Dr David Roberts, the former chairman of the Dispensing Doctors' Association, has escaped censure after admitting responsibility for the death of a patient through "irresponsible" prescribing.
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David Roberts |
The committee ruled that Dr Roberts had made a grave error by prescribing an unfamiliar medicine without checking all the readily available information. It considered the case to be "wholly exceptional" and that it raised wider issues in dispensing practices which would be raised elsewhere.
The committee was told that if Dr Roberts had carried out the proper checks he would have realised that melphalan should be used only in short, sharp bursts.
The GMC barrister (Mr Richard Tyson) said that Dr Roberts's negligence caused him to issue a prescription for nearly four weeks' supply of the medicine instead of four days'.
At an inquest, the cause of Mrs Doswell's death was given as renal failure, septicaemia, bone marrow failure, an overdose of melphalan and multiple myeloma. A pathologist had said that he believed the overdose prescribed by Dr Roberts had caused the bone marrow failure.
The Coventry coroner (Mr David Sarginson) recorded an open verdict (PJ, July 25, 1998, p111). He ruled that Dr Roberts had been "grossly negligent to a level deserving of punishment". He added that the only reason he had not recorded a verdict of unlawful killing was that other people apart from Dr Roberts had also been at fault.
Mr Tyson said that the GMC's case was that Dr Roberts, faced with a relatively rare condition, had prescribed a drug with which he was not familiar without making the proper checks on the dangers it might involve.
In police interviews following the death, Dr Roberts had read a statement of regret at his patient's death, but had refused to answer further questions, Mr Tyson went on. No prosecution had followed.
Mrs Doswell's consultant (Dr Aboobucker Abdul-Cader) told the committee that Mrs Doswell's death had led to a change in practices at St Cross hospital, Rugby, where her treatment had been initiated.
An expert witness (Dr Stephen Brown) said that hospitals had a clear responsibility for prescriptions. He added that to have a patient coming into a general medical practitioner's surgery asking for a medicine usually prescribed by a hospital should set alarm bells ringing. He said that doctors should refer to the British National Formulary if in any doubt about prescriptions.
Dr Brown said: "The paragraph on melphalan would alert doctors that cytotoxics were very dangerous drugs and should only be prescribed by doctors with specialist knowledge."
He added that Dr Abdul-Cader's letter to Dr Roberts setting out her treatment "might not be clear to a layman, but should be clear to any doctor".
Dr Roberts told the committee that he accepted full responsibility for Mrs Doswell's death.
At first he denied that he knew, or should have known, that melphalan should only be prescribed in courses of four to six days, repeated after four to eight weeks. He had not, therefore, been irresponsible. When pressed by Mr Tyson, Dr Roberts accepted that, in retrospect, his prescribing had been irresponsible, although he had not believed it to be so at the time.
Under questioning, he accepted that Mrs Doswell's death had been caused by his misinterpretation of her consultant's letter. He had mistakenly thought that it called for the medicine to be taken for an extended period, rather than in short bursts. He said that this error had been compounded by his failure to read a standard medical reference book closely.
Dr Roberts told the committee that he only looked up the medicine's pack size in one book. He said that he had not looked at the following page in MIMS which warned that melphalan should only be taken for three to four days with breaks between each course. He said that he had not referred to any other books because "I did not think I was initiating treatment, I thought I was repeating the consultant's treatment."
However, Dr Roberts conceded that he should have consulted another doctor before prescribing a medicine he had no knowledge of.
"The mistake was made by me and I have admitted it was made by me all the way through," he said.
Responding to further questions, Dr Roberts said that he had made the mistake during a busy surgery and that he had since installed a computer system that would ensure that such mistakes never happened again.
For Dr Roberts, Mr Stephen Miller, QC, said that other doctors who treated Mrs Doswell at more than one hospital following the overdose had failed to stop the melphalan treatment. He claimed that this showed there was widespread ignorance about the use of melphalan throughout the medical profession.
Mrs Doswell's family is pursuing a claim for damages against Dr Roberts and St Cross hospital. The claim was held in abeyance pending the outcome of the GMC hearing.