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Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr WONG

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PUBLIC RECORD Dates: 04/09/2017 – 12/09/2017 Medical Practitioner’s name: Dr Alice WONG

GMC reference number: 1553231

Primary medical qualification: MB BS 1971 Med Inst (I) Rangoon

Type of case Outcome on impairment New - Misconduct Impaired

Summary of outcome

Erasure Immediate order imposed

Tribunal:

Medical Tribunal Member (Chair) Dr Edward Doyle

Lay Tribunal Member: Ms Val Evans

Medical Tribunal Member: Dr Frances Burnett

Legal Assessor: Mr Alastair Forrest

Tribunal Clerk: Ms Angela Carney

Attendance and Representation:

Medical Practitioner: Not present and not represented

Medical Practitioner’s Representative: N/A

GMC Representative: Ms Elisabeth Acker, Counsel



MPT: Dr WONG

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Allegation and Findings of Fact

That being registered under the Medical Act 1983 (as amended):

1. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and:

a. you failed to notify the GMC of the Placement; Found Not Proved b. you failed to inform the GMC you had applied for medical employment outside the UK; Found Proved c. the Placement involved work at a higher level than Foundation Year One; Found Proved d. the Placement was for 22-26 June 2016 2015 only; Found Proved e. you failed to inform the Hospital Centre or the Authority of your Interim Orders Panel (‘IOP’) conditions; Found Proved f. you failed to inform your line manager at the Hospital Centre of your IOP conditions at least 24 hours before starting work. Found Proved

2. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015:

a. 1; Found Not Proved b. 4; Found Proved c. 5a; Found Proved d. 6; Found Proved



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e. 7a; Found Proved f. 7c. Found Proved

3. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you:

a. signed a declaration in which you ticked the box ‘agree’ to the following:

i. ‘I declare that I have not been found guilty of professional misconduct and there are no allegations outstanding against me, nor am I aware of any circumstances which may give rise to any such allegations’;

Found Proved ii. ‘I declare that all the information supplied in this form is correct’;

Found Proved

b. knew that: i. you were under investigation by the GMC;

Found Proved ii. you had conditions imposed on your registration by the IOP;

Found Proved iii. your answers to the questions at paragraph 3a above were untrue;

Found Proved

c. failed to inform the Board of your IOP conditions in breach of condition 7d. Found Not Proved

4. On 22 July 2015 you emailed the GMC and stated you did the Placement at the Hospital Centre after the agency (Your World Recruitment) said that it would be an ongoing locum from June until early September with an initial one week probation period. Found Proved



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5. The information given at paragraph 4 above:

a. was untrue because the Placement was only for the period set out at paragraph 1d; Found Proved b. you knew to be untrue. Found Proved

6. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were:

a. misleading; Found Not Proved in relation to paragraphs 1a and 3a Found Proved in relation to paragraphs 1b, 1e, 1f and 4 b. dishonest. Found Not Proved in relation to paragraph 1a and 3a Found Proved in relation to paragraphs 1b, 1e, 1f and 4

And that by reason of the matters set out above your fitness to practise is impaired because of your misconduct. Attendance of Press / Public The hearing was all heard in public.

Determination on Service - 4 September 2017

Ms Acker:

1. Dr Wong is neither present nor represented at these proceedings. The Tribunal has seen the MPTS Notice of Hearing letter dated 25 July 2017 sent to Dr Wong’s registered address. It has also seen the signed recorded delivery tracking record which states that the letter was delivered on 26 July 2017. The Notice of Hearing letter was also sent to Dr Wong via email on 25 July 2017. It has noted that the General Medical Council (GMC) sent a letter via recorded delivery containing the Notice of Allegation on 21 July 2017. In the circumstances, the Tribunal is satisfied that notice of this hearing has been properly served in accordance with Rules 20 and 40 of the GMC (Fitness to Practise) Rules 2004.

Determination on Proceeding in Absence – 4 September 2017

2. The Tribunal has noted Dr Wong’s email dated 12 July 2017, in which she stated that she would not be attending the telephone conference, nor would she be attending the hearing in September 2017. It has also noted the email dated 20 August 2017, in which she stated that she will not be attending the hearing as she was travelling



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abroad. She also stated that she would not be represented. The Tribunal has noted that Dr Wong was informed by the GMC that she could make an application to postpone the hearing.

3. The Tribunal has noted that Dr Wong did not request a postponement of the hearing nor has she applied to this Tribunal to adjourn today’s hearing. The Tribunal is satisfied that she is aware of the hearing and has decided not to attend. The Tribunal has borne in mind that, were it to adjourn today’s hearing, there is no indication that Dr Wong would be more likely to attend a future hearing. Given that Dr Wong is aware of the hearing and has stated that she will not be attending, the Tribunal has determined that the public interest would be best served by proceeding with the hearing today in the absence of Dr Wong in accordance with Rule 31 of the Rules, and that no injustice would arise to any party through its doing so.

Determination on Application to amend the allegation - 4 September 2017

4. At the outset of the hearing you made an application to amend paragraph 1d of the allegation. You stated that the allegation refers to the year 2015 and that paragraph 1d contains a typographical error in that it states 2016. You submitted that there would be no injustice to Dr Wong should the Tribunal accede to your application, as she has been aware of the allegation for some time and raised no concern regarding the incorrect date.

5. The Tribunal noted that, apart from the sub-paragraph the allegation refers to matters which all occurred in 2015. The Tribunal noted that Dr Wong has been aware of the allegation from the Notice of Allegation, dated 21 July 2017. She was provided with all the GMC’s evidence which made it clear that the relevant events were all alleged to have occurred in 2015. The Tribunal has noted that Dr Wong has not raised the incorrect date of 2016. 6. The Tribunal has determined that the year 2016 is a typographical error. It considered that there would be no injustice in acceding to your application to amend the incorrect date. Accordingly, the Tribunal acceded to the application to amend the date. Determination on Application to hear witness evidence via telephone - 6 September 2017 7. You made an application to hear witness evidence via telephone under Rule 34 (13) and (14) as the two witnesses Dr A and Dr B are based in Gibraltar. You said that you appreciate that an effect of the Tribunal’s decision to proceed in Dr Wong’s absence is that she will not have the opportunity to comment on this application. You also stated that there was no Case Manager Direction regarding witness attendance via telephone. You said that you recognise that the witness statements could be read but that the Tribunal indicated that it had questions for Dr B and Dr A. You also stated that there



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was a possibility of technical problems regarding witnesses attending via video link. You said that the hearing of this evidence by telephone is particularly in the interests of justice so that that evidence can be heard. 8. The Tribunal considered your application and determined that it would be in the interests of justice to allow the two witnesses who are based in Gibraltar to give evidence via telephone. The interests of justice include economy and expedition in the conduct of proceedings. The evidence was such that the truthfulness of the witnesses was not likely to be in issue, making it less relevant to observe the demeanour of the witnesses. Determination on Facts – 08/09/2017 9. The Tribunal noted that the stem of paragraph 1 has a date of 18 June 2015. The documentation makes it clear that the date should be 19 June 2015. It is clear from YWH’s documentation that the date on which Dr Wong accepted the locum placement in Gibraltar was 19 June 2015. The Tribunal has borne in mind that Dr Wong was provided with the documentation. The Tribunal has determined that amending the date to 19 June 2015 does not change the substance of the stem of paragraph 1 of the allegation. Therefore, of its own volition the Tribunal has determined that there would be no injustice to either party in amending the date to 19 June 2015. 10. It is plain from the evidence of Dr B that the placement was not at St Bernard’s Hospital but at the Primary Care Centre (the Centre), which he describes as being a separate site from the Hospital. In the application form which Dr Wong submitted to the Board she herself gave her proposed address of practice in Gibraltar as ‘Primary Care Centre’. The Tribunal did not consider that the address where Dr Wong worked was a matter of substance and was minded to exercise its power of amendment to correct the error. Having been informed by email that this amendment was under consideration, the GMC responded, again by email, that it would be supportive of this stance. The Tribunal could see no injustice to Dr Wong in correcting what was essentially a drafting error. It therefore amended the stem of paragraph 1 of the allegation and made consequential amendments to paragraphs 1e, 1f and 4 of the allegation. Paragraph 1 and now read as follows:

1. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the

Placement’) working for the Gibraltar Health Authority (‘Authority’) at St

Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre)

and:

a. you failed to notify the GMC of the Placement;

b. you failed to inform the GMC you had applied for medical

employment outside the UK;



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c. the Placement involved work at a higher level than Foundation Year

One;

d. the Placement was for 22-26 June 2016 2015 only;

e. you failed to inform the Hospital Centre or the Authority of your

Interim Orders Panel (‘IOP’) conditions;

f. you failed to inform your line manager at the Hospital Centre of

your IOP conditions at least 24 hours before starting work.

4. On 22 July 2015 you emailed the GMC and stated you did the Placement at the Hospital after the agency (Your World Recruitment) said that it would be an ongoing locum from June until early September with an initial one week probation period.

11. Further the Tribunal noted that the word ‘any’ was missing from the quotation in paragraph 3ai of the allegation, which it has amended as follows:

‘3ai. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you signed a declaration in which you ticked the box ‘agree’ to the following: ‘I declare that I have not been found guilty of professional misconduct and there are no allegations outstanding against me, nor am I aware of any circumstances which may give rise to any such allegations’;’

Background

12. On 22 December 2014 the MPTS Interim Orders Panel imposed conditions on Dr Wong’s registration, for a period of 15 months. Dr Wong attended and was legally represented at that interim order hearing. The interim order was reviewed on 3 June 2015 when the conditions were varied. The new interim conditions were in place when the events referred to in the allegation occurred, but were revoked on 23 July 2015 after the GMC Case Examiners decided to close the case. 13. On 20 February 2015 Dr Wong completed an application form for ‘Your World Recruitment Group’ which traded as ‘Your World Health’ (YWH). On the recruitment agency’s application form Dr Wong declared that she was subject to a GMC investigation but did not state that conditions had been imposed on her registration on 22 December 2014, for a period of 15 months. However, during a telephone conversation on 20 February 2015 Dr Wong informed YWH that she had restrictions on her practice relating to ‘slow work’ and ‘the ability to take blood’. It is clear from a telephone record dated 22 April 2015 that YWH knew that Dr Wong had GMC conditions.



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14. On 18 June 2015 YWH contacted Dr Wong regarding a locum GP post at the Primary Care Centre, Gibraltar for the period of 22-26 June 2015. Initially, Dr Wong told the agency that she could not work until 29 June 2015, but on 19 June 2015 Dr Wong confirmed by telephone that she would accept the locum position. On 22 June 2015 Dr Wong commenced the locum position. However, the locum position was terminated on 25 June 2015, when the Centre became aware of the conditions on her GMC registration. Witnesses 15. The Tribunal heard from the following witnesses in person:

Mr D, GMC Investigation Officer. Mr E, Business Manager of Doctors, Your World Healthcare, Your World

Recruitment Group 16. The Tribunal heard from the following witnesses via telephone:

Dr A, Chairman of the Gibraltar Medical Registration Board.

Dr B, Consultant in Obstetrics and Gynaecology, and Responsible Officer, Gibraltar Health Authority

17. The Tribunal accepted the evidence of each of the above witnesses, which included Mr E’s recognition that there were deficiencies in YWH’s systems and his acceptance that YWH should have highlighted Dr Wong’s interim conditions to the Gibraltar Health Authority. The Tribunal’s Approach 18. The Tribunal has considered each of the paragraphs of the allegation separately. In doing so it has considered all of the evidence adduced in this case. It has noted your submissions on behalf of the GMC. 19. The Tribunal has borne in mind that the burden of proof rests on the GMC throughout and that the standard is the civil standard of proof on the balance of probabilities, although it has taken into account that Dr Wong is a person of good character who has never previously had a finding of dishonesty against her. 20. In reaching its decisions on dishonesty, the Tribunal has had firmly in mind that in order to find dishonesty proved it must be satisfied not only that the conduct was dishonest by the standards of ordinary people but also that Dr Wong herself must have realised that her conduct was dishonest by those standards. Accordingly, it has made the following findings on the facts.



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The Tribunal’s Findings Paragraph 1a

‘1a. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and you failed to notify the GMC of the Placement.’ Found not proved

21. The Tribunal has noted interim condition 1 which states:

‘1. She must notify the GMC promptly of any post she accepts for which registration with the GMC is required and provide the contact details of her employer.’

22. In his oral evidence, Dr A told the Tribunal that at that time it was not a requirement of The Gibraltar Medical Registration Board (the Board) for doctors who were working in Gibraltar to be registered with the GMC. The Tribunal determined that as GMC registration was not a requirement for working in Gibraltar at that time, the condition did not impose a duty on Dr Wong to notify the GMC of the locum placement and there could therefore be no failure in that regard. The GMC did not submit that the duty arose independently from the conditions. Accordingly, the Tribunal found paragraph 1a, not proved.

Paragraph 6a in relation to Paragraph 1a ‘6a. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were misleading.’

Found not proved 23. As the Tribunal found paragraph 1a not proved paragraph 6a in relation to paragraph 1a falls. Paragraph 6b in relation to Paragraph 1a ‘6b. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were dishonest.’

Found not proved 24. As the Tribunal found paragraph 1a not proved paragraph 6b in relation to Paragraph 1a falls. Paragraph 1b

‘1b. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St



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Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and you failed to inform the GMC you had applied for medical employment outside the UK:’ Found Proved

25. The Tribunal has noted interim condition 4 which states:

‘4. She must inform the GMC if she applies for medical employment outside the UK.’

26. The Tribunal noted the evidence of Mr D. He stated that he could find no evidence on Dr Wong’s GMC records that she had informed the GMC of the locum placement in Gibraltar. When questioned, he described the GMC case management system ‘Siebel’ along with the GMC’s procedure for recording communications with doctors and confirmed that it would be highly unusual for any contact with a doctor not to be recorded. He stated that he had never come across such a situation while working for the GMC . 27. The Tribunal has noted that in her correspondence to the GMC, Dr Wong made no reference to notifying the GMC of the locum placement in Gibraltar. 28. The Tribunal found that under the interim order conditions placed on Dr Wong’s registration she had a duty to inform the GMC if she applied for medical employment outside the UK. The Tribunal was satisfied that Dr Wong did not inform the GMC and so she failed in that duty. Accordingly, the Tribunal found paragraph 1b, proved. Paragraph 6a in relation to Paragraph 1b ‘6a. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were misleading.’

Found Proved 29. The Tribunal found Dr Wong failed to inform the GMC she had applied for medical employment outside the UK when she had a duty to do so. The Tribunal considers that in not informing the GMC of the locum placement Dr Wong was misleading the GMC which would have been under the impression that she was complying with the interim conditions on her registration. Accordingly, the Tribunal found paragraph 6a in relation to Paragraph 1b, proved. Paragraph 6b in relation to Paragraph 1b ‘6b. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were dishonest.’

Found Proved 30. The Tribunal noted that Dr Wong attended and was legally represented at the interim order hearing on 22 December 2014. It noted that at the interim order review



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hearing on 3 June 2015, the conditions on Dr Wong’s registration were varied. The Tribunal has noted the letter dated 4 June 2015 from the Medical Practitioners Tribunal Service (MPTS) informing Dr Wong and her legal representatives, RadcliffesLeBrasseur of the varied conditions. It has further noted the letter dated 16 June 2015 from RadcliffesLeBrasseur. 31. The Tribunal considered that Dr Wong was aware of the conditions on her registration and that it was her duty to inform the GMC that she had applied for medical employment outside the UK. The Tribunal considered that Dr Wong’s omission was significant. She must have realised that if she had informed the GMC it might have taken steps to prevent her from fulfilling the locum placement in Gibraltar. The Tribunal considers Dr Wong’s omission to have been dishonest. She deliberately kept information from the GMC which she knew was of importance to it and she did so with a view to obtaining a placement. Accordingly, the Tribunal found paragraph 6b in relation to Paragraph 1b, proved.

Paragraph 1c

‘1c. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and the Placement involved work at a higher level than Foundation Year One;’ Found Proved

32. The Tribunal has noted interim condition 5a which states:

5a. She must confine her medical practice to National Health Service posts at a level no higher than Foundation Year One or equivalent, where her work will be directly supervised by a named Consultant.

33. The Tribunal has noted that the placement in Gibraltar was as a locum GP. During his oral evidence Dr A was asked what a locum GP grade in Gibraltar is equivalent to in the UK. Dr A stated that a GP is someone who is accredited to be a General Practitioner and is on the Gibraltar GP Register. He said that the word locum makes a difference as a locum could be a qualified doctor who has not acquired the GP qualification. He stated that the equivalent to a Foundation Year 1 (FY1) level doctor would only have provisional registration in Gibraltar and a locum GP Post would not be offered to a doctor who is working at FY1 level. An FY1 level doctor would not be allowed to work as a GP as it is an unsupervised post. 34. The Tribunal was satisfied that the Locum GP placement undertaken by Dr Wong was not at Foundation Year One level or equivalent. Accordingly, the Tribunal found paragraph 1c, proved. Paragraph 1d



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‘1d. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and the Placement was for 22-26 June 2016 2015 only;’ Found Proved

35. The Tribunal has noted interim condition 6 which states: ‘6. She must not undertake any locum posts of less than 4 weeks duration.’ 36. The Tribunal has noted the email dated 18 June 2015 from Ms G, Human Resources Department, GHA to YWH, in which Ms G enquires whether Dr Wong would be available to cover a locum GP post for the period 22 June to 26 June 2015. 37. The Tribunal has YWH’s two file notes both dated 18 June 2015 which state that Dr Wong ‘Said she will let me know in the morning if she can start Gibraltar on the 22nd June 2015’ and ‘can’t do the [sic] Gibraltar from 22nd but can from 29th…’ It has also noted the file note dated 19 June 2015 which states: ‘Called in to confirm she CAN [sic] do the assignment…’ 38. The Tribunal has also noted the letter dated 22 June 2015 from the Human Resources Department of GHA to Ms H, Gibraltar Medical Registration Board, which states ‘Please note that Dr Wong has been employed by the Gibraltar Health Authority as a locum General Practitioner from 22nd to the 26th June 2015’. 39. Further the Tribunal has taken account of the emails dated 19 June 2015 from Mr F confirming that GHA Human Resources Department had booked accommodation for Dr Wong from 21-27 June 2015. 40. The Tribunal has also noted that Dr Wong booked her own return flight to Gibraltar. It has taken account of the flight confirmation documents which refer to return flights from Heathrow to Gibraltar departing 21 June 2015 and returning 27 June 2015. 41. The Tribunal also accepted Mr E’s evidence that he was in no doubt that Dr Wong was aware that the locum placement was for 22 June to 26 June 2015. 42. The Tribunal has taken account of Dr Wong’s email to the GMC dated 22 July 2015, in which she stated ‘I did do a locum in Gibraltar after the agency said it would be an ongoing locum from June till early September with an initial one week probation’. 43. The Tribunal was provided with no corroborating evidence that the locum placement for the period 22 June to 26 June 2015 was for a probationary period. Further it has no evidence that it would be an ongoing locum from June to September



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2015. Given the documentary and oral evidence the Tribunal was in no doubt that the locum placement was for the period 22 June to 26 June 2015. Accordingly, the Tribunal found paragraph 1d, proved. Paragraph 1e

‘1e. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and you failed to inform the Hospital Centre or the Authority of your Interim Orders Panel (‘IOP’) conditions;’ Found Proved

44. The Tribunal has noted that Interim condition 7a which states:

‘7a. She must inform the following parties that her registration is subject to the conditions, listed at (1) to (6), above:

a. Any organisation or person employing or contracting with her to undertake medical work’

45. The Tribunal noted the oral and written evidence from Dr B. Dr B, the Responsible Officer, stated that he was informed by Mr C that Dr Wong’s contract had been terminated as she had failed to inform the GHA of the conditions that were imposed. Dr B told the Tribunal that Mr C would have been Dr Wong’s direct line manager at GHA. Dr B told the Tribunal that when a doctor starts work at GHA they are asked by the Human Resources Department to complete a registration form, which is sent to the Gibraltar Medical Registration Board. He stated that Dr Wong completed the form but did not make a declaration that she had conditions on her registration. 46. The Tribunal has taken account of Dr Wong’s email to the GMC dated 22 July 2015, in which she stated ‘I have not realised until Thursday (25.06.2015) lunch time that the agency personnel has not told nor clarified to the prospective employer about my gmc conditions imposed on me, as I have told them the moment I have joined them.’ 47. The Tribunal is satisfied, by Dr Wong’s own account that she did not inform the Centre or GHA about the interim conditions on her registration. Accordingly, the Tribunal found paragraph 1e, proved. Paragraph 6a in relation to Paragraph 1e ‘6a. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were misleading.’

Found Proved



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48. The Tribunal considers that Dr Wong was aware of the interim conditions on her registration. It has determined that Dr Wong’s failure to inform both the Centre and GHA gave the impression that she had no restrictions on her registration which was misleading. Accordingly, the Tribunal found paragraph 6a in relation to paragraph 1e, proved. Paragraph 6b in relation to Paragraph 1e ‘6b. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were dishonest.’ Found Proved 49. The Tribunal has found that Dr Wong was aware of the conditions on her registration, in particular, that she must confine her medical practice to National Health Service posts at a level no higher than Foundation Year One or equivalent and that she must not undertake any locum posts of less than 4 weeks duration. The Tribunal noted that when it came to light that Dr Wong had conditions on her registration the locum placement was terminated. The Tribunal rejects Dr Wong’s assertion that she thought YWH had informed the Centre and the Authority of the conditions. This would make no sense since it must have been clear to Dr Wong that the overall effect of the conditions was to make her ineligible for the placement. The Tribunal considers that Dr Wong deliberately omitted to inform the Centre and GHA about the conditions on her registration and it has determined that her actions were dishonest. Accordingly, the Tribunal found paragraph 6b in relation to paragraph 1e, proved. Paragraph 1f

‘1f. On 18 June 2015 19 June 2015 you accepted a locum placement (‘the Placement’) working for the Gibraltar Health Authority (‘Authority’) at St Bernard’s Hospital Gibraltar (‘the Hospital’) the Primary Care Centre (the Centre) and you failed to inform your line manager at the Hospital Centre of your IOP conditions at least 24 hours before starting work.’ Found Proved

50. The Tribunal has noted that Dr Wong commenced the locum placement on 22 June 2015 and the contract was terminated on Thursday 25 June 2015, when the conditions on her registration came to light. The Tribunal has noted Dr Wong’s email to the GMC dated, 22 July 2015, in which she stated ‘I have not realised until Thursday (25.06.2015) lunch time that the agency personnel has not told nor clarified to the prospective employer about my gmc conditions imposed on me, as I have told them the moment I have joined them.’ 51. The Tribunal is satisfied, by Dr Wong’s own account, that she did not inform her line manager or the Centre about the interim conditions on her registration. Accordingly, the Tribunal found paragraph 1f, proved.



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Paragraph 6a in relation to Paragraph 1f

‘6a. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were misleading.’ Found Proved

52. The Tribunal found that Dr Wong failed to inform her line manager of the conditions on her registration, in particular that that she must confine her medical practice to National Health Service posts at a level no higher than Foundation Year One or equivalent and that she must not undertake any locum posts of less than 4 weeks duration. The Tribunal considers Dr Wong’s omission was misleading to her line manager in the same way as it was to the Centre and the GHA. Accordingly the Tribunal found paragraph 6a in relation to paragraph 1f, proved. Paragraph 6b in relation to Paragraph 1f ‘6b. Your actions at Paragraphs 1a-b and 1e-f and 3-5 above were dishonest.’

Found Proved

53. The Tribunal has found that Dr Wong was aware of the conditions on her registration. The Tribunal noted that when it came to light that Dr Wong had conditions on her registration the locum placement was terminated. The Tribunal rejects Dr Wong’s assertion that she thought YWH had informed GHA and her assumption that her line manager would have been made aware of the conditions. This would make no sense since it must have been clear to Dr Wong that the overall effect of the conditions was to make her ineligible for the placement. The Tribunal considers that Dr Wong deliberately omitted to inform her line manager about the conditions on her registration and it has determined that her actions were dishonest. Accordingly, the Tribunal found paragraph 6b in relation to paragraph 1f, proved. Paragraph 2a

‘2a. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 1;’ Found not proved

54. The Tribunal having found paragraph 1a of the allegation not proved because registration with the GMC was not required for the locum position in Gibraltar and therefore Dr Wong did not have a duty to inform the GMC, it determined that Dr Wong was not in breach of interim condition 1. Accordingly, the Tribunal found paragraph 2a, not proved. Paragraph 2b



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‘2b. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 4;’ Found Proved

55. The Tribunal, having found paragraph 1b of the allegation proved, that Dr Wong failed to inform the GMC she had applied for medical employment outside the UK has determined that this was in breach of interim condition 4. Accordingly, the Tribunal found paragraph 2b, proved.

Paragraph 2c

‘2c. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 5a;’ Found Proved

56. The Tribunal having found paragraph 1c proved, that the locum placement was for a position as a locum GP which was higher than an FY1 or equivalent, it has determined that Dr Wong’s actions were in breach of interim condition 5a. Accordingly, the Tribunal found paragraph 2c, proved. Paragraph 2d

‘2d. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 6;’ Found Proved

57. The Tribunal having found paragraph 1d proved, that the locum placement in Gibraltar was for a period of five days from 22 June 2015 to 26 June 2015 has determined that Dr Wong’s actions were in breach of interim condition 6, in that she must not undertake any locum posts of less than 4 weeks duration. Accordingly, the Tribunal found paragraph 2d, proved. Paragraph 2e

2e. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 7a; Found Proved

58. The Tribunal having found paragraph 1e proved, that Dr Wong failed to inform the Centre or the Authority of her interim conditions has determined that Dr Wong’s actions in failing to inform any organisation or person employing or contracting with her



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to undertake medical work, were in breach of interim condition 7a. Accordingly, the Tribunal found paragraph 2e, proved.

Paragraph 2f 2e. Your actions set out at paragraph 1a-f above were in breach of the following conditions imposed upon your registration by the IOP of the Medical Practitioners Tribunal Service on 3 June 2015, 7c. Found Proved

59. The Tribunal having found paragraph 1f proved, that Dr Wong failed to inform her line manager of her interim conditions has determined that Dr Wong’s actions were, a breach of interim condition 7c. Accordingly, the Tribunal found paragraph 2f, proved. Paragraph 3ai

3ai. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you signed a declaration in which you ticked the box ‘agree’ to the following: ‘I declare that I have not been found guilty of professional misconduct and there are no allegations outstanding against me, nor am I aware of any circumstances which may give rise to any such allegations’; Found Proved

60. The Tribunal has noted the document, which does contain these words and Dr Wong ticked the box to indicate agreement with the declaration. Dr Wong went on to sign the document. Accordingly, the Tribunal found paragraph 3ai, proved. Paragraph 3aii

3aii. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you signed a declaration in which you ticked the box ‘agree’ to the following: ‘I declare that all the information supplied in this form is correct’; Found Proved

61. The Tribunal has noted the document, which does contain these words and Dr Wong ticked the box to indicate agreement with the declaration. Dr Wong went on to sign the document. Accordingly, the Tribunal found paragraph 3aii, proved.

Paragraph 3bi



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3bi. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you knew that you were under investigation by the GMC; Found Proved

62. The Tribunal has noted the ‘Application for Registration as a Medical Practitioner’ form from the Gibraltar Registration Board, which was signed by Dr Wong on 22 June 2015. It has previously noted that Dr Wong attended and was legally represented at the interim order hearing on 22 December 2014 and that on 3 June 2015, the conditions were varied. Dr Wong and RadcliffesLeBrasseur were informed of the variation in the letter dated 4 June 2015 from the Medical Practitioners Tribunal Service (MPTS). The Tribunal also took account of the letter dated 16 June 2015 from RadcliffesLeBrasseur. The Tribunal also found that Dr Wong was aware of the conditions on her registration. The conditions on Dr Wong’s registration were not revoked until 23 July 2015. 63. The Tribunal accepted the evidence of Mr D who confirmed that until the conditions were revoked, Dr Wong remained under investigation. 64. The Tribunal was satisfied that Dr Wong would have known that she remained under investigation as the interim order was for a period of 15 months and had not, at that time, been revoked. Accordingly, the Tribunal finds paragraph 3bi, proved. Paragraph 3bii

3bii. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you knew that you had conditions imposed on your registration by the IOP; Found Proved

65. The Tribunal has previously noted that Dr Wong attended and was legally represented at the interim order hearing on 22 December 2014 and had been made aware of the variation of those conditions on 3 June 2015. Accordingly, the Tribunal found paragraph 3bii, proved. Paragraph 3biii in relation to 3ai

3bii. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you knew that your answers to the questions at paragraph 3a above were untrue; Found not proved

66. The Tribunal was of the view that the wording of the question set out in paragraph 3ai was not clear. It considered that the word ‘such’ towards the end of the



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question must be a reference back to the expression ‘professional misconduct’ earlier in the question. The Tribunal therefore considers that the declaration should be interpreted as if it read as follows: ‘I declare that I have not been found guilty of professional misconduct and there are no allegations of professional misconduct outstanding against me, nor am I aware of any circumstances which may give rise to any allegations of professional misconduct .’ If the declaration were not interpreted in this way there would be no indication of the type of allegation which the person signing the form was required to declare. 67. There has been no evidence whether the expression ‘professional misconduct’ has any special meaning in the law of Gibraltar. In the absence of any such special meaning the Tribunal does not consider that the words are apt to cover deficiencies in professional performance. The Tribunal does not know whether the allegations which led to the imposition of the interim order of conditions were allegations of professional misconduct or (in the terminology of the United Kingdom legislation) allegations of deficient professional performance. The GMC has thus failed to prove that there were allegations of professional misconduct outstanding against Dr Wong, or circumstances which might give rise to such allegations. It is not disputed by the GMC that Dr Wong had not been found guilty of professional misconduct. The Tribunal could not therefore be satisfied that the answer which Dr Wong gave to the question was wrong. Even if the Tribunal’s interpretation of the question is incorrect, it considers that a United Kingdom doctor might reasonably interpret the question in that way and it could not be satisfied that Dr Wong did not do so. Thus even if she was wrong in the answer she gave, the Tribunal was not satisfied that she knew her answer was wrong. Accordingly, the Tribunal found paragraph 3biii in relation to 3ai, not proved. Paragraph 3biii in relation to 3aii

‘3biii. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and you knew that your answers to the questions at paragraph 3a above were untrue; Found not proved

68. Dr A did not dispute that (apart from the declarations) Dr Wong had completed the application form correctly. The form did not require Dr Wong to provide her GMC registration number because her medical qualification had not been obtained in the United Kingdom. The information which Dr Wong provided in the form was correct and although Dr A expressed the hope that a doctor with conditions on the registration would declare this there was nothing on the form which required them to do so. Accordingly, the Tribunal found paragraph 3biii in relation to 3aii, not proved.



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Paragraph 3c

3c. On 22 June 2015 you completed an application form for registration as a medical practitioner which you then sent to the Gibraltar Medical Registrations Board (‘the Board’) and failed to inform the Board of your IOP conditions in breach of condition 7d. Found not proved

69. The Tribunal has noted interim condition 7d which states:

‘‘7. She must inform the following parties that her registration is subject to the conditions, listed at (1) to (6), above:

d. Any prospective employer or contracting body (at the time of application)’

70. The Tribunal accepted Dr A’s evidence that the Gibraltar Medical Registration Board was not Dr Wong’s prospective employer or contracting body at the time of her application. Therefore Dr Wong did not have a duty under condition 7d to inform the Gibraltar Medical Registration Board about the conditions on her registration and was not in breach of condition 7d. Accordingly, the Tribunal found paragraph 3c, not proved. 71. The Tribunal considered whether it should exercise its powers of amendment to delete the words ‘in breach of condition 7d’ from this sub-paragraph, although the GMC did not invite it to do so. The Tribunal had in mind that this was a potentially serious allegation, since when coupled with paragraph 6b it amounted to an allegation that Dr Wong had dishonestly withheld information from the Board in order to obtain registration as a Medical Practitioner in Gibraltar to which she would not otherwise be entitled. 72. The Tribunal bore in mind that it would not be in the interests of justice for such a serious allegation to be found not proved because of a drafting error. As a matter of ordinary language the amendment would be straightforward and the sub-paragraph would still make sense. However, the Tribunal took the view that the amendment would be a matter of substance: the GMC have relied only upon condition 7d as the source of the duty to inform the Board of the interim order of conditions and there had been no argument whether there was an independent duty (such as under Good Medical Practice), the breach of which might give rise to a ‘failure’ on the part of Dr Wong. The Tribunal did not consider it appropriate to embark on such an investigation on its own initiative at this late stage and considered that it might cause injustice to Dr Wong if it were to make this substantive amendment without notice to her. It therefore did not exercise its power of amendment.



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73. As the Tribunal found paragraph 3c not proved, paragraphs 6a and 6b fall in relation to 3c. Paragraph 4

4. On 22 July 2015 you emailed the GMC and stated you did the Placement at the Hospital after the agency (Your World Recruitment) said that it would be an ongoing locum from June until early September with an initial one week probation period. Found Proved

74. The Tribunal has taken account of Dr Wong’s email to the GMC dated 22 July 2015, in which she stated ‘I did do a locum in Gibraltar after the agency said it would be an ongoing locum from June till early September with an initial one week probation’. Accordingly, the Tribunal found paragraph 4, proved. Paragraph 6a in relation to 4 75. The Tribunal found that Dr Wong’s email in which she stated that the placement would be an ongoing locum from June to September 2015, was misleading in that it was not an accurate account of what had happened. Accordingly, the Tribunal found paragraph 6a in relation to paragraph 4, proved. Paragraph 6b in relation to 4 76. The Tribunal has found that Dr Wong was aware of the conditions on her registration and in particular condition 4 that ‘she must not undertake any locum posts of less than 4 weeks duration’. The Tribunal rejects Dr Wong’s assertion that the placement would be an ongoing locum from June until early September 2015. The Tribunal considers that Dr Wong deliberately told an untruth to the GMC. Accordingly, the Tribunal found paragraph 6b in relation to paragraph 4, proved. Paragraph 5a

5. The information given at paragraph 4 above was untrue because the Placement was only for the period set out at paragraph 1d; Found Proved

77. The Tribunal found allegation 1d proved that the placement was for the period 22-26 June 2016. The Tribunal was provided with no corroborating evidence that the locum placement for the period 22 June to 26 June 2015 was for a probation period. Further it has no evidence that it would be an ongoing locum from June to September 2015. The Tribunal has therefore concluded that the information provided by Dr Wong in her email dated 22 July 2015, to the GMC was untrue. Accordingly, the Tribunal found paragraph 5a, proved.



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Paragraph 5b

5b. The information given at paragraph 4 above you knew to be untrue.

Found Proved

78. The Tribunal has noted that Dr Wong booked her own flights to Gibraltar departing 21 June 2015 and returning 27 June 2015. Dr Wong knew that the placement was for the period 22 June to 26 June 2015. Therefore Dr Wong would have known that the information she provided in her email to the GMC was untrue and Dr Wong would have known it was untrue. Accordingly, the Tribunal found paragraph 5b, proved. 79. As to paragraphs 6a and 6b in relation to paragraphs 3, 4 and 5 the GMC presented the case on the basis that the only actions described in those paragraphs were those in paragraphs 3a, 3c and 4. The Tribunal adopted the same approach and therefore made no finding under paragraphs 6a and b in relation to 3b and 5. Determination on Impairment - 11/09/2017 Ms Acker: Submissions 1. You referred the Tribunal to paragraphs 65, 66, 68 and 73 of the GMC’s guidance Good Medical Practice (2013) (GMP). You stated that Dr Wong, in applying for a position with the Gibraltar Health Authority (GHA) was in the exercise of her profession. You submitted that Dr Wong’s dishonest conduct would be regarded as deplorable by fellow practitioners. You stated that in lying to her Regulator i.e. the GMC and a prospective employer, GHA, Dr Wong’s conduct would be considered deplorable in the minds of other practitioners. You stated that Dr Wong’s dishonesty represents serious professional misconduct. 2. You reminded the Tribunal that it had found that Dr Wong breached a number of her interim conditions. You also reminded the Tribunal that it found that Dr Wong was dishonest in that she failed to tell GHA about the interim conditions before 22 June 2015. Dr Wong also failed to tell her immediate line manager at her place of work. You also reminded the Tribunal of Dr Wong’s email to the GMC dated 22 July 2015 in which she lied about the length of the placement. You submitted that Dr Wong’s dishonesty was repeated, prolonged and serious and it impaired the GMC’s ability to ensure safe practice. 3. You stated that there is a risk of repetition in that Dr Wong could behave in the same way in the future. You drew the Tribunal’s attention to Dr Wong’s lack of insight, as shown by her failure to appear at this hearing to allow an assessment of her degree of insight and by her written responses to the GMC overlooking her own responsibilities.



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4. In Dr Wong’s absence you stated that mitigation could be that: the original matters which led to the interim conditions were dropped, the agency failed to inform the potential employer of Dr Wong’s conditions and there are no previous GMC findings or outstanding matters. 5. Nevertheless, you stated that this mitigation does not impact on the Tribunal’s finding of dishonesty. You submitted that Dr Wong knew she was subject to interim conditions and of the requirement to inform. You also submitted that it is for the doctor to abide by the procedures and any conditions imposed. 6. You directed the Tribunal’s attention to the case of CHRE v NMC & Paula Grant [2011] EWHC 927 (Admin) and Dame Janet Smith’s Fifth Shipman Report. Paragraph 25.50 of the Fifth Shipman Report sets out the reasons why it might be concluded that a doctor is unfit to practise or that his/her fitness to practise is impaired:

“(a) that the doctor presented a risk to patients, (b) that the doctor had brought the profession into disrepute, (c) that the doctor had breached one of the fundamental tenets of the profession and (d) that the doctor’s integrity could not be relied upon”

7. You reminded the Tribunal that no patient harm has been alleged and that the original concerns that had led to the interim conditions had been subsequently dropped. Nevertheless, you submitted that Dr Wong’s dishonest conduct has brought the profession into disrepute, has breached one of the fundamental tenets of the profession and that her integrity could not be relied upon. You submitted that there is clearly misconduct in Dr Wong’s case, that such misconduct brings the profession into disrepute and is so serious as to amount to impaired fitness to practise. The Tribunal’s Decision 8. The Tribunal has given careful consideration to all of the evidence that has been adduced and has also taken account of your submissions on behalf of the GMC. 9. The Tribunal has exercised its own judgement in considering the matter of impairment. Throughout its deliberations, the Tribunal has borne in mind its duty to balance Dr Wong’s interests with the public interest, which includes the protection of the public, the maintenance of public confidence in the profession and the promotion and maintenance of proper professional standards and conduct. Misconduct 10. The Tribunal found that Dr Wong failed to comply with the interim conditions on her registration, which were imposed following an assessment of the concerns raised



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about her practice by the Interim Orders Panel in December 2014. The Tribunal noted that Dr Wong applied for a GP placement in Gibraltar without informing the GMC she had done so, applied for a position above Foundation Year One level or equivalent and the post she applied for was for a period of less than four weeks. On commencing that placement Dr Wong failed to inform her employer, the GHA, and failed to inform her immediate line manager at the Primary Care Centre at least 24 hours before starting work. Dr Wong maintained the deceit that she was free to practise without restriction until her contract was terminated. Further in an email dated 22 July 2015 Dr Wong lied to the GMC about the duration of the placement. 11. The Tribunal was satisfied that Dr Wong was fully aware of the interim conditions on her registration. The Tribunal considers Dr Wong’s breach of several of her interim conditions to have been a blatant disregard for her regulatory body, the GMC. Further, her dishonest conduct occurred as part of her professional practice. The Tribunal has determined that Dr Wong’s dishonest conduct was repeated and prolonged. Her dishonest conduct was compounded in her response to the GMC in her email dated 22 July 2015, in which she attempted to blame others for her failure to inform and lied about the length of the placement. 12. The Tribunal considers that Dr Wong’s dishonest conduct has brought the profession into disrepute. In being dishonest with her Regulator, her employer and her line manager she breached an important principle of the profession, namely the duty to be honest and open and act with integrity. It considers that Dr Wong’s integrity cannot be relied upon. The Tribunal has determined that Dr Wong’s breach of interim conditions and her dishonesty amount to misconduct. Impairment 13. The Tribunal has taken account of paragraphs 65, 66, 68 and 73 of GMP (2013) which state:

‘65. You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.

66. You must always be honest about your experience, qualifications and current role.

68. You must be honest and trustworthy in all your communication with patients

and colleagues. …

73. You must cooperate with formal inquiries and complaints procedures and

must offer all relevant information…’

14. The Tribunal next considered whether Dr Wong’s fitness to practise is currently impaired by reason of her misconduct. In so doing, it had regard to whether Dr Wong’s misconduct is easily remediable, whether it has been remedied, and whether it is highly unlikely to be repeated.



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15. The Tribunal accepted that dishonesty is capable of remediation, albeit this is difficult to demonstrate. 16. The Tribunal has received no evidence that Dr Wong has reflected on the potential impact or serious implications of her dishonest conduct. Nor has it received evidence of any remediation she has undertaken to address her misconduct. Further, the Tribunal has noted Dr Wong’s email dated 20 August 2017 in which, even with hindsight and having had the opportunity to reflect, she did not accept responsibility for her dishonest conduct. The Tribunal is concerned that this email is bereft of insight into any aspect of her misconduct. 17. The Tribunal considers there to be a real risk that Dr Wong’s misconduct could be repeated. 18. The Tribunal also determined that the need to uphold standards and public confidence in the profession would be undermined if a finding of impairment was not made in this case. Accordingly, in the circumstances, the Tribunal determined that Dr Wong’s fitness to practise is impaired by reason of her misconduct pursuant to Section 35C(2)(a) of the Medical Act 1983, as amended. Determination on Sanction - 12/09/2017 Ms Acker: 1. Having determined that Dr Wong’s fitness to practise is impaired by reason of her misconduct, the Tribunal has now considered what action, if any, it should take with regard to her registration. 2. In so doing, the Tribunal has given careful consideration to all the evidence adduced, together with your submissions on behalf of the General Medical Council. Submission 3. You stated that sanction is a matter for the Tribunal and it must consider the potential sanctions in ascending order. You reminded the Tribunal that the purpose of sanctions is not to punish the doctor. 4. You referred the Tribunal to the Sanctions Guidance (2017) (the SG), in particular paragraphs 108-128 relating to erasure. You reminded the Tribunal of its findings in the impairment determination that Dr Wong’s dishonesty was repeated to different organisations and people. You stated that Dr Wong lied to her employer, her direct line manager and to the GMC.



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5. You reminded the Tribunal that it found that Dr Wong’s dishonesty was repeated and prolonged and was compounded by her email to the GMC which demonstrated a blatant disregard for her regulatory body. You reminded the Tribunal that the dishonesty was repeated over six weeks and that the Tribunal has concluded that Dr Wong’s integrity cannot be relied upon. 6. You further submitted that, since the Tribunal had found that there is a risk of repetition, there may be a risk to patients and to the public interest. You also submitted that Dr Wong’s assertion that she had no choice other than to relinquish her licence to practise is not sufficient to protect the public interest. 7. You submitted that erasure is the appropriate sanction in this case. The Tribunal’s Approach 8. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this Tribunal exercising its own judgement. 9. In reaching its decision, the Tribunal has taken account of the SG. It has borne in mind that the purpose of sanctions is not to be punitive, but to protect patients and the wider public interest, although they may have a punitive effect. 10. Throughout its deliberations, the Tribunal has applied the principle of proportionality, balancing Dr Wong’s interests with the public interest. It has considered the statutory overarching objective, which includes to: a. protect and promote the health, safety and wellbeing of the public b. promote and maintain public confidence in the medical profession c. promote and maintain proper professional standards and conduct 11. The Tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction. Mitigating factors 12. The Tribunal has had in mind the following factors which emerged from Dr Wong’s correspondence: • XXX • Dr Wong’s assertion that she has retired from clinical practice in this country • Dr Wong’s assertion that she had no choice but to relinquish her GMC licence to practise • The original allegations against Dr Wong were dropped by the GMC



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13. XXX. The Tribunal noted that Dr Wong stated that she has retired from clinical practice and had no choice but to relinquish her GMC licence. The Tribunal is mindful that Dr Wong may decide to reapply for a licence to practise which would allow her to return to clinical practice. The Tribunal has borne in mind that sanctions attach to a doctor’s registration and not their licence. Aggravating factors 14. The Tribunal consider the following to be aggravating factors in this case: • No evidence of insight • No evidence that Dr Wong has acknowledged her dishonest behaviour • No evidence of remediation The Tribunal’s Decision Undertakings 15. The Tribunal noted that no undertakings have been offered by Dr Wong. No Action 16. In coming to its decision as to the appropriate sanction, if any, to impose in Dr Wong’s case, the Tribunal first considered whether to conclude the case by taking no action. 17. The Tribunal considers that there are no exceptional circumstances in this case and it has determined that, in view of the serious nature of the Tribunal’s findings on impairment, it would not be sufficient, proportionate or in the public interest to conclude this case by taking no action. Conditions 18. The Tribunal next considered whether it would be sufficient to impose conditions on Dr Wong’s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 19. The Tribunal found that Dr Wong breached several of the interim conditions imposed on her registration. It also found that she was dishonest. The Tribunal is of the opinion that a period of conditional registration would not adequately reflect the serious nature of Dr Wong’s misconduct; nor, in a case involving dishonesty, could conditions be devised that would protect the public interest and maintain public confidence in the medical profession. Further the Tribunal cannot be satisfied that Dr Wong would comply with conditional registration.



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20. The Tribunal has, therefore, determined that it would not be sufficient to direct the imposition of conditions on Dr Wong’s registration. Suspension 21. The Tribunal then went on to consider whether suspending Dr Wong’s registration would be appropriate and proportionate. 22. The Tribunal has noted that suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and the public about what is regarded as behaviour unbefitting a registered doctor. Further, suspension would be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession and for conduct that is serious but falls short of being fundamentally incompatible with continued registration. 23. The Tribunal also bore in mind that suspension may be appropriate where there has been acknowledgement of fault and where the tribunal is satisfied that the behaviour or incident is unlikely to be repeated. 24. The Tribunal has previously found that Dr Wong has no insight into her misconduct. Furthermore Dr Wong has not attended this hearing and despite an invitation to do so has not provided written submissions or evidence of remediation. It found that Dr Wong breached the interim conditions imposed on her registration and lied to her regulatory body. Dr Wong has failed to acknowledge that she breached her interim conditions and her dishonest behaviour. 25. In breaching her conditions the Tribunal considers that Dr Wong 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. 26. Notwithstanding Dr Wong’s previous good character, the Tribunal is not satisfied that Dr Wong’s integrity can be relied upon. The Tribunal concluded that there is a real risk that Dr Wong will repeat her dishonest behaviour. 27. The Tribunal has therefore determined that it would be neither appropriate nor proportionate to suspend Dr Wong’s registration. Erasure 28. The Tribunal considers that the following factors are engaged in this case (Sanctions Guidance paragraph 109):



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a A particularly serious departure from the principles set out in Good medical practice where the behaviour is fundamentally incompatible with being a doctor. b A deliberate or reckless disregard for the principles set out in Good medical practice and/or patient safety. h Dishonesty, especially where persistent and/or covered up. i Putting their own interests before those of their patients. j Persistent lack of insight into the seriousness of their actions or the consequences. 29. Even taking into account the potential mitigating factors, the Tribunal has determined that Dr Wong’s misconduct is fundamentally incompatible with her continuing to practise medicine. Therefore, it has determined that, in the particular circumstances of this case, it would not be sufficient or proportionate to suspend her registration. The Tribunal is of the view that the public interest requires that it be made clear that Dr Wong’s behaviour is unacceptable in a member of the medical profession. 30. Accordingly, the Tribunal has determined to direct that Dr Wong’s name be erased from the Medical Register. In the light of all the evidence presented to it, it is satisfied that erasure is a proportionate sanction in his case. 31. The effect of the foregoing direction is that, unless Dr Wong exercises her right of appeal, her name will be erased from the Medical Register 28 days from the date on which written notice of this decision is deemed to have been served upon her. Determination on Immediate Order - 12/09/2017 Ms Acker: 1. Having determined that Dr Wong’s registration 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 on Dr Wong’s registration. 2. You submitted, on behalf of the GMC, that an immediate order is necessary. You referred to the Tribunal’s impairment determination. It was your submission that Dr Wong poses a risk to patients and an immediate order is necessary to guard against this and to maintain public confidence in the profession. 3. The Tribunal has considered the guidance set out in the Sanctions guidance on immediate orders (paragraphs 172 – 178). It noted that it may impose an immediate



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order where it is satisfied that it is necessary for the protection of members of the public, or is in the public interest or is in the best interests of the practitioner. 4. The Tribunal has determined that, given its findings on impairment, it is necessary and is in the public interest to suspend Dr Wong’s registration forthwith. 5. The immediate order of suspension will remain in force until the substantive direction takes effect, or until the outcome of any appeal is decided. The substantive sanction of erasure, as already announced, will take effect 28 days from when written notice is deemed to have been served upon Dr Wong, unless an appeal is lodged in the interim. 6. That concludes this case. Confirmed Date 12 September 2017 Dr Edward Doyle, Chair

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