Dishonesty allegation defended by remediation

Junior doctor Dr Z contacts Medical Protection for assistance when the Medical Council investigates her falsified notes. By Mohammad Shahid, Legal Adviser, Medical Protection.

Dr Z was a junior doctor working in her GP rotation. She consulted Mrs A and reviewed the notes after the consultation. On reflection, she considered there were gaps in her assessment of Mrs A, in light of her presentation; Dr Z was concerned about how this would be perceived by her training principals. In order to make her consultation look better, Dr Z retrospectively recorded several observations that had not taken place.  

The fact of the false entries came to light when Mrs A requested her records, and noted the additional actions that she said had not taken place. 

When asked about the entries by her supervisers, Dr Z stated that Mrs A must have been lying or was confused. Dr Z went further and suggested possible misdocumentation from another patient case. 

Dr Z’s actions were said to be dishonest and she appeared before a hearing at the Medical Council.

How Medical Protection assisted 

Dr Z requested assistance from Medical Protection and we were able to support her through the regulatory process. This included during the investigation phase, guiding Dr Z through the procedural rules, the statutory considerations of the Council and its case examiners, and the particulars of a response to the allegation.

During the three-stage hearing, we further supported Dr Z by explaining the principles and law underpinning matters of probity, and their significance as a fundamental tenet of good medical practice. We also provided guidance on the meaning of impairment of fitness to practise, to help inform Dr Z’s understanding of the process, but importantly Dr Z’s understanding of the concept of remediation.

Outcome 

All facts were admitted and found proved. The hearing found that Dr Z’s actions amounted to misconduct but it also concluded that a fully informed member of the public or profession, made aware of Dr Z’s exceptional efforts to gain insight and remediate, would be reassured by Dr Z’s thorough and professional response to the allegation. It considered that Dr Z had developed a level of insight sufficient to offset concerns engendered by their previous misconduct and that a finding of impairment was not necessary to maintain public confidence in the profession or maintain proper professional standards and conduct.

Learning points

This was an exceptional outcome given the nature of the allegation. At the time, matters of probity and dishonesty routinely attracted at least a finding of impairment, usually on the basis such a finding is necessary to maintain public confidence in the profession and maintain proper professional standards and conduct.

While this was a fairly low level probity matter, such issues should still be regarded as serious and merit a careful and thorough approach to case presentation, whether contested or not.

This case served to demonstrate that even against the backdrop of serious, repeat dishonesty, the law on impairment of fitness to practise does not prevent a favourable outcome. What is called for, certainly in those cases where dishonesty is conceded, is a genuine and comprehensive approach to reflection, insight and remediation.

Dr Z’s period of reflection and insight spanned some three years. Dr Z had reflected in depth on the likely causes of the underlying conduct. She had been open to supervisers and peers about the incident, delivering presentations on how the issues in the case engaged the fundamental tenets of good medical practice. Dr Z had also attended a number of professional courses that targeted the issues in the case. 

The extent of Medical Protection guidance and support took nothing away from the fact that this was an ardent professional committed to her profession and to maintaining standards; this, for the hearing, was plain to see.