“You have been in medical practice for 13 years and during that time have had considerable educational support. Your training number was withdrawn during your training at the West Midlands Deanery and your last assessment at the Wales Deanery Assessment Panel, on25 September 2009 , concluded that you were not suitable to continue training. Problems with insight have been a recurring theme in the evidence presented. It has been an ongoing issue in relation to your professional performance. In your Annual Assessment Review Form, dated16 September 2009 , your Educational Supervisor, Mr Flynn, stated that you needed to target the area of self reflection/insight as a priority regardless of future career intentions. He also stated that you would benefit from improving your teamwork skills. In your statement which you read to the Panel yesterday you failed to acknowledge appropriately, and take responsibility for, the deficiencies in your professional performance, stating that the comments on your TO2 forms were only a reflection of the immense stress and anxiety you were going through with GMC restrictions on your registration and your Fitness to Practise hearing pending. Given the performance assessment team’s finding that your professional performance was cause for concern in the area of limits, your lack of clinical insight causes the Panel to doubt your ability to work within safe clinical limits.”
“Your actions or omissions could have resulted in misleading the interview panel into believing you were better suited to the post than you actually were. You did not correct the authorship with the college despite several requests from Dr Dey. Furthermore, you subsequently attempted to mislead Mr Flynn and Mr Roseblade with regard to the deliberate nature of your actions. The Panel believes that your repeated dishonesty was driven by your desire to progress professionally. Your inappropriate, misleading and dishonest actions, both in terms of the incomplete portfolio you presented at interview and the issue of primary authorship, breached fundamental tenets of the medical profession, was liable to bring the profession into disrepute and had the potential to pose a risk to patient safety. In these circumstances, it is satisfied that your conduct is sufficiently serious as to amount to misconduct and, further, that your fitness to practise is impaired because of that misconduct.”
“In failing to demonstrate clinical insight and work within appropriate limits, you have put your own interests before the interests of patients, prioritising your own professional ambition over patient safety. You have demonstrated a continued lack of insight into both the performance and misconduct elements of this case. The Panel believes that you have little or no real insight into your professional deficiencies, particularly in relation to your practical skills, and in matters of probity. In the Panel’s view this reveals a serious attitudinal problem.”
“Furthermore, in respect of your misconduct, the Panel is not satisfied that you have any developing insight into your past misconduct. You have provided little evidence of your understanding, reflection or insight into the serious adverse findings made by the previous Panel. Whilst you have accepted that you acted dishonestly in respect of the incomplete portfolio you submitted, during your evidence you continued to reiterate that there was a misunderstanding with Dr A regarding the Article. The Panel is also concerned that your evidence was inconsistent i.e. when cross-examined you gave differing accounts of the consultants you had worked with in India and the frequency of that work. Furthermore, you misled the Panel in respect of your status to undertake clinical work in Australia and the requirements to work in a clinical post in India. The Panel considers that you appeared to be trying to provide answers the Panel expected you to give.”
“Hi Mr Gee Let me fill you in as to what happened to me when YOU decided (collectively) to not TRAIN me in the West Midlands. The GMC (collectively) decided that the training standard in your deanery at that time was POOR.. I attach their determination...”
“I apologise for m email to you in 2017 that you decided to forward to the General medical council. It would have been kinder if you had sirted (sic) this directly with me”
“41. The Tribunal did not accept that Dr Sengupta had sent the email expecting that Dr Gee would ignore it or that he would choose not to read it. It considered that her initial approach to him in these terms was, at best, ill-considered, particularly bearing in mind that he had already explained that he was no longer able to help her, and that her intemperate email of10 November 2017 was unacceptable. Furthermore, her apology to him in June 2018 appeared to suggest that she blamed him for drawing this correspondence to the attention of the GMC. The Tribunal also took account of the timing of this incident, which took place after Dr Sengupta had already undertaken a good deal of learning and CPD activities focused on her shortcomings. 42. The Tribunal considered that Dr Sengupta’s reaction to Dr Gee’s correspondence was a concerning example of her emotional response to negative events, demonstrating that as late as November 2017, she was continuing to deflect responsibility for her actions onto others, and continued to blame the Deanery where she had worked for deficiencies, rather than recognising her own responsibility for them. She also suggested in her evidence that she knew better than Dr Gee himself about what help he could give her. The Tribunal considered that Dr Sengupta was so keen to be restored to the Medical Register that this clouded her judgment. The Tribunal took the view that, notwithstanding her written reflection on the incident, Dr Sengupta’s interaction with Dr Gee demonstrated a concerning lack of insight into her own shortcomings, which, if repeated in a clinical environment, could have serious implications for patients and colleagues.”
“45. While the Tribunal acknowledged that Dr Sengupta has made some efforts with her CPD activities, her log does not show a continued and demonstrable commitment to keeping her knowledge up to date. Moreover, it considers that she has not provided evidence to show that she has taken appropriate courses, demonstrating her ability to apply her clinical skills in practical situations. 46. Further, and particularly in the light of her recent interaction with Dr Gee, the Tribunal is not satisfied that Dr Sengupta has genuinely accepted responsibility for her own failings in this regard. The Tribunal was concerned that there may be a repetition by Dr Sengupta, if restored, of the issue identified by the 2010 Panel, namely that she may apply for numerous unsuitable posts, clouded by her need to obtain employment.”
“50. The Tribunal was concerned that Dr Sengupta’s oral evidence was evasive and, at times, unreliable. It acknowledged that Dr Sengupta had apologised for her conduct and had undertaken some relevant CPD activities. However, it noted that she had linked a number of her apologies to requests for a supportive statement, which raised concerns that she was adopting a ‘tick box’ approach towards the gathering of evidence of remediation, rather than showing that she had genuinely appreciated the extent of her dishonesty. As a result, the Tribunal could not be satisfied that these email apologies were entirely genuine. Furthermore, the Tribunal was concerned that Dr Sengupta’s conduct towards Dr Gee demonstrated a continuing failure to appreciate her own role in her present difficulties, both in relation to her clinical deficiencies and her misconduct. This was particularly concerning, as her original email to him on10 November 2017 post-dated many of the CPD activities on which she sought to rely to support her contention that she would not repeat her misconduct. The Tribunal considered that her behaviour towards him undermined her contention that she had made profess in the development of insight. 51. In summary, the Tribunal considered that Dr Sengupta has made progress in remediating her dishonest behaviour with regard to the Case Report, reducing the possibility that she would behave in a similar way in the future. However, although the Tribunal acknowledged that Dr Sengupta’s misconduct, as a whole, might be capable of remediation, it was not satisfied that she has, in fact, demonstrated that she has remediated it and gained genuine insight into it. Her attitude, especially towards her clinical deficiencies, remains a matter of concern and the Tribunal was not convinced that she would not repeat behaviour to conceal the extent of her clinical performance if a similar situation were to arise again. The Tribunal also noted that, in view of its conclusions in relation to Dr Sengupta’s deficient professional performance, concerns remain regarding whether Dr Sengupta’s clinical skills and knowledge are up to date.”
“(1A) The over-arching objective of the General [Medical] Council in exercising their functions is the protection of the public. (1B) The pursuit by the General Council of their over-arching objective involves the pursuit of the following objectives – (a) to protect, promote and maintain the health, safety and well-being of the public, (b) to promote and maintain public confidence in the medical profession, and (c) to promote and maintain proper professional standards and conduct for members of that profession.” (a) to protect, promote and maintain the health, safety and well-being of the public, (b) to promote and maintain public confidence in the medical profession, and (c) to promote and maintain proper professional standards and conduct for members of that profession.”
“(i) before deciding whether or not to make a direction to suspend indefinitely the applicant’s right to make further applications for restoration under section 41(9) of the Act, the Medical Practitioners Tribunal shall (i) consider any representations made and evidence received, and (ii) where the applicant is present, invite further representations and evidence from him specifically upon this issue.”
“(1) The following decisions are appealable decisions for the purposes of this section, that is to say— … (b) a decision of Medical Practitioners Tribunal under section 41(9) below giving a direction that the right to make further applications under that section shall be suspended indefinitely; … (4) A person in respect of whom an appealable decision falling within subsection (1) has been taken may, before the end of the period of 28 days beginning with the date on which notification of the decision was served …. appeal against the decision to the relevant court. (5) In subsections (4)… “the relevant court”— … (c) in the case of any other person, means the High Court of Justice in England and Wales. … (7) On an appeal under this section from a Medical Practitioners Tribunal, the court may— (a) dismiss the appeal; (b) allow the appeal and quash the direction or variation appealed against; (c) substitute for the direction or variation appealed against any other direction or variation which could have been given or made by a Medical Practitioners Tribunal; or (d) remit the case to the MPTS for them to arrange for a Medical Practitioners Tribunal to dispose of the case in accordance with the directions of the court, and may make such order as to costs … as it thinks fit.” (b) a decision of Medical Practitioners Tribunal under section 41(9) below giving a direction that the right to make further applications under that section shall be suspended indefinitely; (c) in the case of any other person, means the High Court of Justice in England and Wales. … (b) allow the appeal and quash the direction or variation appealed against; (c) substitute for the direction or variation appealed against any other direction or variation which could have been given or made by a Medical Practitioners Tribunal; or (d) remit the case to the MPTS for them to arrange for a Medical Practitioners Tribunal to dispose of the case in accordance with the directions of the court, and may make such order as to costs … as it thinks fit.”
“(3) The appeal court will allow an appeal where the decision of the lower court was— (a) wrong; or (b) unjust because of a serious procedural or other irregularity in the proceedings in the lower court.” (b) unjust because of a serious procedural or other irregularity in the proceedings in the lower court.”
“33. Practitioners have a statutory right of appeal to the Board undersection 40 of the Medical Act 1983 , which does not limit or qualify the right of the appeal or the jurisdiction of the Board in any respect. The Board’s jurisdiction is appellate, not supervisory. The appeal is by way of a rehearing in which the Board is fully entitled to substitute its own decision for that of the committee. The fact that the appeal is on paper and that witnesses are not recalled makes it incumbent upon the appellant to demonstrate that some error has occurred in the proceedings before the committee or in its decision, but this is true of most appellate processes. 34. It is true that the Board’s powers of intervention may be circumscribed by the circumstances in which they are invoked, particularly in the case of appeals against sentence. But their Lordships wish to emphasise that their powers are not as limited as may be suggested by some of the observations which have been made in the past. In Evans v General Medical Council (unreported)19 November 1984 the Board said: “The principles upon which this Board acts in reviewing sentences passed by the Professional Conduct Committee are well settled. It has been said time and again that a disciplinary committee are the best possible people for weighing the seriousness of professional misconduct, and that the Board will be very slow to interfere with the exercise of the discretion of such a committee… The committee are familiar with the whole gradation of seriousness of the cases of various types which come before them, and are peculiarly well qualified to say at what point on that gradation erasure becomes the appropriate sentence. This Board does not have that advantage nor can it have the same capacity for judging what measures are from time to time required for the purpose of maintaining professional standards.”
“36. An appellate court must approach a challenge to the sanction imposed by a professional disciplinary committee with diffidence. In a case such as the present, the committee's concern is for the damage already done or likely to be done to the reputation of the profession and it is best qualified to judge the measures required to address it… Mr Khan is, however, entitled to point out that (a) the exercise of appellate powers to quash a committee's direction or to substitute a different direction is somewhat less inhibited than previously…(b) on an appeal against the sanction of removal, the question is whether it ‘was appropriate and necessary in the public interest or was excessive and disproportionate’…and (c) a court can more readily depart from the committee's assessment of the effect on public confidence of misconduct which does not relate to professional performance than in a case in which the misconduct relates to it…”
“102. Derived from Ghosh are the following points as to the nature and extent of the section 40 appeal and the approach of the appellate court: “i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act; ii) the jurisdiction of the court is appellate, not supervisory; iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the Tribunal; iv) the appellate court will not defer to the judgment of the Tribunal more than is warranted by the circumstances; v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the Tribunal for reconsideration.” “i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act; ii) the jurisdiction of the court is appellate, not supervisory; iii) the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the Tribunal; iv) the appellate court will not defer to the judgment of the Tribunal more than is warranted by the circumstances; v) the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate; vi) in the latter event, the appellate court should substitute some other penalty or remit the case to the Tribunal for reconsideration.”
“62. Turning to remediation, the Tribunal accepted that there have been no significant concerns regarding Dr Sengupta’s academic knowledge and theory and that since 2018 she has developed an impressive portfolio of learning, a view largely supported by Mrs Raghavan. 63. However, in terms of the application of that knowledge and Dr Sengupta’s physical and practical skills, the Tribunal was provided with very limited evidence to reassure it that Dr Sengupta would be competent at a practical level at applying her academic knowledge in a clinical setting. It considered that the practical activities she has undertaken, on models or simulators was to her credit, but insufficient to address the performance issues identified. This view is supported by the evidence of Mrs Raghavan and Dr Sengupta herself that she would require direct supervision on a return to practice.”
“The Tribunal gave careful consideration to the submission of Mr Deacon that her position is no different to that of a trainee in obstetrics and gynaecology or someone returning from a long career break. However, the Tribunal did not accept this submission. The submission does not take account of the serious deficiencies identified in Dr Sengupta’s performance, identified more than 20 years after she first qualified a doctor. Nor does it take into account that Dr Sengupta is seeking to return to practice after a 13 year break from practice, after her performance had already been found to be deficient. The Tribunal found that a trainee would have more recent clinical experience. The Tribunal was concerned that the available evidence did not provide assurance that Dr Sengupta’s level of practical skill was beyond that of a final year medical student, over 30 years since she first qualified as a doctor.”
“.. the Tribunal must focus on its duty to the public and reminds itself that it cannot order restoration subject to conditions. In those circumstances, the Tribunal concluded that it could not be assured that Dr Sengupta is safe to practice and is no longer a risk to patients.”
“72. The Tribunal noted that Dr Sengupta wrote these emails after her attendance at an MSc Medical Ethics Course. Although no formal finding of dishonesty was made in 2018 regarding these emails, Dr Sengupta accepted in her oral evidence to this Tribunal, that she knew at the time that what she wrote was untrue. (emphasis added) 73. The Tribunal was also troubled by Dr Sengupta’s oral evidence which did not reassure the Tribunal that she had put dishonesty behind her. When confronted by a direct question about when she first realised her conduct was dishonest, Dr Sengupta either could or would not give a consistent answer. At first she answered that she knew at the time that her actions were dishonest. The she said, “I don’t know what I thought at that point in time after all these years. All I can say is what I said to the panels and what the determination was then. It was 2007 and now we are in 2021. It is very hard to say what I thought then. All that I recollect is that I put the folder there. I took out the bad bits. I put in the good bits and I wanted a job for my promotion and for my career gains.” 74. In addition, the Tribunal was not reassured by Dr Sengupta’s evidence that she understood the trigger mechanisms for her dishonesty. She said, “After investigating my previous misconduct, I have identified my triggers. These include tiredness, feeling frustrated and so on. It is one of my triggers and if I am tired, I know how to ask for time out or rest times, or taking a break.”
“78. The Tribunal found that Dr Sengupta now accepts that her episodes of dishonesty are her responsibility alone and she cannot blame others. The Tribunal found that this represented a step forward in insight and deserved to be acknowledged. Nevertheless, it was insufficient to persuade it that Dr Sengupta is unlikely to be dishonest in future. Given that the dishonesty was persistent and repeated, even after Dr Sengupta attended a professional ethics course, the current evidence fails to sufficiently demonstrate that she has fully understood her dishonesty, and put that dishonesty behind her. (emphasis added) 79. In light of these concerns and apparent contradictions, the Tribunal found that a significant risk of repetition remains. It considered it highly unlikely that Dr Sengupta would repeat the exact behaviour and be dishonest about the same issues, but there remains a significant risk of further dishonesty if other stressful situations arise.”
“In reaching its decision, the Tribunal has taken account of all the evidence before it, both oral and documentary. The Tribunal has already given a detailed determination on the application for restoration in this case and it has taken those matters into account at this stage of the proceedings.”
“13. With regard to Dr Sengupta’s misconduct the Tribunal reminded itself that it had already found that she had not developed full insight despite the passage of time. 14. With regard to Dr Sengupta’s clinical performance, the Tribunal had regard to its findings that, despite the passage of time, she had not remediated these and that the prospect of her being able to do so was now greatly reduced. 15. The Tribunal concluded that in all the circumstances, it was not in the public interest to allow Dr Sengupta to make another application with so little prospect of success.”
“As part of their submissions, the GMC will present any evidence about new allegations that have not previously been determined by a tribunal. The doctor will have been given notice of any new allegations in advance of the hearing and provided with copies of any information or evidence that underpins them. It is for the GMC to prove new allegations on the balance of probabilities.”
“There’s been a number of references to an email in 2017, which has been variously described as “intemperate”
“Dr Sengupta accepted in her oral evidence to this Tribunal, that she knew at the time that what she wrote was untrue.”
“We have already handed down a written determination and that is the end of it”
“…There is no basis for the assertion that suspension of the right to apply for restoration should be restricted to very clear cases, or should be regarded as exceptional. The PCC’s discretion to impose a suspension order is, on the face of the legislation, unconfined and unfettered. The Committee was not obliged to start with a presumption that the power to make a suspension order was in any way an exceptional or unusual remedy. It was entitled to have regard, in exercising the discretion, to the public interest. It was also entitled to have regard to the interest of those who would be otherwise affected by repeated applications for restoration, such as (as in the present case) the family of the victim of a doctor’s misconduct which has taken an active part in the proceedings, which may suffer anguish and be caused expense by repeated restoration applications by the doctor.” order: i) At the remitted hearing, whether to the same or a differently constituted Tribunal, the findings in the restoration decision would stand save for the findings of dishonesty in relation to the emails to Dr Gee and the conclusions about her honesty which are based on those findings. ii) My provisional view is that I should direct that at the remitted hearing the MPT should proceed on the basis of the findings of the 2018 MPT in relation to these emails i.e. it should not consider whether Dr Sengupta acted dishonestly in this regard or base its decision on any such finding. However, I accept that Mr Tankel did not have a sufficient opportunity to address the question whether the 2021 MPT could in principle add to the findings of the 2018 MPT in this way and therefore have not reached a final view on the question. Permission to claim judicial review?