GMC finds three doctors guilty of irresponsible prescribing to addicts

London Owen Dyer

The founder of one of the United Kingdom�s best known private drug addiction clinics has been found guilty by the General Medical Council of irresponsible prescribing practices that could have fed dangerous drugs into the black market.

Colin Brewer, the retired head of the Stapleford Centre, was found guilty of irresponsible prescribing along with two of his former colleagues, Dr Hugh Kindness and Dr Ronald Tovey. Four other doctors from the centre were cleared of misconduct�Anthony Haines, Nicolette Mervitz, Martin O�Rawe, and Timothy Willocks.

The Stapleford hearing has been the biggest case in the GMC�s history, taking up 114 days of hearings. It began in February 2004 and was then expected to last three months but was prolonged by a lengthy adjournment due to Dr Brewer�s ill health, and by the sheer quantity of evidence presented (BMJ 2004;329:818, BMJ 2004;328:483, 28 Feb). Seven doctors is the largest number ever to face GMC disciplinary proceedings in one hearing, and the cases of many patients were reviewed.

Dr Brewer, however, was the focus of many of the charges. He founded the Stapleford Centre at the Home Office�s request in 1987. It had branches in Belgravia and Essex.

His care was found to have been "inappropriate and irresponsible" in 11 of the 12 patients whose history was reviewed by the fitness to practise panel.

One case involved a fatality. Dr Brewer provided Grant Smith, aged 29, with a home detoxification programme in August 2001. This required taking 10 drugs, including diazepam, flunitrazepam, chlorpromazine, clonidine, prochlorperazine, and omeprazole. Mr Smith�s mother was to oversee the process and was told to call the Stapleford Centre with any questions.

After a telephone call from Mrs Smith, Dr Brewer additionally prescribed temazepam and clomethiazole, but he did not tell Mrs Smith that these were instead of and not in addition to the flunitrazepam. Mr Smith went to bed having taken diazepam, chlorpromazine, flunitrazepam, temazepam, and clomethiazole. He died in his sleep of aspiration pneumonia.

Drs Brewer, Tovey, and Kindness were all found to have inappropriately provided drugs for pain management. In one patient, Dr Brewer prescribed dextromoramide, a short acting opiate, initially for chest pain from a fractured rib, then for dental caries, and ultimately for a painful ankle.

Dr Tovey prescribed diamorphine (heroin) to a known heroin addict who claimed to have back pain, despite lacking a licence to prescribe this drug. Dr Brewer and Dr Kindness were found to have written excessively large prescriptions that risked being diverted to the black market. One of Dr Kindness�s patients picked up 3500 ml of methadone mixture and 1086 methadone tablets on a single occasion.

Dr Brewer was also found to have failed to monitor patients effectively with hair and urine tests. In some cases, tests showed that patients were not taking the drugs that he had supplied them with, raising the question of diversion. On another occasion, a patient continued to be prescribed methadone maintenance even though tests showed that he was still taking heroin.

The panel has yet to decide whether the findings against the three doctors amount to serious professional misconduct. It will reconvene in July to rule on this question.