A LEAKED letter has revealed the "extreme concern" among Northern Ireland doctors following a damning report into the hospital deaths of five children.
Correspondence seen by The Irish News indicates the level of alarm within the medical profession about the introduction of a 'duty of candour' - the key recommendation of a public inquiry which delivered a devastating assessment of senior doctors and health service managers.
The findings of the 14-year-long hyponatraemia inquiry were published last month and concluded that four of the children's deaths were avoidable.
Mr Justice O'Hara, the High Court judge who led the inquiry, said some medics had behaved "evasively, dishonestly and ineptly" and criticised some witnesses who had to have the "truth dragged from them".
To date, no senior doctor linked to the extensive report has commented on its findings while the British Medical Association (BMA) - the main union for doctors in the north - has also remained silent.
The judge described the 'candour' legislation as the most central of the report's 96 recommendations and one that should be implemented "as a matter of urgency".
"That would impose a duty to tell patients and their families about major failures in care and to give a full and honest explanation," Mr Justice O'Hara said.
But a letter sent by BMA Northern Ireland council chair Dr John D Woods to members raises concerns about the "helpfulness" of the measure and infers it could instead lead to a culture of "fear" and "blame".
Dr Woods also refers to a high-profile case in England involving a trainee doctor who was struck off after admitting her failings in the death of a six-year-old boy.
"All of you will have seen the recent report from the O’Hara Hyponatraemia Inquiry and coverage of the case in England involving Dr Bawa Garba. I know many of you are extremely concerned about the events surrounding these cases, how they have been reported in the media and the impact this will have on doctors," he wrote.
"Both cases touch on the issue of medical error being subject to criminal sanctions.
"Is this helpful in encouraging and supporting doctors to report genuine error? Will this encourage the culture of openness that is necessary to improve safety?
"Can we raise concerns without fear of being blamed? How do we escalate problems when we are working under extreme pressure?
"These and other questions have been raised by BMA members in recent days."
The union chief warns of the pressures doctors are currently facing and calls for more "accountability" for senior NHS managers.
"Doctors in both primary and secondary care are working in a system under substantial pressure, which is often under-staffed and under-resourced... We have to hold decision makers to account about the risks of the environment we are currently working in and they must provide support to staff to do this safely."
The letter was sent a fortnight after the release of the report.
The Irish News asked the BMA if Dr Woods would expand on his comments but he declined an interview.
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