QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Strand, London, WC2A 2LL |
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B e f o r e :
(Sitting as a High Court Judge)
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MOHAMMED EL-HADI ABDUL-RAZZAK |
Appellant |
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- and - |
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GENERAL PHARMACEUTICAL COUNCIL |
Respondent |
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Kenneth Hamer (instructed by Head of Professionals Regulation, General Pharmaceutical Council) for the Respondent
Hearing date: 26 April 2016
Written submissions dated 4 and 13 May 2016
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Crown Copyright ©
Sir Stephen Silber :
Introduction
The Duties of the Responsible Pharmacist
Chronology
"1. You were first registered as a pharmacist on 15 August 2012;"
2. On 27 September 2012, a supply of Amoxicillin 500mg, a prescription only medicine, was made from Safeer ('the Pharmacy') by the counter assistant Ali Madani.
3. On 27 September 2012, a supply of Diazepam 5mg and Viagra 100mg, prescription only medicines, were made from the pharmacy by the counter assistant, Hosum Auda.
4. On 5 October 2012, a supply of Diazepam 5mg, a prescription only medicine, was made from the pharmacy by the counter assistant, Hosum Auda.
5. You were the responsible pharmacist at the pharmacy at the times that the supplies detailed at paragraphs 2 and/or 3 and/or 4 were made;
6. In relation to the supplies at paragraphs 2 and/or 3 and/or 4.
i) The supply was made otherwise than in accordance with a prescription given by an appropriate practitioner;
ii) Your failure to adequately supervise the counter assistant caused or permitted an unlawful supply to be made from the pharmacy;
iii) You ought to have known that the supply would be, or was, unlawful.
By reason of the matters set out above, individually or cumulatively, your fitness to practise is impaired by reason of misconduct."
i. Ground One: The Breaches Issue. The Committee's findings of fact in relation to sub-paragraphs 6(ii) and 6(iii) of the Particulars of Allegation were contrary to the weight of the evidence and were wrong in relation to each of the three supplies.
ii. Ground Two: The Impairment of Fitness to Practise Issue. The finding of current impairment is unsustainable for a number of reasons, including that the Committee failed to take account of the Appellant's impeccable record in the period of more than three years since the offending behaviour which occurred days after he was registered as a pharmacist and its decision was substantially founded on an unfair criticism of the conduct of the Appellant's defence.
iii. Ground Three: The Sanctions Issue. The Committee ought to have taken into account the period when his registration had previously been suspended by an Interim Suspension Order pending the hearing before the Committee and the previous recommendation from the Registrar to the Investigating Committee that the appropriate sanction for the Appellant was that he should receive advice. In any event, six months suspension was, in itself, an excessive and an unjustified period of suspension.
The Approach to Challenges to the Decision of the Committee on Factual Issues
"(3) The appeal court will allow an appeal where the decision of the lower court was (a) wrong..."
"214.The issue at this stage is whether the [Solicitors Disciplinary Tribunal's] key conclusions that Mr Shaw was dishonest in a number of respects and that Mr Turnbull was dishonest in one specific, albeit important, respect are "plainly wrong". My function is to review the evidence and to apply to it a strict yardstick; it is not to second-guess the SDT's findings or to substitute my views for theirs even if, for example, I were of the opinion that the conclusions are probably wrong (for the avoidance of doubt I do not hold that opinion). "Plainly wrong" imports a higher onus of persuasion, and for good reason: the reviewing Court does not see and hear the witnesses. "
"9. I accept and adopt the approach outlined in these authorities, in particular that although the court will correct errors of fact or approach:
(i) it will give appropriate weight to the fact that the Panel is a specialist tribunal, whose understanding of what the medical profession expects of its members in matters of medical practice deserves respect;(ii) that the tribunal has had the advantage of hearing the evidence from live witnesses;
(iii) the court should accordingly be slow to interfere with the decision on matters of fact taken by the first instant body;
(iv) findings of primary fact, particularly if found upon an assessment of the credibility of witnesses are close to being unassailable, and must be shown with reasonable certainty to be wrong if they are to be departed from;
(v) but that where what is concerned is a matter of judgment and evaluation of evidence which relates to police practice, or other areas outside the immediate focus of interest and professional expertise of the [fitness to practise panel], the court will moderate the degree of deference it will be prepared to accord, and will be more willing to conclude that an error has, or may have been, made, such that a conclusion to which the Panel has come is or may be "wrong" or procedurally unfair. To this extent I accept and adopt the submissions of [counsel for the appellant]".
Ground 1-The Breaches Issue
The second supply
"No observer of the scene would ever have thought that [the Appellant] was supervising or trying to supervise or exercise any authority over the assistant. It is perhaps not surprising that [the Appellant] has sought to suggest that the provision of Viagra and the diazepam on that occasion was covered by prescription – as we have already stated, in our view a well-nigh hopeless proposition- as the lack of supervision is so closely apparent. We find the allegation in Paragraph 6 (ii)[3] proved in relation to [the second supply]".
"far from convinced that [the Appellant] was ever sufficiently informed or instructed about the procedures at the pharmacy to enable him effectively to supervise the safe running of the pharmacy; or that he took any or any sufficient measures to ensure he could exercise authority and control over, and therefore supervise, the activities of counter assistants"
"What is the (sic) quite apparent from that footage is that not a word was spoken by Mr Abdul-Razzak to the assistant. He showed not the slightest interest in what the assistant was saying or doing; or in the medicine that he was obtaining from the dispensary for the customer. Further, and in our view tellingly, the assistant displayed no concern at the proximity of Mr Abdul-Razzak and no endeavour to obscure and conceal from him what he was doing. He conversed quite openly with the customer (reporter) in the presence and hearing of Mr Abdul-Razzak. No observer of the scene would ever have thought that Mr Abdul-Razzak was supervising or trying to supervise or exercising any authority over the assistant. It is perhaps not surprising that Mr Abdul-Razzak has sought to suggest that the provision of Viagra and Diazepam on this occasion was covered by a prescription – as we have already stated, in our view a well-nigh hopeless proposition – as the lack of supervision is so clearly apparent. We find the allegation [that the Appellant's failure to adequately supervise the counter assistant caused or permitted an unlawful supply to be made from the pharmacy] proved in relation to [the second supply]."
The First and Third Supplies
a. even though a prescription was required for the supply of the Amoxicillin for the first supply and of Diazepam for the third supply, none was produced for either supply and yet the supply was made;
b. the Committee found that there were no labels on the packaging on the first and third supplies, as there should have been as they were prescription-only medicines;
c. the Committee concluded "on the basis of [the Appellant's] evidence, we are far from convinced that [the Appellant] was ever sufficiently informed or instructed about the procedures at the pharmacy to enable him effectively to supervise the safe running of the pharmacy; or that he took any or any sufficient measures to ensure he could exercise authority and control over, and therefore supervise, the activities of counter assistants";
d. the counter assistant making the first and third supplies were able immediately and with the bare minimum of enquiry to make these supplies;
e. There is no evidence in the video to show that the Appellant supervised the first or third supplies in any way;
f. The Appellant has not given any explanation as to why he did not supervise the first or third supplies in any way; and that
g. The word "prescription" does not appear anywhere in the translated transcript relating to the supply of Diazepam in the third supply.
Conclusion
Issue 2 –The Impairment of Fitness to Practise Issue
"A person's fitness to practice is to be regarded as "impaired" for the purposes of this Order only by reason of (a) misconduct…".
"(2) In relation to evidence about the conduct or behaviour of the registrant which might cast doubt on whether the requirements as to fitness to practise are met in relation to the registrant, the Committee must have regard to whether or not that conduct or behaviour—
(a) presents an actual or potential risk to patients or to the public;
(b) has brought, or might bring, the profession of pharmacy into disrepute;
(c) has breached one of the fundamental principles of the profession of pharmacy; or
(d) shows that the integrity of the registrant can no longer be relied upon."
" what we consider to be an insuperable obstacle to finding of no impairment, that is throughout the case, [the Appellant] has refused to recognise that he was in any way at fault, or even that there was any unlawful supply of prescription-only medicines to a reporter posing as a patient whilst he was the responsible pharmacist."
"[T]here is no premise upon which we can find or be assured that if Mr Abdul-Razzak found himself in a position where he was the responsible pharmacist in a pharmacy where the rules were not being followed or obeyed about the supply of prescription-only medicines, he would ensure that such unlawful practices did not continue. In the circumstances our assessment and conclusion is that the Registrant's fitness to practise is impaired."
The Approach to Impairment to Fitness to Practice
i) Impairment is a matter of judgment rather than proof; see Council for the Regulation of Health Care Professionals v. General Medical Council and Biswas [2006] EWHC 464 (Admin) at [40] – [41];ii) "However, it is essential, when deciding whether fitness to practise is impaired, not to lose sight of the fundamental considerations emphasised [in Cohen] at paragraph 62, namely the need to protect the public and the need to declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession" per Cox J in Council for Healthcare Regulatory Excellence v. Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin) [71];
iii) Insight – the expectation that a doctor will be able to stand back and accept that, with hindsight, he should have behaved differently, and it is expected he will take steps to prevent reoccurrence – is an important factor in a hearing (per Collins J in R (Bevan) v. General Medical Council [2005] EWHC 174 (Admin) at [34] and [39]);
iv) In relation to impairment, it was rightly a matter of concern that the facts were not admitted until the hearing ( per Ouseley J in R (Sharma) v. General Dental Council [2010] EWHC 3184 (Admin); and that
v) "It must be highly relevant in determining if a doctor's fitness to practice is impaired that first his or her conduct which led to the charge is easily remediable, second that it has been remedied and third that it is highly unlikely to be repeated" Cohen v GMC [2008] EWHC 581 Admin at [65] per Silber J.
Issue 3-The Sanctions Issue
"Miss Davies, on behalf of the Council, has submitted that a period of suspension is the appropriate sanction. We have come to the same conclusion. Our reasons are that a notable feature of the Registrant's conduct is his lack of insight and further that the sanction must serve the purpose of restoring public confidence in the profession, and maintaining standards of practise which it should do by conveying the message to the public and the profession that the conduct of the Registrant in failing to supervise or control properly or at all the activities of assistants supplying the pharmacy's customers with medicines cannot be tolerated and is unbefitting of a person registered with the Council".
The Submissions
"[T]here is no premise upon which we can find or be assured that if [the Appellant] found himself in a position where he was the responsible pharmacist in a pharmacy where the rules were not being followed or obeyed about the supply of prescription-only medicines, he would ensure that such unlawful practices did not continue".
"will reflect on his behaviour in September/October 2012, and his failings at the time, and will provide the Committee at a review to take place prior to the expiry of the suspension, evidence that he has revised his attitude towards his own contribution towards, and responsibility for, the unlawful and potentially harmful occurrences that occurred at Safeer Pharmacy in 2012".
"[I]n making their decision on the appropriate sanction, panels need to be mindful that they do not give undue weight to whether or not a doctor has previously been subject to an interim order for conditions or suspension imposed by the Interim Orders Panel, or the period for which that Order was effected…An interim order and the length of that order are unlikely to be of much significance for panels."
"the Solicitors Disciplinary Tribunal comprises an expert and informed tribunal, which is particularly well placed in any case to assess what measures are required to deal with defaulting solicitors and to protect the public interest. Absent any error of law, the High Court must pay considerable respect to the sentencing decisions of the tribunal. Nevertheless, if the High Court, despite paying such respect, is satisfied that the sentencing decision was clearly inappropriate, then the court will interfere"
"28. …[I]t has been said many times that the Professional Conduct Committee is the body which is best equipped to determine questions as to the sanction that should be imposed in the public interest for serious professional misconduct. This is because the assessment of the seriousness of the misconduct is essentially a matter for the Committee in the light of its experience. It is the body which is best qualified to judge what measures are required to maintain the standards and reputation of the profession.
29. …The Committee was entitled to give greater weight to the public interest and to the need to maintain public confidence in the profession than to the consequences to the Appellant of the imposition of the penalty."
Conclusion
(a)"what we consider to be an insuperable obstacle to finding of no impairment, that is throughout the case, [the Appellant] has refused to recognise that he was in any way at fault, or even that there was any unlawful supply of prescription-only medicines to a reporter posing as a patient whilst he was the responsible pharmacist.[9]" and that
(b)"[T]here is no premise upon which we can find or be assured that if Mr Abdul-Razzak found himself in a position where he was the responsible pharmacist in a pharmacy where the rules were not being followed or obeyed about the supply of prescription-only medicines, he would ensure that such unlawful practices did not continue. In the circumstances our assessment and conclusion is that the Registrant's fitness to practise is impaired.[10]"
(c) "Miss Davies, on behalf of the Council, has submitted that a period of suspension is the appropriate sanction. We have come to the same conclusion. Our reasons are that a notable feature of the Registrant's conduct is his lack of insight and further that the sanction must serve the purpose of restoring public confidence in the profession, and maintaining standards of practise which it should do by conveying the message to the public and the profession that the conduct of the Registrant in failing to supervise or control properly or at all the activities of assistants supplying the pharmacy's customers with medicines cannot be tolerated and is unbefitting of a person registered with the Council[11]".
Note 1 . Paragraph 6(ii) of the Particulars of Allegation against the Appellant [Back] Note 2 Paragraph 6(iii) of the Particulars of Allegation against the Appellant [Back] Note 3 That the Appellant failed “to adequately supervise the counter assistants caused or permitted an unlawful supply to be made from the pharmacy”. [Back] Note 4 See paragraph 23 above [Back] Note 5 See paragraph 93 below for a summary of those reasons. [Back] Note 6 See paragraph 23,88 and 89 for judicial statements supporting this approach. [Back] Note 7 See Paragraph 23 above [Back] Note 8 See Paragraphs 25 to 50 above, [Back] Note 9 See Paragraph 57 above [Back] Note 10 See Paragraphs 59 and 79 above. [Back] Note 11 See Paragraph 74 above. [Back] Note 12 See Paragraphs 51 to 68 above [Back]