HOW do you define what is a case of "most serious" medical malpractice?

A leaked internal Department of Health document, revealed by The Northern Echo today, shows that the Chief Medical Officer, Dr Liam Donaldson, rejected legal advice that he could recommend a public inquiry into the Richard Neale affair because he wanted "to ensure public inquiries are reserved for the most serious cases".

The obvious implication is that Dr Donaldson does not consider the Neale affair to be a "most serious" case.

But Neale left two patients dead in Canada, yet still got a job in North Yorkshire. In this country, he left 88 patients with very serious injuries and more than another 160 with very serious concerns about their treatment. And still he was able to get another job in this country, and a substantial pay-off from North Yorkshire.

Is not two dead and 88 seriously injured "most serious"?

It is even more serious given the current state of the National Health Service. Doctors are in such short supply that health authorities are desperate to employ anyone with the right qualifications. The North-East is looking to recruit consultants from Germany and GPs from Spain. The Department of Health is supporting these international moves, and is assisting in the cutting of red tape to enable the imports to start work as soon as possible.

But if the public are to have faith in this short-term fix for the NHS, they need to know that lessons have been learned and procedures have been tightened since Neale came from Canada with his appalling record concealed.

And the best - and most obvious - way of doing this is to hold an inquiry in the open so that everyone can see what went wrong, why it went wrong and what is being done to ensure that it never happens again.

Alan Milburn, the Health Secretary in whose Darlington constituency some of Neale's victims live, persists in following Dr Donaldson's advice in holding an inquiry behind closed doors.

When Mr Milburn's right to hold a private inquiry was upheld by a judicial review, William Hague, in whose Richmond constituency Neale was based, said: "Now it will be impossible to be certain that all the facts about this appalling saga are known and lessons for the future may not be learned."

Two dead, 88 seriously injured and public confidence in the NHS potentially damaged - by anyone's definition, surely a "most serious" case.