Fitness to PractiSe Panel
14 and 15 May 2007
7th Floor, St James’s Buildings, 79 Oxford Street, Manchester, M1 6FQ

Name of Respondent Doctor:       Dr Deepak Kumar CHITKARA

Registered Qualifications:              Mb ChB Manc

Registered Address:                        Merseyside
                                                              
Registration Number:                      2772530

Type of Case:                                     Review case of impairment by reason of misconduct.

Panel Members:                                Dr L Buchanan, Chairman (Medical)
                                                               Mr J Colwill (Lay)
                                                               Dr H Laing (Medical)
                                                              
Legal Assessor:                                Mr K Brown

Specialist Performance Adviser: Mr P A

Secretary to the Panel:                    Miss R Carr

Representation:
GMC: Mr Peter Main, QC, instructed by GMC Legal, represented the General Medical Council.

Doctor: Dr Chitkara was present and was represented by Mr Martin Forde, QC, instructed by Ryan Solicitors.

Determination on impaired fitness to practise

“Dr Chitkara: A Fitness to Practise Panel commenced consideration of your case on 24 April 2006. In light of the evidence before it, that Panel determined that your fitness to practise was impaired as a consequence of your misconduct and determined that it was necessary to suspend your registration for a period of 12 months. 

The allegation centred on five specific areas of concern, namely:

1.         Your failure to take appropriate action with regard to the implantation of faulty Aquasense intraocular lenses. You carried out a right cataract extraction and lens replacement on a patient. Following the operation you were notified by the manufacturer of problems with clouding of the lenses but you did not notify the patient of this. In addition you told a member of staff that you had reviewed all the relevant patients post operatively and there had been no problem with the lenses. The previous Panel found that your conduct had been irresponsible, seriously below the standards to be expected of a registered medical practitioner and not in the best interests of the patient.

2.         Conducting two separate but connecting trials without the approval of a Research Ethics Committee or the consent of patients. You admitted that your conduct in relation to this matter was irresponsible and not in the best interests of the patients. The previous Panel also found that your conduct fell seriously below the standard to be expected of a registered medical practitioner and was dishonest.

3.         Your failure to attend a Boots clinic on 21 May 2004 by purporting to be ill when in fact you were not ill. The previous Panel found that your conduct in this regard was irresponsible and dishonest.

4.         Your failure to make yourself available to deal with post operative complications when it was expected by your colleagues that you would be available and, in the aftermath of the complications which did arise, acting in an inappropriate manner towards clinic staff. The previous Panel found that your conduct in this regard was irresponsible, not in the best interest of the patient and intimidating in respect of the member of clinical staff.

5.         Making exaggerated claims in a brochure as to your role in the development of various surgical techniques. The Advertising Standards Authority found the claims to be in breach of the Committee of Advertising Practice (CAP) Code and the previous Panel found that your conduct in relation to the advertising material was dishonest.

In the light of your serial breaches of General Medical Council (GMC) guidance and disregard for the principles set out in the GMC’s publication, “Good Medical Practice” the Panel found that your behaviour had fallen seriously below the standard to be expected of a registered medical practitioner and determined that your fitness to practise was impaired. The Panel took a serious view of the multiplicity, level and nature of the findings made against you. In order to mark the gravity of the misconduct the Panel determined that it was necessary to suspend your registration for a period of 12 months.

The Panel, in April 2006, required that the reviewing Panel receive the following:

• Evidence of your insight into your behaviour.
• Evidence of the steps you have taken to keep your medical knowledge up to date.
• Evidence that you have worked with a Postgraduate Dean, or their nominated Deputy, to formulate a personal development plan, specifically designed to address the deficiencies which have been central to this case i.e: interpersonal skills and ethics and procedures to follow when conducting research.
• A copy of your personal development plan and a record of educational activities attended.
• Evidence that you have met with your Postgraduate Dean, or their nominated Deputy, on a regular basis to discuss the progress towards your achieving the aims set out in your personal development plan and to undergo a formal appraisal.
• Testimonials from professional colleagues and other persons of standing to provide the GMC with information as to your conduct throughout the period of your suspension.

The Panel has today reviewed your case. It has considered, under Rule 22 (f) of the General Medical Council (Fitness to Practise Rules) 2004, whether your fitness to practise is impaired. It has taken into account all the evidence placed before it and the submissions made by Mr Main, QC, on behalf of the GMC and those made by Mr Forde, QC, on your behalf. The Panel has also been assisted by the advice of the Specialist Performance Advisor, Mr A, a Consultant Ophthalmic Surgeon.

The Panel has been provided with letters from Professor B, Postgraduate Dean of the Mersey Deanery. Professor B met with you on 18 July 2006, 25 October 2006 and 7 March 2007 providing you with support and advice during the period of your suspension. In his letter, dated 13 March 2007, he stated that, “Dr Chitkara appears to have engaged appropriately in the educational process and he has prepared an appropriate appraisal portfolio with a personal development plan.” He went on to state that he was pleased that you had appeared to have made satisfactory progress.

Dr C, Consultant Ophthalmologist, was appointed as your mentor and provided you with advice on your continuing medical education and personal development plan, and carried out an informal appraisal of the steps taken and the progress made during the period of your contact with him. Dr C reported, in his letter of 1 March 2007, that he was reasonably satisfied with your efforts and progress. In particular he noted the following:

• That you had attended various courses addressing the areas of research, ethics, audits and surveys, interpersonal relationships, team work and leadership skills and your attendance at clinical meetings
• That you had engaged with the CPD programme of the Royal College of Ophthalmologists and you had signed up to, and undertook, activities on line at regular intervals.
• That you had attended appropriate meetings, undertook reading to update your medical knowledge and that you continued your professional development.
• That you had taken steps to keep in contact with clinical practice, in a limited way, in your capacity as a technician at Viewpoint Vision Services wherein you had developed interpersonal relationships with fellow health professionals and other support staff.
• That you had applied some of the knowledge and experiences gained in carrying out an audit of clinical material collected in the past prior to the suspension and appraisals to assess the various skills that had been gained, such as communication and team working.

Dr C recommended that on resumption of practice, you should consider refreshing your surgical skills by undertaking surgical procedures under the supervision of your colleagues having regard to the possibility of de-skilling during the period of your suspension.

This Panel notes the letter, dated 6 March 2007, from Mr D, a Consultant Ophthalmic Surgeon at the Viewpoint Clinic. He stated that he had been aware of your suspension and that you had been working as a technician since that date. He confirmed that you had not given any clinical advice to patients during that time and had worn a name badge clearly stating that you were a technician. Mr D also recorded that you had attended various meetings throughout the period of your suspension, had taken the opportunity to read and summarise at least nine articles per month from leading ophthalmic journals which had kept you up to date with current day activities in ophthalmology and that you had dealt with patient administration.

Mr D has provided oral evidence at this hearing. He stated that he would be willing to supervise you for a period of one to two months, or as long as necessary, should the Panel allow you to return to medical practice.

Mr E, Consultant Ophthalmic Surgeon at the Viewpoint Clinic, in a letter of 12 March 2007, concurred with the observations made by Mr D stating that you had made serious efforts to address your education in the areas of your faults and had prepared yourself for re-establishing your career.

The Panel has noted your written submission, dated 12 March 2007, in which you stated that you deeply regretted your actions and made assurances that you will not repeat your behaviour. The Panel considers that you have demonstrated insight into your behaviour.

The Panel has also been provided with numerous supportive testimonials from professional colleagues and patients who attest to your competence as a doctor and to your conduct in the interval since the previous hearing. In addition, it has been assisted by the oral evidence of Mrs F, Mr G and Mr H.

With regards to the steps you have taken to keep your medical knowledge up to date, Mr Main, on behalf of the GMC stated that the files you had provided were, “extraordinary and impressive” and indeed, were the best he had seen.

This Panel has examined the content of your personal development plan. It provides detailed evidence of your continuing professional development, including your attendance at conferences and on courses. It also provides a summary of the reading and professional development exercises you have undertaken to address those areas identified by the previous Panel as being a cause for concern. Taken together, the evidence you have presented at this hearing assures the Panel that you have maintained your medical knowledge since the suspension of your registration. The Panel is therefore satisfied that you have provided all the information requested of you by the previous Panel and commends you on the steps you have taken since May 2006.

In relation to impairment, Mr Main submitted that the Panel had to make a determination as to whether your fitness to practice is impaired. Mr Forde submitted, on your behalf, that it is was not necessary for the Panel to consider the issue of impairment and, as such, it should move directly to Rule 22 (g) of the procedure rules to determine whether it is necessary to impose a sanction in this case. The Panel accepted the advice of the Legal Assessor that it should first consider whether your fitness to practice is impaired.

In determining whether your fitness to practise is impaired the Panel had regard to all the evidence. The Panel noted Mr Main’s submission that the GMC took a “neutral” position on the issue of impairment. It also had regard to your recognition, through Mr Forde, of the serious nature of the previous actions which brought you before the GMC, and your acceptance that the Panel may have concerns about you returning to unrestricted practice.

The Panel has had regard to the GMC’s Indicative Sanctions Guidance which indicates that a question of impairment arises where the concerns 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 had regard to the guidance, in relation to review hearings, which states:

“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.”

The Panel is satisfied that you now appreciate the gravity of the matters that led to the suspension of your registration, that you have addressed those matters, and that you have shown insight into your actions.  Having considered all the evidence the Panel has determined that your fitness to practise is not impaired. The Panel considers that the period of suspension imposed upon you has sufficiently marked the seriousness of the misconduct that was considered by the previous Panel.

Having determined that your fitness to practise is not impaired the Panel went on to consider whether it is necessary to make a further direction under Section 35D (5) of the Medical Act 1983. The Panel considers that it is in the public interest to impose conditions on your registration to ensure you regain all the necessary skills that are required by a Consultant Ophthalmic Surgeon, through supervision and mentoring, before returning to unrestricted practice.

The Panel will now invite further submissions from Mr Main and Mr Forde as to the suggested nature and duration of those conditions, and as to whether your case should be reviewed.”

Determination on sanction

“Dr Chitkara: The Panel has determined and announced that your fitness to practise is not impaired. The Panel has also announced that it is necessary, in the public interest, to impose conditions on your registration before you return to unrestricted practice.

The Panel has considered the submissions made by Mr Main, QC, on behalf of the General Medical Council (GMC) and those made by Mr Forde, QC, on your behalf, as to the appropriate conditions to impose in this case. It has also been guided by the advice of the Specialist Performance Adviser, Mr A. It has noted the guidance contained within the GMC’s Indicative Sanctions Guidance – April 2005.  The Panel is conscious of the fact that the purpose of any sanctions is not to be punitive, but to protect patients and the public interest. 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.

In his letter dated 6 March 2007, Mr D, Consultant Ophthalmic Surgeon at the Viewpoint Clinic stated that he would be happy to supervise you for a period of one to two months, or until such time that he felt that your expertise had returned. Mr D has provided oral evidence at this hearing, during which he confirmed this position. Mr D recommended that you undertake the following procedures under his supervision:

• 5 to 10 cases of laser refractive surgery
• 6 cases of intraocular surgery

Mr D told the Panel that he would provide the GMC with written confirmation of your completion of these supervised operations.

Mr A, Specialist Performance Adviser, concurred with Mr D’s suggestion that your initial surgical procedures be supervised as described above, and was of the opinion that once those procedures had been carried out you would have sufficient skills to enable you to undertake unrestricted practice.

The Panel has noted, and is encouraged by, the steps you have taken to maintain your medical knowledge and skills. The Panel considers that you require a period of conditional registration to enable you to return to unrestricted practice. The Panel has therefore determined that it is appropriate to impose the following condition on your registration for a period of three months:

1.         Your initial 10 cases of laser refractive surgery and 6 cases of intraocular surgery must be performed under the direct supervision of Mr D.

The Panel next considered whether it should exercise its powers to order a review of your case.  The Panel determined that, as the primary reason for imposing a period of conditional registration is to protect the public interest during the short period of time needed for you to regain all the necessary skills that are required by a Consultant Ophthalmic Surgeon, no purpose would be served by holding a review hearing of this case before the end of the period of conditional registration.

The effect of the foregoing direction is that unless you exercise your right of appeal, your registration will become subject to the specified condition 28 days from when this notice is deemed to have been served upon you.  A note explaining your right of appeal will be supplied to you. In the mean time your registration will remain suspended by virtue of the decision of the Fitness to Practise Panel on 5 May 2006.”

Confirmed

15 May 2007                                                                                                             

Chairman

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