PUBLIC RECORD. Record of Determinations. Medical Practitioner: Date: 20/07/2017. GMC reference number: Lahore. Impaired

Transcription

1 PUBLIC RECORD Date: 20/07/2017 Medical Practitioner s name: GMC reference number: Primary medical qualification: Type of case Review - Deficient professional performance Summary of outcome Conditions, 18 months. Review hearing directed Tribunal: Legally Qualified Chair Medical Tribunal Member: Medical Tribunal Member: Dr Haseeb BABAR MB BS 2009 University of Health Sciences Lahore Outcome on impairment Impaired Mr Damian Cooper Dr Alison Graham Dr Jill Edwards Tribunal Clerk: Ms Sarah Ryan Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and not represented N/A Mr Paul Williams, Counsel Attendance of Press / Public The hearing was all heard in public. 1

2 Determination on Impairment - 20/07/2017 Dr Babar: Background 1. The tribunal does not intend to rehearse the full factual background to your case, as this is set out in previous determinations. The 2015 Panel 2. This is your second review hearing. Your case was first considered by a Fitness To Practise Panel which concluded in July 2015 ( the 2015 Panel ). Misconduct 3. The 2015 Panel found dishonest conduct in relation to your interaction with colleagues when your wife had been present at the hospital where you worked. It also found that you had failed to comply with your interim order conditions and that you had failed to engage with education and training. Deficient Professional Performance 4. Between 27 and 29 October 2014 you underwent the 'tests of competence' section of a GMC Performance Assessment. Your professional performance was found to be "unacceptable' in the following areas: a. maintaining professional performance; b. assessment. 5. Your professional performance was found to be a "cause for concern' in the following areas: a. clinical management; b. operative/technical skills; c. working with colleagues. 6. The 2015 Panel determined that your fitness to practise was impaired by reason of your misconduct and deficient professional performance. It determined to suspend your registration for a period of six months The 2016 Tribunal 7. Your case was next reviewed by a in January 2016 ( the 2016 Tribunal ). 2

3 Misconduct 8. The 2016 Tribunal was satisfied that since the previous hearing you had demonstrated insight into your misconduct, engaged with your regulator, and shown a willingness to engage in remediation. It noted that there had been no repetition of the misconduct which brought you to the attention of the GMC and it was satisfied that you were unlikely to repeat your misconduct in the future. Furthermore, the 2016 Tribunal noted that the finding of impairment was made in order to declare and uphold proper standards and maintain public confidence in the medical profession. In all the circumstances, it determined that your fitness to practise was no longer impaired by reason of your misconduct Deficient Professional Performance 9. The 2016 Tribunal noted that the deficiencies found proved by the 2015 Panel were serious and wide-ranging, and included shortcomings in skills that are fundamental for a doctor. Furthermore, it was noted that you scored 25% in the knowledge test, which was the lowest score seen by the performance assessor in his 15 years of experience. 10. Whilst the 2016 Tribunal accepted that you had a positive attitude towards remediation, it was of the view that you had not provided sufficient and satisfactory evidence that your professional performance had met the required standard to practice safely. Accordingly, the 2016 Tribunal determined that your fitness to practise was impaired by reason of your deficient professional performance. It determined to impose conditions on your registration for a period of 18 months. 11. The 2016 Tribunal considered that today s tribunal would be assisted by receiving: Results of any knowledge test undertaken A personal development plan A reflective statement Evidence of weekly meetings with his supervisor(s) Reports from clinical supervisor(s) and educational supervisor(s) Evidence of continued professional development to include work based assessments and case based learning Testimonials from patients and colleagues Any other evidence you considered would assist a reviewing Tribunal. 3

4 Evidence Documentary Evidence 12. The tribunal had regard to an from you to the GMC dated 11 May 2016, which enclosed a Personal Development Plan ( PDP ) for the period February to May The tribunal had regard to an from you to the GMC dated 21 April 2017, which enclosed a PDP for the period February 2016 to April 2017, and an undated reflective statement. 14. The tribunal had regard to an from you to the GMC dated 21 June This enclosed two certificates confirming that: On 5 March 2016, you participated in the ECG Survival Training Course and, On 16 February 2017, you completed the Acute Life-Threatening Events Recognition And Treatment (ALERT) Course. 15. The tribunal had regard to a document showing your results for Part 1 of the Membership of the Royal Colleges of Physicians of the United Kingdom ( MRCP ) exam and your MRCP exam history. 16. The tribunal had regard to an printout of your Oriel account, which listed job applications undertaken by you between May 2016 and June 2017 GMC Submissions 17. Mr Williams, on behalf of the GMC, submitted that you have made efforts to address your deficient professional performance, but that the level of engagement, insight, and reflection demonstrated by you has only scratched the surface. Mr Williams stated that the evidence you have provided for this hearing does not indicate a level of self-analysis that is required to be assured that your fitness to practise is no longer impaired. 18. Mr Williams submitted that as you have been out of work since the last hearing, you have been unable to meet some of the requirements set out by the previous tribunal, such as providing reports from an educational and clinical supervisor. Mr Williams stated that whilst no blame is apportioned to you for this situation, it has had a practical impact in that you have not been able to work under the supervision of senior practitioners who could guide you and assist you in improving your clinical skills. He added that you have not taken a knowledge test, however you are not to blame for this the test is not undertaken in isolation, but rather is part of a wider package, and was not required by the GMC at this time. 4

5 19. Mr Williams submitted that, for all of the above reasons, your fitness to practice remains impaired by reason of your deficient professional performance. Your Submissions 20. During the course of your submissions, you drew the tribunal s attention to your reflective statement. 21. You submitted that it has been a difficult time for you since the last hearing, but that you realised that you needed to move on and address your deficient professional performance. 22. You submitted that you have made efforts to address the deficiencies in your clinical knowledge. You stated that that you have taken Part 1 of the MRCP exam twice this year and although you have been unsuccessful at both attempts, your scores have significantly improved, 402 to 487 respectively. You stated the most recent score is evidence that you have improved in your preparation for the test. You stated that you have booked another test for September 2017 and hope to obtain the required score of You submitted that, since the last hearing, you have applied and interviewed for several jobs in the UK over the last 18 months, but have been unsuccessful. You drew the tribunal s attention to evidence of your job applications. You stated that that the reason you have not been able to find work for this is that the current conditions imposed on your registration stipulate that you must work in training posts at the level of FY1 and FY2, but that you have had difficulty in securing these posts. 24. You submitted that your fitness to practise remains impaired, but that you wish to prove yourself as a doctor and make a fresh start. Application for evidence to be given by telephone 25. During the hearing, you made an application for your wife, Dr A, to give oral evidence on your behalf by telephone. 26. Mr Williams, on behalf of the GMC, did not oppose the application. 27. The tribunal granted the application under Rule 34(13) and (14) of the General Medical Council (Fitness to Practise) Rules 2004 (as amended)(the Rules). Oral evidence 28. In her oral evidence, Dr A stated that since the last hearing, you have made efforts to remediate your deficient clinical knowledge. She stated that you have 5

6 studied hard and prepared adequately for the MRCP exams, and although you have so far been unsuccessful, you have applied to take the test again later this year. Dr A stated that the MRCP is far beyond the knowledge base of a Foundation Year (FY) doctor and stated that your scores have improved significantly in your most recent test. 29. Dr A stated that you have been applying for jobs but that you have been unsuccessful. She stated that the reason for this is that the current conditions imposed on your registration stipulate that you can only work in training posts, which are, in her view, scarce in the UK and are difficult to attain when you are subject to conditions on your registration. 30. Dr A stated that your fitness to practise remains impaired, but that you will not be able to fully address your deficient clinical performance until you are back in practise. She stated that you should be given the opportunity to apply for nontraining posts with supervision. The Tribunal s Decision 31. Whilst the tribunal has taken into account all of the evidence before it, as well as submissions made during the course of the hearing, the decision as to whether your fitness to practise is currently impaired is a matter for this tribunal exercising its own judgement. In so doing, the tribunal has borne in mind that its statutory overarching objective is to ensure the health, safety, and wellbeing of the public, the promotion and maintenance of public confidence in the profession, and the promotion and maintenance of proper standards of conduct and behaviour. 32. The tribunal first considered whether you have complied with the conditions which were imposed on your registration by the 2016 Tribunal, in accordance with Rule 22(f) as follows: (f) the shall consider and announce its finding on the question of whether the fitness to practise of the practitioner is impaired or whether the practitioner has failed to comply with any requirement imposed upon him as a condition of registration, and shall give its reasons for that decision; 33. The tribunal noted that it has heard no submissions, nor has it been provided with any evidence to indicate that you have failed to comply with the conditions. It was satisfied that you have sought to engage with the conditions by the production of a PDP and a reflective statement, however it was of the view that these were of a superficial standard. The tribunal was otherwise satisfied that you have complied with the conditions to the extent that you were able, in terms of applications for training posts. 6

7 34. The tribunal next considered whether you have provided sufficient and satisfactory evidence that you have addressed your deficient professional performance. In so doing, it had regard to the material which the 2016 Tribunal considered would assist it in today s review. 35. You have provided a PDP, a reflective statement, two CPD certificates, as well as evidence of job applications and tests taken by you. The tribunal was of the view that this evidence was lacking in terms of quality and breadth, and gave only cursory attention to the clear and detailed requirements set out by the 2016 Tribunal. 36. The tribunal then considered your level of insight. It noted that the 2016 Tribunal was concerned that you lacked full insight into the seriousness of the deficiencies identified in the performance assessment. The tribunal had regard to the evidence and submissions made by you, as well as the oral evidence given by Dr A. The tribunal noted that you have made efforts to improve your clinical knowledge by reading and online education. However, there was no evidence presented to it of the volume, content, or level of achievement, except in relation to Part 1 of the MRCP exam. It was therefore of the view that you continue to lack full insight. 37. The tribunal recognises that you have faced difficulties in gaining employment, and therefore have been unable to provide evidence such as supervisor reports or testimonials. However, it was of the view that this evidence could have been produced by another means, for example, by securing a clinical attachment which included supervision, or by seeking out Locum Appointments for Training posts (LATs). The tribunal noted that you have not undertaken a further GMC knowledge test, but accepted Mr William s submissions that this is a matter that has been out of your control. 38. Taking all of the above into consideration, the tribunal determined that it has insufficient evidence before it to indicate that you have fully addressed the serious and wide-ranging deficiencies found proved by the 2015 Panel. 39. Accordingly, the tribunal has determined that your fitness to practise remains impaired by reason of your deficient professional performance. Determination on Sanction - 20/07/2017 Dr Babar: 1. Having determined that your fitness to practise is impaired by reason of your deficient professional performance, the tribunal has now considered what action, if any, it should take with regard to your registration. 7

8 2. In so doing, the tribunal has given careful consideration to all the evidence adduced, including the submissions from Mr Williams, on behalf of the GMC, and those made by you. GMC Submissions 3. Mr Williams submitted that, given the tribunal s findings, the appropriate and proportionate sanction in this case is a further period of conditions. He submitted that such a sanction would protect patients and maintain public confidence in the profession. Submissions on your behalf 4. You submitted that you are discouraged that the tribunal has determined that your fitness to practise remains impaired, particularly its determination that you continue to lack insight. You stated that this is a finding which has been found in previous hearings, despite efforts demonstrated by you to remediate the deficiencies in your clinical performance. You submitted that you would benefit from clearer instructions on what is needed in order to demonstrate that you have full insight. You submitted that you should be permitted to seek employment in non-training posts. The Tribunal s approach 5. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this tribunal exercising its own judgement. 6. In reaching its decision, the tribunal has taken account of the Sanctions Guidance (May 2017 edition). It has borne in mind that the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect. 7. Throughout its deliberations, the tribunal has applied the principle of proportionality, balancing your interests with the public interest. It has taken account of the statutory over-arching objective, which includes the protection of the public, the maintenance of public confidence in the profession, and the promoting and maintaining of proper professional standards and conduct for members of the profession. 8. The tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction. 8

9 No Action 9. In coming to its decision as to the appropriate sanction, if any, to impose in your case, the tribunal first considered whether to conclude the case by taking no action. Taking no action following a finding of impaired fitness to practise would only apply in exceptional circumstances. The tribunal determined that, in view of the tribunal s findings on impairment, it would be neither sufficient, proportionate nor in the public interest, to conclude this case by taking no action. Conditions 10. The tribunal next considered whether it would be sufficient to impose conditions on your registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 11. The tribunal had regard to paragraphs 81 and 82 of the Sanctions Guidance, in which it states: 81 Conditions might be most appropriate in cases: a involving the doctor s health b involving issues around the doctor s performance c where there is evidence of shortcomings in a specific area or areas of the doctor s practice d where a doctor lacks the necessary knowledge of English to practise medicine without direct supervision. 82 Conditions are likely to be workable where: a the doctor has insight b a period of retraining and/or supervision is likely to be the most appropriate way of addressing any findings c the tribunal is satisfied the doctor will comply with them d the doctor has the potential to respond positively to remediation, or retraining, or to their work being supervised. 12. The tribunal noted that you have been out of clinical practice for a period exceeding four years. It was concerned by your submission that you should be permitted to apply for clinical posts other than training posts, following such a period 9

10 away from clinical practice. It was of the view that this submission, in itself, demonstrated that a deeper level of insight is needed by you in order to fully address the deficiencies identified. The tribunal would encourage you to continue to apply for foundation and LAT posts throughout the coming year. 13. The tribunal was also concerned at your submission that you expect to be in the same position as you are now, and were at the 2016 Tribunal, at the end of any future period of conditions. The tribunal believes that this need not be the case and that it is within your gift to change the course of events, with appropriate third party support. 14. The tribunal was satisfied that the current conditions imposed on your registration are, on the whole, appropriate, proportionate, workable, and measurable. However, it took account of the difficulties that you stated you have had in finding a supervisor who could assist you with and approve your PDP. It was of the view that it was possible to formulate a set of conditions which could adequately address this issue. 15. The tribunal therefore determined that a period of conditional registration would be a sufficient, appropriate, and proportionate sanction to protect members of the public and to maintain public confidence in the profession. It concluded that a further period of 18 months would allow you the opportunity to further develop your insight and address the deficiencies in your professional performance. 16. The following conditions relate to your employment and will be published: 1. You must notify the GMC of the details: a. of any post you are offered, including your job title, job location and the responsible officer (or their nominated deputy) before you accept such a post; b. of the contact details of your employer and/or contracting body, including your direct line manager; c. of any organisation where you have practising privileges and/or admitting rights; d. of any training programmes you are in; e. of any formal disciplinary proceedings against you are started by your employer and/or contracting body, within seven calendar days of being formally notified of such proceedings; f. if you apply for a post outside the UK. 10

11 2. You must allow the GMC to exchange information with any person involved in monitoring your compliance with YOUR conditions. 3. a. You must have a workplace reporter approved by your responsible officer (or their nominated deputy) and must inform the GMC of these arrangements. b. You must not start/restart work until your responsible officer (or their nominated deputy) has approved your workplace reporter and this approval has been forwarded to the GMC. 4. a. You must design a personal development plan (PDP), approved by your responsible officer (or their nominated deputy). If you do not have a responsible officer, you may identify another suitable person with the necessary expertise to fulfil this role, subject to their agreement, such as the Head of Foundation School, Director of Medical Education or Dean (or their nominated deputy). The PDP must be designed with specific aims to address the deficiencies in the following areas of your practice: maintaining professional performance, assessment, clinical management, operative/technical skills, working with colleagues. b. You must give the GMC a copy of your approved PDP within three months of these conditions becoming effective. c. You must give the GMC a copy of your approved PDP on request. d. You must meet with your responsible officer (or their nominated deputy) or alternative suitable persons, as required, to discuss your achievements against the aims of your PDP. 5. a. You must have an educational supervisor approved by your responsible officer (or their nominated deputy) and must inform the GMC of these arrangements. b. You must not start/restart work until your responsible officer (or their nominated deputy) has approved your educational supervisor and this approval has been forwarded to the GMC. 6. a. You must only work in a Foundation level training post. b. You must not work as a locum, except in an approved LAT post. 11

12 7. a. You must be closely supervised in all of your posts by a clinical supervisor, as defined in the Glossary for undertakings and conditions. Your clinical supervisor must be approved by your responsible officer (or their nominated deputy) and you must inform the GMC of these arrangements. b. You must not start/restart work until your responsible officer (or their nominated deputy) has approved your clinical supervisor and this approval has been forwarded to the GMC. 8. You must inform the GMC before working: a. as a locum / in a fixed term contract b. out-of-hours b. on-call. 9. You must undertake an assessment of your performance, on a date given by the GMC, unless notified by the GMC that this assessment is not necessary. 10. You must inform the following persons of the conditions listed at [1] to [9]: a. your employer and/or contracting body b. your responsible officer (or their nominated deputy) c. your immediate line manager at your place of work, at least 24 hours before starting work (for current and new posts including locum posts) d. any prospective employer and/or contracting body, at the time of application e. the responsible officer of any organisation where you have, or have applied for, practising privileges and/or admitting rights, at the time of application. Suspension 17. The tribunal did consider whether to suspend your registration. It determined that, at this juncture, this would be an inappropriate and disproportionate sanction. 12

13 Review hearing 18. The tribunal has directed that, shortly before the end of the period of conditions, your case will be reviewed by a. It considered that a future tribunal reviewing this matter would be assisted by: Results of any performance assessment undertaken A personal development plan based upon the advice and guidance of a senior clinician/suitable person which will seek to address the issues concerning your deficient professional performance A reflective statement that demonstrates depth of insight and the need for remediation. Evidence of weekly meetings with your supervisor(s) Reports from clinical supervisor(s) and educational supervisor(s) Evidence of continued professional development to include work based assessments and case based learning Testimonials from patients and colleagues Any other evidence you consider would assist a reviewing Tribunal. 19. Unless you exercise your right of appeal, this decision will take effect 28 days from when written notice of this determination is deemed to have been served upon you. The conditions currently imposed on your registration will remain in effect until the appeal period has concluded. If you decide to exercise your right of appeal the sanction currently imposed on your registration will remain in effect until the outcome of the appeal has been decided. 20. That concludes this case. Confirmed Date 20 July 2017 Mr Damian Cooper, Chair 13