Allegation of inadequate skills and facilities

The Council receives a significant number of complaints each year in relation to issues of treatment. This relates to a complaint against a doctor, who may have afforded inappropriate or inadequate treatment for a patient’s condition.g

No. of Complaints Relation to Treatment

Year                                                       2011   2010   2009

No. of complaints                                     121    86       81

In one recent inquiry, a complaint concerned treatment afforded to a patient who availed of the practitioner’s services at a cosmetic surgery clinic.

Following the inquiry which was held in public the practitioner was found guilty of the following:

  • The practitioner carried out a breast augmentation procedure on the patient in circumstances where the clinic concerned did not have adequate facilities for the management of post operative infection;
  • Following the patient’s consultation with the practitioner, the practitioner failed to take appropriate steps to include blood tests and/or swab tests and/or failed to refer the patient to a hospital;
  • Following the patient’s attendance at the clinic on further dates the practitioner failed to arrange appropriate steps to include blood or swab tests and/or a referral to hospital;
  • Subsequent on the patient’s consultation with the practitioner, the practitioner failed to diagnose a post operative wound infection, failed to arrange to take adequate steps and failed to consider post operative infection as a cause for the patient’s illness;
  • Consequence on a further consultation, the practitioner diagnosed that the patient was suffering from a severe allergic reaction in circumstances where there was no clinical justification for same and the practitioner failed to take any adequate steps consequent on this diagnosis;
  • Consequent on further consultations the practitioner failed to arrange for the patient to be referred to hospital.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners provides guidance to doctors on issues relating to the treatment of patients. The sections of particular relevance to this inquiry included Paragraph 12, ‘Appropriate skills and facilities’, which advises that where a practitioner may not have the professional skills or the necessary facilities to provide appropriate care to a patient, they should refer the patient to a colleague who can meet those requirements.

Informed consent to treatment and in particular paragraphs 35.1, 35.2 as well as paragraph 36.2 relating to ‘Information for patients’ were also relevant to this inquiry. Paragraph 60.1, relating to ‘Referral of Patients’ was also relevant as no attempt had been made to consider with the patient whether the patient’s general practitioner ought to be informed about the procedure or whether any reports ought to be sent to the general practitioner following the procedure.

The inquiry, having considered that the facts were proven beyond reasonable doubt, concluded that the practitioner was guilty of professional misconduct.

At the subsequent meeting of the Council, it considered the report of the Fitness to Practise Committee together with all of the evidence considered at the inquiry (transcripts of the evidence together with the exhibits relied on) and decided to cancel the practitioner’s registration.
The subsequent decision was confirmed by an Order of the High Court.

Explanatory Notes: 
The case studies outlined are based on inquiries held under the provisions of Part 8 of the Medical Practitioners Act 2007 (“The Act”). The purpose of these case studies is to provide learning outcomes from inquires.

Names, places and certain facts have accordingly been omitted and/or altered.

Allegations against doctors at inquiries before the Fitness to Practise Committee (“FTPC”) are set out in a document known as a Notice of Inquiry.

Evidence given at an inquiry (whether oral or documentary) is required to be proved to the criminal standard i.e. beyond reasonable doubt. The evidence in presented to the FTPC by the CEO. The doctor is normally represented by his/her solicitor (although some doctors are unrepresented).

Having considered all of the evidence, the role of the FTPC is to decide whether the facts have been proved beyond reasonable doubt and, if so, whether the facts as proved amount to either professional misconduct, poor professional performance or other grounds as may have been set out in the notice of inquiry.

The grounds on which inquiries are decided include professional misconduct and poor professional performance.
Professional misconduct is defined in paragraph 2.1 of the Ethical Guide as:
a) Conduct which doctors of experience, competence and good repute consider disgraceful or dishonourable; and/ or
b) Conduct connected with his or her profession in which the doctor concerned has seriously fallen short by omission or commission of the standards of conduct expected among doctors.Poor professional performance is defined by the Medical Practitioners Act 2007:

‘Poor professional performance, in relation to a medical practitioner, means a failure by the practitioner to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of medical practitioners practising medicine of any kind practised by the practitioner.’

Any sanction to be imposed on a doctor’s registration is a matter for the Medical Council.