A psychiatrist specialising in the treatment of drug misusers who was struck off by the General Medical Council for leaving blank prescriptions for a nurse and failing to supervise addiction clinics properly has had his erasure from the medical register quashed on appeal. The judicial committee of the Privy Council last week ruled that the GMC's decision to strike Enrique Mateu-Lopez off the register in November 2002 was "excessive and disproportionate." The three judges—Lord Hutton, Sir Anthony Evans, and Sir Philip Otton—concluded that "in all the circumstances of the case the appellant's erasure was neither necessary for the protection of the public nor for the maintenance of public confidence in the profession." Giving judgment, Sir Philip said it was evident that Dr Mateu had been placed under considerable pressures and had asked for help. "It was not forthcoming, and he had pressed on as best he could." Dr Mateu qualified in Spain in 1961 and trained as a psychiatrist in England. He was appointed consultant psychiatrist at St George's Hospital, Stafford, in 1972 and was put in charge of the hospital's addiction unit in 1989. He was running addiction clinics at St George's and associated clinics elsewhere from 1998 to 2000 when, according to the GMC charges, he failed to adequately supervise the running of the clinics, delegated responsibility to nursing staff for the issue of prescriptions for controlled drugs, and failed to ensure that patients were adequately medically examined or assessed before prescriptions were issued. He admitted all the charges. Sir Philip said Michael Jones, a nurse with 30 years experience, had given "an illuminating insight" into the working of the unit. Mr Jones, with whom Dr Mateu left blank prescriptions when he was away, told the GMC that the work was stressful and very demanding, with budget linked targets to be met. He described the practice as "crisis management." Representations made to the authorities had little effect, he said. Dr Mateu was a workaholic who had "pushed himself to the limit." An inquiry by the former medical director of the trust found that there was no indication that any patient had come to actual harm. Dr Mateu explained that if he had not left blank, signed prescription forms when he went away clinics would have had to be cancelled. Existing patients receiving methadone treatment would have reverted to illegal street heroin, and new patients would have been denied the opportunity to stop taking heroin. Sir Philip said that although a finding of serious professional misconduct was inevitable "it was not inevitable that the ultimate sanction of erasure had to be invoked." The judge took into account that if the sanction stood Dr Mateu, who had had "an unblemished career," would be leaving the profession at the age of 66 with the "opprobrium of erasure." He added: "All the testimonial evidence—and, indeed, the testimony of the witnesses—indicated that the appellant had been throughout his career a dedicated doctor who was trying to do the best he could in difficult circumstances."