Fitness to PractiSe Panel
15 june 2007
7th Floor, St James’s Buildings,
Name of Respondent Doctor: Dr Giovanni Vincenzo BELCARO
Registered Qualifications: State
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
Ms Carole Beard
GMC: Mr Michael Williams, Counsel, instructed by GMC Legal
Doctor: Not present and not represented
Determination on impaired fitness to practise
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
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.
15 June 2007 Chairman