Month: March 2020

No man has a good enough memory to be a successful liar
–Abraham Lincoln

In our previous blog we looked at some serious misconceptions which have been implanted in the minds of Selected Medical Practitioners (SMPs). Now we need to focus on the shortcomings of certain SMPs.

For new readers, we first need to explain that the Police (Injury Benefit) Regulations 2006, govern a compensation scheme which grants pensions to officers injured and disabled in the line of duty who, as a result, have to leave the police service. The Regulations require the scheme managers to appoint a ‘duly qualified medical practitioner’ to decide certain medical questions. Usually, the medical professional is a doctor, who needs to be on the register maintained by the General Medical Council. The doctor, once appointed, is generally referred to as the SMP or selected medical practitioner.

We made the important point in the last blog that SMPs are nearly all doctors who have not made it their professional objective to do what is accepted to be the main work of doctors, such as healing the sick, researching for cures to diseases, or caring for the terminally ill. Instead, they chose to find work in the field of occupational medicine, formerly known as industrial medicine, where they spend their days, to quote, from various sources, ‘. . . concerned with the maintenance of health in the workplace, with secondary objectives of maintaining and increasing productivity and social adjustment in the workplace.’

An objective observer may consider there is an inbuilt conflict of interest where a doctor is employed by a commercial organisation in a role which is essentially to assist productivity.

It might also be thought that an occupational health doctor employed in the public sector would be free of any hint of conflict of interest, for there is no pressure on them to have an eye on their employer’s profit margin, Sadly, when it comes to the police service, whilst there is no profit margin to worry about, Chief Constables fret, with good cause, over the costs of running their force. They are encouraged to make savings by successive Governments, who in the same breath will demand greater efficiency and falling crime rates.

No wonder then that some Chief Constables have looked at the cost of providing injury pensions and have strayed into dangerous territory by enabling their HR and Occupational Health managers, along with the SMPs used by their force, to be ‘inventive’ with their application of the law governing the administration of injury pensions.

Elsewhere in this website, there are numerous examples of the sharp practices which have resulted from some Chief Constables forgetting entirely that their responsibility to the law precludes them from putting their worries over their shrinking budgets before their duties as managers of the police injury benefit scheme.

Put simply, police injury benefits should be managed with no thought to the financial effect of decisions made regarding a serving officer’s or injured retired officer’s medical condition. Decisions made by a SMP need to be made free of any pressure, whether overt or merely hinted at, to act in ways which are influenced by financial outcomes.

Some SMPs, however, have been misdirected over the nature and extent of their role within the Regulations. However, we do acknowledge that not all SMPs have been tainted by what can only be described as, pardon the pun, ‘indoctrination.’

We applaud all honest and decent SMPs, and members of HR and Occupational Health departments in those forces where they have ignored or dismissed the nonsense touted by a small handful of people whose disreputable motivations are tinged with biase.

It needs to be made clear that all medical interviews and examinations conducted by SMPs are of damaged people. Every officer or former officer they see will have suffered a potentially life changing physical or mental injury. Many will have suffered both physical and mental damage. They deserve to be approached with kindness and understanding. Qualities which are entirely lacking in some SMPs.

The man on the Clapham omnibus would be forgiven for thinking that scheme managers and SMPs would make their prime responsibility the welfare of the officer or former officer. Shamefully, that is generally not the case.

For example, we hear frequently of the complete lack of any regard to both the practical and psychological difficulties faced by officers and former officers when called to attend a medical examination or interview. It’s not hard to wonder at the unthinking attitude of any force which apparently sees nothing amiss in arranging for these SMP sessions to take place on police premises.

This should be the last place a traumatised individual should be asked to visit. This choice of venue is guaranteed to increase the risk of triggering flashbacks in PTSD sufferers, and inevitably gives the impression of an intention to control and dominate events. The oppressive nature of this arrangement illustrates the unhelpful attitude we see in some forces, where injured, disabled former officers are seen only as a drain on resources, Although they have left the force, and are no longer employees, some forces deal with them as though they were.

Instead of being politely asked to attend a SMP session, they are often, ‘advised an appointment has been arranged’. No consideration given as to whether the place or the time, or the travelling to and from might be inconvenient or difficult for the individual.

IODPA believes that all SMP sessions should be held on neutral territory, preferably a medical facility, properly designed and equipped to cater for the needs of disabled people. SMP appointments should be made at a time and place convenient to the individual, not arranged entirely for the convenience of the force or the SMP.

We have heard much about the unpleasant and coercive practice whereby the SMP asks the disabled person to complete a “customer satisfaction” survey. The pensioner is told something along the lines of, ‘No, you can’t take it with you to complete and send it back. You must do it now, and no, you can’t have a copy. Complete it before I commence my examination and interview and if you don’t then I may not be able to proceed.’

Coercive behaviour of that nature is unbecoming of any medical professional. We have heard of SMPs who are never more happy than when their decisions are appealed. They can sit back and let the force’s legal department take over whilst they look forward to another fat fee for attending the appeal hearing. At the going rate for SMP services of around £250 an hour, that is as shady dealer Arthur Daley would say, ‘A nice little earner.’

We are frequently told of SMPs reports which bear little to no relationship to what was said and done during an examination or interview. In the most extreme examples an SMP has told the pensioner verbally during the examination/interview that the decision will be no alteration in disablement, and hence no reduction in pension payments, only for the SMP’s report to show otherwise.

We have heard of venues where ‘security cameras’ capture the arrival of the disabled individual and follow their progress right into the room where the examination/interview is to take place. Whilst capturing video for security purposes is acceptable, it is not at all acceptable for a SMP to then view the footage to see how the disabled person arrives, whether they come by car, and what make and model of car, or whether they drive or not, or how they manage the stairs, opening doors, how they walk, etc. All done without the individuals knowledge or consent, and with a view to taking these observations into consideration when making a medical decision.

Mention of video recording leads us naturally into what has been a contentious issue, and the cause of much distress to disabled officers and former officers who are assessed by a SMP. The Regulations do not set out anything about audio or video recording. Nor do they grant any power whatever to SMPs to allow them to ban recording by the individual.

No honest SMP would see any reason to object to recording. Those who have objected can only have done so with one objective in mind, and that is to prevent an accurate record of proceedings being made, so their version of events can not be successfully challenged.

We also hear, too frequently, of SMPs who either downright refuse or strongly object to the disabled individual having a friend, supporter, or carer present during the examination/interview. This of course gives rise to justified suspicion that the SMP wishes to place the individual at a disadvantage whilst also ensuring that there is no witness to the proceedings who might later dispute the SMP’s version of what was said and done.

Needless to say, the GMC and other medical professionals’ organisations advise all doctors conducting any professional interaction with individuals to allow a friend, carer or chaperone to be present if the patient so wishes.

And it is the use of the term ‘patient’ which some SMPs think gives them wriggle-room to behave in ways that contravene GMC guidelines. They claim that the individual is not their patient, so the guidelines don’t apply. In thinking this they are sorely mistaken and IODPA advises all its members and any non-members reading this that no SMP can refuse the individual in having a friend, carer, supporter, or even a legal representative present.

It is frankly indicative of their combative mind-set that some SMPs would even dream of trying to refuse or object to the presence of a companion. Due variously to misinformation, lack of information, deficient expertise, even natural inclination, some SMPs see themselves as protectors of their force’s budgets. They are on a mission to seek out every little opportunity to find a reason however flimsy, however inventive, or however fly-in-the-face of the facts it is, to come to a decision which results in a reduction of benefits due.

In a blog published last year https://iodpa.org/2018/07/03/recordingreviews/ we said:

IODPA therefore advocates that anyone who attends a medical interview or examination by a SMP, or any other doctor to whom they have been referred to by a SMP, should not only insist they are accompanied throughout by a friend, but should also make a recording of the entire event, and should do so openly.

We advise that the doctor be told the session is being recorded.

If any doctor objects, then the objection should be acknowledged and the doctor told they have no legal power to prevent the recording.

Doctors should have no cause to object, for a recording is as much a protection for them as is it is to the individual.

Recording is lawful because you are only processing your own personal information and are therefore exempt from data protection principles.

The recording remains the property of the individual, who may well find it could be admitted as evidence should they decide to appeal any decision made by the SMP, or if matters go to an industrial tribunal or judicial review. The GMC will also likely accept the recording as evidence in any complaint proceedings against a doctor.

A SMP is supposed to be an independent medical expert whose role is to weigh all the medical evidence lawfully available in a truly disinterested manner. It should not be any concern of the SMP whether any decision they make results in financial advantage or disadvantage to the individual. Their responsibility is to the Regulations, which require them to make a decision, and by clear inference to make that decision free of bias, and with due consideration of all relevant factors, with the exclusion of irrelevant factors.

Presently, that is not happening universally. In plain terms, there is a whole lot of dodgy behaviour going on, both with some SMPs and HR/ Occupational Health staff. In the worst cases the corruption has spread to the top of the tree.

For the sake of all that is decent, for the sake of the reputation of the medical profession, for the sake of the health and well being of disabled officers and former officers, this must stop.