- guardian.co.uk, Friday June 9 2000 02.11 BST
His remarks, universally condemned as arrogant beyond belief, raise the temperature just days before Richard Neale, a second gynaecologist, is due to face the General Medical Council, charged with a catalogue of botched operations, sub-standard treatment and falsification of documents.
The Neale case raises very similar questions to the Ledward case about hospital managers' handling of suspect doctors. Mr Neale had his licence revoked by the Canadian authorities in 1985, yet went on to practise in the UK until he was suspended by the GMC last year.
In 1995 he was paid £100,000 by a hospital trust to leave and given a clean reference that enabled him to get work elsewhere.
Ian Bogle, chairman of the British Medical Association, reacted with horror to the remarks of Mr Ledward, who was clearly unabashed by the damning report into his practice in Kent published last week by Jean Ritchie QC. Dr Bogle said he felt sorry for any of Mr Ledward's former patients or their relatives who were listening.
"It was arrogant, conceited and deluded, and it missed out the one thing that should have started that off - 'I'm sorry'," said Dr Bogle.
Andrew Foster, a director of the NHS Confederation, which represents hospital managers, said: "I did find that a quite breathtaking interview. But unfortunately one of the characteristics of seriously poorly performing doctors is that they do lack insight into their own performance - and then you get a very offensive interview like that."
The Ritchie report condemned hospital managers and medical staff for doing nothing to stop Mr Ledward practising when there were clear questions over his competence.
Clear parallels can be seen with Mr Neale's case. There have already been questions asked about the conduct of managers at the Friarage hospital in Northallerton, North Yorkshire, where Mr Neale worked for 10 years. The case is also likely to lead to more attacks on the embattled GMC, with questions over how much its officers knew about Mr Neale's Canadian history, and when they knew it.
Last night the College of Physicians and Surgeons of Ontario, which revoked Mr Neale's licence, told the Guardian that the GMC was informed by letter of the revocation at the time. "At the time, the process was that we informed the Medical Council of Canada and a notice was sent to all jurisdictions," said Jill Hefley of the college.
She said they received confirmation from the council that the letter had gone out to relevant authorities abroad, one of which would have been the GMC.
The GMC is expected to say it has no record of receiving such a letter. While its critics will make capital of the fact that it knew Mr Neale had been found unfit to be a doctor and did nothing, GMC officers are likely to say that they cannnot act on the basis of the findings of a tribunal abroad. A doctor's incompetence has to be proved in the UK before it can strike him off the register.
Mr Neale's licence was revoked in Canada after one of his patients died during an induced termination. She was 40 and high risk. He was found to have given her inappropriate drugs, one of which was not allowed in the hospital, and to have altered the medical record to show a dose 10 times less than the one he actually gave.
The Friarage hospital did not know of the Canadian verdict before Mr Neale was taken on, but it was told not long after. By 1993 there was unhappiness about the gynaecologist's work. It is understood the trust convened a panel to investigate and ended by demoting him. In 1995, Mr Neale was suspended. The trust wanted rid of him and gave him a payoff of £100,000 and a good reference.
Mr Neale went to work in Leicester as a locum, where he lasted only a matter of months, and then moved to the Isle of Wight.
It was one of his patients there who made the first official complaint against him to the GMC in February 1998.
Partly because of the publicity, including a Panorama programme, complaints began to flood in to the GMC: it is understood there have been 62, of which 14 were sufficiently robust to be heard in the hearings that will last at least four weeks.
Because of the large number of complaints, the investigation into Mr Neale has taken longer than usual. His suspension last September was only possible once the complaints had been approved by a prelimnary committee to go forward to the professional conduct committee.
Yesterday Mr Neale said: "From Monday, my future as a doctor is on the line. I have always maintained that I am a caring and competent surgeon.
"I have also never failed to express my regret for the distress and inconvenience suffered by those of any patients who experienced post-operative complications."
The GMC, which has embarked on a modernisation programme, may well attract flak for failing to investigate Mr Neale earlier.
In the past 10 years, it has struck off six doctors from Canada and the US whose licences were revoked abroad - in each case after carrying out an investigation in the UK.
