"Belgische arts werkte zonder erkenning in Brits ziekenhuis"
Uit de Belgische krant "Het Laatste Nieuws" van 30/04/2013 overgenomen van persagentschap Belga.
De Belgische neuroloog Johannes Peperkamp heeft te horen gekregen dat hij als arts niet aan de slag mag in Groot-Brittannië. Hij werd eerder betrapt op het werken als arts zonder de nodige erkenning. Dat meldt de Britse omroep BBC.
Peperkamp werkte als neuroloog in het King's Mill Hospital in 2012, hoewel zijn erkenning was ingetrokken omdat hij geen bijdragen betaalde. Hij had ook negatieve rapporten gekregen over het bijhouden van gegevens en zijn gebrekkige medische kennis. Toen bekend werd dat hij niet de vereiste erkenning had, werd zijn arbeidscontract beëindigd.
The General Medical Council stuitte al in 2005 op pijnpunten zoals zijn diagnoses en de manier waarop hij gegevens bijhield. Inspecteurs meldden dat Peperkamp zelfs geen elementaire kennis had van de neurologie. De man beloofde dat zijn prestaties zouden verbeteren, maar in 2008 vertrok hij richting België.
Erkenning ingetrokken
Op 9 maart 2012 werd Peperkamps erkenning ingetrokken omdat hij geen bijdragen betaalde. Toen hij in juni een erkenning aanvroeg, bleek uit zijn cv dat hij in het ziekenhuis van King's Mill als arts had gewerkt zonder erkenning. Voordien had hij gewerkt in de Royal Aberdeen Infirmary in 2005 en in het Southampton Royal Hospital in 2006.
Peperkamp kreeg te horen dat zijn gedrag roekeloos en gevaarlijk was en indruiste tegen de normen die voor artsen gelden in Groot-Brittannië. Het ziekenhuis in Nottinghamshire heeft zijn werking herzien, zodat de personeelsdienst voortaan dubbelcheckt of de artsen erkenning hebben om als arts in het land te werken.
FITNESS TO PRACTISE PANEL OF THE
MEDICAL PRACTITIONERS TRIBUNAL SERVICE
22 – 25 APRIL 2013
7th Floor, St James’s Buildings, 79 Oxford Street, Manchester, M1 6FQ
Name of Respondent Doctor: Dr Johannes Petrus Christianus PEPERKAMP
Registered Qualifications: Artsexamen 1973 Universiteit van Amsterdam
Area of Registered Address: Belgium
Reference Number: 6082137
Type of Case: Restoration
Panel Members: Mrs S Hollingworth, Chairman (Lay)
Dr S Marwick (Medical)
Ms S Fenoughty (Lay)
Legal Assessor: Mr L Hughes
Secretary to the Panel: Ms C Beard
Representation:
GMC: Mr R Kitching, Counsel, instructed by GMC Legal
Doctor: Present and is represented by Mr J Verschueren, Advocaat, Belgium.
Determination on the Application for Restoration
Dr Peperkamp: You have applied to the General Medical Council (GMC) for the restoration of your name to the Medical Register. The Panel has considered your application in accordance with the provisions set out in Section 32 of the Medical Act 1983 (as amended) and Rule 24 of the General Medical Council (Fitness to Practise) Rules 2004.
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You qualified as a doctor from the University of Amsterdam in 1961 and since that time you have practised extensively as a Neurologist. You have worked in different parts of the world, coming first to the United Kingdom (UK) in 2004. In 2005 the GMC received information regarding your professional performance while employed by NHS Grampian. Having considered this information, a Case Examiner decided that it would be appropriate for an assessment of your professional performance to be carried out. The Performance Assessment took place in 2006, by which time you were working at Southampton Hospital. The Assessment found deficient professional performance on your part and consequently in January 2008 you agreed to comply with detailed undertakings proposed by the GMC. On 9 March 2011 your name was erased administratively from the Medical Register on the basis of non-payment of your annual retention fee. This application for the restoration of your name to the Medical Register was made on 8 June 2012.
The Panel heard oral evidence from Dr A, the Assessment Team Leader, who produced the Assessment Report (the Report). The Panel found him to be a reliable and credible witness who confirmed the contents of the Report. Dr B, Consultant Neurologist at King’s Mill Hospital, Ms C of the Investigation Section of the GMC, and Mrs D, from King’s Mill Hospital, also gave evidence. The Panel found them to be credible witnesses who confirmed the documented facts adduced.
Background
The Performance Assessment (the Assessment) took place in 2006. The Panel has been provided with a copy of the Performance Assessment Report produced by the Performance Assessment Team (the Team).
The Assessment concentrated on your work in the Royal Aberdeen Infirmary in 2005 and Southampton Royal Hospital in 2006.
In Aberdeen you were subject to an unusually onerous workload, having been appointed as part of a waiting list initiative. You saw a large number of new patients in outpatients, often up to 12 per session, as a result you were rarely able to review your original findings and it was, therefore, difficult to link your provisional diagnoses with the results of investigations. The medical assessors on the Team had concerns about your workload in Aberdeen and felt that you had too little time to see too many new patients.
In Southampton you had a more conventional workload and you were able to review your own patients.
The Team looked at 15 areas of your performance as a doctor. Whilst a number of acceptable areas of your practice were identified, even having regard to the particular practical difficulties which you encountered in Aberdeen, the Team found that overall there were three areas giving cause for concern, namely:
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Assessment of the patient’s condition;
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Providing or arranging investigations; and
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Communication with patients.
The Team also judged two areas to be unacceptable:
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Providing and arranging treatment; and
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Record keeping.
The Team considered that particular concern was raised by your lack of familiarity with drugs used in epilepsy, this being confirmed from the medical records. Furthermore, the specialist assessors considered your failings to be largely concerned with the treatment of epilepsy and Parkinson’s disease, which they considered to be the “bread and butter” of neurology.
In finding your standard of “Record keeping” unacceptable the Team found that there were no circumstances, in either hospital, which made it difficult for you to keep good records. Your records were found to be difficult to read, entries were unsigned, brief and in some cases incomplete, with important information missing. During the Assessment, at times, you could not clarify what was in your own medical records. The Team was particularly concerned as you were working as a locum, with the important expectation that detailed records would be available for another clinician to take over the care of patients.
Within the Assessment’s Test of Competence, your performance in the Knowledge Test and the Objective Structured Clinical Examination was found to be unacceptable.
The Team’s opinion was that the standard of your professional performance had been deficient; that it was likely that this could be improved by remedial action; and that you should undertake a period of limited practice before undergoing a further assessment.
On 11 January 2008, you agreed to comply with 19 detailed undertakings proposed by the GMC, aimed at addressing the risk posed by your deficient professional performance, so as to allow you to work as a neurologist in the UK.
In a telephone conversation of 5 February 2008, you told a GMC Investigation Officer that you had left the UK and were working in Belgium. It was explained to you that when you returned to the UK you would be expected to comply with the undertakings. The Investigation Officer also explained to you that if you wanted the undertakings to be varied then you would have to write to the GMC setting out your reasons. They stressed to you that the undertakings were binding and that until the GMC varied or revoked them you would have to abide by them if you returned to the UK.
The GMC wrote to you on several occasions following this, reminding you that your registration remained subject to detailed undertakings and asking you for
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information so that they could review your case. You responded to a number of these letters via email and, amongst other things, you indicated that you intended to return to the UK to seek employment. There appeared to be an obvious and repeated failure on your part to provide cogent details of any meaningful remedial steps that you had taken.
On 23 February 2010, you told a GMC Investigation Officer that you were actively looking for work in the UK. You were told that you must inform the GMC within seven days of your return to the UK if you accepted work for which registration was required.
On 25 January 2011, you contacted the GMC by telephone and, in response to a question from you, a GMC Investigation Officer told you that you were still subject to undertakings, and they could not be removed as the GMC had not received evidence to show that you had remediated your performance and that your fitness to practise was not impaired. You were asked once again if you could send any evidence regarding your past deficient professional performance. Whilst you said that you would do so, the Panel observes that you did not. The Investigation Officer informed you of the steps that you would have to take to have the undertakings removed or varied, including undergoing another performance assessment. You enquired about Voluntary Erasure from the Medical Register and it was explained to you that as you had not paid your annual retention fee the GMC would establish whether you could be erased administratively.
On 9 March 2011, your name was removed administratively from the Medical Register, with your consent, on the basis that you had failed to pay your annual retention fee. You were informed of this by a letter, which told you that this meant you were not permitted to undertake any form of medical practice within the UK for which registration was required and that if you needed any information or advice you could contact the GMC.
On 8 June 2012, you completed an application for restoration to the Medical Register. As part of your application you submitted your curriculum vitae (CV). Notwithstanding being first subject to undertakings, and subsequently erased from the Medical Register, you recorded under the employment history section of your CV that, you had, in fact, worked in the UK at Chelsea and Westminster Hospital between September 2007 and June 2008 and at Kings Mill Hospital between 10 May 2012 and 9 June 2012.
On 26 July 2012, you were notified by letter from a GMC Investigation Officer that your application for restoration had been passed to her because, at the time your name was erased from the Register, there was an open investigation relating to your fitness to practise and that you had agreed to a set of undertakings restricting your practice as a result of the investigation. You were asked you to provide further comments and information in respect of your application. You replied by a letter dated 30 July 2012 in which you apologised and contended that you did not
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understand that you were not able to practise in the UK and that it was the fault of the hospital and the agency for not checking the GMC Register.
Your evidence
You explained the stressful and difficult circumstances you found yourself working in whilst in Aberdeen. You said that you found Southampton Hospital to be an easier working environment.
You said that you were “stunned” when you saw the result of the Assessment. You said that you felt that you had been assessed as a general practitioner rather than a specialist, but you accepted some of the Team’s findings as set out in their Report, such as your deficiencies in record keeping and the Panel found that you had broadly accepted that in 2006 your professional performance as a consultant was deficient. You said you have continued working outside of the UK since the Performance Assessment, most recently in private practice; that there have been no complaints about your work, and that you have been on courses and attended conferences to keep your medical knowledge up to date.
You told the Panel that you did not consider there to be any remaining deficiencies in your professional practice. You accepted that you knew you had been subject to undertakings, albeit that, you stated that you did not understand what undertakings meant in relation to your work. You said that you had a “negative feeling” about the undertakings and because of this, and your uncertainty, you did not ask the GMC for clarification. In due course, when challenged and taken to two of the pertinent undertakings, you accepted that they were in fact clear.
You told the Panel that you took the post at King’s Mill Hospital as you thought you were eligible to do so. You said that “nothing” was going through your mind about your registration status and that you did not remember about the undertakings. You said you were just glad to have a job in the UK and had not intended to “bypass the GMC”.
You presented the Panel with certificates of attendance on some courses and conferences during 2005 to 2012, which you had attended to keep your clinical knowledge up to date, and a number of testimonials dated between 2004 and 2012. However, none of the testimonials appear to have been written specifically in connection with, or recognising, the actual nature of these proceedings. The Panel has also had regard to the paragraph from the witness statement of Bradley King from the agency who secured your employment at King’s Mill Hospital that a junior member of staff had not picked up the fact that you were not registered.
Submissions
Both Mr Kitching and Mr Verschueren addressed the Panel with closing submissions.
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Mr Kitching invited the Panel to refuse your application for restoration to the Medical Register both on the basis of your history of deficient professional performance and misconduct on your part. He argued that neither had been satisfactorily remediated and he submitted that you displayed no insight into the facts giving rise to your deficient professional performance and your misconduct. He submitted that as a result of these matters all three strands of the public interest test are engaged in your case.
Mr Verschueren, through concise and thoughtful submissions, invited the Panel to accede to your application for restoration to the Medical Register. By reference to the Performance Assessment, he highlighted that no one has come to harm as a result of your actions. He accepted, on your behalf, that you had made mistakes in relation to failing to act upon correspondence with the GMC. He detailed the positive reasons for restoring your name to the Medical Register, in particular, that as a result of your experience you could be useful particularly to junior colleagues. The Panel was particularly grateful to him for his attendance and the representation that he provided, acknowledging that he had done so at short notice and at some personal inconvenience. The Panel considered that no advocate could have done more on your behalf.
Legal Advice
The Legal Assessor advised that there are three possible decisions the Panel can make. It may grant the application or it may refuse the application.
Alternatively, the Panel may adjourn and give such direction as it thinks fit, including that you should undergo an assessment of your performance or health.
The Legal Assessor advised that, in order to make its decision, the Panel first has to decide whether your fitness to practise is currently impaired by reason of deficient professional performance and/or misconduct.
He invited the Panel to consider two major principles:
1. Are you fit to practise? and
2. Will the public's trust and confidence in the profession be undermined by the restoration of your name onto the Medical Register?
The Legal Assessor advised that it is for the GMC to prove the facts which are alleged to give rise to the deficient professional performance and/or misconduct and the standard of proof is that applicable to civil proceedings, which is the balance of probabilities.
The Panel has had regard to case law the Legal Assessor detailed to assist the Panel in relation to its determination of whether your fitness to practise is impaired by reason of deficient professional performance and/or misconduct.
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He suggested that the Panel may consider it helpful to ask itself the following questions:
1. If established, what insight have you demonstrated into your deficient professional performance and/or your misconduct?
2. Is the deficient professional performance and/or conduct remediable?
3. Has it been remedied? and
4. What is the likelihood of repetition?
The Legal Assessor advised the Panel that if it concludes that your fitness to practise is currently impaired that does not automatically mean that your application for restoration to the register should automatically be rejected. It remains a matter for the Panel to determine whether your name should be restored to the Medical Register. Ultimately the burden of establishing that you are fit to practise and to be restored to the Medical Register rests upon you. You must satisfy the Panel that your name should be restored. The standard of proof is the civil standard, the balance of probabilities.
The Legal Assessor reminded the Panel that there that there is no power to restore to the Medical Register with conditions.
The Legal Assessor advised that in deciding this application for restoration to the register the Panel has had regard to the principle of proportionality, weighing the interests of the public with your interests. The public interest, has been at the forefront of the Panel’s mind, it included the public interest in enabling a suitable doctor to return to safe practice, but also the wider public interest of the protection of patients, the maintenance of confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour.
The Panel has accepted the advice of the Legal Assessor in full.
The Panel’s Decisions
In considering your application, the Panel has taken account of all the evidence, both oral and documentary, together with Mr Kitching’s submissions, on behalf of the General Medical Council, and those of Mr Verscheuren, on your behalf.
Throughout its deliberations, the Panel applied the principle of proportionality, balancing your interests with the public interest. It also bore in mind its responsibility to protect the public interest. The public interest includes, amongst other things, the protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.
In accordance with the legal advice, the Panel first considered whether your fitness to practise is currently impaired by reason of deficient professional performance
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and/or misconduct. In so doing, it has considered the issues of insight, remediation and repetition.
In relation to deficient professional performance, the Panel has accepted the Team’s findings, in particular, that they considered the standard of your professional performance had been deficient. The Panel has borne in mind that no meaningful challenge has been mounted in relation to the Report.
The Panel accepts that the deficiencies highlighted are, in principle, remediable and that there is no evidence that you have directly harmed patients. Moreover, you have presented evidence to show that those you have worked with in the past consider you to be a caring doctor who only wants the best for his patients.
At the forefront of the Panel’s mind was the need to protect patients. Acknowledging that you have both been in practice, throughout the past seven years and have attended training courses, the Panel is not satisfied that you have either accepted or fully addressed the particular weaknesses identified in the Assessment and remedied the deficiencies. Nor have you provided adequate tangible, objective evidence, as to your continuing professional development, such as an independent assessment of your current practice. The Panel, therefore, cannot be confident that there will not be a repetition of similar deficient professional performance in the future.
The Panel has concluded that because of the deficiencies identified in your performance, which have not been remedied, and your lack of insight into them, it cannot be satisfied that you do not currently present a risk to patients.
In all the circumstances, the Panel has determined that by reason of your past deficient professional performance, your fitness to practise was impaired at the time of the events, and that it remains impaired today.
In relation to misconduct, the Panel has considered the chronology as set out above in the background section of the determination. The Panel found that many of the explanations or excuses you sought to make lacked credibility and consistency. It found your evidence at times to be evasive. Furthermore, the Panel was not persuaded that you have gained any insight into the performance weaknesses and issues of misconduct.
In relation to your work in the UK since the undertakings took effect on 11 January 2008, you accepted that you worked at Chelsea and Westminster Hospital without disclosing your undertakings and you now recognise that you should have done so. Furthermore, when you worked at King’s Mill Hospital, even if you believed that you had not been erased from the Medical Register, you knew, or should have known, that you were subject to undertakings, and were failing to comply with them. The Panel considered that in failing to disclose information in relation to your registration status your actions lacked integrity.
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Doctors occupy a position of privilege and trust in society and are expected to uphold proper standards of conduct. Members of the public are entitled to place complete reliance upon the integrity of doctors. The relationship between the profession and the public is based on the expectation that medical practitioners will act at all times with absolute integrity. Your actions were serious because they undermined the trust the public place in the medical profession and the declaring and upholding of proper standards of conduct and behaviour.
You practised as a doctor in the UK when you were not registered. Such behaviour was wholly inappropriate for a medical practitioner. It represented a reckless disregard for the systems which are designed to safeguard the interests of patients and to maintain high standards within the profession.
The Panel was in no doubt that your actions and/or omissions amounted to serious misconduct, such that, a finding of impaired fitness to practise is justified today on the grounds that it is necessary to protect patients, maintain public confidence in the profession, and to declare and uphold proper standards of conduct and behaviour.
In all the circumstances, the Panel has determined that by reason of your past misconduct, your fitness to practise was impaired at the time of the events, and that it is impaired today.
Having reached the above decisions, the Panel was of the view that no useful purpose would be served by adjourning for a performance assessment. It was not satisfied that you have presented sufficient evidence to show that a new assessment team would reach a substantially different conclusion to that reached in 2006.
In considering your application for restoration, the Panel has had at the forefront of its mind its duty to ensure the protection of patients, to declare and uphold proper standards of conduct and behaviour, and to maintain public confidence in the profession. Your actions and/or omissions had the potential to place patients at risk of harm, undermined the reputation of the profession and the standards of conduct and behaviour required of a medical practitioner.
Accordingly, having considered all the evidence and having weighed up all the aspects of the public interest and applying the principle of proportionality, the Panel has determined to reject your application for restoration to the Medical Register.
The Panel will now invite submissions from the parties as to whether the period which should elapse before you are allowed to make another application for restoration should be 12 months or another specified period, pursuant to Regulation 4(9) of the GMC (Restoration following Administrative Erasure) Regulations 2004.
Determination on the period which should elapse before Dr Peperkamp is allowed to make another application for restoration
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Dr Peperkamp: The Panel invited Mr Kitching and you to make submissions as to the appropriate period which the Panel should direct, pursuant to Regulation 4(9) of the GMC (Restoration following Administrative Erasure) Regulations 2004, to elapse before you are permitted to make a further application for restoration.
The Panel has made serious findings in relation to deficient professional performance and misconduct and it has doubts as to the extent of your insight.
The Panel is of the view that you need time to reflect on the matters highlighted by this Panel and to be able to demonstrate that you have gained sufficient insight into your actions and/or omissions. Applying the principle of proportionality, balancing your interests with the public interest, the Panel has determined that the appropriate time to elapse before you are allowed to make a further application for restoration is 12 months from the date the decision was announced.
That concludes this case.
Confirmed
25 April 2013 Chairman
mijn ouders kende neuroloog Peperkamp (werkzaam in 073 en 040), hij had ook voor tonnen aan kunst gedeclareerd en toen de FIOD op controle kwam verzon hij dat hij thuis ook een praktijk had... hij heeft toen in een paar dagen tijd voor ruim een ton een 'dokterskantoor' inclusief wachtruimte laten maken... voor zijn bar werd een nepwand geplaatst etc. de kunst hing ineens in de wachtruimte ipv bij de bar... bizar verhaal wat nog steeds rond gaat, heb het via mijn ouders uit 1e hand vernomen dus zal wel kloppen...
www.geenstijl.nl
(1) Hij is getrouwd met (Niet openbaar).
Zij zijn getrouwd
Kind(eren):
(2) Hij is getrouwd met (Niet openbaar).
Zij zijn getrouwd
Kind(eren):
grootouders
ouders
broers/zussen
kinderen
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