PUBLIC RECORD

Record of Determinations – Fitness to Practise Panel
PUBLIC RECORD
Dates 03 November 2014 - 11 November 2014
Name of Medical Practitioner
Dr Jason Payman Tahghighi
Primary medical qualification
MB ChB 1991 University of
Manchester
GMC reference number
3546064
Type of case
New - Misconduct
Outcome on impairment
Impaired
Summary of outcome
Suspension, 12 months.
Review hearing directed
Immediate order imposed
Panel
Lay Panellist (Chair)
Lay Panellist
Medical Panellist
Mr David Flinter
Mr Robert McKeon
Dr Maureen Crawford
Legal Assessor
Secretary to the Panel
Mr Nigel Parry
Miss Rosanna Sheerin
Attendance and Representation
Medical Practitioner
Medical Practitioner’s Representative
GMC Representative
Present and represented
Ms Mary O’Rourke QC,
instructed by Ryan Solicitors
Mr Paul Williams, Counsel
Allegation and Findings of Fact
“That being registered under the Medical Act 1983, as amended:
1.
You were employed as an Out of Hours General Practitioner for Go
To Doc Limited (‘GTD’) in June 2010.
Admitted and found proved
2.
On 04 June 2010 you were asked by GTD to make a home visit to:
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3.
4.
a.
a patient identified as 69512 (a minor) (‘Patient A’),
Admitted and found proved
b.
a patient identified as 69523 (‘Patient B’),
Admitted and found proved
c.
a patient identified as 69521 (a minor) (‘Patient C’),
Admitted and found proved
d.
a patient identified as 69528 (‘Patient D’).
Admitted and found proved
In relation to Patient A you:
a.
failed to make a visit to his home,
Admitted and found proved
b.
failed to carry out an adequate assessment of him,
Admitted and found proved
c.
failed to carry out an examination of him,
Admitted and found proved
d.
diagnosed him with a viral illness when you did not or could
not have known this to be an accurate assessment,
Admitted and found proved
e.
failed to provide any advice regarding his care to a member
of Patient A’s family/appropriate carer.
Admitted and found proved
You asserted that you had spoken to someone and/or a family
friend in relation to Patient A on 04 June 2010 by stating words to
that effect in:
a.
a meeting with A, Head of Governance for GTD, on 17 June
2010,
Admitted and found proved
b.
a Case Review Structured Reflective Template form dated
17 June 2010 relating to GTD’s request for you to visit
Patient A,
Admitted and found proved
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c.
5.
his medical records.
Admitted and found proved
In relation to Patient C you:
a.
failed to prioritise his visit,
Admitted and found proved
b.
failed to make a visit to his home,
Admitted and found proved
c.
failed to carry out an adequate assessment of him,
Admitted and found proved
d.
failed to carry out an examination of him,
Admitted and found proved
e.
diagnosed him with a viral illness when you did not or could
not have known this to be an accurate assessment,
Admitted and found proved
f.
failed to:
Admitted and found proved
g.
i.
make enquiries to see whether he had been taken,
for assessment and / or treatment, to a medical
facility,
Admitted and found proved
ii.
make adequate efforts to establish his whereabouts,
Admitted and found proved
iii.
take adequate steps to ensure you/the out of hours
service could be contacted, if necessary,
Admitted and found proved
iv.
follow GTD’s Failed Encounters Policy in relation to
your failed visit to him,
Admitted and found proved
failed to provide any advice regarding his care during the
voicemail message left by you on his mother’s mobile phone
at
i.
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02:35,
Admitted and found proved
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Record of Determinations – Fitness to Practise Panel
ii.
h.
6.
03:10,
Admitted and found proved
left a message on his mother’s mobile telephone voicemail
service at 02:35 stating that you were ‘very busy with visits’.
Admitted and found proved
You asserted that you visited the house of Patient C on 04 June
2010 by stating words to that effect:
a.
in a meeting with A, Head of Governance for GTD, on 10
June 2010,
Admitted and found proved
b.
in a meeting with A, Head of Governance for GTD, on 17
June 2010,
Admitted and found proved
c.
in an undated Case Review Structured Reflective Template
form relating to GTD’s request for you to visit Patient C,
Admitted and found proved
d.
in an undated statement written by you for GTD in relation
to Patient C,
Admitted and found proved
e.
in your witness statement which relates to the matter of the
GMC investigation, which is dated 12 August 2010,
Admitted and found proved
f.
in your second witness statement which relates to the
matter of the GMC investigation, which is dated 13 August
2010,
Admitted and found proved
g.
in your witness statement which relates to the matter of the
inquest touching the death of Patient C, which is dated 19
January 2012.
Admitted and found proved
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Record of Determinations – Fitness to Practise Panel
7.
Your conduct at paragraphs 4, 5(h), and 6 was:
a.
misleading,
Admitted and found proved in relation to paragraphs 4,
5(h), and 6
b.
dishonest.
Admitted and found proved in relation to paragraphs 4,
5(h), and 6
And that by reason of the matters set out above your fitness to practise is
impaired because of your misconduct." Found proved
Attendance of Press / Public
The Panel agreed, in accordance with Rule 41 of the General Medical Council
(Fitness to Practise) Rules 2004, that the press and public be excluded from those
parts of the hearing where matters under consideration were deemed confidential.
Determination on Admissibility of Supplementary Evidence
Mr Williams:
1.
The Panel has determined that the press and public be excluded from these
proceedings, pursuant to Rule 41 of the General Medical Council (Fitness to Practise)
Rules 2004 (“the Rules”), since some issues in this case XXX. This determination will
therefore be read in private. However, as this case does concern Dr Tahghighi’s
alleged misconduct a redacted version will be published at the close of the hearing
XXX.
2.
You have told the Panel that you wish to call Mr A and Ms A to give evidence
at this stage of the proceedings (Stage 2) under Rule 17(2)(j) of the Rules. You
submitted that both witnesses have provided witness statements but that you now
wish to ask them supplementary questions. Before asking these questions, you
would arrange for supplementary statements to be taken. You submitted that Mr A
can speak to factual events on 4 June 2010, in particular to Dr Tahghighi’s behaviour
and demeanour on the day in question. XXX.
3.
Ms O’Rourke has objected to your proposed course of action. She submitted
that the hearing is now at stage two - impairment - as all facts have previously been
admitted and found proved. She submitted that the current witness statements
stand as evidence in chief and that it is inappropriate under the Rules for
supplementary evidence to be adduced at this stage.
4.
The Panel noted the advice of the Legal Assessor in this matter.
5.
The Panel considered Rule 17(2)(j) of the Rules which states:
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“the FTP Panel shall receive further evidence and hear any further
submissions from the parties as to whether, on the basis of any facts found
proved, the practitioner's fitness to practise is impaired”
6.
The Panel has determined that under Rule 17(2)(j) you are entitled to call
both witnesses at this stage of the proceedings and the Rules do not preclude you
from doing so. However, you are not allowed to ask supplementary questions unless
Ms O’Rourke agrees, which she does not, or the Panel permits you to do so.
7.
In considering the proposed supplemental questions the Panel also
considered Rule 34(1) of the Rules. This rule states:
“The Committee or a Panel 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.
In reaching its decision, the Panel has borne in mind the principle of acting in
fairness to both parties.
9.
In relation to both witnesses, the Panel has considered carefully both the
information provided by you as to the nature of the evidence which you wish to
adduce and the arguments by Ms O’Rourke against its admission. The Panel does
not see how the information which can be provided by either of these witnesses is
likely to offer any material assistance to the Panel in its determination on
impairment. XXX the extremely subjective nature of this evidence means that it is
not information on which the Panel could place any significant weight, and it is
therefore not relevant to the issue of current impairment.
10.
The Panel has therefore determined not to accede to your request to ask
supplementary questions.
Determination on Impairment
Dr Tahghighi:
1.
The Panel has determined that the press and public be excluded from these
proceedings, pursuant to Rule 41 of the General Medical Council (Fitness to Practise)
Rules 2004 (“the Rules”), since some issues in this case XXX. This determination will
therefore be read in private. However, as this case does concern your alleged
misconduct, a redacted version will be published at the close of the hearing XXX.
2.
At the outset of the proceedings Ms O’ Rourke, QC admitted on your behalf all
the facts alleged and the Panel announced these as having been admitted and found
proved.
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Record of Determinations – Fitness to Practise Panel
3.
The Panel has considered under Rule 17(2) of the General Medical Council
(GMC) (Fitness to Practise) Rules Order of Council 2004 whether, on the basis of the
facts found proved, your fitness to practise is impaired by reason of your alleged
misconduct. It has into taken account all of the evidence adduced during the course
of the proceedings, both oral and documentary. In this respect, the Panel received
evidence from:





Dr A, XXX
Dr B, XXX
Dr C, XXX
Ms A, Head of quality and clinical leadership at GTD,
Mr A, driver for GTD.
It has also taken into account Mr Williams’s submissions on behalf of the GMC and
Ms O’Rourke’s submissions on your behalf.
4.
Mr Williams submitted that the facts found proved amount to misconduct and
that your fitness to practise is impaired. He drew the Panel’s attention to the GMC’s
Indicative Sanctions Guidance (ISG) (April 2009, revised August 2009, March 2012
and March 2013) and references therein to relevant paragraphs of Good Medical
Practice. He also drew the Panel’s attention to the relevant case law. He submitted
that your false record keeping in relation to Patients A and C could have potentially
impacted on future patient care. In relation to the finding of dishonesty, he
submitted that your actions were calculated and for your own benefit. He submitted
that your actions on the night in question were to lighten your own workload which
put patients at risk. He submitted that your dishonesty was compounded by the
prolonged period of time during which you attempted to cover it up. He submitted
that in this regard your actions bring the medical profession into disrepute.
5.
Ms O’Rourke submitted that you acknowledge that your actions amount to
misconduct, although she submitted that your dishonesty was not persistent. She
did not make any positive representations in relation to your fitness to practise being
impaired.
6.
The Legal Assessor advised the Panel that the question of impairment is a
matter for its judgment and does not depend upon a burden or standard of proof.
Background
7.
Your case came to the attention of the GMC by way of a referral letter dated
19 July 2010 from Go to Doc Ltd (GTD). GTD is an out of hours service provider
working within the Greater Manchester region. You were employed on a sessional
basis to attend to out of hours calls.
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Record of Determinations – Fitness to Practise Panel
8.
You were providing out of hours care during the early hours of 4 June 2010
as part of an 8 hour shift which commenced at 11 pm on 3 June 2010. Following
triage by GTD’s clinicians you were requested to make visits to the following patients
(all were classified as ‘less urgent: see within six hours’):
• Patient A: an eleven-year-old male patient
 Patient B: a sixty-eight-year-old male patient
• Patient C: a five-month-old male patient
 Patient D: an eighty-two-year-old female patient
Patient A
9.
A triage entry was made at 11.59 pm on 3 June 2010 which states
‘Symptoms: boiling hot, has a temp, saying every limb in body aching, burning up
from head to toe’.
10.
An entry was made by a doctor (not by you) at 1.48 am on 4 June 2010
which states ‘multiple attempts failed – wrong number. In view of symptoms,
forwarded for visit’.
11.
You made an entry in the records at 1.58 am on 4 June 2010 which states
‘spoke with someone who is not related to patient – wrong number given by original
caller; symptoms described to call handler are flu-like symptoms. Diagnosis: viral
illness. Treatment: patient with adult so call completed without need for home visit
as they can call back if any concerns – I did not feel they warranted disturbing at
this time of the morning; own GP follow up please’.
12.
You failed to make a visit, carry out an adequate assessment or examination
of Patient A. You diagnosed him with a viral illness when you did not know or could
not have known this to be an accurate assessment. You did not provide any advice
regarding his care to Patient A’s family/appropriate carer.
13.
At a subsequent meeting with Ms A, Head of Governance for GTD, on 17 June
2010 you asserted that you had spoken to Patient A’s family/appropriate carer which
you did not.
Patient C
14.
A record of triage was made by a Nurse Adviser starting at 11.37 pm on
3 June 2010 and the clinical summary entered at 12.49 am on 4 June 2010 states
that Patient C had ‘had a fever since that afternoon and felt very hot despite regular
neurofen. Had one loose motion earlier and was out in the sun briefly with no
protection. Not feeding well and wakes up to cry’.
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Record of Determinations – Fitness to Practise Panel
15.
A triage was carried out by a doctor (not you) at 1.04 am and the entry states
that Patient C had a high temperature and was crying; he had had a high
temperature since 7 pm and had a bit of diarrhoea but had no chest or other
symptoms and no rash. The entry states ‘NO MONEY, NO TRANSPORT, VISIT’.
You made an entry in Patient C’s records which states ‘rang mobile number at
2.30 am and again at 3.10 am asking for mother to call back – no call back and
symptoms can be in keeping with viral illness. Diagnosis likely viral illness; message
left for own GP follow up during surgery hours – I decided that visit at this time of
the morning not necessary as likely family asleep as not even answering their own
phone which was in use earlier in the evening .’
16.
17.
You failed to prioritise a visit, make a visit or carry out an adequate
assessment or examination of Patient C. You diagnosed him with a viral illness when
you did not know or could not have known this to be an accurate assessment. You
failed to make enquiries to see whether he had been taken for assessment and/or
treatment to a medical facility. You failed to make adequate efforts to establish his
whereabouts, take adequate steps to ensure you/the out of hours service could be
contacted, if necessary, or follow GTD’s Failed Encounters Policy in relation to your
failed visit to him. You also failed to provide any advice regarding his care during the
voicemail message left by you on his mother’s mobile phone at 02:35 am and 03:10
am. You left a message on his mother’s mobile telephone voicemail service at 02:35
am stating that you were ‘very busy with visits’.
18.
In meetings with Ms A on 10 June 2010 and 17 June 2010 you asserted that
you visited the house of Patient C on 4 June 2010 which you did not.
19.
You also made the assertion that you had visited Patient C on
4 June 2010 in a number of documents: an undated Case Review Structured
Reflective Template form in relation to GTD’s request for you to visit Patient C,
an undated statement written by you for GTD in relation to Patient C, your
witness statement dated 12 August 2010 which relates to the matter of the GMC
investigation, your second witness statement dated 13 August 2010 which
relates to the matter of the GMC investigation and your witness statement dated
19 January 2012 which relates to the matter of the inquest touching the death
of Patient C.
Impairment considerations
20.
The Panel followed a two-step process. First, the Panel considered whether
the facts found proved amount to misconduct. It then considered on the basis of its
findings whether your fitness to practise is impaired.
21.
Throughout its deliberations, the Panel has borne in mind its responsibility to
protect the public interest. The public interest includes not only the protection of
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Record of Determinations – Fitness to Practise Panel
patients but also the maintenance of public confidence in the profession, and the
declaring and upholding of proper standards of conduct and behaviour.
22.
The Panel has noted the submission made on your behalf, by Ms O’ Rourke,
that misconduct is admitted.
Standards of care
23.
In considering your alleged misconduct the Panel took account of the relevant
passages contained within the version of Good Medical Practice (GMP), as applicable
at the time (November 2006).
24.
The opening page states:
“Patients must be able to trust doctors with their lives and health. To justify that
trust you must show respect for human life and you must:
Make the care of your patient your first concern
…
Be honest and open and act with integrity
…
You are personally accountable for your professional practice and must always be
prepared to justify your decisions and actions”



25.
The Panel has determined that the facts found proved as described in
paragraphs 3, 4, 5, 6 and 7 of the Allegation demonstrate your failure to act in
accordance with those duties.
26.
More specifically, Paragraph 1 of GMP states:
“Patients need good doctors. Good doctors make the care of their patients their
first concern: they are competent, keep their knowledge and skills up to date,
establish and maintain good relationships with patients and colleagues, are
honest and trustworthy, and act with integrity.”
27.
Paragraph 2 states:
“Good clinical care must include:
(a) adequately assessing the patient’s conditions, taking account of the
history (including the symptoms, and psychological and social factors),
the patient’s views, and where necessary examining the patient
(b) providing or arranging advice, investigations or treatment
where necessary
(c) referring a patient to another practitioner, when this is
in the patient’s best interests.”
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Record of Determinations – Fitness to Practise Panel
28.
Paragraph 3 states:
“In providing care you must:
(a) recognise and work within the limits of your competence
…
(g) make records at the same time as the events you are recording or as
soon as possible afterwards
(h) be readily accessible when you are on duty
…
(j) make good use of the resources available to you.”
29.
The Panel has accepted the agreed documentary evidence of Dr D, GP, GMC
expert, in his report dated 7 July 2012. The Panel has considered paragraphs 16 and
17 of that report in particular in which Dr D is of the opinion that the overall
standard of care provided by you fell below that expected of a reasonably competent
General Practitioner. He stated that this opinion is based on your apparent failure to
perform home visits in order to make an appropriate and adequate assessment of
Patient A and Patient C, the failure to keep appropriate and adequate records, and
the failure to follow the designated Failed Encounters policy. Dr D concluded that
due to your failure to ensure an adequate and appropriate assessment of Patient C,
the standard of care provided by you fell seriously below that expected of a
reasonably competent General Practitioner.
30.
The Panel has noted that patients were exposed to real, as opposed to
perceived, risk.
31.
The Panel has concluded that the incidents taken together are sufficiently
serious to amount to misconduct. The Panel has found that you failed to adhere to
the proper standards of conduct and behaviour expected of doctors.
Dishonesty
32.
Considering misconduct in relation to your dishonesty the Panel noted the
standards in GMP and particularly paragraphs 56, 57 and 67 which relate to probity.
“Probity means being honest and trustworthy, and acting with integrity: this
is at the heart of medical professionalism” (56)
“You must make sure that your conduct at all times justifies your patients’
trust in you and the public’s trust in the profession” (57)
“If you are asked to give evidence or act as a witness in litigation or formal
inquiries, you must be honest in all your spoken and written statements…”
(67)
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Record of Determinations – Fitness to Practise Panel
33.
The Panel has determined that the facts as admitted and found proved in
relation to paragraph 7 demonstrate your failure to act in accordance with these
paragraphs of GMP.
34.
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 upon doctors to be honest. The relationship between the
profession and the public is based on the expectation that medical practitioners will
act at all times with absolute integrity.
35.
The Panel has determined that you breached the principles of probity
contained within GMP. Having considered all the evidence placed before it, the Panel
has concluded that your dishonest acts fell seriously short of the standards of
conduct that the public and patients are entitled to expect from all registered
medical practitioners and would be viewed as deplorable by fellow practitioners.
36.
Your actions in this regard could have had serious consequences for these
patients’ future medical care and this amounts to particularly serious misconduct on
its own. Not only does this contribute to the Panel’s overall assessment of your
fitness to practise but it is also sufficiently serious to bring the profession into
disrepute.
37.
The Panel considers that your dishonesty has been persistent in nature. It
notes that persistency can take many forms. On the day/night in question you may
have been dishonest for your own personal advantage but you subsequently
endeavoured to cover up your initial dishonesty over a prolonged period of time and
in the form of both oral and documentary statements. You had ample time from 4
June 2010 to admit your inappropriate actions on the night in question but you failed
to do so until much later. It has been submitted on your behalf that your statement
which relates to the matter of the inquest touching the death of Patient C dated
19 January 2012 has not been put in front of the inquest as it has not taken place
yet. The Panel considers the fact the inquest will not be taking place until March
2015 as irrelevant. It has not been provided with any supplementary statement that
you intend to place before the inquest.
38.
The Panel has determined that your persistent dishonesty amounts to
misconduct.
Impairment Decision
39.
The issue of impairment is one for the Panel to determine exercising its own
judgment. The Panel has taken into account the public interest which includes the
need to protect patients and the public, to maintain public confidence in the
profession, and to declare and uphold proper standards of conduct and behaviour.
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Record of Determinations – Fitness to Practise Panel
The Panel has also considered whether you have demonstrated any insight into your
behaviour and the likelihood of any recurrence of your misconduct.
40.
In considering the matter of impairment, the Panel has noted the case of
Cohen v GMC [2008] EWHC 581 (Admin) in which Silber J stated, at paragraph 65:
“…It must be highly relevant in determining if a doctor’s fitness to practise is
impaired that first his or her conduct which led to the charge is easily
remediable, second that it has been remedied and third that it is highly
unlikely to be repeated.”
41.
It also noted Dame Janet Smith’s criteria for impairment set out in her fifth
Shipman report and cited in CHRE v NMC and 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.”
42.
The Panel has noted the submission made by Ms O’Rourke on your behalf
that impairment is not contested.
43.
XXX
44.
The Panel has noted that your case involved failures of clinical management
with particularly serious potential consequences for patients concerned. It will
therefore require a considerable weight of evidence for the Panel to be persuaded
that your fitness to practise should not be considered impaired on these grounds
alone.
45.
The Panel has considered that your misconduct, in relation to the standard of
care you provided to patients can, in principle, be remedied. In considering whether
you have remedied this misconduct, the Panel has taken into account the
documentary evidence provided by your current clinical supervisor, Dr E, dated 18
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Record of Determinations – Fitness to Practise Panel
October 2013, 25 March 2014 and 3 September 2014 who attests to your being a
competent GP and that no concerns have been raised in relation to you. This
indicates that your misconduct in this regard has been remedied to a point. The
Panel notes however that you have been working in a restricted and structured
capacity due to interim order panel conditions which do not allow you to work as an
out of hours GP. In these circumstances, the Panel cannot be confident that all
aspects of your misconduct have been addressed and that you would not repeat
your previous actions in the future if a similar set of circumstances were to arise.
46.
With regard to your dishonesty, this Panel does not consider that your actions
are easily remediable and it has not been provided with any evidence of appropriate
remedial steps. XXX and your restricted working conditions can be regarded as
effective remediation.
47.
The Panel has found that you have breached a fundamental tenet of the
medical profession, by failing to provide a good standard of practice and care. The
Panel has determined your failures of clinical management could have had serious
consequences for Patient A and C. Further the Panel concluded that your actions had
brought the profession into disrepute and that your integrity could not be relied
upon in view of the finding of dishonesty against you. All four of the criteria outlined
by Dame Janet Smith for a finding of impairment are therefore satisfied.
48.
The Panel has been provided with no direct evidence of your level of insight,
if any, into your misconduct. It notes that the full unqualified admissions which are
now before it in relation to the Allegation were not made until 6 working days before
the start of this hearing. The first acknowledgement of your misconduct which you
appear to have made was to Dr C, on 9 May 2013, when you said that you still
believed your description of events to be true but that you accepted it could not be
so. The Panel was particularly concerned by the submission made on your behalf
that the inquest relating to Patient C has not yet taken place, with the implication
that your dishonesty in the witness statement prepared for it might be mitigated by
this. This confirms that your lack of insight persists today.
49.
In the light of these factors, the Panel cannot be satisfied that there will be
no repetition of your misconduct. Furthermore, and in any event, the Panel
considers that the gravity of your misconduct is such that public confidence in the
profession and the regulatory process would be undermined if a finding of
impairment were not made in the particular circumstances of this case. For these
reasons the Panel has determined that your fitness to practise is impaired by reason
of your misconduct.
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
Determination on Sanction
Dr Tahghighi:
1.
The Panel has determined that the press and public be excluded from these
proceedings, pursuant to Rule 41 of the General Medical Council (Fitness to Practise)
Rules 2004 (“the Rules”), since some issues in this case XXX. This determination will
therefore be read in private. However, as this case does concern your alleged
misconduct, a redacted version will be published at the close of the hearing XXX.
2.
Having determined that your fitness to practise is impaired by reason of your
misconduct, the Panel has now considered what action, if any, it should take with
regard to your registration.
3.
In so doing, the Panel has given careful consideration to all the evidence
adduced, including the written testimonials XXX together with Mr Williams’s
submissions on behalf of the GMC and Ms O’Rourke’s submissions on your behalf.
4.
Mr Williams submitted that the appropriate sanction in your case is erasure.
He drew the Panel’s attention to the submissions he previously made at the
impairment stage which included the relevant paragraphs of the GMC’s Indicative
Sanctions Guidance (ISG). He submitted that the breaches of GMP as identified by
the Panel in its determination on impairment were serious and that your dishonest
actions were for your own benefit and placed patients at risk.
5.
He submitted that your dishonest behaviour was sustained, significant and
that you thought that you could cover up your dishonest actions. He submitted that
an order of conditions couldn’t address the seriousness of your misconduct in any
way. He submitted that an order of suspension was not sufficient given the
circumstances of your case. He submitted that in relation to the sanction of erasure
the Panel should have regard to the factors set out in paragraph 82 of the ISG.
6.
Ms O’Rourke submitted that suspension is the appropriate sanction given the
circumstances of your case. She submitted that you have accepted that dishonesty is
something which is taken very seriously. She submitted that there are varying
degrees of dishonesty and that not every act of dishonesty must be met with a
sanction of erasure. She also submitted that your actions need to be assessed within
the context they occurred and that your personal circumstances at the time in 2010
are highly relevant to assess the quality and gravity of your dishonesty.
7.
She submitted that you are a competent and well regarded practitioner in the
Manchester area as evidenced by the large amount of highly positive testimonial
evidence from professional colleagues, patients and family members. She submitted
that your actions on 4 June 2010 were out of character and a one off incident in a
medical career spanning more than twenty years.
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
8.
The decision as to the appropriate sanction to impose, if any, in this case is a
matter for this Panel exercising its own judgement.
9.
In reaching its decision, the Panel has taken account of the ISG. It has borne
in mind 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.
10.
Throughout its deliberations, the Panel has applied the principle of
proportionality, balancing your interests with the public interest. The public interest
includes the maintenance of public confidence in the profession, and the declaring
and upholding of proper standards of conduct and behaviour.
11.
The Panel has already given a detailed determination on impairment. It has
taken those matters into account during its deliberations on sanction and balanced
them against the additional evidence and submissions received at this stage.
12.
The Panel has also taken account of the aggravating and mitigating factors in
your case. The principal aggravating factors identified by the Panel are that on the
night of 4 June 2010 you prioritised your own needs over those of your patients;
XXX was a consequence of your own free decision to work excessive hours in the
preceding period; that you lied and maintained that lie on a number of occasions;
and the potential impact on your patients of your failures on that night.
13.
The Panel accepts that there are a number of mitigating factors in your case
as identified by Ms O’Rourke. The Panel notes that there is no evidence of previous
bad character, and notes the expressions of remorse made to your medical
supervisor. The Panel accepts Ms O’Rourke’s submission that the testimonials
presented attest to you being a good and competent doctor and there is no evidence
that any patients were actually harmed as a result of your actions. The Panel also
accepts that during June 2010 your personal circumstances were extremely stressful
XXX and your difficult financial situation.
14.
The continuing misrepresentation of your position in subsequent oral and
documentary statements, including the inquest statement on 19 January 2012, was
previously regarded by the Panel as a persistent cover up of your failures on 4 June
2010. In its considerations at this sanction stage, the Panel has been persuaded by
Ms O’ Rourke’s submissions on your behalf that this should be viewed as part and
parcel of the original lie told in 2010 i.e. a default maintenance of the previous
untenable position. The Panel notes that this misrepresentation was consistent
throughout the period of time and you made no attempt to embellish it.
15.
In coming to its decision as to the appropriate sanction, if any, to impose in
your case, the Panel first considered whether to conclude the case by taking no
action.
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
16.
The Panel determined that in view of the serious nature of its findings in
relation to your dishonesty, it would not be sufficient, proportionate nor in the public
interest, to conclude this case by taking no action.
17.
The Panel next considered whether it would be sufficient to impose conditions
on your registration. It has borne in mind that any conditions imposed would need
to be appropriate, proportionate, workable and measurable.
18.
The Panel is of the opinion that a period of conditional registration could have
been appropriate in relation to the matters relating to the standard of care you
provided but, given the totality of circumstances which includes your dishonesty, an
order of conditions would result in a disservice to public confidence in the medical
profession. The Panel has, therefore, determined that it would not be sufficient to
direct the imposition of conditions on your registration.
19.
The Panel then went on to consider whether suspending your registration
would be appropriate and proportionate. The ISG at paragraph 69 states:
“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. Suspension from the register
also has a punitive effect, in that it prevents the doctor from practising (and
therefore from earning a living as a doctor) during the period of suspension.
Suspension will be an appropriate response to misconduct which is sufficiently
serious that action is required in order to protect patients and maintain public
confidence in the profession. However, a period of suspension will be
appropriate for conduct that falls short of being fundamentally incompatible
with continued registration and for which erasure is more likely to be the
appropriate response (namely conduct so serious that the Panel considers
that the doctor should not practise again either for public safety reasons or in
order to protect the reputation of the profession). This may be the case, for
example where there may have been acknowledgement of fault and where
the Panel is satisfied that the behaviour or incident is unlikely to be
repeated…”
20.
The Panel has also noted paragraph 75 which states:
“This sanction may therefore be appropriate when some or all of the following
factors are apparent (this list is not exhaustive):
- A serious breach of Good Medical Practice where the misconduct is not
fundamentally incompatible with continued registration and where therefore
complete removal from the register would not be in the public interest, but
which is so serious that any sanction lower than a suspension would not be
sufficient to serve the need to protect the public interest.
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
-…
-…
- ..
- 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.”
21.
In relation to dishonesty, the Panel has taken account of paragraphs 105 and
108 of ISG which states:
The GMC’s guidance, Good medical practice, states that registered doctors
must be honest and trustworthy, and must never abuse their patients’ trust in
them or the public’s trust in the profession
“You must make sure that your conduct justifies your patients’ trust in you
and the public’s trust in the profession.” (Good medical practice paragraph
65)
Dishonesty, even where it does not result in direct harm to patients but is for
example related to matters outside the doctor’s clinical responsibility, e.g.
providing false statements or fraudulent claims for monies, is particularly
serious because it can undermine the trust the public place in the profession.
The Privy Council has emphasised that:
“…Health Authorities must be able to place complete reliance on the
integrity of practitioners; and the Committee is entitled to regard
conduct which undermines that confidence as calculated to reflect on
the standards and reputation of the profession as a whole.”
22.
The Panel regards your actions as serious breaches of Good Medical Practice.
As part of its duty to protect the public interest, the Panel must declare and uphold
proper standards of conduct and behaviour. The Panel is also aware that the ISG
makes it clear that misconduct involving dishonesty may lead to erasure especially if
persistent and/or covered up.
23.
Although the Panel considers the breaches of GMP as being serious the Panel
does not consider them fundamentally incompatible with continued registration. The
Panel recognises that your XXX and the Panel has received evidence that it is being
actively and effectively managed. XXX
24.
XXX
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
25.
On balance the Panel accepts that this was an isolated incident arising from a
specific set of circumstances XXX. XXX dishonesty, it is likely to have impacted on
your judgment. The Panel is satisfied that you are taking effective steps to prevent a
recurrence of the circumstances which led to your misconduct and, although it
cannot rule out any risk of repetition, it considers your risk of repeating your
dishonest behaviour has been mitigated to a level which may be compatible with a
sanction of suspension.
26.
The Panel has reached the view that your misconduct, although serious, is
not so serious in the particular circumstances of this case, as to be fundamentally
incompatible with you continuing to be a registered medical practitioner. The
misconduct was plainly out of character during a very stressful period of your life.
27.
The Panel carefully considered whether suspension would be a sufficient
sanction to maintain confidence in the profession and to achieve the declaring and
upholding of proper standards of conduct and behaviour. In this case the Panel has
concluded that suspension would be sufficient to achieve this.
28.
The Panel considers it significant that your misconduct and your related
dishonesty arose from a period of a few hours on the night of 3/4 June 2014. Save
for the related inquest statement, this is over four years ago. There is no evidence of
any previous misconduct and the Panel has received abundant testimonial evidence
from past and present colleagues and patients that there has been no repetition of
this misconduct or any other instance of concern since then. Furthermore, much of
the testimonial evidence relates to how well you are coping with your current
workload. XXX Fellow practitioners who worked with you previously on out of hours
shifts spoke of you in positive terms raising no concerns about your conduct.
29.
There is a public interest in potentially allowing a competent practitioner the
opportunity to return to practice. In all the circumstances, the Panel considered that
the sanction of erasure sought by the GMC would be disproportionate given your
record and the fact that your misconduct on 4 June 2010 has not been repeated.
30.
In all the circumstances, the Panel has determined that it would be both
sufficient and proportionate to suspend your name from the Medical Register for a
period of twelve months. In deciding on the length of suspension, the Panel took
into account the nature of your dishonesty, and the need to demonstrate clearly to
you, the profession and the public that such conduct is unacceptable. In the
absence of hearing direct evidence from you, the Panel was unable to reach a firm
conclusion about the current level of your insight and considered that this period
would also allow you to fully reflect on the matters that have brought you before
your regulatory body.
31.
Shortly before the end of the period of suspension, your case will be reviewed
by a Fitness to Practise Panel. A letter will be sent to you about the arrangements
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
for the review hearing. At this next hearing, the Panel reviewing your case will wish
to be assured that you have addressed all the issues that have brought you before
this Panel and will be aided by direct evidence from you. That Panel may be assisted
by:








A personal development plan,
Evidence of steps you have taken to address your clinical failings in this case
and to prevent any future repetition,
Evidence of insight into the matters which brought you before this Panel,
Evidence that you have kept your general medical skills and knowledge up to
date including your Continuing Professional Development documentation,
XXX
A reflective diary,
Any further testimonials,
Any other evidence you wish to present to assist the Panel.
32.
The effect of this direction is that, unless you exercise your right of appeal,
your name will be suspended from the Medical Register for a period of twelve
months, with effect from 28 days from when written notice of this determination has
been served upon you. A note explaining your right of appeal will be sent to you.
Determination on Immediate Order
Dr Tahghighi:
1.
Having determined that your registration will be suspended from the Medical
Register, for a period of 12 months, the Panel has considered in accordance with
Section 38 of the Medical Act 1983, as amended, whether your registration should
be subject to an immediate order.
2.
The Panel has considered the submissions of Mr Williams and Mr Pollard. The
Panel has also considered the advice of the Legal Assessor.
3.
Mr Williams submitted that an immediate order of suspension is appropriate in
the public interest having regard to all the circumstances in this case. He also drew
the Panel’s attention to relevant sections of the ISG in particular paragraphs 121126.
4.
Mr Pollard submitted that the imposition of an immediate order is not
necessary in this case. He submitted that the Panel has been provided with
documentary evidence which denotes the lack of risk to patient safety. He submitted
that it is recognised that the matters in your case are serious but that the public
interest has been served by the substantive order of suspension made by the Panel.
5.
The Panel has determined that, given the serious nature of the Panel’s
findings, it is necessary both for the protection of patients and otherwise in the
FTP: Dr TAHGHIGHI
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Record of Determinations – Fitness to Practise Panel
public interest, to make an order suspending your registration immediately. The
public interest in this context is defined as the maintenance of public confidence in
the profession and the upholding of proper standards of conduct and behaviour. The
Panel notes that the substantive order of 12 months’ suspension does mark the
public interest and that it could be argued that failing to make an immediate order in
similar terms could be seen as weakening that message. The Panel also notes
however that you have been working under a set of stringent conditions which now
ceases to operate and it has no evidence before it as to your current ability to work
unsupported by those conditions and the potential impact on patient safety in
consequence.
6.
This means that your registration will be suspended with effect from today.
7.
The interim order of conditions currently imposed on your registration is
revoked.
8.
The substantive direction for suspension, as already announced, will take
effect 28 days from when notice is deemed to have been served upon you, unless
you lodge an appeal in the interim. If you do lodge an appeal, the immediate order
for suspension will remain in force until the appeal is determined.
9.
That concludes this case.
Confirmed
Date 11 November 2014
FTP: Dr TAHGHIGHI
Mr David Flinter, Chair
21

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