PUBLIC RECORD. Record of Determinations. Medical Practitioner: Date: 22/10/2018. GMC reference number: Medyczny. Review - Misconduct

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PUBLIC RECORD Date: 22/10/2018 Medical Practitioner s name: Dr Shazia Akram GMC reference number: 7094045 Primary medical qualification: Type of case XXX Review - Misconduct Lekarz 2010 Warszawski

1 PUBLIC RECORD Date: 22/10/2018 Medical Practitioner s name: Dr Shazia Akram GMC reference number: Primary medical qualification: Type of case XXX Review - Misconduct Lekarz 2010 Warszawski Uniwersytet Medyczny Outcome on impairment XXX Impaired Summary of outcome Suspension, 6 months Review hearing directed Tribunal: Legally Qualified Chair Medical Tribunal Member: Medical Tribunal Member: Miss Rachel Wedderspoon Dr Srinivasarao Babarao Dr Josanne Holloway Tribunal Clerk: Miss Elly McQuinn Miss Lauren Culkin Attendance and Representation: Medical Practitioner: GMC Representative: Not present and not represented Ms Louise Kitchin, Counsel Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held partly in public and partly in private. 1

2 Determination on Impairment - 22/10/2018 BACKGROUND 1. At the outset of these proceedings the Tribunal determined that certain parts of this case be heard in private pursuant to Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 ( the Rules ). Therefore, the press and public will be excluded from those parts of the hearing XXX and this determination will be read in private. However, as this case does also concern Dr Akram s alleged misconduct, a redacted version will be published at the close of the hearing XXX. 2. The Tribunal does not propose to rehearse the detailed background of Dr Akram s case, but has had regard to the determinations of the previous Tribunals. The 2017 Tribunal 3. Dr Akram s case was first considered by a in 2017 ( the 2017 Tribunal ) where the following was found proved: That Dr Akram, between 3 November 2014 and 6 February 2015 and whilst working for the City Hospitals Sunderland NHS Foundation Trust ( the Trust ), undertook locum work for 10 Hospitals, when she knew she had been medically excluded from doing so, and knew or ought to have known that she required permission to work elsewhere. It was found that Dr Akram did not have permission to carry out secondary employment, and knew that she had been informed by representatives of the Trust that she should not carry out locum work; That Dr Akram had sent an inappropriate to a Colleague on 11 December 2014 which breached the Trust s intranet and Policy; That on 1 January 2015 Dr Akram had attended a meeting at the Trust in which she stated he had not been working elsewhere as a locum when she knew this to be untrue; That in a letter dated 1 February 2015 Dr Akram stated she had done little more than a few shifts here and there, which she knew was untrue; 2

3 4. The 2017 Tribunal found that Dr Akram s behaviour in respect of knowingly needing permission from the Trust, and not having that requisite permission to carry out secondary or locum employment was dishonest. It also found that Dr Akram s XXX denial of working as a locum externally to the Trust, and her claim that she had done little more than a few shifts here and there amounted to both misleading conduct and dishonesty. 5. The 2017 Tribunal determined that Dr Akram s actions in respect of undertaking locum work when she had been told she could not do so amounted to misconduct, as she breached the fundamental tenet of Good Medical Practice 2013 to act with honesty and integrity at all times, which would be regarded as deplorable by fellow practitioners. It found that Dr Akram was impaired by reason of her misconduct XXX and determined to suspend her registration for a period of 12 months. It considered that such a suspension would give Dr Akram adequate time to reflect on her misconduct, further develop her insight XXX. 6. The 2017 Tribunal directed a review hearing and recommended that the reviewing Tribunal would be assisted by XXX a reflective piece on her dishonesty in which she shows fully developed insight and an understanding of the gravity and impact of her dishonesty on the public s confidence in the medical profession; evidence that she had kept her medical knowledge up to date; and evidence she has obtained a registered medical practitioner to act as a mentor to assist in her reflective piece and advise on resumption of her medical career. The 2017 Tribunal also considered that any reviewing Tribunal would be greatly assisted by Dr Akram s attendance Review Hearing 7. Dr Akram s case was reviewed on 12 February, 16 March and 9 May 2018 ( the 2018 Review Hearing ), having gone part-heard twice. That Tribunal noted the evidence of Dr Akram s attendance at Continuing Professional Development ( CPD ) programmes, her apology to her Colleague, and her oral evidence in relation to the support network she had XXX. It also considered the findings and determinations of the 2017 Tribunal. It determined that while there was a lot of improvement with regard to Dr Akram s insight and remediation, concerns remained as to her understanding of her misconduct. XXX. The Tribunal therefore concluded Dr Akram s fitness to practise remained impaired by reason of her misconduct XXX, and determined to suspend Dr Akram s registration for a further period of four months for Dr Akram to XXX focus on CPD to show she was no longer impaired and enable her to return to medical practice. 8. The Tribunal directed a review hearing and considered it would assist any reviewing Tribunal if Dr Akram provides XXX further evidence of CPD including certificates of attendance, log of readings/online courses, and reflections on any CPD; and any other information Dr Akram considers relevant XXX. 3

4 Today s Review Hearing 9. This Tribunal has today reviewed Dr Akram s case and has considered, in accordance with Rule 22(l)(f) of the Rules, whether her fitness to practise remains currently impaired. In doing so it has considered the submissions made by Ms Kitchin, Counsel, on behalf of the GMC. The Outcome of Applications Made during the Impairment Stage 10. The Tribunal determined that service had been effected, pursuant to Rules 20 and 40 of the General Medical Council (Fitness to Practise Rules) 2004 as amended ( the Rules ). It granted the GMC s application, made pursuant to Rule 31 of the Rules to proceed in Dr Akram s absence. The Tribunal s full decision on the application on service and proceeding in absence is included at Annex A. The Evidence 11. The Tribunal has taken into account all the documentary evidence adduced during the course of these proceedings, including: The Record of Determinations from the 2017 Tribunal Hearing; The Record of Determinations from the 2018 Review Hearing; Letter to Dr Akram from the MPTS dated 10 May 2018 with outcome of 2018 Tribunal; Letter to Dr Akram from the MPTS dated 11 June 2018 with details of suspension taking effect; to Dr Akram from the GMC dated 3 July 2018; Letter to Dr Akram from the GMC dated 3 July 2018 (enclosed in above of 3 July 2018) regarding outcome of 2018 Review Hearing and giving details of what Dr Akram needed to do next XXX and enclosing Case Review Team decision of 2 July 2018, XXX, contact details form and notification form; to Dr Akram from the GMC dated 19 July 2018; Letter to Dr Akram from the GMC dated 19 July 2018 (enclosed in above of 19 July 2018) requesting information in preparation of this review hearing; Letter to Dr Akram from the GMC dated 1 August 2018 re-requesting information as requested in the letter of 19 July 2018; Submissions Submissions on behalf of the GMC 4

5 12. On behalf of the GMC, Ms Kitchin referred the Tribunal to paragraphs 163 and 164 of the Sanctions Guidance 2018 Edition ( SG ), which state: 163 It is important that no doctor is allowed to resume unrestricted practice following a period of conditional registration or suspension unless the tribunal considers that they are safe to do so. 164 In some misconduct cases it may be self-evident that, following a short suspension, there will be no value in a review hearing. However, in most cases where a period of suspension is imposed, and in all cases where conditions have been imposed, the tribunal will need to be reassured that the doctor is fit to resume practice either unrestricted or with conditions or further conditions. A review hearing is therefore likely to be necessary, so that the tribunal can consider whether the doctor has shown all of the following (by producing objective evidence): a b c d they fully appreciate the gravity of the offence they have not reoffended they have maintained their skills and knowledge patients will not be placed at risk by resumption of practice or by the imposition of conditional registration. 13. Ms Kitchin submitted that Dr Akram was sent various notifications, by post and , from the MPTS and GMC of the previous outcome, this review hearing XXX to which she had not responded. XXX. She submitted that Dr Akram therefore remains impaired XXX. 14. Ms Kitchin further submitted that Dr Akram had not provided the GMC with any of the material recommended in the 2018 Review Hearing, namely, evidence of her attendance at CPD programmes; XXX; a reflective statement; or any other useful information which may assist this Tribunal. Ms Kitchin stated that this was the second time Dr Akram had failed to use the time afforded to her by the Tribunal to properly address the concerns of insight and remediation, with respect to XXX her misconduct. She submitted that the Tribunal could therefore not be satisfied that her misconduct would not be repeated, and bearing in mind all these matters, Dr Akram s fitness to practise also remains impaired by reason of her misconduct. The Tribunal s Decision 5

6 15. The Tribunal reminded itself that it must determine whether Dr Akram s fitness to practise is impaired as of today, taking into account Dr Akram s conduct XXX at the time of the allegations together with any relevant developments since then such as insight, whether the matters are remediable, or have been remedied and any likelihood of repetition. The Tribunal also reminded itself that any consideration of and determination on impairment was a matter of its own independent judgment. 16. The Tribunal also reminded itself of the statutory overarching objective. XXX 17. XXX 18. XXX 19. XXX Misconduct 20. The Tribunal considered that there is an evidential burden on Dr Akram to produce material which demonstrates she has addressed and remediated her misconduct, including CPD certificates, a reflective piece, or any other information. It noted that she is engaging with the GMC at times, however, she had not provided any information or documentation to show she had continued to develop her insight or remediate her misconduct since the 2018 Review Hearing earlier this year. 21. XXX. 22. The Tribunal therefore concluded that it had no evidence before it to enable it to make findings that Dr Akram had gained insight or remediated since her last review hearing. It therefore determined that her fitness to practise remains impaired by reason of her misconduct. Determination on Sanction - 22/10/ Having determined that Dr Akram s fitness to practise remains impaired by reason of her misconduct XXX, the Tribunal now has to decide on the appropriate sanction, if any, to impose. 2. The Tribunal has considered the evidence adduced at the Impairment stage, as well as the submissions made by Ms Kitchin on behalf of the GMC. Submissions 6

7 3. On behalf of the GMC, Ms Kitchin submitted that it was not appropriate for the Tribunal to impose conditions in this case. She referred the Tribunal to the decision of the 2018 Review Hearing, whereby it was determined that appropriate and workable conditions could not be formulated in this case XXX. XXX. 4. Ms Kitchin referred the Tribunal to paragraphs 91 and 97 of the Sanctions Guidance 2018 Edition ( SG ), which state: 91 Suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor. Suspension from the medical register also has a punitive effect, in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension, although this is not its intention. 97 Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate. a b c d e f g A serious breach of Good medical practice, but where the doctor s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors. In cases involving deficient performance where there is a risk to patient safety if the doctor s registration is not suspended and where the doctor demonstrates potential for remediation or retraining. In cases that relate to the doctor s health, where the doctor s judgement may be impaired and where there is a risk to patient safety if the doctor were allowed to continue to practise even under conditions, or the doctor has failed to comply with restrictions or requirements. No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor s unwillingness to engage. No evidence of repetition of similar behaviour since incident. The tribunal is satisfied the doctor has insight and does not pose a 7

8 significant risk of repeating behaviour. 5. She stated that while Dr Akram s misconduct constituted a serious breach of the GMC s Good Medical Practice 2013 ( GMP ), there was some evidence that remediation could be successful. She further stated that there was no evidence Dr Akram had repeated her misconduct, and she had developed some insight since her misconduct, demonstrated by her agreement at her last review that suspension was appropriate. 6. Ms Kitchin submitted that despite Dr Akram s insight, and her assertion at the previous review hearing in May 2018 that she would be fit to practise within six months, she has not been able to demonstrate this as yet. Ms Kitchin further submitted that if Dr Akram is committed to returning to medical practice, and shows she is willing to engage on a consistent basis, then a further period of suspension would provide adequate time XXX to show she has gained greater insight and has sufficiently remediated. Ms Kitchin stated that for all the reasons highlighted an order of suspension is the most appropriate sanction in the circumstances. The Tribunal s Approach 7. The Tribunal noted that the decision as to the appropriate sanction to impose, if any, is a matter for this Tribunal exercising its own judgement. It reminded itself of the need to consider the SG and apply the principle of proportionality, weighing the interests of Dr Akram with the wider public interest. 8. The Tribunal acknowledged that the purpose of any sanction imposed should not be punitive, but may have a punitive effect. It considered each sanction, starting with the least restrictive, whilst balancing the factors identified above. Aggravating and Mitigating Factors 9. The Tribunal determined that it had no evidence before it to consider any aggravating or mitigating factors in this hearing. The Tribunal s Decision No action 10. The Tribunal considered that given Dr Akram s XXX need for her to further develop her insight and remediate her misconduct, it was not appropriate or proportionate to take no action in this case. Conditions 11. The Tribunal next considered whether to impose a period of conditions on Dr Akram s registration. 8

9 12. It considered that it had no evidence before it to guide it as to what conditions would be appropriate, proportionate, workable and measurable in this case. It concluded that conditions are not practical because Dr Akram has not practiced medicine since 2014 XXX there was no information about her level of insight into her misconduct. The Tribunal therefore determined that conditions were not appropriate in this case. Suspension 13. The Tribunal considered that in order for Dr Akram to XXX gather information regarding the remediation of her misconduct, a period of further suspension is the most appropriate sanction. 14. XXX. The Tribunal was concerned that it should impose a period of suspension that was sufficient for Dr Akram to XXX adduce sufficient evidence of her insight and remediation. It therefore determined to impose a further period of suspension on Dr Akram s registration for six months. 15. The effect of the Tribunal s decision is that, unless Dr Akram exercises her right of appeal, her name will be suspended from the Medical Register on the date when the previous order would otherwise expire. The sanction currently imposed on Dr Akram s registration will remain in effect until the appeal period has concluded. If Dr Akram decides to exercise her right of appeal, the sanction currently imposed on her registration will remain in effect until the outcome of the appeal has been decided. The MPTS will write to Dr Akram confirming the dates of when the new period of suspension will commence. Review Hearing 16. The Tribunal determined to direct a review of Dr Akram s case. A review hearing will convene shortly before the end of the period of suspension, unless an early review is sought. The Tribunal wishes to clarify that at the review hearing, the onus will be on Dr Akram to demonstrate how she has remediated her misconduct, developed insight XXX. It therefore may assist the reviewing Tribunal if Dr Akram adduces the following: Evidence in the form of a reflective piece that she has reflected on her dishonesty, fully appreciates its gravity and the impact dishonesty has on the public s confidence in the profession, and that she has fully developed her insight; Evidence that she has kept her knowledge up to date during the periods of suspension, which may include evidence of her attendance at CPD programmes; and Any other information that Dr Akram considers will assist the Tribunal. 9

10 17. The Tribunal noted that Dr Akram may find it helpful to have a mentor, however, this is not a necessary requirement in her development of insight and remediation. 18. It also considered it would be of great assistance to any reviewing Tribunal if Dr Akram were to participate in the proceedings, or attend in person. 19. That concludes this case. Confirmed Date 22 October 2018 Miss Rachel Wedderspoon, Chair ANNEX A 22/10/

11 Application on Service and Proceeding in Absence Service 1. Dr Akram is not present and is not represented at this hearing. The Tribunal therefore first considered whether notice of this hearing had been properly served on her in accordance with Rules 20 and 40 of the GMC s (Fitness to Practise Rules) Order of Council 2004, as amended ( the Rules ) and paragraph 8 of Schedule 4 to the Medical Act 1983, as amended. 2. Ms Kitchin, Counsel, on behalf of the GMC, provided the Tribunal with a bundle of service which included the following documents: A screenshot of Dr Akram s registered postal address; Letter to Dr Akram notifying her of this review hearing, and attaching the bundle of documentation to be used in support of the GMC s case, dated 10 September 2018 ( the letter ); A screenshot of tracking details for the letter, showing its delivery on 18 September 2018; from the MPTS to Dr Akram with notice of hearing for this review hearing and Dr Akram s reply stating she would not be able to attend due to not being in the country, both dated 12 September 2018; A screenshot of tracking details for notice of hearing letter sent by the MPTS on 12 September, showing the letter was delivered and signed for by Dr Akram at 11:10 a.m. on 13 September Ms Kitchin submitted that given the above information, the Tribunal can be satisfied that service has been properly affected in accordance with Rule 40 of the Rules. 4. Having considered the evidence before it and Ms Kitchin s submissions, the Tribunal was satisfied that all reasonable efforts have been made to serve Dr Akram with notice of this hearing in accordance with Rules 20 and 40, and paragraph 8 of Schedule 4 to the Medical Act 1983, as amended. It determined that Dr Akram was both aware of the hearing, and had responded to notice of the hearing to demonstrate such awareness. Proceeding in Dr Akram s absence 5. The Tribunal then went on to consider whether it would be appropriate to exercise its discretion to proceed with this hearing in Dr Akram s absence pursuant to Rule 31 of the Rules. 6. The Tribunal had full regard to the interests of Dr Akram and the effects of proceedings in her absence. It bore in mind that Dr Akram had been given sufficient 11

12 notice of this hearing and the documentation to be adduced by the GMC herein, and that despite this, she had voluntarily absented herself in her of 12 September 2018 where she stated she would not be able to attend as she would not be in the Country. 7. The Tribunal took full account of the fact that Dr Akram was served with appropriate notice about today s hearing, was aware of the hearing and had communicated she was unable to attend due to being out of the Country, and had made no application to adjourn. It concluded it was proportionate to continue with today s Review Hearing in her absence. 8. The Tribunal therefore determined that it is appropriate, fair, just and in the public interest to proceed with this hearing in accordance with Rule 31 of the Rules. 12

In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public.

In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. PUBLIC RECORD Dates: 27/11/2018-29/11/2018 Medical Practitioner s name: Dr Stamatios OIKONOMOU GMC reference number: 6072884 Primary medical qualification: Type of case New - Misconduct Ptychio Iatrikes