PUBLIC RECORD. Record of Determinations. Medical Practitioner: Dates: 19/06/ /06/2018 & 2 August GMC reference number:

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1 PUBLIC RECORD Dates: 19/06/ /06/2018 & 2 August 2018 Medical Practitioner s name: Dr Muhammad Bhatti GMC reference number: Primary medical qualification: Type of case New - Conviction / Caution MD 1998 Virgen Milagrosa University Foundation Outcome on impairment Impaired Summary of outcome Suspension, 1 month Tribunal: Legally Qualified Chair Medical Tribunal Member: Medical Tribunal Member: Mr Leighton Hughes Dr John Garner Dr Vivek Sen Tribunal Clerk: Ms Jan Smith Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and represented Mr Rafar Ali, Solicitor (19 21 June 2018 only) Ms Rachel Cooper, Counsel (2 August 2018 only) Ms Emma Gilsenan, Counsel 1

2 Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in schedule 1, Medical Act 1983 (the 1983 Act) to protect, promote and maintain the health, safety and well-being 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 that profession. Determination on Facts & Impairment - 21/06/2018 Facts 1. At the outset of these proceedings Mr Ali, Solicitor Advocate, on behalf of Dr Bhatti, admitted the allegation in its entirety, in accordance with Rule 17(2)(d) of the General Medical Council (GMC) (Fitness to Practise) Rules 2004, as amended (the Rules). As a result of the admissions made, the Tribunal announced that the Allegation had been admitted and found proved in full in accordance with Rule 17(2)(e). Admissions and The Tribunal s Findings on Facts 2. The admitted facts of Dr Bhatti s case are as follows: 1. On 27 January 2017, at Burnley Magistrates Court, you were convicted of the following offences, in that on or before 15 October 2014, being in control of 143 Manchester Road, Burnley, you: a. failed to take such general fire precautions so as to ensure the safety of residents pursuant to Article 8(1)(b) of The Regulatory Reform (Fire Safety) Order 2005, which failure placed one or more relevant persons at risk of death or serious injury in case of fire contrary to Article 32(1)(a) of the Regulatory Reform (Fire Safety) Order 2005; Admitted and found proved b. failed to have a suitable system of maintenance and failed to maintain in an efficient working order and good repair a fire alarm pursuant to Article 13(1)(a) of The Regulatory Reform (Fire Safety) Order 2005, which failure placed one or more relevant persons at risk of death 2

3 or serious injury in case of fire contrary to Article 32(1)(a) of The Regulatory Reform (Fire Safety) Order 2005; Admitted and found proved c. failure to ensure that escape routes and exits could be used as quickly and as safely as possible by failing to provide adequate fire doors on the ground first and second floors as required under Article 14(2)(b) of The Regulatory Reform (Fire Safety) Order 2005, which failure placed one or more relevant persons at risk of death or serious injury in case of fire contrary to Article 32(1)(a) of The Regulatory Reform (Fire Safety) Order 2005; Admitted and found proved (d) failed to provide locks on emergency doors that can be easily and immediately opened by any person required to use them in an emergency (namely, the final exit-front door) as required by Article 14(2)(f) of The Regulatory Reform (Fire Safety) Order 2005, which failure placed one or more relevant persons at risk of death or serious injury in case of fire contrary to Article 32(1)(a) of The Regulatory Reform (Fire Safety) Order Admitted and found proved 2. On 14 February 2017, at Burnley Magistrates Court, you were fined: a. 600 in relation to the offence described in paragraph 1a; and Admitted and found proved b. 200 in relation to the offence described in paragraph 1c. Admitted and found proved 3. Having announced these findings on the facts, the Tribunal must now decide, in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts which have been admitted and found proved as set out previously, Dr Bhatti s fitness to practise is impaired by reason of his conviction. Evidence 4. The Tribunal was provided with documentary evidence from the GMC which comprised: Memorandum of Conviction Lancashire Fire & Rescue Service investigation and prosecution file Sentencing remarks of District Judge James Clarke 5. The Tribunal was also provided with documentary evidence from Dr Bhatti which comprised: 3

4 Insight and reflection statement Curriculum Vitae of Dr Bhatti Course completion evidence Letter from Burnley Borough Council re HMO licensing of 143 Manchester Road from XXX at University of Manchester Letter to GMC from Mr A dated 27 April 2018 Letter to GMC from MR A dated 6 May 2018 Letter from Acorn Heights Letter from University of Manchester dated 13 June 2018 Letter from APPS UK dated 10 June 2018 ARCP Assessment papers dated 27 September 2017 Placement assessment dated 30 July 2016 Teaching feedback of Mr B ARCP Assessment papers dated 28 September 2017 Letter from Dr C 6. Dr Bhatti gave oral evidence to the Tribunal. The Tribunal found the focus of his evidence to be an attempt to re-open the facts giving rise to his conviction, rather than addressing his current fitness to practise. Whilst accepting the fact of his conviction he repeatedly sought to distance himself from responsibility, placing blame elsewhere. The Tribunal found his expressions of apology and remorse to be a little formulaic, rather than displaying meaningful insight into, or full regret for, his conduct. Background 7. Dr Bhatti qualified in March 1998 and, at the time of the events in question, was training as a specialist registrar with a view to becoming a consultant in public health medicine. Dr Bhatti owned 3 properties in Burnley, 143, 143A and 145 Manchester Road. 145 Manchester Road was rented by Burnley Football University although Burnley Borough Council bore the responsibility for obtaining the relevant licences and ensuring fire regulation compliance. 8. On 25 July 2014, Dr Bhatti requested an inspection of 143 Manchester Road by the local Council and Fire Regulation Officers. Following the inspection Dr Bhatti agreed to rent the property to one tenant, whose rent was paid for by the local Council. He was informed that he could accommodate up to 3 tenants before he was required to apply for an HMO (House in Multiple Occupation) licence. 9. In September 2014, Dr Bhatti was contacted by Mr A of Embrace Corporation Limited with a view to renting the property for multiple occupation. The unchallenged evidence was that this was not possible because of the steps which needed to be taken to bring the property up to the required legal standards. Nevertheless, on 26 September 4

5 2014, Dr Bhatti let 143 Manchester Road, by way of an assured shorthold tenancy, to Embrace Corporation. 10. On 15 October 2014 the Lancashire Fire and Rescue Service visited 143 Manchester Road. It was occupied by 12 French students and two teachers. During the visit the Fire and Rescue Service found: (a) Inadequate, ill-fitting and damaged fire doors, wedged open and with damaged or poor self-closing devices; (b) Poor fire separation between the basement and other floors of the premises due to holes in the ceiling of the basement; (c) The front door and back door were fitted with locks that required keys to open them from the inside; (d) A faulty fire alarm system with damaged sounders, cables and unsuitable detection (which took a number of days to repair to full working order); and (e) There was an absence of any portable fire-fighting equipment preventing occupants from fighting a fore or using an extinguisher to aid their escape in an emergency. 11. On 11 November 2016, Dr Bhatti entered pleas of Not Guilty to the criminal offences brought by Lancashire Fire and Rescue Services but was convicted, as outlined above, on 27 January On 14 February 2017 he was sentenced and was fined a total of 800 for offences relating to breaches of fire safety regulations. On 15 February 2017 Dr Bhatti lodged an appeal and this was heard at Burnley Crown Court on 27 July The appeal against conviction and sentence was dismissed and the sentence was confirmed. Dr Bhatti was ordered to pay a further 2980 towards the cost of the prosecution, over and above the 4,000 he was ordered to pay in the Magistrates Court. 12. In two s, dated 30 January 2017, Dr Bhatti made a self-referral to the GMC, giving details of the offences of which he had been found guilty and convicted at Burnley Magistrates Court on 27 January 2018, although at that stage he had not been sentenced. Impairment GMC Submissions 13. Ms Gilsenan submitted that Dr Bhatti s fitness is currently impaired. It was her contention that Dr Bhatti s admissions at the outset of this hearing were hollow. She submitted that Dr Bhatti has not truly accepted the findings of the criminal court 5

6 and, as a result, his insight is very limited. Ms Gilsenan also described the attempts Dr Bhatti has made with regard to remediation as minimal. Defence Submissions 14. Mr Ali submitted that Dr Bhatti s fitness was not currently impaired. He told the Tribunal that Dr Bhatt s expressions of remorse and apology were genuine. Mr Ali submitted that, although Dr Bhatti had challenged the criminal charges against him, it did not mean that this should be taken into account when considering his level of insight. Indeed, Mr Ali submitted, Dr Bhatti has demonstrated substantial insight and remediation and has changed his practice with regard to how he approaches the letting of his property. Relevant Legal Principles 15. The Tribunal has borne in mind 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. 16. In deciding whether Dr Bhatti s fitness to practise is impaired, the Tribunal has exercised its own judgement. It 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 of conduct for members of the profession. 17. The Tribunal reminded itself that the purpose of these proceedings is not to punish a doctor for past wrongdoing but to maintain proper standards in the profession and to protect the public. The Tribunal must look forward, not back, but in order to determine whether a doctor is currently fit to practise without restriction, it must take into account the way in which a doctor has acted, or failed to act, in the past. Tribunal Decision 18. The Tribunal has given careful consideration to all the oral and documentary evidence adduced during the course of these proceedings. It has also taken account of submissions made by Ms Gilsenan, Counsel, on behalf of the GMC, and the submissions made by Mr Ali, on behalf of Dr Bhatti. 19. In its deliberations, the Tribunal has taken into account Dame Janet Smith s criteria for impairment set out in her fifth Shipman report and cited in CHRE v NMC and Grant [2011] EWHC 927 (Admin) which states: 6

7 Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. 20. In the circumstances of this case and the offences for which Dr Bhatti has been convicted, the Tribunal has concluded that he has breached fundamental tenets of the medical profession and has brought the profession into disrepute. The Tribunal accepts that Dr Bhatti s clinical ability is not in question. However his conduct clearly created a risk to the students who occupied the accommodation at 143 Manchester Road. The Tribunal has determined that, although Dr Bhatti did not act dishonestly, his conduct has brought his integrity into question. 21. The Tribunal determined that, as a doctor (and particularly a doctor working in public health medicine) who was also a landlord and owner of multi-roomed properties, Dr Bhatti had a duty to ensure that he knew the regulations and standards of provision of safe and liveable accommodation, whether that accommodation was for a children s home, a house of multiple occupation, a nursing home or a residential let of any kind. If he was not cognizant of these rules and standards he had a duty to take appropriate advice from professional people. 22. In the Tribunal s view, Dr Bhatti failed in his duty to keep his knowledge about these matters up to date. Also, he failed to seek the appropriate professional advice. As a consequence, he exposed a number of young students to a risk of harm. The Tribunal has also taken account of the remarks of the District Judge Clarke who, in his sentencing remarks stated: Dr Bhatti made a commercial decision to let the property, presumably for some financial gain to himself, despite the renovation of the property being less than complete. He was aware that the tenant, Embrace Corporation Ltd, intended to let the property to a number of foreign students relatively quickly. I rejected his evidence that he was letting the house as a residential let. 7

8 23. The Tribunal has taken into account the evidence provided regarding insight and remediation, and it assessed the likelihood of repetition. The Tribunal acknowledges that criminal conduct may be difficult to remediate but it is of the view that the failings giving rise to his conviction were potentially remediable. 24. The Tribunal agreed with the submission made by Ms Gilsenan that Dr Bhatti still does not truly accept responsibility for the offences which gave rise to his conviction. Notably, in his evidence in relation to the tenancy agreement, he maintained that he, personally, was not in breach of the regulations. Throughout his evidence Dr Bhatti continued to resile from his criminal conviction, seeking to minimise his responsibility for fire safety regulations his conviction his associated responsibility as a doctor 25. The Tribunal considered that, whilst Dr Bhatti admitted the fact of his conviction at the outset of this hearing, it was clear throughout his evidence that he did not take full responsibility for the offences which led to his conviction. In submissions it was alleged that Dr Bhatti s conviction was due partly to poor legal representation. In his evidence, Dr Bhatti told the Tribunal that he would not have been convicted if the Court had heard the evidence of Mr A and that this Tribunal should look at all the facts afresh in consideration of his case. 26. The Tribunal considers that Dr Bhatti s conduct was serious and that it represented significant departures from the principles of Good Medical Practice (issued March 2013 and updated in April 2014), in particular paragraph 1 which states: 1. Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law. 27. The Tribunal has also had regard to paragraph 65 of Good Medical Practice which states, in respect of honesty and integrity: 65. You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. 28. The Tribunal recognised that integrity is often as useful shorthand to express the higher standards which society expects from professional persons and which professions expect from their own members. Integrity does not require a doctor to be a paragon of virtue, but it connotes adherence to the high ethical standards 8

9 inherent in an individual's professional role. The Tribunal was satisfied that Dr Bhatti's conduct demonstrated a lack of integrity; he made a commercial decision to rent a property which he knew would be occupied by a number of foreign students, when he knew that the property did not meet the safety criteria for multiple occupancy. Such behaviour fell far below the standard of conduct and behaviour expected of a doctor, particularly a doctor practising in public health medicine. 29. The Tribunal has concluded that Dr Bhatti s insight is still limited. Whilst he was perfectly entitled to contest the criminal charges and maintain his innocence after the criminal matters had concluded, the Tribunal does not consider that Dr Bhatti has demonstrated any meaningful reflection into his conduct. In particular, he does not appear to have fully understood the impact on public confidence in the medical profession of a doctor of his standing having committed offences which resulted in a criminal conviction at Burnley Magistrates Court. 30. In relation to remediation, the Tribunal considers that the conduct which gave rise to the conviction was remediable by a doctor with good insight into the offences, who has reflected fully and taken proper steps to develop his knowledge. The Tribunal has been provided with is a certificate which confirms Dr Bhatti s attendance at a course entitled Fire Safety: How to protect your tenants and your property on 30 May This was some three weeks before this hearing, three and a half years after the offences in question and more than a year since the date of his conviction. The Tribunal has also had regard to the sentencing remarks of District Judge James Clarke who stated Dr Bhatti took remedial steps after the intervention of the Fire and Rescue Service and Dr Bhatti has no previous conviction. The Tribunal acknowledges that there have been no further incidents since the events in The Tribunal has not received any evidence of other specific remediable measures taken by Dr Bhatti since his conviction although it acknowledges his oral evidence that he would act differently in the future and would accept the advice of others with regard to letting properties. In the Tribunal s view, full remediation is born out of meaningful insight and the doctor s acceptance of full responsibility for the offences which gave rise to criminal conviction. The Tribunal has concluded that, for all the reasons stated above, Dr Bhatti s conduct has not been sufficiently remedied. 32. The Tribunal acknowledges that no clinical concerns have been raised with regard to Dr Bhatti s medical practice. It has also taken into account the testimonial evidence which has been provided on behalf of Dr Bhatti, which attests to his honesty and trustworthiness. The Tribunal went on to consider whether there was a risk of repetition of Dr Bhatti s conduct. Despite Dr Bhatti s lack of insight and limited attempts at remediation, it found that in light of his experience in a criminal court and with this regulatory process, and his evidence on the impact it has had on him, that the risk of repetition of his offending behaviour is low. 9

10 33. The Tribunal is of the view that a reasonable and properly informed member of the public, in possession of the full facts of this case, would be surprised if there was no finding of impairment of Dr Bhatti s fitness to practise. The Tribunal is satisfied that Dr Bhatti s criminal conviction, and the behaviour giving rise to it, clearly undermines the trust and confidence the public has in the profession. It did not consider that Dr Bhatti had acted dishonestly in any way. However, integrity is a fundamental expectation on the part of a doctor and the Tribunal has found that Dr Bhatti s conduct lacked integrity. The Tribunal is in no doubt that, in all the circumstances, a finding of impairment is required in order to maintain public confidence in the profession and to uphold proper standards of conduct. 34. For the reasons outlined above, the Tribunal has determined that Dr Bhatti s fitness to practise is currently impaired by reason of his conviction, pursuant to Section 35C(2)(a) of the Medical Act 1983, as amended. Determination on Sanction - 02/08/ Having determined that Dr Bhatti s fitness to practise is impaired by reason of his conviction, the Tribunal now has to decide, in accordance with Rule 17(2)(n) of the Rules, on the appropriate sanction, if any, to impose. The Evidence 2. The Tribunal has taken into account evidence received during the earlier stages of the hearing, where relevant to reaching a decision on sanction. It received no further evidence today from either Ms Gilsenan, Counsel on behalf of the GMC, or Ms Cooper, Counsel on behalf of Dr Bhatti. Submissions 3. In summary, Ms Gilsenan submitted that, given Dr Bhatti s misconduct, the appropriate sanction in his case was one of suspension. She drew the Tribunal s attention to a number of paragraphs of Sanctions Guidance (SG) (February 2018) which she submitted were relevant to Dr Bhatti s case. 4. Ms Gilsenan told the Tribunal that, in 2011, Dr Bhatti had been arrested by the police and had failed to inform the GMC. As a result, the GMC had given him advice which referred him to paragraph 58 of Good Medical Practice (GMP) (November 2006) relating to the need to inform the GMC without delay if he had accepted a caution from the police, had been charged with or found guilty of a criminal offence. Ms Gilsenan accepted that the case had been closed with the advice and that there have been no fitness to practise issues raised against Dr Bhatti. 10

11 5. Ms Gilsenan referred to Dr Bhatti s evidence at these proceedings and his apparent inability to accept his convictions which, she submitted goes to the character, credibility and conduct of a doctor. She also referred to the Tribunal s finding of a lack of integrity which, she submitted, may be a pivotal feature when considering the appropriate sanction. Ms Gilsenan submitted that Dr Bhatti is an experienced doctor who has gone through a long period of training and that he should know that honesty and integrity are at the heart of medical professionalism. 6. Ms Gilsenan referred to the District Judge Clarke s sentencing remarks when he stated that: Dr Bhatti made a commercial decision to let the property, presumably for some financial gain to himself, despite the renovation of the property being less than complete She reminded the Tribunal that Dr Bhatti has maintained that the responsibility for ensuring compliance with the fire regulations did not sit with him as the landlord. She submitted that there has been no reflection of his conviction or his actions since then. 7. Ms Gilsenan submitted this is not a case where it is appropriate to take no action and there are no exceptional circumstances in Dr Bhatti s case which could warrant taking no action. 8. In relation to the imposition of conditions on Dr Bhatti s registration, Ms Gilsenan submitted that, given the findings of the Tribunal at the impairment stage, conditions would be wholly inappropriate and disproportionate and would not address the public interest, in particular to maintain public confidence in the profession. 9. Ms Gilsenan submitted that, because of his limited insight and the impact of his behaviour on the reputation of the profession, it would be appropriate and proportionate to suspend Dr Bhatti s registration. Ms Gilsenan did not make any submission as to the appropriate length of any such suspension. 10. In summary, Ms Cooper referred to the incident in 2011 and told the Tribunal that investigations had been made by the GMC and the Trust who employed him at that time and no findings had been made and the case was subsequently closed with the advice from the GMC. 11. Ms Cooper submitted that Dr Bhatti genuinely believed that, at the time of the breaches relating to fire safety in 2014, he was not responsible for ensuring the premises were suitable for the planned occupation. 11

12 12. Ms Cooper told the Tribunal that subsequent to the breaches, Dr Bhatti took remediable steps and that the properties had then been inspected by the local authority and were not found to be deficient for the purposes of renting. She said that Dr Bhatti has continued to rent out the properties with no further breaches of the regulations. Ms Cooper submitted that Dr Bhatti now has a better understanding of the rules applying to landlords renting out their property. She said that he talks to the local authority to ensure that he complies with all the regulations. 13. Ms Cooper reminded the Tribunal that it did not find that Dr Bhatti was dishonest and that there was a low risk of repetition of his behaviour. In terms of the sanction to impose, Ms Cooper submitted that undertakings and conditions do not apply in this case because no clinical concerns have been raised. Therefore the options open to the Tribunal were either to take no further action or to suspend Dr Bhatti s registration. 14. Ms Cooper submitted that Dr Bhatti is a very good clinician who has been practising for more than 20 years. She reminded the Tribunal that Dr Bhatti had sought to become a consultant in public health but had been stymied by being involved in these proceedings. She reminded the Tribunal that the events in question happened four years go. 15. Ms Cooper submitted that it would be appropriate for the Tribunal to take no action and that the finding of impairment of Dr Bhatti s fitness to practise itself would be in the public domain and would be sufficient to mark the seriousness of his actions. 16. It was Ms Cooper s contention that to suspend Dr Bhatti s registration would be disproportionate and unnecessarily punitive. The Tribunal s Determination on Sanction 17. The Tribunal reminded itself again at this stage of proceedings, there is no burden or standard of proof and the decision on sanction is a matter for the Tribunal s judgment alone. 18. In reaching its decision, the Tribunal has given careful consideration to SG generally. It has borne in mind the main reason for imposing sanctions is to protect the public and the wider public interest pursuant to the overarching objective set out in section 1 of the Medical Act 1983 (as amended), already rehearsed in the determination on impairment. Sanctions are not intended to punish or discipline doctors, although they may have a punitive effect. 19. The Tribunal has borne in mind that in deciding what sanction, if any, to impose, it should consider all the sanctions available, starting with the least 12

13 restrictive. It should also have regard to the principle of proportionality, weighing the interests of the public against those of the doctor. 20. Mitigating Factors No previous fitness to practise concerns have been established Evidence of good clinical practise over many years There have been no further breaches of the fire safety regulations since the incident in 2014 Evidence of positive compliance since 2014 Dr Bhatti undertook a fire safety course How to protect your tenants and your property, albeit four years after the event and only shortly before appearing at these proceedings. Dr Bhatti had been given advice by the GMC in 2011 for failing to report a police arrest. Clearly Dr Bhatti heeded this advice by informing the GMC immediately about the matters relating to fire safety regulations. A large volume of testimonials attesting to Dr Bhatti s clinical excellence and his probity 21. Aggravating Factors Dr Bhatti s continued inability or willingness to accept full responsibility for the conduct giving rise to his criminal conviction Limited insight into the impact on public confidence in the profession and his personal responsibility to ensure compliance with fire safety regulations The findings of the Criminal Court and of this Tribunal that his criminal conduct arose at the prospect of financial gain from a commercial venture. No Action 22. In coming to its decision as to the appropriate sanction, if any, to impose in Dr Bhatti s case, the Tribunal first considered whether to take no action. The Tribunal considered paragraphs SG, in particular paragraph 68 which states: 68 there may be exceptional circumstances to justify a Tribunal taking no action. 23. This was a serious matter which involved significant risks to the public. The Tribunal bore in mind the public concern in relation to fire safety following the Grenfell Tower disaster. Dr Bhatti was practising in the field of public health and he took a commercial decision to abrogate his responsibility for his tenants. In the Tribunal s view, his conduct giving rise to his conviction undermines public confidence in the medical profession. Furthermore, the Tribunal has already found, during the impairment stage, that Dr Bhatti s conduct demonstrated a lack of integrity, a fundamental expectation of a doctor. 13

14 24. In all the circumstances, the Tribunal has rejected Ms Cooper s submission that these events occurred in very exceptional circumstances. It considered that to take no action would fail to fulfil the overarching objective which includes to: a. protect and promote the health, safety and wellbeing of the public b. promote and maintain public confidence in the medical profession c. promote and maintain property professional standards and conduct for the members of the profession. 25. The Tribunal has determined that, in the clear absence of exceptional circumstances, taking no action in Dr Bhatti s case would be neither appropriate nor proportionate. Conditions 26. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Bhatti s registration. It has borne in mind that any conditions must be appropriate, proportionate, workable and measurable. 27. The Tribunal agrees with the submissions of both Ms Gilsenan and Ms Cooper that there are no conditions which could be formulated in this case which would be workable or relevant as this is not a health case and there are no clinical concerns. The Tribunal has concluded that a period of conditional registration would be entirely inappropriate. Suspension 28. The Tribunal then considered whether to suspend Dr Bhatti s registration. In doing so, it has considered paragraphs of SG. It was of the view that paragraph 91, as referred to by Ms Gilsenan was of particular relevance: 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. 29. The Tribunal concluded that public confidence in the medical profession could not be maintained without the imposition of a sanction which reflects the criminal conduct of Dr Bhatti. The Tribunal reminded itself of its duty to protect the public interest and to declare and uphold proper standards of conduct and behaviour. 14

15 30. The Tribunal has borne in mind its findings at the impairment stage that Dr Bhatti has only limited insight into his conduct which resulted in a criminal conviction and has not fully remediated his behaviour. Nevertheless, the Tribunal considered that in light of Dr Bhatti s experience in the criminal courts and with this regulatory process, together with his evidence of the impact it has had on him, the risk of repetition was low. 31. The Tribunal has concluded that a period of suspension would be appropriate in Dr Bhatti s case. This would send a message to the public that his conduct was unacceptable and will not be tolerated. The Tribunal considered that no sanction less than the suspension of Dr Bhatti s registration would meet the need to maintain public confidence in the profession. 32. In all the circumstances, the Tribunal has determined to suspend Dr Bhatti s registration for a period of one month. In deciding on this period of time, it took into account the seriousness of his conduct but has also borne in mind that there have been no clinical concerns about Dr Bhatti s practice over many years. 33. The Tribunal does not wish to deprive the public and the profession of the services of a valuable doctor for any longer than required. However, it has determined that any lesser sanction would be insufficient to promote and maintain both public confidence in the profession, and standards and conduct for members of the profession. No review hearing 34. The Tribunal has had regard to paragraph 164 of the SG which states: in some misconduct cases it may be self-evident that, following a short suspension, there will be no value in a review hearing... The Tribunal is satisfied that Dr Bhatti is unlikely to repeat his actions, there are no patient safety issues in this case and no reason to believe Dr Bhatti will become de-skilled during the short period of suspension. 35. 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. Dr Bhatti has already undertaken some steps in remediation, particularly in working with local authorities to ensure his compliance with fire safety regulations. 36. In these circumstances, the Tribunal is satisfied that a review hearing would serve no purpose and has determined not to direct such a hearing. 15

16 Determination on Immediate Order 02/08/ Having determined that Dr Bhatti s registration be suspended for a period of one month, the Tribunal has considered, in accordance with Rule 17(2)(o) of the Rules, whether his registration should be subject to an immediate order. Submissions 2. Ms Gilsenan said that her instructions were that an immediate order was not required. 3. Ms Cooper did not have any submissions to make in relation to an immediate order. The Tribunal s Determination 4. In reaching its decision, the Tribunal had regard to paragraph 173 of the Sanctions Guidance, which state: 173. An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety. For example, where they have provided poor clinical care or abused a doctor s special position of trust, or where immediate action must be taken to protect public confidence in the medical profession. 2. The Tribunal has concluded that, as there are no patient safety issues in this case and as it has already determined to suspend Dr Bhatti s registration for one month in order to meet the public interest aspects, it would be inappropriate and disproportionate to impose an immediate order. 3. This means that Dr Bhatti s registration will be suspended 28 days from when notice of this decision is deemed to have been served upon him, unless he lodges an appeal. If Dr Bhatti does lodge an appeal he will remain free to practise unrestricted until the outcome of any appeal is known. 7. That concludes this case. Confirmed Date 02 August 2018 Mr Leighton Hughes, Legally Qualified Chair 16

17 ANNEX A 19/06/2018 Determination on Application to exclude evidence under Rule Ms Gilsenan, Counsel, acting on behalf of the GMC, objected to the inclusion of evidence contained within the Defence bundle provided to the Tribunal by Dr Bhatti, in accordance with Rule 34 of the General Medical Council (Fitness to Practise) Rules 2004 (as amended) ( the Rules ). 2. Ms Gilsenan particularly referred to sub-paragraphs (1), (3) and (5) of Rule 34 which state: 34. (1) The Committee or a Tribunal may admit any evidence they consider fair and relevant to the case before them, whether or not such evidence would be admissible in a court of law. (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 (5) The only evidence which may be adduced by the practitioner in rebuttal of a conviction or determination certified in the manner specified in paragraph (3) or (4) is evidence for the purposes of proving that he is not the person referred to in the certificate or extract. 3. Ms Gilsenan referred the Tribunal to the Defence bundle which had an index of documents numbered In relation to documents 1 10, but excluding 2, 3 and 6, Ms Gilsenan submitted that these documents attempt to rebut the facts giving rise to Dr Bhatti s conviction and are, therefore, inadmissible within the provisions of Rule 34. She reminded the Tribunal that it is not its function to query the conviction and that to accept further evidence in this regard would go behind that decision. Ms Gilsenan referred to the full admission made by Dr Bhatti at the commencement of this hearing and submitted that these documents were not relevant at the impairment stage of this hearing. 4. In relation to documents 9 and 10 which are letters to the GMC from a Mr A, Ms Gilsenan told the Tribunal that these, too, seek to undermine Dr Bhatti s conviction. Furthermore, she said that Mr A was not available for either the GMC or the Tribunal to test the credibility of the evidence being provided. Therefore, she submitted, the provisions of Rule 34 have not been met. 17

18 5. Ms Gilsenan submitted that all the documents numbered 2, 3 and 6 and were relevant to the impairment stage of this hearing and were admissible. 6. On behalf of Dr Bhatti, Mr Ali accepted that evidence could not be presented which appeared to go behind the fact of a criminal conviction. However, he told the Tribunal that there was a foggy patch between the evidence of Mr A and Dr Bhatti and that Mr A s evidence was relevant to the conviction. He had not been a willing participant in the court process relating to Dr Bhatti s conviction. Mr Ali said that Dr Bhatti relied on Mr A s evidence. In fact, Dr Bhatti appears to be of the opinion that, if Mr A had given evidence at his criminal trial, he would not have been convicted. 7. The Tribunal has carefully considered the Defence bundle. In relation to document 1, this is a skeleton argument advanced on behalf of Dr Bhatti as opposed to evidence. The Tribunal was satisfied that it was, therefore, not subject to the provisions of Rule 34. The Tribunal will consider its contents, but would not feel obliged to follow it or any part of it unless it happened, independently, to agree with those submissions on the basis of independent admissible evidence. 8. It is common ground that documents 2, 3 and 6 are relevant to the impairment stage of the hearing and are, therefore, admissible. 9. In relation to documents 4 and 5, the Tribunal found that their content goes to the fact and circumstances giving rise to the conviction and the respective liabilities of Dr Bhatti and Mr A. Therefore, this evidence is not relevant at this stage of the hearing as it seeks to go behind the conclusive evidence of the offence committed in accordance with Rule 34(3). 10. In respect of document 7, the Tribunal considered that this was relevant and admissible. It related to a time after the commission of the offence, but prior to the conviction in 2017, in which Dr Bhatti appears to have engaged with Burnley Borough Council and demonstrated an appreciation of their housing regulatory function. 11. With regard to document 8, this relates to the XXX Dr Bhatti and, plainly, will be relevant at this impairment stage of the hearing. 12. In respect of documents 9 and 10, the Tribunal has concluded that, in so far as they dealt with matters relating to Dr Bhatti s character, they are relevant to his case and are therefore admissible. However, any part of these documents which have anything to do with the facts giving rise to the conviction will not be considered by the Tribunal, for the same reasons as set out in relation to documents 4 and It is common ground that documents are relevant to Dr Bhatti s case and are admissible. 18