“4. An appeal under these rules does not require permission to appeal. The appeal is technically by way of rehearing, but in reality involves a review of the evidence and material before the Panel in accordance with the parameters set out in Gupta vGMC[2002] 1 WLR 1691 and Ghosh v GMC[2001] 1 WLR1915 , conveniently summarised by Stanley Burnton J, as he then was, in Threlfall v General Optical Council [2004] EWHC2683 (Admin) at paragraph 21 where he said this: “Because it does not itself hear the witnesses give evidence, the court must take into account that the Disciplinary Committee was in a far better position to assess the reliability of the evidence of live witnesses where it was in issue. In that respect, this court is in a similar position to the Court of Appeal hearing an appeal from a decision made by a High Court Judge following a trial. There is, however, an important difference between an appeal from a High Court Judge and an appeal from a Disciplinary Committee. The Disciplinary Committee possesses professional expertise that a High Court judge lacks …. This court appreciates that such a Disciplinary Committee is better qualified to assess evidence relating to professional practise, and the gravity of any shortcomings, and it therefore accords the decision of the Committee an appropriate measure of respect, but no more: see Ghosh vGeneral Medical Council[2001] UKPC 29 ,[2001] 1 WLR1915 , at [33] and [34] and Preiss v General Dental Council[2001] UKPC 36 ,[2001] 1 WLR 1926 at [26] and [29]. These decisions make it clear that the court should be more ready to overrule a disciplinary tribunal than previously appeared to be the case. It however remains the position that an Appellant must establish an error, of law or fact or of judgment, on the part of the tribunal.” 5. Although I have referred to that convenient summary, I should, I think, quote what was said in Gupta v GeneralMedical Council [2002] 1 W.L.R. 1691 , where the following appears: “[T]he obvious fact [is] that the appeals are conducted on the basis of the transcript of the hearing and that, unless exceptionally, witnesses are not recalled. In this respect, these appeals are similar to many other appeals in both civil and criminal cases from a judge, jury or other body who has seen and heard the witnesses. In all such cases the appeal court readily acknowledges that the first instance body enjoys an advantage which the appeal court does not have, precisely because that body is in a better position to judge the credibility and reliability or the evidence given by the witnesses. In some appeals that advantage may not be significant since the witnesses’ credibility and reliability are not in issue. But in many cases the advantage is very significant and the appeal court recognises that it should accordingly be slow to interfere with the decisions on matters of fact taken by the first instance body. This reluctance to interfere is not due to any lack of jurisdiction to do so. Rather, in exercising its full jurisdiction, the appeal court acknowledges that, if the first instance body has observed the witnesses and weighed their evidence, its decision on such matters is more likely to be correct than any decision of a court which cannot deploy those factors when assessing the position. In considering appeals on matters of fact from the various professional conduct committees, the Board must inevitably follow the same general approach. Which means that, where acute issues arise as to the credibility or reliability of the evidence given before such a committee, the Board, duly exercising its appellate function, will tend to be unable properly to differ from the decisions as to fact reached by the committee except in the kinds of situation described by Lord Thankerton in the well known passage in Watt or Thomas vThomas [1947] A.C. 484 , 484–488.”
“I do not find it necessary to review the many decisions of this House, for it seems to me that the principle embodied therein is a simple one, and may be stated thus: I. Where a question of fact has been tried by a judge without a jury, and there is no question of misdirection of himself by the judge, an appellate court which is disposed to come to a different conclusion on the printed evidence, should not do so unless it is satisfied that any advantage enjoyed by the trial judge by reason of having seen and heard the witnesses, could not be sufficient to explain or justify the trial judge’s conclusion; II. The appellate court may take the view that, without having seen or heard the witnesses, it is not in a position to come to any satisfactory conclusion on the printed evidence; III. The appellate court, either because the reasons given by the trial judge are not satisfactory, or because it unmistakably so appears from the evidence, may be satisfied that he has not taken proper advantage of his having seen and heard the witnesses, and the matter will then become at large for the appellate court. It is obvious that the value and importance of having seen and heard the witnesses will vary according to the class of case, and, it may be, the individual case in question.” 6. In relation to the sanction imposed, and the approach to reviewing it in this court, my attention has been drawn to the case of Fatnani Raschid v General Medical Council [2007]EWCA Civ 46 where Laws LJ (with whom Chadwick LJ and Sir Peter Gibson agreed) said this: “As it seems to me the fact that a principal purpose of the Panel’s jurisdiction in relation to sanctions is the preservation and maintenance of public confidence in the profession rather than the administration of retributive justice, particular force is given to the need to accord special respect to the judgment of the professional decision-making body in the shape of the Panel.” 7. I must conduct my review of the FPP’s decision by reference to those guidelines. “Because it does not itself hear the witnesses give evidence, the court must take into account that the Disciplinary Committee was in a far better position to assess the reliability of the evidence of live witnesses where it was in issue. In that respect, this court is in a similar position to the Court of Appeal hearing an appeal from a decision made by a High Court Judge following a trial. There is, however, an important difference between an appeal from a High Court Judge and an appeal from a Disciplinary Committee. The Disciplinary Committee possesses professional expertise that a High Court judge lacks …. This court appreciates that such a Disciplinary Committee is better qualified to assess evidence relating to professional practise, and the gravity of any shortcomings, and it therefore accords the decision of the Committee an appropriate measure of respect, but no more: see Ghosh vGeneral Medical Council[2001] UKPC 29 ,[2001] 1 WLR1915 , at [33] and [34] and Preiss v General Dental Council[2001] UKPC 36 ,[2001] 1 WLR 1926 at [26] and [29]. These decisions make it clear that the court should be more ready to overrule a disciplinary tribunal than previously appeared to be the case. It however remains the position that an Appellant must establish an error, of law or fact or of judgment, on the part of the tribunal.” “[T]he obvious fact [is] that the appeals are conducted on the basis of the transcript of the hearing and that, unless exceptionally, witnesses are not recalled. In this respect, these appeals are similar to many other appeals in both civil and criminal cases from a judge, jury or other body who has seen and heard the witnesses. In all such cases the appeal court readily acknowledges that the first instance body enjoys an advantage which the appeal court does not have, precisely because that body is in a better position to judge the credibility and reliability or the evidence given by the witnesses. In some appeals that advantage may not be significant since the witnesses’ credibility and reliability are not in issue. But in many cases the advantage is very significant and the appeal court recognises that it should accordingly be slow to interfere with the decisions on matters of fact taken by the first instance body. This reluctance to interfere is not due to any lack of jurisdiction to do so. Rather, in exercising its full jurisdiction, the appeal court acknowledges that, if the first instance body has observed the witnesses and weighed their evidence, its decision on such matters is more likely to be correct than any decision of a court which cannot deploy those factors when assessing the position. In considering appeals on matters of fact from the various professional conduct committees, the Board must inevitably follow the same general approach. Which means that, where acute issues arise as to the credibility or reliability of the evidence given before such a committee, the Board, duly exercising its appellate function, will tend to be unable properly to differ from the decisions as to fact reached by the committee except in the kinds of situation described by Lord Thankerton in the well known passage in Watt or Thomas vThomas [1947] A.C. 484 , 484–488.” “I do not find it necessary to review the many decisions of this House, for it seems to me that the principle embodied therein is a simple one, and may be stated thus: I. Where a question of fact has been tried by a judge without a jury, and there is no question of misdirection of himself by the judge, an appellate court which is disposed to come to a different conclusion on the printed evidence, should not do so unless it is satisfied that any advantage enjoyed by the trial judge by reason of having seen and heard the witnesses, could not be sufficient to explain or justify the trial judge’s conclusion; II. The appellate court may take the view that, without having seen or heard the witnesses, it is not in a position to come to any satisfactory conclusion on the printed evidence; III. The appellate court, either because the reasons given by the trial judge are not satisfactory, or because it unmistakably so appears from the evidence, may be satisfied that he has not taken proper advantage of his having seen and heard the witnesses, and the matter will then become at large for the appellate court. It is obvious that the value and importance of having seen and heard the witnesses will vary according to the class of case, and, it may be, the individual case in question.” “As it seems to me the fact that a principal purpose of the Panel’s jurisdiction in relation to sanctions is the preservation and maintenance of public confidence in the profession rather than the administration of retributive justice, particular force is given to the need to accord special respect to the judgment of the professional decision-making body in the shape of the Panel.”
“We have, indeed, been very satisfied with her performance here on our Liver Unit.”
“During her time on the ward there were no problems with her communication and in fact she got a very positive feedback from a ward sister on her ability to work with the nurses. There were no problems reported by my [Specialist Registrar] about any difficulties in working within the team. There were also no problems reported back from patients or relatives. She presented a [professional] attitude. Her clinical skills [were] those I would have expected in a doctor coming to the end of their ST1 year.”
“There are a number of areas in which it appears that Dr Naguib’s knowledge of medical management, assessment of investigations, prescribing, and practical procedures may be below standard. There is also the impression from … members of staff that when issues of concern have been raised she has not sought more senior advice and has also been confrontational. I have personally spoken to Dr Naguib and told her that a number of members of staff have complained about her whilst she has been working at Cookridge and the general issues involved. Some of the staff were concerned that we may yet receive complaints from patients. I have advised Dr Naguib that if she does do further similar posts in the future she should look particularly at seeking advice when appropriate, following local protocols, considering that advice when it is from someone with more experience, and working on developing better relationships with colleagues. I do not know whether similar issues have been raised in previous placements. It is possible that this has been a “one off” episode. However, we would not consider re-employing Dr Naguib at this hospital.”
“For completeness, I should add that we have received copies of assessment forms from the locum agency with whom Dr Naguib is currently working which indicate that she is above average.”
“We found that Dr Nagiub had an adequate knowledge base but that she was unable to apply it consistently in her work as a doctor or during the Tests of Competence. Dr Nagiub’s performance was variable. For example, she managed some patients well and developed effective working relationships with some colleagues. On the other hand, some patient care was unsafe and some relationships with colleagues were unacceptable .... In our opinion Dr Nagiub’s performance has been deficient and her work should be restricted to closely supervised posts but not as short-term locum.”
“Deficient professional performance The Panel understands that performance assessments are routinely used to assess doctors and that the GMC procedure is now well established. The Panel accepts that the process is reasonable and structured to test the pertinent elements of professional performance, and to ensure that a doctor functions at a level at which the safety of the public can be maintained. The assessment took the form of a knowledge based test, objective structured clinical examination (OSCE), record review, case based discussion and third party interviews. The Panel found the Performance Assessors to be knowledgeable and experienced. It recognised that Dr Sharma was part of the Assessment Team specifically because of his comparable clinical experience to you. The Panel notes the evidence of the Assessors in relation to the standard expected from you, the reasons for their individual judgments and their judgments in relation to the overall Assessment Report. Dr Cox told the Panel that the Performance Assessment was a qualitative and not a quantitative assessment. He explained that the Assessment Team do not count up the ‘Acceptables’, ‘Unacceptables’ and ‘Cause for concern’ judgments to reach an overall conclusion as to a doctor’s performance. The Panel also notes that you have vigorously challenged the validity of the Performance Assessment and its subsequent findings. [The Panel then made express findings concerning the conclusions of the Performance Assessment Report] The Panel notes the findings of the Performance Assessment Report that you have a good level of medical knowledge having passed the Professional Linguistic Assessment Board Test (PLAB) with 71% of correct answers against a pass score of 63%. In addition, you also passed the more difficult Member of the Royal College of Physicians (MRCP) part 1 knowledge test in 2006. However, a further conclusion within the report was that, despite this knowledge, you were unable to apply it consistently in your work as a doctor during the tests of competence. Your performance was found to be deficient. [The Panel then made a further finding concerning the conclusions of the Performance Assessment Report] The Panel notes that in his evidence Dr Cox, Lead Performance Assessor, made concessions with regard to some of the individual judgments made. For example, in relation to record 306, Dr Cox accepted that in the absence of corroboration from colleagues, Dr Sharma’s judgment was not a good example to quote. Additionally, Dr Cox apologised for his error regarding DVLA guidance for patients after a myocardial infarction. However, this had no impact on the overall conclusions of the report. In evidence, all the Assessors maintained their opinions and reasonings behind both individual judgments and the overall conclusions of the report. The Panel is satisfied that the overall conclusions of the Performance Assessment Report are an accurate reflection of how you performed on the day. Misconduct The Panel found Nurses Dickinson and Costello to be credible witnesses and their evidence to be clear and measured. Furthermore, the Panel was satisfied with the veracity of patient MH’s evidence and that of his friend, Mr W, who accompanied him to Trafford General Hospital on the evening of17 September 2008 . The Panel acknowledge that there were minor discrepancies in the evidence of MH and Mr W, which were understandable due to the passage of time. However, in relation to the incident itself, their evidence was clear and consistent. The Panel accepts the consistent version of events put forward by the GMC’s witnesses, in preference to your account. Even if your account were accepted on those facts, your care of MH was substandard and the patient suffered unnecessary pain. [The Panel then made express findings concerning the manipulation of MH’s fracture] The Panel heard from Nurse Costello, the Shift Co-ordinator on17 September 2008 . She told the Panel that whilst she was informed that you had requested the plaster trolley, morphine and Entenox, she had not been informed of the patient’s x-ray results. She also stated that there had been no request for a bed in the resuscitation bay for MH to have sedation and manipulation. Nurse Costello told the Panel that she knew nothing about your plan to manipulate MH’s wrist in the Minor Injuries cubicle in the A&E department. You also told the Panel that you did not discuss with Nurse Costello your plan to manipulate MH’s wrist. [Further finding of fact made] In his evidence MH told the Panel that you returned to the cubicle, where he was waiting with a nurse and Mr W. He stated that you picked up his arm and began to pull and twist it. He told the Panel that at no point did you explain what you were about to do. Mr W corroborated this account in his oral evidence. You told the Panel that you performed the manipulation alone and confirmed that the plaster trolley was not available at that time, so you were unable to put on the back slab. [Further finding of fact made] The Panel has noted the evidence of Dr Stuart, Consultant in Emergency Medicine and Clinical Director, who told the Panel in cross-examination that the care you gave to MH was without adequate pain relieving medication and analgesia, and with no sedation whatsoever. He explained that the patient was treated in a seriously substandard way and suffered unnecessary pain. The Panel also heard from Mr Burdett-Smith, Consultant Emergency Physician and GMC expert witness. He told the Panel that it is not good practice only to provide pain relief. He stated that it appeared that the procedure was carried out without adequate pain relief or sedation, inflicted pain and was not successful. He confirmed that this particular procedure has not changed much in 20 years. The manipulation of a displaced fracture in a young man should not be carried out under analgesia alone,but requires sedation or anaesthesia. It also requires the necessary equipment to be available and two operators. The Panel accepts the evidence of Dr Stuart and Mr Burdett- Smith. Further, it notes MH’s own evidence that the manipulation was so painful that although it only took approximately 60 seconds, it felt as if he endured it for hours. Mr W also told the Panel that during the manipulation of MH’s wrist, he was writhing in agony on the bed. [Further finding of fact made] MH told the Panel that you picked up his arm and began to twist and pull it. He also told the Panel that at no point prior to doing this did you explain your intentions or ask if he consented to the manipulation. Mr W also told the Panel that you did not ask MH if you could manipulate the arm before you proceeded to do so. In re-examination Mr W told the Panel that the attempt to manipulate the arm occurred so unexpectedly, without any prior discussion, that he imagined that the element of surprise was part of medical rationale. Although both MH and Mr W agreed that there was some dialogue between you and MH prior to the manipulation, both were adamant that you did not ask MH if you could manipulate his wrist. Mr BurdettSmith told the Panel that informed consent means that the patient must understand what is to be done and then agree to that treatment. [Further finding of fact made] MH told the Panel that following the manipulation he informed you that he could no longer move his fingers and that the pain in his arm had increased. He told the Panel that you did not respond to this and left the cubicle. Mr W told the Panel that MH was unable to make a fist shape with his hand after the manipulation. Mr W stated that MH asked you whether this was normal, however, he did not believe you replied before leaving the cubicle again. [Further finding of fact made] The Panel has read the form completed by you in relation to your Employment Tribunal case against Trafford Healthcare NHS Trust, which has been adduced in evidence. In this form you state that you have been a victim of “being witch-hunted” by three senior nurses, who have harassed and bullied you. You provide the submission of a clinical incident form as an example of this discrimination and “witch-hunt”
“Deficient professional performance The Panel first considered whether your fitness to practise is impaired by reason of deficient professional performance. In doing so it has taken account of all the evidence adduced at this hearing, as well as the submissions made by you and those made by Mr Kennedy. This aspect of the case centred on the Performance Assessment Report where your overall performance in the Observed Structured Clinical Examination (OSCE) was judged to be poor and your professional performance was found to be unacceptable or giving rise to cause for concern in a number of areas. Additionally, it was found that you were unable to apply knowledge consistently to your work as a doctor. The Panel notes that you displayed an unusual reaction to the stressful performance assessment environment. However, the assessors felt that you had calmed downbefore the OSCE clinical skills test. You performed well in the knowledge test despite being upset, answering 142 questions correctly out of 200 questions. The Panel notes that there is evidence that you have a satisfactory level of medical knowledge. However, the Performance Assessment Report stated that despite this knowledge you were unable to apply it consistently in your work as a doctor. At the time of the GMC assessment in May 2007 your performance was very poor. However, you have worked since this time and most recently you have worked at Warrington Hospital as a full-time Locum Staff Grade in Elderly Care and General Medicine. You were in this role for approximately eight months until February 2010 when you resigned to prepare for this hearing. In their evidence before the Panel both Dr Bentley, Divisional Medical Director and Dr Akpan, Consultant Physician, were positive about your clinical ability and both confirmed that you had made a valuable contribution during your time at Warrington Hospital. Nevertheless, the Panel is concerned by your inability to accept that there are any deficiencies with regard to your professional performance. In your closing submissions on impairment you frequently denounced the Performance Assessment as “duff” and described the assessment team as “dishonest”, “crooked” and “racially motivated”
“In a misconduct or deficient performance case, the task of the Panel is to determine whether the fitness to practise is impaired by reason of misconduct or deficient performance. It may well be, especially in circumstances in which the practitioner does acknowledge his deficiencies and take prompt and sufficient steps to remedy them, that there will be cases in which a practitioner is no longer any less fit to practise than colleagues with an unblemished record.”
“In short, the purpose of [fitness to practise] proceedings is not to punish the practitioner for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. The FPP thus looks forward not back. However, in order to form a view as to the fitness of a person to practise today, it is evident that it will have to take account of the way in which the person concerned has acted or failed to act in the past” (paragraph 32). The Panel accepted the evidence of Dr Stuart, who told the Panel that you treated MH in a “seriously substandard” manner and that he was concerned by your inability to understand the gravity of the situation. Dr Stuart stated that you focussed on what you alleged to be the substandard treatment of other patients by other doctors, but that his focus, as your clinical director, was on the index case of MH, for which a serious incident report was raised. He told the Panel that he was as concerned by your behaviour after the event as he was by your conduct during the clinical care of MH, and that he still remains as concerned now as he was then by your refusal to accept the pain and suffering caused to MH and your lack of any apology to him. The Panel has also accepted the evidence of Mr Burdett-Smith who was categorical on what constitutes informed consent and the proper standard of care when manipulating a fracture. He told the Panel that he would be concerned about a doctor of your grade, practising at this level, who showed this level of lack of insight as to how to manage a common injury such as MH’s. The Panel did see some evidence of occasions when you sought advice from others. However, it cannot be satisfied that you have learned anything from the Trafford incident or that you would not repeat your misconduct again. The Panel is concerned that you appear to find it difficult to accept that you are not always right. This unwarranted confidence in your own ability is despite the contrary opinions of senior colleagues and experts, and as such, makes you a potentially dangerous doctor. Furthermore, the Panel has had regard to Good Medical Practice (2006 edition) and is conscious that your treatment of MH and interaction with colleagues contradicts many of the principles contained therein. For example, the Panel has borne in mind the duties detailed in the front cover of the document, namely that doctors must: “Provide a good standard of practice and care - Keep your professional knowledge and skills up to date - Recognise and work within the limits of your competence - Work with colleagues in the ways that best serve the patients’ interests”
“The adjective serious has to be given its proper weight, and in other contexts there has been reference to conduct which would be regarded as deplorable by fellow practitioners.”
“Finally, the Panel has considered your behaviour throughout this hearing. The Panel is most concerned that your conduct throughout has been rude, insulting, racist, abusive and, at times, bullying and intimidating. You have abused every witness who gave evidence on behalf of the GMC, the GMC legal team, the Panel Chairman, the Panel and the Legal Assessors who sat on the first half of the case. You have refused to acknowledge the impropriety of the wild, offensive and unsubstantiated allegations and insults which you have gratuitously levelled at participants in this hearing. During the Performance Assessment and whilst giving evidence to this Panel, the Performance Assessors were subjected to a barrage of insults from you, ranging from dishonesty and racial bias to sexual promiscuity. Further, in cross-examinationyou insulted Dr Cox when you called him an ignoramus and accused him of being dishonest and unethical. In your closing submissions on impairment, you continued with this abusive and insulting behaviour. You referred to Dr Reith as an “arrogant racist” and Professor Gulati as “the twisted dishonest racist”
“You must treat your colleagues fairly and with respect. You must not bully or harass them, or unfairly discriminate against them by allowing your personal views to affect adversely your professional relationship with them. You must not make malicious and unfounded criticisms of colleagues that may undermine patients’ trust in the care or treatment they receive, or in the judgment of those treating them.”
“ … Having determined that your fitness to practise is impaired by reason of deficient professional performance, misconduct the Panel has now considered what action, if any, it should take with regard to your registration. Mr Kennedy referred the Panel to the General Medical Council’s Indicative Sanctions Guidance (ISG) (April 2009, revised August 2009) and highlighted paragraphs which he felt were of particular relevance. He invited the Panel to consider the aggravating and mitigating features of this case, and the issue of insight. Mr Kennedy submitted that if questions of adverse mental health had been absent from this case, then erasure would be theappropriate sanction. However, as the Panel had been unable to establish the effect, if any, your health had upon your performance and misconduct, the GMC stopped short of making submissions on erasure. Mr Kennedy submitted that the GMC had no specific submissions to make regarding the Panel taking no action or accepting undertakings, as he stated that such sanctions are not a proportionate response in this case. Mr Kennedy further submitted that conditional registration was not appropriate as it was clear that many of the criteria outlined in the ISG are unfulfilled. He submitted that suspension, therefore, is the appropriate sanction in your case. He further submitted that if your registration is suspended or made subject to conditions, this should be done with immediate effect. In a brief oral submission relating to sanction, you told the Panel that you would be submitting a list of undertakings for consideration and asked to be allowed to make your submissions in writing. In due course you provided a written document entitled “Submissions for undertakings – for 26/04/10”
“When deciding whether conditions might be appropriate the Panel will need to satisfy itself that most or all of the following factors (where applicable) are apparent having regard to the type of case...This list is not exhaustive: - No evidence of harmful deep-seated personality or attitudinal problems. - Identifiable areas of the doctor’s practice in need of assessment or retraining. - Potential and willingness to respond positively to retraining, in particular evidence of the doctor’s commitment to keeping his/her knowledge and skills up to date throughout his/her working life, improving the quality of his/her work and promoting patient safety... - Willingness to be open and honest with patients if things go wrong… - In cases involving health issues, evidence that the doctor has genuine insight into any health problems, has been compliant with the GMC’s guidance on health…and that he/she will abide by conditions relating to his/her medical condition(s), treatment and supervision. - Patients will not be put in danger either directly or indirectly as a result of conditional registration itself. - It is possible to formulate appropriate and practical conditions to impose on registration.”
“…on the ethos of the team (hospital) and its head.”
“This sanction [suspension] may therefore be appropriate when some or all of the following factors are apparent (this list is not exhaustive): - A serious breach of Good Medical Practice where the misconduct is not fundamentally incompatible with continued registration and where therefore complete removal from the register would not be in the public interest, but which is so serious that any sanction lower than a suspension would not be sufficient to serve the need to protect the public interest. - In cases involving deficient performance where there is a risk to patient safety if the doctor’s registration were not suspended and where the doctor demonstrates potential for remediation or retraining. - In cases which relate to the doctor’s health, where the doctor’s judgment may be impaired and where there is a risk to patient safety if the doctor were allowed to continue to practise even under conditions. - No evidence of harmful, deep-seated personality or attitudinal problems. - No evidence of repetition of similar behaviour since incident. - Panel is satisfied doctor has insight and does not pose a significant risk of repeating behaviour.” 52. The Panel has considered the above criteria carefully and it considers that while some are fulfilled, there is uncertainty surrounding others and some are not met at all. The Panel wishes to make it clear that aspects of this case crossed the threshold for erasure from the Medical Register. However, as there remain outstanding questions regarding how your mental health might have affected your misconduct and your performance assessment, the Panel felt erasure would not be appropriate. 53. In its determination on impairment, the Panel explained that you were a potentially dangerous doctor due to your unwarranted confidence in your own ability and your refusal to acknowledge your deficiencies and weaknesses. This belief has led to you refuting the conclusions of the Performance Assessment Report, the findings of the investigation by Trafford General Hospital with regard to your treatment of MH and the differential diagnoses of the GMC’s Health Assessors. Furthermore, it has resulted in wholly unacceptable behaviour throughout this hearing before your regulatory body. 54. As a result of your lack of insight, the Panel cannot be assured that you will not repeat past behaviour or that your practice is remediable. For example, you completed a course on the assessment and management of a Colles fracture on29 September 2008 . However, despite this training you have repeatedly asserted to the Panel that you treated MH appropriately and disputed expert views on sedation. The Panel is mindful of its duty to protect patients, maintain public confidence in the profession, and declare and uphold proper standards of conduct and behaviour. 55. In the light of the above, the Panel has determined to suspend 56. However, a Performance Assessment will need to be undertaken at some point prior to your returning to practice. 57. In relation to your treatment of MH and your behaviour during the Performance Assessment and throughout this hearing, the Panel has borne in mind paragraph 69 of the ISG which explains the deterrent effect of suspension, when it is used to send out a signal to the doctor, the profession and to the public as to what is regarded as behaviour unbefitting a registered medical practitioner. 58. Shortly before the end of the period of suspension, your case will be reviewed by a Fitness to Practise Panel. A letter will be sent to you about the arrangements for the review hearing. At this next hearing, the Panel reviewing your case will wish to be assured that you have addressed all of the shortcomings identified at this hearing. The future Panel will be assisted by receiving the following information: Performance Assessment Reports from those parts of the assessment which you are able to undertake whilst suspended from practice • Evidence of any insight you have into the pain and suffering you caused MH when you manipulated his wrist at Trafford General Hospital • Evidence of continuing professional development”
“In view of the nature of its findings on impairment, the Panel has determined that it is in the public interest, necessary for the protection of members of the public and in the best interests of the practitioner to impose an immediate order for suspension. This means that Dr Nagiub’s registration will be suspended immediately, from the date upon which written notice of this decision is deemed to have been served upon her. Additionally, the interim order currently imposed on Dr Nagiub’s registration will be revoked on this date. The direction for substantive suspension, as already announced, will take effect 28 days from the date upon which written notice of this decision is deemed to have been served upon Dr Nagiub, unless she lodges an appeal in the interim. If she does lodge an appeal, the immediate order of suspension will remain in force until the substantive direction takes effect.”
“d. General 1. The Appellant was not represented and was disadvantaged in the presentation of her case. There was unfairness amounting to serious procedural irregularity caused by frequent interruption when the Appellant was cross-examining witnesses. The Panel Chair obstructed the Appellant, for example by switching off her microphone. The Panel failed to have due regard to her difficulties in her presentation of the case and placed too much weight upon issues of the Appellant’s behaviour during the hearing before the Panel and too little weight on the evidence of her good behaviour and as to her conduct and her fitness to practise beyond the confines of the hearing room in her day to day working life. 2. The Panel gave undue weight to the manner in which the Appellant conducted herself before the Panel (including inappropriate language), when considering her medical performance and professionalism as a doctor in her day to day working life. Insufficient consideration was given by the Panel to the extreme level of stress that the Appellant was under when she represented herself before the Panel and the impact of that stress on her ability to conduct her own case.”
“My role was explained to me before the starting of the assessment and, essentially, when I did the assessment I was working at SHO and my role was to ensure that the assessment that was being carried out was held at an appropriate level for an SHO and that the standard was not set too high or too low for the purposes of the assessment.”