The duty of candour

On 24 March 2005, Andreas Lubitz deliberately crashed a German wings airliner into the Alps killing himself and 149 passengers.  Police found a medical certificate declaring him unfit to fly.  He turned up for work anyway. The French investigators reported he had taken psychiatric medication the night before the crash.

A 49-year-old French pilot was banned from flying for life and handed a prison sentence after struggling to land his Airbus 320, having taken drugs the night before. Anything that impairs a pilot’s ability to make decisions and execute tasks increases the risk of accidents.

This is why aviation authority regulations are so strict.  They specify minimum time periods between admission to hospital and flying and strictly rule out taking even hay fever medication or tranquillisers. A pilot’s error is costly.

Odis Pitts, a bus driver crashed into multiple cars, then struck a railroad bridge injuring passengers. Police found him unresponsive at the wheel. He overdosed the night before. He was sentenced to 10 years in jail. Drivers’ errors are costly too. That is why US federal regulations require commercial drivers to be tested for drugs before employment and randomly after. Those found with any measurable amount of drugs are put ‘out of service’ and referred for evaluation and treatment.

Dr Batak Shokouhi, a Manchester GP was struck off the register and will never practise after being caught abusing drugs. Doctors’ errors are costly too. That is why the Medical Council obliges all doctors to raise concerns when patients’ safety is compromised by colleagues. Patients’ interest comes first and overrides personal and professional loyalties.

Doctors are clearly instructed that they should not wait for proof to raise concerns. The Medical Council should be informed immediately if there are serious risks to patients. The concern should be made public if patients remain at risk. When this doesn’t happen, patients die.

At Stafford hospital, 1,200 patients died between 2005 and 2009 because medical staff protected the organisation and their colleagues instead of patients. The Francis report concluded that the “shocking care” occurred because “staff who spoke out were deterred from doing so through fear and bullying”. The report highlighted the “duty of candour” – the necessity of transparency to prevent tragedy.

On 23 March, Education Minister Justyne Caruana was admitted to hospital. According to a DOI statement, she was in a “stable condition” and “recovering”. The statement was vague and raised more questions than it answered. Journalists contacted the Ministry of Education with questions.  The Ministry failed to reply.

Reports leaked out that the Minister was being treated for a drug overdose. This was never denied. Some, including former President Coleiro Preca, were outraged. “Shameful lack of ethics and empathy in trying to sensationalise the grief that this woman, mother and political person is going through” she denounced. “We have crossed the line” she added.

Labour Party President Ramona Attard chimed in: “This woman has gone through difficult times, I respect the privacy of the individual… there is a line that should never be crossed”.

The very next day, Minister Caruana returned to work uploading a photo of herself: “Back in office, thanks for the support”. It had been mere hours since she was hospitalised, allegedly for an overdose.

The Minister’s worrying saga raises several concerns.  Should a pilot, bus driver or doctor on medication unwell enough to be admitted to hospital return to work a few hours after an overdose? Why is publication of their names, personal details and medical issues acceptable?  The simple answer is that the interests of the public override the personal right to privacy of such individuals.

The role of Ministers in public office is no less taxing, stressful or demanding than a pilot’s, a bus driver’s or a doctor’s. The public they serve has every right to know that Ministers are fit to serve and competent to make decisions.

Nobody would climb onto a plane whose pilot was discharged from hospital after an overdose hours before.  Who would put his children onto the school bus whose driver had been previously treated for an overdose?  Coleiro Preca’s outrage about the release of information is misguided. So is Ramona Attard’s.

When former prime minister Alfred Sant was suffering from colon cancer and required treatment the public had a right to know.  Sant did the right thing.  He was transparent and informed the nation of his health issues.  Regular updates with explicit details of his surgery were provided. Didn’t Sant have a right to privacy, too? Were the hospital authorities crossing the line, as Coleiro Preca put it, when they showed us the gory images of how his colonic tumour was excised by his surgeon Anthony Zammit? No.

Caruana’s health issues are of keen public interest, especially to teachers and students at this disruptive time. Her precipitous return to work is deeply worrying. Nobody should be ‘back in office’ hours after hospitalisation – particularly a Minister, making crucial decisions.

Her return raises serious concerns about her insight. As Ramona Attard pointed out, “this woman has gone through difficult times in the last few months”. Caruana’s judgement has long been suspect.  Her latest actions leave no doubt.

Her decision to return to work is not smart – it puts the public and her own health at risk. If a driver is back at work, hours after overdosing, he faces jail. The minister, however, is lauded. Struggling with the pressures of office and personal circumstances, she is making the wrong calls.

The prime minister has two pressing duties. The duty to protect the public from decisions taken by a potentially unfit minister. But also the duty of care towards his minister. If revelations about the Minister’s hospital admission are correct, a few hours of ‘observation’ won’t suffice.

As doctors we are taught that delaying help for a colleague in trouble with such issues can be fatal – and for more than just the single colleague. We have a duty of candour. So does the prime minister.