Dr. Purabi Ghosh v The General Medical Council
| Jurisdiction | UK Non-devolved |
| Judge | Lord Millett |
| Judgment Date | 18 June 2001 |
| Neutral Citation | [2001] UKPC 29 |
| Court | Privy Council |
| Docket Number | Appeal No. 69 of 2000 |
| Date | 18 June 2001 |
[2001] UKPC 29
Present at the hearing:-
Lord Bingham of Cornhill
Lord Cooke of Thorndon
Lord Millett
Privy Council
[Delivered by Lord Millett]
This is an appeal by Dr Ghosh from a direction of the Professional Conduct Committee ("the Committee") of the General Medical Council ("the Council") made on 9th October 2000 that her name be erased from the Register.
Dr Ghosh is aged 52. She qualified as a doctor in 1973 and has been in general practice in East London since 1983. She worked as locum tenens to general practitioners.
In February 1994 she was working in that capacity for Dr Bannerjee, a general practitioner in sole practice in Canning Town, during his absence on holiday. One of Dr Bannerjee's patients was a two year old boy, David Neil. He was unwell over the weekend. On the Monday morning 7th February 1994 his mother telephoned the surgery, described his symptoms and asked for a home visit. Dr Ghosh told David's mother that she was too busy to make a visit, and without having examined David wrote a prescription for Klaricid, an antibiotic, for his mother to collect from the surgery. David's mother rang again in the afternoon and again asked for a home visit. Dr Ghosh did not visit David or make any arrangements for him to be admitted to hospital for observation. On the following day David's mother took him to hospital, where he was operated on and treated for acute appendicitis and peritonitis.
In March 1996 Dr Ghosh was employed as a locum for Dr Subramanian, a general practitioner in sole practice in Chingford, during his absence on holiday. One of Dr Subramanian's patients was William Lea, who had been discharged from hospital on 21st February with terminal cancer. Dr Ghosh visited him at his home on 6th March. He died two days later. Dr Ghosh was responsible for attending the funeral parlour to complete a cremation form in respect of Mr Lea. She attended the parlour but completed the form inaccurately, falsely stating (for example) that she was the ordinary medical attendant of the deceased.
These two incidents led to Dr Ghosh's appearance before the Committee on 22nd April 1998. At the conclusion of the hearing, which lasted three days, the Committee made findings which can be summarised as follows:
(i) on 7th February 1994 she twice failed to visit David Neil when requested to do so;
(ii) she prescribed Klaricid for him without having put herself in a position to make an adequate assessment of his condition and treatment needs;
(iii) she did not make any, or any adequate, arrangements for David's condition to be assessed in hospital;
(iv) by her actions and omissions she failed to ensure that David received adequate medical assessment and treatment, and failed to make an adequate record of the events of 7th February in David's medical records.
(v) she failed to visit Mr Lea on 4th March 1996;
(vi) she did not take sufficient care in filling in Mr Lea's cremation form.
The Committee found that Dr Ghosh had been guilty of serious professional misconduct. The Chairman said that the Committee was concerned by the evidence of her failure to fulfil her professional responsibilities to a patient in her care, and that the standard of care which she had provided fell short of the standard which the public and the profession were entitled to expect of a registered medical practitioner. The Committee directed that for a period of two years Dr Ghosh's registration should be conditional on the following requirements:
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(1) She was to seek and follow the advice of a Director of Postgraduate General Practice Education in undertaking supervised re-training in general practice designed to remedy the deficiencies in her clinical knowledge and skills revealed during the course of the proceedings with particular reference to clinical assessment, record keeping and communication skills;
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(2) Before the next hearing of her case by the Committee she was to supply the Council with objective evidence of the satisfactory completion of this programme of retraining;
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(3) She was not to engage in locum posts in any capacity;
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(4) She was not to engage in any unsupervised practice or in single-handed practice;
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(5) She was to advise any prospective employer and any agency with which she was registered, or whom she approached concerning medical employment, of the conditions imposed on her registration.
The Chairman told Dr Ghosh that, unless she exercised her right of appeal, her registration would become subject to the conditions 28 days after the date when written notice of the direction was to be treated as having been served upon her. He told her that the Committee would resume consideration of her case at a meeting to be held before the end of the period of conditional registration, when the Committee would consider whether to take further action. He said that at intervals during her conditional registration she would be asked to send to the Council the names of those who had advised her and participated in her retraining. Reports would be sought by the Council from them about the advice and training she had been given and their assessment of her progress. Their reports would be put before the Professional Conduct Committee at the resumed hearing.
Following the hearing Dr Ghosh lodged an appeal to the Privy Council. She later withdrew the appeal and the conditions attached to her registration took effect on 21st October 1998. In the meantime the Council had written to Dr Jackson, the Director of Postgraduate General Practice Education, and asked him to arrange appropriate re-training for Dr Ghosh "to enable her to remedy the shortcomings in her professional skills which came to light during the hearing of her case". Dr Jackson was provided with a copy of the conditions which the Committee had imposed and subsequently received a transcript of the hearing before the Committee.
At Dr Jackson's request Dr Reed Bowden, the Associate Dean of Postgraduate General Practice Education, undertook responsibility for the supervision of Dr Ghosh's retraining programme. After contacting Dr Ghosh he wrote to her outlining an educational plan and confirming that she had agreed to it. The plan included attendance at a course on communication skills, which Dr Reed Bowden identified as an area of special importance. He pointed out that if her appeal was unsuccessful and the Council's conditions remained the same, she would be required to produce written evidence that the educational plan was being followed.
Dr Reed Bowden met Dr Ghosh for the first time on 5th June 1998. Dr Ghosh arrived half an hour late for her interview, gave no apology for being late, and kept looking at her watch as if she had another appointment. According to Dr Reed Bowden's notes, they seemed to be speaking different languages at first, and he found it difficult "to get on the same wavelength" and to persuade her that "he was not supposed to re-run the G.M.C. hearing". She evidently did not accept the Committee's findings, but she did agree that attitudinal and communication problems rather than lack of medical knowledge were behind her difficulties, and she confirmed that she was prepared to enter an educational plan as summarised in his letter.
In November 1998, after the withdrawal of her appeal, Dr Ghosh met Mr Carson of East London and The City Health Authority, and it was agreed that she should be employed as an assistant in the practice of Drs Gopinthan and Kalhoro ("the practice") and work under their supervision. Mr Carson wrote to Dr Ghosh on 25th November confirming her undertaking (i) to agree an educational plan in writing with Dr Reed Bowden who would monitor her progress and provide a report to the Council on its satisfactory completion and (ii) to agree with the practice a procedure for assessing her progress and reporting it in a structured way. Mr Carson told her that this would allow her to have the appropriate evidence available for the Council when required.
Dr Ghosh began work at the practice on 1st December 1998. Dr Reed Bowden met Drs Gopinthan and Kalhoro a few days later and agreed with them detailed proposals for her retraining with monthly reporting to him. Special attention was to be paid to Dr Ghosh's communication and attitude, including punctuality and response to calls. She was to undergo one hour a week of tutorials with either Dr Gopinthan or Dr Kalhoro with a brief written record of what was covered each time; her attendance at courses was to be recorded; and a record was to be kept of complaints of her work as well as compliments or praise.
Dr Reed Bowden wrote to Dr Ghosh on 25th November asking her to confirm that she was putting into practice what had previously been agreed between them. Having had no reply, he wrote to her again on 17th December setting out what had been agreed with Drs Gopinthan and Kalhoro. He asked Dr Ghosh to send him any additional records every month so that he could report to the Council.
Between the end of January and the end of March 1999 Dr Ghosh attended eight workshops of between one and two hours each at Newham General Hospital on various subjects. On 21st April Dr Reed Bowden reported to the Council that Dr Ghosh had been working for nearly six months; the practice had adapted well to Dr Ghosh's in-house educational needs; and weekly tutorials were being held. He said that Dr Ghosh had agreed with him to continue to attend training courses, to seek out and attend a consultation skills course, and to keep a record of educational experience. He told the Council that he himself had initially experienced poor communication from Dr Ghosh, with letters unacknowledged and a meeting missed, but that...
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