GP’s suicide after suspension for administering an overdose provokes a storm in the Netherlands

BMJ 2013; 347 doi: (Published 05 November 2013) Cite this as: BMJ 2013;347:f6673
  1. Tony Sheldon
  1. 1Utrecht, Netherlands

A GP in the Netherlands who was suspended for administering a very high dose of a pain killer and sedative to a dying patient has been found dead, in what is believed to have been an act of suicide. His death has sparked concern among doctors.

Dr Nico Tromp’s suspension occurred after public prosecution service officials, including police, had arrived unannounced and searched his home. He was subsequently interviewed and suspended from practising medicine. Several days later he was found dead. As a result the Dutch GPs’ association (LHV) has called for an independent investigation.

The Dutch healthcare inspectorate, in an attempt to clarify the facts, has made public the injunction suspending his practice, which details an “acute, serious and extensive risk to patient safety.”

In answer to the society, the inspectorate said the case was not about euthanasia, palliative sedation, or assisted suicide but a treatment “far outside normal medical care.”

Dr Tromp’s patient was dying at home of cancer, and—despite signing an earlier euthanasia declaration—he had now chosen palliative care and was receiving morphine plasters for his pain and shortness of breath. Dr Tromp had been on holiday and had therefore not seen his patient for several weeks. When he arrived together with a trainee GP for a home visit he was shocked to see how his patient’s condition had deteriorated.

He later told the inspectorate that he felt something must be done and there was no time to follow procedures or begin palliative sedation. He immediately fetched extra supplies of drugs and injected his patient with 1000 mg morphine and 350 mg sedative dormicum (midazolam). His patient died and Dr Tromp recorded a “(natural) death,” arguing that the high dose medication was given in the context of palliative sedation.

Concerned, the trainee informed her supervisors at Amsterdam’s Academic Medical Centre, which in turn alerted the healthcare inspectorate. Given the nature of the case, the inspectorate alerted the public prosecution service, which began a criminal investigation.

Because of the “considerable unrest” caused by the case, the medical centre later clarified in a letter to all involved in GP training that “such was the transgression of normal treatment guidelines” that they had no choice other than to inform the inspectorate and not discuss the matter first with the GP, which is the normal accepted procedure. This had never happened before.

It stresses the case was an “excessive and conscious contravention of the norms of treatment.”

The GPs’ association’s chair, Steve van Eijck, has welcomed the clarification from the inspectorate that these were exceptional circumstances and that GPs adhering to the guidelines can continue to offer important terminal care, but he says the “tragedy” is not yet over. The inspectorate will now complete an investigation.

Dutch legal criteria for euthanasia require a second opinion, consultation with the patient, and a well considered request.1


Cite this as: BMJ 2013;347:f6673

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