King's Mill A&E doctor 'catapulted into a senior role he was never fit for'
An inexperienced A&E doctor who failed three patients and fell asleep whilst working for 36 hours solid has kept his job after NHS bosses were accused of ''catapulting him into a senior role he was never fit for.''
Dr Tarek Seda, 41, did not have sufficient qualifications to be in charge of a hospital's emergency department yet was assigned as the only senior doctor on duty during two consecutive night shifts.
One woman he examined for heart issues was mistakenly given betablockers whilst another patient who had a fever after being treated for cancer was given a cursory examination from Seda from the bottom of her bed. A third patient who was seriously ill had a breathing tube inserted in his throat without anaesthetic being administered.
The incidents at Kings Mill Hospital occurred whilst Seda was worked two night shifts plus a day shift in between. He had been given little training or assessment by officials at the Sherwood Forest NHS trust and had fallen asleep during his shifts due to severe exhaustion.
A report compiled by a medical expert said: ''This doctor has been catapulted into a senior role he was never fit for and was stuck on the night shift. His employer never assessed how competent he was and never gave him a proper induction. The Trust failed here in terms of its recruitment. The reality was that Dr Seda should have made it clear that he wasn’t up to this.''
At the Medical Practitioners Tribunal Service in Manchester, Seda was found guilty of serious professional misconduct but escaped with a 12 month suspension. He was also found guilty of unrelated dishonesty offences. He has since been working at a hospital in Oman.
The incidents occurred in June 2017 after Seda - who qualified in Egypt - was working for the private medical organisation Doctorcall. The father of four had applied for a job at Kings Mill Hospital and was interviewed over Skype but it is thought officials failed to properly establish his job credentials.
He successfully completed 28 shifts despite failing to clarify his previous work experience before being told he would be the only doctor on duty during two consecutive night shifts.
One woman known as Patient A had Atrial Fibrillation but Seda failed to consider her low blood pressure or seek advice from an on-call cardiologist and mistakenly gave her the beta blocker Metoprolol.
The second woman known as Patient C had an infection but Seda wrongly advised her to take paracetomol and failed to examine her properly. The third patient who was being treated for an undisclosed condition was intubated on the word of a ward deputy sister without having the relevant experience as a senior clinician.
During the shifts Seda failed to inform any colleagues he was going on a break and was taking ''power naps.''He was later reported following concerns from colleagues.
Elizabeth Dudley-Jones lawyer for the General Medical Council said: ''The fact is he clearly was under pressure from his employers to work consecutive night shifts and a day shift in between - but any exhaustion or lack of experience doesn't excuse him.
''The main reason for imposing sanctions is to protect the public and there have been serious breaches of good medical practices - one involving deficient performance which posed a risk to patient safety. The doctor made a series of poor judgements which so easily could have led to seriously adverse outcomes including death.''
Seda himself told the hearing: ''I was new and being on my own on a night shift was not easy. I admit I should have contacted a senior doctor for the patient with low blood pressure or sought guidance on how to treat her. It was quite difficult really and I was quite exhausted as well and I didn’t have proper induction.
''It’s been difficult for me to act independently, when I had hardly started and did not have enough support or a heads up. I was trying to do my best but I can’t work alone.''''
He added: ''I had the interview through Skype and I should have clarified or explained to them by work history. But I wanted to be trained, to be able to do the job properly and I expected there to be training. I expected the job would be a progression of development in the department. But I should have clarified that I didn’t have enough skills and experience to act on my own.
''I did later kind of explore this and explain this to a senior colleague that I want to be supervised but not during the interview. I was not robust enough in giving my view in interview. They told me what I should do and I didn’t explain to them what I need. I had worked in emergency medicine before but always had support with me. It was a mistake and I learnt obviously from that.
''I shouldn’t have just left this to the employers - I should have said this is what I have done, I’m only a locum. I’m completely ashamed because I was treating people who I should have made better.''
His lawyer Alan Jenkins said Seda said: ''Obviously he was trying to do the best he can but he can’t work alone with no training, assessment or educational supervision.
''When he applied for the position at Kings Mill hospital he said he wanted to work part time and not on a Tuesday. But that information wasn’t passed on. He did a total of 30 shifts and had no complaints made during the first 28 shifts including the first night shift. He was then expected to work during the day and told he has to come in again that night.
''He is regarded as someone who works well with colleagues. One says “he was pleasant, interactive and don’t remember having concerns about his skills my overwhelming memory of this chap how polite he was.” On night duties a few concerns were raised. He had applied for this job thinking he would get more training and would have other more senior doctors with him.
''He didn’t start off on a gold path he was working for the best part of two years as a hotel doctor. He wasn’t the most successful doctor when it came to wanting to pursue a career in general practise and it was suggest there was a place for him in medicine in the UK.
''He interacted entirely appropriately in the first 28 shifts then was a problem with nights which he had flagged up. He couldn’t work Tuesdays and was told he had got too. It seems the senior doctor did not realise he was working on the day when he had come in.''
''He explained his position to the trust and was told he would have to come in. He does so but gets criticised for having done so. The trust have failed him in terms of recruitment. When applying for the job he was told he would get more training and supervision and it would be a job he could learn. The first night shift there should have been a senior to him but wasn’t one on that shift.
'Then he was working during the day and was forced to come in that night. He felt he had no clinical support and worked alone. He
was suffering from tiredness and was told in firm terms he had to come in.''
Panel chairman Ms Christina Moller told the hearing: ''The Tribunal found many instances where Dr Seda’s care fell below, and in some areas seriously below, the standards expected of someone in his position.
''These included matters which were at a very basic level of medical training and knowledge. Any doctor working in an Emergency Department at any level should be aware of the need to take an adequate history from patients, examine patients and to maintain an accurate patient record.
''Despite the fact that Dr Seda was clearly under pressure from one of his employers to work consecutive night shifts, with a day clinic in between, the serious clinical errors were so fundamental that any exhaustion or lack of experience does not excuse them. The undoubted shortcomings in the clinical management of the emergency department did not excuse Dr Seda’s failings.
''But the tribunal took account of the unfavourable working circumstances of Dr Seda which included the lack of an adequate induction for his role and a lack of supervision by senior staff. These factors caused Dr Seda a degree of work related stress due to his relative inexperience.''