Intended for healthcare professionals


GP is struck off after writing reports on holiday sickness for wife’s law firm

BMJ 2019; 367 doi: (Published 21 October 2019) Cite this as: BMJ 2019;367:l6128
  1. Clare Dyer
  1. The BMJ

A GP who wrote expert reports on holiday sickness claims for his wife’s law firm has been struck off the UK medical register for failing to declare a conflict of interest and repeatedly diagnosing food poisoning in tourists without sufficient evidence.

A medical practitioners tribunal also found that Zuber Bux, 47, had carried out an unsafe circumcision in the community, of a 15 month old baby with a heart defect. The child was admitted to hospital a few hours after the procedure.

Bux qualified at Liverpool in 1994 and worked as a GP in the area. Since 2016 he has done locum and out-of-hours work, but before that he was a practice partner.

He began to produce medicolegal reports for his wife’s firm in 2008 on road accident cases. He stopped this in 2011 after the defence solicitor in a claim complained about a potential conflict of interest. Bux consulted the Medical Defence Union and was told that the General Medical Council (GMC) could potentially see his relationship with his wife’s firm as a conflict.

In 2015 he was asked by an agency to take on reports again for his wife’s firm. The agency told him that a “Chinese wall” had been set up to insulate him from his wife’s work, and he agreed. He wrote about 400 reports on holiday sickness claims over the next two years, earning about £72 000 (€83 800; $93 500).

GMC notification

Bux was reported to the GMC by Beachcomber Tours after he diagnosed a condition by telephone in a patient who had stayed at a Mauritius resort in October 2015. He wrote that she had infective gastroenteritis as a result of food poisoning, which he concluded on the balance of probabilities was due to inadequate food preparation and food handling at the hotel.

He did not mention in his report that she had been seen by the resort’s doctor, who had diagnosed viral acute colitis. A manager with the tour company discovered his wife’s role at the law firm, where she was by 2015 a salaried partner, and notified the medical regulator.

In 2018 a medical report by Bux drew criticism from a county court judge in a claim made against the tour operator Thomas Cook. The judge criticised the “Chinese wall” arrangement and said that the report lacked “anything passing for objective expert analysis,” although he did not rule that there was a conflict of interest.

Misleading and dishonest

The GMC ultimately accused Bux of misconduct in four cases, involving reports on five patients. All were given a telephone diagnosis of infective gastroenteritis caused by food poisoning. Bux’s reports did not mention different diagnoses from three other doctors who had seen the patients in person. The tribunal found these reports to be misleading, dishonest, and financially motivated.

It also found proved all charges against him in the separate allegation relating to a community circumcision. The infant being circumcised, named only as “Patient A,” had a congenital heart condition, tetralogy of Fallot. Bux failed to take an adequate history or to record the specific heart condition and did not appreciate the risks or inform the parents about them, the tribunal found. He inappropriately carried out the procedure in the community and did not administer sufficient analgesia, it found.

Julia Oakford, chairing the tribunal hearing, called it “a serious case involving a vulnerable child where Dr Bux adopted a cavalier approach to the procedure resulting in a hospital admission of Patient A in a potentially life threatening situation.”

The holiday sickness reporting, she said, “involved dishonesty that was covered up; it involved lying to solicitors; false declarations to the Court; deceptive expert reports; and it was financially motivated. Overall, it was wholly deplorable and reprehensible behaviour by a doctor.”

Bux’s own lawyer conceded to the tribunal that its findings of repeated dishonesty made erasure the likely outcome.

Oakford noted that Bux had shown only limited insight into his failings in the circumcision and had not apologised for the medical reports. “Erasure is the only proportionate sanction to protect the public,” she said. Bux will be struck off after 28 days unless he appeals.