Northern Ireland's Department of Health has expressed "deep concern" over findings of "significant failures" in the care and treatment of patients of former neurologist Dr Michael Watt.
The Regulation and Quality Improvement Authority (RQIA) published a report of the expert review into the clinical records of 44 deceased patients who had been under the care of former Belfast Health and Social Care Trust consultant neurologist.
That came after a 2018 recall of thousands of Dr Watt's patients at the Belfast Trust - the biggest in UK medical history at the time. It has been found around one in five of his patients were wrongly diagnosed.
The Department of Health issued an apology on Tuesday morning following the RQIA report publication.
A statement said: "The findings published [on Tuesday] are deeply concerning, and it is recognised they will be distressing for families involved in the Phase Two process.
"The Department would like to thank the families involved for their significant engagement throughout this exceptionally difficult process.
"On behalf of the wider HSC system, the Department apologises to them for the significant healthcare failings that have been identified."
Meanwhile, a PSNI spokesperson said it was considering the findings of the various reviews and investigations into Dr Watt's work.
"We will continue to liaise with the RQIA, Department of Health and Public Prosecution Service and will consider all relevant material before determining whether or not it will be necessary to conduct a formal investigation," a statement added.
The Belfast Trust also apologised.
A spokesperson said: "Belfast Trust is wholly and unreservedly sorry to everyone who has been affected by the neurology recalls since May 2018. Our thoughts today are with the families of those patients who have sadly passed away."
The panel highlighted concerns over clinical decision-making, diagnostic approach, communications with other clinicians, as well as poor communication with patients and with families.
A Department of Health spokesperson continued: "The Department very much welcomes the RQIA’s commitment in taking forward the recommendations from the Phase Two review and its work to address the strategic issues identified."
The RQIA is an independent health and social care regulatory body.
It commissioned the Royal College of Physicians (RCP) to undertake the review in August 2020 at the direction of the Department of Health.
The spokesperson added: "The Department would like to thank the RQIA and the Royal College of Physicians team for their comprehensive work and detailed engagement with the families.
"The Department and the RQIA will assess the findings from Phase Two to inform next steps in the review of deceased patients’ records.
"All material factors will be taken into consideration for any future phases of this work. This will include taking account of the lessons learned, addressing expectations of the families of deceased patients, and making best use of limited health care resources."
More than 5,000 patients in Northern Ireland were recalled, the biggest ever in the region, when it was found that Dr Watt had misdiagnosed patients.
Among conditions being treated were stroke, Parkinson's disease and multiple sclerosis.
The key findings of the RQIA review include:
There was a lack of empathy and often a failure to consider patients’ needs holistically.
There were concern over the assessment and initial management of patients; aspects of clinical decision-making; diagnostic approach; prescribing; the communications and engagement with other clinicians; and interactions with patients.
The review team identified concerns or omissions and their potential to lead to harm in almost half of the cases examined, including that some of the treatments prescribed were unnecessary and invasive.
In several instances, the review team believed patients had been denied holistic, supportive care that may have made their condition, and ultimately end of life care, easier to manage.
In almost half the cases reviewed the team did not consider the diagnosis to have been secure.
While in most cases, the review team did not identify any concerns with the recorded cause of death, they stated that in several instances the review of death certification, or referral to a medical examiner or coroner, was recommended.
The review team concluded that more than half of cases were graded “poor care” or “very poor care” in terms of initial management of the patient, and that clinical decision making was “poor” or “very poor”.
They found that more than half of cases reviewed there was “poor care” or “very poor care” in terms of communication with colleagues, and that there was little evidence that multidisciplinary team input into complex cases was sought.
RQIA's chair, Christine Collins, said: "I commend the courage and openness of all those families who came forward to engage in this review.
"Family accounts starkly illustrate how failings by an individual practitioner, and by the system, led to deep human impacts and resulting harm, both to the deceased patients and to their bereaved families."
"While this process has been difficult and may not have produced the outcome sought by some families, RQIA sincerely thanks every family for their patience, their personal commitment and the invaluable contribution they have made on behalf of their loved ones."
RQIA's chief executive, Briege Donaghy, said: "Our staff, have been deeply moved through our involvement with the bereaved families.
"We are determined that the actions we take, driven by the findings from this review, will improve clinical practice, the safety of services and the experience of patients and of families."
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