The GMC thought so and investigated Dr M but the Medical Practitioners Tribunal disagreed and found neither misconduct nor impaired fitness to practice (“FTP”).
Dr M, an experienced GMC registered psychiatrist, was faced with a patient who, though lacking capacity, was aware of the medication they were on and would discuss their medication with the medical staff. The patient had been treated with Zuclopenthixol Decanoate (“ZD”) administered as an injection for over a year but they complained about the side effects. ZD was therefore changed but the patient’s condition deteriorated. Other medications were ruled out and it was decided that ZD should be given covertly.
Dr M did not take this decision at all lightly and there are important facts relevant to the course of action that was taken. Dr M believed it was in the patient’s best interest to receive ZD, the Second Opinion Approved Doctor had approved the care plan, the patient’s family had been consulted and agreed with the plan, the MDT had been apprised and agreed the plan and it was always intended that they would reveal ZD had been administered to the patient when he was sufficiently recovered to understand.
The reason the medication was administered covertly was to establish whether the patient really was suffering side effects from ZD. The deception involved the staff at the hospital and they were all told under no circumstances to reveal to the patient he was being given ZD. One dose was administered covertly. The following week a nurse inadvertently informed him that he was being given ZD. A short time after, the patient demonstrated tremors and attributed them to the ZD. Dr M by this point knew of the nurse’s slip and when the patient questioned why a different looking needle was used, they were told by Dr M that the needle was made by a new manufacturer and he was still on Risperidone. This of course was not true. Dr M had agreed this approach with the interim Head of Care, who accompanied her to discuss care with the patient.
The allegations at the Tribunal hearing focussed on the dishonesty element. The GMC’s expert doctor gave evidence that GMP had been breached, it was inappropriate for information to be withheld from the patient given his previous express wishes and telling an untruth could damage the therapeutic relationship. Dr M’s expert acknowledged GMP but stated that “it is not logical to argue from the general to the particular, and anyone who has practiced ‘at the coal face’ with patients like this will be well aware that such guidance may at times regrettably represent a counsel of perfection more than a feasible scenario”. The Dr’s expert also noted that there can be little damage to the therapeutic relationship with a psychotic patient.
The MPT did not find dishonesty. Dr M had been open and transparent at all times with every person involved with the patient’s care and every person had endorsed the treatment plan. The Tribunal concluded that ordinary decent people would not regard the doctor’s conduct as dishonest. They went on to find that there was no serious misconduct and therefore no impairment of FTP.
It must be noted that the findings are of course fact specific and there was a prima facie breach of GMP. The case also references that following the index facts an urgent legal opinion was sought as to the patient’s future treatment and the plan was updated so that there would be no more covert administration of ZD albeit it would be administered using restraint if necessary. Please contact us with any queries and we can provide any relevant advice should you require legal support in respect of your FTP.
