There are numerous variables that might arise (the test, the basis of the suspicion, the urgency, other symptoms, seniority of clinician), the answer given by the Medical Practitioners Tribunal in Dr K’s case outlined below was that ignoring the hospital policy was serious misconduct but the doctor’s fitness to practise was not impaired.
Patient A was treated by Dr K over three days. He presented with hyperkalaemia – high levels of potassium in the blood which can cause cardia arrythmias and cardiac arrest leading to death. The expert evidence was that a level of 7.6 mmol/L is a medical emergency. The hospital policy was that if the level was 6.4 mmol/L or greater, the patient should be treated with calcium gluconate infusion, insulin dextrose infusion, nebulised salbutamol and then calcium resonium.
When under Dr’s K care Patient A’s level was 7.6 mmol/L on day 1 and day 2 but he did not follow the Trust’s policy. It was another doctor who administered the treatment in line with the Trust’s policy albeit then Dr K cooperated.
In point of fact Dr K was quite right in his suspicion that the test result was false, the potassium level was artificially high and this was a case a pseudo-hyperkalaemia. He also appeared to have carefully considered all the relevant facts – pseudo-hyperkalaemia had been suspected at the previous hospital prior to Patient A’s transfer, there is a distance to travel for the test which can spoil the sample, possibility of haemolysis, the risks posed by the wrong treatment, additionally patient A was difficult and would resist giving a sample and lashed out at staff. Dr K however did not note any of this down at the time and frankly admitted his record keeping was not what it should have been.
Two other doctors in the case gave evidence that a reading of 7.6 was potentially fatal and needed immediate treatment. They agreed with the Trust policy and opined that the treatment could always be stopped once the true result came to light, a POC Test could also have been taken. Evidence was also presented to the effect that deviating from Trust policy should only have been undertaken after a discussion with a consultant and it was not correct for a junior doctor to have acted alone in that way.
The Tribunal accepted Dr K acted in accordance with his genuinely held belief and that he had good reasons for doing so. They decided however that the conduct fell below that of a reasonably competent GP Trainee and though the patient was not harmed there was a risk. It was held to be serious misconduct. The Tribunal did not however find that Dr K’s fitness to practise was impaired. There was clear evidence that his practice was safe because there were testimonials from senior colleagues that any such risk was highly unlikely to be repeated.
