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Other patients 'failed by locum' Inquest hears of fatal injection
(41 minutes later)
An inquest into the deaths of two patients treated by an overseas out-of-hours doctor has heard concerns about his treatment of two other patients. An inquest into the deaths of two patients treated by an overseas out-of-hours doctor has heard details of how he gave a fatal overdose to one.
Dr Daniel Ubani flew from Germany the day before he saw patients in Cambridgeshire on 16 February 2008. The coronor in Wisbech was told the patient, David Gray, thanked Dr Daniel Ubani after two injections of the painkiller diamorphine.
One patient, David Gray, died after Dr Ubani gave him a huge overdose of painkiller. Mr Gray, 70, told his partner he was starting to feel better - but was dead within hours.
The Wisbech inquest heard his care of another patient was described by her GP as "unusual and not correct". Dr Ubani had flown in from Germany the day before for his first UK shift.
Phyllis Fletcher, who had a severe form of the lung condition COPD, was given a linctus by Dr Ubani. Two of the patients - Mr Gray and Iris Edwards, an 86-year-old care home resident - he saw the following day, 16 February 2008, died.
There was something about Dr Ubani I wasn't quite sure about Stephen CowleyPartner of patient Out-of-hours 'failing'There was something about Dr Ubani I wasn't quite sure about Stephen CowleyPartner of patient Out-of-hours 'failing'
Mr Gray's partner, Lynda Bubb, described him as an "intelligent and motivated man".
She said he had called the NHS out-of-hours service after he suffered pain in his kidneys and stomach.
Dr Ubani arrived and, in Ms Bubb's words, seemed dithery and muttered to himself a lot.
He gave Mr Gray two injections of diamorphine. The court heard the patient took Dr Ubani's hand, and said thank you.
Mr Gray told his partner soon afterwards that he was starting to feel better already.
She said she cleared up the syringes, which had been left on the windowsill, but after an hour or so, realised something was wrong. Mr Gray died that evening.
Other patients
The inquest also heard concerns about Dr Ubani's treatment of two other patients treated on the same night.
His care of another patient was described by her GP as "unusual and not correct".
Phyllis Fletcher, who had a severe form of the lung condition COPD, was given a linctus by Dr Ubani.
But in a statement to the inquest, her GP, Dr Carol Walcott, listed seven alternative courses of action that she felt should have been taken.But in a statement to the inquest, her GP, Dr Carol Walcott, listed seven alternative courses of action that she felt should have been taken.
Another patient, Sandra Banks, who was regularly taking nine different medicines, described in a statement that she'd begun vomiting after Dr Ubani visited her and gave her an injection. Another patient, Sandra Banks, who was regularly taking nine different medicines, described in a statement that she had begun vomiting after Dr Ubani visited her and gave her an injection.
She was later admitted to Addenbrooke's Hospital in Cambridge.She was later admitted to Addenbrooke's Hospital in Cambridge.
Her daughter, Julie Singer, and partner, Stephen Cowley, were present during the visit.Her daughter, Julie Singer, and partner, Stephen Cowley, were present during the visit.
In a statement, Mr Cowley said: "There was something about Dr Ubani I wasn't quite sure about.In a statement, Mr Cowley said: "There was something about Dr Ubani I wasn't quite sure about.
"The main thing was a breakdown in language."The main thing was a breakdown in language.
"He seemed to brush off far too quickly a list which contained all Sandra's medication.""He seemed to brush off far too quickly a list which contained all Sandra's medication."
Earlier the inquest heard from Dr Ubani's driver on the day, Lesley Dent.
She said: "I found him very pleasant - very well-mannered and good humoured, very professional."
Prison sentencePrison sentence
The inquest is set to focus on the deaths of Mr Gray, 70, who was given an overdose of the painkiller diamorphine after being seen by Dr Ubani, and his next patient, care home resident Iris Edwards, 86, who later died of a heart attack.
Mr Gray's family say the case raises questions over the use of overseas doctors for evening and weekend cover.Mr Gray's family say the case raises questions over the use of overseas doctors for evening and weekend cover.
Stuart Gray: "It's a fundamental mistake that woudn't have happened with a UK-trained GP"
An agency had supplied him to Take Care Now, the company which was running the NHS out-of-hours service in Cambridgeshire. The contract was terminated at the end of last year.An agency had supplied him to Take Care Now, the company which was running the NHS out-of-hours service in Cambridgeshire. The contract was terminated at the end of last year.
In April 2009, the German authorities gave Dr Ubani a nine-month prison sentence, suspended for two years, and he was ordered to pay a £4,500 fine for causing death by negligence.In April 2009, the German authorities gave Dr Ubani a nine-month prison sentence, suspended for two years, and he was ordered to pay a £4,500 fine for causing death by negligence.
He continues to practise as a cosmetic surgeon in the west German town of Witten.He continues to practise as a cosmetic surgeon in the west German town of Witten.
Dr Ubani later said in a letter to Mr Gray's sons that he was not familiar with diamorphine, because it was not routinely prescribed by doctors in Germany.Dr Ubani later said in a letter to Mr Gray's sons that he was not familiar with diamorphine, because it was not routinely prescribed by doctors in Germany.
Less stringent checks
Stuart Gray: "It's a fundamental mistake that woudn't have happened with a UK-trained GP"
The system changed after GPs negotiated a different contract six years ago. Responsibility for out-of-hours cover in England passed to primary care trusts.The system changed after GPs negotiated a different contract six years ago. Responsibility for out-of-hours cover in England passed to primary care trusts.
European legislation means doctors are free to work in different parts of the EU, and are subject to less stringent checks than other foreign doctors arriving in the UK.European legislation means doctors are free to work in different parts of the EU, and are subject to less stringent checks than other foreign doctors arriving in the UK.
The General Medical Council (GMC) has spent years pressing for a legal obligation for doctors' disciplinary records to be shared.The General Medical Council (GMC) has spent years pressing for a legal obligation for doctors' disciplinary records to be shared.
Investigations by the NHS regulator - the Care Quality Commission (CQC) - and the GMC into the Dr Ubani case are ongoing.Investigations by the NHS regulator - the Care Quality Commission (CQC) - and the GMC into the Dr Ubani case are ongoing.
An interim report by the CQC last October said all NHS trusts needed to "dig deeper" and ensure they were providing good quality services during evenings and weekends.An interim report by the CQC last October said all NHS trusts needed to "dig deeper" and ensure they were providing good quality services during evenings and weekends.
The Department of Health has ordered a review to find out what extra steps need to be taken to strengthen out-of-hours services in England - though some critics say this remit should be much wider.The Department of Health has ordered a review to find out what extra steps need to be taken to strengthen out-of-hours services in England - though some critics say this remit should be much wider.
The inquest is due to sit for 10 days, and will conclude early next month.The inquest is due to sit for 10 days, and will conclude early next month.
Dr Ubani has been called to appear at the inquest but is not expected to attend the hearing.Dr Ubani has been called to appear at the inquest but is not expected to attend the hearing.