General Medical Council v Goslakkal

This is a claim brought by a Part 8 claim form for an extension of an interim period of suspension first granted by and Interim Orders Panel of the General Medical Council on 18th March 2012. The claim is brought pursuant to section 41A(6) and (7) of the Medical Act 1983 and the extension sought is a period of 7 months, to 7th September 2013 until 6th April 2014, when it is anticipated that the Fitness to Practise hearing concerning the defendant will be resolved.

The defendant does not appear and is not represented. However, a certificate of service has been filed which demonstrates that he has been served as provided for by the order made by His Honour Judge Raynor QC sitting as a judge of this court on 7th August 2013.

The allegations which are faced by the defendant concern the treatment of a total of four patients. The claimant was a specialist paediatric neurologist. He was a consultant in that specialism.

There are two medical reports to which my attention has been drawn. The first by Dr Carlos De Sousa MB BS, BSc MD MRCP MRCPCH, consultant paediatric neurologist, employed at the Great Ormond Street Hospital for Sick Children. He deals with three patients in the course of a careful and lengthy report . The patients are identified in the report as being respectively "TH", "VH" and "BC". The criticisms in each case are of over treatment and over investigation and of a failure to take account of the possibility that the symptoms of which the complaint was being made or explainable on psychological rather than physical grounds.

It is not necessary that I set out in detail the treatments for each of the patients because the summary runs over many pages of the report. The short point however is that in relation to TH, a particular complaint is made concerning the treatment of alleged pain, for which there were no objectively identifiable explanation, of oral morphine. There is a complaint in relation to others of over treatment running over many days and involving a number of different investigations. In relation to BC, again, it is alleged there has been a failure to take account of other psychological possibilities.

Dr De Sousa concludes, at paragraph 3.1 of his report and in relation to TL, that it was not appropriate to prescribe oral morphine, that there were insufficient clinical signs and no supportive results to substantiate the particular diagnosis made. In relation to treatment of patient VH and the use of opiates that was considered to be inappropriate. In relation to patient BC, again the treatment was concluded being inappropriate.

Dr De Sousa was asked to say whether the treatment fell below the standard to be expected of a reasonable competent consultant paediatric neurologist to which his answer was that it did. He was then asked to say whether the care given to each of the patients fell seriously below required standard, to which the response was that the defendant had failed adequately to diagnose all three patients, did not consider psychological and social factors and adhered to improbable diagnoses in the face of contradictory clinical evidence and did not take into account the views of others within the treatment team and in the result the conclusion was, as I have described. Overall, it was, as it was put in paragraph 3.9.2, that whilst the actions and treatments appear to have been driven by genuine concern for his patients it was a flawed concern because of his apparent inability to consider social and psychological problems.

Had that been where matters rested it might have been thought that this was at worst on the borderline of alleged misconduct meriting interiom suspension but matters do not rest there. A further patient is also involved: a child who I will refer to for the present purposes as Patient A. That child died age 10 years, either during or shortly following his admission to hospital and treatment by the defendant. The patient is described in the expert report as having complex partial seizures, difficult behaviour, attention problems and was under treatment with two anti-epileptic drugs. The defendant advised that the patient be admitted to hospital, weaned off all medication over 5 days when different drugs would be tried and their effectiveness monitored. The process commenced on 23rd March 2009 and Patient A died on 25th March 2009.

The report is, as one would expect in relation to an allegation of this level of seriousness, lengthy and careful. A number of questions are asked and answered. But at paragraph 17 and under the heading "Whether the overall standard of care provided by the defendant during the period of treatment fell below that expected of a reasonable competent consultant" the conclusion was that it did, for particularly the reasons identified in B1 through to 5 in the report.

The reporting doctor then turned to the question of whether the care provided fell seriously below the relevant standard, to which he concluded that it did, for the reasons identified in paragraph 17B 1 to 5 of his report by reference to an allegation of unnecessary video EEG telemetric treatment, a failure to consider or document drug reduction properly and a failure to recognise that what was being proposed was far too aggressive and would expose the patient to the risk of death in circumstances that in fact occurred. Severe criticism is made of the quality of note keeping that was adopted and of a failure to type out a clinic letter at any stage.

In those circumstances, there are a series of four patients, where two independent experts have concluded that the standard of treatment provided by the defendant fell seriously below the standard to be expected of a consultant paediatric neurologist.

Against that background I then turn to the test that has to be applied in the circumstances of this case. They are as identified in the statute and as identified by the Court of Appeal in the well-known case of GMC v Hiew. I am not required to consider whether or not the allegations which are made against the defendant are true but rather to test whether the public interest, the protection of patients and the protection of the doctor require the imposition, continuation or extension of a period of interim suspension over until the hearing before the Fitness to Practise Panel, having regard to the nature of the allegations which are made.

I am satisfied, having regard to the allegations which are made and the contents of the two independent expert reports that I have referred to that it is appropriate to extend suspension in the interest of the public and for the protection of patients over until the hearing before the Fitness to Practise Panel, which it is anticipated will be completed within the period of extension sought. This is not a case where it can be said the General Medical Council have delayed unreasonably. The initial period of 18 months suspension will expire only later this week and the period of continued suspension which is sought is modest and proportionate in the circumstances. There will be an order in the terms sought.

So far as costs are concerned, I allow costs as sought. The costs are modest. The rate that has been adopted is the recommended rate for a grade D fee earner in the city of Manchester. The hours that are worked are modest in the extreme. Counsel's fees are modest as well as having regard to the public nature of the work that is being undertaken, the total sum and the aggregate is proportionate and reasonable and I assess the costs in that sum, namely £1797.80.

MR ATHERTON: Thank you very much. There is a draft order.

HIS HONOUR JUDGE PELLING: Yes. The date today is the 5th. I have amended it by inserting my name, amending paragraph 2 so it reads: "The claimant shall serve a copy of this order upon the defendant as provided for by the order of HHJ Raynor QC dated 7th August 2013", which was the one giving permission served by e-mail, "costs in the sum of £1797.80" which is the figure which you asked for and otherwise as drafted.

MR ATHERTON: I am much obliged to your Lordship. At the risk of sticking my head over the parapet, does your Lordship wish me to type that out and send it back to the court?

HIS HONOUR JUDGE PELLING: That is very kind of you to offer, I appreciate it. If you could e-mail it that will be appreciated.