THE chair of a Public Inquiry into the Dr Michael Watt recall scandal has revealed his "extreme disappointment" at a decision preventing a full hearing into the medic's work going ahead.
In a confidential letter seen by The Irish News, Brett Lockhart QC also warns the "vacuum" created by the consultant neurologist being allowed to remove himself from the medical register could lead to the probe "being shouldered with expectations that cannot be fulfilled" - due to the limitations of its terms of reference.
The Lockhart inquiry's remit is 'governance' and focuses on the systems in place that led to the biggest patient recall in Northern Ireland, while the General Medical Council (GMC) was investigating the retired medic's work.
Last week former patients of Dr Watt were left reeling after it emerged his application for "voluntary erasure" from the register had been granted by the Medical Practitioners Tribunal Service (MPTS) (which conducts hearings) meaning that an open and full tribunal into alleged "safety concerns" about Dr Watt's clinical practice will not proceed.
Patients wrote to Mr Lockhart to express their "devastation" at the development - which came a week after fresh claims about the consultant were aired in a BBC Spotlight programme.
Responding to the letter from the 'Neurology Recall Patient Support group', the inquiry chair outlined his personal concerns and revealed the GMC had sought legal advice as to whether a hearing could now take place in Dr Watt's absence.
He also stressed the lengths the team had gone to in probing Dr Watt's psychiatric medical assessments - which showed he was not fit to appear before the public inquiry.
Mr Lockhart wrote: "The decision not to hear the GMC case and allow findings to be made is extremely disappointing. I fear the vacuum created leads to the Independent Neurology Inquiry being shouldered with expectations that cannot be fulfilled, because of the process we are required to follow within the Terms of Reference," Mr Lockhart wrote on October 11.
"While governance procedures and systems may be viewed as rather dry, the reality is that they are inextricably linked to good patient outcomes and an improvement in patient safety.
"I can state at this stage that our report will consider the relationship between governance and safe clinical practice."
The inquiry chair noted that his "understanding of the legal position" meant that the tribunal could have proceeded "in any event" - even if "Dr Watt was not in attendance".
"While that would not be an ideal situation, it would have enabled evidence to be adduced and findings to be made. The present situation is unsatisfactory, particularly for patients and in this regard I am acutely conscious that you have all been told “again and again” that the GMC will be dealing with the regulatory aspects of Dr Watt’s practice.
"We have written to the GMC and have been informed that they have retained senior counsel to advice on the question of whether there are any legal remedies open to them."
Former patient Danielle O'Neill last night said the "detailed personal response" from Mr Lockhart had helped restore her faith in his inquiry.
"He is putting us at heart of this inquiry...we really do feel the inquiry panel are fighting on behalf of the patients," Ms O'Neill, a member of the Neurology Recall Patient Support group, said.
"We also want to note how extremely supportive the inquiry panel has been to those patients in distress who have contacted them since the news broke about Dr Watt removing himself from the medical register.
"We are aware they have written to Belfast trust to expedite psychological support."
Meanwhile, the correspondence also outlines the inquiry's handling of extensive psychiatric reports over a two-year period prior to the panel calling Mr Watt to give evidence in person seven months ago.
He did not appear on health grounds.
Patients spoke of their distress after the Spotlight programme claimed the inquiry team did not carry out a face-to-face assessment of Dr Watt using its own psychiatrist - but instead relied on an independent assessment to "quality assure" the reports by Dr Watt's psychiatrist.
Public health expert Dr Gabriel Scally appeared in the programme and expressed concerns about the matter.
In his letter to patients, Mr Lockhart stresses that the inquiry's mental health assessments in relation to Dr Watt's fitness to appear were not just a "paper exercise".
He also discloses he spoke to Dr Scally after the programme was aired.
Mr Lockhart wrote: "Given the limited explanation given in the Spotlight broadcast I can understand how patients may have assumed that the assessment was cursory.
"As I have sought to explain, the situation implied is entirely different to the reality of how the decision was taken.
"I also spoke with Dr Gabriel Scally following the programme and had a cordial and helpful conversation, which I think explained our position."
Meanwhile, The Irish News asked the GMC to confirm if, as mentioned in Mr Lockhart's letter, if it had sought legal advice and was to challenge the MPTS decision - and whether it was considering a Judicial Review.
The organisation stated last week it had to no power to appeal Dr Watt's voluntary erasure from the medical register.
But following the emergence of the leaked correspondence, the GMC issued a statement to The Irish News, confirming:
"We are getting advice from leading counsel on our options to challenge the decision of the medical practitioner tribunal as we do not have a right of appeal."
