GMC reference number: Primary medical qualification: MB ChB 2013 University of Glasgow. Impaired Impaired

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1 PUBLIC RECORD Dates: 09/10/ /10/2017 Medical Practitioner s name: Dr Ediz Halit EKREM GMC reference number: Primary medical qualification: MB ChB 2013 University of Glasgow Type of case New - Conviction / Caution New - Misconduct Outcome on impairment Impaired Impaired Summary of outcome Erasure Immediate order imposed Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Mrs Kim Parsons Ms Bronwen Cooper Dr Ranjana Rani Tribunal Clerk: Mr Sewa Singh Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Not present and not represented None Ms Elizabeth Dudley Jones, Counsel Allegation and Findings of Fact That being registered under the Medical Act 1983 (as amended): 1. On 3 May 2017 at Croydon Crown Court you were convicted of: making indecent photograph or pseudo-photograph of child x 1; making indecent photograph or pseudo-photograph of child x 2. Found Proved in its entirety 1

2 2. On 3 May 2017 you were sentenced to: a. 16 months imprisonment; b. Sex Offenders registration for 10 years; c. a Sexual Harm Prevention Order [SHPO] for a period of 10 years (under s.103 of the Sexual Offences Act 2003); d. deprivation of a laptop and hard drive (under s.143 Powers of Criminal Courts (Sentencing) Act 2000); e. no separate penalty in respect of paragraph 1b. Found Proved in its entirety 3. You failed to notify the GMC without delay that you had been charged with the criminal offences detailed in paragraphs 1a and 1b. Found Proved 4. You failed to notify the GMC without delay that you had been convicted of the criminal offences as detailed in paragraphs 1a and 1b. Found Proved Attendance of Press / Public The hearing was all heard in public. Determination on Preliminary Procedural Matters, Facts and Impairment - 10/10/2017 Ms Dudley Jones: Service 1. Dr Ekrem is neither present nor represented at this hearing. The tribunal was made aware that he is currently serving a 16 month sentence of imprisonment at HMP Brixton. 2. You, on behalf of the General Medical Council (GMC), provided the tribunal with a service bundle which included the Notice of Allegation (NOA) and the Notice of Hearing (NOH). The NOA was sent to Dr Ekrem at HMP Brixton on 5 September 2017 as shown by the documentary proof of posting before the tribunal. It was delivered and signed for at this address at 09:09 on 6 September The NOH was sent to Dr Ekrem at HMP Brixton on 6 September 2017 as shown by the documentary proof of posting before the tribunal. It was delivered and signed for at this address at 09:55 on 7 September

3 4. You submitted that proper service of the NOA and NOH had taken place. 5. Having considered all the evidence, the tribunal was satisfied that the NOA and NOH were in the proper form and were served more than 28 days before today s hearing. Accordingly the tribunal was satisfied that due service of these documents had taken place in accordance with Rules 15 and 40 of the GMC (Fitness to Practise) Rules 2004, as amended ( the Rules ). Proceeding in Absence 6. With regard to proceeding in the doctor s absence, you told the tribunal that it had a discretion to proceed in the absence of the doctor pursuant to Rule 31. You submitted that Dr Ekrem is aware of today s hearing and has voluntarily absented himself. 7. You referred the tribunal to two letters received from Dr Ekrem. In the first letter dated 2 August 2017 Dr Ekrem stated: I have just received the letter from the GMC dated 28 th July 2017 regarding new information coming forward in failing to notify the GMC of my charge/conviction. I would like to make clear that my lack of engagement in corresponding with the GMC was due to the strain and stress I was under during my period on bail. I also believed that the detective dealing with my case at the police was informing you of the progress with regards to charge and conviction. Regardless of what the GMC decides with this new information, I intend to comply. I understand that the gravity of my offences precludes any future employment in healthcare, and have come to terms with and accept this. As such I do not intend to contest or provide any further comment with regards to my possibility of future practice. 8. In the second letter dated 22 August 2017, Dr Ekrem referred to his letter of 2 August He went on to say: I realise that my behaviour regarding my failure to notify the GMC was not the peak of professional etiquette, however I could not have done more at the time under that extreme stress and pressure. 9. Dr Ekrem went on to reiterate that he did not intend to practice medicine again and stated My intention now is to rehabilitate with services and help offered to me here and on released on licence, to put this chapter of my life 3

4 behind me and look forward to be a contributing, useful member of society and my community in whichever way possible that may be. 10. You informed the tribunal that the GMC wrote to Dr Ekrem at HMP Brixton on 13 September With this letter it enclosed the proof of service and proceeding in absence bundle. The GMC also advised Dr Ekrem that, as he was not legally represented, it was open to him to make an application to attend the hearing from prison, via videolink, as shown by the documentary proof of posting before the tribunal. It appears likely that this was delivered and signed for at 09:26 on 14 September The tribunal noted that the GMC has received no such application. 11. You said that Dr Ekrem has not requested an adjournment nor has he expressed a wish to be represented. You submitted that it is in the public interest for the hearing to proceed today. 12. The tribunal has borne in mind that the discretion to proceed in Dr Ekrem s absence should be exercised with the utmost care and caution. The tribunal considered the documentation before it and accepted that Dr Ekrem is aware of today s hearing and has noted Dr Ekrem s letters dated 2 and 22 August The tribunal has had regard to the issue of fairness to Dr Ekrem and to the GMC in the proper discharge of its regulatory function. Notwithstanding that the decision to proceed today does not afford an opportunity for the tribunal to hear from Dr Ekrem, the tribunal does not consider that any adjournment would be likely to secure his attendance in the future. In his letter of 2 August 2017, he stated...as such I do not intend to contest or provide any further comment with regards to my possibility of future practice.. The tribunal was of the view that the matters contained within the allegation should be dealt with expeditiously and that to delay consideration of them would serve no purpose. 14. Having considered all the evidence provided, the tribunal has determined that it is in the public interest that it should proceed with this case in his absence. It was satisfied that no injustice to Dr Ekrem would result from its decision to do so. The tribunal has therefore determined that the hearing should proceed in the absence of Dr Ekrem, in accordance with Rule 31 of the Rules. Background 15. Dr Ekrem is a doctor with full registration with the GMC. At the time of these events (October 2016), he was working as a Junior Doctor (Foundation Year 1) in the Neo-natal Department at Croydon Health Services NHS Trust ( the Trust ). 4

5 16. On 28 October 2016, the GMC received information from Mr A of the Metropolitan Police that Dr Ekrem had been arrested for possession of indecent images of children. Dr Ekrem made admissions and a number of computers were taken from his address. Dr Ekrem was interviewed by the police and released on bail conditions, which included not to have unsupervised contact with any person under the age of 18 years. 17. On 31 October 2016, the GMC was informed by the Trust that Dr Ekrem had been excluded from the Trust for two weeks, following his arrest. 18. On 6 March 2017 at Bromley Police Station, Dr Ekrem was charged with the three offences below, one relating to each category: Make indecent photograph / pseudo-photograph of a child, on or before October 2016 at within the CCC made an indecent photograph, namely moving or still images of category A, B and C, of a child, CONTRARY TO SECTIONS 1 (1)(A) AND 6 OF THE PROTECTION OF CHILDREN ACT On 5 April 2017 Dr Ekrem entered a guilty plea at Bromley Adult In Custody Magistrates Court to three counts of possession of indecent images totalling some 52,000. He was committed to the Crown Court for sentence under Section 3 Powers of Criminal Courts (Sentencing) Act 2000). 20. On 3 May 2017 at the Crown Court in Croydon, Dr Ekrem was convicted of: 1) Making indecent photograph or pseudo photograph of child x1 2) Making indecent photograph or pseudo photograph of child x2 21. Dr Ekrem was sentenced to: 16 months imprisonment; Sex Offenders registration for 10 years; A Sexual Harm Prevention Order (SHPO) for a period of 10 years (under s.103 of the Sexual Offences Act 2003); Deprivation of a laptop and hard drive (under s.143 Powers of Criminal Courts (Sentencing) Act 2000); and No separate penalty in respect of 2) above Documentary Evidence 22. The tribunal was provided with the GMC Hearing bundle which included: 5

6 Facts The witness statement of Mr B, Investigation Officer at the GMC, dated 24 July 2017 A short format Pre-Sentence Report dated 18 April 2017 The Judge s sentencing remarks dated 3 May 2017 Certificate of Conviction from Croydon Crown Court dated 2 June 2017 Paragraph 1 1. On 3 May 2017 at Croydon Crown Court you were convicted of: a) making indecent photograph or pseudo-photograph of child x 1; b) making indecent photograph or pseudo-photograph of child x 2. Found Proved in its entirety Paragraph 2 2. On 3 May 2017 you were sentenced to: a. 16 months imprisonment; b. Sex Offenders registration for 10 years; c. a Sexual Harm Prevention Order [SHPO] for a period of 10 years (under s.103 of the Sexual Offences Act 2003); d. deprivation of a laptop and hard drive (under s.143 Powers of Criminal Courts (Sentencing) Act 2000); e. no separate penalty in respect of paragraph 1b. Found Proved in its entirety 23. The tribunal considered paragraph 1 and 2 above together. It had regard to the Certificate of Conviction ( the Certificate ) dated 2 June 2017 and to Rule 34(3) of the General Medical Council ( GMC )(Fitness to Practise) Rules Order of Council 2004 as amended ( the Rules ) which states: (3) Production of a certificate purporting to be under the hand of a competent officer of a Court in the United Kingdom or overseas that a person has been convicted of a criminal offence or, in Scotland, an extract conviction, shall be conclusive evidence of the offence committed. 6

7 24. The tribunal noted that the charges are consistent with the content of the Certificate. Accordingly, the tribunal accepted this as evidence of the offences committed and the sentence imposed. It was satisfied that the requirements of Rule 34(3) had been met and therefore it found paragraphs 1 and 2 of the allegation proved. Paragraph 3 3. You failed to notify the GMC without delay that you had been charged with the criminal offences detailed in paragraphs 1a and 1b. Found Proved Paragraph 4 4. You failed to notify the GMC without delay that you had been convicted of the criminal offences as detailed in paragraphs 1a and 1b. Found Proved 25. The tribunal considered paragraphs 3 and 4 together. 26. The tribunal noted that you were charged on 6 March 2017; found guilty on 5 April 2017; and sentenced on 3 May It also took into account that in his witness statement, Mr B stated: The GMC operates a case management software called Siebel which stores information relating to a doctor s registration. Communications between a doctor and the GMC are also stored on Siebel. I have access to all documents and registration information relating to Dr Ekrem. I have now reviewed all documentation on Seibel relating to Dr Ekrem s registration. I can confirm that I cannot find any record to demonstrate that Dr Ekrem notified the GMC of him having been charged or convicted of a criminal offence It also had regard to the Charge Sheet dated 6 March 2017 which clearly shows that Dr Ekrem was charged with three counts of possession of indecent images totalling Furthermore, it noted the Certificate of Conviction dated 2 June The tribunal had regard to paragraph 75(b) of Good Medical Practice (GMP) (2013 version). This states that: 29. You must tell us without delay if, anywhere in the world: a.. 7

8 b you have been charged with or found guilty of a criminal offence 30. In his letter dated 22 August 2017 Dr Ekrem stated I realise that my behaviour regarding my failure to notify the GMC was not the peak of professional etiquette, however I could not have done more at the time under that extreme stress and pressure. 31. In view of the information above, the tribunal was satisfied that Dr Ekrem failed to notify the GMC that he had been charged with, and convicted of, the criminal offences detailed in paragraphs 1a and 1b. It therefore found paragraphs 3 and 4 of the allegation proved. Impairment Submissions on behalf of the GMC 32. You submitted that Dr Ekrem s fitness to practise is currently impaired. You referred the tribunal to relevant authorities and said that Dr Ekrem had breached numerous aspects of GMP and had failed to make patient safety his first concern. 33. In relation to his conviction, you told the tribunal that the nature of Dr Ekrem s conviction, which involved downloading thousands of indecent images of children, and including some that fell within category A, was so serious that it resulted in his imprisonment. You told the tribunal that Dr Ekrem by his own admission stated that he had been downloading such images since he was 14 or 15; had a long ingrained problem which had spiralled out of control and got gradually worse; and that he was unable to function without viewing such images. 34. You submitted that there was a clear pattern of similar offending behaviour over a long period of time. Dr Ekrem had breached fundamental tenets of GMP. You said that Dr Ekrem had chosen paediatrics as his speciality area of medical practice which meant that he had access to vulnerable young children. 35. In relation to misconduct, you drew the tribunal s attention to paragraph 75 of GMP. You told the tribunal that Dr Ekrem s actions were serious and amounted to misconduct. 36. In relation to insight, you referred the tribunal to Dr Ekrem s Pre-Sentence Report in which Dr Ekrem described that he was relieved at having been being apprehended. You said that this demonstrated some insight by Dr Ekrem into his wrongdoing. Dr Ekrem breached fundamental tenets of GMP, and in all the circumstances, his fitness to practise was and still is impaired. 8

9 The Tribunal s approach 37. The tribunal has borne in mind that there is no burden or standard of proof at this stage. It is a matter for this tribunal, exercising its own judgement, to determine whether Dr Ekrem s fitness to practise is currently impaired. Throughout its deliberations, the tribunal has borne in mind the overarching objective, which is to: protect and promote the health, safety and wellbeing of the public promote and maintain public confidence in the medical profession promote and maintain proper professional standards and conduct for the members of the profession. 38. The tribunal has taken into account the submissions made by you. It first considered whether the facts found proved in this case amounted to misconduct. Misconduct 39. The tribunal had regard to the 2013 edition of GMP which was in effect at the time of the events. It considered that Dr Ekrem s conduct was a significant departure from the principles of GMP, in particular paragraphs 65 and 75(b). These state: 65. You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. 75. You must tell us without delay if, anywhere in the world: a.. b you have been charged with or found guilty of a criminal offence 40. The tribunal was of the view that Dr Ekrem s actions potentially put young vulnerable patients at risk because he would have had unsupervised access to them. By his own admission, his obsession to download indecent images has been going on over a long period of time, and had always been getting gradually worse. He had chosen to become a doctor and practise in a paediatric specialty which could be considered a deliberate and predatory act or decision in order that he could pursue his own sexual gratification. The tribunal noted that there was no evidence of any inappropriate behaviour in the workplace. 9

10 41. The images which Dr Ekrem downloaded were of an extremely serious nature as described in the sentencing remarks of HHJ Ainley: What you have been doing has been feeding a market in the most appalling perverted imagery for a period of many years. You are now 31. You have been looking and storing these images for a period of many years. There is absolutely no need for me to go into the particulars of some of the imagery but suffice to say that it includes dreadful scenes of the rape of little girls of the ages of the four or five, girls who are obviously suffering terrible pain and distress. These are very real victims indeed and the only way the court protect them is by imposing sentences of imprisonment and that is what I feel I have to do in this case. 42. It also had regard to the Pre-Sentence Report in which it states: Mr Ekram described a feeling of relief in being apprehended. He states that he has previously tried to stop downloading and viewing these images but has not been able to stop himself. Dr Ekrem describes himself as broken, dysfunctional and faulty... It is clear that he wishes to address his offending behaviour, stating that it s been going on for a long time, its ingrained, I want to stop. Mr Ekrem shows remorse for his actions. 43. The report also states Dr Ekrem admitted that he had downloaded and viewed indecent images since he was aged 14/15. He states his preference and masturbatory fantasises revolve around pubescent and pre-pubescent female children between the ages of 6 and 15, particularly school girls. 44. The tribunal noted the GMC s submission that there is no evidence to suggest that Dr Ekrem shared any of the images he downloaded with other users. However, the tribunal has had regard to the undated statement of Mr C, Digital Forensic Investigator with the Sexual Offences, Exploitation and Child Abuse Command Hi-Tech Crime Unit. In this, Mr C stated: Limewire is a P2P (Peer-to-Peer) file downloading program. Peer to peer applications allow for the downloading and sharing of files without the need for a central server hosting the content. Users are able to search for a range of media (books, music, videos, programs, etc) within the program, then download that file from other users. While the user is downloading, the partially downloaded file is made available for other users to download. Users can elect to continue to allow other users to download files from them once the file has finished downloading this is often referred to as seeding. 45. In the circumstances, the tribunal concluded that Dr Ekrem s conduct constituted a very serious departure from the professional standards set out in GMP. 10

11 In all the circumstances, the tribunal has come to the conclusion that his conduct in downloading indecent images of children, and not notifying his Regulator that he had been charged and convicted of these offences, breached the principles of GMP and brought the medical profession into disrepute. His actions would be regarded as deplorable by fellow practitioners. 46. The tribunal therefore concluded that the facts found proved amounted to misconduct which is serious. Impairment 47. Dr Ekrem s criminal actions have clearly breached the fundamental tenets of the profession and of GMP. This is a case where the conduct leading to Dr Ekrem s conviction is serious, in that he downloaded approximately 52,000 indecent images of children and repeated his behaviour over a long period of time. He stored the images on a removable hard-drive. Dr Ekrem told the police that he had placed a block on any file name containing the word pedo. The tribunal preferred the evidence of Mr C that Dr Ekrem had no such filter in place. In addition, he chose to work as a doctor in a paediatric department of a hospital, which involved treating young children, when he was well aware of his own broken, dysfunctional and faulty behaviour. He placed patients at risk of harm and brought the profession into disrepute. 48. While the tribunal notes that, in the Pre-Sentence Report, Dr Ekrem is quoted as stating that he wanted to stop, the tribunal has not been provided with any evidence which supports this. 49. Further, Dr Ekrem failed to notify his Regulator that he had been charged with, and convicted of, the offences as described above, contrary to paragraph 75(b) of GMP, demonstrating a lack of openness with his Regulator. 50. Accordingly, the tribunal is clear that public confidence in the profession would be seriously undermined if a finding of impairment were not made. The tribunal is also clear that the same can be said of the requirement to maintain proper standards of conduct within the profession. The tribunal notes that Dr Ekrem was only sentenced 6 months ago and there are 10 months remaining of his sentence. 51. In all the circumstances, the tribunal has concluded that Dr Ekrem s fitness to practice is currently impaired by reason of his conviction and misconduct. Determination on Sanction - 11/10/2017 Ms Elizabeth Dudley Jones: 11

12 1. Having determined that Dr Ekrem s fitness to practise is impaired by reason of conviction and misconduct, the tribunal has now considered what action, if any, it should take with regard to Dr Ekrem s registration. GMC Submissions 2. You submitted, on behalf of the GMC, that the appropriate sanction in this case is one of erasure. You explained to the tribunal that the main reason for imposing a sanction is to protect the public. You stated that the tribunal should have regard to proportionality when determining what sanction to impose on Dr Ekrem s registration and that the reputation of the profession as a whole is more important than the interests of any individual doctor. You said that the tribunal should have regard to mitigating and aggravating factors when determining sanction. You said that the tribunal should consider the sanctions available starting with the least restrictive first. 3. You submitted that Dr Ekrem s actions were a significant departure from the tenets of GMP, the benchmark doctors are expected to meet. In view of the nature of the concerns in this case, you submitted that taking no action was not an option, and that workable conditions could not be formulated to address the concerns. 4. You referred the tribunal to a number of paragraphs, in particular 91, 92 and 97 (a), (e), (f), (g) of the Sanctions Guidance (SG) (May 2017 version) which identify when suspension might be appropriate. You submitted that Dr Ekrem downloaded thousands of indecent images of children including some that fell within category A. You told the tribunal that Dr Ekrem by his own admission stated that he had been downloading such images since he was 14 or 15; had an ingrained problem which had spiralled out of control and got gradually worse; and that he was unable to function without viewing such images. With regard to insight, you submitted that, although Dr Ekrem appeared to be remorseful for his actions, he had not shown any insight into the seriousness of his actions and therefore his behaviour is irremediable. 5. You then referred the tribunal to paragraphs 107, 108, 109, 116, 117, 142, 147, and of SG. You submitted that paragraph 109 provides a list of factors that indicate when erasure is appropriate and you submitted that (a), (b), (d), (e), (f), (g), (h), (i) and (j) are present in this case. 6. You submitted that Dr Ekrem s actions are fundamentally incompatible with his continued registration on the medical register and invited the tribunal to impose an order of erasure. 12

13 The Tribunal s approach 7. In reaching its decision, the tribunal has taken account of the SG and the statutory over-arching objective, which includes protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession, and promoting and maintaining proper professional standards and conduct for the members of the profession. 8. The tribunal recognises that the purpose of a sanction is not to be punitive, although it may have a punitive effect. Throughout its deliberations, the tribunal has applied the principle of proportionality, balancing Dr Ekrem s interests with the public interest. The decision as to the appropriate sanction, if any, to impose in this case is a matter for the tribunal exercising its own judgement. The tribunal has considered the sanctions available to it, starting with the least restrictive. Mitigating and aggravating factors 9. Before reaching its decision on what sanction, if any, to place on Dr Ekrem s registration, the tribunal identified the aggravating and mitigating factors in this case. 10. It found the following to be a mitigating factor: Dr Ekrem in his letters to the GMC, dated 2 and 22 August 2017, acknowledged and accepted that the consequences of his actions meant that he would not be able to practise medicine in the future. 11. The tribunal was mindful of the Pre-Sentence Report which stated Mr Ekrem shows remorse for his actions. Further, the tribunal had regard to the fact that Dr Ekrem was a FY1 junior doctor and therefore is at a very early stage of his career and has limited experience. However, the tribunal was of the view that Dr Ekrem s reported remorse is not evidence of his insight into his actions. To the contrary, the tribunal has not identified any evidence that Dr Ekrem has insight into his actions. In respect of his position as a FY1 junior doctor, the tribunal concluded that this was irrelevant in view of the very serious nature of the offences committed by Dr Ekrem. 12. It found the following to be aggravating factors: The serious nature of Dr Ekrem s conviction and the sentence imposed; The Pre-Sentence Report indicates that Mr Ekrem posed a risk of reconviction for a sexual offence and a risk of serious harm to children; His obsession to download indecent images had been ongoing over a long period of time, around 15 years; He downloaded approximately some 52,000 indecent images of children of an extremely serious nature, some of which were of the most serious category A; 13

14 He repeated his actions in that he stored the images on a removable harddrive so that they could be viewed again; His lack of insight; He chose to work as a doctor in a paediatric department of a hospital, which involved treating young vulnerable children and gave him unsupervised access to them, which potentially placed them at risk of harm; His conviction and misconduct bring the profession into disrepute; He was aware his behaviour had always been getting gradually worse and that he could not function without viewing indecent images, but appears not to have taken steps to tackle this behaviour; He failed to notify his Regulator that he had been charged and convicted of these offences. No action 13. The tribunal first considered whether it could take no action. It noted that when a doctor s fitness to practise is impaired, taking no action usually only arises when there are exceptional circumstances. It determined that because of the seriousness of Dr Ekrem s conviction together with the tribunal s duty to maintain public confidence in the profession and to uphold proper standards of conduct and behaviour given the serious nature of the concerns identified, and the absence of any exceptional circumstances, it would not be adequate, appropriate nor in the public interest to take no action in this case. Undertakings 14. None were put before the tribunal to consider. In any event, because of the nature of the concerns in this case, undertakings would not be appropriate given the seriousness of Dr Ekrem s behaviour, including his failure to notify his Regulator of his charge and conviction. Conditions 15. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Ekrem s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 16. The tribunal has taken account of the SG and has had regard to paragraph 79 and 81 which outline when conditions might be appropriate and when they are likely to be workable. The tribunal has determined that none of the factors listed in those paragraphs apply in this case. Further, because of the nature of the concerns in this case, conditions would not mark the seriousness of Dr Ekrem s conduct, nor would they adequately address the public interest in this case. 14

15 Suspension 17. In determining whether it would be appropriate to suspend Dr Ekrem s registration, the tribunal had regard to the principle of proportionality, weighing the interests of the public against Dr Ekrem s. 18. The tribunal has had regard to paragraphs 92 and 97 of SG. Paragraph 97 provides a list of factors, some or all of which are likely to be present in a case where suspension may be appropriate. It found that none of these factors, set out below, applied in Dr Ekrem s case: a. 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. e. No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor s unwillingness to engage. f. No evidence of repetition of similar behaviour since the incident. g. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour. 19. The tribunal is mindful that Dr Ekrem s actions involved downloading approximately 52,000 indecent images of children of an extremely serious nature, some of which were in the most serious category A, repeated over a long and protracted period of time, for which he was convicted and given a custodial sentence of 16 months. It has also noted the references in the Pre-Sentence Report where Dr Ekrem described that he was relieved at having been apprehended; he had previously tried to stop himself and described himself as broken, dysfunctional and faulty. There is no evidence before the tribunal that Dr Ekrem made any attempt to disclose his behaviour to the authorities or to seek appropriate help from relevant agencies. Combined with the fact that Dr Ekrem has not provided the tribunal with any evidence that he has insight into his actions or the steps he has taken to remediate his behaviour, the tribunal concluded that Dr Ekrem s actions are fundamentally incompatible with his continued registration on the medical register. 15

16 20. The tribunal considered whether there was a risk of repetition of Dr Ekrem s behaviour. Having considered all the evidence available, it was of the view that there is a significant risk of Dr Ekrem repeating his behaviour, particularly as he has not demonstrated any insight into his actions. 21. The tribunal has determined that a period of suspension would not be adequate or appropriate to reflect the seriousness of Dr Ekrem s behaviour, or to uphold proper professional standards, maintain public confidence in the profession, and protect the safety and well-being of the public. Erasure 22. The tribunal has had regard to the factors set out in paragraph 109 of the SG, the presence of any of which is likely to indicate that an order of erasure may be appropriate. The tribunal found the following present in Dr Ekrem s case: a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. b. A deliberate or reckless disregard for the principles set out in Good Medical Practice d. Abuse of position/trust (see Good Medical Practice, paragraph 65: You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession ) e. Violation of a patient s rights/exploiting vulnerable people f. Offences of a sexual nature, including involvement in child pornography g. Offences involving violence i. Putting their own interests before those of their patients j. Persistent lack of insight into the seriousness of their actions or the consequences. 23. There is no evidence before the tribunal that Dr Ekrem has offered any apology for his behaviour, taken any steps to remediate his misconduct, or that he has reflected on his actions. Dr Ekrem has not provided any evidence that he has insight into his actions or that he appreciates that by creating demand for these images, he has contributed to the harm caused to these children. 16

17 24. The tribunal has concluded that there is a significant risk of Dr Ekrem repeating his misconduct given the long period over which he downloaded and saved the images, with it getting gradually worse. In the tribunal s view, Dr Ekrem chose to become a doctor and practise in a paediatric specialty which could be considered a deliberate and predatory act or decision in order that he could pursue his own sexual gratification. By doing so, he potentially placed patients at risk of harm. Dr Ekrem clearly had the potential to violate young patients rights, for his sexual gratification. 25. The tribunal has had regard to the sentencing remarks of HHJ Ainley referred to above. 26. Dr Ekrem failed to uphold the proper standards of behaviour expected of doctors by the public, and his conduct breached fundamental tenets of GMP. His failure to comply with the relevant professional standards was serious and his conduct brought the profession into disrepute. 27. Further, Dr Ekrem s criminal actions have clearly breached the fundamental tenets of the profession and of GMP. Dr Ekrem s conduct leading to his conviction is very serious. He has shown a blatant disregard for the principles of GMP, compounded by his failure to disclose his charge and conviction. 28. The tribunal has determined that erasure from the medical register is proportionate. It is the only sanction that will fulfil the overarching objective of protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession and promoting and maintaining proper professional standards and conduct for members of that profession. 29. Having weighed all the matters set out above, and having ensured that it has attached due weight to the principle of proportionality, the tribunal has determined that Dr Ekrem s name should be erased from the medical register. Determination on Immediate Order - 11/10/2017 Ms Elizabeth Dudley Jones: 1. Having determined that Dr Ekrem s registration should be suspended, the tribunal has now considered, in accordance with Section 38 of the Medical Act 1983 as amended, whether it should suspend his registration with immediate effect. Submissions on behalf of the GMC 2. You referred the tribunal to its determination on sanction and submitted that an immediate order is necessary for the protection of members of the public and in the public interest. 17

18 Tribunal s decision 3. The tribunal has taken account of the relevant paragraphs of the SG (May 2017 version) in relation to when it is appropriate to impose an immediate order. Paragraph 172 of the SG states: The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public, or is otherwise in the public interest, or is in the best interests of the doctor 4. The tribunal has determined that, given the serious nature of Dr Ekrem s conviction and misconduct, and its findings in relation to his impairment and the appropriate sanction, it is necessary in the public interest to make an order suspending his registration immediately. 5. The interim order of suspension currently imposed on Dr Ekrem s registration is revoked. 6. The substantive decision of erasure, as already announced, will take effect 28 days from when notice is deemed to have been served upon Dr Ekrem, unless he lodges an appeal in the interim. If Dr Ekrem lodges an appeal, the immediate order for suspension will remain in force until such time as the outcome of any appeal is determined. 7. That concludes the case. Confirmed Date 11 October 2017 Mrs Kim Parsons, Chair 18