On the afternoon of Wednesday, June 20, during a session at the Local Medical Committee conference in central London, a group of doctors quietly filed out of the conference hall and assembled outside, where they bowed their heads and stood in silence for one minute.
At the same time, several hundred miles away, 800 people were crammed into the small Crwys chapel in Gowerton, near Swansea. With the main chapel and the vestry packed, the crowd spilled out of the church where scores of people waited in silence. Almost every doctors' surgery in Swansea had closed for the afternoon, and patients requiring attention were seen on an emergency basis only. An entire community had come to a halt in a mark of respect to Philip Evans, a much respected local GP who had died the previous week, age 53.
Dr Evans's body was found by an RAF helicopter on June 12, 150ft down the jagged cliffs at Rhosilli, a well-known beauty spot on the Gower peninsula. His wife and 17-year-old daughter had reported him missing 24 hours earlier; when colleagues searched his office they found two handwritten suicide notes, one addressed to his wife, the other to a fellow GP at the surgery. His folded coat was later recovered from the top of the cliff.
The death of Philip Evans is a sorry story of tragedy compounded by tragedy: the sudden death of one man which led to the needless suicide of another. Evans was a busy local GP, an award-winning specialist in asthma and much in demand from his patients, many of whom flooded local papers with letters of shock and condolence after his death. But it was not pressure of work, his family insists, that led to him to take his own life. Rather they blame unwieldy and blunt-edged NHS bureaucracy and a culture which tacitly encouraged bereaved relatives to look for blame for a death which it seems could not, alas, have been foreseen.
Fifteen months earlier, Diane Oliver, a patient at Evans's surgery, had phoned the Gowerton practice about her son Michael, 33. Mrs Oliver said she told one of the partners that Michael had a fever and was shaking, and was told to bring him into the surgery the following day. On March 10, Michael Oliver was seen by Evans, who described him as having "flu-like symptoms" and sent him home with antibiotics.
But 25 minutes after arriving home, according to Mrs Oliver, Michael's condition suddenly deteriorated. He turned blue, she said, managing to gasp, "Call an ambulance, I'm dying". He was taken to Swansea's Morriston hospital but died later that evening. It was the same hospital to which Evans's body would be flown just over a year later.
There is little among the bare facts of Oliver's death to explain the tragic sequence of events that was to follow. And that is part of the problem, because the facts about his death were, and remain, few. In the days that followed, his shocked and grieving family came to blame the medical practice - and by extension, Evans - for the death. And all this was splashed across the pages of the local newspapers.
A postmortem was carried out which suggested that the cause of death was pneumonia, a finding that was accepted by the coroner at the subsequent inquest. The family then made a formal complaint to Iechyd Morgannwg health authority about the practice, the implication being that Evans had missed a serious illness and their son died as a result.
Mrs Oliver sent him a copy of the hymn sheet from her son's funeral, with Oliver's picture on the front of it. It upset Evans enormously. In the months that followed, Mrs Oliver gave regular briefings to local papers over the status of her complaint against the Gowerton practice. The initial finding of pneumonia as the cause of death was widely reported, as were some of the conclusions of an independent inquiry into the death, which found that Evans's care of Oliver was "not in all respects appropriate". The report, which also said the surgery's telephone procedures should be improved, was meant to be confidential, but selective parts of it were leaked to the press. The overall impression given was that Evans had made a catastrophic mistake.
Evans's colleagues knew that he was extremely troubled by the events. He took a break from work for a while, but returned to seeing patients on condition that he sought counselling and had a daily meeting with a colleague. He tried the British Medical Association's advice line, but couldn't relate to the counsellor. He became more and more withdrawn, until he lost all confidence.
"What really drove him over the edge, I think, was that he felt that he had brought bad publicity onto the practice and onto the family," his widow Julie told the Guardian yesterday, in her first interview. "Every time he saw a patient he thought they must be thinking, 'Well, he made one mistake, what if he makes a mistake with me?'
"He was a very private man so found it difficult to open up to anyone. I never knew that he was so close to the edge. I always thought that people who are depressed are withdrawn and have no motivation, whereas he was painting the garden fence on the afternoon before he died."
When Evans killed himself, the media, encouraged by Mrs Oliver, took his death as an admission of guilt. "The day after Michael died, Dr Evans came to the house and went down on his hands and knees in front of us and said, 'Mr and Mrs Oliver, I do not know what to tell you. I totally misread and misdiagnosed the symptoms,'" Mrs Oliver told the Western Mail. "My husband replied, 'Doctor, that is no good to us. Our son is dead.'"
(Mrs Evans says that her husband did visit the family to say how sorry he was for their loss, but would never have got down on his knees. "He never thought that he had made a mistake. He was very upset, but after 27 years with not a complaint about him you would think he would recognise someone who was near death.")
In a particular display of crassness, David Mellor, writing in the Sunday People, seemed to suggest that Evans had done the decent thing in taking his own life: "What a contrast his acceptance of responsibility is from all those dodgy docs who butcher patients and then brazenly persuade the General Medical Council to let them continue hacking away." But Mellor got his facts wrong, stating that Evans had missed an advanced cancer in Oliver. (The Press Complaints Commission is investigating a complaint by the BMA.)
Through all this the Evans family said nothing. "I can look back now and say that we shouldn't have shut up," says Mrs Evans. "We all took it and thought that common sense would prevail. We are reasonable people and we couldn't believe this was happening." Her husband, she says, felt constrained by his duty of confidentiality to the patient. "I know my husband felt that it wasn't his place to say things, to let it become a tit-for-tat situation. He was very much for keeping quiet. To his cost, unfortunately."
Three weeks ago, however, as the inquest into Evans's death was concluded, his friends and family finally broke their silence. They revealed that pathology tests showed that Oliver probably did not die of pneumonia. In fact it is still not known what caused the young man's blood pressure to drop to catastrophic levels. Certainly, Evans did not realise quite how ill Oliver was. But it is questionable whether any other doctor would have treated him differently.
The outcome of all this could have been much happier, Mrs Evans believes, if the complaint against her husband had been handled differently. The first step when a patient has a grievance against a doctor or surgery, which is not an issue of medical negligence, is for the local NHS health authority to attempt to mediate between the two parties, and if possible settle the whole matter without taking it any further. If the complainant is not satisfied with this, he or she can then request an independent panel to investigate the case.
The problem in this case, Mrs Evans says, is that Mrs Oliver was extremely hostile to any attempts at mediation. After the inquest into Evans's death, the practice manager at the Gowerton surgery revealed that Mrs Oliver, who has since died, had made repeated calls to the surgery after her son's death, even saying there were "fresh graves" waiting for Evans and other staff members, to the point where the Gowerton practice asked the health authority for permission to involve the police. Mrs Evans believes that the health authority should have realised that this was a person who would not necessarily be mollified by an independent inquiry, whatever its findings.
"The result was that because the complainant was confrontational straight away and refused to talk to anyone, and just wanted to talk to the newspapers, no one carried out local resolution," she says. "The practice wrote a letter to the complainant saying how they saw things and she rejected it. What they should have realised was that this person needed help herself rather than being effectively encouraged to channel her anger into someone else."
In fact, the process threw up more questions than answers for a family that had been led to expect some resolution. It concluded that "inappropriate" behaviour by Evans was unlikely to have affected the sad outcome of Oliver's condition.
'The complaints procedure is meant to reach a resolution but nothing was gained by that procedure at all," says Mrs Evans. "We were back where we started, except that my husband was driven into the illness of depression. He began to have less confidence in himself. He had never been depressed in his life, he was always an optimist, loved his work, but he just couldn't concentrate any more. None of us really saw it. He was always the person we would turn to."
Mrs Evans argues that doctors must have more support when a complaint is made against them, that health authorities must make greater efforts to mediate between the parties and give the aggrieved family a reasonable sense of what resolution they can expect, and that those involved in dealing with a complaint must be given the resources and training to deal with a grievance more quickly. Her husband would have been better off if he had been accused of criminal negligence, she points out, because then he would have the force of his union behind him, and the case could not be reported until a conclusion had been reached.
After months of grief and further savaging of her husband's reputation, Mrs Evans is now resolved to set the record straight. "I think after all that suffering we have had I'm going to damn well make my voice heard. Not that I'm doing this out of a need to blame anyone, I'm just very, very concerned. It's frightening when I look back that this actually happened. A community has lost a good doctor, a family has lost a husband, a father, over what? Just hysteria. It's like a force of evil came into the house and took over, and ended up with someone destroying themselves."