Dr Sally Old
This sad case concerns a young boy who died of acute bilateral streptococcal pneumonia and necrotising tonsillitis.
An out of hours GP had spoken on the phone to a child's father the evening before his death, but did not see or refer him.
The GP, who had a previously unblemished career, later faced the 'multiple jeopardy' of a coroner's inquest, a clinical negligence claim, Performer's List conditions, the attention of the media and a GMC investigation.
The three-year old patient was initially brought to his GP for treatment for an eye infection. Over the next three days he developed a fever, sore throat and bad smelling breath. His father brought him to the out of hours base where he was diagnosed with tonsillitis and prescribed penicillin. The father was also advised on fluids and giving paracetamol and told to 'report if not well'.
Over the next 36 hours, the child became more unwell with vomiting, diarrhoea and loss of his voice. His father called the out of hours service again reporting that his son was getting worse, was lethargic and not drinking enough fluids. Another GP, an MDU member, called back about 20 minutes later and reassured him that it might take the antibiotics another day to take effect. He advised the father to continue offering fluids, to use paracetamol, and if his son was no better the following day (a Monday) to bring him to see his own GP.
The boy was found dead at 7.00 the next morning. The post mortem suggested death was due to acute bilateral streptococcal pneumonia and acute necrotising streptococcal tonsillitis. The GP was notified he would be required to give evidence at an inquest into the boy's death. The MDU helped the GP prepare a statement and instructed a solicitor to represent him before and during the inquest.
The family pressed the coroner to consider whether the doctor's actions amounted to gross negligence, which raised the possibility of a manslaughter charge.
At the inquest the family were legally represented and submitted a statement from a paediatric intensivist expert who opined that, on the balance of probabilities, the child would have survived if he had been admitted the night his father spoke to our member. The family's legal team also criticised him for not following the 'three strike rule' of seeing and referring a child where the parents had contacted the GP three times in a short space of time. The family pressed the coroner to consider whether the doctor's actions amounted to gross negligence, which raised the possibility of a manslaughter charge.
The coroner returned a verdict of natural causes 'in circumstances where neglect contributed'. The family lodged a clinical negligence claim soon afterwards which the MDU settled on the doctor's behalf for £50,000 plus costs.
The doctor wrote to the parents expressing his deep sadness and regret at the death of their child and asking them to accept his apology. He transferred to hospital medicine for two years before reapplying to return to the PCT Performers List. He was allowed back on the List with conditions, involving working only in approved posts, undergoing appraisal and completing various training courses, including a 3-day paediatric course. He cooperated fully and was later admitted unconditionally to the Performers List.
Then, seemingly out of the blue, the doctor received a letter from the GMC informing him that they were investigating the case, enclosing press cuttings about the inquest from almost three years earlier.
It then transpired that a TV documentary team had picked up the story and sought the doctor's comments for a programme they were making about allegedly substandard GPs. The MDU's press office supported him throughout.
A few months later, the GP appeared before a GMC Interim Orders Panel. The Panel considered the extensive remediation he had undertaken and testimonials provided, and concluded that no interim order was needed.
The GMC investigation continued with an examination of the allegations against him based on expert evidence they had received. It was possible that he would be suspended from the register. However, the Case Examiners accepted the doctor's evidence of remediation in the form of CPD records, an audit of his work for out of hours, and his reflections on the case and in particular the 'three strike rule', as well as his letter to the child's family.
The Case Examiners closed the case with advice to review the guidance in Good Medical Practice (2013) on assessing, diagnosing and treating patients (paragraph 15). This case illustrates the role that an early apology and acceptance of failings, where appropriate, and work to remediate them has in ensuring that a doctor can continue to practise without sanction by the GMC.
Dr Sally Old
Sally was a consultant clinical oncologist before joining the MDU in 2006. She trained in hospital medicine before specialising in cancer treatment, including radiotherapy. With a main interest in thoracic oncology, including lung cancer and mesothelioma, her clinical role involved producing reports for solicitors and the local Coroners. This sparked her desire to know more about medico-legal medicine. Sally has an LLM in Medical Law and Ethics from the University of Kent. She is a Member of the Faculty of Forensic and Legal Medicine and sits on its Revalidation Committee.
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