PUBLIC

Fitness to PractiSe Panel of the

medical practitioners tribunal service

13 dECEMBER 2013

7th Floor, St James’s Buildings, 79 Oxford Street, Manchester, M1 6FQ

Name of Respondent Doctor: Dr Krishnamurthy SRIKANTH

Registered Qualifications: MB BS 1992 University of Madras

Area of Registered Address: India

Reference Number: 5203326

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

Panel Members: Mrs Ailsa Granne, Chairman (Lay)

Dr Norman Gourlay (Medical)

Miss Anne Robertson (Medical)

Legal Assessor: Mr Douglas Hogg, QC

Secretary to the Panel: Mrs Rebecca Faulkner

Representation:

GMC: Mr Hugh Davies, Counsel, instructed by GMC Legal

Doctor: Dr Srikanth is neither present nor represented.

Determination on impaired fitness to practise

1. Mr Davies: Dr Srikanth is neither present nor represented at these proceedings today. The Panel has considered whether notice of this hearing had been properly served upon him in accordance with Rule 20 and Rule 40 of the General Medical Council (Fitness to Practise) Rules 2004 (“the Rules”) and Schedule 4, Paragraph 8 of the Medical Act 1983 (as amended). In so doing, the Panel has taken into account all the information placed before it, together with your submissions on behalf of the General Medical Council (GMC).

2.The Panel has had regard to the GMC’s notice of hearing recorded letter dated 1 November 2013 , sent to Dr Srikanth’s registered address informing him of today’s hearing. Whilst the letter was undelivered, delivery had been attempted, as required to Dr Srikanth’s registered address. The Panel has noted that the notice of hearing was also sent by the MPTS on 1 November 2013 to an active email address. Dr Srikanth responded and acknowledged the notice of hearing on 14 November 2013. Further, a letter dated 12 December 2013 from Ward Hadaway Law Firm, on behalf of Dr Srikanth, confirms that they have instructions from Dr Srikanth to the effect that he has been properly served with notification of the hearing.

3. In the light of the above the Panel is satisfied that the notice of this hearing was properly served upon Dr Srikanth.

4. The Panel next considered whether to proceed with this hearing in the absence of Dr Srikanth, in accordance with Rule 31.

5. The Panel has borne in mind that it has a discretion to continue a hearing in the practitioner’s absence, though this is to be exercised with “the utmost care and caution” and with close regard to the overall fairness of the proceedings. It has balanced the interests of the practitioner with the public interest in having this case heard.

6. The Panel has had regard both to Dr Srikanth’s email acknowledgement of notice to the MPTS of 14 November 2013 and the letter dated 12 December 2013 from Ward Hadaway Law Firm confirming service of notification. The Panel also took into account the email dated 12 December 2013 from Dr Srikanth to the GMC. Dr Srikanth has not applied to adjourn the hearing. The Panel is of the view that Dr Srikanth is aware of these proceedings today and that he has voluntarily waived his right to attend or be represented. The Panel also notes that written submissions have been made by Ward Hadaway Law Firm on Dr Srikanth’s behalf for the Panel to consider.

7. In all the circumstances the Panel has determined that it is fair and in the interests of justice to proceed with the hearing in Dr Srikanth’s absence. The Panel wishes to emphasise that it draws no adverse inference from his absence.

8. The Panel has reviewed the background of Dr Srikanth’s case which was first considered by a Fitness to Practise Panel in December 2012 (the 2012 Panel). On 7 December 2009, Patient A, having been diagnosed with carcinoma, was scheduled to undergo a planned hemicolectomy. On 2 December 2009, at Dr Srikanth’s request, Dr C, a specialist Registrar undertook a pre-operative assessment of Patient A. The plan included “laryngectomy tube once asleep”.

9. Dr Srikanth made partial admissions, including that on the morning of the planned surgery, he did not read Patient A’s notes and did not examine him in sufficient detail to note his history of a total laryngectomy. Dr Srikanth admitted that he attempted to intubate the trachea through the mouth, attempted to ventilate Patient A with a bag and face mask and instructed Operating Department Practitioner (ODP) Ms A to cover the site of the tracheostomy whilst he attempted intubation. Further, Dr Srikanth admitted to discarding, after the incident, the original anaesthetic chart and a second version of the anaesthetic chart. It was found by the 2012 Panel that Dr Srikanth had made an attempt to persuade ODP Ms A to provide a misleading report.

10. The 2012 Panel determined that Dr Srikanth’s conduct fell far below the standard expected of a registered medical practitioner and therefore amounted to serious misconduct. The 2012 Panel considered that his errors related primarily to his clinical practice, and were theoretically remediable. However the Panel also bore in mind the issue of probity in that Dr Srikanth attempted to persuade ODP Ms A to provide a misleading report. The 2012 Panel considered that Dr Srikanth presented a risk to patients as it was not satisfied his behaviour would not be repeated, and that his fitness to practise was impaired by reason of his misconduct.

11. The 2012 Panel determined that, in light of Dr Srikanth’s acceptance of his error, his remorse shown and the steps he had taken toward remediation of his failings, Dr Srikanth would be made subject to conditional registration for a period of 12 months. The 2012 Panel considered that this period of conditional registration would allow Dr Srikanth the opportunity to continue a programme of re-skilling and to demonstrate that his clinical failings had been rectified.

12. In order to assist the Panel at this review hearing today, that 2012 Panel suggested Dr Srikanth should provide the following information:

·  Evidence of any educational/training courses completed and how he has benefitted from them

·  Reports from his named supervisors specifically referring to the issues arising from the allegations found proved.

13. This Panel has met today to review Dr Srikanth’s case. It has considered, under Rule22(f) of the Rules, whether his fitness to practise is impaired by reason of his misconduct. In doing so it has taken account of all the evidence placed before it, Mr Davies submissions on behalf of the GMC, the written submissions made by Mr Stuart Sutton, Ward Hadaway Law Firm on behalf of Dr Srikanth and the information from Dr Srikanth as set out in his email to the GMC dated 12 December 2013.

14. You submitted on behalf of the GMC that there has been no meaningful contact with Dr Srikanth since August 2013. There is information from Dr Srikanth to the effect that he is employed in India, but you cannot confirm the nature of work he may be undertaking there. You submitted that no positive case in regard to addressing impairment has been put forward by or on behalf of Dr Srikanth.

15. You submitted that the incident before the 2012 Panel was of a very serious clinical nature, with a number of facets, including lack of probity. You submitted that there has been no progress or evidence of remediation, equally no evidence of insight. Further you submitted that the factors which indicated impairment in 2012 are still present.You submitted that as of December 2013, Dr Srikanth’s fitness to practise is impaired. You made no submission on a breach of conditions by Dr Srikanth.

16. The Panel has had regard to Dr Srikanth’s written submissions to the GMC dated 12 December 2013. Dr Srikanth states that he continues to work outside of the NHS and is keen to continue his clinical and academic practice. He reports that he is employed by the Madras Medical Mission, India and states that he has been offered further placements in places such as the Middle East and Papua New Guinea. Dr Srikanth writes that he is “slightly perturbed with the review hearing as well as I understand all followed the incident on 7 December 2009, but I had been moving between jobs and will require more time to give evidence to the GMC in the form of feedback and appraisals and there of (sic) (…) In the current situation I am keen to maintain the conditions and there of (sic) will revaluate and with progress of more time I will give more evidence to the GMC…” Dr Srikanth states that he will attend a review hearing as soon as he secures a placement to work within the NHS.

17. The Panel has considered the submissions in the letter dated 12 December 2013 from Ward Hadaway Law Firm on behalf of Dr Srikanth. The letter reports that Dr Srikanth presently practises outside the UK, and has no present intention to return, although he does hope to do so one day. It is submitted that Dr Srikanth has been compliant with the conditions on his registration.

18. Whilst the Panel has borne in mind the submissions made, the decision as to whether Dr Srikanth’s fitness to practise is impaired is one for it to reach, exercising its own judgement.

19. The Panel has noted that the GMC has written to Dr Srikanth on a number of occasions since the conclusion of his hearing in December 2012. In response to a request from Dr Srikanth, the GMC , in an email of 28 May 2013 gave examples of acceptable evidence related to remediation, including certificates of attendance and/or feedback from courses he may have attended, a reflective diary addressing the issues which led to his referral, and discussing probity issues identified at the original hearing with his workplace supervisor.

20. Dr Srikanth was appointed as locum consultant anaesthetist from 18/19 March to 31 July 2013 with the University Hospitals Morecambe Bay NHS Foundation Trust, supervised by Dr B, Consultant Anaesthetist & Associate Medical Director. The Panel has noted that two supervisor’s reports have been supplied today, namely those of Dr B, dated 18 May 2013 and 26 July 2013. In response to a specific question, raised in the Work Place Report Form of 18 May 2013, Dr B indicated that Dr Srikanth had no specific educational targets but had agreed a Personal Development Plan. Dr B reported that Dr Srikanth had been compliant with his conditions. The Panel has noted that no subsequent evidence has been presented in relation to the implementation of the Personal Development Plan.

21. The Panel accepts that there has been no breach of conditions, in that Dr Srikanth informed the GMC of his intention to work in India, which the Panel treats as compliance with condition 4 of the order of conditions. The Panel considers that it has not been provided with evidence of retraining, reflection or remediation as recommended by the 2012 Panel. As a result the Panel considers that Dr Srikanth has made no progress since his original fitness to practise hearing towards either clinical or educational remediation and it cannot be satisfied that his situation has changed, far less improved. The Panel is concerned that Dr Srikanth still appears to have limited insight into his remediation. In the absence of sufficient evidence of remediation and insight, the Panel is concerned about the risk of repetition. The Panel also considers that Dr Srikanth, and his legal representatives, in submitting that he would accept a continued order of conditions, are impliedly accepting that his fitness to practise remains impaired.

22. In all the circumstances the Panel has therefore determined that Dr Srikanth’s fitness to practise is impaired by reason of his misconduct, pursuant to Section 35C(2)(a) of the Medical Act 1983, as amended.

Determination on sanction

1. Mr Davies: Having determined that Dr Srikanth’s fitness to practise is impaired by reason of misconduct, the Panel has now considered what action, if any, it should take with regard to his registration.

2. The Panel has given careful consideration to all the evidence adduced, together with your submissions on behalf of the General Medical Council (GMC) and those made in writing by and on behalf of Dr Srikanth.

3. You submitted that an order of at least suspension should be imposed. You stated that there is no evidence that Dr Srikanth understands the failings which have been identified in his practice, and that on the basis of the evidence before the Panel, it is impossible to conclude that he has adhered to the principles of Good Medical Practice. You submitted that there is no objective evidence to demonstrate that Dr Srikanth has embarked on any remedial action, nor any evidence to suggest that Dr Srikanth has displayed insight.

4. You submitted that the GMC are particularly concerned that any conditions should be workable or measurable. You noted that Dr Srikanth has expressed a desire to return to work in the UK. You submitted that in all the circumstances an order of suspension was appropriate.

5. Both Dr Srikanth and his legal representatives submitted that an order of conditions could be continued.

6. The decision as to the appropriate sanction, if any, to impose in this case is a matter for this Panel exercising its own judgement.

7. In reaching its decision, the Panel has taken account of the GMC’s Indicative Sanctions Guidance (revised August 2009 and March 2012) (ISG). It has borne in mind that the purpose of sanctions is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect.