![]() |
[Home] [Databases] [World Law] [Multidatabase Search] [Help] [Feedback] [DONATE] | |||||||||
The Judicial Committee of the Privy Council Decisions |
||||||||||
|
THE FUTURE OF BAILII DEPENDS ON USERS LIKE YOU
If you want to be able to use BAILII in the future, please consider making a donation to celebrate BAILII's 25 years of providing free access to law.
Your donation, no matter the size, will help BAILII maintain the legal databases that you and many other users rely on. If every visitor this month gives just £5, it will have a significant impact on BAILII's ability to continue providing this vital service.
| ||||||||||
|
You are here: BAILII >> Databases >> The Judicial Committee of the Privy Council Decisions >> Bijl v. General Medical Council (GMC) [2001] UKPC 41 (2 October 2001) URL: https://www.bailii.org/uk/cases/UKPC/2001/42.html Cite as: [2001] UKPC 41 |
||||||||||
[New search]
[Context
]
[View without highlighting]
[Printable RTF version]
[Help]
Bijl
v.
General
Medical
Council
(GMC) [
2001]
UKPC 41 (2 October
2001)
PrivyCouncil
Appeal No. 78 of 2000
Mr. WillemBijl
Appellant
v.
TheGeneral
![]()
Medical
![]()
Council
Respondent
FROM
THE PROFESSIONAL CONDUCT COMMITTEE
OF THEGENERAL
![]()
MEDICAL
![]()
COUNCIL
JUDGMENT OF THE LORDS OF THE JUDICIAL
COMMITTEE OF THE PRIVYCOUNCIL,
Delivered the 2nd October2001
------------------
Present at the hearing:-
Lord Hoffmann
Lord Mackay of Clashfern
Lord Clyde
[Delivered by Lord Hoffmann]
------------------
General
Medical
Council
to direct that the name of the appellant Willem
Bijl
be erased from the register. The direction followed a finding on the previous day, from which there is no appeal, that he had been guilty of serious professional misconduct.
Medical
Act 1983 to entertain an appeal by way of rehearing from such a direction, it has traditionally and rightly exercised that jurisdiction with circumspection. As the Board said in Evans
v
General
Medical
Council
(unreported) Appeal No 40 of 1984 at p. 3:
"… a disciplinary committee are the best possible people for weighing the seriousness of professional misconduct and … the Board will bevery
slow to interfere with the exercise of discretion of such a committee … The Committee are familiar with the whole gradation of seriousness of the cases of
various
types which come before them and are peculiarly well qualified to say at what point on that gradation erasure becomes the appropriate sentence. This Board does not have that advantage nor can it have the same capacity for judging what measures are from time to time required for the purpose of maintaining professional standards."
validity
of these remarks which are not based upon any principle restrictive of the appellate powers of the Board but on obvious common sense. European jurisprudence on human rights does not suggest that they are incompatible with the right to a hearing by an independent and impartial tribunal in accordance with Article 6(1) of the Convention: see Wickramsinghe
v
United Kingdom (Application No 31503/96 9 December 1997) (unreported) and Stefan
v
United Kingdom (App. No 29419/95 9 December 1997) EHRR Commission Supplement CD 130.
Bijl
was a consultant urologist at Basildon Hospital. On 2 July 1996 he carried out a "keyhole" operation upon Mrs Mary Love to break down and remove a large staghorn stone which was lodged in her left kidney. Mrs Love was 61 and suffered from a
variety
of ailments including urinary tract infections, diabetes, chronic ischaemic heart disease, left
ventricular
failure, hypertension and obesity. She had had a hysterectomy and a triple by-pass. The consultant anaesthetist in attendance, Dr Simon Thomson, assessed the level of risk she posed in anaesthetic terms on a scale from 1 (fit) to 5 (moribund) as 3 (severe chronic disease which is not immediately life-threatening).
general
anaesthetic. Dr Chan, consultant radiologist in attendance, created a track though which Mr
Bijl
could have access to the kidney stone. He punctured the kidney with a needle down which he passed a guide wire which in turn enabled a sheath to be passed into the kidney. The purpose of the sheath is to control bleeding from the kidney tissue and to enable a nephroscope (a kidney telescope) to be passed into the kidney, so that Mr
Bijl
could see and attack the stone. These preliminary works took some time because the guide wire kinked. It was 4.00 pm before Dr Chan satisfied himself that Mr
Bijl
had a clear
vision
of the stone and left the theatre.
Bijl
was looking through his telescope trying to see the stone while Nurse Tannock kept the operation area free of blood clots by continuous irrigation with saline fluid. He was using a lithotripsy (a probe which emits short bursts of energy) to break the stone into pieces which could be removed with forceps. His note described progress as tedious.
visibly
draining through a tube into a large pouch at the operating table. At 5.15 pm Dr Thomson was concerned about the amount of blood loss and measured the haemoglobin level. It had fallen from 12.9 before the operation to 7.1. There was a
general
discussion about the significance of this measurement, which appeared to indicate a considerable loss of blood. Dr Thomson gave the patient a transfusion of two units. At 5.45 pm there was an episode of hypotension (drop in blood pressure) which Dr Thomson was able to correct and stabilise by reducing the intravenous supply of isoflurane and introducing some gelofusine. He told Mr
Bijl,
who was still having trouble in locating and breaking up the stone, that unless he was making better progress he should consider abandoning the operation in half an hour.
Bijl
said that he was making good progress. Parts of the stone were breaking up and could be removed. The operation continued for another half an hour. At 6.45 pm there was another episode of hypotension and Dr Thomson said that he thought they should stop. Mr
Bijl
stopped and a Wallace drain was inserted. The
visible
rate of blood flow into the collection bag was substantial. More blood arrived for transfusion. Dr Thomson gave the patient another four units and arranged for her to be transferred to the Intensive Treatment Unit.
Bijl
changed, wrote up his notes and returned to the theatre to say that he was going home. Dr Thomson, surprised, said "She is not out of the woods yet, she's bleeding and has a low blood pressure". Mr
Bijl,
not taking or understanding the hint, said that he would be available on the telephone if required. He thanked the team and left.
virtually
no pulse. Her life was in danger. Dr Thomson rang Mr
Bijl's
number but he was still in his car on the way home. He called another surgeon, Mr Osborne, who carried out an emergency operation to clamp the site of the bleeding in the kidney. This stabilised her condition but she died two days later. The pathologist who carried out the autopsy identified the cause of death as hypovolaemic shock following the operation. It should be said that there is no suggestion that the outcome would have been different if Mr
Bijl
had stayed and performed the emergency operation himself.
Bijl
were twofold: first, that despite obvious indications of substantial loss of blood he had carried on the operation for far too long and, secondly, that after completing the operation, he abandoned the patient when her condition was still serious. The length of the operation was the product of a largely unstated consensus between surgeon and anaesthetist, although both were criticised by the expert witnesses for failing to engage in any kind of discussion. But the Committee was obviously most concerned about the second charge, which they described as "seriously irresponsible and a grave neglect of proper professional standards". They also spoke of Mr
Bijl's
"continuing lack of insight", by which their Lordships think they meant that his explanations for what happened that afternoon suggested an unduly rigid
view
of the demarcation of responsibilities between the surgeon and the other members of the operating team. Some of Mr
Bijl's
answers gave the impression that he considered that his duty was to look through the telescope and demolish the stone while the anaesthetist's duty was to keep the patient alive. This was consistent with what appeared to have been an almost total absence of communication between Mr
Bijl
and the rest of the team about the patient's condition during the operation.
Bijl
himself said in evidence that his decision to leave the hospital was certainly a mistake which he would never make again.
medical
profession and the National Health Service:
"The Government, themedical
profession and the NHS pledge … without lessening commitment to safety and public accountability of services, to recognise that honest failure should not be responded to primarily by blame and retribution but by learning and by a drive to reduce risks for future patients."
views
for those of the Committee on the appropriate penalty. In the present case since Mr
Bijl
is aged 56 erasure means the end of his
medical
career. The Committee have not expressly said why this, the maximum sentence available, was necessary in this case. So far as they clearly thought this was a serious lapse which they describe as the appellant abandoning his patient when her condition was still serious, their Lordships entirely agree. However the appellant accepted that his decision to leave the hospital was certainly a mistake, but as already mentioned, he clearly determined never to make that mistake again. Their Lordships note that there was a period of over four years between the operation and the Committee's decision when these serious charges were outstanding. During that time Mr
Bijl
did succeed in obtaining employment as a locum consultant urologist in other hospitals, without so far as appears any complaint about the standard of his work. While giving great weight to the judgment of the Committee their Lordships feel difficulty in the light of these circumstances in being satisfied that erasure involving a complete cessation of Mr
Bijl's
medical
work was necessary when suspension with the possibility of imposing detailed conditions on his carrying on practice is available. The two charges of which Mr
Bijl
was convicted arose out of one operation, at the later part of a career of service in Holland, Nigeria and the United Kingdom. Both involved serious errors of judgment but neither involved any allegation against his practical skills as a doctor such as might be difficult to improve at a late stage of a career. Mr
Bijl
has had a serious lesson which on the evidence available should prevent a repetition of these errors of judgment, were he to be allowed to practise in the future, particularly if he does so under conditions intended to avoid such repetition. Their Lordships' duty in the exercise of their responsibility in this
very
unusual case, when they cannot be satisfied that erasure was necessary, after giving full weight to the
view
of the Committee, is to act on their own
view.
Medical Act 1983. There will be no order as to the costs of the appeal.