Tribunal rejects call to strike off doctor who received “inadequate induction” from hospital
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l7026 (Published 18 December 2019) Cite this as: BMJ 2019;367:l7026
A medical practitioners tribunal has refused the General Medical Council’s (GMC) request to strike off a doctor who admitted a catalogue of clinical errors, took breaks without telling colleagues, and forged a certificate of employment, after the tribunal determined that he had received inadequate induction and support from the hospital that employed him.
The tribunal instead suspended Tarek Seda for 12 months, the maximum period available. Its chair, Christina Moller, said, “In view of the trust’s undoubted failings, acknowledged in their own internal report, the tribunal took the view that it would not be proportionate to erase Dr Seda on the basis of his failings, serious though they were.”
Moller also accused the GMC of initially failing to pass on information to its expert witness about deficiencies in Seda’s workplace that were potentially mitigating factors in his conduct.
In June 2017 Seda, who qualified in Egypt in 2002, had recently started working as a specialty doctor in emergency medicine at King’s Mill Hospital, part of Sherwood Forest Hospitals NHS Foundation Trust. During two consecutive night shifts he made basic errors in treating three patients. Between the two shifts he travelled to London by train and worked for one day as a GP.
In the case of one woman with low blood pressure and apparent atrial fibrillation, he prescribed intravenous metoprolol, a clearly inappropriate choice, said Moller, since it further lowers blood pressure. He did not obtain consent or take a proper history, or he would have known that the patient was already taking beta blockers.
He failed to properly examine a patient who had a fever or to pass on “safety netting” instructions. This case contributed to “a wider picture of misconduct” on Seda’s part, said Moller, but she noted extenuating circumstances including “confusing” hospital guidelines, which might have led him into error.
In a third case he attempted to intubate a patient without using anaesthetic and despite lacking the necessary expertise. But this did not form part of a wider picture of misconduct, the tribunal found. “The tribunal accepts that his management was wrong but also that he believed he had been asked to take action in a critical situation,” said Moller, adding that he “should not have been put in this position.”
She noted that the GMC’s expert, Wayne Hamer, had remarked during a GMC telephone conference, “This doctor has been catapulted into a senior role he was never fit for and stuck on the night shift. His employer never assessed how competent he was and never gave him a proper induction.”
Dishonest acts
Seda admitted sleeping during his night shifts, but this was not misconduct, the tribunal found, as “power naps” during breaks can be part of the job. But his failure to keep colleagues informed of his whereabouts was found to be serious misconduct.
He had also committed dishonest acts, the tribunal found. He omitted to mention to a potential employer interim conditions imposed on him before the hearing. And he falsified an employment certificate, although the information he provided on it was not itself false.
In October 2018, after the case of Hadiza Bawa-Garba, the GMC announced that it was rolling out “human factors” training for decision makers, case examiners, and clinical experts, to “give doctors the assurance that their actions will be seen clearly against the backdrop of any system failings.”
Bawa-Garba, who was convicted of gross negligence manslaughter after the death of a 6 year old boy, was suspended for 12 months by a tribunal that considered systemic failures in her workplace. The GMC appealed to the High Court, which struck her off, but the Court of Appeal overturned her erasure, ruling that tribunals could take into account the full context in which a doctor was working.1
But in Seda’s case, said Moller, “the GMC did not originally provide [Hamer] with those sections of the trust’s report revealing inadequacies in the emergency department. The tribunal was concerned at this omission because systemic and other issues in the emergency department would adversely affect any doctor’s ability to perform and were clearly relevant to the [expert’s] findings.”
Redacted reports
A GMC spokesperson told The BMJ that the conclusions of external reports were redacted so as not to bias experts’ opinions, but the full report was given to the tribunal before the hearing.
The GMC also took issue with the tribunal’s summary of the expert’s evidence. Moller said that Hamer told the tribunal that the GMC had advised him not to include in his report his views on the failings of the emergency department, including the inappropriateness of the level at which Seda had been expected to work.
The transcript of the hearing shows that Hamer said, “I don’t think the GMC was advising me not to include it, but on the evidence presented at that time, I think a decision was not to put that in.”
Anthony Omo, the GMC’s director of fitness to practise, said, “The context in which doctors work is fundamental to our assessment of their practice. We were deeply concerned that the tribunal described the expert witness’s evidence in the way that it did, as had it been correct it would represent a serious departure from our policy.
“We will be raising the matter with the Medical Practitioners Tribunal Service directly and looking in detail at our approach to this case to confirm we acted appropriately.”
A spokesperson for Sherwood Forest Hospitals said that the trust had “made a number of improvements to and strengthened our pre-employment checks and induction processes for doctors.”
References
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