Doctor Discharged A&E Patient 2 Days Before Her Death, Hearing Told

Ian Leonard

May 12, 2021

Editor's note, 13 May 2021: This article was updated with additional information.

A doctor wrongly discharged an A&E patient who'd complained of severe stomach pain and died just 2 days later, a medical tribunal heard.

Dr Kamal Abusin - a surgeon previously at the centre of a separate case where a man received a £6.7m payout after almost dying during an operation - is accused of failing to provide good clinical care to the patient.

He discharged the woman - known as Patient C - believing she had gastritis but it was later found she had an ischaemic small bowel.

A Medical Practitioners Tribunal Service (MPTS) fitness to practise hearing heard how the woman arrived at Rotherham General Hospital's A&E department on the evening of October 7, 2016.

Chloe Fairley, for the General Medical Council (GMC), said the patient had experienced "severe stomach pains" and was examined by Dr Abusin early the following day.

Dr Abusin, who has worked for locum agencies and trusts across the UK, discharged the woman around 2 hours later and told her to keep taking her gastro medication, Ms Fairley said.

Discharged While in Pain

Giving evidence, the patient's daughter said her mother had been "screaming in pain" and had needed a wheelchair when she was discharged.

Ms Fairley said Patient C had gone home with her daughter only for them to return later to the hospital's A&E unit.

The woman underwent a laparotomy and was found to have an "incurable" ischaemic small bowel and died on October 10, 2016.

Dr Abusin has admitted several charges, including a failure to evaluate the patient's symptoms, a failure to undertake appropriate investigations and failing to admit the patient.

But he denies failing to reassess the patient's symptoms and vital signs and not giving her "safety netting" advice.

His QC Mary O'Rourke claimed he'd told the patient to return to hospital or contact her GP if her pain continued.

She also said Patient C had spent longer with Dr Abusin than her daughter claimed and had needed a wheelchair because she was "drowsy" and "unsteady" after being given morphine.

But Dr Abusin failed to make contemporaneous notes about the patient and has admitted making retrospective entries that were incomplete.

Observations

Expert witness Stephen Hearns, a consultant in emergency medicine based at the Alexandra Hospital in Paisley and lead consultant for Emergency Medical Retrieval Service (EMRS), said the patient had a history of kidney stones and he would have expected Dr Abusin to carry out a more thorough assessment of her condition.

He said a diagnosis of gastritis didn't "fit in with the clinical picture" and it was "concerning" that the patient's vital signs were not monitored in the hours prior to her discharge.

Ms O'Rourke argued that Mr Hearns had set the "bar too high" in deciding whether Dr Abusin's standards fell below those expected of a middle-grade doctor.

And she disputed Mr Hearns claim that there were no regular observations of the patient and the "onus" was on the doctor to ensure they were done.

She claimed a nurse had "primary responsibility" and she'd failed to make notes in the patient's records.

Ms O'Rourke added that Dr Abusin disputed many of the facts, so it was necessary to hear his evidence.

Allegations of Inaccurate CVs

Dr Abusin is also facing allegations of falsifying CVs that were submitted to four locum agencies and one trust.

Ms Fairley said the CVs were "misleading" and "dishonest" because they claimed he'd worked in the UK between August 2008 and December 2009 when a statement he provided to a 2011 medical tribunal said he was out of the country during that time.

He's admitted sending CVs to two locum agencies that contained inaccurate information about his employment at Ipswich Hospital.

Patient Records Removed

Dr Abusin admits 18 of the 28 charges against him, which also include removing patient material and breaching conditions of his registration, imposed at a tribunal in July 2017, which required him to notify the GMC about new posts.

He removed confidential records relating to 25 patients, including operation lists, correspondence and photos, from Portsmouth Hospital Trust premises between May 2000 and July 2008.

On other occasions he removed patient records in breach of policies and guidelines while working for Lewisham and Greenwich NHS Trust, Pennine Acute Hospitals NHS Trust, Furness Hospital and Dartford and Gravesham NHS Trust between June 2011 and October 2015.

He also inappropriately stored patient information on his personal mobile while working for the Chelsea and Westminster Foundation Trust.

Previous Damages

Dr Abusin previously appeared at a medical tribunal in October 2011 after a patient nearly died during an operation to donate a kidney to his father.

The 39-year-old man suffered a heart-attack, irreversible kidney failure and needed 100 units of blood and fluids as a result of the operation at Portsmouth's Queen Alexandra Hospital in February 2008.

He then spent 2 months in hospital recovering, a year on dialysis and needed his own kidney transplant from his sister.

The man was awarded £6.7m damages by a High Court in 2011 after Portsmouth Hospitals NHS Trust admitted liability on the basis that the operation was performed "not only negligently but to a degree recklessly," a judge said.

The damages were so high to reflect the man's future loss of earnings after he'd set up his own pharmaceutical market research agency.

His lawyers also argued that his life expectancy had been shortened by about 10 years, with the payout including the costs of private treatment for the rest of his life.

Dr Abusin's fitness to practise was found not impaired by the tribunal panel so he received no sanction, although a GMC prosecutor had wanted him to be given a warning.

But the panel ruled his actions did not warrant a warning, saying it could have affected his future employment prospects.

It found that Dr Abusin had not been negligent in opting to remove the kidney in the way he chose or for his treatment of the patient's haemorrhage.

But it found he'd failed to discuss the increased risks of the procedure with the patient and not kept proper medical notes.

The hearing is continuing.

Ian Leonard is a freelance journalist experienced in covering MPTS hearings.

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