Consultant is struck off for dishonesty over case of girl who died from meningococcal septicaemiaBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m241 (Published 21 January 2020) Cite this as: BMJ 2020;368:m241
A consultant in emergency medicine has been struck off the UK medical register after a tribunal found he lied repeatedly to cover up his failure to recognise and treat meningococcal septicaemia in a 6 year old girl who later died.
Harsha Rajanna was an specialty trainee year 6 registrar in emergency medicine in February 2017 when he failed to examine Layla-Rose Ermenekli properly. Layla’s mother had brought her to the Royal Oldham Hospital’s emergency department, feeling ill and with a high temperature. Rajanna did not notice a rash on her hip, the tribunal found.
After a brief test of tolerance for liquids, he ordered her discharged, but a concerned paediatric sister called in a junior doctor who noticed a non-blanching rash on the child’s hip, which she recognised as a classic sign of meningococcal septicaemia.
The junior doctor alerted Rajanna but, she told the tribunal in a statement, “Dr Rajanna made me feel that I was worrying unnecessarily. He reassured me and was confident with his impression of Patient A’s condition and the rash.”
Nevertheless, a senior paediatric doctor also examined Layla, and concurred with the junior. Layla was admitted to paediatrics and given intravenous antibiotics, but she worsened rapidly and died after a cardiac arrest about four hours after first being examined.
Rajanna was not accused of causing the child’s death, but of failures in her care and of lying about the night’s events, first to an inquiry by Pennine Acute Hospitals NHS Trust, and later under oath at a coroner’s hearing.
In both cases he claimed that he had seen “a bruise-like area.” At the coroner’s hearing he testified that Layla’s mother had told him it was caused by bumping into a table. He also claimed to have told this to the junior doctor when she brought the rash to his attention.
Both the mother and the junior doctor testified at his medical practitioners’ tribunal hearing that this was untrue and that he never mentioned a bruise or mark that day. Layla’s mother had dialled 111 before taking her to hospital, and had been told to examine her body thoroughly, and had reported no marks.
Described as a “credible and compelling witness” by the tribunal’s chairman David Urpeth, Layla's mother was “steadfast” in rebutting his claim about the bruise. She also denied Rajanna’s claim that discharging the child had been her idea.
Had this been the case, said Urpeth, Rajanna would have recorded it in his notes as being contrary to his advice.
Rajanna was “an unreliable and non-credible witness,” the tribunal found. “He often conflated his usual practice with his memory” in a way that the tribunal found “deliberately misleading,” said Urpeth.
The vagueness of his recollection was not convincing, said Urpeth, given that “the events were incredibly serious, and Dr Rajanna has had to revisit them on a number of occasions.”
Rajanna’s dishonesty was persistent, developed over time, and “has led to further anguish” for Layla’s mother, who had been cross-examined as a result, said Urpeth.
Counsel for the GMC asked for a sanction of erasure. Rajanna had been the only staff member not to apologise to the family at the coroner’s court, she noted. He had apologised later, she said, but this was “cheapened” by his continued denial of some of his clinical failings and of dishonesty.
Rajanna’s counsel argued that he had an otherwise unblemished 18 year record, had a young family to support, and since 2019 had been working in an area where recruitment is difficult, as a consultant in emergency medicine at Tameside Hospital. He said the trust investigation report showed failings across the board and urged the tribunal to be alive to the risk that Rajanna could be made a scapegoat for the actions of the whole emergency department.
“The tribunal determined that Dr Rajanna’s dishonesty is incompatible with continued registration,” said Urpeth. “The tribunal felt the public expect to be able to trust their doctors and Dr Rajanna cannot instil that trust.”