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June 25, 2016

GMC warning for doctor

Ed Madden, BL

Ed Madden, BL, on a case in which a GMC Committee considered a complaint against a doctor who, having accepted a registrar post in Dublin, subsequently accepted a similar post in New Zealand.

Between 1 January 2009 and 31 December 2009, Dr Naveed Ahmed, who qualified as a doctor in Pakistan, was employed as an Anaesthetic Registrar at the Mater Hospital in Dublin. On 23 October 2009, he accepted an offer of a post at the Adelaide and Meath Hospital in the city. This was a six-month post commencing on 1 January 2010.

Dr Ahmed had earlier applied through a recruitment agency for a similar post with the Otago District Health Board (the Board) in New Zealand. On 8 December 2009, he was offered the post. He duly accepted the offer and, on 21 December 2010, returned the signed Employment Agreement with an agreed commencement date of 1 February 2010; the commencement date was subsequently revised to 22 February 2010.

On 9 February 2010, Dr Ahmed informed the recruitment agency that he would not be taking up the post in New Zealand after all. Three days later, the Board wrote to the General Medical Council in London to express their “extreme dissatisfaction” with Dr Ahmed for not having taken up the post. Dr Ahmed is a registered doctor with the GMC.

On foot of this correspondence, the GMC wrote to Dr Ahmed on 24 February 2010 to invite his comments. By email correspondence dated 15 March 2010, Dr Ahmed informed the GMC that the commencement date for the post in New Zealand had not been agreed. He said that he had never been made aware that the hospital had put him on a rota commencing on 22 February 2010. He expressed his surprise at being put on such a rota before he had actually arrived in the country.

In email correspondence dated 10 March 2010, the Board provided the GMC with further documentation concerning Dr Ahmed’s agreement to take up the post. They also outlined some of the costs which they had incurred as a consequence of his taking up the post.

By letter dated 19 July 2010, the GMC advised Dr Ahmed that it had completed its preliminary investigation into the concerns raised by the Board, and invited his comments in respect of allegations “which appear to raise a question” as to whether his fitness to practise was impaired. The GMC also advised that their Case Examiners considered that this was a case that might be concluded with a warning and asked whether he would be prepared to accept such a warning.

Vexatious and scandalous
On 1 September 2010, solicitors acting for Dr Ahmed wrote to the GMC claiming that the complaint from the Board was “vindictive, vexatious and/or scandalous”.

They explained that Dr Ahmed had not made any definite arrangements with the Board about “start times, dates or travel to New Zealand with his family”. In this regard, reference was made to the commencement date in the employment agreement being subject to Dr Ahmed obtaining registration with the Medical Council of New Zealand, obtaining the relevant work visa and being covered by medical indemnity insurance.

They submitted that it was entirely unreasonable and altogether premature for the Board to have put Dr Ahmed on any roster. The doctor was acutely aware of his responsibilities and duties towards his patients and would not knowingly have put any patients at risk. In further correspondence with the GMC dated 20 September 2010, the solicitors advised that their client did not consider that a warning was warranted.

On 20 October 2010, the GMC wrote to Dr Ahmed to advise that his case had been referred to an Investigation Committee and invited him to attend an oral hearing. When the hearing took place on 29 November 2010, Dr Ahmed was not present and was not represented. In the course of the hearing, Counsel for the GMC referred to paragraph 49 of the GMC publication Good Medical Practice, which provides as follows:
“Patient care may be compromised if there is not sufficient medical cover. Therefore, you must take up any post, including a locum post, you have formally accepted and you must work your contractual notice period, unless the employer has reasonable time to make other arrangements.”

Counsel claimed that there had been a significant departure from the terms of paragraph 49 and that Dr Ahmed’s behaviour was sufficiently serious to require a formal response from the GMC by way of a warning to him.

Calculated fashion
Having considered the evidence in the case, the Committee was satisfied that by agreeing to take up both the post in Ireland and the post in New Zealand, Dr Ahmed had acted “in a calculated fashion that would inevitability lead to him letting down one of these parties”. In the event, Dr Ahmed had let down the Board.

While the Committee understood his reasons for not taking up the post in New Zealand — which were related to his ability to qualify for inclusion on the Specialist Register in Ireland — he did not advise the Board that he would not be taking up the post in that country until eight working days before he was scheduled to commence employment. In those circumstances, the ability of the Board to ensure adequate patient cover was “jeopardised”. In addition, there was a financial cost to the Board.

The Committee noted that Dr Ahmed was “of previous good character” and that there were no concerns about his clinical practice. They were concerned, however, about what they referred to as his lack of insight into the seriousness of his actions. In this regard, they rejected the charge made by his solicitors that the complaint was vindictive, vexatious or scandalous.

In the view of the Committee, Dr Ahmed’s behaviour represented a significant departure from the standards expected of a professional doctor, and was such that public confidence in the profession might be undermined if the GMC were not to take any action.

In the circumstances, it was proportionate to direct that a formal warning concerning his conduct be attached to his record for a period of five years. The Committee said that if there were to be any repetition of the conduct on Dr Ahmed’s part, it might result in a finding of impaired fitness to practise.

Ref: GMC Investigation Committee Hearing: 29 November 2010; Ref No 5193220