A medical director was unfairly dismissed and ‘suffered detriments’ after raising whistleblowing concerns about the response to and the failure to pass on medical advice in relation to COVID-19 and other matters, a tribunal has ruled.
The Employment and Equality Tribunal found that Rosalind Ranson, who was supported in her legal action by the BMA, was subjected to ‘a pattern of disgraceful behaviour’ at work, and was undermined and misrepresented by senior colleagues when seeking to discharge her duties in responding to the COVID-19 pandemic.
Dr Ranson was appointed medical director of the Isle of Man’s DHSC (Department of Health and Social Care) in January 2020. A new organisation, Manx Care, was being created in April 2021, to focus on the delivery of services, and Dr Ranson began her role with the understanding that she would transfer to it as medical director, but she was told in December 2020 that this would not be happening.
The tribunal in Douglas (pictured above), Isle of Man, heard that at the start of the pandemic in March 2020, there was a debate about how the island should respond. Dr Ranson and her medical team considered that the advice of PHE (Public Health England) was flawed and, in particular, not appropriate for the Isle of Man.
The approach being followed by the Isle of Man Government and Public Health Isle of Man was to follow PHE on the mainland. Dr Ranson’s advice included closing the borders. In putting this forward, Dr Ranson was reflecting the view of the specialist medical group that Dr Ranson had formed to advise on the pandemic response.
The tribunal judgement, released last week, found: ‘The PHE policy had been to stop COVID-19 community testing and to concentrate on delaying the spread of the virus by strategies designed to buy time to be more ready for the later peak. Dr Ranson’s concern at that time was that it was “reckless” to follow that strategy because it would mean that the spread of infection on the island would very rapidly be out of control with exponential growth in infection if the public were to follow that advice.’
But her line manager, the DHSC’s interim chief executive Kathryn Magson, appeared to Dr Ranson not to welcome her approach and, the tribunal found, would have been displeased when Dr Ranson made a direct approach to the island’s health and social care minister David Ashford in March 2020. The modelling done by Dr Ranson’s team had shown that, with an unmitigated spread of infection, the island would reach ITU capacity within six weeks of the first case. Later that day she received what she felt was a reprimand from Ms Magson.
The tribunal judgement says: ‘It appeared that Dr Ranson had a duty to represent the views of the island’s medical profession and to do her best to ensure that politicians and others beyond [the Council of Ministers] had an opportunity to consider the advice being given.’
Dr Ranson convened an emergency meeting of the island’s senior medical leadership team and the group called for the reversal of the decision to stop community testing and to close the borders for all but essential travel.
Unbeknownst to Dr Ranson, the advice she was communicating was not passed on to the Council of Ministers. In Dr Ranson’s view, had the advice been followed it would have meant fewer deaths and a shorter lockdown on the island. This led to Dr Ranson raising her concerns with another minister, Dr Alex Allinson, telling him that crucial information had not been passed on.
The tribunal, which was held earlier this year, heard that Dr Ranson had been subjected to a number of vindictive and demeaning actions as a result of raising her concerns about the failure to pass on information.
Unwanted at work
Later that year, Ms Magson met with the chair and chief executive of Manx Care, due to take over the running of health and social care services in April 2021 and raised performance-related concerns about Dr Ranson. The Manx Care officers decided not to employ her on this basis and to advertise the post instead. The judgement says: ‘… the tribunal considered that Miss Magson’s allegation of the need for performance management seemed (and was) ludicrous and unjustifiable.’
In December 2020, Dr Ranson was told she would not be receiving the medical director job with Manx Care. Shortly after, her PA was moved away without warning or consent. She later lost her own office, and her belongings had been put in storage. She had been given a different office with a broken chair, no computer screen, no telephone and her nameplate no longer appeared on the door – similar, in the tribunal’s words, ‘to the satirical manner of making an employee feel not wanted’.
The judgement says: ‘In career-damage terms for Dr Ranson, matters peaked during the reports made by Miss Magson to Mr Foster and Mrs Cope which misled them into not even considering appointing Dr Ranson for the role for which the tribunal concluded she had been destined from the outset. In image terms, further damage was caused from December 2020 through until March 2021 by the further detriments found to be proven. These had affected Dr Ranson more particularly in her image with her peers whilst ultimately also impacting on her future career. From October 2020 at least until 31 March 2021, she endured a period of torrid humiliation with stoic dignity….’
Dr Ranson said in evidence that part of the reason for the treatment she received was that she made a series of ‘protected disclosures’ – statements which under whistleblowing legislation mean that the person who makes them should be protected from detriment.
An example was in May 2020, when she emailed about a graph on the Isle of Man government website which she said gave a falsely reassuring impression of the risk of an uncontrolled spread of virus. The tribunal heard that she was ‘shut down’ by her line manager, who expressed irritation that she had raised the concern.
When Dr Ranson did not get the Manx Care job, she remained in a medical director job at the DHSC which the organisation did not appear to have planned for, an ‘almost meaningless shell of a role’.
Remedy and compensation
Dr Ranson, a former GP, executive medical director, national professional adviser for the Care Quality Commission, council member of the GMC, and now unemployed, was found by the tribunal to have been unfairly dismissed, and that she suffered detriment having made protected disclosures about health and safety.
The tribunal will hold a further hearing to deal with the ‘alleged “concoction”’ of material documents, selective non-disclosure of, and late disclosure of, documents. The ruling says: ‘But for the persistence of Dr Ranson in refusing to accept the integrity of the respondent’s disclosure… there might have been a serious miscarriage of justice.’
The tribunal will then turn to the issue of remedy to determine the compensation that should be awarded to Dr Ranson.
Dr Ranson said after the case: ‘The past two years have seen the highest but also the lowest parts of my career. The highest because eventually the Manx Government and healthcare leaders did heed my advice and the team I led and COVID-19 was, for a time, eradicated on the island. However, if my advice had been heeded earlier, more lives would have been saved.
'As a doctor, my duty is to put patients and public first and this was made almost impossible by the campaign that was waged to make my work life untenable, to undermine my credibility and professionalism and finally force me out of a role I had been so looking forward to making a success.
‘The financial and wellbeing support from the BMA has been absolutely crucial to me and to this case. Standing up as a whistleblower is extremely difficult, even when you know it's the right thing to do. There were times when it felt a very lonely place to be as efforts to make my work life as unbearable as possible gathered momentum and I can wholeheartedly understand why many doctors, in similar positions, may feel they simply cannot fight for justice.
'But I knew what I had to say was right and I was doing it in the interests of the patients and wider public on the island. The tribunal's decision isn't just a victory for me, it is also a victory for the principle of whistleblowing and for doctors having the freedom and independence to speak the truth.’
Justice at last
BMA council chair Chaand Nagpaul said: ‘It is shameful and unacceptable that doctors who speak out about patient safety concerns can suffer victimisation and detriment for their commitment to patient care.
'This also dissuades others from feeling able to speak up and threatens the ability for the NHS to become a safer health service. Having personally communicated with Dr Ranson about the unwarranted attack and disadvantage she suffered, I am pleased that the BMA supported her successfully and that justice has been delivered.
'We need radical reform of the culture in our health service in order to prevent other doctors suffering such ordeals simply for speaking the truth in the interest of patients.’
BMA public health committee chair Penelope Toff said: ‘In light of many public health professionals' experience in the pandemic and since public health was moved out of the NHS in 2013, this tribunal outcome further emphasises the importance of medical experts having professional autonomy and confidence to speak out, publish, collaborate and advocate for the good of the population, regardless of where they are employed.
'Those in positions of power – employers and elected representatives – should work together with public health specialists and clinicians for the benefit of the population's health and wellbeing. Decisions on health and social care policy – even in emergencies – should wherever possible, be evidence-based and informed by the advice of both those with on-the-ground public health expertise and senior clinicians and must be free from the undue influence of political, commercial and personal vested interests.’
Isle of Man chief minister Alfred Cannan issued a statement regarding the case. He said he was unable to discuss in detail many aspects of the findings as there were matters that still needed to be settled by the tribunal. However, he said: ‘This tribunal has raised a number of substantive questions regarding Government performance and culture and has understandably damaged confidence in Government. I stand today to acknowledge the deep discomfort that we feel with the evidence and findings of this tribunal, and I acknowledge our shortcomings.’
He promised to start a ‘process of fundamental and wide-ranging reform across the public sector’.