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Singh v General Medical Council (GMC) [2003] UKPC 15 (17 February 2003)

ADVANCE COPY

Privy Council Appeal No. 53 of 2002

Dr. Usha S.N. Singh Appellant

v.

The General Medical Council Respondent

FROM

THE PROFESSIONAL CONDUCT COMMITTEE

OF THE GENERAL MEDICAL COUNCIL

---------------

REASONS FOR REPORT OF THE LORDS OF THE

JUDICIAL COMMITTEE OF THE PRIVY COUNCIL OF THE

21st January 2003, Delivered the 17th February 2003

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Present at the hearing:-

Lord Hoffmann

Lord Walker of Gestingthorpe

Sir Philip Otton

[Delivered by Lord Hoffmann]

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1. At the conclusion of the hearing on 21st January 2003 their Lordships agreed humbly to advise Her Majesty that the appeal ought to be dismissed with costs and that they would give their reasons later. This they now do.
2. Dr Singh appeals against findings of the Professional Conduct Committee of the General Medical Council that she was guilty of serious professional misconduct in connection with her treatment of two patients and its direction that her name be erased from the register.
3. The facts found by the PCC were as follows. On 2 December 1998 the first patient ("Mr A") attended at Cramlington Health Centre, a general practice surgery where Dr Singh was working as a locum. He complained of urethral discharge and pain in micturating, brought a urine sample which appeared to contain blood and suggested that it should be tested. Dr Singh told him that the tests would be done by the consultant with whom Mr A already had an appointment about two weeks later. She took no other steps to investigate his condition. Nor did she keep any notes of the consultation.
4. Five days later Mr A went directly to a hospital, where he was diagnosed as having advanced colorectal cancer. He was admitted but discharged on 21 December because nothing more could be done and died on 31 December.
5. On 20 June 1999 Dr Singh, while working for Healthcall, a deputising service, visited the second patient ("Mrs B") at a residential home for old people in Killingworth. She was told by a staff member that Mrs B, who was 84, seemed hot and confused. Dr Singh made no examination further than putting her hand on Mrs B's stomach. She diagnosed constipation and prescribed an enema. Mrs B's condition deteriorated after the visit and she died the next day. Dr Singh's notes were sketchy and undated.
6. The Committee considered that in both cases the patient had received gravely inadequate treatment. They were also of the view that the case was aggravated by two other matters. First, Dr Singh's record keeping was well below the standard expected of a medical practitioner, particularly when she is a locum or deputy and the patient is likely to be seen next by someone else. Secondly, Dr Singh had failed to co-operate with the process of inquiry and had told lies about what had happened. The Health Authority had set up an Independent Review Panel to consider Mr A's case which was fixed for 2 February 2000. Dr Singh was notified of the date on 3 November, but less than two weeks before the hearing she told the authority that she was going to India and would not be able to attend.
7. At the hearing before the PCC Dr Singh said that there were two old ladies at Killingworth, both called Mrs B. One was Alicia and the other was Alethea. The one who afterwards died had been properly examined. She had felt her pulse and ausculated her heart and lungs. The one who was given a cursory examination was someone else.
8. The Committee rejected this as a fabrication, inspired by Dr Singh's discovery the fact that the records sometimes referred to Mrs B as "Alicia" and sometimes as "Alethea", no doubt due to mishearing. They accepted the evidence of witnesses from the home, present at the time of the visit, who said that there was only one Mrs B and that she had been given the treatment (or lack of it) which they described.
9. Dr Singh represented herself before the Board. Her grounds of appeal were similar in relation to both patients. The man who presented himself as Mr A did not appear to have anything wrong with him. He did say that he had urethral discharge and brought a urine sample, but seemed otherwise healthy. Dr Singh was led to wonder whether the man she saw really was the Mr A who had died so soon afterwards.
10. As for Mrs B, the patient she saw could not have been the Mrs B in respect of whom she was charged. The documents show conclusively that there were two patients called Mrs B because some refer to a person called Alicia and some refer to a person called Alethea, who happen to have had the same date of birth. She saw Alethea and not Alicia.
11. Their Lordships do not find it necessary to say more than that there was ample evidence upon which the Committee was entitled to reach the conclusions which it did. The matters to which Dr Singh refers cast no doubt upon their validity. In the light of those and the other findings, the direction that Dr Singh's name be erased was entirely proper.