Saturday, 8 June 2024

GMC rules the doctor's are not accountable for the actions and errors of non-qualified doctors.

 


The General Medical Council (GMC), which regulates the UK medical profession have just ruled that doctors and GPs are not accountable for the decision and actions of non-qualified doctors such as 'physician associates' (PA's) and 'anaesthesia associates' (AA's), who they supervise, as long as GMC standards and guidance are followed.

On 12th November 2022, Benedict (Ben) Peters, a 25-year-old solicitor from Cheadle, was found dead at the home of his parents. The day before his death, Ben had gone to the Manchester Royal Infirmary Ambulatory Care Unit complaining of chest pain, shortness of breath, heart palpitations, a sore throat and an aching arm. An ECG was undertaken along with a Chest X-ray and both were found to be normal. Blood tests were also taken. While waiting for his results, Ben experienced a severe episode of vomiting. At MRI, he was seen by a Physician Associate who diagnosed 'panic attack/gastric inflammation' and he was given a prescription for Propranolol and Omeprazole. The duty Consultant seems to have concurred with this diagnosis even though he hadn't seen Mr. Peters to examine him. A post mortem examination confirmed that Ben had died as a consequence of complications arising from an underlying heart defect which had not been diagnosed during his life. He had died as a result of a "catastrophic haemorrhage of his aorta."

In his report dated May 16, 2023, Chris Morris, the Area Coroner for Manchester South, had this to say about the case of Benedict Peters.

"During the course of the inquest the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows. It is a matter of concern that despite the patient's reported symptoms, in view of his age and extensive family history of cardiac problems, Mr Peters was discharged from the Ambulatory Care Unit without being examined/reviewed in person by a doctor. It is a further matter of concern that according to the evidence of the Consultant Physician, no policy or protocol exists within the Trust as to when patients may or may not be discharged from the Ambulatory Care Unit without a medical review taking place. In my opinion action should be taken to prevent future deaths and I have believe you have the power to take such action."

The Manchester University Foundation Trust offered their sincere condolences to Ben's family and said, "Sadly, routine tests do not always pick up on this tragic condition and Ben's circumstances were truly unfortunate.."

What cannot be denied is that Ben Peters was never seen or examined by a qualified doctor while he was at MRI and the diagnosis by the physician associate was completely wrong. Had he received an MRI scan, it's likely that the aortic tear that killed him could have been detected and Mr Peters could have received surgery to correct the problem.

As for the GMC's ruling, I'm not sure that this in itself indemnifies a doctor against an action for medical negligence even if they have followed GMC guidance and standards. In law, all doctors owe a duty of care to their patients which requires them to provide care at a level reasonably expected of any competent doctor, nurse, midwife, surgeon etc. Many years ago, I learned about a legal concept called vicarious liability. This means that any employer can be held responsible for the unlawful actions of an employee arising from negligence or harassment or discrimination in the workplace. The law requires employers to hire competent fellow employees and this applies within the medical profession.

There have been a number of well publicised cases that have involved misdiagnosis by Physician Associates who receive less medical training than a doctor. Patients may well think they're speaking to a qualified doctor when that is not the case.


4 comments:

Milton Pena said...

The lowering of the standards in the NHS over the last 10 years has been truly massive.
The situation in many Trusts is very much worse than when the review of failing hospitals, including Tameside, took place in 2012!
Yet, it is accepted and avoidable harm and deaths occur daily by the hundreds across the country. ( Reported by the Royal College of Emergency Medicine)

Editor said...

Thanks Milton,
I think what we're seeing is the beginning of a process of de-skilling medicine and replacing doctors and GPs with less qualified staff. In engineering they were known as 'dilutees', less skilled workers employed to do the work or part of the work, of a skilled man. I know that they've been trying to do this for years in the electrical contracting industry. I tend to feel that the GPs have brought a lot of this on themselves. Since the COVID lockdown in 2020, it has become difficult to get to see a GP and many have become reluctant or averse to conducting face-to-face appointments. Doctors working within the NHS hospitals have no choice. I also think the NHS has been under a process of managed decline for many years. What we're seeing today, are record numbers of people going private to obtain adequate medical treatment and to jump queues. NHS hospitals are even encouraging this. We're losing the NHS by default.

Dave Ormsby said...

I recently saw a PA myself at my GP surgery. I must say that in my case he was supervised throughout by a GP. He took details of my symptoms, reported back to the DR and then he returned to the room with the DR, who conducted a physical examination and then went through each stage with the PA. The DR explained to him what he thought it was, why it may have happened and what to prescribe. The PA then phoned me a few days later to ask about my condition and as it had not cleared completely, he spoke to the GP and I was referred for a scan. It was pretty efficient all around.

Dave said...

I don't disagree with the theme of your contention. The process of deskilling is now endemic in our system. It's a natural extension of the neo-liberal ideology. What is interesting is that it is now encroaching upon traditionally middle class occupations. What was applied to the skilled working classes is now expanding to the professions. What are the political implications of this evolution?
In my case it was self-evidently a training and educational process. for the PA. It works effectively in some situations as long as the GP is at hand and double checks the assessment and diagnosis. I can see that it takes time pressure off the GP, but the key question is how this additional time is utilized.