- Dr Bala Kovvali failed to recognise diabetic ketoacidosis
- Andre Fellow had no history of diabetes but his body ran out of insulin
- Kovvali, 64, admitted causing the death by gross negligence
By Anna Edwards
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An out-of-hours doctor has been jailed for two-and-a-half years for manslaughter after he failed to send a seriously ill diabetic man to hospital - diagnosing him as 'depressed with a headache'.
Dr Bala Kovvali ignored the classic signs of diabetes-related poisonous acids building up in 42-year-old Andrew Fellows' body, a court heard.
Instead of dialling 999 for an ambulance, the on-call locum told Mr Fellows' mother that her son was depressed and had a headache and should see his own doctor the next day.
Less than nine hours later Mr Fellows died at home from diabetic ketoacidosis.
Sheffield Crown Court heard how Mr Fellows became thirsty in the week before he died
A test which takes less than a minute would have alerted the GP to raised blood-sugar levels and it is 'virtually certain' Mr Fellows would have survived with an insulin injection and rehydration.
Jailing the doctor Judge Roger Keen told him: 'It was criminal negligence and a wholly preventable death followed.'
Experts who examined the case said any competent doctor would have recognised the classic symptoms of ketoacidosis and Dr Kovvali's breach of duty to his patient was 'appalling and gross.'
It was revealed at Sheffield Crown Court that the GP was based in India but flew to Britain to work every summer for two or three months for the nationwide doctors' deputising service Primecare.
He was arrested in the United States and extradited after a Sheffield coroner adjourned an inquest into Mr Fellows' death for police investigations.
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Father-of-two Kovvali, 64, admitted causing the death of Mr Fellows by gross negligence in failing to carry out an adequate clinical assessment, failing to send Mr Fellows to hospital as an emergency and failing to diagnose diabetic ketoacidosis from which he died.
Michael Burrows QC, prosecuting, said Mr Fellows, who lived with his family in Handsworth, Sheffield had no medical history of diabetes but suffered from anxiety and depression.
In the week before his death, the painter and decorator was working outside and became restless and began drinking huge quantities of water. Both he and his mother Brenda believed he had caught sunstroke.
When her son's condition worsened Mrs Fellows called Primecare at 17.50 on June 4, 2009.
She told a triage nurse her son was 'very muddled and mumbling', his breathing was erratic and his eyes were sunken with his breath smelling odd 'like pear drops.'
She was asked about his depression and replied: 'He had had episodes before but if this is depression I've never seen one as bad as this.'
Dr Kovvali was asked to attend Mr Fellows and arrived at 21.13. Mrs Fellows expected her son to be taken to hospital and had even packed a bag for him.
He had now decided to quit as a doctor and 'will not be working in the UK ever again'?
Mrs Fellows asked if her son was in a coma or had an infection and specifically if he might be diabetic. 'She says Dr Kovvali shook his head to all these questions,' said Mr Burrows.
'According to Mrs Fellows, Dr Kovvali did not have any equipment with him and did not examine her son. He said he was depressed and advised that he should see his own GP the following day for his medication to be reviewed.'
After the doctor left, Mrs Fellows gave her son something to drink but he could not swallow.
He appeared so dehydrated she gave him an ice cube at 1am. She returned at 6am to find him dead in bed.
The court heard Mr Fellows had basically run out of insulin in his body. It switched to burning fatty acids and produced acidic ketones.
When ketones are produced in excess the blood becomes more acidic and blood-sugar levels rise leading to a coma which can be fatal.
Professor of Forensic Medicine Ian Wall, who reviewed the case, said he considered the patient's confusion, thirst, smell, sunken eyes and inability to answer were 'classic symptoms of ketoacidosis.'
Dr Kovvali should have checked sugar levels in the patient's blood or urine and he should have been immediately admitted to hospital 'where he could have been treated or saved.'
Professor Robert Tattersall, a retired professor of clinical diabetes, said the GP's records were 'grossly deficient' and he could and should have measured blood sugar.
'It would have taken less than a minute and shown high blood sugar levels. Dr Kovvali should then have called for for an ambulance as an emergency... the failure to diagnose his condition was the main cause of death.'
Dr Kovvali, who worked as a GP in Sheffield from 1981 to 1988 before returning to India, was arrested in the United States on August 27, 2012 and brought back to the UK.
When questioned he admitted he had a blood-sugar testing kit in his car which he failed to use.
It was clearly criminally negligent and a wholly preventable death followed?
Just a fortnight after Mr Fellows died, Dr Kovvali attended another patient Christopher Timms who had been diagnosed with type 1 diabetes and prescribed insulin.
He felt unwell but the GP told him not to take his insulin as well as failing to examine him or test for ketones.
A consultant said the advice to stop taking insulin was 'wholly inappropriate' and lack of insulin would have put the patient 'in a life-threatening situation in a matter of hours.'
In a victim impact statement Mrs Fellows said that to test her son's blood 'would have been such a small thing to do but that one small thing would have saved her son's life.'
Stephen Climie QC, defending, said the doctor had 'misdirected' himself.
He had a particular interest in mental health matters and coupled with Mr Fellows not taking his medication it led him to rule out diabetes as a risk factor.
He qualified as a doctor in India in 1973 and came to the UK a year later. He completed his training before becoming a GP and had been subject to appraisals in the years leading up to these events. 'He is not allowed to practise without supervision,' said Mr Climie.
He had now decided to quit as a doctor and 'will not be working in the UK ever again.' His wife back in India was ill and lived alone and had been badly affected by his arrest.
Judge Keen told Kovvali: 'You have devoted your working life to caring for others. I have seen glowing references as to your competence, empathy and thoughtfulness.
'It is a tragedy for you that this brought about an end to your career, destroyed your good character and your ability to work in this country.'
He went on: 'However the nature of your offending is too serious for anything other than a custodial sentence.
'You failed to recognise Mr Fellows' condition despite the fact that all the classic signs of a diabetic condition were present.'
He had opted for a diagnosis that was contrary to all the evidence. 'That was a gross breach of your duty of care,' said the judge. 'An expert has called your decision appalling. I agree. It was clearly criminally negligent and a wholly preventable death followed.'
After the hearing Mrs Fellows said: 'We want everyone to know how much we loved Andrew. He was a loving son, brother, grandson, uncle, nephew and cousin and his death has caused a huge hole in the lives of everyone who knew him.
'He was honest and upright, funny and sensitive. He loved science and nature and was very proud of the fact that he got a BSc degree later in life.
'He was known to his friends as "Fell" and was described by them as the man with the hundred watt smile.'
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