Fitness to PractiSe Panel
23 to 26 may 2011
7th Floor, St James’s Buildings, 79 Oxford Street, Manchester, M1 6FQ
Room 12
Name of Respondent Doctor: Dr Ugorji Timothy Wilson ONYEANI
Registered Qualifications:MB BS 2003 University of Nigeria
Area of Registered Address:East Ayrshire
Reference Number: 6096388
Type of Case: New case of impairment by reason ofmisconduct
Panel Members:Dr H Marcovitch, Chairman (Medical)
Dr A Goldstein (Medical)
Mr I Ashraf (Lay)
Legal Assessor: Mr A Webster
Secretary to the Panel:Ms V Bean
Representation:
GMC: Mr Hugh Davies, Counsel, instructed by GMC Legal
Doctor: Not present and not represented
allegation
“That being registered under the Medical Act 1983, as amended:
1.Between 6 August 2008 and 25 January 2009, you were employed as an FTSTA1 (ST1) in the Department of Neurosurgery by NHS Greater Glasgow and Clyde Health Board (the Trust); Found proved
2.a.Whilst on paid parental leave from the Trust you worked agency shifts for Medacs Healthcare as follows
At Glasgow Royal Infirmary on:
i.17 September 2008 from 08.00 – 17.00, Found proved
ii.18 September 2008 from 08.00 – 17.00, Found proved
At Victoria Infirmary on:
iii.19 September 2008 from 20.00 – 09.30, Found proved
iv.20 September 2008 from 20.00 – 09.30;Found proved
b.You were paid for the Medacs Healthcare work set out in 2(a); Found proved
3.You submitted mileage claims to Medacs Healthcare as follows
a.17 and 18 September 2008 from Brighton to Glasgow, 576 miles at 23pence per mile (totalling £132.48), Found proved
b.19, 20 and 21 September 2008 from Southampton to Glasgow, 854520miles at 23 pence per mile (totalling £196.42£119.60), Found proved, as amended
c.27 September 2008 from Carlisle to Kilmarnock, 160 miles at 23pence per mile (totalling £36.80), Found proved
d. 17 October 2008 from Brighton to Glasgow, 770 miles at 23pence per mile (totalling £177.10), Found proved
e.18 October 2008 from Brighton to Glasgow, 672 miles at 23pence per mile (totalling £154.56), Found proved
f.19 October 2008 from Brighton to Glasgow, 870 miles at 23pence per mile (totalling £200.10), Found proved
g.2 November 2008 from Southampton to Glasgow, 1,0041,200miles at 23pence per mile (totalling £230.92£276.00); Found proved, as amended
4.a.In relation to each of the claims set out at 3(a) to 3(g) only mileage from Kilmarnock to Glasgow was payable, Not found proved
b.a mileage claim of about 1838miles would have been appropriate at 23pence a mile (totalling about £4.14£8.74); Not found proved
5.On Sunday 2 November 2008 you
a.were scheduled to be on duty at the Trust in the Department of Neurosurgery at the Southern General Hospital from 08.30 until 21.30, Found proved
b.undertook a shift for Medacs Healthcare commencing at 20.00 in Glasgow Royal Infirmary, Found proved
c.worked consecutively for a 26 hour period which ended at 10.30 on 3November 2008; Found proved
6.Whilst suspended from duty you submitted a medical certificate to the Trust dated 16 January 2009, which you knew had been altered; Found proved
7.Your conduct as set out in paragraphs 2, 3, 5 and 6 was
a.dishonest, Found proved
b.misleading; Found proved
8.In relation to paragraph 5 your conduct was not in the best interests of patient care; Found proved
And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct.”
Determination on facts
“Mr Davies: At the outset of these proceedings, the Panel determined that notice of this hearing was properly served upon Dr Onyeani, in accordance with Rule 40 of the General Medical Council (Fitness to Practise) Rules 2004 (“the Rules”), and it determined to proceed in his absence.
The Panel has borne in mind that Dr Onyeani is neither present nor represented during these proceedings. It has drawn no adverse inference from his absence.
The Panel has given consideration to all the evidence adduced in this case, both oral and documentary, and to the submissions made by you, on behalf of the General Medical Council (GMC). It has also taken account of the correspondence from DrOnyeani to the GMC, dated 19 and 20 May 2011.
The Panel found each of the witnesses to be credible.
You applied to amend the following paragraphs of the allegation: Paragraphs 3(b), 3(g) and 4(b). The Panel determined that these amendments could be made without injustice to the doctor and so acceded to your application.
The Panel has considered each paragraph of the allegation separately. It has made the following findings on the facts:
Paragraph 1
“Between 6 August 2008 and 25 January 2009, you were employed as an FTSTA1 (ST1) in the Department of Neurosurgery by NHS Greater Glasgow and Clyde Health Board (the Trust);”
has been found proved.
The Panel has had regard to Dr Onyeani’s employment confirmation letter of 3July2008 from the Greater Glasgow and Clyde NHS Board (“the Health Board”). It has also had regard to the letter of 1 February 2009 from the Health Board confirming the date of DrOnyeani’s resignation.
Paragraphs 2(a)(i) to (iv):
“Whilst on paid parental leave from the Trust you worked agency shifts for Medacs Healthcare as follows
At Glasgow Royal Infirmary on:
i.17 September 2008 from 08:00 – 17:00,
ii.18 September 2008 from 08:00 – 17:00,
At Victoria Infirmary on:
iii.19 September 2008 from 20:00 – 09:30,
iv.20 September 2008 from 20:00 – 09:30;”
have been found proved.
The Panel has noted Dr Onyeani’s completed application form for parental leave in September 2008. The Panel accepted the oral evidence of Mr A, Consultant Neurosurgeon, who was in charge of the staff rota at the relevant time. He confirmed the dates of Dr Onyeani’s parental leave.
In respect of the dates of agency work, as set out in paragraph 2(a), the Panel has had regard to the timesheets completed and signed by Dr Onyeani and the subsequent invoices from Medacs Healthcare to the relevant hospital for the hours claimed.
Paragraph 2(b):
You were paid for the Medacs Healthcare work set out in 2(a);
has been found proved.
The Panel has received evidence of Dr Onyeani’s claims for the shifts set out in 2(a) and the corresponding invoices from Medacs. It has heard the oral evidence of Mrs B, an employee of Medacs, regarding the mechanism for payment of locums placed by Medacs. The Panel has taken account of the witness statement of Mrs B, which DrOnyeani gave his unqualified willingness to be presented to this Panel. This statement confirms the payment history for Dr Onyeani in the tax year 2008 and exhibits details of payments made to him for the weeks ending 18 and 27September 2008 respectively.
Paragraphs 3(a) to (g):
“You submitted mileage claims to Medacs Healthcare as follows
a.17 and 18 September 2008 from Brighton to Glasgow, 576 miles at 23pence per mile (totalling £132.48),
b.19, 20 and 21 September 2008 from Southampton to Glasgow, 854520 miles at 23 pence per mile (totalling £196.42£119.60),
c.27 September 2008 from Carlisle to Kilmarnock, 160 miles at 23pence per mile (totalling £36.80),
d. 17 October 2008 from Brighton to Glasgow, 770 miles at 23pence per mile (totalling £177.10),
e.18 October 2008 from Brighton to Glasgow, 672 miles at 23pence per mile (totalling £154.56),
f.19 October 2008 from Brighton to Glasgow, 870 miles at 23pence per mile (totalling £200.10),
g.2 November 2008 from Southampton to Glasgow, 1,0041,200miles at 23pence per mile (totalling £230.92£276.00);”
have been found proved, as amended.
The Panel has had regard to the timesheets completed and signed by Dr Onyeani, which include details of the mileage claimed. The Panel has also had regard to the evidence of Mrs B as to the nature and use of the timesheets.
Paragraph 4(a)
“a.In relation to each of the claims set out at 3(a) to 3(g) only mileage from Kilmarnock to Glasgow was payable,”
has been found not proved.
The Panel has no evidence before it regarding the precise arrangements as to what a doctor is entitled to claim in travel expenses. In her oral evidence Ms C, Human Resources Manager for the Health Board, told the Panel that she thought it was expected that a doctor would claim travel from his home address to his place of work, although she could not advise the Panel of the terms of any policy on this. She acknowledged that, sometimes, there were exceptional circumstances and it was possible that alternate arrangements could be agreed by the doctor with the hospital. The Panel has no evidence before it from the hospitals involved.
Paragraph 4(b)
“b.a mileage claim of about 1838 miles would have been appropriate at 23pence a mile (totalling about £4.14£8.74);”
has been found not proved, as amended.
The Panel considered that this paragraph related to the claims as set out in paragraphs 3(a) to (g). The Panel has no evidence before it as to whether or not Dr Onyeani was entitled to claim mileage only from his home address.
Paragraphs 5(a) to (c):
“On Sunday 2 November 2008 you
a.were scheduled to be on duty at the Trust in the Department of Neurosurgery at the Southern General Hospital from 08:30 until 21:30,
b.undertook a shift for Medacs Healthcare commencing at 20:00 in Glasgow Royal Infirmary,
c.worked consecutively for a 26 hour period which ended at 10:30 on 3November 2008;”
have been found proved.
The Panel has had regard to the duty rota for the Department of Neurosurgery at the Southern General Hospital for November 2008, explained by Mr A, which confirms DrOnyeani’s shift on 2November 2008.
The Panel has had regard to the note taken by Ms C of Dr Onyeani’s comments on 9January 2009 at a Health Board investigatory meeting and the handwritten statement provided by DrOnyeani, dated 9 January 2009. These are inconsistent in respect of the actual times worked. The Panel has relied upon Dr Onyeani’s signed and submitted locum agency timesheet, which states that he commenced his shift at 20:00.
Paragraph 6:
“Whilst suspended from duty you submitted a medical certificate to the Trust dated 16January 2009, which you knew had been altered;”
has been found proved.
The Panel accepted the evidence of Dr D, General Practitioner, that she saw DrOnyeani on 6January2009 and dated the medical certificate accordingly.
The Panel considered it extremely unlikely that a qualified medical professional would fail to notice a discrepancy on a medical certificate with which he had been provided and which he submitted only after about two weeks. The Panel was satisfied that DrOnyeani knew that it had been altered.
Paragraph 7(a):
“Your conduct as set out in paragraphs 2, 3, 5 and 6 was
a.dishonest,”
has been found proved.
The Panel has followed the advice of the Legal Assessor in making its findings in respect of Dr Onyeani’s alleged dishonesty. Firstly, it should ask itself whether what the doctor did was dishonest by the standards of reasonable and honest people. Secondly, and only if it has satisfied itself in that matter, it should ask itself whether the doctor realised that what he was doing was dishonest by those standards.
Paragraph 7(a) in respect of paragraph 2
The Panel has heard that the Health Board’s parental leave policy specifically forbids undertaking employment whilst on parental leave. Dr Onyeani claimed he was unaware of the policy at the time but the Panel was satisfied that he should have done so. In addition, the parental leave application form Dr Onyeani completed makes clear the purpose of the leave.
Paragraph 7(a) in respect of paragraph 3(a)
The Panel heard evidence that Medacs was aware that DrOnyeani was staying in Southampton and it accepted that he may have been entitled to claim for the journey from Southampton to Glasgow. However, Dr Onyeani claimed mileage from Brighton to Glasgow and further claimed an extra 100 miles for that journey than is the stated to be the distance on the AA route planner.
Paragraph 7(a) in respect of paragraph 3(b)
This claim is for work undertaken in Glasgowcommencing 19 September 2008. The previous day, Dr Onyeani had been working at a different hospital in Glasgow, for which he had already claimed a journey from the south coast to Glasgow. As Dr Onyeani was already in Glasgow, the Panel found this claim to be dishonest. It considered the possibility that the claim may have been made for a return journey to Southampton but the mileage claimed for that journey was beyond that stated on the AA route planner.
Paragraph 7(a) in respect of paragraph 3(c)
The Panel noted the Medacs computer records which show that Dr Onyeani was offered this locum shift, by telephone, at 12.56 pm on 27 September 2008. The formal confirmation of this shift, dated 27 September 2008, gives the start time of the shift as 1.30 pm on that same day. DrOnyeani could not have made the journey from Carlisle to Kilmarnock, a distance of around 100miles, or even one half of that if the claim was for a return journey, in 30 minutes.
Paragraph 7(a) in respect of paragraph 3(d), (e) and (f)
The Panel found that it was neither possible nor feasible for Dr Onyeani to make three round trips between Southampton and Glasgow on three consecutive days, given the time available between each of the three locum shifts worked.
The Panel noted that, in his email to the GMC of 19 May 2011, Dr Onyeani claimed to have taken flights from Bournemouth to Glasgow in respect of some of these journeys. The Panel rejected this explanation as the timesheets claim mileage from Southampton to Glasgow and no flight details or receipts were submitted.
Paragraph 7(a) in respect of paragraph 3(g)
The Panel has evidence before it that Dr Onyeani did not travel from Southampton to Glasgow for this locum shift. That shift was scheduled to commence at 20:00 on 2November 2008. DrOnyeani must have been in Glasgow already as he was on duty at the Southern General Hospital in Glasgow until 21:30 that same day.
Paragraph 7(a) in respect of paragraph 5
Dr Onyeani agreed to a locum shift with the consequence that he was scheduled to be on duty,and therefore to be paid, at two separate hospitals simultaneously.
Paragraph 7(a) in respect of paragraph 6
The Panel has already found that Dr Onyeani knew that the medical certificate had been altered and was in no doubt that his submission of it was dishonest.
The Panel noted that Dr Onyeani initially blamed the alteration of the medical certificate on his children, who were aged two years and three months at that time. When challenged by Ms C as to the credibility of this, he then suggested that Dr D had made an error in dating.
The Panel did not find Dr Onyeani’s explanations credible.
Paragraph 7(b):
“Your conduct as set out in paragraphs 2, 3, 5 and 6 was
b.misleading;”
has been found proved.
Having found Dr Onyeani’s conduct as set out in these paragraphs to be dishonest, the Panel was in no doubt that they were also misleading.
Paragraph 8:
“In relation to paragraph 5 your conduct was not in the best interests of patient care;”
has been found proved.
By accepting to undertake a shift at one hospital before that at another was completed, there would have been an overlap period during which Dr Onyeani had a duty of care to patients in two different hospitals simultaneously, making it impossible for him to fulfil his duties as a doctor and so potentially placing patients at risk. The Panel has also heard of the importance to patient safety of the shift change handover. The Panel found that there was a risk that DrOnyeani’s actions endangered this essential process at one or both hospitals.
Having reached findings on the facts, the Panel will now invite you to adduce further evidence and make any further submissions as to whether, on the basis of the facts found proved, Dr Onyeani’s fitness to practise is impaired.”
Determination on impaired fitness to practise
“Mr Davies: The Panel has considered whether Dr Onyeani’s fitness to practise is impaired by reason of his misconduct, in accordance with Section 35C(2)(a) of the Medical Act 1983, as amended. In considering the question of impairment, the Panel has taken account of all the evidence, both oral and documentary, and your submissions, on behalf of the General Medical Council (GMC).
You submitted that Dr Onyeani’s fitness to practise is impaired by reason of his misconduct.
The issue of impairment is one for the Panel to determine exercising its own judgment. The Panel has taken account of the public interest which includes the need to protect patients and the public, to maintain public confidence in the profession, and to declare and uphold proper standards of conduct and behaviour.
The Panel first considered whether Dr Onyeani’s actions amounted to misconduct.
The Panel has made several findings of dishonesty in respect of Dr Onyeani’s conduct. These relate to his:
- undertaking paid locum work whilst on paid parental leave in direct contravention of the Greater Glasgow and Clyde Health Board’s policy;
- making false mileage claims to Medacs Locum Agency;
- undertaking overlapping paid shifts;and
- knowingly submitting an altered medical certificate to his employers.
The Panel has had regard to the GMC’s guidance entitled Good Medical Practice (2006). This guidance stresses the fundamental importance of honesty and integrity in the medical profession. Under the heading “The duties of a doctor registered withthe General Medical Council” it states:
“Patients must be able to trust doctors with their lives and health. To justify that trustyou must show respect for human life and you must:
…
Be honest and open and act with integrity
…
- Never abuse your patients’ trust in you or the public’s trust in the profession.”
Under the heading ‘Probity’, paragraphs 56 and 57 of Good Medical Practice (2006) state:
“Being honest and trustworthy
56.Probity means being honest and trustworthy, and acting withintegrity: this is at the heart of medical professionalism.
57.You must make sure that your conduct at all times justifiesyour patients’ trust in you and the public’s trustin the profession.”
Under the heading ‘Writing reports and CVs, giving evidence andsigning documents’ paragraphs 63 and 65 of Good Medical Practice (2006) state:
“63.You must be honest and trustworthy when writing reports,and when completing or signing forms, reports andother documents.
…
65.You must do your best to make sure that any documents youwrite or sign are not false or misleading. This means that youmust take reasonable steps to verify the information in thedocuments, and that you must not deliberately leave outrelevant information.”
Dishonest conduct in a doctor has the potential to damage the public’s perception of the profession as a whole.
The Panel has also found that Dr Onyeani’s actions in undertaking to work overlapping shifts at two separate hospitals was not in the best interests of his patients and had the potential to place patients at risk. Paragraph 3(h) of Good Medical Practice (2006) states:
“In providing care you must:
h.be readily accessible when you are on duty”
In particular, the Panel was concerned that Dr Onyeani’s actions potentially endangered the shift handover process at one or both hospitals. The Panel has heard that the handover process is a vital aspect of good patient care. Under the heading “Sharing information with colleagues”, paragraph 50 of Good Medical Practice (2006) states: