Dr Raisah Sawati v The General Medical Council
| Jurisdiction | England & Wales |
| Judge | Mrs Justice Collins Rice |
| Judgment Date | 11 February 2022 |
| Neutral Citation | [2022] EWHC 283 (Admin) |
| Docket Number | CO/3228/2021 |
| Year | 2022 |
| Court | Queen's Bench Division (Administrative Court) |
[2022] EWHC 283 (Admin)
THE HONOURABLE Mrs Justice Collins Rice
CO/3228/2021
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
Strand, London, WC2A 2LL
Mr Martin Forde QC (instructed by the Medical Protection Society/Medical Defence Union) for the Appellant
Ms Catherine Callaghan QC (instructed by GMC Legal) for the Respondent
Hearing dates: 18 th & 19 th January 2022
Approved Judgment
Introduction
Raisah Sawati had set her heart on becoming a doctor since her mid-teens. She won a place at Manchester University to study medicine, graduating in 2012. By August 2013 she had completed the first year of her foundation clinical training and was embarking on her second. But she started to encounter setbacks.
Matters came to a head in 2017 when, her second year of training still incomplete, she was reported to the General Medical Council (GMC). The GMC investigated concerns about both her performance and possible misconduct. These concluded in formal allegations, and regulatory proceedings before a Medical Practitioners Tribunal. Dr Sawati finally completed her foundation training in 2019. But on 17 th August 2021, the Tribunal found a number of the GMC's allegations proved, and ordered her erasure from the register with immediate effect. Her career as a doctor was ended before it had got fully under way.
Dr Sawati appeals that decision, as is her right under section 40 of the Medical Act 1983. She says there were serious defects in the Tribunal's approach to some of its findings of fact, and to its sanction decision, making the outcome wrong and unfair.
The Tribunal proceedings
(i) The allegations, defences and findings of fact
Dr Sawati faced allegations of misconduct relating to six separate incidents over a period of four years between January 2014 and January 2018. She also faced allegations of deficient professional performance, based on a GMC performance assessment carried out between November and December 2018.
(a) The first misconduct allegation (patient records/dishonesty)
This related to an incident during Dr Sawati's first placement. She had seen a patient in a nursing home on 6 th January 2014 and noted in his records ‘upper respiratory infection’ and ‘aggressive behaviour’. The patient died the following morning of respiratory causes. Dr Sawati agreed that a few hours later, knowing that, she added to her previous note, under the heading ‘upper respiratory infection’, that she had discussed the patient's case and medication with her clinical supervisor. It was accepted she had discussed the case with her supervisor. But it was alleged she had not discussed the respiratory symptoms. It was not alleged Dr Sawati's conduct had had any effect on the patient or his care. But the GMC objected that the addition to the record was made improperly, without indicating it was retrospective, and was knowingly misleading and dishonest.
Dr Sawati said she ‘ believed’ or ‘ was fairly certain’ that she had discussed the respiratory symptoms as well as the aggressive behaviour. She denied dishonesty in any event. She accepted (and the performance assessment confirmed) that she had problems with communication and record keeping. She said she had been unsure about procedure for noting an entry as being retrospective.
The Tribunal established as primary fact that Dr Sawati had not discussed the patient's respiratory symptoms with her supervisor, only the aggressive behaviour. It preferred the supervising doctor's evidence.
Turning to Dr Sawati's state of mind, the Tribunal found she knew that, as a trainee, she had to discuss the details of all the patients she saw. It was satisfied she was familiar with procedure for making retrospective entries in patients' records and noting them as such. It concluded she had in fact known she had not discussed respiratory symptoms with her supervisor. It concluded her actions were not just an example of poor record-keeping (although it accepted that was a general issue for her) and an attempt to update the records in the interests of accuracy, but ‘ a deliberate attempt to give the impression that she had spoken to Dr Power about Patient A's respiratory symptoms’. It made a finding of dishonesty.
(b) The second misconduct allegation (unauthorised absence)
This related to an incident over a year later, when Dr Sawati was placed at Manchester Royal Infirmary. She agreed that on 20 th January 2015, at around 11am, she asked permission from a consultant doctor to leave the main theatre block to undertake some audit work for another consultant. She accepted that around two hours later she was discovered in an on-call room lying on a bed with her eyes closed. Dr Sawati said she had been unwell but had been embarrassed to say so.
The Tribunal accepted Dr Sawati suffered from a longstanding and painful condition about which she was understandably sensitive. Her medical records supported that.
(c) The third misconduct allegation (shift-swapping/dishonesty)
This incident happened a further two years later, in January 2017, at another hospital placement. Dr Sawati told the hospital rota manager she had agreed with another doctor to swap shifts. It was alleged the other doctor had not agreed to swap (indeed had positively refused to do so); she had known that; and had therefore been dishonest.
Dr Sawati said she had formed a genuine impression that her colleague had agreed to the swap. But she acknowledged there could have been a misunderstanding, leading her to ‘jump the gun’; she said other conversations about shift-swapping happened, sometimes fleeting in nature and the context of a busy hospital environment. She denied dishonesty.
The Tribunal found as primary fact that Dr Sawati had discussed shift-swapping with another doctor. But it preferred that doctor's account that he had not agreed to swap the shifts in question, and had said so.
The Tribunal rejected the idea that there could have been a misunderstanding (although it accepted that communication skills were an area of concern about Dr Sawati). In any event, it found that, on her own account, any agreement could have been provisional only (that is, expressly subject to confirmation by the other doctor). So it found that when she reported an agreement, she must have known this at best knowingly understated its no more than provisional nature. It made a second finding of dishonesty.
(d) The fourth misconduct allegation (self-assessment/dishonesty)
On 21 st January 2017, Dr Sawati was involved in the treatment of a patient brought to A&E with symptoms of cardiac arrest. She subsequently filled out a form indicating she had demonstrated a ‘leadership’ role. The GMC alleged, and Dr Sawati denied, dishonesty.
The Tribunal found her self-assessment had been reviewed and endorsed at the time by the consultant who had led the treatment of the patient. The Tribunal accepted that review and endorsement of these self-assessments by a more senior doctor was standard practice; they were essentially a training tool as between a doctor in foundation training and her supervisors. It had no bearing on the treatment of patients. The consultant said that on reflection his endorsement of a demonstrated leadership role was not accurate.
The Tribunal found the self-assessment form had been an opportunity for Dr Sawati to show she had performed well and to highlight her competencies; she had been proud of her contribution to the treatment of the cardiac patient and had wanted to show herself in the most positive light. She genuinely believed she had shown aspects of leadership and was unlikely to have been deliberately misleading in completing a form she knew would be reviewed by senior clinicians. The Tribunal was not satisfied Dr Sawati knew she had not demonstrated a leadership role at the time, so her actions could not be considered dishonest.
(e) The fifth misconduct allegation (unauthorised absence)
The GMC alleged that on 7 th March 2017, while on duty in A&E, Dr Sawati went missing for a couple of hours and was found in the women's changing rooms lying down on a bench, wrapped in a blanket with her eyes closed.
Dr Sawati said that she was again unwell and had briefly sat down to allow painkillers to work. The Tribunal accepted she had been unwell, but preferred the evidence of the senior sister who discovered her that she had been lying down, not sitting. It found she had been absent for around two hours without telling anyone she was ill.
(f) The sixth misconduct allegation (interview/dishonesty)
Dr Sawati was interviewed for a core training position on 31 st January 2018. Her interviewer noted that two of her training certificates – advanced life support (ALS) and advanced trauma life support (ATLS) – had expired. It was alleged she responded that she was booked onto an ALS course in May 2018 and an ATLS course in June 2018. It was alleged she was not booked onto either course, so her reply was dishonest. Dr Sawati said her answers had been muddled and flustered and she had been confused about which course she was booked on. She denied dishonesty.
The Tribunal established as primary fact that Dr Sawati had said she was booked on both courses. It found she was indeed booked on the ALS course, but not the ATLS course.
In relation to her state of mind, the evidence of the interviewer had been that when he challenged Dr Sawati to specify exactly which...
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