From the GMC fitness to practise panel

Rajkumar (June 2015)

Providing drug without prescription – vulnerable patient – invitation to patient to collude in malpractice.

Facts

The Doctor, without formally prescribing it, gave a patient lorazepam on a home visit, and then told her not to inform his secretary of what he had done. At the time the patient was under the care of the Mental Health Team who had been trying to reduce her medication.

The doctor had obtained the drug from unused medication which had been returned to him by another patient.

Evidence was given that until about 10 years ago it was not unusual for doctors to have an “emergency bag” of medication, made up of unused drugs returned by other patients. However, the practice went out of date 25 years ago.

In this particular case even a medical student should have realised that lorazepam was an inappropriate medication.

Mitigation

The doctor accepted his failings and had taken steps to improve procedures in his practice.

Decision

The doctor’s actions fell just short of impairment. He had tried to conceal the provision of medication and in doing so attempted to persuade a vulnerable patient to collude with him. He only made a note of the medication given when made aware of Police involvement. The Committee considers that these matters amount to a serious departure from Good Medical Practice.

A formal warning had be attached to the doctor’s registration.

Dawson (August 2015)

Drink driving by well respected doctor

Facts

While driving the doctor collided with a parked vehicle. She was breathalysed and found to be over the limit. She was prosecuted and banned from driving for 17 months and fined £650.

Mitigation

She had been honest and co-operative with the police. This was an isolated incident which took place at a time of great personal stress. Moreover, she had since learnt that the measures of alcohol with which she had been served were larger than normal.

Since her conviction she had undergone rehabilitative measures, including the attendance on a drink driving awareness course. She had already suffered considerably as a result of her own actions.

Decision

Drink driving is a serious matter capable of bringing the profession into disrepute.

Despite the considerable mitigation, including excellent testimonials from friends and colleagues, a formal warning was appropriate.

Gold (July 2015)

Premature discharge of suicidal patient – subsequent suicide of patient – unconvincing testimonials provided –

Facts

The doctor was the responsible clinician for a patient at an acute psychiatric unit. The patient had been admitted after recovering from serious spinal injuries sustained by jumping off a 40 foot building.

Having initially been admitted under S.2 of the Mental Health Act, the patient remained at the hospital as an informal patient. He was discharged on 18^th May 2012, and took his own life 4 days later.

There appears to have been some conclusion as to whether a full discharge was planned or whether the patient was merely intended to have a period of home leave. The doctor was also at fault in not seeing the patient and assessing his risk on the morning of the 18^th May.

The discharge was not adequately planned and was inappropriate in view of the fact, amongst others, that the patient had put a shoe lace ligature around his neck on the day before he was discharged. Discharge should have been a far more gradual process.

Decision

The discharge was confused and premature.

The doctor made no genuine expression of regret or remorse, and only made partial admissions as to his responsibility. The committee noted that no apology made was made during the hearing. The Committee were not reassured by the testimonials provided, as the majority are not from senior colleagues, and many of the referees were not informed of the nature of the allegations.

A warning recording the committee’s findings was to be attached to the doctor’s registration.

Obaidullah

Police caution, whether formal warning justified – loss of temper in context of acrimonious divorce – relevance of previous spent convictions

Facts

The Doctor, who was going through a stressful divorce, made an abusive telephone call to his ex-wife. He accepted a police caution under the Malicious Communications Act.

He had had previous warnings in respect of motoring convictions 5 and 9 years earlier, and in respect of which he had failed to inform the GMC.

Mitigation

The doctor reacted in a human way to a stressful incident. At the time he had been working without a break for 10 days in a busy A&E department. He was physically and emotionally exhausted. He had been separated from his wife and daughter for 3 months.

Since the incident he had undergone counselling and attended an anger management course. It was submitted on his behalf that there was, as a result, no risk of repetition. Excellent testimonials were presented on his behalf.

Decision

There were no risks to patients but the committee felt the doctor had only partial insight into his conduct. He was still trying to put some of the blame for his conduct onto his ex-wife.

Although both previous warnings were spent at the date of the hearing, one was still current at the date of the incident.

The committee had to uphold public confidence in the medical profession and a further warning was appropriate.

Smith (May 2015)

Police caution for possession of single cannabis ciagrette, whether formal warning justified

Facts

The Doctor was found in possession of a single cannabis cigarette in her garden when the police attended after somebody reported a female acting suspiciously outside the house late in the evening.

She had accepted a police caution. Having done so, by her own admission she then smoked another cannabis cigarette.

Mitigation

There were no clinical concerns and no previous complaints.

Decision

There were some concerns over inconsistent reports of cannabis use. The committee could not see this as an isolated incident. A formal warning was appropriate.