|Practitioner:||Mr Gornorri Rama Krishnayya|
|Charge Characteristics:|| Inadequate
Failure to recognise significance of symptoms
The Director of Proceedings charged that Mr Krishnayya was guilty of professional misconduct in that between 12 December 1996 and 1 January 1997 Mr Krishnayya:
The particulars are amended after the Director of Proceedings withdrew two particulars in her closing submissions.
The charge arose out of Mr Krishnayya’s care and treatment of a patient following abdominal surgery on 12 December 1996. The patient was discharged from hospital on 14 December 1996. She described the wound as becoming painful. Pus pockets appeared on the outside of the wound and it leaked an unpleasant substance. Mr Krishnayya prescribed an antibiotic. His evidence was that this was a prophylactic prescription, rather than a prescription for wound infection. He did not record the prescription in the patient's notes. At about Christmas 1996 the patient experienced leg pain (there was some confusion as to which leg or where on her leg). She alleged that Mr Krishnayya did not examine her leg at all and that he told her it was just her body settling down after surgery.
In the early hours of 1 January 1997 the patient experienced severe chest pain. She telephoned Mr Krishnayya the next morning but was unable to contact him until 10.30am. Mr Krishnayya subsequently examined her at Parkside Hospital and arranged for her to be admitted to Napier Hospital. In Napier Hospital the patient was diagnosed as suffering from a deep vein thrombosis, although no diagnostic tests to confirm this diagnosis were undertaken at the time as it was a public holiday and no staff or facilities were available. A V/Q scan on 3 January 1997 was normal. There was no evidence of a venogram or Doppler ultrasound being carried out at Napier Hospital at any time. All investigations carried out on admission showed results within the normal range. The patient was discharged on 12 January 1997 and was prescribed the anticoagulant Warfarin for three months.
The Tribunal found Mr Krishnayya was not guilty of professional misconduct.
Mr Krishnayya simply recorded 'checked' in the patient's records kept in relation to her post-operative visits. The Tribunal's view, when considering particular (a), was that the record "checked" whilst brief, made by an experienced specialist practitioner in the context of his usual practice giving routine post-operative care, conveyed all of the information he might need for future reference. However, the Tribunal stated, the adequacy of medical notes will be increasingly defined in terms of their effectiveness in managing risk, including the risk of complaint and a clear contemporaneous record enables a doctor to give evidence refreshed and corroborated by the written record. The Tribunal was satisfied that Mr Krishnayya's record of his patient's care was not out of keeping with the norm. The Tribunal accepted Mr Krishnayya's concession that the antibiotic prescription should have been recorded but did not find this omission to be a culpable oversight, particularly as the information was included in his letter referring the patient to Napier Hospital when it mattered.
When considering particular (b), the Tribunal accepted the possibility of miscommunication between Mr Krishnayya and his patient. The Tribunal found it relevant that Mr Krishnayya arranged and attended eight post-operative consultations with the patient and personally attended to the dressing of her wound. The Tribunal held that this care could not be characterised as casual.
The Tribunal found the expert evidence established (and Mr Krishnayya accepted) that if the patient had complained of leg pain then Mr Krishnayya should have followed it up and carried out the proper investigations. However, the evidence given to the Tribunal on this point was confused and uncertain. The Tribunal found particular (c) was not established.
The Tribunal determined that none of the particulars supporting the charge were proven.