Doctor is allowed back to work after five year suspension with 16 conditions on his registration

BMJ 2012; 345 doi: (Published 19 November 2012) Cite this as: BMJ 2012;345:e7844
  1. Clare Dyer
  1. 1BMJ

A consultant anaesthetist suspended from work for five years after the death of a patient has been allowed to retrain and return to practice.

The UK Medical Practitioners Tribunal Service held that Michael Seng Teik Lim’s fitness to practise was impaired because of his misconduct and deficient professional performance but concluded that he had “good insight” into his clinical deficiencies and was “strongly motivated to correct them.”

The tribunal service’s fitness to practise panel placed 16 conditions on Lim’s registration for 18 months, including that he must work only in the NHS and at a level lower than consultant.

Suspensions lasting five years or longer were not uncommon before NHS employers’ disciplinary procedures were overhauled to end the “suspension culture,” but such a lengthy exclusion is unusual nowadays.

The current disciplinary framework, set out in Maintaining High Professional Standards in the Modern NHS in 2005,1 requires employers to refer issues about doctors’ capability to the National Clinical Advisory Service for advice before taking action.

Lim was excluded from duty by his employer, Royal Wolverhampton Hospitals NHS Trust, in December 2007, after the death of a patient and was suspended from the medical register on an interim basis by the General Medical Council in November 2008.

The trust referred the death of the patient, a 76 year old woman who was undergoing a revision hip arthroplasty, to West Midlands police, but the Crown Prosecution Service decided in November 2009 not to prosecute. She had a complex medical history, including chronic renal failure, diabetes, hypertension, ischaemic heart disease, and myocardial infarction.

The fitness to practise panel found deficiencies in Lim’s assessment of the patient and in “the monitoring of key clinical indicators, the administration of anaesthesia and the management of her loss of cardiac output during the operation.”

He also faced charges arising from a review of 512 cases by Alan Aitkenhead, professor of anaesthesia at Nottingham University, who reported in September 2009.

The panel told Lim that it found his practice to be “deficient in respect of your dural puncture rate, management of intraoperative and postoperative care and aspects of your anaesthetic regime.”

Lim also admitted using offensive language to a nurse and a junior doctor and refusing to assess a critically ill patient when he was the only critical care consultant on call and was asked to do so by a consultant oncologist.

The panel ordered the conditions to take effect immediately rather than the more usual order, which suspends the sanction for 28 days. This means that the conditions will be in place pending any appeal.

Lim’s counsel, Mark Sutton QC, asked the panel not to immediately impose the sanction requiring him to practise below consultant level. He argued that this might allow the trust to sack him “forthwith,” thwarting the outcome of any appeal and breaching his right to a fair trial under the European Convention on Human Rights.

But the panel said that this argument was “speculative” and that it had no power to make only part of the sanction operate immediately.

Lim took the trust to the High Court when it decided to hold a capability hearing under its disciplinary procedures in January 2011 after consulting the National Clinical Advisory Service but without asking it for an assessment. He won a ruling preventing the hearing going ahead.

The court ruled that the trust could go ahead without an assessment only if “an NCAS assessment panel advises that the practitioner’s performance is so fundamentally flawed that no action plan has a realistic chance of success,” which had not happened in Lim’s case.


Cite this as: BMJ 2012;345:e7844