Rao v General Medical Council
| Jurisdiction | UK Non-devolved |
| Judge | Sir Philip Otton |
| Judgment Date | 09 December 2002 |
| Neutral Citation | [2002] UKPC 65 |
| Docket Number | Appeal No. 21 of 2002 |
| Court | Privy Council |
| Date | 09 December 2002 |
[2002] UKPC 65
Privy Council
Present at the hearing:-
Lord Millett
The Rt. Hon. Justice Gault
Sir Philip Otton
The appellant, Narasinga Mukunda Rao, appeals from a direction of the Professional Conduct Committee (PCC) of the respondent Council given on 22 February 2002 that the registration of the appellant should be conditional for a period of 18 months in consequence of the admission and proof of certain of the facts set out in the Notice of Inquiry and a determination that in relation to those facts he was guilty of serious professional misconduct.
The appellant is a registered medical practitioner. After initially practising both as a General Practitioner and in hospital medicine in Bangalore he obtained full registration with the General Medical Council in 1977. He undertook various positions in the United Kingdom in hospital medicine and underwent GP training. He became the GP Principal in August 1990 at the Health Centre, Prince Charles Road, Wrexham, where he still practises. Healso undertakes four sessions each week as a Clinical Assistant at Wrexham Maelor Hospital. In addition, he runs a shared-care scheme clinic in the Wrexham Community Drug and Alcohol Office.
On 29 December 1998 Dr Rao was working for the Wrexham General Practice Out of Hours Co-Operative. At about 22.30 he had a telephone conversation with a Mrs Pritchard, the estimated length of which was between two and five minutes and the substance of which formed the basis of the complaint against him.
Sheena and Colin Pritchard were married in 1996. In 1989 Colin Pritchard had suffered a serious back injury which prevented him from working. He was diagnosed with cervical spondulosis. His incapacity caused him severe depression. He was prescribed Diazepam and Dihydrocodeine. His depression worsened over the years and he was subsequently referred to a consultant psychiatrist. In September 1998 Mr Pritchard had a chest infection for which he was prescribed Amoxicillin and Prednisolone, a steroid. The drugs did not help and his condition worsened, particularly over the Christmas period. On 29 December Mr Pritchard appeared very drowsy. His wife felt that he looked very ill, his speech was slurred and his tongue was falling out of his mouth. He went to bed and when Mrs Pritchard checked on her husband at about 10.15 that evening she found him lying on his side in an awkward position, his lips and fingers were blue and his breathing was noisy. Mrs Pritchard telephoned the surgery. Because of the hour she was transferred to the Out-of-Hours service, speaking to a receptionist and then subsequently to the Appellant. That night Mr Pritchard died at his home in his sleep. He was 34 years old. An inquest found the cause of death to be respiratory depression and an accidental overdose of Diazapam and Dihydrocodeine.
The essence of the case against the appellant was that on the information given to him by Mrs Pritchard he failed to give adequate and appropriate advice and that he should have visited or arranged a GP visit or summoned an ambulance. The precise facts upon which the case rested are reflected in the particulars of the charge and the findings of the Committee.
The charge set out in the Notice of Inquiry and as amended at the outset of the hearing was as follows:-
"1. At the material time you were employed by the Wrexham General Practice Out of Hours Co-Operative.
Admitted
2.a. On the 29th December 1998 at about 22:30 hours Mrs Sheena Pritchard telephoned the Out of Hours Co-Operative.
Admitted
b. Mrs Pritchard spoke first to a receptionist who then put the call through to Dr Narasinga Rao.
Admitted
c. Mrs Pritchard explained that her husband, Mr Colin Pritchard, was a psychiatric patient and on medication.
Admitted
d. That Mr Pritchard's lips and fingers had turned blue.
Admitted
e. That Mr Pritchard's breathing was very rapid.
Found proved
f. That Mr Pritchard's breathing was very noisy.
Subsequently withdrawn
3.a. You failed to ask what all the drugs were which Mr Pritchard was taking.
Subsequently withdrawn
b. You failed to find out whether there were clinical signs indicating a drug overdose.
Admitted
c. You failed to ask whether this was the first time Mr Pritchard was cyanosed.
Admitted
d. You failed to enquire whether Mr Pritchard's state of health had deteriorated.
Admitted
4. Given the history provided to you by Mrs Pritchard, you should have arranged for Mr Pritchard's breathing to be assessed medically.
5. Your advice was inadequate and inappropriate in that you failed to put yourself into a position to make an accurate professional assessment of Mr Pritchard's condition;
And that in relation to the facts alleged you have been guilty of serious professional misconduct."
The appellant was ultimately found guilty of serious professional misconduct in relation to the facts admitted and proved against him. The Chairman announced the determination and direction of the Committee in the following terms:-
"Dr Rao would you please stand. On the evening of 29 December 1998 you were employed by the Wrexham General Practice Out of Hours Co-operative. At about 22:30 hours the receptionist passed on to you a telephone call from Mrs Sheena Pritchard. We have considered the differences between Mrs Pritchard's and your accounts of this call. We are satisfied so that we are sure that the generality of her account is accurate and, in particular that she was concerned about the health of her husband, Mr Colin Pritchard, and so expressed herself. Mrs Pritchard explained that her husband was a psychiatric patient and on medication, that his fingers and lips had turned blue and that his breathing was very rapid. Mrs Pritchard also gave you the names and dosages of all the medication that Mr Pritchard was taking at the time.
During the course of the telephone consultation with Mrs Pritchard you have admitted that you failed to find out if there were any clinical signs indicating a drug overdose, whether this was the first time Mr Pritchard was cyanosed and also whether the state of Mr Pritchard's health had deteriorated. You concluded that Mr Pritchard's condition was not serious and reassured Mrs Pritchard accordingly. Mr Pritchard subsequently died of respiratory depression and accidental drug overdose.
You now accept that, given the history that Mrs Pritchard provided, you should have arranged for Mr Pritchard's breathing to be assessed medically, that your advice wasinadequate and that you failed to put yourself into a position to make an accurate professional assessment of Mr Pritchard's condition …
The Committee have listened to the submissions of your counsel, the evidence of the witnesses called on your behalf and have noted the material submitted in mitigation. The Committee have heard that you are a caring, considerate, hard-working, respected general practitioner, that you have no previous history with the GMC and that you have worked as a clinical assistant to the satisfaction of the consultant responsible for the Accident and Emergency Department at Wrexham Maelor Hospital. The Committee have noted the support of colleagues who have travelled to give evidence on your behalf and have noted your own testimony and your expressions of regret regarding the events of 29 December 1998.
However, the Committee have also noted the testimony of the expert witness Dr Wright. He explained that cyanosis is a very serious clinical sign and that this description alone should have provoked either an immediate visit by a GP or a 999 ambulance being called for Mr Pritchard.
The Committee have also noted that you accept that cyanosis is a serious clinical sign yet have not been able to explain satisfactorily why you failed to take either of the appropriate steps.
In the light of Mrs Pritchard's testimony regarding your telephone consultation with her,...
To continue reading
Request your trial
-
Dr Jonathan Richard Ashton v The General Medical Council
...shows that Dr Ashton's conduct could not properly be regarded as misconduct. Ms Bradley referred the Court in this regard to Rao v GMC [2002] UKPC 65; Silver v GMC [2003] UKPC 33 and Nandi v GMC [2004] EWHC 2317 (Admin). 31 More generally, Ms Bradley referred to the fact that mere negligenc......
- R ( Campbell) v General Medical Council
-
Threlfall v General Optical Council
......Where it appears to a registered optician that a person consulting him is suffering from an injury or disease of the eye the registered optician shall, subject to rules 5 to 8 below, refer that person to a registered medical practitioner…in testing the sight of such a person…but in such case the optician shall forthwith report to that practitioner any findings of injury or disease of the eye of which the practitioner may be unaware." The issues in this appeal . 15 ......
-
R (Calhaem) General Medical Council
...right approach, at least in that case, was to assess the appellant's past performance over a significant period of time. 32 In Rao v General Medical Council (9 December 2002), the Privy Council quashed a finding of serious professional misconduct. The legal assessor in that case had advised......