Dr Mohamed Ahmed

Profession: Biomedical scientist

Registration Number: BS53388

Hearing Type: Review Hearing

Date and Time of hearing: 12:00 30/03/2016 End: 14:30 30/03/2016

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Struck off

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Allegation

 

In the course of your employment as a Biomedical Scientist at Trafford Healthcare NHS Trust between February 2009 and January 2010:

1. You failed to report sample tests in a timely and accurate manner, in particular:

a. You failed on two occasions, 9 and 10 July 2009, to report an incidence of N. gonorrhoea identified by you in slide samples 28226 and 28227

b. In slide sample 146878;

i. Your failure to record various test results on time caused the final results to be reported after 12 days, which was an unacceptable delay.

 

2. In blood culture and ICU samples processed during your induction in April 2009:

a. You failed to send out a timely report on a probable paratyphi A Salmonella in relation to slide sample 7666;

c. You failed to record test results in the reporting system;

d. You failed to do an Aesculin test although you recorded this on the reporting system;

e. You failed to do a controlled sens test on a blood culture sample with a coliform, even though a direct sens test had been done;

f. You failed to send out an interim report of the results of the direct sens test in (e) above;

g. You failed to report on two sets of blood cultures that showed probable positives for blood contaminants;

h. You failed to record on the reporting system that organisms had been beaded;

i. You recorded on the reporting system that no anaerobes were present although you had not done the relevant test;

j. You left blood culture bottles out overnight without reason;

k. You failed to follow up a report of Streptococcus sp on samples with further identification tests;

m. You failed to send an interim report on Enterococcus sp present on a Cath tip;

n. You recorded results as '3 types of cols' and 'mixed organisms' without giving further detail;

o. You discarded the plates for the sample in (n) above at 24 hours instead of re- incubating them, which meant it was not possible to test and report on the sample at 48 hours;

i. You failed to record 24 hour results for sputum cultures or urine cultures with coliform growths to support an interim report.

 

3. You failed to identify common pathogens and parasites accurately, in particular:

a. On 24 April 2009 you failed to identify a growth of Moraxella on a sputum plate;

b. During May 2009 you were unable to describe or identify Campylobacter from a coliform by morphology;

c. During May 2009 you were unable to distinguish Giardia cysts from common yeast cells in a faecal wet prep sample;

d. During May 2009 you were unable to differentiate between Cryptosporidium and a yeast cell;

e. During May 2009 you were unable to identify E.coli and E. histolytica cysts, as well as Giardia cysts, in sample 146814;

f. On 12 May 2009 you identified Giardia cysts in a sample referred as 'contact with Giardia' that on checking, proved to be negative for that parasite;

 

4. Your technique for preparing samples appropriately was inadequate, in particular:

a. During June 2009, you incorrectly sampled a deposit from a faecal sample by not pouring the Supernatant away;

b. On 1 June 2009, you incorrectly sampled a deposit from a bronchial washing sample by not removing the Supernatant and using a loop in a conical tube to extract the material;

c. On 2 June 2009, you incorrectly sampled a deposit from a faecal sample by not mixing the deposit.

 

5. The matters set out in paragraphs 1-4 above constitute a lack of competence

 

6. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

 

At the substantive hearing on 29 September 2011 the Panel found particulars 1 (a – b), 2 (a, e, f, g, h, i, j, k, m, n, o) 3(a – f), 4 (b - c) proved, amounted to lack of competence and the Registrant’s fitness to practise to be impaired which resulted in the Panel imposing a suspension order.

Finding

Preliminary Matters

 

Service

 

1.             The Panel was satisfied, on the basis of the available documents, that proper notification of this hearing had been given to the Registrant, in accordance with Rule 3 of The Health Professions Council (Conduct and Competence Committee) (Procedure) Rules Order of Council 2003 (“the Rules”).

 

Proceeding in absence

 

2.             The Registrant was neither present nor represented. Mr Thompson, on behalf of the HCPC, made an application that the Panel hears the case against the Registrant in his absence. He submitted that the Registrant was fully aware of the hearing but had chosen not to attend. Although the Registrant had indicated a wish to participate by telephone, Mr Thompson drew the attention of the Panel to emails which had twice been sent to the Registrant asking for a telephone number, but that no telephone number had been received. Mr Thompson further submitted that there was a public interest in the expeditious disposal of cases and reminded the Panel that the review of this order prior to its expiry was mandatory.

 

3.             The Panel heard and accepted the advice of the Legal Assessor. It noted that proceeding in the absence of the Registrant was a discretion which must be exercised with the utmost care and caution.

 

4.             At the Panel’s request, the Hearings Officer attempted to telephone the Registrant on the number held on the HCPC’s database. The Panel was informed that the number was no longer in service.

 

5.             The Panel considered the application very carefully. It noted that the Registrant had participated by telephone at the last hearing in 2014. It further noted that the HCPC had requested a telephone number from the Registrant but that he had not responded to that repeated request. The Panel concluded that the Registrant was aware of the hearing and had chosen voluntarily to absent himself from it. There was no request for an adjournment and the Panel was of the view that even if it did adjourn the case today, there was no indication that the Registrant would attend on the next occasion. The Panel was aware that this was a mandatory review and that the substantive conditions of practice order had to be reviewed prior to its expiry on 28 April 2016. It noted that it had the benefit of the Registrant’s brief written submissions as to his view of the appropriate outcome today and that it would be able to take those submissions into account. The Panel also considered the fact that if any decisions are reached today which are adverse to the Registrant, he has the right to request an early review under Article 30(2) of the Order.

 

6.             In all the circumstances, the Panel determined that it was fair, appropriate and in the interests of justice to proceed in the Registrant’s absence.

 

 

Background

 

7.             At the substantive hearing the Registrant’s fitness to practise was found to be impaired in the light of a number of allegations relating to his clinical competence whilst working as a senior biomedical scientist at Trafford General Hospital from April to July 2009. That Panel found in a large number of cases the Registrant had failed to record samples accurately or on time, including blood, faecal, sputum and urine samples from patients in ITU and from Wards. He failed to identify common pathogens and parasites and the Panel found that his technique in preparing samples was inadequate. The Panel at the substantive hearing concluded that the Registrant’s clinical competence had fallen far short in a number of ways, he had displayed careless and dangerous practices, and there were disturbing shortfalls in his fundamental biomedical knowledge and practice relative to basic medical laboratory testing and analysis. The failings were so serious that his fitness to practise was impaired and a suspension order imposed.

 

8.             At the last review hearing on 4 April 2014, the Panel determined that the Registrant’s fitness to practise remained currently impaired. That Panel was in a position to hear directly from the Registrant by telephone and assess how he had reflected on past events and it concluded:

 

“…whilst the Registrant may express the view he is working in surroundings which might have some equivalence to practice in the United Kingdom (UK), there is an inevitable lack of tangible evidence of which to verify that comparison. Whilst it must be remembered that a Registrant could choose to work abroad and return to work in the UK without such enquiries made by the regulator, this Panel must give consideration to current impairment of fitness to practise taking all matters into account including the significant lack of competence findings made in 2011. In light of the same, whilst acknowledging the Registrant has done a great deal to explain the nature of his current practice and keeping his knowledge and skills up-to-date, it must conclude when considering his fitness to practise in terms of competence, that his practice is currently impaired. In light of this, the Panel has reminded itself of the Indicative Sanctions practice note and considers a Caution Order would be ineffective as there remains a risk to patients and public interest if the Registrant were allowed to practise without restriction at this time.

 

Taking account of the need to protect patients’ safety and maintain public confidence in the profession and the regulator, the Panel considers a Conditions of Practice Order to be a necessary and proportionate response.”

 

9.             However, that Panel also commented:

 

“The Panel went on further to consider whether a period of suspension would be necessary and proportionate, but considered that such an Order would be disproportionate given the Registrant’s current work to-date and the Panel’s confidence that he would comply with conditions in order to return to safe practice in the UK.”

 

 

Decision

 

10.           The Panel has paid careful attention to the earlier Panel decisions in this case, the documentation provided by the parties and the submissions of Mr Thompson on behalf of the HCPC. It has also considered the written comments of the Registrant contained within his emails to the HCPC as recently as 27 March 2016. It has accepted the advice of the Legal Assessor and has consulted and applied the HCPC’s Indicative Sanctions Policy, whilst coming to its own independent decision.

 

11.           The Panel first considered whether the Registrant’s fitness to practise remains currently impaired.

 

12.           The Panel was of the view that the serious shortcomings identified in the Registrant’s practice were capable of remediation. However, there was no evidence before the Panel that any of the failings had been remediated. The Panel noted the CPD certificates previously submitted by the Registrant to the 2014 Panel. It had some concerns about the provenance and authenticity of the certificates due to, for example, basic spelling errors contained within the certificates and the appearance of some of the signatures purporting to come from the same person. However, notwithstanding those concerns, in this Panel’s judgement the certificates do not focus on those elements of the Registrant’s practice which were in need of remediation. Furthermore, the Panel was very concerned that the most recent CPD certificate was from December 2013, before the last review hearing, and that there had been no further certificates submitted since that date.

 

13.           In the Panel’s judgement, the findings of fact by the substantive Panel demonstrated serious failings in the Registrant’s practice. Those failings put patients at significant risk of harm, brought the profession into disrepute and breached fundamental tenets of the profession. In the absence of any significant remediation the Panel was extremely concerned that those failings, if repeated, would do so again.

 

14.           The Panel took into account the Registrant’s “Statement of case” which he had provided to the last reviewing Panel. This Panel was concerned that the statement failed to demonstrate adequate insight on the part of the Registrant into his failings. Since that statement there had been no further detailed reflection on the part of the Registrant. There has been no evidence submitted by him to show that he has developed an understanding of the seriousness of his failings and no real engagement by him with his regulator or profession other than to indicate a desire for voluntary removal from the HCPC register or an extension of the current conditions of practice order for two years.

 

15.           The Panel noted the confidence that the previous Panel had expressed that the Registrant comply with the conditions of practice in order to return to safe practice in the UK. Although acknowledging the difficulty in obtaining a professional post in the UK whilst subject to conditions of practice, the Panel was very concerned that in almost two years the Registrant had not worked in the UK as a biomedical scientist, which would have allowed him the opportunity to demonstrate a willingness to remediate and a commitment to the profession. Neither had the Registrant submitted any evidence of any jobs which he had applied for.

 

16.           In all the circumstances, in the absence of any remediation, insight or reflection, the Panel determined that the Registrant’s fitness to practise remains currently impaired.

 

17.           The Panel then considered what sanction, if any, to impose. It bore in mind that any sanction must be proportionate and must balance the public interest with the Registrant’s own interests in practising his chosen profession. The Panel reminded itself that, although not intended to be so, a sanction may inevitably be punitive. It therefore carefully considered what sanction was the most appropriate with the least restriction in all the circumstances of this case.

 

18.           The Panel concluded that a caution order would be wholly inappropriate as it would not protect the public from the risks which it has already identified exist by the Registrant continuing to practise without restriction. Nor would such a sanction be appropriate in the public interest; public confidence in the profession and in the regulatory process would be seriously undermined if a caution order was imposed in these circumstances.

 

19.           The Panel next considered whether to extend the current conditions of practice order. Although the previous Panel considered that conditions of practice were workable, that decision was based upon the Registrant’s indication that he still wished to work in the UK and had demonstrated a willingness to comply with conditions. However, this Panel came to the conclusion that the Registrant’s request in his email of 27 March 2016 to the HCPC to “either keep the current conditions for another 2 years (this will give me a better chance to reapply for jobs in the UK as a band 5 BMS and later, hopefully, lift off the conditions order) OR voluntary [sic] remove my name from the HCPC register and I will reapply to join the register after 5 years from the day of voluntary removal as per terms and conditions” was lacking in any credible demonstration that he would comply with any conditions this time around.  The Panel noted that the Registrant had been out of practice as a biomedical scientist in the UK since September 2011. The Panel was concerned that the Registrant had significantly de-skilled in that period. It therefore came to the conclusion that to extend the conditions of practice for a further period would fail to achieve any useful outcome and would only increase the risk of a repetition of the failures which are yet to be remediated.

 

20.           The Panel next considered whether to impose a suspension order.  It noted that the Registrant was suspended from practice by consecutive Panels of the Conduct and Competence Committee between 2011 and 2014 and that little has been gained as a result.  The Panel considered carefully whether anything would now be achieved by a further period of suspension. It had no evidence that the Registrant would take the opportunity of a suspension order to address the serious issues which have been outstanding since 2011 and nothing would be gained by imposing yet another suspension order upon the Registrant’s registration. It therefore determined that a suspension order was neither proportionate nor appropriate in all the circumstances of this case.

 

21.           Having considered carefully and ruled out any lesser sanction, the Panel was left with no alternative other than to impose a striking-off order. In order to satisfy itself that such a sanction was, indeed, the only appropriate outcome, the Panel reminded itself that serious professional failings had been identified which have not been remediated, that the Registrant has shown very limited insight and that although there has been some engagement with the HCPC, in the Panel’s view such engagement has been superficial. The Panel concluded that there had been no real reflection by the Registrant on the findings of the previous Panels or of the impact of his failings upon patients and the profession generally. 

 

22.           The Panel considered the professional and reputational hardship which a striking off order may have upon the Registrant but in all the circumstances the need to protect the public, to maintain public confidence in the profession and declare and uphold proper standards of conduct and performance outweighed the Registrant’s interests in this regard.

Order

That the Registrar is directed to strike the name of Mr Mohamed Ahmed from the Register on the expiry of the existing order, namely 28 April 2016.

Notes

This Order will come into effect on expiry of the current Order on 28 April 2016.

Hearing History

History of Hearings for Dr Mohamed Ahmed

Date Panel Hearing type Outcomes / Status
30/03/2016 Conduct and Competence Committee Review Hearing Struck off