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Cite as: [2025] EWHC 823 (Admin)

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Neutral Citation Number: [2025] EWHC 823 (Admin)

Case No: AC-2023-LON-003847

IN THE HIGH COURT OF JUSTICE

KING’S BENCH DIVISION

ADMINISTRATIVE COURT

 

Royal Courts of Justice

Strand, London, WC2A 2LL

 

Date: 7 April 2025

 

Before :

 

MRS JUSTICE LANG DBE

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Between :

 

 

BASHIR AHMEDSOWIDA

Appellant

 

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GENERAL MEDICAL COUNCIL

Respondent

 

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Michael Forde KC and Gary Summers (instructed by Edwin Coe LLP) for the Appellant

Rory Dunlop KC (instructed by GMC Legal) for the Respondent

 

Hearing dates: 18 & 19 March 2025

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Approved Judgment


 

 

This judgment was handed down remotely at 10.30 am on 7 April 2025 by circulation to the parties or their representatives by e-mail and by release to the National Archives.

 

.............................

 

MRS JUSTICE LANG DBE

 

Mrs Justice Lang:

1.               The Appellant, who is a doctor, appeals under section 40 of the Medical Act 1983 (“MA 1983”), against the decision of a Tribunal (“the Tribunal”) of the Medical Practitioners Tribunal Service (“MPTS”), dated 23 November 2023, which found that his fitness to practise was impaired by reason of misconduct and ordered that his registration should be suspended for a period of 12 months.  

2.               This was a re-consideration of the decision of an earlier panel of the MPTS made on 21 January 2021 (“the 2021 Tribunal”).  The 2021 Tribunal found that the Appellant’s fitness to practise was impaired by reason of misconduct and imposed a sanction of erasure from the medical register.  The 2021 Tribunal exercised its powers under section 38 MA 1983 to impose an immediate suspension order, in the public interest, in the light of its finding that his conduct was fundamentally incompatible with continued registration. His registration was therefore suspended from 16 April 2021.

3.               The Appellant appealed to the High Court under section 40 MA 1983. On 21 December 2021, Kerr J. allowed the Appellant’s appeal, and set aside the 2021 Tribunal’s finding of impairment and the sanction of erasure. Kerr. J ordered that the case be remitted to the MPTS for re-consideration of the issues of impairment and sanction by a differently constituted panel, on the basis of the 2021 Tribunal’s findings of serious misconduct, modified in accordance with the judgment of the Court.  In particular, he ordered that:

i)                paragraph 15 of the Allegation shall be treated as non-serious misconduct;

ii)              the conduct found “reckless” at the impairment stage shall not be treated as dishonest conduct; and

iii)            the decisions on impairment and sanction must be taken without reference to or taking into account the Appellant’s decision to contest the particulars of the Allegation made against him or the manner in which he contested them.

4.               In the light of his successful appeal, the Appellant’s full registration was reinstated on 21 December 2021, after a suspension lasting 8 months.  

5.               The Tribunal did not exercise its powers under section 38 MA 1983 to impose an immediate suspension order on 23 November 2023, and so the Appellant has remained on the register pending the outcome of this appeal.    

History

6.               The Appellant was born in Afghanistan in 1972 and he is a British citizen.  He studied medicine and graduated from Ibne-Sina Balkh Medical School, Balkh University, Afghanistan in 1996.

7.               The incidents which are the basis of the Allegation against him occurred between January 2015 and May 2018, in a number of different hospitals and trusts. Because of its length (56 paragraphs), the Allegation is set out in an Annex to this judgment.

8.               The particulars of serious misconduct which were found proved by the 2021 Tribunal, and upon which the Tribunal based its re-consideration, were as follows:

i)                providing false information concerning his employment at Antrim Area Hospital in his First CV (paragraph 7(b) of the Allegation);

ii)              providing false information concerning his employment in his Second CV (paragraph 9(c) and (d) of the Allegation);

iii)            failure to declare that he was a trainee at the NIMDTA from August 2010 to March 2018 in his Second CV (paragraph 9(e) of the Allegation);

iv)             false identification of his Responsible Officer in his application to the Trust (paragraph 10(e) of the Allegation);

v)               failure to declare that he was a trainee at NIMDTA from August 2010 to March 2018 in his application to the Trust (paragraph 10(f) of the Allegation);

vi)             failure to follow the instructions of Dr B (paragraph 15(a) of the Allegation);

vii)           failure to follow the instructions of Dr D (paragraph 15(c) of the Allegation);

viii)         providing misleading information to Dr E that he had worked in Obstetrics and Gynaecology for 3 years since 2010 and had completed his ST1, ST2 and ST3 on 14 September 2017 (paragraphs 19(b) to 26 of the Allegation);

ix)             failure to provide Dr E with details of his previous posts and training in Obstetrics and Gynaecology (paragraphs 27(b) and (c) of the Allegation);

x)               The Appellant’s dishonest email to Dr E about his failure to meet with her on 27 October 2017 (paragraphs 29, 31 and 32 of the Allegation);

xi)             The Appellant’s dishonest email to Dr G dated 1 November 2017 concerning his alleged attempts to meet Dr G (paragraphs 38 to 43 of the Allegation);

xii)           The Appellant’s dishonest email to Dr A dated 15 May 2018 that, on 18 August 2016, Dr A and Dr I had instructed him to refrain from divulging information relating to the investigation conducted by AAH and NIMDTA (paragraphs 44 to 48 of the Allegation);

xiii)         The Appellant’s dishonest statement to Dr A on 14 November 2017 that the Hospital had not raised any concerns about him until after his resignation (paragraphs 49, 50(d), 51 and 52 of the Allegation); and

xiv)         The Appellant’s dishonest statement to Dr A on 14 November 2017 that concerns had been raised at the Hospital by only one person (paragraphs 53 to 56 of the Allegation).

9.               In accordance with Kerr J.’s ruling, the Tribunal did not treat the failure to follow the instructions of Dr C (paragraph 15(b) of the Allegation) as serious misconduct.  

Legal framework

10.            The Appellant has a statutory right of appeal to the High Court against the order of the Tribunal, pursuant to section 40 MA 1983.  The powers of the High Court on appeal are to quash the order made, substitute any order which could have been made by the Tribunal, or remit the case to the MPTS for them to arrange to dispose of it in accordance with the directions of the Court (section 40(7) MA 1983).  

11.            The appeal is governed by CPR Pt 52 and PD 52D.  It is an appeal by way of rehearing, but without re-hearing the evidence. Under CPR 52.21(3), the question for the Court is whether the decision of the Tribunal is “wrong” or “unjust because of a serious procedural or other irregularity in the proceedings in the lower court”.  

12.            In Sastry v General Medical Council [2021] EWCA Civ 623, Nicola Davies LJ reviewed the authorities and set out the principles applicable to a practitioner’s  appeal under section 40 MA 1983 (as distinguished from an appeal by the General Medical Council (“GMC”) under section 40A MA 1983), as follows:

“101.  The breadth of the section 40 appeal and the appellate nature of the court's jurisdiction was recognised by the Judicial Committee of the Privy Council in Ghosh and set out at [33] and [34] of the judgment of the Board given by Lord Millett. At [33] Lord Millett noted that the statutory right of appeal of medical practitioners under section 40 of the 1983 Act "does not limit or qualify the right of the appeal or the jurisdiction of the Board in any respect. The Board's jurisdiction is appellate, not supervisory. The appeal is by way of a rehearing in which the Board is fully entitled to substitute its own decision for that of the committee."

102.  Derived from Ghosh are the following points as to the nature and extent of the section 40 appeal and the approach of the appellate court:

i) an unqualified statutory right of appeal by medical practitioners pursuant to section 40 of the 1983 Act;

ii) the jurisdiction of the court is appellate, not supervisory;

iii)  the appeal is by way of a rehearing in which the court is fully entitled to substitute its own decision for that of the Tribunal;

iv) the appellate court will not defer to the judgment of the Tribunal more than is warranted by the circumstances;

v)  the appellate court must decide whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate;

vi)  in the latter event, the appellate court should substitute some other penalty or remit the case to the Tribunal for reconsideration.

103.  The courts have accepted that some degree of deference will be accorded to the judgment of the Tribunal but, as was observed by Lord Millett at [34] in Ghosh, "the Board will not defer to the Committee's judgment more than is warranted by the circumstances". In Preiss, at [27], Lord Cooke stated that the appropriate degree of deference will depend on the circumstances of the case. Laws LJ in Raschid and Fatnani, in accepting that the learning of the Privy Council constituted the essential approach to be applied by the High Court on a section 40 appeal, stated that on such an appeal material errors of fact and law will be corrected and the court will exercise judgment but it is a secondary judgment as to the application of the principles to the facts of the case ([20]). In Cheatle Cranston J accepted that the degree of deference to be accorded to the Tribunal would depend on the circumstances, one factor being the composition of the Tribunal. He accepted the appellant's submission that he could not be "completely blind" to a composition which comprised three lay members and two medical members.

104.  In Khan at [36] Lord Wilson, having accepted that an appellate court must approach a challenge to the sanction imposed by a professional disciplinary committee with diffidence, approved the approach and test identified by Lord Millett at [34] of Ghosh.

105.  It follows from the above that the Judicial Committee of the Privy Council in Ghosh, approved by the Supreme Court in Khan, had identified the test on section 40 appeals as being whether the sanction was "wrong" and the approach at the  hearing, which was appellate and not supervisory, as being whether the sanction imposed was appropriate and necessary in the public interest or was excessive and disproportionate.

…..

112.  Appropriate deference is to be paid to the determinations of the MPT in section 40 appeals but the court must not abrogate its own duty in deciding whether the sanction imposed was wrong; that is, was it appropriate and necessary in the public interest….”

13.            In Raschid and Fatnani v General Medical Council [2007] EWCA Civ 46, Laws LJ emphasised the purpose of the tribunal’s jurisdiction, saying:

“19. ….As it seems to me the fact that a principal purpose of the Panel’s jurisdiction in relation to sanctions is the preservation and maintenance of public confidence in the profession rather than the administration of retributive justice, particular force is given to the need to accord special respect to the judgment of the professional decision-making body in the shape of the Panel.  That I think is reflected in the last citation I need give.  It consists in Lord Millett’s observations at paragraph 34 of Ghosh v GMC [2001] 1 WLR 1915, page 1923G:

“The board will afford an appropriate measure of respect to the judgment in the committee whether the practitioner’s failing amount to serious professional misconduct and on the measures necessary to maintain professional standards and provide adequate protection to the public.  But the board will not defer to the committee’s judgment more than is warranted by the circumstances.”

20. These strands in the learning then, as it seems to me, constitute the essential approach to be applied by the High Court on a section 40 appeal.  The approach they commend does not emasculate the High Court’s role in section 40 appeals: the High Court will correct material errors of fact and of course of law and it will exercise a judgment, though distinctly and firmly a secondary judgment, as to the application of the principles to the facts of the case.”

14.            In Simawai v General Medical Council [2020] EWHC 2168 (Admin), Julian Knowles J. rejected the practitioner’s appeal against the length of a nine month suspension order, stating:

“72.  Reading the Tribunal's findings as a whole, it was clearly of the view that the Appellant had further work to do in order to gain full insight into his behaviour and to remediate it, and that the period of suspension had to be sufficient to allow that work to be completed and to be presented at a review hearing. Given the appropriate level of deference which I must afford to the Tribunal's determination, I am unable to say that a figure of nine months was wrong. I can take it the Tribunal knew the sort of timescales that would be necessary to allow the doctor to complete the necessary work and, in light of that work, to ensure the public and profession was fully protected.

73.  I readily acknowledge that a period of nine months' suspension will seriously impact on the Appellant's career and to that extent it represents a punishment. However, as Sir Thomas Bingham MR said in Bolton, supra, p. 598 the intention of disciplinary proceedings is often not punitive even if they have that effect.”

Sanctions Guidance (“SG”)

15.            The SG is non-statutory guidance which is approved by the Council of the GMC, and developed by a steering group of Medical Practitioners, MPTS and GMC staff, for use by Tribunals.

16.            Under the heading “Why do we impose sanctions?”, the SG states:

“14 The main reason for imposing sanctions is to protect the public. This is the statutory overarching objective, which includes to:

a protect and promote the health, safety and wellbeing of the public 

b promote and maintain public confidence in the medical profession

c promote and maintain proper professional standards and conduct for the members of the profession.

15 Each reference to protecting the public in this guidance should be read as including the three limbs of the overarching objective set out in paragraph 14.

16 Sanctions are not imposed to punish or discipline doctors, but they may have a punitive effect.

Maintaining public confidence in the profession 

17 Patients must be able to trust doctors with their lives and health, so doctors must make sure that their conduct justifies their patients’ trust in them and the public’s trust in the profession (see paragraph 65 of Good medical practice). Although the tribunal should make sure the sanction it imposes is appropriate and proportionate, the reputation of the profession as a whole is more important than the interests of any individual doctor.

Promoting and maintaining proper professional standards and conduct

18 Failure to follow Good medical practice does not automatically mean action will be taken. The guidance sets out the principles of good practice, not thresholds at which it is considered a doctor is unsafe to work.

19 Good medical practice is the benchmark that doctors are expected to meet subject to any mitigating or aggravating factors. Action is taken where a serious or persistent breach of the guidance has put patient safety at risk or undermined public confidence in doctors.”

17.            The SG gives guidance on taking a proportionate approach to imposing sanctions:

Taking a proportionate approach to imposing sanctions

20 In deciding what sanction, if any, to impose the tribunal should consider the sanctions available, starting with the least restrictive. It should also have regard to the principle of proportionality, weighing the interests of the public against those of the doctor (this will usually be an impact on the doctor’s career, e.g. a short suspension for a doctor in training may significantly disrupt the progression of their career due to the nature of training contracts).

21 However, once the tribunal has determined that a certain sanction is necessary to protect the public (and is therefore the minimum action required to do so), that sanction must be imposed, even where this may lead to difficulties for a doctor. This is necessary to fulfil the statutory overarching objective to protect the public.”

18.            In GMC v Khetyar [2018] EWHC 813 (Admin), at [22], Andrew Baker J. characterised the SG’s guidance on the principle of proportionality as an “authoritative steer”. Whilst the MPTS were entitled to depart from that steer, “[d]oing so requires careful and substantial case-specific justification”.

19.            The SG sets out mitigating factors to be considered, including remediation (paragraphs 31 - 33), expressions of regret and apology (paragraph 42 - 43) and the doctor’s insight into the concerns (paragraphs 45 - 49).

20.            The SG gives guidance on suspension of registration at paragraphs 91 - 106. Erasure is considered at paragraphs 107 - 111.  One of the factors that may indicate erasure is appropriate is dishonesty, particularly where it is persistent  or covered up.  Dishonesty is considered in more detail at paragraphs 120 - 128.

The Appellant’s grounds of appeal

21.            In the grounds of appeal lodged with the Appellant’s Notice, the Appellant appealed against (1) the determination on impairment; and (2) the determination on sanction. However, in the Appellant’s skeleton argument, the Appellant stated:

“17. In overview the single Grounds (sic) of Appeal  advanced is as follows:

Ground 1: The Tribunal made serious errors in their determinations on sanction. In particular, they misapplied the Court of Appeal case of ADIL and failed properly [to] take into account the immediate suspension order passed by the 2021 Tribunal and give appropriate credit for it in assessing the length of the suspension.”

This indicated that the appeal was only against sanction, not impairment.  However, the skeleton argument then proceeded to refer to the submissions on impairment in the grounds of appeal.

22.            Because of the ambiguity of the Appellant’s case,  I requested clarification, prior to the hearing, as to whether the Appellant was challenging the determination on impairment, in addition to the determination on sanction. Mr Dunlop KC, counsel for the Respondent, replied stating that there was no pleaded ground of appeal challenging the Tribunal’s findings on impairment, and/or whether the Appellant had full insight or posed a risk of repetition, and he would resist any attempt to amend the grounds at this late stage. At the beginning of the hearing, Mr Forde KC, counsel for the Appellant, confirmed that he was not pursuing a challenge to the determination on impairment and he only relied upon paragraphs 2 to 5 of the grounds of appeal as background to his submission on sanction. Despite this assurance, in my view Mr Forde KC’s submissions did amount to a challenge to the Tribunal’s findings on impairment.  In the circumstances, I decided that the best course was to deal with all the matters raised by the Appellant.

Appellant’s submissions on paragraphs 2 to 5 of the grounds of appeal (impairment)

23.            The Appellant challenged paragraph 79 of the Tribunal’s determination on impairment (“D/79”), where it found that his insight was incomplete, that he had not fully remediated his misconduct, and so the Tribunal could not be assured that he was highly unlikely to repeat his misconduct, and therefore some risk of repetition remained.

24.            The Appellant submitted that the Tribunal failed to give appropriate weight to the solid evidence of remorse, insight and remediation which he summarised as follows:

i)                CVs: Between 18 January 2023 and 6 August 2023, the Appellant completed two courses on the preparation of medical CVs and application forms. 

ii)              CPD courses on probity and ethics: Between 18 and 19 September 2023,  the Appellant completed five courses on probity and ethics, including avoiding mistakes and misconduct, insight, professionalism and standards relating to doctors, reflection, and remediation. 

iii)            Responding to investigations: On 18 September 2023, the Appellant completed five courses on issues relating to investigations including avoiding mistakes and misconduct, dealing with complaints and investigations, establishing boundaries among staff and ethical standards relating to doctors. 

iv)             Working with colleagues: Between 2 and 21 April 2023, the Appellant completed 14 courses on establishing and maintaining relations amongst colleagues, including communications skills, dealing with conflict, team dynamics in the work, decision making for individuals and groups, negotiations and referrals. 

v)               A course with Dr Crawford of Oxford Medical.

vi)             Case Based discussions and Patient Colleague Feedback.

vii)           Character witnesses.

viii)         A reflective written statement addressing remediation and insight among other matters.

ix)             Annual appraisals.

x)               Revalidation.  Mr Forde KC withdrew the Appellant’s assertion that he had been revalidated on two occasions, following correction by the Respondent, as revalidation has been deferred during the ongoing disciplinary proceedings.

xi)             Oral evidence to the Tribunal.

25.            In paragraph 26 of his skeleton argument, the Appellant listed many favourable statements about the Appellant, extracted from the evidence.  

26.            The Appellant submitted that these categories of evidence should have led the Tribunal to conclude that the change in the Appellant was transformational and that his insight and remediation had reached a high threshold where the Tribunal could be satisfied that the Appellant was highly unlikely to repeat his past misconduct.

Conclusions on paragraphs 2 to 5 of the grounds of appeal (impairment)

27.            The Tribunal addressed these issues in its determination on impairment, applying the relevant legal principles. In my view, it is important to have regard to the legal framework within which the Tribunal made its findings, as set out below:   

The Relevant Legal Principles

28. The Tribunal reminded itself that at this stage of proceedings, there is no burden or standard of proof and the decision of impairment is a matter for the Tribunal’s judgement alone.

29. The Tribunal must determine whether Dr Ahmedsowida’s fitness to practise is impaired today, taking into account Dr Ahmedsowida’s conduct at the time of the events and any relevant factors since then such as whether the matters are remediable, have been remedied and any likelihood of repetition.

30. Whilst there is no statutory definition of impairment, the Tribunal is assisted by the guidance provided by Dame Janet Smith in the Fifth Shipman Report. The Tribunal noted that any of the following features are likely to be present when a doctor’s fitness to practise is found to be impaired:

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 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.’

31. The Legally Qualified Chair (‘LQC’) advise the Tribunal to consider to the case of Yeong v GMC [2009] EWHC 1923 (Admin), also cited in CHRE v NMC & Grant [2011] EWHC 927 (Admin) which states that in some cases the misconduct may breach fundamental principles to such an extent that a finding of impairment is justified simply to maintain public confidence on the profession. Where a Tribunal considers that fitness to practise is impaired for such reasons, and it requires a firm declaration of professional standards so as to promote public confidence in that medical practitioner and the profession generally, efforts made by the practitioner to address his problems and to remediate may be of far less significance.

32. The LQC also referred the Tribunal to the cases of Yussuf v GMC [2018] EWHC 13 (Admin) and Sawati v GMC [2022] EWHC 283 (Admin). With regard to the former, he advised that the principles in that case had some bearing although it must have in mind that Yussuf specifically was a case concerning reviews of substantive sanction orders, and there had yet been no initial finding of impairment in this case. He advised the following principles may be relevant, adapting from Yussuf and bearing in mind the Order of Kerr, J:

i. The Tribunal cannot go behind and would not re-open the findings of fact;

ii. The doctor is entitled to have defended the case: no account of that fact should be taken into account, nor anything concerning manner of defence;

iii. The doctor is entitled to not accept the Tribunal’s findings;

iv. Alternatively, the doctor is entitled to say that he accepts the findings in the sense he does not seek to go behind them while still maintaining a denial of the conduct underpinning the tribunal’s findings (the Tribunal noting that Dr Ahmedsowida did not say he denied everything in this case);

v. When considering whether fitness to practise is impaired, it is relevant for the tribunal to know whether or not the doctor admits the misconduct (and the factual findings);

vi. Admitting the Misconduct is not a ‘condition precedent’ (i.e. a pre-requisite) to establishing that the doctor (i) understands the gravity of the misconduct and (ii) is unlikely to repeat it;

vii. A want of candour at a hearing may be a relevant consideration but whether there had been such, and the relevance was a matter for the Tribunal to determine.

33. In relation to Sawati, the LQC advised that there were certain principles set out in the judgement regarding how the Tribunal must consider a defence by a doctor which has been rejected in the Tribunal’s findings. He advised that the Order of Kerr J had directed the Tribunal’s approach to the doctor’s defence of the case, and the Tribunal was bound by this. However, the third summarised principal in paragraph 109 of the Sawati judgement still had relevance, namely:  (iii) ‘how far 'lack of insight' is evidenced by anything other than the rejected defence’.

34. The Tribunal noted that dishonesty is said to be difficult to remediate. It reminded itself that there is acknowledged to be a ‘spectrum’ of dishonesty and where this case fell should be considered in light of the detailed findings. However, as set out in Bolton v The Law Society [1993] ECWA Civ 32, dishonesty in professionals is regarded as a serious matter.”

28.            The Tribunal began its lengthy consideration of impairment by considering the evidence and findings of serious misconduct.  It concluded as follows:

“36. The Tribunal considered that Dr Ahmedsowida’s behaviour amounted to a pattern of repeated dishonesty in order to cover up issues and this serious dishonesty persisted between July 2017 and May 2018. Dr Ahmedsowida was not honest about his skills, experience and capabilities and hid information from colleagues that would have allowed them to make informed and possibly different decisions about appointments to clinical roles and suitable candidates. In doing so he risked putting himself in positions where he could not safely manage and treat patients. 

37. In his submissions, Mr Gledhill suggested that Dr Ahmedsowida’s actions had caused “no harm”. The Tribunal accepted it was correct that it had no evidence of harm having been caused. However, it also noted that Dr Ahmedsowida failed to follow the instructions of Dr B and that a patient had lost a lot of blood during a caesarean section. Another patient had to have their perineum re-sutured, because Dr Ahmedsowida removed some stitches, contrary to the instructions of Dr D. The Tribunal concluded that both the failure to follow instructions and the dishonesty in relation to applications and CV’s gave rise at least to a risk of harm to patients.

38. The Tribunal’s view of seriousness was further reinforced by the fact that Dr Ahmedsowida first made an application which included false information, there were then two clinical episodes where his skills were questioned and he then made a second dishonest application seeking further employment.

39. The Tribunal also considered that serial dishonesty caused prejudice to public confidence in the profession, as it undermined the public’s trust in doctors.

40. The Tribunal considered the submissions made in respect of breaches of GMP. It noted that not every finding of misconduct, or breach of GMP will result in a finding of impairment.  There had been a number of occasions on which Dr Ahmedsowida had failed to be honest in preparing his CV and application. This was a direct contravention of paragraphs 66 and 68 (set out above). If the public became aware of these matters, it would undermine its trust in the profession, contrary to paragraph 65. Dr Ahmedsowida’s failure to follow instructions contravened his obligations in relation to paragraph 36 and also risked undermining public confidence.

41. When confronted about concerns with the information he had provided, Dr Ahmedsowida compounded this by his attempts to cover up and avoid telling the truth. The 2021 Tribunal made a clear finding that he was deliberately covering things up and that this was not a mistake or misunderstanding, and this Tribunal did not go behind those findings. The Tribunal also acknowledged that dishonesty in professionals is a serious matter, undermining public trust. The Tribunal considered that overall, the level of dishonesty was high.

42. The Tribunal also noted that the conclusion of the 2021 Tribunal was that Dr Ahmedsowida’s misconduct was remediable. Dr Ahmedsowida referred the Tribunal to this finding by the 2021 Tribunal and relied on it. This Tribunal considered that, the Order of Kerr J having set aside the previous determination of the 2021 Tribunal as to impairment, this was a matter for its own judgement. 

43. The Tribunal, having carefully considered the findings of the 2021 Tribunal as to the facts and misconduct concluded that, in its judgement, the dishonesty is capable of remediation. However, it also concluded that Dr Ahmedsowida’s misconduct, being repeated and serious was likely to require significant and demonstrable remediation. 

…..

 45. …. the Tribunal considered that there were two significant matters it had to take into account in this case. Firstly, the Tribunal had been directed to take nothing into account as to Dr Ahmedsowida’s decision to defend the case, nor the manner in which he defended it. Second, due to the particular circumstances of the case, Dr Ahmedsowida has had the opportunity of a significant period of time in which to undertake his remediation, between the stages of the case. 

…..

47. The Tribunal did find some assistance from the principles that the learned High Court judge set out in Yussuf which the Tribunal took into account. It acknowledged that Dr Ahmedsowida is entitled to not accept the full factual findings against him. However, it is relevant for the Tribunal to understand whether and the extent to which, the doctor accepts the findings of misconduct. The Tribunal accepted that it was still possible for Dr Ahmedsowida to demonstrate that he had gained full insight into the misconduct found. The Tribunal decided that it should therefore make an assessment as to how far Dr Ahmedsowida had demonstrated the development of full insight.

48. The Tribunal therefore went on to consider whether Dr Ahmedsowida has demonstrated insight and remediated his misconduct, on its assessment of the evidence provided.”

29.            In my judgment, the Tribunal’s assessment of the evidence and its findings of misconduct were a measured and reasonable exercise of its specialist judgment. I also consider that the Tribunal correctly directed itself on the approach to adopt in considering remediation and insight.

30.            In my view, it is apparent from the determination, at D/50 - D/70, that the Tribunal gave careful consideration to the substantial amount of documentary evidence produced by the Appellant, as well as his oral evidence and the oral evidence of his character witnesses.  The Tribunal addressed the main categories of evidence in turn, and gave its assessment of them, which it then summarised at D/71 - D/76. I consider that the assessments were fair.  The Tribunal was entitled to find that much of the evidence was insufficient to address its findings and concerns, for the reasons it gave. The Tribunal had the advantage of hearing oral evidence from the Appellant, as well as his witnesses. In my view, hearing the Appellant give evidence would have been of value in assessing the Appellant’s remediation and insight.   

31.            Mr Forde KC particularly relied upon on the reflective statement, emphasising its high standard.  However, I was concerned by the contrast with the Appellant’s oral evidence, which even Mr Forde KC conceded was “confused” in places (e.g. transcript page 270).  The Appellant was not always able to express himself clearly and sometimes did not answer the question asked (e.g. transcript page 272).  It seemed to me that the high quality of the reflective statement was probably, at least in part, a result of the professional assistance that the Appellant received with the drafting and content.

32.            Mr Forde KC took issue with the Tribunal’s finding at D/70 that the Appellant talked about mentoring but did not provide any details of specific mentoring.  I consider that the Appellant’s oral evidence on mentoring was confused.  At times he appeared to equate mentorship with seeking advice from senior colleagues (e.g. transcript pages 211, 251, 238). During submissions on sanction, the Tribunal Chair asked his representative, Mr Gledhill, whether any work had gone into identifying a mentor. It was clear from Mr Gledhill’s reply that no mentor had been approached or appointed as yet (transcript page 346).  In his reflective statement, the Appellant described his future plans to actively seek a mentor (Remediation bundle, pages 1274, 1275), but he did not refer to a current mentoring relationship.

33.            At D/71, the Tribunal summarised the issue for the Tribunal as follows:

“71. The Tribunal considered that all four limbs of Dame Janet Smith’s test, as set out above, are applicable in this case. Dr Ahmedsowida had created an unwarranted risk of harm by failing to follow instructions and failing to be honest in providing information about his past clinical experience. His actions risked bringing the profession into disrepute, if the public became aware of the dishonesty, and he had breached the fundamental tenet of honesty amongst the profession and acted dishonestly. The issue for the Tribunal was the extent to which it could be satisfied from the serious findings of misconduct and the evidence of remediation, that Dr Ahmedsowida was ‘highly unlikely’ to repeat the misconduct.”

34.            The Tribunal then concluded that some risk of repetition remained:

Risk of repetition

77. The Tribunal considered that the seriousness and persistence of the dishonesty as found by the 2021 Tribunal in this case pointed to attitudinal issues and a willingness to be dishonest, in the past. The Tribunal was also concerned that the findings, such as in relation to the failure to follow instructions demonstrated an over confidence in his own skills and experience and an unwillingness to respect senior colleagues.

78. The Tribunal considered how these concerns affected its assessment of whether there remains a risk of repetition. In doing so, the Tribunal acknowledged that there is no evidence of any repetition since the time of the events and that these proceedings have had a salutary effect on Dr Ahmedsowida. 

79. The Tribunal concluded that it had not received sufficient evidence which could satisfy it that he has developed full insight into this or has reflected on the causes of such behaviour or put in place sufficient preventative measures to ensure there is no repetition. It concluded that a structure has been devised by Dr Ahmedsowida but he has not yet sufficiently accessed that plan or structure to complete his remediation. Given that his insight remains incomplete, and he has not fully remediated his misconduct, the Tribunal could not be assured that he is highly unlikely to repeat his misconduct at this stage, and therefore some risk of repetition remains.”

35.            Mr Forde KC challenged the Tribunal’s conclusion in D/79, arguing that the Tribunal had ample and sufficient evidence to find that the Appellant did not pose a significant risk of repeating behaviour.  In my view, the judgment of the Tribunal was well-founded.  A pattern of serious dishonesty and attitudinal issues did require significant and demonstrable remediation.  The Tribunal was entitled to conclude that remediation and insight were incomplete, and further work was required.  I bear in mind that the members of the Tribunal will have had experience of assessing remediation and insight from sitting on other cases.

36.            At D/80, the Tribunal determined that, in view of the findings of serial dishonesty, a finding of impairment was also necessary in order to uphold the statutory overarching objective and to maintain public confidence in the profession.  The Appellant conceded at paragraph 1 of the grounds of appeal that the finding of impairment could be upheld on public interest grounds.

37.            At D/81, the Tribunal determined that the Appellant’s fitness to practise is currently impaired by reason of misconduct.

38.            Therefore, for the reasons set out above, the Appellant’s challenge to the Tribunal’s findings on impairment,  under paragraphs 2 to 5 of the grounds of appeal, does not succeed.

Appellant’s submissions on the length of suspension

39.            The Appellant accepted that a suspension was appropriate for deterrent and public interest reasons.  However, the Appellant submitted that the Tribunal made serious errors in determining the length of the suspension. 

40.            The Tribunal misapplied the Court of Appeal case of Adil v GMC [2023] EWCA Civ 1261, in particular the passage at [100]:

“It may also be appropriate to take into account periods of interim suspension insofar as the sanction is intended to mark the gravity of the offence so as to send a message to the profession and to the public.”

41.            The Tribunal was wrong not to take into account, and give credit for, the 8 month period of the first suspension, when assessing the length of the suspension. This was not an interim order suspension, but part and parcel of the implementation of the original sanction of erasure imposed by the 2021 Tribunal. 

42.            At paragraph 43 of the determination on sanction (“S/43”), the Tribunal stated that suspension would serve as a deterrent and would also allow for remediation. At S/49, the Tribunal reversed the two reasons for suspension, referring first to remediation and then to deterrence. The Appellant submitted that the position was correctly stated at S/43: the primary reason for the suspension was deterrence and time for remediation was a secondary reason.

Conclusions on the length of suspension

43.            The Tribunal correctly followed the guidance in the SG by identifying  mitigating and aggravating factors, and then considering each potential sanction in ascending order of severity, starting with the least restrictive.

44.            At S/28, the Tribunal concluded that it would not be sufficient, proportionate, or in the public interest to take no action. At S/32, the Tribunal concluded that, given the nature of the misconduct, involving dishonesty, the Tribunal could not formulate appropriate conditions which would be workable and which would manage attitudinal concerns.

45.            The Tribunal considered the SG on suspension and decided to impose an order for suspension for the following reasons:

“35. The Tribunal carefully considered the factual and misconduct findings of the 2021 Tribunal and the Order of the High Court together with its own determination on impairment and the submissions advanced by the parties.  The Tribunal balanced the public interest with Dr Ahmedsowida’s interests.

36. The Tribunal noted that suspension has a deterrent effect and can be used as a signal to the doctor, the profession and the public about what is regarded as behaviour unbefitting of a registered doctor. It also acknowledged that suspension is an appropriate response to misconduct which is sufficiently serious that action is required in order to protect members of the public or maintain public confidence in the profession.

37. When considering whether suspension is the appropriate sanction in this case, the Tribunal had regard to all of the circumstances. It acknowledged that the misconduct was serious, but Dr Ahmedsowida has expressed remorse for his behaviour, and taken steps towards remediating his misconduct, including providing reflective statements and undertaking targeted CPD courses.

38. The Tribunal accepted and took into account the advice it had received. It understood from the case of Simawi and the cases referred to in that judgement, that dishonesty is regarded seriously, particularly where persistent and covered up. This point is also made in the SG, at paragraph 128. The latter states:

128   Dishonesty, if persistent and/or covered up, is likely to result in erasure

39. The Tribunal also considered that the case of Bolton makes clear that the reputation and standing of the profession is an important matter and may outweigh the plight of the individual. Therefore, the Tribunal considered, the misconduct and impairment found in the case warranted the Tribunal to consider a high sanction. 

38. [paragraph numbering incorrect here] The Tribunal noted from the SG that the same key considerations which relate to the question of whether suspension is appropriate also feature in respect of considering whether to erase a doctor’s registration, in this misconduct case, namely the serious breach of GMP. The Tribunal considered that the facts of the case also satisfied a number of the factors in the SG which indicate erasure might be appropriate. One key factor appeared to be whether the behaviour was ‘fundamentally incompatible’ with being a doctor. 

39. [paragraph numbering incorrect here] The Tribunal considered that this still allowed it to consider the full circumstances of the case. This included a full assessment of the doctor’s fitness to practise and his attempts at remediation. It noted that the indicators that suspension might be appropriate included:

“e No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor’s unwillingness to engage.

f No evidence of repetition of similar behaviour since incident.

g The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour.”

40. The Tribunal took into account that, in the unusual circumstances of this case, Dr Ahmedsowida had been given the opportunity of a period of almost two years, in which to demonstrate his remediation. He had been able to work again as a doctor without restriction, from December 2021 until the present. There had been no further concerns raised with his practice and no evidence of repetition. 

41. The Tribunal was satisfied that Dr Ahmedsowida had put a great deal of effort into his CPD and his reflective statements. It considered that he has not gone far enough along the process of remediation which he has himself identified. However, the Tribunal did not consider that it had before it evidence that such a process would be unsuccessful, if the doctor continues with it. 

42. The Tribunal accepted that Dr Ahmedsowida has a degree of insight, although it requires further development. The first part of the development of insight had been Dr Ahmedsowida’s acceptance that the findings of misconduct had been made, his apology and expression of remorse. He had set out in his reflective statements a recognition of the effect of the misconduct on the profession and the public. The Tribunal has set out above in its determination on Impairment how Dr Ahmedsowida has further work to do to persuade a Tribunal that he has fully remediated. The Tribunal acknowledged that, as had been stated in Giele, there can be a public interest in returning a doctor to practice, in an appropriate case. 

43. The Tribunal therefore determined that suspension of his registration was the appropriate sanction. It considered that suspension will serve as a deterrent to warn that his conduct is unacceptable. A period of suspension would also allow for Dr Ahmedsowida to carry on with his remediation, the outcome of which will then be considered by a further Tribunal at a later point, as the Tribunal will direct a review of the order. 

44. The Tribunal concluded, taking all matters into account, that allowing for the remediation that Dr Ahmedsowida has commenced and the prospect that he may be successful in remediating his past misconduct, his conduct is not fundamentally incompatible with registration.

45. The Tribunal is satisfied that suspension would be sufficient to meet the overarching objective and, in particular promoting and maintaining public confidence and proper professional standards in the medical profession. The Tribunal considered that an informed member of the public would be aware not only of the doctor’s misconduct, but also of the history of the remediation on which Dr Ahmedsowida had embarked and the fact that he had been in work for a considerable period since the High Court appeal without further incident. 

46. The Tribunal took into account that a period of suspension will have a serious effect on Dr Ahmedsowida, professionally, financially and personally. It acknowledged the evidence that had been given about the effect of the previous period of immediate suspension on Dr Ahmedsowida and the submission made by Mr Gledhill. However, the Tribunal considered that it was bound to apply a serious sanction, in light of the serious misconduct which had occurred. The Tribunal balanced Dr Ahmedsowida’s interests with the public interest and found that the sanction of suspension was proportionate.

47. Having decided that Dr Ahmedsowida’s conduct was not fundamentally incompatible with continued registration as a doctor, the Tribunal determined that a period of suspension was the least sanction which met the level of impairment. Accordingly, the Tribunal considered that erasure was unnecessary and would therefore be disproportionate in the circumstances.”

46.            The Tribunal then went on to consider the length of the suspension, and concluded that it should be the maximum period of 12 months, for the following reasons:

Length of Suspension

48. Having determined to impose a period of suspension on Dr Ahmedsowida’s registration, the Tribunal went to on to consider the length of the period of suspension. It considered the following paragraphs of SG:

100 The following factors will be relevant when determining the length of suspension:

a) the risk to patient safety/public protection

b) the seriousness of the findings and any mitigating or aggravating factors

c) ensuring the doctor has adequate time to remediate.

101 The Tribunal’s primary consideration should be public protection and the seriousness of the findings. Following any remediation, the time all parties may need to prepare for a review hearing if one is needed will also be a factor’

49. The Tribunal considered that a sufficient period of suspension is needed to allow time for Dr Ahmedsowida to complete his remediation. In addition, there is a need to mark the seriousness of Dr Ahmedsowida’s misconduct and to declare and uphold proper standards of behaviour, taking into account the aggravating and mitigating factors in this case. 

50. Having taken all these matters into account the Tribunal determined to impose a twelve-month period of suspension on Dr Ahmedsowida’s registration. It considered that the case, involving as it does, persistent dishonest conduct, was serious. Therefore a period of twelve months is proportionate to the gravity of the findings of the Tribunal and would be sufficient to send a signal to Dr Ahmedsowida, the wider profession and the public.

51. The Tribunal considered the submission that Dr Ahmedsowida had already served a period of immediate suspension of approximately eight months, from the conclusion of the 2021 Tribunal in April 2021 until the successful appeal in December 2021. The Tribunal accepted the submission that the cases of Adil and Lusinga demonstrated that it, in an appropriate case, it could take this period into account in determining the length of suspension. 

52. The Tribunal noted, however, paragraph 101 of Adil. The Tribunal considered that the suspension in this case is required for a period sufficient to return Dr Ahmedsowida to fitness to practise, to mitigate the risk and to protect the public whilst his remediation continues. In the circumstances, the Tribunal did not consider that it is appropriate to take into account the previous period of immediate suspension when determining the length of this suspension. It therefore did not take the previous immediate suspension into account.”

47.            In Adil, Popplewell LJ gave the following guidance on whether and when to take into account previous periods of interim suspension when imposing a sanction of suspension:

“99. ….. Insofar as the purpose of the sanction is to punish the practitioner or deter him from repetition of the conduct in question, it is a matter of  common fairness that account should be taken of the punitive and deterrent effect of having already been deprived of the ability to practice for a period under temporary suspension orders.  To that extent there is a direct analogy with sentencing for criminal conduct in which time spent in prison on remand is automatically credited against the sentence imposed for the offence.

100. It may also be appropriate to take into account periods of interim suspension insofar as the sanction is intended to mark the gravity of the offence so as to send a message to the profession and to the public.  If, for example, there were a contrite practitioner with full insight into misconduct which was sufficiently serious to warrant suspension, the necessary message could be sent to the profession and the public by the tribunal making clear that the gravity of the misconduct needed to be marked by a suspension of a stated length; but that in fairness to the practitioner, he should be allowed to return to practice immediately, or within a lesser period, by reason of his already having been deprived of the ability to do so in the period prior to the imposition of the sanction.  Messages depend upon the terms in which they are sent, and tribunals ought to be able to frame their decisions in language which enables the appropriate message to be sent whilst ensuring fairness to the practitioner in question.

101. However where, or insofar as, the suspension is required to return the practitioner to fitness to practise, and/or to mitigate the risk of further commission of the misconduct, and/or for the continued protection of the public from harm, periods of interim suspension may have little or no relevance.  In those cases the length of suspension is tailored to what is necessary for the removal of impairment, removal of risk of repetition, and maintaining the safety of the public.  Time already spent suspended from practice has no direct bearing on the length of a suspension which is necessary to achieve these objectives.  To give credit for time away from practice under interim suspension orders in such cases would be likely to undermine those objectives in protecting the public from harm, promoting professional standards in the profession and promoting and maintaining trust in the profession.

102. This is consistent with the decision of Dingemans J, as he then was, in Kamberova v Nursing and Midwifery Council [2016] EWHC 2995 (Admin) and his reasoning at [36] and [40].  We were referred to the remarks made by Eady J in Ujam v. General Medical Council [2012] EWHC 683 (Admin) at [5] and Silber J in Abdul-Razzack v General Pharmaceutical Council [2016] EWHC 1204 (Admin) at [84]-[85].   They were saying no more than the particular purposes of professional sanctions mean that there is no universal analogy with periods of imprisonment served on remand.  That point is well made.  It does not mean, however, that time spent suspended under interim orders should generally be ignored, and it may be required to be taken into account in favour of the practitioner within the framework of the sanctioning objectives in the ways I have suggested.

103. In this appellant’s case the suspension was required to rehabilitate him so as to remedy his continued impairment to practice through lack of insight;  to remove or mitigate the risk of further commission of the misconduct; and for the protection of the public from harm.  The six month period was necessary for those objectives, to which the period spent suspended under interim suspension orders was irrelevant.  In those circumstances there was no error in the Tribunal failing to reduce it on account of the interim suspension orders.  I would reject ground 3.”

48.            Thus, the Court of Appeal in Adil distinguished two kinds of suspensions:

i)                Where the period of suspension imposed is required to punish, deter or mark the gravity of the misconduct so as to send a message to the profession.  In such a case, periods of interim suspension should be taken into account.

ii)              Where the period of suspension imposed is required in order “to return the practitioner to fitness to practise, and/or to mitigate the risk of further commission of the misconduct, and/or for the continued protection of the public from harm”.  In such a case, periods of interim suspension have ‘little or no relevance’.

49.            The Court of Appeal in Adil does not expressly address what is to happen when a case falls into both categories i.e. where a particular period of suspension is required both to mark the gravity of the misconduct and to return the practitioner  to fitness to practise.  I agree with the Respondent’s submission that, logically, periods of interim suspension should not be taken into account in such a case.  In such a case, giving credit for previous interim suspensions would be likely to undermine the public interest in the way identified in Adil at [101]. It would or could result in a practitioner either returning to practise while their fitness to practise was still impaired or (where a review has been ordered) a premature review hearing.

50.            In this case, the Tribunal found that there were two justifications for the period of suspension:

i)                the seriousness of the misconduct and the need to send a signal to the Appellant, the profession and the public (S/50); and

ii)              to return the Appellant to fitness to practise, to mitigate the risk and to protect the public whilst his remediation continues (S/52).

51.            In my judgment, the Tribunal was correct to hold that, in these circumstances,  no credit should be given for the previous period of immediate suspension.  This decision was consistent with the guidance in Adil and ensures that there was sufficient time for the Appellant to complete his remediation.  Whilst I recognise the financial and professional difficulties caused by suspension, the sanction furthers the statutory overarching objective, as set out in paragraph 14 of the SG (see paragraphs 16 and 17 above).  As the SG states, sanctions are not imposed to punish or discipline doctors, but they may have a punitive effect.  I consider that this sanction is necessary in the public interest and proportionate.  

52.            At the hearing, Mr Forde KC raised a new point, namely, that there was an inconsistency between the Tribunal’s  finding on the one hand that this case fell within Adil at [101] because a period of twelve months suspension was necessary to develop insight and complete remediation, and on the other hand, deciding an immediate suspension order under section 38 MA 1983 was not necessary. 

53.            The SG gives guidance on immediate suspensions at paragraphs 172 - 178:

Immediate orders

172 The tribunal may impose an immediate order if it determines that it is necessary to protect  members of the public, or is otherwise in the  public interest, or is in the best interests of the  doctor. The interests of the doctor include  avoiding putting them in a position where they  may come under pressure from patients, and/or  may repeat the misconduct, particularly where  this may also put them at risk of committing a criminal offence. Tribunals should balance these factors against other interests of the  doctor, which may be to return to work pending  the appeal, and against the wider public interest, which may require an immediate order.

173 An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety. For example, where  they have provided poor clinical care or abused a doctor’s special position of trust, or where  immediate action must be taken to protect  public confidence in the medical profession.

……

178 Having considered the matter, the decision whether to impose an immediate order will be at the discretion of the tribunal based on the facts of each case. The tribunal should consider the seriousness of the matter that led to the substantive direction being made and whether it is appropriate for the doctor to continue  in unrestricted practice before the substantive  order takes effect.”

54.            The Tribunal set out its reasons for not making an immediate order of suspension, as follows:

The Tribunal’s Determination 

6. In reaching its decision, the Tribunal has exercised its own judgement, and has taken account of the principle of proportionality. The Tribunal has borne in mind that it may impose an immediate order where it is satisfied that it is necessary for the protection of members of the public, is in the public interest, or is in the best interests of the practitioner. 

7. The Tribunal had regard to the following paragraphs of the SG: [The Tribunal set out SG paragraphs 172, 173, 178].

8. The Tribunal noted that Dr Ahmedsowida had been working as a competent doctor since January 2022 and considered that the imposition of an immediate order was not necessary for the protection of the public.

9. The Tribunal also considered that the public interest had been met by the substantive order.

10. Further, the Tribunal noted that the GMC had not submitted that such an order was necessary.

11. In the circumstances the Tribunal determined that the imposition of an immediate order on Dr Ahmedsowida’s registration was not necessary to protect the public or to satisfy the wider public interest. There was no suggestion that an immediate order was in the doctor’s interest.

12. This means that Dr Ahmedsowida’s registration will be suspended from the Medical Register 28 days from the date on which written notification of this decision is deemed to have been served, unless he lodges an appeal. If Dr Ahmedsowida does lodge an appeal he will remain free to practise unrestricted until the outcome of any appeal is known.”

55.            In response, Mr Dunlop KC referred to the case of Ashton v GMC [2013] EWHC 943 (Admin), where a doctor appealed successfully against an immediate suspension order, Stuart-Smith J. explained, at [78]:

“The Guidance recognises that the effect of an order of immediate suspension is to impose an additional period of suspension upon a doctor because he or she will normally not be suspended until the expiry of 28 days or, if an appeal is brought, until the appeal has been disposed of.  The statutory test for the imposition of an immediate order is either (a) that it is necessary for the protection of members of the public, or (b) that it is in the public interest, or (c) that it is in the best interests of the practitioner.”

56.            The Fitness to Practise Panel in Ashton directed suspension for six months in order to afford time for remediation, and imposed an immediate order of suspension.  The High Court dismissed the ground of appeal challenging the six month suspension but allowed the appeal against the immediate order. 

57.            I agree with Mr Dunlop KC’s submission that the High Court in Ashton thus recognised the possibility that suspension might be necessary, to complete remediation and develop insight, but an immediate order might not be necessary.  The judgment in Ashton at [72] - [74] and [80] reflects the different focus of a sanction and an immediate order.  The decision on sanction focuses on what is required to bring the doctor back to full fitness to practise.  The decision on whether to make an immediate order is focused on whether the doctor is likely to repeat the misconduct in the relatively short period of time it will take to exhaust any right of appeal. 

58.            Ashton therefore demonstrates that there is no inconsistency between finding some risk of repetition in general (which needs to be addressed by way of further remediation) but no significant risk of repetition in the relatively short period of time it takes to exhaust appeal rights.  The Tribunal in this case was entitled to find that a suspension order for twelve months was necessary to develop insight and complete remediation, but not to impose an immediate order pending any appeal, for the reasons they gave.   

Final conclusion

59.            For the reasons set out above, the appeal is dismissed.


 

ANNEX  - The Allegation

Dr Bashir Ahmedsowida

 

GMC reference number: 6127894

 

That being registered under the Medical Act 1983 (as amended):

 

Inter Deanery Transfer request

 

1. On 19 January 2015, you submitted an Inter Deanery Transfer request (‘the Request’) to the head of Northern Ireland Medical and Dental Training Agency (‘NIMDTA’) School of Obstetrics and Gynaecology. Admitted and found proved

 

2. The Request contained your signature which confirmed that you were

‘currently in receipt of a satisfactory ARCP/RITA Outcome’. Admitted and found proved

 

3. Your ARCP Outcome as of 19 January 2015 was N11 and therefore was not a satisfactory ARCP Outcome. Admitted and found proved

 

4. You knew that your ARCP Outcome as of 19 January 2015 was unsatisfactory.

Admitted and found proved

 

5. Your actions as described in paragraphs 1 and 2 were dishonest by reason of

paragraphs 3 and 4. Found Proved

 

Job application to Worcestershire Royal Hospital (‘the Hospital’)

 

6. You completed a job application form (‘First Application’) which was submitted

to the Hospital prior to 24 July 2017 in which you:

 

a.    stated that you were awarded an MBBS (MD medical degree):

i.     on 1 January 2003; Admitted and found proved

 

ii.    from Balks Medical University; Admitted and found proved

 

b.      stated that you were awarded a distinction for Professional and Linguistic Assessment Board (‘PLAB’) part one;

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the First Application in this respect;

 

c.    stated that you were awarded a distinction for PLAB part two;

Although admitted, found not proved by reason that the Tribunal did

not find that Dr Ahmedsowida completed the First Application in this

respect;

d.      stated that you were awarded a score of 7.5 in your International English Language Testing System (‘IELTS’);

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the First Application in this respect;

 

e.       stated that in your current or any previous employment, you had not been subject to any restrictions placed on your clinical practice as part of the revalidation process; Admitted and found proved

 

f.     stated that your Responsible Officer was Dr A Dr I;

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the First Application in this respect;

 

g.   completed the declaration at the end of the First Application which confirmed that the information which you had provided was true and complete.

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the First Application in this respect.

 

7. You completed a CV (‘First CV’) which was submitted to the Hospital prior to 24 July 2017 in which you stated that you:

 

a. studied for an MBBS: Admitted and found proved

 

i. between January 2003 and August 2007;

Admitted and found proved

 

ii. at Balkh Medical University (Moscow);

Admitted and found proved

 

b. worked at were employed by Antrim Area Hospital (‘AAH’):

 

i. as a second year Speciality Trainee in Trauma and

Orthopaedics; Admitted and found proved

 

ii. between 4 August 2011 and 3 December 2013. Admitted and

found proved

 

Job application to Birmingham Womens and Childrens NHS Foundation Trust (‘The

Trust’)

 

8. On or around November 2018, you began working at the Trust as junior clinical fellow in Obstetrics and Gynaecology. Admitted and found proved

 

9. You completed a CV (‘Second CV’) which was submitted to the Trust on or around March 2018 in which, in respect of paragraphs 9(a), 9(b), 9(c) and 9(g) below you stated, and, in respect of paragraphs 9(d), 9(e) and 9(f) below, you failed to declare :

 

a. stated that you were awarded an MBBS on 1 January 2003; Admitted and found proved

 

b. stated that your date of birth is 1 January 1976;

    Admitted and found proved

 

c. stated that you were employed by North Devon General from 5 August 2016 to March 2018; Admitted and found proved

 

d. failed to declare your employment with the Hospital; Found Proved

 

e. failed to declare that you were a trainee at the NIMDTA from August 2010 to March 2018; Found Proved

 

f. failed to declare that you had been excluded from your post at NIMDTA between 21 November 2011 until 31 July 2014; Found not Proved

 

g. stated that you worked at were employed by Antrim Area Hospital:

 

i. as a second year Speciality Trainee in ‘Obs & Gyna’; Admitted and found proved

ii. between 4 August 2011 and 3 December 2013 3 August 2014.

Admitted and found proved

 

10. On 24 July In or around March 2018, you completed a job application form (‘Second Application’) which was submitted to the Trust in which, in respect of

paragraphs 10(a), 10(b), 10(c), 10(d), 10(e), 10(g) and 10(h) below, you stated,

and, in respect of paragraph 10(f) below, you failed to declare, and, in respect of

paragraph 10(i) below, you completed:

 

a. stated that you were awarded a distinction for PLAB part one;

Although admitted, found not proved by reason that the

Tribunal did not find that Dr Ahmedsowida completed the Second Application in this respect

 

b. stated you were awarded a distinction for PLAB part two;

Although admitted, found not proved by reason that the

Tribunal did not find that Dr Ahmedsowida completed the Second Application in this respect

 

c. stated that you gained an overall score of 7.5 in your IELTS test on 15

May 2005;

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the Second Application in this respect;

 

d. stated that your date of birth is 1 January 1976; Admitted and found

proved

 

e. stated that your Responsible Officer was North Devon District Hospital;

Admitted and found proved

 

f. failed to declare that you were a trainee at the NIMDTA from August 2010 to July 2018; Found Proved

 

g. stated that you had not in your current or any previous employment been subject to any restrictions placed on your clinical practice as part of the revalidation process;

Admitted and found proved

 

h. stated that you were awarded an MBBS:

 

i. on 1 January 2003; Admitted and found proved

 

ii. from Balks Medical University; Admitted and found proved

 

i. completed the declaration at the end of the Second Application which

confirmed that the information which you had provided was true and

complete

Although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida completed the Second  Application in this respect

 

11. You included information in the:

 

a. First Application as outlined in paragraph 6a-g that was untrue;

 

in respect of paragraph 6(a), admitted and found proved

 

in respect of paragraphs 6(b), (c), and (d), although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida had completed the First Application in these respects

 

in respect of paragraph 6(e), found not proved

 

in respect of paragraphs 6(f) and (g), although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida had completed the First Application in these respects.

 

b. First CV as outlined in paragraph 7a-b that was untrue; Admitted and

found proved in relation to paragraphs 7a and 7b

 

c. Second CV as outlined in paragraph 9a-c and g that was untrue;

in respect of paragraph 9(a) to 9(c), admitted and found

proved

 

in respect of paragraph 9(g), found not proved

 

d. Second Application as outlined in paragraph 10a-e and g-i, that was

untrue.

 

in respect of paragraphs 10(a) to (c), although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida had completed the Second Application in these respects.

 

in respect of 10(d), admitted and found proved

 

in respect of paragraph 10(e), admitted and found proved

 

in respect of paragraph 10(g), found not proved

 

in respect of paragraph 10(h), admitted and found proved

 

in respect of paragraph 10(i), although admitted, found not proved by reason that the Tribunal did not find that Dr Ahmedsowida had completed the Second Application in this respect.

 

12. You knew that the information included in the:

 

a. First Application as outlined in paragraph 6a-g was untrue;

 

The Tribunal’s findings in relation to whether Dr Ahmedsowida knew

the information included in the First Application as outlined in

paragraph 6(a) - (g) was untrue were as follows:

 

in respect of paragraph 6(a), found proved

 

in respect of paragraphs 6(b) to (d), found not proved

 

in respect of paragraphs 6(e), found not proved

 

in respect of paragraphs 6(f) and (g), found not proved

 

b. First CV as outlined in paragraph 7a-b was untrue;

 

The Tribunal’s findings in relation to whether Dr Ahmedsowida

knew the information included in the First CV as outlined in

paragraph 7(a) –(b) was untrue were as follows:

 

in respect of paragraph 7(a), found proved

 

in respect of paragraph 7(b), found proved

 

c. Second CV as outlined in paragraph 9a-c and g was untrue;

 

The Tribunal’s findings in relation to whether Dr Ahmedsowida

knew the information included in the Second CV as outlined in

paragraph 9(a) –(g) was untrue were as follows:

 

in respect of paragraph 9(a), found proved

 

in respect of paragraph 9(b), found proved

 

in respect of paragraph 9(c), found proved

 

in respect of paragraph 9(g), found not proved

 

d. Second Application as outlined in paragraph 10a-e and g-i, was untrue.

 

The Tribunal’s findings in relation to whether Dr Ahmedsowida

knew the information included in the Second Application as

outlined in paragraph 10(a) –(i) was untrue were as follows:

 

in respect of paragraph 10(a), (b) and (c), found not proved

 

in respect of paragraph 10(d), found proved

 

in respect of paragraph 10(e), found proved

 

in respect of paragraph 10(g), found not proved

 

in respect of paragraph 10(h), found proved

 

in respect of paragraph 10(i), found not proved

 

 

13. Your actions as described at:

 

a.    paragraphs 6-7 and 9-10 save for paragraphs 9d-f and 10f were dishonest by reason of paragraphs 11 and 12;

 

The Tribunal’s findings in relation to whether Dr Ahmedsowida’s actions were dishonest at paragraphs 6-7 and 9-10 (save for paragraphs 9(d-f) and 10(f)) by reason of paragraphs 11 and 12 are set out below.

 

in respect of paragraph 6(a), found proved

 

in respect of paragraphs 6(b) to (g), found not proved

 

in respect of paragraph 7(a), found proved

 

in respect of paragraph 7(b), found proved

 

in respect of paragraph 9(a), found proved

 

in respect of paragraph 9(b), found proved

 

in respect of paragraph 9(c), found proved

 

in respect of paragraphs 9(g), found not proved

 

in respect of paragraphs 10(a) to 10(c), found not proved

 

in respect of paragraph 10(d), found proved

 

in respect of paragraph 10(e), found proved

 

in respect of paragraph 10(g), found not proved

 

in respect of paragraph 10(h), found proved

 

in respect of paragraph 10(i), found not proved

 

b.    Paragraphs 9d-f and 10f were dishonest by reason that the facts and matters which you did not declare were true and you had an obligation to declare them when submitting the second CV and the second application to the Trust for employment

 

in respect of paragraph 9(d), found proved

 

in respect of paragraph 9(e), found proved

 

in respect of paragraph 9(f), found not proved

 

in respect of paragraph 10(f), found proved

 

 

Employment at the Hospital

 

14. On 24 July 2017, you began employment as an ST1 at the Hospital on the

junior rota in Obstetrics and Gynaecology.

Admitted and found proved

 

15. You failed to follow the instructions of your supervising colleagues on or

around:

 

a. 18 August 2017 when you performed a caesarean section on a patient whilst being supervised by Dr B and you:

i. ignored Dr Bs advice to use a diathermy to stop the patient’s bleeding; Found Proved

 

ii. ignored Dr B’s instruction to perform a lower uterine incision, instead performing a higher uterine incision; Found Proved

 

iii. did not accept Dr B’s assistance when delivering the patient’s baby; Found Proved

 

b. 1 September 2017 when you performed an elective caesarean section whilst being supervised by Dr C and you performed a sharp dissection on the patient rather than a blunt dissection as suggested by Dr C; Found Proved

 

c. 11 September 2017 when you attended a patient in the second stage of labour whilst being supervised by Dr D and you ignored one or more requests by Dr D to leave the stitches in the patient’s perineum in place.

Found Proved

 

16. You withheld information which you considered to be relevant to Dr C prior to

an elective caesarean section which you undertook on or before 1 September 2017

(‘the procedure’) in that you:

 

a. performed the caesarean section procedure under the supervision of Dr C; Found Proved

 

b. said to Dr C ‘what would you say if I told you before that I hadn’t done a CS for two years’ or words to that effect after you performed the caesarean

section procedure. Found Proved

 

17. On or before 1 September 2017 you failed to disclose to Dr C that prior to the procedure you had not performed a caesarean section for two years prior to 1 September 2017 undertaking the procedure. Found Proved

 

18. You failed to appropriately communicate with a patient on or before 11 September 2017 whilst being supervised by Dr D in that you did not explain in terms the patient could understand that you needed to use a ‘Kiwi’ to assist with the patient’s delivery. Found proved

 

19. You provided misleading information to the Hospital:

 

a. on or around 2 August 2017 in that you implied to Dr E that you had given up your training number to do research;

Found not Proved

 

b. on 14 September 2017 in that you stated to Dr E that you had:

 

i. worked in Obstetrics and Gynaecology for three years since 2010 or words to that effect; Found Proved

 

ii. completed ST1, ST2 and ST3 or words to that effect. Found Proved

 

20. You held a training number with Northern Ireland Obstetrics and Gynaecology

Training Programme during your employment with the Hospital. Admitted and found proved

 

21. You knew that you held a training number whilst you were employed at the Hospital. Admitted and found proved

 

22. You had not worked in Obstetrics and Gynaecology for three years since 2010. Admitted and found proved

 

23. You knew that you had not worked in Obstetrics and Gynaecology for three

years since 2010. Admitted and found proved

 

24. You had only completed ST1 and ST2 as of 14 September 2017.

Found Proved

 

25. You knew that you had only completed ST1 and ST2 as of 14 September 2017. Found Proved

 

26. Your actions as described at paragraph 19 were dishonest by reason of

paragraphs 20-25.

The Tribunal find paragraph 26 of the Allegation not proved in relation to

paragraph 19(a)

 

The Tribunal find paragraph 26 of the Allegation proved in relation to

paragraph 19(b)

 

27. You failed to engage with the Hospital in that you did not provide:

 

a. Dr E, your clinical director, with the following by 19 September 2017 as requested on 14 September 2017:

 

i. details of your previous posts; Found not Proved

 

ii. details from your E-portfolio; Found not Proved

 

iii. details of your training; Found not Proved

 

b. Dr E with details of your previous posts and training in Obstetrics and Gynaecology by 22 September 2017 as requested on 19 21 September 2017;

Found Proved

 

c. Dr E with details of your previous posts and training in Obstetrics and

Gynaecology by 29 September 2017 as requested on 27 September 2017.

Found Proved

 

28. On 27 October 2017, Dr E requested that you meet with her at the Hospital.

Admitted and found proved

 

29. On 27 October 2017, you emailed Dr E to state ‘unfortunately you were busy to meet me, and I have left a message to the directorate office F to let you know of my attendance’. Admitted and found proved

 

30. You did not attempt to meet Dr E on 27 October 2017 as requested. Found Proved

 

31. You knew that you had not attempted to meet Dr E on 27 October 2017.

Found Proved

 

32. Your conduct as detailed in paragraph 29 was dishonest by reason of paragraphs 30 and 31. Found Proved

 

33. On 30 October 2017, Dr E requested that you meet with her on the Delivery

Suite at the Hospital. Found not Proved

 

34. On 30 October 2017, you emailed Dr E to state ‘I have attended to see you,

unfortunately I am told that you are very busy in LW (on call)’. Admitted and

found proved

 

35. You did not attempt to meet with Dr E on the Delivery Suite at the Hospital

on 30 October 2017 as requested. Found Proved

 

36. You knew that you had not attempted to meet Dr E on 30 October 2017.

Found Proved

 

37. Your conduct as described in paragraph 34 was dishonest by reason of paragraphs 35 and 36. Found not Proved

 

38. On 6 October 2017, Dr G emailed you to ask you arrange a meeting with him.

Admitted and found proved

 

39. On 10 October 2017, Dr G emailed you to confirm that you had not arranged a meeting as requested. Admitted and found proved

 

40. On 1 November 2017, you emailed Dr G and stated ‘I have been continually trying to arrange an appointment with you via your secretaries and HR, but to no avail’. Admitted and found proved

 

41. Between 6 October 2017 and 1 November 2017, you had not attempted to

arrange an appointment with:

 

a. Dr G; Found Proved

 

b. Dr G via Dr G ’s secretaries; Found Proved

 

c. Dr G via the Hospital’s Human Resources department.

Found Proved

 

42. You knew that you had not attempted to arrange an appointment with the individuals as set out in Paragraph 41 above. Found proved

 

43. Your actions as described in paragraph 40 were dishonest by reason of paragraphs 41b-c and 42. Found proved

 

NIMDTA

 

44. On 4 August 2010, you began training in the Northern Ireland Obstetrics and

Gynaecology Training Programme as part of NIMDTA.

Admitted and found proved

 

45. On 15 May 2018, you emailed Professor H Dr A to state that ‘on 18th August 2016, the day of my ARCP to which I was strictly being instructed by (Prof. H Dr A and Dr. I) to refrain from divulging any related information in relation to th e investigation conducted by J AAH and NDMTA (sic)’. Admitted and found proved

 

46. You had not been informed by either Professor H Dr A or Dr I on 18 August 2016 to refrain from divulging any information relating to the investigation conducted by AAH and NIMDTA. Found Proved

 

47. You knew that you had not been informed by either Professor H Dr A or Dr I on 18 August 2016 to refrain from divulging any information relating to the investigation conducted by J AAH and NIMDTA. Found Proved

 

48. Your actions as described in paragraph 45 were dishonest by reason of paragraphs 46 and 47. Found Proved

 

49. On 14 November 2017, you told Professor H Dr A that the Hospital had not raised concerns about your practice with you until you had submitted your resignation or words to that effect. Found Proved

 

50. The Hospital had notified you that they had concerns about your practice on

the following occasions:

a. on 2 August 2017 at a meeting; Found not Proved

 

b. on or around 2 August 2017 by way of letter; Found not Proved

 

c. on 21 August 2017 at a meeting; Found Not Proved

 

d. on 14 September 2017 at a meeting. Found Proved

 

51. You knew that the Hospital had informed you about its concerns about your practice on the dates outlined in paragraph 50 above which was prior to your resignation.

 

Found not proved in relation to the meetings with Dr E on 2 and 21 August 2017 and in relation to the letter from her dated 2 August 2017 to which paragraph 50(a), (c) and (b) refer respectively.

 

Found proved in relation to the concerns about Dr Ahmedsowida’s practice notified to him at the meeting with Dr E to which paragraph 50(d) refers.

 

52. Your actions as described in paragraph 49 were dishonest by reason of paragraph 50 and 51.

 

Found proved in respect of Dr Ahmedsowida’s statement to Dr A on 14 November 2017 as it relates to the meeting on 14 September 2017.

 

Found not proved in respect of Dr Ahmedsowida’s statement to Dr A on 14 November 2017 in respect of the communications between Dr E and Dr Ahmedsowida dated 2 August 2017 (at a meeting and by email) and on 21 August 2017 (by email).

 

53. On 14 November 2017, you told Professor H Dr A that concerns had been raised at the Hospital by only one person or words to that effect. Found Proved

 

54. You were informed by Dr E on 14 September 2017 that concerns about your practice at the Hospital had been raised by consultant colleagues or words to that effect. Found Proved

 

55. You knew that concerns had been raised at the Hospital by more than one person. Found Proved

 

56. Your actions as described in paragraph 53 were dishonest by reason of paragraphs 54 and 55. Found Proved

 

 

And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct.

 


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