PUBLIC RECORD of Determinations – Medical Practitioners Tribunal MPT: Dr GOVERDHAN 1 PUBLIC RECORD Dates: 03/01/2018 - 10/01/2018 Medical Practitioner’s name: Dr Srinivas

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  • Record of Determinations

    Medical Practitioners Tribunal

    MPT: Dr GOVERDHAN

    1

    PUBLIC RECORD Dates: 03/01/2018 - 10/01/2018 Medical Practitioners name: Dr Srinivas Venkatachalapathy GOVERDHAN

    GMC reference number: 5186084

    Primary medical qualification: MB BS 1991 Bangalore

    Type of case Outcome on impairment New - Misconduct Impaired

    Summary of outcome

    Suspension, 6 months. Review hearing directed

    Tribunal:

    Legally Qualified Chair Mrs Linda Lee

    Lay Tribunal Member: Mrs Katriona Crawley

    Medical Tribunal Member: Dr Bryn Davies

    Tribunal Clerk: Miss Emma Saunders and Mr Michael Murphy

    Attendance and Representation:

    Medical Practitioner: Present and represented

    Medical Practitioners Representative: Mr David Morris, Counsel, instructed by Gordons Partnership LLP

    GMC Representative: Mr David Toal, Counsel

    Attendance of Press / Public The hearing was all heard in public. Determination on Facts - 05/01/2018 Preliminary Matter 1. At the start of proceedings, it was acknowledged that Dr Davies, the medical member of the Tribunal, is of the same clinical speciality as Dr Goverdhan, namely Ophthalmology. Mr Morris stated that there was no suggestion of bias but there was a

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    risk that needed to be guarded against that a Tribunal member from the same speciality might express expert opinions in camera that would not have been discussed in open session. He made reference to the cases of Lawrence v GMC [2012] EWHC 464 (Admin) and GMC v Southall [2010] EWCA Civ 407. The Legally Qualified Chair advised the Tribunal on this point and confirmed that the Tribunal would be mindful that a decision was not made on the basis of an expert view that had not been the subject of evidence or argument in the proceedings. Background 2. Dr Goverdhan qualified with an MBBS in 1991 and prior to the events which are the subject of the hearing Dr Goverdhan completed a number of post-graduate qualifications in Ophthalmology and then worked as a medical officer in charge of eye camps and cataract surgery in Aravind Eye Hospital. Dr Goverdhan completed Senior House Officer posts in the UK from 1998 onwards. He completed a PhD in Ophthalmology at the University of Southampton in 2008 and obtained a Specialist Registrar post in Ophthalmology in 2006. Dr Goverdhan obtained his Certificate of Completion of Training in Ophthalmology in 2011. 3. At the time of the events Dr Goverdhan was practising as an Associate Professor and Honorary Consultant in Ophthalmology at the University of Southampton and the Southampton Hospitals NHS Trust (the Trust). Dr Goverdhan left his posts at the Trust in April 2016 and obtained a locum post as a Consultant Ophthalmologist at the Salisbury NHS Foundation Trust. 4. The allegations stem from concerns regarding Dr Goverdhans treatment and management of Patients A to D. The General Medical Council (GMC) allege that Dr Goverdhan failed to adequately examine Patient Bs eye and failed to diagnose Basal Cell Carcinoma (BCC) in the left lower eyelid on 5 April 2014. Further, that in July 2014, Dr Goverdhan amended Patient Bs medical record to suggest that he had considered BCC on 5 April 2014 when this was untrue and he knew it to be untrue. 5. The GMC allege that that there were failures in regard to the cataract surgery that Dr Goverdhan performed on Patient A on 20 May 2015, including that there was inappropriate communication and a failure to advise Patient A properly about the change in refractive plan, which meant the prescription would not be left at -2.00 as requested by Patient A. Further, it is alleged that Dr Goverdhan amended Patient As operation record to suggest he had used viscoat and a soft shell technique and that this was maintained in a letter to Patient A in July 2015 and during a meeting with the Clinical Lead for Ophthalmology in October 2015. It is alleged that Dr Goverdhan knew this information to be untrue and that his actions were dishonest. 6. The GMC also allege that Dr Goverdhan inappropriately arranged for Patients C and D to have photodynamic therapy laser treatment (PDT) in August and September

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    2015, respectively. Further, that there was an alleged failure to refer Patient C for melanoma management and an alleged failure to diagnose Patient Ds lesion correctly. 7. The initial concerns were raised with the GMC in April 2016 about Dr Goverdhans treatment of Patient A and the alleged alteration of Patient As medical notes. The referral to the GMC was further to a local investigation which arose from these initial concerns. The Allegation and the Doctors Response 8. The Allegation made against Dr Goverdhan is as follows:

    Paragraph 1 On 5 April 2014 you consulted with Patient B and you failed to:

    a. adequately examine Patient Bs eyes; To be determined b. diagnose Patient Bs Basal Cell Carcinoma in the left lower eyelid; To be determined c. urgently refer Patient B for an oculoplastic opinion. To be determined

    Paragraph 2 On or around 22 July 2014 you amended Patient Bs medical record of 5 April 2014 to suggest that you had considered possible Basal Cell Carcinoma in Patient Bs left lower eyelid during the consultation of 5 April 2014. To be determined Paragraph 3 The information you provided as referred to in paragraph 2:

    a. was untrue; To be determined b. you knew to be untrue. To be determined

    Paragraph 4 Your actions as described at paragraphs 2 and 3 were dishonest. To be determined

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    Paragraph 5 On 20 May 2015 you performed cataract surgery (the Procedure) upon Patient A and you:

    a. inappropriately communicated with Patient A in a dismissive and brusque tone; Admitted and found proved b. failed to allow Patient A adequate time to read the consent form; Admitted and found proved c. failed to discuss the various refractive options with Patient A; Admitted and found proved d. failed to properly advise Patient A about the change of refractive plan in not leaving Patient As prescription at -2.00; Admitted and found proved e. failed to properly consider Patient As medical records prior to the Procedure in that you:

    i. missed that Patient A had been diagnosed with corneal endothelial degeneration; Admitted and found proved ii. failed to take in to account that Patient A requested to be left myopic (-2.00) in the right eye; Admitted and found proved

    f. failed to keep adequate records for Patient A. Admitted and found proved

    Paragraph 6 On 1 July 2015 you amended Patient As operation record of 20 May 2015 to suggest that you had used:

    a. viscoat; Admitted and found proved b. a soft shell technique. Admitted and found proved

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    Paragraph 7 You wrote a letter dated 14 July 2015 to Patient A asserting that you had used:

    a. viscoat; Admitted and found proved b. a soft shell technique. Admitted and found proved

    Paragraph 8 On 2 October 2015, during a meeting with the Clinical Lead for ophthalmology and the Division B Clinical Lead, you initially advised that:

    a. the amended operation record of 1 July 2015 had been created at the time of the Procedure; Admitted and found proved b. you had not amended Patient As operation record of 20 May 2015. Admitted and found proved

    Paragraph 9 The information you provided as referred to in paragraphs 6 to 8:

    a. was untrue; Admitted and found proved b. you knew to be untrue. Admitted and found proved

    Paragraph 10 Your actions as described at paragraphs 6 to 9 were dishonest. Admitted and found proved Paragraph 11 On 27 August 2015 you consulted with Patient C and you:

    a. inappropriately arranged for Patient C to be treated with photodynamic therapy laser treatment and:

    i. University Hospital Southampton is not a centre approved for ocular oncology treatment; Admitted and found proved

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    ii. you did not have an in-depth working knowledge of ocular oncology; Admitted and found proved

    b. failed to refer Patient C for melanoma management at a recognised national ocular oncology centre. Admitted and found proved

    Paragraph 12 On 17 September 2015 you consulted with Patient D and you:

    a. failed to diagnose Patient Ds pigmented lesion as a naevus; Admitted and found proved b. inappropriately diagnosed choroidal melanoma; Admitted and found proved c. inappropriately arranged for Patient D to have photodynamic therapy treatment (PDT) To be determined and:

    i. PDT is not a proven treatment for choroidal melanoma; (admitted as to fact but not admitted as to stem c) ii. Patient D had not at that stage been seen by a regional ophthalmology oncology unit; (admitted as to fact but not admitted as to stem c) iii. you did not have an in-depth working knowledge of ocular oncology. (admitted as to fact but not admitted as to stem c)

    The Admitted Facts 9. At the outset of these proceedings, through his counsel, Mr Morris, Dr Goverdhan made admissions to some paragraphs and sub-paragraphs of the Allegation, as set out above, in accordance with Rule 17(2)(d) of the General Medical Council (GMC) (Fitness to Practise) Rules 2004, as amended (the Rules). In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced these paragraphs a