PUBLIC RECORD · 2020. 11. 26. · Dr Francisca UGWU GMC reference number: 7076886 Primary medical...

Record of Determinations –

Medical Practitioners Tribunal

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PUBLIC RECORD Dates: 23/09/2019 - 04/10/2019 08/07/2020 – 10/07/2020; 02/11/2020 – 04/11/2020; 10/11/2020 – 11/11/2020

Medical Practitioner’s name:

Dr Francisca UGWU

GMC reference number: 7076886

Primary medical qualification: MB BS 2008 Nnamdi Azikiwe University

Type of case Outcome on impairment New - Deficient professional performance Impaired New - Misconduct Impaired

Summary of outcome

Erasure

Immediate order imposed

Tribunal:

Legally Qualified Chair Mr Nicholas Flanagan

Lay Tribunal Member: Ms Elizabeth Daughters

Medical Tribunal Member: Dr Ranjana Rani

Tribunal Clerk: Mr Michael Murphy (23/09/2019 – 02/10/2019) Mr Sewa Singh (03/10/2019 – 04/10/2019); (08/07/2020 – 10/07/2020); (02/11/2020 – 04/11/2020); (10/11/2020 – 11/10/2020)

Attendance and Representation:

Medical Practitioner: Present and not represented

GMC Representative: Mr Ian Brook, Counsel



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Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held partly in public and partly in private. Overarching Objective Throughout the decision making process the tribunal has borne in mind the statutory overarching objective as set out in s1 Medical Act 1983 (the 1983 Act) to protect, promote and maintain the health, safety and well-being of the public, to promote and maintain public confidence in the medical profession, and to promote and maintain proper professional standards and conduct for members of that profession. Determination on Facts - 03/10/2019 Background 1. Dr Ugwu qualified in Nigeria in 2008. Prior to the events which are the subject of the hearing, she was practising in the Emergency Medicine department of Queen Elizabeth’s Hospital (QEH), Woolwich. At the time of the events she was practising as a Clinical fellow, working part-time at Foundation Year (FY) 2/FY3 level, within the Acute Medicine Department of QEH on a 12-month contract. Dr Ugwu started this role in August 2017 and her responsibility was to assess patients in order to make a diagnosis and to then formulate management plans which would be overseen by a Consultant. 2. The Allegation that is under consideration stems from performance concerns and misconduct matters relating to her employment with Lewisham and Greenwich NHS Trust (‘the Trust’) and its subsequent termination in February 2018. 3. Concerns were raised with the GMC on 26 February 2018 by Dr F, the Responsible Officer for the Trust. Dr Ugwu was allegedly made aware of a possible referral before it was submitted during a meeting (the Meeting) on 27 December 2017. The referral ultimately arose from Dr D’s and other clinician’s concerns about her performance and conduct. 4. The performance concerns were around her lack of understanding of the principles of the management of patients and her failure to comply with treatment and investigation plans. Following this, she underwent a GMC performance assessment (PA) in July 2018 which stated that the standard of her performance was unacceptable in a number of areas as follows:

Domain 1: Knowledge, Skills and Performance

Maintaining Professional Performance Unacceptable

Assessment Unacceptable



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Clinical Management Unacceptable

Operative/Technical Skills No judgement

Record Keeping No judgement

Domain 2: Safety and Quality

Safety and Quality No judgement

Domain 3: Communication, Partnership and Teamwork and Domain 4:

Maintaining Trust

Relationships with Patients Unacceptable

Working with Colleagues Unacceptable

5. The PA report highlighted that ‘due to the nature of the assessment and the fact that it was not possible to undertake a medical records review or observation of practice, there was insufficient evidence to make a judgement in three categories: Operative/Technical Skills, Record Keeping and Safety and Quality.’ 6. Dr Ugwu also scored below the standard set score in a knowledge test (the Test) administered by the GMC. She scored 34.17% in the Test, which was below the standard set mark of 67.25%. It is therefore alleged that Dr Ugwu’s fitness to practise is impaired by reason of deficient professional performance. 7. On 29 May 2018 Dr Ugwu was instructed by the Trust (the Trust Instruction) not to contact or visit any members of its staff and not to visit staff areas unless explicitly invited to do so. She was provided with a single point of contact for the Trust, with all communications to be made by email. Dr Ugwu was subsequently instructed by the GMC (the GMC Instruction) to desist from contacting any Trust staff who were being interviewed as part of the PA. Despite these instructions, it is alleged that Dr Ugwu contacted certain members of Trust staff and gained access to restricted areas of the Trust. It is then alleged that Dr Ugwu refused to leave the areas and behaved in a manner which was intimidating and rude towards members of Trust staff. The GMC allege that this behaviour breached the Trust’s instruction and the GMC’s instruction, as well as caused harassment. The GMC therefore alleged that her fitness to practice is additionally impaired by reason of misconduct. The Outcome of Applications Made during the Facts Stage 8. The Tribunal refused Dr Ugwu’s application, made pursuant to Rule 17(2)(g) of the General Medical Council (Fitness to Practise Rules) 2004 as amended (‘the Rules’), that, there was insufficient evidence for the Tribunal to uphold paragraphs 8(c), 9(b), 9(c), 10(b) and 11(b) of the Allegation. On behalf of the GMC, Mr Brook submitted that the Tribunal should reject Dr Ugwu’s application. The Tribunal determined that there was a case to answer for in relation to paragraphs 8(c), 9(b), 9(c), 10(b) and 11 (b) of the Allegation and therefore rejected Dr Ugwu’s application. The Tribunal’s full decision on the application is included at Annex A.



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The Allegation and the Doctor’s Response 9. The Allegation made against Dr Ugwu is as follows: That being registered under the Medical Act 1983 (as amended):

1. Your employment with Lewisham and Greenwich NHS Trust (‘the Trust’) ended on 27 February 2018. To be determined

2. In July 2018 you underwent a General Medical Council (‘GMC’) assessment of the standard of your professional performance (‘the PA’). Admitted and found proved

3. Your professional performance was unacceptable in the following areas: a. Maintaining Professional Performance; To be determined

b. Assessment; Admitted and found proved

c. Clinical Management; Admitted and found proved

d. Relationships with Patients; To be determined

e. Working with Colleagues. To be determined

4. In the Knowledge Test, you scored 34.17%. This is below the standard

set score of 67.25%. Admitted and found proved

5. On the dates set out in Schedule 1 you were instructed by the Trust to desist from: a. contacting any member of the Trust staff; Admitted and

found proved

b. making visits to staff at the Trust; Admitted and found proved

c. visiting staff areas of the Trust unless you were explicitly invited to do so and were accompanied by a staff member at all times, (‘the Trust Instruction’). Admitted and found proved

6. On 26 July 2018 you were instructed by the GMC to desist from contacting the Trust staff who were being interviewed as part of the



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PA (‘the GMC Instruction’). Admitted and found proved

7. Despite the Trust Instruction and the GMC Instruction, you: a. contacted the Trust staff on the dates set out in Schedule 2;

Admitted and found proved

b. attended the Trust to speak to the Trust staff on the dates set out in Schedule 3. Admitted and found proved

8. On 27 July 2018 during your attendance at the Trust you: a. gained access to a restricted area of the Trust; Admitted and

found proved

b. failed to appropriately identify that you were not a staff member at the Trust; To be determined

c. refused to leave the restricted area of the Trust. To be determined

9. On 1 August 2018 during your attendance at the Trust you: a. gained access to a restricted area of the Trust; Admitted and

found proved

b. behaved in a manner that was:

i. intimidating; To be determined

ii. rude; To be determined

c. used the Trust’s on-site telephone to contact your Responsible officer on his:

i. work mobile phone; To be determined

ii. personal mobile phone. To be determined


found proved



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b. behaved in a manner that was intimidating. To be determined

11. Your conduct as described in paragraphs 7 to 10: a. was in breach of the:

i. Trust Instruction; Admitted and found proved in relation to paragraphs admitted only

ii. GMC Instruction; Admitted and found proved in relation to paragraphs admitted only

b. amounted to harassment. To be determined The Admitted Facts 10. At the outset of these proceedings, Dr Ugwu made admissions to some paragraphs and sub-paragraphs of the Allegation, as set out above, under Rule 17(2)(d) of the General Medical Council (GMC) (Fitness to Practise) Rules 2004, as amended (‘the Rules’). In accordance with Rule 17(2)(e) of the Rules, the Tribunal announced these paragraphs and sub-paragraphs of the Allegation as admitted and found proved. Factual Witness Evidence 11. The Tribunal received evidence on behalf of the GMC, in the form of witness statements and in person at this hearing, from the following witnesses:

• Dr D, Acute Medicine Consultant at the QEH, in person; • Dr E, consultant in Renal and Acute Medicine at QEH, in person; • Dr F, Consultant in Anaesthesia and Intensive Care, Deputy Medical Director

and Responsible Officer at the Trust, in person; • Ms H, Nursing Sister in Critical Care at the QEH, in person; • Mr G, Assistant Director for Medical Workforce and Medical Education at the

Trust, in person; • Ms I, Practice Development Nurse at QEH, in person.

12. Dr Ugwu also gave oral evidence at the hearing. Expert Witness Evidence 13. The Tribunal received evidence from three expert witnesses, called by the GMC, who made up the PA team. Dr C was the PA Team Leader and is a retired Consultant Paediatrician who has been an Educational and Clinical Supervisor for Foundation Year Trainees. Dr A was the Medical Assessor, he is a Registrar in Acute Medicine and a trained GMC Performance Assessor. Mrs B was the Lay Assessor and



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is a solicitor specialising in healthcare law, she also sits as a lay member on the GMC’s Registration Appeals Panel. 14. The three expert witnesses conducted a performance assessment on Dr Ugwu in July 2018 and provided the full report (the Report) to the Tribunal to assist it in understanding the professional standards to be expected of a registered medical practitioner. They also gave oral evidence at the hearing in person. Documentary Evidence 15. The Tribunal had regard to the documentary evidence provided by the parties. This evidence included, but was not limited to, correspondence between Dr Ugwu and the parties involved in this hearing and also:

• The fitness to practise (Ftp) referral form completed by Dr F, dated 26 February 2018;

• Notes from the Meeting regarding incidents raised at the Trust; • Dr Ugwu’s PA portfolio; • Dr E’s third-party interview; • Dr D’s third-party interview;

• Summary provided by GMC to Performance Assessor’s ahead of the Report; • Letter from PA team to Dr Ugwu summarising the Report’s overall

conclusions. The Tribunal’s Approach 16. In reaching its decision on facts, the Tribunal has borne in mind that the burden of proof rests on the GMC and it is for the GMC to prove the Allegation. Dr Ugwu does not need to prove anything. The standard of proof is that applicable to civil proceedings, namely the balance of probabilities, i.e. whether it is more likely than not that the events occurred. The Tribunal’s Analysis of the Evidence and Findings 17. The Tribunal has considered each outstanding paragraph of the Allegation separately and has evaluated the evidence in order to make its findings on the facts.

‘1. Your employment with Lewisham and Greenwich NHS Trust (‘the Trust’) ended on 27 February 2018.’

18. It was agreed by the parties that Dr Ugwu’s most recent employment with the Trust started on 29 August 2017, with her working on a part-time basis. In November 2017, a dispute arose regarding Dr Ugwu’s ability to work evenings and weekends, which the Trust required and considered essential, but Dr Ugwu did not. Following several meetings regarding the issue, on the 27 December 2017 the Trust



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witnesses stated the decision was made that Dr Ugwu’s employment would be terminated. 19. Dr Ugwu accepts that she was informed of the termination and that she was present at the Meeting; her case is that the dismissal was unfair. All of the evidence presented to the Tribunal concurred that she did not work after the 27 February 2018, she was not paid and had no ongoing employment relationship. There is no evidence that she sought to appeal the decision. The termination of Dr Ugwu’s employment was confirmed in a letter sent to her on 11 January 2018, which she admitted she had received. The Tribunal noted the neutral language used in the Allegation and was therefore satisfied on the evidence that Dr Ugwu’s employment did end on 27 February 2018. 20. Accordingly, the Tribunal found paragraph 1 of the Allegation proved.

‘3. Your professional performance was unacceptable in the following areas: a. Maintaining Professional Performance; …d. Relationships with Patients; Determined and found proved e. Working with Colleagues. Determined and found proved’

21. The Tribunal was aware that concerns were raised regarding all elements of Dr Ugwu’s practice. It noted that she scored below the 25th centile in all the Objective Structured Clinical Examination (OSCE) stations and the reasoning behind this was ‘that she was unable to prioritise and complete tasks, could not grasp underlying principles and the reasoning behind them and lacked insight’. 22. The Tribunal had regard to the Report which was conducted in compliance with established GMC guidance by independent assessors and stated that:

‘The Team Leader and Lay Assessor consider Dr Ugwu is not fit to practise as a doctor and should be removed from the medical register. This is due to the evidence of persistent failure to comply with the professional standards appropriate to the work she did and her performance which clearly departs from the performance described in ‘Good Medical Practice… The other Medical Assessor considered that Dr Ugwu was fit to practise on a limited basis but should only practise under direct supervision at F1 level.’

23. The Report confirmed that the PA team’s ‘unanimous conclusion was that Dr Ugwu’s performance was deficient’. The Tribunal noted that Dr Ugwu has admitted some of her deficiencies, but not all of them, whilst the PA team were all in agreement that her performance was extremely poor. This is consistent with Dr Ugwu’s knowledge test results which were well below the standard set mark. Two of



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the assessors noted that Dr Ugwu’s performance was one of the worst they had come across throughout their extensive experience. 24. The Tribunal was aware of the wide range of communication issues raised in the referral with regard to Dr Ugwu’s relationships with patients and her ability to work with colleagues. The Tribunal noted that the assessors had conducted third party interviews with two consultants who had been supervising Dr Ugwu. It had regard to the Report which summarised that:

‘Dr Ugwu’s approach to patients sometimes lacked empathy and appeared confrontational. She was not always sensitive to patient’s needs and, like her approach to assessment and clinical management, was poorly focused so that patients were not fully informed, and she did not allay their concerns. Dr Ugwu also had difficulty working with colleagues.’

25. The Tribunal investigated the methodology utilised in the PA and carefully analysed the appendices presented. The Tribunal was satisfied that Dr Ugwu was assessed at a level appropriate for her training and experience. It also considered some of the individual judgements on the assessment in detail before accepting the conclusion of the report - it was wholly evidence based and reflected a fair assessment of Dr Ugwu’s performance. 26. It therefore concluded that the maintenance Dr Ugwu’s professional performance, her relationships with Patients and the way in which she worked with colleagues was unacceptable. 27. Accordingly, the Tribunal found paragraphs 3(a), 3(d) and 3(e) of the Allegation proved.

‘8. On 27 July 2018 during your attendance at the Trust you: …b. failed to appropriately identify that you were not a staff member at the Trust’

28. The Tribunal considered whether it would have been appropriate for Dr Ugwu to identify herself to an appropriate person, upon arrival at the Critical Care Unit, that she was not a current member of staff. It found that Ms H made the inference, simply from Dr Ugwu’s assertion to the effect of ‘I’m a doctor’, that she was in fact a doctor employed by the Trust. This inference is further apparent in the messages sent from Ms H to Dr F on 27 July 2018. Dr Ugwu was not wearing a hospital ID badge and was wearing casual clothes. There was no evidence from Ms H or otherwise that anyone had asked if Dr Ugwu was an employee. Dr Ugwu insisted that she did not claim to be an employed doctor of the Trust, although she conceded



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that she did not identify herself as being a former employee. 29. In balancing the evidence the Tribunal was not persuaded that the GMC had established that Dr Ugwu should have identified herself as an ex-member of staff at the Trust in the circumstances. The Tribunal was satisfied that Ms H formed the impression that Dr Ugwu was an employee, but could not be satisfied that this view required correction. The Tribunal noted that Dr F was the Responsible Officer for the Trust and there may have been many reasons why doctors or trainees would require his attention. 30. Accordingly, the Tribunal found paragraph 8(b) of the Allegation not proved.

‘8. On 27 July 2018 during your attendance at the Trust you:

…c. refused to leave the restricted area of the Trust’ 31. The Tribunal considered it to be implicit that in order to refuse to leave the restricted area, Dr Ugwu had to have been asked to leave this area. The Tribunal examined Ms H’s evidence which confirmed she did not make such a request of Dr Ugwu. Dr Ugwu stated that she wished to speak to Dr F and left of her own volition. The Tribunal accepted Dr Ugwu did remain in the area for 10 – 15 minutes, but in the absence of a specific request, it could not be satisfied that she had refused to leave the area. 32. Accordingly, the Tribunal found paragraph 8(c) of the Allegation not proved.

‘9. On 1 August 2018 during your attendance at the Trust you: …b. behaved in a manner that was:

i. intimidating;

ii. rude.’

33. The Tribunal had regard to the witness statement of Ms H in which she stated, ‘I would describe Dr Ugwu as intimidating’. Ms H also stated in her oral evidence that Dr Ugwu began to wave her hands when Ms H informed Dr Ugwu that she knew Dr Ugwu was not a current member of staff at the Trust. Dr Ugwu admitted that it is possible this occurred. The Tribunal also had regard to the message, considered to be a contemporaneous note, sent from Ms H to Dr F on 1 August 2018 which stated that Dr Ugwu ‘is here being being rude to me (sic)’. 34. The Tribunal noted Dr Ugwu’s evidence that she felt disrespected, but it accepted Ms H’s evidence that Dr Ugwu became more intimidating and rude as time progressed. The Tribunal was satisfied that the two were in an enclosed space,



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voices were raised and Dr Ugwu was very persistent. The Tribunal found that Dr Ugwu did not respond appropriately when Ms H said that ‘I know you’re not employed by the Trust… and security needed to be called’. The Tribunal also found Dr Ugwu’s criticisms of Ms H to be unreasonable. Ms H was challenging her appropriately as she had a responsibility to ensure the ward was safe having been previously informed that Dr Ugwu was no longer permitted on Trust property and she called security of she did attend. 35. Some of the incident between Ms H and Dr Ugwu was witnessed by Ms I, who noted Dr Ugwu was behaving unprofessionally, albeit she did not describe the interaction as being rude. However, Dr Ugwu and Ms I agreed that Ms I had only witnessed the end of the exchange with Ms H, at which point the situation had calmed down. 36. The Tribunal concluded that Dr Ugwu did not react or respond appropriately when challenged, despite there being a valid reason and was satisfied that she behaved in a manner that was intimidating and rude. 37. Accordingly, the Tribunal found paragraphs 9(b)(i) and 9(b)(ii) of the Allegation proved.

‘9. On 1 August 2018 during your attendance at the Trust you: …c. used the Trust’s on-site telephone to contact your Responsible officer on his: i. work mobile phone; ii. personal mobile phone.’

38. This paragraph of the Allegation wholly relies upon the evidence of Dr F, who stated that he believed there was a policy at the Trust not to allow outside calls to be directed to consultants’ mobile phones. Dr F also stated when he had tried to contact other consultants, he had had to leave his number for a return call. Dr Ugwu accepted that she had made the calls to Dr F, albeit she stated that they were from her own mobile phone, not through the Trusts’ system. Dr Ugwu also admitted she had made previous calls to Dr F and left answer phone messages. 39. The Tribunal received no objective evidence regarding a Trust policy or evidence from the switchboard of their compliance with any policy. The Tribunal also noted Ms H gave evidence, which the Tribunal accepted, that she rang Dr F on the same day without the switchboard’s involvement. 40. The Tribunal did not find Dr F to be a persuasive witness, he had a poor recollection of certain events and was vague in his response to some questions. It



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therefore considered there to be insufficient evidence presented to establish that Dr Ugwu utilised the Trust telephone to call Dr F. The Tribunal concluded that the GMC had not discharged the persuasive burden on this point. 41. Accordingly, the Tribunal found paragraphs 9(c)(i) and 9(c)(ii) of the Allegation not proved. ‘10. On 9 August 2018 during your attendance at the Trust you:

…b. behaved in a manner that was intimidating.’ 42. The Tribunal bore in mind that Dr Ugwu arrived at the Trust unannounced in a restricted area, despite repeated instructions not to contact members of staff or attend at the hospital. Dr E stated that Dr Ugwu had stood very close to her to address her. Dr E needed to leave work at this point, as she was on annual leave, but Dr Ugwu obstructed her and prevented her departure. Dr E was concerned about the persistence of Dr Ugwu and stated that she ‘was afraid during this interaction. I felt that Dr Ugwu was physically intimidating, as she was standing within two feet of me and I had my back against the wall’. The Tribunal found Dr E’s evidence to be balanced, fair and clear. 43. Dr Ugwu recalled the exchange and accepted that she was ‘persistent’ with Dr E, but denied this was intimidating as this was only a perception. The Tribunal found Dr Ugwu to have raised her voice, repeatedly asked the same questions, and did not respond to reasonable requests made by Dr E. The Tribunal accepted Dr E’s evidence and concluded that Dr Ugwu’s behaviour was intimidating. 44. Accordingly, the Tribunal found paragraphs 10(b) of the Allegation proved.

‘11. Your conduct as described in paragraphs 7 to 10:

a. was in breach of the:

i. Trust Instruction; ii. GMC Instruction;’

45. Dr Ugwu has already admitted that she received the Trust and GMC instructions and breached them in her prior admissions to paragraphs 7 to 10 of the Allegation. The Tribunal determined that the further paragraphs of the Allegation now found proved were also in breach of the Trust and GMC instructions and therefore finds them proved in relation to these paragraphs. 46. Accordingly the Tribunal found paragraphs 11(a)(i) and 11(a)(ii) proved in relation to paragraphs 9(b)i, 9(b)ii & 10(b).



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‘11. Your conduct as described in paragraphs 7 to 10:

b. amounted to harassment.’ 47. The Tribunal defined harassment as behaviour that causes or results in intimidation, alarm or distress through words, acts or other behaviour that is unwanted or otherwise unreasonable. The Tribunal considered each relevant paragraph of the Allegation to consider if it amounted to harassment. 48. The Tribunal had regard to the minutes of the Meeting and noted that there was some discussion of a possible referral of Dr Ugwu to the GMC due to her deficient professional performance. The Tribunal received no evidence about whether Dr Ugwu was specifically informed about the decision to refer her to the GMC in advance of the referral or the final date of her employment. Indeed, the only evidence the Tribunal heard was that Dr Ugwu was informed of the GMC referral in a meeting on 7 March 2018, with Dr F and Mr G, following the termination of her employment and over a week after the referral was made. There was no evidence that Dr Ugwu was provided with any pastoral support or any assistance following her referral by the Trust. 49. In relation to paragraphs 7(a) and 7(b), the Tribunal concluded that Dr Ugwu’s admission that she had contacted various Trust staff resulting in one text and one voicemail to each individual would be unlikely to have caused them intimidation, alarm or distress. The Tribunal was satisfied that Dr Ugwu was contacting staff at the Trust in order to obtain a reference, which considering the abrupt termination of her contract and the chronology was not unreasonable. Accordingly, the Tribunal found paragraph 11(b) not proved in relation to paragraphs 7(a) and 7(b). 50. The Tribunal considered paragraphs 8(a), 9(a) and 10(a) and concluded that gaining access to the Trust did not in itself amount to harassment. It found that Dr Ugwu had been directed not to attend, but there was no evidence of an individual being caused harassment as a result of her simply attending the hospital. Accordingly, it found paragraph 11(b) not proved in relation to paragraphs 8(a), 9(a) and 10(a). 51. The Tribunal next considered paragraphs 9(b)i and 9(b)ii. It bore in mind that Ms H felt intimidated by Ugwu’s behaviour and that this caused her some distress. This was reflected in the messages Ms H sent to Dr F on 1 August 2018. Dr Ugwu had little recollection of the events, but conceded that this may have been Ms H’s perception. The Tribunal accepted Ms H’s evidence that she was intimidated and in distress on 1 August 2018. Dr Ugwu was behaving unreasonably in entering the relatives room, having been repeatedly instructed not to attend the hospital and having been asked to leave the ward. The Tribunal therefore concluded that Dr



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Ugwu’s behaviour amounted to harassment in this instance. Accordingly, the Tribunal found paragraph 11(b) proved in relation to paragraphs 9(b)i and 9(b)ii. 52. Lastly, the Tribunal considered paragraph 10(b). It noted that Dr Ugwu had previously texted and emailed Dr E, having been instructed not to do so. Dr E had not replied, but Dr Ugwu proceeded to confront her in person, despite being previously advised by Dr E that she could not supply a reference. The Tribunal was satisfied that Dr Ugwu caused Dr E considerable alarm and distress through her persistent and unwanted behaviour. Dr E was trying to leave the hospital as she was off duty, but Dr Ugwu’s behaviour alarmed Dr E to the extent she felt unsafe and asked a colleague to escort her to her car. Accordingly, the Tribunal found paragraph 11(b) proved in relation to paragraph 10(b). The Tribunal’s Overall Determination on the Facts 53. The Tribunal has determined the facts as follows:

1. Your employment with Lewisham and Greenwich NHS Trust (‘the Trust’) ended on 27 February 2018. Determined and found proved

2. In July 2018 you underwent a General Medical Council (‘GMC’) assessment of the standard of your professional performance (‘the PA’). Admitted and found proved

3. Your professional performance was unacceptable in the following areas: a. Maintaining Professional Performance; Determined and found

proved

b. Assessment; Admitted and found proved

c. Clinical Management; Admitted and found proved

d. Relationships with Patients; Determined and found proved

e. Working with Colleagues. Determined and found proved

4. In the Knowledge Test, you scored 34.17%. This is below the standard set score of 67.25%. Admitted and found proved

5. On the dates set out in Schedule 1 you were instructed by the Trust to desist from:



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a. contacting any member of the Trust staff; Admitted and found proved

b. making visits to staff at the Trust; Admitted and found proved

c. visiting staff areas of the Trust unless you were explicitly invited to do so and were accompanied by a staff member at all times, (‘the Trust Instruction’). Admitted and found proved

6. On 26 July 2018 you were instructed by the GMC to desist from contacting the Trust staff who were being interviewed as part of the PA (‘the GMC Instruction’). Admitted and found proved

7. Despite the Trust Instruction and the GMC Instruction, you: a. contacted the Trust staff on the dates set out in Schedule 2;

Admitted and found proved

b. attended the Trust to speak to the Trust staff on the dates set out in Schedule 3. Admitted and found proved

8. On 27 July 2018 during your attendance at the Trust you: a. gained access to a restricted area of the Trust; Admitted and

found proved

b. failed to appropriately identify that you were not a staff member at the Trust; Not proved

c. refused to leave the restricted area of the Trust. Not proved


found proved

b. behaved in a manner that was:

i. intimidating; Determined and found proved

ii. rude; Determined and found proved



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c. used the Trust’s on-site telephone to contact your Responsible officer on his:

i. work mobile phone; Not proved

ii. personal mobile phone. Not proved


found proved

b. behaved in a manner that was intimidating. Determined and found proved

11. Your conduct as described in paragraphs 7 to 10: a. was in breach of the:

i. Trust Instruction; Admitted and found proved in

relation to paragraphs7(a), 7(b), 8(a), 9(a), 10(a). Determined and found proved in relation to paragraphs 9(b)i, 9(b)ii & 10(b)

ii. GMC Instruction; Admitted and found proved in relation to paragraphs7(a), 7(b), 8(a), 9(a), 10(a). Determined and found proved in relation to paragraphs 9(b)i, 9(b)ii & 10(b)

b. amounted to harassment. Determined and found proved in relation to paragraphs 9(b)i, 9(b)ii & 10(b)

Determination on Impairment - 04/11/2020 1. The Tribunal now has to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts which it has found proved, Dr Ugwu’s fitness to practise is impaired by reason of Misconduct and Performance. Background to these proceedings 2. XXX. 3. XXX.



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4. XXX. 5. Dr Ugwu’s hearing was listed to be reconvened in May 2020. However, due to the COVID-19 pandemic situation, the hearing was postponed. 6. The hearing was relisted and reconvened on 8 July 2020, as a virtual hearing. However, due to technical difficulties with Dr Ugwu’s internet connection, and issues with her participation via the dial-in option, the hearing was adjourned, with a specific request by the Tribunal and from Dr Ugwu that the hearing be relisted to be held at the hearing centre at St James’s Building (SJB) in Manchester. 7. Arrangements were made for the hearing to reconvene on 2 November 2020 at SJB. Dr Ugwu was informed of the reconvened hearing dates via email on 25 August 2020. In further correspondence, Dr Ugwu explained that she would not be able to attend the hearing in person because of restrictions in place due to COVID-19, requiring her to self-isolate for 14 days upon her arrival to the UK. It was therefore agreed by the MPTS Case Management Team (CMT), to grant Dr Ugwu’s request to participate in the hearing remotely, subject to a successful skype for business test call having been conducted. However, the test calls via skype for business proved unsuccessful. 8. In an email dated 19 October 2020, Dr Ugwu again advised that she would not be able to attend the hearing in person due to the requirement to self-isolate for 14 days, and sought a solution as to the best way for her to participate in the hearing. On the same date, the CMT advised Dr Ugwu that she would be able to join the hearing via telephone, if the difficulties experienced with her skype for business had not been resolved. On 27 October 2020, Dr Ugwu advised the GMC that the skype for business test call was not done and that she was still abroad. Dr Ugwu made it clear that she would wish to participate in the hearing via telephone. The Tribunal granted Dr Ugwu’s request to participate in the hearing via telephone. The Tribunal noted that at no stage did either Dr Ugwu or the GMC seek a further adjournment of the hearing. 9. XXX The Evidence 10. The Tribunal has taken into account all of the oral and documentary evidence received during the facts stage of the hearing. 11. It also noted Dr J’s evidence to the Tribunal via telephone, where he was cross-examined by Dr Ugwu. XXX



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12. The GMC did not wish to provide any further evidence to the Tribunal at this stage of the proceedings. Dr Ugwu was invited to provide any further documentary or oral evidence, but she stated that she did not wish to. Submissions On behalf of the GMC 13. Mr Brook provided the Tribunal with written submissions (exhibit C8). He submitted that Dr Ugwu’s actions were sufficiently serious to amount to misconduct. He referred the Tribunal to several authorities on the issue of impairment. Mr Brook referred the Tribunal to its determination on the facts and highlighted several matters which the Tribunal found proved. He reminded the Tribunal that at the time of Dr Ugwu’s conduct, she was no longer employed by the Trust and that she had been advised by the Trust that it would only give her a professional reference, confirming the dates of her employment with the Trust, and yet Dr Ugwu attended at the hospital and harassed staff. Mr Brook submitted that Dr Ugwu’s conduct would be regarded as deplorable by fellow practitioners. He reminded the Tribunal of the overarching objective and said that Dr Ugwu’s conduct fell within the second limb of that objective, i.e. to maintain public confidence in the profession. 14. In relation to deficient professional performance, Mr Brook reminded the Tribunal of the findings of the Performance Assessment (PA) team, which found Dr Ugwu’s performance was deficient, together with its recommendations. He also reminded the Tribunal that Dr Ugwu’s Objective Structured Clinical Examination (OSCE) scores were in the lower quartile of the level expected. Mr Brook submitted that, as a consequence, Dr Ugwu was unfit to practise. Mr Brook also reminded the Tribunal of the PA team’s recommendation that Dr Ugwu was only fit to practise under supervision. 15. In relation to Dr Ugwu’s insight, Mr Brook told the Tribunal that prior to her PA, Dr Ugwu had received regular feedback by both of her former clinical supervisors but that she had not accepted their advice. Mr Brook submitted that she showed no insight whatsoever and seemed to think she was entitled to behave as she did wilfully ignoring the directions of the Trust and her regulator. 16. In relation to remediation, Mr Brook told the Tribunal that Dr Ugwu had not provided any evidence of the steps she had taken to remediate her conduct. Further, she has not provided any evidence to address the concerns in relation to her clinical performance, for example, attendance or completion of relevant courses. He submitted that there is no evidence that Dr Ugwu has reflected on her conduct or on her clinical performance. Mr Brook submitted that Dr Ugwu’s fitness to practise was and remains impaired. 17. Mr Brook invited the Tribunal to find Dr Ugwu’s fitness to practise is currently impaired.



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Dr Ugwu 18. Dr Ugwu told the Tribunal that her fitness to practise is not impaired. She said that she only wanted to know why the Trust had dismissed her from employment, and that she only wanted to obtain a reference from the Trust so that she could move on. Dr Ugwu said that she could not understand why her fitness to practise had been called in to question. She said that she had not done anything wrong and stated words to the effect of ‘what else did they expect me to do’. She added that in her view, her behaviour was justified. 19. In relation to the concerns about her performance, Dr Ugwu, by her own admission, accepted that her knowledge test score was low, and areas of her PA were deficient. However, she told the Tribunal that she had studied for eight years to become a doctor and she did not accept the conclusion of the PA team. Dr Ugwu told the Tribunal that she was not in the XXX ‘right frame of mind’ at the time of the PA. 20. Dr Ugwu added that she had not undertaken any clinical practice for the past two years because her licence had been suspended. Dr Ugwu said that she had not undertaken any courses, and added, in response to a question, she had no written evidence of her reflection or remediation. She stated that she had read a few articles now and then but she did not provide any evidence of her learning to the Tribunal. Dr Ugwu submitted that her fitness to practise is not impaired. The Tribunal’s Approach 21. The Tribunal reminded itself that at this stage of the proceedings there is no burden or standard of proof and the decision on impairment is a matter for the Tribunal’s judgement alone. 22. In approaching the decision, the Tribunal was mindful of the two-stage process to be adopted. First whether the facts as found proved amounted to misconduct which was serious professional misconduct, and then second whether that misconduct led to a finding of current impairment. 23. The Tribunal has already given a detailed determination in relation to the factual findings in Dr Ugwu’s case. It has taken those matters into account in its deliberations. It has also taken into account the submissions made by Mr Brook and Dr Ugwu. 24. The Tribunal must determine whether Dr Ugwu’s fitness to practise is impaired today, taking into account her conduct at the time of the events and any relevant factors since then such as insight, whether the matters are remediable, have been remedied and there is any likelihood of repetition.



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25. Throughout its deliberations, the Tribunal has been mindful of its responsibility to uphold the overarching objective as set out in the Medical Act 1983 (as amended). That objective is the protection of the public and involves the pursuit of the following: a. to protect, promote and maintain the health, safety and wellbeing of the public b. to maintain public confidence in the profession c. to promote and maintain proper professional standards and conduct for members of the profession The Tribunal’s Decision 26. The Tribunal first considered whether the facts found proved are a sufficiently serious departure from the standards of conduct reasonably expected of Dr Ugwu as a registered medical practitioner to amount to misconduct. In its deliberations, the Tribunal had regard to the current version of GMP (March 2013). It also noted that Misconduct is not defined by statute but it has been said to be serious professional misconduct or conduct which a fellow professional would regard as deplorable. 27. The Tribunal had regard to paragraphs 1 and 65 of GMP. These state: ‘1. Patients need good doctors. Good doctors make the care of their

patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law.

65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.’ Impairment by reason of deficient professional performance 28. The Tribunal first considered the report of the PA team, dated 3 September 2018. It noted the Dr Ugwu’s standard of performance was found to be unacceptable in a number of areas, and reached no judgement in others, as follows:

Domain 1: Knowledge, Skills and Performance Maintaining Professional Performance Unacceptable Assessment Unacceptable Clinical Management Unacceptable Operative/Technical Skills No judgement Record Keeping No judgement Domain 2: Safety and Quality Safety and Quality No judgement



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Domain 3: Communication, Partnership and Teamwork and Domain 4: Maintaining Trust Relationships with Patients Unacceptable Working with Colleagues Unacceptable

29. The Tribunal also took into account that the PA team’s unanimous conclusion was that ‘Dr Ugwu’s performance was deficient’ and that concerns were raised regarding all elements of Dr Ugwu’s clinical practice. It noted that Dr Ugwu scored below the 25th centile in all the Objective Structured Clinical Examination (OSCE) stations and the reasoning behind this was ‘that she was unable to prioritise and complete tasks, could not grasp underlying principles and the reasoning behind them and lacked insight’. 30. In their report, the independent assessors stated:

‘The Team Leader and Lay Assessor consider Dr Ugwu is not fit to practise as a doctor and should be removed from the medical register. This is due to the evidence of persistent failure to comply with the professional standards appropriate to the work she did and her performance which clearly departs from the performance described in Good Medical Practice… The other Medical Assessor considered that Dr Ugwu was fit to practise on a limited basis but should only practise under direct supervision at F1 level.’

31. The Tribunal took into account the wide range of communication issues raised in the referral with regard to Dr Ugwu’s poor performance, relationships with patients and her ability to work with colleagues. The Tribunal noted that the assessors had conducted third party interviews with two consultants who had been supervising Dr Ugwu. It had regard to the Report which summarised that:

‘Dr Ugwu’s approach to patients sometimes lacked empathy and appeared confrontational. She was not always sensitive to patient’s needs and, like her approach to assessment and clinical management, was poorly focused so that patients were not fully informed, and she did not allay their concerns. Dr Ugwu also had difficulty working with colleagues.’

32. In their report, the PA team stated in conclusion that:

‘Dr Ugwu’s interaction and communication with medical and administrative staff was poor due to:

• her failure to carry out instructions; • her challenging behaviour; • her lack of reliability;



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• her inability to understand the reasons for specific requests; • her failure to seek and accept advice; • her poor time keeping and unavailability when on duty; and • the level of supervision she required.

This caused difficulties within team-working. Dr Ugwu’s performance is not compliant with the standards of Good Medical Practice (GMP)…’

33. The Tribunal had particular regard to the evidence of Dr C, who advised that he believed Dr Ugwu’s clinical competence to be at the level of a final year medical student. 34. The Tribunal considered that the concerns identified by the PA team were similar concerns to those identified by Dr F and Dr E. These concerns were communicated to Dr Ugwu while she was employed at the Trust, and as a consequence, the Trust put in place mechanisms to assist Dr Ugwu, including: moving her to a different department where she may be able to build upon and demonstrate her clinical skills; putting in place a mentor; and one-to-one sessions with her supervisor. The Tribunal noted that Dr Ugwu did not accept this assistance, instead considering it as unjustified restrictions on her clinical work. 35. The Tribunal carefully considered the results of the PA, in particular, in light of Dr Ugwu’s submission that she was ‘not in the best place’ at the time the PA took place. The Tribunal had provided Dr Ugwu with several opportunities to supply evidence of any particular difficulties she faced at the time of the PA, but no relevant evidence has been provided to the Tribunal. XXX. Furthermore, the Tribunal noted that the concerns about Dr Ugwu’s clinical practice extended beyond the results of the PA, as previous clinical supervisors had also raised concerns. 36. In her submissions to the Tribunal, Dr Ugwu did not accept that her clinical skills were inadequate, nor did she accept the findings and conclusions of the PA team. The Tribunal noted that Dr Ugwu had admitted some of the paragraphs of the Allegation; including that her professional performance was unacceptable in the areas of assessment and clinical management. Dr Ugwu did not provide the Tribunal with any evidence of the steps she has taken to address the concerns identified in the PA report, or supply evidence that she had kept her medical knowledge and skills up to date since her last clinical post in January 2018. Throughout these proceedings, Dr Ugwu did not acknowledge any failings in her clinical competence. The Tribunal was of the view that in the absence of any such acknowledgement or acceptance of weaknesses in her knowledge or skills, it would not be carrying out its public duty if a finding of impairment were not made.



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37. The Tribunal considered that Dr Ugwu’s persistent refusal to accept deficiencies in her performance, coupled with her lack of insight or remediation, causes the Tribunal to conclude that she presents a continued risk to patient safety. 38. It therefore determined that Dr Ugwu’s fitness to practise is impaired by reason of her deficient professional performance. Misconduct 39. The Tribunal then considered the matters relating to Dr Ugwu’s conduct. It took into account that Dr Ugwu had been instructed by the Trust to desist from contacting any member of staff at the Trust, making visits to staff at the Trust, and visiting staff areas of the Trust, unless explicitly invited to do so and accompanied by a member of staff at all times. Further, Dr Ugwu had been instructed by her regulator, the GMC, to desist from contacting staff at the Trust who were being interviewed as part of the PA. 40. Notwithstanding the clear instructions, which Dr Ugwu accepted she received and understood, she visited the Trust on three occasions: 27 July 2018, 1 August 2018 and 9 August 2018, and further made contact with staff at the Trust via written and telephone communication. 41. On 27 July 2018, Dr Ugwu gained access to restricted staff areas at the Trust. 42. On 1 August 2018, Dr Ugwu again gained access to a restricted staff area and behaved in a manner towards a member of staff, which was intimidating and rude. This was in a clinical setting, in front of patients and colleagues. 43. On 9 August 2018, Dr Ugwu gained access to a restricted area and again behaved towards a member of staff in a manner which was intimidating. The Tribunal bore in mind that Dr Ugwu arrived at the Trust unannounced in a restricted area, despite repeated instructions not to contact members of staff or attend at the hospital. Dr E stated that Dr Ugwu had stood very close to her to address her. Dr E needed to leave work at this point, as she was on annual leave, but Dr Ugwu obstructed her and prevented her departure. Dr E was concerned about the persistence of Dr Ugwu and stated that she felt afraid and that Dr Ugwu had been physically intimidating. The Tribunal considered Dr Ugwu’s actions to be both intimidating and harassing, causing fear and anxiety to her former colleagues. 44. The Tribunal considered Dr Ugwu’s behaviour breached the instructions of the Trust and of her regulator, as well as provisions of GMP, particularly paragraphs 1 and 65. It determined that an ordinary and decent member of the public, and fellow professionals, aware of the facts, would consider Dr Ugwu’s actions deplorable.



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45. In all the circumstances, the Tribunal determined that Dr Ugwu’s actions fell far short of the standards of conduct reasonably to be expected of a doctor. The Tribunal concluded that Dr Ugwu’s actions amounted to serious professional misconduct. Impairment by reason of misconduct 46. The Tribunal, having found that the facts found proved amounted to serious professional misconduct, went on to consider whether Dr Ugwu’s fitness to practise is currently impaired by reason of her misconduct. 47. The Tribunal had regard to paragraph 76 of the judgment in the case of CHRE v NMC & Paula Grant [2011] EWHC 927 (Admin), in which Mrs Justice Cox provided a helpful approach to the determination of impairment: ‘Do our findings of fact in respect of the doctor’s misconduct…show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or… d. has in the past acted dishonestly and/or is liable to act dishonestly in the future.’ 48. The Tribunal considered whether Dr Ugwu’s misconduct was capable of being remediated, has been remediated, and whether it was likely to be repeated. In so doing, it considered whether there was evidence of Dr Ugwu’s insight into her misconduct and any steps taken by her to remediate it. 49. The Tribunal took into account that doctors occupy a position of privilege and trust. They are expected to act in a manner which maintains public confidence in them and in the medical profession and to uphold proper standards of conduct. The Tribunal determined that Dr Ugwu’s conduct brought the medical profession into disrepute and breached fundamental tenets of the medical profession. 50. Dr Ugwu has not provided any evidence of the steps she has taken to address the concerns identified, such as testimonials, or a personal reflection of the impact of her actions upon her colleagues and on the reputation of the medical profession. The evidence before the Tribunal is of a repeated pattern of behaviour not in accordance with GMP.



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51. Further, in her submissions to the Tribunal, Dr Ugwu continued to insist that her actions were appropriate and justified. The Tribunal did not have any evidence that Dr Ugwu recognises the impact of her conduct on others. In terms of Dr Ugwu’s insight, during her evidence at the facts stage, Dr Ugwu accepted her conduct could be perceived as aggressive, however, throughout the proceedings, she has repeatedly stated that all of her actions were justified. Dr Ugwu has therefore demonstrated very little insight into her misconduct, leading to the concern that there is a high risk of similar behaviour being repeated. 52. The Tribunal reminded itself of the fundamental principles, as set out in GMP. The Tribunal determined that Dr Ugwu’s conduct would be considered unacceptable, unprofessional and deplorable by members of the profession and the public alike. It considered that her behaviour had brought the medical profession into disrepute and had breached a fundamental tenet of the profession. The Tribunal considered that the public would expect there to be a finding of impairment in a case where the doctor had behaved as Dr Ugwu did. 53. In the circumstances, the Tribunal concluded that a finding of impaired fitness to practise is required in order to maintain public confidence in the profession and to promote and maintain proper professional standards and conduct for members of the profession. 54. The Tribunal has therefore determined that Dr Ugwu’s fitness to practise is impaired by reason of her misconduct. Determination on Sanction - 11/11/2020 1. Having determined that Dr Ugwu’s fitness to practise is impaired by reason of deficient professional performance and misconduct, the Tribunal now has to decide in accordance with Rule 17(2)(n) of the Rules on the appropriate sanction, if any, to impose. Evidence 2. Mr Brook, on behalf of the GMC, informed the Tribunal that there was no further evidence to be provided for this stage. 3. Dr Ugwu confirmed that she had received and read the Tribunal’s determination on impairment, sent to her via email on 4 November and again on 5 November 2020. She stated that she did not agree with the Tribunal’s finding that her fitness to practise is impaired. 4. She informed the Tribunal that she may have some witnesses, who were based in Nigeria, to give evidence on her behalf. She explained that the witnesses



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could provide details of her medical education in Nigeria and explain her medical knowledge. Dr Ugwu stated that due to short notice, these witnesses were unable to give evidence to the Tribunal at the present time. She added that they would need time to read and familiarise themselves with the Tribunal’s determinations on facts and impairment. Dr Ugwu was unable to say when these witnesses would be available to provide evidence. She stated that she did not seek an adjournment of these proceedings and did not require any further time to consider her position or to provide any further evidence. 5. Dr Ugwu explained to the Tribunal that the witnesses she would seek to rely upon would be able to describe her medical education and her clinical experience when she worked in Nigeria, which was a considerable time ago. The Tribunal noted this evidence was historical and was unlikely to be relevant to the matters before it, and therefore proceeded with the hearing. Submissions on behalf of the GMC 6. On behalf of the GMC, Mr Brook submitted that the appropriate sanction was erasure. Mr Brook reminded the Tribunal that the majority of the PA team were of the opinion that Dr Ugwu was not fit to practise and should be removed from the register. The dissenting medical assessor on the PA team considered that Dr Ugwu was fit to practise only on a limited basis. 7. Mr Brook said that Dr Ugwu has not provided any evidence of reflection or remediation in relation to the findings of the PA team. He added that Dr Ugwu had not presented any evidence to demonstrate she had kept her medical knowledge up to date and had improved her clinical skills. 8. In relation to the misconduct aspect, Mr Brook submitted that Dr Ugwu has not accepted any wrongdoing, and has not provided any evidence of insight into the misconduct. He submitted that Dr Ugwu continues to maintain that her actions were justified. He said there was no evidence before the Tribunal that Dr Ugwu would not repeat her behaviour. 9. Mr Brook reminded the Tribunal that Dr Ugwu has previously breached instructions given to her by her former employer and by her regulator, which may demonstrate that conditions or suspension would not be workable. 10. He drew the Tribunal’s attention to relevant paragraphs of the Sanctions Guidance (‘SG’) (November 2019 version), particularly paragraph 94: suspension may be appropriate where there is acknowledgement of fault and the Tribunal is satisfied that the behaviour is unlikely to be repeated. Mr Brook submitted, however, that Dr Ugwu has not acknowledged any wrongdoing and has not demonstrated any evidence of insight into the deficiencies in her clinical performance, or the steps taken to address the concerns identified by the PA team.



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11. Turning to erasure, Mr Brook referred the Tribunal to paragraph 109(j) of SG which deals with a persistent lack of insight, and submitted that this was present in Dr Ugwu’s case. He submitted that erasure was the only way to protect members of the public and to maintain standards in the medical profession. Submissions by Dr Ugwu 12. Dr Ugwu reminded the Tribunal that she had not undertaken any clinical practice for the past two years since her interim suspension. She said that this had made it hard for her to secure suitable employment or to show that her medical knowledge was up to date. She accepted that her clinical skills were not perfect, but this did not mean that she was incapable of practising or undertaking work as a doctor. She asked the Tribunal not to judge her purely on the basis of the PA. 13. In relation to the risk of repeating the misconduct, Dr Ugwu said that her dismissal from the Trust was unjust, and that this was why she responded in the way she did. Dr Ugwu said that she did not accept that she lacked insight as, at the time of her actions, she did not know why she had been dismissed and she felt humiliated. 14. Dr Ugwu explained that she was in a vicious cycle: due to her suspension, she was unable to work as a clinician and did not have the appropriate qualifications for other roles. She stated that it would be difficult for her to be in, what she described, a lesser graded position because she would not ‘stay silent’ if she felt a doctor were doing something wrong. She stated that she had her own view point that hierarchy was important and any doctor she may have to work with may not have the same level of clinical experience as her. 15. Dr Ugwu said that she did not agree with, nor deserve to be, suspended or erased. The Tribunal’s Approach 16. The decision as to the appropriate sanction, if any, to impose is a matter for the Tribunal, exercising its own judgement. In so doing, it has given consideration to its findings of fact, misconduct and impaired fitness to practise and the submissions made by Mr Brook and by Dr Ugwu. 17. Throughout its deliberations the Tribunal bore in mind that the purpose of sanctions is not to be punitive, but to protect the public interest. The public interest includes protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession, and declaring and upholding proper standards of conduct and behaviour. In making its decision, the Tribunal also had regard to the principle of proportionality, and it considered Dr Ugwu’s interests as well as those of



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the public. It also considered and balanced the mitigating and aggravating factors in this case. 18. The Tribunal identified the following mitigating and aggravating factors were relevant: Mitigating Factors

• Dr Ugwu has willingly participated in these proceedings, and has engaged with the GMC investigation and the PA, XXX;

• There is no evidence that Dr Ugwu has breached the current interim order of suspension;

• No previous regulatory proceedings and admissions to some paragraphs of the Allegation.

Aggravating Factors

• Dr Ugwu’s lack of acceptance of her deficiencies in relation to her clinical

performance; • Her lack of acknowledgement of any wrongdoing or fault in relation to the

misconduct matter; • There is no evidence of insight or any remediation into either her deficient

professional performance or her misconduct; • There is no evidence that she has kept her medical knowledge and skills up to

date, for example, completing any training courses or online learning. The Tribunal’s Decision No action 19. The Tribunal first considered whether it could take no action. It noted that when a doctor’s fitness to practise is impaired, taking no action usually only arises when there are exceptional circumstances. The Tribunal has borne in mind the overarching objective, which included to maintain public confidence in the profession and to uphold proper standards of conduct. 20. The Tribunal determined that there were no exceptional circumstances in this case which outweighed the elements of the overarching objective. It therefore determined that it would not be adequate, proportionate, nor in the public interest, to conclude this case by taking no action. Conditions 21. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Ugwu’s registration. The Tribunal took account of the SG, in



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particular paragraphs 1, 79, 81 and 82. It also had regard to paragraph 85, which states:

“85 Conditions should be appropriate, proportionate, workable and measurable.”

22. The Tribunal has already found that Dr Ugwu failed to comply with instructions given to her by her senior colleagues during her clinical work, and that she failed to comply with the instructions of the Trust and her regulator. It also found that Dr Ugwu’s actions amounted to serious misconduct and that her fitness to practise is impaired. The Tribunal was concerned by Dr Ugwu’s persistent lack of acceptance of any wrongdoing or any insight into the deficiencies in her clinical performance or her misconduct. There is no evidence of insight or remediation into the concerns raised. The Tribunal could not be satisfied that Dr Ugwu would comply with conditions. The Tribunal also considered that it was simply not possible to create a workable set of conditions in relation to the matters before it. 23. Further, conditions would not adequately mark the seriousness with which the Tribunal viewed the concerns about Dr Ugwu’s clinical performance or her misconduct. It therefore determined that conditions would not be an appropriate, sufficient or proportionate response in this case and would not adequately address the public interest in this case. Suspension 24. The Tribunal then went on to consider whether a period of suspension would be an appropriate and proportionate sanction to impose on Dr Ugwu’s registration. 25. The Tribunal took into account paragraphs 93, 94, and 97(a), (e) and (g) of the SG which state:

“93. Suspension may be appropriate, for example, where there may have been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. The tribunal may wish to see evidence that the doctor has taken steps to mitigate their actions. 94 Suspension is also likely to be appropriate in a case of deficient performance or lack of knowledge of English in which the doctor currently poses a risk of harm to patients but where there is evidence that they have gained insight into the deficiencies and have the potential to remediate if prepared to undergo a rehabilitation or retraining programme.

97. Some or all of the following factors being present (this list is not exhaustive) would indicate suspension may be appropriate.



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a. A serious breach of Good medical practice, but where the doctor’s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors.

e No evidence that demonstrates remediation is unlikely to be successful, eg because of previous unsuccessful attempts or a doctor’s unwillingness to engage. g The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour.” 26. There is no evidence before the Tribunal that Dr Ugwu has addressed the deficiencies in her clinical performance or taken any steps to remediate her misconduct. In addition, there is no evidence that she has reflected on her actions. Dr Ugwu has not provided any evidence that she has insight into her actions or that she appreciates the impact they may have had on the public interest or the reputation of the medical profession. The Tribunal noted that Dr Ugwu’s misconduct took place over two years ago and there had been no previous disciplinary proceedings against her. However, there remains a lack of acknowledgement of any fault or wrongdoing by Dr Ugwu. 27. The Tribunal noted that one of the concerns raised by Dr Ugwu’s senior colleagues was that she did not listen to them or to her patients. The Tribunal took into account that in its report, the PA team found Dr Ugwu’s performance to be below the standards expected in all areas, including communication with patients. The PA team was concerned that Dr Ugwu’s inability to listen to patients could potentially lead to harm and she therefore posed a risk to patients. 28. Dr Ugwu has not accepted nor has she provided any evidence that she has reflected on, or remediated the concerns identified by the PA team, despite the assessment taking place over two years ago. Instead, Dr Ugwu has continued to insist that her clinical performance is not deficient. 29. Dr Ugwu has failed to uphold the proper standards of behaviour expected of doctors by the public, and her conduct has breached fundamental tenets of the profession. Her failure to comply with the relevant professional standards was serious and her conduct brought the profession into disrepute. 30. The Tribunal was mindful that a period of suspension is a temporary measure designed to remove a doctor from medical practice in anticipation that the doctor will return having addressed the concerns. In light of the information before it, including the absence of evidence of insight and remediation, the Tribunal was not



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satisfied that a period of suspension would have that effect. In any event, taking all the circumstances into account, the Tribunal does not consider that a period of suspension is sufficient to address the seriousness with which it views the concerns about Dr Ugwu’s deficient professional performance and her misconduct, and the need to uphold proper professional standards and maintain public confidence in the profession. Erasure 31. Having determined that imposing conditions on or suspending Dr Ugwu’s registration would be insufficient sanction, the Tribunal determined to erase her name from the medical register. It had regard to paragraphs 108 and 109 of the Sanctions Guidance, which state: “108. Erasure may be appropriate even where the doctor does not present a risk to patient safety, but where this action is necessary to maintain public confidence in the profession. For example, if a doctor has shown a blatant disregard for the safeguards designed to protect members of the public and maintain high standards within the profession that is incompatible with continued registration as a doctor. 109. Any of the following factors being present may indicate erasure is

appropriate (this list is not exhaustive). a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. i Putting their own interests before those of their patients (see Good

medical practice paragraph 1: – ‘Make the care of [your] patients [your] first concern’ and paragraphs 77–80 regarding conflicts of interest).

j. Persistent lack of insight into the seriousness of their actions or the

consequences.” 32. The Tribunal considered the findings of the PA team and its concerns in respect of Dr Ugwu’s professional performance and the potential impact upon patient safety. The Tribunal was particularly disturbed by Dr Ugwu’s continuing failure to recognise the seriousness of the concerns identified by the PA team. 33. The Tribunal reminded itself that Dr Ugwu’s actions amounted to serious misconduct, which could undermine public trust in the medical profession and also undermines the upholding of proper professional standards and conduct.



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Furthermore, Dr Ugwu has continued to maintain that her actions in relation to her misconduct are justified. This led the Tribunal to conclude there remained a serious risk of repetition. 34. The Tribunal therefore determined that, for the reasons stated above, Dr Ugwu’s deficient professional performance and her misconduct are fundamentally incompatible with her continued registration on the Medical Register. The Tribunal concluded that erasing Dr Ugwu’s name from the Medical Register would be the only proportionate sanction to impose in order to protect the public, maintain public confidence in the medical profession and declare and uphold the proper standards of conduct and behaviour. 35. Accordingly the Tribunal determined that Ugwu’s name should be erased from the Medical Register. Determination on Immediate Order - 11/11/2020 1. Having determined that Dr Ugwu’s name should be erased from the Medical Register, the Tribunal has now considered, in accordance with Section 38 of the Medical Act 1983 as amended, whether to impose an immediate order to suspend her registration. 2. The Tribunal has borne in mind the test to be applied with regards to imposing an immediate order; it may impose an immediate order if it determines that it is necessary to protect members of the public, or is otherwise in the public interest, or is in the best interests of the doctor. Submissions on behalf of the GMC 3. Mr Brook submitted that an immediate order should be imposed. He referred the Tribunal to the relevant paragraphs of the SG. Dr Ugwu 4. The Tribunal did not hear any submissions from Dr Ugwu, as she was not present during this stage of the proceedings. The Tribunal noted that following its announcement of its decision on sanction, at 12:10, a copy of the Tribunal’s determination was sent to Dr Ugwu via email. Parties were advised that the hearing will resume at 14:05. At around 14:05, the Tribunal Assistant sent an email to Dr Ugwu to remind her that the hearing will resume shortly and Dr Ugwu would be contacted via telephone, as she had been. Three attempts were made to contact Dr Ugwu via telephone but none were successful. On each occasion a message was heard stating that the number was unreachable.



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5. Mr Brook, upon invitation by the Tribunal, submitted that the hearing should proceed in Dr Ugwu’s absence. 6. The Tribunal considered whether it should proceed in Dr Ugwu’s absence. It took into account the need to ensure fairness to Dr Ugwu and balanced her interests with the public interest in dealing with these matters expeditiously. Taking into account the previous difficulties experienced with Dr Ugwu’s participation in these proceedings, the Tribunal was of the view that it would serve no purpose to delay these proceedings any further, and that it would be disproportionate to do so. It therefore decided to proceed in Dr Ugwu’s absence. Tribunal’s decision 7. The Tribunal has taken account of the relevant paragraphs of the SG in relation to when it is appropriate to impose an immediate order. Paragraph 172 of the SG states:

“The tribunal may impose an immediate order if it determines that it is necessary to protect members of the public, or is otherwise in the public interest, or is in the best interests of the doctor…”

8. The Tribunal has determined that, given the seriousness with which it viewed Dr Ugwu’s deficient professional performance and her misconduct, and given its findings on the facts, and in relation to Dr Ugwu’s impairment and the appropriate sanction, it is necessary, for the protection of the public, in the public interest and to maintain standards in the medical profession, to make an order suspending Dr Ugwu’s registration immediately. 9. The substantive decision of erasure, as already announced, will take effect 28 days from when notice is deemed to have been served upon Dr Ugwu, unless she lodges an appeal in the interim. If Dr Ugwu lodges an appeal, the immediate order for suspension will remain in force until such time as the outcome of any appeal is determined. 10. The interim order currently imposed on Dr Ugwu’s registration is revoked with immediate effect. 11. That concludes the case. Confirmed Date 11 November 2020 Mr Nicholas Flanagan, Chair



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ANNEX A – 30/09/2019 Application for no case to answer from Dr Ugwu 1. At the close of the case on behalf of the General Medical Council (GMC), Dr Ugwu made submissions under Rule 17(2)(g) of the GMC (Fitness to Practise) Rules 2004 (the Rules) in respect of those paragraphs of the Allegation not already admitted and found proved. Rule 17(2)(g) states:

‘the practitioner may make submissions as to whether sufficient evidence has been adduced to find some or all of the facts proved and whether the hearing should proceed no further as a result, and the Medical Practitioners Tribunal shall consider any such submissions and announce its decision as to whether they should be upheld’.

Submissions

2. Dr Ugwu submitted that the evidence of the GMC is tenuous and suffers from inherent weakness and inconsistency in relation to certain paragraphs of the Allegation. She submitted that there is insufficient evidence for the Tribunal to uphold paragraphs 8(c), 9(b), 9(c), 10(b) and 11(b) of the Allegation, so it would be inappropriate to proceed with these at the fact-finding stage. 3. On behalf of the GMC, Mr Brook submitted that the Tribunal should reject Dr Ugwu’s application. He directed the Tribunal to the evidence presented at this hearing, both oral and documentary, and argued that there is evidence present for each paragraph of the Allegation that Dr Ugwu has raised in her application which could lead the Tribunal to find these paragraphs proven. He referred the Tribunal to the salient witness statements presented to this Tribunal, including exhibits such as telephone messages and emails, as well as to the live testimony provided. The Tribunal’s Decision 4. The Tribunal distinguished between its approach to the evidence at this stage of the proceedings and the approach to be taken at the end of the fact-finding stage. It bore in mind that its role at this stage is not to make findings of fact but to determine whether the evidence heard in the GMC’s case, taken at its highest, is such that the Tribunal could find an alleged fact proved on the balance of probabilities. The Tribunal bore in mind that if it finds that there is sufficient evidence for the hearing to proceed on a particular paragraph, it will then have to decide in the light of all the evidence before it at the end of the fact-finding stage, whether that paragraph has in fact been found proved or not.



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5. The Tribunal considered the evidence placed before it in relation to paragraph 8(c) of the Allegation and, in particular, the oral evidence of Ms H and her witness statement dated 28 February 2019. These provided her account of Dr Ugwu’s refusal to leave the restricted area of the Trust on 27 July 2018. The Tribunal also noted the messages between Ms H and Dr F dated 27 July 2018. It therefore concluded that the evidence presented was sufficient for a reasonably directed Tribunal to conclude that this paragraph could be found proven. 6. The Tribunal next considered the evidence presented in relation to paragraph 9(b) of the Allegation and noted that there were some inconsistencies between the witness evidence of Ms I and Ms H, but this may relate to different time periods. It had regard to Ms H’s witness statement, in which she described Dr Ugwu’s behaviour ‘as intimidating…’. Therefore, the Tribunal concluded that the evidence presented was sufficient for a reasonably directed Tribunal to conclude that this paragraph could be found proven. 7. The Tribunal analysed the evidence presented in relation to paragraph 9(c) of the Allegation. It had regard to the oral evidence of Dr F and to his two witness statements, which both referred to the phone calls made by Dr Ugwu to Dr F. The Tribunal noted that certain inferences could then be made from this but there has been no independent evidence submitted from the switchboard at the Trust, either to show that the calls were made in close time proximity or there was any policy about contacting clinicians at home. Accordingly, it concluded that, despite some inadequacies and inconsistencies, there was sufficient evidence for a reasonably directed Tribunal to conclude that this paragraph could be found proven. 8. The Tribunal considered the evidence presented for paragraph 10(b) of the Allegation. It had regard to the oral evidence of Dr E and to her witness statement of 1 May 2019, which addressed if Dr Ugwu’s behaviour was intimidating in relation to when Dr Ugwu attended a restricted area of the Trust. Dr E stated, ‘I was afraid during this interaction’. The Tribunal was satisfied that adequate evidence has been provided. Accordingly, it concluded that the evidence presented was sufficient for a reasonably directed Tribunal to conclude that this paragraph could be found proven. 9. The Tribunal lastly considered the evidence presented in relation to paragraph 11(b) of the Allegation. It bore in mind all of the evidence presented for paragraphs 7 to 10 and noted that there are inconsistencies in the evidence provided as to whether Dr Ugwu’s actions amounted to harassment. Nevertheless, the Tribunal concluded that the evidence submitted was sufficient for a reasonably directed Tribunal to conclude that this paragraph could be found proven. 10. The Tribunal therefore determined that there was a case to answer for in relation to paragraphs 8(c), 9(b), 9(c), 10(b) and 11 (b) of the Allegation and rejected Dr Ugwu’s application.



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ANNEX B – 04/10/2019

DETERMINATION ON Rule 17(7)(a) (Heard in Private)

1. On 3 October 2019 (Day 9), the Tribunal announced its determination on the facts. The hearing then resumed in private session in accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 (the ‘Rules’). 2. The Tribunal raised a matter with the parties under Rule 17 of the Rules. This states: ‘(7) At any stage in the proceedings before making a determination that a

practitioner’s fitness to practise is impaired, the Medical Practitioners Tribunal may, having regard to the nature of the allegation under consideration, adjourn and direct that—

(a) an assessment of the practitioner’s performance or health be carried out in accordance with Schedule 1 or 2; or’ 3. XXX 4. XXX Submissions 5. XXX 6. XXX. The Tribunal’s Decision 7. XXX 8. XXX 9. XXX 10. XXX 11. XXX 12. The Tribunal considered that it will need five days to conclude this case. XXX. 13. This hearing is now adjourned.



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ANNEX C – 09/07/2020 DETERMINATION ON ADJOURNMENT On 8 July 2020 1. The Tribunal reconvened on 8 July 2020, to decide in accordance with Rule 17(2)(l) of the Rules whether, on the basis of the facts which it has found proved, Dr Ugwu’s fitness to practise is impaired by reason of misconduct and Performance. 178. At the commencement of the hearing, the Tribunal was informed of communications from Dr Ugwu on 7 July 2020 indicating technical difficulties in joining the hearing and her inability to participate. The Tribunal noted that the MPTS practise is to undertake a test call the day before the scheduled hearing and noted that Dr Ugwu did not participate in such a test call. 179. The Tribunal was also provided with an email from Dr Ugwu, timed at 06:54 on 8 July 2020, in which she stated:

‘My internet connection developed some fault late yesterday. I am however out to fix it before the tribunal begins; if otherwise however I will inform you.

[XXX] I was only requesting a change in time for the second GMC witness, I will however leave this to the tribunal as stated.’

180. In a further email, dated 8 July 2020 and timed at 09:07, Dr Ugwu provided an update. She stated:

‘Unfortunately the problem has not been fixed, I regret to inform you that I will not be present at the tribunal this morning. I will inform you when the problem is fixed.’

181. This information was communicated to the Tribunal by Mr Brook. At 09:55, the Tribunal decided to adjourn the hearing until 10:30 to enable the GMC to make inquiries as to the availability of the two witnesses, before it could make a decision about Dr Ugwu’s request. Specifically, the Tribunal asked that the following questions be put to Dr Ugwu: • What steps she has taken to restore her internet connection? • Will this be done today, and if not, by when? • Would she be able to join the hearing by telephone? • What was her view about the Tribunal proceeding in her absence today?



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182. The Tribunal resumed at 10:32 - Mr Brook provided an update as to the availability of the witnesses. At 10:40, the Tribunal decided to adjourn the hearing until 11:30 to allow Dr Ugwu time to resolve her internet issues. 183. The Tribunal resumed at 11:30 - Mr Brook informed the Tribunal that Dr Ugwu was still out attempting to resolve her internet issues. The Tribunal adjourned for a short period. 184. The Tribunal resumed at 11:48 – Mr Brook confirmed to the Tribunal the availability of the two witnesses on 9 July 2020. The Tribunal adjourned until 14:00 to allow Dr Ugwu further time to resolve her internet issues. 185. The Tribunal resumed at 14:05 and after receiving an update, that Dr Ugwu had not been able to resolve her internet issues, decided at 14:12, to adjourn the hearing until 09:00 on 9 July 2020. On 9 July 2020 186. The hearing resumed on 9 July 2020. The Tribunal was informed by the MPTS staff that Dr Ugwu had managed to resolve her internet issues but was having some technical difficulties accessing the hearing via the skype link. The Tribunal was also informed that Dr Ugwu had made efforts to resolve this issue and had sent an email, timed at 03:04 on 9 July 2020, stating:

‘I was unable to join the meeting; I tried with a better network now. With my system I was unable to uninstall the downloaded 'skype for business'.

Kindly give my phone number to the tribunal in case this does not work.

Since you are colleagues are available at 08:00 hours I will attempt to join at that time since someone is available to sign me in’

187. During the course of the morning, Dr Ugwu was unable to join via skype but was able to join via the telephone number provided to her in the email sent to her by the MPTS. The hearing commenced. The Tribunal put a number of questions to Dr Ugwu to establish whether she would be able to participate in the hearing satisfactorily, given she was unable to access the hearing via skype, and was participating via telephone from Nigeria. These included whether she intended to return to the UK; and whether she would be willing to participate with these proceedings in person. In addition, Dr Ugwu confirmed that she had received an electronic copy of all of the documentation placed before the Tribunal. Dr Ugwu was in this part of the hearing for approximately 14 mi

PUBLIC RECORD · 2020. 11. 26. · Dr Francisca UGWU GMC reference number: 7076886 Primary medical...

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