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GMC confirms that incorrect use of DNRs can amount to impaired fitness to practise

Doctors should consult with patients and their families before imposing DNR orders

Photo of doctor: istock

16 July 2012

The General Medical Council has ruled that the failure by a doctor to consult a patient and their family before imposing a Do Not Resuscitate Order (DNR), a failure to record clear reasons for a DNR and an inappropriate use of DNR are all reasons  “capable of amounting to impaired fitness to practise”.

The decision follows the case of Barbara Evans who died in December 2007 at the age of 84. Following her death, her daughter, Caroline Feeman, obtained copies of her medical records and was shocked to find that whilst a patient at St James’s Hospital in Leeds, her mother had been designated DNR in July 2006.

Mrs Evans’ medical notes recorded that she was “improving clinically” and was “clinically well in herself”, yet despite this the notes also recorded that unknown to her, or her family, her treating doctor had decided that should she suffer a cardio or respiratory arrest, she would not be resuscitated.

Fortunately, Mrs Evans did not require resuscitation and was shortly afterwards discharged home. A couple of months later, in September 2007, she returned to hospital and again was designated DNR without her consent or knowledge. The medical notes recorded the decision as “doing well. Home Saturday. Not for resus.”

Had Barbara required resuscitation in either July or September 2006, it would have been withheld. Mrs Evans went on to resume an active and enjoyable life, including travelling to the USA to visit her great grandson.
Some 18 months later in December 2007, Barbara was hospitalised again, this time under the care of a different doctor. She suffered a cardiac arrest, was successfully resuscitated and spent the following two weeks enjoying precious time with her family before she passed away.

Mrs Feeman made a complaint to the General Medical Council about the doctor who authorised the two DNRs without consent and in circumstances where they seemed inappropriate.

The General Medical Council initially refused to consider the initial complaint and she contacted law firm Leigh Day & Co to persuade the General Medical Council to reconsider.

In June 2012 the GMC finally announced that a failure by doctors to consult a patient and their family before imposing a DNR, a failure to record clear reasons for a DNR and an inappropriate use of DNR was “capable of amounting to impaired fitness to practise”.

However they declined to investigate Mrs Evans’ case further on the grounds of passage of time and the fact that the relevant Trust had already been criticised by the Care Quality Commission and required to provide further staff training on DNRs.

Merry Varney, from Leigh Day & Co who is representing Mrs Feeman said:

“We have been contacted by many people, including Mrs Feeman, who are concerned by the use of DNRs on elderly or disabled patients simply on the basis of their age or disability. Although this doctor will not face a GMC investigation, it is encouraging to have confirmation from the regulatory body that improper use of DNRs, including failing to speak to patients and families and imposing DNRs without adequate clinical reasons which are recorded in the notes, can lead to sanctions being imposed on their ability to practise.”

Caroline Feeman said:

"I felt that my mother was betrayed by those whom she trusted with her health during the hospitalizations in question.

"I was astounded that my mother could be made DNR without consultation with either her or her family.  I remain concerned that the arbitrary nature of the DNR orders could result in the refusal of treatment of patients whose lives could significantly benefit from resuscitation.

"I hope that others will use elements from my mother's case to continue the pressure against the arbitrary imposition of DNR without consultation."

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