QUEENS BENCH DIVISION
ADMINISTRATIVE COURT SITTING AT PRESTON CROWN COURT
ON APPEAL FROM THE PROFESSIONAL CONDUCT COMMITTEE
OF THE GENERAL MEDICAL COUNCIL
Strand, London, WC2A 2LL
B e f o r e :
| DR MOSTAFA MAHDY MOHAMED ABU-ROMIA
|- and -
|THE GENERAL MEDICAL COUNCIL
Mr. Richard Pearce (instructed by the in-house legal team) for the Respondent
Hearing dates : 17 October 2003
Crown Copyright ©
Mr Justice Wall:
The GMC's case against the Appellant
The Committee considered the standard of your practice and standard of care compared with that expected of an ordinary doctor practising at a small private clinic. Nevertheless, the Committee are in no doubt that your conduct in respect of Ms A and Ms B fell seriously short of accepted standards for the management of overweight (persons with BMI (Body Mass Index) of 25-29.9) and obesity (persons with BMI of 30 and over). Ms A and Ms B had a BMI of approximately 27. Your history-taking and physical examination were at best cursory and your record-keeping poor. Your dispensing of an appetite-suppressing drug without any real attempt at managing the patient with diet or exercise regimes was unacceptable. Moreover, the Committee feel that you should have taken the opportunity to re-consider your practice in view of the fact that the product licence of Diethylpropion had been withdrawn. The Committee remain concerned by your lack of understanding of the seriousness of the deficiencies in your practice demonstrated in your evidence before them and with the nature and extent of your training in this area. The Committee have determined that because of your proven gross departures from the appropriate professional standards you are guilty of serious misconduct.
The Committee have considered carefully all the evidence presented today, including the favourable testimonials submitted in your behalf and the mitigation advanced by your counsel. The Committee did take into account the fact that you have not been the subject of any proceedings by the GMC prior to the events involving the current proceedings. It was noted that the product licence for Diethylpropion was restored on 24 December 2002. The Committee have also carefully considered the issue of proportionality. However, they are also mindful that it is the duty of this Committee to protect patients and maintain public confidence in the medical profession. It is important to ensure that the public continues to have confidence in the medical profession and that the reputation of the profession is upheld.
In these circumstances the Committee have decided that it is necessary to take action against your registration and have considered the range of sanctions available. In view of the serious nature of their findings, the Committee are of the view that it would not be sufficient to conclude this case with a reprimand.
The Committee then considered whether to impose conditions on your registration, which would need to be proportionate, enforceable and measurable. We have concluded that no such conditions would be appropriate.
The nature of the findings against you are serious and the Committee have concluded that it is not appropriate to allow you to continue in medical practice at this time. The Committee have therefore directed the Registrar to suspend your registration for a period of 9 months. The Committee are quite satisfied that the consequences of this remedy on you are not disproportionate to the risk from which it is seeking to protect the public.
The Notice of Appeal
1. Clear history in medical field for 33 years
2. The two doctors on GMC Committee, one ophthalmologist and geriatrician are not experienced in general anaesthesia or diet.
3. The GMC barrister accused me of lying. Also, he was pointing out the fact that I was qualified from Egypt in 1969. He was implying that I don't know my job. The barrister is not medically qualified himself.
4. The two patients which gave evidence are bogus patients
5. The licence of the appetite suppressant is the dispute between the GMC and the pharmaceutical which make the medication and legally distribute
6. There is no single evidence that I have committed serious professional misconduct.
The finding that the medical history of the two patients was not obtained
The allegation that the medication was dispensed without sufficient information being given to the patient about the nature of the medication
The medication was dispensed without advising non-pharmacological means
The allegation that the medication was dispensed at a time when Diethylpropion did not have a product licence in the United Kingdom
The allegation that Diethylpropion was prescribed inappropriately and irresponsibly
(a) The absence of a Product Licence for Diethylpropion
(b) The statement of the Medical Controls Agency and the Committee on Safety of Medicines that Diethylpropion should have been withdrawn from 11th May 2001;
(c) The failure of the Appellant to try non-pharmacological means of managing the patients before prescribing Diethylpropion, in breach of the Royal College of Physicians' guidelines;
(d) The fact that neither Ms A nor Ms B had a Body Mass Index in excess of 30 (or 28 with co-morbidities) such as to justify the consideration of the use of pharmacology to manage their weight;
(e) The absence of any factors peculiar to Ms A or Ms B that justified the use of pharmacology in their cases;
(f) The inference from the evidence of the Appellant (for example at Day 2 pages 87E – 88D) that his practice in prescribing drugs was based upon how he had been taught but that he had not kept himself up to date with current thinking such as that contained in the guidance from the Royal College of Physicians.
The allegation that the Appellant failed to inform patients' General Practitioners of the prescription of Diethylpropion
On or about 26 August 2001, Ms B again attended the Image Clinic. She saw you in consultation because she had explained to the nurse that she was encountering problems with the treatment and we are satisfied so as to be sure that the referral by the nurse made you aware of that. You prescribed a quantity of Diethylpropion 75mg. The Committee found proved that the medication was dispensed without sufficient information being given to Ms B about the nature of the medication and without attempting to help Ms B manage her weight with non-pharmacological means
My analysis of the Committee's finding of serious professional misconduct