Fitness to Practise Panel of the General Medical Council hearing 8 February 2011 and 3 March 2011
This is a review case of impairment by reason of misconduct. The Panel was reminded of the background to the case.
On 7 July 2004, whilst the doctor was working as a consultant surgeon, he performed an upper component incisional hernia on patient A. When the patient was transferred to another hospital, he did not speak to the consultant who took over the care of the patient and he did not provide an adequate operation note at the time of the transfer. There as an investigation into the patient’s treatment and the doctor agreed that until the investigation was complete, he would not perform any clinical or practical procedures at the Trust or in private practice. Between August 2004 and March 2006, he performed clinical or practical operative procedures at a different hospital.
On 4 June 2009, a GMC Fitness to Practise Panel found that the doctor’s fitness to practise was impaired and imposed 7 conditions. The case was reviewed on 4 May 2010 and the Panel found that due to the seriousness of the misconduct, the doctor’s fitness to practise remained impaired. The Panel also expressed concerns about the doctor’s de-skilling as a result of his time away from active surgical practise. The Panel varied the conditions on the doctor’s registration and set out the information it felt would benefit future Panels when they reviewed his case. This was:-
1. Documentary evidence of any courses you have attended as part of your CPD [ ] review.
2. A report from your workplace supervisor about your progress under supervision and the progress you have made in relation to your refresher training.
3. Information from your employer as to your conduct and behaviour in the intervening period of the conditions becoming effective and the review hearing.
4. Information from the medical department of the Civil Aviation Authority as to your conduct and behaviour in the intervening period of the conditions becoming effective and the review hearing.”
The doctor had begun work as an honorary consultant surgeon on 6 August 2010. The doctor had provided workplace report forms from a consultant surgeon and his workplace supervisor. The consultant surgeon stated that the doctor had complied with the conditions on his registration and that he was not aware of any complaints regarding the doctor. There was also a letter dated 28 January 2011 from the medical staffing supervisor at the hospital who stated that there was no issues about the doctor’s conduct.
The doctor gave evidence saying that he enjoyed his work. He felt that he was making progress. He felt that he would be able to work unsupervised within a number of weeks, but that this had not yet been confirmed by his supervisor.
The doctor said that he now wrote a note of every operation he carried out and included this in the patient’s notes prior to them arriving on the ward. He explained that his contract at the hospital had expired, but that he had been asked informally to stay on to cover holiday leave for other surgeons.
Counsel for the GMC submitted that the doctor was not yet ready to practise without supervision.
Counsel for the doctor submitted that his fitness to practise was no longer impaired and that the conditions should be allowed to expire. He reminded the Panel that the original finding of impairment related to misconduct. He stated that the doctor had complied with all of his conditions. He also submitted that the doctor’s position was comparable to that of the doctor returning to medical practise following maternity leave or an injury, and no-one would suggest the fitness to practise of a doctor in that situation was impaired.
The Panel stated that it was disappointed that the reports did not directly address the concerns about the doctor’s fitness to practise. The Panel also noted that there was no confirmation from the doctor’s medical supervisor that he was safe to practise unrestricted as a consultant surgeon. The Panel found that in the absence of adequate evidence from the doctor’s supervisor, it could not be satisfied that all the concerns of the original Panel had been addressed.
The Panel therefore determined that the doctor’s fitness to practise remained impaired by reason of his misconduct. The Panel then considered sanction.
Determination on sanction
The Panel applied the principle of proportionality, weighing the public interest against the doctor’s own interests. They recognised that the purpose of sanctions is not to be punitive, although they may have a punitive effect, but to protect patients and the wider public interest. The Panel considered taking no action against the doctor. However, as the doctor still required supervision during his clinical work, they made the decision that action should be taken.
The Panel determined that to continue to conditions on the doctor’s registration would be sufficient. It determined that they should be extended for a period of 6 months. This would give the doctor an appropriate amount of time to demonstrate that he can practise independently as a consultant surgeon whilst protecting patients and the winder public interest. Conditions are:-
- He must notify the GMC promptly of any post he accepts for which registration with the GMC is required and provide the GMC with the contact details of his employer.
- At any time that he is employed, or providing medical services, which require him to be registered with the GMC, other than work as an aero medical examiner for the UK Civil Aviation Authority, he must agree to the appointment of a workplace supervisor, approved by the GMC. The supervisor must oversee his performance at work and agree to provide regular reports to the GMC.
- He must allow the GMC to exchange information with his employer, or any organisation for which he provides medical services, and any individual involved in his re-training and supervision.
- He must inform the GMC of any formal disciplinary proceedings taken against him, from the date of this determination.
- He must confine his medical practise to posts:
- Within the NHS geared towards providing him with appropriate refresher training; and/or
- As an aero medical examiner for the UK Civil Aviation Authority.
- He must inform the following parties that his registration is subject to the conditions, listing at 1 – 5 above;
- Any organisation or person employing him to undertake medical work;
- Any prospective employer (at the time of application).