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GMC v Dr Chumroo

Fitness to Practise Panel Hearing 18-19 February 2009

GMC v Dr Chumroo

Representation:

GMC: Ms N Bruce, GMC Counsel represented the General Medical Council.

Doctor: Dr Chumroo was present and was represented by Mr A Hockton, Counsel instructed by George Dodd Solicitors.

Allegation

“That being registered under the Medical Act 1983, as amended,

  1. Between 4 February 2004 and 31 July 2007 you were employed as a Senior House officer at the Swansea NHS Trust (“the Trust”); Admitted and Found Proved
  2. On a date between 17 September 2007 and 12 November 2007 you submitted a document to the Educational Commission for Foreign Medical Graduates which,
    1. Purported to have been generated by the Trust, Admitted and Found Proved
    2. Misrepresented the work that you had experienced at the Trust; Admitted and Found Proved
  3. Your actions in submitting the document at 2. above were,
    1. Misleading, Admitted and Found Proved
    2. Dishonest; Admitted and Found Proved

And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct.

Determination on facts and impaired fitness to practise

Dr Chumroo

At the outset of these proceedings Mr Hockton, on your behalf, made a number of admissions. The Panel therefore recorded allegations 1, 2a, 2b, 3a and 3b as admitted and found proved.

The Panel has considered, on the basis of the allegations admitted and found proved, whether your fitness to practise is impaired pursuant to Section 35C (2) (a) of The Medical Act 1983, as amended, by reason of your misconduct. In doing so, it has taken into account the Indicative Sanctions Guidance, in so far as it deals with the meaning of Fitness to Practise, and has noted the advice of the legal assessor that a finding of impairment is a matter for the professional judgement of the Panel.

The Panel has borne in mind that it has a duty to protect the public interest, which includes the protection of patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour.
The Panel has considered all the oral and documentary evidence that has been presented to it, including the submissions made by Mr Hockton, on your behalf, and those made by Ms Bruce, on behalf of the General Medical Council. For the avoidance of doubt the Panel has had no regard to the documents that were erroneously sent to it prior to the hearing.

Ms Bruce has submitted that given the clear admission of dishonest conduct your fitness to practise is impaired by reason of your misconduct. Mr Hockton submitted that when considering whether your fitness to practise is impaired the Panel should take into account the following factors:

  1. you made a full admission of dishonesty both at the outset of this hearing and when first approached by the GMC;
  2. you realised shortly after submitting the document that you had acted wrongly and you sought to withdraw the application;
  3. your personal circumstances; and
  4. the positive bundle of testimonials which demonstrate that you have informed others of your actions and have learnt appropriate lessons.

The Panel has heard that between 4 February 2004 and 31 July 2007 you were employed as a Senior House Officer at the Swansea NHS Trust (“the Trust”). On a date between 17 September 2007 and 12 November 2007 you submitted a document to the Educational Commission for Foreign Medical Graduates which purported to have been generated by the Trust. In that document you misrepresented the work that you had undertaken at the Trust. You have accepted that your actions in submitting the document were both misleading and dishonest.

The Panel has considered the circumstances that you state led to your misconduct and your actions since the misconduct occurred. You have apologised for your actions and have accepted that your conduct was improper and inexcusable. Your dishonest conduct cannot however be justified.

The Panel has a duty to maintain public confidence in the profession. It takes a serious view of your dishonest conduct. You made a calculated attempt to deceive, which involved physical manipulation of the document. In your deception you represented yourself as having gained experience in several fields of clinical work, in the full knowledge that you had never actually undertaken such work. This was potentially very dangerous as it could have clearly led to patients being at risk of harm.

Doctors occupy a position of privilege and trust in society and are expected at all times to be honest and open and act with integrity. They must make sure that their conduct at all times justifies both their patients’ and the public’s trust in the profession.
Good Medical Practice (2006 – applicable at the time) states at paragraphs 63-65:

“You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.
You must always be honest about your experience, qualifications and position, particularly when applying for posts.
You must do your best to make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents, and that you must not deliberately leave out relevant information.”

In the light of its findings, and in particular the finding of dishonesty, it has concluded that your fitness to practise is impaired by reason of your misconduct.

The Panel will now invite further submissions, under Rule 17(2)(l), from Ms Bruce and Mr Hockton, as to the appropriate sanction, if any, to be imposed on your registration. Submissions on sanction should include reference to the Indicative Sanctions Guidance, using the criteria as set out in the guidance to draw attention to the issues which appear relevant to this case.

Determination on sanction

Dr Chumroo:

The Panel has already determined that your fitness to practise is impaired by reason of your misconduct.

The Panel has considered what action, if any, to take in relation to your registration. It has noted the submissions made by Ms Bruce, on behalf of the General Medical Council (GMC) and those made by Mr Hockton, on your behalf. Ms Bruce has invited the Panel to consider making a direction suspending your registration whilst Mr Hockton has invited the Panel to impose a period of conditional registration.

The Panel has borne in mind that any sanction imposed must be proportionate and appropriate, and that its purpose is not to be punitive, but to protect members of the public and the public interest. The public interest includes not only the protection of patients, but also the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. The Panel has taken into account the Indicative Sanctions Guidance published by the GMC. It recognises that the decision on sanction is a matter for the Panel exercising its own judgement.

The Panel has carefully considered all the relevant issues in this case. It is aware that your registration is currently suspended as a result of an interim order and has not been informed of any other formal proceedings being taken against you by the GMC. It has noted that your dishonest conduct occurred on a date between September 2007 and November 2007 and that there is no evidence of misconduct since then. There is also no evidence before the Panel to demonstrate that your misconduct caused any direct harm to patients.

The Panel has noted your account of the emotional problems that you were experiencing at the time of your dishonest conduct and the difficulties that you envisaged were likely to arise in securing suitable employment. You have accepted that whilst this may, to some extent, explain your behaviour it did not excuse it or provide a defence for your dishonest conduct.

The Panel has taken account of the bundle of supportive testimonials from professional colleagues. The testimonials suggest that your conduct was out of character and that you are considered to be a competent, hardworking, and well-respected doctor. It also took into account the oral evidence of Dr M, Medical Director at Lake Districts Health Board, New Zealand. Dr M confirmed that he has been acting as your supervisor since March 2008. In his evidence Dr M stated that he considered you to be an honest man with a promising future and his testimonial states:

“My personal view is that Dr Chumroo is a good doctor, an improving doctor, and that he has developed insight and has learnt a big lesson. I believe that he is doing sufficient to warrant further opportunity to redeem himself…….”

In its deliberations on sanction, the Panel considered whether it would be appropriate and proportionate to conclude your case without imposing any sanction. However it determined, having taken into account all the matters raised in mitigation, that in the light of the seriousness of the matter, such a course of action would be wholly insufficient.

The Panel next considered whether to place conditions on your registration. The Panel is mindful that any conditions imposed must be appropriate, proportionate, measurable and workable. The Panel determined that, while it may be possible to frame conditions around your understanding of your dishonest action, the seriousness of your misconduct makes the imposition of conditions inappropriate and disproportionate.

The Panel then went on to consider whether a period of suspension would be an appropriate and proportionate sanction.
The Panel has considered the references to dishonesty and sanctions in the GMC’s Indicative Sanctions Guidance, the GMC’s publication ‘Good Medical Practice’ and the relevant case law. Dishonesty, even where it does not result in direct harm to patients, is particularly serious because it undermines the trust that the public places in the profession. The public is entitled to expect that a doctor is fit to practise and follows the GMC’s principles of good practice detailed in Good Medical Practice, which sets out the standards of competence, care and conduct expected of all doctors. The Panel would wish to make clear that it will not tolerate such a breach of professional standards with which all doctors are expected to comply. However, the Panel finds that your misconduct constituted an isolated incident and that there is no significant risk that it will be repeated. The Panel accepts that you have shown contrition and remorse for your actions and that you have learnt from this experience. The Panel finds that you do not display evidence of harmful deep-seated personality or attitudinal problems.

The Panel determined that a period of suspension would be an appropriate and proportionate sanction to protect patient safety and the public interest.

The Panel then considered what period of suspension would be appropriate. The period imposed must be sufficient to mark the Panel’s disapproval of your conduct, maintain public confidence, and send to the public and the profession a clear message about the standard of behaviour required and in particular that medical practitioners must be honest and trustworthy.

The Panel has taken into account the matters that have been adduced as mitigation. It has noted that you realised shortly after submitting the document that you had acted wrongly and sought to withdraw the application. You also made a full admission of dishonesty both when first approached by the GMC and at the outset of this hearing. The Panel has noted that you have apologised for your behaviour and have shown insight into your misconduct.

Having considered all the circumstances of your case the Panel has determined that it is appropriate and proportionate to direct the Registrar to suspend your registration for a period of six months. It considers that a suspension for a longer period would be disproportionate and would potentially deprive the public of the services of an otherwise competent and dedicated doctor who has shown genuine remorse.

The Panel next considered whether it would be necessary to review your case before the end of the period of suspension. The Panel does not consider there are any patient safety issues or that any useful purpose would be served by reviewing your case at the end of the period of suspension. The Panel would however recommend that during the period of suspension you take sufficient steps to ensure that your medical knowledge is kept up to date.

The effect of the foregoing direction is that, unless you exercise your right of appeal, your registration will be suspended for a period of six months commencing twenty-eight days after formal notice of this direction is deemed to have been served upon you. A note explaining your right of appeal will be provided to you.

Having directed that your registration should be suspended, the Panel must now consider whether it is necessary to order that your registration be suspended forthwith. The Panel invites submissions on this matter.

Determination on immediate sanction

Dr Chumroo:

Having directed that your registration should be suspended, the Panel has considered in accordance with Section 38 of the Medical Act 1983, as amended, whether your registration should be suspended forthwith.

Ms Bruce, on behalf of the General Medical Council (GMC), has invited the Panel to suspend your registration immediately and to revoke the interim order that is currently on your registration. Mr Hockton has submitted that it is not necessary for the suspension to be imposed forthwith.

The Panel has determined that it is not necessary for the protection of members of the public, nor in the public interest, nor in your interests to make an order suspending your registration forthwith. In coming to this decision the Panel took into account that there are no patient safety issues. It is of the view that the public interest is sufficiently protected by the direction that your registration be suspended for a period of six months.

The Panel has also determined that the interim order should be revoked forthwith.

The substantive direction for suspension, as already announced, will take effect twenty-eight days from the date when notice is deemed to have been served on you, unless you lodge an appeal.

That concludes this case.

Confirmed

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