St Helier Hospital A&E doctor suspended for 7 months

Dr Atila Morlocan was also found to have wrongly diagnosed another patient, leading to her having to have emergency surgery. 

Following his seven-month suspension by the Medical Practitioners Tribunal Service (MPTS), St Helier Hospital has admitted that it has changed its prescribing practices.

It now also provides doctors with more training on how to spot Cauda Equina Syndrome, which Morlocan failed to diagnose.

The MPTS case focused on two incidents involving Dr Morlocan, where he was reported to have provided poor clinical care. Both took place at St Helier A&E ward, where he worked as a speciality doctor. 

Patient A was an 80-year-old man who attended St Helier A&E on July 28, 2018. He came in complaining of leg pain and an inability to bear weight on his leg following a fall two weeks before and facet joint injection five or six days earlier.

After being triaged by a nurse in A&E, patient A eventually came into contact with Dr Morlocan who carried out a consultation. Dr Morlocan viewed the nurse’s note and subsequently identified Patient A’s condition as sciatica.

He then gave him a diazepam and co-codamol prescription for his pain and demonstrated certain exercises that were so effective in relieving his symptoms that Patient A was able to bear weight. 

He also gave patient A a number for a physiotherapist. The patient returned to A&E the next day and again on July 31.

At that meeting, Dr Morlocan prescribed medication of 4 tablets of tramadol, and 50mcg of fentanyl patches to be taken once every 72 hours. Unfortunately, Patient A died two days later on August 2.

During the hearing, the tribunal heard how Morlocan decided to prescribe Patient A with fentanyl patches, despite not having sight of any GP notes.

In his evidence, Morlocan said his decision to prescribe fentanyl patches was due to Patient A’s repeat attendances at A&E and his pain not being managed by the analgesics that had already been prescribed. 

He stated that, at the time of the prescription, he believed that Patient A was not opiate naïve because he had told him he had previously taken opiates.

According to the MPTS opiate naive refers to when “someone who is currently not receiving opiates, has not been on opiates for any length of time or not taking opiates on a regular basis”.

While the GP notes did confirm that patient A had taken opiate patches in the past, these were the weaker buprenorphine not fentanyl, and were prescribed in 2016. Dr Morlocan prescribed 50mcg/hr every 72 hours, which was over four times the dose recommended by medical professionals.

Moreover, Molocan accepted that he had not queried the absence of any opiates in the nurse’s triage notes.

The tribunal subsequently decided that Morlocan did not provide good clinical care when making that prescription for Patient A.

Morlocan was also found to have not given the patient sufficient ‘safety netting advice’ about the possible risks of taking fentanyl at such a high dose.

The doctor was told by a nurse on July 31 that Patient A wanted to discharge himself and “do a runner.”

As a result, Dr Morlocan advised him not to drive after taking fentanyl or tramadol. However, when it came to providing information about the strength of the opiates, the doctor relied upon asking Patient A’s wife to relay the safety information found inside a pamphlet that came with the prescription. 

This was deemed “inadequate” by the tribunal, which held that more care should have been shown considering the “extremely potent opiates” being prescribed. 

In addition to his involvement with Patient A, Morlocan was also judged on his interactions with another patient three years. That individual, named Patient D, attended St Helier A&E after an ambulance had collected her from her home following a fall.

According to the paramedic, Patient D was experiencing symptoms of bilateral sciatica, which included significant pain that prevented her from getting up. Once at A&E, Dr. Morlocan gave her back exercises to perform and deep tissue massage instructions.

He also advised her to undertake the exercises after taking the diazepam that had been previously prescribed by her GP. Following this, she was released from A&E without any further action required.

On June 1, Patient D suffered a further fall where she sustained an ankle fracture. At A&E she underwent an MRI scan and was subsequently diagnosed with Cauda Equina Syndrome, which required surgery.

According to the NHS: “Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.” In the recent hearing, the tribunal found that Dr Morlocan had erred in not initially diagnosing Patient D with Cauda equina on their first meeting in May. 

The tribunal said that Dr Molocan had disregarded the National Institute for Health and Care Excellence (NICE) guidelines when dealing with Patient D. They found that she was suffering from bilateral leg pain, a “red-flag” symptom of Cauda Equina, and should have undergone immediate emergency surgery.

Dr Morlocan qualified in 2012 from Titu Maiorescu University of Bucharest, Romania with an MD in General Medicine, he later moved to the United Kingdom (UK) in 2014 where he has practiced since. The tribunal heard how Dr Morlocan was of previous good character and heard many testimonials in which his colleagues attested to his excellent patient care as an A&E doctor. 

On August 2 2024, the MPTS issued Dr Morlocan with a seven-month suspension for “very serious clinical failings,” barring him from practice. This suspension will become active 28 days after the final decision.

When approached for comment, a representative from Epsom and St Helier University Hospitals NHS Trust told the local democracy reporting service (LDRS) how the doctor’s actions forced them to reassess their A&E practices. 

They told the LDRS how they have now changed our prescribing practices in response to Dr Morlocan’s interactions with Patient A.

They now prohibit A&E staff from prescribing opioid patches and are reviewing pharmacy practices for dispensing opioids.

In response to Patient D’s experiences, they have now introduced measures to ensure greater staff awareness of red flags for Cauda Equina Syndrome.

These include teaching sessions, a checklist box in the assessment document for when a patient comes in with back pain and newly updated patient information leaflets.

A spokesperson for Epsom and St Helier University Hospitals NHS Trust added: “We investigated these concerns when they first came to light, and have taken learnings from what happened by introducing new measures in our emergency departments.”