“1. INTRODUCTION 1.1 The procedures set out below are designed to ensure that the fullest and fairest consideration is accorded to medical and dental practitioners in the event of incidents or complaints regarding their conduct or competence. 1.2 The procedures will apply to all medical and dental staff substantively employed within the Trust. 1.3 The procedure(s) to be followed following allegations of misconduct will depend on the nature of the allegation. In determining this the following definitions will apply:- PERSONAL CONDUCT – Performance or behaviour of a practitioner due to factors other than those associated with the exercise of medical or dental skills. PROFESSIONAL CONDUCT – Performance or behaviour of a practitioner arising from the exercise of medical or dental skills. PROFESSIONAL COMPETENCE – Adequacy of performance of a practitioner related to the exercise of their medical or dental skills and professional judgment. Where the nature of the alleged misconduct is disputed the matter shall be referred to a panel comprising the Medical Director, Chairman of the Senior Medical Staff Committee and a consultant from outside the Trust acceptable to both parties, who shall determine the procedure to be followed. 1.4 Additionally, allegations or complaints may be made regarding a practitioner’s repeated failure to honour contractual commitments. 1.5 To determine the appropriate procedure to invoke in any particular case, a Preliminary Assessment will be made by the Medical Director. Preliminary Assessments will be made as indicated in paragraph 2 below. 1.6 Where the Preliminary Assessment indicates that disciplinary action is necessary, one of the following procedures will be utilised: a) In cases of Personal Misconduct – the Trust’s general Disciplinary Procedure …; b) In cases of Professional Misconduct or Professional Incompetence, where action short of dismissal is deemed to be the likely outcome, and in cases of failure to honour contractual commitments – The Review Procedure … ; c) In cases of Professional Misconduct or Professional Incompetence, where dismissal may well be the outcome – the Serious Professional Misconduct/Incompetence Procedure, including Appeal against Termination of Employment … 1.7 Where, in the Medical Director’s opinion, a practitioner’s continued attendance at the workplace is or would be prejudicial to an investigation or good working, or is not in the interests of patients, the public or other staff, the practitioner may be suspended from duty on full pay pending the outcome of the preliminary enquiries or the full investigation. In each case, consideration and implementation of suspension shall at all times be in accordance with the Health Service Guidelines set out in HSG (94) 49. 1.8 Authority to suspend or to extend a suspension period is vested in the Medical Director. 1.9 The time limits set out in these procedures shall apply in all cases, unless there is mutual agreement to vary them. 1.10 Nothing contained in this procedure shall remove the right of practitioners appointed under Whitley Council Terms and Conditions of Service from appealing to the Secretary of State under Paragraph 190 of the Terms and Conditions of Service for Hospital Medical and Dental Staff, where he/she considers that his/her appointment is being unfairly terminated. 2. PRELIMINARY ASSESSMENT 2.1 A preliminary assessment will be conducted by the Medical Director and Chairman of the Senior Medical Staff Committee to ascertain whether or not a prima facie case exists which warrants disciplinary action being taken. The allegations will normally be discussed with the practitioner concerned. 2.2 This Assessment may determine that: a) there is no substance to the allegation or complaint and that no further action is necessary, b) the practitioner may be experiencing health problems …, c) there is substance to the allegation or complaint that either: (i) the Trust’s general Disciplinary Procedure for Personal Misconduct shall be invoked …; (ii) the Review Procedure shall be invoked …; (iii) the matter warrants referral to the Chief Executive for the Serious Professional Misconduct/Incompetence Procedure to be invoked …; and in all instances the practitioner will be advised in writing accordingly. … 4. THE REVIEW PROCEDURE … 4.7 When the Review Panel completes its review, it shall provide a written report to the Chief Executive, signed by the three panel members, in two parts:- a) Part One shall detail the evidence submitted or received by the Panel, a copy of which will be provided to the practitioner and all parties who gave evidence. 14 days will be allowed for comments on factual accuracy. b) Part Two shall advise if and to what extent the practitioner is at fault, and make recommendations. Part Two shall be available only to the Chief Executive for his/her further action. The Review Panel itself shall not have any disciplinary powers. 4.8 After considering any comments received as to factual accuracy, the Chief Executive shall decide what action is appropriate. 4.9 If disciplinary action is decided upon, the Chief Executive will arrange a disciplinary hearing involving the Medical Director and will convey to the practitioner the substance of the panel’s views and recommendations in good time before the hearing. Depending upon the circumstances and gravity of the case, he/she will issue either:- a) a first written warning, or b) a final written warning … 5. SERIOUS PROFESSIONAL MISCONDUCT/ INCOMPETENCE PROCEDURE 5.1 Unless the Chief Executive considers that there is no case to answer, the practitioner should be advised immediately in writing and be given one week in which to seek advice and make representations before any decision to proceed is made. If the Chief Executive decides that there is a case to answer but there is no substantial dispute as to the facts, any further action should be in accordance with paragraphs 5.11 to 5.14 below. If there is a dispute as to the facts, the Chief Executive should set up an Inquiry panel comprising; a) A legally qualified Chairperson, nominated by the Chief Executive and approved by the Chairman of the Senior Hospital Medical Staff Committee. b) A practitioner from outside the Trust, nominated by the Trust and approved by the Chairman of the Senior Medical Staff Committee. c) A third member who may vary, depending on whether the case involved professional misconduct or professional incompetence. In cases of professional misconduct the third member should be a lay person, not a member of the Trust Board, who is nominated by the Trust and approved by the Chairman of the Senior Medical Staff Committee. In cases of professional incompetence (or where charges relate to conduct between one practitioner and his/her professional colleagues) a third member who is also a practitioner form outside the Trust, nominated by the Chairman of the Senior Medical Staff Committee and approved by the Trust. In the case of senior doctors, consultation with the national Joint Consultants Committee is recommended before professional members are chosen. 5.2 The practitioner member (or one of the practitioner members where two such members are appointed) should be of the same specialty and of the same or higher grade as that of the practitioner against whom the allegation or complaint has been made. 5.3 The panel shall be provided with precise terms of reference, drawn up by the Chief Executive and agreed with the Inquiry Panel Chairperson. 5.4 The practitioner against whom the allegations or complaint has been made shall be informed, in writing, of the setting up of the Inquiry Panel, and its terms of reference, and be afforded not less than 21 days notice to prepare his/her case. He/she should be furnished, as soon as is practicable, with copies of correspondence or written statements made, and a list of probable witnesses. 5.5 The Inquiry Panel Chairperson will determine the procedure and rules regarding the admission of evidence, and may if he/she so wishes, hold a preliminary hearing with the parties, or their representatives for this purpose. 5.6 The Inquiry Panel Chairperson will conduct the investigations during the hearing. 5.7 The Trust and the practitioner have the right to be represented at the Inquiry Panel hearing by a lawyer. The practitioner also has the right to appear personally at the hearing, to hear all the evidence presented, to cross-question witnesses and to present his/her own witnesses who in turn may be cross-questioned. 5.8 The Trust will provide secretarial support to the Inquiry Panel. 5.9 The Inquiry Panel shall, on completion of its deliberations, prepare a report in two parts: a) Part One shall set out the Inquiry Panel’s findings and all the relevant facts of the case, but contain no recommendations as to action. This part will be copied to the practitioner against whom the allegations or complaint has been made, and all those who gave evidence who will be given four weeks in which to submit proposals for correction of facts or setting out in greater detail the facts on any particular matter which has arisen. The Inquiry Panel shall decide whether to accept any proposed amendments and whether or not to make any further inquiries. b) Part Two shall contain the Inquiry Panel’s view as to whether the practitioner is at fault and contain recommendations as to disciplinary action. Part Two shall be available only to the Chief Executive for his/her further action. The inquiry panel itself will not be given any disciplinary powers. 5.10 On receipt of Part two of the report, the Chief Executive shall decide what action is appropriate. If the panel finds the practitioner to be at fault the substance of the panel’s views and recommendations shall be made available to the practitioner, in good time before any hearing, giving him the opportunity to put in a plea of mitigation. 5.11 If disciplinary action is decided upon, the Chief Executive will arrange a disciplinary hearing at which, depending upon the circumstances and the Inquiry Panel’s recommendations, he/she will: a) Issue a First Written Warning, or b) Issue a Final Written Warning, or c) Dismiss. 5.12 In issuing a warning, the Chief Executive will clearly state:- (i) the reasons for the warning (ii) the improvement expected and, if appropriate, the period of time given for improvement; (iii) how long the warning will remain in force; (iv) that continued unsatisfactory performance or conduct will lead to a Final Written Warning, or if a Final Written Warning has been issued, to possible dismissal. (v) the right of appeal and timescale for doing so. 5.13 Warnings will be confirmed in writing to practitioners within seven days of a disciplinary hearing and will remain in force, as follows:- First Written Warning – Six Months Final Written Warning – Twelve Months 5.14 In the event of dismissal, the employee will be notified in writing, as to:- (i) the reasons for his/her dismissal (ii) the period of contractual notice payable where applicable and the effective date of determination of employment; and (iii) his/her right of appeal and timescale for doing so. 5.15 the Serious Professional Misconduct/Incompetence Procedure shall normally be concluded within a time period not exceeding 20 weeks. …”
“DISCIPLINE In matters of misconduct you will be subject to the Trust’s procedures and policies relating to discipline and dismissal. The Trust will also take account of guidance laid down in Health Circular HC 90(9) as it relates to disciplinary procedures for Hospital and Community Medical and Dental Staff where such guidance is appropriate to the employment of consultants and staff within the Walsgrave Hospitals NHS Trust”
“Dear Dr Mattu In accordance with the agreed procedure I am enclosing a copy of Part 2 of the Panel’s report. You will see that the panel has made a number of findings of fault arising out of its findings of fact and it recommends that disciplinary action be taken. I have given careful consideration to the report and at this stage, in the light of the serious findings made against you, I do not feel able to accept that the maximum sanction should necessarily be a first written warning as recommended by the Panel. Accordingly, I have decided to commence disciplinary proceedings against you. The basis for those proceedings and the matters which you will be required to answer are set out in the attached appendix. One of the possible outcomes of those proceedings could be your dismissal. I shall write to you further to discuss the details of the procedure which will be followed and to arrange a suitable hearing date; I do not anticipate that this will take place before Easter. I have considered whether your exclusion from work should continue pending the outcome of the Disciplinary Hearing. Clearly, the situation between now and your Disciplinary Hearing needs to be handled with sensitivity. I suggest it would be helpful for you to meet with Mr Martin Lee, Medical Director to discuss your individual professional needs in this interim period. It is important that you receive whatever help is necessary to secure your successful reintegration into medical practice, without prejudice to the final outcome of the hearing”
“The sting of the allegations brought against Dr Mattu is that he abused his power and manipulated Dr Lencioni and Dr Gieowarsingh [two of his research fellows]. We reiterate that, for the purposes of this matter, the parties have included ‘procuring’ within the meaning of the word ‘pressure’ when it appears in the allegations. We have taken the word ‘campaign’ to mean ‘to engage in a process in order to achieve a certain goal’”
“It is, in my judgment, an intrinsic part of the structure (and indeed only fair) that the matters relevant to the sanction, subject to what may properly be called mitigation, should, in so far as they are adverse to the member of staff concerned be limited to those which the Panel has found. Otherwise the member of staff would be being sentenced for matters which had not been established against him by the proper contractual procedure”
“The proposal that the disciplinary panel can ignore their own disciplinary procedure and deal with the claimant without having alleged any further misconduct by him but yet sentencing him, as it effectively is, for other misconduct is wholly misconceived”
“… the Chief Executive should not decide to dismiss Dr Mattu unless he is satisfied that the matters found proved against Dr Mattu constitute serious professional misconduct (what is sometimes called gross misconduct) and that dismissal is the appropriate course of action”
“… the conduct amounting to gross misconduct justifying dismissal must so undermine the trust and confidence which is inherent in the particular contract of employment that the master should no longer be required to retain the servant in his employment”
“Whether the conduct amounts to serious professional misconduct is a matter for the individual employer to decide having regard to all the relevant facts which have been found proved, any mitigating circumstances and, in this case, the findings and recommendations of the Panel in Part 2 of the Report. The Chief Executive is not bound by the Panel’s view as to whether or not Dr Mattu was at fault nor by its recommendation. Clearly he must give considerable weight to those matters but always remembering that as Chief Executive he represents the body which has to decide whether to continue to employ the employee and that reasonable people can differ in their judgment as to the seriousness of particular types of misconduct”
“a) proceeding any further with the proposed disciplinary action as set out in the letter dated7 April 2006 from David Roberts, the Chief Executive of the Defendant, to the Claimant; b) convening a disciplinary meeting to consider any of the allegations set out in the Appendix to the letter dated7 April 2006 from David Roberts to the Claimant, other than a meeting convened in accordance with paragraph 5.11 of the Defendant’s Policy Statement No. 3A, Medical & Dental Staff Disciplinary Procedure, namely to consider any plea in mitigation from the Claimant and any other circumstances the Chief Executive or any other person may wish to raise and/or consider in mitigation (but not in aggravation) of disciplinary sanction recommended by the Panel of Inquiry chaired by Mr Andrew Stafford QC; c) imposing on the Claimant in relation to the allegations made against the Claimant following and arising out of his suspension on21 February 2002 , any disciplinary sanction more severe than that recommended by the Inquiry Panel chaired by Mr Andrew Stafford QC in Part 2 of its report, namely a First Written Warning”
“… In my view, very clear words would be required if matters entirely irrelevant to the gravity of the specific misconduct which has been investigated by the panel and any personal mitigation of the practitioner could be taken into account in deciding what disciplinary action to take”
“There is no indication in the document that the panel is required to have regard to anything other than the gravity of the misconduct and any personal mitigation available to the practitioner in deciding what action to recommend; or that the Chief Executive is entitled to have regard to any wider considerations when deciding what action to take”
“The submission in the round, nevertheless, is that the Trust has taken disciplinary proceedings and that the claimant in the course of the inquiry hearing made allegations about the management of the Trust and of some of his colleagues. The panel has found that some of these were not substantiated, and the fact that these were part of his conduct of his case before the inquiry entitles defendants to take them into account at the disciplinary hearing consequent upon the panel’s finding”
“In what circumstances, and to what extent, the Chief Executive may depart from the recommendation of the Panel as to disciplinary sanction?”