public record · 2020-06-26 · to dr saeed’s credit that he had undertaken such a course,...

Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr SAEED 1

PUBLIC RECORD The GMC successfully appealed the decision of the Medical Practitioners Tribunal in June 2019 to suspend Dr Saeed’s registration for a period of 12 months. The Court ordered that the suspension be quashed and the case be remitted for reconsideration of sanction only. A copy of the appeal judgment is not accessible online for free. The name of the case is General Medical Council v Muhammad Saqib Saeed, the neutral citation for the judgment is [2020] EWHC 830 (Admin) and the case number is CO/2687/2019. If you wish to view the judgment you can contact the High Court direct to obtain a copy. Please also see the record of determinations from Dr Saeed’s original hearing which concluded in June 2019.

Dates: 24/06/2020 - 25/06/2020

Medical Practitioner’s name: Dr Muhammad Saqib SAEED

GMC reference number: 7398648

Primary medical qualification: MB BS 2005 University of Peshawar - Ayub Medical College

Type of case Outcome on impairment New - Conviction Impaired

Summary of outcome

Erasure Immediate order imposed

Tribunal:

Legally Qualified Chair Mr Robin Ince

Lay Tribunal Member: Ms Sue Disley

Medical Tribunal Member: Dr Shazad Amin

Tribunal Clerk: Miss Emma Saunders



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Attendance and Representation:

Medical Practitioner: Not present and not represented

Medical Practitioner’s Representative: N/A

GMC Representative: Mr David Birrell, Counsel

Attendance of Press / Public In accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004 the hearing was held in public. 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 Sanction - 25/06/2020 Background 1. Dr Saeed’s case was first considered by a Medical Practitioners Tribunal (MPT) on 10 to 12 June 2019 (‘the 2019 Tribunal’). 2. The 2019 Tribunal considered the Allegation that, on 6 July 2018 at Maidstone Crown Court, Dr Saeed was convicted of one count of Controlling and Coercive Behaviour towards Ms A between the start of December 2016 and 11 August 2017, and one count of Assault Occasioning Actual Bodily Harm against Ms A on 11 August 2017. 3. It was also alleged that Dr Saeed was sentenced to 22 months imprisonment suspended for two years, 200 hours of unpaid work, a Rehabilitation Activity Requirement for 30 days, and a restraining order. 4. The 2019 Tribunal was provided with the Certificate of Conviction dated 4 September 2018 and found the Allegation proved in its entirety.



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5. On 29 August 2018, in his sentencing remarks with regard to the first count of Controlling and Coercive Behaviour, Judge Griffith-Jones addressed Dr Saeed with regard to his behaviour towards Ms A as follows:

“You ruled the roost and were demanding of her obedience. You were abusive and threatening towards her when, occasionally, she displayed signs which you interpreted as a challenge to your authority, your supremacy... You even sought to check up on her when you were out by leaving recording devices running from time to time. To a very large extent, she was required to conform to your wishes and demands and to do as she was told. Absent your permission, her freedom to go out and about, to visit her friend - although she only had one real friend in England - and otherwise to act as she may have wished, whilst not totally constrained in that obviously you were not always at her side, was very severely curtailed. In short, you made her life a misery.”

6. With regard to the second count of Assault Occasioning Actual Bodily Harm, His Honour Judge Griffith-Jones addressed Dr Saeed concerning the events of 11 August 2017 as follows:

You had an argument over [Ms A] having posted online to her close circle of family and friends a video of her... The video was innocuous, but you took exception to it. You berated her and an argument ensued in which you were again abusive and, on this occasion, you lost all self-control and you slapped her and throttled her,… she called the police. Fortunately, her injuries were limited to bruising around her neck but plainly this must have been a particularly traumatic and very upsetting incident for her.

7. The sentencing remarks made by HHJ Griffith-Jones gave further details of the background to these incidents as follows:

“XXX

The reality is that XXX served to entrench and intensify your feelings of entitlement and power over her and, as time went on, your behaviour towards her progressively deteriorated; your demands and requirements of her increased, along with the restrictions which you sought to place upon her and the abuse which you directed at her... …Turning then to mitigation, plainly there is no credit due to you, as would have been the case in the event of any guilty plea. Indeed, you remain in denial and, not surprisingly therefore, have shown no real remorse, although you are an educated and intelligent man, and I note that you do appear to accept that, in certain respects at least, your behaviour left something to be desired. That is encouraging. You now experience feelings of shame at the



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situation which you are now facing following your convictions. As I have said, I am prepared to accept that the deceit inflicted on you and your family served as a feature of some provocation to you, albeit it manifestly cannot and does not justify the excesses to which you descended thereafter over such a significant period of time.”

8. The 2019 Tribunal determined that Dr Saeed’s fitness to practise was impaired by reason of his conviction. It stated that, over a nine-month period, Dr Saeed acted in a controlling and coercive manner towards Ms A, causing her both sustained emotional distress and, on 11 August 2017, physical harm via an assault apparently triggered by Ms A’s posting of an innocuous video to her relatives. 9. The 2019 Tribunal was satisfied that Dr Saeed’s convictions brought the profession into disrepute and that his actions breached a fundamental tenet of the medical profession, in that he did not act within the law. 10. In considering whether Dr Saeed has developed insight, the 2019 Tribunal noted the then GMC Counsel, Mr Birrell’s, submission that Dr Saeed still maintained his innocence and blamed Ms A, alleging that she made up the allegations which led to his conviction. However, the 2019 Tribunal was aware that Dr Saeed was acquitted of a number of allegations, and without clarity on which specific allegations Dr Saeed blamed Ms A for, found it difficult to draw such adverse inferences as Mr Birrell then suggested. That said, the Tribunal did note some contradiction in the doctor’s suggestion that he accepted that the conviction “has impaired my fitness to practise as [it] does have effect (sic) upon public confidence in the medical profession…” yet stated, in the same paragraph, “I, however, still maintain that the allegations… were made up…” 11. The 2019 Tribunal further noted that, in his statement, Dr Saeed accepted that the conviction had impaired his fitness to practise. He also set out that “…any physical, emotional, verbal abuse & aggression is unacceptable…” The 2019 Tribunal did not, however, accept that simply referring to his actions as ‘unacceptable’ was evidence of sufficient insight. Whilst the 2019 Tribunal accepted Dr Saeed’s argument that ‘maintenance of innocence’ did not necessarily indicate a lack of insight, it considered that the actions Dr Saeed had taken at that stage did not demonstrate that he fully appreciated the seriousness of his actions. 12. The 2019 Tribunal took account of Dr Saeed’s attendance at XXX from November 2018 - April 2019. However, whilst the 2019 Tribunal accepted that it was to Dr Saeed’s credit that he had undertaken such a course, apparently voluntarily, that Tribunal considered that it was of limited value because it had seen no evidence of the content of this course and the material impact it had had on Dr Saeed’s reflection on, and insight into, his offences. Further, the letter from the course provider, Ms B, XXX, referred only to completion of XXX…course’ but did not indicate



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whether the course addressed either anger management issues or the underlying causes which led to his controlling behaviour. 13. The 2019 Tribunal therefore was of the view that Dr Saeed had, through the reflection provided in his statement and his actions in attending the course, begun to develop insight, but no more than that. It followed therefore that the 2019 Tribunal found that Dr Saeed had not remediated his actions. 14. The 2019 Tribunal determined to suspend Dr Saeed’s registration for 12 months, directed a review hearing and imposed an immediate order of suspension. It gave as its reasons the following:

“…25. Dr Saeed has, to date, not demonstrated significant insight into his offending. He has however, via the statement he has provided for this hearing, and the course XXX he has taken, demonstrated that he is able to proactively identify and take steps in order to reflect on and begin to address his unacceptable behaviour. The Tribunal considered that, although this is well short of demonstrating full insight into his unacceptable actions towards Ms A, it did demonstrate that Dr Saeed has the capability and motivation to gain such insight and remediate his offending. Further, the Tribunal took into account that Dr Saeed was acquitted of five of the seven charges he faced a Crown Court, XXX. It was of the view that his acquittal on these charges may have fostered a sense of injustice against Ms A, which has as yet prevented him from gaining insight into his assault upon her and the profound impact it has had upon her. 26… Further, it was satisfied that this period will provide Dr Saeed with sufficient time and opportunity to properly reflect on, and gain insight into, his offending, such that he will not repeat such behaviour.”

15. In deciding that an order of suspension was the appropriate and proportionate sanction as opposed to an order of erasure, the 2019 Tribunal stated:

“…the Tribunal accepts that, absent any mitigating factors, Dr Saeed’s convictions arguably could have justified his immediate erasure. However…the Tribunal does not find that Dr Saeed has displayed a ‘persistent’ lack of insight into the seriousness of his actions or their consequences. The Tribunal notes that it is less than a year since his conviction and sentence in August 2018 and that the XXX course only concluded in April of this year. The Tribunal believes that his proactivity in seeking assistance XXX (and his indication in his statement that ‘I will use the understanding and techniques learned in the XXX program and plan to do further XXX if needed to better manage issues in future XXX.’) is a clear indication that Dr Saeed accepts that this is a feature of his character which he needs, and is willing, to address. On that basis the Tribunal considers that



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his insight is a ‘work in progress’ and is not, at present, persistent. For this reason in particular the Tribunal considers that erasure is not at the present time the proportionate response. However, Dr Saeed must be under no illusion that the decision whether to suspend or erase him was finely balanced.”

16. Finally, the 2019 Tribunal indicated as follows:

“30… The Tribunal wishes to clarify that at the review hearing, the onus will be on Dr Saeed to demonstrate how he has developed full insight into the impact of his actions. It therefore may assist the reviewing Tribunal if Dr Saeed provides it with:

• evidence that he has reflected further on the findings of the Crown Court and the Tribunal and has developed insight into his offending and the impact it has had on Ms A XXX. This may take the form of a reflective statement;

• evidence that he has sought to remediate his actions by addressing his anger management and controlling/coercive behaviour issues. This could be through relevant courses and/or XXX;

• evidence that he has kept his medical knowledge and skills up to date; testimonials and/or references which may be professional or personal from people whom it is clear are aware of the findings of the Crown Court and this Tribunal;

• any other information that Dr Saeed considers will assist.”

17. The current Tribunal pauses to confirm that, although the ensuing GMC appeal to the High Court (see below) resulted in the 2019 Tribunal decision on sanction being quashed, it considered it nonetheless necessary to set out in some detail parts of the 2019 Tribunal’s reasoning in relation to sanction in order to contextualise its approach to the remittal by the High Court for it to reconsider the issue of sanction. GMC Appeal 18. The General Medical Council (GMC) decided to appeal the sanction decision of the 2019 Tribunal. It argued that the sanction imposed by the 2019 Tribunal was not sufficient for the protection of the public. The GMC sought to have the sanction decision quashed and asked the High Court either to substitute the sanction of erasure from the Medical Register or to remit the matter of sanction to this Tribunal, to be determined in the light of the High Court’s judgment. 19. The GMC appealed the 2019 Tribunal’s decision on the grounds that:

a. the MPT failed to apply the Sanctions Guidance properly by failing to apply paragraph 109 of the Sanctions Guidance;



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b. the MPT failed to apply the Sanctions Guidance by erring in its consideration of paragraph 119; and c. the MPT’s sanction of suspension failed to reflect the true seriousness of Dr Saeed’s convictions

20. Dr Saeed submitted documentation for the High Court to consider including a document entitled ‘Response to the Appeal’, the determinations of the Medical Practitioners Tribunals in relation to three other medical practitioners, and a copy of the transcript of the Court of Appeal judgment in Bawa-Garba v GMC [2018] EWCA Civ 1879. This Tribunal has been provided with copies of this documentation. 21. The appeal was heard on 21 January 2020 before Mr Justice Murray, who in his judgment dated 7 April 2020 concluded that the appeal should be allowed. Mr Justice Murray stated that the 2019 Tribunal’s determination on sanction would be quashed and the matter remitted to the MPTS for it to arrange an MPT to dispose of this case, having regard to the court’s judgment. Within the judgment, Mr Justice Murray stated:

“76… Ultimately, however, given the very serious nature of and “extreme harm” (in the words of the sentencing judge) caused by Dr Saeed’s offences against Ms A, it was, in my view, incumbent on the MPT to deal clearly, in particular, with factors (c), (d), (e) and (g)… I accept that the Sanctions Guidance is non-statutory guidance and is not formally binding on the MPT… and I also accept Dr Saeed’s submission that paragraph 109 simply sets out a non-exhaustive list of factors that “may” indicate that erasure is the appropriate sanction. … 77. I consider, however, that… the MPT is obliged to have proper regard to the Sanctions Guidance and, when departing from it, to do so for sound reasons and to state those reasons clearly in its decision. The MPT failed to do that in this case, at a minimum, in relation to factors (c), (d), (e) and (g), and not sufficiently clearly, if at all, in relation to factors (a) and (b)… it is not sufficient to rely on a ‘generalised assertion that erasure would be a disproportionate sanction’…” “83… But it is not proper, in principle, for the MPT to depart from paragraph 119 of the Sanctions Guidance simply on the basis that it has also ordered a review hearing at which it has the power to extend the period of suspension. The original sanction must reflect the seriousness of the offending, and if the MPT is going to depart from the principle set out in Fleischmann and paragraph 119, it needs to have sound reasons to do so and to set those reasons out clearly in its decision. Accordingly, the appeal succeeds also on the second Ground of Appeal.”



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84. Accordingly, the appeal succeeds also on the second Ground of Appeal.” “85. Regarding the third Ground of Appeal, which is that the sanction of suspension failed to reflect the true seriousness of Dr Saeed’s convictions, we are once again in the territory of the evaluative judgment of the MPT and the need for this court to give appropriate deference to it, even if that is lesser deference given the lack of witness evidence at the hearing and the nature of Dr Saeed’s underlying conduct. It is clear from my analysis of the first two Grounds of Appeal that this appeal must succeed due to the insufficiency of its reasons in relation to a number of relevant factors in paragraph 109 of the Sanctions Guidance and due to the MPT having erred in its consideration of paragraph 119 of the Sanctions Guidance. It is not, therefore, necessary for me to reach a definitive view on the third Ground of Appeal.” 86. The GMC has urged me to quash the MPT’s determination on sanction and to substitute a sanction of erasure. I am not persuaded, however, that that must follow. If the deficiencies of reasoning highlighted by this judgment are addressed by the MPT following a redetermination of the question of sanction, it may be the case that suspension, rather than erasure, is a justified outcome, however surprising that might seem, prima facie, given the seriousness of Dr Saeed’s original offences, the context in which they occurred and, on the evidence I have reviewed, his apparent lack of remorse and lack of or very limited insight into the seriousness of his actions and, in particular, the extreme harm he inflicted XXX. 87. It seems to me, therefore, that the proper disposal, having allowed the appeal, is to exercise the court’s power under section 40A(6) of the 1983 Act to (i) quash the MPT’s determination on sanction and (ii) remit the matter to the Medical Practitioners Tribunal Service (“MPTS”) for it to arrange for an MPT to dispose of this case, having regard to this judgment”.

Today’s Hearing 22. As such, the Tribunal has convened to determine afresh what sanction, if any, should be imposed on Dr Saeed’s registration, in accordance with Rule 17(2)(n) of the GMC (Fitness to Practise) Rules 2004, as amended (‘the Rules’). 23. For completeness, the Tribunal comprises the same Tribunal members as at the 2019 Tribunal hearing. Moreover, Mr Birrell once again, as he had done before the 2019 Tribunal, represented the GMC. Service and Proceeding in Absence - 24 June 2020

Service



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24. Dr Saeed is neither present nor legally represented at this hearing. 25. The Tribunal was provided with a copy of a Service bundle from the GMC. This included the Medical Practitioners Tribunal Service (MPTS) notice of hearing letter dated 7 May 2020 and a GMC information letter dated 18 May 2020. Both letters were sent to Dr Saeed by email only. 26. The Tribunal has been provided with an email from Dr Saeed dated 13 May 2020 in which he confirmed receipt of the MPTS notice of hearing. 27. On 2 June 2020 the GMC sent a follow up email to Dr Saeed to ask him to confirm he had received their correspondence and whether he would be attending this hearing remotely. The Tribunal has been provided with Dr Saeed’s response, also dated 2 June 2020, in which he confirmed receipt of both GMC emails (including correspondence and the draft hearing bundle) and stated that he would “not be attending remotely”. 28. Mr Birrell, Counsel on behalf of the GMC, stated that Dr Saeed had received and acknowledged notice of this hearing and referred to the email correspondence from Dr Saeed. 29. The Tribunal determined that notice of this hearing had been served on Dr Saeed in accordance with Rule 40 of the GMC’s (Fitness to Practise) Rules 2004, as amended, (‘the Rules’), and paragraph 8 of Schedule 4 to the Medical Act 1983, as amended. Proceeding in Absence 30. The Tribunal then went on to consider whether it would be appropriate to proceed with this hearing in Dr Saeed’s absence pursuant to Rule 31 of the Rules. The Tribunal was conscious that the discretion to proceed in the absence of a doctor should be exercised with the utmost care and caution, balancing the interests of the doctor with the wider public interest. It also took account of the authorities of: GMC v Adeogba [2016] EWCA Civ 162, GMC v Theodoropolous [2017] EWHC 1984 (Admin) and R v Jones [2003] 1 AC 1 (CA). 31. Mr Birrell invited the Tribunal to proceed with the hearing in Dr Saeed’s absence. He stated that Dr Saeed had responded by email to confirm that he would not be attending this hearing. He submitted that there was no value in an adjournment. 32. The Tribunal had regard to the email from Dr Saeed dated 2 June 2020. In the circumstances, the Tribunal determined that it was fair and appropriate to proceed in Dr Saeed’s absence because he has voluntarily absented himself, no



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application is made for an adjournment and such an adjournment would be unlikely to result in Dr Saeed’s participation at a subsequent hearing. The Evidence 33. The Tribunal was provided the following documentation at this hearing, which it has taken account of:

• The determinations of the 2019 Tribunal hearing on Service and Proceeding in Absence, Facts and Impairment;

• The main hearing bundle that was submitted in respect of the 2019 Tribunal hearing, which consisted of the Certificate of Conviction dated 4 September 2018, the Pre-Sentence Report dated 28 August 2018 and the Court Transcript dated 29 August 2018;

• The bundle of documents that Dr Saeed submitted in respect of the 2019 Tribunal hearing, which included a statement from Dr Saeed, a number of character statements and references, multi-staff and patient feedback, and certificates of courses undertaken;

• The documentation that Dr Saeed submitted for the High Court appeal (received by the GMC on or about January 2020);

• The High Court Judgment of Mr Justice Murray dated 7 April 2020; • Transcripts of the three days of Dr Saeed’s substantive hearing (10 to 12 June

2019), which included the 2019 Tribunal’s determination on sanction. GMC Submissions 34. Mr Birrell stated that the matter of sanction is for the Tribunal exercising its own independent judgement. He submitted that the appropriate and proportionate sanction in this case is one of erasure. Mr Birrell referred the Tribunal to the wording of the overarching objective and stated that the reputation of the profession as a whole is more important than the interests of one doctor. 35. Mr Birrell stated that the Tribunal was dealing with very serious misconduct. He reiterated the seven points that he made at the 2019 Tribunal hearing in respect of Dr Saeed’s behaviour. Mr Birrell stated that Dr Saeed’s offending had led to a lengthy custodial sentence, albeit that it was suspended. He referred to the sentencing remarks of His Honour Judge Griffith-Jones on 29 August 2018, that the controlling or coercive behaviour “was persistent action over a prolonged period” and that it was behaviour that was “extreme” and “calculated to humiliate”. Further, that Ms A was “vulnerable, XXX”. 36. Mr Birrell submitted that the assault was serious and that it had the potential to have been more serious. He referred to the sentencing remarks where it referred to the incident on 11 August 2017 where Dr Saeed “lost all self-control and you slapped her and throttled her”. Mr Birrell made the point that the conviction was an



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assault occasioning actual bodily harm, which on the scale of violent offending is far more serious than common assault. He cited as evidence of this that ABH carried a much longer maximum custodial sentence than common assault. He submitted that the injuries to Ms A could have been far more serious and that throttling of the neck can lead to much more serious injuries, which it thankfully did not on this occasion. Mr Birrell stated that the offending caused “extreme harm” to Ms A and that the repercussions for her had been “catastrophic”. 37. Mr Birrell referred to the assertion from Dr Saeed at the criminal trial that his victim practised a deceit on him, which came as something of a surprise to him, and that might have provoked him to act as he did. Mr Birrell submitted that this deceit does not count as a mitigating factor for the Tribunal, which is part of the regulatory process. He referred to the sentencing remarks of HHJ Griffith-Jones in August 2018 that the deceit “manifestly cannot and does not justify the excesses to which [Dr Saeed] descended thereafter over such a significant period of time”. Mr Birrell stated that the suggestion of provocation did not hold up to scrutiny when looking at the timeline of events, whereby Dr Saeed discovered the deceit in about April 2016, the coercive behaviour began in December 2016 and the violent assault took place in August 2017. Mr Birrell submitted that, even if the deceit did mitigate Dr Saeed’s position in the criminal case, it should not do so before this Tribunal. He referred to the case of GMC v Jagjivan [2017] EWHC 1247 (Admin), which held that:

“Matters of mitigation are likely to be of considerably less significance in regulatory proceedings than to a court imposing retributive justice, because the overarching concern of the professional regulator is the protection of the public.”

38. Mr Birrell stated that there had been a rather troubling development in this case since the 2019 Tribunal hearing. He referred to a document entitled ‘Response to the Appeal’ that Dr Saeed had submitted in his documentation to the High Court, namely where he stated:

“I have made a catastrophic mistake in my statement where I Omitted a word NOT, the statement should have been (sic): I, however, still maintain that the allegations NOT leading to my conviction were made up by [Ms A]…”

Mr Birrell stated that Dr Saeed refers to his limited English but submitted that this does not stand up to scrutiny. He referred to the remarks from Mr Justice Murray where he expressed serious reservations that it was a typographical error and indeed he opined it was not credible. Mr Birrell asked the Tribunal to take these remarks into account. He submitted that, in a case where insight is very important, Dr Saeed was being disingenuous and seeking to mislead the High Court and, by



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extension, this Tribunal. Mr Birrell submitted that this demonstrated a reduction in the level of Dr Saeed’s insight. 39. Mr Birrell submitted that Dr Saeed’s lack of insight amounts to an aggravating factor. He referred to paragraph 52 of the Sanctions Guidance (18 November 2019) (‘the SG’) and stated that it has now been two years on from Dr Saeed’s conviction and he has provided no new additional evidence of insight or remediation. He referred to Mr Justice Murray’s comments that Dr Saeed had a “lack of or very limited insight into the seriousness of his actions”. 40. Mr Birrell referred to paragraph 117 of the SG, that:

“However, the tribunal should bear in mind that the sentence or sanction previously imposed is not necessarily a definitive guide to the seriousness of the offence. There may have been personal circumstances that led the court or regulatory body to be lenient. For example, the court may have expressed an expectation that the regulatory body would erase the doctor. Similarly, the range of sanctions and how they are applied may vary significantly amongst other regulatory bodies.”

He referred to the remarks of HHJ Griffiths-Jones, that Dr Saeed had “lost [his] good character and I accept that the damage which these convictions will inflict on [Dr Saeed’s] future career is itself likely to be extreme”. Mr Birrell argued that this comment should be interpreted as an indication that the sentencing Judge expected Dr Saeed to be erased by the GMC and therefore exercised additional leniency by suspending the sentence of imprisonment. Mr Birrell therefore asked the Tribunal not to place much weight on the fact that Dr Saeed received a suspended sentence. 41. In relation to the available sanctions, Mr Birrell submitted that the Tribunal taking no action would be totally inappropriate and there was nothing exceptional about the case to justify it. He stated that conditions would also not be appropriate or workable. Mr Birrell submitted that suspension would also not be appropriate as this was a case where Dr Saeed’s conduct was fundamentally incompatible with continued registration. He stated that there has been no acknowledgement of fault by Dr Saeed and the Tribunal could not be satisfied the conduct would not be repeated. 42. Mr Birrell submitted that erasure of Dr Saeed’s name from the Medical Register would the minimum required to meet the requirements of the overarching objective. He resubmitted that suspending Dr Saeed would be to put his interests before the reputation of the medical profession. Mr Birrell stated that any other outcome would damage the reputation of the profession and of the regulator. 43. Mr Birrell made reference to paragraph 109 of the SG as to factors which may indicate that erasure is appropriate. He submitted that Dr Saeed’s actions were a



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particularly serous departure from the principles of Good medical practice (GMP), and that serious and deliberate harm had taken place. Mr Birrell reminded the Tribunal of the sentencing remarks that Dr Saeed’s actions were “calculated to humiliate” and that Ms A was a vulnerable victim. He submitted that the Tribunal was dealing with a persistent lack of insight and pointed to the disingenuous statement made by Dr Saeed in his statement to the High Court. 44. Mr Birrell submitted that Dr Saeed has committed an extremely serious criminal offence and has brought the profession into disrepute. He stated that Dr Saeed’s insight was even less than it was in June 2019 and that erasure was the only sanction that would send the necessary and required message to both the doctor and the profession. Mr Birrell submitted that such a sanction was, in all the circumstances, proportionate. The Tribunal’s Determination on Sanction 45. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this Tribunal exercising its own judgement. It has had regard to the principle of proportionality. 46. In reaching its decision, the Tribunal has taken account of the SG (namely the revised version dated November 2019, which post-dates the previous hearing in June 2019). It has borne in mind that the purpose of the sanctions is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect. It has taken account of the overarching objective of sanctions to protect the public as set out in paragraph 14 of the SG. Finally, it has reminded itself of its findings on impairment and on the breaches of GMP as detailed in paragraph 10 of its determination on impairment. 47. The Tribunal has had regard to the comments of Mr Justice Murray in the Judgment dated 7 April 2020 as he required it to do. Furthermore, it has taken account of the information currently before it and has not limited itself merely to consideration of the material before the 2019 Tribunal. The additional information includes Dr Saeed’s written submissions to the High Court (which run to 15 pages and attachments). Moreover, the Tribunal notes in particular the complete lack of any further submissions from Dr Saeed specifically in relation to this current hearing which was convened to re-examine the question of sanction. Although its previous decision on sanction was quashed, the Tribunal nevertheless anticipated that Dr Saeed would take the opportunity to demonstrate to the Tribunal before it re-made the decision on sanction that he had reflected on his actions and had taken advantage of the additional time given to him to remediate those actions. That Dr Saeed has not done so is a matter that the Tribunal considers it should take into account to his detriment. Aggravating and mitigating factors



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48. The Tribunal gave careful consideration to the aggravating and mitigating factors present in Dr Saeed’s case. 49. In mitigation the Tribunal had regard to the following factors:

• The Tribunal noted that Dr Saeed accepted that ‘…any physical, emotional, verbal abuse & aggression is unacceptable…’ and had proactively undertaken XXX course, demonstrating that in 2019 he was open to undertaking steps towards remediation. However, despite a further 12 months having passed, there is no evidence before the Tribunal that he has taken any further steps to remediate his behaviour. The Tribunal therefore considered that the lack of evidence of continuing and developing insight and remediation to be significant and therefore decided that the weight that could be attached to this point was now reduced.

• In relation to risk of repetition, the Tribunal notes that in 2019 it concluded that that Dr Saeed was perceived as being more of a risk to XXX than anyone else but that, as he has been unable to demonstrate how he would behave towards XXX, the risk of repetition remained. The Tribunal considers that, as no further remediation appears to have taken place since June 2019, the risk of repetition remains.

• The Tribunal nonetheless noted that the risk of reconviction as identified

in the Pre-Sentence Report was described as low, and HHJ Griffith-Jones also stated that “you pose a low risk of further offending in the future.”

• The Tribunal acknowledged the context, although it noted that it was not

a justification, in which the offences occurred. It observed that HHJ Griffith-Jones commented specifically on the breakdown of trust between Dr Saeed and Ms A, which had a material effect on Dr Saeed’s subsequent worsening behaviour.

• The Tribunal considered, as it had in 2019, that the testimonials and

references provided on behalf of Dr Saeed provided limited mitigation. It noted that, beyond a testimonial written by Dr Saeed’s sister, none of the other referees state clearly that they are aware of the offences Dr Saeed has committed, although some do note that they are providing their letters for fitness to practise proceedings. It further took account of the fact that, despite the 2019 Tribunal’s suggestion that the authors of those and future references should confirm that they were aware of the convictions, no such additional testimonials have been forthcoming. With regard to Dr Saeed’s actions in a professional capacity, as it had in 2019, the Tribunal was able to place more weight on the positive feedback provided by nine patients and 26 colleagues about his practice, along with



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the reference of his Educational Supervisor who it accepted would know him well from a professional perspective.

• There have been no previous findings of impaired fitness to practise made

against Dr Saeed, nor is there any evidence that he has he acted in such a manner in the period of almost three years since August 2017. Further, it is clear from HHJ Griffith-Jones’s sentencing remarks that, prior to his conviction, Dr Saeed was considered of good character, with the Judge describing him as “…a man who has served the community very well, both in his work as a doctor and, more widely.”

50. The Tribunal balanced the mitigating factors against what it considered to be the aggravating factors in this case:

• The Tribunal considered that 22 months’ imprisonment, albeit suspended, is a significant sentence and demonstrates the seriousness with which HHJ Griffith-Jones regarded Dr Saeed’s criminal offences. The Tribunal notes that the sentence was suspended primarily because of Dr Saeed’s “exemplary character… the other mitigation… and the fact that you spent a not insignificant period on remand, which I have no doubt will have provided you with a salutary lesson.”

• The coercive and controlling behaviour displayed by Dr Saeed was not an

isolated matter but continued over a period of nine months and was described by HHJ Griffith-Jones as “calculated” and “extreme” behaviour towards a “vulnerable” person, Ms A.

• Dr Saeed’s assault in August 2017 upon Ms A was serious, and he

deliberately caused her physical harm by slapping and throttling her.

• Dr Saeed has shown little or no signs of remorse, does not appear to have apologised for his actions and, in his statement produced for the 2019 hearing, still appeared to blame Ms A for making false allegations against him. The Tribunal has reminded itself that Dr Saeed initially faced seven allegations of which only two were found proved and therefore notes that this might be a reason why Dr Saeed still blames Ms A, although of course this cannot apply to the allegations for which he was found guilty. On that point, the Tribunal has considered separately the issue regarding the attempted amendment to his original statement (see paragraph 51 below).

• The Tribunal also considered that paragraphs 56(c) and (d) of the SG

(which consider issues of ‘Conduct in a doctor’s personal life’) were aggravating factors, in that “Tribunals are also likely to take more serious actions where certain conduct arises in a doctor’s personal life” including



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“inappropriate behaviour towards vulnerable adults” and “misconduct involving violence”. The Tribunal agrees with Mr Birrell’s submission that the effect of Dr Saeed’s actions upon Ms A was “catastrophic”.

Dr Saeed’s amendment of his previous statement 51. The Tribunal considered as a specific issue the statement given by Dr Saeed in the document entitled ‘Response to the Appeal’ that he submitted to the High Court, where he stated:

“I have made a catastrophic mistake in my statement where I Omitted a word NOT, the statement should have been (sic): I, however, still maintain that the allegations NOT leading to my conviction were made up by [Ms A]…”

52. The Tribunal took account of the remarks from Mr Justice Murray that:

“52. First, Dr Saeed should carefully have checked the accuracy of the Respondent’s MPT Statement, given its importance. So, with reasonable diligence, the evidence he now seeks to give could have been available at the hearing before the MPT. Secondly, there is plenty of evidence that Dr Saeed, in fact, took the view that all of the allegations were false and made up by Ms A. It is unlikely that any of the additional evidence he now seeks to give would have made much difference to the outcome of the MPT hearing. 53. Finally, regarding the principal example of the alleged accidental omission of the word “not” from the sentence… Dr Saeed’s evidence that he intended to include that word and accidentally omitted it is not credible [the Tribunal’s emphasis] for several reasons. First, even bearing in mind that English is not his native language, it is a very odd and unnatural way of saying what he now says he meant. Secondly, there is plenty of evidence, as I have already said, that he continued to deny all allegations, including those on which he was convicted. Also, in the very next sentence, he refers to a passage in the case of Karwal v GMC that concerns maintenance of innocence in relation to actual convictions, not unproven allegations…”

53. The Tribunal was persuaded that the comments by Mr Justice Murray amounted to a finding of fact that Dr Saeed’s purported explanation was “not credible” which bind this Tribunal. In any event, it would have come to the same conclusion independently for the same reasons cited by Mr Justice Murray. It agreed that that such an important and fundamental point would have been double checked by the practitioner.



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54. The Tribunal noted the comments of Dr Saeed in his documents to the High Court that the error had arisen due to his use of English, which is not his first language. The Tribunal was aware that this might be a factor but noted that Dr Saeed had demonstrated his understanding of, and ability to express himself in, English by citing various legal authorities and asking for them to be taken into account. 55. Moreover, even if the Tribunal had accepted that Dr Saeed had made a genuine error, it nonetheless noted that there was still no apology for his actions. All Dr Saeed has stated is that his behaviour was “unacceptable”; he has not expressed any remorse or made any other statement to suggest that he genuinely regrets his actions insofar as they relate to Ms A or the profession. 56. The Tribunal therefore determined, as had Mr Justice Murray, that Dr Saeed had not been credible when suggesting that he had made a typing error in his original statement to the 2019 Tribunal. The Tribunal agreed with Mr Birrell that Dr Saeed’s attempted explanation in his submissions to the High Court was disingenuous and is an additional aggravating factor in this case. Insight 57. The Tribunal took account of paragraph 46 of the SG:

“A doctor is likely to have insight if they: a. accept they should have behaved differently (showing empathy and understanding) b. take timely steps to remediate… and apologise at an early stage before the hearing c. demonstrate the timely development of insight during the investigation and hearing.”

58. The Tribunal had regard to Dr Saeed’s written statement in which he acknowledged that such behaviour was “unacceptable”, but notes that he has not said he is sorry for what he had done. There has been no apology to Ms A or to the profession for his actions. The Tribunal was also aware the no further steps towards remediation or any further reflections have been provided by Dr Saeed, despite the additional time that has passed. The Tribunal concluded that, whilst Dr Saeed did initially seem keen to develop his insight, no progress towards this aim has been exhibited, and the Tribunal has no evidence before it to support any suggestion that Dr Saeed has demonstrated the timely development of insight. It therefore determined that Dr Saeed’s insight is very limited.



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No action 59. In coming to its decision as to the appropriate sanction, if any, to impose in Dr Saeed’s case, the Tribunal first considered whether to conclude the case by taking no action. 60. The Tribunal determined that, in view of the serious nature of the Tribunal’s findings on impairment, it would be neither sufficient, proportionate nor in the public interest to conclude this case by taking no action. Conditions 61. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Saeed’s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 62. The Tribunal concluded that a period of conditional registration would not be appropriate in terms of the need to protect the public interest and maintain public confidence in the medical profession. It was also unable to formulate any suitable or appropriate conditions. 63. The Tribunal therefore determined that it would not be sufficient to direct the imposition of conditions on Dr Saeed’s registration. Suspension 64. The Tribunal then went on to consider whether suspending Dr Saeed’s registration would be appropriate and proportionate. 65. The Tribunal had regard to paragraph 93 of the SG:

“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….”

The Tribunal noted that there has been no expression of remorse or apology by Dr Saeed to either Ms A or the profession for his actions and behaviour. It determined that there was limited evidence of insight at the time of the June 2019 hearing but that there is now no evidence of any further insight, remediation or reflection from Dr Saeed. Moreover, it took account of the disingenuous explanation that Dr Saeed made in his submissions to the High Court and the finding of Mr Justice Murray that his explanation had not been credible. The Tribunal also had regard to the aggravating and mitigating factors and to its conclusion in terms of insight, as listed above.



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66. The Tribunal paid specific regard to paragraph 97 of the SG, as to the factors which would indicate that suspension may be appropriate. It concluded that the following were potentially relevant in this case:

“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. f. No evidence of repetition of similar behaviour since incident. g. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour.”

67. In terms of paragraph 97(a), the Tribunal had regard to Dr Saeed’s convictions that included a conviction for assault occasioning actual bodily harm, and the sentence of two years imprisonment (albeit suspended) that was imposed. It concluded that Dr Saeed’s conduct had the potential to be incompatible with continued registration. 68. With regard to paragraph 97(e), the Tribunal was of the view that Dr Saeed has had ample opportunity to develop further insight but has not done so. It referred to its comments above as to Dr Saeed’s insight but found the evidence of any further insight since June 2019 to be severely lacking. Similarly, in relation to paragraph 97(g), as the Tribunal was not satisfied that Dr Saeed has any real insight into his actions, it therefore determined that Dr Saeed poses a significant risk of repeating the behaviour. 69. The Tribunal noted that there had been no evidence of repetition of similar behaviour, as at paragraph 97(f), and took this into account in its deliberations. 70. The Tribunal balanced the aggravating and mitigating factors in its consideration of the question of sanction. It had particular regard to the question of insight, the seriousness of Dr Saeed’s actions and the fact that there has been no real acknowledgement of fault. 71. In all the circumstances, the Tribunal determined that it would not be sufficient or appropriate to suspend Dr Saeed’s registration. Given all of the



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information before it, an order of suspension would now not adequately protect the public, maintain public confidence in the profession or uphold proper professional standards for members of the profession. Further, Dr Saeed having not taken the opportunity given to him to utilise the interim period since the 2019 hearing to develop any further insight, the current Tribunal has no confidence that he would now utilise the time given to him by a further suspension to develop such insight. Erasure 72. The Tribunal considered whether it would be appropriate and necessary to erase Dr Saeed’s name from the Medical Register. 73. The Tribunal had particular regard to paragraph 109 of the SG, which detailed the factors which may indicate that erasure is appropriate. It concluded that the following sub-paragraphs were relevant in this case:

“a. A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor.”

74. The Tribunal concluded that Dr Saeed’s convictions were very serious matters which had justified a sentence of two years imprisonment, albeit suspended. The Tribunal determined that Dr Saeed’s behaviour was a particularly serious departure from the principles set out in GMP and was behaviour that was potentially fundamentally incompatible with continued registration.

“b. A deliberate or reckless disregard for the principles set out in Good medical practice and/or patient safety.”

75. The Tribunal noted that the criminal conviction related to an assault occasioning actual bodily harm that could have had potentially fatal consequences. It determined that Dr Saeed’s actions represented, at the very least, a reckless disregard for the principles set out in GMP.

“c. Doing serious harm to others (patients or otherwise), either deliberately or through incompetence and particularly where there is a continuing risk to patients…”

76. The Tribunal determined that Dr Saeed’s actions included a deliberate assault on Ms A that resulted in harm. The Tribunal took this into account and noted the sentencing remarks of HHJ Griffith-Jones that the behaviour was “calculated to humiliate”.



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“d. Abuse of position/trust (see Good medical practice, paragraph 65: ‘You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession’).”

77. The Tribunal was of the view that the relevance of this factor was perhaps less clear. It noted Dr Saeed’s comments that he had found out about a deceit by Ms A and that this was part of his justification for the assault. However, the Tribunal considered that this was substantially negated by the sentencing remarks of HHJ Griffith-Jones that it “manifestly cannot and does not justify the excesses to which [Dr Saeed] descended thereafter over such a significant period of time”. The Tribunal took more account of the longer period of coercive behaviour, which it concluded amounted to an abuse of position/trust in relation to Ms A. The Tribunal noted that Ms A was not a patient but nevertheless, considered that his actions would, in the Tribunal’s opinion, have damaged the public’s trust in the medical profession on the basis that doctors should not cause harm to anyone.

“e. Violation of a patient’s rights/exploiting vulnerable people… … “g. Offences involving violence.”

78. The Tribunal noted the sentencing remarks of HHJ Griffith-Jones that Ms A was a vulnerable person and that the conviction involved violence. The Tribunal took both of these factors into account.

“h. Dishonesty, especially where persistent and/or covered up” 79. The Tribunal was aware that there are no allegations of dishonesty in this case. It did however take account of Mr Justice Murray’s comments and its own conclusions in respect of the disingenuous statement that Dr Saeed provided in his documentation for the High Court, which arguably amounted to an attempt to cover up his true beliefs.

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

80. The Tribunal acknowledged in June 2019 that Dr Saeed’s insight was developing. However, it has received no further reflections or evidence of remediation in the interim. If anything, the position has now worsened given the passage of time, the disingenuous statement by Dr Saeed to the High Court and the remarks of Mr Justice Murray as to the lack of insight. Despite having been given the opportunity and clear directions from the 2019 Tribunal as to the use of time for Dr Saeed to develop further insight into his actions, this has not taken place. It is now some three years on from the assault and two years from the convictions. No expression of remorse or apology to either Ms A or the profession has been provided by Dr Saeed. The Tribunal determined that the position is now such that Dr Saeed



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has demonstrated a “persistent lack of insight” as described at paragraph 109(j) of the SG. 81. The Tribunal was of the view that paragraph 108 of the SG was also of relevance in this case:

“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...”

82. There is very limited evidence of any insight and there has been no apparent remediation undertaken by Dr Saeed. It found the persistent lack of insight, the seriousness of the convictions, his lack of acknowledgement of fault and the serious departure from the principles of GMP, to be key aggravating factors in this case. 83. In summary, the Tribunal considered that, notwithstanding the judgement of Mr Justice Murray which made pertinent and correct observations about the Tribunal’s failure properly to express its reasoning, it had come to a fair decision in June 2019 in deciding to suspend Dr Saeed for a period of 12 months so that he could develop further insight into his actions. However, the 2019 Tribunal made it clear that its decision was finely balanced between suspension and erasure, so Dr Saeed was on notice that it was for him to continue his efforts to remediate his behaviour. Nonetheless, Dr Saeed has failed to take advantage of that opportunity. Moreover, in the interim, he has acted disingenuously as set out above. The Tribunal also found it remarkable that Dr Saeed had gone to the effort of producing 15 pages of submissions for the High Court appeal yet had failed completely to engage with this Tribunal hearing even though it was making a decision that would have a significant impact upon his career. 84. In all the circumstances, the Tribunal determined that it was necessary and proportionate to direct that Dr Saeed’s name be erased from the Medical Register. It concluded that this was appropriate and would sufficiently protect the public, maintain public confidence in the profession and uphold proper professional standards for members of the profession. Determination on Immediate Order - 25/06/2020 1. Having determined to erase Dr Saeed’s name from the Medical Register, the Tribunal has considered, in accordance with Rule 17(2)(o) of the Rules, whether Dr Saeed’s registration should be subject to an immediate order. GMC Submissions



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2. Mr Birrell submitted that an immediate order was necessary in this case. He referred to the SG, including paragraph 173:

“An immediate order might be particularly appropriate in cases where the doctor poses a risk to patient safety. For example, where they have provided poor clinical care or abused a doctor’s special position of trust, or where immediate action must be taken to protect public confidence in the medical profession.”

3. Mr Birrell submitted that an immediate order was in the public interest given the Tribunal’s findings and was necessary to protect public confidence in the profession. He stated that there would be no prejudice to Dr Saeed in imposing an immediate order as the doctor is abroad and has no wish to return to work. The Tribunal’s Determination 4. In making its decision the Tribunal exercised its own judgement. It had regard to paragraph 172 of the SG, which 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…”

5. The Tribunal referred to its previous determinations and the conclusions that it has drawn, including Dr Saeed’s persistent lack of insight, the seriousness of the convictions, his lack of acknowledgement of fault and the serious departure from the principles of GMP. 6. The Tribunal has no evidence to suggest that the imposition of an immediate order would cause prejudice to Dr Saeed since it has no information about his current circumstances. 7. In all the circumstances, the Tribunal determined to impose an immediate order of suspension on Dr Saeed’s registration. The Tribunal determined that this was in the public interest and was necessary in order to maintain public confidence in the profession. The Tribunal was also of the view that it was appropriate for the immediate order to be imposed in order for the relevant safeguards to be in place during any appeal period. 8. This means that Dr Saeed’s registration will be suspended from when notification is deemed to have been served. The substantive direction, as already announced, will take effect 28 days from when written notice of this determination has been served upon Dr Saeed, unless an appeal is made in the interim. If an appeal is made, the immediate order will remain in force until the appeal has concluded.



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9. The interim order currently imposed on Dr Saeed’s registration will be revoked when the immediate order takes effect. 10. That concludes this case. Confirmed Date 25 June 2020 Mr Robin Ince, Chair

public record · 2020-06-26 · to dr saeed’s credit that he had undertaken such a course,...

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