A GP has been suspended after failing to make personal appointments for a patient who was later admitted to hospital.
Dr. Alyn Williams, who worked at Chapel Street Surgery in Billericay, was scolded for not providing “appropriate clinical care.”
The medic, who has worked as a general practitioner since the 1990s, conducted a series of telephone consultations with the unidentified male patient in 2020 and 2021.
But he had repeatedly failed to report symptoms in medical records, arrange and check-in in-person follow-up consultations with the patient about his symptoms.
Over the course of nine months, patient’s health ‘deteriorated significantly’ as vital personal temperature and oxygen checks were not performed by Dr Williamsleaving him hospitalized with a heart infection, which can be life-threatening.
Dr. Alyn Williams, who worked at Chapel Street Surgery in Billericay, was scolded for not providing “appropriate clinical care.” The physician, who has worked as a general practitioner since the 1990s, conducted a series of telephone consultations with the patient in 2020 and 2021. and follow up with the patient about his symptoms
The proportion of GP appointments in England held face-to-face in May was 69.8 per cent. This is down from the 70 percent in April, the highest recorded since the pandemic
a medical tribunal panel Dr Williams suspended for failing to provide ‘adequate care’ and ‘severely below expected standards’.
It was “obvious” that the patient’s illness “might not have become so severe had Dr. Williams provided the necessary and adequate care,” they concluded.
Dr. Williams said he chose not to have face-to-face consultations during Covid in 2020 and 2021 because at age 66 he was obese and more vulnerable to the virus.
The male garage employee, known only as Patient A by the panel, had been registered with the practice for 20 years.
He initially in May 2020, during the height of Covid, developed a persistent chesty cough and nasal drip – a buildup of mucus in the back of the throat.
WHAT IS ENDOCARDITIS?
Endocarditis is an infection of the inner lining and valves of the heart.
If left untreated, it can lead to life-threatening heart failure.
Endocarditis affects about one in 30,000 people in the UK and four in 100,000 in the US each year.
Symptoms often develop slowly over several weeks and may include:
- Flu-like symptoms – tiredness, headache, chills, cough, sore throat
- Unexplained weight loss
- Pale skin
- Painful muscles and joints
Endocarditis is usually caused by bacteria, which can enter the bloodstream and travel to the heart.
It is more common in people who have had heart valve surgery, suffer from heart disease, are an intravenous drug user, or have poor oral hygiene.
Treatment begins with intravenous antibiotics.
Surgery may be needed to repair heart damage.
Source: British Heart Foundation
Dr. Williams prescribed a nasal spray during a telephone consultation at the time.
But still with the same symptoms, after another telephone consultation and a course of antibiotics, he was referred for a full-body CT scan.
Dr. Williams consented to the patient within two weeks. However, his complaints persisted.
Blood tests returned in December also revealed high levels of CRP — 117 milligrams per liter (mg/L) — indicating inflammation of the blood vessels.
In general, a CRP value between one and five milligrams per liter (mg/L) is considered normal.
The patient then had a telephone consultation with Dr Williams on December 14, after complaining that he still felt exhausted and had continued to lose weight.
But he was again prescribed a course of antibiotics.
He told the panel that he “couldn’t remember” Dr Williams asking about his breathing or if he had a fever.
During a subsequent telephone consultation on January 4, the patient complained that he was bedridden for much of the day due to lack of energy.
Medical records of the appointment, made by Dr Williams, noted: “Still feeling rubbish, start eating and drinking, always cold now, haven’t had a Covid test, should try to book one because it appears to have a viral infection. ‘
During a final telephone consultation on Jan. 7, Dr. Williams arranged for a referral from the community to have the patient’s blood checked again.
No hospital referral or face-to-face follow-up was reported in the medical records.
But his condition continued to deteriorate and just two days later on January 9, he was admitted to hospital where it was discovered that he had also lost 3.5 stone (22 kg) in just four months.
Doctors diagnosed endocarditis, an infection of the heart’s inner lining and valves, requiring surgery and a hospital stay.
It’s usually diagnosed by checking for symptoms such as fever or nodules — small lumps — on your fingers and toes, and a stethoscope check of the heart, which detects unusual sound caused by disturbed blood flow through the heart.
Over the course of nine months, the patient’s health “deteriorated significantly,” leading him to be hospitalized with a heart infection that, if left untreated, could prove life-threatening. But without in-person appointments, vital patient temperature and oxygen checks were not completed by Dr. Williams. Pictured, Chapel Street Surgery in Billericay
If left untreated, endocarditis can lead to life-threatening heart failure. Surgery may be needed to repair heart damage.
In oral testimony given at the tribunal, Dr C, a general practitioner and medical expert working on behalf of the General Medical Council, said: ‘Had patient A been personally assessed (on 14 December) there might have been other symptoms, like a high temperature.’
They added: ‘On January 4, 2021, when his symptoms included loss of appetite and he was significantly worse than before Christmas, he needed to be seen.
“A doctor would need to know the patient’s temperature and whether his oxygen level was low.
“Patient A had unresolved underlying symptoms. Antibiotics had been tried, his symptoms got worse and he had new symptoms and got worse.”
In his defense, Dr. Williams said he was aware that some GP practices did see patients in person in 2020 and early 2021, but did not do so, in part due to construction work limiting available rooms and the need to keep patients isolated.
The number of face-to-face GP appointments in England fell to just 10 per cent during the first wave of the pandemic, as Britons were told to stay home to limit the spread of the virus.
Normally he would have sent patient A to a ‘medical assessment unit’ but it was closed in 2020 due to Covid, Dr Williams also claimed.
However, there was a “Respiratory Red Hub” that he could have referred the patient to, which treats respiratory infections.
Dr. Williams also argued that patient A was “adamant he didn’t want to go to hospital” as he was concerned about caring for his wife who was terrified of Covid.
But IIn their ruling, the Medical Practitioners Tribunal Service concluded that Dr Williams should be suspended.
He repeatedly failed to arrange a personal appointment with Patient A and refer him to the hospital, as it turned out.
The ruling states that ‘it was more likely than not that patient A would have gone to hospital if advised to do so’.
The patient had had surgery in September 2020 for his Covid vaccine, in November for a CT scan at the hospital and in December for blood work and his flu shot, they added.
They also criticized Dr William’s behavior and “contradictory” evidence.
They wrote: ‘While taking responsibility for the very poor administration, he was adamant that nothing more could have been done for Patient A as he was at full capacity and yet refused to go to hospital.
“In the undated document, he incorrectly noted December 13 as the date of the telephone consultation where the hospitalization was first discussed.
“He did not mention in the GP’s notes that patient A was recommended to go to the hospital, nor that patient A refused at any of the consultations.”
The panel also found that Dr. Williams repeatedly failed to record reported weight loss symptoms.
At the week-long hearing, he acknowledged that his notes about the patient’s symptoms were “appalling.”
But the tribunal noted that he did take a record-keeping course, which was recommended as a result of the local investigation in May 2021.
He has also practiced as a general practitioner in the UK since 1993 and no other complaints or referrals have been made against him or his practice.
The Tribunal concluded that there was a low risk of recurrence of the misconduct.
However, they determined that his actions “did not adequately protect patient A” and “public confidence in the profession was undermined by this failure.”
The tribunal said the suspension would send a message to the profession and the general public.