PUBLIC RECORD Dates: 16/11/2015 to 23/11/2015 Medical Practitioner s name: Dr Nital Chimanlal KARIA GMC reference number: 6025676 Primary medical qualification: Type of case New - Misconduct MB ChB 2002 University of Bristol Outcome on impairment Impaired Summary of outcome Suspension, 12 months. Review hearing directed Panel: Lay Panellist (Chair): Lay Panellist: Medical Panellist: Mrs Carrie Ryan-Palmer Ms Val Evans Dr Vishal Kaushik Legal Assessor: Panel Secretaries: Attendance and Representation: Medical Practitioner: Medical Practitioner s Representative: GMC Representative: Mr Peter Gribble Ms Laura Wilson Ms Esther Morton Present and represented Mr George Hugh-Jones, Counsel, instructed by RadcliffesLeBrasseur Mr Steve McNally, Counsel 1
Allegation and Findings of Fact That being registered under the Medical Act 1983 (as amended): 1. On the 4 February 2014 you completed a claim form ( claim form ) and made a claim against your Income Protection Policy with Aviva Health UK Limited. Found Proved 2. XXX 3. XXX 4. XXX 5. In the claim form you signed a declaration indicating that you would notify Aviva Health UK Limited immediately if your relevant circumstances changed in any way or if you undertook any work, paid or unpaid. a. You did not comply with the terms of that signed declaration in that you failed to inform Aviva Health UK Limited that you had undertaken employment. Found Proved in its entirety 6. In the claim form you signed a declaration indicating that the information you provided in support of the claim was true and complete to the best of your knowledge. a. You did not comply with the terms of that signed declaration in that the information you provided to Aviva Health UK Limited was not true and complete. Found Proved in its entirety 7. XXX a. XXX b. XXX c. X 8. On the 14 April 2014 you were contacted by telephone by Aviva to discuss your claim. During that telephone call you provided the following information. a. XXX 2
9. Between the 4 February 2014 and the 2 May 2014 you worked as a locum General Practitioner at 60 sessions on the dates, and at the GP practices, outlined in Schedule 1. Admitted and Found Proved 10. In respect to allegations paragraphs 3 8 above, your conduct was: a. misleading; Admitted and Found Proved in relation to paragraphs XXX and 8 Found Proved in relation to paragraphs XXX 5, 6 and X b. dishonest. Admitted and Found Proved in relation to paragraphs X and 8 Found Proved in relation to paragraphs XX, 5, 6, X and X And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct. Attendance of Press / Public The Panel agreed, in accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004, that the press and public be excluded from those parts of the hearing where matters under consideration were deemed confidential. Determination on Facts Dr Karia: Hearing in Private 1. At the beginning of this hearing the panel, in accordance with Rule 41(3)(X) of the General Medical Council (Fitness to Practise) Rules 2004 (the Rules) determined that, as parts of this hearing relate to matters involving XXX, the hearing should proceed in private when such matters are discussed. A redacted version of this determination will be produced in due course. Admissions 2. At the outset of the hearing Mr Hugh-Jones made the following admissions on your behalf: Paragraph 7 3
XXX Paragraph 8 a. XXX b. XXX On the 14 April 2014 you were contacted by telephone by Aviva to discuss your claim. During that telephone call you provided the following information. a. XXX Paragraph 9 Between the 4 February 2014 and the 2 May 2014 you worked as a locum General Practitioner at 60 sessions on the dates, and at the GP practices, outlined in Schedule 1. Admitted and Found Proved Paragraph 10 In respect to allegations paragraphs 3 8 above, your conduct was: a. misleading; Admitted and Found Proved in relation to paragraphs XX and 8 b. dishonest. Admitted and Found Proved in relation to paragraphs XX and 8 3. The panel therefore announced as admitted and found proved paragraph 7 a and b, paragraph 8 in its entirety, paragraph 9 in its entirety, paragraph 10a in relation to paragraphs XX and 8, and paragraph 10b in relation to 7b and 8. The admissions stood following a subsequent amendment to the stem of paragraph 10. Amendments to the Allegation 4. During the course of the hearing, Mr McNally applied under Rule 17(3) to make a minor amendment to the allegation. Mr McNally submitted that the amendment related to terminology in the allegation, and that paragraph 10 of the 4
allegation referred to allegations 3-8 rather than paragraphs 3-8. This application was not opposed by Mr Hugh-Jones on your behalf. The panel was satisfied that the proposed alterations could be made without injustice and were, in fact, in accordance with the procedure of the MPTS. Accordingly, it has accepted the following amendment: 10. In respect to allegations paragraphs 3 8 above, your conduct was: a. misleading; b. dishonest. Application to Hear Evidence via Videolink 5. During the course of the hearing, Mr McNally made applications to hear evidence from two witnesses via videolink. Neither application was opposed by Mr Hugh-Jones on your behalf. The panel determined that, by receiving the evidence from both witnesses via videolink, the hearing would proceed expeditiously, whilst the witnesses would be both seen and heard. Background 6. You took out an income protection policy with Aviva Health UK Limited (Aviva). On 4 February 2014 a claim form was completed and a claim was made against your income protection policy with Aviva. It was alleged that, in that claim form, you stated that XXX and that since XXX you had attempted to do occasional locum work but had not been successful with this. It was alleged that you stated, in the claim form, that you XXX. 7. Aviva had concerns about the claim and took a number of actions in relation to those concerns. These included arranging XXX and putting you under covert surveillance over a number of days. During that surveillance Aviva had further interviews with you. They eventually rejected your claim and cancelled your policy. They also reported you to the GMC in relation to the concerns which they had identified. Evidence Received 8. The panel received statements (with related exhibits) from the following people: Ms A, Practice Manager at Oakwood Medical Practice Ms B, Practice Manager at Woodlands Medical Practice Ms C, Practice Manager at Connaught Medical Practice Ms D, Practice Manager at Parkfield Medical Centre 5
Ms E, Practice Manager at The River Surgery Ms F, Practice Manager at Arnos Grove Medical Centre Ms G, Practice Manager at Wick Health Centre Ms H, General Practitioner at Brick Lane Surgery 9. The panel received oral evidence, in addition to written statements (with related exhibits), from Ms I, Technical Case Manager in the Income Protection Department at Aviva and from Mr J, Claims Consultant in the Income Protection Department at Aviva. 10. Following an application made by Mr McNally, the panel determined that their oral evidence would be heard via videolink. The panel found both witnesses to be clear, credible and convincing. They answered questions openly and referred where necessary to documents. 11. It was acknowledged on your behalf that you had signed the declarations in the claim form, stating that you would notify Aviva if your relevant circumstances changed in any way or if you undertook any form of work. The declarations also asked for confirmation that the information which you had provided in the claim form was true and complete to the best of your knowledge. It was alleged that you did not comply with the terms of those declarations, in that you failed to inform Aviva of work carried out by you, and that the information within that claim form was not true and complete. 12. You admitted that, on 19 March 2014 you were XXX in relation to your claim for income protection with Aviva, XXX. 13. You admitted that, on 14 April 2014 you were contacted by Aviva by telephone and stated that, in your circumstances at that time, you were unable to work in any capacity. You also admitted that, between 4 February 2014 and 2 May 2014 you undertook 60 sessions as a locum GP. 14. The panel heard no evidence from you. It received a copy of your driving licence. Findings 15. The panel has given consideration to all the evidence adduced in this case, both oral and documentary, and has taken account of the submissions made by Mr McNally on behalf of the GMC, and the submissions made by Mr Hugh-Jones on your behalf. 16. The panel considered each paragraph of the allegation separately. Accordingly, it made the following findings of fact: Paragraph 1 6
On the 4 February 2014 you completed a claim form ( claim form ) and made a claim against your Income Protection Policy with Aviva Health UK Limited. Found Proved 17. The panel was provided with your individual income protection claim form, dated 4 February 2014, and the accompanying letter dated 5 February 2014 from Hampton Dean Ltd. The panel determined that, by signing your claim form in a number of places, you had confirmed that it was true and complete to the best of your knowledge. You also confirmed that you would notify Aviva of any change of circumstances or if you should carry out any work, paid or unpaid. The panel noted that you subsequently engaged with Aviva and provided further information in support of your claim, during telephone conversations with those handling your claim, and during your claims visit from Ms K. 18. The panel therefore found this paragraph proved. Paragraph 2 XXX 19. XXX Paragraph 3 XXX 20. XXX Paragraph 4 XXX 21. XXX Paragraph 5 In the claim form you signed a declaration indicating that you would notify Aviva Health UK Limited immediately if your relevant circumstances changed in any way or if you undertook any work, paid or unpaid. 7
a. You did not comply with the terms of that signed declaration in that you failed to inform Aviva Health UK Limited that you had undertaken employment. Found Proved in its entirety 22. On your behalf, Mr Hugh-Jones acknowledged your agreement that you had signed the declaration indicating that you would notify Aviva if your relevant circumstances changed or if you undertook any work. In Aviva s Recommendation Report dated 9 May 2014 it was written that you stated you had undertaken a few locum sessions in May 2013, and that you had worked a bit in June, July and August 2013, and had completed some work every month since. The panel also had regard to Schedule 1, which contained the admitted dates and locations of your locum sessions. One such session was on 5 February 2014, the day after you had signed and dated this form. You admitted to working a total of 60 locum shifts between 5 February 2014 and 30 April 2014. In light of your admissions, the panel found the evidence to be clear and unequivocal that you had failed to inform Aviva that you had undertaken employment, and therefore that you had not complied with the terms to which you had agreed in the form. The panel found this paragraph of the allegation proved. Paragraph 6 In the claim form you signed a declaration indicating that the information you provided in support of the claim was true and complete to the best of your knowledge. a. You did not comply with the terms of that signed declaration in that the information you provided to Aviva Health UK Limited was not true and complete. Found Proved in its entirety 23. On your behalf, Mr Hugh-Jones acknowledged your agreement that you had signed the declaration indicating that the claim form was true and complete to the best of your knowledge. The panel noted that, in response to the question regarding the date from which you were unable to work to your full capacity, you stated 19 September 2012. This was corroborated by Ms K s report, following her visit to you on 19 March 2014. In her report, Ms K stated that you had informed her that you had been absent from work since September 2012. The panel also noted that, in reply to a request for information about a return to work on the claim form, XXX. 8
24. In her oral evidence, Ms I confirmed the accuracy of the Recommendation Report dated 9 May 2014 which noted your admission that you had undertaken a few locum sessions in May 2013, and that you had worked a bit in June, July and August 2013, and had completed some work every month since. This was not disputed on your behalf. 25. The panel determined that there was evidence that the claim form was not true and complete to the best of your knowledge. It also determined that your remarks regarding a return to work were inaccurate. The panel therefore found this paragraph of the allegation proved. Paragraph 7 XXX 26. XXX 27. XXX 28. XXX Paragraph 10 XXX XXX XXX In respect to allegations paragraphs 3 8 above, your conduct was: a. misleading; Admitted and Found Proved in relation to paragraphs 7a, 7b and 8 Found Proved in relation to paragraphs 3, 4, 5, 6 and 7c 29. You admitted that your conduct in relation to some of the information which you had provided to Ms K was misleading. You also admitted that, in the telephone call with Aviva on 14 April 2014, your assertion that in your present circumstances you were not able to work in any capacity was misleading. 9
30. The panel determined that your conduct regarding your completion of the claim form, the signing of declarations and the information which you gave during your claim visit from Ms K all had the capacity to mislead. The panel therefore found paragraph 10a proved in relation to paragraphs 3, 4, 5, 6 and 7c of the allegation. 31. XXX 32. XXX b. dishonest. Admitted and Found Proved in relation to paragraphs X and 8 Found Proved in relation to paragraphs X, 5, 6, X and X 33. In relation to paragraph 5: the panel found that you did not comply with the terms of the signed declaration, as you failed to inform Aviva that you had undertaken locum sessions since May 2013 and that you continued to undertake locum sessions between 5 February 2014 and 30 April 2014. It noted that you only disclosed to Aviva that you had been undertaking locum work following your discussion with Ms I once surveillance had been undertaken and your claim had been declined by Aviva. The panel determined that this conduct was dishonest and persistently so, as you only confessed the truth once your claim had been denied. 34. In relation to paragraph 6: the panel determined that, in light of the evidence that you had worked locum sessions since May 2013, you knew at the time of signing the claim form and the declarations that the information it contained was not true and complete. The panel determined, therefore, that your conduct was dishonest. 35. In relation to paragraph 7a and 7c: the panel determined that the information which you provided to Ms I was dishonest. The panel considered all of the evidence, both written and oral, which had been provided by Aviva. XXX. The panel noted that your claim visit from Ms K took place on 19 March 2014, and that you admitted undertaking locum sessions on both 18 March 2014 and 20 March 2014. The panel determined that the information which you had provided to Ms K was deliberately untrue and, therefore, dishonest. 36. The panel, therefore, found paragraph 10b proved in relation to paragraphs X 5, 6, XX of the allegation. Determination on Impairment 10
Dr Karia: Submissions 1. On behalf of the GMC, Mr McNally submitted that your fitness to practise is currently impaired by reason of your misconduct. 2. Mr McNally reminded the panel of Dame Janet Smith s fifth Shipman report in which she identified four tests for panels where impairment of a doctor s fitness to practise is being considered. Mr McNally submitted that three of the four tests applied to your case: bringing the profession into disrepute breaching one of the fundamental tenets of the profession, and the doctor s integrity could not be relied upon 3. Mr McNally submitted that your dishonesty was serious, persistent and occurred over a period of time. He submitted that you evidently lacked insight into that dishonesty. He added that your dishonesty was even more striking in the context of the chronology of events, as you worked locum sessions on the day after signing and dating the claim form, in the days immediately before and immediately after being visited by Ms K, and on the same day on which you spoke to Mr J on the telephone. Despite your locum sessions you continued to assert that you were unable to work until after your claim for income protection had been declined. 4. Mr McNally submitted that probity was at the heart of the medical profession and that Good Medical Practice has clear guidance about acting with honesty and integrity. He submitted that your conduct fell so seriously short of those standards that the panel should find that your fitness to practise is impaired. 5. On your behalf, Mr Hugh-Jones relayed your admission to the allegation and stated that your fitness to practise is impaired. He submitted that you admitted a significant degree of acceptance and blame, and that you had insight into your behaviour. He submitted that you accepted that your actions amounted to serious misconduct and that your representations to Aviva were serious and dishonest. 6. Mr Hugh-Jones submitted that your representations to Aviva were a single venture of dishonesty spread out over three months and included the submission of the form, the visit from Ms K and the discussion with Ms I. The Panel s Decision 7. The panel reminded itself that there is no burden of proof at this stage. It is a matter for the panel to determine whether your fitness to practise is impaired, exercising its own judgment. It bore in mind its responsibility to ensure the 11
protection of patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. Misconduct 8. First, the panel considered whether your actions amounted to misconduct that was serious. You were dishonest when you signed and dated your claim form as a true and accurate record, in your dealings with the staff who handled your claim on behalf of Aviva, and during your visit from Ms K. 9. You were under an obligation to inform Aviva of each locum session which you undertook, once you had signed and dated the declaration agreeing to provide notification of any changes to your circumstances or if you had undertaken any work. You undertook 60 locum sessions in 10 different GP practices over the period of three months between signing the form and your claim being declined. On each occasion you worked a locum session you were under an obligation to inform Aviva. You always failed to do this. The panel determined that such dishonesty was deliberate, persistent and protracted. 10. The panel, therefore, determined that your dishonest actions amounted to misconduct that was serious. Impairment by Reason of Misconduct 11. Second, the panel considered whether your misconduct was so serious that your fitness to practise is impaired as a result. 12. There is no evidence to suggest that you present a risk to patients or that there are concerns regarding your clinical skills. 13. However, the panel considered the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession. Good Medical Practice (2013) states that doctors should be honest and open and act with integrity. The panel determined that you were neither honest nor open with Aviva in your pursuit of a claim on your income protection policy, despite the opportunities which you were given to be so. 14. The evidence showed that your dishonesty ended only when it was discovered by Aviva and you were confronted about it. The panel determined that this lack of insight into your conduct was compounded by your apparent lack of remorse in the face of discovery, only showing concern about gaining a further income protection policy. 12
15. Despite being told by Mr Hugh-Jones of your significant degree of acceptance, blame and insight, the panel has seen no evidence to support this assertion. The panel has also received no evidence to show that you understand the impact which your dishonesty has had and may have on colleagues, patients or the public. The panel accepted that dishonesty is difficult to remediate, but considered that it had seen no evidence to suggest any attempts to remediate on your part. 16. The panel took account of your partial admissions in relation to the allegation at the outset of the hearing, and your full admissions once the facts had been found proved by the panel. The panel was not of the view, though, that this demonstrated full insight into your dishonesty. 17. The panel determined that your dishonest actions have brought the profession into disrepute. It was of the view that the medical profession and the public would consider your conduct to have been deplorable, and that public confidence in the profession would be damaged were a finding of impairment not made in this case. 18. In all the circumstances, the panel has determined that your fitness to practise is currently impaired by reason of your misconduct. Determination on Sanction Dr Karia: 1. Having determined that your fitness to practise is impaired by reason of your misconduct, the panel has now considered what action, if any, it should take with regard to your registration. 2. In so doing, the panel has given careful consideration to all the evidence adduced, together with Mr McNally s submissions on behalf of the General Medical Council (GMC) and those of Mr Hugh-Jones on your behalf. Evidence 3. During the course of Mr Hugh-Jones submissions, the panel was provided with a substantial bundle of documents. This contained evidence of general continuing professional development (CPD), CPD relating to ethics and medicine, a reflective statement from you, a letter from your wife, testimonials from colleagues, and feedback from patients and colleagues. Submissions 13
4. Mr McNally submitted that the appropriate sanction in your case was erasure. He submitted that such a serious departure from the principles set out in Good Medical Practice as your misconduct had been, would undermine public confidence in the profession. He submitted that this was a calculated and planned dishonesty, in which you persistently repeated false information and failed to disclose that you were working locum sessions. He submitted that you knew and understood that you were under an obligation to inform Aviva of all work which you undertook, and that you knew it would influence your claim for income protection. 5. Mr McNally submitted that you had displayed a lack of remorse and a lack of insight into your behaviour. This was evidenced, he submitted, by your request for a refund of your premiums and your enquiries regarding alternative income protection immediately after learning that your policy with Aviva had been cancelled. 6. In relation to the documents submitted on your behalf, Mr McNally stated that it was for the panel to assess the weight of this evidence, and that the panel would be justified in having reservations about your reflections on your dishonesty, as it could be regarded as an attempt to minimise your actions. Mr McNally referred the panel to paragraph 133 of the Sanctions Guidance, which addressed the seriousness of dishonesty related to matters outside a doctor s clinical responsibility. 7. Mr Hugh-Jones reminded the panel of the declaration made on your behalf, at the outset of the impairment stage, that your fitness to practise is currently impaired. He suggested that the matters found proved amounted to dishonesty of a limited nature, albeit repeated. Mr Hugh-Jones submitted, in the circumstances, that suspension would adequately maintain public confidence in the profession, and that erasing your name from the Medical Register would be disproportionate. 8. Mr Hugh-Jones referred the panel to evidence of the relevant CPD which you had undertaken. This included attendance at courses on ethics, reading and producing written reflections and being mentored by Mr L, who has known you for over 15 years and been your mentor since 2014. Mr Hugh-Jones also referred the panel to various testimonials from professional medical colleagues and from individuals who know you through your charity work. He stated that those testimonials attested to your clinical excellence and reminded the panel of paragraph 29 of the case of Giele v GMC [2005] EWHC2143 (Admin), which stated: I do not doubt that the maintenance of public confidence in the profession must outweigh the interests of the individual doctor. But that confidence will surely be maintained by imposing such sanction as is in all the circumstances appropriate. Thus in considering the maintenance of confidence, the existence of a public interest in not ending the career of a competent doctor will play a part. Furthermore, the fact that many patients and colleagues have, in the knowledge of the misconduct found, clearly indicated their views that erasure was not needed is a matter which can carry some weight in deciding how confidence can properly be maintained. 14
9. Mr Hugh-Jones submitted that your previously unblemished career, your strong list of acts of reparation, the credible evidence of your insight contained within your reflections and the testimonials provided by those who know you well demonstrate your true character. He submitted that the panel could rest assured that your dishonesty was an isolated episode of misconduct which will not be repeated. 10. Mr Hugh-Jones submitted that erasing your name from the medical register would be devastating and disproportionate. He informed the panel of your personal and financial circumstances. He submitted that the views of your medical colleagues in the knowledge of the allegation and as expressed in the testimonials, was that erasure was not necessary. This, Mr Hugh-Jones submitted, provided some weight in how public confidence in the profession could be maintained by suspending you. He further submitted that it was not in the public interest to end the career of a competent doctor, particularly in light of the pattern of early retirement in general practice. The Panel s Approach 11. In reaching its decision, the panel has taken account of the Sanctions Guidance (August 2015), particularly paragraphs 13, 15 and 16. The panel reminded itself that: The main reason for imposing sanctions is to protect the public. This is the statutory overarching objective, which includes: a. protecting the health, safety and wellbeing of the public b. maintaining public confidence in the profession c. promoting and maintaining proper professional standards and conduct for the members of the profession. Sanctions are not imposed to punish or discipline doctors, but they may have a punitive effect. 12. Throughout its deliberations, the panel applied the principle of proportionality, balancing your interests with the public interest. It is imperative that patients are able to trust doctors with their lives and health, so doctors must make sure that their conduct justifies their patients trust in them and the public s trust in the profession the reputation of the profession as a whole is more important than the interests of any individual doctor. The public interest includes, amongst other things, the protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding proper standards of conduct and behaviour. This is in line with the overarching objective of the GMC. 15
13. The panel has already given detailed determinations on facts and impairment and it has taken those matters into account during its deliberations at the sanction stage. Aggravating Factors 14. The panel considered that there were a number of aggravating factors in your case. Your dishonesty was sustained over three months and related to the accounts provided by you to a range of people. On every one of the 60 occasions during which you worked a locum session you were under an obligation to inform Aviva of the work. You failed to do this. Further, despite the various opportunities which you had to end your deception of Aviva, your misconduct only ended once your application had been refused and you had been confronted by Ms I. 15. You did not give oral evidence at this hearing, although you produced a reflective statement, as part of the substantial defence bundle. The panel was unable to fully explore the depths of your insight solely from this statement. It was not clear to the panel, therefore, what you had learnt or understood from these proceedings. The panel was also mindful that your reflections had not been tested through cross-examination. Mitigating Factors 16. The panel considered that there were a number of mitigating factors in your case. It took account of your admissions to Ms I as detailed in the Aviva Recommendation Report dated 9 May 2014, where it was recorded that you admitted to having worked locum sessions. Of your own volition, you supplied Aviva with full and frank disclosure of information which would otherwise not have been obtained. Despite your regrettable lack of expressed remorse to Aviva, it is to your credit that Ms I noted in her report He was very open about the fact that he had worked and confirmed that he wished that he had told us about this. 17. The panel attributed due weight to the testimonial evidence which had been provided by colleagues and friends. Almost without exception, they spoke of their shock at learning of the allegation and described your misconduct as being completely out of character. The panel noted that these testimonials were given in response to a letter from your instructing solicitors which set out the allegation and stated that you had provided inaccurate information which was misleading and dishonest. The panel was informed of your circumstances at the time of your dishonesty. These included difficulties in your GP partnership, XXX and the financial difficulties which you were facing. 18. You were previously of good character and the panel has no evidence to suggest that there are, or have ever been, any other concerns about your conduct or practice. Indeed, the panel has seen clear evidence attesting to your clinical excellence. 16
No Action 19. In coming to its decision regarding the appropriate sanction, if any, to impose in this case, the panel first considered whether to conclude the case by taking no action. The panel determined that this case was not exceptional and in view of your frank admissions and the serious nature of the panel s findings on impairment, it would be neither sufficient, proportionate nor in the public interest to conclude this case by taking no action. Conditions 20. The panel next considered whether it would be sufficient to impose conditions on your registration. It bore in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 21. The panel considered that a period of conditional registration would not address or adequately reflect the serious nature of your misconduct. It further considered that, in a case involving lack of integrity, conditions would not be appropriate or workable, and would not maintain public confidence in the medical profession. 22. The panel, therefore, determined that it would not be sufficient to direct the imposition of conditions on your registration. Suspension 23. The panel next considered whether suspending your registration would be an appropriate and proportionate sanction in this case. Paragraph 80 of the Sanctions Guidance states: Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate: a. a serious breach of Good medical practice where the misconduct is not fundamentally incompatible with continued registration and where therefore complete removal from the medical 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 or maintain confidence in doctors f. no evidence of repetition of similar behaviour since incident 17
g. the panel is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour. 24. It is clear that your misconduct was contrary to the guidance provided by paragraph 65 of Good Medical Practice which states You must make sure that your conduct justifies your patients trust in you and the public s trust in the profession. The panel considered that your misconduct was serious. In order, therefore, to uphold public confidence in the profession and to ensure the maintenance and promotion of proper standards of conduct and behaviour, it determined that any sanction lower than suspension would not be appropriate. 25. The panel considered whether or not you have demonstrated insight into your conduct. It noted that you have undertaken a number of courses regarding ethics in the medical profession and that you have attempted to reflect both on your own case and on other ethical dilemmas regarding GMC registration. The panel attributed due weight to the fact that you began to engage with a mentor in 2014 and have been seeing him regularly. You have also sought other ways to manage any future stress, for example through mindfulness. In your reflective statement you said to reflect insight on the steps of remediation, I am in the process of organising further professional mentoring sessions that can guide me through the remediation process after further reflecting on my case. The gravity of my errors will stay with me forever. 26. Given your limited admissions and the panel s findings at the first stage of this hearing, the panel has concerns about the level of insight which you have demonstrated that you currently possess. The panel has not been able to satisfy itself that you fully comprehend the impact which your dishonest conduct will have on public confidence in the profession. It has noted, however, your assertion in your reflective statement that in attending the Professional Ethics Courses, I understand the importance of gaining and maintaining trust in the profession and the potential for my actions to have a negative spiralling effect on the medical profession as a whole. 27. The panel considered that your reflective statement served to demonstrate that you have limited but emerging insight into your dishonest conduct. It is of note that the evidence which had been placed before this panel indicates that your previous good character aligned with your conduct, since the events which have brought you here, have resulted in the high regard of your colleagues, friends and patients which you enjoy. 28. You have engaged with the GMC investigation and informed your employers once the GMC investigation commenced. There is evidence that you have also taken steps to address your future reactions to stressful situations. The panel is, therefore, satisfied that you do not pose a significant risk of repeating your dishonest conduct. 18
29. During the course of its deliberation, the panel considered the Sanctions Guidance in relation to erasure. It was of the view that, although you had departed from the principles set out in Good Medical Practice, your behaviour was not fundamentally incompatible with being a doctor. 30. In determining the appropriate sanction the panel acknowledged the difficulties it faced. You committed a serious act of dishonesty. It is indisputable that seeking to defraud your insurer was wholly reprehensible. The fact that a combination of Aviva s assiduous processing of your claim and your ineptitude in the manner of your making it resulted in no financial loss to the company does not in any way excuse your duplicity. Action has to be taken in order to maintain public confidence in the profession. However, there are no concerns in relation to your clinical skills and there are a number of testimonials attesting to your clinical skills and excellence. Your permanent removal from the Medical Register would be a significant loss to the profession and the public. 31. The panel was of the view that, although your dishonesty was persistent and covered up, you have displayed some insight into your dishonest conduct and its consequences. The panel, therefore, determined that erasure would be a disproportionate sanction in this case, and was therefore not appropriate. 32. Having satisfied itself that erasure was a disproportionate and inappropriate sanction in this case, the panel determined that suspension is the appropriate sanction. In order to mark the seriousness with which the panel viewed your misconduct, to maintain public confidence in the profession and to promote and maintain proper professional standards and conduct for members of the profession, the panel determined that your suspension must be for the maximum period allowed. Your registration will be suspended for 12 months. 33. The effect of the panel s decision is that, unless you exercise your right of appeal, you will be suspended from the Medical Register 28 days from the date on which written notice of this decision is deemed to have been served upon you. Review hearing directed 34. The panel has directed that shortly before the end of the period of suspension, your case will be reviewed by a fitness to practise panel. At that hearing, the panel reviewing your case may be assisted by the following: Evidence that you fully appreciate the gravity and impact of your misconduct (for example, through a reflective portfolio), Objective evidence that your mentoring has enabled you to develop full insight into the gravity and impact of your misconduct, Objective evidence of your integrity and honest conduct since the imposition of your suspension, 19
Objective evidence that you have maintained your skills and knowledge, including evidence of CPD, Relevant, up-to-date testimonials and references from people of good standing, Any other evidence that you think will assist the panel. Determination on Immediate Order Dr Karia: 1. Having determined that you will be suspended from the Medical Register for a period of 12 months, the panel has considered, in accordance with Section 38 of the Medical Act 1983, as amended, whether your registration should be subject to an immediate order. 2. On behalf of the GMC, Mr McNally submitted that the matter of an immediate order is one for the panel to determine, and that he is not instructed to seek an immediate order. 3. On your behalf, Mr Hugh-Jones submitted that there is no need for an immediate order on your registration. He referred the panel to the case of Davey v GDC [2015] QBD 8 th October 2015, particularly paragraph 14. 4. The panel considered paragraph 148 of the Sanctions Guidance which states that: The panel may impose an immediate order where it is satisfied that it is necessary for the protection of members of the public, or is otherwise in the public interest, or is in the best interests of the doctor. 5. The panel has determined that, given that there are no patient safety concerns and that there are no issues regarding your clinical practice, it is not necessary to make an order suspending your registration immediately. The panel is of the view that the substantive direction for suspension will adequately address the public interest concerns identified in this case. 6. This means that the substantive direction for suspension, as already announced, will take effect 28 days from when notice is deemed to have been served upon you, unless you lodge an appeal in the interim. 7. That concludes this case. Confirmed Date 23 November 2015 Mrs Carrie Ryan-Palmer, Chair 20
Schedule 1 MEDICAL PRACTICE DATE OF SESSION (number is the number of sessions at the specified practice) 1. 1. Oakwood Medical Practice 5 February 2014 2. 1. Hayat Medical Centre 7 February 2014 3. 1. Arnos Grove Medical Centre 10 February 2014 4. 2. Arnos Grove Medical Centre 11 February 2014 5. 1. Tynemouth Medical Practice 12 February 2014 6. 3. Arnos Grove Medical Centre 13 February 2014 7. 4. Arnos Grove Medical Centre 17 February 2014 8. 1. Wick Health Centre 17 February 2014 9. 1. The River Surgery 18 February 2014 10. 1. Connaught Medical Practice 18 February 2014 11. 2. Wick Health Centre 20 February 2014 12. 3. Wick Health Centre 21 February 2014 13. 2. Hayat Medical Centre 4 March 2014 14. 1. Woodlands Medical Practice 5 March 2014 15. 3. Hayat Medical Centre 6 March 2014 16. 2. Connaught Medical Practice 11 March 2014 17. 3. Connaught Medical Practice 12 March 2014 18. 4. Connaught Medical Practice 13 March 2014 19. 2. Tynemouth Medical Practice 13 March 2014 20. 5. Connaught Medical Practice 14 March 2014 21. 6. Connaught Medical Practice 17 March 2014 22. 2. Oakwood Medical Practice 18 March 14 23. 4. Hayat Medical Centre 18 March 2014 24. 3. Oakwood Medical Practice 20 March 14 25. 5. Hayat Medical Centre 20 March 2014 26. 2. The River Surgery 21 March 2014 27. 6. Hayat Medical Centre 24 March 2014 28. 7. Connaught Medical Practice 25 March 2014 29. 7. Hayat Medical Centre 25 March 2014 30. 8. Connaught Medical Practice 27 March 2014 31. 8. Hayat Medical Centre 27 March 2014 32. 4. Oakwood Medical Practice 28 March 14 33. 9. Hayat Medical Centre 28 March 2014 34. 10. Hayat Medical Centre 31 March 2014 35. 9. Connaught Medical Practice 1 April 2014 36. 5. Oakwood Medical Practice 2 April 2014 37. 11. Hayat Medical Centre 3 April 2014 38. 6. Oakwood Medical Practice 4 April 2014 39. 10. Connaught Medical Practice 8 April 2014 1
40. 3. Tynemouth Medical Practice 9 April 2014 41. 4. Tynemouth Medical Practice 10 April 2014 42. 1. Brick Lane Surgery 11 April 2014 43. 1. Parkfield Medical Centre 14 April 2014 44. 3. The River Surgery 15 April 2014 45. 11. Connaught Medical Practice 15 April 2014 46. 12. Hayat Medical Centre 15 April 2014 47. 7. Oakwood Medical Practice 16 April 2014 48. 4. Wick Health Centre 16 April 2014 49. 2. Brick Lane Surgery 16 April 2014 50. 12. Connaught Medical Practice 17 April 2014 51. 13. Hayat Medical Centre 17 April 2014 52. 5. Wick Health Centre 22 April 2014 53. 13. Connaught Medical Practice 22 April 2014 54. 5. Tynemouth Medical Practice 22 April 2014 55. 6. Tynemouth Medical Practice 23 April 2014 56. 7. Tynemouth Medical Practice 24 April 2014 57. 14. Hayat Medical Centre 24 April 2014 58. 15. Hayat Medical Centre 25 April 2014 59. 16. Hayat Medical Centre 28 April 2014 60. 14. Connaught Medical Practice 30 April 2014 2