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Decision No: 98/22D
Practitioner: Dr Rita Eileen Middleton
Charge Characteristics: Inadequate care
Breach of Code
Failure to ensure a specimen was examined
Failure to recognise the significance of symptoms
Additional Orders: Doctor denied name suppression:
Order of Tribunal's own motion for a document from the DP:
Judicial Review - Director of Proceedings sought judicial review of the Tribunal's ability to order the production of documents - held s 65(4) of the HDC Act 1994 does not provide outright protection against providing documents - HDC and Anor v MPDT and Anor (High Court, CP 141/98 and CP 177/98, Ellis J, 9 December 1998)
Decision: 9822dfindings
Decision with Reasons: 9822dfindingssuplaw



The Director of Proceedings charged that Dr Middleton's care of her female patient between April 1996 and October 1996 was inadequate in that she:

  1. Failed to appreciate the significance of and act appropriately upon the patient's continued complaint of persistent heavy bleeding.
  2. Failed to adequately explore the patient's past history of iron deficiency, anaemia or to consider the severity of the complaints that the patient was making.
  3. Failed to test the patient's haemoglobin levels on a regular basis.

Such conduct reflecting adversely on Dr Middleton's fitness to practice medicine, being professional misconduct.



The patient had a history of persistent and heavy bleeding. The first consultation Dr Middleton had with the patient took place on 3 November 1995. There were further consultations on 12 December 1995, 16 February 1996, 18 April 1996, 13 May 1996 and 26 June 1996. At a further consultation on 7 October the patient asked Dr Middleton to certify her for receipt of a sickness benefit as she felt her problem of heavy blood loss was causing an inability to work. The patient's perception of Dr Middleton's response to this request was that her problem was more likely depression than menorrhagia. On 12 October the patient fainted in the street. Dr Middleton arranged for her acute admission to hospital. Her Hb level was 64 and she was given 3 units of pack cell blood transfusion. The patient was found to have uterine fibroids with menorrhagia causing severe anaemia.



The Tribunal found Dr Middleton not guilty of professional misconduct.

The Tribunal accepted Dr Middleton's evidence of her awareness of the patient's complaint of heavy bleeding. The Tribunal found that Dr Middleton took steps, at her first consultation with the patient, to assess the patients haemoglobin, iron levels and other symptoms. Dr Middleton obtained the patient's medical record from her previous GP. Those records documented the patient's past history of iron deficiency and anaemia.

Dr Middleton tested the patient's haemoglobin levels on a regular basis; she ordered blood tests on three separate occasions. The Tribunal considered that Dr Middleton might have failed on occasions to communicate adequately with the patient her concern for the patient's condition and what she was doing to try to alleviate it. The Tribunal also noted that given that the patient's problem was of a discreet and personal nature she may have been inhibited when discussing it with Dr Middleton.

The Tribunal found that with the benefit of hindsight Dr Middleton could have been more proactive in her management of the patient's bleeding problems. However, the Tribunal considered the charge that Dr Middleton's care of the patient was inadequate, had not been established.



The Tribunal made the following recommendations:

  • That charges do not contain recitals of breaches of rights under the Code.
  • That charges should be framed in accordance with either sub-section (1)(a), (b) or (c) of section 109.

The Tribunal also commented on the non-compliance of an order by the Director of Proceedings. The Tribunal also considered it was inappropriate for some of the documents from the file of the HDC to be placed before the Tribunal.