Ahmed v Fitness to Practice Committee of The Medical Council and Another
| Jurisdiction | Ireland |
| Judge | Mr. Justice Mícheál O'Higgins |
| Judgment Date | 05 March 2024 |
| Neutral Citation | [2024] IEHC 168 |
| Court | High Court |
| Docket Number | RECORD NO 2022 / 51 SP |
In the Matter of S. 75 (1) of the Medical Practitioners Act 2007
and
[2024] IEHC 168
RECORD NO 2022 / 51 SP
THE HIGH COURT
Lorna Lynch SC and Nathan Reilly BL instructed by Sheridan Quinn Solicitors for the appellant.
Tom Hogan SC and Nessa Bird BL instructed by Fieldfisher Solicitors for the respondents.
Judgment of Mr. Justice Mícheál O'Higgins delivered on the 5 th day of March 2024
. This is a doctor's appeal of a finding of “Poor Professional Performance” following an Inquiry held by the Fitness to Practice Committee of the Medical Council under the Medical Practitioners Act 2007. The case concerns the circumstances in which a once–off error will amount to Poor Professional Performance (“PPP”).
. The events the subject of the inquiry occurred a long time ago in November 2012. The Fitness to Practice inquiry took place on various dates in March and July 2015. The appellant represented himself at the hearing. He faced nine charges overall, some of which were sub–divided. The first respondent (“the Committee”) dismissed all charges except charge 7(b) which reads as follows:
“ On or around 6 November 2012 in respect of patient BK who was transferred from Bon Secours Hospital, Tralee, Co. Kerry, [he]:
(b) Failed to request the following basic tests to include, but not limited to:
(i) Blood tests; and/or
(ii) Urine tests; and/or
(iii) Kidney function tests”.
. The Committee found that this allegation had been proven as to fact and that it amounted to “Poor Professional Performance” within the meaning of the 2007 Act. The Committee recommended the sanction of an admonishment, which is the second lowest form of sanction.
. In accordance with the statutory process, the Committee sent a report on the Inquiry to the second respondent (the Medical Council) and the Medical Council decided to impose the sanction of “advice” which is the lowest form of sanction available under the Act.
. By originating notice of motion issued on the 4 th of April 2022, the appellant appealed under s. 75 of the 2007 Act, the findings and report of the Committee and the decision of the Medical Council to impose the sanction of “advice”.
. As will be apparent from the short chronology above, an interval of some six and a half years elapsed between the notification of the Medical Council's decision (September 2015) and the lodging of this appeal (April 2022). I will explain what happened in the intervening period later in this judgment. Firstly, however, I will detail the background facts leading to the Committee's decision to commence the disciplinary process.
. The appellant, Dr. Ahmed, was born in 1980. He received his medical qualifications and initial training in Pakistan. Before he came to Ireland, he had some experience as a House Officer in General Medicine in Pakistan in 2004 and then as a Senior House Officer in General Medicine in a hospital in Oman. He applied for the position of registrar with the Oncology Department in the Midwestern Regional Hospital, University Hospital Limerick (“UHL”) in May 2012. He was successful at interview and commenced his duties as a Registrar in the Oncology Department in July 2012. The appellant was then aged 32. He is now 43.
. On the 6 th of November 2012, he was on–call in UHL and was informed that a patient who was 28 years old was being transferred from Bons Secours Hospital in Tralee to the Oncology Ward in UHL that evening. As the Registrar on call, he was required to admit the patient and carry out an examination. The patient in question (B.K.) arrived later than expected at approximately 7:30 p.m. The letter of referral was from a Consultant Surgeon in Tralee and was dated the 6 th of November 2012. It was addressed to Dr. Denis O'Keeffe, Consultant Haematologist in UHL. The letter recorded that the patient had been admitted to the Bons Secours in Tralee the day before (5 th November) with severe abdominal pain. The letter recorded that on examination the referring surgeon could feel a palpable mass in the upper abdomen and there were enlarged lymph nodes in several areas. A CT scan of chest, abdomen and pelvis revealed a large mass in the retroperitoneal area, pushing forward the pancreas, aorta and bowel. There were also lumps in the lungs. The diagnosis was said to be widespread lymphoma. The referring surgeon indicated that the patient would need further treatment and that the referring surgeon would organise for a biopsy the following morning if there was a delay in getting him a bed in UHL.
. The appellant was contacted by nurses on the evening of the 6 th November once B.K. had been received in the oncology ward. The appellant reviewed the patient with the staff nurses. However, he did not write up notes of his examination. It is common case that he did not undertake blood, urine or kidney function tests. The CEO of the Medical Council contends that these are “basic tests”. The failure to order these tests forms the basis of the disciplinary finding that the appellant is now appealing to the High Court.
. At some point during his dealings with B.K., the appellant was called away to see another patient who was very unwell and needed to be examined in the Accident and Emergency Department. The appellant says in his responding letter that having to deal with this other patient led him to forget to write up the notes of his examination of B.K.
. The next morning, the locum Consultant, Dr. Fadalla, who was a Consultant Haematologist, checked on patient B.K. On the previous day, he had discussed the case with his colleague Dr. Denis O'Keeffe, who had accepted the referral from the surgeon in the Bons Secours. Dr. Fadalla attended to B.K. in the ward but was concerned that no admission notes had been written up, and it was not known what level of examination had taken place or history taken. Dr. Fadalla rang the appellant to ask him about his examination of the patient. According to Dr. Fadalla, the appellant became verbally abusive, and dismissed the consultant's concerns and the need for repeating the blood tests. Dr. Fadalla was not happy with the appellant's management of the patient.
. When Dr. O'Keeffe, the consultant whose patient B.K. was, started on his ward round on the 7 th of November, he discovered that there were no notes on the appellant's admission and examination, and learned that no blood tests had been ordered. He spoke with Prof. Gupta, the Oncology Consultant in UHL and the Regional Director for Cancer Services and relayed that he was concerned about patient B.K. who was very unwell and had needed a lot of morphine overnight to control his pain. Prof. Gupta and Dr. O'Keeffe decided to speak to the appellant in the nursing area. That conversation became heated, so Prof. Gupta moved the conversation into a more private room. Dr. O'Keeffe asked the appellant about his examination of the plaintiff and sought explanations as to why tests had not been ordered and examination notes not written up. Again, the appellant became defensive and dismissive. Voices became raised, so Prof. Gupta brought the conversation to a close and told the appellant he should go home and that the Manager of Cancer Care Services would contact him later.
. According to a complaint subsequently filed by Prof. Gupta with the Manager of Cancer Care Services in the Hospital, and subsequently with the Medical Council, this incident in November was one of a number of occasions when the appellant's conduct and interactions with staff and patients was called into question, during the period of July to November 2012, when he first started in the role as Registrar in UHL. This eventually resulted in the appellant facing some 9 disciplinary charges in a Notice of Inquiry, some of which related to his management of other patients.
. However, while the prior history and lead–up to the incident is undoubtedly relevant and cannot simply be air–brushed out of the picture, it should be noted that the only disciplinary charge now before the court is the sole allegation (charge 7(b)) that the appellant failed to request blood, urine and kidney function tests for patient B.K. Save as an issue of context and background, the court is not concerned with any earlier incidents or other allegations included in the original Notice of Inquiry. All of these have now fallen away, except for allegation 7(b) relating to patient B.K.
. It should also be noted from the outset that it is common case that the appellant's failure to order the tests in question did not cause injury to the patient and did not in fact have any causal consequence.
. Before I address the evidence in this case in greater detail, I should firstly outline what is meant by a finding of “Poor Professional Performance” and detail the nature of a s. 75 appeal and the legal regimen that applies to the process.
. The term “Poor Professional Performance”, in relation to a medical practitioner is defined in s. 2 of the 2007 Act as:
“a failure by the practitioner to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of medical practitioners practising medicine of the kind practised by the practitioner”.
. The emphasis in the statutory definition is on the issue of a doctor's competence. The leading case on the elements of PPP is the decision of the Supreme Court in Corbally v. The Medical Council [2015] 2 IR 304. I will come back to the Corbally decision later as it is very relevant to the legal issues that arise in this case. For the moment, it is sufficient to note that the Supreme Court decided...
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