Clinical Continuity Breach: The Missing Interval
Recorded by Miss Lilah Bell at Bath Road Surgery. Live clinical record established.
No audit trail. No lawful deletion notice. No restoration pathway.
Primary care transferred. Historical diabetes records not transmitted or available.
⚠ Discovery: 2-year clinical history missing or deleted
Overview
This disclosure concerns the deletion and non-preservation of live patient medical records by Bath Road Surgery, 134 Bath Road, Hounslow, London, TW3 3ET, whilst the patient remained alive, registered, and reliant upon those records for ongoing care, safeguarding, and legal accountability. The clinicians pleaded in the associated proceedings are Dr. Sunil Mayor and Dr. Akhil Mayor. The matter is defended by Gordons Partnership Solicitors LLP.
The matter arises from the discovery that core elements of the patient’s primary care record covering diagnosis, treatment history, continuity of care, and clinical decision-making were no longer available when lawfully requested. The absence of these records was not limited to ancillary or administrative material but extended to clinically material data ordinarily required to evidence patient history, risk, and treatment pathways.
The deletion or failure to preserve these records occurred without lawful justification, without transparency, and without any documented process capable of explaining how or why records fundamental to patient safety and legal rights had ceased to exist. At the point of discovery, the patient was alive, vulnerable, and engaged in both medical and legal processes for which the integrity of those records was essential.
This disclosure is made in the public interest because the preservation of patient medical records is a foundational obligation within primary care. Where such records are deleted or rendered unavailable during the lifetime of a patient, the consequences extend beyond individual harm to systemic risk, undermining safeguarding, continuity of care, and the ability of patients to assert their rights within regulatory and legal frameworks.
Context and Trigger
This disclosure is triggered by the point at which the absence of core primary care records became apparent in circumstances where those records were required for ongoing medical care, safeguarding, and the proper examination of clinical decision-making.
The context is not a retrospective records-management issue arising after death or long-term archival transfer, but the deletion or non-preservation of active patient medical data while the patient remained alive, registered, and reliant upon primary care services. The missing records related to clinically material matters and were integral to continuity of care, risk assessment, and the patient’s ability to understand, evidence, and challenge treatment history.
The trigger for disclosure was the failure of the GP surgery to account for the disappearance of these records when lawfully requested, coupled with the absence of any transparent explanation, audit trail, or remedial process capable of restoring or validating the data. This failure occurred at a time when the records were directly relevant to safeguarding considerations and to legal and regulatory processes in which the integrity of the medical record was essential.
The disclosure therefore arises at the point where record deletion or non-preservation moved beyond an internal administrative failure and into a matter of public interest, engaging patient safety, governance obligations, and the reliability of primary care record-keeping as a foundation of lawful medical practice.
Factual Sequence
The patient was registered with the GP surgery and received primary care over a sustained period during which clinically material information was generated, including diagnoses, prescriptions, investigations, and records relevant to continuity of care and safeguarding.
At a later stage, the patient made a lawful request for access to their primary care records in circumstances where those records were required for ongoing medical management and for the examination of prior clinical decision-making. Upon that request, it became apparent that significant elements of the patient’s medical record were no longer available.
The missing material was not confined to peripheral or administrative entries but included data that would ordinarily form part of a continuous and auditable clinical history. No prior notice had been given to the patient that records had been deleted, removed, or otherwise rendered unavailable, and no explanation was provided at the point of discovery as to when or how the loss had occurred.
Subsequent attempts to obtain clarification or restoration of the records did not produce any contemporaneous audit trail, lawful deletion notice, or documentary justification capable of accounting for the absence of the data. The GP surgery did not provide evidence of a compliant records-management process that would explain the deletion or non-preservation of live patient records.
Throughout this period, the patient remained alive, registered, and dependent upon primary care services, with the missing records directly affecting the ability to evidence medical history, assess clinical risk, and engage meaningfully with both medical and legal processes reliant upon the integrity of the primary care record.
Record Integrity Analysis: The Evidential Gap
✓ Complete Clinical Record
- Type 2 Diabetes diagnosis recorded
- Baseline HbA1c established
- Medication history initiated
- Comorbidity markers present
- Risk stratification documented
- Continuity pathway established
✗ Critical Data Absent
- No diabetes history transferred
- No HbA1c trend data
- No medication response records
- No safeguarding documentation
- Only: Registration confirmation
- Only: Administrative metadata
Chronological Record
This section sets out the verified chronology relevant to the Claimant’s medical status, transfer of primary care, and subsequent recognition and management of diabetes. The timeline is derived from the Subject Access Request disclosure and associated records and is presented to establish the temporal sequence of clinically and legally material events.
Chronological Timeline
| Date | Event | Source / Record | Notes |
| 28 June 2018 | Type 2 diabetes mellitus recorded (replacing non-diabetic hyperglycaemia) | GP medical record | Recorded by Miss Lilah Bell at Bath Road Surgery, Hounslow |
| 2018–2022 | Claimant remains a diagnosed diabetic; receives secondary breast care in London | Medical history | Diabetes diagnosis remains part of live patient record |
| 10 May 2022 | Registration with Theale Medical Centre as new GP practice | New patient registration record | Primary care transferred from Bath Road Surgery |
| May 2022 – April 2024 | No documented diabetes-specific reviews or management entries | Theale Medical Centre record | Period following registration with no recorded diabetes care |
| 22 April 2024 | First recorded diabetes-related medication review at Theale | GP consultation record | First diabetes-related entry since registration |
Breaches
I. Deletion / non-preservation of clinically material live patient records.
Reason: Clinically material record content ceased to exist during the patient’s lifetime without lawful basis, notice, or governance proof.
Frameworks invoked: I–III, IX–XI, XII–XXIV, XXVIII–XXX, XXXI–XXXIV, XXXIX.
II. Loss of longitudinal continuity-of-care record (diagnosis, treatment pathway, decision-making evidence).
Reason: The record is no longer a continuous and auditable clinical history; continuity and risk cannot be safely evidenced.
Frameworks invoked: I–III, IX, X, XIII, XIV–XVIII, XXII, XXVIII–XXX.
III. Failure of transparency and accountability (no lawful justification, no documented process)
Reason: No deletion authority, explanation, or compliant process was provided when lawfully required.
Frameworks invoked: XIV, XVIII–XXI, XXV–XXVII, X, XI.
IV. Failure to produce an audit trail identifying who did what, when, and under what authority.
Reason: Absence of contemporaneous audit logs and governance documentation defeats demonstrable compliance.
Frameworks invoked: XVIII–XXII, XXVIII–XXIX, XXXIX.
V. Failure to restore, validate, or remediate record integrity once loss was discovered.
Reason: No remedial pathway capable of restoring availability or evidencing integrity was supplied.
Frameworks invoked: X, XI, XXII–XXIV, XXVIII–XXIX.
VI. Frustration of lawful access request (SAR/right of access) for clinically material data.
Reason: Requested personal data could not be provided, and the failure was not supported by evidence or compliant explanation.
Frameworks invoked: XXV–XXVII, XVIII–XXI.
VII. Security/integrity control failure (loss/destruction/unavailability of high-risk health data).
Reason: Unexplained loss of health data indicates inadequate technical/organisational measures and integrity safeguards.
Frameworks invoked: XVII, XXII–XXIV, XII, XIX–XXI.
VIII. Clinical governance failure (systems/processes not operated effectively).
Reason: The event evidences a breakdown in governance processes required to ensure compliant record management.
Frameworks invoked: X, XI, IX, XXVIII–XXX.
IX. Safeguarding and risk assessment impairment.
Reason: Removal of longitudinal record content weakens safeguarding thresholds and risk evaluation in chronic illness contexts.
Frameworks invoked: I–III, IX–XI, XXX.
X. Interference with ability to evidence and challenge clinical decision-making in legal/regulatory processes.
Reason: Evidence substrate removed; the patient’s capacity to assert rights and scrutinise decisions is impaired.
Frameworks invoked: V–VI, XXXI–XXXIV, XXXVI–XXXVII.
XI. Non-discrimination risk where vulnerability/disability is engaged.
Reason: Record loss produces disproportionate barrier effects in access to care and redress for vulnerable persons.
Frameworks invoked: XXXIV, XXXVIII.
XII. Adverse inference / spoliation consequence exposure.
Reason: Where material evidence is missing without lawful explanation, inference may be drawn against the party responsible.
Frameworks invoked: VI, XXXIX.
Governance Collapse Hierarchy: 40 Legal Duties Breached
UDHR Arts 7, 8
Legal Frameworks
I. Common law duty of care (negligence) — clinical record integrity / continuity of care
“You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.”
Analysis:
Deletion or non-preservation of clinically material primary care records while the patient is alive, registered, and reliant upon those records for ongoing care and safeguarding engages foreseeable patient safety harm and accountability harm, triggering the duty to maintain reasonable systems of care and record integrity.
II. Bolam — professional negligence baseline (accepted practice)
“He is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art…”
Analysis:
A reliable, continuous, auditable clinical record is part of “proper” medical practice. If material history ceases to exist without lawful basis, audit trail, or restoration pathway, the adequacy of the system/practice falls for scrutiny against accepted professional standards.
III. Bolitho — logical defensibility qualification
“…if… the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible.”
Analysis:
Where a records controller cannot produce a lawful basis, audit evidence, or a coherent governance explanation for the disappearance of clinically material data, the asserted “practice” is not logically defensible as compliant clinical governance—particularly where safeguarding and continuity depend on those records.
IV. Common law confidentiality (medical confidence)
“A duty of confidence arises when confidential information comes to the knowledge of a person… in circumstances where he has notice… that the information is confidential.”
Analysis:
Medical record stewardship carries heightened obligations of control, integrity, and proper handling. Unexplained disappearance of clinical content while the patient remains under care engages governance failure in the handling of confidential medical information.
V. Procedural fairness / natural justice (effective ability to know and challenge)
“No man is to be judged without a hearing.”
Analysis:
Where clinically material records are deleted or rendered unavailable, the patient is deprived of the evidential basis needed to understand, evidence, and challenge clinical decisions—especially where safeguarding and legal accountability are engaged.
VI. Duty to preserve evidence where litigation/regulatory scrutiny is reasonably contemplated (adverse inference risk)
“The court may presume that evidence which could be and is not produced would, if produced, be unfavourable to the person who withholds it.”
Analysis:
Where the controller cannot account for why clinically material records “ceased to exist”, the evidential consequence is exposure to adverse inference and regulatory suspicion; the loss itself becomes probative of governance breach and/or concealment.
VII. Misfeasance in public office (conditional: public function + reckless/intentional illegality)
“The tort… consists of the malicious exercise of a power possessed by a public officer.”
Analysis:
If the GP practice (or associated actors) were operating a public function and the deletion/non-preservation was deliberate or recklessly indifferent to illegality and likely harm, misfeasance is engaged as a public-law accountability route.
VIII. Illegality / ultra vires (conditional: breach of mandatory governance duties)
“A public authority may do only that which it is authorised to do.”
Analysis:
If deletion occurred contrary to mandatory NHS/IG governance duties applicable to the controller/processor, the act is outside lawful authority, engaging illegality/ultra vires consequences and invalidating any attempt to normalise the loss.
IX. GMC (doctor professional duties) — records must be clear and accurate
“You must keep clear, accurate and legible records.”
Analysis:
Where a GP system cannot preserve or produce clinically material history, it conflicts with the core professional obligation of record accuracy and clarity. The duty is not satisfied by asserting compliance; it requires actual auditable continuity of the medical record.
X. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 — Regulation 17 (good governance)
“Systems or processes must be established and operated effectively to ensure compliance with the requirements in this Part.”
Analysis:
Unexplained loss of clinically material records indicates governance system failure: absence of effective processes for retention, auditability, integrity controls, and restoration, particularly in high-risk safeguarding and chronic disease contexts.
XI. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 — Regulation 20 (duty of candour)
“The duty of candour is a duty on a registered person to act in an open and transparent way…”
Analysis:
Where record loss is discovered, a compliant response requires openness, explanation, and corrective steps. Silence, opacity, or inability to account for deletion/non-preservation engages candour failure as a governance breach.
XII. UK GDPR Article 9(1) — health data as special category
“Processing of personal data revealing… data concerning health… shall be prohibited…”
Analysis:
Medical records are special category data. Their processing requires heightened safeguards and a lawful condition. Unexplained deletion/non-preservation during active care reliance amplifies compliance burden and governance scrutiny.
XIII. UK GDPR Article 9(2)(h) — health care condition
“processing is necessary for the purposes of… medical diagnosis, the provision of health or social care or treatment…”
Analysis:
Primary care records exist to enable diagnosis, care, and treatment. Deletion/non-preservation of clinically material history undermines this necessity basis and indicates that processing is not being managed in a way consistent with care delivery obligations.
XIV. UK GDPR Article 5(1)(a) — lawfulness, fairness, transparency
“processed lawfully, fairly and in a transparent manner in relation to the data subject”
Analysis:
Deletion/non-preservation without lawful justification, transparency, and audit trail breaches the foundational rule of lawful and transparent processing for health data.
XV. UK GDPR Article 5(1)(d) — accuracy
“accurate and, where necessary, kept up to date”
Analysis:
A record missing clinically material history cannot be treated as accurate or reliably up to date. This is not minor deficiency; it defeats longitudinal clinical safety and accountability.
XVI. UK GDPR Article 5(1)(e) — storage limitation (retention)
“kept in a form which permits identification of data subjects for no longer than is necessary…”
Analysis:
If clinically material entries were deleted prematurely, storage limitation has been misapplied. Medical record retention requires structured retention periods and controlled disposal, not disappearance during active reliance.
XVII. UK GDPR Article 5(1)(f) — integrity and confidentiality
“processed in a manner that ensures appropriate security… including protection against… loss… or damage”
Analysis:
Unexplained loss/unavailability of clinical data indicates security and integrity control failure. Health data processing requires robust resilience against destruction and loss.
XVIII. UK GDPR Article 5(2) — accountability
“The controller shall be responsible for, and be able to demonstrate compliance…”
Analysis:
A controller must evidence compliance via audit trails, deletion logs, lawful basis, and restoration actions. Failure to demonstrate is itself a breach, independent of intent.
XIX. UK GDPR Article 24(1) — controller responsibility
“the controller shall implement appropriate technical and organisational measures to ensure and to be able to demonstrate that processing is performed in accordance with this Regulation.”
Analysis:
The duty is active and continuous. A GP system that cannot preserve or produce clinically material patient history indicates inadequate measures and governance architecture.
XX. UK GDPR Article 25(1) — data protection by design and by default
“the controller shall… implement appropriate technical and organisational measures… designed to implement data-protection principles…”
Analysis:
Records systems must be designed to prevent uncontrolled deletion, preserve auditability, and maintain availability for clinical and rights-based purposes. Disappearance of core data indicates design/default failure.
XXI. UK GDPR Article 30(1) — records of processing activities (ROPA)
“Each controller… shall maintain a record of processing activities under its responsibility.”
Analysis:
Where deletion/non-preservation occurs, the controller must be able to evidence governance (systems, retention rules, deletion basis). Absence of documentary governance trail is incompatible with ROPA obligations in high-risk health processing.
XXII. UK GDPR Article 32(1) — security of processing
“the controller and the processor shall implement appropriate technical and organisational measures to ensure a level of security appropriate to the risk…”
Analysis:
Health records require high-assurance integrity, resilience, and availability safeguards. Unexplained unavailability of clinically material data indicates security governance failure against an elevated risk domain.
XXIII. UK GDPR Article 33(1) — notification of a personal data breach
“the controller shall without undue delay… notify the personal data breach to the supervisory authority…”
Analysis:
Loss/destruction/unavailability of health data can constitute a personal data breach. If thresholds are met, failure to assess/notify engages Article 33 breach handling failures.
XXIV. UK GDPR Article 34(1) — communication of a breach to the data subject
“the controller shall communicate the personal data breach to the data subject without undue delay.”
Analysis:
Where record loss creates high risk to rights and freedoms (including care safety and ability to evidence history), communication duties arise unless a lawful exception applies.
XXV. UK GDPR Article 12(1) — transparent handling of rights requests
“The controller shall take appropriate measures to provide any information… in a concise, transparent, intelligible and easily accessible form…”
Analysis:
A lawful request met by opacity, non-explanation, and no audit basis is non-compliant. The standard is transparent, evidenced handling not assertion.
XXVI. UK GDPR Article 15(1) — right of access (SAR)
“The data subject shall have the right to obtain from the controller confirmation as to whether or not personal data… are being processed, and… access to the personal data…”
Analysis:
Where clinically material records cannot be produced, the controller must evidence what is held and provide an evidenced explanation of deletion/non-preservation. Otherwise, access rights are frustrated in substance.
XXVII. Data Protection Act 2018 — health data governance / enforcement framework
“An Act to make provision for the regulation of the processing of information relating to individuals…”
Analysis:
The DPA 2018 supplies the domestic enforcement and compliance architecture for UK GDPR duties in the UK context, including special category health data handling and remedies pathways.
XXVIII. NHS Records Management Code of Practice (England) — record reliability and auditability
“Reliable — Full and accurate record of the transaction or activity or fact.”
Analysis:
Primary care record systems must be reliable, complete, and auditable. Loss of clinically material history while care is ongoing is a governance breach against NHS record reliability requirements.
XXIX. Primary care information governance / GP record system obligations (system-level)
“Records… must be managed in a way which supports patient care and is legally and professionally compliant.”
Analysis:
Whether held within GP systems or supplier platforms, IG obligations require controlled retention, audit trails, and availability. Unexplained disappearance of core clinical entries indicates systemic governance failure.
XXX. Safeguarding and clinical risk governance — continuity depends on a longitudinal record
“Safeguarding is everyone’s responsibility.”
Analysis:
Safeguarding, chronic disease management, and risk escalation depend on continuity and access to history. Record deletion/non-preservation during active vulnerability increases foreseeable risk and undermines lawful safeguarding practice.
XXXI. ECHR Article 8 — respect for private life (medical data integrity)
“Everyone has the right to respect for his private and family life, his home and his correspondence.”
Analysis:
Medical records fall within private life. Deletion/non-preservation of clinically material records without lawful basis, transparency, and corrective pathway is an interference with informational autonomy and the practical integrity of Article 8 protections.
XXXII. ECHR Article 6(1) — fair hearing (civil rights)
“In the determination of his civil rights and obligations… everyone is entitled to a fair and public hearing…”
Analysis:
If record deletion/non-preservation impairs the ability to evidence history, challenge clinical decisions, or pursue civil accountability/regulatory routes, Article 6 fairness/equality-of-arms consequences are engaged.
XXXIII. ECHR Article 13 — effective remedy
“Everyone whose rights and freedoms… are violated shall have an effective remedy…”
Analysis:
Where the evidential foundation is removed by record loss, remedies become illusory in practice. The interference with redress mechanisms engages effective remedy principles.
XXXIV. ECHR Article 14 — non-discrimination (where vulnerability/disability is engaged)
“The enjoyment of the rights and freedoms… shall be secured without discrimination…”
Analysis:
Where vulnerability/disability is relevant, record-loss effects can be disproportionately harmful and create barrier effects in access to care and redress, engaging non-discrimination protections.
XXXV. ICCPR Article 17 — privacy
“No one shall be subjected to arbitrary or unlawful interference with his privacy…”
Analysis:
Arbitrary deletion/non-preservation of medical records, absent lawful basis and safeguards, engages privacy as an unlawful/arbitrary interference with data integrity in a high-sensitivity domain.
XXXVI. ICCPR Article 14(1) — equality before courts and tribunals / fair hearing
“All persons shall be equal before the courts and tribunals.”
Analysis:
Where record integrity failure obstructs effective participation in legal processes (including complaints, regulation, civil proceedings), ICCPR Article 14(1) supports the fairness/equality framing as interpretive context.
XXXVII. ICCPR Article 2(3) — effective remedy
“Each State Party… undertakes… to ensure that any person whose rights… are violated shall have an effective remedy…”
Analysis:
If deletion/non-preservation disables meaningful enforcement or complaint pathways by removing the evidential substrate, effective remedy obligations are engaged as interpretive reinforcement.
XXXVIII. ICCPR Article 26 — equality before the law / non-discrimination
“All persons are equal before the law and are entitled without any discrimination to the equal protection of the law.”
Analysis:
Where record loss creates unequal access to protection, safeguarding outcomes, or redress—especially for vulnerable persons—ICCPR equality protections are engaged as interpretive context.
XXXIX. Adverse inference / spoliation consequence (evidential outcome)
“The court may presume that evidence which could be and is not produced would… be unfavourable…”
Analysis:
Where the controller cannot produce an audit trail or lawful basis for destruction, adverse inference arises: the absence itself becomes evidence of governance breach and may be treated as unfavourable to the deleting/non-preserving party.
XL. Aggravation / uplift factor (obstruction and uncertainty multiplier)
“Aggravated damages… are awarded where the defendant’s conduct has injured the claimant’s proper feelings of dignity and pride.”
Analysis:
Intentional or reckless governance collapse causing record loss increases harm valuation by adding obstruction, uncertainty, safeguarding risk, and forced evidential reconstruction burdens; this supports uplift/aggravation logic within the disclosure architecture.
Safeguarding & Accountability Impact Matrix
| Impact Domain | Clinical Risk | Legal Rights Impact |
|---|---|---|
| Continuity of Care | No HbA1c trends visible to new GP. Risk of inappropriate medication changes. | Right to safe medical treatment (Art 2 ECHR) undermined. |
| Safeguarding | Vulnerability markers lost. Safeguarding threshold assessment impossible. | Protection from harm mechanisms disabled (Care Act 2014, Safeguarding duties). |
| Clinical Accountability | Prior clinical decisions unauditable. Causation analysis blocked. | Access to justice blocked (Art 6 ECHR). Adverse inference triggered. |
| Data Subject Rights | Patient unable to verify accuracy of current care against history. | GDPR Art 15 (Access), Art 5 (Accuracy) breached. Informational autonomy destroyed. |
| Regulatory Scrutiny | CQC/GMC unable to assess quality of care without longitudinal record. | Effective remedy prevented (Art 13 ECHR). Spoliation of evidence. |
Conclusion
This disclosure concerns the deletion and non-preservation of clinically material live patient medical records at Bath Road Surgery (Hounslow, Bath Road), in circumstances where the patient remained alive, registered, and reliant upon those records for safe continuity of care, safeguarding, and legal accountability. The clinicians pleaded in the associated proceedings, Dr. Sunil Mayor and Dr. Akhil Mayor, are not peripheral to this issue: in primary care, the GP is the accountable clinical gatekeeper, and the surgery is the accountable custodian of the longitudinal medical record upon which national continuity-of-care and safeguarding functions depend.
The effect is not a minor administrative deficit but a substantive collapse of record integrity affecting diagnosis history, treatment pathways, risk assessment, and the capacity to evidence and scrutinise clinical decision-making. Where clinically material history is deleted or rendered unavailable during a patient’s lifetime, continuity of care becomes structurally compromised, safeguarding thresholds are weakened, and the patient’s ability to assert lawful rights within medical, regulatory, and legal processes is impaired.
The absence of a lawful explanation, deletion authority, contemporaneous audit trail, or remedial restoration pathway elevates the matter beyond internal records-management failure and into a public-interest governance issue. If a GP surgery cannot evidence who authorised deletion, when it occurred, on what basis it was performed, and what steps were taken to restore or validate the record, the failure is one of clinical governance and professional accountability, not merely data processing. The disclosure is therefore made to ensure that this record-integrity event is treated as requiring formal accountability and audit-level verification, given the clear patient-safety implications and the reasonable concern that similar record failures may affect other patients who are unable to detect or challenge such loss.
Structural Impact Formula
The Structural Impact Score ($SIS$) is defined as:
$SIS = \left( \sum_i w_i \cdot x_i \right)\!\left( 1 + \lambda \sum_{i\lt j} x_i x_j \right)$
Where:
- $x_i$ are binary structural variables activated in this disclosure
- Activated variables: $P, D, L, V, R, I, SC$, each taking value $1$
- $w_i$ are the base weights assigned to each activated structural variable
- $\lambda$ is the interaction amplification coefficient
- $\sum_{i\lt j} x_i x_j$ runs over all distinct pairs of active variables to capture compound systemic effects
Structural Impact Result
For this disclosure, the activated structural variables are:
$P, D, L, V, R, I, SC$ (7 variables active, each $x_i = 1$)
The interaction pair count is:
$\binom{7}{2} = 21$
Accordingly, the Structural Impact Score resolves to:
$SIS = \left( w_P + w_D + w_L + w_V + w_R + w_I + w_{SC} \right)\!\left( 1 + \lambda \cdot 21 \right)$
Structural Impact Meaning
An $SIS$ value produced by seven concurrently active structural variables with $\binom{7}{2} = 21$ interaction pairs indicates a compound systemic collapse rather than isolated administrative or clinical error.
The co-activation of procedural breakdown ($P$), defence or evidential obstruction ($D$), longitudinal care disruption ($L$), vulnerability amplification ($V$), rights and regulatory interference ($R$), institutional interlock ($I$), and safeguarding/control failure ($SC$) demonstrates mutually reinforcing defects across clinical governance, data integrity, patient safety, and legal accountability.
The interaction multiplier $\left(1 + \lambda \cdot 21\right)$ confirms that the overall impact escalates beyond simple addition: each structural defect intensifies others. Within ordinary clinical, governance, data protection, and procedural standards, this profile reflects a systemic record-integrity collapse, impaired continuity of care, and elevated safeguarding risk that cannot be addressed by isolated correction alone.