Record of Determinations –
Medical Practitioners Tribunal
PUBLIC RECORD
Dates: 28/11/2016 – 30/11/2016
Medical Practitioner’s name: Dr Nashwa Mounir Abdallah SHERIF
GMC reference number:
4761833
Primary medical qualification:
MB BCh 1982 Ain Shams University
Type of case
Restoration following disciplinary erasure
Summary of outcome
Restoration application refused. Right to make further applications suspended
indefinitely.
Tribunal:
Lay Tribunal Member (Chair)
Mrs Carol-Anna Ryan-Palmer
Lay Tribunal Member:
Mr Darren Shenton
Medical Tribunal Member:
Mr Thomas George
Legal Assessor:
Mr Alastair McFarlane
Tribunal Clerk:
Ms Rosanna Sheerin
Attendance and Representation:
Medical Practitioner:
Present and not represented
GMC Representative:
Mr Peter Atherton, Counsel
Attendance of Press / Public
The hearing was all heard in public.
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Determination on Application for Restoration - 30/11/2016
Application to admit witness statement of Dr A- 28 November 2016
Mr Atherton:
1.
You applied on behalf of the General Medical Council (GMC), for the written
witness statement of Dr A, Clinical Pathology Specialist, Ein Shams University, Egypt
to be admitted in evidence.
2.
You submitted that Dr Sherif had not indicated, prior to her attendance at the
hearing this morning, that she would require Dr A to attend these proceedings. You
informed the Tribunal that Dr A was in Egypt and that it would be disproportionate
to ask her to travel to the UK to give evidence to this Tribunal. You informed the
Tribunal that Dr A was not prepared to give her evidence via video link for religious
and privacy reasons, but that the GMC had ensured her potential availability via the
telephone.
3.
You submitted that the Tribunal was entitled to admit evidence considered to
be fair and relevant under Rule 34(1) of the General Medical Council (Fitness to
Practise) Rules 2004 (“the Rules”).
4.
Dr Sherif submitted that she did not agree with the statement of Dr A and
wished for her to be available to give evidence via telephone, so that she could
question her.
Tribunal Decision
5.
In reaching its decision, the Tribunal considered all the circumstances. These
included:




6.
the availability of the witness,
the need for the witness to attend in person,
the importance of the witness evidence to the proceedings, and
fairness to all parties
It also considered Rule 34(11), (13) and (14) of the Rules which states:
“(11) Having regard to any directions given by a Case Manager, on the
application of a party, the Committee or a Panel may admit any signed
witness statement containing a statement of truth as the evidence-in-chief of
the witness concerned.
(13) A party may, at any time during a hearing, make an application to the
Committee or Tribunal for the oral evidence of a witness to be given by
means of a video link or a telephone link.
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(14) When considering whether to grant an application by a party under
paragraph
(13), the Committee or Tribunal must—
(a) give the other party an opportunity to make representations;
(b) have regard to—
(i) any agreement between the parties, or
(ii) in the case of a Tribunal hearing, any relevant direction
given by a Case Manager; and
(c) only grant the application if the Committee or Tribunal consider
that it is in the interests of justice to do so.”
7.
Further, the Tribunal considered Rule 34(1) of the Rules. It states:
“The Committee or a Tribunal may admit any evidence they consider fair and
relevant to the case before them, whether or not such evidence would be
admissible in a court of law.”
8.
The Tribunal noted that Dr A is in Egypt and that it would not be reasonable
to expect her to travel to the UK to provide evidence. It noted that she did not wish
to provide evidence via video link for religious and privacy reasons. The Tribunal
determined that it was fair in all the circumstances for Dr A to give evidence via
telephone link which would provide Dr Sherif and the Tribunal with an opportunity to
put questions to Dr A.
9.
The Tribunal therefore determined, under Rule 34(1), not to accede to your
application to admit in evidence the written statement of Dr A.
10.
As a matter of record, on the first day of the hearing, you started to adduce
Dr A’s evidence via telephone link from Egypt using a telephone interpretation
service. As a result of difficulties which included the drafting of the statement, the
quality of that evidence, technical and audibility issues you made the decision not to
rely on that evidence. The Tribunal considered your decision to be fair and in the
interests of justice. Accordingly, it directed itself to ignore Dr A’s brief oral evidence
and the written witness statement which was provided to the GMC.
Restoration Application
Dr Sherif:
11.
You applied to the GMC for the restoration of your name to the Medical
Register. This was your second restoration application. The Tribunal considered
your application in accordance with the provisions set out in Section 41 of the
Medical Act 1983 (as amended) and Rule 24 of the Rules.
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12.
The Tribunal took account of all the evidence before it. This was evidence
which was oral and written. Included in this evidence was a transcript and minutes
of your original Fitness to Practise hearing (which took place on 3-13 October 2006,
7-8 January 2007 and 4-6 February 2007), documents relating to the High Court
Appeal hearing, documents submitted for your first restoration hearing (which took
place on 23-25 June 2014) and the minutes of that hearing. The Tribunal also
considered both your restoration application forms and the oral evidence which you
gave during this hearing.
Background
13.
In 2007 a Panel (‘the 2007 Panel), acting in accordance with the GMC Rules
and pursuant to Section 35C (2)(a) of the Medical Act 1983, as amended,
determined that your Fitness to Practise was impaired by reason of your misconduct.
The original case concerned your involvement in a number of slimming clinics, which
were open for short periods of time and were not well organised. The paragraphs of
the Allegation found proved included:

The provision of medical services at numerous slimming clinics when
registration, pursuant to the Care Standards Act 2000, had not been
granted,

Failing to store controlled drugs safely, properly, and in accordance with
the Misuse of Drugs (Safe Custody) Regulations 1973 (as amended),

Clinical failings in respect of three patients, including inadequate medical
examinations, inappropriate prescribing, breach of confidentiality and not
informing the patients’ general practitioners of the treatment you were
providing,

Causing and/or permitting a colleague to dispense diethylpropion to a
patient, at a time when you knew or should have known that the
colleague was suspended by the General Medical Council,

Dishonesty, in providing a letter to the GMC containing false information
regarding the aforementioned medical practitioner,

Conduct which was inappropriate, unprofessional, not in the best interests
of the patients and likely to bring the profession into disrepute.
14.
The 2007 Panel concluded that your conduct fell seriously short of the
standard expected of a registered medical practitioner and that you had seriously
departed from the relevant professional standards, as set out in Good Medical
Practice. It was not satisfied that you had full insight into your misconduct and
considered that there was a significant risk of you repeating your behaviour. The
Panel concluded that, despite the explanations and apologies offered by you in
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Record of Determinations –
Medical Practitioners Tribunal
mitigation, a period of suspension would not adequately reflect the seriousness of
your behaviour. The 2007 Panel determined to erase your name from the Medical
Register.
Application for Restoration to the Medical Register in 2014
15.
You made an application for your name to be restored to the Medical Register
in 2014 and that hearing took place between 23 and 25 June 2014. During that
hearing a further matter was raised. It concerned an issue in 2012 involving Dudley
Group NHS Trust. It was said that you had attempted to use hospital facilities when
you attended the Clinical Education Centre (the Centre) at the Hospital to undertake
a Core Medical Training (CMT) Course and you had also pre-booked an IT training
session in the library. When challenged, you had given false information regarding
your position and standing at the Russells Hall Hospital, Dudley Group NHS Trust by
stating that you worked in the Histology Department at the Hospital.
16.
The Fitness to Practise Panel in 2014 (‘the 2014 Panel’) determined that it
was to your credit that you made an effort to access the Centre for professional
development but it considered that you should have sought permission to do so. It
determined that it was inappropriate for you, when challenged, to have stated that
you worked for the Trust. The 2014 Panel determined that your behaviour was
inappropriate, unprofessional and, at the very least, misleading.
17.
At your hearing in June 2014, the 2014 Panel had concerns regarding your
insight into your past misconduct. The 2014 Panel determined that you had provided
little evidence of your understanding, reflection or insight into the serious adverse
findings made by the 2007 Panel. The 2014 Panel was concerned that, although you
had demonstrated some regret, you misunderstood the purpose of sanction, in
particular its role in upholding public confidence in the profession. The 2014 Panel
considered that you demonstrated “a gross lack of insight”.
18.
The 2014 Panel considered that you had not fully understood what you
needed to do to demonstrate your rehabilitation. The 2014 Panel explained that it
would have been assisted by evidence from you, which showed that you had fully
reflected on and addressed your dishonesty and your inappropriate and
unprofessional conduct. The 2014 Panel was concerned that you had been out of
practice for over seven years, and you had made little attempt to show that you had
tried to remediate your misconduct. You also provided almost no relevant evidence
to show how you had tried to maintain and keep your medical knowledge and skills
up-to-date.
19.
The 2014 Panel considered that you ought to have realised that your
knowledge and competence would have declined whilst you have been out of
practice.
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20.
Your first application for restoration to the Medical Register was refused on
25 June 2014.
Tribunal’s Task
21.
The Tribunal reminded itself that its power to restore a practitioner to the
Medical Register is a discretionary one which is to be used on the understanding that
its primary responsibility is to act in accordance with the over-arching objective as
set out in the Medical Act 1983 (as amended). That over-arching objective is the
protection of the public and involves the pursuit of the following objectives:
a. to protect, promote and maintain the health, safety and wellbeing of the
public
b. to maintain public confidence in the profession
c. to promote and maintain proper professional standards and conduct for
members of that profession.
22.
Whilst considering your case, the Tribunal was careful to balance your
interests with the over-arching objective. (This is known as applying the principle of
proportionality).
23.
The Tribunal took account of all the evidence presented to it during this
hearing. The Tribunal also considered the evidence and determination from your
restoration hearing in 2014 and the minutes, determination and transcripts from
your hearing in 2007. The Tribunal also took account of your submissions and those
of Mr Atherton, on behalf of the GMC.
24.
The Tribunal reminded itself that it has no power to restore your name to the
Register with conditions or to limit your registration in any way. The Tribunal is not
required to make formal findings about facts or impairment but it bore in mind the
concept of fitness to practise when reaching its decision. The Tribunal noted that the
duty to demonstrate that your name should be restored to the Medical Register and
that you are fit to practise is on you.
25.
This Tribunal recognises that it is not bound by comments made by the 2014
Panel which considered your first application for restoration to the Medical Register.
This Tribunal though has noted the guidance and recommendations which the 2014
Panel gave to you in its determination.
New Evidence before the Tribunal
26.
With regard to your current application for restoration, you stated in your oral
evidence that you have continued to maintain your medical knowledge by keeping
up-to-date through reading medical journals including the BMJ. You provided
documentary evidence including:
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


Certificate of entry onto the Consultant Register as Consultant in Clinical
Pathology from Egyptian Medical Syndicate on 3 November 2009
Experience Certificate from Ain Shams University dated 5 January 2016
Certificate of attendance- 5th annual conference of Clinical & Chemical
Pathology Department dated 7-9 May 2015
27.
In your oral evidence to the Tribunal, you stated that, if your name is restored
to the Medical Register, you will not prescribe Class C drugs again. You said that you
will only prescribe drugs recommended by the Royal College of Physicians. You
stated that you will not work in slimming clinics. You said that you will not provide
references. You stated that you will be honest in the future and that you will not “tell
lies”.
28.
You added that for the last two years you have been working for
approximately six months of each year in Egypt as a Consultant in Clinical Pathology
in a laboratory in a student hospital.
Submissions
29.
Mr Atherton submitted that your name should not be restored to the Medical
Register. Mr Atherton drew the Tribunal’s attention to the document “Guidance for
doctors on restoration following erasure by a medical practitioners tribunal”. In
particular he drew the Tribunal’s attention to paragraph 10 which states:
“What factors do the medical practitioners tribunal take into account when
considering the application for restoration?
The tribunal will consider a number of factors, including the following:
a
The circumstances that led to erasure.
b
The reasons given by the previous tribunal (or committee) for the decision to
direct erasure.
c
Whether you have any insight into the matters that led to erasure.
d
What you have done since your name was erased from the register.
e
The steps you have taken to keep your medical knowledge and skills up to
date and the steps you have taken to rehabilitate yourself professionally and
socially.”
30.
Mr Atherton stated that the GMC based its opposition to your application on
all the factors outlined above in paragraph 10. He drew the Tribunal’s attention to
the findings made by the 2007 Panel, which included dishonesty and submitted that
your behaviour was repeated and constituted misconduct of a serious nature. He
submitted that your misconduct covered the full range of professional obligations for
a practitioner.
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Record of Determinations –
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31.
Mr Atherton submitted that the onus was upon you to demonstrate to this
Tribunal that you have reflected on the findings made by the Panel in 2007 and the
2014 Panel. He stated that you have completely failed to do this. Mr Atherton drew
the Tribunal’s attention to the oral evidence you provided. He submitted that, based
on your answers to questions, you appeared to have little understanding of the
standards which are required of a doctor. He stated that, at times, the evidence you
gave was in conflict with evidence which you had provided before.
32.
Mr Atherton submitted that, on any view, yours “is the thinnest of
applications”. He stated that your application is wholly devoid of any meaningful
evidence as it does not address the concerns and findings made at the original
hearing in 2007 or at your restoration application hearing in 2014.
33.
You submitted that you were disappointed with what you heard from
Mr Atherton, on behalf of the GMC, and that you wish for your name to be restored
to the Medical Register.
Tribunal’s Decision
34.
Before reaching a decision on the restoration application, the Tribunal first
considered whether it should adjourn and direct that you should undergo an
assessment of your performance and/or health and/or knowledge of English.
35.
The Tribunal considered the Restoration Application Form which you
completed and signed, but did not date. This was received by the GMC on
30 November 2015. The Tribunal also considered the documents which you had
provided to the GMC in support of your application.
36.
The Tribunal noted that it is now twelve years since your misconduct and
more than nine years since your name was erased from the Medical Register. In the
circumstances the Tribunal had no doubt that nothing would be achieved by
adjourning this hearing and giving a direction for you to undergo an assessment of
your performance and/or health and/or knowledge of English as there is almost no
evidence that you have kept your medical knowledge up-to-date in any event.
37.
The Tribunal considered that it was to your credit that you had undertaken
laboratory work in Egypt. However, the Tribunal did not have any independent
evidence of the nature of the work undertaken by you within the laboratory
environment. It appeared to be low level laboratory work which was not equivalent
in any way to the level of a consultant in pathology as you stated that you were
learning from the technicians. The Tribunal did not consider this to be meaningful
professional development.
38.
The Tribunal next considered whether your name should be restored to the
Medical Register.
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Record of Determinations –
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39.
The Tribunal considers that the misconduct for which you were erased from
the Medical Register in 2007 was very serious. The Tribunal has serious concerns
regarding your insight into your past misconduct. In your oral evidence you stated
that you did not understand the meaning of the term “insight”. This, as well as the
absence of any demonstration of insight by you, was of grave concern to the
Tribunal. The Tribunal noted that you disputed some of the findings that had been
made by the 2007 Panel including some which you had admitted. In the Tribunal’s
judgment this further indicated a lack of insight into your failings.
40.
You have provided no real evidence of your understanding, reflection or
insight into the serious findings made by the previous Panels. You have shown some
regret, but your evidence has, again, focussed almost completely on the impact
which erasure has had upon you “emotionally and financially”. As a result, the
Tribunal cannot be satisfied that there will not be further repetitions of this type of
misconduct.
41.
The Tribunal has considered the documents you have provided. Only one of
these relates to your Continued Professional Development (CPD) in medicine when
you attended a biochemistry conference in Egypt. The evidence which you have
provided shows that at most, you have completed seventeen hours CPD in ten
years. You stated in your oral evidence that you would wish to return to medical
practice in your specialty of pathology and that you have been working intermittently
in Egypt in that field. However, you have not provided any evidence to support your
statement that you have maintained your CPD.
42.
The Tribunal determined that the documents which you have provided are
completely inadequate to show that you are professionally competent to return to
unrestricted practice as a medical practitioner. In relation to the reading which you
stated that you had done, the Tribunal noted that you have provided no record of
what was read, what you have learnt, any reflection on it and its relevance.
43.
You have now been out of practice for over ten years. The Tribunal judged
that you have produced almost no evidence to show that you have tried to
remediate your misconduct or maintain and keep your medical knowledge and skills
up-to-date. The Tribunal has no evidence that you have any insight about the
actions you must take to demonstrate that your medical knowledge is up to date and
that you are able to practice safely. As a result, the Tribunal has determined that if
you were allowed to return to practice there would be a substantial and serious risk
to patient safety.
44.
For all these reasons the Tribunal determined that patient safety could not be
ensured and public confidence in the profession would be seriously undermined if
your application was granted. The Tribunal reminded itself that this is your second
application for restoration. It considered that the evidence which you have provided
to this Tribunal is even more deficient than that which you provided to the 2014
Panel. The Tribunal has concluded that you have failed to satisfy it that you are
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suitable for your name to be restored to the Medical Register. The Tribunal therefore
refuses your application.
Determination on whether to indefinitely suspend the right to make
further applications for restoration - 30/11/2016
Dr Sherif:
1.
Having already determined that your application for restoration be refused,
the Tribunal went on to consider, in accordance with Section 41(9) of the Medical
Act 1983, as amended (the Act), whether to direct that your right to make further
applications for restoration should be suspended indefinitely.
2.
In so doing, the Tribunal has taken account of all the evidence before it, both
oral and documentary. The tribunal has already given a detailed determination in
this case and it has taken those matters into account at this stage of the
proceedings. The tribunal has taken account of the submissions made by
Mr Atherton, on behalf of the GMC, and your own submissions.
3.
Mr Atherton drew the Tribunal’s attention to the document “Guidance for
doctors on restoration following erasure by a medical practitioners tribunal”. In
particular he drew the Tribunal’s attention to paragraphs 20 and 21 which state:
“If my application was unsuccessful can I apply again?
Yes, unless your right to apply again has been suspended (see below).
However you cannot make a further application for restoration until 12
months have elapsed from the date of your last application. (20)
If you make two unsuccessful applications, your right to make further
applications may be suspended indefinitely by the tribunal that considers your
application for restoration. If this happens, you can apply for the suspension
to be reviewed after three years have elapsed from the date on which the
tribunal made the decision to suspend indefinitely your right to make further
applications. If a tribunal does not lift the suspension on your right to apply,
you can apply again but only after three years from the date of the last
tribunal’s decision.” (21)
4.
Mr Atherton submitted that for the second time an application for restoration
has been made by Dr Sherif and refused by a Panel/Tribunal. He submitted that this
is the second time a Tribunal has identified deficiencies and these deficiencies are
ongoing. He submitted that based on the findings made by the Tribunal your right to
make further applications for restoration should be suspended indefinitely.
5.
You opposed the application made by Mr Atherton on behalf of the GMC and
submitted that it would be unfair for the Tribunal to make a direction that your right
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to make further applications for restoration should be suspended indefinitely. You
stated that you need to work again and that this was disappointing and depressing.
6.
This Tribunal has borne in mind the submissions made in reaching its decision
at this stage of the proceedings. In doing so, it has exercised its own judgement.
7.
Throughout its deliberations, the Tribunal has been mindful of the
overarching objective of the GMC as set out in the Medical Act 1983 (as amended).
That overarching objective is the protection of the public and involves the pursuit of
the following:
a. to protect, promote and maintain the health, safety and wellbeing of the
public
b. to maintain public confidence in the profession
c. to promote and maintain proper professional standards and conduct for
members of that profession.
8.
This Tribunal has already noted that it considered itself to be in a very similar
position to that of the 2014 Panel. The Tribunal noted your conduct when you
received the determination on your application for restoration which cemented the
Tribunal’s consideration that you have little or no insight.
9.
The Tribunal has determined that your history clearly shows your continued
rejection of some of the findings made by the original Panel in 2007 and that you
have persistently failed to remediate your misconduct. The Tribunal considers that,
after nine years, you are highly unlikely to change your conduct in order to take the
significant and substantial steps which would be necessary for your name to be
restored to the Medical Register.
10.
In light of the above, the Tribunal is not confident that were it to allow you to
apply for restoration to the Medical Register in the foreseeable future, your situation
would be materially different.
11.
The Tribunal considered that the public interest also includes the proper
discharge of the regulator’s function and the proper use and allocation of its
resources. The Tribunal considered that it would not be in the public interest for
repeated applications for restoration, that were devoid of merit, to be made.
12.
Having considered all of the evidence before it, the Tribunal has determined
that it is appropriate and proportionate in the circumstances to direct that your right
to apply for restoration to the medical register be suspended indefinitely. In
accordance with section 41(11) of the Act you may apply to the Registrar for a
review of this direction, but not before three years.
13.
That concludes this case.
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Record of Determinations –
Medical Practitioners Tribunal
Confirmed
Date 30 November 2016
MPT: Dr SHERIF
Mrs Carol-Anna Ryan-Palmer, Chair
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