Dr Natasha Ranga v General Medical Council

Hearing date: 11 October 2022

Approved Judgment

This judgment was handed down remotely at 3.00pm on 14 October 2022 by circulation to the parties or their representatives by e-mail and by release to the National Archives.

This is a statutory appeal by Dr Natasha Ranga against a Direction of the Medical Practitioners Tribunal (“the Tribunal”) that her name be erased from the Medical Register for misconduct. It is a challenge to sanctions only. The particulars of misconduct were in the following areas:

(i) Dishonesty in submitting two academic exercises that were plagiarised and not her own work;

(ii) Breaching patient confidentiality;

(iii) Dishonesty in communication with another doctor and a patient's solicitor;

(iv) Failure to keep records.

The Appellant challenges the sanction of erasure from the Medical Register on the grounds it was neither necessary nor proportionate for the maintenance of public confidence or otherwise in the public interest.

A relevant history is as follows. FACTS

Between the end of December 2017 and the early days of January 2018 Dr Ranga submitted two essays due, indeed overdue, in respect of her MSc in Medical Leadership at De Montfort University. One was an “education” essay and one was a “research” essay.

It was necessary for her to sign a declaration in respect of each:

“ By submitting this assignment online I understand that I am certifying that this is my own work and that I understand plagiarism is an academic offence. All material in this assignment which is not my own work has been referenced and no material is included which is substantially the same as material I have already submitted for assessment purposes in any other module. I have read and understood the current university document on “Bad Academic Practice” and “Academic Offences.”

In truth, and as subsequently admitted, the Education Essay used a large amount of materials copied and pasted from other sources without attribution. The Research Essay had been procured from a commercial website known as “assignments.com” and had not been written by Dr Ranga.

When the matter was investigated at the University in April 2018 Dr Ranga declined to attend an investigation, but made a written submission. At this point she admitted plagiarism in respect of the Education Essay, but not in respect of the Research Essay which she still maintained was her own work. The Academic Practice Officer at De Montfort University made a decision to the effect that she had acquired and submitted work which was not her own. Eventually, between May and August 2019 she did admit that the Research Essay was written by somebody else. At a Performance Meeting at the University held on 16 May 2019 almost a year and a half later, she had continued to deny wrongdoing in connection with her Research Essay. By the subsequent meeting on 14 August 2019 she admitted the true position.

The Responsible Officer referred the conduct to the General Medical Council (“GMC”). That Responsible Officer was prepared to support the Appellant if she provided evidence of remediation, remorse and understanding. She did not submit any evidence of this to the Officer but she undertook mentoring with three practitioners.

The second set of allegations against Dr Ranga arose out of an entirely different matter.

In February of 2018 a woman known as “Patient C” contacted Dr Ranga on Instagram because she was unhappy about treatment she had received from a practitioner referred to in the proceedings as “Dr D”. She had been offered and received lip fillers and a product called Profhilo on the basis that the latter would reduce hollowness under her eyes. Her communication indicated that her confidence had been shattered — but he did not see things in that way. She explained she had wanted her money back from Dr D. She messaged Dr Ranga to discuss the treatment she had received, asking if Dr Ranga could give her some advice also about reporting somebody who had given incorrect treatment. It would appear that Dr D is a high profile practitioner with a social media following including on television.

Dr Ranga saw Patient C at what was described as an initial appointment on 23 February 2018. It was Patient C's evidence, accepted by the Tribunal, that Dr Ranga told her that the treatment she had received from Dr D was inadequate and/or inappropriate because she now had lumps in her lips and the product Profhilo would not, as she had been told, correct the hollowness under her eyes. Patient C and Dr Ranga did not agree about details of the consultation and what Dr Ranga had said; also, for example, Patient C was clear no one else was present whereas Dr Ranga said her assistant was there. Importantly, Patient C told the GMC that Dr Ranga had told her she was surprised Dr D had used Profhilo, it was generally for older patients and unsuitable for someone of her age. Dr Ranga was sympathetic to her and she was advised by Dr Ranga to complain to the GMC: she understood that Dr Ranga supported her complaint of inadequate treatment.

After this initial consultation, Patient C began proceedings against Dr D. About a year later in March 2019 Patient C contacted Dr Ranga asking her to write a letter/report in support of her claim against Dr D, reflecting their consultation. She wished her to confirm that Patient C had visited Dr Ranga and that her opinion was that Profhilo was not the correct treatment. Dr Ranga replied she could not write a report as “it was just an initial consultation”. At this time, however, on about 11 March 2019, Dr Ranga contacted Dr D on Instagram herself, without having sought or received any consent from Patient C. She said she had consulted with Patient C but had found no abnormalities. On the next day Dr Ranga sent an email to Dr D's solicitor saying again there had been no abnormalities in Patient C's presentation and saying she had advised Patient C to go back and see her “initial injector”. This was repeated in an email to Dr D himself on 6 April 2019.

Just before the trial was due to come on, when witness statements were exchanged, Patient C discovered from the statements, the breach of confidence and what Dr Ranga had said to Dr D. In her evidence Patient C described feeling betrayed and explained that her mental health had suffered as a result.

ADMISSIONS

Dr Ranga admitted before the Tribunal that she knew plagiarism was an academic offence and that she had falsely stated that each of the essays were her own work as set out and knew that that was untrue. She admitted dishonesty in respect of each of the essays.

With respect to the treatment of Patient C, Dr Ranga admitted that she had contacted Dr D by Instagram and had inappropriately confirmed that she had consulted with Patient C and discussed her concerns about Dr D's treatment. She accepted she had failed to obtain consent for disclosing confidential information, and did not tell Patient C that she had contacted Dr D and Ms E. she also admitted she had failed to make, maintain and retain appropriate medical records of her consultation with Patient C. Save as to these admissions she did not make any admission as to what she had said in consultation nor what she had communicated to Dr D and she did not admit that she had been dishonest in the course of these transactions. In the hearing she denied the truth of Patient C's claims about the initial consultation and what was said.

THE TRIBUNAL'S DETERMINATION

The Tribunal, when it came to make its final Determination, found proved that Dr Ranga had informed Patient C that Dr D's treatment was inadequate and/or inappropriate in that there were lumps in her lips, Profhilo would not correct the hollowness of her eyes and had told Patient C she was not an appropriate candidate for it. The Tribunal also found proved that she had emailed Dr D's legal representative Ms E, claiming falsely that she had found no abnormalities in Patient C's presentation and saying, falsely, that she had advised Patient C to go back and see Dr D with her concerns. It was also found against her that she had said, falsely, that her assistant had been present during the Consultation. The allegation that she had falsely said that there were no abnormal findings to Dr D was also proved. In respect of each of these matters, therefore, dishonesty, although not all admitted, was determined against her.

On Dr Ranga's behalf Miss Tanchel who also appears before me today, had accepted that the actions amounted to misconduct and that Dr Ranga's fitness to practice was currently impaired. This she accepted on the basis of the public interest, that is to say the public interest in maintaining high standards and the reputation of the profession.

In considering its Determination on impairment the Tribunal reminded itself there was no burden or standard of proof as such, rather it was a matter of judgement for the Tribunal. They determined independently, consistently with the admission, that fitness to practice was impaired. They reminded themselves they should consider whether the public interest required a finding of impairment, for example where the need to uphold proper professional standards and public confidence in the profession would be undermined if they did not do so, according to the principles set out in CHRE v NMC and Paula Grant[2011] EWHC 927 (Admin).

The Tribunal made express reference to relevant principles set out in Good...