Gastroenterologist overturns GMC’s “irrational” misconduct ruling

BMJ 2012; 344 doi: (Published 27 April 2012) Cite this as: BMJ 2012;344:e3051
  1. Clare Dyer
  1. 1BMJ

A consultant gastroenterologist who was found guilty of misconduct by the General Medical Council has won a ruling quashing the “irrational” decision after representing himself at the High Court in London.

Rakesh Aga, a consultant with Medway NHS Trust in Kent, argued that a GMC fitness to practise panel should not have found him guilty of misconduct for failing to spot immediately that a diabetic patient with impaired consciousness was hypoglycaemic. He was unable to appeal in the usual way because the panel had ruled, despite the “misconduct,” that his fitness to practise was not impaired.

His only recourse was to apply for a judicial review at the High Court, where he appeared without a lawyer against a barrister instructed by the GMC.

The patient, X, whom Aga had seen previously and had recommended for a liver transplant, had been in hospital for five days, unknown to him, and had experienced several hypoglycaemic episodes of which he was unaware.

The consultant was in the middle of a ward round at 1130 am on 19 November 2007 when he was told for the first time that the patient was in the hospital. He broke off the ward round, looked at the online database for information about X and reached his bed at 1140 am, where he found him in a “stuporous condition.”

No one told him of X’s previous hypoglycaemic episodes and there was no glucose chart at X’s bedside. He delegated the task of looking at the patient’s notes to a trainee doctor, but the trainee did not spot the references to low blood glucose in the notes.

Mr Justice Eady said Aga had told him “that in his many years’ experience he had never seen a patient in this condition in hospital. The insulin/calorific imbalance simply should not have been allowed to happen by those caring for him over the previous five days.” He thought it “so unlikely in the case of a hospital inpatient that he felt the need to canvass, mentally, other possible causes.”

The judge said Aga had carried out “the appropriate drill on finding a patient unconscious.” He referred to the ABC routine: the checking of airways, breathing, and circulation. He then went on to the DEFG (Don’t Ever Forget Glucose).

At 1145 am he made an emergency management plan, which was put into immediate effect. A blood glucose test enabled a firm diagnosis of hypoglycaemia and X was effectively treated with an intravenous glucose solution. Aga argued that this prompt action probably saved X’s life. He went on to have the liver transplant and, the judge was told, was now doing well.

The judge said Aga had been “fully entitled” in the short time available to delegate the task of reading and summarising the patient’s notes to a junior doctor while he examined the online database. Although it might be possible to criticise the consultant for failing to recognise the cause of X’s unconsciousness, there had been no act or omission which adversely affected the patient.

In so far as there was any act of omission at all, it could not be characterised as “particularly grave” so as to be considered misconduct. “I cannot see any rational basis for categorising what happened as ‘misconduct.’ I do not believe that any reasonable onlooker would apply that word to the events I have outlined. I will therefore quash the decision accordingly,” said the judge.

Aga told the BMJ he had read nine books on judicial review before launching the case. He added: “The facts were so strong that if truth and justice had their way it would succeed. After a lot of bad luck I finally got a judge who clearly saw the wood for the trees and had done his homework. The GMC has to raise its game.”


Cite this as: BMJ 2012;344:e3051