Suspension of nurse who gave drug on consultant's instructions

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7076.299 (Published 25 January 1997) Cite this as: BMJ 1997;314:299

***We received 13 other letters commenting on Kellett's article, all of which criticised the management and argued that the nurse should not have been suspended.

What has happened to clinical freedom?

  1. D M D White, Retired consultant, mental health of the elderlya
  1. a 1 Wall Park Road, Brixham, Devon
  2. b Department of Old Age Psychiatry, Chase Farm Hospital, Enfield EN2 8JL
  3. c Mental Health Act Commission, Nottingham NG1 6BG
  4. d Department of Health Care of the Elderly, Royal London Hospital, London E1 4DG
  5. e St George's Hospital Medical School, London SW17 0RE
  6. f Heathlands Mental Health NHS Trust, Frimley, Camberley GU16 5QE
  7. g Psychological Medicine Unit, South Kensington and Chelsea Mental Health Centre, London SW10 9NG

    Editor–My first reaction on reading John M Kellett's article was one of anger. The article concerned the suspension of a nurse who, on a consultant's instructions, had added haloperidol to a cup of tea given to a patient who had refused the offer of admission or a tranquilliser.1 Why should what, in my experience as a psychogeriatrician, was a not uncommon procedure be made the subject of such administrative overreaction?

    But as I brooded on the matter my anger gave way to concern. I noted that the unit general manager subsequently instructed the consultant “to stop releasing information of this type [that is, an account of his clinical actions and the reasons for them] to relatives or patients.” I also noted that the consultant was “invited” to meet the unit general manager and senior community physician to “discuss” the matter; that this was in fact a disciplinary procedure is clear, the consultant being told to “avoid publicity” pending a regional inquiry.

    When I was a student I was taught that the responsibility of doctors to their patients was a personal one and that their actions were subject only to the judgment of their peers (that is, the General Medical Council) or the courts–usually civil but, in extreme instances, criminal. When did it become acceptable for a manager (who presumably has no medical training at all) and a community physician (who, despite his or her own skills, is unlikely to fulfil the college's requirements for a consultant post in the psychiatry of old age) to give instructions to or discipline a consultant? What has happened to clinical freedom?

    As for the unfortunate sister, it should …

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