Tobacco Documents Online

News Consultant suspended for not ge ag consent for cardiac procedure Clare Dyer, ltgal correspcmden~ BMJ A consultant at Great Ormond Street children's hospital Lon- don, was suspended f~om the medical register for six months last week for carrying out a car- disc procedure on a 6 year old girl without her parents' consent. James Taylor, a paediatric cardiologist, was found guilty of serious professional misconduct by the General Medical Council for performing a balloon dilata- tion catheterisation on Debbie Jenkins, who died the following day. Her parents, Ross and Carolyn, had consented only to a diagnostic catheteri~don. The Jenkinses gave evidence that they had spedfically stated they did not want Debbie. who had previously had two open heart operations, to undergo balloon catheterisadon because they regarded it as risky. An allegation that Dr Taylor was aware that the Jenkinses did not want that particular proceo dure to be undertaken was found unproved, but the GMC found that he had informed Mrs Jenk- ins the previous day that he would not use a balloon catheter. Dr Taylor admitted performing the balloon catheterisation with- out consent but argued that he had sui~ient medical ground~ to proceed without consent. He told the professional con- duct committee that he had tried without success to find Mrs Jenk- ira, who was waiting at the hospi- tal after discovering a deformed stent and deciding to correct it by the balloon procedure. The bal- loon bu~t and attempts to relieve it failed. The remains of the balloon caused a blockage, cutting off the blood flow to the brain. Dr Taylor told the commit- tee that he thought he was justi- fled in Debbie's best interests in carrying out the procedure with- out specific consent. Two other comultants gave evidence on Dr Taylor's behalf that they would have done the same, though one said that he would have consulted with col- leagues fi~t. Yet the law is dear that treatment can be given with- out consent in the patent's best interests only in the case of "necessity"-where there is an emergency or (if the padent is an adult) where the padent is incom- petent to consent. Sir Herbert Duthie, chairman of the committee, told Dr Taylor. "Consent to treatment is an essential part of the contract of trust between padents and doc- tor. Doctors must do their best to explain to patients the treatments which are proposed and to obtain their patients' consent. Where, subsequently, further procedures are considered neces- sary, the doctor mnst seek addi- tional consent." There were exceptional drcumstances of the kind which would have justified proceeding without [Debbie's] Dr Taylor's solldtor, Alison Troake, said that hi~ lawyers were considering an appeal Great Ormond Street hospital has made a number ofchange~ to try to prevent a recurrence, includ- ing a revised consent form with a new secdon to record a parent's specific objection to any proee- dure; internal telephones in walto ing and smoking areas; and me~age pagers for parents to use during procedures or operations. Robert Creighton, chief exec- utive of the hospital, said: "I would be disu'essed if people felt the hospital had been less than supportive to dds particular fami- ly. The idea they've been left Dr Taylor acted without consent stranded and unsupported is, in my view, erroneous." Repl,ving to Mr Creighton's suggestion on BBC's N/nt O'Clock News that the case could lead to doctor~ practis- ing more conservative medicine, the family's solidtor, Graham Pearl said: 'q"he only issue is that this doctor went ahead knowing he didn't have consent when it wasn't an emergency." (See p 949 and www.bmj.com) E] MMR vaccine policy is backed Hllary Bower, Lond~ An expert group has backed vaccination with the combined measles, mumps, and rubella (MMR) vaccine after a day long examination of controversial evidence claiming that vaccina- tion is linked with bowel disease and autism. Proibssor John Pattison. chairman of the expert group, said: "There is ao evidence what- soever that would lead anyone to suggest a change in the current vaccination policy in the The 37 strong group con- vened by the Medical Research Council last week, said that there was no evidence of a causal role for MMR vaccination in autism. The link postulated bv researchers from the Royal Free Hospital (7 March, p 724) could be a coincidence as the first symptoms of autism and MMR vaccination both generally occur in the second year of life, the group said. The group a/so found that available e~'idence did not sup- port a causal role for persistent measles ~us in Crohn's disease. "Using the most sensitive molecu- lar techniques, all groups failed to detect measles virus in bowel tis- sue of padents with Crohn's dis- ease and did not confirm earlier work using less sensitive electron microscopy and antibody tech- niques," said Professor Pattison. Any further work in this area must involve independent labo- ratories using a full controls and agreed ~perimemal protocols, the group added. Chief medical officer Dr Kenneth Caiman reiterated that parents should continue to immunise their children with the triple vaccine and dismissed calls to administer the vaccines sepa- rately. "There is no evidence that giving the component vaccines separately has any benefit. It may even be more ha_mfful because it would expose chil- dren and their contacts to these serious diseases over a much longer period," he said. In a press statement the researchers at the Royal Free Hospital agreed that vaccine pol- icy should not be altered but said they would continue to invest- gate the "very, rare" association. Professor George Radda, chief executive of the MRC. said that the council would consider set- ring up an expert steering .group to monitor further research. Z BMJ" VOLL'ME 316 28 MARCH 1998 955