'Tired' locum doctor overdosed patient

A 70-year-old patient died after a foreign doctor working his first shift for an out-of-hours GP service in Britain gave him an overdose of the powerful painkiller diamorphine for a kidney complaint, an inquest heard yesterday.

David Gray was suffering pain from kidney stones when he was given more than 10 times the normal daily dose of the drug, the pharmaceutical form of heroin, on 16 February 2008 by Dr Daniel Ubani, 66, a locum doctor from Germany who had arrived in the country the previous day.

Iris Edwards, 86, a care home resident who was Dr Ubani's next patient, died a day later of a heart attack.

On the first day of the inquest into the deaths, which has put NHS provision for out-of-hours GP care in the dock, Lynda Bubb, Mr Gray's partner, said Dr Ubani spoke little English and seemed tired and uncertain. She had called the out-of-hours GP service in Cambridgeshire when Mr Gray became unwell.

Ms Bubb said Dr Ubani had seemed "dithery" and was "muttering to himself" when he arrived to examine Mr Gray, almost four hours after her call.

"He did not speak very much English but what he said I understood. He seemed very tired and not as alert as he could have been as a doctor," she said. She told him that Mr Gray usually received 100mg of pethidine as pain relief. "I knew they did not carry pethidine so I said it needed to be diamorphine," she added.

Dr Ubani gave Mr Gray two injections and then left the syringes on the window sill, Ms Bubb said. Mr Gray thanked the doctor and said he felt better before falling asleep. Later she realised there was something wrong and called an ambulance. A doctor who later examined Mr Gray's body said he would have died within 10 minutes.

The inquest in Wisbech, Cambridgeshire, which is due to last 10 days, comes after the Care Quality Commission (CQC), the NHS regulator, highlighted problems with out-of-hours GPs services in England during its investigation into the case.

Inquiries were launched by the General Medical Council, which licenses foreign doctors to practise in Britain, and the CQC, following Mr Gray's death. In an interim report last October, the CQC warned NHS trusts that they were only "scratching the surface" in terms of how they monitored the quality of out-of-hours services and needed to "dig deeper". The GMC called for tighter controls on the employment of foreign doctors.

In Germany, Dr Ubani was charged with causing death by negligence, given a nine-month suspended sentence and ordered to pay €5,000 (£4,500) costs.

The prosecution, which is allowed under German law, means he cannot be charged in the UK. Dr Ubani is reported to be still practising as a cosmetic surgeon in the town of Witten in Germany.

Mr Gray's family said the case raised questions over the use of overseas doctors for evening and weekend cover. An agency had supplied Dr Ubani to Take Care Now, the company which was running the NHS out-of-hours service in Cambridgeshire. Its contract was terminated at the end of last year.

The GMC has been pressing for tougher checks on the language ability and medical expertise of foreign doctors from the EU. Niall Dickson, its chief executive, said all EU doctors should be tested like those from the rest of the world before they practise in the UK. The hearing continues.