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Anaesthetist could face prosecution after GMC strikes her off

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7527.1226-c (Published 24 November 2005) Cite this as: BMJ 2005;331:1226
  1. Clare Dyer, legal correspondent
  1. BMJ

    Crown Prosecution Service lawyers are to look again at the practice of a former consultant anaesthetist after the General Medical Council ordered her to be struck off the medical register last week for “unlawfully” ending a patient's life.

    The service, which decided that there was insufficient evidence to prosecute Dr Ann David in 2001 after police investigated a number of patients' death, will reopen the file.

    Dr David, aged 47, from Rayleigh, Essex, could face a prosecution after lawyers from the service study evidence to the GMC fitness to practise panel, which decided that she took “active measures” to “prematurely” end the life of Robert Symons, aged 60, a milkman from Basildon, Essex.

    Prosecutors will also look at a report commissioned by her former employers, Basildon and Thurrock University Hospitals NHS Foundation Trust, handed over last month, which strongly criticised the care of two patients.

    On 22 January 1999, Mr Symons was transferred from a medical ward at Basildon Hospital to intensive care in a hypotensive dehydrated hypoxic condition.

    A plan was made to correct his dehydration with intravenous fluids, insert a nasogastric tube for feeding, continue to keep him on antibiotics, and to ventilate artificially if necessary. On 26 January he was intubated and mechanically ventilated on Dr David's instructions, and on 10 February she performed a tracheostomy.

    On 16 February she decided to withdraw treatment on the grounds that he had an overwhelming infection that was not responding to treatment with strong antibiotics, his ventilatory requirements were increasing, and there was no possibility of survival off the ventilator.

    Although Mr Symons's family were strongly opposed, Dr David withdrew ventilation, extubated Mr Symons, and gave him 20 mg of intravenous diazemuls (a diazepam emulsion). He died 20 minutes later. The cause of death was given as staphylococcal pneumonia.

    The panel found that Dr David had failed to explore further reasonable treatment options—adjustments to ventilation, administration of diuretics, the tapping of pleural fluid, investigation for unusual infections, and treatment if appropriate with antibiotics and antifungal agents.

    He was not in imminent danger of dying and was recorded as being conscious and oriented. The manner of treatment withdrawal brought his life to an end “earlier than would have occurred naturally” was inappropriate, was not in his best interests, and failed to take into account the sensitivities of his wife and family, the panel found.

    Dr David's use of a far higher dose of diazemuls than needed for sedation, given more rapidly, was “clear evidence of substantial incompetence which directly caused the death.” The panel “bore in mind the legal doctrine of double effect but felt that this unequivocal evidence led to the clear conclusion that [Mr Symons's] death occurred sooner that it might otherwise have done.”

    Before the hearing, the panel had refused Dr David's application to remove herself voluntarily from the register. She told the panel that she was “disillusioned by everything that had happened” and planned to become a maths teacher.

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