Part 11 - Complaint about Dr Mrozinski, a locum GP
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Complaint that a GP unreasonably prescribed amoxicillin to a patient recorded as being allergic to penicillin, and mishandled the patient’s subsequent complaint
Background to the complaint
Mrs K’s history of penicillin allergy, based on her account of a previous reaction, was marked on her medical summary card, on her Lloyd George (paper) folder and on her computer records.
On 3 June 2004, shortly before her honeymoon in Mexico, Mrs K had an appointment for vaccinations at the surgery. The Nurse was concerned about vaccinating Mrs K, who was congested, and arranged for her to see Dr Mrozinski. By Mrs K’s account Dr Mrozinski asked her if she was allergic to antibiotics, to which she replied: not that she was aware of. (Mrs K was aware of her penicillin allergy but did not associate antibiotics with penicillin.) Dr Mrozinski prescribed a five-day course of amoxicillin, an antibiotic of the penicillin family.
Mrs K flew to Mexico on 9 June 2004. The next day a rash appeared on her back and arms. Her body became red, swollen and hard to the touch, covered in lumps and blisters. She assumed she had been prescribed penicillin. Mrs K spent the last days of her holiday in her hotel room, and she described the flight home as ‘painful and frightening’. She immediately saw her regular GP, who told her that Dr Mrozinski had written on her notes that he had asked her if she was allergic to penicillin, to which she had answered that she was not. Mrs K disputed that account of the consultation.
The complaint to Trafford North/South Primary Care Trust (the Trust) and the Healthcare Commission (the Commission)
On 28 June 2004 Mrs K complained to the Trust, asking for an apology and compensation for her ruined honeymoon and the distress Dr Mrozinski had caused her. After Dr Mrozinski failed to attend a local resolution meeting arranged by Mrs K’s GP, she told the Trust that she wanted a full written response to her complaint from Dr Mrozinski. His eventual reply did not provide an account of his actions nor explain why he had prescribed antibiotics. He said that if Mrs K was questioning his clinical competence or claiming gross professional misconduct she should contact the General Medical Council (GMC). If she was claiming medical negligence she should expect a possible counterclaim. The Trust made several attempts to engage Dr Mrozinski in the complaints process, and reminded him of his responsibilities under the GMC guidance and NHS Complaints Procedure. When no substantive response was forthcoming, Mrs K took her complaint to the Commission, which began an investigation.
The Case Manager visited the surgery, where Mrs K’s GP demonstrated the warning notice displayed on the computer when an attempt was made to prescribe a drug to a patient with a recorded sensitivity or allergy. It was noted that the warning could be manually overridden. The GP pointed out Dr Mrozinski’s computer entry, prescribing amoxicillin for Mrs K. The Commission wrote to Dr Mrozinski three times asking for a response to Mrs K’s complaint, but received no reply. With Mrs K’s agreement the Commission referred her complaint direct to the Ombudsman in April 2005, as we have powers to obtain evidence from witnesses.
What we investigated
We investigated whether Dr Mrozinski had unreasonably prescribed amoxicillin to Mrs K and whether he had appropriately handled her complaint about that. We took account of the GMC’s 2001 publication, ‘Good Medical Practice’, which stated that clinicians must explain fully and promptly what has happened if harm has been suffered. It also stated they should appropriately apologise and that patients who complain about care or treatment they have received have a right to a prompt, open, constructive and honest response. We also bore in mind the NHS Executive’s Guidance on the NHS Complaints Procedure for General Practices which reminds GPs of the need to ‘listen carefully and understand the person’s perspective – empathise’.
What our investigation found
We concluded, on the basis of clinical advice from the Ombudsman’s GP Adviser, that it was not certain that amoxicillin was the cause of Mrs K becoming unwell: although Mrs K was not aware of it, she had twice been prescribed penicillin (in 1994) with no ill effect.
Mrs K’s penicillin allergy was clearly recorded; although Dr Mrozinski did not totally disregard the need to check if she was allergic before writing a prescription, he should not have disregarded the allergy warnings, or overridden a computer alert, without discussion with her. He should also have recorded that Mrs K’s understanding that she was not allergic to antibiotics was inconsistent with her medical records. There was conflicting evidence about what Dr Mrozinski had asked Mrs K during the consultation, which could not be resolved.
Dr Mrozinski’s initial response to Mrs K’s complaint was unhelpful, negative and belligerent in tone, and his threat of a counterclaim did not comply with NHS complaints regulations and GMC guidance. It was only after we contacted Dr Mrozinski about Mrs K’s complaint, that he provided a response to the substance of it, but there was no explanation of why he had not provided an earlier explanation and no apology. Dr Mrozinski’s refusal before then to explain his actions showed a blatant disregard of GMC guidance and the NHS Complaints Procedure.
We concluded our investigation in September 2006 and upheld Mrs K’s complaints. Although it was not clear that she had suffered as a result of Dr Mrozinski’s prescription, he should not have prescribed antibiotics without further discussion, and should have told her that it was recorded that she was allergic to penicillin. Dr Mrozinski’s handling of Mrs K’s complaint was totally unacceptable; his repeated refusal to respond to the substance of her complaint put her to unnecessary time and trouble, and added to her distress.
Outcome
We recommended that Dr Mrozinski send Mrs K a written apology and pay her £250 compensation for the unnecessary distress he had caused her. He refused to do so and wrongly questioned the Ombudsman’s authority to investigate clinical matters. At our suggestion, the Trust made the payment to Mrs K themselves, on the basis that ‘the patient is more important than the principle’.
