IBRAHIM: DOCTOR FACING ‘WARNING’ FOR SENDING PNEUMONIA GIRL HOME WITH CALPOL

A doctor who sent home a four year old girl with a deadly pneumonia infection and told her parents to give her Calpol is to learn whether he will receive an official warning today (Weds).

Dr Shoab Ibrahim was told last month that he could continue with his career after the General Medical Council ruled he had learned his lesson.

He had failed to listen to the parents’ concerns about their daughter Hannah and did not carry out ‘simple but important’ tests that would have shown she was seriously ill.

The doctor sent them home with instructions to keep giving their daughter Calpol – liquid paracetamol for children – and noted he would review her in a week, the hearing was told.

Within hours she collapsed and died after succumbing to the infection she had been fighting for up to seven days.

Dr Ibrahim was told that he was guilty of misconduct in his treatment of the girl, but his failings were ‘highly unlikely to be repeated’.

Andrew Hurst, for the GMC, told a resumed hearing today (Weds) it would be in the public interest for them to issue an official warning.

He said: ‘A warning records that the General Medical Council considers these failings serious misconduct that would impair Dr Ibrahim’s fitness to practice if repeated.

‘General practice is busy and demanding but it can never be considered routine. Many patients may present with everyday symptoms but it’s a GP’s role to assess each case individually.’

But Ranald Davison (corr), for Dr Ibrahim, argued his client had already been punished enough.

He said: ‘The panel needs to consider the effect this warning might have. It remains a significant sanction and clearly a significant mark on the doctor’s reputation.

‘He has already gone through an investigation process by his own body and the stresses and strains of a full fitness to practise conduct hearing.’

A GMC warning will stay on a doctor’s records for five years and must be disclosed to any potential employers.

Warnings can also be viewed by the public on the organisation’s website, the hearing was told.

Dr Ibrahim had first diagnosed Hannah with an upper respiratory chest infection after seeing her at the Robert Frew Medical Centre in Wickford, Essex, on December 29, 1998.

She had become ill during a family trip to the pantomime a few days earlier, suffering from a cough, high temperature and vomiting and showed little interest in food and drink.

He told the girl’s mother to give her Calpol, and reassured the parents that she would have recovered in three to four days.

But Hannah failed to improve over the next few days and was eating and drinking less and less.

She became so ill that she showed no interest in a new bike her parents had got for her fourth birthday on December 30, the hearing was told.

Her worried parents phoned NHS Direct for advice on December 1 and were again advised simply to keep giving her Calpol.

The next day, they got an emergency appointment with Dr Ibrahim, by which time their daughter was so weak she had to be driven to the nearby surgery and carried into the waiting room.

Hannah’s mother, referred to as Mrs A, told the hearing: ‘I was really worried about her..

‘I was really upset the night before after speaking to NHS Direct – I knew what they said was not right, I knew she needed to see somebody.’

The child’s parents said Ibrahim remarked ‘You are back again’ when they carried their seriously ill daughter into the surgery.

The couple said they gave a full list of her symptoms, said she was getting worse, was not keeping down food and drink and seemed to be breathing faster.

They claimed Dr Ibrahim kept his back half turned to them for most of the six minute appointment and took ‘moments’ to carry out an examination of the girl.

As they described Hannah’s symptoms, the doctor said half turned away from them, entering information into his computer, said Mrs A.

He listened to her chest for a ‘few seconds’ in a consultation lasting only five or six minutes, and carried out no other investigations, she said.

They were sent home with instructions to keep giving her Calpol and fluids and the doctor noted in her medical records that he would review the situation if she was not better after a week.

But hours later, their daughter collapsed and died.

Mrs A has said when she tried to take her daughter to the toilet at around 12.30am the following morning her legs ‘just buckled under her’.

They were preparing to take her to hospital at 2am when she collapse, and despite the efforts of paramedics, she was pronounced dead at 4.30am.

A post mortem exam subsequently found she was suffering from pneumonia for between two days and a week.

Dr Ibrahim admitted that he failed to test Hannah’s capillary return time during the consultation on 2 January 2009, and did not record make an adequate detailed assessment.

But he claimed that he had not been told key details about the girl’s deteriorating condition at a second appointment and said he had been unfairly blamed for the girl’s death.

He said: ‘My understanding right from the beginning was that Mrs A and Mr A felt right from the beginning that it is because of me that these things all happened, but that isn’t actually the case.

‘I was there to help their daughter.’

The doctor claimed he ‘would not have formed the same view at all’ about Hannah’s condition if he had been told that she was not keeping food and drink down and was breathing faster.

‘If the child’s condition is getting worse, you don’t sit on it,’ he said.

He was found to have failed to take sufficient account of the concerns expressed by the girl’s parents, including that her condition had got worse, she was unable to keep food and drink down, was breathing fast and was still vomiting and coughing..

The panel ruled he failed to carry out ‘important but simple tests’ and did not take sufficient account of the ‘constellation of signs’ relating to his patient’s condition.

It meant that he failed to put himself in a position to diagnose that the girl was suffering from a serious illness such that urgent assessment in hospital by a paediatric specialist was required without delay.

Panel chairman Sheleen McCormack had earlier said the girl’s parents had been ‘clear, consistent and reliable’ in their evidence, whereas the doctor was ‘inconsistent in several material respects’.

But she said the doctor had addressed the problems that led to his failures after undergoing
re-training.

‘The panel considers that you have shown insight into the seriousness of your misconduct, and that you have taken sufficient steps to address the deficiencies identified in this case to the point that they are highly unlikely to be repeated.’

She told the doctor: ‘The panel is in no doubt that your misconduct is serious. It has, however, heard that this is your first appearance before a GMC fitness to Practise Panel, there having been no previous issues concerning your conduct.

‘There is no evidence, nor has it been suggested, that there has been a repetition of such misconduct since the 2 January 2009.’

Ms MacCormack said that they were ‘very mindful’ of the circumstances surrounding the tragic death of the child.

‘The panel has borne in mind that it has not been suggested that your misconduct led to the death of HC, nor that you should have diagnosed her condition.

‘Having determined that you have shown insight into your misconduct and that you have remedied the deficiencies in this case, the panel does not consider in the particular circumstances of this case that the wider public interest requires a finding that your fitness to practise is impaired.’

Dr Ibrahim, who qualified in Pakistan in 1988, has been allowed to practising without restrictions as a result of the decision.

The panel is due to rule on whether he should receive an official warning later today.
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