Doctor struck off over death of patient

Doctors' leaders called for tighter controls on the employment of locums last night after an anaesthetist was struck off for mistakes relating to the death of a 10-year-old boy and a woman left in agony during a Caesarean.

Doctors' leaders called for tighter controls on the employment of locums last night after an anaesthetist was struck off for mistakes relating to the death of a 10-year-old boy and a woman left in agony during a Caesarean.

John Evans-Appiah was found guilty of serious professional misconduct over a series of "critical failings" including the death of Darren Denholm during a routine dental operation.

Dr Evans-Appiah was born in Ghana and trained in the Ukraine before coming to Britain in 1977, and spent more than two decades in 42 temporary jobs. The General Medical Council's hearing into his conduct has focused attention on overseas-trained doctors working as locums with no support or on-the-job training.

Last night the British Medical Association called for tougher measures for assessing locum doctors. Dr Ian Bogle, chairman of the BMA Council, said Dr Evans-Appiah's case was "very disturbing" and action was needed to provide effective supervision and guidance for locums early in their careers.

"Otherwise they tend to become permanent locums without access to proper training and study leave. The inclusion of rigorous methods for assessing the competence of locum doctors will be an important test of the General Medical Council's proposals for revalidation of doctors.

"When doctors are moving from post to post, often for short periods of employment, quality checks on their competence are absolutely vital," he said.

Yesterday's GMC ruling said Dr Evans Appiah, 58, of Leyton, east London, had failed to meet the "basic standards" of care to which every patient was entitled. He was found to have failed to ensure an adequate level of anaesthesia before allowing a dentist to begin extracting a rotten tooth from Darren Denholm, of Armadale, West Lothian, in October 1998.

The boy suffered a heart attack in the dentist's chair at the Peffermill clinic, Edinburgh. Dr Evans Appiah was found to have aggravated matters by failing to follow "basic life support procedure". The committee said he compounded his incompetence by dishonestly trying to create false records of the case.

Three weeks after that incident, Dr Evans-Appiah left Hazel Woolger, aged, 33, from Maidstone, Kent, in agony when he failed to provide a proper level of anaesthesia during a Caesarean, leaving her able to feel through the nerves in her abdomen.

During the operation he was guilty of "bizarre" behaviour, demonstrating a "disturbing lack of proper standards" when he picked up a piece of equipment that had dropped on the floor and wiped it in his mouth before inserting it in Mrs Woolger's windpipe.

Mrs Woolger had earlier told the hearing that the operation at the Maidstone Hospital, Kent, was like a scene from Nightmare on Elm Street, which left her feeling as if she had been "hit in the stomach by a sledgehammer".

Dr Evans-Appiah admitted not keeping adequate clinical records in respect of Mrs Woolger, whose baby was born healthy.

Earlier the tribunal had been told that Dr Evans-Appiah had put a patient's life in danger when he mistakenly gave a paralysis-inducing drug to a woman during a Caesarean, which stopped her breathing spontaneously.