Intended for healthcare professionals


Locums should have log books

BMJ 1994; 308 doi: (Published 11 June 1994) Cite this as: BMJ 1994;308:1572
  1. D J Dye
  1. St Lawrence Hospital, Chepstow, Gwent NP6 5YX.

    EDITOR, - Clare Dyer's article on a consultant who was found guilty of serious professional misconduct after failing to investigate complaints that a locum, Dr Behrooz Irani, was endangering patients contains a factual error. In February 1993 (that is, six months after the incident at Castle Hill Hospital) Dr Irani was not working in Hull but was employed as a locum consultant anaesthetist at St Lawrence Hospital, Chepstow. The incident in which Dr Irani left the operating theatre to make a telephone call led to an operating department assistant noticing that the patient in whose charge he was left was receiving a hypoxic gas mixture and was beginning to show signs of oxygen desaturation. Fortunately we were using a computerised anaesthetic record system, which captures all physiological and machine data, and we were able to confront Dr Irani with this incontrovertible evidence of his incompetence. Dr Irani was immediately dismissed from his post and was reported to the General Medical Council.

    A worrying aspect of this affair is that Dr Irani was able to obtain a post as a locum consultant anaesthetist in Chepstow, having received three good references (two from a previous employer and one from a consultant in Hull) after the events at Castle Hill Hospital in August 1992. I believe that Dr Irani's medical registration should have been suspended pending an inquiry into the incident at Castle Hill Hospital. If he had been required to carry a log book detailing his previous employment and, more particularly, the names of supervising consultant staff we might have been aware of his previous problems before interviewing him for the post in Chepstow.

    Locum staff of any grade should be under the supervision of a named senior member of consultant staff in their specialty at the hospitals in which they work. This could be the college clinical tutor or the Chairperson of the anaesthetic division. If the names of these supervising doctors were entered into a log book carried by the locum along with the dates of their employment it would be relatively easy for potential employers to trace the locum's activities and previous posts. It has been suggested that such a system would be cumbersome and expensive, but incidents such as that at Castle Hill Hospital are far from isolated and the costs in human misery alone are enormous.


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