Report of the Fitness to Practise Committee following an Inquiry held pursuant to Part 8 of the Medical Practitioners Act 2007

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1 Report of the Fitness to Practise Committee following an Inquiry held pursuant to Part 8 of the Medical Practitioners Act 2007 Registered Medical Practitioner: Dr Mihai Anton Registration Number: Registered Address: Str. Tutora Nr 8 Bl P2, Sc C, Et 4, Apt Lasi Romania Date of Inquiry: Members of Inquiry Committee: Legal Assessor: Appearances - For the Chief Executive: For the Practitioner: 13 th & 14 th October, 2014 Dr Michael Ryan (Chair) Ms Marie Kehoe Mr Brendan Healy Mr Seamus Woulfe S.C. Mr Rory Mulcahy S.C. instructed by Mc Dowell Purcell Solicitors. Not present & not represented Findings of the Committee: Allegation 1: 1. That on or around 14 January 2013 Dr Anton a. left work early at 2pm without receiving prior authorisation to do so; and/or b. during a telephone conversation with Ms Julie Carroll, Staff Nurse, told Ms Carroll that he would return to the hospital to carry out a Gentamicin level blood test but failed to do so; and/or Having regard to the evidence adduced, the Committee found that : Page 1

2 Allegation 1 (a) was proven as to fact. The evidence of Ms Carroll and the admission of Dr Anton in his statement of 12 th February, 2012 Allegation 1(a) did not amount to professional misconduct. Allegation 1(a) did not amount to poor professional performance. Allegation 1 (b) was proven as to fact. The evidence of Ms Carroll established this beyond a reasonable doubt. Allegation 1(b) did not amount to professional misconduct. Allegation 1(b) did not amount to poor professional performance. Allegation 2: That In respect of one or more Outpatient Clinics; a. Was unwilling to examine one or more post-operative patients; and/or b. despite being shown by Dr Suzanne McMahon how to dictate and/or write notes in the patients charts, following his review of one or more of the patients referred to in allegation 2(a) above, failed to dictate and/or write notes in the charts for any or all of the patient(s) seen by him at the Out- Patients clinics; and/or Allegation 2(a) was not proven as to fact. Page 2

3 The evidence of Dr McMahon established that Dr Anton did examine the patients. Allegation 2(b) was not proven as to fact. Allegation 3: That on or around 16 January 2013, while accompanying Dr Mc Mahon on a ward round; a. was unable to write an accurate record of Dr Mc Mahon s examination(s) in one or more of the patients medical notes without being provided with assistance from Dr Mc Mahon; and or b. when Dr Mc Mahon asked him to order a kidney function(s), urea and electrolytes test did not appear to understand the nature of the test(s) and/or what it was Dr Mc Mahon was asking him to do; and or c. was unable to order a kidney function, urea and electrolytes test(s) for a patient despite Dr Mc Mahon explaining the process to him on more than one occasion. Allegation 3(a) was proven as to fact. The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 3(a) did not amount to professional misconduct. Allegation 3(a) did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 3(b) was proven as to fact. Page 3

4 The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 3(b) did not amount to professional misconduct. Allegation 3(b) did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 3(c) was proven as to fact. The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 3(c) did not amount to professional misconduct. Allegation 3(c) did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 4: That on or around 17 January 2013, following the replacement of a TAT tube for a patient, Dr Anton asked Dr Suzanne McMahon for the route to prescribe/administer Paracetamol in circumstances where he knew or ought to have known the appropriate route was Per Oral Allegation 4 was proven as to fact. Page 4

5 The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 4 did not amount to professional misconduct. Allegation 4 did not amount to poor professional performance. Allegation 5: That on or around 18 January 2013, in relation to a child with a recurrence of Hodgkins disease, despite being instructed not to consent the patient by Dr Suzanne McMahon and/or Mr Brice Antao, Dr Anton proceeded to try to consent the patient by transcribing the patient s operation on the line on the Consent Form for the consultant s name. Allegation 5 was proven as to fact. This was established beyond a reasonable doubt on the evidence of Dr McMahon and Mr Antao. Allegation 5 did not amount to professional misconduct. The evidence of Mr Wheeler did not establish this beyond a reasonable doubt. Allegation 5 did not amount to poor professional performance. The evidence of Mr Wheeler did not establish this beyond a reasonable doubt. Allegation 6: That In relation to the theatre list on or around 18 January 2013; a. failed to scrub in competently for theatre in that he had difficulty putting on the gown and/or surgical gloves in accordance with the aseptic technique ; and/or b. on one or more occasion(s) during the theatre list continued to require assistance to put on the gown and/or surgical gloves; and/or c. during the theatre list contaminated the sterile field in that he placed a Page 5

6 contaminated glove packet on a gown; and/or d. during the theatre list contaminated the sterile field in that he touched Mr Brice Antao, Consultant Paediatric Surgeon and/ or Dr Evelyn Ervine; and/ or e. while assisting at the operating table failed to understand basic instructions, to include; i. failing to let go of a retractor despite being asked to do so on one or more occasion(s) by Mr Brice Antao; and/or ii. continuing to hold Trocars during a procedure despite being asked not to do so on one or more occasion (s) by Mr Brice Antao. Allegation 6(a) was proven as to fact. The evidence of Mr Antao and Nurse Jeanette Neary established this beyond a reasonable doubt. Allegation 6(a) did not amount to professional misconduct. The evidence did not establish this beyond a reasonable doubt. Allegation 6(a) did not amount to poor professional performance. The evidence did not establish this beyond a reasonable doubt. Allegation 6(b) was proven as to fact. The evidence of Mr Antao and Nurse Jeanette Neary established this beyond a reasonable doubt. Allegation 6(b) did not amount to professional misconduct. The evidence did not establish this beyond a reasonable doubt. Allegation 6(b) did not amount to poor professional performance. The evidence did not establish this beyond a reasonable doubt. Page 6

7 Allegation 6(c) was proven as to fact. The evidence of Dr McMahon and Mr Antao established this beyond a reasonable doubt. Allegation 6(c) did not amount to professional misconduct. Allegation 6(c) did not amount to poor professional performance. Allegation 6(d) was proven as to fact. The evidence of Mr Antao established this beyond a reasonable doubt. Allegation 6(d) did not amount to professional misconduct. Allegation 6(d) did amount to poor professional performance. The Committee was satisfied beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric surgery, notwithstanding the evidence of Mr. Wheeler that this conduct amounted to professional misconduct. Allegation 6(e)(i) was proven as to fact. The evidence of Dr Antao established this beyond a reasonable doubt. Allegation 6(e)(i) did not amount to professional misconduct. Page 7

8 Allegation 6(e)(i) did not amount to poor professional performance. Allegation 6(e)(ii) was proven as to fact. The evidence of Mr Antao established this beyond a reasonable doubt. Allegation 6(e)(ii) did not amount to professional misconduct. Allegation 6(e)(ii) did not amount to poor professional performance. Allegation 7: That between on or around 18 January 2013 and 24 January 2013 Dr Anton displayed poor clinical knowledge in that he queried whether a cut down procedure should be carried out on a patient in circumstances where he could not insert an intravenous line; Allegation 7 was not proven as to fact. Allegation 8: That on or around 19 January 2013, Dr Anton failed to understand a request from Mr Jonathan McGuinness, Consultant Cardiothoracic Surgeon to scrub in for theatre. Allegation 8 was not proven as to fact. No evidence was adduced to support this allegation. Page 8

9 Allegation 9: 1. That Dr Anton on or around 21 January 2013; in relation to a patient undergoing a herniotomy procedure; a. despite being instructed not to consent any patient by Dr Suzanne McMahon and/or Mr Brice Antao obtained consent from the patient s parents; and/or b. obtained parental consent for an herniorrhaphy procedure in circumstances where he ought to have known the patient was scheduled for a herniotomy procedure; and/or c. indicated to Mr Brice Antao on or around the 21 January 2013 that he believed that a herniorrhaphy procedure and a herniotomy procedure were the same procedure when he ought to have known that was not the case; and or Allegation 9(a) was proven as to fact. The evidence of Mr Antao and Dr McMahon established this beyond a reasonable doubt. Allegation 9(a) did not amount to professional misconduct. The Committee finds that the test for professional misconduct was not established beyond reasonable doubt. Allegation 9(a) did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 9(b) was proven as to fact. The evidence of Mr Antao and Dr McMahon established this beyond a reasonable doubt. Allegation 9(b) did not amount to professional misconduct. The Committee finds that the test for professional misconduct was not established Page 9

10 beyond reasonable doubt. Allegation 9(b) did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 9(c) was proven as to fact. The evidence of Mr Antao established this beyond a reasonable doubt. Allegation 9(c) did not amount to professional misconduct. The evidence of Mr Wheeler did not satisfy the Committee beyond a reasonable doubt. Allegation 9(c) did amount to poor professional performance. The evidence of Mr Wheeler satisfied the Committee beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 10: That following the ward round on or around 22 January 2013 Dr Anton; a. was unable to write the patients clinical notes in the patients charts; and/or b. completed a TPN Prescription and/or a discharge prescription for Augmentin Duo under the supervision of a nurse. Allegation 10(a) was not proven as to fact. Not pursued at the conclusion of the evidence. Allegation 10(b) was not proven as to fact. Not pursued at the conclusion of the evidence. Page 10

11 Allegation 11: That on or around 23 January 2013, following a telephone conversation with Dr Orla O Leary, Senior House Officer, Endocrinology Dr Anton: a. failed to record the name, date of birth and/or chart number for a patient on St Brigid s ward; and/or b. failed to communicate adequately a message to Dr Suzanne Mc Mahon from Dr Orla O Leary in relation to the patient, on St Brigid s ward referred to in allegation 11(a), who required a Broviac IV for chemotherapy; and/or c. acted in a rude manner to Dr O Leary. Allegation 11(a) was proven as to fact. The evidence of Dr O Leary established this beyond a reasonable doubt. Allegation 11(a) did not amount to professional misconduct. Allegation 11(a) did not amount to poor professional performance. Allegation 11(b) was proven as to fact. The evidence of Dr O Leary established this beyond a reasonable doubt. Allegation 11(b) did not amount to professional misconduct. Allegation 11(b) did not amount to poor professional performance. Page 11

12 Allegation 11(c) was not proven as to fact. Allegation 12: That on or around 23 January 2013, Dr Anton brought a patient and family into a room on the day ward that may have posed an infection risk and/or remained in the room with the patient in circumstances where signage had been placed on the door that read This Room needs to be cleaned-please do not use and/or there was a plastic yellow hazard sign in the room beside an area of water. Allegation 12 was proven as to fact. The evidence of Mr Antao and Dr McMahon established this beyond a reasonable doubt. Allegation 12 did not amount to professional misconduct. Allegation 12 did amount to poor professional performance. The evidence of Mr Wheeler established beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. Allegation 13: That on one or more occasion(s) Dr Anton failed to attend in a timely manner and/or make himself available to the surgical team, including but not limited to any or all of the following: a. On or around 18 January 2013, attended the Paediatric Surgery office at approximately 8.00 am in circumstances where Dr Suzanne McMahon told him to attend the day ward at 7.30 am on 18 January 2013 to admit patients; and/or b. On or around 18 January 2013, despite being told by Mr Brice Antao to take a 30 minute break between theatre cases at approximately 1.00pm, did not return to theatre until approximately 3.00pm; and/or c. On or around 21 January 2013, attended the Paediatric Surgery office at approximately 8.15 am in circumstances where Dr Suzanne McMahon told Page 12

13 him to attend the day ward at 7.30 am on 18 January 2013 to admit patients; and/or d. On or around 22 January 2013, attended the Outpatients Clinic approximately one and a half hours late; and/or Allegation 13(a) was proven as to fact. The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 13(a) did not amount to professional misconduct. Allegation 13(a) did not amount to poor professional performance. Allegation 13(b) was proven as to fact. The evidence of Mr Antao and Dr Hadjuk established this beyond a reasonable doubt. Allegation 13(b) did not amount to professional misconduct. Allegation 13(b) did amount to poor professional performance The Committee was satisfied beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric surgery, notwithstanding the evidence of Mr. Wheeler that this conduct amount to professional misconduct. Page 13

14 Allegation 13(c) was proven as to fact. The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 13(c) did not amount to professional misconduct. Allegation 13(c) did amount to poor professional performance The Committee was satisfied beyond a reasonable doubt that Dr. Anton failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric surgery, notwithstanding the evidence of Mr. Wheeler that this conduct amount to professional misconduct. Allegation 13(d) was not proven as to fact. Allegation 14: That on one or more occasion(s) Dr Anton was unable to use the Hospital s bleep system including but not limited to any or all of the following: a. On or around 16 January 2013, incorrectly listed the recipient s number as his extension number on a number of occasions; and/ or b. On or around 16 January 2013, failed to answer his bleep when contacted by a cardiothoracic surgeon requesting you to attend theatre; and/ or c. On or around 19 January 2013, failed to accurately record a message received through his bleep from a cardiothoracic surgeon; and/ or d. Failed to communicate adequately or at all a message received on his bleep in respect a patient Fiona to Dr Mc McMahon; Allegation 14(a) was proven as to fact. The evidence of Dr McMahon proved this beyond a reasonable doubt. Allegation 14(a) did not amount to professional misconduct or poor professional performance. Page 14

15 The evidence of Mr Wheeler proved beyond a reasonable doubt that this was neither professional misconduct nor poor professional performance. Allegation 14(b) was not proven as to fact. No evidence was adduced. Allegation 14(c) was not proven as to fact. No evidence adduced. Allegation 14(d) was proven as to fact. The evidence of Dr McMahon established this beyond a reasonable doubt. Allegation 14(d) did not amount to professional misconduct or poor professional performance. The evidence of Mr Wheeler proved beyond a reasonable doubt that this was neither professional misconduct nor poor professional performance. The allegation of a breach of the Medical Practitioner s Act, 2007 is: That he failed to respond to a notice seeking information in relation to the events which form the basis of the allegations and/or sub allegations listed at 1-13 above, which issued to him pursuant to section 59(7) of the Medical Practitioner s Act, 2007 by the Chairperson of the Medical Council s Preliminary Proceedings Committee in or around the 2 October 2013 The Committee found that this allegation was proven as to fact. The evidence of Ms Carol Fitzgerald established this beyond a reasonable doubt. The additional cumulative allegation of poor professional performance is: Page 15

16 In relation to r more than one of the factual allegations and/or sub allegations listed at 1 14 above, he failed to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of a Senior House Officer working in Paediatric Surgery. The Committee was not satisfied beyond a reasonable doubt that any combination of allegations justified an additional cumulative finding of poor professional performance. The additional cumulative allegation of professional misconduct is: In relation to more than one of the factual allegations and/or sub allegations listed at 1 14 above, his conduct amounted to a serious falling short of the standards of conduct expected among doctors. The Committee was not satisfied beyond a reasonable doubt that any combination of allegations justified an additional cumulative finding of professional misconduct SIGNED: DR MICHAEL RYAN CHAIRPERSON FITNESS TO PRACTISE COMMITTEE DATE: 29 th October, 2014 Page 16

Report of the Fitness to Practise Committee following an Inquiry held pursuant to Part 8 of the Medical Practitioners Act 2007.

Report of the Fitness to Practise Committee following an Inquiry held pursuant to Part 8 of the Medical Practitioners Act 2007 Registered Medical Practitioner: Dr James Cassidy Registration Number: 366328