A consultant physician who admitted several failings in his treatment of an elderly woman who died of pneumonia shortly after she was discharged from hospital was told today he can resume “unrestricted practice”.
The fitness to practice panel of the General Medical Council which has been hearing Dr Ken Graham’s case this week ruled that the mistakes he made in his care of 84-year-old Eileen Peterson at the Gilbert Bain Hospital in Lerwick in March 2005 amounted to misconduct.
However, considering the length of time that has elapsed, the lessons Dr Graham has learned, the fact that he had expressed “genuine and sincere” regret to Mrs Peterson’s family, the new procedures he has put in place at the hospital and the many positive testimonials submitted on his behalf by colleagues and patients, the panel decided that allowing him to return to work would “not place patients at risk, nor would it damage the public’s confidence in the profession”.
Dr Graham had admitted to the panel in Manchester earlier this week that he had failed to adequately assess Mrs Peterson’s hydration and the nature and extent of her infection; that his decisions to treat her with amoxicillin and discharge her to her care home, Taing House, were inappropriate; and that his clinical notes were of poor quality. As such, his conduct “fell below the standard expected of a consultant physician”.
Yesterday Dr Graham, former medical director of NHS Shetland, was cleared of deliberately misleading a fatal accident inquiry into Mrs Peterson’s death.
Today, the panel said: “[Y]our clinical failings on 9th March 2005 amount to a single instance of negligent treatment, which included a number of omissions. On that day, you failed to provide the care that Patient A [Mrs Peterson] was entitled to receive. As such, you breached several fundamental aspects of Good Medical Practice. In considering the interests of the patient, her family and the wider public, the Panel has concluded that your conduct was unacceptable and would be regarded as deplorable by fellow practitioners. For these reasons, the Panel has determined that your conduct was serious and amounts to misconduct.”
In deciding how do deal with Dr Graham, the panel noted that “the gravity of your misconduct would have resulted in a finding that your fitness to practice was impaired at the time”.
But, considering whether his fitness to practice was currently impaired, members of the panel took into account the 2005 fatal accident inquiry, a report from the ombudsman and the GMC proceedings.
“Together with the learning points gained from your role as Medical Director for NHS Shetland, where you had to review and scrutinise complaints made against other clinicians, these inquiries have provided you with an opportunity to reflect on your failings and to learn from them. Taken together, they amount to what can only be described as a chastening learning experience for you and one from which you have learnt.”
The panel said Dr Graham now ensures his medical notes are kept up-to-date and of a high standard. He had also initiated the training of junior doctors in note-keeping and introduced note-keeping audits.
“You improved clinical standards in your hospital by introducing a new fluid balance chart [and] an early medical warning system and implemented appropriate changes to improve the reliability of discharge letters. Importantly you also introduced fortnightly critical incident analysis meetings, including the analysis of any deaths which had occured on the ward.
“The Panel is satisfied that you have demonstrated subtstantial insight and remedied your clinical failings … the Panel is of the view that these proceedings have had a salutary effect upon you and that it is highly unlikely that you would repeat such behaviour in the future.”
The panel also decided against imposing a warning on Dr Graham’s registration.
In a statement, NHS Shetland said a review would be carried out to see whether any further lessons could be learned and to ensure that the improvements introduced were maintained.
“NHS Shetland recognises the importance of the GMC as a way of protecting, promoting and maintaining the health and safety of the public by ensuring proper standards in the practice of medicine, and we have complied in full with the requests made by the GMC approaching and during the hearing.
“We previously co-operated with the fatal accident inquiry and Scottish Public Services Ombudsman (SPSO) investigation into this case. We are aware that some aspects of the patient in question’s care was not of the standard we aspire to and we have previously apologised to the family for this.
“We are pleased, however, that the GMC panel recognised that lessons had been learned by Dr Graham and NHS Shetland through the fatal accident inquiry, the ombudsman report and the fitness to practise proceedings into this case.”
The statement went on: “Now the hearing has finished we will review whether there are any further lessons that can be learnt and ensure that the improvements that have been made are maintained.”