PUBLIC RECORD - mpts-uk.org...Jan 23, 2020 · Certificate from Dr Turner on 8 November 2017, dated the same day, covering a period of 8 weeks. On 6 December 2017 the Case Manager

Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr TURNER 1

PUBLIC RECORD

Dates: 15/01/2020 - 23/01/2020

Medical Practitioner’s name: Dr Stephen TURNER

GMC reference number: 4191465

Primary medical qualification: MB ChB 1995 University of Glasgow

Type of case Outcome on impairment New - Misconduct Impaired

Summary of outcome

Suspension, 10 months. Immediate order imposed

Tribunal:

Legally Qualified Chair Ms Christina Moller

Lay Tribunal Member: Ms Jacqueline Telfer

Medical Tribunal Member: Dr Damian McDermott

Tribunal Clerk: Ms Keely Crabtree

Attendance and Representation:

Medical Practitioner: Present and not represented

GMC Representative: Ms Suzie Kitzing, 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.



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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 and Impairment - 22/01/2020 1. The Tribunal granted Ms Kitzing’s application to make a typographical amendment of the Allegation in relation to Paragraph 3 (c). The application was made pursuant to Rule 17(6) of the General Medical Council (‘GMC’) (Fitness to Practise) Rules 2004, as amended (‘the Rules’). Dr Turner did not oppose the application. The Tribunal was satisfied that there would be no injustice to either party if the Allegation was amended. Accordingly, The Tribunal granted Ms Kitzing’s application. Background

2. Dr Turner graduated in 1995 from Glasgow University with a Bachelor of Medicine, Bachelor of Surgery MBChB (Hons) degree. Subsequently, Dr Turner became a Member of the Royal College of Surgeons in 2000. In 2013, Dr Turner obtained an MD (equivalent to PhD) from Glasgow University. Dr Turner gained full registration with the GMC in August 1996.

3. In November 2008 Dr Turner was erased from the medical register for non-payment of the annual retention fee. Dr Turner made a restoration application in January 2010 and was granted restoration to the medical register. He obtained a Licence to Practise in January 2011.

4. Dr Turner’s revalidation date was 4 April 2017. On 14 September 2015, the GMC emailed Dr Turner to advise that NHS Greater Glasgow and Clyde had removed him from their list of doctors for revalidation. The GMC requested that Dr Turner confirm his new designated body or confirm that he did not have one using his GMC online account. On 15 February 2016, Dr Turner informed the GMC that he did not have a designated body.

5. On 17 October 2016 the GMC wrote to Dr Turner advising him that he needed to submit his annual revalidation return by 14 February 2017. The GMC sent further correspondence to Dr Turner on 6 February 2017 and 13 February 2017. Dr Turner emailed the revalidation team on 9 February stating that he was working as a clinical fellow in Glasgow Royal on a fixed term contract.



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6. On 25 February 2017 and 27 February 2017, the GMC sent a formal final notice by letter and email to Dr Turner that informed him the GMC were considering withdrawing his licence because he had failed to provide the required evidence for revalidation. The letter and email advised Dr Turner that he had a further 28 days to submit his revalidation return. In addition, the GMC sent Dr Turner a reminder email stating that he must book a place for a revalidation assessment by 30 March 2017.

7. On 27 March 2017 Dr Turner emailed the GMC stating that he was having trouble entering details on his GMC online account. He also said that he had an appraisal booked within the next four weeks, that his supervisor was away, and no date had been set. Dr Turner stated that he had collected personal development (‘PD’) records and other information and asked if the Registrar could give him a further 4 weeks to complete his return.

8. On 29 March 2017 Dr Turner sent an additional email to the GMC revalidation team stating that he had a family bereavement and requested a month’s extension.

9. Dr Turner did not submit his annual revalidation return, nor did he take any steps to undergo the revalidation assessment. Therefore, a referral was made to the GMC Assistant Registrar for a decision as to whether Dr Turner’s Licence to Practise should be withdrawn in accordance with the GMC (Licence to Practise and revalidation) Regulations 2012 (as amended) (‘the Regulations’).

10. On 5 May 2017 the Assistant Registrar considered the referral and concluded that Dr Turner’s Licence to Practise should be withdrawn in accordance with Regulation 4(3)(b) and (c) of the Regulations. Dr Turner was notified of the decision the same day by letter and email.

11. On 30 May 2017 the GMC received a Notice of Appeal from Dr Turner against the decision to withdraw his licence for failure to meet revalidation requirements. The GMC appeals team responded to Dr Turner on 14 June 2017 stating that any further documents he wished to use in support of his appeal must be submitted by 29 July 2017.

12. On 1 August 2017, Dr Turner emailed the GMC appeals team stating incorrectly that he was currently unwell and had been admitted to hospital. Dr Turner asked for an extension of 10 days to send documents in support of his appeal. The GMC appeals team responded to Dr Turner the same day advising him that an application had been made to strike out his appeal, but he was given the opportunity to provide reasons why he had not complied with the appeals rules. Dr Turner was given a deadline of 15 August 2017 to provide his response.

13. On 13 August 2017 Dr Turner emailed the GMC appeals team stating that he had been unwell for the past 5-6 weeks, had needed surgery to his abdomen and would submit a Medical Certificate to confirm. The GMC appeals team received a further email



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from Dr Turner on 28 August 2017 stating that he was still unwell, recovering from major surgery and would provide a Medical Certificate.

14. On 4 September 2017 the GMC appeals team informed Dr Turner that the Case Manager had given him until 18 September 2017 to provide his evidence of ill health. Otherwise a decision would be made to strike out his appeal.

15. On 19 September 2017 Dr Turner emailed the GMC appeals team and stated incorrectly that he was in hospital for chemotherapy and apologised for not sending in his Medical Certificates. The GMC appeals team responded to Dr Turner the same day to advise that his Medical Certificates would be required by the end of the week.

16. On 23 September 2017 Dr Turner emailed the GMC appeals team and provided a copy of a Medical Certificate dated 22 September 2017 which covered a period of 6 weeks. In response the GMC appeals team wrote to Dr Turner on 28 September 2017 and advised him that the Case Manager had decided not to strike out his appeal and requested that he submit his appeal bundle by 25 October 2017.

17. On 24 October 2017 the GMC appeals team received a further Medical Certificate from Dr Turner dated 10 October 2017 covering a period of 4 weeks. On 7 November 2017 the GMC appeals team emailed Dr Turner and asked him to submit his appeal bundle or a further Medical Certificate as his previous one had expired. Dr Turner responded by email that day and stated that he was still in hospital but that he would send in a Medical Certificate. The GMC appeals team received a further Medical Certificate from Dr Turner on 8 November 2017, dated the same day, covering a period of 8 weeks. On 6 December 2017 the Case Manager advised Dr Turner that the deadline to submit his appeal bundle would now be 3 January 2018.

18. On 11 January 2018 the GMC appeals team emailed Dr Turner to say that a short extension to 15 January 2018 had been granted. Dr Turner emailed the appeals team on 16 January 2018 to advise that he would be able to submit his appeal bundle by 17 January 2018. The GMC appeals team did not receive Dr Turner’s appeal bundle by 17 January 2018 and the Case Manager allowed a further extension until 30 January 2018.

19. On 29 January 2018 the GMC appeals team received another Medical Certificate from Dr Turner for a period of 8 weeks.

20. On 7 February 2018 the GMC appeals team was notified of concerns that Dr Turner had been working while submitting Medical Certificates to the GMC. However, the Case Manager made a decision that it was no longer appropriate to contact Dr Turner whilst he had a valid Medical Certificate and that the GMC would wait until the Medical Certificate had expired before contacting him.

21. On 12 March the GMC appeals team reviewed Dr Turner’s case and took a further look at the Medical Certificate he had submitted on 29 January 2018. It was noted that the handwriting was similar to the Medical Certificates which had been submitted



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previously and that the name of the doctor who had signed it appeared strange. The signing doctor’s name was checked against the medical register, but no results were found.

22. On 22 March 2018 Dr Turner sent a handwritten letter to the GMC appeals team stating that his last round of treatments had set him back a little and that he had some appeal material in mind.

23. Dr Turner did not submit his appeal bundle and therefore the GMC case Manager made the decision to strike out his appeal on 4 April 2018. On 5 April 2018 the GMC received a further Medical Certificate from Dr Turner dated 20 March 2018 covering a period of 6 weeks. However, the GMC had already commenced a fitness to Practise investigation in respect of Dr Turner.

24. In response to a request from the GMC on 26 March 2018 Medacs Healthcare completed and submitted a Responding to Fitness to Practise Concerns form for Dr Turner and provided the GMC with information regarding locum work he had done through them.

25. Dr Turner had initially contacted Medacs Healthcare to register on 23 September 2017 and signed his application forms on 14 November 2017. Dr Turner’s first placement was as a locum ST 3 in Surgery at Monklands Hospital, Airdrie, initially from 3 January 2018 until 31 January 2018. Dr Turner had been notified of his placement by email on 29 December 2017. His position at Monklands Hospital was later extended until 31 May 2018.

26. On 6 March 2018, Monklands Hospital called Medacs Healthcare to say that Dr Turner had not turned up for work and that he had made no contact as to why he had not attended. Medacs Healthcare attempted to contact Dr Turner on a number of occasions, but no response was received.

27. On 29 March 2018, Madacs received a letter from Dr Turner containing a Medical Certificate. The letter advised that Dr Turner had been considerably unwell and had been too stressed to deal with anything apart from his health at that time.

The Allegation and the Doctor’s Response

28. The Allegation made against Dr Turner is as follows:

1. In correspondence with the GMC Registration Appeals Team you falsely

stated:

a. on 1 August 2017: “I am currently unwell and admitted to hospital”;

Admitted and found proved



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b. on 13 August 2017: “I have been unwell for the past 5-6 weeks and

was taken into surgical for an abdominal complaint”; Admitted and

found proved

c. on 28 August 2017: “I have been seriously ill for about 8 weeks now

but recovering from major surgery”; Admitted and found proved

d. on 19 September 2017: “I am still an inpatient following surgery and

soon to get chemo”; Admitted and found proved

e. on 7 November 2017: “still in hospital”; Admitted and found proved

f. on 17 November 2017: “forgive the paper + writing standard, all I

have available as inpatient again”. Admitted and found proved

2. You knew the comments you made at paragraph 1 above were false.


3. You submitted a false statement of fitness to work, (‘Med 3’) to the GMC on

the following dates:

a. 23 September 2017, Med 3 dated 22 September 2017; Admitted and

found proved

b. on or around 24 October 2017, Med 3 dated 10 October 2017;


c. 8 November 2018 2017, Med 3 dated 8 November 2017; Admitted

and found proved

d. 29 January 2018, Med 3 dated 16 January 2018; Admitted and

found proved

e. 5 April 2018, Med 3 dated 20 March 2018. Admitted and found

proved

4. You knew the Med 3’s set out at paragraph 3 above were false. Admitted

and found proved

5. In order to avoid having your Licence to Practise revoked, you undertook

actions at:

a. paragraphs 1-2 above; Admitted and found proved



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b. paragraphs 3-4 above. Admitted and found proved

6. Your actions at paragraph 1 were dishonest by reason of paragraphs:

a. 2; Admitted and found proved

b. 5a. Admitted and found proved

7. Your actions at paragraph 3 were dishonest by reason of paragraphs:

a. 4; Admitted and found proved

b. 5b. Admitted and found proved

8. On 29 March 2018 you submitted a false Med 3 dated 20 March 2018 to

Medacs Healthcare. Admitted and found proved

9. You knew the Med 3 set out at paragraph 8 above was false. Admitted and

found proved

10. Your actions at paragraph 8 were dishonest as a consequence of paragraph 9.


And that by reason of the matters set out above your fitness to practice is impaired because of your misconduct. To be determined The Admitted Facts

29. At the outset of these proceedings, Dr Turner admitted the facts as set out in the Allegation, in accordance with Rule 17(2)(d) of the Rules. In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced these paragraphs and sub-paragraphs of the Allegation as admitted and found proved.

Impairment

30. In light of Dr Turner’s response to the Allegation made against him, there are no facts to be determined. The Tribunal is therefore now required to determine whether Dr Turner’s fitness to practise is impaired by reason of his misconduct.

Evidence

31. The Tribunal considered all the documentary evidence provided by Dr Turner and the GMC. This evidence included, but was not limited to:



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• GMC Restoration after administrative erasure application document dated 5 March 2010;

• Determination: Restoration application dated 11 November 2010; • GMC chronology of events; • Dr Turner’s Curriculum Vitae; • Letter from Dr A, General Practitioner (‘GP’) dated 13 December 2019;

• Letter from Dr B, XXX, dated 19 November 2019.

32. The Tribunal received documentary evidence from the following witnesses on behalf of the GMC:

• Ms C, Revalidation Manager at Madacs Healthcare; • Mr D, GMC Revalidation Operations Manager; • Ms E, GMC Appeal’s Co-ordinator (Registration Appeals Team); • Dr F, Clinical Fellow in Plastic Surgery at the Glasgow Royal Infirmary; • Ms G, Human Resources Advisor to Medical Staffing at NHS Greater Glasgow

and Clyde.

33. Dr Turner provided his own witness statement dated 20 December 2019 and also gave oral evidence at the hearing. In addition, the Tribunal received evidence from the following witness on Dr Turner’s behalf:

• Dr B, by telephone link, previously agreed by parties prior to the hearing.

34. Counsel for the GMC provided copies of four authorities to Dr Turner in good time for him to consider before making submissions on Impairment:

• Nicholas-Pillai 2009 EWHC 1048 • Grant 2011 EWCH 927 • Chaudhary 2017 EWCH 2561 • Nwachuku 2017 EWHC 2085.

Submissions on behalf of the GMC

35. On behalf of the GMC, Ms Kitzing outlined the staged approach to misconduct and impairment and referred to Dr Turner’s departures from Good Medical Practice (2013) (‘GMP’). Ms Kitzing submitted that the facts in this case amount to misconduct which is serious and that, as a result, Dr Turner’s fitness to practise is currently impaired. 36. Ms Kitzing acknowledged that a finding of dishonesty does not always lead to a finding of impairment. However, she submitted that any form of dishonesty by a member of the medical profession is likely to be considered to be serious and is difficult to remedy. Therefore, a finding of impairment was necessary to reaffirm the standards expected of doctors and to maintain public confidence in the medical profession.



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Dr Turner’s submissions 37. XXX. Dr Turner told the Tribunal that his decision to appear unrepresented was not solely financial. It was also important to him to speak in an honest, open and unmediated way to the Tribunal. 38. Although he has not yet completed a course on issues relating to honesty, Dr Turner told the Tribunal that he intends to share his recent experience, XXX, with other health professionals in due course. 39. Dr Turner confirmed that he has no criminal record and believes his character to be good. He anticipates that his reflection on his dishonest actions will be life long, but he does not believe that his dishonesty will ever be repeated and does not regard his fitness to practise as currently impaired. However, Dr Turner acknowledged in answer to questions from the Tribunal, that dishonesty is of interest to the media and that his actions would have an impact on the public’s perception of the medical profession. He described his disorganisation and dishonesty as extremely serious. 40. Dr Turner submitted that his admissions at the outset of the hearing show insight. He also stated that he believes his actions amounted to misconduct and that he bitterly regrets them. 41. Dr Turner stated that his path to revalidation is now clearer to him. XXX. The Relevant Legal Principles 42. The Tribunal had regard to the authorities as referred to by Ms Kitzing and the Legally Qualified Chair (‘LQC’). It reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision on impairment is a matter for the Tribunal’s judgement alone. Not every case of misconduct results in a finding of impairment. 43. 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 misconduct which was serious and, if so, whether the finding of that misconduct which was serious, leads to a finding of impairment. 44. The Tribunal reminded itself that it must determine whether Dr Turner’s fitness to practise is impaired today, taking into account his actions at the time of the events giving rise to the Allegation together with any relevant factors since, to include whether the matters are remediable, have been remedied and any likelihood of repetition.



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45. The Tribunal reminded itself that it must determine whether Dr Turner has demonstrated insight and, if so, to what extent. The Tribunal should bear in mind throughout its deliberations the statutory overarching objective, which includes:

a. Protecting, promoting and maintaining the health, safety and wellbeing of the public,

b. Promoting and maintaining public confidence in the medical profession, c. Promoting and maintaining proper professional standards and conduct

for members of that profession. 46. The Tribunal had regard to CHRE v NMC and P Grant [2011] EWHC 927 (Admin):

‘Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

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; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly in the future.’

47. The Tribunal had regard to Remedy UK v GMC 2010 EWHC 1245 (Admin). Misconduct is of two principal kinds. First, misconduct going to fitness to practise in the exercise of professional practice. Second, morally culpable or otherwise disgraceful conduct outside or within professional practice. Conduct falls into the second category if it is dishonourable or attracts some kind of opprobrium – that fact may be sufficient to bring the profession of medicine into disrepute and it does not matter whether or not it is directly related to the exercise of professional skills. 48. The word misconduct in Medical Act 1983 section 35C(2)(a) connotes a serious breach indicating that a doctor’s fitness to practise was impaired. It is important to set the matters complained of in the context of the doctor’s whole practice: Calhaem v GMC 2007 EWHC 2606.

49. The need to maintain public confidence in the medical profession and declaring and upholding standards of behaviour may mean that a doctor’s fitness to



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practise is impaired by reason of certain acts of misconduct of themselves. This is because the public simply would not have confidence in him, or in the profession’s standards, if the tribunal regarded that sort of conduct as leaving fitness to practise unimpaired. A finding of impairment can be necessary to reaffirm to the public and doctors the standard of conduct expected of them: Yeong v GMC 2009 EWHC 1923. 50. Chaudhary confirms the importance of the overarching objective, the tripartite public interest and the need for Tribunals to conduct a proper balancing exercise of all three elements of the public interest test, rather than to focus on just one aspect of the test. Modified Good Character Direction 51. The LQC gave a modified good character direction to the Tribunal. Dr Turner is a person of largely good character who has only one regulatory issue recorded ten years ago, not for dishonesty. 52. Firstly, Dr Turner has given evidence at the impairment stage. Good character is a positive feature of Dr Turner which the tribunal should take into account when considering whether or not his evidence is accepted as credible. 53. In addition, the fact that Dr Turner has only one previous regulatory issue (not involving dishonesty) goes to the likelihood, or otherwise, of him behaving dishonestly in future. This is his only episode of dishonesty. The lack of other instances must be taken into account when assessing any propensity to be dishonest in the future.

54. Judging the weight to be given to the Dr’s relatively good character and its relevance to impairment is a matter for the tribunal, taking account of all the evidence. As this case involves intermediate character the Tribunal must consider the age and nature of any previous incident, as well as intervening events in deciding whether or not Dr Turner has regained his good character; this is at the discretion of Tribunal. 55. Neither Ms Kitzing or Dr Turner had any comments on the LQC’s legal advice. When asked if they accepted it, they both said yes. The Tribunal’s Determination on Impairment Misconduct 56. The tribunal first considered whether Dr Turner’s actions amount to misconduct.



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57. The Tribunal considered that the following paragraphs of the current edition of Good Medical Practice (2013) (‘GMP’) were relevant:

‘65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.

68. You must be honest and trustworthy in all your communication with patients and colleagues. This means you must make clear the limits of your knowledge and make reasonable checks to make sure any information you give is accurate.

71. You must be honest and trustworthy when writing reports, and when

completing or signing forms, reports and other documents. You must make sure that any documents you write or sign are not false or misleading.

a. You must take reasonable steps to check the information

is correct. 58. The Tribunal was of the view that doctors occupy a position of privilege and trust in society and are expected to uphold proper standards of conduct. Members of the public are entitled to place complete reliance on doctors being honest. The relationship between the profession and the public is based on the expectation that medical practitioners will act at all times with integrity. Dishonesty, even where it does not result in actual harm to patients, is particularly serious because it can undermine the public’s trust and confidence in the medical profession. 59. XXX 60. XXX 61. XXX 62. XXX 63. XXX, the Tribunal considered that forging a series of Medical Certificates and misleading his regulator for several months amounted to a wrongful mode of performance of professional duty, as conceived in Mallon v GMC 2007 CSIH 17. 64. The word misconduct in the Medical Act 1983 section 35C(2)(a) connotes a serious breach indicating that a doctor’s fitness to practise is impaired: Calhaem. It is important to set the matters complained of in the context of the doctor’s whole practice and the Tribunal has done so, taking account of his largely unblemished career. The only previous issue relates to non-payment of fees XXX about a decade



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ago. Dr Turner returned successfully to practise and provided medical services for many years to the public, without incident. The Tribunal takes account of this, XXX. 65. Nevertheless the Tribunal considered that Dr Turner’s behaviour fell short of the standards reasonably expected of doctors and that this was serious. XXX, Dr Turner repeatedly forged Medical Certificates to support untrue claims of physical ill-health to the GMC and his deception was sustained over time. XXX. He was able to distinguish right from wrong in 2017 to 2018 and thus most people would regard his actions as deplorable. 66. It is not alleged that Dr Turner’s misconduct occurred directly in the context of his professional practice, although it did involve misleading his regulator. Dr Turner has acknowledged the importance of appraisal, revalidation and licensing procedures. He implicitly accepted that his behaviour undermined that process, which is designed to keep the public safe and to maintain public confidence in the profession. 67. The Tribunal considered that forging medical certificates, particularly using the name of a real doctor, and deceiving the GMC amounted to morally culpable or otherwise disgraceful conduct, as referred to in Remedy UK. His behaviour was dishonourable and would attract opprobrium from medical colleagues as well as the public. That is sufficient to bring the profession of medicine into disrepute. It does not matter whether or not it was directly related to the exercise of professional skills: Remedy UK at [37]. 68. The Tribunal concluded that, taking account of all the circumstances in this case, Dr Turner’s dishonest conduct fell far below the standards expected of a doctor, was contrary to GMP guidance and breached a fundamental tenet of the medical profession: honesty and integrity. The Tribunal therefore concluded that Dr Turner’s actions amounted to misconduct and that that misconduct was serious. Impairment 69. Having assessed Dr Turner’s actions in light of principles referred to in relevant authorities and guidance, the Tribunal found that facts admitted and found proved amount to misconduct. The Tribunal went on to consider whether Dr Turner’s fitness to practise is currently impaired by reason of that misconduct. 70. The GMC allege that impairment of Dr Turner’s fitness to practise arises from

events in 2017 – 2018, as opposed to a continuing state of affairs, but the Tribunal

must consider whether or not Dr Turner’s fitness to practise is currently impaired by

reason of past misconduct. To do this the Tribunal has taken account of Dr Turner’s

XXX, changes in his conduct and attitude since the matters found proved actually

occurred, with a focus on his future. We take account of Dr Turner’s level of insight,

acceptance of responsibility and efforts to correct remediable issues.



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71. Impaired is an ordinary word in common usage, not defined in the Medical

Act. GMP provides context, particularly those paragraphs that refer to probity.

72. The Tribunal has taken account of the absence of any history of dishonesty

and accepted Dr Turner’s evidence that he is generally a person of integrity. There is

a spectrum of dishonest behaviour and dishonesty does not have to be an ‘all-

pervading or immutable trait’: Chaudhary at [57]. The Tribunal accepted Dr Turner’s

evidence that he is usually a truthful person and intends to be so in future.

73. The Tribunal has taken account of Dr Turner’s written and oral evidence; it

indicates a significant level of insight. He fully accepts that he should have behaved

differently, telling the Tribunal that he let himself and his profession down. He has

been open and honest with the Tribunal, acknowledging gaps in his memory. He has

expressed genuine remorse and cooperated with his regulator and the Tribunal.

74. Demonstrating that dishonest behaviour has been remediated is not as

straightforward as showing an improvement in clinical skills. However, Dr Turner has

not sought to evade responsibility XXX and accepted that his dishonesty amounted

to misconduct. This is evidence of real insight.

75. However, insight is not yet complete. Dr Turner described himself as

’incredibly remorseful and bewildered’. This indicates that he has not yet fully

understood the reasons XXX and other triggers for his dishonesty.

76. XXX. As he is unrepresented, Dr Turner appeared to be unaware of the

benefit of providing witnesses with a copy of the Allegation. The Tribunal draws no

adverse inference from this. However, although he knew that Dr Turner had to

appear before a Medical Practitioners Tribunal, Dr B’s evidence cannot be interpreted

in the context of him having full knowledge of the detail of the Allegation.

77. In determining impairment the Tribunal has considered future risks in light of

previous conduct. Facts admitted and found proved do not establish a risk of direct

harm to others, except in so far as Dr Turner’s misconduct had potential to

undermine regulatory protections. However, Dr Turner has brought the profession

into disrepute by forging Medical Certificates and misleading his regulator; his

dishonest actions breach at least one fundamental tenet of the medical profession.

78. His insight, remorse XXX minimise the risk of any repetition of similar

behaviour. XXX. The Tribunal does not consider it likely that he would act

dishonestly, breach any fundamental tenet of GMP or bring the medical profession

into disrepute in the future.

79. Although the Tribunal heard no evidence that Dr Turner presents a direct risk

to patients, the need to maintain public confidence in the medical profession and

declare and uphold professional standards means that Dr Turner’s fitness to practise

is impaired by reason of his dishonest acts of misconduct in themselves. This is



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because the public simply would not have confidence in Dr Turner, or in the

profession’s standards, if this Tribunal regarded his misconduct as leaving his fitness

to practise unimpaired. A finding can be necessary to reaffirm to the public and

doctors the standard of conduct expected of them: Yeong.

80. Chaudhary reminds the Tribunal of the importance of the overarching

objective, the tripartite public interest and the need for Tribunals to conduct a

proper balancing exercise of all three elements of the public interest test, rather than

to focus on just one aspect of the test. The Tribunal considers that, although Dr

Turner does not present a risk to patients, the need to maintain confidence in the

medical profession requires there to be a finding that his current fitness to practise is

impaired, as does the need to declare and uphold professional standards.

81. Accordingly, the Tribunal determined that Dr Turner’s conduct fell far short of the standards of conduct reasonably to be expected of a doctor, such that it was necessary in the public interest to declare and uphold professional standards by making a finding of impairment. Determination on Sanction - 23/01/2020 1. Having determined that Dr Turner’s fitness to practise is impaired by reason of misconduct, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction, if any, to impose. The Evidence 2. The Tribunal has taken into account evidence received during the earlier stages of the hearing where relevant to reaching a decision on sanction. GMC Submissions 3. In the course of her submissions on behalf of the GMC, Ms Kitzing referred the Tribunal to relevant paragraphs in the ‘Sanctions Guidance’ (February 2018 edition) (‘the SG’). In summary, Ms Kitzing submitted that the appropriate and proportionate sanction in this case is erasure of Dr Turner’s name from the medical register. Ms Kitzing submitted that such a sanction would promote and maintain public confidence in the medical profession and would promote and maintain proper professional standards and conduct for members of the profession. 4. Ms Kitzing submitted that, in light of the Tribunal’s findings on impairment, taking no action in this case would be inappropriate. She said that it was extremely difficult to see how the Tribunal could formulate any workable conditions on Dr Turner’s registration that would be an appropriate response to his misconduct, namely his dishonesty.



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5. Ms Kitzing submitted that the usual sanction for dishonesty is erasure as it is important for the public to have trust in doctors. Although a sanction must be proportionate, the reputation of the medical profession is more important than that of an individual doctor. Dr Turner breached the principle of honesty in a serious and persistent way, such that the regulatory system was undermined. 6. There are no exceptional circumstances justifying taking no action against Dr Turner. Undertakings have not been offered, so cannot be considered. 7. Although there is no evidence that Dr Turner would not comply with conditions, this sanction is not appropriate to address the public interest in this case. It is difficult to remediate dishonesty and the GMC submits that Dr Turner’s misconduct has not been remediated. 8. With regard to suspension Ms Kitzing said that, the Tribunal would have to be satisfied that Dr Turner’s behaviour was unlikely to be repeated. The SG at paragraph 97 lists factors that would indicate that suspension may be appropriate, such as remediation, insight and no evidence of repetition. The GMC submits that suspension is not appropriate in this case as it cannot be said that Dr Turner’s conduct falls short of being fundamentally incompatible with continued registration. 9. Ms Kitzing submitted that erasure is required to maintain public confidence in the medical profession as well as to declare and uphold standards. Even if there is no risk to patients, Dr Turner has exhibited a blatant disregard for regulatory safeguards. Whilst the GMC does not rely on patient safety to justify erasure, there was a particularly serious departure from GMP: Dr Turner abused his position of trust and covered up his original dishonesty persistently, by submitting false Medical Certificates. Erasure is the least restrictive option to satisfy the public interest. Dr Turner’s Submissions 10. Dr Turner submitted that public confidence in the medical profession must be maintained. He welcomed the opportunity to explain his actions to the Tribunal, as he knows this process contributes to maintaining public confidence. 11. Dr Turner clarified to the Tribunal that his earlier use of the term ‘bewildered’ referred back to his bewildered state at the time of the events, when he was not as XXX as he is today. He now has more clarity of thought. 12. Dr Turner recognised that his case is not exceptional and did not ask the Tribunal to take no action. However, he urged the Tribunal to take account of the background to his dishonest behaviour. His pathway to remediation and demonstration of honesty is ongoing, with the support of relatives, colleagues and XXX. Dr Turner said that he recognises more fully the importance of engaging with XXX and he acknowledged that



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he did not do so in 2017 – 2018. He said that it can be ‘hard for a doctor to approach the GMC as it is a regulatory body’ although it is sometimes necessary. 13. Dr Turner referred to the insight he expressed at the impairment stage, as well as his ongoing efforts to remediate his behaviour. During breaks in the Tribunal hearing Dr Turner said that he identified courses provided by the British Medical Association and medical defence organisations on ethics, probity, legal issues and revalidation; he will continue his professional development in these areas. 14. Dr Turner reminded the Tribunal that dishonesty is not a monolithic concept and questions of degree arise. He said that he has been willing to engage openly. There have been no other episodes of dishonesty. The Tribunal can be satisfied that he has sufficient insight into triggers for his misconduct not to repeat it. 15. Dr Turner acknowledged that the decision is for the Tribunal but submitted that erasure would be disproportionate in all the circumstances. LQC advice 16. The decision as to the appropriate sanction, if any, is a matter for this Tribunal exercising its own judgment. In reaching its decision, the Tribunal has taken account of the SG and the statutory over-arching objective. The Tribunal recognises that the purpose of a sanction is not to be punitive, although it may have a punitive effect. 17. Throughout its deliberations the Tribunal has applied the principle of proportionality, balancing Dr Turner’s interests with the public interest. It reminded itself that it should only impose the minimum sanction necessary to achieve the over-arching objective. In deciding what sanction, if any, to impose the Tribunal considered each of the sanctions available, starting with the least restrictive. It also identified and took account of the mitigating and aggravating factors in this case. 18. Raschid and Fatnani v GMC 2007 1 WLR 1915 states that the Tribunal is centrally concerned with the reputation or standing of the profession, rather than the punishment of the doctor, despite the fact that sanctions may have a punitive, even a devastating, effect. 19. The aim of the SG is to promote consistency of decisions and transparency: CRHP v GMC and Leeper 2004 EWHC 319. The Tribunal must have regard to the SG, although each case will depend on its own facts and guidance must not be regarded as laying down a rigid tariff.

20. Any departure from the guidance must be explained: Doree 2017 EWCA Civ 319. A Tribunal need not ‘adhere’ to the guidance, but it should apply the SG. If the tribunal has sound reasons for departing from the SG it must state those



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reasons clearly in their decision. The SG is intended to be flexible and is not comprehensive or specific in describing all circumstances where a particular order is a suitable sanction.

21. Mitigation can affect the type of sanction, as well as the length of a

relevant order. In Wisniewska v NMC 2016 EWHC 2672 it was said that, where

there are only two options for sanction such as striking off or suspension, it is

critical that the available mitigation is applied when evaluating the proportionality

of a suspension as well as when considering erasure.

22. Although mitigation can reduce the length of suspension, it could also pull a

case back from the brink of strike-off and mean that a suspension is proportionate.

Mitigation must be assessed by the tribunal when looking at both these issues.

Mitigation can affect the type of sanction, as well as the length of a relevant order.

23. In GMC v Mmono [2018] EWHC 3512 the court found that ‘six of the indicia

for erasure were present’, including a particularly serious departure from the

principles set out in GMP. It found that Dr Mmono had been dishonest in his

dealings with his Regulator which placed his dishonesty at the more serious end of

the spectrum. It found little evidence of insight or remediation or reflection. No

good or cogent reason was provided by the Tribunal to justify suspension over

erasure as there was none. Although Dr Mmono did not attend his Tribunal, he was

give opportunity to ‘develop insight’ by the MPT. Factors referred to by the High

Court included ‘blatant dishonesty’ on more than one occasion, absence of insight,

‘poor reflection’, a ‘hollow’ apology to the Tribunal and an ‘absence of relevant

mitigation’. The court said that ‘dishonesty by a medical professional is always

serious, adding that ‘a dishonest misleading of the Regulator is at the most serious

end of the spectrum as it undermines the system of professional regulation upon

which the public is entitled to rely’. Substituting the sanction of erasure for a 12

month suspension the court said the ‘Sanctions Guidance points squarely in the

direction of erasure’.

24. In GMC v Khetyar [2018] EWHC 813 cited in Mmono, the Sanctions

Guidance was described as providing an ‘authoritative steer for tribunals as to

what is required to protect the public, even if it does not in any particular case

dictate the outcome’.

25. Theodoropoulos 2017 EWHC 2017 considered the case of a doctor who had

not demonstrated insight into his dishonesty. Misconduct does not have to occur in

a clinical setting before it renders erasure, rather than suspension, the appropriate

sanction. When considering if an act of dishonesty is ‘an isolated incident’ a

Tribunal must consider whether or not it required forethought as well as the

seriousness of the potential outcome.



MPT: Dr TURNER 19

26. Fopma v General Medical Council [2018] EWHC 714 is authority for the

proposition that failure to disclose pertinent facts can be described as ‘persistent’

dishonesty if it is ongoing throughout the relevant time.

Comments on legal advice

27. Ms Kitzing submitted that principles articulated in Bijl v GMC 2001 UKPC 42

should be regarded with great caution and the Tribunal agreed to do so. Bijl stated

that a Tribunal should not be obliged to erase an otherwise competent and useful

doctor who presents no danger to the public in order to satisfy public demand for

blame and punishment. However, the Tribunal agreed with Ms Kitzing that, while

there might be a public interest in enabling a doctor’s return to safe practice, the

tripartite public interest remains the primary concern. Other than that, neither party

had any comment on the legal advice, which was accepted.

Background

28. A previous GMC panel had to consider restoration following administrative erasure. After that Dr Turner had a number of different locum positions were he felt inadequately supported, which would have been very difficult for him XXX. 29. XXX 30. XXX 31. The Tribunal was impressed with the changes Dr Turner has made since 2018, XXX and obtained work outside medicine. He has shown that he is now able to adhere to a routine and focus on his responsibilities. 32. The Tribunal accepted Dr B’s evidence that Dr Turner is recovering from a ‘chronic state of demoralisation’. He was knocked off course for several years and some of his medical roles were unrewarding. Locum positions did not provide stability. 33. XXX 34. XXX. Dr Turner aims, in future, to take a more positive direction in life, avoiding any negative spiral. XXX. 35. XXX 36. XXX



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37. XXX

The Tribunal’s Determination on Sanction Aggravating and mitigating factors Mitigating factors 38. The Tribunal has evidence that Dr Turner has a good level of insight into factors contributing to his disorganisation in 2017 - 2018, deception and forgery of Medical Certificates. He admitted the Allegation at the outset of the hearing, apologised and expressed deep remorse. XXX, he has taken significant steps to reduce the likelihood of any recurrence of his dishonest behaviour. 39. Dr Turner has not previously been found to have impaired fitness to practise. The Tribunal accepts his evidence that he is, in general, a person of integrity with only one blemish on his regulatory record, an administrative erasure for non-payment of fees XXX. 40. XXX 41. XXX 42. Dr Turner admitted the Allegation, apologised to his regulator, explained himself to the Tribunal and answered all questions asked. XXX. 43. Dr Turner gave detailed evidence at some length, expressed remorse and regret. He has been honest and open with the Tribunal. 44. In terms of reflection on his dishonest misconduct and remediation, Dr Turner accepts that he should have behaved differently. He wrote to the MPTS on 20 December 2020 to say that he would not contest the Allegation. 45. Dr Turner told the Tribunal that he welcomed the opportunity to explain himself and to ‘be judged’. The Tribunal considers that he continues to develop insight, for example by expressing his intention to attend courses on probity, take revalidation examinations and share his experience with other clinicians, XXX. Aggravating factors 46. Against those mitigating factors, the Tribunal considered that any dishonesty by a doctor must always be regarded as serious, particularly were it has potential to undermine the regulatory system.



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47. The Tribunal considered that Dr Turner lacked probity at the time of his repeated forgeries of medical certificates and persistent dishonesty with his regulator, as he did not set the record straight until challenged. He was dishonest in his communication with the GMC over several months. The Tribunal’s Determination on Sanction 48. Dishonesty by a medical professional is always serious, especially when it involves misleading the GMC and undermining the system of professional regulation upon which the public is entitled to rely. XXX. 49. XXX No action 50. The Tribunal first considered whether to conclude the case by taking no action. Taking no action following a finding of impaired fitness to practise would only be appropriate in exceptional circumstances. The Tribunal determined that there are no exceptional circumstances in this case and that it would not be sufficient, proportionate, or in the public interest to conclude this case by taking no action. Conditions 51. The Tribunal next considered whether to impose conditions on Dr Turner’s registration. In so doing, it bore in mind that any conditions imposed would need to be appropriate, proportionate, workable, and measurable. In the light of its findings, the Tribunal determined that it would not be possible to formulate a set of appropriate conditions which could adequately address Dr Turner’s dishonest misconduct. Conditional registration would not be a sufficient, appropriate, or proportionate sanction to satisfy the public interest, in particular to maintain trust in the profession. Suspension 52. The Tribunal next considered whether it would be appropriate and proportionate to suspend Dr Turner’s registration. A sanction of suspension has a deterrent effect and would send a signal to Dr Turner, the profession, and the public about the standard of behaviour expected of all doctors. Suspension is an appropriate response to misconduct which is sufficiently serious that action is required in order to maintain public confidence in the profession, provided that the doctor’s misconduct is not fundamentally incompatible with continued registration. 53. Dr Turner’s misconduct is sufficiently serious that action is required to promote and maintain public confidence in the medical profession, and to promote



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and maintain proper professional standards and conduct for members of that profession. 54. However, having had regard to the specific circumstances of this case, and having carefully balanced the aggravating and mitigating factors in this case as set out above, the Tribunal was satisfied that Dr Turner’s misconduct is not fundamentally incompatible with continued registration and that erasing his name from the medical register would be disproportionate, punitive, and otherwise not in the public interest. 55. The Tribunal does not consider that the Sanctions Guidance points squarely in the direction of erasure in Dr Turner’s case. 56. In all the circumstances, the Tribunal determined to suspend Dr Turner’s registration for a period of 10 months. The Tribunal considered that this sanction was sufficient, appropriate and proportionate and that it marked the seriousness with which the Tribunal viewed Dr Turner’s misconduct. The Tribunal was satisfied that such a sanction would be sufficient to promote and maintain both public confidence in the profession, and standards and conduct for members of the profession. 57. The Tribunal determined to direct a review of Dr Turner’s case. A review hearing will convene shortly before the end of the period of suspension, unless an early review is sought. The Tribunal wishes to clarify that, at the review hearing, the onus will be on Dr Turner to demonstrate how he has remediated and developed full insight. Dr Turner may like to provide the reviewing Tribunal with a personal written statement demonstrating any insight gained into his misconduct XXX, courses on probity/ethics or other professional development, as well as in preparation for revalidation. He is invited to submit any other documents he thinks may assist, including testimonials. Determination on Immediate Order - 23/01/2020 1. Having determined that Dr Turner’s registration should be suspended for a period of 10 months, the Tribunal has considered, in accordance with Rule 17(2)(o) of the Rules, whether Dr Turner’s registration should be subject to an immediate order. 2. The Tribunal may impose an immediate order if it determines that it is necessary to protect members of the public, or is otherwise in the public interest, or is in the best interests of the doctor. Submissions 3. On behalf of the GMC, Ms Kitzing submitted that an immediate order of suspension is necessary in the public interest given the seriousness of the case. This is primarily to maintain public confidence in the profession.



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4. Dr Turner, did not have any response to the GMC’s submissions. The Tribunal’s Determination 5. In reaching its decision the tribunal referred to the relevant paragraph of the SG. It exercised its own judgement and had regard to the principle of proportionality. 6. The Tribunal is of the view that, public confidence in the profession would be undermined if the doctor could return to work pending a period of appeal. In these circumstances, the Tribunal concluded that an immediate order was in the public interest in particular to maintain confidence in the medical profession. 7. This means that Dr Turner’s registration will be suspended from when notification is deemed to have been served. The substantive direction, as already announced, will take effect 28 days from when written notice of this determination has been served upon Dr Turner, unless an appeal is made in the interim. If an appeal is made, the immediate order will remain in force until the appeal has concluded. 8. The interim order currently imposed on Dr Turner’s registration will be revoked when the immediate order takes effect. 9. That concludes this case. Confirmed Date 23 January 2020 Ms Christina Moller, Chair

Documents

PUBLIC RECORD - mpts-uk.org...Jan 23, 2020 · Certificate from Dr Turner on 8 November 2017, dated the same day, covering a period of 8 weeks. On 6 December 2017 the Case Manager