It is likely to be relevant but also likely it will take more than just that as reason for a defence to succeed. There is High Court authority confirming that at a Medical Practitioner Tribunal (“MPT”) hearing systemic failings can be relevant at the sanctions stage, it is still an open question whether they are relevant at the impairment stage.
In Dr A’s case the MPT declined to find serious misconduct and held her fitness to practise (“FTP”) was not impaired. Dr A was locum Registrar in a very busy paediatric department. A 6 month old baby died of an overdose of morphine which accelerated the end stage of their life – they suffered a rare genetic disorder and were under the care of the community palliative care team. The morphine was prescribed by a consultant and administered at approximately 7pm by a nurse. The GMC accused Dr A of providing inadequate care in failing to enquire about the morphine prescription error, failing to clarify the prescription error on the Prescribing and Medications System, failing to seek advice from the pharmacist and failing to examine for signs of morphine toxicity. The patient died at 11:45 pm on the day in question.
Dr A was working the night shift that evening from 9pm to 9am, she was a locum doctor and it was only her second shift in the hospital. The evidence was that it was very busy and there was a backlog of patients to discharge. The MPT explicitly took account of those facts in its judgement. It also found that Dr A did not have direct access the Electronic Prescribing and Medications System and the system had not flagged the error. The MPT accepted that this was a clinically complex case, there were no obvious signs of morphine toxicity and it was a single omission relating to one patient in a short window of time.
In Dr A’s case no reference was made by either party or the MPT to Good Medical Practice (“GMP”), most likely because it would be unreasonable to do so given the timing of events. GMP includes (at 25.b) however that if patients are at risk because of inadequate premises, equipment or other resources, policies or systems, a registrant should put the matter right if possible or raise it with the organisation or in line with GMC Guidance – Raising and acting on concerns about patient safety. As akin to whistling in the wind as it may seem, in some cases this may be relevant and there are many instances of doctors citing workloads and how they affect their practice in FTP hearings. Alongside the FTP issues there may well be serious whistleblowing implications where systemic issues arise in your practice.
In these cases it is crucial that all the mitigating arguments and evidence are put forward in any defence. If you do require advice on any FTP issue you are facing please contact us and we can provide advice specific to your case.
