Fitness to practise determination

Fitness to Practise Determination
The following case was heard by a Fitness to Practise Panel. It is presented here to give an example of one possible outcome of breaching a principle in Good Medical Practice. It is not intended to give a clear threshold between acceptable and unacceptable behaviour. Each case which comes before a Fitness to Practise Panel is judged on its own merits and assessed on the particular circumstances of the case. The doctor conducted telephone consultations with and provided private prescriptions for customers of an on-line pharmacy. He issued a private prescription for Viagra [Sildenafil] and subsequently and dishonestly made a note purportedly setting out the substance of a telephone consultation with the patient, which was false in that he did not at any stage have any such contact with that patient. By issuing a prescription without undertaking a consultation he failed to: • discuss with the patient his medical condition and history; • carry out an assessment of the patient’s condition; • identify the likely cause of the patient’s condition; • ensure that the proposed prescription was justified; • make appropriate arrangements for follow up. Relevant paragraphs of Good Medical Practice
The case relates to the Probity section of GMP, specifically paragraphs 56 and 57 on being honest and trustworthy and paragraphs 63 and 65 on completing forms. It also relates to the Good clinical care section, specifically paragraphs 2a on assessing a patient’s condition and 3b on prescribing. Determination on impaired fitness to practise
“Dr X: The Panel has considered, on the basis of the facts found proved, whether your fitness to practise is impaired by reason of your misconduct. The Panel is aware that a finding of impairment is a matter for its professional judgement. The Panel has kept in mind the observations that have been made by the courts on the issue of impairment as to the proper approach to be followed. They include that impairment is separate from misconduct and that it does not follow automatically from a finding of misconduct that the doctor’s fitness to practise is impaired. The Panel’s task is to take account of the proven conduct of the practitioner and then to consider it in the light of all the other relevant factors known to it. The Panel has throughout its deliberations kept in mind its responsibility to protect the public interest. The public interest includes the protection of patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. The Panel has considered all the oral and documentary evidence that has been presented to it, including the submissions made by Mr K QC, on behalf of the General Medical Council (GMC) and those made by Mr F, on your behalf. Mr K has submitted that your fitness to practise is impaired by reason of your misconduct. He referred the Panel to the two deliberate acts in this case which involve the prescribing of Viagra without a consultation and the subsequent falsification of medical records. Mr F has submitted that whilst the Panel may find your actions amount to misconduct it did not necessarily follow that your fitness to practise should be found to be impaired. He argued that your fitness to practise was not impaired. He submitted that your actions constituted an isolated act of misconduct that were unlikely to be repeated. He referred the Panel to your long career in general practice in which you have demonstrated integrity both before and after this one incident. Mr F drew the Panel’s attention to a number of testimonials to further show that your fitness to practise is not impaired. Whilst working for XXXX you conducted telephone consultations with and provided private prescriptions for customers of an on-line pharmacy, XXXX. On [date removed] you issued a private prescription for Viagra [Sildenafil 50 mg tablets] in the name of E H. The Panel has found that on or about [date removed] you made a note purportedly setting out the substance of a telephone consultation with E H, which was false in that you did not at any stage have any such contact with that patient. This action was clearly dishonest. Furthermore, by issuing a prescription without undertaking a consultation you failed to: • discuss with the patient his medical condition and history; • carry out an assessment of the patient’s condition; • identify the likely cause of the patient’s condition; • ensure that the proposed prescription was justified; • make appropriate arrangements for follow up. The Panel has found this conduct to be inappropriate and not in the best interests of your patient. You have accepted that despite never having practised from the XXXX Health Centre, XXXX, you signed the private prescription for Viagra on headed paper showing your practice address as of the XXXX Health Centre. The Panel has found this to be misleading. The Panel has had regard to both Good Medical Practice (2006) and the GMC’s guidance ‘Good Practice in Prescribing Medicines’ (published in May 2006 and withdrawn in September 2008). Good Medical Practice states that patients must be able to trust doctors with their lives and health. To justify that trust doctors must: • make the care of the patient their first concern; • protect and promote the health patients and the public; • be honest and open and act with integrity. Good Medical Practice also states that, doctors must make sure that their conduct at all times justifies your patients’ trust in you and the public’s trust in the profession. “ In providing care you must 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; …… and keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment….” “You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. “You must do your best to make sure that any documents you write or sign are not false or misleading….” Good Practice in Prescribing Medicines states: “When prescribing medicines you must ensure that your prescribing is appropriate and responsible and in the patient’s best interests. To do this you must: Be in possession of, or take, an adequate history from the patient, including: any previous adverse reactions to medicines; current medical conditions; and concurrent or recent use of medicine, including non prescription medicines.” Probity is clearly at the heart of medical professionalism and the Panel takes a serious view of your dishonest conduct. Doctors occupy a position of privilege and trust in society and are expected at all times to be honest and trustworthy. Your actions fell seriously short of the requirements outlined in Good Medical Practice and Good Practice in Prescribing Medicines. The Panel has concluded that the facts found proved are serious and amount to misconduct. The Panel then considered the question of impairment as set out in the relevant case law to which the Panel was helpfully referred. The reasons for impaired fitness which the courts have identified include that the doctor presents a risk to patients; that he has brought the profession into disrepute; that he has breached one of the fundamental tenets of the profession; and that his or her integrity cannot be relied upon. Whilst acknowledging that each case must be determined on its own merits, the Panel found that the last three of these four examples applied to your case. The cases of Cohen v GMC [2008] EWCA 581 (Admin) and Azzam v GMC [2008] EWHC 2711 (Admin) were about clinical performance whereas the present case involves a finding of dishonesty. It accepts that your initial conduct in issuing a prescription for Viagra, despite being aware of potential side effects, without undertaking a consultation could be seen as an isolated error of judgement that is unlikely to be repeated. However you significantly compounded this error by falsifying the medical records. Your conscious act to misrepresent the situation was not an inadvertent error but a deliberate act of dishonesty. Furthermore the Panel has not been provided with any evidence of acknowledgement or recognition by you of the seriousness of your conduct. The Panel took into account the testimonials from both professional colleagues and patients, which attested to your professionalism, integrity, commitment and overall ability as a General Practitioner. The Panel has also seen no evidence of any other complaints made against you or of any repetition of any similar incidents. The Panel has found you to have breached a number of basic principles set out in Good Medical Practice. Your actions clearly undermine public confidence in the profession and the upholding of proper standards of conduct and behaviour. It brings the profession into disrepute and your integrity cannot be relied upon. Dishonesty is a breach of trust and compromises your relationship to both patients and colleagues. The Panel has concluded that your fitness to practise is currently impaired by reason of your misconduct.”

Source: http://www.gmc-uk.org/330.pdf_37406549.pdf