?

Erm...

Dr Turner, the consultant on call.

Erm...

Had Dr Turner ever given you the impression that he would respond unfavourably

— if you asked him for assistance? — No.

Dr Kirkby.

I'm sure you realise housemen are encouraged to seek guidance from senior doctors.

Yours is a training post,

and therefore,

if a more senior colleague sanctioned one of your actions...

the responsibility would be his.

Dr Kirkby, did you contact Dr Turner?

Er...no.

(Judge) Thank you.

Both Dr Kirkby

and Dr Collin have related the events surrounding the death of Mr Mcintyre.

We have also heard written testimony from the pathologist,

Professor Lester,

who cites the most likely cause of death as anaphylactic shock...

due to incorrect reconstitution of chemotherapy.

Can you offer an alternative explanation, Dr Yates?

Er...

No, ma‘am.

To my regret...

| cannot.

Er...

But...

| want to say that | believe

that it would be unjust

if the outcome of today's hearing is to single out an individual for blame.

The broader culprit

is the training of and expectations placed on junior hospital doctors.

In summary,

we have heard how a tired and inexperienced houseman,

Dr Kirkby,

made an error in mixing a solution of a chemotherapy drug,

which proved fatal to Geoffrey Mcintyre on the evening of December 25th.

We have heard that Dr Kirkby had received no formal training in handling chemotherapy.

And how his endeavours to obtain assistance proved unsuccessful.

Primum non nocere.

"First, do no harm"

is an age-old maxim of medical practice.

Despite his own misgivings,

Dr Kirkby pressed on when he had not exhausted all the options

of contacting more senior colleaques,

or simply declining to carry out the procedure

on the grounds that it represented a threat to patient safety.

| believe that Dr Kirkby acted with reckless negligence,

and | therefore record a verdict of unlawful killing in the case of Geoffrey Mcintyre.

The case will be referred to the Crown Prosecution Service,

and it may be that at some point in the future,

Dr Kirkby will be asked to face a criminal charge of manslaughter.

(Sobs)

ALL rise.

Sorry about that.

I'm sorry, who might you be?

Oh, I'm the solicitor appointed by the health board to represent you Lot.

Believe me, Phil, everything will be fine.

Er, Alec, listen...

Why? Why did you kill him, eh?

Why did you kill him?

You know my husband's in the ground because of you.

Why did you do it?

Why didn't you think to call a proper doctor, eh?

Why? Something should be done about doctors like you, something should be done!

| hope you rot in hell!

You murderer!

(Sobs) You...

| want him...

| want...

— | want Geoff. — (Turner inaudible)

| want him.

| want him back.

(Continues sobbing)

Well, I'LL come straight to the point, shall I?

Basically we're in the business of recruiting

well—motivated, well-qualified people like yourself.

So what do we have to offer, eh? Well, let's look at the points. Hours of work first of all

I'm well aware of the horrendous hours that you have to work at the moment.

With us it is strictly nine to five.

Our financial package is generous, | think you'll agree.

We had somebody join our company a year and a half ago,

they're now pulling in 30, 35K a year,

company car with a mobile phone,

generous pension scheme as well and a good holiday allowance.

You would have a life outside of work as well

It's quite unusual for us to recruit somebody direct from the NHS,

but | think somebody with your skills, we'd certainly be very interested in.

Can someone call an ambulance, please, now?

Do you need any help, love?

It's OK, I'm, er...

I'm a doctor.

It's my job.

In recognition of your, erm...

30 years’ dedicated service...

— (Knock on door) — Come in.

| would like to present you with this cheque for £50.

Dr Yates.

Mr Tennant.

Just thought you'd like to know

one of the housemen who was joining us next February has withdrawn.

The word's got around this administration asks the earth of its doctors

before throwing them to the Lions.

You and |, Dr Yates, we do the best job we can.

I'LL be clearing my desk by the end of the week.

| can't recall the last occasion

when a manager was brought to book over an “error of judgment.”

I'm being promoted, Dr Yates.

The assistant manager is carrying the can. She's not complaining, of course.

20,000 golden handshake and she gets to keep the BMW.

I'm supposed to be flying off on holiday this afternoon.

— Ill still be able to go, won't I? — If it's not broken.

But, er, if it needs a plaster, then you can't fly, low air pressure and that.

— What's the damage? — Nothing broken. Tell him the good news.

Your friends are back.

— Get the car. — What?

Go outside and get the car.

| want to see Dr Rajah.

— Broken. It will need a plaster. — No way.

Way. Look, mate, | feel pretty bad about you losing your holiday,

— so I'll buy it off you, 50 quid. — 50 quid?

Are you going to get a better offer today?

I've just got my stuff. I'm back at work.

— Where are you going? — On holiday.

Look after the flat while we're gone.

I'LL send you a postcard.

Right.

see ya.

Let's have an urgent blood count, U&E, clotting and glucose.

Blood bank should have his type, if not, four units of O negative.

Cross—match 12. Straightaway.

BP 90 over AO.

A bit worrying. Let's start 5% dextrose on this side, not saline.

Last thing we need is a hepatic encephalopathy.

Varices again. Best bet now will be a Sengstaken tube.

That's what a registrar's for.

Debbie, can you get on to the endoscopy suite to send up a Sengstaken, please?

Also see if there's any vasopressin.

— James, | reckon he needs a central line. — | agree.

(Andrew) Let's get a central line trolley for James, please.

Tachycardic as anything.

— That haematol's nearly down. — |'m onto it.

Where's the cross—match?

Uh—-uh. OK. He needs a tube now. Let's get him to Endoscopy, see what we can do on the way.

Get the trolley, please.

I'm home.