Fitness to PractiSe Panel

17-25 July 2006

Hallam Street, London

 

 

Name of Respondent Doctor:    Dr David Alexander PUGH

 

Registered Qualifications:           MB BS 1972 Lond; MRCS Eng LRCP Lond 1972

 

Registered Address:                     Hertfordshire

 

Registration Number:                   1576221

 

Type of Case:                                  New case of impairment by reason of a conviction and misconduct.

 

Panel Members:                             Dr P Jefferys, Chairman (Medical)

Dr M Elliot (Medical)

                                                            Mrs J Mackay (Lay)

Mr A Simanowitz (Lay)

Mr J Walsh (Lay)
 

Legal Assessor:                             Mr Robin Hay

 

Secretary to the Panel:                 Caroline Tomlinson

 

Representation:

 

GMC: Mr Tom Kark, Counsel, instructed by Field Fisher Waterhouse, represented the General Medical Council.

 

Doctor: Dr Pugh was not present but was represented by Mr Barry Gilbert, Counsel, instructed by the Henry Milner and Company Solicitors and on the final day by Ms Merrick, Counsel, instructed by Henry Milner and Company Solicitors.

                                                        

 

 

Allegation:

 

“That being registered under the Medical Act 1983,

 

1.         Between January 2002 and February 2003 you were a registered medical practitioner practising as the Medical Director of Lifeline Care Ltd which operated private medical clinics in Elstree and Sheffield;

Admitted and found proved

 

2.         During that period you had overall responsibility for the clinical care provided by Lifeline Care Ltd;

Admitted and found proved

 

Care Standards Registration

 

3.         Under the Care Standards Act 2000 you were required as a private medical practitioner to be registered with the National Care Standards Commission as from 1 April 2002;

Admitted and found proved

 

4.         At no time between 1 April 2002 and February 2003 were you registered with the National Care Standards Commission and you were in breach of a legal duty;

Admitted and found proved

 

Procedures relating to Vaccines

 

5.         At both Medical Clinics in Elstree and Sheffield you offered single antigen measles, mumps and rubella vaccinations;

Admitted and found proved

 

6.         Between 4 June 2002 and 8 January 2003 while you resided in Australia two locum doctors were employed by Lifeline Care Ltd whilst you retained overall control and responsibility for the care provided;

Admitted and found proved

 

7.         Prior to leaving for Australia you developed protocols for the reconstitution, storage, refrigeration and transportation of vaccines to be used by your staff at the clinic;

Admitted and found proved

 

8.         You instructed Wendy O’Keefe, who had no medical or pharmaceutical qualifications, how to prepare multi dose vaccinations;

Admitted and found proved

 

9.         It was inappropriate so to instruct her;

 

10.       The procedures undertaken by staff under your instructions included,

 

a.         Reconstituting individual vaccine doses and decanting them into multi-dose containers,

Admitted and found proved

 

b.         Reconstituting vaccinations in less than the amount of solvent recommended by the manufacturer,

Admitted and found proved

 

c.         Transporting and storing the vaccine with inadequate cold-chain procedure safeguards,

 

d.         Storing the reconstituted vaccine for longer periods of time prior to use than the manufacturers recommended,

 

e.         Adopting inadequate sterilisation procedures,

 

f.          Injecting patients with vaccine prepared and stored in the manner described above;

 

11.       Your actions set out above in paragraph 10. were,

 

a.         Inappropriate,

 

b.         Contrary to good medical practice,

 

c.         Not in the best interests of your patients;

 

Conviction

 

12.       As a result of the concerns raised a number of parents asked for tests to be carried out to discover whether their children had been effectively immunised at your clinic. Blood samples were obtained and sent to an independent laboratory. In respect of four of the reports received back, you falsified the results thereon and passed those false results on to the parents of the children concerned;

Admitted and found proved

 

13.       You were arrested on 27 March 2003 for making a false instrument. On

8 October 2004 you pleaded guilty at the Cambridge Crown Court to four counts of using a false instrument with intent. On 22 December 2004 you were sentenced to nine months imprisonment;

Admitted and found proved

 

Patient  Mr B

 

14.       During the period between January 2002 and February 2003 when you were a registered medical practitioner practising as the Medical Director of Lifeline Care Ltd, Mr B (date of birth 13 December 1992) was a patient of yours;

Admitted and found proved

 

 

15.       Mr B is autistic;

Admitted and found proved

 

16.       Between April 2002 and March 2003 you treated Mr B with Secretin injections, Secretin nasal spray and Bethanecol for which you charged his mother Mrs B privately;

Admitted and found proved

 

17.       During the relevant period you posted material on your Medical Centre Web Site entitled ‘Secretin – Treatment for Autism’;

 

18.       Some of the statements made by you on the website were not justified on the basis of information available to the medical profession in 2002;

 

19.       In publishing these statements you acted in a manner contrary to good medical practice in making unjustifiable claims about the effectiveness of the drug for the purpose of treating autism;

 

20.       You also made claims personally to Mr B’s mother about the effectiveness of treating Mr B with Secretin which were not justified on the basis of information available to the medical profession in 2002;

 

21.       In making these claims to Mrs B you acted in a manner contrary to good medical practice by,

 

a.         Making unjustifiable claims about the effectiveness of the drug for the purpose of treating autism,

 

b.         Exploiting Mrs B’s vulnerability;

 

22.       In treating Mr B with Bethanecol you did not act in his best interests;

 

Mis-statements

 

23.       In January 2003 you had a number of meetings with Dr Joel Bonnet (Director of Public Health Hertsmere PCT), Dr Woolaway (Director of Public Health Bedfordshire and Hertfordshire Strategic Health Authority) and Kirsten Dettmer (Inspector at the National Care Standards Commission). You were advised that a recall procedure would be necessary for patients who had received their vaccines since June 2002;

Admitted and found proved

 

24.       Following the publication of an article in the press in February 2003 public concern was raised as to the methods adopted at your clinic in relation to the use of vaccines. A number of parents of children who had received vaccinations at your clinics requested tests to satisfy them that their children were properly immunised;

Admitted and found proved

 

 

25.       On or about 7 February and 9 February 2003 you sent out letters to the parents of children who had been vaccinated at your clinics.

Admitted and found proved

 

26.       In your letters of 7 and 9 February 2003 you made a number of misstatements about your actions and the possible consequences thereof;

 

27.       The statements and representations you made in your letters of

7 and 9 February 2003 were misleading;’

 

And that by reason of the matters set out above your fitness to practise is impaired because of:

a.         Your misconduct,

 

b.         Your conviction.”

 

Determination on facts:

 

“Mr Gilbert:     At the outset of the hearing, you admitted on behalf of Dr Pugh a number of allegations, which are as follows:-

 

Allegations 1, 2, 3, 4, 5, 6, 7, 8, 10a, 10b, 12, 13, 14, 15, 16, 23, 24 and 25.

 

The Panel has already recorded that those allegations have been admitted and therefore found proved.

 

In relation to the allegations not admitted, the Panel has given detailed consideration to all the evidence adduced in this case, including the written and oral evidence. It has borne in mind the submissions made by Mr Kark on behalf of the GMC and your submissions on behalf of Dr Pugh. It has accepted the advice of the Legal Assessor.

 

The Panel has considered the remaining allegations separately and, applying the criminal standard of proof, has made the following findings on the facts: 

 

Allegation 9 has been found proved

In reaching this finding, the Panel had regard to the expert evidence of Professor Finn, who made it clear that it was inappropriate to have asked the Practice Manager, Wendy O’Keefe, who had no medical or pharmaceutical qualifications, to undertake the preparation of multi-dose vaccines because that forms an integral part of the immunisation procedure. The Panel took into account the evidence of Wendy O’Keefe, who, by her own admission, stated that she did not understand the vaccine manufacturer’s recommendations. The Panel was also mindful of the Department of Health’s guidance “Immunisation against Infectious Diseases” and paragraph 46 of the General Medical Council’s guidance “Good Medical Practice”, which states “When you delegate care or treatment you must be sure that the person to whom you delegate is competent to carry out the procedure…”     

 

Allegation 10c has been found proved

Allegation 10d has been found proved

Allegation 10e has been found proved

Allegation 10f has been found proved

In reaching its findings in relation to allegations 10c to 10f, the Panel took into account Wendy O’Keefe’s evidence as to how the vaccine was transported, stored and reconstituted. The Panel accepted the expert evidence of Professor Finn that such arrangements were inadequate and unsafe.

 

 According to Dr Pugh’s memorandum dated 10 November 2002, entitled “vaccination procedures”, the reconstituted vaccines could be used over eight hour periods. This was contrary to the manufacturers’ recommendations. In relation to the vaccine for mumps (mumpsvax), the manufacturer recommends that the vaccine should be used “as soon as possible” after reconstitution and for Moraten Berna, the vaccine must be used “immediately”. 

 

In the light of its findings in relation to Allegation 10, Allegation 11 in its entirety has been found proved.

 

Allegation 17 has been found proved

The Panel was satisfied on the basis of the undisputed documentary evidence of the website which bore the details of the Elstree Aero-Medical Centre, Doctor Pugh’s name, personal email, and telephone/fax contact details.

 

Allegation 18 has been found proved

Allegation 19 has been found proved

Among the unjustifiable claims made were “The second concern, is whether the Secretin will “work” for your child – the answer is yes – provided you are prepared for your child to have a sufficient number of injections” and the statement “Stay with the programme and you will see results”.

Allegation 20 has been found proved

Allegation 21a has been found proved

Allegation 21b has been found proved

In reaching its findings in relation to these allegations, the Panel accepted Mrs B’s clear account of her consultation with Dr Pugh and the expert evidence of Dr Jardine, who summarised the published evidence on Secretin and autism available at the relevant time.

 

Allegation 22 has been found not proved

There was insufficient evidence that the treatment of Master B with Bethanecol was contrary to his best interests.

 

Allegation 26 has been found proved

Allegation 27 has been found proved

A number of statements in both letters were unfounded. Among them were included the following:-

In respect of the letter of 7 February 2003

“ We have carried out reliable antibody blood tests on 28 of these children…                   

 - all of these children have been shown to be immune to the illnesses against which they were vaccinated...

This confirms my belief that there is no cause for concern and that no action need be taken.”

In respect of the letter of 9 February 2003

“We … adhere to the World Health Organisation’s recommendation and policy and also that of the manufacturers of the vaccines.”

 

The Panel will now invite Mr Kark to adduce further evidence and make any further submissions as to whether, on the basis of the facts found proved, Dr Pugh’s fitness to practise is impaired. You will then have the opportunity to respond on behalf of Dr Pugh and call any evidence if you wish to do so.”

 

 

Determination on impaired fitness to practise:

 

“Mr Gilbert:     The Panel has considered all the evidence presented to it, as well as the submissions made by both Counsel, and the qualified concession made by you on behalf of Dr Pugh. It has also accepted the advice of the Legal Assessor. 

 

It is the Panel’s task to consider, on the basis of the allegations found proved, whether Dr Pugh’s fitness to practise is impaired pursuant to Section 35C (2) (a) of the Medical Act 1983, as amended, by reason of his misconduct and his conviction.

 

The Panel has heard that between January 2002 and February 2003 Dr Pugh was a registered medical practitioner practising as the Medical Director of Lifeline Care Ltd which operated private medical clinics in Elstree and Sheffield; he had overall responsibility for the clinical care provided by Lifeline Care Ltd.

 

National Care Standards Commission

Under the Care Standards Act 2000 Dr Pugh was required as a private medical practitioner providing immunisation, to be registered with the National Care Standards Commission (NCSC) as from 1 April 2002; at no time was he so registered. This was in breach of a statutory duty. The Panel accepted the evidence of Kirsten Dettmer (Inspector at the NCSC) that the purpose of registration was to ensure conformity with certain standards as well as provide monitoring and checks of doctors in private practice. In Dr Pugh’s case this would include arrangements for storage, sterilisation, and administration of vaccines. Although this failure of Dr Pugh was not as serious as the other issues, it was in breach of paragraph 11 of Good Medical Practice (May 2001). This states that doctors should observe and keep up to date with the law and statutory codes of practice which affect their work.

 

Procedures relating to Vaccines

At both private medical clinics, in Elstree and Sheffield, Dr Pugh offered single antigen measles, mumps and rubella vaccines.

 

The Panel wish to make it clear that it has not concerned itself with the relative merits of single antigen vaccines and the MMR (measles mumps rubella) combined vaccine. The issue is the manner in which the single antigen vaccines were used by Dr Pugh.

 

Between 4 June 2002 and 8 January 2003 whilst he resided in Australia two locum doctors were employed by Lifeline Care Ltd; Dr Pugh retained overall control and responsibility for the care provided. Prior to leaving for Australia Dr Pugh gave instructions for the reconstitution, storage, refrigeration and transportation of vaccines to be used by his staff at the clinic. He showed an employee, who had no medical or pharmaceutical qualifications, how to prepare multi- dose vaccines. It was inappropriate to instruct her because vaccine reconstitution forms an integral part of the immunisation procedure. This should only be undertaken by an appropriately trained healthcare professional.

 

The procedures undertaken by staff under Dr Pugh’s instructions included:

 

 

The Panel found his actions in this regard to be inappropriate, contrary to good medical practice and not in the best interests of his patients.

 

Dr Pugh failed to provide adequate care to these patients and delegated inappropriately. The Panel considered him to be reckless in his disregard for the safety of the young children whose parents trusted him to deliver adequate immunisation against these infectious diseases in a safe and responsible manner.

 

Misinformation 

In January 2003 Dr Pugh had meetings with Dr Joel Bonnet (Director of Public Health Hertsmere Primary Care Trust), Dr Woolaway (Director of Public Health Bedfordshire and Hertfordshire Strategic Health Authority) and Kirsten Dettmer (Inspector at the NCSC). He was advised that a recall procedure would be necessary for children who had received their vaccines since June 2002. This was because there was a risk that some of the children would not be protected from the diseases against which they had been immunised.  Following the publication of an article in the press in February 2003 public concern was raised about the methods adopted at Dr Pugh’s clinic in relation to the use of vaccines.

 

The Director of Public Health, Dr Bonnet, drafted a detailed letter advising parents about the actions they should take to ensure that their children were properly immunised. It was agreed with Dr Pugh that he would forward this letter to all parents on 8 February 2003. However, on 7 and 9 February 2003, Dr Pugh wrote his own letters to the parents of children who had been vaccinated at the clinics. These included a number of misleading statements about his actions and the possible consequences thereof. By these letters he falsely reassured parents that the concerns raised about the efficacy of the immunisations were unjustified and that the parents had nothing to worry about. This was contrary to the guidance in Good Medical Practice (May 2001) where it states that doctors must fully and promptly explain to the patient what has happened and the likely long and short-term effects. Not only did Dr Pugh fail to do this but he contradicted the advice given by the Director of Public Health and did not co-operate fully with the investigations into his practice. The Panel considered these actions to be a gross breach of trust on the doctor’s part. It would have had the inevitable consequence of fuelling parental concerns and anxieties about the treatment their children had received. Furthermore, it would be likely to undermine confidence in the medical profession as a whole.

 

 

Conviction

As a result of the concerns raised, a number of parents asked for tests to be carried out to discover whether their children had been effectively immunised at Dr Pugh’s clinic. Blood samples were obtained and sent to an independent laboratory. In respect of four of the reports received back, Dr Pugh falsified the results thereon and passed those false results to the parents of the children concerned. He was arrested on 27 March 2003, and on 8 October 2004 he pleaded guilty at the Cambridge Crown Court to four counts of using a false instrument with intent. On 22 December 2004 he was sentenced to nine months imprisonment. The Panel notes the seriousness with which this crime was viewed by the Judge, who, in his sentencing remarks, stated that falsifying results and lying about them to parents constituted a breach of trust and could serve to undermine confidence in the medical profession.

 

 The Panel concurs with this view and reiterates that this attempt to deceive parents, whose children had not been effectively immunised, constituted a serious departure from the honesty and probity expected of registered medical practitioners. The nature of the conviction alone would have warranted a finding that the doctor’s fitness to practise is impaired.

 

Patient  Master B

Between January 2002 and February 2003 whilst Dr Pugh was operating his private medical clinic in Elstree, Master B (born in 1992), an autistic child, became his patient.

 

Dr Pugh administered to Master B Secretin injections, Secretin nasal spray and Bethanecol for which he charged fees to Mrs B. He made claims to Master B’s mother about the effectiveness of treating her child with Secretin. These claims were not justified in the light of information readily available to the medical profession in 2002. The Panel noted that Mrs B would have been anxious to seek any treatment to relieve her son’s symptoms and concluded that she was therefore in a vulnerable position. In the circumstances, Dr Pugh failed to explain fairly the likely benefits and probability of success of the proposed treatment. Instead he made claims about its effectiveness for which there was little support in medical literature and gave Mrs B false hopes of amelioration of her son’s condition.

 

The Panel has found that during the relevant period he posted material on his Medical Centre Web Site entitled ‘Secretin – Treatment for Autism’. On the basis of information available to the medical profession in 2002, some of the statements made by Dr Pugh were unjustified.  In publishing these statements he acted in a manner contrary to good medical practice in making unjustifiable claims about the effectiveness of the drug for the purpose of treating autism, contrary to paragraphs 48, 49 and 50 of Good Medical Practice (May 2001), which states that in regard to published information :

 

“…the information must be factual and verifiable…must not make unjustifiable claims about the quality of your services…offer guarantees of cures nor exploit patients’ vulnerability or lack of medical knowledge”

 

The Panel considered that the material published on the website contained many falsehoods, inaccuracies and exaggerated claims.

 

In all the circumstances the Panel has found Dr Pugh’s fitness to practise is impaired by reason of his misconduct and his conviction.

 

Having determined that his fitness to practise is impaired, the Panel will invite further submissions from Mr Kark and from you as to the appropriate sanction, if any, to be imposed on Dr Pugh’s registration.”

 

Determination on sanction:

 

“The current Interim Order imposed on Dr Pugh’s registration is hereby revoked.

 

The Panel has previously determined and announced that Dr Pugh’s fitness to practise is impaired by reason of his misconduct and conviction.

 

In 2002 there was significant demand in England for single antigen vaccines from parents concerned about the MMR (Mumps Measles Rubella) vaccine. Dr Pugh decided to respond to the demand at his private clinic at Elstree aerodrome and a subsidiary clinic held in a sports centre in Sheffield. 

 

The Panel wish to make it clear that it has not concerned itself with the relative merits of single antigen vaccine and the combined MMR vaccine. The issue is the manner in which the single antigen vaccines were used by Dr Pugh. Live vaccines must be stored and reconstituted under carefully controlled conditions to ensure that they are effective and safe. They can be inactivated if they are not kept within a strict temperature range or if they are contaminated by traces of chemicals. Reconstituted vaccines do not contain preservatives and thus become an ideal environment for the growth of dangerous organisms which can cause life threatening infections if injected.

 

Before his planned absence in Australia in June 2002 Dr Pugh decided to speed up the vaccine administration process by combining single antigen vaccines to form multi-dose vaccines. He then expected his staff to immunise as many as 30 children per hour.

 

The preparation of multi-dose vaccines as directed by Dr Pugh involved the following procedure:

 

Bottles which had formerly contained local anaesthetic were placed in an autoclave (an apparatus for sterilisation by steam). After removal they were allowed to cool. The bottles were not cleaned before being autoclaved and as a consequence there was a risk that traces of their original contents remained after the autoclave process.

 

The vaccine was then reconstituted (made up) with diluent and the bottles were filled with the reconstituted vaccine. Dr Pugh’s instructions were to put the contents of 10 or more single dose vials into each bottle.

 

Each single dose should be reconstituted with the volume of diluent recommended by the manufacturer. However, in or about November 2002 Dr Pugh gave instructions that only 40% of the required diluent should be used. The bottles were resealed using the original rubber bung, which had been immersed in “Trigene” for 24 hours before re-use. In evidence, the Panel heard that the bungs would be re‑used until they showed “signs of wear and tear”. The preparation and the filling of the bottles, which took some 30 minutes, took place in a non-sterile environment.

 

Professor Finn, an acknowledged expert in this field, described the reconstitution of the vaccine as an integral part of the immunisation procedure which should be undertaken only by a doctor, pharmacist or trained nurse. He explained that whoever undertakes vaccine reconstitution must have an understanding of the whole immunisation procedure. Dr Pugh delegated the reconstitution of vaccines to an employee who had no medical or pharmaceutical training and who was unable, on her own admission, to understand the manufacturers’ written instructions. This “streamlining” procedure dramatically increased the risks of infection and immunisation failure in those children attending his clinics.

 

One of the vaccines had to be administered immediately after reconstitution, yet Dr Pugh allowed it to be used for up to 8 hours. For some of this time that vaccine was left at room temperature. These vaccines are live and very heat sensitive, needing controlled refrigeration both before and after reconstitution. Dr Pugh arranged for unreconstituted vaccines to be stored in refrigerators in the garage at the home of an employee. Furthermore, the arrangements made for transport and storage of the vaccines (before and after reconstitution) were unsafe. On occasion non-approved coolbags were used which jeopardised the recommended cold-chain process.

 

Dr Pugh was in breach of his statutory requirement to register his private clinics with the National Care Standards Commission (NCSC). Had he done so, a detailed inspection of the premises and procedures would have followed. This would have revealed the shortcomings of his immunisation procedures and could have protected children from these additional risks.

 

Dr Pugh’s written memorandum dated 10 November 2002 was in breach of both Department of Health and World Health Organisation (WHO) guidelines. WHO guidelines, setting out the minimum standards which should be adhered to, were designed for use where resources available for immunisation are very limited.  Dr Bonnet, the local Director of Public Health described Dr Pugh’s procedures as a whole as ‘outrageous’ and Professor Finn expressed his opinion of them as “indescribably awful, it is horrifying and in my experience, totally unprecedented”.

 

In February 2003 Dr Bonnet wished to advise parents of children immunised at the clinics of the risks to which their children had been exposed and of the actions he recommended to ensure that they were effectively immunised. Dr Pugh declined, on grounds of confidentiality, to disclose the identities and addresses of those children. He agreed to forward a letter from Dr Bonnet to all the relevant parents.  Around the same time that Dr Bonnet’s letter was to have been forwarded, Dr Pugh sent his own two letters to those parents. His letters gave false reassurance to the parents and directly contradicted the advice given in the letter written by the Director of Public Health. This action could only have served to confuse parents and undermine their confidence in the medical profession.

 

By his deliberate falsification of blood test results Dr Pugh deceived some parents into believing that their children were immune when they were not. At his trial for offences arising from this deception, Dr Pugh was sentenced to nine months’ imprisonment. The Judge described his actions as “a very significant breach of trust that not only affected the patients and their parents, but also potentially undermined confidence in (his) profession”. The Panel agree.

 

In relation to patient Master B, a 10 year old child with autism, Dr Pugh gained the consent of his mother to a prolonged and expensive course of treatment with Secretin. He made an unjustifiable assertion about Master B’s likely response to treatment that was not based on knowledge available to the medical profession at the time.

 

Mrs B, in her evidence to the Panel, acknowledged that Dr Pugh had not made promises or given guarantees but he said “the speech would come; the more you gave (injections) the more words would appear”. She said he told her that at least six injections were needed before positive results would be seen and that a child similar to hers had responded very well to such a course. In response to a suggestion that Dr Pugh had not guaranteed success, Mrs B replied, “Yes, but when you are being told by a doctor.. it can help my little boy … then I have to believe what he’s saying to me, surely?”

 

Furthermore, Dr Pugh’s website made a series of unfounded claims about Secretin which were likely to mislead parents of children with autism, who, because of the condition, are commonly desperate for treatments that might help.

 

Dr Pugh failed to provide safe clinical care to the children immunised at his clinics, unnecessarily exposing them, their siblings and other children, to the risk of potentially fatal infectious disease. His attempts to cover up his failings and repeated dishonesty in the process, is behaviour of the most reprehensible kind from a doctor. He gained consent from vulnerable parents to unproven treatment by giving misleading information. These actions significantly undermined public confidence in the medical profession.

 

The Panel has considered what action, if any, should be taken against Dr Pugh’s registration.

 

The Panel has considered all the oral and written evidence in this case together with the submissions made by both Counsel as to the appropriate sanction and has accepted the advice of the Legal Assessor. 

 

The Panel has had regard to the GMC’s Indicative Sanctions Guidance.  The purpose of sanction is not to be punitive, but to protect patients and the public interest.  The public interest includes the protection of patients, maintenance of public confidence in the profession and declaring and upholding proper standards of conduct and behaviour.

 

The Panel has also borne in mind the principle of proportionality, weighing the interest of the public with Dr Pugh’s own interests.

 

The Panel has taken account of Dr Pugh’s letter of 27 March 2006. He accepts that his actions constituted “clear departures from good medical practice”, that he had “caused a great deal of harm to the reputation of the profession as a whole”, and further, that he “contravened all medical, religious and personal ethics”. The Panel noted Dr Pugh’s expressions of remorse in relation to his unacceptable immunisation procedures. However, since that letter the Panel has received no evidence from Dr Pugh addressing the treatment of Master B, the false assurances to parents following the uncovering of unacceptable practice in his clinics, nor to his false claims as to the value of Secretin.

 

The Panel regard Dr Pugh’s failures as fundamental. Notwithstanding the mitigation and apologies expressed, the findings against him represent a serious breach of the standards of conduct that the public is entitled to expect from registered medical practitioners. The Panel concluded it is necessary to take action against his registration. 

 

The Panel next considered whether placing conditions on Dr Pugh’s registration would be appropriate in this case.  Any conditions must be proportionate, measurable and workable.  Dr Pugh has had a long career in medicine and the Panel noted the submission that it was only in one isolated area of practice (namely the vaccine programme) that he fell short of good medical practice. However the Panel concluded that he also fell short in his treatment and care of Master B, and that his dishonesty in attempting to cover up failures on his part and his exaggerated claims regarding the efficacy of certain treatments, breached the basic standards expected of all doctors.

 

Given these serious failings the Panel cannot formulate any conditions which would address those concerns and in any event they would be insufficient to protect members of the public nor would they be in the public interest.

 

The Panel went on to consider whether it would be sufficient to suspend Dr Pugh’s registration.  In doing so it has carefully considered the guidance contained within the Indicative Sanctions Guidance at page S1-14 as to when a suspension might be appropriate.

 

The Panel is of the view that the public interest requires it to be made clear that the behaviour Dr Pugh has demonstrated is wholly unacceptable in the medical profession.  There are four areas in which Dr Pugh’s behaviour is incompatible with his continuing to be a registered medical practitioner and they are as follows:

 

1.   Failure to provide an acceptable level of treatment/care;

2.   Exploitation of vulnerable parents.

3.   Repeated dishonesty.

4.   Abuse of trust

 

The Panel has considered that a profession's most valuable asset is its collective reputation and the confidence it inspires in members of the public. It has also borne in mind the words of Lord Bingham, Master of the Rolls (as he then was), in the case of Bolton v Law Society, quoted by the Privy Council in the case of Dr Gupta (Privy Council Appeal number 44 of 2001).

 

      “The reputation of the profession is more important than the fortunes of any individual member. Membership of a profession brings many benefits, but that is part of the price.”

 

The Panel has concluded that Dr Pugh’s behaviour is fundamentally incompatible with his continuing to be a registered medical practitioner because of his conviction and misconduct and has determined that, for the reasons set out, suspension is insufficient.

 

Accordingly, the Panel has determined to erase Dr Pugh’s name from the Medical Register.

 

Having reached this decision, the Panel is minded to consider whether it is necessary for Dr Pugh’s registration to be suspended forthwith.” 

 

Determination on immediate sanction:

 

“Ms Merrick:   Having determined that the Doctor’s registration should be erased, the Panel has now considered in accordance with Section 38(1) of the Medical Act 1983 as amended, whether a further order should be made for immediate suspension.

 

The Panel has considered the submissions made by Counsel for the GMC and noted there are no submissions on the doctor’s behalf. It has accepted the advice of the Legal Assessor.

 

In view of the serious nature of the Panel’s findings, in particular Dr Pugh’s dishonesty and exploitation of vulnerable persons, the Panel determines that for the protection of members of the public and in the public interest, it is necessary to suspend his registration with immediate effect.

 

This means that the Doctor’s registration will be suspended from today. The substantive direction for erasure will take effect 28 days from when written notification is deemed to have been served upon Dr Pugh, unless he lodges an appeal in the interim.  If Dr Pugh does lodge an appeal, the immediate suspension will remain in force until the appeal is determined.

 

That concludes the case.”

 

 

 

 

Confirmed

 

 

 

25 July 2006                                                                                                            Chairman