Should doctors be sent to prison for clinical negligence?

In February 2010, consultant colorectal surgeon David Sellu operated on a patient with a perforated bowel, who subsequently died. The surgeon was found guilty of manslaughter by gross negligence and sentenced to two and a half years in prison. Although his management of the patient was clearly inadequate and the delays unfortunate, many have found it hard to see what value to society is served by imprisoning a 67-year-old surgeon. A GMC enquiry followed by some sort of censure might be considered a more appropriate response to this case, rather than a police prosecution.

Read more about this case in Roger Kirby’s article The consequences of medical mistakes: the stakes are getting higher!, published in the November/December 2014 issue of Trends in Urology & Men’s Health.

Should doctors be sent to prison for clinical negligence? Leave a comment below – we would love to know what you think!

Comments (76) Add yours ↓
  1. Declan Murphy

    Roger’s blog explores a situation which we seem to be encountering ever more frequently. Being a doctor carries serious responsibilities and when we get it wrong, the consequences may be very serious. Dr Sellu clearly deserved to take much of the responsibility for this disaster (whatever happened to “the sun should never set or rise on a suspected bowel perforation”??), it also appears that the isolated private practice environment in which this took place also contributed. Does the private hospital also not have some responsibility to ensure that there is emergency anaesthetic cover available at all times? I think the blame (and severe penalties) could have been spread more widely in this situation.

    Declan Murphy, Melbourne

    November 27, 2014 Reply
    • Richard Morey

      I think that anaesthetic on call for private patients is extremely complex and whilst needing to be debated did not affect the outcome in this case. If necessary immediate transfer to the NHS could have occurred. Many provincial private hospitals do not have the facilities or expertise to provide adequate ITU care and I suspect that had the patient survived his operation would have been transferred out to the NHS anyway. Happy to discuss this further.

      December 2, 2014 Reply
  2. Jon Rees

    Thanks Roger – it’s a difficult one – the question ‘should doctors go to prison for clinical negligence’ is hard to answer yes/no – there will always be a point at which the negligent act crosses from being a civil offence into being a criminal act, and we should always be aware of the potential consequence of our (in)actions. But, I would wholly agree that in the vast majority of cases, a custodial sentence benefits no one and is an example of an outdated criminal justice system…

    It brought to mind parallels with sport – when does an act committed on a sporting field cross the line from being dealt with by the internal governing body, to being one for the police and justice system – this recent rugby league ‘assault’ springs to mind!


    November 27, 2014 Reply
  3. Ben Challacombe

    Having read a lot about this case it does seem over the top to me, and people i have discussed this with, to send this man to prison. He answered the phone when not on call and the sequence of events had catestrophic consequences. But he was trying to help in a very difficult situation.
    Just a glance at the hundreds of comments supporting him on this site tells us so much about the high esteem he was held in by his colleagues.

    November 30, 2014 Reply
  4. Christopher Woodhouse

    I suspect that the CPS thought of this case as one where the classic ‘man on the Clapham Omnibus (MOCC)’ would think that serious harm or death could result from Mr Sellu’s actions, rather than as medical negligence. Although clinicians will all have an anxiety that we could have been in the same position, we must not consider ourselves to be immune from such an accusation. In this case, there were several other people and organisations who share the blame and if Mr Sellu was being tried as a person rather than as a consultant surgeon, it does seem very unfair that he had to carry all of the consequences.
    I have not been able to see in any of the articles why the bowel perforated after an apparently uncomplicated TKR. I speculate that with such an unexpected event, the MOCC might think that removal to a hospital that could provide multi-disciplinary care would have been better, hence the accusation of manslaughter rather than medical negligence.
    It is very sad to see that the lives of very many people have been destroyed by these events.

    December 1, 2014 Reply
  5. Declan Cahill

    Please also visit the David Sellu website and read the many notices there and feel free to offer comments.
    David Sellu has an excellent reputation according to those I have sopoken to that worked for him as juniors. A great teacher, good surgeon etc. What a desperate career summary to end up in jail. It appears to have been a trait of his to say “yes I can help”. On this occassion he couldn’t convert it. This will come to translate into ” sorry but I can’t guarantee my undivided attention for this case of YOURS, therefore it’s got to be a no,” when called about a private patient on the orthopedic service for instance.

    December 1, 2014 Reply
  6. Culley Carson

    This is a very frightening article. In the US where medical malpractice is rampant and law firms advertise on TV for patients with sling failures and CV disease and TRT, we have not yet gotten to the stage of imprisoning physicians for medical malpractice. There have been a few that went to prison for fraud, gross neglect with dire consequences.

    It gives one pause when a phone calls in the night for help with a patient that you don’t know or are not secure in thinking that the system can help in finding the appropriate consultants or imaging. We all do our best to help patients and feel very distraught when bad things happen to those under our care, but to think that when things don’t go as we would have liked and, despite our best efforts, the patient does not do well, we will be held criminally responsible, is very scary. While the lawyers in this case were off the rails in my opinion, it is only with talented defense attorneys and well prepared expert witnesses that we can fight this abuse of legal power.

    December 1, 2014 Reply
  7. Mike Kirby

    This is a sad and eye opening event, which shows how dangerous our work has become. I guess we all do our best, but mistakes happen, and when they do, we feel great pain ourselves and guilt. Clearly great vigilance is essential when dealing with potentially lethal conditions and team work is essential; it seems that he was not well supported. A custodial sentence is not the way to deal with this event.

    December 2, 2014 Reply
  8. Richard Morey

    A well balanced article describing a sorry tale indeed. There are several episodes where the care given to Mr Hughes could be considered to be substandard. The delay in arranging an urgent CT scan compounded by the prioritisation of an elective private list does not look good and I suspect influenced the judge’s decision. The failure to document clinical findings in effect meant that nothing appeared to have been done. Doctors have been under the spotlight for some time now and we cannot expect to be treated differently by the law to a teacher who fails to adequately supervise an outing of children or a motorist who kills a pedestrian whilst using a mobile phone. Unfortunately a custodial sentence was inevitable but like others I would be interested to know the judge’s thoughts as to the benefit of locking A 67 yr old man up and not suspending the sentence. I assume it was to send a powerful message to us as for a dedicated professional the criminal record and erasure from the medical register would have been shameful enough.

    December 2, 2014 Reply
  9. Roger Kirby

    The response to this blog and the article in Trends that it is based upon, “The Consequences of Medical Mistakes”, is rather gratifying. The consensus so far seems to be that the imprisonment of David Sellu was an inappropriate response to the mistakes that he (and others) made. Unfortunately, the message that this custodial sentence has sent out is that doctors now need to practice a more defensive form of medicine to avoid the risk of prosecution. This in the end is bound to be bad for patients, doctors and the healthcare system itself.

    December 2, 2014 Reply
  10. Guy Webster

    There does appear to be a blurring of where a line is drawn in many aspects of life and they are extremely difficult to assess, but the lawyers seem able where mortals struggle.

    I am very sorry for the patient’s family but I feel enormous sympathy for David Sellu, clearly a very able and competent doctor, and a compassionate individual who made a mistake and was working in a complex environment that let him down on the day. Good Samaritan acts are a huge concern for medics currently. Because of subsequent legal intervention .

    When Sean Abbott ran in last week to bowl to Phillip Hughes at the SCG it was not with the intention to make him laugh or feel better. Statistically unlikely (1 in 10 million ??) the consequence was tragic for his family and for cricket and the world has lost a supremely talented and young sportsman. I have read that cricketers cannot imagine what Sean Abbott is going through; I suspect a fair few surgeons do. Better to be lucky than talented as one of my bosses used to say at the end of every major case.

    I will be following the sporting and legal implications of last weeks Australian tragedy with great interest.

    December 4, 2014 Reply
  11. PS- Prasanna Sooriakumaran

    This is a tricky one. While I echo the sentiments of Roger and the others that it seems that no-one benefits by putting a 60-something year old surgeon in prison for 2+ years, there has to be an element of punition for a doctor that causes death by gross negligence. There is no doubt he was negligent (he fulfils the 3 pillars: duty of care, breach of that duty, and causation), and the judgment here rests on whether that negligence should result in criminal rather than civil conviction. As is consistent with punitive systems, it’s not just about what good the sentence will do, it’s about making the person pay for his crime. And Mr Sellu will surely do that. PS

    December 4, 2014 Reply
  12. Dr Eric Webb

    I comment as a simple GP, now approaching retirement, but with some experience of the private hospital environment: until recently I sat on the MAC of our local BMI Hospital.
    In my view, first in line of responsibility here stands the private hospital where the disaster occurred – which deserves an urgent inspection by the CQC and – at minimum – to be banned forthwith from carrying out any further surgery requiring overnight care until it sorts itself out.
    The Bulgarian SHO should be suspended from UK practice – and here the GMC itself is at grave fault for failing properly to assess the language skills of incoming EU (and other) doctors.
    Yes of course, Mr. Sellu fouled-up badly. His mistake was to take responsibility. Any GP faced with such a patient at home – or in a GP convalescent bed – would (should!) immediately send him up to the general hospital for a surgical assessment. ‘Simples’!
    Did he deserve to be struck-off? Probably not, but certainly censure and a period of restricted/supervised practice. Perhaps it had come time for him quietly to retire.
    Did he deserve a conviction for manslaughter? No! He made mistakes but there was certainly not the necessary degree of recklessness in his actions / failures. The verdict is a legal nonsense and I hope it will be appealed. Did he in any case deserve a custodial sentence? Most certainly not!
    Dr. Sellu has at least the consolation that he is both more competent and more caring than his trial judge. The unhappy thought occurs, even in this day and age, that if he had a white skin he would probably still be a free man.

    December 6, 2014 Reply
  13. Matthew Bultitude

    Indeed a very sad story. i suppose a key question is whether he really suspected bowel perforation on the Thursday night. If so then surely he did need a CT +/- laparotomy that night. Having said that, so many other problems/ questions in this case as mentioned in other posts above. Clearly issues with David Sellu for the GMC to decide on … but manslaughter and prison – really?!

    What I think this cases does highlight is that we (as doctors/ surgeons) will have to be far more defensive in our practice – probably to the detriment of patients. Private hospitals are also going to have to sort themselves out. David Sellu was under no obligation to accept the referral on the Thursday, and the hospitals are going to have to organise (and pay for) an on-call rota for acute specialities. The story of David Sellu having to ring round multiple anaesthetists is one that many surgeons will relate to.

    December 7, 2014 Reply
  14. David Redman

    Medicine is not always practised by ‘doing our best’ despite pompous protestations to the contrary. Normally this does not matter but when something like this case happens it is subjected to intense and sometimes unreasonable scrutiny. Perfection is hard to achieve and most medical management will be found wanting. It is hard to deny the need for endless tests and referrals but we do have to be sensible.
    Poor Mr. Sellu is a victim of the mood of the age which insists that the privileged eg bankers, doctors, politicians journalists etc. should be punished.
    Release him

    December 8, 2014 Reply
  15. Roger Kirby

    On top of an increasing risk of a manslaughter charge against a doctor who has made a serious medical mistake, the GMC are contemplating increasing the strictures it applies to medical errors. Doctors could face a “trial by media” if proposed changes to the General Medical Council’s guidance on sanctions go ahead, the BMA has warned.

    The association raised the concern in response to a GMC consultation on the way that the regulator deals with concerns about doctors through its guidance for the panels that investigate doctors’ fitness to practise. The Medical Defence Union has also raised concerns about the guidance and has called for the warnings that the GMC sends to doctors to be scrapped.[1]

    According to the BMA, the GMC consultation suggested that fitness to practise panels should consider taking action to maintain public confidence in doctors even when a doctor had remediated, if the concerns were sufficiently serious or persistent. “The BMA fears this could lead to panels punishing doctors who pose no threat to the public, solely on the basis that failure to do so might incur the disapproval of the public. It warns there is a risk of doctors facing ‘trial by media,’” the BMA said.

    The association also queried proposals that could have an effect on whistleblowers. The GMC’s consultation proposed that fitness to practise panels should “consider more serious action where cases involve a failure to raise concerns and, in the most serious cases, to remove or suspend doctors from the medical register to maintain public confidence.”[2] The BMA said that this was “fraught with difficulty,” because failure to raise concerns may reflect organisational and cultural failings. “It highlights legal advice indicating that the proposal ignores implications for other areas of law, especially whistleblowing,” the association said.

    Mark Porter, the BMA’s chair of council, said that, although patient safety had to be paramount, some of the GMC’s proposals went a step too far. He said, “We all want doctors to be working to the highest standards and, where things have gone wrong, be held to account. However, we are concerned that the GMC proposals are disproportionate and could have unintended consequences in areas such as raising concerns or a doctor’s right to defend themselves, which would be counterproductive.”

    Rimmer A. GMC warnings should be scrapped, says MDU. BMJ Careers 17 Nov 2014.
    General Medical Council. Reviewing how we deal with concerns about doctors. Aug 2014.

    December 14, 2014 Reply
  16. Vaibhav Modgil

    As a trainee surgeon, this case certainly focuses the mind. It is, in all honesty, frightening.

    At a time when the NHS is under severe financial pressure, with further plans to cut expenditure, health professionals are asked to become ever more efficient and continue to meet targets. At the same time, I agree with Matthew Bultitude’s comments – we are ever more defensive in our practice.

    I remember distinctly talking of the ‘art of medicine’ in my personal statement when applying for medical school. That art is not simply to learn a collection of facts, and master one’s subject matter, but also to trust one’s intuition and rely on a growing experience within medicine. There can be no excuse for genuine neglect of a patient, and nor should doctors be exempt from accountability if such allegations are proven to be true.

    However, defensive medicine is now well and truly being practised in the UK. We are not quite at the stage where everyone with abdominal pain has a CT scan in the Emergency Department to ensure doctors are covered medico-legally, but I wonder if that’s where we are heading. Striving for excellence, as opposed to fear of being reprimanded, is what should drive doctors when treating each patient. Such tragic cases are likely to encourage the latter, at a time when the NHS can least afford it.

    December 16, 2014 Reply
  17. Ahmad

    I work as a GP and I have a lot of sympathy for the risks surgeons, for that matter all clinical doctors, face on a daily basis, not least because I have several friends who are also surgeons.

    Regarding the article on David Sellu and the delay in doing investigations and acting upon them. I find that this is commonplace in the current health systems we work in and it is pure unadulterated luck that we do not see more harm than what should actually happen as a result! I honestly cannot see that a prison sentence is the right thing for him, nor in the public interest. Public lust for retribution, allegedly, and the need to maintain public confidence, allegedly, would have been served if he had a professional rebuke or similar. After all, the PTSD Dr Sellu will suffer from, from this act of omission is surely enough punishment for him! From my readings, he was an otherwise excellent surgeon, who only happened to be human. But he didn’t choose to be human, to be fallible, did he?

    Take for example this URL link Here it is said a subdural was “successfully managed at home”, secondly further tests were not possible due to lack of facilities on the patient with dizziness and double vision and so the patient was advised to come into hospital the next day. By inference, David Sellu was simply unlucky then, no?

    There are many examples, and I am sure you will agree with me here, where there are narrow misses, often due to systems errors (working in busy environments), and it just so happened, employing the retrospectoscope, that harm did not follow.

    January 5, 2015 Reply
  18. Dr.Ken Menon

    In this tragic case one needs, as far as possible, to review events and the judgement dispassionately to arrive at conclusions that would help surgeons and all doctors. With the massive outpouring of sympathy for the surgeon and his family and the shock expressed by the medical profession at the nature of the sentence, one also needs to look at this case from the view points of the family of the deceased. The judge’s remarks provide an insight to their feelings and the enormity of their loss.

    When the patient was first seen by him, Mr. Sellu clinically suspected bowel perforation. This is a surgical emergency with worsening sepsis and high mortality. At that point every effort should have been made to confirm or dismiss the diagnosis of perforation. Confirmation of diagnosis would have mandated emergency surgery the same night, which would, undoubtedly, have improved the chances of survival. That the surgeon ‘wanted the patient to have a peaceful night’ could not be a defence. By the events of that night the patient was consigned to deterioration. It is within the realms of possibility that, if perforation and hence peritonitis was suspected, the patient had been in this condition for several hours. Knowing that 37000 patients die annually of sepsis, these events constitute the first serious acts of negligence. .

    Did he review the patient on the following morning and what was the content of the review? Here, we are left in much doubt as to what transpired, if indeed he did review the patient.

    When informed that there was radiological evidence of perforation, Sellu made a gross error of judgement in postponing surgery until later that day. The error of judgement arose in his failure to prioritise urgent surgery for a life threatening emergency. In reality this is gross negligence.

    It is difficult to agree with the statement that the ‘management of the patient was clearly inadequate’. On the contrary, management of the patient was grossly negligent, amounting to a ‘wilful blindness’ to the gravity of the evolving situation.

    In R v Adomako (1994) the Law Lords upheld the decision of the Appeal Court, of gross negligence manslaughter in that instance. That there was gross negligence in this case is without doubt. The resulting death has to be seen in that light. In this, apparently exemplary, sentence the judge was sending a clear message that in cases of criminal negligence manslaughter, a custodial sentence could be expected.

    Private hospitals have a duty of care to patients in ensuring that facilities are available to deal with complications and emergencies in their premises. Is it too much to ask that each hospital has a duty anaesthetist, radiologist, surgeon etc. to cover any eventuality?

    Yet again the failure to document what was done and/ or said has failed Mr. Sellu in his defence, although given the turn of events it is unlikely to have materially affected the outcome of the case. It remains vital to record any and all contacts with and about a patient that one has responsibility for.

    Reading the many messages of support for David Sellu a not uncommon theme is a failure to adequately recognise that serious errors and omissions have occurred resulting in the loss of life. One cannot agree more with a previous statement by the author – ‘One enduring feature of the medical profession is a reluctance to face up to and admit freely that an error has occurred’.

    While it is important to support a fallen colleague, we must resolve that this is done alongside recognition of the errors that led to the fall. In this way we could learn from mistakes, improve practice and send a clear message to patients and the public that, while errors will continue to occur, we shall at all times work to reduce risks and learn from errors, to help avert similar ones in the future. This is what the airline industry has done; we need to follow as a matter of urgency.

    January 6, 2015 Reply
  19. Matt Dunckley

    Very interesting number of comments. All is not as it seems in this case and it most certainly was not the case that Mr Sellu simply made a treatment plan for the patient to have “a quiet night.” Thats what the Prosecution would have you believe……Neither can anyone without knowing all the facts conclude that ” that there was gross negligence in this case was without doubt.” Its public knowledge that there was clear disagreement between the experts on this fact. With respect to failure to document please be very careful by casting judgement on this when you don’t know all the facts. As to “exemplary sentence ” well I’d simply say that as a surgeon “there but for the grace of God go I and all of us” and I challenge any surgeon to say on their worst day… Could that ever happen to me?. That’s why this was all wrong and should rightly be challenged.

    January 18, 2015 Reply
  20. Ahmad

    This case below is very similar to Mr Sellu’s case, but it will end in a compensation award and lessons learned; things put in place to make sure it does not happen again.

    Why shouldn’t Mr Sellu suffer the same fate, why did he have to go to jail when the doctor or team of doctors in this case below will not?

    February 23, 2015 Reply
  21. Roger Kirby

    For all of those interested in this important issue there is an upcoming “Doctors and Manslaughter” meeting in London. Do take a look at this link:
    and register for a modest £25. A very worthwhile investment if it keeps you out of prison!

    February 25, 2015 Reply
  22. Roger Kirby

    Check out the first ten mins of this BBC programme. It sets the scene for the disaster…..

    March 3, 2015 Reply
  23. Roger Kirby

    Another issue that is troubling is that David Sellu, having already suffered the indignity of imprisonment for the management of this case, will now have to go through the trials and tribulations of a GMC investigation. There has been a great deal of disquiet about the way in which the GMC pursues its investigations recently. Not least because 28 doctors, including two trainees, have committed suicide while under GMC investigation. I have a blog running on the website: entitled “Is GMC investigation an ‘occupational hazard’ that doctors should accept?” Comments on that aspect of this case are most welcome.

    March 7, 2015 Reply
  24. Mervyn58

    An interesting read – how many privately operated patients end up in NHS A&E? And then the NHS have to fix the problem. Do the private hospitals then pay the NHS for all the care? It would appear private hospitals are compounding the load on the NHS – and lining their own pockets at the same time! Maybe the private hospitals should be fined if their patient ends up at an NHS hospital. In this case, I think blame can be apportioned to the private hospital for failing to complete an operation to a safe standard. It can also be apportioned to the trust for the management of resources. And it can be apportioned to the all the “umbrella” organisations that the NHS has, that should have made sure that there was a suitable resolve for the scenario that caused the death. Was this doctor trained to a high enough standard for the job position that he had undertaken? The doctor is to blame if he knew that delaying action would cause death – and he went on his tea break. If he had pursued every possible avenue and could do no more then this is not his fault.
    But on the question of “should a doctor be sent to prison for clinical negligence?” YES YES YES! But defining the allegation of negligence and proving that the one person is 100% to blame IS when they should go to prison. If there are co-workers who are too scared of whistle-blowing then they are also putting themselves at risk of “joint manslaughter”. If the management infrastructure is poor and can be linked to the death, then the management are also at risk of being sent to prison. If there is a pattern of poor practice then it becomes a bit easier to upgrade “misadventure” to “manslaughter”.

    May 20, 2015 Reply
  25. Roger Kirby

    A doctor and two nurses have recently been charged over the death of a woman who had left an abortion clinic hours earlier.
    Dr Adedayo Adedeji, 62, is accused of manslaughter by gross negligence and by failing to take reasonable care of people affected by his work.
    Nurses Gemma Pullen, 31, and Margaret Miller, 54, are charged with the same offence.
    The expectant mother, 32, reportedly died in a taxi in January 2012 following an abortion at a clinic in Ealing, west London.
    All three have been summoned to appear at Ealing Magistrates’ Court on June 19.
    It was reported in 2013 that the woman had travelled to the capital from Dublin, having been refused the operation in Ireland.
    According to the Irish Times, a post-mortem showed the mother-of-one had died from a heart attack caused by extensive internal blood loss.
    Speaking anonymously, the woman’s husband allegedly told the paper his wife had had a child in Ireland in 2010, but added the pregnancy had been painful and complicated by fibroids – a condition that could have caused infertility if treated.
    Last year it was reported the number of Irish women travelling to the UK for abortions had dropped below 3,000 for the first time.

    June 6, 2015 Reply
  26. Roger Kirby

    And another manslaughter charge against a doctor:
    Doctor and nurse appear in court charged with manslaughter of six-year-old Jack Adcock.
    “A doctor and a nurse appeared in court recently charged with the manslaughter of a six-year-old boy at Leicester Royal Infirmary.
    Dr Hadiza Bawa-Garb and ward sister Theresa Taylor pleaded not guilty at Nottingham Crown Court to the manslaughter by gross negligence of Jack Adcock at the hospital on February 18 2011.
    Dr Bawa-Garb (38) of Watkin Road, off Upperton Road, Leicester, and Theresa Taylor (55), of Henley Road, Western Park, Leicester, were granted unconditional bail.
    Staff nurse Isabel Amaro (47), of Balmoral Court, Manchester, did not appear in court due to ill health”.
    There does seem to be little doubt that manslaughter charges against members of the medical profession are becoming more prevalent. How should this change the way we practice?

    Read more:

    June 7, 2015 Reply
  27. Roger Kirby

    And yet another example of the ways things are going:

    June 21, 2015 Reply
  28. Roger Kirby

    This story seems destined to run and run. The Times on Saturday ran an article on David Sellu which emphasised that sending surgeons to prison for their clinical errors seems only likely to make the profession more “risk averse” and more likely to practice defensive medicine:
    It costs more to incarcerate a person for a year than it would to send your son to Eton! It does seem very hard to see what good has come from the imprisonment of Mr Sellu, who was just on the verge of retirement from surgery before the sentence was given

    July 13, 2015 Reply
  29. Roger Kirby

    Listen to this LBC interview with Jeremy Hunt in which I ask him if it is sensible to send doctors to prison for manslaughter after a medical error:

    July 13, 2015 Reply
  30. Roger Kirby

    Jenny Vaughan and Ian Franklin have composed a letter of support for David Sellu:
    Do follow the link and read it and if you feel so inclined add your signature to the list of those who feel that David should not have been imprisoned.

    July 24, 2015 Reply
  31. Roger Kirby

    Read the article in the Daily Mail about the David Sellu case: Some interesting revelations! And many supportive comments.

    July 26, 2015 Reply
  32. Roger Kirby

    Read this article in the Guardian about David Sellu’s forthcoming appeal against his manslaughter prosecution

    August 7, 2015 Reply
  33. Roger Kirby

    And another manslaughter charge against a healthcare professional:

    September 10, 2015 Reply
  34. Eric Webb

    For the time being, details of this case remain sparse. However – and as with David Sellu – it seems inherently extremely unlikely that – however lamentable her performance – Honey Rose demonstrated anything like the degree of wilful recklessness in her assessment of the poor lad concerned which would justify the charge, let alone a guilty verdict.

    We note too that – like Dr. Sellu – she is non-white. But off course, that could not possibly influence our incorruptible Police Force or prosecuting authorities. Perish the very suggestion!

    September 12, 2015 Reply
  35. Roger Kirby

    Worryingly other healthcare professionals are also being charged with manslaughter. Here is another recent example:
    Surely we should be taking a stand and pointing out that criminalization of those individuals who make errors when caring for their patients prevents lessons from being learned about the problems with the system which have led to the “fatal mistake” being made in the first place?

    September 19, 2015 Reply
  36. Roger Kirby

    There is now a petition to get the conviction of David Sellu overturned. Here is the link:

    September 19, 2015 Reply
  37. Philip

    People are human. They all make mistakes and even more so when they are stressed and busy.
    Do all lawyers and Journalists never make an error? The regulatory bodies need to handle these situations otherwise what is the point of having them?

    October 6, 2015 Reply
  38. Roger Kirby

    And another case for those following this sorry saga:

    October 17, 2015 Reply
  39. Eric Webb

    The rule ought to be that errors – however gross or seeming-gross – in the course of honest professional practice are to be left to the regulatory bodies. If investigation by those bodies reveals contributory dishonesty or unprofessional behaviour, the CPS ought to be notified. If Errol Cornish mis-represented his qualifications on appointment, if he cheated his revalidation or reappraisal – including the concealment or some or other disability – if he came on duty drunk or under the influence of drugs, prosecution may well be justified; and of the Hospital Authority if it ought to have been aware of suchlike infractions, if it failed to make proper checks.

    I have mixed feelings here. Our own Hospital Authority – which I had better not identify – has a pretty poor record of neonatal deaths (not maternal) over recent years, has been in and out of special measures, subject to an internal enquiry, recently earned the coroner’s criticism yet again. That they are now demonstrably at risk of a charge of corporate manslaughter in case of any repetition could perhaps be salutary!

    October 19, 2015 Reply
  40. Roger Kirby

    Another doctor found guilty of manslaaughter this week and now awaiting sentence.

    There is an importnat question mark over whether the resuscitation would have been successful in such an ill child? I also understand that the hospital laboratory results system was down until 4 o’clock on the day in question. Like so many of the cases above there is an element of “system error” involved here that the judiciary do not seem to take fully into account, preferring instead to pin the blame on an individual doctor.

    November 5, 2015 Reply
  41. Roger Kirby

    “If my husband can be jailed, so can any surgeon”

    His spotless career had spanned 40 years, but Dr David Sellu was sent to prison after the death of a patient. His wife Catherine tells Margarette Driscoll in an article in the Sunday Times her fear: others will be put off practising medicine…

    Article by Margarette Driscoll Published in the Sunday Times 15th November
    David Sellu has lost his liberty, career and income, says his wife Catherine
    After a career as a consultant surgeon, packing breakfast cereals and sweeping prison corridors isn’t just humiliating; it feels surreal. David Sellu once had an enviable life: the mantelpiece at the family home in Hillingdon, west London, is adorned by a photograph of Sellu and his wife, Catherine, in evening dress setting off to a party at Ealing Hospital.

    These days a very different image of her husband is etched on Catherine’s mind. “I went to visit him, and the prison shirt he was wearing had only one button. He sat clutching the front to keep it from gaping open, trying to maintain some kind of dignity,” she says.

    “There was a hole in his prison shoe. It was really heart-rending to see and so very unfair. David is a broken man; his life has been trashed.”

    In November 2013 Sellu, 68, was convicted of manslaughter by gross negligence and sentenced to 2½ years in prison after a patient died in his care. James Hughes, a retired builder from Co Armagh, had been admitted to the Clementine Churchill Hospital in Harrow, northwest London — where Sellu ran his private practice — in February 2010 for a simple knee operation. In the days after the operation, which was performed by another surgeon, Hughes, 66, began suffering agonising abdominal pain and Sellu, a colorectal specialist, was asked to examine him.

    Sellu’s attempt to help ended disastrously for both men. After a series of delays and misunderstandings among the team looking after him, Hughes was given emergency surgery for a perforated bowel but died the next day. Sellu, as the surgeon in charge, was blamed for his death.

    “The very sad thing is that as well as the trauma for us, the Hughes family still don’t have justice,” says Catherine.

    “It is tragic that Mr Hughes died but one person doesn’t work alone in a hospital. David has never denied there are things he could have done differently, but this was a difficult, complex case and what’s happened to him is part of a very worrying trend. Who will want to become a surgeon if they have the threat of criminal prosecution hanging over them when things go wrong? This is certainly not going to improve patient safety.”

    The Sellu case has caused huge disquiet in the medical community. He was no “rogue” surgeon but a solid, trusted professional who was often asked to operate by colleagues and had treated several VIPs.

    Last August I wrote about him in The Sunday Times Magazine, highlighting a small but worrying number of cases where the police had been called in to investigate medical mishaps. Within days a website set up by supporters ( had received hundreds of messages and the campaign to have his conviction overturned has continued to gather pace.

    A petition to this end has attracted nearly 2,000 signatures and in the summer more than 300 doctors, including many senior consultants and 16 professors, put their names to a letter to Clare Marx, president of the Royal College of Surgeons. They expressed alarm at recent prosecutions and asked for a review of expert witnesses in cases brought against medical personnel, offering to work with the lord chief justice’s office to ensure that any trials are fair.

    There are no official figures but anecdotal evidence suggests criminal prosecution is becoming more common in medical emergencies. Earlier this month Dr Hadiza Bawa-Garba was found guilty of manslaughter after she wrongly halted attempts to save the life of Jack Adcock, 6, when he stopped breathing, having mixed him up with another child who had a “Do not resuscitate” order. Adcock, who had Down’s syndrome, was admitted to Leicester Royal Infirmary suffering from sickness and diarrhoea in February 2011. Just 11 hours later he was dead.

    In Kent two doctors were charged with manslaughter by gross negligence and a hospital trust with corporate manslaughter earlier this year over the death of a woman giving birth by emergency caesarean section. Criminal charges were also brought last month against Mid Staffordshire NHS Foundation Trust over the deaths of four patients.

    No one denies that in all these cases things went terribly wrong; the question is whether a criminal court is the right place to discover why. Hughes’s family may feel justice has been done, but deaths and medical mishaps have traditionally been investigated in a “no blame” atmosphere that allows doctors and nurses to speak openly about things they think might have got wrong.

    A recently introduced “duty of candour” is designed to ensure patients and families receive an honest account of what happened if something goes wrong. But many believe that if criminal charges are a prospect, doctors will be wary of admitting mistakes or will simply refuse to operate on difficult cases. “Who will want to take on high-risk cases if there’s a possible prison sentence waiting if things go wrong?” asks Catherine.

    The Sellu case was complicated by the fact that it happened in a private hospital. In an NHS facility a fully staffed emergency operating theatre is always on hand. Private hospitals such as the Clementine Churchill are set up — often excellently — to perform pre-arranged elective surgery, not emergencies. Theatres are booked and staffed according to planned schedules.

    Hughes’s condition had started to deteriorate on a Friday afternoon. There was no anaesthetist available and Sellu spent several fruitless hours trying to find someone who could assist him with the operation. If he had washed his hands of Hughes, ordered an ambulance and sent him to the nearest NHS hospital he would probably not have ended up in jail.

    A root cause analysis carried out by the Clementine Churchill a month after Hughes died found that the hospital’s procedures for dealing with emergencies that developed after routine operations were “not robust enough to prevent a systemic failure”. The report found that monitoring was inadequate and there were failings in the procedures for escalating concerns.

    There was a delay in giving Hughes a CT scan, confusion over when Sellu had seen Hughes and whether he had prescribed antibiotics to keep Hughes stable. Sellu insisted he had; the registrar on duty denied having received that instruction.

    The hospital had no emergency anaesthetic rota and it was late evening before a suitable anaesthetist was found. By then it was too late. Hughes could hardly be stabilised for anaesthetic and died later from sepsis. In sentencing Sellu the judge acknowledged that Hughes’s condition was so serious that he might have died anyway but said Sellu had been “far too laid-back” in his approach to a life-threatening case.

    Hughes died in February 2010. Sellu continued to work at the Clementine Churchill until September that year, when BMI Healthcare, the hospital’s owner, commissioned an independent report that recommended his suspension. At the inquest the coroner called in the police.

    Sellu was released in February and is serving the rest of his sentence on licence. He is not able to speak publicly but is keeping his mind active by learning French and Arabic and writing a book. When he was convicted, friends urged him to appeal but Catherine says they were “feeling too fragile, shaken, shattered” to proceed. With the passage of time, Sellu has regained his strength and has decided to seek leave to appeal now: a preliminary hearing is expected within the next couple of months.

    Throughout the drama Catherine, a matron in the accident and emergency unit at Ealing Hospital, has been Sellu’s most stalwart supporter. They met many years ago at Hammersmith Hospital. Sellu, a bright boy from Sierra Leone, had won a scholarship to study medicine in Britain and was in his first job as a registrar. Catherine was a staff nurse in intensive care.

    They have four children, one of whom lives in Oman, where the Sellus resided for five years shortly after they were married. Another recently qualified as a doctor.

    “But [he is] not working as a doctor; sadly he is disillusioned,” says Catherine. “What kind of message does a case like this send out?”

    All the children were at home to welcome Sellu back but it was a subdued return. “It had been hard enough to see him in prison, but there was something about walking back through the front door . . . it hits home, what you’ve lost,” says Catherine.

    “Not just David’s liberty, his career, his income, but the plans we had for the future. It’s all been taken away. Our only hope now is that his reputation will be restored. This is a very tough way to end a 40-year unblemished career. He may be home but it isn’t over.”

    November 16, 2015 Reply
  42. Roger Kirby

    David’s appeal against his sentence is due to be heard on the 9th December 2015. We are all keeping our fingers crossed on his behalf!

    December 3, 2015 Reply
  43. Roger Kirby

    A surgeon whose jailing for manslaughter over a patient’s death at a private hospital caused widespread alarm among doctors has won permission to appeal against his conviction.
    Three judges at the Court of Appeal in London granted colorectal surgeon David Sellu, 68, leave to appeal after a short hearing.
    Sellu, a senior consultant surgeon with a successful 40-year career in the NHS, was sentenced to 2 ½ years in prison in November 2014 for contributing to the death of James Hughes in February 2010 at the Clementine Churchill Hospital in Harrow, north London[i]. He was called in after Hughes, 66, a retired builder, developed abdominal pains in the wake of a routine knee operation.
    Sellu operated on Hughes just over 24 hours after he first saw him, but he died from a perforated bowel. An internal investigation by the hospital found “systemic failures” but the report was not disclosed at Sellu’s trial and he was blamed for a catalogue of delays.[ii]
    More than 300 doctors, including professors of surgery, signed a letter to the president of the Royal College of Surgeons noting that “unexpected deaths in healthcare more commonly result from a chain of events rather than one individual doctor’s gross negligence”.
    Sellu’s lawyers were given permission to appeal on the ground of fresh evidence showing, first of all, that Hughes’ risk of death at the time Sellu first saw him was much higher than the 2.6% put forward by the prosecution. Secondly, his lawyers argued that the significance of the fact that Hughes had been given dabigatran, a new generation oral anticoagulant, was not fully appreciated at the time.

    December 10, 2015 Reply
  44. David Redman

    How did anyone get away with suggesting a mortality of 2.5% for an emergency laparotomy particularly a perforated bowel? Did the defence not query this?

    December 11, 2015 Reply
  45. Ahmad

    Excellent news – thanks for the update Mr Kirby.

    So it appears to be true when they say there are 3 types of lies: “lies, damned lies, and statistics”

    December 11, 2015 Reply
  46. Roger Kirby

    Read this piece in the Mail on Sunday:

    December 13, 2015 Reply
  47. Roger Kirby

    Check out a new website focusing on the issue of gross negligence manslaughter charges against healthcare workers put together by Jenny Vaughan and Ian Franklin and others. Here is the link:

    February 16, 2016 Reply
  48. Roger Kirby

    Another manslaughter charge against a healthcare professional:

    May 8, 2016 Reply
  49. Roger Kirby

    Two GPs in Wales are now on trial for gross negligence manslaughter for failing to recognise that a child was seriously ill with Addison’s disease. Follow this link to read the details:

    May 14, 2016 Reply
  50. Roger Kirby

    Roger Kirby May 30, 2016 at 10:56 am Reply
    A GP was today cleared of killing a 12-year-old boy by gross negligence after he died from Addison’s disease. Dr Lindsay Thomas, 42, had been on trial for two weeks for causing the death of schoolboy Ryan Morse after he died from the rare condition. Her colleague, Dr Joanne Rudling, 45, is charged with manslaughter and trying to pervert the course of public justice, after she also received a call from Ryan’s mother, and then allegedly manipulated his medical records days after he died. But Mrs Justice Judge Nicola Davies today dismissed the charge against Dr Thomas by directing the jury to find her not guilty of manslaughter. The judge said: ’In law, on the charge of gross negligence manslaughter, there is no case to answer. ‘I direct that a verdict of not guilty be entered by you, the jury.’ Dr Thomas was charged after schoolboy Ryan died in his home in December 2012, from Addison’s Disease – a condition which includes progressive anaemia, low blood pressure, weakness and discolouration of the skin. His mother had called Dr Thomas at Brynithir Surgery in Aberystwyth, West Wales, 24 hours before her son died for advice about his condition. The prosecution said the GP should have realised the schoolboy was dying, and should have called for an ambulance or gone to visit the boy herself. But Judge Davies told the court Dr Thomas’ actions didn’t amount to manslaughter. Outside the court Dr Thomas, from Tredegar, Gwent, read a short statement saying she was ‘very pleased’ at the outcome. She said: ’I would like to thank family, friends, patients and my legal team for their support. ‘Once again I offer my condolences to Ryan’s family.’ Dr Rudling, of Pontprennau, Cardiff, denies manslaughter and trying to pervert the course of public justice. The trial continues at Cardiff Crown Court.

    May 30, 2016 Reply
  51. Dr Eric Webb

    An address to the Medico-Legal Society by Professor Terence Stephenson – Chairman of the GMC – on 10th December 2015 is reported in the latest issue of the Society’s Journal (The GMC as a Patient Safety Organisation; Vol 84, part 2, pp. 74 – 86). In the course of the Discussion following, ‘a male member of the audience’ raised the case of David Sellu and asked ‘what was being done about manslaughter and the idea of recklessness, and so on’ and the extent to which the GMC are involved in advising the Government about this.
    Prof Stephenson’s response is worth reading in full but it boils down to ‘Sweet FA’! ‘It is for the CPS to look at the evidence and make decisions about whether they prosecute in the public interest. I am personally not aware of us having any role in advising Government or the CPS whether they should or should not. I don’t think we would do it; it would be interfering with the criminal justice system.’
    Pathetic! It is up to the GMC – if it is to be any use at all – to MAKE a role for itself over this issue in the interests of both profession and public. Stephenson has the right – and the duty – to speak out, to drive home the message that in all save the most egregious cases it is for the GMC, not the Courts, to investigate alleged medical malpractice. Letting the criminal justice system, directed – if that is quite the right term – by the witless CPS, prosecute medical error arbitrarily, at random, with next to no proper understanding of the issues, thereby destroying professional morale, is no service to patients either.

    May 31, 2016 Reply
  52. Roger Kirby Prossor of Urology

    “I had tried to prepare myself mentally, but I had no bag. I wasn’t suitably dressed: I was in a suit. And now I was locked in a tiny cubicle, being hurled from side to side as the van lurched around corners. I felt sick, both physically and psychologically.
    ‘If you treated animals the way we treat prisoners on their way to jail, animal rights groups would be incensed. And this was only the beginning”.

    November 20, 2016 Reply
  53. Roger Kirby Professor of Urology

    A spokesperson for the Royal College of Surgeons said:

    “It is welcome news that judges have found David Sellu was wrongly convicted of gross negligence manslaughter. Many in the surgical community were greatly concerned by the case.

    “Wrongful convictions only harm the NHS’ efforts to improve patient care and culture, as well as efforts to seek justice where it is correctly deserved. The judiciary and the Government must commit to urgently reviewing any lessons learnt from this case for future criminal prosecutions”.

    November 20, 2016 Reply
  54. Roger Kirby Professor of Urology

    Senior surgeon’s conviction for manslaughter is quashed
    BMJ 2016; 355 doi:

    November 25, 2016 Reply
  55. Roger Kirby Professor of Urology

    December 4, 2016 Reply
  56. Roger Kirby Professor of Urology

    An all-day meeting at the Royal Society of Medicine on “Patient Safety, Litigation and Gross Negligence Manslaughter”, with speakers including David Sellu, Sir Robert Francis QC and Professor Sir Terence Stevenson, Chairman of the GMC has been organised on Friday the 21st April. You can register online here:,-litigation-against-doctors-and-gross-negligence-manslaughter.aspx
    Do come along and join the discussion.

    January 14, 2017 Reply
  57. Roger Kirby Professor of Urology

    Another salutary case:

    January 22, 2017 Reply
  58. Roger Kirby Professor of Urology

    Check out this editorial in Trends: ‘Justice at last’

    February 8, 2017 Reply
  59. Roger Kirby Professor of Urology

    Read this piece in the BMJ about comments made by Sir Robert Francis about the need for managers to be regulated in the same way as doctors:

    April 25, 2017 Reply
  60. Roger Kirby Professor of Urology

    If this subject interests you take a look at this BJUI blog:

    April 26, 2017 Reply
  61. Roger Kirby Professor of Urology

    Here are the videos from our meeting at the Royal Society of Medicine on the 21st of April. It includes David Sellu’s “Mistake or Manslaughter” and some other great talks: Do take a look.

    June 3, 2017 Reply
  62. Roger Kirby Professor Roger Kirby

    Oh dear! Another potential medical manslaughter case:

    July 2, 2017 Reply
  63. Roger Kirby Professor of Urology

    Latest news: Honey Rose, the optometrist convicted of gross negligence manslaughter (GNM) for failing to recognise papilloedema in a child, has had her conviction quashed by Lord Leveson, the same law lord who overturned David Sellu’s GNM conviction: Sanity is beginning to prevail!

    July 31, 2017 Reply
  64. Roger Kirby Professor of Urology

    Read about the judgement on the gross negligence manslaughter charge brought against this Welsh GP in the most recent case –

    September 2, 2017 Reply
  65. Roger Kirby Professor of Urology

    As followers of this blog will know, there has been a recent rise in the range of healthcare workers charged with “manslaughter by gross negligence.” Although prosecutions are still rare there is widespread concern that staff cannot learn from errors or near misses in a culture of blame or under threat of criminal charges. However, the GMC duty of candour tells healthcare workers to be open and honest, when things go wrong. This anonymised survey will take you no more than two minutes of your time to fill out and is being done to get a sense of your views. If you wish you can also follow the final link (qu11) through to a very important consultation being done by the sentencing council (closing date 10/10/17). Without amendment of their proposals, healthcare workers could be facing new jail time of 12 years in the most ‘severe’ cases. There have been two recent successful appeals which have shown that both convictions for Surgeon David Sellu and Optometrist Honey Rose were unsafe. The results of this survey are anonymous but will be presented to the Crown Prosecution Service so they are aware of the impact of criminal prosecution on patient care. Survey link

    September 14, 2017 Reply
  66. Dave Kingston Consultant

    I think in some ways no- a doctor should not be sent to prison for clinical negligence. At the same time, it really does depend on the severity of the negligent act, and the consequences of it. Surely the Law would dictate that any more serious act of negligence would come under a separate category. Cases like this,500-in-compensation/ have resulted in compensation claim and expenses for the medical team. I think this is the most efficient method of compensating the patient. After all, a medical professional has a lot of responsibility. Like Jon says, a custodial sentence only outlines an outdated criminal justice system.

    September 19, 2017 Reply
  67. Ahmad GP

    I really feel as doctors we wake up in the morning to go to work with the very good intention and moral imperative to do good, and what’s best for our patients, often under admittedly very pressurised circumstances.
    So when things go wrong, and whereas i believe in such a thing as “no fault compensation”, i feel it’s both unjust and detrimental to the interests of wider society to further punish the doctor to the degree of manslaughter etc.
    After the patient who has suffered, and the grief of the loved ones, who do you think next is suffering and would forever have etched in their minds the trauma and injury to the said patient, the doctor of course. And so the theme of “second victim” needs to be expanded upon and perhaps by increasing he corpus of research here it would help mitigate the draconian sentences society currently wants to inflict on doctors who are largely very good people, if i say so myself.

    September 20, 2017 Reply
  68. Roger Kirby Professor of Urology

    A workshop was held on the 4th October between the Royal Society of Medicine (RSM), the Crown Prosecution Service (CPS) and the British Medical Association (BMA) in Chandos House. The difficult issue of gross negligence manslaughter (GNM) prosecutions of doctors was discussed. A summary of the conclusions will be published, in the meantime here is the link to a short statement from the BMA: .

    October 11, 2017 Reply
  69. Roger Kirby Professor of Urology

    Video of Surgeon David Sellu talking about his time in Belmarsh prison after being wrongly convicted of medical manslaughter

    February 3, 2018 Reply
  70. Roger Kirby Professor of Urology

    A view on the GNM prosecution of doctors from the Royal Society of Medicine:

    February 5, 2018 Reply
  71. Roger Kirby Professor of Urology

    David Sellu, the surgeon jailed for gross negligence manslaughter who later had his conviction overturned, has been comprehensively cleared of misconduct by a medical practitioners tribunal.

    The General Medical Council alleged that he failed to provide good clinical care to James Hughes, the patient whose death had been at the centre of the criminal case against him.1 But after a six week hearing in which the tribunal took extensive evidence from many witnesses, many of them staff and clinicians working at the private hospital where Hughes had died, not one of the allegations against Sellu was found proved.

    The result means in effect that charges that were found proved to the higher criminal standard (beyond reasonable doubt) by a crown court jury did not even reach the lower standard of proof applying in the tribunal (on the balance of probabilities).

    The outcome will fuel concern, already widespread, about the use of the criminal law to pin the blame for a patient’s death on a single individual working in a complex system where multiple factors are at play.

    March 16, 2018 Reply
  72. Roger Kirby Professor of Urology

    Doctors for the NHS are supporting the online letter to GMC re implications Dr Bawa-Garba case and implications of over-turning judgement by tribunal and proceeding to request erasure (my interpretation of the letter, which is full and detailed)

    The letter is found and can be signed if people support at the following link

    March 28, 2018 Reply
  73. Roger Kirby Professor of Urology

    Here is the BMA’s response to Sir Norman Williams review of GNM has been published on the BMA’s website:

    May 5, 2018 Reply
  74. Roger Kirby Professor of Urology

    Take a listen to this RSM podcast on suicide and doctors:

    July 28, 2018 Reply
  75. Roger Kirby Professor of Urology

    August 8, 2019 Reply

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