Fitness to PractiSe Panel
11 June 2008
7th Floor, St James’s Buildings,
Name of Respondent Doctor: Dr
Marisa VIEGAS
Registered Qualifications: MB
BS 1980
Registered Address:
Registration Number: 2653479
Type of Case: Review case of impairment by reason of: misconduct.
Panel Members: Dr E Melrose, Chairman (Medical)
Mr S Galbraith (Medical)
Mr C Wheeler (Lay)
Legal Assessor: Mr T Jones
Secretary to the
Panel: Miss L Meads
Representation:
GMC:
Mr D Friesner,
Counsel, instructed by GMC Legal.
Doctor:
Present but not represented.
Determination on impaired fitness to practise
Dr Viegas: This is a
review hearing of your case following a Fitness to Practise Panel’s finding in June 2007 that your fitness to
practise is impaired by reason of your misconduct.
This Panel has
noted the background to your case and your fitness to practise history as
outlined by Mr Friesner, on
behalf of the General Medical Council (GMC), and set out in the documents
presented to the Panel which include the minutes of the Fitness to Practise
Panel of 19 to 30 March and 14 to 28 June 2007.
In summary the Panel, in 2007, found that up to around the end of 1995 you were Ms A’s General Practitioner.
Thereafter you advised Ms A on alternative therapies. You knew that Ms A had
been diagnosed with idiopathic dilated cardiomyopathy in 1995 and had
thereafter been under the care of Professor B, Professor of Cardiac Medicine at
the
The Panel made
findings that in June and August
2004 you did not adequately assess Ms A’s condition based upon history,
symptoms or an examination. You did not take any, or any adequate steps to
communicate with Ms A’s General Practitioner and/or treating consultant to
ensure that they were advised as to the changes in treatment you were
recommending. You also gave advice by email or telephone which you knew was
contrary to the advice given and treatment prescribed by Ms A’s treating
doctors. The Panel found that your conduct in August 2004 contributed to Ms A’s
death. It also found that your conduct, in both June and August 2004, was
inappropriate, unprofessional, not in the best interests of Ms A and
irresponsible.
That Panel determined that your fitness to practise was impaired by
reason of your misconduct and suspended your registration for a period of 12
months. It also stated that for this review hearing you should provide evidence that you have developed full
insight into your actions and understand the gravity of your misconduct so that
you are not at risk of repeating this behaviour. In addition, the previous
Panel stated that it would be helpful for this Panel today to receive evidence
that you have kept your clinical knowledge up to date, and that this could
include attending accredited refresher courses in clinical medicine.
The Panel has today
reviewed your case. It has considered, under Rule 22(f) of the GMC
(Fitness to Practise) Rules 2004, whether your fitness to practise is
impaired. It has taken into account all
the evidence placed before it, the submissions made by Mr Friesner, on
behalf of the GMC, and your own evidence.
In determining
whether your fitness to practise is impaired, the Panel considered the GMC’s
Indicative Sanctions Guidance (April 2005). In particular, at paragraph 11 of
section 1, it states that:
“Neither the Act nor the Rules
define what is meant by impaired fitness to practise but for the reasons
explained below, it is clear that the GMC’s
role in relation to fitness to practise is to consider concerns which are so
serious as to raise the question whether the doctor concerned should continue to practise either with
restrictions on registration or at all.”
The Panel noted
your evidence that you have spent time since the last hearing thoroughly
reviewing all of Ms A’s medical records and that you dispute the findings of
the Fitness to Practice Panel in 2007.
The Panel has not
been provided with any evidence from you that you have developed insight into
your actions or any evidence that you understand the gravity of your misconduct
so that you are not at risk of repeating this behaviour.
Furthermore, you
have not provided any relevant evidence that you have kept your clinical
knowledge up to date neither have you attended any accredited refresher
courses. You were specifically asked to provide this information at the
previous hearing. You told the Panel that the reason for not doing so is that
you reside in
It is not within
this Panel’s remit to go behind the previous Panel’s findings. You told the
Panel that you consider a gross miscarriage of justice has occurred. However, you
had the right to appeal the decisions made by the previous Panel but you did
not do so.
In view of the absence of any objective evidence that you have addressed
the concerns raised previously, the Panel has, pursuant to Section 35C(2)(a) of
the Medical Act 1983, as amended, determined that your fitness to practise is
impaired by reason of your misconduct.
The Panel will now
invite further submissions from Mr Friesner as to the appropriate sanction, if
any, to be imposed on your registration. You will then be given an opportunity
to respond. Submissions on sanction should include reference to the Indicative
Sanctions Guidance, using the criteria as set out therein to draw attention to
the issues which appear relevant to this case.
Determination on sanction
Dr Viegas: The
Panel has already determined that your fitness to practise is impaired by
reason of your misconduct. The Panel must now determine what action, if any, to
take in relation to your registration.
Mr Friesner on behalf of the General Medical
Council (GMC) submitted that erasure is the appropriate sanction in this case.
You told the Panel that you had nothing further to say in response. The Panel
has used its own independent judgment as to what sanction, if any, should be
imposed.
In determining
whether to take action against your registration, the Panel has balanced the
public interest against your own interests and taken into account the principle
of proportionality. The Panel is mindful that although the purpose of sanctions
is not to be punitive but to protect the public interest, they may have a
punitive effect. The public interest includes the protection of patients, the
maintenance of public confidence in the profession and the declaring and
upholding of proper standards of conduct and behaviour.
The Panel has had regard to all the guidance contained within the
Indicative Sanctions Guidance, and has noted paragraph 32 at page S1-7 which
states:
“It is important that no doctor should be
allowed to resume unrestricted practice following a period of conditional
registration or suspension unless the panel can be certain that he or she is
safe to do so. …The Panel will also need to satisfy itself that the doctor has
fully appreciated the gravity of the offence, has not re-offended, and has
maintained his or her skills and knowledge and that patients will not be placed
at risk by resumption of practice or by the imposition of conditional
registration.”
In view of the
serious nature of the findings against you the Panel has determined that it is
necessary to take further action against your registration.
The
Panel considered whether it would be sufficient to impose a period of
conditions on your registration. Any
conditions should be appropriate, proportionate, workable and measurable. It has determined that the imposition of conditions would
not uphold professional
standards or maintain public confidence in the medical profession.
The Panel went on
to consider whether it would be sufficient to suspend your registration for a
further period.
Apart from the
testimonial from Dr C, dated 20 May 2008, you have not provided any other
information requested by the previous Panel which might have assisted this
Panel in its assessment of your fitness to practise or demonstrated your
commitment to keep your clinical knowledge up to date.
The Panel has noted
paragraph 46 at page S1-10 of the Indicative Sanctions Guidance which states
under the heading: Failing to provide an
acceptable level of treatment/care
“Cases in this category are ones
where a practitioner has not acted in a patient’s best interests and has failed
to provide an adequate level of care, falling well below expected professional
standards. Such cases may involve factors
identified on page S1-15 of this guidance.
A particularly important consideration
in such cases is whether or not a doctor has, or has the potential to develop,
insight into these failures.
Where this is not evident, it is likely that conditions on registration or
suspension may not be appropriate or sufficient.”
The Panel has noted
your own evidence at page 38 of your documentation where you state
“This would suggest that my
standards of diagnosis and protection of patients are not shared by the
profession or its regulators and therefore
I request that this review panel do not restore my name to the Medical Register
of the
The Panel has
considered the Indicative Sanctions Guidance relating to suspension found at
page S1-14 which states a number of factors to be considered including:
“Panel is satisfied doctor has
insight and does not pose a significant risk of repeating behaviour.”
The Panel has also
considered the previous Panel’s determination on sanction. It states
“The Panel considers that, although
you lack insight into your conduct in this regard, you have the potential to
develop insight into this crucial
area of medical care.”
You told the Panel
today in your own evidence that given the same identical circumstance, you
would do the same thing again.
Therefore the Panel
is not satisfied that you have demonstrated any insight into the serious matters
which have brought you before this Panel, despite having been suspended for a
year.
The Panel has
concluded that your behaviour is fundamentally incompatible with your
continuing to be a registered medical practitioner and has determined that, for
the reasons set out above a further period of suspension is insufficient.
Accordingly, the
Panel has determined to direct that your name be erased from the Medical
Register.
The effect of the foregoing determination is
that, unless you exercise your right to appeal, your name will be erased from
the register, with effect from 27 July 2008, once the current period of
suspension has expired on 26 July 2008. Should you appeal, your current period
of suspension will remain in place until the appeal is decided. Written notice
of this decision will be served upon you in accordance with the Medical Act
1983, as amended.
That concludes this case.
Confirmed
June 2008 Chairman