Doctor cleared of failing to tell cancer patient her condition was terminal
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Version 0 of 1. A doctor at the centre of sports doping allegations has been cleared of failing to tell a cancer patient her condition was terminal. Dr Mark Bonar maintained he was fulfilling the woman’s wish to “hold on to as many days as she could in this world” as he administered an unconventional nutritional treatment. A medical tribunal found the doctor gave the treatment when it was dangerous to do so and that the risks associated with it were increased by inadequacies in her care. In March, Bonar, 38, was reported to have claimed he treated more than 150 sports people, including Premier League footballers, with banned substances such as EPO, human growth hormones and steroids. He dismissed the Sunday Times allegations as “false and very misleading”. Since last year he has faced unrelated matters in relation to his care of an American in her 40s at a five-star Mayfair hotel apartment between December 2013 and January 2014. Patient A received total parenteral nutrition (TPN) – a form of intravenous feeding lasting eight hours per day – in a treatment plan drawn up by Bonar. She had earlier travelled to Germany, accompanied by Bonar, to receive TPN from an oncologist, which was said to have improved her quality of life. Following her return to the UK she was admitted to a London hospital in November 2013 with a suspected severe infection. A transfer was later due to take place to a private clinic, but that fell through because of unpaid medical bills and Bonar said he was forced into “a temporary arrangement” of treatment at the apartment. Patient A did not wish to be admitted to an NHS hospital where she was fearful she would contract infections, or be subject to the Liverpool Care Pathway, a medical practitioners tribunal sitting in Manchester heard. Safeguarding concerns were raised after two nurses complained about the woman’s care and admitted her to hospital as an emergency on 16 January. She died two months later, although it was not part of the General Medical Council’s case that Bonar’s treatment shortened her life. The GMC alleged that his treatment made her discomfort “worse rather than better” as she was treated ineffectively in “chaotic conditions”. On Tuesday, the tribunal said it was satisfied there was no option for curative treatment for Patient A’s cancer in the early part of 2013. It added: “All the evidence the tribunal heard demonstrated that Patient A knew that the treatment she was receiving was only palliative. “The tribunal was satisfied that Patient A was fully aware that there was no option for curative treatment and you had no duty to inform her further.” But the tribunal found that he administered TPN when it was dangerous to do so: “The tribunal accepted that the arrangements you made were intended to be temporary, but it must have been clear from the outset that finding alternative facilities in which to treat Patient A was going to be difficult.” It said it was satisfied that risks associated with TPN were increased by inadequate monitoring of her electrolyte levels and inadequate communication between members of the medical team when her sodium level “dropped dangerously” on 16 January. The multidisciplinary team treating Patient A was “inadequately constituted ... with limited experience of TPN administration outside of hospital”, the tribunal said, and disorganisation led to medical notes not being made available to all members of the team. The tribunal also found that Bonar failed to work with colleagues in the patient’s interests when he did not seriously consider the concerns of both nurses. It said his response was “dismissive”, but there was not sufficient evidence to say his conduct “crossed the line into aggression”. Bonar was cleared of administering TPN when it was not clinically indicated and when it was unlikely to improve Patient A’s health. A second doctor who treated Patient A at the apartment, Sussex-based GP Siegfried Trefzer, faced similar misconduct allegations. He too was found to have administered TPN when it was dangerous to do so and without the assistance of a multidisciplinary team or the supervision of an appropriate consultant. The tribunal will next consider whether the doctors’ fitness to practise is impaired because of their misconduct. A range of sanctions could follow, including erasure from the medical register. The tribunal is listed to sit until Friday. |