Can a GP breach confidentiality to save a bat colony?
The scene
A GP contacted the MDU with a confidentiality query. She had seen a man in his 50s who was attending with a sore foot after a fall from a ladder the day before.
The patient was advised to go to the ED for an X-ray as the GP strongly suspected a calcaneal fracture. The patient explained he had been attempting - unsuccessfully - to remove bats living in his loft before he applied for planning permission to extend his house.
It occurred to the GP that his activity may be illegal, and she wondered if she should report it to the police.
Our advice
The MDU adviser confirmed that under Regulation 43 of the Conservation of Habitats and Species Regulations 2017 (as amended), it is potentially a criminal offence to deliberately disturb, capture or transport a bat. The Bat Conservation Trust has a detailed summary of this on its website.
However, the doctor would need to consider if she could justify breaching his confidentiality in the public interest.
The GMC's guidance on Confidentiality: good practice in handling patient information (paragraphs 63-70) explains the duty of confidentiality is not absolute and there can be a public interest in disclosing information to protect individuals or society from risks of serious harm, such as from serious crime.
The guidance doesn't define serious crime, but examples from the Department of Health are, "crimes that cause serious physical or psychological harm to individuals (such as murder, manslaughter, rape and child abuse)". It also references crimes involving substantial financial loss or gain, and crimes that cause serious harm to the security of the state and public order.
The outcome
The MDU adviser asked the GP if they felt they could justify contacting the police in the public interest. The GP concluded that the interference with the bats did not, in her view, meet the threshold of a serious crime for this purpose.
However, she did resolve to contact the patient in a few days to make him aware that his plan to evict for his winged lodgers could be a criminal offence.
Rattled by a snake bite dilemma
A foundation year two doctor was working in the emergency department when a patient presented with blurred vision, dizziness and mouth swelling along with extreme pain and swelling of her right hand due to a snake bite. The patient explained that she kept timber rattlesnakes as pets, and that one had bitten her.
The MDU member and the supervising consultant had started initial treatment for the patient and promptly contacted the National Poisons Information Service (NPIS) for further advice on management. The NPIS advised that anti-venom would be appropriate for this case and confirmed they would arrange delivery of the relevant substance.
When the plan was explained to the patient, she produced a vial from her bag with a label that read, 'crotalidae polyvalent' and asked that she be given this anti-venom while they waited for the NPIS delivery. There was no expiry date on the bottle. The foundation doctor called the MDU advice line to check the medico-legal position on administering medication provided by a patient.
Our advice
Snakebites are still thankfully rare in the UK, but a study by the UK NPIS published in 2022 showed that snakebite injuries were on the rise in the UK due to an increase in exotic pet ownership. However, it's unusual for private owners to carry anti-venom. In this case, the patient had bought the vial online the year before.
By contrast, establishments where wild animals are kept for exhibition to the public must ensure the availability of 'in-date' anti-venom, either at the establishment or local hospital.
The outcome
The MDU adviser highlighted that due to the uncertain origin of the vial the doctor could not be certain what it contained. In addition, there was no guarantee that it had been stored and transported correctly or was in date.
Most anti-venoms need to be refrigerated and have a short shelf life. With that in mind, the foundation doctor was advised not to administer the patient's anti venom but to speak to a NPIS consultant for their opinion and document this.
This would ensure the patient received safe and recommended treatment, while also demonstrating doctors had made the decision about whether or not to administer the patient's supply after taking expert advice.
A rat-related complaint
A GP contacted the MDU for assistance with a clinical negligence claim made by the mother of a six-year-old child.
The allegations related to a single consultation six months earlier when the child had a six-day history of a flu-like illness. The GP's notes demonstrated that they took a thorough history to include mention of no ENT, GI or urinary symptoms, respiratory issues, myalgia, meningism, lymphadenopathy or rashes.
In addition, the GP had excluded a history of recent foreign travel and if anyone else in the house was unwell. Observations were normal aside from a mild pyrexia, and an examination revealed no specific findings.
The GP advised the mother to give the child antipyretics and fluids, and provided safety-netting advice, including red flags.
Some days later, the mother took her son to an out-of-hours GP as he had deteriorated and was now complaining of myalgia, particularly calf pain and red eyes. The GP asked if the child had been doing any water sports because he was considering leptospirosis - a disease you can get from rat urine in water.
At this point, the child explained he had a couple of pet rats who shared his snacks when they were watching TV. The GP referred the patient to paediatrics where leptospirosis was confirmed.
Our advice
The claim included the allegation that the first GP should have asked about pets, as if she had done so an earlier diagnosis of leptospirosis might have been made and treatment with oral antibiotics would have avoided a lengthy hospital stay.
The UK Health Security Agency has guidance on reducing the risk of human infection from pet rodents. This includes advice that even healthy pet rodents should be assumed to carry infective organisms (including leptospirosis), that you should not kiss or share food with your pet rodents, and that owners should tell doctors they keep rats if they are attending for a possible infective illness.
The GP was advised to contact NHS Resolution as the claim was covered under the Clinical Negligence Scheme for General Practice (CNSGP) but the MDU would be happy to review her statement.
The outcome
A year later, the GP updated the MDU adviser to explain the claim had been successfully defended. The expert witnesses for both parties confirmed her assessment of the child had been entirely thorough and appropriate for a non-specific febrile illness with nothing to suggest leptospirosis. It was concluded that there was no breach of duty by not asking proactively about pet rodents.
The GP had also reflected on the case and now was more likely to ask about pet ownership when seeing patients with flu-like symptoms. However, she appreciated that it would be impossible to cover all possible sources of infection in the limited time available to assess patients in primary care.
This page was correct at publication on 09/10/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Dr Ellie Mein Medico-legal adviser
MB ChB MRCOphth GDL LLM
Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.