The God complex: Part 1

Hello and welcome to the Sloan Newscast from the Observer. I'm Alexi Mostras and if you think this episode sounds a bit different, you'd be right. I'm very excited to be stepping in as the new host of the show. Each week I'll introduce a brand new amazing story reported by our brilliant journalists at the paper and beyond. We'll cover everything from Trump to TikTok, terrifying and sing to Taylor Swift and always with a focus on what really matters people. As F. Scott Fitzgerald almost said, "Story is character and character is story." That's what the Sloan Newscast is all about. This week I want you to imagine that it's 1997 and you're a passenger on a particular flight, Korean Air 801 coming into land at Guam. It's 1 a.m. and the weather is poor. The rain is hammering against the sheet metal of the Boeing 747. But you're not paying much attention. Maybe you're concentrating on your in-flight movie. Maybe you've got your headphones in. You trust the professionals to bring you home safe and sound. But in the cabin, that sacred space where life and death decisions are made, things are about to go badly wrong. The flight group can't see out of the window. The weather is too bad. To land, they're supposed to use something called an instrument approach. Basically, it's a procedure that tells the captain exactly where to fly and how low to go. But on this night, part of the system isn't working. The captain has to land himself. Still, there's a procedure for this too. He's supposed to fly the plane progressively lower, step by step. There's a first officer and a flight engineer. They're supposed to tell the captain if he's going wrong. But they don't. It's only after a warning goes off when the plane is less than 500 feet from the ground, that the first officer suggests a boarding and circling around. By this time, it's too late. Six seconds later, the plane hits the side of a hill, killing 228 of the 254 people on board. If you're a passenger, you wouldn't even see it coming. There's a reason I'm taking you back to the inner workings of a cockpit in the late 1990s. It's because of what was uncovered about the incident in its aftermath. Investigators found that the flight crew had plenty of opportunities to challenge the captain, to tell him that he'd made a mistake. But they didn't take them. And the reason for this? Overdeference. The investigators ruled that overdeference was a plausible factor in the crash. The junior officers were just too in awe of the captain to speak up. In that cabin, the captain was basically God. When Malcolm Gladwell wrote about flight 801 in his 2008 book Outliers, he suggested that Korean airline pilots were particularly prone to not challenging senior officers, but actually the problem of deference is well-known in the West too. These days, airlines across the world train their first officers to speak up even if it means offending their boss. Of course, this isn't just a problem 30,000 feet in the air. On the ground, in hospitals, a chief surgeon is the equivalent of the airline captain. The operating theatre is another sacred space where one person's word can feel like the law, and where decisions and actions can have serious consequences for their colleagues and for patients. That's the subject of today's slow newscast, surgeons with absolute power who decided to abuse it, and the deference and blindness of regulators and colleagues, which has kept them in practice. Sported by the observers' political editor Rachel Salvesta and produced by Gary Marshall, this is the God Complex. I hope you enjoy it, and just the warning before we start, this episode covers allegations of sexual misconduct. I was actually asked by somebody senior within the department because they realised that there was a problem within this particular department. My name was given forward to anybody that wanted to come and talk to me, so that's how it all came about. For a time, Elizabeth worked at a hospital in Oxford as a freedom to speak up Guardian. She was someone whose staff could turn to, confidentially, if they wanted to report concerns about patient safety, bullying, harassment, that kind of thing. This particular problem had been brewing in the Oxford Transplant Centre for years. Now, Elizabeth was being told that a highly regarded surgeon called James Gilbert was being accused of sexually assaulting his colleagues in the middle of operations. And how many people got it in touch with you about this man? There were six, six individuals contacted me, and many of the stories were very similar, and what were they saying? Basically, they were raising concerns about the surgeon and his inappropriate behaviour, his sexual harassment, but that had obviously been going on for a very long time within the department, and sadly, hadn't been addressed. Elizabeth became involved at the tipping point of this scandal when the hospital could no longer afford to brush it under the carpet, and were you shocked by what you heard? I don't think I was shocked. I think I was more angry and upset by what I heard, really. And how big a problem do you think this is in the NHS? Is this a one-off case? Or do you worry that there's a wider issue? I absolutely don't think this is a one-off case. I think it happens more than we probably realise. I've been investigating this story on and off for years. At first, I thought that the case of James Gilbert was a shocking one-off, but the more I've looked into it, the more victims have come forward with their own stories, doctors and now patients too. Their experiences span time and geography, but there's something that unites them. They all want the system to change. I'm Rachel Solvester, and this is the Sloan newscast from the Observer. This week, the GOG Complex. Episode 1. In early January, I take a train out of London to start at the beginning. I'm here to meet a surgeon. She's now a senior consultant surgeon in the NHS. I'm going to call her Alice. It's not her real name, but she doesn't want to be identified publicly, and it's for that reason that we've changed her voice. She's worked hard to get where she is, and she doesn't want her life to be defined by one man. I remember quite clearly at 13 being fascinated by all sorts of things, and feeling like I've only got one life and I really needed to decide what I'm going to do with it. She decides that she wants to help people, and the way to do that is to become a doctor. And then basically everything I did for men was just focused on doing medicine. She falls in love with the idea of being a surgeon, the sterile precision of the operating theatre. It is this kind of sacred, undisturbed time where you are just allowed to completely focus on one thing, and that's kind of wonderful that you can understand. Alice arrives at the prestigious Oxford Transplant Centre as a surgical trainee in 2011. I think I felt more daunted than excited to be there, but I knew that this is, you know, I'm really lucky that I'm in Oxford, and I'll be in Oxford Transplant Unit. She's new to the city, and she doesn't know anyone. Every day she has a long commute, and she has a young family at home, so it's a period of significant change. She's feeling physically exhausted and emotionally isolated, and it's at this point that she meets her new boss, James Gilbert, the senior consultant who's going to be her educational supervisor. So I remember very clearly he telling me that he was the youngest ever appointed, Transplant consultant, he describes himself as a golden boy of the department, and from what she can see, he's technically brilliant. Which is a good thing, because an educational supervisor like Gilbert plays a pivotal role in a trainee surgeon's career. They're a mentor who's supposed to impart their knowledge and skills, but they also write your reports, approve your next role, and that affects which part of the country will move to next. The amount of power over your life is huge, it's not just your professional life, it's your whole life. Alice is navigating her new hospital, and the top priority for trainee surgeons is to practice. They need to build up a certain amount of time in the operating theatre to qualify, and it's the supervisor who controls their access to surgery. Surgery is an apprenticeship model training, and if you have a good mentor and a good trainer, it can be the most amazing experience with someone developing you, progressing you, nurturing you. But if you are unlucky, then they can destroy you, can't they? You know, I think it was maybe three months since job, there's a very, very clear moment where I remember thinking, I didn't know what to think. Alice remembers a moment that she's checking blood test results one evening, about three months into the job. She's looking out for any abnormalities. It's a long narrow office with only one way in and out, and she's sitting on her own at a computer by their window. And he just came, and he sat next to me, and he didn't say anything, he just was looking at me up and down at my body. And he just suddenly said, "I've been watching you, and you're pretty perfect, aren't you?" And he's not talking about me professionally, I know, because he's looking at my body, and he's looking at my breasts. And I, I just completely froze. I was physically trapped, but I also had no idea what was going, I just, I just couldn't compute what was happening. And I didn't really know to do, I didn't know how to respond, I didn't know what, I just literally froze, said absolutely nothing. I don't think I breathed at all until he'd such to go away. And then I just carried on doing the blood results. She doesn't know how to interpret what's just happened. She wonders whether it's something to do with how she's dressed. I remember thinking, if I was in my twenties and in a CD club in London, I might expect that to happen to me, but I was at work. And I just, I kept thinking it's, have I done something? Was it my fault? What did I do? Alice is already in an uncomfortable position, because Gilbert makes it clear that she's his favourite trainee. He tells her things about her colleagues. That's a communication to me that I have the power to control the narrative of what other people are going to think of you. And I can tell you what I think, and I can tell you negative things about other trainees. And if you are not compliant, I will do the same to you whilst also saying inappropriate sexual things. And so you felt, I felt confused, I felt complicit, I felt dishonest, I felt disloyal to my other trainees. And I just didn't know I didn't know what it was, it was completely bewildering. But I just knew I had to keep my head down, and I just had to keep, I just had to get through this rotation, I'd keep training. The comments keep coming. He asks whether she's wearing matching underwear. There are constant sexually suggestive remarks. Then there's a time when she's flushing a patient's artery with fluid after an operation. You're flushing at pressure enough to wash out the blood, so it has to be at pressure. And yes, sometimes there's some splashing and things. And he would always say, oh, I didn't know you were a spurter. What he's employing is that he has just made you orgasm in the middle of an operation. And so you feel disgusted. Gilbert gets physical too. He was always massaging you as if it was like, you know, he was your coach before some sort of physical performance. He would like, get your shoulders and massage you before you went into the theatre or he would, because you're in theatre, so there's this kind of negative pressure system to keep the air sterile. You know, there was the anacetic rim and the theatre rim. And if you got caught between two rims, he would always grab you and tickle you. So yes, he did do this touching. Was it, you know, was it an aggressive assault? No, but was it inappropriate touching? Absolutely yes. It's really unsettling to be touched, you know, before we were about to do an operation, which you'd really quite like to focus and learn from. Some of the grouping and touching takes place in the operating theatre, even during surgery. A few months after the incident in the computer room, she's sitting opposite Gilbert in theatre. They have a patient on the operating table in between them. So you can't see under the table. And I remember, he took my leg, my thigh between his thighs and squeezed it really tight. So that had to be deliberate. I knew that was deliberate. So at that point, you kind of like, no, he absolutely knows what he's doing. All of those inadvertent touches of my legs, he's known all along what he was doing. Alice can't believe it. They're in the middle of an operation and the consultant surgeon is focused on squeezing his trainee's thigh. I don't think he's thinking about the patient. I think he's totally thinking and enjoying the fact that he's literally playing with you like a cat playing with the mouse. And what does everyone else in the operating theatre do? The problem is that I think unless you've been in an operating theatre, it's difficult to want people to say to you why, why don't anyone say anything or do anything, but it's your under the theatre lights. So everyone's kind of vision because the rest of the room is not highlighted. You've kind of got this vision of just what's going on on the table. What's happening under the table is hidden because there is a drape over the operating table. People can't see that. And everyone else is busy focused on doing the rest of their jobs. So there's this kind of almost intimate sound like the most inappropriate word, but there is this kind of small environment where there's machine and there's noise. So it's very easy to say something that only the person at the operating table will hear and no one else will hear it. And of course, if things are happening under a table which is draped, you can't see it. So absolutely, can you be sexually harassed or touched in isolation in the middle of an operating theatre and no one else understands or realizes what's going on. Absolutely. And are you also trapped? Yeah, you can't leave the patient. You've got a professional commitment. You started an operation. You can't just walk away from a patient who is open on the table. So, you know, were you raked and you weren't? Were you sexually assaulted? Well, he used to touch. He used to touch you. But, you know, were you physically harmed? No. But it was the constant psychological games that you were playing the whole time that made you keep second-guessing yourself. Were you frightened, ever? I looked back and I think I just wouldn't admit to myself how on edge I was on edge the whole time and I looked back at it and it was so stressful. I think I was really quite thin because so stressed. And did you report him? I think I went through most of that year trying to keep it all to myself. Everyone externally thought I was his favourite and so I felt like if I spoke to somebody, it would reveal my own complicity or my own guilt in the situation. Alice eventually moves on to another job in a different area and tries to put it all behind her. She only shares her experience with a few trusted trainee colleagues. And it's a couple of years later, in 2014, a new trainee seeks her out. She wants to speak with her alone. One of the most difficult things that I find is that another trainee came up to me and said, "Is this happened to you? And will you come forward with me to complain?" And at the time, I had gone through an awful lot of other things personally and I didn't feel that I could come forward. I have to live with that. Always. And as a result, you know, I keep having to remind myself that the only person responsible for James Gilbert's behaviour is James Gilbert. But I subsequently found out in 2021 that there had been trainees affected by his behaviour every single year. And I feel hugely responsible for that. I think we are the tip of the iceberg. This is Grace, the trainee who came to Alice. Grace isn't her real name. Like Alice, she wants to keep some level of anonymity. She's also now a senior consultant surgeon, and she doesn't want her patients to think of her as a victim. I know that she finds it incredibly hard to talk about Gilbert. She says she has shelved the memories at the back of her mind and only reaches for them when she really needs to. But she's agreed to tell her story, because like Alice, she hopes that by speaking up, something might finally change. I do think the system does need to change, and therefore I'm duty bound to be a part of that change, so that's why I do it. What's her striking sitting opposite them is how driven, intelligent and capable they both are, but how powerless they were made to feel. These are brilliant women who are saving lives every day, but they were manipulated and abused within the NHS. In some ways, Grace has moved on with her life and her career, but she's not willing to let this issue go, because she thinks there's something specific about surgery, which is enabling sexual predators like Gilbert. I used to liken it to the Karate kids, they are Mr Miyagi to you. So if Mr Miyagi says wax on, wax off, and you don't quite understand, you still do wax on, wax off, because that's Mr Miyagi, and you are very beholden to them in that way. So it's a lot. It's a huge power imbalance, and you're instantly dependent on them. When did you start to sense boundaries being broken down? So straight away, the very first thing he did, once we sat down and we'd got scrubbed and we were at the patient's table, one of the very first things he did very soon into the operation was feel my foot and my leg with his foot, and then asked me out loud in front of everybody whether he was feeling my first or whether that was the dichermy pedal. And I knew, of course, it was my first and my leg, and his foot actually touched the inner part of my thigh just above my knee. So I knew then this was completely abnormal behaviour, it's behaviour, I've not witnessed since, and I've not experienced before. And so as soon as that happened, I guess I went through a lot of emotions, like shock, that that was happening, couldn't really believe it. And at the same time, because he'd asked a question I then had to say something, so I managed to utter the words, it's my foot, and then it stopped, but straight away then, for the rest of the operation, I couldn't think of anything else other than what had just happened. Gilbert disputes his version of events, but like Alice, Grace says a pattern of behaviour develops. So every time you were in theatre with him, you knew the inappropriate printness was going to continue. Gilbert asks Grace what she likes to do at the weekends, she innocently says she goes to the gym, he looks her up and down, and says she doesn't need to work out, she looks great in a pair of scrubs. He tells her, he bets she's really wild on a night out. So I just did a catheter change, and he came up behind me and put his head on my shoulder and whispered in my ear, you know, go and touch it, you know, don't be scared of it, it won't bite. And obviously I then did hold, you know, penis and put the catheter in with him watching me do that. And you know, he knows that you're not going to step back, you're not, what are you going to do? Gilbert also contests this, but Grace recalls feeling increasingly uncomfortable and threatened. One of the tactics she uses to defuse the situation is to tell him that she has a boyfriend. When I told him I had a boyfriend, I felt really bolstered because I thought, this is it, I've got a boyfriend and there's nothing he can say to me because I have a boyfriend. And in response to that, he said, I know how you like it impaired because I bet you like it rough because, you know, I bet you, I bet you cry sometimes, I bet you also. Grace says she went from a confident, positive, high-performing young woman to a shell of herself. She avoided operating with Gilbert, which was disastrous for her career, because she never got into theatre. So she had huge gaps in her training. People like James Gilbert are taking patients who have organ failure and are dependent on the NHS machines or dependent on doctors or special treatments that literally keep them alive. And then you're taking an organ and you're giving patients the gift of life, which is of course incredible, but it must give you that certain God complex. You can see how in the wrong mind you could really warp that. I think there is an element of because you're doing so much good, how could you be doing any bad or what's the harm in what you're doing. Grace eventually decides to complain about it. She's heard that Gilbert is spreading rumors that she's a bad trainee. I just wants to be believed and I needed to be removed from the post. There's no sexual misconduct process at the hospital, and so the situation is managed through the bullying and harassment policy. Instead of confronting Gilbert about his behaviour, a senior figure at the hospital asks Grace about her own sexual history. He did tell me, "Are you sure you want to do this?" Because you're single and you know, your history is there any are there any skeletons in your closet is what he said to me. And of course I said, "Oh nothing, we can think of. I don't know. I don't know what you mean." Grace is offered an informal mediation meeting, but there's no admission of sexual harassment or repercussions for Gilbert. At the meeting, she tells her room what she wants. All I want going forward out of this meeting is that you can can somebody please assure me that this won't happen again. I don't want this to happen to any other girl ever. And what assurance do I have that's going to happen? And looking about that's actually quite brave for me to have said at that meeting. The head of the surgery school makes a commitment to have regular meetings with Gilbert and keep tabs on him. And that was the end of the meeting. And he didn't keep an eye on him. No, he promoted him to be in charge of all core trainees. So he was the training program director for all core surgical trainees. So his power got greater. Grace moved to a different hospital and had to make up the operating hours she'd missed in her own time. So his career advanced and yours was harmed. Exactly that is exactly what happened. Do you think there was a cover-up of culture at the trust or within the NHS? I think it was just brushed under the carpet. What is it about the NHS that has allowed that system to develop? Because these consultant surgeons, particularly like him, they're very revered. They're in a god-like status. They're like a high priest at the Vatican. And I'm a nobody. I'm a trainee. I'm nothing to nobody. But they bring an income for the trust. There's a status. And there's a lot that goes along with it. And so of course the culture and the environment should be to preserve these people at all costs compared to a trainee who's feeding who's going to come and go as worth nothing. Did you find cases of women who dropped out of surgery because of James Gilbert? Yes. What happened? Well, I think they just found it all too distressing and they were worried about their careers so they decided that they would go into something else, which is shocking because some of them apparently were exceptionally good surgeons. So what did you decide to do? What I did was obviously listen to their stories and then I compiled a report. Elizabeth, the freedom to speak up Guardian, sends her report to senior management. It leads to a formal investigation by May 2022, Gilbert is sacked by the NHS Trust. But that doesn't mean he can't practice as a doctor and Alice says his career didn't end there. He took up a job at the private hospital down the road, which for me, if you are going to maintain power, overall your previous colleagues, what are you going to do? You're going to get a management position at the private hospital down the road because then you're going to control everyone's private practice. Gilbert is also reported to the General Medical Council, the GMC. They recommend that he should be struck off and the case goes to the medical practitioner's tribunal service. They run hearings and make decisions about whether doctors are fit to practice. Four women, including Alice and Grace, agree to testify at the tribunal. I was warned it was going to be the James Gilbert show and it was all about him and it wasn't all about us. When you get to the tribunal, it becomes very apparent that James Gilbert has a full legal team, legal representation at barrister level, I think it's a KC, they have a full strategy and you have one statement that was written by someone else based on your meeting with them and you've approved it and that's it. You have no barrister or legal support? Everything had no legal support, no barrister. We had a five minute briefing by the GMC's barrister, literally five minutes, five minutes before you're about to give evidence and that's it. The women across examined sitting just a few meters from Gilbert. They feel as if they, not he, are on trial. For them, the experience is almost worse than the original harassment. There are three people on the panel listening to the case, a legal expert, a medic and a lay member. The only training they've had on sexual misconduct is a single seminar as part of a one-day training course. So was there a chance for us to have a victim impact statement because I'm sure if the panel had really heard what happened to me and how I felt about it and how it's impacted me 10 years later, was any of that taken into account, but instead it was James Gilbert bringing witness after witness to provide testimonies to how wonderful he was and how amazing he is as a surgeon and his own blemish record. But the thing is, it doesn't matter how brilliant you are. I don't think if you're touching people and you're sexually harassing others, then how brilliant a surgeon you are is completely irrelevant. Gilbert admits that many of the allegations are true. The tribunal finds that he touched women inappropriately without their consent and created an intimidating, hostile, degrading, humiliating or offensive environment for female surgeons over the course of 13 years. The panel determines that his actions were sexually motivated and an abuse of his senior position. It concludes that his fitness to practice as a doctor is impaired, but instead of being struck off, Gilbert is suspended for just eight months. It felt absolutely devastating. It felt devastating for me as an individual. I felt devastated for the people who had clearly had the courage to come forward as other victims and all I could think about was all of the other people's careers that he had destroyed or permanently altered. The suspension was later increased to 12 months on appeal, but in September, Gilbert became eligible to start operating on patients again. What do you think about James Gilbert now? I think it's very difficult. I think the obvious thing is he's a highly trained professional and we need surgeons. The NHS needs him. I think pattern is important and repeated behaviour and showing insight is important and these are all things that the GMC and the MPTS put a lot of emphasis on is showing true genuine remorse really being able to reflect on your behaviour showing insight and the issue with James Gilbert is I didn't see a scrap of remorse or insight. I don't feel in any of the statements that I've seen that he's put out that there is any evidence of genuine remorse or insight or behavioural change. Last week, the GMC tried again to get him struck off at the court of appeal. As I'm writing this, the judgement is still pending, but in a statement Gilbert told me that he'd used his 12-month suspension period to reflect upon and remedy his behaviours to ensure they never occur again. He said he remains committed to moving forward as the professional colleague that he should be during his return to surgery and that he'd have what he called mentorship and oversight. At a hearing last year, he apologised to his victims and promised to be an ambassador for change against inappropriate workplace behaviour, particularly towards female colleagues. My personal feeling is he would be the last person who would be an ambassador for change and that is a real insult given everything I've been through those words are just nothing but insulting. And I'm insulted he's been given a platform to be able to say such such words. The thought of that person going back into the workplace, having access to patients, having access to other trainees is appalling. And what does that say about the regulatory bodies that guard our professional standards? Do our professional standards mean absolutely nothing if you're happy to have a sexual predator of over a decade with multiple victims go back and practices a surgeon? It means absolutely nothing. The James Gilbert case is shocking, but after spending hours speaking with Alison Grace about their own experience, they were urging me to dig because they knew they weren't alone. They pointed me to a survey which found that two-thirds of women working in surgery had been sexually harassed by a colleague at work. Nearly a third had been sexually assaulted, and there were eleven instances of rape. Misogyny exists everywhere in society, but there seems to be a particular problem in surgery. This may be partly because it's still one of the most male-dominated medical specialisms, only 17% of surgical consultants are women, and just 9% of trauma and orthopedic surgeons are women. The barrister Helena Kennedy, who did a review on diversity for the Royal College of Surgeons, told me there was a culture where sexual misconduct is too often accepted or ignored. But perhaps there's also something about the mindset required to be a surgeon that encourages this kind of behaviour. The thing that really jumped out from me was that sexual harassment was quite a common form of professional wrongdoing, and that it was more an issue for doctors than it was relative to any other professional. So that struck me as interesting. Rosalind Sal is professor of organisational psychology at the Adam Smith Business School, which is part of Glasgow University. She's recently finished a three-year study looking at sexual misconduct by staff in health and social care. She was handed a large set of data from the professional standards authority, thousands of cases of misconduct. She realised that when it comes to doctors, there's a form of moral licensing at work. And that's about an individual who views all of the amazing things that they do to save lives as this kind of balance sheet that's giving them all of this credit that then can allow them to offset other things that they do that are less laudable and excuse them. So they almost think because they're doing a lot of good, they can do whatever they want sexually that's bad. We've seen this with other cases around the world of individuals who have viewed and regarded as lifesavers, the first civil case in Australia of an oncologist, where despite him admitting his guilt, more than 100 people step forward to say that he'd saved their lives and therefore he was an amazing human being. Is there a particular problem with surgeons? So we found in our work with the Royal College of Surgeons and with the survey that we undertook that there seemed to be issues around surgery. I think one of the most concerning issues is that we're continuing to send trainees to spaces that we know bad things are likely to happen to them. Do you think patients are being put at risk as well? I think sad they are because if I can't call you out on misconduct in that way, what else will I not be calling you out on that could be endangering patients. We know that there are correlations in individuals who think the rules don't apply to them that cross all kinds of forms of their behaviors. It's terrifying to think that all this could be going on around you while you're unconscious on an operating table. Then Alice tells me she's heard about a disturbing case of sexual misconduct involving a doctor and a patient. Coming up in episode two of The God Complex. I thought I knew the world. The perpetrators walk among us. I don't see how he could be seen to be fit to practice. It's a clear case of child sexual abuse. Episode two will be available to listen to next week. If you'd like to listen to it now, you can subscribe to the Observer Plus on Apple or Spotify. The God Complex is reported by me, Rachel Silvester. The producer is Gary Marshall. Sound design by Dominic DeLargey. The editor is Jasper Corbett. The Observer.