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At the heart of general practice since 1960

Figures show trust in MMR not yet restored

Fallout from Shipman has irrevocably changed the climate of palliative care, says GP Dr Paul Davis ­ by Nerys Hairon

Stripped of his belt and tie and with his pockets emptied, Dr Paul Davis waited in a police cell for the questioning to start again.

In what circumstances had one of his patients, a terminally-ill 85-year-old man, died at his home 10 months earlier? What care had Dr Davis given the man in his final hours? Why had he given him diamorphine? Did he help him die more quickly?

Meanwhile, a local newspaper was preparing its front-page story for the next morning, naming the GP arrested on suspicion of murdering one of his patients.

Dr Davis's care trust had divulged his name to the paper's reporters.

In the post-Shipman world of increased scrutiny and suspicion, Dr Davis's nightmare is one that could now happen to any GP.

Police had first visited Dr Davis's singlehanded practice in the rural

Essex village of Castle Hedingham on October 7, asking him to come to the station a week later to be interviewed under caution about the death of George Letch.

He did not know that when he arrived he would be arrested on suspicion of Mr Letch's murder. 'It was extremely traumatic when I entered the police station to be arrested on suspicion of the murder of a patient,' Dr Davis says.

'I think it was undignified and unnecessary but the police were going through the mandatory process.'

What followed was a gruelling set of six 45-minute interviews, including a video link to a forensic toxicologist, and two visits to the cells. But at the end of a day of interrogation, which also included a police search of his home and surgery, Dr Davis was released on bail without charge.

Two months on, police have now dropped the case. Dr Davis was never charged. The GMC has placed no restrictions on him.

Despite being completely cleared, Dr Davis says was forced to endure 'a harrowing experience with great uncertainty about the outcome'.

He recalls how in the days after he was arrested, people whispered and pointed at him while he was shopping, branding him 'the murderer'. Dr Davis adds: 'It makes you want to withdraw socially.'

Dr Davis and his wife, Philippa, say Witham, Braintree and Halstead Care Trust 'ruined their lives' for the nine weeks until the charges were dropped. The trust had decided to name him in a statement to the media.

'Once the press knew who it was, we were hounded,' Mrs Davis says. 'They sat outside the house.'

John Summers, director of primary care at the trust, says it had no choice as a police statement identifying a 51-year-old male GP who had been treating a patient in Sible Hedingham had already narrowed it down to just two doctors.

He says: 'In order to protect the other GP and allay the fears of patients, we decided to name the GP.'

But he insists the trust 'did everything possible' to get Dr Davis back to work as soon as possible and had 'backed him to the hilt'. Dr Davis says he remains 'unhappy' that the trust released his details to the press.

The patient, George Letch, was a good friend of Dr Davis. So much so he left him £1,000 in his will. He was suffering from four conditions before he died in December 2003 ­ COPD, ischaemic heart disease, an ischio-

rectal abscess and a carcinoma.

Despite being urged by both an oncologist and Dr Davis to go to hospital, Mr Letch was adamant he wanted to die at home.

Dr Davis made three visits to Mr Letch's home on the evening before he died. He diagnosed pneumonia on his first call and gave him a small dose of diamorphine to ease severe pain and anxiety. He gave Mr Letch another dose on his third visit, before leaving at 11.30.

On his morning visit at 6.30am, before starting surgery, Dr Davis discovered that Mr Letch had died overnight on his own.

After the death, the first time Dr Davis knew there was something amiss was when Mr Letch's cremation was cancelled because a friend had reported the death to police as suspicious.

But it would be a further 10 months before Dr Davis knew he was suspected of Mr Letch's murder. He believes that because of the fallout from the Shipman case, police latched on to the fact he was a singlehanded GP ­ despite the fact he had only been singlehanded for nine days before the patient died.

He adds that police were also interested in the fact Mr Letch had left him £1,000 in his will.

Part of their questioning focused on whether the GP had agreed to

accelerate Mr Letch's death, or if

the patient had requested a living will.

Dr Davis says: 'They were concerned about my intention because I was a beneficiary in the will. I wish he had never left me anything.'

Dr Davis, who has now returned to work full-time, says he is now determined to recruit a part-time partner because he feels so vulnerable to people doubting his actions. He adds that treating a dying patient at home has become so fraught with danger for GPs because of post-Shipman suspicions they should avoid doing it.

'My advice to anyone else is that they should try never to get themselves into that situation. GPs should avoid giving palliative care at home to patients who live by themselves.'

Dr Michael Taylor, chair of the Small Practices Association, says doctors need protection from 'malice and ignorance', otherwise patients will suffer.

'If you want to regulate things more fully then there has got to be an even-handedness in the regulations,' he says.

'If society wants us to do the job to the best of our ability then it has got to stop putting us through the grinder at somebody's whim.'

Dr Davis and his wife still do not know who reported the death as suspicious and why.

Mrs Davis says: 'You can't put every doctor through this kind of hell when a patient dies at home.'

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