Universiteto. That being registered under the Medical Act 1983, as amended:

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1 PUBLIC RECORD Dates: 29/01/ /01/2018 Medical Practitioner s name: Dr Ali ISMAIL GMC reference number: Primary medical qualification: Type of case New - Misconduct Gydytojas 2006 Kauno Medicinos Universiteto Outcome on impairment Impaired Summary of outcome Suspension, 9 months. Immediate order imposed Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Mr Stephen Mooney Mr Paul Curtis Dr Jill Edwards Tribunal Clerk: Mr David Salad Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and represented Mr Angus Gloag, Counsel Mr Daniel Fugallo, Counsel Allegation and Findings of Fact That being registered under the Medical Act 1983, as amended: 1. On or around 7 October 2016 you submitted time sheets for work done at Whittington Health NHS Trust dated 7 October 2016 which were: a. not signed by a consultant; Admitted and found proved 1

2 b. completed to give the impression that they had been approved by a consultant. Admitted and found proved 2. You knew that prior to submitting the time sheets described at paragraph 1 above a consultant had to: a. sign them; Admitted and found proved b. approve them. Admitted and found proved 3. On or around 11 October 2016 you completed a reference ( the Reference ) which you purported that Dr A had: a. written; Admitted and found proved b. Signed. Admitted and found proved 4. You knew that Dr A had not: a. written the Reference; Admitted and found proved b. signed the Reference. Admitted and found proved 5. Your actions as set out in paragraphs 1-4 were dishonest. Admitted and found proved And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct. Attendance of Press / Public The hearing was all heard in public. Determination on Impairment - 29/01/2018 Dr Ismail: 1. At the outset of the hearing, Mr Gloag, Counsel, made admissions on your behalf to the allegation in its entirety. The tribunal therefore announced all of the paragraphs of the allegation as admitted and found proved as follows: That being registered under the Medical Act 1983, as amended: 1. On or around 7 October 2016 you submitted time sheets for work done at Whittington Health NHS Trust dated 7 October 2016 which were: 2

3 a. not signed by a consultant; Admitted and found proved b. completed to give the impression that they had been approved by a consultant. Admitted and found proved 2. You knew that prior to submitting the time sheets described at paragraph 1 above a consultant had to: a. sign them; Admitted and found proved b. approve them. Admitted and found proved 3. On or around 11 October 2016 you completed a reference ( the Reference ) which you purported that Dr A had: a. written; Admitted and found proved b. Signed. Admitted and found proved 4. You knew that Dr A had not: a. written the Reference; Admitted and found proved b. signed the Reference. Admitted and found proved 5. Your actions as set out in paragraphs 1-4 were dishonest. Admitted and found proved 2. With no facts remaining in dispute, and no further evidence at the impairment stage, the tribunal proceeded to hear submissions on whether your fitness to practise is impaired by reason of misconduct. Background 3. The events covered by the allegation relate to your employment as a locum doctor in Orthopaedics and Trauma at Whittington Health NHS Trust ( the Trust ) in October At this time you were employed by Medacs Healthcare ( Medacs ) an agency which provides locum staff to private and public healthcare providers. 4. You have admitted that, on or around 11 October 2016, you completed a reference pro forma ( the Reference ) which should have been completed by a supervising doctor reporting on your placement at the Trust. In this case the reporting doctor would have been Mr A, a Consultant Orthopaedic Surgeon employed by the Trust. The form set out various competencies such as clinical skills and investigation and diagnosis with categories ranging from Unacceptable to Above average for the supervising doctor to select. You had filled in the form, 3

4 selecting either Average or Above average for all of the categories. You had also written the comment Happy to employ in future in a box provided for further information, and completed the details of Mr A, including filling in the signature box. 5. At the conclusion of your placement with the Trust, you sent the completed form to Medacs and another locum agency, Holt Doctors ( Holt ) with whom you hoped to find employment. However, as Holt required the reference to be filled in on their own pro forma, they ed Mr A attaching a copy of the Medacs form which you had completed. Mr A responded on 20 October 2016, stating that he had not completed the Medacs form and that an investigation was required. 6. Holt passed the matter to Medacs to investigate. This led to a phone call between you and Ms C, a Placement Officer at Medacs. Ms C informed you that Mr A had reported that he had not completed the Reference. You told Ms C that you had been in to see Mr A and he had completed the Reference, along with your timesheets for the week, and Mr A had signed them all. Ms C pointed out to you that the last date upon which Medacs had received a timesheet from you was on the 10 October 2016, whereas the Reference was signed and dated 11 October You told Ms C that you would check your records and contact her again. 7. Medacs checked their file with regard to your employment and found two timesheets which appeared to have been approved by Mr A. On 28 October 2016, it ed copies of these timesheets to Mr A. He confirmed by the same day that he had not approved the timesheets. 8. The next contact that Medacs received from you was in an dated 1 November In the you mentioned delayed payments from your shifts at the Trust, and stated that you had been to meet Mr A to discuss the matter with him, but he was on annual leave until 2 November You asked that Medacs update their system with the Reference and provide outstanding payment to you for shifts you had undertaken at the Trust. 9. Medacs referred the matter to the GMC for investigation, leading to these proceedings. 10. The Tribunal noted that the GMC made it clear it was not part of their case that the times of your shifts for which you were claiming payment using the timesheets dated 7 October 2016 were false or inaccurate. Evidence Factual witness evidence 11. The Tribunal received written statements on behalf of the GMC, which were not challenged by you, from the following witnesses: 4

5 Mr A, Consultant Orthopaedic Surgeon at the Trust; Ms B, Head of Compliance at Medacs; Ms C, Placement Officer at Medacs. Documentary evidence 12. The Tribunal had regard to the documentary evidence provided by the parties. This included, but was not limited to: a schedule of admissions to the full allegation signed by you and dated 8 January 2018; a copy of the Reference; Medacs timesheets covering the period 3 7 October 2016; relevant correspondence between you, Mr A, representatives of the Trust, Medacs and Holt; screenshots from Medacs s in-house database detailing contact with you by telephone and . The Tribunal s determination on impairment 13. The Tribunal has deliberated on whether your fitness to practise is impaired by reason of misconduct. In considering the question of impairment, the Tribunal has taken account of all the evidence, both oral and documentary, along with the submissions of Mr Fugallo, Counsel, on behalf of the GMC and those of Mr Gloag, Counsel, on your behalf. Submissions 14. Mr Fugallo submitted that in all but the most exceptional and trivial cases, a finding of dishonesty creates a presumption of impairment. He submitted that honesty is a central and necessary part of a doctor s conduct. He drew the tribunal s attention to paragraphs of Good Medical Practice (2013 Edition) ( GMP ) which he submitted were relevant to your case. He submitted that the conduct which you have admitted involves dishonesty on more than one occasion. He reminded the Tribunal that you had admitted dishonesty both in relation to the completion and submission of work records and appending the signature of Mr A, and also in relation to filling in an assessment form as if it had been completed by Mr A. You subsequently provided this assessment form to two different agencies: Medacs and Holt. 15. Mr Fugallo stated that, when you had been initially challenged about the provenance of the assessment, your initial response, as recorded by Ms C, was for you to persist in your assertion that this document was what it appeared to be. He 5

6 submitted that this was a similar circumstance to the timesheets which you also said were completed by Mr A, when you knew that they were not. He submitted that your admitted dishonesty could not conceivably be categorised as the very rare instance which would not lead to impairment. He submitted that the facts found proved consisted of clear violations of principles of GMP and that this should lead to impairment. 16. Mr Gloag, acting on your behalf, told the Tribunal that you had admitted that your fitness to practise is impaired by reason of misconduct in advance of the hearing. The relevant legal principles 17. The Tribunal reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision of impairment is a matter for the Tribunal s judgment alone. 18. In approaching the decision, the Tribunal was mindful of the two stage process to be adopted: first whether the facts as found proved amounted to misconduct and that the misconduct was serious, and then whether the finding of that misconduct which was serious could lead to a finding of impairment. 19. The Tribunal must determine whether your fitness to practise is impaired today, taking into account your conduct at the time of the events and any relevant factors since then such as whether the matters are remediable, have been remedied and any likelihood of repetition. 20. In deciding whether your fitness to practise is impaired, the Tribunal has borne in mind the statutory overarching objective which is to protect the public. This includes: to protect and promote the health, safety and wellbeing of the public; to promote and maintain public confidence in the medical profession and to promote and maintain proper professional standards and conduct for members of the profession. The Tribunal s determination on impairment Misconduct 21. The Tribunal first considered whether your actions amounted to misconduct. Misconduct can be found in circumstances where there have been serious departures from expected standards of conduct and behaviour, which can be identified by reference to GMP. 22. With regard to your conduct, the tribunal identified that the following paragraphs of GMP are relevant to your case: 6

7 65 You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. 68 You must be honest and trustworthy in all your communication with patients and colleagues. 71 You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. You must make sure that any documents you write or sign are not false or misleading. a You must take reasonable steps to check the information is correct. b 23. The Tribunal was satisfied that your actions with regard to the timesheets and the Reference constituted serious departures from these paragraphs of GMP. Honesty is a fundamental tenet of the profession and the Tribunal was of the view that your dishonest conduct would be considered deplorable by fellow practitioners. 24. In these circumstances, the tribunal concluded that your conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to misconduct. Impairment 25. Having found that the facts found proved amounted to misconduct, the tribunal went on to consider whether, as a result of that misconduct, your fitness to practise is currently impaired. 26. The Tribunal was of the view that your initial admitted dishonest acts were compounded by the fact that, on two occasions (26 October 2016 and 1 November 2016) you reiterated your claim to Medacs that Mr A had completed the reference and the timesheets. It considered that making a false statement over the telephone and sending a false in this manner were further acts which led it to conclude that it could not been satisfied that you would not repeat such dishonesty in the future. 27. The Tribunal acknowledged that it has heard no specific evidence or submissions with regard to your insight into your dishonesty, or with regard to any efforts to remediate on your part. It accepted that dishonesty is in itself difficult to remediate. Further, it acknowledged that you have accepted that your fitness to practise is impaired by misconduct. The Tribunal found that the misconduct found 7

8 proved in your case included the breaching of a fundamental tenet of the profession through your dishonest actions. It considered that this lack of probity brought the profession into disrepute. 28. In these circumstances the Tribunal considered that a finding of impairment was necessary to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of the profession. 29. The Tribunal has therefore determined that your fitness to practice is impaired by reason of misconduct Determination on Sanction - 30/01/2018 Dr Ismail: 1. Having determined that your fitness to practise is impaired by reason of your misconduct, the Tribunal deliberated on what action, if any, to take with regard to your registration. 2. In so doing, the Tribunal gave careful consideration to the documentary evidence received at the hearing, where relevant, to reaching a decision on sanction. It also took into account your oral evidence given at this stage of the hearing, together with Mr Fugallo s submissions on behalf of the GMC and Mr Gloag s submissions on your behalf. Submissions 3. Mr Fugallo drew the Tribunal s attention to various paragraphs of the Sanctions Guidance (May 2017) (the SG) which he considered to be relevant in your case. He submitted that sanctions less serious than suspension were not appropriate in dishonesty cases and that suspension and erasure were the categories that may be more appropriate for the Tribunal s consideration. He told the Tribunal that there is evidence of repeated dishonesty in your case with regard to the timesheets and the Reference. He stated that your initial reaction to the local investigation was to persist in the dishonesty and claim Mr A had signed the relevant documents. He submitted this was evidence of more than isolated dishonesty on your part. 4. Mr Fugallo invited the Tribunal to look carefully at the testimonials which you have provided. He stated that they have not been provided in advance and therefore the GMC has had no opportunity to make any checks and this may be relevant to any weight the Tribunal attaches to them. He submitted that the Tribunal should consider whether the testimonials are directly relevant to the misconduct in this case. He said that the Tribunal may wish to consider how sincere or timely your 8

9 expressions of regret have been, and what stage your level of insight has reached at the time of this hearing. 5. Mr Gloag referred the Tribunal to the documents adduced on your behalf at this stage. These included your witness statement dated 17 January 2018, your CV, Continuing Professional Development (CPD) certificates and testimonials, references and assessment forms completed by former colleagues. He told the Tribunal that a remarkable series of events had occurred in your life at the time that your dishonesty occurred referring to the legal, family and financial issues that were ongoing at the time. He said that these issues had overwhelmed you and although they were not an excuse to act as you did, they placed your actions in context. He told the Tribunal that, although the testimonials you have provided were not specifically written with these proceedings in mind, they would provide a snapshot of how those who have worked with you view you, demonstrating that you are a good doctor. 6. With regard to your insight, Mr Gloag told the Tribunal that you have fully engaged in these proceedings and admitted to the full allegation prior to this hearing and have not contested that your fitness to practise is impaired. He submitted that you have attended the hearing and given evidence to address the matters, providing unambiguous evidence of insight. He described the changed circumstances of your life with the legal, family and financial issues either resolved or much improved. He accepted on your behalf that taking no action or imposing conditions would not be appropriate in this case. He submitted that erasure would be wholly inappropriate in these circumstances before the Tribunal. He submitted that the appropriate sanction was one of suspension for a period of six nine months. Tribunal s approach 7. The decision as to the appropriate sanction, if any, is a matter for this Tribunal exercising its own judgement. In reaching its decision, the Tribunal has taken account of the SG and the statutory over-arching objective, which includes protecting and promoting the health, safety and wellbeing of the public, promoting and maintaining public confidence in the medical profession, and promoting and maintaining proper professional standards and conduct for the members of the profession. The Tribunal recognises that the purpose of a sanction is not to be punitive, although it may have a punitive effect. 8. Throughout its deliberations, the Tribunal has applied the principle of proportionality, balancing your interests with the public interest. It reminded itself that it should only impose the minimum sanction necessary to achieve the overarching objective. In deciding what sanction, if any, to impose the Tribunal considered each of the sanctions available, starting with the least restrictive. It also considered and balanced the mitigating and aggravating factors in this case. 9

10 The tribunal s determination on sanction Taking no action 9. The Tribunal first considered whether to conclude your case by taking no action with regard to your registration. The Tribunal has already determined that your fitness to practise is impaired by reason of your misconduct. It determined that given the serious departures from GMP it found, and in the absence of any exceptional circumstances, it would be inappropriate to conclude this case by taking no action. Conditions 10. The Tribunal next considered whether it would be sufficient to impose conditions on your registration. Any conditions imposed would need to be appropriate, proportionate, workable and measurable. It gave due regard to the SG, particularly paragraphs which cover the imposition of conditions. 11. The Tribunal was of the view that it could not formulate conditions to address the issues raised by your dishonesty. Further, given the seriousness with which it views your misconduct, it determined that a period of conditional registration would not adequately protect public confidence in the profession. Suspension 12. The Tribunal moved on to consider whether it would be sufficient to impose a period of suspension on your registration. The Tribunal has borne in mind the SG in relation to suspension, including paragraphs 91 and 92 in which it states: 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. 92 Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession). 10

11 13. The Tribunal has set out the seriousness with which it regards your misconduct in its determination on impairment and will not repeat this here. It found that your dishonesty was aggravated by your subsequent denials of your actions as part of the local investigation. This meant that your dishonesty was prolonged for a period beyond the few days in which you submitted the timesheets and the Reference. 14. The Tribunal identified a number of mitigating factors in your case. It took into account the significant pressures that were present in your life when your misconduct occurred, including divorce, along with other legal and family proceedings, as well as serious financial problems. It was of the view that these matters did not excuse your resorting to dishonesty, but placed your actions in the context of the numerous stressors that were present in your life at that time. 15. In addition, the Tribunal found it significant that your actions with regard to the timesheets were not undertaken through financial gain. The working hours which you submitted were correct and you were later paid for them in full. You acted as you did in order to speed up the process of receiving money that was due to you to service legal costs. Further, in the Reference, you did not seek to overstate your skills, providing lower competency scores for yourself than a colleague had done on a similar form a short time before this. The Tribunal acknowledged that no risk to patients had been identified in relation to your misconduct. 16. The Tribunal placed limited weight on the testimonials you had provided, considering that they were not provided in advance of this hearing. Further, there was no evidence that their authors were aware of these proceedings, the nature of the allegation or your admissions which significantly diminished their value. 17. The Tribunal took into account that you have engaged with the regulatory process. It found that it was to your credit that you made full admissions to the allegation before this hearing and did not seek to challenge that your fitness to practise was impaired. In addition, the Tribunal gave weight to your oral evidence at the sanction stage of this hearing. You accepted the seriousness of your actions, apologised for them and stated that you would not repeat them. The Tribunal found that your evidence demonstrated insight into your actions. It noted that the significant external stressors which were present in your life have to a large extent been addressed, substantially reducing the risk of repetition. 18. The Tribunal was of the view that your misconduct, although serious, was not fundamentally incompatible with continued registration. It noted that the hospital that had raised the allegation against you had subsequently re-employed you as a locum. It was satisfied that erasure would be disproportionate, in light of the significant number of mitigating features present in your case. 11

12 19. In all the circumstances, the Tribunal determined to suspend your registration for nine months. In deciding on this period of time, the Tribunal took into account the seriousness of your actions and the need to demonstrate clearly to you, the profession and the public that your actions were unacceptable. It determined that a suspension of this length would promote and maintain both public confidence in the profession and standards and conduct for members of the profession. 20. The Tribunal has determined that a review hearing is not required in your case. There are no patient safety issues in this case and no reason to believe you will become de-skilled during the period of any suspension. The principal purpose of the Tribunal s sanction is to uphold public confidence in the profession and to promote and maintain proper professional standards and conduct. The Tribunal was satisfied that such a hearing would serve no purpose in the circumstances before it. It considered that there is no new evidence which you could make available to a reviewing Tribunal that you could not provide at the current hearing. 21. The effect of this direction is that, unless you exercise your right of appeal, this decision will take effect 28 days from when written notice of this determination is deemed to have been served upon you. A note explaining your right of appeal will be supplied to you. Determination on Immediate Order - 30/01/2018 Dr Ismail: 1. Having determined that your registration be suspended for a period of nine months, the Tribunal has now considered, in accordance with Section 38(1) of the Medical Act 1983 as amended, whether it should suspend your registration with immediate effect. Submissions 2. Mr Fugallo, on behalf of the GMC, told the Tribunal that he had no instructions to submit that an immediate order was required. He said that the GMC was neutral on the point and adopted the content of his submissions on sanction. 3. Mr Gloag stated that you did not object to the imposition of an immediate order. Tribunal s Decision 4. Having considered the submissions of Mr Fugallo and those of Mr Gloag, alongside paragraphs of the Sanctions Guidance (May 2017), the Tribunal balanced the public interest against your own interests. 12

13 5. The Tribunal has determined that it is necessary to suspend your registration immediately. In light of the seriousness of its findings regarding your misconduct, the Tribunal considered that it was necessary to confirm its decision at the sanction stage by making the order immediate. It was satisfied that this was in the public interest given its findings regarding your dishonesty. 6. This means that your registration will be suspended from today. 7. The substantive direction for suspension, as already announced, will take effect 28 days from the date on which written notice of the decision is deemed to have been served upon you, unless you lodge an appeal in the interim. If you do lodge an appeal, the immediate suspension will remain in force until the appeal is decided. Confirmed Date 30 January 2018 Mr Stephen Mooney, Chair 13