An A&E doctor has avoided being struck off after an "aggressive" and "derogatory" rant at a colleague. Dr Sebastian Johns' outburst came after he turned up for work at Haverfordwest's Withybush Hospital in a sleep-deprived state, a medical tribunal heard.
Dr Johns, who qualified in 2007, took up a locum post as an emergency doctor at Withybush in November 2020 and worked regular shifts there until the following May when the incident took place. Tribunal chairwoman Becky Miller said Dr Johns had worked "an additional set of night duty on four consecutive night shifts", finishing at 9.30am on May 14, 2021. The next day he arrived two hours late for his 9am shift after being phoned four times by a colleague named only as Dr A who was the consultant in charge of the A&E.
Dr Johns apologised for being late and said he had slept through six alarms. Dr A asked him to make up the two hours that day so he finished his shift at 11pm. He sent Dr A an email at 2.30am raising concerns over the rota and telling her he was sleep-deprived. Dr Johns was scheduled back in work at 9am that day but arrived around 15 minutes late, according to Dr A.
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Mrs Miller said: "Dr A noticed that Dr Johns was walking differently and seemed to be walking a few paces before losing his balance and staggering side to side, which she thought was unusual. Sister Catrin Wyn Griffiths, the nurse in charge of the emergency department, also noticed Dr Johns walk in and described him as ‘wobbly’. Sister Griffiths noticed that Dr Johns looked tired, was pale and sweaty, and looked unkempt, like his clothes had not been ironed."
The tribunal heard that during the morning handover Dr Johns was "writing things on the whiteboard despite this typically being the role of the consultant" and that he spelled a patient's name incorrectly. Dr A asked if he was all right and he replied: "Sleep deprivation. I haven’t slept."
The consultant took Dr Johns into an office and asked if he had been drinking, which he denied. The tribunal chairwoman added: "Dr A asked again and said she would rather know if Dr Johns had been drinking, so she could keep the floor safe, but Dr Johns again interrupted and repeatedly stated: ‘Sleep deprivation’. Dr Johns then became angry and told Dr A that he was sleep-deprived because of her as he had been working nights and only had one day off before starting the weekend day shift on the rota.
"Dr Johns stood up and spoke to Dr A in an aggressive manner, raising his voice and pointing at her as he did so. Dr A informed Dr Johns that he was clearly unfit for work and suggested he go home and they deal with the issue another time. However, when Dr A stood up, Dr Johns stated: ‘So fire me then’ several times and called Dr A obnoxious. Dr A sat down again and asked Dr Johns to do the same but he refused to do so, saying: ‘You can’t talk to me like a school teacher’. Dr Johns continued to speak in an angry manner such that Dr A was frightened and wanted to leave the glass office.
"Dr Johns then said that if Dr A was going to report him to the GMC (General Medical Council) he would report her to the GMC. Upon leaving the office Dr Johns called Dr A obnoxious again and stated she was rude... Dr A asked Dr Johns to give his car keys to Sister Griffiths due to concerns about him driving but he refused to do so. Dr Johns then looked towards Sister Griffiths and she noticed his pupils were very large. From her observations of the incident Sister Griffiths also formed the view that Dr Johns was intoxicated."
In a previous tribunal Dr Johns was alleged to have turned up to work at Merthyr Tydfil's Prince Charles Hospital A&E in 2018 while in an unfit state due to intoxication and sleep deprivation. Those allegations were found proven though Dr Johns said he did not believe he had consumed alcohol before attending work on that occasion.
But in the latest tribunal the panel said they could not be satisfied that Dr Johns was under the influence of alcohol in the 2021 incident. They pointed out that witnesses did not smell alcohol on him or describe his eyes as being glazed over. His "symptoms" could just have been the result of sleep deprivation, they added.
They also took into account the email he sent Dr A at 2.30am, which read: "I’m really sorry about today, and the recent complaints about me doing my best in ridonculous [sic] situations... A&E registrars need more [than] 24 hours recovery going from nights to 9am days. Fact. You know that... Why do A&E registrars get five days off before night shifts instead of any days off after night shifts = insane."
The panel concluded that Dr Johns had turned up to work while unfit and "behaved aggressively in raising his voice, pointing at [Dr A's] head, and making derogatory comments towards her". They then considered whether he was fit to continue practising.
Mr Donoghue, representing the GMC, said Dr Johns' conduct had led to Dr A breaking down in tears at work and having to take time off. But Mr Day, representing Dr Johns, argued that "like many doctors" his client was suffering with exhaustion and attended work hoping he would "perk up", never intending to "cause upset". Dr Johns was off work for a year and a half due to the incident and he has attended courses on burnout and tiredness, Mr Day added.
Mrs Miller said the panel recognised "this was a single isolated incident, which occurred at a particularly stressful time for Dr Johns and the profession as a whole". The panel concluded that his fitness to practise was not impaired although he had "undermined public confidence" and trust in the profession. A warning has been placed on his registration.
Lisa Gostling, of Hywel Dda University Health Board, said: "The individual was not employed by Hywel Dda University Health Board and was engaged as a locum via an agency for a brief period of time. Any required investigation would be conducted by the individual’s agency."
The health board did not answer whether changes had been made to the hospital's working patterns since the incident. You can read more of the latest health stories here.
