Dangerous NHS care "after hours"



A foreign on-call doctor [above], who admitted killing an elderly patient with a morphine overdose on his first ever shift in Britain, has escaped prison because of a legal loophole. German doctor Daniel Ubani, who specialises in anti-ageing medicine and cosmetic surgery, was employed as a locum to provide out of hours care from a base in Suffolk. During his first day's cover in Britain he was called to the Cambridgeshire home of 70-year-old David Gray who was suffering from kidney pains for a routine visit. But instead of administering pethidine - a moderate painkiller - to the patient, Dr Ubani injected him with 10 times the dose of morphine, after confusing the two drugs due to tiredness. Three hours after the consultation, Mr Gray died at his home in Manea.

The death exposes the flaws in the current system of out-of-hours care which is reliant on foreign doctors who are unfamiliar with British practices and have no previous knowledge of their patients. Many foreign doctors travel for hours before starting a shift. But critics believe such a commute could leave medics tired - and put patients' health at risk.

In 2004, about 90 per cent of GP surgeries chose to stop providing night-time and weekend care - so the service is provided by external agencies in most parts of the country. In rural and deprived areas it is particularly hard to find British doctors to do the work, so foreigners increasingly fill the gaps. Nearly half of Britain's surgeries hire overseas doctors. Almost a third of practices in Northumberland, Tyneside and East Anglia employ GPs from overseas.

The NHS watchdog Care Quality Commission has launched an investigation saying: 'This is a deeply disturbing case and one that must be thoroughly looked into.'

As soon as they were informed of the death, Suffolk Doctors On Call, the agency who hired Dr Ubani, dismissed him and he flew back to his clinic in Germany. Detectives from Cambridgeshire Police began an immediate investigation and following post mortem examinations, a forensic pathologist concluded the cause of death was diamorphine poisoning. In March, the Crown Prosecution Service (CPS) issued a European Arrest Warrant to bring Dr Ubani back to the UK with the prospect of charging him with manslaughter.

But two weeks later, British prosecutors were told legal action against the doctor had been started in Germany. To the dismay of his family, he then pleaded guilty to manslaughter in front of a German Court, who sentenced him to a nine-month suspended prison sentence and €5000 (£4,500) fine.

The CPS are now likely to close their case against Dr Ubani, as under the double-jeopardy rule people cannot be prosecuted twice for the same crime unless there are specific exceptions. His son Rory Gray, said: 'We are very disappointed that no-one is going to be held responsible. We wanted him to return to Britain to face justice.'

Mr Gray's partner, Lynda Bubb, who had called the out-of-hours service, said: 'I want no-one else to go through what we have been through. They have to work out a way this does not happen again.' It is believed the family are now considering taking civil action against Dr Ubani.

Writing to the family, Dr Ubani, who has been a GP in Germany for 22 years, blamed his mistake on exhaustion and asked for forgiveness. He said: 'It is with a very heavy heart that I write you this letter to express my deepest sympathy and remorse for the fatal mistake that I made and the circumstances that led to the untimely death of your believed father.' He added: 'There is no amount of remorse, grief or explanation on my part that can satisfy or replace the life your father and head of your family. 'The circumstances arose from the confusion between the drugs pethidine and diamorphine, which was administered in a very high dosage.'

Dr Ubani said he was under 'tremendous stress' before taking over his shift. He flew in from Germany, and then took a car hire drive to Colchester to meet my job agency for instructions. He later drove to Ipswich for coaching, before heading to Newmarket Hospital where he was based. He said: 'My nerves were overstretched, I was too tired and lacked concentration and these factors played a major role in the mistake that occurred.'

Suffolk Doctors On Call, which supplies doctors for Take Care Now, one of the Britain's leading independent healthcare providers, said it has now changed its procedures.

A spokesman for Cambridgeshire Police said: 'A thorough investigation was conducted into this matter in conjunction with the Crown Prosecution Service. 'We had completed the complex process of obtaining arrest warrants for Europe and are disappointed that any subsequent prosecution was not allowed to reach its natural conclusion in this country.'

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Australia: The killer bitch that the NSW ambulance sees no reason to fire

They had good grounds to fire her years ago -- but government employees are a protected class, of course



THE horrendous triple-0 record of the operator who took teenager David Iredale's last harrowing call includes hanging up on a desperate caller and ignoring emergency calls to read novels. The callous attitude of Stacey Dickens is revealed in the triple-0 operator's ambulance service disciplinary records, obtained by The Daily Telegraph.

Five years before she ignored David's pleas for a rescue helicopter and put him on hold while he was lost and dying in the Blue Mountains, Ms Dickens was disciplined for terminating an emergency call. Like David's case, ambulance officers were having difficulty finding Riyadh Alenzi, who had collapsed and stopped breathing while working at the Leppington Pastoral Company on September 10, 2001.

When a colleague called triple-0 to ask when a lost ambulance would arrive at the Bringelly company in Sydney's southwest, Ms Dickens terminated the call and failed to try to call him back despite having the number.

The Daily Telegraph has gained exclusive access to Ms Dickens' disciplinary record, including other incidents in which she was chastised for reading novels while on the job. According to the documents, on some occasions there were triple-0 calls flooding into the Sydney ambulance operations centre while she remained engrossed in her book.

Despite her record and even after admitting at an inquest into David Iredale's death that her mind was not on the job and that she was failing to absorb what the dying teenager was telling her, Ms Dickens is still employed by the NSW Ambulance Service as a triple-0 operator.

In the Leppington Pastoral Company incident, the ambulance arrived 45 minutes after the original call, and Mr Alenzi recovered. A spokesman for Health Minister John Della Bosca refused to weigh into Ms Dickens' position with the ambulance service or whether she had been disciplined.

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