QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
London WC2A 2LL
B e f o r e :
|DR ANTHONIPILLAI NICHOLAS-PILLAI||Claimant|
|GENERAL MEDICAL COUNCIL||Defendant|
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Mr Ivan Hare and Mr Chris Hamlet (instructed by GMC Legal) appeared on behalf of the Defendant
Crown Copyright ©
"We enclose our client's consent for release of medical records ... We are instructed to consider proceedings in relation to a circumcision operation which was undertaken on 27 April 2001. Please could you forward your records in connection with this incident ..."
"Mother wants circumcision for religious reason.
Gen. Condition P
Past H/O Nil significant.
O/E Font Normal. P
Locally - unremarkable.
Heart lungs. P
Explained the procedure."
Normal skin preparation - Savlon wash.
Pre med Phenogram.
Foreskin cleaned. 1% lignocaine infiltrate around the ridge (2ml).
good local effect.
dissected the foreskin up to the ridge and secured bleeders with clamps - catgut tie to stop bleeder.
Circular dissection and about 2.5cm to 3cm skin removed.
Skin sutures purse string - no bleeding.
paraffin dressing with (gauze) dressing.
advised regarding follow up and call SOS telephone No."
"2. On 10 April 2001, patient A's father brought patient A to the surgery in order for you to circumcise patient A.
3. In carrying out the said circumcision,
a. You removed an excessive amount of external skin from patient A's penis,
b. You removed insufficient of the inner skin from patient A's penis.
d. You carried out the operation in such a manner that the suture lines contracted over the tip of the penis leaving only a pinhole;
4. On 25 July 2001, revision surgery was performed to patient A's penis.
5. As a result of the matters set out at Head of Charge 3, patient A's penis is cosmetically abnormal.
6. On or about 5 March 2004 you sent a letter to Christian Khan, a firm of solicitors acting on behalf of patient A,
a. You enclosed with that letter medical notes that you said related to patient A,
b. Those notes purported to state that,
(i) you saw patient A in consultation on 10 April 2001,
(ii) you circumcised Patient A on 27 April 2001;
7. The said notes were,
a. Inaccurate and/or,
b. Not prepared contemporaneously with or as soon as possible after the matters to which they related;
8. Your conduct as set out at Head of Charge 3 was,
a. Not in the best interests of patient A and/or,
b. Below the standard to be expected of a reasonably competent medical practitioner;
9. Your conduct as set out at Heads of Charge 6 and/or 7 was,
b. Intended to mislead and/or,
c. Below the standard to be expected of a reasonably competent medical practitioner."
"The impression given by you in these notes was that you had an initial consultation with the parents of Patient A on 10 April 2001 before carrying out a circumcision on Patient A on 27 April 2001."
That statement appears immediately after the sentence which reads:
"The panel has already found that the notes of the operation dated 27 April 2001 were inaccurate and not prepared contemporaneously."
"You have accepted that you enclosed with the letter dated 5 March 2004 the medical notes that you said related to Patient A. Those notes purported to state that you saw Patient A in consultation on 10 April 2001 and that you circumcised Patient A on 27 April 2001. This therefore gave the impression that you had carried [out] an initial assessment of Patient A before carrying out the circumcision some two weeks later."
"The Panel considers that your dishonesty, as found proved under Head of Charge 9, undermines the trust which the public place in the profession."
"Moreover, it considers that this dishonest conduct is compounded by the fact that you have given inconsistent and unreliable evidence at this hearing."
"The panel considers that your dishonesty, as found proved under Head of Charge 9, undermines the trust which the public place in the profession. In addition, as announced in its determination on your fitness to practise, this panel was concerned about your misleading instructions to your solicitors, RadcliffesLeBrasseur."
"If his denial were to be disbelieved then the Committee would have to consider his conduct regarding [Mr B] on the footing that he had received four requests to visit her but had failed to do so and on the footing also that he had lied on oath about two of the telephone calls."
"For these reasons the Board will accord an appropriate measure of respect to the judgment of the Committee whether the practitioner's failings 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. The Council conceded, and their Lordships accept, that it is open to them to consider all the matters raised by Dr Ghosh in her appeal; to decide whether the sanction of erasure was appropriate and necessary in the public interest or was excessive and disproportionate; and in the latter event either to substitute some other penalty or to remit the case to the Committee for reconsideration."
"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."
"44. Dishonesty, even where it does not result in direct harm to patients but is for example related to the doctor's private life, is particularly serious because it undermines the trust the public place in the profession. Examples of dishonesty in professional practice could include ... improperly amended patient records ..."
Those comments appear in the paragraphs dealing with erasure, which refer to dishonesty as amongst the three most serious areas of concern.
The panel received, and I have read, testimonials for Dr Nicholas-Pillai, and evidence from Dr Marks, in which he spoke of his long knowledge of Dr Nicholas-Pillai and of his astonishment that this act of dishonesty had occurred. I proceed on the basis that, apart from this incident, Dr Nicholas-Pillai has had an exemplary professional career, and one which is of great value to his patients, and that in depriving his patients of his services for six months, they will be deprived of something of value to them.
These cases always result in the balancing of one public interest against another. In cases of actual proven dishonesty, the balance ordinarily can be expected to fall down on the side of maintaining public confidence in the profession by a severe sanction against the practitioner concerned. Indeed, that sanction will often and perfectly properly be the sanction of erasure, even in the case of a one-off instance of dishonesty. In this case, the panel, it seems to me, took a merciful course by deciding only to suspend Dr Nicholas-Pillai, and to do so for six months. I find it quite impossible to say that that sentence was disproportionate to the professional misconduct which it found proved, or is in any way open to criticism.
I therefore reject the second of the two grounds of appeal, as I did the first.