Dr R was a Consultant Orthopaedic Surgeon and it was alleged that he inappropriately treated four patients.  In respect of three of the patients the Tribunal largely found that the GMC had not proven their case and so a large number of the allegations were not proven.  There were a number of clinical findings that supported Dr R’s particular courses of treatment, his account had not been accepted by the GMC. To Dr R’s credit, he admitted a number of the allegations albeit late in the day at the start of the hearing.

However, in relation to one patient Dr R carried out wrong-site surgery by injecting the patient’s right hip with anaesthetic and steroids rather than the patient’s left hip.  As you would expect this led to a series of allegations being levelled against Dr R, including that the patient had not given consent to any treatment to her right hip, that Dr R had failed to follow guidance in not performing a final check and not properly communicated with the theatre team to confirm the correct site.  Dr R made things rather worse by then requesting an MRI scan on the right hip despite the fact he knew it was it was not necessary.  It was found he did so in a bid to try and post hoc justify the injection to the right hip.  He gave the patient a “spurious” explanation for the intervention, she was unaware of the error at that moment.  After the procedure Dr R amended the consent form by deleting the words ‘left’ and inserting the word ‘right’ and he changed the surgical site marking.  Again to his credit, Dr R made various late in the day admissions to many of the allegations including the duty of candour to the patient and some dishonesty in relation to his conduct.

The errors came to light following a hospital investigation and the hospital subsequently made the referral to the GMC. Dr R had lied to his colleagues for several weeks in spite of being encouraged to tell the truth. More than ten years prior to this hearing Dr had been suspended by an MPT for dishonesty connected to constructing misleading emails.  The Tribunal were concerned that he had not connected both incidents, the similarity being that they both showed him lying to colleagues over several weeks, it was not the case this was a single isolated incident.

There was undisputed evidence Dr R’s clinical outcomes from his busy practice were nothing short of excellent and Dr had made an apology to the patient.   The difficulty that Dr faced was that his insight and remediation were insufficient to dissuade the Tribunal that his conduct might not be repeated.  Dr R had represented himself and it was clear from the case report there were important elements of remediation missing.  It is key that remediation is approached systematically to stand any chance of defending dishonesty.  It must be noted however that there is authority that dishonesty is difficult to remediate.  The Tribunal remarked that patient safety and public perceptions required the most serious sanction and so determined Dr R’s name should be erased from the register.

Most practitioners will be well aware of their own organisation’s policies on clinical errors.  Likewise, there are various domains touching on the duty of candour with patients in addition to  the GMC’s and Nursing and Midwifery Council’s joint guidance “Candour – openness and honesty when things go wrong”.   Please note that the comments in this case review are generic, if you have any fitness to practise concerns please contact us for specific advice on your matter.