Health Service OmbudsmanA London GP practice did not give a young man with severe learning disabilities, behavioural problems and epilepsy the medication he needed on the grounds of cost and ignored disability discrimination law in the process, according to a report by the Health Service Ombudsman.

The case stemmed from an incident in April 2011, when the mother of the young man – known as Mr H for legal reasons – asked her GP practice for a repeat prescription of midazolam in liquid form to help her son’s epilepsy. The GP refused this request, saying that it was too expensive and he would only prescribe her son suppositories or tablets in future. However, Mr H’s mother, known only as Ms B, advised the GP her son had only been prescribed liquid medicine from a very young age, as his learning disabilities caused him to become very distressed if he had to swallow tablets.

But Ms B was told by the GP to “find a GP with bigger budgets who would be happy to prescribe the medications”.

The Ombudsman’s investigation found service failure by the practice – and specifically that they failed to consider their obligations under disability discrimination law, and didn’t follow accepted medical guidelines. GMC guidance sets out that when prescribing medicines doctors must ensure that the prescribing is appropriate and responsible and in the patient’s best interests. It also states that doctors should, when appropriate, ‘establish the patient’s priorities, preferences and concerns’ and ‘discuss other treatment options with the patient’.

Health Service Ombudsman, Julie Mellor, said: “This is yet another case where someone with learning disabilities has been failed. When there are failures in the care and treatment of people with learning disabilities, there are consequences in terms of their health and in too many cases, their life expectancy.

“In this instance, the decision not to prescribe suitable medication was one based on cost alone – and that can’t be right. Proper consideration of the patient’s best interests would have meant carrying on this young man’s usual prescription. This case is particularly worrying because the preference and concerns of this young man’s mother about his medication were ignored, as was the Mental Capacity Act. 

“One size does not fit all and doctors should carefully consider the impact on the patient when making decisions about care and treatment. The recommendations made by the confidential inquiry into premature deaths of people with learning disabilities are particularly relevant to this case. Regular training of health staff on the Mental Capacity Act, as recommended by the inquiry, would be a great place to start. And we are pleased to see the Department of Health in their response to this inquiry taking this issue seriously and recommending that advice on the Mental Capacity Act be easily available 24 hours a day.”