GMC changes its mind over allegations against anaesthetist
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《英国医生杂志》
A consultant anaesthetist who was told that she would not face charges of misconduct over allegations that she hastened the deaths of patients in the intensive care unit where she worked now faces a hearing after the General Medical Council changed its mind.
The GMC has decided to go ahead with charges that Ann David made an "inappropriate and premature" decision to withdraw treatment from a comatose patient, Robert Symons; that she took the decision without consulting professional colleagues or the patient抯 relatives; and that she withdrew treatment in a way which "was inappropriate and brought Mr Symons?life to an end earlier than would have occurred naturally."
Dr David, who has been suspended from her job at Basildon Hospital in Essex since 30 June 2002, challenged the GMC抯 turnaround at the High Court in London. But in a ruling just before Christmas, the court refused to intervene.
Basildon and Thurrock General Hospitals NHS Trust called in the Royal College of Anaesthetists to look into the consultant抯 practice in 2000 after medical colleagues raised concerns about her work.
The college highlighted 45 cases, of which seven were investigated in detail as sample cases. The police were alerted but the Crown Prosecution Service decided not to prosecute.
The 45 cases were sent to the GMC. The medical screener at the council referred only the seven sample cases to the preliminary proceedings committee, which later decided not to refer them to the professional conduct committee for a hearing.
Among the 38 cases not investigated in detail was that of Mr Symons, a patient at Basildon hospital, who was transferred to the intensive care unit on 22 January 1999 in a shocked, hypoxic, and comatose condition. Dr David was responsible for his clinical care. He died on 15 February 1999 after he was taken off a ventilator, extubated, and given 20 mg diazepam.
His widow, Edna, brought a compensation claim against the trust over her husband抯 death. Her solicitors sent the GMC a report from their expert witness criticising Dr David抯 care of Mr Symons, arguing that the withdrawal of treatment was premature and adding "there is no doubt that the combination of sedation and the removal of airway shortened his life."
The GMC also received a letter from the trust抯 solicitors enclosing reports from two experts who were advising the trust in defending the claim. One was critical of Dr David抯 management of the case and the other was said to have told the trust抯 solicitors in a telephone conversation that there was "evidence of intentional killing."
Dr David was backed by an expert report obtained by her own solicitors which said that Mr Symons?death was inevitable at the time the decision to withdraw treatment was made and which described the drug dosages as "modest" and within the therapeutic range.
The GMC also commissioned its own expert抯 report, which said extubation was possibly premature and expressed concerns that Mr Symons had been given diazepam when he had already had morphine, that the 20 mg dose was given as a single bolus, rather than gradually, and that he might not have been given the chance to breathe spontaneously.(BMJ Clare Dyer legal correspondent)
The GMC has decided to go ahead with charges that Ann David made an "inappropriate and premature" decision to withdraw treatment from a comatose patient, Robert Symons; that she took the decision without consulting professional colleagues or the patient抯 relatives; and that she withdrew treatment in a way which "was inappropriate and brought Mr Symons?life to an end earlier than would have occurred naturally."
Dr David, who has been suspended from her job at Basildon Hospital in Essex since 30 June 2002, challenged the GMC抯 turnaround at the High Court in London. But in a ruling just before Christmas, the court refused to intervene.
Basildon and Thurrock General Hospitals NHS Trust called in the Royal College of Anaesthetists to look into the consultant抯 practice in 2000 after medical colleagues raised concerns about her work.
The college highlighted 45 cases, of which seven were investigated in detail as sample cases. The police were alerted but the Crown Prosecution Service decided not to prosecute.
The 45 cases were sent to the GMC. The medical screener at the council referred only the seven sample cases to the preliminary proceedings committee, which later decided not to refer them to the professional conduct committee for a hearing.
Among the 38 cases not investigated in detail was that of Mr Symons, a patient at Basildon hospital, who was transferred to the intensive care unit on 22 January 1999 in a shocked, hypoxic, and comatose condition. Dr David was responsible for his clinical care. He died on 15 February 1999 after he was taken off a ventilator, extubated, and given 20 mg diazepam.
His widow, Edna, brought a compensation claim against the trust over her husband抯 death. Her solicitors sent the GMC a report from their expert witness criticising Dr David抯 care of Mr Symons, arguing that the withdrawal of treatment was premature and adding "there is no doubt that the combination of sedation and the removal of airway shortened his life."
The GMC also received a letter from the trust抯 solicitors enclosing reports from two experts who were advising the trust in defending the claim. One was critical of Dr David抯 management of the case and the other was said to have told the trust抯 solicitors in a telephone conversation that there was "evidence of intentional killing."
Dr David was backed by an expert report obtained by her own solicitors which said that Mr Symons?death was inevitable at the time the decision to withdraw treatment was made and which described the drug dosages as "modest" and within the therapeutic range.
The GMC also commissioned its own expert抯 report, which said extubation was possibly premature and expressed concerns that Mr Symons had been given diazepam when he had already had morphine, that the 20 mg dose was given as a single bolus, rather than gradually, and that he might not have been given the chance to breathe spontaneously.(BMJ Clare Dyer legal correspondent)