MPTS - PUBLIC RECORD...is not clinically indicated for the purposes of pain relief for someone getting a tattoo because the risks of adverse effects outweigh the potential benefits;

Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr MCALLISTER 1

PUBLIC RECORD

Dates: 24/08/2020 - 08/09/2020

Medical Practitioner’s name: Dr Katy MCALLISTER

GMC reference number: 7042366

Primary medical qualification: MB ChB 2009 University of Dundee

Type of case Outcome on facts Outcome on impairment New - Misconduct Facts relevant to impairment

found proved

Impaired

New - Conviction Facts relevant to impairment found proved

Impaired

Review - Conviction

Impaired

Summary of outcome

Erasure

Tribunal:

Legally Qualified Chair Mr Simon Bond

Medical Tribunal Member: Dr Janet Nicholls

Medical Tribunal Member: Dr Candida Borsada

Tribunal Clerk: Mr Stuart Peachey

Attendance and Representation:

Medical Practitioner: Not present and not represented

GMC Representative: Ms Chloe Fairley, Counsel




Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held partly in public and partly in private. Overarching Objective Throughout the decision making process the Tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect, promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Determination on Facts - 03/09/2020 Rule 41 1. The Tribunal determined that, pursuant to Rule 41 XXX of the Rules, this determination will be announced in private given that it relates to XXX. However, a redacted version will be published at the close of the hearing. Background 2. The General Medical Council (‘GMC’) received a referral from NHS Tayside (‘the Trust’) raising concerns regarding the removal, by Dr McAllister, of vials of Midazolam from Ninewells Hospital, where Dr McAllister was employed until 2017. 3. The GMC also received a referral relating to an allegation that, on 9 May 2015, Dr McAllister left medications at her house instructing her friend Mrs A to take those medications in advance of Mrs A having a tattoo. It is further alleged that Dr McAllister left painkilling medication for Mrs A at the tattoo studio. Mrs A subsequently died on 10 May 2015. 4. It is also alleged that in 2019, Dr McAllister was convicted and sentenced under the:

• Road Traffic Act 1988; and

• Customs and Excise Management Act 1979. The Outcome of an Application Made during the Facts Stage 5. The Tribunal granted the GMC’s application, made pursuant to Rules 31 and 40 of the GMC (Fitness to Practise Rules) 2004 as amended (‘the Rules’), that service had been effected and to proceed in Dr McAllister’s absence. The Tribunal’s full decision on the application is included at Annex A.




The Allegation and the Doctor’s Response 6. The Allegation made against Dr McAllister is as follows: Ninewells Hospital

1. On one or more occasion between 14 December 2012 and 19 September 2014, you:

a. removed the vials of Midazolam as set out in Schedule 1 (‘the Vials’)

from Ninewells Hospital (‘Ninewells’); To be determined b. failed to return the Vials to Ninewells. To be determined

2. You knew that you had:

a. removed the Vials from Ninewells; To be determined

b. failed to return the Vials to Ninewells. To be determined

3. Your actions as set out in paragraph 1 were dishonest by reason of paragraph

2. To be determined

Mrs A

4. On 9 May 2015, in advance of Mrs A getting a tattoo, you:

a. left the medication as set out in Schedule 2 at your home address (‘the Home Address Medication’); To be determined

b. sent the text messages as set out in Schedule 3 to Mrs A.

To be determined

5. Your actions as set out in paragraph 4 were inappropriate in that:

a. codeine on its own is a:

i. ‘Schedule 5 Controlled drug’ with potential for misuse; To be determined

ii. prescription-only medication which should only be supplied

when having adequate knowledge of the patient’s medical history and current medication; To be determined

b. tramadol:




i. is a ‘Schedule 3 Controlled drug’ with potential for misuse;

To be determined

ii. is a prescription-only medication which should only be supplied when having adequate knowledge of the patient’s medical history and current medication; To be determined

iii. should only be prescribed for moderate to severe pain;

To be determined

iv. is not clinically indicated for the purposes of pain relief for someone getting a tattoo because the risks of adverse effects outweigh the potential benefits; To be determined

c. diazepam is a:

i. ‘Schedule 4 Controlled drug’ with potential for misuse;

To be determined

ii. prescription-only medication which should only be supplied when having adequate knowledge of the patient’s medical history and current medication; To be determined

d. the Combination Tablet is a pharmacy-only medication which should

only be supplied when having adequate knowledge of the patient’s medical history and current medication; To be determined

e. the combination of the Home Address Medication had the:

i. potential to cause Mrs A significant harm from:

i. adverse effects; To be determined

ii. drug interactions; To be determined

ii. effect of an increased risk of sedation; To be determined

f. the combination of codeine and tramadol has the effect of an

increased risk of respiratory depression; To be determined




g. the combination of alcohol and the Home Address Medication can increase the risk of:

i. adverse effects; To be determined

ii. drug interactions. To be determined

6. On 9 May 2015, while Mrs A was getting a tattoo at Voodoo Tattoo studio

(‘the Studio’), you:

a. gave Mrs A one additional Combination Tablet at or around 15:00; To be determined

b. advised that Mrs A could take two additional Combination Tablets at or

around 17:30 in your absence; To be determined

c. left painkilling medication at the Studio for Mrs A to take in your absence. To be determined

7. Your action as set out in paragraph:

a. 6a was inappropriate in that:

i. there was potential for Mrs A to suffer adverse effects;

To be determined

ii. the dosing instructions for the Combination Tablets provide for a minimum of four hours between doses; To be determined

b. 6b was inappropriate in that:


To be determined

ii. Mrs A should not have taken a further dose of the Combination Tablets until around 19:00; To be determined

iii. a further dose of the Combination Tablets at 17:30 was not in

line with dosing instructions for the Combination Tablets; To be determined

c. 6c was inappropriate in that:




i. you were not in a position to assess the:

i. effects of the combination of medication already taken by Mrs A; To be determined

ii. side effect of sedation; To be determined

ii. there was an additional potential for Mrs A to suffer serious

adverse effects from additional doses of medication. To be determined

8. Your actions set out in paragraphs 4 to 7 were inappropriate in that:

a. you did not have a clinical relationship with Mrs A;

To be determined

b. Mrs A was a person with whom you had a close personal relationship; To be determined

c. the context for providing medication for Mrs A was not a medical

emergency; To be determined

d. you placed Mrs A at significant risk of harm from adverse effects of medication. To be determined

9. Your actions set out in paragraphs 4 to 8 above contributed to Mrs A’s death

in that the medical cause of Mrs A’s death as per the post-mortem report was combined acute drug toxicity from drugs including:

a. codeine; To be determined

b. tramadol; To be determined

c. diazepam. To be determined

Conviction under the Road Traffic Act 1988

10. On 2 May 2019, at Dundee Sheriff Court you were convicted of driving:

a. whilst unfit to drive through drink or drugs; To be determined

b. without due care and attention, or without reasonable consideration

for other persons using the road or place. To be determined




11. On 30 May 2019:

a. you were sentenced to:

i. carry out unpaid work for 100 hours; To be determined

ii. a community payback order; To be determined

iii. 12 months’ supervision; To be determined

iv. 12 months’ disqualification from holding and obtaining a driving licence, To be determined

in respect of your conviction set out at paragraph 10a;

b. the Dundee Sheriff Court:

i. dismissed your case with an admonition; To be determined

ii. endorsed your driving licence, To be determined

in respect of your conviction set out at paragraph 10b.

Conviction under the Customs and Excise Management Act 1979

12. On 17 September 2019, at Dundee Sheriff Court you were convicted of four

counts of importation or being concerned in the importation of:

a. morphine, a Class A controlled drug; To be determined

b. oxycodone, a Class A controlled drug; To be determined

c. diazepam, a Class C controlled drug; To be determined

d. temazepam, a Class C controlled drug, To be determined contrary to a prohibition or restriction with the intent to evade the prohibition or restriction.

13. On 3 January 2020, you were sentenced to:

a. carry out unpaid work for 210 hours; To be determined

b. a community payback order; To be determined




c. two years’ supervision. To be determined Factual Witness Evidence 7. The Tribunal received live evidence via Video Link, on behalf of the GMC from an expert witness, Dr C, a GP Principal. He provided the following documentation:

• An Expert Report, dated 17 July 2019;

• Additional comments, dated 24 July 2019;

• Addendum amendments, dated 25 July 2019; and

• A Supplemental Expert Report, dated 9 September 2019. Documentary Evidence 8. The Tribunal had regard to all the documentary evidence adduced during these proceedings. This evidence included, but was not limited to:

• Witness statements of:

o Ms D, dated 24 May 2018; and a supplemental witness statement, dated 16 August 2018;

o Ms E, dated 19 July 2018; and a supplemental witness statement, dated 8 August 2018;

o Dr F, dated 31 July 2018; and o Ms G, dated 13 November 2018;

Ninewells allegations

• Email correspondence between:

o Dr McAllister and the Trust, dated 8 – 11 May 2015; o Ms D and Dr F, dated 10 – 18 December 2015; o Ms E and the Police, dated 27 – 28 May 2015; 11 – 16 May 2016; o Mr I and the Trust, dated 30 August 2017; o Dr H and the GMC, dated 11 – 12 November 2017; o Ms E and the GMC, dated 1 August 2018; and o Ms D to the GMC, dated 14 August 2018;

• Ms E’s Police witness statement, dated 23 July 2015;

• The Trust’s investigation meeting notes, dated 16 November 2015;

• Dr McAllister’s witness statement to the Trust’s investigation, dated 16 November 2015 and a further statement, dated 9 December 2015;

• Dr F’s comments attached to Dr McAllister’s witness statement for the Trust’s investigation, dated December 2015;




• Notes of the Trust’s investigation meeting with Dr F, dated 20 May 2016;

• Ms E’s response to questions at the Trust’s disciplinary hearing, dated 10 August 2017;

• Dr McAllister’s case statement to the Trust’s disciplinary hearing, dated 10 August 2017;

• Notes of the Trust’s disciplinary hearing, dated 10 August 2017;

• Dr McAllister’s statement to the GMC, dated 13 November 2017;

• Dr McAllister’s Curriculum Vitae (‘CV’), dated 2017;

• Extracts from public and private transcripts of a MPT Hearing relating to Midazolam, dated 13 November 2017;

• Extract from MPT determination on the Facts and Impairment relating to Midazolam, dated 14 November 2017;

• Notes of the Trust’s appeal hearing, dated 2 August 2018; and

• Letter from BTO Solicitors regarding Dr McAllister’s Rule 7 response, dated 21 September 2018;

• Dr McAllister’s case statement to the Trust’s appeal hearing, dated 2 August 2018;

• Transcripts of oral evidence given to a MPT Hearing in March 2019;

• Documentation regarding a phased return to work provided by Ms D to a MPT Hearing in March 2019;

• A MPT determination on recusal, dated 8 May 2019;

Allegations relating to Mrs A

• Various Police witness statements;

• Dr McAllister’s text message exchange with Mrs A, dated 9 May 2015;

• Transcript of Dr McAllister’s Police interview;

• Mrs A’s post-mortem examination report, dated April 2016;

• GP Records of Mrs A, dated between 2014 – 2015;

• GOV.UK list of controlled Drugs, December 2019 version;

• Correspondence between Mr B and the GMC, dated 28 June 2020 – 22 July 2020;

• Letter from the GMC to Mr B, dated 27 July 2020;

• Transcript of Mr B’s evidence at Dr McAllister’s criminal trial, dated 16 – 17 May 2017;

Allegations relating to convictions Under Road Traffic Act 1988

• Charge sheet, dated 22 August 2018;

• Certificate of conviction, dated 30 May 2019;

• Community payback order, dated 30 May 2019;

• Police prosecution report, dated 17 December 2019;

• Pre-sentence report, dated 28 May 2019;




• Email correspondence from the Court to the GMC, dated 12 December 2019

• Varied community payback order, dated 3 January 2020;

• Updated certificate of conviction, dated 7 February 2020;

Allegations relating to a conviction Under Customs and Excise Management Act 1979

• Charge sheet, dated 5 May 2019;

• Summary of plea entered;

• Pre-sentence report, dated 23 October 2019

• Police prosecution report, dated 17 December 2019;

• Community payback order, dated 3 January 2020;

• Sheriff sentencing remarks, 3 January 2020;

• Certificate of conviction, dated 9 January 2020; and

• Email correspondence from the Court to the GMC, dated 9 January 2020;

XXX

• XXX

• XXX

o XXX o XXX

The Tribunal’s Approach 9. In reaching its decision on the facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. Dr McAllister does not need to prove anything. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities, i.e. whether it is more likely than not that the events occurred as alleged. 10. When considering matters of dishonesty, the Tribunal took account of the principles in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67. It bore in mind that it should first ascertain, subjectively, the actual state of Dr McAllister’s knowledge or belief as to the facts and should then decide whether her conduct was dishonest by applying the objective standards of ordinary decent people. The Tribunal’s Analysis of the Evidence and Findings The 2017 Tribunal 11. During the course of the hearing it became apparent to the Tribunal that Dr McAllister had attended a Medical Practitioners Tribunal (‘MPT’) hearing in 2017 regarding an allegation that her fitness to practise was impaired by reason of her conviction for the possession of Midazolam (‘the 2017 Tribunal’). The Tribunal requested, and were provided




with copies of, extracts from the transcript of the 2017 Tribunal hearing and an extract from the 2017 Tribunal’s determination. The Tribunal noted Ms Fairley’s submission on behalf of the GMC that the 2017 Tribunal only considered matters relating to Dr McAllister’s conviction. Whilst this Tribunal considered documents provided to it in relation to the 2017 Tribunal, it made its own findings and exercised its own independent judgement based on the evidence before it. Findings 12. The Tribunal considered each paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the specific paragraphs in the Allegation. Paragraphs 1, 2 and 3 of the Allegation 13. The vials set out in Schedule 1 are as follows: Product Batch number

Midazolam 10mg/5ml 340072 Midazolam 5mg/5ml 228077 Midazolam 5mg/5ml 04730613A

Chronology of events 14. The Tribunal first of all had regard to the events giving rise to Paragraphs 1, 2 and 3 of the Allegation. 15. On 10 May 2015, following the death of Mrs A, the Police commenced an investigation. During the course of that investigation, the Police conducted a search of Dr McAllister’s home, during which she indicated the location of three vials of Midazolam. The Tribunal noted that it was not disputed that the vials, found in Dr McAllister’s home, were taken by her from Ninewells where she was employed. In May 2017 Dr McAllister pleaded guilty to a criminal charge relating to her possession of those vials. The 2017 Tribunal subsequently considered whether or not Dr McAllister’s fitness to practice was impaired by reason of that conviction. 16. On 11 May 2015, Dr McAllister sent an email to Ninewells referring to the death of Mrs A and stating that she would not be returning to work from sickness absence as she had planned. In her email, she stated:

‘Early yesterday morning one of my best friends just had a sudden unexplained cardiac arrest. I was first on scene along with a single paramedic plus ambulance driver […] Made it to A&E resus but pronounced life extinct after 50 minutes. We don’t know why.




And then the police raided my house and took my phone in case she [Mrs A] had secretly stolen some medications and that’s what killed her. Unlikely but it is still an unexplained death. Was in the CID headquarters all day yesterday […]’

17. The Police contacted the Trust to explain that they had begun an investigation into the fact that they had found controlled medication at Dr McAllister’s house and which the Police suspected had been taken from Ninewells. The Trust began a preliminary investigation and appointed Dr J, Assistant Medical Director for Medicine, as the appropriate medical officer to lead that investigation. Ms D, an HR Business Lead at Ninewells, was appointed to assist Dr J, to ensure that Trust policy was being adhered to. As the Trust’s investigation involved controlled drugs, it was also supported by Ms E, Head of Controlled Drug Governance at the Trust. 18. During the course of the Trust’s investigation, Ms E received details from the Police of the expiry dates and batch numbers relating to each of the three vials found in Dr McAllister’s home, namely:

• 10mg – expiry: 10.2016 - batch no 340072

• 5mg – expiry: 07.2015 - batch no 228077

• 5mg – expiry: 06.2016 - batch no 04730613A Ms E then undertook an investigation to establish whether the vials were received by the Trust and, if so, when. 19. The Trust became aware that Dr McAllister was being charged with criminal offences by the Police and, as a result, Dr J suspended Dr McAllister from work on 10 June 2015. 20. On 23 July 2015, Ms E provided a witness statement to the Police in which she stated that she could not sure be when or where the vials were received by Trust. This was because the batch numbers and expiry dates of medicines were not routinely recorded on receipt from the supplier. However, having considered the stock of Midazolam then held by Ninewells and in particular the expiry dates thereof, Ms E considered it likely that the vials found in Dr McAllister’s home had been taken on separate occasions. 21. On 16 November 2015, an investigation meeting (‘the Investigation Meeting’) was convened by the Trust to review Dr McAllister’s suspension and an allegation that Dr McAllister had admitted taking medications from Ninewells. The Tribunal had regard to the notes of that meeting, during which Dr McAllister gave an explanation as to how the medication came to be at her house. The meeting notes record that during the course of the Police investigation into Mrs A’s death, the Police attended at Dr McAllister’s home. Dr McAllister told the Investigation Meeting that the Police asked her to ‘walk them through’ her house in order to establish whether any medication was missing. During the course of that Police visit Dr McAllister alerted the police to the whereabouts of the vials of Midazolam.




22. During the Investigation Meeting Dr McAllister explained that, from February 2012 to February 2013, she had been a ST in Anaesthetics within an Intensive Care Unit (‘ICU’). As part of that role, Dr McAllister stated that she would have had access to emergency drugs and that, for example, she would sometimes get drugs from the drugs cupboard following a request from a Consultant. When asked about how the drugs had got into her house, Dr McAllister explained that, on a night shift, she would wear a cardigan over her scrubs due to it being cold. Dr McAllister stated it was probable that, following an exhausting shift, when she got home she found the vials of Midazolam in her cardigan pockets. Dr McAllister explained that she put the vials in a safe place ‘on top of the cupboard at the back’ and then had forgotten about them. She stated that she had intended to return the vials to Ninewells but had forgotten. 23. During the course of the Trust’s Investigation Meeting, when asked whether she had removed vials of Midazolam on one or more occasion, Dr McAllister stated that she thought it had occurred only on one occasion. She stated that the issue could be proved if the batch numbers could be found for the drugs and the dates compared. 24. The Tribunal noted that there is no dispute on the evidence that Dr McAllister had removed the three vials set out in Schedule 1 from Ninewells. Further, during the Trust investigation, she acknowledged that she had a duty to return those vials and had intended to do so. 25. Dr McAllister provided a witness statement for the Trust’s Investigation Meeting. In her statement, she stated:

‘One of the items they found belonged to the hospital: I believe it was three small unopened glass vials of Midazolam which I am almost positive had accidently come home with me in my cardigan pocket at the end of a set of nightshifts as an ST2 in anaesthetics around 3 years ago now. As soon as I realised what they were I would have placed them well out of sight, up on a high shelf in a cupboard so my young nieces, who I care for, couldn’t reach them and until I could take them back to ICU or emergency theatres. Unfortunately, being completely out of sight and mind […] I went on as normal and I completely forgot about them until 3 years later when the investigating detectives talked me through my house room by room […] At this point I remembered about the vials at the back […] of the medicine cupboard and described them to the police so they knew where to look and what to look for to ensure they were still there and had not in fact been removed by Mrs A. I gave this information freely to the police before they entered my house […]

Now; I cannot remember at all the exact circumstances around what happened the night/ morning that the Midazolam came home with me: partly because it was 3 years ago and partly because it clearly did not stick out in my mind as an unusual one. I suspect when I brought the Midazolam to the scene the SR or consultant either did not want to use it […]




However, the fact remains that I did accidentally take the medication off the hospital premises and home with me at some point three years ago (I was in anaesthetics from Feb 2012 to Feb 2013 as an ACCS trainee) and I forgot to return them’

26. The Tribunal had regard to the evidence of Dr F, Consultant in Anaesthetics and Intensive Care at Ninewells at the time of the index event. He was asked to comment on Dr McAllister’s statement to the Investigation Meeting. Dr F indicated that in respect of the Midazolam and Dr McAllister’s ICU explanation, he stated that the ICU department only stocked Midazolam as ‘10mg in 2mls’, and that the ‘5mg in 5mls’ are stocked in theatres/ other clinical areas. He commented that he thought it unlikely that a trainee would have ampules of different concentrations and of different expiry dates at a single clinical event. However, he stated that ‘I suppose it is possible’. Further, Dr F confirmed that Midazolam is commonly used for the purpose of sedation and he indicated he has never known of somebody taking medication home, and if they did, there would be an expectation to bring it back on the following day. 27. The Tribunal also had regard to Ms D’s evidence regarding Dr McAllister’s employment history. From August 2012 until August 2013, Dr McAllister worked in Anaesthetics and then, between August 2013 and August 2014, she worked in ACCS Acute Medicine. Ms D also outlined the dates on which Dr McAllister was absent from Ninewells XXX, namely between 15 June 2014 and 20 June 2014 and then from 28 August 2014 to 12 September 2014. 28. On 17 December 2015, Ms E emailed Dr F setting out the distribution dates of the three vials found at Dr McAllister’s home. On 22 December 2015, Ms E produced a report for the Trust investigation where she stated: Midazolam

‘Benzodiazepines such as diazepam, Midazolam, and temazepam are subject to the Misuse of Drugs Regulations as Class C controlled drugs due to their potential for misuse. As medicines, concerns over the likely harms caused by the misuse of Midazolam and temazepam have resulted in these drugs being classified into a higher schedule of control than other benzodiazepines. Midazolam does not, however, require secure storage or record keeping. Three vials of Midazolam were found by the police in Katy McAllister’s house. Information was sought from the manufacturer, Hamelyn on the manufacture and distribution dates of the three vials, which was provided as follows:’

Product Batch number

Date of manufacture

Dates of distribution by manufacturer

Midazolam 10mg/5ml, solution for injection

340072 02/10/2013 27/11/2013 – 22/07/2014





228077 10/07/2012 29/11/2012 – 20/12/2012


04730613A 20/06/2013 04/04/2014 – 14/08/2014

29. Within her report, Ms E stated that the only ‘Anaesthetic’ destinations in Ninewells for Midazolam in a 10mg/5ml preparation between December 2012 and May 2015 were Theatre 16 and the Day Surgery Unit; none were issued to ICU in that period. Ms E stated that Midazolam, in a 5mg/5ml preparation, was issued to a wide range of wards including ICU at Ninewells in that time period. 30. On 10 August 2017, Dr McAllister attended a disciplinary hearing at the Trust. During that hearing, Dr McAllister stated that she was unable to recall the exact circumstances of retaining the vials of Midazolam but that it was most likely a single incident. She stated that she could have taken the vials home whilst in the Cardiology Unit and Acute Medicine. She stated that she seized on her time in Anaesthetics as a likely example, but she could not be sure. Dr McAllister explained that she had forgotten about the vials at her home as they were hidden, but she offered the Trust a full, unreserved apology and realised that she should have returned the vials. XXX. 31. The 2017 Tribunal was convened to determine whether Dr McAllister’s fitness to practise was impaired by reason of her conviction for the possession of Midazolam. Dr McAllister produced a witness statement for the purposes of that hearing, dated 13 November 2017. Within that statement, Dr McAllister stated that she had not worked as a doctor since September 2014; XXX she had been due to commence a phased return to work on 11 May 2015, which did not happen. Dr McAllister stated that she had inadvertently brought home two vials. The Tribunal noted that Dr McAllister had attended the 2017 Tribunal and had been questioned about the circumstances of how the vials of Midazolam had come to be in her possession. The Tribunal noted that the 2017 Tribunal formed the opinion that:

’26. In relation to your possession of the Midazolam, the tribunal determined that it could not safely infer from the evidence that you took this from your place of work on more than one occasion. The tribunal was satisfied that the removal of the Midazolam from your place of work was a genuine mistake and that you did not intend to use or distribute it. The tribunal was of the view that you managed this situation wholly inappropriately but it accepted your evidence that you would act differently in the future’.

32. In May 2018, Ms E produced a supplemental report into her investigation of the vials found in Dr McAllister’s house. Within that report, she set out the distribution dates of the vials of Midazolam, which had been provided to her by the manufacturer:





Date of manufacture

Expiry date

Dates of distribution by manufacturer


340072 02/10/2013 10/2016 27/11/2013 – 22/07/2014


228077 10/07/2012 07/2015 29/11/2012 – 20/12/2012


04730613A 20/06/2013 06/2016 04/04/2014 – 14/08/2014

33. Within her supplemental report, Ms E stated that Dr McAllister moved from the Anaesthetics department to Medicine in February 2013, prior to the distribution by the manufacturer of two of the three vials. In light of her findings, Ms E considered that only CCU stock might have been legitimately accessed by Dr McAllister on a single occasion. She stated that all three vials could have been in CCU between 26 June 2014 and 30 September 2014. However, she stated that the turnover of 5mg/5ml strength by the ward was such that it would be ‘very unlikely’ that the ward would have had stock of batches which were distributed by the manufacturer 15 months apart. She also stated that Midazolam in ‘5mg in 5ml’ ampoules were widely distributed within theatres, wards and other departments; however Midazolam in ‘10mg in 5ml’ ampoules had a more limited distribution. 34. On 2 August 2018 Dr McAllister attended an Appeal Hearing convened by the Trust. The Tribunal were provided with extracts from the notes of that Appeal Hearing. During the hearing Dr McAllister’s representative referred to Dr McAllister’s ‘probable’ account of how she may have taken Midazolam home with her. Dr McAllister’s representative stated that the account given by Dr McAllister was a suggestion but that she could not remember. 35. The Tribunal was provided with transcripts of the evidence given by Ms E, Dr F and Ms D at a MPT hearing held in March 2019 (‘the 2019 Tribunal’). Dr McAllister did not attend the 2019 Tribunal which was held to:

• consider whether or not Dr McAllister’s fitness to practise was impaired by reason of misconduct; and

• to review whether or not Dr McAllister’s fitness to practise was impaired by reason of conviction.

36. However, the 2019 Tribunal recused itself, stating:




‘2. On the previous occasion, the Tribunal indicated there were potential issues of procedural unfairness and outlined these in its adjournment determination dated 2 April 2019. 3. The Tribunal has determined that a fair minded and informed observer would consider it inappropriate for this Tribunal to continue to consider this case, applying the test in Porter v Magill [2002] 2 AC 357. It has therefore determined to recuse itself in its entirety.’

Paragraphs 1 and 2 of the Allegation 37. At various stages of the Trust’s investigation and disciplinary process, Dr McAllister accepted that she had removed the vials from Ninewells, explaining that it was a simple mistake. In addition she admitted that she had failed to return the vials, claiming to have forgotten about them. 38. In all the circumstances, the Tribunal found it was more likely than not that, on one or more occasion between 14 December 2012 and 19 September 2014, Dr McAllister removed and knew that she had removed the vials from Ninewells, and failed to return the vials to Ninewells. 39. Therefore, the Tribunal found Paragraphs 1 and 2 of the Allegation, proved. Paragraph 3 of the Allegation – Dishonesty 40. In relation to the dishonesty alleged, the Tribunal had regard to all the evidence before it and its earlier findings, specifically Paragraphs 1 and 2 of the Allegation. Having done so it has applied the test in Ivey v Genting Casinos namely:

’74 […] When dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.’

41. In considering the subjective limb of the Ivey test, the Tribunal found that Dr McAllister removed and knew that she had:

• removed the vials from Ninewells; and

• failed to return the vials to Ninewells.




XXX

42. The Tribunal noted that the 2017 Tribunal had concluded that Dr McAllister’s removal of the vials from Ninewells was accidental. The Tribunal noted that, whilst the 2017 Tribunal did not have sight of Ms E’s supplemental investigation report, it did have the advantage of hearing evidence from Dr McAllister herself. The Tribunal considered that, whilst it was not bound by the comments of the 2017 Tribunal in relation to Dr McAllister’s removal of Midazolam, the comments of the 2017 Tribunal were powerful, given that it had the opportunity to hear evidence from Dr McAllister herself and to assess her credibility. 43. The Tribunal is acutely aware that during her employment at Ninewells, XXX. The Tribunal did not accept Ms Fairley’s submission that Dr McAllister had deliberately changed her version of events once Ms E’s investigation unfolded. 44. The Tribunal also noted that, on 10 May 2015, Dr McAllister told the Police that she had medication in her home then directed to them to the location where the Midazolam had been stored. It noted that the Police did not have a warrant to search Dr McAllister’s home, and that she had volunteered the information in order to assist the Police investigation into Mrs A’s death. The Tribunal thought it was unlikely that Dr McAllister would voluntarily disclose to the Police the whereabouts of the vials of Midazolam in her home if she had removed them deliberately. 45. The Tribunal noted an email dated 10 November 2017 provided by Dr H, a former Clinical Director of Medicine at the Trust, which stated that it would not be unusual for a vial of a drug such as Midazolam to be placed in the pocket of a doctor’s scrubs during a ‘crash call’. 46. Having regard to the conclusions reached by Ms E during her investigation, the Tribunal determined that it was likely that the Midazolam vials were taken by Dr McAllister from Ninewells on more than one occasion. However, the Tribunal did not accept that this fact significantly increased the likelihood that Dr McAllister had taken the vials deliberately. The Tribunal took into account XXX during her employment at Ninewells and considered it likely that she had removed the vials accidentally and had forgotten to return them. 47. In the circumstances of this case, and applying the objective standards of ordinary decent people, the Tribunal concluded that ordinary decent people would find that Dr McAllister’s actions were not dishonest. 48. Therefore, the Tribunal found Paragraph 3 of the Allegation, not proved. Paragraph 4 of the Allegation 49. Paragraphs 4 to 9 of the Allegation relate to Mrs A.




50. The Tribunal had regard to Dr McAllister’s statement to the Police, dated May 2015. It noted that this was her first account which was given on 10 May 2015 at 10:00am, approximately 4 hours after Mrs A’s death. 51. In her Police statement Dr McAllister described how Mrs A told her that she was going to get a tattoo but that she was terrified of needles and disliked the pain associated with the process. Dr McAllister stated that she told Mrs A that, on 9 May 2015, she would leave ‘some painkillers out’ for her in the kitchen. Dr McAllister said, ‘I would leave the door open for her just to let herself in and take them as it’s important that you take the painkillers an hour beforehand, so that they are working at optimum level and I also wanted time with her beforehand to talk to her and calm her down’. Dr McAllister stated that she asked Mrs A to arrive at her home at 13:00pm. 52. Dr McAllister stated that, on 9 May 2015, she left her home at about 12:50pm. Dr McAllister said that she had left a plastic tub on her cooker, which contained 2x 500mg of paracetamol tablets, 2 codeine and ibuprofen tablets (each which contained 200mg of ibuprofen and 12.8mg of codeine) together with a small note advising Mrs A ‘to take the tablets with some Nesquick (milkshake) so that the Ibuprofen didn’t irritate her tummy’. 53. Dr McAllister stated that she received a text message from Mrs A at around 13:30pm to say that Mrs A had just entered Dr McAllister’s house. Dr McAllister replied to Mrs A telling her not to worry because there was still plenty of time. Dr McAllister informed Mrs A that there was some wine in the fridge and that she would be home in 5 minutes. Dr McAllister told the Police that she had returned to her home at approximately 13:35 and that Mrs A was still there watching television with a glass of wine. She stated that Mrs A had taken the medication by that stage and that the ‘painkillers pot was empty’. 54. In her Police Statement Dr McAllister stated that she and Mrs A got to the tattoo studio at 14:30pm. Once the tattoo procedure had begun, Dr McAllister stated that she had comforted Mrs A by ‘playing with her hair’. Dr McAllister explained that she left the tattoo studio after about half an hour, returning approximately 10 minutes later. When she returned Dr McAllister described giving Mrs A a further codeine ibuprofen tablet due to soreness. Before leaving the tattoo studio again, Dr McAllister stated:

‘I said that [Mrs A] could have more painkillers at half past 5 if she needed them. She either had them herself or I might have taken them out of my bag for her. I said she could take another gram of Paracetamol and 2 Codeine/Ibuprofen tablets, but only if she needed them. I said to give me a phone if there was any bother, meaning if she was still in pain or really anxious. I then left about half 4 (1630 hours)’.

55. Dr McAllister stated that she had sent a text message to Mrs A to ascertain how she was getting on. She stated that she had received a message from Mr B using Mrs A’s phone stating that they were done for the day and that Mrs A was walking up the road ‘blethering pish’. Mr B told Dr McAllister that he had put Mrs A to bed as ‘she was talking pish’.




Dr McAllister stated that she was not concerned about Mrs A ‘or the fact she was talking rubbish’ as she described her as ‘quite a character so I thought this wasn’t out of character’. 56. At around 23:30pm, Dr McAllister stated that she sent a text to Mr B to find out how things were going and he replied that ‘everything was fine and [Mrs A] was snoring away’. 57. During the Police’s investigation they retrieved a number of text messages, between Dr McAllister and Mrs A, from Dr McAllister’s mobile telephone. The Tribunal had particular regard to the following text messages sent by Dr McAllister to Mrs A and which are referred to in Schedule 3 of the Allegation:

‘Text message sent on 9 May 2015 at 09:46am

“Well I got violin till half one so if you want to wander down for bout 1 or quarter past 1 - let yourself in and take all the medicines on top of the cooker that I've left out (it'll look like a lot but at least four of them are different types anti-sickness, rest will be paracetamol, brufen, codeine, tramadol and valium which are all the ones I tried you with already they're just the ones that take the hour to work so take them nearer 1 so [XX] can actually start tattooing at 2 (tell home to get everything set up while you're out) Cosy up on the couch and watch my telly for a bit, just let yourself get more and more relaxed and sleepy (don't fight it if you just cosy up on the couch - by the time I get back you'll feel like you've had a good few G&Ts, I’ll top up with the faster acting ones when I get back and we'll get you staggering up to the shop to get tattooed by 2 at the latest?. How does that sound? Kate x”

Text message sent to Mrs A on 9 May 2015 at 12:44pm

“Back in 2. - help yourself to the rest of the white wine that's left in fridge to aid your relaxation xx”

58. The Tribunal accepted the evidence of contemporaneous text messages between Dr McAllister and Mrs A and obtained by the Police. It noted that, on 9 May 2015, their conversation began at 09:46am and the last exchange was at 18:17pm. Paragraph 4(a) of the Allegation 59. Having regard to the above text message exchange, the Tribunal accepted that Dr McAllister had given Mrs A codeine. However, the Tribunal noted that the Allegation defines the Home Address Medication as comprising the following:

• Codeine

• Tramadol

• Valium (Diazepam)




• Two combination tablets containing 200mg of Ibuprofen and 12.8mg of Codeine (‘the Combination Tablet’)

60. The Tribunal noted the finding in Mrs A’s post-mortem report that the codeine in Mrs A’s system was at a ‘therapeutic’ level. XXX. As a result, the Tribunal concluded that it was more likely than not that Dr McAllister supplied codeine to Mrs A in the form of a Combination Tablet only and not as a separate preparation in addition to a Combination Tablet. 61. Therefore, the Tribunal found that it was more likely than not that, on 9 May 2015, Dr McAllister left the medication as set out in Schedule 2 at her home address with the caveat that codeine was supplied in the form of a Combination Tablet only. Subject to that caveat, the Tribunal found Paragraph 4(a) of the Allegation proved. Paragraph 4(b) of the Allegation 62. The Tribunal accepted the evidence of the text messages sent between Dr McAllister and Mrs A on 9 May 2015, that were obtained by the Police following the seizure and interrogation of Dr McAllister’s mobile telephone. 63. Therefore, the Tribunal found that it was more likely than not that, on 9 May 2015, in advance of Mrs A getting a tattoo, Dr McAllister sent the text messages as set out in Schedule 3, to Mrs A. The Tribunal found Paragraph 4(b) of the Allegation, proved. Paragraph 5 of the Allegation 64. The Tribunal noted that Paragraph 5 of the Allegation relates to the medication allegedly given to Mrs A by Dr McAllister. 65. The Tribunal paid particular regard to Dr C’s Expert Report and his oral evidence given during the course of these proceedings. Dr C’s evidence addressed in some detail the medication outlined in Paragraphs 5(a) to (g) of the Allegation. The Tribunal considered Dr C to be a reliable, credible and straightforward witness who tried his best to assist the Tribunal. 66. The Tribunal had regard to Dr C’s Expert Report, in which he gave the following advice about controlled medication:

‘Medicines covered by the Misuse of Drugs Act (Controlled Drugs) are subject to legal control to prevent them being obtained illegally or misused (NICE, 2019). This legal control governs how controlled medicines can be produced, supplied, prescribed, stored and destroyed (NICE, 2019). Patients prescribed controlled drugs should be especially careful to store them safely, never give them to anyone else and to return any unused medicines to a pharmacy for destruction (NICE, 2019). Controlled drugs are divided into five Schedules based on their potential to cause harm – Schedule 1 drugs are subject to maximum control and Schedule 5 drugs are subject to minimal




control. Further information on the controlled drug schedules is given below (BNF, 2015).’

67. The Tribunal also had regard to Good Medical Practice (2013 edition) (‘GMP’), specifically paragraphs 16(a)(g) of GMP, that states: 16 ‘In providing clinical care you must: a. prescribe drugs or treatment, including repeat prescriptions, only when you

have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs. […] g. wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.’

68. The Tribunal also had regard to Mrs A’s post-mortem report that states:

‘it is well recognised that taking drugs together has an additive or ‘Cocktail effect’ and that this may well result in a fatal combination’

Paragraph 5(a)(i) and (ii) of the Allegation 69. For the reasons already given, the Tribunal found that it was likely that Dr McAllister had left Mrs A codeine in the form of a Combination Tablet. The Tribunal noted that the Combination Tablet is an over-the-counter drug which can be purchased from a pharmacy. 70. The Tribunal was not satisfied that Dr McAllister had left Mrs A codeine ‘on its own’ as opposed to in the form of a Combination Tablet. As a result, the Tribunal found Paragraphs 5(a)(i) and (ii) of the Allegation, not proved. Paragraph 5(b) of the Allegation 71. In his Expert Report, Dr C described Tramadol as follows: ‘Tramadol

‘Tramadol is a prescription-only medication that is indicated for the treatment of moderate to severe pain. Tramadol is a strong opioid analgesic but has fewer of the typical opioid side-effects such as constipation and respiratory depression. Tramadol capsules are a Schedule 3 CD and are subject to the special prescription requirements but exempt from the safe custody requirements’




72. The Tribunal accepted Dr C’s expert evidence that Tramadol is a Schedule 3 controlled drug, is prescription-only medication which should only be supplied when having adequate knowledge of the patient’s medical history and current medication, and should only be prescribed for moderate to severe pain. The Tribunal also accepted Dr C’s expert evidence that Tramadol is not clinically indicated for the purposes of relieving the pain associated with having a tattoo. 73. Therefore, the Tribunal found Paragraph 5(b) of the Allegation, proved. Paragraph 5(c) of the Allegation In his Expert Report, Dr C described Diazepam as follows: ‘Diazepam

‘Diazepam is a prescription-only medication from the benzodiazepine family that is indicated for the short-term treatment of severe anxiety. Diazepam may be associated with tolerance and dependence and has the potential for misuse. Diazepam tablets are a Schedule 4 (Part I) CD’.

74. The Tribunal accepted Dr C’s evidence that Diazepam is Schedule 4 controlled drug with the potential for misuse and is a prescription-only medication that should only be supplied when having adequate knowledge of the patient’s medical history and current medication. 75. Therefore, the Tribunal found Paragraph 5(c) of the Allegation proved. Paragraph 5(d) of the Allegation 76. In his Expert Report, Dr C stated:

‘a combination tablet containing 200mg of ibuprofen and 12.8mg of codeine is available as a branded product from several manufacturers (for example – NurofenPlus). This combination is a Pharmacy Only medicine. As such, it may be purchased from a pharmacy, but the sale must be made under the supervision of a pharmacist and the product is not available for self-selection from the pharmacy shelves. The product is intended for the short-term relief of moderate pain […]’

77. It accepted Dr C’s evidence that the Combination Tablet is a pharmacy-only medication which should only be supplied when having an adequate knowledge of the patient’s medical history and current medication. 78. Therefore, the Tribunal found Paragraph 5(d) of the Allegation proved. Paragraph 5(e) of the Allegation




79. In his Expert Report, Dr C stated:

‘[…] Dr McAllister’s advice for [Mrs A] to take a combination of medicines (including opioids and benzodiazepines) placed [Mrs A] at risk of significant harm from adverse effects and drug interactions.’ ‘Codeine, tramadol, diazepam… can all have a sedative effect, and the effect of these drugs in combination is an additional increased risk of sedation’

80. The Tribunal accepted Dr C’s expert evidence and it found that the combination of the Home Address Medication had the potential to cause Mrs A significant harm from adverse effects and drug interactions, and it had the effect of an increased risk of sedation. 81. Therefore, the Tribunal found Paragraph 5(e) of the Allegation proved. Paragraph 5(f) of the Allegation 82. In his Expert Report, Dr C stated:

‘In addition, there is an additional increased risk of respiratory depression when opioid drugs (such as codeine and tramadol) are taken in combination. […] This combination included codeine, tramadol and diazepam which all have a sedative effect, and the effect of these drugs in combination is an additional increased risk of sedation.’

83. Whilst the Tribunal was not satisfied that Mrs A was given codeine phosphate, it found that she was given 24mg of codeine in the form of the Combination Tablets. The Tribunal accepted Dr C’s evidence that the combination of codeine and tramadol have the effect of an increased risk of sedation. 84. Therefore, the Tribunal found Paragraph 5(f) of the Allegation proved. Paragraph 5(g) of the Allegation 85. In his Expert Report, Dr C stated:

‘Taking alcohol in combination with medication is unwise and potentially dangerous for several reasons (Weathermon and Crabb, 1999). Firstly, alcohol is a central nervous system depressant and can cause drowsiness and light headedness. When alcohol is taken in combination with other sedative medications then the severity of these effects can increase. Secondly, alcohol can interfere with the way that other




drugs are absorbed by the body and metabolised in the liver, and this can make the side effects of other medicines more common and more severe.’

86. Having regard to all the evidence before it, the Tribunal found that the combination of alcohol and the Home Address Medication can increase the risk of adverse effects and drug interactions. 87. Therefore, the Tribunal found Paragraph 5(g) of the Allegation, proved. Paragraph 6 of the Allegation Paragraph 6(a) 88. The Tribunal had regard to Dr McAllister’s police statement where she stated that Mrs A, ‘took another codeine tablet I gave to her’. It noted in Dr McAllister’s statement that she described giving Mrs A another codeine tablet at around 15:00pm. This was because Dr McAllister stated that she had arrived at the tattoo studio at around 14:30pm, stayed for 30 minutes before leaving to go to a cash machine and then returned approximately 10 minutes later. 89. The Tribunal accepted Dr McAllister’s description of giving Mrs A an additional Combination Tablet at or around 15:00. 90. Therefore, the Tribunal found Paragraph 6(a) of the Allegation proved. Paragraph 6(b) 91. In her statement to the Police, Dr McAllister further stated:

‘I said to [Mr B] that [Mrs A] could have more painkillers at half past 5 if she needed them. She either had them herself or I might have taken them out of my bag for her. I said she could take another gram of Paracetamol and 2 Codeine/Ibuprofen tablets, but only if she needed them. I said to give me a phone if there was any bother, meaning if she was still in pain or really anxious.’

92. The Tribunal accepted Dr McAllister’s description of her advice to Mrs A about taking 2 additional Combination Tablets at or around 17:30 in Dr McAllister’s absence. 93. Therefore, the Tribunal found Paragraph 6(b) of the Allegation proved. Paragraph 6(c) 94. The Tribunal had regard to a statement by Ms G, a friend of Mrs A, who attended at the Studio on 9 May 2015. In her statement to the Police, dated 4 June 2015 at 11:14am, Ms G stated:




‘[…] Mrs A asked me to go into a shopping bag which was in the room and pass her a bottle of orange juice. At this time she also asked me to go into one of the cabinets under the counter in the room and get her some tablets. I opened the cabinet door and saw, I think, two boxes of tablets. I did not see what type of tablets they were. The two boxes were white in colour. I did not see the colour of any writing on them if there was writing on them. The boxes were a couple of inches in length. I knew the tablets were not generic ones or ones you could buy in a supermarket, I think they were prescription tablets. [Mrs A] confirmed these were the tablets she wanted and I handed the two boxes to [Mrs A] and I saw [Mrs] A go into the boxes but I did not see how many tablets she took out of them. I saw her place something out of the boxes into her mouth, which I’m pretty sure was a tablet or pill and place it in her mouth, then take a drink of the juice to help her swallow it. This was the only time Mrs A took anything or drank anything whilst I was in the shop with her and [Mr B]’.

95. The Tribunal also had regard to Mrs G’s witness statement dated 13 November 2018 in which she stated:

‘[…] Mrs A asked me to do her a favour and pass her some pills that were in the cabinet. She said that Katy had given her some pills to help with the pain of getting a tattoo done. The cabinet was right beside where I was and so I reached inside and took out a plain box… Mrs A and I carried on our conversation whilst I took the box out of the cupboard… I didn’t question Mrs A about what the pills were or why she had them’

96. The Tribunal had regard to the evidence of Mr B, XXX. In a witness statement provided to the Police, Mr B stated:

‘[…] before she left Katy said to Mrs A to take the same tablets she had given her in the house so many hours later and to leave the rest under the sink at the shop as she was going to take them on Sunday when she got her tattoo done’

97. In a further statement to the Police Mr B also stated:

‘[…] Katy put something which I didn’t properly see under the sink in the tattoo studio. I believed that it was some sort of pain medication for Mrs A… She said that she would leave something for herself under the sink along with what she was leaving for Mrs A but she was going to separate it in some way from the stuff she left for Mrs A. I never saw what she (Katy) left under the sink’

98. The Tribunal had regard to an extract of evidence of Mr B, dated 16 May 2017, during a court hearing involving Dr McAllister. During questioning, Mr B responded to questioning as follows:




Question ‘All right. Having gone to the cupboard you’ve told us Dr McAllister went to the cupboard and she opened it Answer Yes Question Did she do something, having opened the door? Answer Yes Question What did she do? Answer She put the medication in the cupboard Question Alright. How did you know it was medication Answer Er, I knew because, erm … I don’t know the details of the conversation but I knew that, erm, Katy had asked her… asked to take some more after a certain amount of time’ […]

Question ‘All right. And was Dr McAllister there when XXX took some medication? Answer No’

99. Whilst the Tribunal considered that Mr B’s account of the events on 9 May 2015 was less than precise, this was perhaps understandable given that the death of XXX must have been a very traumatic experience for him. Further the Tribunal considered that neither Mr B nor Ms G had any reason to be untruthful. Whilst there was little evidence to suggest what medication was left at the Studio by Dr McAllister (or in what quantity) the Tribunal found, on the balance of probability, that what was left by her included medication for the relief of pain. This was particularly given the evidence before the Tribunal that whilst Mrs A wanted tattoos she was sensitive to the pain involved in the tattooing process.




100. Notwithstanding the lack of precision in their evidence, the Tribunal accepted Mr B’s description of events and that of Ms G. Having carefully considered that evidence the Tribunal concluded that, on balance, Dr McAllister left painkilling medication at the Studio for Mrs A to take in her absence. The Tribunal considered that there was no evidence to suggest that anyone else, other than Dr McAllister, would have left medication for Mrs A. 101. Therefore, the Tribunal found Paragraph 6(c) of the Allegation proved. Paragraph 7 of the Allegation Paragraph 7(a) of the Allegation 102. For the reasons already given, the Tribunal found proved that, on 9 May 2015, while Mrs A was getting a tattoo at the Studio, Dr McAllister gave Mrs A one additional Combination Tablet at or around 15:00. 103. In his supplementary Expert Report, Dr C stated:

‘The dosing instructions for ibuprofen/codeine (200mg/12.8mg) are as follows: take one or two tablets every 4-6 hours, minimum interval between doses four hours, maximum six tablets in 24 hours My opinion is that supply of ibuprofen/codeine (200mg/12.8mg) to [Mrs A] was below the standard expected of a reasonably competent prescribing doctor because of the potential for [Mrs A] to suffer adverse effects. It is also my opinion that is was not appropriate to give [Mrs A] another ibuprofen/codeine (200mg/12.8mg) tablet at about 3pm because the dosing instructions state that there should be a minimum of four hours between doses. However, I do not feel that this failing was seriously below the standard expected because ibuprofen/codeine (200mg/12.8mg) is available without prescription, and the potential for harm is low’.

104. The Tribunal accepted Dr C’s expert evidence in that regard and found Dr McAllister’s actions were inappropriate but did not fall seriously below the standards set out in GMP. 105. As a result, the Tribunal found that Dr McAllister’s actions as set out in Paragraph 6(a) of the Allegation, were inappropriate in that:

• there was a potential for Mrs A to suffer adverse effects; and

• the dosing instructions for the Combination Tablets provide for a minimum of four hours between doses.

106. Therefore, the Tribunal found Paragraphs 7(a)(i) and (ii) of the Allegation proved.




Paragraph 7(b) of the Allegation 107. For the reasons already given, the Tribunal found proved that, on 9 May 2015, while Mrs A was getting a tattoo at the Studio, Dr McAllister advised that Mrs A could take two additional Combination Tablets at or around 17:30 in her absence. 108. In his Expert Report, Dr C stated:

‘If it is accepted that Dr McAllister gave [Mrs A] one ibuprofen/codeine (200mg/12.8mg) tablet at about 3pm, then [Mrs A] should not have taken a further dose of this medicine for four hours, i.e. not until about 7pm. If this account is accepted then my opinion is that Dr McAllister’s advice to [Mrs A] to take another two tablets at about 5-30pm was not appropriate and was below the standard expected because this was not in line with the dosing instructions. However, I do not feel that this failing was seriously below the standard expected because ibuprofen/codeine (200mg/12.8mg) is available without prescription, and the potential for harm is low.’ […] ‘My opinion is that, if the account given in Dr McAllister’s statement to the Police on 10.05.15 is accepted, the supply of ibuprofen/codeine (200mg/12.8mg) to Patient on 09.05.15 was below the standard expected of a reasonably competent prescribing doctor because of the potential for [Mrs A] to suffer adverse effects. However, I do not feel that this failing was seriously below the standard expected because ibuprofen/codeine (200mg/12.8mg) is available without prescription, and the potential for harm is low.’

109. The Tribunal accepted Dr C’s expert evidence in that regard and found Dr McAllister’s actions were inappropriate but did not fall seriously below the standards set out in GMP. As a result, the Tribunal found that Dr McAllister’s actions set out in Paragraph 6(b) of the Allegation were inappropriate in that:

• there was a potential for Mrs A to suffer adverse effects;

• Mrs A should not have taken a further dose of the Combination tablets until around 19:00; and

• a further dose of the Combination Tablets at 17:30 was not in line with the dosing instructions for the Combination Tablets.

110. Therefore, the Tribunal found Paragraphs 7(b)(i), (ii) and (iii) of the Allegation, proved. Paragraphs 7(c)(i)(i) and (i)(ii) of the Allegation 111. For the reasons already set out, the Tribunal found proved that, on 9 May 2015, while Mrs A was getting a tattoo at the Studio, Dr McAllister left painkilling medication at the Studio for Mrs A to take in her absence. 112. In his Expert Report, Dr C stated:




‘My opinion is that it was not appropriate for Dr McAllister to leave this combination of drugs for Patient because of the potential for Patient to suffer significant harm from adverse effects and drug interactions. Codeine, tramadol, diazepam can all have a sedative effect, and the effect of these drugs in combination is an additional increased risk of sedation’.

113. The Tribunal considered that it was inappropriate that Dr McAllister had left Mrs A further tablets to take without being in a position to review her condition. It noted that Mrs A had taken tramadol and diazepam and had been left instructions from Dr McAllister to take more tablets in her absence. The Tribunal considered that was inappropriate given the risk of serious harm to Mrs A from the combination effect of the medication. 114. In all the circumstances, on the balance of probabilities, the Tribunal considered that Dr McAllister’s actions as set out in Paragraph 6(c) of the Allegation, were inappropriate in that she was not in a position to assess the effects of the cocktail of medication already taken by Mrs A and to assess the side effect of sedation. 115. Therefore, the Tribunal found Paragraphs 7(c)(i)(i) and (i)(ii) of the Allegation, proved Paragraph 8 of the Allegation 116. The Tribunal had regards to each of the sub-paragraphs of Paragraph 8 of the Allegation, separately: Paragraph 8(a) of the Allegation 117. The Tribunal accepted that Dr McAllister did not have a clinical relationship with Mrs A and that the medication given to Mrs A by Dr McAllister was not provided in a clinical setting. The Tribunal accepted Dr C’s expert evidence that Dr McAllister’s actions were in breach of, and fell seriously below the standards outlined in, GMP, specifically paragraph 16(a). 118. In all the circumstances, and on the balance of probabilities, the Tribunal found that Dr McAllister’s actions, as set out in Paragraphs 4 to 7 of the Allegation, were inappropriate in that she did not have a clinical relationship with Mrs A. 119. Therefore, the Tribunal found Paragraph 8(a) of the Allegation, proved. Paragraph 8(b) of the Allegation 120. In her Police interview on 8 July 2015, at 12:47pm, Dr McAllister stated during questioning: ‘DC




Ok, we’ll move on then to your relationship with Mrs A and Mr B, how did you meet them? [Dr McAllister] I went into the shop one day […] DC And how would you describe your relationship with them? [Dr McAllister] Really good, they really were nice to me XXX. […] DC Em and you, you described them as good friends and that you were close to them and your relationship was good [Dr McAllister] Yeah’

121. In addition, the Tribunal noted Dr McAllister’s description of Mrs A as one of her ‘best friends’ in an email to the Trust sent by Dr McAllister on 11 May 2015. In her Police statement dated 10 May 2015, Dr McAllister described her relationship with Mr B and Mrs A as follows:

‘[…] About 6 months ago I went to get a tattoo at ‘Voodoo Studio’ on [] Road. That’s when I met Mr B and XXX, Mrs A. Mr B was the tattoo artist and I hit it off with Mr B and Mrs A straight away, and we became really good friends. I would go to their house for meals and drinks and vice-versa and we would go out for meals and things like that’

122. The Tribunal accepted that the above evidence from Dr McAllister demonstrated that Dr McAllister, Mr B and Mrs A had a close personal relationship which was not clinical in nature. Further, the Tribunal noted that, whilst at the Studio, Dr McAllister had ‘played’ with Mrs A’s hair in an attempt to relax her whilst she was having a tattoo procedure. The Tribunal considered that this was further evidence of the close personal relationship between Dr McAllister and Mrs A. 123. In all the circumstances, and on the balance of probabilities, the Tribunal found Mrs A was someone with whom Dr McAllister had a close personal relationship.




124. The Tribunal found that Dr McAllister’s actions, as set out in Paragraphs 4 to 7 of the Allegation, were inappropriate in that:

• Mrs A was a person with whom she had a close personal relationship; and

• consequently, Dr McAllister was in breach of the requirements of GMP. 125. Therefore, the Tribunal found Paragraph 8(b) of the Allegation, proved. Paragraph 8(c) of the Allegation 126. In his Expert Report, Dr C stated:

‘My opinion is that Dr McAllister’s action in providing medication for [Mrs A] was not appropriate because [Mrs A] was a person with whom Dr McAllister had a close personal relationship and the context for providing medication for [Mrs A] (getting a tattoo) was not a medical emergency.’

127. The Tribunal accepted Dr C’s expert evidence in that regard and was satisfied that having a tattoo procedure was not a medical emergency. It therefore found that Dr McAllister’s actions, as set out in Paragraphs 4 to 7 of the Allegation, were inappropriate. 128. Therefore, the Tribunal found Paragraph 8(c) of the Allegation, proved. Paragraph 8(d) of the Allegation 129. In his Expert Report, Dr C stated:

‘The medications referred to in the text messages from Dr McAllister are paracetamol, ibuprofen, codeine, tramadol and diazepam. Dr McAllister also refers to “anti-sickness medicines” and my opinion is that the anti-sickness medicines referred to are likely to include cyclizine. The medication left at the tattoo studio is not known but the information contained in the bundle suggests that Dr McAllister advised [Mrs A] to take the same medication that she had taken in the house. My opinion is that [Mrs A] was at risk of adverse effects from the combination of medicines left by Dr McAllister in the house, in particular the risk of sedation from taking a combination of medicines with a sedative effect. If it is accepted that Dr McAllister left the same combination of medicines at the tattoo studio and advised [Mrs A] to take them then my opinion is that this would lead to an additional increased risk from drug interactions and adverse effects such as, but not limited to, sedation. My opinion is that the potential effects of this combination are difficult to predict because the exact combination and doses of medicines involved is not known. However, the potential for adverse effects and interactions increases significantly with the number and quantity of drugs involved. My opinion is that Dr McAllister’s actions in advising [Mrs A] to take additional medication left at the tattoo studio were seriously below the




standard expected because [Mrs A] was exposed to a significant risk of adverse effects.

130. The Tribunal accepted Dr C’s expert evidence in that regard. Whilst the Tribunal was conscious that there was a lack of clarity as to what medicines were left by Dr McAllister for Mrs A at the Studio it nevertheless accepted Dr C’s expert evidence that the effect of the various medications in combination was to place Mrs A at serious risk of harm from the adverse effects of medication. 131. Therefore, the Tribunal found Paragraph 8(d) of the Allegation proved. Paragraph 9 of the Allegation 132. In his Expert Report, Dr C stated:

‘[…] my opinion is that Dr McAllister’s actions in supplying a combination of medicines and advising [Mrs A] to take this combination contributed to [Mrs A] death as certified by the pathologist.’

133. The Tribunal noted its earlier findings that

• Dr McAllister left the Home Address Medication for Mrs A to take on 9 May 2015;

• The combination of medication provided to Mrs A by Dr McAllister had the potential for Mrs A to suffer adverse effects such as respiratory depression;

• Dr McAllister advised Mrs A to consume alcohol shortly after taking the home address medication;

• The combination of the alcohol and Home Address Medication increased the risk of adverse effects and drug interactions;

• Dr McAllister gave Mrs A an additional combination tablet at 15:00pm on 9 May 2015;

• Dr McAllister left additional painkilling medication at the Studio for Mrs A to take in her absence;

• Dr McAllister, in providing Mrs A with an additional combination tablet and advising her to take further combination tablets at 17:30pm on 9 May 2015 did not follow the dosing instructions;

• The additional painkilling medication left by Dr McAllister at the Studio was inappropriate because Dr McAllister was not in a position to assess the effects of the painkilling medication already taken by Mrs A or the side effect of sedation on her; and

• As a result of Dr McAllister leaving additional painkilling medication at the Studio for Mrs A there was an additional potential for Mrs A to suffer serious adverse effects.




134. The Tribunal also had regard to Mrs A’s post mortem report, which concluded that her death was caused by ‘Combined Acute Drug Toxicity’ from drugs including codeine, tramadol, and diazepam. 135. Having regard to the Tribunal’s findings and the evidence before it, it concluded that it was more likely than not that Dr McAllister’s actions as set out in paragraphs 4 to 8 of the Allegation, contributed to Mrs A’s death. 136. Therefore, the Tribunal found Paragraph 9 of the Allegation, proved. Paragraphs 10 and 11 of the Allegation 137. The Tribunal noted that these Paragraphs of the Allegation relate to an offence under the Road Traffic Act 1988. 138. The Tribunal considered documentation provided to it from Dundee Sheriff Court (including an Extract Conviction Report, dated 8 November 2019) which confirmed that, on 2 May 2019, Dr McAllister was convicted of:

• driving whilst unfit to drive through drink or drugs; and

• without due care and attention, or without reasonable consideration for other persons when using the road or place.

139. As a result of her conviction for driving whilst unfit to drive through drink or drugs at Dundee Sheriff Court, Dr McAllister was sentenced on 30 May 2019 to:

• Carry out unpaid work for 100 hours;

• A community payback order;

• 12 months’ supervision; and

• 12 months’ disqualification from holding and obtaining a driving licence. 140. In respect of Dr McAllister’s conviction for ‘driving with undue care and attention’, Dundee Sherriff Court on 30 May 2019:

• dismissed Dr McAllister’s case with admonition; and

• endorsed Dr McAllister’s driving licence. 141. The Tribunal accepted the documents before it as conclusive evidence of the conviction and sentence of the Court and found Paragraphs 10 and 11 of the Allegation proved in its entirety.




Paragraph 12 and 13 of the Allegation 142. The Tribunal noted that these Paragraphs of the Allegation relate to an offence under the Customs and Excise Management Act 1979. 143. The Tribunal considered documentation provided to it in from Dundee Sheriff Court (including an Extract Conviction Report, dated 9 January 2020), which confirmed that, on 17 September 2019, Dr McAllister was convicted of four counts of importation or being concerned with the importation of:

• morphine, a Class A controlled drug;

• oxycodone, a Class A controlled drug;

• diazepam, a Class C controlled drug; and

• temazepam, a Class C controlled drug. contrary to a prohibition or restriction with the intent to evade the prohibition or restriction.

144. As a result of the above conviction, Dr McAllister was, on 3 January 2020, sentenced by Dundee Sheriff Court to:

• carry out unpaid work for 210 hours;

• a community payback order; and

• two years’ supervision. 145. The Tribunal accepted the documents before it as conclusive evidence of the conviction and sentence of the Court and found Paragraphs 12 and 13 of the Allegation proved in its entirety. The Tribunal’s Overall Determination on the Facts 146. The Tribunal has determined the facts as follows:

Ninewells Hospital

1. On one or more occasion between 14 December 2012 and 19 September 2014, you:

a. removed the vials of Midazolam as set out in Schedule 1 (‘the Vials’)

from Ninewells Hospital (‘Ninewells’); Determined and found proved

b. failed to return the Vials to Ninewells.

Determined and found proved




2. You knew that you had:

a. removed the Vials from Ninewells;


b. failed to return the Vials to Ninewells. Determined and found proved

3. Your actions as set out in paragraph 1 were dishonest by reason of paragraph

2. Determined and not proved

Mrs A

4. On 9 May 2015, in advance of Mrs A getting a tattoo, you:

a. left the medication as set out in Schedule 2 at your home address (‘the Home Address Medication’); Determined and found proved

b. sent the text messages as set out in Schedule 3 to Mrs A.


5. Your actions as set out in paragraph 4 were inappropriate in that:

a. codeine on its own is a:

i. ‘Schedule 5 Controlled drug’ with potential for misuse; Determined and not proved

ii. prescription-only medication which should only be supplied

when having adequate knowledge of the patient’s medical history and current medication; Determined and not proved

b. tramadol:

i. is a ‘Schedule 3 Controlled drug’ with potential for misuse;


ii. is a prescription-only medication which should only be supplied when having adequate knowledge of the patient’s medical history and current medication; Determined and found proved




iii. should only be prescribed for moderate to severe pain; Determined and found proved

iv. is not clinically indicated for the purposes of pain relief for

someone getting a tattoo because the risks of adverse effects outweigh the potential benefits; Determined and found proved

c. diazepam is a:

i. ‘Schedule 4 Controlled drug’ with potential for misuse;


ii. prescription-only medication which should only be supplied when having adequate knowledge of the patient’s medical history and current medication; Determined and found proved

d. the Combination Tablet is a pharmacy-only medication which should

only be supplied when having adequate knowledge of the patient’s medical history and current medication; Determined and found proved

e. the combination of the Home Address Medication had the:

i. potential to cause Mrs A significant harm from:

i. adverse effects;


ii. drug interactions; Determined and found proved

ii. effect of an increased risk of sedation;


f. the combination of codeine and tramadol has the effect of an increased risk of respiratory depression; Determined and found proved

g. the combination of alcohol and the Home Address Medication can

increase the risk of:

i. adverse effects; Determined and found proved




ii. drug interactions. Determined and found proved

6. On 9 May 2015, while Mrs A was getting a tattoo at Voodoo Tattoo studio (‘the Studio’), you:

a. gave Mrs A one additional Combination Tablet at or around 15:00;


b. advised that Mrs A could take two additional Combination Tablets at or around 17:30 in your absence; Determined and found proved

c. left painkilling medication at the Studio for Mrs A to take in your

absence. Determined and found proved

7. Your action as set out in paragraph:

a. 6a was inappropriate in that:

i. there was potential for Mrs A to suffer adverse effects; Determined and found proved

ii. the dosing instructions for the Combination Tablets provide for

a minimum of four hours between doses; Determined and found proved

b. 6b was inappropriate in that:



ii. Mrs A should not have taken a further dose of the Combination Tablets until around 19:00; Determined and found proved

iii. a further dose of the Combination Tablets at 17:30 was not in

line with dosing instructions for the Combination Tablets; Determined and found proved

c. 6c was inappropriate in that:

i. you were not in a position to assess the:

i. effects of the combination of medication already taken

by Mrs A; Determined and found proved




ii. side effect of sedation;


ii. there was an additional potential for Mrs A to suffer serious adverse effects from additional doses of medication. Determined and found proved

8. Your actions set out in paragraphs 4 to 7 were inappropriate in that:

a. you did not have a clinical relationship with Mrs A;


b. Mrs A was a person with whom you had a close personal relationship; Determined and found proved

c. the context for providing medication for Mrs A was not a medical

emergency; Determined and found proved

d. you placed Mrs A at significant risk of harm from adverse effects of medication. Determined and found proved

9. Your actions set out in paragraphs 4 to 8 above contributed to Mrs A’s death

in that the medical cause of Mrs A’s death as per the post-mortem report was combined acute drug toxicity from drugs including:

a. codeine; Determined and found proved

b. tramadol; Determined and found proved

c. diazepam. Determined and found proved

Conviction under the Road Traffic Act 1988

10. On 2 May 2019, at Dundee Sheriff Court you were convicted of driving:

a. whilst unfit to drive through drink or drugs;


b. without due care and attention, or without reasonable consideration for other persons using the road or place. Determined and found proved

11. On 30 May 2019:




a. you were sentenced to:

i. carry out unpaid work for 100 hours; Determined and found proved

ii. a community payback order;


iii. 12 months’ supervision; Determined and found proved

iv. 12 months’ disqualification from holding and obtaining a driving licence, Determined and found proved

in respect of your conviction set out at paragraph 10a;

b. the Dundee Sheriff Court:

i. dismissed your case with an admonition;


ii. endorsed your driving licence, Determined and found proved

in respect of your conviction set out at paragraph 10b.

Conviction under the Customs and Excise Management Act 1979

12. On 17 September 2019, at Dundee Sheriff Court you were convicted of four

counts of importation or being concerned in the importation of:

a. morphine, a Class A controlled drug; Determined and found proved

b. oxycodone, a Class A controlled drug;


c. diazepam, a Class C controlled drug; Determined and found proved

d. temazepam, a Class C controlled drug,

Determined and found proved contrary to a prohibition or restriction with the intent to evade the prohibition or restriction.




13. On 3 January 2020, you were sentenced to:

a. carry out unpaid work for 210 hours; Determined and found proved

b. a community payback order; Determined and found proved

c. two years’ supervision. Determined and found proved

Determination on Impairment - 07/09/2020 Rule 41 1. The Tribunal determined that, pursuant to Rule 41 XXX of the Rules, the determination will be announced in private given that it relates to XXX. However, a redacted version will be published at the close of the hearing. IMPAIRMENT 2. Having given its Determination on the Facts in this case, the Tribunal has considered, in accordance with Rule 17(2)(k) of the Rules, whether, on the basis of the facts which it has found proved, Dr McAllister’s fitness to practise is impaired by reason of misconduct and/or conviction. 3. After handing down its Determination on the Facts, Ms Fairley informed the Tribunal that Dr McAllister was subject to an unexpired sanction. That sanction, of 12 months’ suspension, had been imposed by the 2017 Tribunal, which found that Dr McAllister’s fitness to practise was impaired by reason of a conviction under the Misuse of Drugs Act 1971. Ms Fairley invited the Tribunal to conduct a review of that sanction and she provided it with additional documentation which included, but was not limited to:

• Determinations and Annexes from Dr McAllister’s previous MPTs; and

• Testimonials presented to the 2017 Tribunal attesting to Dr McAllister’s good character; and

• Correspondence to Dr McAllister notifying her of the arrangements for the Tribunal’s review.

4. The Tribunal has separately considered both:

• Those paragraphs of the Allegation found proved at the Facts stage, in accordance with Rule 21A; and

• A review under Rule 22(1)(f) of whether Dr McAllister’s fitness to practise remains impaired by reason of her conviction under the Misuse of Drugs Act 1971.




Background to the Review Elements of the Case 5. The Tribunal does not propose to rehearse the background to Dr McAllister’s previous hearings in detail, beyond the following summary: The 2017 Tribunal (New Hearing) 6. Dr McAllister’s case was initially considered by the 2017 Tribunal. 7. At the hearing of the 2017 Tribunal, Dr McAllister admitted to the entirety of the Allegation against her and, thus, the 2017 Tribunal found proved that:

• On 26 May 2017, at the High Court in Edinburgh, Dr McAllister was convicted of:

o Three counts of supplying or offering to supply a controlled drug to another, contrary to section 4(3)(a) of the Misuse of Drugs Act 1971 (‘the Act’); and

o Two counts of having controlled drugs in her possession, contrary to section 5(2) of the Act;

• On 27 June 2017, at the High Court in Glasgow, Dr McAllister was sentenced to carry out a total of 150 hours of unpaid work within 9 months.

8. The 2017 Tribunal was of the view that the facts giving rise to Dr McAllister’s conviction demonstrated a concerning disregard to her management of controlled drugs. It considered that Dr McAllister should have known the potential harmful effects of supplying a controlled drug to another without appropriate medical supervision and therefore, Dr McAllister had fallen short of the public’s expectations of her as a responsible and safe doctor. It considered that she had undermined public confidence in the medical profession and that her fitness to practise was impaired by reason of her conviction. 9. However, the 2017 Tribunal concluded that Dr McAllister appreciated the magnitude of her actions and understood that she should have behaved differently. It was satisfied that she had significant and meaningful insight into her actions and the consequences of those actions, as well as insight into XXX. The 2017 Tribunal was satisfied that there was only a ‘negligible’ risk that Dr McAllister would repeat the actions which gave rise to her conviction. 10. Having found her fitness to practise impaired, the 2017 Tribunal determined to suspend Dr McAllister’s registration for a period of 12 months. However, the 2017 Tribunal determined that it was not necessary to direct a review hearing. In light of positive testimonial evidence, the 2017 Tribunal was satisfied that:

• there were no concerns as to Dr McAllister’s clinical skills; and

• she would keep her medical skills and knowledge up to date.




Assistant Registrar (‘AR’) (Referral to MPTS) 11. On 15 November 2017, an AR referred Dr McAllister’s case back to the MPTS for a review to be scheduled. The AR determined that, in light of Dr McAllister’s suspension for 12 months, it would be appropriate for a Review Hearing to take place to ensure that Dr McAllister had kept her knowledge and skills up to date. The 2018 Tribunal (Review Hearing) 12. On 16 November 2018, a MPT (‘the 2018 Tribunal’) convened to review whether Dr McAllister remained impaired by reason of her conviction. The 2018 Tribunal heard evidence that, on 23 August 2018, Dr McAllister had been notified by the GMC of an allegation relating to the circumstances of how she came to be in the possession of Midazolam (‘the Midazolam Allegation’), which was one of the controlled drugs for which she was convicted in May 2017. 13. In light of that evidence, the 2018 Tribunal determined to adjourn the review hearing so that a single Tribunal could:

• determine the Midazolam Allegation; and

• conduct a review of Dr McAllister’s suspension. 14. The 2018 Tribunal extended the period of Dr McAllister’s suspension by 6 months, to cover the period of adjournment. The March 2019 Tribunal (New and Review Hearing) 15. On 25 March 2019 a MPT hearing (‘the March 2019 Tribunal’) commenced in order:

• to determine the Midazolam Allegation; and

• to conduct a review of Dr McAllister’s suspension. 16. Dr McAllister was neither present nor represented at the March 2019 Tribunal; neither did she engage with MPTS Case Management nor case preparation in advance of the hearing. However, the March 2019 Tribunal determined that she had been properly served in accordance with Rule 20, 31 and 40 of the Rules and determined to proceed in Dr McAllister’s absence. 17. On 2 April 2019, after reaching a decision as to the facts of the Midazolam Allegation, but prior to conducting a review of Dr McAllister’s suspension, the March 2019 Tribunal identified areas of potential procedural unfairness. In light of those concerns, the March 2019 Tribunal determined to adjourn proceedings for a short period to allow Dr McAllister an opportunity to provide further evidence and/or to seek legal advice.




18. The March 2019 Tribunal also determined to extend the period of Dr McAllister’s suspension for a further 3 months from 11 June 2019 (the date on which her suspension was due to expire). 19. On 8 May 2019, the March 2019 Tribunal reconvened and determined to recuse itself in its entirety, setting out that a fair-minded and informed observer would consider it inappropriate for the Tribunal to continue with the case given the potential issues of procedural unfairness. The August 2019 Tribunal (Review Hearing) 20. On 7 August 2019, a newly constituted MPT (‘the August 2019 Tribunal’) was convened to review whether Dr McAllister remained impaired by reason of her conviction. 21. However, the GMC requested an adjournment of the hearing due to further new allegations relating to Dr McAllister’s involvement in the death of Mrs A (‘the Mrs A Allegations’). The August 2019 Tribunal also heard evidence that a MPTS Case Manager had granted a GMC application to join the Mrs A Allegations and the Midazolam Allegations with a review of Dr McAllister’s suspension. The August 2019 Tribunal was informed that those matters were scheduled to be heard by another MPT and that hearing dates had been set. 22. Consequently, the August 2019 Tribunal directed an adjournment and determined to extend Dr McAllister’s suspension for a further period of 3 months. The November 2019 Tribunal (Review Hearing) 23. On 26 November 2019, a MPT (‘the November 2019 Tribunal’) was convened to review Dr McAllister’s case and was informed that the following, further matters had come to light:

• ‘On 11 September 2019 the GMC was informed by Dundee Sherriff Court that Dr McAllister had been convicted of driving whilst unfit through drink or drugs. She was sentenced to a community payback order with 12 months supervision, 100 hours unpaid work, and was disqualified from driving for 12 months;

• Dr McAllister had pleaded guilty to historic offences (dating from 2017) of Importing Class A (morphine and oxycodone) and Class C (diazepam and temazepam) controlled drugs. She was due to be sentenced in respect of these offences in January 2020; and

• Dr McAllister’s new and review hearing had been scheduled to take place in October 2019, but a postponement had been granted XXX. Dr McAllister had been informed of this decision but had not provided a response. An Assistant Registrar had subsequently decided to refer the new convictions directly to a MPT.’




24. The November 2019 Tribunal heard that the new and review matters were linked, given they all concerned the potential misuse of controlled drugs. The GMC submitted that dealing with all matters at the same time would allow for a fuller assessment of Dr McAllister’s impairment, XXX. 25. The November 2019 Tribunal granted the GMC’s application for an adjournment and determined to extend Dr McAllister’s suspension for a further period of 7 months. The June 2020 Tribunal 26. On 22 June 2020, a MPT (‘the June 2020 Tribunal’) was convened to review Dr McAllister’s case. However, it also determined to adjourn. 27. The June 2020 Tribunal noted that a MPT hearing had been listed to consider Dr McAllister’s case in its entirety on 1 June 2020, but that hearing was postponed due to COVID-19. It accepted that the postponement of that hearing was not the fault of the GMC, and also accepted that was in the public interest (as well as that of Dr McAllister) for all of the issues in the case to be considered at one hearing by the same Tribunal. Given that the postponement of the hearing scheduled for 1 June 2020 was unavoidable, and given the GMC’s submission that the case was ‘ready to go’ in August 2020, the June 2020 Tribunal determined that it was proportionate in all of the circumstances to adjourn. 28. However, the June 2020 Tribunal noted that Dr McAllister’s review hearing had been adjourned on 5 occasions and that her suspension, imposed by the 2017 Tribunal, had been in place for over three years. The June 2020 Tribunal was concerned by the impact of these repeated adjournments XXX and considered that the cumulative impact of the adjournments might not be in the public interest. However, the June 2020 Tribunal also noted that Dr McAllister appeared to be no longer engaging with the MPTS. 29. The June 2020 Tribunal determined to extend the period of Dr McAllister’s suspension for a further period of 4 months to cover the period of adjournment. The Evidence In considering whether or not Dr McAllister’s fitness to practise is impaired by reason of:

• those paragraphs of the Allegation which the Tribunal found proved; and/ or

• by reason of the conviction that gave rise to her suspension by the 2017 Tribunal.

the Tribunal carefully considered all the evidence before it.




Submissions on behalf of the GMC 30. The following is a non-exhaustive synopsis of Ms Fairley’s submission on behalf of the GMC, made during the impairment stage. 31. Ms Fairley submitted that Dr McAllister’s fitness to practise is impaired by reason of her misconduct and conviction in relation to those elements of the Allegation found proven by the Tribunal, and remains impaired by reason of the conviction that led to her suspension in 2017. Mrs A 32. Ms Fairley submitted that Dr McAllister’s actions in leaving medication for Mrs A in the manner, and in the combination, found proven by the Tribunal would be regarded as deplorable by fellow practitioners. She stated that Dr C’s expert evidence was that Dr McAllister’s conduct fell seriously below the expected standards and that her actions, in relation to Mrs A, breached fundamental tenets of the medical profession. 33. Ms Fairley submitted that the Tribunal had made some reference to GMP in its determination on the facts and invited the Tribunal to consider that Dr McAllister had also breached paragraph 65 of GMP, regarding acting with honesty and integrity. She stated that the provision of medication is one of the most basic elements of a doctor’s interaction with a patient. Ensuring that proper safeguards are in place in relation to prescribing medication is something that should be at the forefront of a doctor’s mind. She stated that significant trust is placed in doctors when prescribing medication. 34. Ms Fairley submitted that Dr McAllister’s actions were in breach of GMP, paragraph 16, which refers to a doctor’s obligation to prescribe drugs only with adequate knowledge of the patient’s health. In addition, paragraph 16 provides that doctors should avoid providing medical care to anyone with whom they have a close personal relationship. 35. Ms Fairley submitted that Dr McAllister’s actions put Mrs A at unwarranted risk of harm due to the risk of adverse effects from the drugs she provided to Mrs A and the potential for serious drug interactions. She submitted that Mrs A was not a patient of Dr McAllister and that her actions were outwith a clinical setting. Ms Fairley directed the Tribunal’s attention to the conclusions of the post mortem report which set out the reasons for Mrs A’s death. 36. Ms Fairley drew the Tribunal’s attention to the evidence of Mr B, where he referred to the trust that he had placed in Dr McAllister because she is a doctor. Ms Fairley also reminded the Tribunal of Ms G’s evidence in which she referred to having placed her trust in Dr McAllister. 37. Ms Fairley submitted that Dr McAllister’s actions were a fundamental breach of the tenets of medical practice. Dr McAllister left a cocktail of drugs for her friend, outwith a




clinical setting, in circumstances which were not a medical emergency. Ms Fairley reminded the Tribunal of Dr C’s expert evidence that Dr McAllister’s standard of care in relation to Mrs A was seriously below the standard expected of a reasonably competent prescribing doctor. 38. Ms Fairley submitted that Dr McAllister’s actions towards Mrs A amounted to serious misconduct and there was no indication that Dr McAllister has demonstrated any insight into the seriousness of her actions. Convictions 39. In respect of Dr McAllister’s convictions, Ms Fairley submitted that the Tribunal now has evidence of the earlier MPT hearings. Dr McAllister was before the 2017 Tribunal in respect of two counts of supplying Class C controlled drugs (Temazepam and Diazepam) - one to a colleague in 2014, and one to an ex-partner between November 2014 and May 2015. Further, Ms Fairley stated that Dr McAllister was also convicted of two counts of possessing controlled drugs. 40. Ms Fairley referred to the conclusion of the 2017 Tribunal that the risk of Dr McAllister repeating her actions was ‘negligible’. However, Ms Fairley drew the Tribunal’s attention to evidence that the Police conducted a search of Dr McAllister’s house on 1 September 2017, following allegations that she had imported controlled drugs. Ms Fairley submitted that, whilst no criticism could be made of Dr McAllister’s representative at the 2017 Tribunal, it was nevertheless the case that the 2017 Tribunal had been wrongly informed that no other incidents had occurred since the conviction that gave rise to the hearing. Dr McAllister would have been aware of the Police search of her house and later pleaded guilty to importing Controlled Drugs. Ms Fairley submitted that Dr McAllister’s conviction for importation was very serious and the offence involved a significant degree of planning. Ms Fairley directed the Tribunal’s attention to the pre-sentencing report which in her submission displayed evidence that Dr McAllister sought to justify and minimise the seriousness of her actions. Ms Fairley submitted that Dr McAllister had demonstrated no proper insight into the seriousness of her actions. 41. In relation to Dr McAllister’s driving convictions, Ms Fairley submitted that, in isolation, these were not as serious as the offence relating to the importation of controlled drugs. However, she submitted that it is of grave concern that there is another drug element to Dr McAllister’s offending. Ms Fairley directed the Tribunal’s attention to the pre-sentencing report in which Dr McAllister considered that, at the time of the index event, she felt she was in a clear state of mind. Ms Fairley submitted that this showed a lack of insight on the part of Dr McAllister into her driving offences, which amounted to serious misconduct. 42. Ms Fairley submitted that Dr McAllister has not engaged with these regulatory proceedings or XXX. XXX. 43. Ms Fairley submitted that Dr McAllister has not practiced medicine since September 2014 and that there is no evidence that suggests that Dr McAllister has kept her clinical skills




and knowledge up to date. Ms Fairley submitted that each of the allegations on their own amounted to serious misconduct but, taken together, the level of seriousness increased. Ms Fairley submitted that there was no evidence of any meaningful insight, no attempts at remediation, and no suggestion that the risk of repetition was low. She submitted that all three limbs of the overarching objective were engaged. The Relevant Legal Principles 44. In approaching its decision, the Tribunal was mindful of the two-stage process to be adopted: first, whether the facts as found proved amounted to serious misconduct (or, alternatively, that Dr McAllister has been convicted of the offences set out in the Allegation) and, secondly, whether the doctor’s fitness to practise is currently impaired by reason of that misconduct or conviction. 45. The Tribunal had regard to the advice given by the Legally Qualified Chair as a matter of record. 46. At both stages of the process, the Tribunal was mindful of the overarching objective of the GMC set out in section 1 of the Medical Act 1983 (as amended) which requires the Tribunal to:

a. Protect, promote and maintain the health, safety and well-being of the public, b. Promote and maintain public confidence in the medical profession, and c. Promote and maintain proper professional standards and conduct for

members of that profession. 47. Whilst there is no statutory definition of impairment, the Tribunal was assisted by the guidance provided by Dame Janet Smith in the Fifth Shipman Report, as adopted by the High Court in CHRE v NMC & Grant (2011) EWHC 927. In particular, the Tribunal considered whether its findings of fact showed that Dr McAllister’s fitness to practise is impaired in the sense that she:

a. ‘Has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

b. Has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

c. Has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; […]

48. The Tribunal bore in mind that it must determine whether Dr McAllister’s fitness to practise is currently impaired by reason of misconduct and/or conviction, taking into account




her conduct at the time of the events and any other relevant factors such as any development of insight, whether the matters are remediable or have been remedied and the likelihood of repetition. 49. The Tribunal also bore in mind the observations of Mrs Justice Cox in the case of Grant that ‘in determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant Tribunal should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances’. Impairment by reason of Misconduct Misconduct 50. In determining whether Dr McAllister’s fitness to practise is currently impaired by reason of misconduct, the Tribunal first considered whether the facts found proved amounted to misconduct. 51. The Tribunal considered the relevant paragraphs of GMP which set out the standards that a doctor must continue to meet throughout their professional career. 52. The Tribunal had particular regard to paragraphs 16(a) and (g) of GMP. It applied that standard to the facts found proved. Midazolam 53. The Tribunal found proved that Dr McAllister had knowingly taken vials of Midazolam from Ninewells and had failed to return the vials to Ninewells. However, the Tribunal did not find that Dr McAllister had acted dishonestly and found that her actions were accidental. The Tribunal noted that the GMC had not contended that Dr McAllister’s fitness to practise was impaired by reason of her conduct in relation to the vials of Midazolam. 54. Therefore, the Tribunal did not find that Dr McAllister’s actions, as they related to Paragraphs 1 and 2 of the Allegation, amounted to serious misconduct. Mrs A 55. The Tribunal found proved that Dr McAllister had left the Home Address Medication at her home for Mrs A and had sent the text messages to Mrs A that are set out in Schedule 3 to the Allegation. 56. The Tribunal’s approach was to consider, firstly, whether each aspect of Dr McAllister’s conduct in relation to Mrs A amounted to serious misconduct; it then considered whether Dr McAllister’s overall standard of care to Mrs A amounted to serious




misconduct. Following that analysis, the Tribunal went on to consider whether Dr McAllister’s fitness to practise is impaired by reason of misconduct. Tramadol 57. The Tribunal had regard to Dr C’s expert evidence that Tramadol was not clinically indicated for a tattoo procedure, because the risk of adverse effects outweigh the potential benefits. 58. Dr C also stated that Dr McAllister’s actions in providing Tramadol to Mrs A were seriously below the standards expected of a reasonably competent doctor. This is because Tramadol should only be prescribed for moderate to severe pain and because all doctors should ensure that any treatment provided is clinically indicated. In addition, Dr C advised that Tramadol is a prescription-only medication which requires adequate knowledge of the patient’s medical history and current medication. Dr C considered that Dr McAllister did not have that knowledge and was ‘in clear breach of professional guidance on prescribing’. Dr C noted that Dr McAllister’s failing was ‘especially significant’ because Tramadol is a Schedule 3 Controlled Drug with the potential for misuse. 59. Accepting Dr C’s expert evidence, the Tribunal concluded that Dr McAllister’s actions in supplying Tramadol to Mrs A amounted to serious misconduct. Diazepam 60. The Tribunal noted the acknowledgement in Dr C’s Expert Report that a ‘one off prescription of a small quantity (one or two tablets) of a low dose of Diazepam (2mg)’ might be clinically indicated for someone getting a tattoo who was ‘especially anxious’. 61. However, Dr C’s opinion was that it was not appropriate for Dr McAllister to leave Diazepam for Mrs A because Diazepam is a prescription-only medication which requires adequate knowledge of the patient’s medical history and current medication. Noting that Dr McAllister did not have such knowledge, Dr C’s expert evidence was that Dr McAllister’s supply to Mrs A of Diazepam was seriously below the standards expected of a reasonably competent doctor. This was because of the potential for Mrs A to suffer adverse effects from inappropriate drug treatment. Dr C considered that Dr McAllister was in, ‘clear breach of professional guidance on prescribing’. Dr C stated that the failing was, ‘especially significant’ because Diazepam is a Schedule 4 Controlled Drug with the potential for misuse. 62. Accepting Dr C’s expert evidence, the Tribunal concluded that Dr McAllister’s actions in supplying Diazepam to Mrs A amounted to serious misconduct. Combination Tablet 63. The Tribunal had regard to Dr C’s expert evidence, in which he considered Dr McAllister’s actions in leaving two ibuprofen/codeine (200mg/ 12.8mg) tablets for Patient A.




64. Dr C considered that leaving ibuprofen/codeine for Mrs A was not appropriate in that Combination Tablets are a pharmacy-only medicine which requires asking about the patient’s medical history and current medication. In Dr C’s opinion, Dr McAllister did not have adequate knowledge of Mrs A’s medical history and medication. 65. Dr C went on to consider Dr McAllister’s statement that she had given Mrs A one additional Combination Tablet at approximately 3pm and had advised Mrs A to take another 2 Combination Tablets at approximately 5:30pm. Dr C’s opinion was that Dr McAllister’s actions in that regard were inappropriate in that her advice to Mrs A was not in line with the dosing instructions for Combination Tablets. 66. However given that Combination Tablets are available without prescription and that the potential for harm was low, Dr C’s expert opinion was that Dr McAllister’s actions in relation to the Combination Tablets did not fall seriously below the expected standard. 67. As a result, the Tribunal concluded that, whilst Dr McAllister’s actions in providing Combination Tablets to Mrs A and advising her to take additional Combination Tablets amounted to misconduct, her actions did not amount to serious misconduct. Alcohol 68. For the reasons already set out, the Tribunal found that the combination of alcohol and the Home Address Medication increased the risk of Mrs A suffering adverse effects and drug interactions. The Tribunal noted Dr C’s expert evidence that the addition of alcohol to the Home Address Medication was not clinically indicated as alcohol does not have a therapeutic analgesic effect. Dr C’s opinion was that Dr McAllister’s standard of care in that regard fell seriously below the standard expected because alcohol was not clinically indicated and had a risk of harm. 69. Accepting Dr C’s expert evidence, the Tribunal concluded that Dr McAllister’s advice for Mrs A to consume alcohol with the Home Address Medication amounted to serious misconduct. Painkilling Medication 70. The Tribunal had regard to its findings that Dr McAllister had left painkilling medication at the Studio for Mrs A to take in her absence. 71. Although there was little evidence before the Tribunal as to the nature or quantity of the painkilling medication, the Tribunal found that Dr McAllister’s actions in leaving such medication at the Studio were inappropriate and amounted to serious misconduct because:

• Dr McAllister was not in a position to assess the effect of the combination of medication already taken by Mrs A or the side effect of sedation; and




• There was an additional potential for Mrs A to suffer serious adverse effects from additional doses of medication.

Paragraph 8 of the Allegation 72. For the reasons already set out, the Tribunal found that Dr McAllister’s actions as set out in paragraphs 4 to 7 of the Allegation were inappropriate in that:

• She did not have a clinical relationship with Mrs A;

• Mrs A was a person with whom she had a close personal relationship;

• The context for providing medication for Mrs A was not a medical emergency; and

• She placed Mrs A at significant risk of harm from adverse effects of medication.

73. The Tribunal had regard to Dr C’s expert evidence in which he advised that:

• Professional guidance states that in order to prescribe or supply medicines doctors must have adequate knowledge of the patient’s health and must ensure that the treatment provided is compatible with any other treatments the patient is receiving;

• As Dr McAllister did not have a clinical relationship with Mrs A, she was not in a position to meet the professional requirements for prescribing. Dr C’s opinion was that this action was seriously below the standard expected of a reasonably competent prescribing doctor because:

o The professional guidance on providing medication is clear; and o Mrs A was placed at significant risk of harm from the adverse effects of

medication.

• Professional guidance states that wherever possible doctors must avoid prescribing for anyone with whom they have a close personal relationship and that controlled medicines present particular dangers, occasionally associated with drug misuse. Dr C’s opinion was that Dr McAllister’s actions in providing medication to a person with whom she had a close personal relationship, and where the context was not a medical emergency, fell seriously below the standard expected of a reasonably competent prescribing doctor.

• Dr McAllister’s actions placed Mrs A at significant risk of harm from the adverse effects of medication.

74. Accepting Dr C’s expert evidence, the Tribunal concluded that Dr McAllister’s actions in these regards amounted to serious misconduct and a clear breach of paragraphs 16(a) and (g) of GMP.




Paragraph 9 of the Allegation 75. For the reasons already set out, the Tribunal found proved the entirety of Paragraph 9 of the Allegation, namely that Dr McAllister’s actions contributed to Mrs A’s death. 76. The Tribunal noted the post-mortem report in relation to Mrs A which confirmed that her death was caused by combined acute drug toxicity from drugs including Codeine, Tramadol and Diazepam. 77. The Tribunal also noted its findings that Dr McAllister’s actions:

• in providing with Mrs A with:

o Tramadol o Diazepam o Alcohol; and o Painkilling medication

• in prescribing medication to Mrs A: o outwith a clinical relationship; and o in the context of a close personal relationship (that was not a medical

emergency);

• in placing Mrs A at significant risk of harm from adverse effects of medication

amounted to serious misconduct.

78. Set in that context, the Tribunal concluded that Dr McAllister’s actions in contributing to Mrs A’s death amounted to serious misconduct. Overall Standard of Care 79. The Tribunal considered that Mrs A had placed her trust in Dr McAllister, both as a friend and as a doctor. 80. The Tribunal noted Mr B’s evidence that, ‘I told Katy what Mrs A was doing and she wasn’t concerned so I thought if I was concerned, I was probably just overreacting because I didn’t have the knowledge she would have about any medications Mrs A had taken’. 81. The Tribunal also noted Ms G’s evidence that, ‘I knew Katy was a doctor so I just assumed Katy would know what the tablets were and what they were for’ 82. In light of that evidence the Tribunal accepted the submission of Ms Fairley that Mr B and Ms G placed a degree of trust in Dr McAllister because she is a doctor.




83. In addition, the Tribunal had regard to Dr C’s Expert Report, where he addressed Dr McAllister’s overall standard of care:

‘My opinion is that the standard of care provided by Dr McAllister to [Mrs A] on 09.05.15 was seriously below the standard expected of a reasonably competent prescribing doctor. This is because Dr McAllister’s advice for [Mrs A] to take a combination of medicines (including opioids and benzodiazepines) placed [Mrs A] at risk of significant harm from adverse effects and drug interactions. In addition, Dr McAllister provided prescription only medicines (including controlled drugs) to [Mrs A] despite not having a clinical relationship with her. My opinion is that Dr McAllister’s actions on 09.05.15 were a clear breach of the fundamental principles of good medical practice’.

84. The Tribunal was of the view that Dr McAllister’s overall standard of care was seriously below the standards of a reasonably competent doctor and amounted to serious misconduct. Impairment 85. Having found that a number of Dr McAllister’s actions in relation to Mrs A amounted to serious misconduct, the Tribunal went on to consider whether, as a result, Dr McAllister’s fitness to practise is currently impaired by reason of that misconduct. 86. The Tribunal considered whether Dr McAllister’s misconduct was easily remediable. It considered that her serious misconduct was potentially remediable but noted that it had been presented with no evidence of remediation by Dr McAllister. 87. The Tribunal considered whether there was evidence of any insight by Dr McAllister into her misconduct. It noted that there was little evidence that demonstrated that Dr McAllister either understood the gravity of her misconduct or had demonstrated any insight into her actions. XXX. 88. The Tribunal noted that, in her statement to the Police on 10 May 2015, Dr McAllister gave an account that was contrary to the content of her text message to Mrs A sent at 9:46am on 9 May 2015. Whilst that text message referred to leaving, ‘paracetamol, ‘brufen, codeine, tramadol and Valium’ for Mrs A, Dr McAllister’s police statement merely referred to her leaving 2 paracetamol tablets and 2 Combination Tablets. In addition, Dr McAllister told the Police that, ‘there was no other medication left on the cooker’, that she would ‘never give [Mrs A] Diazepam’ and ‘I don’t think [Mrs A] directly asked me for anything like that’. The Tribunal considered that Dr McAllister’s lack of candour in her statement to the Police on 10 May 2015 demonstrated an absence of insight into the seriousness of her actions and a failure by her to take responsibility. 89. The Tribunal also noted Dr McAllister’s email to Ninewells sent on 11 May 2015 when, after referring to the death of Mrs A, Dr McAllister stated, ‘the police raided my house and




took my phone in case [Mrs A] had secretly stolen some medications and that’s what killed her’. The Tribunal considered this attempt by Dr McAllister to shift the blame for her actions onto Mrs A was deplorable and was further evidence of Dr McAllister’s lack of insight. 90. The Tribunal noted that the 2017 Tribunal considered allegations that Dr McAllister had provided controlled drugs to a former partner and a colleague and that, in 2017, Dr McAllister had pleaded guilty to criminal offences in that regard. Given those facts, and the absence of evidence to suggest any insight or remediation by Dr McAllister, the Tribunal were unable to rule out the risk of any repetition of the index event. 91. Paragraph 1 of GMP provides that good doctors are those who act with integrity and within the law. Paragraph 65 of GMP makes it clear that doctors must make sure that their conduct justifies both patient trust and the public’s trust in the profession. 92. The Tribunal had regard to the overarching objective, namely the protection of the public, the pursuit of which includes the following objectives:

a. to protect, promote and maintain the health, safety and well-being of the public,

b. to promote and maintain public confidence in the medical profession, and c. to promote and maintain proper professional standards and conduct for

members of that profession. 93. The Tribunal found that, in respect of Dr McAllister’s misconduct in relation to Mrs A, all three limbs of the overarching objective were engaged. The Tribunal determined that Dr McAllister’s fitness to practise is currently impaired by reason of misconduct and that a decision to the contrary would seriously undermine the overarching objective. Impairment by reason of Conviction 2019 Convictions Conviction under Road Traffic Act 1988 94. The Tribunal found proved that, on 2 May 2019, Dr McAllister was convicted under the Road Traffic Act 1988, of driving:

• whilst unfit to drive through drink or drugs; and

• without due care and attention. 95. XXX.




96. The Tribunal also had regard to the ‘Analysis of current offence(s)’ in the pre-sentencing report, dated 28 May 2019, which stated:

XXX […] She stated she has limited recollection of the events. Although she stated her car had hit the fence whilst entering the car park and she hit another car whilst driving into the space. XXX.

97. The Tribunal considered that Dr McAllister’s reflections on her state of mind were troubling, in that she apparently considered herself to be capable of driving at the time of the index event. The comments were evidence, in the Tribunal’s view, of a lack of insight into the potentially very serious consequences of her actions, both for other members of the public and XXX, whilst the offences were committed. 98. The Tribunal noted that the pre-sentencing report refers to Dr McAllister becoming involved XXX. However, the Tribunal was presented with no other evidence of any attempt by Dr McAllister to remediate her offences or XXX. 99. Consequently, the Tribunal was not satisfied that Dr McAllister had remediated her offences. XXX or the seriousness of her convictions for road traffic offences. The Tribunal were conscious that the consequences of her actions in driving whilst under the influence could have been catastrophic. 100. The Tribunal had regard to the overarching objective and considered that all 3 limbs were engaged. It considered that Dr McAllister’s road traffic offences had presented a risk to the health, safety and well-being of the public and her behaviour had undermined public confidence in the medical profession and proper professional standards and conduct for members of the profession. 101. In all the circumstances, the Tribunal was of the view that Dr McAllister’s actions in driving whilst unfit and without due care and attention were serious. The Tribunal determined that Dr McAllister’s fitness to practise is impaired by reason of her convictions under the Road Traffic Act 1988. Conviction under Customs and Excise Management Act 1979 102. The Tribunal found proved that Dr McAllister was convicted under the Customs and Excise Management Act 1979 of four counts of importation or being concerned in the importation of:

• Morphine, a Class A drug;

• Oxycodone, a Class A drug;




• Diazepam, a Class C drug; and

• Temazepam, a Class C drug. 103. The Tribunal noted that Dr McAllister’s offences took place between 19 July 2017 and 31 August 2017 and that, following investigation, the Police recovered the following:

• XXX;

• XXX;

• XXX; and

• XXX. Dr McAllister was sentenced on 3 January 2020. 104. The Tribunal noted the prosecution report which states that, on 1 September 2017, the Police executed a search warrant at Dr McAllister’s home, following which she was detained. The prosecution report notes that, whilst some of the items recovered by the Police did not contain controlled drugs, there was no doubt that Dr McAllister ordered the substances online and had them imported into the UK in the belief that they were controlled drugs. A white mobile phone belonging to Dr McAllister was seized by the Police. Upon interrogating her mobile phone, the Police discovered a message requesting the sender of drugs to ‘pack the bottle so pills don’t rattle’. The Tribunal considered that that was a deliberate attempt by Dr McAllister to conceal her criminal activity in importing controlled drugs. 105. The Tribunal regarded Dr McAllister’s convictions under Customs and Excise Management Act 1979 as very serious. It was clear that she had imported, or attempted to import, a significant quantity of controlled drugs on a number of occasions between 19 July 2017 and 31 August 2017. The Tribunal noted that Dr McAllister’s offence was not a ‘one-off’ incident and required a significant degree of planning. 106. The Tribunal had regard to the following extract of the pre-sentence report dated 23 October 2017:

‘Dr McAllister stated there was no planning involved in the offence. However, there is evidence that a significant degree of planning was involved; it was highlighted to Dr McAllister that she would have spent time finding what she thought was a “reputable” doctor online. She stated the amount of drugs she was purchasing and administering was a significantly higher dose XXX. It was outlined that the nature of the index matters involved a degree of planning as she would have had to plan when she was purchasing these online and where she was storing these within the family home’.

107. The Tribunal was troubled by Dr McAllister’s failure to recognise or acknowledge the degree of planning involved in her offences.




108. XXX. Whilst the Tribunal considered that the offences were, potentially, capable of remediation, it had been presented with limited evidence of attempts by Dr McAllister to remediate her offences; similarly, there was little evidence of any insight by Dr McAllister into those offences. 109. The Tribunal noted that the Police search of Dr McAllister’s home, and her detention for offences under the Customs and Excise Management Act 1979, took place in September 2017. The Tribunal noted the proximity of these events to the 2017 Tribunal, which commenced in November 2017. The Tribunal reminded itself that the purpose of the 2017 Tribunal was to determine whether or not Dr McAllister’s fitness to practise was impaired by reason of her conviction for the possession and supply of controlled drugs. 110. During the hearing of the 2017 Tribunal Dr McAllister’s representative submitted that a repetition by Dr McAllister’s actions was ‘wholly unlikely’ in that there had been no further incidents since her 2017 conviction. The 2017 Tribunal concluded that the risk of Dr McAllister repeating her actions was ‘negligible’. 111. The Tribunal considered paragraph 72(b) of GMP that states:

72(b) ‘You must be honest and trustworthy when giving evidence to courts or tribunals. You must make sure that any evidence you give or documents you write or sign are not false or misleading. […] b. You must not deliberately leave out relevant information’.

112. The Tribunal considered that Dr McAllister would have known, during the 2017 Tribunal, that her home had been searched and that she had been detained by Police for offences under the Customs and Excise Management Act 1979. Whilst the Tribunal had no criticism of Dr McAllister’s representative, it took the view that Dr McAllister was in breach of paragraph 72(b) of GMP in permitting her representative to make misleading representations to the 2017 Tribunal. 113. The Tribunal concluded that Dr McAllister’s breach of paragraph 72(b) of GMP was further evidence of her failure to remediate or have insight into her offending. 114. The Tribunal considered that all three limbs of the overarching objective were engaged by Dr McAllister’s convictions under the Customs and Excise Management Act 1979. Whilst the Tribunal acknowledged that there was no evidence that any harm was caused to anyone, other than perhaps to Dr McAllister, it noted the conclusion of the pre-sentencing report that the consequences of her drug importation could have been ‘catastrophic’. The Tribunal concluded that Dr McAllister’s convictions for drug importation presented a risk to the health, safety and well-being of the public, and considered that there was a significant




public health interest in preventing the illegal importation of controlled drugs. The Tribunal also considered that, in committing offences under the Customs and Excise Management Act 1979, Dr McAllister had undermined public confidence in the medical profession and professional standards and conduct for members of the profession. 115. Having considered all the circumstances, the Tribunal found that Dr McAllister’s fitness to practise is impaired by reason of her conviction for offences under the Customs and Excise Management Act 1979. Review of Dr McAllister’s Conviction under Misuse of Drug Act 116. The Tribunal went on to conduct a review of Dr McAllister’s suspension which, as described earlier in this Determination, was imposed by the 2017 Tribunal and then extended by subsequent MPTs. The Tribunal reminded itself that the suspension had been imposed by the 2017 Tribunal as a result of its finding that Dr McAllister’s fitness to practise was impaired by reason of her conviction for offences under the Misuse of Drugs Act 1971. 117. The Tribunal noted that the reason a review was directed in this case was to ascertain whether or not Dr McAllister had kept her skills and knowledge up to date during the period of suspension. The Tribunal noted its finding, earlier in this Determination, that Dr McAllister had misled the 2017 Tribunal by asserting, through her representative, that her risk of reoffending was low given that there had been no incidents since the index event. The Tribunal considered that the 2017 Tribunal may well have come to a different conclusion as to remediation, insight and the risk of repetition, if it had been seized of the facts relating to the Police investigation into Dr McAllister’s drug importation offences. 118. The Tribunal noted that Dr McAllister has not practised medicine since September 2014 and there was no evidence as to whether she had kept her clinical skills and knowledge up to date following her suspension in 2017. XXX. The Tribunal also noted the limited evidence before it of attempts by Dr McAllister to remediate her drug offences; similarly, there was little evidence of any insight by Dr McAllister into her offences. 119. Consequently, and in all the circumstances of this case, the Tribunal determined that in order to:

a. promote and maintain public confidence in the medical profession, and b. promote and maintain proper professional standards and conduct for

members of that profession, It found that Dr McAllister’s fitness to practise remains impaired by reason of her conviction under the Misuse of Drugs Act 1971.




Determination on Sanction - 08/09/2020 Rule 41 1. The Tribunal determined that, pursuant to Rule 41 XXX of the Rules, the determination will be announced in private given that it relates to issues XXX. However, a redacted version will be published at the close of the hearing. SANCTION 2. Having determined that Dr McAllister’s fitness to practise is impaired by reason of her misconduct and conviction, the Tribunal has considered what action, if any, it should take with regard to her registration, in accordance with Rules 17(2)(n) and 22(1)(h) of the Rules. The Evidence 3. The Tribunal had regard to all of the evidence, both oral and documentary, adduced during the course of these proceedings. Submissions 4. The following is a non-exhaustive synopsis of Counsel’s submissions made during the sanction stage. 5. Ms Fairley submitted that the appropriate sanction in this case is to erase Dr McAllister’s name from the Medical Register. She directed the Tribunal’s attention to the Sanctions Guidance (November 2019 edition) (‘SG’), and the Tribunal’s overarching objective. 6. In relation to the mitigating factors present in this case, Ms Fairley reminded the Tribunal that Dr McAllister had pleaded guilty to her criminal charges relating to driving offences and drug importation. However, she submitted that Dr McAllister had little choice given the overwhelming evidence against her. Ms Fairley also acknowledged the testimonial bundle provided on behalf of Dr McAllister to the 2017 Tribunal. However, Ms Fairley submitted that those testimonials had been produced in the absence of knowledge about the Allegation considered by this Tribunal. 7. In relation to the aggravating factors present in this case, Ms Fairley submitted that Dr McAllister has demonstrated a lack of insight, which is highly relevant to the Tribunal’s consideration. She directed the Tribunal’s attention to the pre-sentencing reports where Dr McAllister had sought to minimise her offending. Further, Ms Fairley reminded the Tribunal that there is also a previous finding of impairment against Dr McAllister, arising from the decision of the 2017 Tribunal. In all the circumstances, Ms Fairley submitted that Dr McAllister’s conviction for three criminal offences relating to drugs is a substantial aggravating factor.




8. Ms Fairley submitted that, given the circumstances of this case, it would neither be appropriate nor proportionate for the Tribunal to take no action in this case or to impose an order of conditions on Dr McAllister’s registration. 9. In addition, Ms Fairley submitted that these matters are too serious for the Tribunal to impose an order of suspension on Dr McAllister’s registration. She argued that, in this case, the misconduct is so serious that it is fundamentally incompatible with continued registration. Ms Fairley submitted that, in line with the findings of the Tribunal on impairment, the Tribunal could not be satisfied, given the history of the case and Dr McAllister’s behaviour, that her conduct is unlikely to be repeated. She submitted that there is no evidence before the Tribunal that remediation is likely to be successful as Dr McAllister was committing offences in the period leading up to the 2017 Tribunal. 10. XXX 11. Ms Fairley submitted that Dr McAllister poses a risk to patient safety and her actions were a serious departure from GMP on each element of the Allegation. 12. Ms Fairley noted that Dr McAllister had not received a custodial sentence for her convictions. However, she submitted that the Criminal Court may well have been more lenient in its sentencing given that Dr McAllister is XXX. Ms Fairley submitted that, although no custodial sentence was imposed, Dr McAllister’s offences were nevertheless very serious. 13. Ms Fairley submitted that, in relation to the Allegation, there has been no clear acknowledgement of fault by Dr McAllister or any insight into her actions. She submitted that there is no evidence to satisfy the Tribunal that Dr McAllister’s behaviour is not likely to be repeated. Ms Fairley noted that Dr McAllister’s offending reflects misconduct over a significant period of time. She submitted that the sanction of erasure is necessary and proportionate to protect the public, to maintain public confidence in the profession and uphold and maintain proper professional standards for members of the profession. The Tribunal’s Determination on Sanction 14. The Tribunal took into account its earlier findings, Ms Fairley’s submissions and the documentary evidence adduced during the course of these proceedings. 15. The Tribunal had regard to the advice given by the Legally Qualified Chair, which is a matter of record. 16. The decision as to the appropriate sanction is a matter for this Tribunal’s own independent judgment. The sanction must be proportionate and tailored to the specific circumstances of the case. In reaching its decision, the Tribunal took into account the SG and the statutory overarching objective, which includes the need to:

a. protect, promote and maintain the health, safety and well-being of the public,




b. promote and maintain public confidence in the medical profession, and c. promote and maintain proper professional standards and conduct for

members of that profession. 17. The Tribunal recognised that the purpose of a sanction is not to be punitive, although it may have a punitive effect. Throughout its deliberations, the Tribunal applied the principle of proportionality, balancing Dr McAllister’s interests with the public interest. The Tribunal’s Determination on Sanction Mitigating and Aggravating Factors 18. The Tribunal first of all had regard to the mitigating and aggravating factors. Mrs A 19. In relation to mitigation, the Tribunal considered that Dr McAllister’s motivation was a genuine (albeit misguided and foolish) attempt to help Mrs A, her friend, to alleviate the adverse effects of a tattoo procedure. 20. In relation to the aggravating factors, the Tribunal considered the following issues:

• Dr McAllister had attempted to divert the blame from herself and onto Mrs A in her email to Ninewells on 11 May 2015;

• Dr McAllister had been less than candid to the Police, during her interview on 10 May 2015, in an attempt to mislead the Police investigation; and

• Dr McAllister’s conduct in relation to Mrs A was not a single isolated act but comprised a number of failings, on 9 May 2015, that contributed to Mrs A’s death.

Conviction under Road Traffic Act 1988 21. In relation to the mitigating factors, the Tribunal considered the following factors were present:

• Dr McAllister had pleaded guilty to the Court;

• XXX

• Dr McAllister’s actions did not result in any harm to the public. 22. In relation to the aggravating factors, the Tribunal considered the following factors were present:




• The effect of Dr McAllister’s actions in driving whilst XXX could have been catastrophic; and

• XXX. Convictions under: Customs and Excise Management Act 1979; and under Misuse of Drug Act 23. In relation to the mitigating factors, the Tribunal considered the following factors were present:

• Dr McAllister had pleaded guilty to the Court; and

• XXX

24. In relation to the aggravating factors, the Tribunal considered the following factors were present:

• Dr McAllister’s degree of premeditated planning;

• Dr McAllister’s attempt to avoid detection by requesting that the Controlled Drugs be packaged so they ‘don’t rattle’;

• Dr McAllister’s actions were not a one-off isolated offence, rather they took place over a considerable period of time; and

• Dr McAllister attempted to justify and minimise the seriousness of her actions during her interview with XXX for the purposes of the pre-sentencing report.

Overall 25. The Tribunal had regard to paragraph 54 of the SG that states:

‘Where the GMC, or another regulator, has previously made findings of impaired fitness to practise and imposed a sanction on the doctor’s registration, the tribunal may wish to consider this as an aggravating factor in relation to the case before it’.

26. The Tribunal noted the finding of the 2017 Tribunal, that Dr McAllister’s fitness to practise was impaired by reason of her conviction for drugs related offences. The Tribunal considered that this was a significant aggravating factor overall given that Dr McAllister had gone on to commit further drugs related offences. 27. The Tribunal noted that Dr McAllister had not engaged with the regulatory proceedings since the 2017 Tribunal. There is little evidence before this Tribunal from Dr McAllister of any insight or remediation into her misconduct and conviction, or as to the impairment in her fitness to practise found by the 2017 Tribunal. 28. The Tribunal noted that Dr McAllister committed the drug related offences specified in the Allegation at a time when she was subject to action by the GMC. The Tribunal




considered that, by the time of the 2017 Tribunal, she was well aware that the Police were investigating her for the drug importation offences to which she subsequently pleaded guilty. As the Tribunal noted in its Determination on impairment Dr McAllister permitted her representative to make misleading statements to the 2017 Tribunal. Those statements appear to have led the 2017 Tribunal to conclude that Dr McAllister had demonstrated significant remediation and insight and that the risk of reoffending was low when, in fact, none of these was the case. The Tribunal reminded itself of its earlier finding that Dr McAllister was in breach of GMP in relation to her conduct at the 2017 Tribunal. 29. The Tribunal had regard to the sentencing remarks of Sheriff Carmichael when sentencing Dr McAllister, on 3 January 2020, under the Customs and Excise Management Act 1979. Sheriff Carmichael addressed Dr McAllister as follows:

‘I think you have to view this as being a last chance, Ms McAllister. If you do not succeed on this order this is a very good chance you will go to prison, you understand that?’

[Dr McAllister’s response] ‘I do’ 30. The Tribunal noted that Dr McAllister had committed several drugs offences over a number of years. Whilst there was evidence of Dr McAllister XXX, the Tribunal considered that there was scant evidence before it that Dr McAllister appreciated the gravity of the Allegation, had taken meaningful steps to remediate her misconduct and convictions or had any significant level of insight into those matters. 31. The Tribunal noted that Dr McAllister’s misconduct and criminality involving drugs was persistent and the Tribunal was presented with no evidence that the risk of reoffending was low or, indeed, had diminished at all since her conviction on 3 January 2020. The Tribunal agreed with Ms Fairley’s submission that Sheriff Carmichael was, in imposing a non-custodial sentence, likely to have been influenced by the fact that Dr McAllister XXX. The Tribunal noted Sheriff Carmichael’s warning to Dr McAllister that the sentence imposed by him was her ‘last chance’. 32. The Tribunal was of the view that there was an overall pattern of repeated drug offending, which increased the overall seriousness of Dr McAllister’s behaviour. 33. The Tribunal noted the positive comments about Dr McAllister in the bundle of testimonials presented to the 2017 Tribunal – however the Tribunal noted that many of the testimonials were written in 2015 and then updated for the 2017 Tribunal. The Tribunal considered that the testimonials were of limited relevance given their age and that they were prepared without knowledge of the facts set out in the Allegation.




The Tribunal’s Decision 34. In deciding what sanction, if any, to impose, the Tribunal reminded itself that it must consider each of the sanctions available, starting with the least restrictive, to establish which is appropriate and proportionate in this case. No Action 35. The Tribunal first considered whether to conclude the case by taking no action. The Tribunal noted paragraphs 68 to 70 of SG. 36. The Tribunal was satisfied that there were no exceptional circumstances in Dr McAllister’s case which could justify it taking no action. It determined that, given the circumstances of this case, taking no action would be inappropriate, inadequate and would not be in the public interest. 37. Further, the Tribunal determined that a finding of impairment alone would not be enough to appropriately protect, promote and maintain the health, safety and well-being of the public, promote and maintain public confidence in the medical profession or proper professional standards for members of that profession. Conditions 38. The Tribunal then considered whether imposing an order of conditions on Dr McAllister’s registration would be appropriate. It bore in mind that any conditions imposed should be appropriate, proportionate, workable and measurable. The Tribunal had regard to paragraphs 80, 81 and 82 of the SG. 39. The Tribunal concluded that a period of conditional registration would not be appropriate because of the seriousness of Dr McAllister’s misconduct and conviction. Conditions would not sufficiently mark the gravity of the findings made by the Tribunal. It also considered that it could not formulate practicable and workable conditions that would address those findings. 40. As such, the Tribunal concluded that imposing conditions on Dr McAllister’s registration would not be sufficient to appropriately protect, promote and maintain the health, safety and well-being of the public, promote and maintain public confidence in the medical profession or proper professional standards for members of that profession. Suspension 41. The Tribunal went on to consider whether a period of suspension would be an appropriate and proportionate sanction to impose on Dr McAllister’s registration. The Tribunal noted the SG, specifically paragraphs 92, 93 and 97(a)(e)(f) and (g) which it considered are relevant in this case:




92 ‘Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (i.e. for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession)’. 93 ‘Suspension may be appropriate, for example, where there may have been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actions […]’ 97(a)(e)(f)(g) ‘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, but where the doctor’s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors. […] e. No evidence that demonstrates remediation is unlikely to be successful, e.g. because of previous unsuccessful attempts or a doctor’s unwillingness to engage. f. No evidence of repetition of similar behaviour since incident. g. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour’.

The Tribunal applied those guidelines to the facts found proved. 42. The Tribunal considered that Dr McAllister’s actions were a serious breach of GMP and breached fundamental tenets of the medical profession. It also considered that there had been a lack of engagement by Dr McAllister since the 2017 Tribunal and a complete disengagement with these proceedings. Further, it had regard to the fact that Dr McAllister had provided no evidence to show insight, remediation or remorse for her actions. The Tribunal was also concerned that it had not received any evidence to show that Dr McAllister had reflected on any of the events in this case nor expressed any acknowledgement of fault.




43. The Tribunal noted that, since the 2017 Tribunal, there had been repeated drug related offences and therefore, the Tribunal could not be satisfied that Dr McAllister would not reoffend in the future. 44. Taking all of the above factors of this case into account, the Tribunal considered it unlikely that even the maximum period of 12 months’ suspension could change Dr McAllister’s lack of insight into the seriousness of her misconduct and convictions, or encourage remediation. 45. In all the circumstances, the Tribunal determined that suspension would not be sufficient or proportionate to protect, promote and maintain the health, safety and well-being of the public, promote and maintain public confidence in the medical profession or proper professional standards for members of that profession. Erasure 46. In the circumstances the Tribunal determined that the only appropriate sanction in this case was one of erasure. In reaching its determination, the Tribunal had regard to paragraphs 107, 109(a)(b)(c)(j) and 162(d) which state:

107 ‘The tribunal may erase a doctor from the medical register in any case – except one that relates solely to the doctor’s health and/or knowledge of English – where this is the only means of protecting the public.’ 109 (a)(b)(c)(j) ‘Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive). a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. b. A deliberate or reckless disregard for the principles set out in Good medical practice and/or patient safety. c. Doing serious harm to others (patients or otherwise), either deliberately or through incompetence and particularly where there is a continuing risk to patients […] j. Persistent lack of insight into the seriousness of their actions or the consequences’.

162(d) ‘While misuse of drugs or alcohol is serious, and not solely where linked to criminal conduct, there are certain factors that aggravate these issues. The aggravating factors that are likely to lead the tribunal to consider taking more serious action (this list is not exhaustive) are:




[…] d. misuse of alcohol or drugs that led to a criminal conviction, particularly where a custodial sentence was imposed […]’

The Tribunal applied those guidelines to the facts found proved. 47. The Tribunal noted the serious nature of Dr McAllister’s misconduct and convictions:

• that she had, through her misconduct, contributed to Mrs A’s death;

• her deliberate and repeated disregard of the principles set out in GMP;

• her three convictions relating to drugs;

• her lack of insight into her misconduct and offences;

• her lack of remediation of her misconduct and offences;

• the evidence that Dr McAllister had sought to minimise and justify her offending; and

• her lack of candour to the Police, Ninewells and the 2017 Tribunal.

48. Whilst the Tribunal was conscious that Dr McAllister does not currently present a risk to patient safety in that she is not currently practising medicine, it considered that her conduct, as set out in the Allegations, did present a risk to the health, safety and well-being of the public, given the repeated drug element. Further she had, through her conduct and convictions, undermined public confidence in the medical profession and proper professional standards and conduct for members of that profession. 49. XXX. 50. In all the circumstances, the Tribunal determined that Dr McAllister’s misconduct and offences were fundamentally incompatible with continued registration. 51. The Tribunal therefore concluded that it was necessary:

a. to protect, promote and maintain the health, safety and well-being of the public,

b. to promote and maintain public confidence in the medical profession, and c. to promote and maintain proper professional standards and conduct for

members of that profession. to direct that Dr McAllister’s name be erased from the Medical Register:




• for the new matters under Section 35(d)(2)(a) of the Medical Act 1983 (as amended); and

• Section 35(d)(5)(b) of the Medical Act 1983 (as amended), in respect of the review matters.

52. In the light of all the evidence presented to it, the Tribunal was satisfied that erasure is the necessary, proportionate and appropriate sanction when considering this new and review case. Current Order of Suspension and Appeal Period 53. The Tribunal directed to erase Dr McAllister’s name from the Medical Register. The Medical Practitioners Tribunal Service will send Dr McAllister a letter informing her right of appeal and when the new sanction will come into effect. 54. If Dr McAllister lodges an appeal, the current order of suspension on Dr McAllister’s registration will remain in place during the appeal period. 55. Case Concluded. Confirmed Date 08 September 2020 Mr Simon Bond, Chair




ANNEX A – 24/08/2020

Service and Proceeding in Absence – 24/08/2020 Service 1. Dr McAllister is neither present nor represented at this Medical Practitioners Tribunal (‘MPT’). The Tribunal therefore considered whether the relevant documents had been served properly in accordance with Rule 40 of the Rules, as amended. 2. Ms Chloe Fairley, Counsel, on behalf of the GMC, made submissions in relation to service. She directed the Tribunal’s attention to a:

• GMC letter dated 14 July 2020 that was sent to her registered address (sent by Royal Mail first class post) and her email address;

• A certificate of service of the letter dated 14 July 2020, signed by legal support assistant;

• The Notice of Hearing (‘NOH’) dated 16 July 2020 which was first sent to Dr McAllister’s email address and then, on 20 July 2020 via Royal Mail track and trace, which was signed for on 21 July 2020 at 11:27am by ‘K McAllister’;

• A further GMC letter ‘The GMC’s proposed sanction submission’, sent to Dr McAllister on 3 August 2020;

• A letter to XXX, Solicitor’s, dated 4 February 2020; and

• A telephone note, dated 3 August 2020. 3. Ms Fairley stated that all proper and reasonable attempts had been made to notify Dr McAllister of this hearing and she is aware of the hearing as evidenced the track and trace signature from the MPTS letter, dated 20 July 2020. 4. The Tribunal was persuaded that all the relevant requirements of Rules 20 and 40 of the Rules had been satisfied. Proceeding in Absence 5. Having been satisfied that the NOH has been properly served, the Tribunal went on to consider whether to exercise its discretion under Rule 31 of the Rules to proceed with the hearing in Dr McAllister’s absence. 6. Ms Fairley submitted that it was appropriate to proceed in Dr McAllister’s absence as:

• She has not sought to have this hearing adjourned;

• She is aware of the hearing and the documentation;

• Any delay would not secure her attendance and there is no information before the Tribunal of a reason for her non-attendance;




• all reasonable efforts have been made to serve the NOH on her; and

• It is in the public interest for the hearing to proceed in her absence.

7. The Tribunal noted the relevant case law as outlined by the Legally Qualified Chair, in determining whether to proceed in the absence of a practitioner, to include:

• R v Jones [2003] 1 AC HL; and

• GMC v Adeogba [2006] EWCA Civ 162. 8. The Tribunal has borne in mind that its discretion should be exercised with the utmost care and caution. It also considered the need to balance Dr McAllister’s interests, with the overarching statutory objective: namely the protection of the public. 9. Having performed the appropriate balancing exercise and in accordance with Rule 31, the Tribunal determined it was appropriate to proceed with the hearing in Dr McAllister’s absence, namely that she is aware of the hearing and has voluntarily absented herself. It concluded that it is fair and just and in the public interest to hear this case without further delay and that no useful purpose would be served by an adjournment.




SCHEDULE 1


Midazolam 10mg/5ml 340072

Midazolam 5mg/5ml 228077

Midazolam 5mg/5ml 04730613A




SCHEDULE 2 Codeine Tramadol Valium (Diazepam) Two combination tablets containing 200mg of Ibuprofen and 12.8mg of Codeine (‘the Combination Tablet’)




SCHEDULE 3 Text message sent on 9 May 2015 at 09:46 “Well I got violin till half one so if you want to wander down for bout 1 or quarter past 1 - let yourself in and take all the medicines on top of the cooker that I've left out (it'll look like a lot but at least four of them are are different types anti-sickness, rest will be paracetamol, brufen, codeine, tramadol and valium which are all the ones I tried you with already they're just the ones that take the hour to work so take them nearer 1 so [XX] can actually start tattooing at 2 (tell home to get everything set up while you're out) Cosy up on the couch and watch my telly for a bit, just let yourself get more and more relaxed and sleepy (don't fight it if you just cosy up on the couch - by the time I get back you'll you'll feel like you've had a good few G&Ts, I’ll top up with the faster acting ones when I get back and we'll get you staggering up to the shop to get tattooed by 2 at the latest?. How does that sound? Kate x” Text message sent on 9 May 2015 at 12:44 “Back in 2. - help yourself to the rest of the white wine that's left in fridge to aid your relaxation xx”

Documents

MPTS - PUBLIC RECORD...is not clinically indicated for the purposes of pain relief for someone getting a tattoo because the risks of adverse effects outweigh the potential benefits;