08 June 2023

The outcome of General Medical Council (GMC) v Dr Nithya Santhanalakshmi Shunmugavel Pandian, which was considered by the Medical Practitioners Tribunal Service (MPTS) in May 2023, has sparked controversy amongst medical practitioners due to the unusual stance taken by the Tribunal towards consideration of Dr Pandian’s contemporaneous clinical notes.

Background 

Dr Pandian was employed as a Trust locum doctor in the Ambulatory Care Unit at Kettering General Hospital in May 2019 when she treated Patient A. Patient A had attended hospital due to concerns regarding her blood pressure.  Dr Pandian consulted with Patient A and made contemporaneous clinical notes under the headings: cardiovascular “S1 + S2 +”; respiratory “clear”; and abdomen “soft, non tender”.

Patient A was later reviewed by a consultant.  During the assessment with the consultant, it was Patient A’s evidence that she saw her own medical notes which Dr Pandian had made. However, Patient A contended that Dr Pandian had not carried out a physical examination in order to arrive at the conclusions written in the notes. 

Patient A is said to have raised the issue with the consultant at the time and thereafter made a complaint to the GMC on 4 November 2020.

The Tribunal considered allegations that Dr Pandian had recorded cardiovascular, respiratory and abdominal examination findings with the knowledge that she had not examined Patient A’s heart, breathing and abdomen and whether her actions were accordingly dishonest.

Dr Pandian’s Position

Dr Pandian admitted that she had recorded examination findings in the clinical notes. She stated that it was her, “usual practice to review admission notes, clinical observations, take relevant history and carry out an initial examination… this includes listening to patient’s chest, heart sounds and undertaking an abdominal examination”. She had no doubt that she would have followed her usual practice and made contemporaneous notes in accordance with her observations.

She explained that she could not recall the specific patient but she relied on her recollection from reviewing the patient’s notes and her routine practice.

Determination

It was for the GMC to prove, on the balance of probabilities, that Dr Pandian did not carry out the examinations documented in the clinical notes. They were required to prove that Dr Pandian therefore wrote the notes, knowing that she had not carried out the examinations and that her conduct was dishonest.

The GMC presented evidence from Patient A and Patient A’s husband, who both provided witness statements and gave oral evidence. Patient A and her husband stated that Dr Pandian did not carry out any physical examination.

The Tribunal considered that Dr Pandian could not specifically recall the events but was adamant that she would never make mistakes of this nature. However, they determined Patient A’s evidence to be persuasive and established that on the balance of probabilities Dr Pandian did not examine Patient A.

The Tribunal therefore determined Dr Pandian’s actions to have been dishonest and her fitness to practise was impaired by serious misconduct.

Concluding Remarks 

The decision of the MPTS is of concern to medical practitioners because of the lack of objective evidence presented by the GMC to support its position.  The position entrenched in case law previously emphasised that Tribunals should be wary of fallibility of memory and contemporaneous medical notes are usually held in higher regard in terms of accuracy and importance. Yet, the present case favours recollection as opposed to medical notes which were written contemporaneously.

Four years had elapsed since the events and Dr Pandian had been working without any further incidents. Yet, the Tribunal determined that it was reasonable to impose a sanction of two months’ suspension.

We would welcome clarification from the GMC as to the weight accorded to clinical records contemporaneously recorded when establishing factual evidence in fitness to practise proceedings.

BTO specialises in defending professionals throughout fitness to practise investigations and proceedings. If you have any queries in respect of the fitness to practise process, please do not hesitate to contact us.

Phoebe Crane, Solicitor: pcr@bto.co.uk / 0131 222 2939

Natalie McCartney, Senior Associate and Solicitor Advocate: nem@bto.co.uk / 0131 222 2939