GP says criticism of Covid-19 guidelines was effort to contribute 'discussion about contentious matters'

Seán McCárthaigh

A Wexford GP has told a medical inquiry that comments he posted on social media criticising public health guidelines during the Covid-19 pandemic were designed to contribute to “a legitimate and necessary discussion about contentious matters.”

Dr Billy Ralph, who runs his own practice at The Ballagh Health Centre, The Ballagh, Enniscorthy, Co Wexford, has denied six allegations of professional misconduct in relation to a series of posts on his Twitter (now X) account between October 2020 and June 2022.

Ralph told a fitness-to-practise committee of the Medical Council that he rejected the accusation that his comments undermined public health guidelines during the pandemic.

However, he accepted that the language used in some tweets might have been “overly severe or harsh.”

The allegations relate to a total of 34 individual tweets which variously criticised the National Public Health Emergency Team (NPHET) and Covid-19 vaccinations, particularly to children, as well as the use of facemasks and lockdowns to restrict the spread of the virus.

Another allegation relates to the promotion by Dr Ralph of the use of ivermectin – a prescription medicine used to treat parasitic infections like head lice –- as a treatment for Covid-19 infection.

An expert witness called by the Medical Council told the inquiry that the GP’s social media posts could have caused the public to doubt the safety and effectiveness of measures to restrict the spread of Covid-19.

On the third of the inquiry on Friday, Dr Ralph said that he had tried to practice medicine for over 30 years in a conscientious, independent manner “grounded in clinical experience and assessment of available evidence.”

The GP said he always exercised professional judgement on behalf of his patients and their welfare and dignity.

He claimed there is a responsibility to practice “evidence-based medicine” especially in relation to complex or evolving matters “and not simply to develop a single prevailing position without question.”

The GP said he had posted the tweets during “an unprecedented time in medicine when scientific understanding was evolving.”

He pointed out that views that were now clear with the benefit of hindsight were not necessarily so at the time and his comments were made “in the context of uncertainty.”

While he had followed public health guidelines in his clinical practice, Dr Ralph said he had concerns about them as the pandemic progressed.

The GP outlined how he had tried to raise his concerns with professional bodies as well as sending over 70 e-mails to politicians including the Minister for Health, Simon Harris, as well as the head of NPHET, Tony Holohan before expressing them publicly.

“In my experience those efforts did not lead to meaningful engagement or open discussion,” he observed.

Ralph said his intention in writing articles and posting on social media was not to cause harm or undermine his colleagues but to contribute to what he believed was “a legitimate and necessary discussion about contentious matters.”

He admitted he had been frustrated and upset at the lack of engagement by both the media and medical authorities.

The GP said he understood the public health guidelines were an important part of the framework in which he worked but stressed that they did not displace the exercise of his professional judgement.

Dr Ralph said he had witnessed the impact of some policies on patients who had experienced distress, disruption of care and the withdrawal of education from children which had reinforced his own views.

“At no stage did I believe that expressing views on matters of public health policy in good faith and grounded in my professional experience amounted to breaches of my duties as a doctor,” said Dr Ralph.

Under cross-examination by counsel for the Medical Council, Neasa Bird BL, he said he had tried to engage with medical colleagues via GP Buddy, an online platform for medical practitioners.

However, Dr Ralph described the level of ridicule and vilification he experienced as “disgusting and astonishing.”

He said the level of debate was “juvenile” while the main concern of other doctors seemed to be “how they would earn money in the pandemic.”

The GP agreed that Twitter was not an appropriate forum for discussing complex issues.

He also accepted that his comments on the platform would carry weight as a doctor, despite having a disclaimer that he was not offering medical advice.

Ralph told the inquiry that he had balanced the risk from the public health guidelines with the “theoretical risk of my tweets.”

“I tried multiple forums to point out there were major risks with how this problem was being dealt with and causing as much harm as the illness itself,” he remarked.

As both a doctor and a father, he said he was deeply concerned about the risk of giving Covid-19 vaccines at an early stage of testing to children.

The GP said it was a subject he still got emotional about and he admitted a tweet in which he stated any parent who gave their child the vaccine was “a vile individual” was “like a mini temper tantrum.”

Earlier, the fitness-to-practise committee rejected an application by Ralph to have the case against him dismissed following the conclusion of evidence by lawyers for the Medical Council.

The GP argued the case against him was on the basis that any expressions which introduced doubt about public health guidelines could be characterised as harmful and, in turn, professional misconduct.

Ralph noted that no evidence had been introduced that he had caused harm to any patient.

However, the chairperson of the inquiry, Paul Harkin, said the fitness-to-practice committee was satisfied there was a substantial body of evidence on which it could make a finding.

The hearing was adjourned to a date still to be determined to allow the committee question Dr Ralph and for closing submissions to be heard.