GMC was wrong to suspend obstetrician four years after baby died

BMJ 2008; 337 doi: (Published 18 November 2008) Cite this as: BMJ 2008;337:a2612

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  1. Clare Dyer
  1. 1BMJ

    An obstetrician has won a High Court ruling quashing a “flawed” General Medical Council decision that his fitness to practice was impaired in 2007 because of failings four years earlier when a baby died.

    The GMC panel found in October 2007 that Hassam Azzam, when a specialist registrar in obstetrics and gynaecology at South Tyneside General Hospital in September 2003, was guilty of “inappropriate, inadequate, and irresponsible” conduct in failing to arrange the immediate delivery of a 19 year old woman’s baby after reading a “pathological” cardiotocography trace.

    The GMC also found Dr Azzam to have behaved irresponsibly in failing to attach a fetal scalp electrode, omitting to review the mother within 30 minutes, and failing to ensure that his replacement, who had come on duty, was aware of the seriousness of the situation.

    But Mr Justice McCombe, who heard the doctor’s appeal against the GMC’s findings, said that the panel’s job was to decide whether a doctor’s fitness to practice was impaired for the future and that it must take into account evidence that any shortcomings had been remedied by the time the case came to be heard.

    He said, “The evidence of Dr Azzam’s rehabilitation was outstanding and uncontested. It required to be given substantial weight in deciding whether the doctor’s fitness to practice was truly impaired for the future.”

    The GMC panel was concerned with a serious error of professional judgment over a limited period, the judge added. Earlier court decisions, including that in the case of the paediatrician Roy Meadow, required the panel to “look forward and to consider in the light of that and of the evidence as to the doctor’s conduct and ability demonstrated in the intervening period whether his fitness to practise was impaired by the events over 20 minutes on 1 September 2003.”

    Dr Azzam had produced 38 pages of testimonials for the GMC. He was strongly supported by Martyn Pitman, his supervising consultant at Royal Hampshire County Hospital in Winchester, where he was working as a senior specialist registrar when the GMC heard his case.

    Mr Pitman told the BMJ this week that Dr Azzam had been so disillusioned with his treatment by the GMC that he had left Britain and was now working as a consultant in Canada. “The GMC in its infinite wisdom has lost us one of the best trainees I’ve ever had the pleasure to work with,” he said. “We paid for his training and he was an exemplary trainee. Now we’ve lost him to another country.”

    Mr Pitman’s testimonial to the GMC said that Dr Azzam’s level of knowledge and clinical skills were “well above the level which we currently see in trainees of his level of seniority. His CTG [cardiotocograph] interpretation ability is now, in my view, significantly better than many of his peers. He now uses these skills to teach junior members of the obstetric and midwifery staff.” Mr Pitman was supporting Dr Azzam “without reservation” in applications for a consultant post, in which he believed Dr Azzam would excel.

    In oral evidence Mr Pitman told the GMC panel: “ My biggest concern . . . is if a trainee who has passed through a training programme in one of the most highly respected obstetric and gynaecological training regions in this country, . . . having had four years flawless training in this region, [is] to be found now by the GMC in any way as being unfit to practise, that casts a major concern in both my mind and I am sure the entire specialty’s mind as to how the GMC would respect and value structured training programmes at specialist registrar level.”

    Mr Justice McCombe said that even if the finding of impairment had stood, the penalty of one month’s suspension was too harsh. The purpose of the GMC proceedings was not to punish but to protect the public.

    “The public, as patients, did not need protection from Dr Azzam. On the contrary, on the uncontested evidence, it needed his professional skill,” said the judge.


    Cite this as: BMJ 2008;337:a2612

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