Yassin v The General Medical Council

JurisdictionEngland & Wales
CourtQueen's Bench Division (Administrative Court)
JudgeMr Justice Cranston
Judgment Date23 Oct 2015
Neutral Citation[2015] EWHC 2955 (Admin)
Docket NumberCase No: CO/3184/2015

[2015] EWHC 2955 (Admin)

IN THE HIGH COURT OF JUSTICE

QUEEN'S BENCH DIVISION

ADMINISTRATIVE COURT

Royal Courts of Justice

Strand, London, WC2A 2LL

Before:

The Honourable Mr Justice Cranston

Case No: CO/3184/2015

Between:
Yassin
Appellant
and
The General Medical Council
Respondent

Christopher Geering (instructed by Direct Access) for the Appellant

Tom Cross (instructed by Gemma Brown, the in-house solicitor at the General Medical Council) for the Respondent

Hearing dates: 14/10/2015

Mr Justice Cranston

Introduction

1

This is an appeal under section 40 of the Medical Act 1983 against a direction of a Fitness to Practise Panel ("the Panel") to erase the appellant from the medical register. It is an appeal confined to the Panel's determination on the facts. The appellant's grounds concern a lack of specificity in some of the allegations and that, in relation to two findings of dishonesty, the Panel was wrong or failed to provide adequate reasons. There is a further ground based on new medical evidence.

Background

2

In August 2008 the appellant, having qualified as a medical student in Scotland, commenced work as a Foundation Year 1 ("FY1") trainee doctor. There was a Fitness to Practise hearing in 2011 concerning events in 2009. The Panel found that the appellant had dishonestly changed marks awarded to her in written feedback from two nurses to give a better impression of her professional performance, and dishonestly fabricated a story to explain a failure to order blood tests for a patient who collapsed a few days later. The Panel concluded that her attitude when giving evidence demonstrated a serious lack of insight into her failings. In her evidence she "maintained [her] denials and lies, and sought to deflect responsibility for [her] your actions to others". It suspended her for three months.

3

In 2012 the appellant was referred to the General Medical Council ("the GMC") again following events between August 2011 and July 2012, when she had been a Foundation Year 2 ("FY2") trainee assigned in Oxfordshire (between August 2011 – December 2011 and April 2012 to July 2012) and Buckinghamshire (December 2011 – April 2012). There was a 16 day hearing in January this year. The Panel heard evidence from 13 witnesses called by the GMC and had another 4 witness statements. The appellant gave evidence herself, called two witnesses and submitted further written evidence. She was represented by counsel who cross-examined and made submissions.

4

Early in its determination on the facts, the Panel commented on the witnesses who had given evidence. Having regard to demeanour, consistency and clarity, the Panel concluded that all the witnesses for the GMC gave clear and straightforward evidence, appeared to be concerned with professionalism and patient safety, had no apparent motive to lie, and were credible and compelling. By contrast, the Panel considered that the appellant was vague and evasive in her answers. She persistently avoided answering direct questions with clear and straightforward answers and appeared to have an inconsistent recall. The Panel considered that many of her answers were untrue. The Panel therefore determined that, on the whole, her evidence was less credible and less reliable than that of the witnesses for the GMC.

5

The Panel then considered the evidence on the charges. The Panel found that 53 of the charges were proved. Nine of them involved dishonesty. The Panel's conclusions on the substantive charges which it found proved were as follows:

Charge 2: From time to time between August 2011 and July 2012 you:

a. arrived late for ward rounds; found proved.

b. left ward rounds without informing your colleagues; found proved.

c. left the ward and were not contactable; found proved.

d. failed to take responsibility for the care of patients who arrived unwell in the clinical area; found proved.

e. took an unnecessarily prolonged time to complete tasks assigned to you or passed those tasks on to others; found proved.

f. took an unnecessarily prolonged time to complete discharge summaries; found proved.

g. failed to answer your bleep; found proved.

h. failed to attend Multi-Disciplinary Team ('MDT') clinics; found proved.

i. completed TTO and discharge summaries with incomplete information including incomplete clinical history; found proved.

j. failed to carry out effective handovers; found proved.

k. failed to communicate correct information to team members; found proved.

l. failed to carry out investigations in a timely and safe way; found proved.

Charge 4: On 8 February 2012, on completing your day shift, you:

a. failed to check a patient's bloods; found proved

b. wrongly stated that there was nothing to hand over; found proved.

Charge 5: On 17 March 2012 when you were called to investigate a patient with a gastro-intestinal bleed you:

a. failed to examine the patient; found proved.

Charge 6: On the afternoon of 1 May 2012 you were not on the ward and could not be contacted; found proved.

Charge 7: On 14 June 2012 you:

a. left the MDT clinic before it had finished; admitted and found proved.

b. failed to inform a member of the team that you were leaving; found proved.

c. failed to share the workload; found proved.

Charge 8: From time to time between August 2011 and July 2012 you:

a. failed to engage with colleagues when asked questions relating to the care of patients; found proved.

b. ignored colleagues; found proved.

Charge 9: On 20 September 2011 you admitted a patient in her absence as not a 'blue bloater or pink puffer'; admitted and found proved.

Charge 10: On 10 February 2012, at approximately 09:00, you interrupted Dr A during a ward round and:

a. spoke to her in an angry manner; found proved.

b. falsely stated that you had handed over a patient to a colleague when you did not do so; and found proved.

c. falsely informed Dr B that your colleague had taken responsibility for an incident involving the death of a patient; found proved.

Charge 11: On 10 February 2012 at approximately 16:30 you confronted Dr C in an angry manner about allegations that you had not answered your bleep; found proved.

Charge 12: On 15 March 2012 at approximately 14:00 you angrily confronted and shouted at a staff nurse in the presence of a colleague; found proved.

Charge 14: From time to time between August 2011 and July 2012 you:

a. when asked why outstanding jobs for patients had not been completed you falsely claimed that:

i. you did not know the jobs needed doing; found proved.

ii. you had not been allocated the task; found proved.

iii. the job had been completed; found proved.

Charge 15: On 13 February 2012 when asked by Dr D about hand back and triage patients you:

a. falsely replied that none had been triaged; found proved.

b. falsely claimed to have contacted the on-call team; and found proved.

c. failed to carry out a satisfactory handover; found proved.

Charge 16: On 7 September 2011, at an induction meeting with your educational supervisor, you falsely stated that you had not had any problems with your previous training; found proved.

Charge 17: On 30 November 2011 you were asked to arrange a meeting with your educational supervisor once you had started a new job but failed to do so; found proved.

Charge 19: On 12 July 2012 you submitted a job application to the Northampton General NHS Trust falsely stating that you were not the subject of a fitness to practise investigation by a regulatory body in the UK; found proved.

Charge 20: Your conduct as described in paragraphs 10(b) and (c), 14, 15, 16, 18, and 19 above was:

a. Misleading; found proved in relation to 10(b) and 10(c), 14(e)(i), 14(e)(ii) and 14(e)(iii), 15(a) and 15(b), 16, and 19.

b. Dishonesty; found proved in relation to 10(b) and 10(c), 14(e)(i), 14(e)(ii) and 14(e)(iii), 15(a) and 15(b), 16 and 19.

6

The Panel commented further on each of the findings of misconduct and dishonesty. As regards charge 19, it said that it had considered her explanation but was not persuaded that she could have overlooked the inaccuracy: entries on the form immediately before and after the answer to this question appeared to have been updated correctly.

7

The Panel then considered whether the appellant's fitness to practise was impaired. It found that the facts proved amounted to misconduct which could properly be characterised as serious. In failing to adhere to the principles of being honest and trustworthy at the material time, and in continuing to be dishonest before the Panel, her conduct had fallen short of the standards of a doctor. Her fitness to practise was consequently impaired. She provided no evidence that she had reflected on her failings since the hearing in 2011 or since she was again referred in 2012, she had not apologised for any of the acts or omissions, she had maintained her denial of wrongdoing and she lacked insight into the potential consequences of her lack of probity. Given that she had no insight into the implications for patient safety as a result of her dishonesty when she made errors, the Panel could not be satisfied that she would not repeat her misconduct. Her lack of insight, her failure to remediate her failings and the fact that the Panel could not be satisfied that she would not repeat her wrongdoing, put patient safety at risk. The public's confidence in the medical profession and need to declare and uphold proper standards of conduct and behaviour in the profession would be undermined if a finding of impairment was not made.

8

The Panel's determination on sanction was postponed through lack of time. When sanction was considered in June this year, the appellant adduced medical evidence about her epilepsy. An email from...

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