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Locum GP from India is jailed for manslaughter in UK after failing to spot diabetic ketoacidosis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1042 (Published 14 February 2013) Cite this as: BMJ 2013;346:f1042
  1. Clare Dyer
  1. 1BMJ

A locum GP who worked out of hours has been jailed for two and a half years at Sheffield Crown Court after admitting the manslaughter of a 42 year old man who died after the doctor failed to recognise the signs of diabetic ketoacidosis.

Bala Kovvali, 64, was based in India but flew to the United Kingdom every summer to work for the national deputising service Primacare. He had qualified in India but had trained as a GP in the UK.

He admitted causing the death of Andrew Fellows by failing to carry out an adequate clinical assessment, failing to refer him to hospital as an emergency, and failing to diagnose diabetic ketoacidosis.

Charges of gross negligence manslaughter against doctors are rare and guilty pleas rarer still. In most cases where doctors have contested the charges, juries have acquitted them.

Fellows, a painter and decorator, had a history of anxiety and depression but no history of diabetes. He had been working outside on 4 June 2009 when he became thirsty and started drinking large quantities of water.

When his condition worsened, his mother, who thought he had sunstroke, phoned Primacare. She told a triage nurse that he was “muddled and mumbling,” his breathing was erratic, his eyes were sunken, and his breath smelled “like pear drops.”

She told the court that she had specifically asked Kovvali whether her son had diabetes, but he shook his head. He advised that Fellows was depressed and should see his own GP the next day.

Kovvali was arrested in the United States and extradited after the Sheffield coroner adjourned an inquest into the death so that the police could investigate.

Experts told the crown court that if the locum had tested sugar concentrations in Fellows’s blood or urine and arranged for his immediate admission to hospital he could have been saved. The failure to diagnose his condition was the cause of his death.

Kovvali has been on the UK’s GP register since 2006 but is currently suspended. His barrister, Stephen Climie QC, told the court that his client, who had a particular interest in mental health matters, had decided to leave medicine and “will not be working in the UK ever again.”

Sentencing Kovvali, Judge Roger Keen told him, “You have devoted your working life to caring for others. I have seen glowing references as to your competence, empathy, and thoughtfulness.

“It is a tragedy for you that this brought about an end to your career [and] destroyed your good character and your ability to work in this country.”

But the judge said that the only option was a custodial sentence. Kovvali had failed to recognise his patient’s condition despite the presence of all the classic signs and opted for a diagnosis that was contrary to all the evidence.

“That was a gross breach of your duty of care. An expert has called your decision ‘appalling.’ I agree. It was clearly criminally negligent, and a wholly preventable death followed.”

Primacare said that Kovvali had met all the standards required by the primary care trust.

Notes

Cite this as: BMJ 2013;346:f1042