DETERMINATION ON THE FACTS AND IMPAIRMENT - 25/10/2017

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1 PUBLIC RECORD Dates: 25 to 26 October 2017 Medical Practitioner s name: Dr Swathi Deepak PAI GMC reference number: Primary medical qualification: Type of case New - Misconduct MB BS 1998 Manipal Academy Outcome on impairment Impaired Summary of outcome Suspension, 3 months. Tribunal: Legally Qualified Chair Medical Tribunal Members: Tribunal Clerk: Miss Rachel Wedderspoon Dr Damian McDermott Dr Nigel Langford Ms Esther Morton Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and represented Mr Austin Welch, Counsel, instructed by Stephensons Solicitors Ms Susanna Kitzing, Counsel, instructed by GMC Legal Attendance of Press / Public The hearing was all heard in public. DETERMINATION ON THE FACTS AND IMPAIRMENT - 25/10/2017 FACTS Background 1. Dr Pai qualified in 1998 and obtained registration with the GMC in Dr Pai obtained Membership of the Royal College of Paediatrics and Child Health in June 2003, and prior to the events which are the subject of this hearing worked as a locum Senior 1

2 House Officer and Specialist Registrar in Paediatrics and/or Neonates in a number of hospitals throughout Northern England and Wales. 2. On 16 March 2013 Dr Pai agreed a schedule of undertakings with the GMC; these undertakings required her to be supervised in all posts and to not undertake work above the level of Specialist Trainee 4 in paediatrics. These undertakings were revoked in October At the time of the events in question Dr Pai was practising as a Locum Consultant Paediatrician at the Diana Princess of Wales Hospital, Grimsby ( the Hospital ) a post she remains in today. 4. In June 2016 Dr Pai submitted an application for a Certificate of Eligibility of Specialist Registration ( CESR ) to the GMC; in October 2016 Dr Pai provided the GMC with evidence in support of her CESR application. This evidence contained verification signatures purporting to be from seven doctors, and hospital stamps purporting to be from six hospitals. 5. Concerns were raised about the validity of one of more of these signatures by the GMC s Specialists Applications Team. Ms H, Specialists Applications Team Coordinator, contacted three of the doctors who were purposed to have signed the documents; all three confirmed that the signatures were not theirs. Ms H passed her findings onto the GMC s Legal department, and further concerns were identified regarding the validity of the purported hospital stamps. These concerns form the basis of this hearing. The Outcome of Applications Made during the Facts Stage 6. Ms Kitzing, for the GMC, and Mr Welch, for the doctor, confirmed that paragraph 1 of the Allegation erroneously referred to 18 June The Tribunal was invited to amend paragraph 1 to read On a date in June 2016 in accordance with Rule 17(6) of the General Medical Council (Fitness to Practise Rules) 2004 as amended ( the Rules ). The Tribunal was satisfied that this amendment could be made without injustice to either party, and paragraph 1 was amended accordingly. The Allegation and the Doctor s Response 7. The Allegation made against Dr Pai is as follows: 1. On the 18 On a date in June 2016, you submitted to the General Medical Council an application for a Certificate of Eligibility of Specialist Registration ( CESR ). Amended in accordance with Rule 17(6) Admitted and found proved 2. On 7 October 2016 you submitted the evidence for your CESR application which contained: 2

3 a. verification signatures purporting to be from the doctors detailed in schedule one; Admitted and found proved b. hospital stamps purporting to be from the hospitals detailed in schedule two. Admitted and found proved 3. One or more of the signatures from the doctors detailed in schedule one were not signed by the doctors. Admitted and found proved 4. One or more of the signatures as described at paragraphs 2 and 3 above were falsified by you. Admitted and found proved 5. You knew that one or more of the signatures as described at paragraphs 2 and 3 above were falsified. Admitted and found proved 6. One or more of the stamps from the hospitals detailed in schedule two were not the official stamps of those hospitals. Admitted and found proved 7. One or more of the stamps as described at paragraphs 2 and 7 above were created by you. Admitted and found proved 8. You knew one or more of the stamps as described at paragraphs 2 and 7 above were falsified. Admitted and found proved 9. Your actions described at paragraphs 1 to 8 above were: The Admitted Facts a. misleading; Admitted and found proved b. dishonest. Admitted and found proved 8. At the outset of these proceedings Dr Pai, through her Counsel, made admissions to all paragraphs and sub-paragraphs of the Allegation, as set out above, in accordance with Rule 17(2)(d) of Rules. In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced the Allegation as admitted and found proved in its entirety. IMPAIRMENT 9. The Tribunal now has to decide in accordance with Rule 17(2)(k) of the Rules whether, on the basis of the facts admitted and found proved as set out above, Dr Pai s fitness to practise is impaired by reason of misconduct. 3

4 The Evidence 10. The Tribunal has taken into account all the evidence received during the facts and impairment stages of the hearing. 11. The Tribunal received evidence on behalf of the GMC in the form of witness statements from the following witnesses who were not called to give oral evidence at the facts or impairment stage: Ms H, Specialist Applications Team Coordinator; Dr B, Consultant Neonatologist at Sheffield Teaching Hospitals; Dr G, Consultant Neonatologist at Hull and East Yorkshire Hospitals; Dr C, Consultant Paediatrician at Barnsley Hospital; Dr D, Locum Consultant Paediatrician at the Hospital; Dr F, Consultant Paediatrician at Sheffield Children s Hospital; Dr A, Consultant Paediatrician at Doncaster and Bassetlaw Hospital; Dr E, Consultant Paediatrician at York Hospital. 12. Dr Pai provided her own witness statement dated 25 August The Tribunal also had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to, evidence submitted by Dr Pai in support of her CESR application, correspondence between the GMC and three of the purported evidence signatories, colleague references submitted on Dr Pai s behalf, CPD certificates submitted by Dr Pai, and Dr Pai s written reflections on her actions. Submissions 14. On behalf of the GMC, Ms Kitzing submitted that Dr Pai s actions amounted to misconduct that was serious. She submitted that, through her actions, Dr Pai showed a lack of probity and integrity in the context of her work as a doctor, and that this dishonesty could have presented a risk to patients in that Dr Pai may have been appointed to a role she was not verified for. Ms Kitzing submitted that Dr Pai s actions could seriously undermine public confidence in the medical profession, and stated that - whilst Dr Pai has shown insight into her misconduct and has begun remediation the public interest would be undermined if a finding of impairment were not made in the circumstances. Ms Kitzing therefore invited the Tribunal to find that Dr Pai s fitness to practise is currently impaired by reason of misconduct. 15. On behalf of Dr Pai, Mr Welch invited the Tribunal to consider Dr Pai s early admissions made to the GMC in October 2016, as set out in Ms H s witness statement. He further invited the Tribunal to consider the steps she has already taken to remediate. Mr Welch submitted that Dr Pai has taken a mature and sensible approach, and knows that she has engaged in misconduct that was serious. He submitted that Dr Pai 4

5 recognised that public confidence in the medical profession would be undermined by her misconduct, and on this basis, accepted that her fitness to practise is currently impaired. 16. Mr Welch further submitted that the documents provided by Dr Pai to the GMC were authentic, and that it was only the verification of the documents by signature and stamp that had been forged. He invited the Tribunal to view Dr Pai s misconduct in this context, but stated that he did not wish this to detract from her full admission. The Relevant Legal Principles 17. The Tribunal reminded itself that, at this stage of proceedings, there is no burden or standard of proof and the decision of impairment is a matter for the Tribunal s judgment alone. 18. In approaching its decision, the Tribunal was mindful of the two stage process to be adopted: first whether the facts as found proved amounted to misconduct, and that the misconduct was serious; second, whether the finding of that misconduct which was serious could lead to a finding of impairment. 19. The Tribunal must determine whether Dr Pai s fitness to practise is impaired today, taking into account Dr Pai s conduct at the time of the events and any relevant factors since then such as whether the matters are remediable, have been remedied and any likelihood of repetition. The Tribunal s Determination on Impairment Misconduct 20. In determining misconduct, the Tribunal bore in mind that its primary responsibility is to its statutory overarching objective, which is as follows: To protect, promote, and maintain the health, safety, and well-being of the public; To promote and maintain public confidence in the medical profession; To promote and maintain proper professional standards and conduct for members of that profession. 21. The Tribunal determined that Dr Pai s actions breached a number of the key principles set out in Good Medical Practice ( GMP ). It had regard to paragraphs 65 and 66 of GMP, which state: You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession 5

6 You must always be honest about your experience, qualifications and current role 22. The Tribunal determined that, by knowingly submitting falsified signatures and by falsifying hospital stamps in support of her CESR application, Dr Pai failed to be honest about her experience and qualifications. Further, it determined that her conduct in so doing did not justify patients trust in her or in the profession as a whole. 23. The Tribunal next had regard to paragraph 68 of GMP, which states: You must be honest and trustworthy in all your communications with patients and colleagues. This means you must make clear the limits of your knowledge and make reasonable checks to make sure any information you give is accurate 24. The Tribunal determined that, by knowingly providing documents that were falsely verified, Dr Pai was not honest in her communications with colleagues. Further, in so doing, she was not honest about the limits of her knowledge. 25. Lastly, the Tribunal had regard to paragraph 71 of GMP, which sets out that: You must be honest and trustworthy when writing reports, and when completing or signing forms, reports, and other documents. You must make sure that any documents you write or sign are not false or misleading. a b You must take reasonable steps to check the information is correct 26. The Tribunal determined that Dr Pai was not honest when submitting documentation that she knew was falsely verified, and that her actions in so doing were both false and misleading. 27. Bearing all of the above in mind, the Tribunal concluded that Dr Pai s conduct fell so far short of the standards of conduct reasonably to be expected of a doctor as to amount to misconduct. Impairment 28. Having found misconduct, the Tribunal went on to consider whether, as a result of that misconduct, Dr Pai s fitness to practise is currently impaired. 29. In determining impairment, the Tribunal had regard to the case of PSA v GMC and Uppal [2015] EWHC 1304 (Admin) ( Uppal ), in which Mrs Justice Lang set out that: 6

7 In my judgment, the PSA s submission that a doctor s fitness to practise is impaired if he acts dishonestly does not accurately reflect the statutory scheme or the authorities, since, even in cases of dishonesty, a separate assessment of impairment is required, and not every act of dishonesty results in impairment. 30. It further had regard to the case of CHRE v NMC & Grant [2011] EWHC 927 (Admin) ( Grant ), where Mrs Justice Cox set out that: It is clear, notwithstanding the references in those passages to whether fitness to practise has been impaired, that the question is always whether it is impaired as at the date of the hearing, looking forward in the manner indicated by Silber J in his judgment. The question for this Committee as at 21 April 2010 was therefore is this Registrant s current fitness to practise impaired? An assessment of current fitness to practise will nevertheless involve consideration of past misconduct and of any steps taken consequently by the practitioner to remedy it. Silber J recognised this when referring, at paragraph 65, to the necessity to determine whether the misconduct is easily remediable, whether it has in fact been remedied and whether it is highly unlikely to be repeated. However it is essential, when deciding whether fitness to practise is impaired, not to lose sight of the fundamental considerations emphasised at the outset of this section of his judgment at paragraph 62, namely the need to protect the public and the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession. 31. Having regard to the principles set out in Uppal and Cox, the Tribunal bore in mind that a finding of dishonesty does not necessarily lead to a finding of impairment. It further bore in mind the need to consider past misconduct as well as any remediation undertaken and the likelihood of repetition, combined with the need to protect the wider public interest and to declare and uphold proper standards of conduct and behaviour. 32. The Tribunal accepts that Dr Pai has insight into her misconduct, and that she has attempted to remediate this misconduct. It noted that she admitted falsifying signatures to the GMC in October 2016, and that she has made full admissions at this hearing. It further bore in mind the references and statements received from Dr Pai s colleagues which attest to her being of otherwise good character for example, in his statement of 8 April 2017 Dr G wrote: This is out of character for Dr Pai as she is very honest and sincere. I am surprised Dr Pai has done this 7

8 Similarly in her statement of 9 December 2016 Dr E described Dr Pai s behaviour as totally out of character. Given these factors, the Tribunal was satisfied that likelihood of repetition of similar misconduct in future was low. 33. However, the Tribunal also bore in mind that Dr Pai s misconduct occurred over a period of at least 10 months and that she forged the signatures of seven doctors at six different hospitals on her CESR application document. It considered that, by falsely verifying documents as part of the CESR application process, Dr Pai could have been appointed to a position for which she may not have been suitably qualified, and that this could have posed a real and serious risk to patient safety. Further, it determined that her actions in falsifying signatures and hospital stamps could seriously undermine public confidence in the medical profession as a whole. Patients need to be confident that their doctors act with integrity at all times and have the requisite qualifications; Dr Pai s conduct undermined this confidence and trust. The Tribunal further determined that fellow practitioners would consider Dr Pai s attempt to gain access to the specialist register without having the requisite verified documentation to be deplorable, and not in line with proper professional standards. It therefore determined that a finding of impairment was necessary not only to protect public confidence in the medical profession, but also to declare and uphold proper standards of conduct and behaviour for fellow practitioners. 34. Accordingly, the Tribunal has determined that Dr Pai s fitness to practice is impaired by reason of misconduct. DETERMINATION ON SANCTION - 26/10/ Having determined that Dr Pai s fitness to practise is impaired by reason of misconduct 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. 3. The Tribunal received further evidence on behalf of Dr Pai including: Witness evidence from Dr Pai, in person; Witness evidence from Dr E, in person. Submissions 4. Ms Kitzing, on behalf of the GMC, submitted that it would not be appropriate to take no action in Dr Pai s case, and stated that doing so would be wholly inappropriate given her admitted dishonesty. In relation to conditions, Ms Kitzing submitted that whist Dr Pai does have insight into her misconduct dishonesty is 8

9 difficult to remediate, and conditions would not satisfactorily address Dr Pai s misconduct and failings. She therefore submitted that a period of suspension would be both appropriate and proportionate; the Tribunal heard that suspension would have a deterrent effect, and would deter other practitioners from carrying out similar misconduct in future. Further, she submitted that suspension would also serve to maintain public confidence in the medical profession. Ms Kitzing submitted that, given Dr Pai s insight, admissions, and attempts to remediate, her misconduct did not warrant erasure from the medical register. In relation to length of any order imposed, Ms Kitzing submitted that this was a matter for the Tribunal. 5. Mr Welch, on behalf of Dr Pai, informed the Tribunal that Dr Pai understands the seriousness of her actions, and he invited the Tribunal to take the following factors into consideration when reading its decision on sanction: The context and background of the allegation, and the fact this was an isolated act of dishonesty in the overall career of an otherwise honest doctor; The understanding and insight that Dr Pai has shown, the evidence of remorse and regret, and the efforts she has made to remediate her behaviour (which includes a sustained period of reflection and remediation); Her present position and clinical abilities, including the fact that no clinical concerns have been raised, and that she is a valued member of her team. 6. Mr Welch accepted that it would not be appropriate to take no action in Dr Pai s case, and submitted that whilst Dr Pai would comply with any conditions imposed on her registration she recognised that conditions would not be the ordinary course of action when addressing dishonesty. Should the Tribunal consider conditions to be unworkable, Mr Welch invited it to consider a sanction of suspension rather than erasure. In so doing, he invited it to consider the case of Abbas v GMC [2017] EWHC 51 (Admin) ( Abbas ), where the judgment of Atkinson v GMC [2009] EWHC 3636 (Admin) was approved. In Abbas, Mr Justice Nicol set out that erasure is likely in cases where there has been persistent dishonesty, but that a lesser sanction might be appropriate in cases where there the doctor has insight. Given Dr Pai s insight into her misconduct and the fact her misconduct was out of character and isolated in the context of her career, Mr Welch submitted that suspension rather than erasure would be the appropriate and proportionate sanction in her case. The Tribunal s Determination on Sanction 7. The decision as to the appropriate sanction to impose, if any, is a matter for this Tribunal exercising its own judgement. In reaching its decision, the Tribunal has taken account of the Sanctions Guidance ( SG ), and has borne in mind that the purpose of a sanction is not to be punitive, although a sanction may have a punitive 9

10 effect. The Tribunal has applied the principle of proportionality, weighing Dr Pai s interests with the wider public interest. No action 8. The Tribunal first considered whether to conclude Dr Pai s case by taking no action. It determined that there were no exceptional circumstances in this case that would warrant it taking no action, and considered that doing so would be wholly disproportionate given its findings at the impairment stage. Conditions 9. The Tribunal next considered whether it would be sufficient to impose an order of conditions on Dr Pai s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable, and measureable. 10. The Tribunal heard from Dr E that the Hospital would be willing to support Dr Pai should the Tribunal impose an order of conditions or similar on Dr Pai s registration, and it bore in mind that Dr Pai has previously complied with undertakings agreed with the GMC in relation to a separate matter. However, the Tribunal also had regard to paragraph 81 of the SG, which sets out that conditions are likely to be most appropriate in the following circumstances: Cases involving the doctor s health; Cases where there are issues around the doctor s performance; Cases where there is evidence of shortcomings in a specific area or areas of the doctor s practice; Cases where the doctor lacks the necessary knowledge of English to practice medicine without direct supervision. 11. The Tribunal considered that none of the above factors are present in Dr Pai s case. The Tribunal found impairment of Dr Pai s fitness to practise on the basis of dishonesty, and it bore in mind that there are no workable conditions that could practically mitigate against dishonesty. It therefore determined that conditions would not sufficiently address Dr Pai s impairment, nor would they serve to uphold public confidence in the medical profession. On this basis, the Tribunal determined that conditions would neither be workable nor appropriate. Suspension 12. The Tribunal next considered whether a period of suspension would be appropriate in Dr Pai s case. In so doing, it had regard to paragraph 91 of the SG, which sets out that: 10

11 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 13. The Tribunal next had regard to paragraphs 92 and 93 of the SG, which set out that: 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 Suspension may be appropriate where there may have been acknowledgment 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 14. The Tribunal has already found that Dr Pai s misconduct was serious, and it was satisfied that action needed to be taken in order to uphold public confidence in the medical profession. However, it also bore in mind the mitigating factors in Dr Pai s case, which include the following: Dr Pai has acknowledged fault, not just at this hearing, but as early as October 2016 when the concerns first came to light. She has been candid and open at this hearing, has made full admissions, and has conceded both dishonesty and impairment. The Tribunal noted from testimonial evidence that Dr Pai has been open with her colleagues about her misconduct, and has reflected on it in her most recent appraisal dated April Whilst Dr Pai s misconduct was pre-meditated and spanned a period of 10 months, the evidence before the Tribunal indicates that this was an isolated circumscribed event in the context of an otherwise unblemished career. It had regard to paragraph 19 of Uppal, in which Mrs Justice Lang concluded: In my view, it is reasonable to assume that the Panel was well aware of the evidence, and knew that the events had not all occurred on a single occasion. The Panel was making the legitimate point that this episode was an isolated incident in her professional career. She was a person of good character and there was nothing to indicate other episodes of dishonesty, before or since. This Tribunal was similarly satisfied that Dr Pai s misconduct was an isolated incident in her professional career, and it has been provided with testimonial evidence attesting to her good character and integrity. The Tribunal has already referred to Dr G s statement of 8 April 2017 in which she opined that 11

12 Dr Pai s behaviour was out of character it further had regard to the reference provided by Dr I, Medical Director at the Hospital, who wrote on 31 May 2017 that: There have never been any questions raised over [Dr Pai s] honesty and integrity, or her attitude or professional behaviour This would appear to be a totally isolated act which she obviously deeply regrets The Tribunal also noted the reference dated 15 September 2017 provided by Dr J, Consultant Paediatrician at the Hospital and Dr Pai s appraiser. Dr J wrote: [Dr Pai] has always acted honestly and with integrity to the best of my knowledge Dr Pai has reflected on her actions and is sincerely sorry for what she has done Whilst Dr Pai has made known that there were personal stressors present when her misconduct occurred (including a house move, a new job, and family difficulties), she has not attempted to rely on these stressors as an excuse for her behaviour; the Tribunal determined that this was to her credit. Dr Pai has full insight into her misconduct as evidenced by her admissions and her acceptance of impairment. She has provided the Tribunal with a reflective log which evidenced her regret and remorse, and she has attended courses in an attempt to remediate her dishonesty, including a course on acting openly and honestly. The Tribunal noted that this remediation began in June 2016, and that she has continued her reflection and remediation since that time. It was satisfied that Dr Pai has taken all possible and adequate steps to remediate, and that given her insight this remediation will be ongoing. 15. Bearing these points in mind, the Tribunal was satisfied that whilst serious - Dr Pai s conduct fell short of being fundamentally incompatible with continued registration. 16. The Tribunal next had regard to paragraph 97 of the SG, which sets out a number of factors that indicate suspension may be appropriate. The following factors are present in Dr Pai s case: A serious breach of GMP, but where the doctor s misconduct is not fundamentally incompatible with continued registration; No evidence that demonstrates remediation is unlikely to be successful; No evidence of repetition of similar behaviour since incident, The Tribunal is satisfied that the doctor has insight and does not pose a significant risk of repeating behaviour. 12

13 17. The Tribunal further had regard to paragraph 32 of Abbas, as follows: Understandably, in the context of deciding what sanction is appropriate, a finding of dishonesty is of particular significance, especially if it is persistent and combined with a lack of insight. In such circumstances, 'nothing short of erasure is likely to be appropriate' see Naheed v GMC [2011] EWHC 702 (Admin) at [22] per Parker J. Plainly, the individual circumstances of the case must be considered and there can be no universal or inflexible rules in this context. As Blake J. said in Atkinson v GMC [2009] EWHC 3636 (Admin) at [13], 'erasure is not necessarily inevitable and necessary in every case where dishonest conduct by a medical practitioner has been substantiated. There are cases where the panel, or indeed the court on appeal, have concluded in the light of the particular elements that a lesser sanction may suffice and it is the appropriate sanction bearing in mind the important balance of the interests of the profession and the interests of the individual. It is likely that for such a course to be taken, a panel would normally require compelling evidence of insight and a number of other factors upon which it could rely that the dishonesty in question appeared to be out of character or somewhat isolated in its duration or range, and accordingly there was the prospect of the individual returning to practice without the reputation of the profession being disproportionately damaged for those reasons.' 18. Bearing all of the above in mind, the Tribunal determined that a period of suspension would be appropriate and proportionate. In reaching this decision, it bore in mind the mitigating factors in Dr Pai s case, and was satisfied that suspension would serve to uphold the wider public interest. This includes sending a message to the public and the profession about what is behaviour unbefitting of a registered medical practitioner, and promoting and maintaining professional standards and conduct for members of the profession. 19. In determining the length of the order of suspension, the Tribunal had regard to the mitigating factors listed above, which include Dr Pai s acceptable of the facts, her insight, and her remediation. It also bore in mind Dr E s evidence that Dr Pai is a highly valued member of a team serving a vulnerable group of individuals in an underserved area of the country. It further considered that Dr Pai did not fabricate the CESR supporting documents themselves, and that whilst still serious - her dishonesty was limited to fabricating the verification of these documents. Weighing these factors with the interests of the public, the Tribunal determined that a period of three months suspension would be appropriate. The period of three months sends a message to the public and the profession marking the seriousness of Dr Pai s misconduct, but also recognises Dr Pai s insight, admissions, and remediation. 13

14 It determined that a period of longer than three months would be disproportionate, and could lead to a period of de-skilling which would not be in the public interest. 20. The Tribunal therefore determined to suspend Dr Pai s registration for a period of three months. Review 21. In determining whether it was necessary to direct a review hearing, the Tribunal had regard to paragraph 164 of the SG, which sets out that: In some misconduct cases it may be self-evident that, following a short suspension, there will be no value in a review hearing 22. The Tribunal noted that there are no current clinical concerns in Dr Pai s case, and it heard from Dr E that she is a valued member of her team. The Tribunal has imposed a period of three months suspension in order to mark the seriousness of Dr Pai s misconduct, and in order to send a message to the public and the profession about behaviour unbefitting of a medical practitioner. In light of Dr Pai s remediation and insight to date, the Tribunal considered that risk of repetition is low. Further, given the period of suspension is for three months, there is little risk of de-skilling. Given these factors, the Tribunal determined that a review hearing was not necessary in Dr Pai s case. The Tribunal therefore determined not to direct a review hearing. DETERMINATION ON IMMEDIATE ORDER - 26/10/ Having determined to suspend Dr Pai s registration for a period of three months, the Tribunal next considered, in accordance with Rule 17(2)(o) of the Rules, whether Dr Pai s registration should be subject to an immediate order of suspension. Submissions 2. Neither Ms Kitzing nor Mr Welch submitted that it was necessary to impose an immediate order in this case. The Tribunal s Determination 3. Given there are no patient safety concerns in Dr Pai s case, the Tribunal determined that it was not necessary to impose an immediate order of suspension on Dr Pai s registration. The Tribunal was satisfied that the substantive order for suspension as already announced is sufficient to protect the public interest and to address Dr Pai s misconduct. It was further satisfied that allowing Dr Pai to remain in unrestricted practice until the substantive suspension comes into effect will not adversely impact upon patient safety. 14

15 4. This means that Dr Pai s registration will be suspended 28 days from today, unless she lodges an appeal. If Dr Pai does lodge an appeal she will remain free to practise unrestricted until the outcome of any appeal is known. 5. There is no interim order to revoke. 6. That concludes Dr Pai s case. Confirmed Date 26 October 2017 Miss Rachel Wedderspoon, Chair 15

16 Schedule One Dr A Dr B Dr C Dr D Dr E Dr F Dr G 16

17 Schedule Two Doncaster and Bassetlaw Hospital Sheffield Teaching Hospitals Barnsley Hospital York Hospital Sheffield Children s Hospital Hull and East Yorkshire Hospitals NHS Trust 17