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Disciplinary Action Against Dr. Michele Langdon:
Minutes of GMC Professional Conduct Committee


In January 2003, The British General Medical Council (GMC) found family practitioner Michelle Langdon, guilty of serious professional misconduct and banned her from practicing for three months. Press reports state that Langdon had advised a couple that the gastrointestinal symptoms of their 11-month-old were caused by "geopathic stress patterns" beneath their home and then "dowsed" for a remedy by swinging a crystal attached to a chain over a book of herbal remedies. A hospital emergency department subsequently found that the child had gastroenteritis. The GMC also examined evidence that another patient had been prescribed a herbal remedy for a sore throat after Langdon dowsed for the treatment and that a third patient was given homeopathic remedies for a sore throat. Here are the minutes of the hearing at which GMC's decision was made.


Date of Hearing: 13 ­ 16 January 2003

Name of respondent doctor: LANGDON, Michelle Linda

Registered qualifications: MB BS 1978 London

Registered address: Brunswick Medical Centre, 53 Brunswick Centre, London, WC1N 1AF

Panel: Professor Whitehouse (Chairman), Dr Dalton, Mr Kyle, Mr Lee, Mrs Simester

Legal Assessor: Mr John Melville Williams, QC

Type of Case: New Conduct

Committee Secretary: Fiona Browne

Representation: Dr Langdon was present and represented by Mr Dennis Matthews, Counsel, instructed by RadcliffesLeBrasseur Solicitors. Mr Jeremy Donne, Counsel, instructed by Field Fisher Waterhouse, Solicitors to the Council represented the Complainants.

Charge

"That, being registered under the Medical Act,

1. At all material times you were a General Practitioner at the Brunswick Medical Centre, 53 Brunswick Centre, London, WC1N 1AF and you were responsible for the care of Heather Charles,
Kira Jinkinson and Christopher Lemonius. Admitted and found proved

2. On 8 June 2000 Heather Charles consulted you complaining of a suspected throat infection and an injured ankle. Admitted and found proved

3. You told Heather Charles that you practised both conventional and "natural" medicine and asked her to agree to be treated by natural or complementary medicine. You then prescribed homeopathic medicine having selected, or confirmed your selection of, the remedy by use of "dowsing". Found proved

4. Heather Charles' condition did not improve and two days later she consulted a doctor in Copenhagen who prescribed antibiotics for her throat infection; Found proved

5. Your management and treatment of Heather Charles was,

a. Inadequate and/or, Found proved

b. Below the standard of care of a registered medical practitioner in that you,

i. failed to conduct a proper medical examination, Found not proved
ii. failed to take a full medical history, Found not proved
iii. failed to obtain her informed consent to receive homeopathic treatment and homeopathic remedy; Found proved

6. On 19 October 2000 Bethan Jinkinson took her daughter Kira Jinkinson to see you in consultation. During a brief examination you examined Kira's throat, ears and commented on her runny nose. You told Bethan Jinkinson that her daughter's problems could be due to cold or teething and that she may have mucous in her stomach making her vomit. You advised her to return to your surgery the next day if Kira's symptoms did not improve; Admitted in part and found proved in its entirety

7. Your management and treatment of Kira Jinkinson on the above date was,

a. Inadequate and/or, Found not proved

b. Below the standard of care expected of a registered medical practitioner in that you,

i. failed to conduct a proper examination, Found not proved

ii. failed to exclude the possibility of a serious illness. Found not proved

8.        a. On 20 October 2000 Bethan Jinkinson returned to your surgery with her daughter for a further consultation as her symptoms had worsened from the previous day, Admitted in part and found proved in its entirety

b. When she walked into your consulting room you confirmed her address and without examining Kira or discussing possible treatment options with Ms Jinkinson you:

i. talked about the existence of geopathic stress lines in the vicinity of her house and that geopathic stress could cause cot death. Found proved

ii. prescribed phosphorus for Kira's condition having selected, or confirmed your selection of, that remedy by dowsing. Found proved

9. Later on 20 October 2000 Kira was taken to the A & E department at the University College Hospital London where she was diagnosed as suffering from gastroenteritis.
Found proved

10. Your management and treatment of Kira on 22 October 2000 was,

a. Inadequate and/or, Found proved

b. Below the standard of care expected by a registered medical practitioner in that you,

i. failed to conduct a proper examination, Found proved

ii. failed to take an adequate history, Found not proved

iii. failed to arrive at a proper diagnosis, Found not proved

iv. failed to make an adequate note of your consultation, Found proved

v. failed to give specific advice about Kira's fluid intake or what should be done if her condition deteriorated, Found proved

vi. failed to obtain informed consent from Bethan Jinkinson for Kira to receive homeopathic treatment and a homeopathic remedy, Found proved

vii. put Bethan Jinkinson under pressure to accept the services of a geopathic stress consultant, David Perry, and failed to inform her that Mr Perry was not medically qualified; Found proved

11. On 13 June 2002 Christopher Lemonius consulted you complaining of a sore throat; Admitted and found proved

12. During your consultation with Chrisopher Lemonius you examined his throat. You declined to prescribe antibiotics for the treatment of this patient's condition and entered into a discussion about homeopathic remedies with the patient and prescribed to him a number of such remedies; Found proved

13. On 15 June 2002 Christopher Lemonius attended the A & E Department at the University College Hospital London where he was examined. He was referred to the Ear Nose and Throat Department of the Royal ENT Hospital where he was diagnosed with pharyngitis with right peritonsillar oedema and possible early peritonsillar abscess; Found proved

14. Your management and treatment of Christopher Lemonius was,

a. Inadequate and/or, Found not proved

b. Below the standard of care expected of a Registered Medical Practitioner in that you,

i. failed to conduct a proper examination, Found not proved

ii. failed to make an adequate note of your examination, Found proved

iii. failed to obtain informed consent from Christopher Lemonius to receive homeopathic treatment and a homeopathic remedy, Found proved

iv. did not prescribe antibiotic medication; Found not proved

15. On 11 October 2002 Christopher Lemonius consulted you because he was depressed; Admitted in part and found proved in its entirety

16. During the consultation Christopher Lemonius asked you to prescribe him antidepressant medication and to refer him for counselling; Found not proved

17. You declined to prescribe antidepressant medication for this patient, instead you talked about homeopathic remedies and subsequently prescribed him a number of such remedies; Found proved

18. Subsequent to his consultation with you Christopher Lemonius heard nothing further from you regarding any referral for counselling; Found proved

19. Your management and treatment of Christopher Lemonius was,

a. Inadequate and/or, Found not proved

b. Below the standard of care expected of a registered medical practitioner in that you,

i. failed to consider the suicide risk to this patient, Found proved

ii. failed to make an adequate note of your consultation, Found not proved

iii. failed to obtain informed consent from the patient to receive homeopathic treatment and remedies, Found proved

iv. failed to refer the patient for counselling; Found not proved

20. In respect of your treatment of all the above named patients you failed to,

a. Consider the effect of your use on your patients of alternative medicine, Found proved

b. Ensure that your personal beliefs did not prejudice your patients' care;' Found proved

And that in relation to the facts alleged you have been guilty of serious professional misconduct.
Guilty of serious professional misconduct

Determination

Dr Langdon: In making their determination, the Committee have not considered the merits of homeopathic medicine nor any other form of complementary or alternative medicine. It is not within the remit of this Committee to consider these matters. The duty of this Committee is to consider your medical practice applying those standards to be expected of a registered medical practitioner.

At all material times, you were a General Practitioner practising medicine at the Brunswick Medical Centre, 53 Brunswick Centre, London, WC1N 1AF.

Between June 2000 and October 2002 you were consulted by three patients, Bethan Jinkinson with her daughter, Kira, Heather Charles, and Christopher Lemonius.

Ms Bethan Jinkinson consulted you on 19 October 2000 with her 11 month old daughter Kira who had been vomiting. They returned to your surgery on 20 October 2000 for a further consultation as Kira's symptoms had worsened. When they entered your consulting room on this occasion, you confirmed their address and, without examining Kira or discussing possible treatment options with Ms Jinkinson, you talked about geopathic stress lines in the vicinity of her house and said that these could cause cot death. You prescribed phosphorus, a homeopathic remedy, for Kira's condition having selected, or confirmed, your selection by dowsing in the presence of Ms Jinkinson. You also put pressure on Ms Jinkinson to accept the services of a geopathic stress consultant by indicating the risk to Kira of cot death. The GMC publication "Good Medical Practice" (July 1998) states that "good clinical care must include an adequate assessment of the patients condition based on the history and clinical signs and, if necessary, an appropriate examination."

Your management of Kira on this occasion was inadequate.

In respect of Heather Charles and Christopher Lemonius, and Ms Jinkinson, the Committee found that you failed to obtain their informed consent before you prescribed homeopathic or natural remedies for them. Nor did you explain the rationale for using dowsing in the process of the selection of a remedy. The GMC publication "Seeking patients' consent: the ethical considerations" (November 1998) confirms that patient autonomy is paramount. It states "it is for the patient, not the doctor, to determine what is in the patient's best interests. Nonetheless, you may wish to recommend a treatment or a course of action to patients, but you must not put pressure on patients to accept your advice. In discussion with patients, you should give a balanced view of the options and explain the need for informed consent." All three patients have told this Committee that in coming to see you, they did not seek a homeopathic remedy. Your management in respect of these patients was inadequate and below the standard expected of a registered medical practitioner.

With all three patients, you failed to explain the alternative treatments that you were offering. The Committee wish to emphasise that it is your responsibility as a doctor to ensure that your patient has given informed consent.

Mr Lemonius consulted you when he was depressed and you failed to identify that he was at potential risk of suicide at that time. You declined to prescribe anti-depressant medication for him, instead you discussed and prescribed a number of homeopathic remedies. Your management and treatment of Mr Lemonius was below the standard of care expected from a registered medical practitioner because you failed to obtain his informed consent to receive homeopathic treatment and remedies.

In two of these patients, you failed to make adequate notes of your consultations. The GMC publication "Good Medical Practice" (July 1998) states that a doctor should "keep clear accurate and contemporaneous records which report relevant clinical findings, the decisions made, the information given to patients and any drugs or other treatment prescribed".

The Committee have found that your behaviour has fallen far short of the standards expected of a registered medical practitioner. The Committee have found you guilty of serious professional misconduct.

The Committee have taken into account your previous good record and the testimonials submitted on your behalf from professional colleagues and patients. They also noted the high regard in which you are held by the patients who came to give evidence at the hearing today. The Committee noted that you had sought assistance and training from your Primary Care Group particularly in obtaining informed consent.

The nature of the findings against you are serious. The Committee have decided that neither a reprimand, nor the imposition of conditions upon your registration, would reflect the seriousness of the findings against you.
The Committee have considered whether it is necessary or appropriate to erase your name from the Medical Register. However, they have concluded that it is sufficient and proportionate to suspend your medical registration for a period of 3 months.

The Committee have therefore directed the Registrar to suspend your registration for a period of three months. The effect of the foregoing direction is that, unless you exercise your right of appeal, your registration will be suspended 28 days from today for a period of three months.

The Committee strongly recommend that you take the opportunity during your suspension, to consider the effect of your use on your patients of alternative medicine in order to ensure that, in future, your personal beliefs do not prejudice your patients care. This should include continuing to take advice from your Primary Care Group.

That concludes your case.

Signed Date


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This article was posted on January 22, 2003.