A foreign out-of-hours doctor who killed a pensioner with a painkiller overdose on his first and only shift in Britain was struck off the medical register today.
Nigerian-born Dr Daniel Ubani flew into the UK from Germany and injected David Gray, 70, with 100mg of a pain relief drug - 10 times the recommended dosage.
Mr Gray, who was suffering from kidney stones, died at his home in Manea, Cambridgeshire, a few hours after he was given the massive overdose of diamorphine on February 16 2008.
A General Medical Council Fitness to Practise Panel concluded it had "grave concerns" about Dr Ubani's clinical competence in his treatment of three patients on that date and warned there was a risk of him repeating his errors.
Today, the panel ruled that a period of suspension was not sufficient in the case.
Panel chairman Dr Brian Alderman said: "In all the circumstances, the panel is satisfied that erasure is the only means of protecting patients and maintaining public confidence in the profession."
Dr Ubani, 67, a specialist in cosmetic medicine based in Witten, Germany, admitted causing the pensioner's death after confusing the morphine with another drug.
He was given a nine-month suspended sentence in Germany for death by negligence but still works as a doctor in that country, the GMC panel heard.
The doctor - who did not attend the disciplinary hearing in Manchester - remains free to continuing practising in his home country despite today's ruling.
The GMC also looked at Dr Ubani's treatment of two other patients on the same day - Sandra Banks, 59, who was given the wrong medication for a migraine, and Iris Edwards, 86, who was found dead in her care home a few hours after he treated her.
Dr Ubani had flown into the UK the day before and only had a few hours' sleep before starting a 12-hour shift, the panel heard.
He was working for SuffDoc, part of the out-of-hours GP service provider Take Care Now, for £45 an hour.
The evening before he started the shift, he was given several hours' training on the firm's computer system at its headquarters in Colchester, Essex, the hearing was told.
He was also given an induction by a doctor, who gave him a sheet listing all of the available drugs and for which illnesses to administer them.
That doctor expressed concerns that Dr Ubani had no experience of working for the NHS, did not know the area, and that he did not have enough time to properly train him.
But his report was not read until two days after Mr Gray's death.
The vials of medicine given to Dr Ubani were all the same size - 10mg - except for the diamorphine, which was in a 100mg tube, the panel heard.
Before visiting Mr Gray, Dr Ubani went to the home of Ms Banks, who was suffering from a migraine.
He injected her with painkillers, which made her condition worse, and left the syringe in her bedroom.
She was later taken to hospital in an ambulance after her condition deteriorated, the panel heard.
After seeing Mr Gray, Dr Ubani went to visit Ms Edwards at her care home in Ely, Cambridgeshire.
She was not sent to hospital even though her heart was racing and she had low blood pressure, and she later died of a heart attack.
A coroner recorded a verdict of natural causes as it was unclear if she would have lived had she gone to hospital.
The panel concluded that Dr Ubani made "recurrent mistakes" with all three patients and was guilty of misconduct.
Following the announcement, Health Secretary Andrew Lansley said: "I support the panel's verdict, which ensures that Dr Ubani can never practise medicine in this country again.
"This was a tragic case resulting from a failing out-of-hours system and I offer the Gray family again my sincere condolences.
"There is no doubt that out-of-hours care needs urgent reform.
"GPs are best placed to ensure patients get the care they need, when they need it. If GPs are responsible for commissioning out-of-hours care, I believe many will also decide to play an enhanced role in providing these services themselves.
"Empowering GPs in this way will achieve better services for patients and more control of local services for GPs.
"In addition, I am working closely with the GMC to ensure that foreign healthcare professionals are not allowed to work in the NHS unless they have proven their competence and language skills.
"We are currently exploring a number of options to put a stop to foreign doctors slipping through the net.
"We are also committed to improving patients' access to urgent care services and end the confusion over what services are available when.
"In doing so, we will introduce a new single telephone number to direct patients to the right service, first time. This number - 111 - will be free to call and available 24/7.
"It will be launched in County Durham and Darlington this summer and in Nottingham City, Lincolnshire and Luton before the end of the year."
Niall Dickson, chief executive of the GMC, said: "On the general issue of doctors coming to work here from the European Union, the GMC remains extremely concerned that the current arrangements do not provide patients with the protection they need.
"Patient safety must come first and we need to plug the gaping hole in our current procedures.
"As the guardian of standards for doctors working in this country, the GMC must be able to assess the language and clinical competence of doctors who come from Europe, as we already do for doctors coming from the rest of the world.
"The coalition Government has made this a priority and we are working with the Department of Health and the European Commission to find a solution.
"In the meantime, it is all the more important that employers exercise their responsibilities and ensure that the doctors they take on are competent, proficient in English and fit to do the job they are being given."
The panel heard evidence that Dr Ubani was competent in spoken English and his employers had no problems understanding him.
In his correspondence with the GMC in which he expressed his remorse, the panel said his written English was equally satisfactory.
His employers, Cimarron UK Ltd, had no evidence of his experience as a GP and relied instead on the certifications produced by him as a result of the reciprocal registration arrangements with the European Union.
Cimarron made assumptions about Dr Ubani's experience and competence based on the fact that he was registered with the GMC, was on the Cornwall & Isle of Scilly's PCT performers list and was classified by the GMC as exempt from UK vocational training requirements for general practice, the panel said.
Chairman Dr Alderman said: "The panel has concerns that, whilst there may be a perception that registration with the GMC is an automatic indication of competence, it notes that the GMC is not in a position to test either the medical competence or language skills of doctors from the EU.
"The panel notes that, following this incident, Cimarron no longer employs doctors from the EU."
The panel found that Dr Ubani failed to recognise and work within the limits of his own competence and it was "unacceptable" to prescribe and administer a controlled drug, diamorphine, with which he was not familiar.
It also ruled that he had shown no evidence that he fully acknowledged his deficiencies or had attempted to remedy them.
Before the hearing, Dr Ubani sent an email to the GMC, saying: "I shall not be attending said hearing. I feel it should not serve any positive purpose."
Dr Alderman concluded: "Dr Ubani's conduct over a period of one day demonstrated numerous and particularly serious departures from the relevant professional standards as set out in Good Medical Practice.
"The panel has taken into account the totality of the findings against Dr Ubani and has concluded that his misconduct and conviction is fundamentally incompatible with his continuing to be a registered medical practitioner."
At the conclusion of the inquest into Mr Gray's death, Cambridgeshire North and East coroner William Morris said the doctor was "incompetent" and ruled Mr Gray was unlawfully killed.
He said his death amounted to gross negligence and manslaughter.
Mr Gray's family recently accepted £40,000 compensation from sources which remain confidential as part of the payout agreement.
The family has also lodged a complaint with the European Court of Human Rights against the German and UK governments over the handling of the criminal inquiry into the death, a spokeswoman for Anthony Collins Solicitors said.
Cambridgeshire Police, which was investigating Mr Gray's death, issued a European arrest warrant for Dr Ubani to bring him back to the UK to face a possible manslaughter charge.
But, as the warrant was issued, it emerged legal proceedings had already been instigated in Germany against the doctor who the GMC panel was told had practised there for 22 years "without incurring any such fatal mistakes".
At a court in Witten, the doctor pleaded guilty to causing death by negligence - a lesser charge. He was given a nine-month suspended sentence and ordered to pay 5,000 euros (£4,300) costs.
The prosecution, allowed under German law, means he cannot be extradited to face charges in the UK.
The family, including Mr Gray's sons, Stuart and Rory, who attended the GMC hearing, claim the handling of the criminal inquiry was a violation of their human rights. If their claim is upheld they could claim compensation from both governments.
Success at the court could also see the German government overturn Dr Ubani's conviction, which would allow him to be charged with corporate manslaughter.
Stuart Gray, a general practitioner, today welcomed the move to strike off Dr Ubani but said the loophole allowing doctors from the EU to work in Britain without proper prior scrutiny needs closing as a "matter of urgency".
Dr Gray said: "This loophole is not due to be reviewed by the European Commissioner for another two years. The Health Secretary should holds talks with him soon as possible to look at this.
"It needs to be done as a matter of urgency otherwise we will have more Ubanis. Who knows how many there are like him out there practising in this country? It's frightening."
He added: "We welcome today's decision but it was an expected decision because he really had no idea of what he was doing.
"What he was doing carrying out general practice in this country, I really don't know."Reuse content