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Locum GP who gave poor care to five patients is struck off

BMJ 2018; 361 doi: (Published 11 May 2018) Cite this as: BMJ 2018;361:k2125
  1. Clare Dyer
  1. The BMJ

An out of hours locum GP who gave substandard care to five patients and made dishonest statements on a cremation form has been struck off by a medical practitioners’ tribunal panel in Manchester.

Vikram Krishnappa was found to have provided poor clinical care to five patients over a 14 month period between late 2013 and early 2015, while working as a locum GP in the out of hours service at Cardiff Royal Infirmary.

Most of the cases involved multiple failings and each, on its own, constituted serious misconduct, the tribunal ruled.

In the case of a 3 week old baby, he failed to urgently refer her to hospital for more tests, breaching NICE guidelines for children under 5 with a fever. He ignored multiple red signs on the “traffic light” system used to spot serious infections in children, the General Medical Council’s expert witness told the hearing. The tribunal found that Krishnappa had posed a serious risk to the infant and failed to communicate properly with her parents.

In another case, he sought to diagnose a rash over the telephone when good practice requires a physical examination. Although his notes described a classic shingles presentation, he failed to consider that possibility and provisionally diagnosed cellulitis, prescribing an inappropriate antibiotic.

On another occasion he ignored guidelines demanding that high priority be given to arranging a home visit for a palliative care patient in considerable pain and distress. In another, he failed to take a proper history or adequately examine a patient who had cerebral palsy, and failed to refer him to hospital for further tests and investigations that were indicated. He was later diagnosed with necrotising fasciitis, although this was not at first identified in hospital, and the tribunal did not regard Krishnappa’s missing the diagnosis as a failure.

Krishnappa also dishonestly completed a cremation form on a patient whom he had not seen when alive, saying he had last seen him 28 days before his death, and signed a statement attesting that his responses on the form were true.

Krishnappa, who qualified in Mysore, India, in 1998, moved to Britain in 2006, and registered as a GP in 2013, did not attend the hearing. His last contact was a 2015 email to the GMC that said: “Suspend my licence to practise and suspend my registration. Don’t send any further letters or further notifications. I’m not practising since 1 August 2015. I’ll be on jobseeker’s [allowance] soon. Thank you.”

There was “no evidence that he had sought to apologise to any of the patients, shown any remorse or insight, or undertaken any type of remediation since the first complaint was made against him,” said Kim Kneale, chair of the tribunal.

“His misconduct occurred over a 14 month period, involved a variety of issues, and placed multiple patients at risk of harm, some of whom were particularly vulnerable,” said Kneale. “In these circumstances, the tribunal concluded that Dr Krishnappa’s behaviour is fundamentally incompatible with being a doctor, and it has determined to erase his name from the medical register.” His name will be erased after 28 days unless he appeals.

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