Thursday, 23 August 2012

Dr Freddy Patel erased from medical register

G20 pathologist Freddy Patel suspended for four months. Dr FreddyPatel registered under name of Mohmed Saeed Sulema has been erased from medical register by the General Medical Council (GMC) in United Kingdom. It appears that he served institution(s) for a long time in cover ups which may partially explain why he has been erased only now. His alleged dishonesty would be acceptable to the GMC and to his colleagues if it was not for an American tourist making a video recording of newspapers seller's death when he was hit by a policeman and handing video in to authorities. The high profile of some of the cases Dr Freddy Patel reported on as forensic pathologist came to the attention of the media causing public outcry. This made medical profession look bad and GMC was forced to act. Here is Guardian reporting. 

Dr Freddy Saeed was not erased for his post-mortem failures in the case of Ms E who was a prostitute and murdered. The duty of doctor, in this case forensic pathologist, is not to judge the corpse because of her lifestyle but to report impartially on post-mortem findings. Ms E murderer went on to attack other women. Dr Freddy Patel was erased for his deficient post-mortem reporting in a case of a man.

Dr Freddie Patel is only one of the several experts known to Doctors4Justice whose medical reports have attracted criticism because of their glaring omissions, dishonesty and conclusions contrary to Good Medical Practice. These experts have been reported to the GMC. The General Medical Council is more protective of their own Fitness to Practice Panel members, or those expert witnesses who have assisted GMC in their fitness to practice hearings despite extensive evidence known to the GMC of the breaches of Good Medical Practice by those experts.

The difference between some of those complaints to GMC about expert witnesses and Dr Freddy Patel's case is that media have been misled and had to pay a heavy financial and reputation price because of that. For example, Telegraph in the defamation case won by LJ Sedley. Media were misinformed that elderly would die if relocated from one residential home to another. With such dramatic claims by experts no wonder media reported it passionately. In fact, the experts misled the courts. LJ Stephen Sedley in High Court saw through it but GMC willfully closed their eyes to expert witness failings when these were reported to them. Dr Freddy Patel is, clearly, not English, but those experts whom GMC protected are. One works for GMC's Medical Practitioners Tribunal Service as Fitness to Practice Panelist even today! Despite having hundreds of pages of evidence against him, GMC extended his contract further into 2013. This expert worked in private practice and used NHS facilities without NHS permission or permission of Secretary of State for Health as required by law. It did not occur to GMC they should remove him for repeated dishonesty over many years and from judging other doctors.

Previous GMC FTP findings in the case of Freddy Patel.

Like in a game of chess where there is a bishop figure GMC felt it necessary to employ a Reverand to judge Dr Mohmed Saeed Sulema Patel. GMC does not appear to consider conflicts of interest but merely allows Fitness to Practice  panelists to report conflicts whatever they like and then GMC pay no attention to it unless it suits them. The same GMC rules on reporting of conflicts of interests are not equally upheld amongst all the fitness to practise panellists. Contrary to the obligation under the GMC policy to update their interests when members do not GMC Head of Fitness to Practice Empanellment tolerates it and furthermore justifies it. We do not have evidence that Medical Practitioners Tribunal Service is acting independently of GMC. Although a part-time judge has been appointed to oversee it and he is responsible to Parliament, all the power has remained in the hands of GMC who investigate complaints and fix the panel membership as they like. Women and ethnic minorities remain at risk (that then makes it to the number which in effect is the majority of doctors) when appearing before GMC fitness to practice panel, because even those panelists known and complained about as having attitudinal problems are not only allowed to remain there but their contract is actually, extended.
 Fitness to Practise Panel
Determination on sanction
Dr Mohmed Saeed Sulema PATEL

Dr Patel

Having determined that your fitness to practise is impaired by reason of misconduct and deficient professional performance, the Panel has now considered what action, if any, it should take in relation to your registration.

In doing so, the Panel has carefully considered all the evidence adduced throughout this hearing together with the submissions made by Mr Jackson QC on behalf of the GMC, and those made by Mr Hopkins QC, on your behalf.

Mr Jackson took the Panel through the chronology of your involvement with Fitness to Practise procedures.  This has included your appearance before the Professional Conduct Committee in January 2002, your appearance before a Fitness to Practise Panel which concluded in September 2010 and a further appearance before a Fitness to Practise Panel which concluded in March 2011.  This latter Panel reviewed the matters before the Panel in September 2010 and also considered new matters in relation to Miss E.  This Panel has reviewed the matters before the Panel which concluded in March 2011 and also reached findings against you in a new case related to Mr Tomlinson.  Mr Jackson referred this Panel to some of the evidence before it, and also to the comments it made in its determination on impairment.

Mr Jackson referred the Panel to the GMC’s Indicative Sanctions Guidance (April 2009, with 7 August 2009 revisions and March 2012 revisions).  He reminded the Panel of the range of sanctions available to it.  It is the GMC’s submission that the appropriate sanction in this case is one of erasure. 

Mr Jackson submitted that the starting point is the gravity and the persistence of the departures from required professional standards over a number of years.  He submitted that the issues of competence, insight and probity remain current, and serious concerns remain in relation to your fitness to practise. 

Mr Jackson submitted that your failures are serious, especially when considering the issue of future risks posed if you were to return to practice as a forensic pathologist, reporting on any post mortem examinations and giving evidence in relation to the same. 

Mr Jackson reminded the Panel that there have been two findings of dishonesty against you.  In one case this was in the context of GMC/Fitness to Practise proceedings and in one case in the course of your practice.  He submitted that serious dishonesty, when repeated, may be inconsistent with continued registration.  Mr Jackson, with specific reference to insight, referred the Panel to various aspects of your conduct.

Mr Hopkins made submissions on the basis of the previous Panel’s determinations and also this Panel’s determination.  He also referred the Panel to the Indicative Sanctions Guidance and the relevant paragraphs contained therein.

Mr Hopkins invited the Panel to consider that any return to practice could be limited as follows:

  • To perform only routine section 19 post mortem examinations.
  • Not to carry out post mortem examinations on children.
  • Not to carry out forensic post mortem examinations.

Mr Hopkins submitted that there is a public interest in allowing an experienced pathologist to provide a service that is of general benefit.  He told the Panel of your experience, over 30 years, and submitted that pathologists with your depth of experience are in short supply.

Mr Hopkins reminded the Panel of its findings and submitted that, but for its finding of dishonesty, he would have submitted that the appropriate sanction in relation to clinical misconduct and deficient professional performance would have been conditions that allowed a return to directly supervised practice.  However, Mr Hopkins submitted that you recognised that your dishonesty potentially places this case in the sanction category of suspension or erasure.

Mr Hopkins invited the Panel to consider the mitigating circumstances present in your case, including but not limited to, the effect of Fitness to Practise proceedings on your ability to practise.  He observed that you have effectively been unable to do so for a period of nearly two years.

Mr Hopkins referred the Panel to the effect of your suspension on your personal circumstances which has included considerable financial hardship to you, your wife and your children.  It was submitted that you would wish to return to limited practice in order to improve your financial circumstances and to augment your pension income.

Mr Hopkins addressed the Panel in relation to remediation and the steps you have taken to remediate your practice and your recognition that there is more work to be done.

In relation to insight, Mr Hopkins reminded the Panel that you conceded impairment at the last hearing and also at this hearing.  Mr Hopkins went on to illustrate your insight with reference to your admissions and your acknowledgement that your practice was out-dated and sub-standard in a number of respects in this case concerning Mr Tomlinson.

In conclusion, Mr Hopkins submitted that the public interest is not best served by erasure which would be neither necessary nor proportionate.  He submitted that if the Panel felt it necessary to take action on your registration beyond conditions, then a further short period of suspension would be a proportionate response to the adverse findings.  He further submitted that it is in the public interest that you, as a highly experienced pathologist, are permitted to return to limited practice with safeguards.

Whilst the Panel has borne in mind the submissions made, the issue as to what sanction, if any, to impose is one for it to determine exercising its own judgement.

Throughout its deliberations the Panel has borne in mind its duty to protect the public and the public interest.  The public interest includes, amongst other things, protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour, as set out in the GMC’s guidance “Good Medical Practice”.  The Panel has taken account of the Indicative Sanctions Guidance.

The Panel has also applied the principle of proportionality, weighing the public interest against your own interests.  It recognises that the purpose of the sanctions is not to be punitive but to protect patients and the wider public interest, although they may have a punitive effect.

The Panel has borne in mind the facts found proved in this case, as set out in its previous determination on the facts and also its determination on impairment and its detailed reasoning.

The Panel has considered your personal circumstances, and taken them into account, while it considered the mitigation put forward by Mr Hopkins on your behalf. 

The Panel has also taken account of the bundle of testimonials submitted.  Those testimonials describe you as helpful and courteous.  However, they do not address your current competence, they date from two years ago, and were prepared at a time when the authors would not have been aware of the particulars of the allegation against you in relation to the case concerning Mr Tomlinson.

The Panel first considered whether to conclude your case by taking no action.  It took account of paragraph 48 of the Indicative Sanctions Guidance.  Given the seriousness of the multiple findings against you, the Panel has determined that there are no exceptional circumstances present, and it would be wholly insufficient and inappropriate to take no action on your registration.

The Panel next considered whether it would be sufficient to place conditions on your registration.  It has borne in mind that any conditions would need to be appropriate, proportionate, workable and measurable. 

It has taken account of the Indicative Sanctions Guidance at paragraphs 57 and 58, which state:

“57.    Conditions might be most appropriate in cases involving the doctor’s …, performance or following a single clinical incident or where there is evidence of shortcomings in a specific area or areas of the doctor’s practice. Panels will need to be satisfied that the doctor has displayed insight into his/her problems, and that there is potential for the doctor to respond positively to remediation/retraining and to supervision of his/her work.

58.     The purpose of conditions is to enable the doctor to … remedy any deficiencies in his/her practice whilst in the meantime protecting patients from harm…”

The Panel considers that there remain identifiable areas of your practice where further remediation is required.  Through your Counsel you have accepted this.  The Panel accepts that it is difficult to remedy a deficiency that requires a ‘hands on’ approach while you are suspended.

However, the Panel notes that the various Fitness to Practise proceedings have concerned a number of incidents over a number of years. 

The Panel is concerned about the evidence before it and its own conclusion that you have a closed mind-set and are unwilling to concede to conclusions of others in the face of overwhelming evidence.  When you gave your evidence to the Panel in March and May 2012, the Panel has now learned you were undertaking a period of remediation in relation to the concerns of the previous Panels.  Despite this, your evidence to it lacked insight into your failings and did not demonstrate any change in attitude in relation to the post mortem examination carried out on Mr Tomlinson. 

Your rigid mind-set, illustrated by your inability to reflect on the case of Mr Tomlinson, and your unwarranted confidence in your own abilities, does not convince this Panel that it would be appropriate to impose conditions, even with the most stringent supervision, on your registration.  The Panel considers that you have a deep-seated attitudinal problem. 

Additionally, the Panel has found that you were dishonest in attempting to conceal the fact of a first post mortem report in the second report relating to Mr Tomlinson.  This was the second finding of dishonesty, the first being in relation to information contained within your CV in the case relating to Miss E.   

Having considered all these matters the Panel has determined that conditions would be insufficient to protect the public and would not be in the public interest. 

The Panel then went on to consider whether a period of suspension would be an appropriate sanction.  It has taken account of paragraph 69 of the Indicative Sanctions Guidance, which states:

“69.    Suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered medical practitioner…”

The Panel considered paragraph 75 of the Indicative Sanctions Guidance where a list is provided so as to assist a Panel’s decision as to whether suspension is appropriate.  The following factors in that list are particularly relevant to you:

“75.         This sanction may therefore be appropriate when some or all of the following factors are apparent…
-        No evidence of harmful, deep-seated personality or attitudinal problems.
-        No evidence of repetition of similar behaviour since incident.
-        Panel is satisfied doctor has insight and does not pose a significant risk of repeating behaviour.”

The Panel does believe that you have a deep-seated attitudinal problem.  The Panel also believes that for reasons given earlier, it is not convinced that there will not be a repetition of similar behaviour.  It notes that there has already been repetition of similar behaviour as a number of the findings in the cases of Miss E and Mr Tomlinson show similar failings. 

You have twice been suspended for your failings in relation to post mortem examinations you have carried out.  You have now appeared before a Fitness to Practise Panel three times.  The failings against you both historically and presently involve five separate post mortem examinations.  It is of grave concern to this Panel that, despite efforts by previous Panels to guide you as to remediation, your evidence in relation to this case concerning Mr Tomlinson was far from reassuring in terms of what you have learned and how you have modified your thinking in relation to interpretations of findings and clinico-pathological correlation. 

The Panel considers that the most worrying aspect of this case is your lack of insight.  In considering insight, it has taken account of paragraph 34 of the Indicative Sanctions Guidance which states:

“34.    This ‘insight’ - the expectation that a doctor will be able to stand back and accept that, with hindsight, they should have behaved differently, and that it is expected that he/she will take steps to prevent a reoccurrence - is an important factor in a hearing. When assessing whether a doctor has insight the panel will need to take into account whether he/she has demonstrated insight consistently throughout the hearing, e.g. has not given any untruthful evidence to the panel or falsified documents…”

The Panel is not satisfied that you have significant insight into your failings and is not satisfied that there is no risk of repetition.  In reaching this conclusion the Panel reminded itself that you failed to recognise any contrary view to your conclusion as to the cause of death of Mr Tomlinson, even when this was robustly challenged by three pathologists, and your strong assertion that all the matters relating to Mr Tomlinson were within your own knowledge.

The Panel has determined, that for the reasons detailed, suspending your registration for a further period would not be sufficient in the public interest.

Therefore, the Panel has deemed the only appropriate sanction to be one of  erasure.  It has reached this decision on two separate bases.

First, is the harm done to public confidence in the profession through the failures in the post mortem examinations of Miss B, Baby C, Mrs D, Miss E and Mr Tomlinson.  These failures also illustrate the potential harm to what Dr Fegan-Earl described as the ‘end users’ of the coronial system, for example, a potential failure to detect clandestine homicides in either section 19 or section 20 post mortem examinations.  The Panel is of the view that these matters alone take it beyond the question of suspension and therefore to erasure.

Second, the Panel then considered whether your dishonesty at a previous Fitness to Practise Panel and in the present case concerning Mr Tomlinson, of themselves, constituted grounds for erasure and the Panel determined that it did so.  Dishonesty destroys the public’s trust in the individual doctor and undermines both public confidence in the profession, and the need to declare and uphold proper standards of conduct and behaviour.  Your dishonesty confirms the Panel’s finding at the impairment stage that your integrity cannot be relied upon.

Accordingly, the Panel determined that, in the public interest, it has no option other than to direct that your name be erased from the Medical Register.  The Panel took this decision after careful consideration of all the factors in your case.

This means that, unless you lodge an appeal, your name will be erased from the Medical Register 28 days from the date on which notification of this decision is deemed to have been served on you.  The current suspension on your registration will remain in force until any appeal is decided or until the erasure is effective.

That concludes the case.