Can a single event involving a serious lapse in standards when dealing with a violent and aggressive patient result in a doctor being erased from the Register?

Where the lapse was serious, basic checks not undertaken and later dishonesty, yes.

Doctor A was a Forensic Medical Examiner and was called by the police to assess a patient who was being detained under the Mental Health Act.  The patient had been arrested on suspicion of possession a controlled substance.  Dr A believed the patient to be displaying symptoms of an overdose and noted a cut to his foot, he advised the police the patient should be taken to hospital.   A couple of hours later the patient was reported to have breathing difficulties and Excited Delirium was mentioned by an officer.  The patient collapsed while in an ambulance, Dr A was not in attendance and the patient died the following evening.  The IPCC investigated and referred Dr A to the CPS for a decision on whether to charge for gross negligence manslaughter, the CPS decided there was insufficient evidence for the charge.  There was a Coroner’s Inquest and the conclusions included a finding there had been a failure to recognise the signs of Excited Delirium as an emergency and a failure to carry out an adequate assessment.  The excessive and prolonged restraint of the patient sped up the effects of Excited Delirium.

The doctor admitted that that he had not; assessed capacity, introduced himself as a doctor, obtained medical history, ascertained what drugs were thought to have been taken, spoken to the patient at all, checked his pupils or temperature or breathing or face which was covered by a spit mask and failed to implement an adequate treatment plan by failing to make it clear it was an emergency.  The Tribunal further found that Dr A had made representations that were dishonest, these related to assertions he had made regarding whether he had seen the patient’s face or not.

The index facts occurred in a custody cell, Dr A gave evidence that there were maybe 6, 7, or 8 officers restraining the patient, that he was shouting all the time and struggling, swearing.  He described the patient as a violent, aggressive and a strong man who was uncooperative.

The Doctor admitted impairment on the basis of the facts but endeavoured to seek suspension agreeing the seriousness warranted a long suspension.  The Tribunal however determined erasure was warranted.  It cited the serious dishonesty, persistent dishonesty in trying to cover up the errors, a lack of remediation and insight and that a lesser sanction would not uphold the necessary standard expected of the profession.