An NHS consultant physician is the subject of a criminal and GMC investigation following the death of a patient with multiple organ failure. By Dr Beth Walker, medicolegal consultant at Medical Protection.
Dr B, an NHS consultant physician, was involved in the care of an NHS patient who died of multi-organ failure following complications from a radiology investigation. There were differences in opinion among various doctors involved regarding the care provided. The matter was investigated internally by the Trust and later an inquest was opened into the death by the coroner.
The NHS Trust’s legal team had originally felt it could represent all employees involved. However, Dr B was informed only a few days before the inquest was due to commence that, due to a disagreement between themselves and other doctors involved, they could no longer represent them. Dr B then contacted Medical Protection via the urgent 24/7 out-of-hours telephone line for assistance.
How Medical Protection got involved
The medicolegal consultant for the case promptly took steps to manage the situation, including appointing a solicitor who was instructed to represent Dr B’s interests and acquiring an experienced barrister to attend the inquest hearing with the member.
A further complication arose when a criminal allegation was made arising from the Trust’s investigation of the matter and Dr B was contacted by the police to be interviewed under caution. The solicitor on the case corresponded with the police inspector on Dr B’s behalf and successfully disputed the indication to conduct an interview under caution. Instead, the solicitor attended the police station with Dr B to give a witness statement and the criminal matter was eventually closed.
At the inquest, Dr B was criticised in the coroner’s conclusion. Pursuant to the obligations set out in paragraph 75 of Good Medical Practice, they made a self-referral to the GMC. Dr B’s solicitor and medicolegal consultant were able to provide guidance and support at all stages of this process, including undertaking meaningful reflection and identifying targeted CPD helping to demonstrate the learning taken from these events and changes to future practice.
The GMC opened an investigation and instructed an expert to review the case, who was critical of Dr B’s care, leading to allegations of impaired fitness to practise being put to the member at the GMC’s ‘Rule 7’ stage. As part of assisting the member in preparing a response to these allegations, Medical Protection instructed its own defence expert, who in contrast to the GMC’s, was almost entirely supportive of the care provided.
The ‘Rule 7’ stage
The defence expert’s report and Dr B’s efforts in reflection and remediation were key in securing a very good outcome at the ‘Rule 7’ stage. The options available to the GMC’s case examiners at the ‘Rule 7’ stage are to close the case with no action, offer a warning, offer undertakings (usually reserved for health cases) or to refer the case on to the Medical Practitioner Tribunal Service for a Fitness to Practise hearing.
After consideration of this complex case, the case examiners decided that the ‘realistic prospect test’ of establishing that Dr B’s fitness to practise was currently impaired was not met and that a warning would not be appropriate. The case was closed with no further action.
The family’s response
On hearing this outcome from the GMC, the patient’s family were very unhappy and sought a review of this decision. This was a distressing development for our member at the end of what had already been a long-running and stressful experience. Throughout the case, Dr B had access to Medical Protection’s free and independent counselling service.
The medicolegal consultant provided further instructions to the solicitor who provided strong representations on Dr B’s behalf to the GMC as to why it was felt the threshold was not met to review the original decision. These submissions were successful, and the outcome remained that the case was closed with no further action.
All these developments unfortunately stemmed from one single involvement in this patient’s care, demonstrating the importance of having professional protection and the support and expertise of Medical Protection’s medicolegal team.
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