Oncologist Administered 'Vetoed' High-risk Treatment, Tribunal Hears

Ian Leonard

September 10, 2021

MANCHESTER—World-renowned oncologist Professor Justin Stebbing administered "high-risk" treatment to two terminally ill cancer patients despite it being vetoed in one patient's case by his supervisors, a medical tribunal heard.

Prof Stebbing, a cancer medicine and oncology professor at Imperial College London with a private practice in Harley Street, is appearing before a Medical Practitioners Tribunal Service (MPTS) fitness to practise hearing.

He's accused of failing to provide good clinical care to 12 patients between March 2014 and March 2017 and faces charges which include the inappropriate treatment of patients given their advanced cancer or poor prognosis, overstating life expectancy and the benefits of chemotherapy, and continuing to treat patients when it was futile.

Prof Justin Stebbing

Patient I

The tribunal heard how Prof Stebbing has admitted inappropriately treating one patient - Patient I - who was prescribed cetuximab in combination with FOLFXOX chemotherapy.

Sharon Beattie, QC for the GMC, said the cetuximab was contraindicated in patients with NRAS mutant colorectal cancer and Prof Stebbing had failed to note - in any records - his "rationale" for prescribing it.

But cancer expert Professor Sikora, who's appearing as a defence witness, disagreed that it was contraindicated but described the treatment as "high-risk".

He claimed the patient was relatively fit and had wanted active treatment when he approached Prof Stebbing and no clinical trials were available.

Prof Sikora said that while cetuximab was less effective in such patients if he'd responded the drug "could have saved his life".

Patient L

He also described Prof Stebbing's treatment of another patient - Patient L - as "high risk".

The patient, from New Zealand, was admitted to the Princess Grace Hospital in March 2017, where he was diagnosed with a small bowel obstruction and then given irinotecan-based chemotherapy.

Prof Stebbing had previously admitted charges of prescribing the treatment when it was contraindicated by the obstruction - as evident on a CT scan - and ignoring conditions that had been placed on his practice by HCA Healthcare.

Those conditions required him to get authorisation from two supervisors before changing a patient's treatment.

But Patient L was given the chemotherapy the day after Prof Stebbing received an email saying his request had been rejected.

One supervisor had also warned Prof Stebbing by phone call the evening before the treatment that it had been vetoed.

Abdication of Duty 

Ms Beattie said if the treatment was "high-risk" that made it all the more important for Prof Stebbing to have "frank" discussions with Patient L about the risks involved.

"So to not have that conversation, I would suggest, was an abdication of his duty," she said.

Prof Sikora said he accepted it was not known whether any conversations had taken place but the patient had wanted treatment and had been "well informed and a master of his own destiny".

He acknowledged that if he'd been faced with the same situation he would have carried out an examination of the patient.

"It wasn't a huge error and it didn't change the course of things," he said.

"It wasn't urgent to see the patient but it should have been done in a timely fashion before any treatment."

More Charges Admitted

Prof Stebbing had denied charges relating to failures to examine the patient on admission to the hospital, to obtain fully informed consent for chemotherapy, to discuss the treatment with the patient and to carry out a clinical review, and to act in accordance with measures put in place to monitor his practice.

But he admitted the allegations following Prof Sikora's evidence, and in total, has now admitted 24 of 36 charges against him.

That includes admissions on all charges relating to five of 12 patients.

Impartiality?

As in previous hearings, Ms Beattie questioned Prof Sikora's impartiality as a witness after rebutting his claims that expert witnesses called by the GMC had changed their opinions about the appropriateness of Prof Stebbing's treatment of three other patients.

She said Prof Sikora had claimed the two experts, Dr Ernie Marshall and Dr Helen Innes, both consultant oncologists at The Clatterbridge Cancer Centre, has "resiled their positions", which simply wasn't the case.

Prof Sikora claimed that he must have made the claim "for a reason", describing discussions with the GMC experts as "difficult".

But Ms Beattie pointed out that the claims - made in supplementary reports by Prof Sikora - weren't even supported by his own original reports, which had been signed by all parties including another expert, Professor Nick Plowman.

She told Prof Sikora: "Much as you claim to be an impartial, independent observer in fact you have involved yourself, firstly, in the process by volunteering your services.

"Secondly, by writing to Dame Clare Marx [former chair of the GMC] and thirdly, sadly, by not being impartial in the evidence you have given.

"I'm afraid I must suggest that to you."

Prof Sikora replied: "You can suggest it but it's not true."

The hearing is continuing.

Prof Sikora comments on cancer issues for Medscape UK.

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

Credits:
Lead Image: MPTS
Image 1: Kerry Elsworth

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