PUBLIC RECORD. Record of Determinations Medical Practitioners Tribunal. Dates: 03/02/ /02/2016

Transcription

1 PUBLIC RECORD Dates: 03/02/ /02/2016 Medical Practitioner s name: Dr Marc ABECASSIS GMC reference number: Primary medical qualification: Type of case Restoration following administrative erasure State Exam 1989 Universita degli Studi di Roma "La Sapienza" Outcome on impairment Summary of outcome Restoration application granted. Tribunal: Lay Tribunal Member (Chair) Medical Tribunal Member: Medical Tribunal Member: Mr Neil Sykes Dr Claire Fang Dr Nigel Langford Legal Assessor: Tribunal Clerk: Mr Gary Tobin Ms Jean Gleeson Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Present and not represented NA Ms Suzanne Kitzing, Counsel Attendance of Press / Public The hearing was all heard in public. 1

2 Determination on Restoration Dr Abecassis: 1. You have applied to the General Medical Council ( GMC ) for the restoration of your name to the Medical Register following your administrative erasure for non payment of fees. 2. The Tribunal considered your application in accordance with the provisions set out in Section 41 of the Medical Act 1983 (as amended), Regulation 4 of the GMC (Restoration following Administrative Erasure) Regulations 2004 and Rule 24 of the General Medical Council (Fitness to Practise) Rules 2004 (as amended)( the Rules ). 3. In so doing, it took account of all the evidence, both oral and documentary, together with Ms Kitzing s submissions on behalf of the GMC and those made by you. Background 4. This is your first application to have your name restored to the Medical Register since your name was erased for non-payment of fees in June You made this restoration application to the GMC on 9 July Your certificate of good standing from France stated that that you had been subject to two sanctions of disciplinary restriction to practise medicine made by the French medical regulators. This prohibition ran from 1 March 2011 to 30 June The Regional Council of the College of Physicians for the City of Paris sanctioned you in at a hearing which took place on 24 November 2009 in relation to breaches of articles 19 and 20 of the French Code of Medical Ethics; Article 19 (article R OF THE CSP) Medicine must not be practised as a business. Any direct or indirect form of advertising, and particularly any decoration or sign giving a doctor s premises the appearance of a place of business is forbidden. Article 20 (article R OF THE CSP) A doctor must pay due regard to the use that may be made of his name, of his professional status or of his statements. He must not allow public or private institutions in which he practices or with which he is associated to use his name or his professional status for advertising purposes. 6. The Regional Council of the College of Physician for the City of Paris found that: 2

3 the elements found on the various sites promoting Dr Abecassis, constitute serious breaches of the aforementioned code of ethics 7. That regulator found that you had shown contempt for ethical requirements and placed a prohibition on you from practising medicine for 2 months. You appealed this sanction. The appeal was heard on 6 October 2010 by the National Disciplinary Chamber of the College of Physicians. After considering your appeal it decided to reduce your prohibition from two months to one month 8. The Disciplinary Chamber of the First instance of the College of Physicians in Ile de France issued your second sanction at a hearing which took place on 31 March The complaint investigated related again to breaches of 19 and 20 of the French Code of Medical Ethics as well as breaches to Articles 31, 34 and 54: Article 31 (article R OF THE CSP) A doctor must refrain, even when not on duty, from any conduct likely to bring the profession into disrepute. Article 35 (article R OF THE CSP) A doctor owes to any patient that he examines, advises and treats, honest, clear and appropriate information about his state of health and the investigations and treatment he proposes. Throughout the patient s illness, the doctor should tailor his explanations to the patient s personality and do his best to ensure that they are understood. However, a doctor must respect a patient s request not to be informed of a diagnosis or a prognosis, unless others are in danger of contamination. Great care must be taken in revealing a terminal prognosis, but persons close to the patient should normally be informed, unless the patient has already indicated that he does not wish them to be informed or has designated third parties to whom the information should be given. Article 54 (article R OF THE CSP) When several doctors co-operate to examine or treat a patient, each doctor must present an individual statement of fees. The remuneration of an assistant or assistants chosen by a doctor to work under his supervision is included in his statement of fees. 9. These matters related to a complaint from a patient, hereafter referred to as Patient A. That Disciplinary Chamber found that at the time of the events you appeared on an internet site related to sexual surgery setting yourself out as 3

4 specialist in male and female intimate surgery whilst you had not obtained recognition of the qualification required in this field. It also found that an article presenting you as a plastic surgeon specialising in intimate surgery appeared on an internet site and gave the name of the clinic in which you practised surgery which was in contravention of Public Health Code which prohibits direct or indirect advertising. 10. In relation to your interactions with Patient A, that Disciplinary Tribunal found that you had back-dated a procedure cost estimate to coincide with the statutory time period for reflection with regard to cosmetic surgery. It further determined that you carried out part of the surgical procedure which you were not qualified to undertake, which you had stated to the patient was carried out by another surgeon Dr C. There were also inconsistencies regarding how Dr C was to be paid. 11. The Disciplinary Chamber prohibited you from practising medicine for six months. 12. You appealed this sanction and an appeal hearing was held on 6 October 2010, by which time you had qualified as a plastic surgeon. On appeal the National Disciplinary Chamber of the College of Physicians determined to reduce the period of prohibition from six months to three months. 13. Since your prohibition you have been practising in both France and Switzerland without restriction. Your Evidence 14. You provided oral evidence to the Tribunal. The Tribunal found you to be a credible witness who answered the question posed to you directly. It did not find you to be evasive, indeed you volunteered that you had received a warning in the 1990s. It noted that although you said that you did not agree with certain aspects of the processes of the French medical regulators, for instance you stated that your request that an expert report be carried out regarding Patient A s complaint was ignored, you said that you respected their decisions. 15. You said that you perform surgery on the external male and female genitalia and that you were one of the first doctors in Europe to research these procedures in the 1990s and early 2000s. You said that this work brings together many specialisms including urology, gynaecology and plastic surgery. You explained that you have been specialising in this work exclusively for 20 years and that your name is very well known in this field of practice in France. 16. In relation to issues of advertising your professional medical services, which is prohibited in France, you stated that you were often interviewed and quoted in the French media, as you are one of the few specialists performing such procedures. 4

5 You said that you did not mean these articles to be taken as advertising your professional services. You said as soon as you received the complaint about your website you took it down and tried to get third parties to remove any mention of you on their websites. You said you never intentionally advertised your services and never put the prices of your services on your website. You said you paid a company to try and get any mention of you removed from the internet to ensure that you complied with the ruling of the Regional Council of the College of Physicians for the City of Paris. You agreed that you breached Articles 19 and 20 in relation to advertising your services but this was not a voluntary breach and when you were told of this error you did your utmost to resolve these issues immediately. 17. You acknowledged that you made mistakes when interacting with journalists. You said that you should have asked to see the texts of their stories before they were printed to ensure that they did not contain any factual errors such as calling you a plastic surgeon before you had qualified as one. You said you are now more prudent in your communications with the press. 18. In relation to Patient A you accepted that you made an error in relation to attaining her consent for the procedure. You said that you accept that there was a big communication problem and she did not receive enough information about her procedure. You said that you understand and accept that Patient A may have felt betrayed by you. However, you maintained that Dr C did undertake the surgical procedure that you were not qualified to do. You said you can understand why this was not clear to the French regulators as you admitted that the administrative environment was not as it should have been at the time. Dr C did not accompany you to the disciplinary hearing even though you asked him to attend and you said you thought his nonattendance may have confused the regulator. 19. You said that you have learned a lot since these events five years ago. You said that you have qualified as a plastic surgeon. You have improved your communication skills and have now changed your practice including producing improved information sheets and changing the consent procedure. You are stricter with yourself in relation to your administrative practice and check everything with your assistant. 20. You said that you were motivated to come to the UK for both family and professional reasons. You said you were not trying to come to the UK because you were not doing well in your medical career in France. 21. You told the Tribunal about your current practice in Paris. You said that you see on average 10 patients in a half-day session, typically three sessions per week and operate on about 4-6 cases a week. You said you attend conferences as a speaker a number of times during the year. You told the Tribunal about how you keep your medical knowledge and skills up to date. You said that you undertake case based discussions at your clinic each month and that you constantly read 5

6 professional papers. You said you have travelled around the world to learn from other doctors who work in your area of expertise. You also send reports regarding significant events in your practice to specialist bodies for consideration. You reminded the Tribunal that you have been practising without any issue in both France and Switzerland without incident since you prohibition ended in GMC Submissions 22. Ms Kitzing submitted that the GMC opposes your application to have your name restored to the Medical Register. She said that this was due to the issues in relation to your previous prohibition from practice in France, not to the issues in themselves, but to your remediation and insight into these matters. She said that you have told the Tribunal that you have remediated in relation to the prohibition of advertising, your communication skills and improved administration skills. However, there is a central area that you have not remediated which is your integrity in regards to Patient A and whether Dr C carried out the surgical procedure that you were not qualified to undertake. She submitted that you do not understand the importance of these findings or the seriousness of the allegations. 23. Ms Kitzing reminded the Tribunal that it cannot go behind the findings of the French medical regulators which found that you performed surgery that you were not qualified to do. She said that public confidence in the profession would be undermined were you to be allowed to practice whilst there were issues, which the GMC considers are continuing issues, regarding your integrity. She said that in relation to proper professional standards and conduct your actions were incongruous. Submissions on your behalf 24. You submitted that you do not wish to be judged and condemned again for your actions of five years ago. Legal Advice 25. The Tribunal has accepted the advice of the Legal Assessor who advised that it is for you to bring the evidence in support of your application that your name should be restored to the Register. The question of whether you are fit to practise and whether your name should be restored to the Medical Register is one for the Tribunal using its own judgement. The Tribunal s Decision 26. In considering your application for restoration, the Tribunal has taken account of the statutory overarching objective, which includes protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession, and 6

7 promoting, and maintaining proper professional standards and conduct for the members of the profession. It also recognises that it has a duty to apply the principle of proportionality, weighing the interests of the public with your own interests, and to act fairly at all times. 27. The Tribunal has borne in mind that, should the Tribunal restore your name to the Register, there is no provision for this to be on the basis of anything other than unrestricted registration. 28. The Tribunal first considered whether it should adjourn and direct that you undergo a performance, health or English language assessment. The Tribunal determined that as there has been no indication that there are any issues regarding your health, English language skills or clinical performance, it did not require you to undergo any such assessment. 29. The Tribunal then considered whether your name should be restored to the Medical Register. In doing so the Tribunal considered the two separate findings of the French medical regulators. In relation to the findings of the Regional Council of the College of Physicians for the City of Paris that you were advertising your clinical services in contravention of the French Code of Medical Ethics, the Tribunal noted that once this complaint had been received by you, you took down your own website promptly. You also made attempts to have any mention of you on third party websites removed. It noted that you have accepted that you did breach the ethical code. The Tribunal considered that your actions after the complaint and your evidence provided to the Tribunal regarding these matters demonstrate that you have reflected on your actions and developed insight and have remediated the practices which led to this sanction. It considers that the risk of you repeating similar behaviour in future is low. 30. In regard to the second determination relating, in the main, to your treatment of Patient A, the Tribunal is satisfied that the production of the decision of The Disciplinary Chamber of the First instance of the College of Physicians in Ile de France is conclusive evidence of the facts found proved. This included its determination that Dr C did not perform the surgical procedure that you were not qualified to do and that you did do this procedure yourself. The Tribunal noted that you maintain your assertion that Dr C performed the surgical procedures on Patient A. 31. The Tribunal noted that the Disciplinary Chamber of the First Instance of the College of Physicians in Ile de France s position in relation to the seriousness of the events changed somewhat and on appeal your prohibition was reduced from six months to three months. 32. The Tribunal further noted that in your evidence you conceded that there were elements of your practice in relation to Patient A which were not satisfactory. It 7

8 had regard to your acknowledgement that your communications with her were unclear and she may not have been fully aware or informed of the procedures and how they would be performed. You also acknowledged that consent was not taken correctly by you. You have accepted that failings in your administrative practice contributed to your prohibition. 33. The Tribunal was aware that it must not go behind the determinations of the French medical regulators but it considered that the areas of concern highlighted by this determination have now been addressed by you. You demonstrated remediation of these actions and have shown insight into your deficiencies. Although you continue to maintain that Dr C did perform the surgical procedure, the Tribunal noted that you accepted the sanction which was given to you even though you do not agree with some of the decisions or processes undertaken. 34. The Tribunal also had regard to the fact that you have been practising without restriction and without any concerns being raised in France for the last five years. This demonstrates that the French medical regulators are satisfied that you are fit to practise. 35. The Tribunal had regard to your evidence that you now give lectures three to four times a year regarding your speciality and have regained your standing in France after your prohibition. After the initial events which led to your prohibition from medical practice you were able to continue your training and qualify as a cosmetic surgeon. You were also able to provide certificates of good standing from both France and Switzerland suggesting that you now demonstrate a good overall standard of practice. There has been no evidence adduced that you have transgressed in the five years since your hearings in France and you seem to be practising without issue. 36. The Tribunal has determined that, in light of the evidence adduced, the matters were dealt with five years ago by the sanctions given by the French regulators which you complied with. There has been no evidence of repetition of similar behaviour since then. Taking all the evidence in the round the Tribunal rejected the GMC s submission that it would be in contravention of the GMC s overarching objective to allow your name to be restored to the Medical Register. 37. In all the circumstance of this case, the Tribunal is of the opinion that there are no patient safety concerns, public confidence in the profession will not be damaged by your return to the Medical Register and the matter of maintaining proper professional standards was dealt with by the French regulator via their sanction five years ago. 38. The Tribunal grants your application for restoration to the register. It directs the registrar to take appropriate steps under Section 41(7) of the Medical Act 1983 (as amended) regarding your licence to practise. 8

9 Confirmed Date 04 February 2016 Mr Neil Sykes, Chair 9