Guilty doctor's penalty mitigated by lapse of time

Chris Donegan • Published 5 Nov 2009 09:00

The doctor responsible for looking after 17-month-old Lucy Crawford the night she was given a fatal overdose of fluid at the Erne Hospital has been found guilty of serious professional misconduct.

The GMC(General Medical Council), which is responsible for ensuring doctors maintain proper standards, has ruled that Dr. Jarleth O'Donohoe did not act in Lucy's best interests and that his treatment of her was below the standard expected of a reasonably competent consultant paediatrician.

Having found him guilty of gross professional misconduct the GMC had a range of sanctions open to it including banning him from practising as a doctor or suspending him. In the end it opted for the most lenient option - a public reprimand.

However, it admitted that if had it heard the case shortly after Lucy's death rather than almost 10 years later its decision "may well have been different".

The case was heard by a Fitness to Practise Panel of two doctors and two lay members.

In deciding what penalty to impose the Panel considered suspending Dr. O'Donohoe, who has continued to work as a consultant paediatrician at the Erne in the years since Lucy's death.

It stated: "The public interest clearly includes ensuring that patients and members of the public can have confidence in the profession. The Panel has carefully considered what useful purpose a period of suspension would serve. A period of suspension would send a signal to the profession and members of the public of what the Panel considers to be behaviour unbefitting a consultant paediatrician."

It told Dr. O'Donohoe: "The Panel is confident that you do not pose a real and present risk to patients and the evidence before it is that you are a competent and useful doctor who provides a valuable service within the community. The Panel is satisfied that a finding of serious professional misconduct is a message in itself, which marks its disapproval of the matters found proved.

"The Panel notes that the public interest must also include a reluctance to deprive the profession of an otherwise competent and useful doctor who presents no danger to patients and members of the public," it stated.

"In all the circumstances the Panel has determined that suspension would not now be proportionate. Had the Panel considered this case shortly after the events in question, its decision may well have been different," it admitted.

"The Panel has therefore determined that it is proportionate and appropriate to conclude your case with a reprimand," it concluded.

Lucy, daughter of Neville and Mae Crawford, from Letterbreen, was admitted to the Children's Ward at the Erne Hospital on April 12, 2000, for observation. She had been sick and the loss of liquid through vomiting had left her moderately dehydrated. When a junior doctor was unable to insert a drip into her arm to give her fluid intravenously Dr. O'Donohoe, who was on call, was called in. He successfully inserted a line into the child's arm but the little girl was then given a fatal overdose of the wrong fluid.

The GMC Fitness to Practice Panel found that on April 12, 2000, Dr. O'Donohoe attended, assessed and inserted an intravenous line into Lucy but in doing so did not calculate an acceptable plan of fluid replacement. It found that he did not write down what fluid she was to be given and the rate of infusion. It found that he did you ensure that the nursing staff on the ward knew of an adequate fluid replacement plan or system for monitoring its progress and that he did not check Lucy again prior to a fatal seizure at 3am.

The Panel found that on April 14, two days after Lucy's death, Dr. O'Donohoe wrote down a fluid management plan for her that was "inaccurate and misleading" but not dishonest, as alleged in the charges against him.

In any event, it found that the plan was not appropriate.

It concluded that Dr. O'Donohoe's actions were not in Lucy's best interests and fell below the standards to be expected of a reasonably competent consultant paediatrician.

It then went on to consider whether this amounted to serious professional misconduct.

It noted that the GMC's barrister, Mr. Nigel Grundy, had submitted that Dr. O'Donohoe had breached fundamental tenets of Good Medical Practice and that the breaches were serious and had serious consequences. Mr. Grundy further submitted that they increased the risk of tragedy for Lucy and that Dr. O'Donohoe had failed in his duty of care to her.

The Panel found that he had breached Good Medical Practice.

It told Dr. O'Donohoe: "Having considered all the evidence, the Panel has taken account of the fact that your misconduct related to one patient over a relatively short space of time, and not to a number of patients over a longer period of time. However, the potential consequences of your misconduct were serious and placed that patient at an unnecessary risk of harm.

"The Panel has considered the public interest. The public interest includes the protection of patients, the maintenance of public confidence in the medical profession and the declaring and upholding of proper standards of conduct and behaviour. You failed in each of these and this, coupled with your breaches of Good Medical Practice, has led the Panel to determine that you have been guilty of serious professional misconduct," it concluded.

It then went on to consider what penalty to impose.

Mr. Grundy had submitted that the case should not be considered at the lower end of the spectrum of serious professional misconduct and that suspension was the appropriate and proportionate sanction.

Dr. O'Donohoe's barrister, Ms Alison Foster, submitted that what the Panel might have thought was an appropriate sanction 10 years ago when Lucy was killed should now be mitigated by the lapse of time. She emphasised that this was a single patient and a single incident and that there was no indication that anything similar had ever taken place before nor had it been repeated.

Ms Foster argued that Dr. O'Donohoe was a careful, insightful and respected doctor. She stated that he made one mistake that contributed to disastrous consequences and she invited the Panel to give weight to the efforts he has made to prevent any possible repetition.

The Panel also considered testimonial evidence from a Dr. Raza, Dr. Marshall and Mr. Geddes.

The Panel initially considered taking no action against Dr. O'Donohoe.

But: "Mindful of its duty to act in the public interest, the Panel determined that this would not be a sufficient response."

The fact that a period of almost 10 years has elapsed since the events in question weighed heavily with the Panel. It found the testimonial evidence, particularly from Dr. Marshall, compelling in terms of the difficulties and pressures in the working environment at that time.

The Panel said it had heard about the corrective steps taken within the Children's Ward by Dr. O'Donohoe and the guidance and protocols which he has developed and introduced in order to prevent any recurrence of such an incident.

"This demonstrates a degree of insight into the matters which have brought you before this Panel and identifies the lessons you have learned," it told Dr. O'Donohoe.

The Panel concluded that the "proportionate and appropriate" penalty was a reprimand.

The GMC explains: "This is the lowest sanction that can be applied. It may be appropriate where the offence is at the lower end of the spectrum in order to mark the fact that the behaviour was unacceptable and must not happen again. A reprimand does not affect the doctors registration it is disclosed if anyone enquires about the doctor's fitness to practice history."

Dr. O'Donohoe's entry in the List of Registered Medical Practitioners has been undated. A potential employer or patient looking at his history on the GMC web site will find details of the Fitness to Practice hearing into the events that led to Lucy Crawford's death.

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This article appeared in Impartial Reporter 05 Nov 09

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