A locum doctor working in the Highlands has been suspended for a month after a toddler he diagnosed with constipation died five weeks later from cancer.
The 19-month-old girl, who has not been named, was seen in hospital twice by Dr Abdul Bhutto who failed to diagnose a tumour.
Instead, he prescribed an enema, believing the child was constipated.
He also failed to get a second opinion or send the child for x-rays.
A tribunal of the Medical Practitioners Tribunal Service (MPTS) found that Bhutto failed to take into account “information provided by family members” or carry out vital tests to diagnose his patient.
The toddler, known only in the report as Patient A, died on November 25, 2019 – five weeks after she was first seen in the Highland hospital which has not been named in the report.
Bhutto, an experienced medic of some 40 years, was working as a locum registrar in the Highlands from October 11 to November 11, 2019.
Highland toddler died after incorrect diagnosis
It was during this time, NHS 24 referred the child to the Paediatric Assessment Unit (PAU) where Bhutto was working.
He made an initial and incorrect diagnosis of the child on October 20 at an emergency appointment in the hospital. In his notes, he described the child as “distressed”.
The girl was taken to hospital by her worried mum after she found a blood clot in her toddler’s nappy.
The mum, and grandparent, had also found a lump in the child’s stomach.
Bhutto examined the child and noted a large mass in her abdomen at which point he diagnosed the lump as constipation and gave an enema.
It later emerged the child was in fact suffering from neuroblastoma, a cancer that develops from immature nerve cells.
At a hearing of the MPTS Bhutto admitted failing to check the child’s pulse and blood pressure or arrange an x-ray or an ultrasound of the abdomen.
His legal advisor explained his actions, saying the child had had a bowel movement and Bhutto thought the matter resolved.
On November 6 he met the child again, on a second emergency admission, at the PAU.
Again, he admitted that he did not take an adequate medical history or try to establish the cause of the fever. For a second time, he prescribed constipation medication.
Sending the child home, he did not ask for a second opinion from a more senior consultant – as should have been the practice – or send her for follow-up x-rays.
Crown Office was contacted with concerns raised about Dr Abdul Bhutto
Nine days later, the toddler collapsed and was rushed to Glasgow for specialist treatment where she later died.
The cause of death was listed as “complications of left neuroblastoma and associated therapy”.
It was then that concerns were raised with the General Medical Council (GMC) via the Crown Office about Bhutto. The mother made statements to the police.
It was alleged to police that incomplete observations were made when the child attended the PAU, that treatment did not follow local or national guidance, and that no explanation for the symptoms was made.
The GMC referred the matter to the MPTS.
A tribunal into Bhutto’s fitness to practice was held in private ending on June 28, with the outcome published today.
In the report, an expert paediatrician reviewed the case, and said: “Care fell seriously below standard in Dr Bhutto’s lack of adequate examination skills.
“Patient A was therefore not diagnosed at a time when management of the tumour
could have taken place, before she became critically ill.”
In a letter to the tribunal from Dr Bhutto, he said he was “very sorry for
her tragic outcome”.
Not ‘deliberate or reckless’
He continued: ” I will continue to reflect on this case for the rest of my career.
“I accept my mistakes, have educated myself and will continue to keep up-to-date to ensure that no mistakes of this nature are repeated in the future.”
The tribunal concluded that Dr Bhutto’s conduct fell so far short of the standards of conduct reasonably expected of a doctor as to amount to serious misconduct, and his fitness to practise impaired.
Mr Bhutto’s legal advisor argued it was an isolated case and there was not any “deliberate or reckless disregard for the patient”. He had never been before the GMC or the tribunal service before.
Bhutto was suspended for one month.
He can still make an application to the MPTS for an appeal against the suspension.
An NHS Highland spokeswoman said: “NHS Highland is deeply sorry and offers our sincere condolences to the family involved in this incident.
“We can confirm that Dr Bhutto was working as a locum within our health board at the time but no longer works for NHS Highland.”