A GP in England who arranged for the blood of five patients to be tested for HIV without their consent was found guilty of serious professional misconduct and severely reprimanded by the General Medical Council last week.
Dr John Nicholls admitted that he was wrong not to seek explicit consent from the patients but said that he believed he was acting in their best interests.
Sir Donald Irvine, chairing the professional conduct committee, told him: “Such a benevolent paternalistic attitude has no place in modern medicine. Patients have certain fundamental rights, including the right to be fully involved in decisions relating to their treatment and care. This includes decisions specifically relating to the testing of samples for HIV infection.”
Dr Nicholls was also found guilty of failing to counsel the five about having the test, and of failing to give adequate counselling to another patient whose consent he had obtained.
In each case, the committee found that there was insufficient clinical indication to justify testing the patients for HIV. One was seeking the emergency contraceptive pill because she had been raped, and the others presented with a range of problems including chronic sinusitis, which failed to respond to antibiotics, concern about failure to gain weight, and oral thrush. All the test results were negative.
Several of the patients told the GMC they were “shocked” to discover from Dr Nicholls's partners in 1997 that blood samples taken from them had been tested for the virus.
The practice came to light while Dr Nicholls was on holiday and another partner at the Tadcaster medical centre in North Yorkshire found the results of the blood test on Ms F, the patient with chronic sinusitis, in his tray. She was called in and asked if she had consented to the test.
The partners consulted the GMC about the rules on consent for HIV testing. They contacted the laboratory where the blood was tested to identify which other patients had been tested for HIV. The patients were called in to be interviewed and counselled, and the partners made a formal complaint to the GMC.
Dr Nicholls is no longer a member of the Tadcaster partnership but has what his solicitor, John Mitchell, described as a “very successful” sole practice in nearby Bramham.
Patients rallied round with testimonials to the GMC. In deciding to limit the penalty to a severe reprimand, the committee took into account Dr Nicholls's “frank admissions” at the outset that he acted wrongly.
“But above all we gave greatest weight to the evidence given by your character witnesses,” said Sir Donald.