Veeravalli v General Medical Council [2022] EWHC 747 (Admin) (31 March 2022)
The High Court has upheld a decision by a medical practitioners tribunal to impose a Conditions Order in Veeravalli v General Medical Council.
In this case, the Appellant, Daniel Veeravalli, appealed against the decision of the Medical Practitioners Tribunal (“the Tribunal”), made on 3 September 2021, that his fitness to practise was impaired by misconduct, and that conditions were to be imposed on his registration for a period of 12 months.
The General Medical Council’s (“GMC”) fitness to practice proceedings concerned the Appellant’s management of Patient A whilst she was in labour. Patient A was admitted to the hospital at 06.50 on the morning of 8 March 2017. Labour had begun and she was experiencing strong and regular contractions. By 07.25, she had full cervical dilation.
Patient A’s baby (Patient B) was in the breech position, and so delivery was complex. After counselling, she decided to proceed with a vaginal delivery. Progress in the second stage of labour was slow. Administration of the labour-augmenting drug syntocinon (Oxytocin) commenced at 09.11. Patient B’s left leg delivered spontaneously at 09.43. The delivery was difficult. Patient B was delivered at 10.28, but showed no signs of life and was pronounced dead 30 minutes later.
In July 2018, the Inquest into the death of Patient B recorded that the cause of death was osteo-diastasis of the occipital bone on a background of hypoxia.
The Tribunal found that the Appellant had overall responsibility for Patient A’s care. At a staff handover meeting, he recommended the administration of syntocinon (a drug to augment contractions in labour) in Patient A’s case, without direct clinical review. On later reviewing Patient A, he failed to obtain informed consent for continuation of syntocinon, and failed to identify the suspicious baseline heartrate correctly. He also failed to formulate, and obtain consent for, a safe management plan, in discussion with Patient A and her partner.
It is important to make it clear that the GMC did not allege, and the Tribunal did not find, that the Appellant’s acts or omissions caused Patient B’s death.
Appeal
The Appellant’s pleaded grounds of appeal were as follows:
i) The Tribunal’s findings on the Allegations were wrong and irrational.
ii) The determination on misconduct was wrong because:
a) Prior to completion of the handover, it was not clear that the Appellant was designated as the consultant on call. He did not instruct that syntocinon be administered. He did not see Patient A prior to the administration of syntocinon, and by the time he saw her, he made the reasonable assumption that it had been prescribed and that Patient A had consented.
b) Even on the facts found proved by the Tribunal, the adverse findings were very limited and related to deficiencies in obtaining consent and communication at a single point in time after the administration of syntocinon by another.
c) The Tribunal failed to focus on the facts that it had found proved and relied on the opinion of the expert Dr Rao who had based his conclusions on the gravity of the Appellant’s conduct on shortcomings which the Tribunal had not accepted.
d) The Tribunal failed to apply the law on misconduct properly and/or reached an erroneous conclusion.
e) The determination on impairment was wrong principally for the reasons set out in Grounds 1 and 2.
Mrs Justice Lang, in an extensive consideration of the facts relating to the first ground of appeal, rules that “the Appellant has failed to establish that the Tribunal’s findings of fact were wrong or irrational or unfair.
On the second ground, Lang J ruled that “the Tribunal applied the correct legal tests, and exercised its specialist judgment, in determining whether the Appellant’s conduct amounted to serious misconduct. In my view, its judgment was reasonable, and the Appellant has not succeeded in identifying any error in the Tribunal’s approach.”
Finally, on the 3rd ground, Lang J found that “In my judgment, the Tribunal was entitled to conclude, on the basis of the evidence before them, that the Appellant demonstrated little insight in relation to his personal failings, as opposed to his generic responsibility as the Consultant in charge. Instead, he had reflected on the failings of the system and the failings of his colleagues. The Tribunal expressly took into account the Appellant’s attendance at one webinar entitled ‘Decision making and consent: new guidance from the GMC’. However, it also noted the absence of any acknowledgment of the importance of obtaining informed consent in the Appellant’s Reflections.”
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