Medical Practitioners Disciplinary Tribunal

Precis

	Decision No:	98/18D
	Practitioner:	Dr Thomas Nigel Ellison
	Charge Characteristics:	Inadequate notes Inappropriately late referral of patient to hospital Did not follow patient instructions Inadequate care Inadequate diagnosis Falsification of records
	Additional Orders:	Application for the discovery of documents granted: 9818ddislaw Doctor granted interim name suppression: 9818dhearpriminlaw Application to revoke Doctor's interim name suppression granted: 9818drevokedecisionlaw
	Decision:	9818dfindings

Charge:

The Director of Proceedings charged that Dr Ellison was guilty of professional misconduct in that his management and care of his patient between July 1996 until August 1996 was inadequate and was not carried out with reasonable care and skill. In particular it was claimed that Dr Ellison failed to:

Adequately diagnose and act appropriately on the patient's clinical problems from 20 July 1996 until his admission to hospital on 15 August 1996.
Arrange a prompt admission into hospital for the patient.
Appropriately annotate his medical records with the quantity or the length of course of medication prescribed.
Refused to act upon the patient's request to be admitted to hospital on or about the week of 11 August 1996.
Adequately treat and monitor his patient during the period 20 July to 15 August 1996.

Background:

Dr Ellison visited the patient at the patient's home on 20 July 1996. He recorded in his notes that the patient had severe flu and prescribed a broad-spectrum antibiotic and a cough suppressant. The patient's condition was reviewed and Dr Ellison reviewed the patient's condition at his surgery 2 ½ weeks later. A slow improvement was noted and a different antibiotic was prescribed. Following a telephone call from the patient, Dr Ellison saw the patient again on 12 August 1996. The patient presented with indications of pneumonia. Dr Ellison's advice was the patient should go to hospital. His notes recorded the patient declined this option. A chest x-ray on 13 August 1996 showed an area of increased density. Dr Ellison's notes recorded that the patient again refused hospitalisation. The patient was admitted to hospital on 15 August 1996. Pulmonary embolism was diagnosed. The patient died on 17 August 1996 following a cardiac arrest. There was no post-mortem to define the actual cause of death.

Finding:

The Tribunal found Dr Ellison was not guilty of professional misconduct.

The Tribunal found that the totality of Dr Ellison's management of the patient during the period from 20 July to 15 August 1996 was adequate and that his initial diagnosis of the patient's condition was reasonable.

When considering particulars 2 and 4 the Tribunal found that the timing of the patient's admission to hospital was appropriate on the facts of the case. It found there was no evidence to support the allegation that Dr Ellison had falsified his records by adding to them that the patient had refused hospitalisation on at least two occasions.

The Tribunal accepted evidence that a simple statement of the type of medication prescribed is usually sufficient particularly in the case of well known antibiotics with relatively simple dose regimes, and therefore particular 3 was not established.