Fitness to PractiSe Panel
15 june 2007
7th Floor, St James’s Buildings,
Name of Respondent Doctor: Dr
Giovanni Vincenzo BELCARO
Registered Qualifications: State
Exam 1976
Registered Address:
Registration Number: 2791241
Type of Case: Review case of impairment by reason of: misconduct
Panel Members: Mrs
Polly Clark (L) - Chair
Mrs Elisabeth Shend’ge (L)
Dr Peter Wright (M)
Legal Assessor: Mr
Thomas Ward
Secretary to the
Panel: Ms
Ms Carole Beard
Representation:
GMC: Mr Michael Williams, Counsel, instructed by GMC
Legal
Doctor: Not present and not represented
Determination on impaired fitness to practise
Mr Williams:
Dr Belcaro is neither present nor represented at these proceedings. The Panel has noted the UPS Delivery Notification which confirms that the Notice of Hearing was delivered to Dr Belcaro’s registered address and signed for on 10 May 2007. It has also considered the e-mail correspondence between Dr Belcaro and the General Medical Council (GMC). The Panel is satisfied that notice of this hearing has been properly served in accordance with Rules 15(3) and 40 of the GMC (Fitness to Practise) Rules 2004.
The Panel then considered whether to proceed with this
hearing in the absence of Dr Belcaro.
The Panel has considered the e-mail correspondence and note of a
telephone call between Dr Belcaro and the GMC, indicating that Dr Belcaro
is aware of today’s hearing and possible outcomes, and had no intention to
attend or be legally represented. An
e-mail dated 14 June 2007 contains written submissions from Dr
Belcaro for the Panel to consider. In
all the circumstances, the Panel has determined to proceed with this hearing in
the absence of Dr Belcaro, in accordance with Rule 31 of the
aforementioned Rules.
In June 2006, a
Fitness to Practise Panel found that Dr Belcaro’s fitness to practise was
impaired by reason of misconduct and determined that his registration be
suspended for a period of twelve months.
That Panel found proved that Dr Belcaro included the names of Professor A, Dr B and Dr C or agreed to their names
being included in articles as co-authors, knowing that they were not co-authors,
on a total of 86 occasions between 1998 and 2003. That Panel found that Dr Belcaro’s conduct in
relation to the above was misleading, intended to mislead, unprofessional and
likely to bring the medical profession into disrepute.
The Panel today has reviewed Dr Belcaro’s case. It has considered, under Rule 22(f),
whether his fitness to practise is impaired.
In doing so, it has considered all the information provided today
including the schedules, your submissions on behalf of the GMC and Dr Belcaro’s
written submissions of 14 June 2007.
Following the last hearing of Dr Belcaro’s case before a Fitness to
Practise Panel in June 2006, he was informed in writing that the Panel
reviewing his case would expect him to
attend and provide:
This Panel notes that Dr Belcaro has not provided any of these, thereby
failing to cooperate with the GMC. In
his e-mail dated 14 June 2007, Dr Belcaro states that he has kept himself
“fully informed about developments and innovations in my field … but that it is
really difficult to show competence”. He
has, however, provided no evidence to demonstrate that he has kept himself
fully informed. He further states that
he does not know how to ask for letters from people of standing, is far away
from the GMC system and people the Panel would consider of standing. The Panel therefore has no up to date
information regarding Dr Belcaro’s professional practice, medical
knowledge or standing in the community.
Dr Belcaro also
states in his e-mail of 14 June 2007 that he “cannot say anything about
‘probity’ which is a personal concept.”
The Panel is
concerned that Dr Belcaro does not accept the findings of the Panel in June
2006, and has shown no insight into his behaviour. Furthermore, Dr Belcaro does not appear to
have understood the findings of the previous Panel. The
Panel expects a practitioner to seek advice if they are unsure of how to
provide information, for example relating to probity or competence. Dr Belcaro does not appear to have done
this despite the serious nature of his situation. This Panel therefore has no information
before it to demonstrate that Dr Belcaro’s fitness to practise is not
impaired.
In all the circumstances, this Panel is satisfied that Dr Belcaro’s
fitness to practise is impaired pursuant to Section 35C(2)(a) of the Medical
Act 1983, as amended, by reason of his misconduct.
The Panel will now invite further submissions as to the appropriate direction, if any, to be imposed on Dr Belcaro’s registration.
Determination on sanction
Mr Williams:
Having found Dr Belcaro’s fitness to practise to be impaired by reason of
his misconduct, the Panel has considered the appropriate direction which should
be imposed on his registration. It has considered all of the information
before it, the representations from Dr Belcaro and your submissions on behalf
of the GMC.
In reaching its
decision on sanction, the Panel has had regard to the GMC’s Indicative
Sanctions Guidance. It has borne in mind
that any sanction must be proportionate and that its purpose is not to be
punitive. It must balance the interest
of the doctor against those of patients and the public. The public interest includes not only the
protection of patients but also the maintenance of public confidence in the
profession and declaring and upholding proper standards of behaviour.
The Panel has taken
account of paragraphs 44 and 45 of the Indicative Sanctions Guidance, which
state that:
“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….”
“Research misconduct is a further example.
The term is used to describe a range of misconduct from presenting misleading
information in publications to dishonesty in clinical drugs trials. Such
behaviour undermines the trust that both the public and the profession have in
medicine as a science, regardless of whether this leads to direct harm to
patients. Because it has the potential to have far reaching consequences, this
type of dishonesty is particularly serious.”
The GMC’s Good
Medical Practice (1998) states at paragraph 57:
“You have an absolute duty to conduct all
research with honesty and integrity”.
The Panel gave careful consideration as to whether it would be sufficient to impose conditions on Dr Belcaro’s registration. Any conditions would need to be appropriate, proportionate, workable and measurable. The Panel did not think any conditions would be appropriate or measurable in relation to the issue of probity. Furthermore, in light of Dr Belcaro’s failure to comply with the requests of the previous Panel, this Panel did not consider that conditions would be workable. The Panel therefore determined that conditions would not be sufficient in this case.
The Panel then went
on to consider whether suspension would be sufficient in this case. The Indicative Sanctions Guidance states at
page S1-14, that suspension is likely to be appropriate where the Panel is
satisfied that the doctor has insight, where there is no evidence of harmful
deep-seated personality or attitudinal problems, where there is no evidence of
repetition of behaviour, and where a doctor’s behaviour is not fundamentally
incompatible with continuing to be a registered medical practitioner.
Dr Belcaro has
shown a persistent lack of insight into the matters bringing him before the GMC
and has not made efforts to comply with the requests of the previous Panel. In his e-mail of 14 June 2007, Dr Belcaro
states “I do not consider myself member [sic.] of the GMC” and further “I do
not want to be a member of the GMC”.
Most significantly, Dr Belcaro is recorded as saying to a member of the
GMC during a telephone conversation on 19 April 2007 that he felt that an
injustice had been done to him as the practice of putting other people’s names
on academic papers without their consent was a common one. He was asked to confirm that the telephone
note was accurate and Dr Belcaro responded via e-mail that the conversation was
“well reported”. The Panel considers that
such a view is a gross departure from the standards defined in Good Medical
Practice and shows a complete lack of insight.
The Panel takes the view that the public are entitled to expect the
highest standards of probity and honesty from a doctor in all aspects of his
professional work. In the Panel’s view
Dr Belcaro’s comments do not satisfy this expectation. In all the circumstances, the Panel has
determined therefore that a further period of suspension would not be
sufficient in this case, having regard to the public interest in maintaining
appropriate standards and confidence in the profession.
Dr Belcaro is not
present or represented. He has not taken
the opportunity afforded to him to address the problems identified by the
previous Panel. He has thus not engaged
in any meaningful way with the GMC in the past year.
The Panel therefore
directs that Dr Belcaro’s name be erased from the Register. It is satisfied,
having had regard to all the factors listed above, that erasure is necessary
and proportionate in this case.
Unless Dr Belcaro
exercises his right of appeal, this Panel’s direction of erasure will take
effect 28 days from the date when written notice of this direction is deemed to
have been served on him. A note
explaining Dr Belcaro’s right of appeal will be sent to him. The current order of suspension imposed in
June 2006 will remain in place until such time as the substantive direction for
erasure takes effect.
That concludes the case.
Confirmed
15 June 2007 Chairman