PUBLIC RECORD. Record of Determinations Medical Practitioners Tribunal

Transcription

1 PUBLIC RECORD Dates: 01/11/ /11/2017 Medical Practitioner s name: Dr Mohamed AMRANI GMC reference number: Primary medical qualification: Type of case New - Conviction / Caution MD 1987 Universite Catholique de Louvain Outcome on impairment Impaired Summary of outcome Erasure Immediate order imposed Tribunal: Legally Qualified Chair Lay Tribunal Member: Medical Tribunal Member: Mr Hassan Khan Mr Peter Scofield Dr Ronan Brennan Tribunal Clerk: Mr Stuart Peachey Attendance and Representation: Medical Practitioner: GMC Representative: Not present and not represented Mr David Claxton, Counsel, instructed by GMC Legal, represents the General Medical Council. Allegation and Findings of Fact That being registered under the Medical Act 1983 (as amended): 1. On 27 April 2017 at the Central Criminal Court you were convicted of: a. indecent assault on female x2; Found proved 1

2 b. sexual assault on female. Found proved 2. On 8 June 2017 you were sentenced to a: a. total of six months imprisonment suspended for 12 months; Found proved b. suspended sentence supervision order for six months; Found proved c. sex offenders register requirement for five years. Found proved And that by reason of the matters set out above your fitness to practise is impaired because of your conviction. Attendance of Press / Public The hearing was all heard in public Determination on preliminary procedural matters, Voluntary Erasure Application and Facts - 01/11/2017 Mr Claxton: Service and Proceeding in Absence Service 1. At the outset of these proceedings, in the absence of Dr Amrani, you made submissions on behalf of the General Medical Counsel ( GMC ) in relation to service. You directed the Tribunal s attention to a letter enclosing Notice of Hearing ( NOH ), dated 2 October 2017, that has been served upon Dr Amrani by special delivery to his registered address and to his notified address. 2. You submitted that the NOH complied with the requirements of The GMC Fitness to Practise Rules 2004, as amended, ( the Rules ) Rules 15 and The Tribunal had sight of the service documentation including the notice of allegation, dated 7 September 2017, and the NOH, dated 2 October 2017, with their associated proof of delivery. 4. The Tribunal concluded that all the relevant requirements of Rules 15 and 40 of the Rules have been satisfied and that proper service of the documents had been effected. Proceeding in absence 2

3 5. Having been satisfied that the NOH has been properly served, the Tribunal went on to consider whether to exercise its discretion to proceed with the hearing, under Rule 31 of the Rules, in Dr Amrani s absence. 6. You directed the Tribunal s attention to relevant case law on conducting the appropriate balancing exercise in Dr Amrani s case: R v Jones [2003] 1 AC HL; GMC v Adeogba and GMC v Visvardis [2016] EWCA Civ You submitted that it was fair to proceed in Dr Amrani s absence as: All reasonable efforts have been made to serve NOH on Dr Amrani and he is fully aware of these proceedings; Dr Amrani has deliberately absented himself; An adjournment would not resolve the issue and Dr Amrani has not asked for an adjournment; 8. The Tribunal has borne in mind that its discretion should be exercised with the utmost care and caution. It also bore in mind the need to balance Dr Amrani s interests with the overarching statutory objective, namely protection of the public. 9. The Tribunal was satisfied that Dr Amrani is aware of this Medical Practitioners Tribunal ( MPT ) hearing taking place in view of his receipt of the NOH. It had regard to an to him, dated 2 October 2017, which gave him full information about the hearing including, date, time and location. It also noted a letter from Dr Amrani to the GMC, dated 11 September 2017, in which he states I will not be represented and will not attend any hearing. 10. The Tribunal has concluded that Dr Amrani has been given ample opportunity to attend this hearing but has voluntarily absented himself. It also concluded that if an adjournment were to be made Dr Amrani would be unlikely to attend on any future date. The Tribunal has therefore determined that in accordance with Rule 31 it is appropriate to proceed with the hearing in Dr Amrani s absence. It considered that it is fair and in the public interest to hear this case without further delay and that no useful purpose would be served by an adjournment. Voluntary Erasure Application 11. Dr Amrani, on 31 October 2017, made a renewed written application via for voluntary erasure from the Medical Register. His first application was received by the GMC on 13 September 2017 and was subsequently rejected on the 12 October

4 GMC Submissions 12. You submitted, on behalf of the GMC, that given the serious nature of the allegation which Dr Amrani faces, it would be inappropriate for the Tribunal to accede to his renewed application for voluntary erasure. You submitted that you adopt the salient points in the refusal decision by the case examiners in relation to Dr Amrani s application for voluntary erasure which was received by the GMC on 13 September You submitted the Tribunal should have regard to paragraph 3(8) of the GMC (Voluntary Erasure and Restoration following Voluntary Erasure) Regulations 2004, as amended ( the Regulations ) when making its decision. 14. Regulation 3(8) of the Regulations reads as follows: Where, on the date the Registrar receives an erasure application, an allegation against the practitioner has been referred to the MPTS for them to arrange for it to be considered by a under the Fitness to Practise Rules and the hearing before the has commenced, the Registrar shall refer the application to the MPTS for them to arrange for it to be determined by the, and the application shall be determined by the accordingly. The Tribunal s Approach 15. The decision as to whether or not to accede to the application for voluntary erasure is a matter for this Tribunal. In reaching a decision on this matter, the Tribunal had regard to the Regulations and to relevant guidance issued by the GMC guidance on making decisions on voluntary erasure applications. It had regard to the submission made by you and the written correspondence of Dr Amrani. 16. The Tribunal accepted the advice of the Legally Qualified Chair that it would have regard to all the circumstances including the public interest, the doctor s health and likelihood of return to practise. The public interest incorporates the three elements: Protection of patients and public generally from doctors who s fitness to practice is allegedly impaired; The maintenance and promotion of public confidence in the profession; The maintenance and promotion of public confidence in the GMC performance of its statutory functions. 4

5 The Tribunal s Decision 17. The Tribunal considered all the documentary evidence, and at this stage of the proceedings, it made no findings of Fact. It also had regard to the Guidance on making decisions on voluntary erasure application and in particular paragraph 16 which states: If the allegations are primarily about misconduct, a conviction or a determination concerning the doctor s conduct, there are more likely arguments in favour of refusing the application for voluntary erasure. This is particularly likely to be the case if the allegations fall within the categories for which there is a presumption of impaired fitness to practice. In these particular circumstances, voluntary erasure is only likely to be appropriate in exceptional circumstances. These might include situations in which medical evidence from an independent source gives a clear indication that the doctor is seriously ill and would be unfit to participate in our fitness to practise procedures 18. The Tribunal had regard to Dr Amrani s first application for voluntary erasure. In support of that application he submitted a letter to the GMC, dated 11 September 2017, in which he states: I wish to apply for voluntary erasure [ ] I was given the opportunity to work abroad on the absolute condition that I am erased from the GMC [ ] I no longer wish to practice [sic] medicine in this country. Therefore I will not fight for my registration [ ] I am happy for the GMC to be seen as erasing my name. In any case I would be grateful if you could accept my application for erasure. It is vital for my future (potential) employment and it is rather urgent as I have no income. 19. The Tribunal also noted the case examiners decision to refuse Dr Amrani s application for voluntary erasure and the reasons for that decision. Whilst the Tribunal had regard to the case examiners decision to refuse Dr Amrani s application for voluntary erasure, it exercised its own independent judgement when reaching its decision. 20. Dr Amrani, in his letter of 11 September 2017, stated that he had been given the opportunity to work abroad on the absolute condition that I am erased by the GMC. He added that I no longer wish to practice [sic] medicine in this country. However, the Tribunal noted that his Counsel in the criminal trial referred to the prospect of him returning to work in the UK. This Tribunal was concerned by that inconsistency and concluded that there was a real prospect, were he to be granted voluntary erasure, that he might apply for restoration within a short period. 5

6 21. The Tribunal also considered that Dr Amrani was allegedly convicted of sexual offences. The case examiners noted that the GMC had obtained a certificate of conviction, and the likelihood is this would serve as evidence of the offences committed. Given that convictions fall within the categories for which there is a presumption of impaired fitness to practise, voluntary erasure is only likely to be appropriate in exceptional circumstances, none of which were found to be present in this case. 22. In all the circumstances, the Tribunal concluded that public protection, the maintenance and promotion of public confidence in both the medical profession and the GMC s performance of its statutory functions would be undermined if it acceded to Dr Amrani s application. It therefore determined not to grant his application for voluntary erasure. Facts Background to the Case 23. Dr Amrani was employed as a Senior Consultant Cardiac and Transplant Surgeon within The Royal Brompton and Harefield NHS Trust ( the Trust ) between 2001 and He was prosecuted as a result of allegations made by colleagues within the Trust. 24. It is alleged that on 27 April 2017 at the Central Criminal Court, Dr Amrani was convicted of: indecent assault on female x2; and sexual assault on female. 25. It is alleged that on 8 June 2017, Dr Amrani was sentenced to a: total of six months imprisonment suspended for 12 months; suspended sentence supervision order for six months; and sex offenders register requirement for five years. Evidence 26. The Tribunal has given consideration to all the evidence adduced in this case, which included, but was not limited to: Certificate of conviction from the Central Criminal Court, dated 22 June 2017; Indictment, undated; Sentencing remarks, dated 8 June 2017; Case summary (MG5), undated; 6

7 Transcript of police interview with Dr Amrani. 27. The Tribunal noted correspondence between the Central Criminal Court and the GMC, dated 22 June 2017, which enclosed a Certificate of Conviction, which states: Mohamed AMRANI was tried and convicted upon indictment of: Indecent Assault On Female X 2; Sexual Assault on Female. and was sentenced on the 8 June 2017 to: Total of 6 months imprisonment suspended for 12 months; Suspended Sentence Supervision Order for 6 months; Sex Offenders register for 5 years Judge ordered defendant may be placed on barring list by the disclosure and barring service; To pay 8,000 towards costs of the prosecution The Tribunal s Findings 28. The Tribunal considered the paragraphs and sub-paragraphs of the Allegation and made the following findings: Paragraph 1(a)(b) 1. On 27 April 2017 at the Central Criminal Court Dr Amrani was convicted of: a. indecent assault on female x2; found proved b. sexual assault on female. found proved 29. The Tribunal has noted the documentation provided in relation to The Crown Court at The Central Criminal Court, which certified that on the 27 April 2017 Dr Amrani was convicted of indecent assault on female x2 and sexual assault on female. The Tribunal accepts this document as conclusive evidence of the offences committed, and finds this paragraph proved in its entirety. Paragraph 2(a)(b)(c) 2. On 8 June 2017 Dr Amrani was sentenced to a: a. total of six months imprisonment suspended for 12 months; found proved 7

8 b. suspended sentence supervision order for six months; found proved c. sex offenders register requirement for five years. found proved 30. The Tribunal has noted the documentation provided in relation to The Crown Court at The Central Criminal Court, which certified that Dr Amrani was sentenced to a total of six months imprisonment suspended for 12 months, suspended sentence supervision order for six months and put on the sex offenders register requirement for five years on 8 June The Tribunal accepts this document as conclusive evidence of the sentence of the Court, and finds this paragraph proved in its entirety. Determination on Impairment - 02/11/2017 Mr Claxton: Background 1. Between 2001 and 2013, Dr Amrani was employed as a Senior Consultant Cardiac and Transplant Surgeon within The Royal Brompton and Harefield NHS Trust ( the Trust ). As a result of the Trust s investigation into Dr Amrani s conduct, he attended Hammersmith Police Station on 26 May 2015 and was arrested. 2. On 26 May 2015, 24 July 2015 and 9 February 2016 Dr Amrani was interviewed by the police in the presence of his legal representative. At these police interviews, Dr Amrani denied the allegations in a prepared statement which he read out. He gave a no comment response to the remainder of the interview questions. 3. On 29 June 2016, at Hammersmith Police station, Dr Amrani was charged and cautioned to which he made no reply. 4. On 27 April 2017, at the Central Criminal Court, Dr Amrani was convicted of indecent assault on female x2 and sexual assault on female. 5. On 8 June 2017, at the Central Criminal Court, Dr Amrani was sentenced to a total of six months imprisonment suspended for 12 months, suspended sentence supervision order for six months and a sex offender s register requirement for five years. 8

9 Evidence 6. The Tribunal has given consideration to all the evidence adduced in this case, which included, but was not limited to: Certificate of conviction from the Central Criminal Court, dated 22 June 2017; Indictment, undated; Sentencing remarks, dated 8 June 2017; Case summary (MG5), undated; Transcript of police interview with Dr Amrani; Service bundle of documents, various dated; correspondence between Dr Amrani and the GMC, various dated; and Dr Amrani s petition signed by 110 members of staff, undated. GMC Submissions 7. You, on behalf of the General Medical Counsel ( GMC ), submitted that Dr Amrani s fitness to practise is currently impaired by reason of his conviction. You submitted that it is in the public interest to make a finding of impairment because of the gravity of Dr Amrani s underlying behaviour, the fact of his conviction and his subsequent behaviour. You directed the Tribunal s attention to the relevant case law: CHRE v NMC and Grant [2011] EWHC 927 (Admin); and Cohen v GMC [2008] EWHC 581 (Admin). 8. You submitted that Dr Amrani s conviction is for serious sexual misconduct and is at the upper end of criminal wrong doing. You submitted that Dr Amrani abused his position of trust and that the Tribunal should take account of the sentencing remarks from Her Honour Judge Molyneux, when reaching its decision. However, you submitted that the sentencing remarks do not bind this Tribunal, and that the Tribunal should exercise its own its independent judgement. 9. You submitted this is not an isolated incident; it related to three separate occasions, involved two individuals, with a significant gap between the incidents. You also submitted that it is relevant for the Tribunal to consider what Dr Amrani said in his Police interview, in which he criticised one of the complainant s professional performance, claiming that the allegation was false and motivated by personal reasons. You also submitted there was a pattern of consistent denials. 9

10 The Tribunal s Approach 10. The issue of impairment is one for the Tribunal to determine exercising its own judgement on the basis of the facts found proved and the evidence and submissions before it. The Tribunal was conscious that it must have regard to the statutory over-arching objective: 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 took into account the approach to assessing impairment set out in CHRE v NMC and Grant [2011] EWHC 927 (Admin) and in Cohen v GMC [2008] EWHC 581 (Admin). 11. The Tribunal considered whether or not Dr Amrani s conviction should lead to the conclusion that his fitness to practise is impaired. The Tribunal bore in mind that although the events surrounding Dr Amrani s current conviction took place in the past, the question for it to determine was whether his fitness to practise was currently impaired. The Tribunal s Decision 12. The Tribunal noted the guidance given in Good Medical Practice ( GMP ) (2001 edition), which was in effect at the time of the conduct leading to the first two convictions. Paragraph 34 states that You must always treat your colleagues fairly. 13. The Tribunal also noted relevant paragraphs of GMP (2013 edition), which was in effect at the time of the conduct leading to the third conviction. Paragraphs 1, 36 and 65 which state: 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. You must treat colleagues fairly and with respect. You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. 14. The Tribunal concluded that Dr Amrani s behaviour breached fundamental tenets of the profession. The Tribunal noted Her Honour Judge Molyneux s sentencing remarks, in which she states there has been a discussion as to whether this was an abuse of trust. In my judgement, this was an abuse of power arising from the trust placed in you by the hospital and by those who worked with you [ ] this was workplace bullying of a sexual nature. The Tribunal was of the view that Dr Amrani abused his position of power as a Consultant. It noted a significant gap 10

11 between the incidents demonstrating a propensity to commit the offences. The Tribunal determined that the nature of Dr Amrani s conduct which led to the conviction, being the sexual offences, was seriously wrong, bringing the medical profession into disrepute and breaching fundamental tenets of the medical profession. 15. The Tribunal noted the Record of Interview, dated 24 July 2015, in which Dr Amrani stated I strongly believe that she fears the consequences of what I might say about the above mentioned failings. As a result she has invented these assault allegations. In the sentencing remarks, Her Honour Judge Molyneux stated the author of the presentence report has noted defects in your thinking and behaviour which, notwithstanding that you maintain your innocence, as is your right, those defects can be addressed. The Tribunal has not received any evidence that Dr Amrani had addressed these defects. Also, In Dr Amrani s recent correspondence to the GMC, dated 31 October 2017, he stated My position remains the same: I deny all allegations. In light of Dr Amrani s sustained denials, the Tribunal has no evidence of any insight. Given this, the Tribunal could not be satisfied that Dr Amrani was unlikely to repeat his conduct in the future. The Tribunal concluded that it has not seen any evidence that he had insight into his offending or has sought to take steps to remediate his offending behaviour. 16. The Tribunal determined that it is necessary to make a finding of impairment in order to uphold the overarching objective, particularly the public interest. It determined that Dr Amrani s behaviour leading to his conviction fell far below the standards expected by the public, and would undermine public confidence in the medical profession. The Tribunal therefore concluded that in view of the seriousness of the offence, a finding of impairment was necessary in order to promote and maintain public confidence in the medical profession and to promote and maintain proper professional standards of conduct. 17. In all the circumstances, and for the reasons set out above, the Tribunal determined that Dr Amrani s fitness to practise is impaired by reason of his conviction. Determination on Sanction - 03/11/2017 Mr Claxton: 1. Having determined that Dr Amrani s fitness to practise is impaired by reason of his conviction, the Tribunal moved to consider what sanction, if any, it should impose with regard to Dr Amrani s registration. 11

12 Submissions 2. You, on behalf of the General Medical Counsel ( GMC ), submitted that the appropriate and proportionate sanction regarding Dr Amrani s registration was one of erasure. You submitted however, that the sanction was a matter for the Tribunal s own independent judgement. 3. You referred the Tribunal to the relevant paragraphs of the Sanctions Guidance (May 2017) ( SG ) which you suggested apply to this case, specifically paragraphs 148, 154, 157(a)(d)(f), 156 and 158. You also directed the Tribunal s attention to the the case of CHRP v (1) GDC and (2) Mr Fleischmann [2005] EWHC 87 (Admin). 4. You submitted that assessing the seriousness of Dr Amrani s offence would be a useful starting point for the Tribunal when deciding the necessary and proportionate sanction. In this regard you submitted that the offences leading to Dr Amrani s conviction were serious and involved an abuse of position. You further submitted that Dr Amrani has not displayed any insight or expression of regret for his actions. 5. You submitted that there would be a risk of serious damage to public trust in the medical profession if a sanction of erasure were not imposed. The Tribunal s Approach 6. The Tribunal has taken into account all the documentary evidence adduced during the course of these proceedings, and the submissions of the GMC. 7. The decision as to the appropriate sanction is a matter for this Tribunal s own independent judgement. In reaching its decision, the Tribunal has taken account of the SG and the statutory overarching objective, which includes protecting and promoting the health, safety and wellbeing of the public, promoting and maintaining public confidence in the profession, and promoting and maintaining proper professional standards and conduct. 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 Amrani s interests with the public interest. 9. The Tribunal has already provided a detailed determination on Facts and Impairment and it has taken those matters into account during its deliberations on sanction. 12

13 Aggravating and Mitigating Factors Aggravating Factors 10. The Tribunal took account of the following aggravating features: The facts underlying the convictions are serious, particularly given that the conduct occurred within a clinical setting The offences were against junior professional colleagues; The indecent/sexual assaults took place on different occasions, separated by a significant period of time; They involved more than one victim. There was a clear abuse of professional position and trust in the commission of the offences, together with subsequent threats in relation to Dr C; There was an absence of regret or remorse; There was lack of insight and remediation; Mitigating Factors 11. The Tribunal was unable to identify any mitigating factors in relation to the offence itself. The Tribunal did however take account of Dr Amrani s personal mitigation referred to by Her Honour Judge Molyneux in her sentencing remarks which took account of your good character and of your outstanding skills. 12. The Tribunal also had regard to a letter dated 1 June 2017, addressed to Dr A, Medical Director, which enclosed a petition purporting to vouch for Dr Amrani s skills as a practitioner He [Dr Amrani] has excellent technical surgical ability demonstrated by his excellent results including low rates of morbidity and mortality. [ ] We all work with him and want him to return to Harefield Hospital. There is no dispute that Dr Amrani is an exemplary heart surgeon and the Tribunal took note of this. The Tribunal s Decision 13. In deciding what sanction, if any, to impose, the Tribunal reminded itself that it must consider each of the sanctions available, starting with the least restrictive, in order to establish the most appropriate and proportionate sanction in this case. No Action 14. The Tribunal first considered whether to conclude the case by taking no action. The Tribunal took account of paragraphs of the SG. 13

14 15. The Tribunal determined that, given the seriousness of Dr Amrani s actions, taking no action would not be appropriate, given that it would neither promote and maintain public confidence in the profession nor promote and maintain proper professional standards and conduct. Conditions 16. The Tribunal next considered whether an order of conditions would be appropriate. It has borne in mind that any conditions imposed should be appropriate proportionate, workable and measurable. The Tribunal took account of paragraphs 81 and 82 of the SG. 17. The Tribunal concluded that a period of conditional registration would not be appropriate in this case given Dr Amrani s lack of insight, his lack of engagement with the GMC and this Tribunal. In addition it would be difficult to formulate conditions to address the concerns in this case. In light of this the imposition of conditions would be inconsistent with the maintenance of public confidence in the medical profession and the promotion and maintenance of proper professional standards and conduct. Suspension 18. The Tribunal went on to consider whether suspension would be an appropriate sanction in this case. The Tribunal had regard to paragraphs 92 and 93 of SG which state: 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). Suspension may be appropriate, for example, where there may have been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actions (see paragraphs 24 49). 19. The Tribunal also noted paragraph 97(e) and (g) of the SG, which state: 14

15 No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor s unwillingness to engage. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour. 20. The Tribunal has not been provided with any evidence that Dr Amrani has accepted responsibility, expressed remorse or developed any insight into his actions. The Tribunal had regard to Her Honour Judge Molyneux s sentencing remarks in which she stated that the author of the presentence report finds, and the Court agrees, that you pose a low risk of reoffending Although the Crown Court placed reliance on this when sentencing Dr Amrani this Tribunal was unable to do so. In particular the Tribunal did not have a copy of Dr Amrani s presentence report and was therefore unaware of the basis upon which the sentencing judge considered Dr Amrani to be a low risk of reoffending. The information before this Tribunal is that Dr Amrani has been convicted of sexual offences in respect of which he maintains his denials. He has not provided any evidence in the form of written material or by attending this hearing in order to demonstrate that he has either insight into his offending or that he has taken steps to remediate his actions. In light of these factors the Tribunal considered that there is a risk of repetition in the future. 21. The Tribunal also noted Her Honour Judge Molyneux s further sentencing remarks in which she stated The consequences for Dr C of your actions have been far-reaching. She now feels undermined and stressed at work. She has described herself as emotionally shattered as a woman and a doctor. The Tribunal determined that this was significant in terms of the impact Dr Amrani s actions had upon the complainants. Her Honour Judge Molyneux also stated that, in relation Dr C, Dr Amrani threatened her employment when his behaviour was challenged. In light of this the Tribunal concluded that Dr Amrani failed to treat his professional colleagues with respect and he abused his power arising from the trust placed in him by the hospital. 22. The Tribunal also had regard to the SG concerning sexual misconduct, specifically paragraphs 149 and 150 which state: More serious action, such as erasure, is likely to be appropriate where a doctor has abused their professional position and their conduct involves predatory behaviour or a vulnerable patient, or constitutes a criminal offence. Sexual misconduct seriously undermines public trust in the profession. The misconduct is particularly serious where there is an abuse of the special position of trust a doctor occupies, or where a doctor has been required to register as a sex offender. More serious action, such as erasure, is likely to be appropriate in such cases. 15

16 23. The Tribunal noted that Dr Amrani abused his position of trust and had been required to register as a sex offender for five years and therefore considered his offending behaviour to be serious, requiring action commensurate with the gravity of the offences. 24. In light of all of these factors, the Tribunal determined that the facts surrounding Dr Amrani s convictions are fundamentally incompatible with continued registration as a medical practitioner. Suspension is therefore an inappropriate sanction. Erasure 25. The Tribunal finally considered the sanction of erasure and whether it was the appropriate and proportionate sanction in this case. The Tribunal had regard to the factors set out in paragraph 109(a)(b)(c)(d)(f)(j) of SG which state: Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive): 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 and/or patient safety. c. Doing serious harm to others (patients or otherwise), either deliberately or through incompetence and particularly where there is a continuing risk to patients. 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 ). f. Offences of a sexual nature j. Persistent lack of insight into the seriousness of their actions or the consequences. 16

17 26. The Tribunal concluded all the factors listed above applied to Dr Amrani s case; and in respect of paragraph 109(c) the Tribunal concluded the emotional distress caused to Dr C constituted serious harm. 27. In reaching its decision, the Tribunal relied upon its reasoning in relation to suspension. 28. The Tribunal has concluded that erasing Dr Amrani s name from the Medical Register is the only proportionate sanction in order to protect the public interest, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards. 29. The effect of the foregoing direction is that, unless Dr Amrani exercises his right of appeal, his name will be erased from the Medical Register 28 days from the date on which written notice of this decision is deemed to have been served upon him. Determination on Immediate Order - 03/11/2017 Mr Claxton: 1. Having determined that Dr Amrani s name be erased from the Medical Register, the Tribunal has now considered whether to impose an immediate order of suspension on Dr Amrani s registration in accordance with Section 38 of the Medical Act 1983, as amended. GMC Submissions 2. You submitted there should be an immediate order made to maintain confidence in the medical profession. You directed the Tribunals attention to paragraph 173 of SG and specifically submitted that Dr Amrani had abused a position of trust. You submitted that public trust and confidence would be undermined if an immediate order was not made. 3. You made a further application that the interim order currently imposed on Dr Amrani s registration be revoked. The Tribunal s Decision 4. In reaching its decision, the Tribunal has exercised its own judgement, and has taken account of the principle of proportionality. The Tribunal has borne in mind that it may impose an immediate order where it is satisfied that it is necessary for the protection of members of the public, is in the public interest, or is in the best interests of the practitioner. It has also borne in mind the guidance given in the relevant paragraphs of the SG. 17

18 5. The Tribunal took account of paragraph 173 of the SG. The Tribunal determined that in light of the gravity of its findings, and in the particular circumstances of this case, an immediate order of suspension was appropriate and necessary. It determined that this was in the public interest. 6. The effect of this order is that Dr Amrani s registration will be suspended from the date when written notice of this decision is deemed to have been served upon him. 7. Unless Dr Amrani exercises his right of appeal, the substantive order of erasure, as already announced, will take effect 28 days after notice of the outcome of this hearing is deemed to have been served upon him. If Dr Amrani does lodge an appeal, the immediate order of suspension will remain in force until the outcome of any appeal is known. 8. The interim order in place on Dr Amrani s registration will be revoked when notice of the immediate suspension is deemed to have been served upon him. 9. That concludes Dr Amrani s case. Confirmed Date 03 November 2017 Mr Hassan Khan, Chair 18