IN THE FAMILY HEALTH SERVICES APPEAL AUTHORITY
Case No: 11170
Mr A D Harbour CHAIRMAN
Dr P R Leigh PROFESSIONAL MEMBER
Mr T P Bennett MEMBER
(GMC No: 0922144)
This is an appeal by way of re-determination under section 49M of the Health and Social Care Act 2001 from the decision of the Waltham Forest Primary Care Trust (the PCT) to suspend Dr A Deva (Dr Deva) from the medical list. This decision was made on the 15th March 2004 and communicated by letter to Dr Deva on the 23rd March 2004. Dr Deva appealed to the Family Health Service Appeal Authority (FHSAA) by letter on the 19th April 2004 and supplemental letter on 20th April 2004.
In summary her letters allege that the processes leading up to her removal from the list were unfair. She also alleges that decision to remove her from the list was ‘obviously unfair’ and that she had been victimised.
The Panel could not identify anything in the procedure that led up to the March 2004 decision by the PCT as being unfair. Dr Deva was informed in detail of the all the allegations against her. She had every opportunity to obtain legal advice. Her reason for seeking an adjournment of the March hearing, and then choosing not to attend that hearing, were muddled and inconsistent.
Although Dr Deva was notified of the FHSAA hearing she did not attend and provided no explanation for her non-attendance. The Panel decided to proceed in her absence. The Panel was provided with a bundle of letters, memoranda, minutes and reports. All these papers were available to the PCT when they came to their decision in March.
The Panel decided to conduct the hearing on the basis of reading these papers and hearing oral evidence. The key reports read by the panel were the :
(a) Review of Dr Diva’s clinical records dated 24 January 2004 by Dr Watts.
(b) Statement of Dr Essex (clinical adviser to PCT concerning the investigation into Dr Deva’s practice) dated February 2004.
(c) Note by Mark Ackary (Performance Review Officer) concerning unfiled clinical correspondence dated October 2003.
(d) Analysis of Dr Deva’s prescribing dated December 2003 by Mona Sood.
The Panel heard oral evidence from Dr Essex and James Slater.
In summary terms the evidence justifying Dr Deva’s removal from the list of medical practitioners falls into three areas: negligent practice demonstrated by the analysis of patient records, the overall pattern of her prescribing putting patients at risk and the general state of her medical records again putting patient’s at risk.
The panel accepted the analysis of Dr Essex where he summarised the failings in Dr Deva’s practice, apparent from Dr Watts and Ms Sood’s analyses, as follows:
Ø Failure to diagnose
Ø Failure to take a history or to examine patients
Ø Failure to undertake relevant investigations in patients with potentially serious problems
Ø Failure to act on abnormal test results
Ø Failure to refer where appropriate
Ø Failure to act on hospital recommendations
Ø Failure to provide basic minimal acceptable care for patients with chronic diseases
Ø Failure to provide appropriate medication to prevent strokes and coronary heart disease in those at risk
Ø Dangerous and inappropriate prescribing
Ø Failure to review repeat prescriptions
Ø Failure to treat diseases such as diabetes when diagnosed
Ø Failure to file critical clinical information in patients records placing many patients at risk by making safe clinical care impossible to provide
The Panel would also add to that list failure to follow child protection procedures. In relation to Dr Deva’s prescription methods, the Panel accepted the written evidence of Mona Sood, and the oral evidence of Dr Essex, who described Dr Deva’s over-prescription of Benzodiazepine in specific cases as ‘phenomenal.’
The failure to maintain Dr Deva’s medical records was an additional factor putting her patient’s at risk. The records in question relate to a period from 1999 to 2003.
Dr Deva’s practice has no chronic disease register and no computerised systems in place. The list size of her practice was excessive with patient numbers of around 3,300 against a national average of around 1800 and in the area where her practice was located of around 2,100.
It appeared that Dr Deva had been practising in isolation for some years. She had not responded to attempts to engage her in clinical audit or ongoing training. In summary many aspects of Dr Deva’s clinical practice appeared to put her patients at risk.
The Panel decided that the decision of the PCT to remove Dr Deva from their list was entirely justified. The Panel, who can make any decision which the PCT could have made, unhesitatingly make the same decision. The Panel also decided that given the circumstances surrounding Dr Deva’s suspension and removal from the list she must be nationally disqualified from all categories of list described in section 49N(1) Health and Social Care Act 2001. Under Rule 47(2) the General Medical Council should be notified of this decision. Because concerns were expressed that Dr Deva may practice if she returns to India the panel direct that the Indian Regulatory Medical Authority/ies are also informed of this decision.
Either party to these proceedings has the right to appeal this decision under and by virtue of Sec.II Tribunals and Inquiries Act 1992.
DATED this…………day of………………2004