The issue of the duty of candour was the key issue in a case concerning Mr A who was a consultant orthopaedic surgeon.
The case concerned a patient in her 90s who presented with right hip pain after a fall. She did not fracture her hip, a CT scan confirmed this.
Despite this, the next day the patient was scheduled for an operation and Mr A went ahead and performed a hip replacement. Unfortunately, Mr A did not review the CT scan report before surgery, by the time he realised there was no fracture it was too late and so he carried on. There a few important mitigating facts about the circumstances. It was not Mr A’s fault surgery was scheduled, she should not have been on the list, it was a busy list, Mr A was quite right to carry on at the point of realising there was no fracture (otherwise there would have been complications) and no one else realised the error or checked the report.
The issue however was that Mr A did not say anything about the absence of an injury to his colleagues during the operation, to his line manager nor later to the patient’s relatives. Neither did he record the lack of a fracture on the records. Mr A made a clinical error in not checking for the CT report prior to operating and he admitted this.
The patient developed post-operative pulmonary embolus and died the following day. The absence of a fracture came to light during the Serious Adverse Incident review. The matter later went to the coroner. The Tribunal were quick to declare that this was serious misconduct in and of itself. They noted that this may not have come to light but for the review and that this lack of candour would be considered deplorable by fellow practitioners. The Tribunal further commented that Mr A was a senior clinician and had a duty to lead by example.
Although this was an isolated incident in a long unblemished career and Dr A displayed significant insight the Tribunal suspended Mr A for a full 12 months and directed a further review hearing. At the review hearing Mr A was permitted to return to practice having kept his skills up to date during the period of suspension.
GMP Rule 45 and the Guidance ‘Openness and honesty when things go wrong: The professional duty of candour’ are some of the current relevant rules and guidance, others arise depending on the facts. Breach of the duty of candour carries serious consequences. Where there are elements of dishonesty it may lead a Tribunal to erase a doctor from the Register.
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