Seven doctors accused of failing to monitor health of addicted patients

Seven doctors from a private addiction clinic were accused this week by the General Medical Council of prescribing too many drugs and of failing to adequately monitor their patients' health. Dr Colin Brewer, now retired, and his former colleagues at the Stapleford Centre, based in London and Essex, are also accused of failing to ensure that patients took the drugs themselves, rather than selling them on. In addition, Dr Brewer is accused of seeking to interfere with potential witnesses to the GMC's Professional Conduct Committee. It is alleged that he wrote to Professor John Strang of the National Addiction Centre and Dr Susan Ruben of the Liverpool Drug Dependency Clinic, urging them to withdraw expert reports for the GMC that criticised two other doctors from the Stapleford Centre. The case against the seven began in February, but was immediately adjourned to October because Dr Brewer was ill (BMJ 2004;328:483, 28 Feb). It is now expected to last until January and will probably be the last case to be heard at the GMC's offices in Hallam Street, as the GMC is currently relocating to Regent's Place. Outside the tribunal, demonstrators paraded to protest against Britain's drug addiction policy. NHS clinics generally prescribe low doses of methadone, often only enough for 24 hours, and start reducing the dosage at the outset of treatment. The Stapleford Centre adopted a more liberal approach, allowing patients to decide when they were ready to be weaned off their addiction. Newspapers have billed the case as a decisive showdown between two schools of thought on addiction treatment, but Andrew Collender QC, for the GMC, said that doctors' opinions were not the issue: "This inquiry is not about differences of opinion in the responsible debate about the treatment of drug users. This inquiry is about failure by these doctors to exercise care in certain specific respects." The charges against the seven doctors list 16 patients, several of whom were seen by more than one doctor. Dr Brewer is accused of misconduct in the treatment of 13 patients. The other six doctors are Anthony Haines, Hugh Kindness, Nicolette Mervitz, Martin O'Rawe, Ronald Tovey, and Timothy Willocks. The first day's evidence centred on a patient named only as Mr RF, who first came to the Stapleford Centre in 1990, aged 23. He was prescribed 17 different drugs between 1990 and 2003. Mr RF had an "unremarkable" heroin habit at the outset of treatment, said Mr Collender, "Thirteen years later he was truly remarkable for the number of different drugs he was prescribed." Some of the most serious charges concern a patient named as Mr GS, who died as a result of aspiration of vomit after taking home a "DIY home detox" kit containing 16 different drugs. The GMC accuses Dr Brewer of neglecting to inform the patient's general practitioner of the treatment and failing to adequately monitor his progress and explain the dosages. Several of the Stapleford Centre's patients have offered testimonials praising the doctors' work, and criticising the standard of care offered to drug misusers by the NHS.