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October 25, 2014

Doctor found herself in ‘Catch-22′ situation

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Ed Madden, BL

Ed Madden, BL, looks at a recent English High Court case in which a doctor appealed against the decision of a Fitness to Practise Panel of the General Medical Council to erase her name from the medical register.

In January 2009, the Fitness to Practise Panel of the General Medical Council (GMC) identified significant deficiencies in the professional performance of Dr Olufunmilayo Adeyemi in the following areas of practice: (1) management of anaesthetic induction; (2) intubation technique; (3) record keeping; (4) recognition of and response to crucial events; (5) proper understanding of the responsibilities of an anaesthetist; and (6) communication skills.

The Panel placed conditions on her registration for a period of 12 months.  By this time she had already been subject to conditions imposed by the Interim Orders Panel of the Council for a little over three years.

When Dr Adeyemi’s case was reviewed by another Fitness to Practise Panel in January 2010, she did not attend the hearing and was not represented.  She maintained that she was in Nigeria at the time dealing with family matters and that the hearing should not have proceeded in her absence.  However, the Panel accepted evidence that she had been notified of the hearing and believed that her absence was both “voluntary and willful”.  The Panel, therefore, refused an adjournment and proceeded to conduct the review.

They found that although Dr Adeyemi had complied with some of the conditions imposed in 2009, in particular in relation to the formulation of a professional development plan, her efforts to do so were “half-hearted”.  She had not fully grasped the purpose or the reason for the imposition of conditions on her registration and tended to blame others for her deficiencies.

The Panel decided that her professional performance continued to be impaired and that “on a fine balance” it would be “sufficient” to suspend her registration for a period of 12 months.  Dr Adeyemi appealed to the High Court against both the decision not to adjourn the hearing and the decision to suspend her registration.  The Court found that the appeal was without merit.

The doctor’s case was reviewed by a new Fitness to Practise Panel in 2011. The Panel expressed their deep concern that since the last review in 2010, Dr Adeyemi had made only limited efforts to address the issues raised with her; yet she believed she had fully addressed them. Her failure to demonstrate that she had kept her medical skills and clinical knowledge up to date amounted to a particularly serious departure from the principles set out in the Council’s publication Good Medical Practice.

Dr Adeyemi had at this stage been out of clinical practice for some five years.  This, the Panel found, presented a continuing risk of harm to patients. They were also concerned by the doctor’s “attitudinal problems” and her persistent lack of adequate insight into her failure to address her deficient professional performance.

Incompatible
The Panel concluded that her behaviour was fundamentally incompatible with her continuing to practise medicine and decided that her name should be erased from the Medical Register.  Dr Adeyeni again appealed to the High Court, claiming that the decision to erase her name from the register was unfair and disproportionate to the allegations made against her.

The appeal came on for hearing in February 2012. Having heard the evidence in the case, Mr Justice Bean said he appreciated that a doctor who is suspended from practice is in a difficult position.

It is extremely difficult for the practitioner to obtain any sort of work involving clinical practice, even under supervision. This creates what might be described as a ‘Catch-22’ situation.

The judge said, however, that it was very difficult to describe as “perverse” — a term used by counsel for Dr Adeyemi — the Panel’s finding concerning the doctor’s failure to keep her medical skills and clinical knowledge up to date. That finding, and the conclusion that it amounted to a particularly serious departure from the principles of good medical practice, was not a finding of “wickedness or willful default”; it was simply a finding of fact.

Mr Justice Bean said that given it was the duty of the GMC to protect members of the public, the members of the Panel were clearly entitled to find that Dr Adeyemi’s name should be erased from the medical register. The Court went on to dismiss the appeal.

Reference: [2012] EWHC 425 (Admin).