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Record of Determinations –

Medical Practitioners Tribunal

MPT: Dr KALAF

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PUBLIC RECORD Dates: 12/10/2017 – 18/10/2017 Medical Practitioner’s name: Dr Abbass Neima KALAF GMC reference number: 7481305 Primary medical qualification: Artsexamen 2004 Utrecht University Type of case Outcome on impairment New - Misconduct New - Language impairment

Impaired Impaired

Summary of outcome Erasure Immediate order imposed

Tribunal:

Legally Qualified Chair Mr Nathan Moxon

Lay Tribunal Member: Mrs Cindy Mackie

Medical Tribunal Member: Dr Barry Adams-Strump

Tribunal Clerk: Mr Matt O’Reilly

Attendance and Representation:

Medical Practitioner: Present and represented

Medical Practitioner’s Representative: Mr Ben Rich, Counsel, instructed by Slater and Gordon

GMC Representative: Mr Alex Mills, Counsel

Allegation and Findings of Fact That being registered under the Medical Act 1983 (as amended):

1. You were employed by Hywel Dda University Health Board (‘the Board’) as a LAS in Paediatrics based at Glangwili General Hospital between 5 August 2015 and 18 November 2015. Admitted and found proved



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Surrey and Sussex Healthcare NHS Trust

2. On 4 February 2016 you submitted an application form for the vacancy of ST1-3 Locum Appointment for Service (‘LAS’) in Paediatrics at Surrey and Sussex Healthcare NHS Trust (‘the Surrey and Sussex Trust’) via the NHS Jobs website (‘the Application Form’). Admitted and found proved

3. The Application Form contained information which was inaccurate in that you:

a. answered ‘No’ to the question ‘Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or in any other country?’; Admitted and found proved

b. stated that East Kent Hospitals University NHS Foundation Trust was your current/most recent employer between November 2014 and February 2015; Admitted and found proved

c. stated that East Kent Hospitals University NHS Foundation Trust was your previous employer between November 2014 and March 2015.

4. You knew that the Application Form contained information which was inaccurate in that you knew at the time you submitted it that:

a. you were the subject of a fitness to practise investigation by the

General Medical Council; Admitted and found proved

b. your most recent employer was the Board between 5 August 2015 and 18 November 2015. Admitted and found proved

5. You submitted Disclosure Barring Services (‘DBS’) Self Declaration Forms (‘the DBS Forms’) to the Surrey and Sussex Trust dated:

a. 17 March 2016; Admitted and found proved

b. 5 April 2016. Admitted and found proved

6. The DBS Forms contained information which:



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a. was inaccurate, in that you answered ‘No’ to the question ‘Are you currently the subject of any investigation or fitness to practise proceedings by any licensing or regulatory body in the United Kingdom or in any other country?’; Admitted and found proved

b. you knew to be inaccurate, in that you knew at the time you submitted the DBS Forms that you were the subject of a fitness to practise investigation by the General Medical Council; Admitted and found proved

7. Your actions as described at paragraphs 3 to 6 were:

a. misleading; Admitted and found proved b. dishonest. Admitted and found proved

English Language

8. On 20 August 2016, you undertook an assessment of your knowledge of English, namely the International English Language Testing System (‘IELTS’) test, and achieved the following scores:

a. Listening: 5.5; Admitted and found proved

b. Reading: 5.0; Admitted and found proved c. Writing: 6.0; Admitted and found proved

d. Speaking: 6.0. Admitted and found proved

9. Your scores for the IELTS test areas at paragraphs 8a to 8d above were

below the minimum acceptable score of 7.0. Admitted and found proved

10. Your overall score of 5.5 for the IELTS test was below the minimum

acceptable overall score of 7.5. Admitted and found proved

And that by reason of the matters set out above your fitness to practise is impaired because:



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a. of your misconduct in respect of paragraphs 1 to 7;

b. you do not have the necessary knowledge of English in respect of paragraphs

8 to 10.

Attendance of Press / Public The tribunal agreed, in accordance with Rule 41 of the General Medical Council (Fitness to Practise) Rules 2004, that the press and public be excluded from those parts of the hearing where matters under consideration were deemed confidential. Determination on Facts and Impairment - 17/10/2017 Dr Kalaf: Preliminary Matters Application to amend the allegation 1. At the outset of the hearing Mr Mills, counsel on behalf of the General Medical Council (“the GMC”), made an application to remove a paragraph in the charges in relation to an allegation that on 7th October 2015 you prescribed Trimethoprim once daily to Patient A, a dose that was inappropriate. Mr Mills submitted that it was no longer the intention of the GMC to put this charge before the tribunal to consider. 2. Mr Mills made a further application to remove paragraph 3c from the allegations;

‘‘3. The Application Form contained information which was inaccurate in that you:

a. …

b. …

c. stated that East Kent Hospitals University NHS Foundation Trust was your previous employer between November 2014 and March 2015.’’

3. Mr Mills conceded that reference to having previously worked at East Kent Hospitals University NHS Foundation Trust was not itself inaccurate and that charge 3c should therefore be removed. 4. Mr Rich, on your behalf, did not oppose the amendment of the charges as proposed by Mr Mills.



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5. The tribunal had regard to the General Medical Council (Fitness to Practise) Rules 2004 (‘the Rules’), Rule 17(6) of the Rules, which sets out that:

‘Where, at any time, it appears to the Medical Practitioners Tribunal that –

(a) the allegation or the facts upon which is based and of which the practitioner has been noticed under rule 15, should be amended; and (b) the amendment can be made without injustice,

it may, after hearing the parties, amend the allegation in appropriate terms.’

6. The tribunal was satisfied that the proposed changes could be made without injustice to either party. Accordingly, it determined to amend the charges as proposed. These amendments are reflected in the body of the allegation, as set out below. 7. Within the papers there are various emails from yourself. Whilst signed “Dr Kalaf”, it is noted that in the “from” box it gives the name Abas Algazaly Albermany. At the outset of the hearing you confirmed that this is your tribal name and that you do not use it for any official purposes. Admissions

1. You were employed by Hywel Dda University Health Board (‘the Board’) as a LAS in Paediatrics based at Glangwili General Hospital between 5 August 2015 and 18 November 2015. Admitted and found proved

Surrey and Sussex Healthcare NHS Trust

2. On 4 February 2016 you submitted an application form for the vacancy of ST1-3 Locum Appointment for Service (‘LAS’) in Paediatrics at Surrey and Sussex Healthcare NHS Trust (‘the Surrey and Sussex Trust’) via the NHS Jobs website (‘the Application Form’). Admitted and found proved

3. The Application Form contained information which was inaccurate in that you:

a. answered ‘No’ to the question ‘Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or in any other country?’; Admitted and found proved



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b. stated that East Kent Hospitals University NHS Foundation Trust was your current/most recent employer between November 2014 and February 2015; Admitted and found proved

4. You knew that the Application Form contained information which was inaccurate in that you knew at the time you submitted it that:

a. you were the subject of a fitness to practise investigation by the

General Medical Council; Admitted and found proved

b. your most recent employer was the Board between 5 August 2015 and 18 November 2015. Admitted and found proved

5. You submitted Disclosure Barring Services (‘DBS’) Self Declaration Forms (‘the DBS Forms’) to the Surrey and Sussex Trust dated:

a. 17 March 2016; Admitted and found proved

b. 5 April 2016. Admitted and found proved

6. The DBS Forms contained information which:

a. was inaccurate, in that you answered ‘No’ to the question ‘Are you currently the subject of any investigation or fitness to practise proceedings by any licensing or regulatory body in the United Kingdom or in any other country?’; Admitted and found proved

b. you knew to be inaccurate, in that you knew at the time you submitted the DBS Forms that you were the subject of a fitness to practise investigation by the General Medical Council; Admitted and found proved

7. Your actions as described at paragraphs 3 to 6 were:

a. misleading; Admitted and found proved b. dishonest. Admitted and found proved



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English Language

8. On 20 August 2016, you undertook an assessment of your knowledge of English, namely the International English Language Testing System (‘IELTS’) test, and achieved the following scores:

a. Listening: 5.5; Admitted and found proved

b. Reading: 5.0; Admitted and found proved c. Writing: 6.0; Admitted and found proved

d. Speaking: 6.0. Admitted and found proved

9. Your scores for the IELTS test areas at paragraphs 8a to 8d above were

below the minimum acceptable score of 7.0. Admitted and found proved

10. Your overall score of 5.5 for the IELTS test was below the minimum

acceptable overall score of 7.5. Admitted and found proved

Background 8. We have the benefit of a bundle of documents, exhibit C1, agreed between the parties, which includes witness statements and supporting documentation. We shall refer to this as the bundle throughout our determination. We also have the benefit of a bundle of documents adduced on your behalf which we shall refer to as exhibit D1. 9. You were employed by East Kent University Hospital between November 2014 and March 2015. Thereafter you were employed by Hywel Dda University Health Hospital Board (“the Board”) at Glangwili General Hospital, Carmarthen as a ST1 Paediatric SHO, between 5th August 2015 and 18th November 2015. 10. By letter, dated 17th December 2015 and found at page 100 of the bundle, the Board contacted the GMC to raise the possible need for a fitness to practice investigation against you. You were contacted about this by the GMC by letter dated 13th January 2016 which can be found at page 101. Within that letter there is clear reference throughout to the GMC undertaking an investigation about you. 11. Between pages 105 and 118 there are various e-mails between yourself and Mr A, GMC Investigation Officer, which are dated from 18th January 2016 to 28th



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January 2016. Several of your emails refer to “FPD case reference number: C1-1308974564(6)” in the subject heading. 12. On 4th February 2016 you applied for a position at the Surrey and Sussex Healthcare NHS Trust (“the Trust”) by application form, a copy of which can be found from page 153 of the bundle. 13. At page 4 of that form you were asked:

“Are you currently the subject of a fitness to practise investigation or proceedings by a licensing or regulatory body in the UK or in any other country”.

14. You answered “No” to that question. You accept that the answer was inaccurate. 15. You were also asked to provide your “Current/most recent employer (reference always required)” to which you detailed East Kent University Hospital. You accept that the answer was inaccurate. It is noted that the form included a space to give the reason for leaving the most recent employment and you had left this blank. 16. You were also required to complete Disclosure Barring Services Confidential Self Declaration Forms “DBS forms” on 17th March 2016 and 5th April 2016. These can be located at pages 133 and 138 of the bundle. In both of these forms you were asked:

“Are you currently the subject of any investigation or fitness to practice proceedings by any licensing or regulatory body in the United Kingdom or any other country?”

17. You replied “No” in both forms. You accept that those answers were inaccurate. 18. You were successful with your application with the Trust and a letter sent to you confirming that appointment and dated 19th February 2016 can be found at page 121. Within that letter you were notified that your Responsible Officer was Mr B. You were advised to contact him and you were provided with his e-mail address. 19. You commenced employment with the Trust on 4th April 2016. You contacted Mr B by e-mail, dated 14th April 2016, found at page 144, which states:

“…I have been told that you are my responsible body. It would be great if you have time to book an appointment with you..I need your support to make a good start in the UK”.



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20. You received an “Out of Office AutoReply” as Mr B was on annual leave. It advised you that he was on leave until 20th April 2016. He contacted you upon his return on 20th April 2016 indicating that he was present at the Trust on most Wednesdays and Thursdays. You replied that day to suggest a time to meet but this was not suitable to him. Those e-mails can be found at page 143. In an e-mail you sent him on 22nd April 2016, and found at page 146, you stated:

“I am wondering whether or not we could just come to shake hands at our suitable time”.

21. By letter dated 26th April 2016, and found at page 148, the GMC informed Mr B that you were under an investigation as information had been received that raised concerns about your fitness to practice. 22. Upon receipt of the letter, Mr B spoke to you in private the same day. He details that conversation at paragraph 18 of his witness statement, in which he states:

“I introduced myself and he said he had been expecting me. I asked Dr Kalaf why he had not declared his ongoing investigation by the GMC on his application form. He told me he thought the investigation questions on the Application form only referred to criminal investigations.”

23. By letter dated 5th May 2016, found at page 165, Mr B outlined that it was believed that you had failed to disclose within your application form and DBS forms that you were under a GMC investigation or that you had worked for the Board. You were invited in that letter to attend a disciplinary hearing on 19th May 2016. 24. You attended the disciplinary hearing which was also attended by Trust personnel, including Mr B and Dr C, Chairperson of the Disciplinary Panel and Chief of Surgery at the Trust. Notes of the hearing can be found from page 167. 25. At page 169 the notes record that inaccurate information in forms completed by you had been identified and that you stated, in the hearing:

“did admit I sign didn’t understand – 4 month GMC didn’t inform”. 26. At page 170 you are recorded as stating the following:

“I admit did that – didn’t understand no criminal record – lieing fabricated – no reference, contract. GMC – 4 months ok as a result – they said cant apply anywhere. I contact [Mr B] – speak bt problem – [Mr B] – not respons – difficult situation designated body not help with language…”



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27. At page 172 the notes detail that Mr B had identified during the hearing that the application form states that your last job was for East Kent Healthcare NHS Trust but that your Hospital base was in Wales, which does not make sense. You are recorded as replying:

“My language – difficult to put in right place”. 28. It was put to you that you had failed to mention the Board on the application form and you are recorded as replying:

“Didn’t as no one recognise contract…” 29. It is recorded at page 177 that you were asked about mitigation and that Dr C had asked if it had come down to you not understanding and you replied “maybe”. 30. The outcome of the disciplinary hearing was confirmed to you by letter from Dr C, dated 24th May 2016 and found at page 180. Within that letter it records the following:

“When asked if there were any other mitigating factors to why you did not disclose the information and your response was that due to the language barrier you had difficulty in understanding the wording of the application form”.

31. You were dismissed from the Trust. 32. You attended an English Language test on 20th August 2016. The IELTS Test Report form can be found at page 193 and details the results as particularised in the charges. Impairment 33. Having admitted the charges in their entirety the facts of the case are found proved, the tribunal went on to consider whether your fitness to practise is impaired by reason of your dishonesty, misconduct and your failure to meet the language requirement, in accordance with Rule 17(2)(l). Evidence 34. The tribunal considered the aforementioned bundle before you gave oral evidence. During your oral evidence you adduced exhibit D1 which was read in full by the tribunal before your oral evidence concluded. Oral evidence



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35. You gave oral evidence to the tribunal, during which you detailed your professional history, which includes employment in the Netherlands until 2014. 36. You detailed that the position you were recruited for at the Board was not comparable to that enjoyed by you in the Netherlands but that you accepted it to develop your career in the United Kingdom. In summary, you stated that Glangwili General Hospital was a difficult place to work and was “chaos”. 37. Upon leaving that employment you stated that you applied for a role at Kettering Hospital and described that they were keen to employ you and gave you a start date. However, the Board refused to provide a reference for you and so you were not subsequently offered a position by Kettering Hospital. You stated that you were advised by someone at Kettering Hospital not to give the Board as a reference as they do not wish to provide one. You were asked to clarify this and stated that a Consultant at Kettering Hospital had advised you not to mention the Board when applying for jobs. 38. You detailed that you knew that if you disclosed the Board as your last employer any prospective employer would seek a reference and upon refusal would act the same as Kettering Hospital and fail to offer employment. You also stated that you knew that if you disclosed to any prospective employer that you were subject to a GMC investigation that you would not be employed. You had exhausted your savings and accrued significant debt and needed to obtain paid employment. You stated that this is why you misled upon your application form and DBS forms. You accepted that your actions were dishonest. 39. You were asked why there was reference to Wales as your “Hospital / Base” in your application form and you asserted that this was designed to “trigger” the Trust to ask you about your employment history so that you could disclose the problems you had experienced with the Board. You were asked to clarify when you hoped that such an enquiry would be triggered and replied upon being offered a job by a new employer. You were asked why you had not answered the form honestly and why you had failed to detail the circumstances in the box providing an opportunity to detail “reason for leaving”. You replied that had you done so you believed that the application would have been rejected. 40. You told us that you undertook a remote interview for the position and did not disclose your employment with the Board or the GMC investigation for fear of your application being rejected. 41. You told us that you had intended to disclose the truth to Mr B, hence the e-mails from 14th April 2016 requesting to speak to him. You had not contacted him upon receiving the offer of employment as you were concerned that the offer would be withdrawn. You did not attempt to contact him between 4th and 14th April 2016



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as you wanted to get to know people at the Trust first. You did not detail the information in the e-mails as you wished to discuss it in person. 42. You were asked whether you agreed with the summary of your account within your disciplinary hearing at the Trust, as outlined within the letter to you from Dr C. You denied that you had stated during the disciplinary hearing that any inaccurate information on your application or DBS forms was due to language problems. 43. You accepted during your oral evidence that you should not have been dishonest. You expressed regret and stated that you would never be dishonest again. You stated that you recognise the damage to your reputation, the reputation of the profession and the effect upon patients. 44. You accepted that your August 2016 IELTS score was insufficient. You have taken the test thereafter every three months but failed to obtain the requisite grades. You took it two weeks ago and you are awaiting the results. 45. It was noted by the tribunal that there appears to be an inconsistency in relation to an MRCPCH qualification. Within your application form you stated that you had obtained this in 2013. In an e-mail from you to Mr A of the GMC, dated 8th March 2016, you stated that you are preparing for the RCPCH exam. In your curriculum vitae, found within exhibit D1, you assert to have obtained the qualification in 2014. The tribunal asked you to clarify what appears to be inconsistencies and you detailed that there are several parts to the qualification and that you had been exempt from completing part 1 and had completed part 2 in 2013. 46. Mr Rich was concerned that the tribunal may be raising a satellite issue that was not subject to the GMC investigation and charges before us. Mr Mills agreed that any inconsistency does not form part of the present proceedings and stated that he was not inviting the tribunal to make any adverse credibility findings as a result. 47. The tribunal discussed this discrete issue in camera and concluded that for the reasons outlined by Mr Rich and Mr Mills it was not necessary to determine whether there has been material inconsistencies and if so whether any credibility findings arise as a consequence. We indicated to you and the advocates that we do not know the cause of any inconsistencies, there may be a perfectly innocent explanation and that no adverse credibility findings were to be made as a consequence.



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GMC Submissions 48. Mr Mills acknowledged that you have been candid in accepting that you have acted dishonestly and that you did so as you believed that otherwise you would not secure employment. 49. He submitted that whilst you assert that you had intended to tell the Trust the truth the evidence of that intention is lacking. He noted that we may consider implausible your account of referencing Wales in your application form to trigger an enquiry. 50. He submitted that you were knowingly dishonest within the application form and the DBS forms on 17 March 2016 and 5 April 2016 to conceal the fact that you were the subject of a fitness to practice investigation by the GMC. 51. He submitted that there was no evidence that you had any intention or made any attempt to inform the Trust of your past difficulties, that even if you had, your actions were still dishonest and the potential of your failing to gain employment because of the difficulties you had encountered was not acceptable mitigation. He submitted that you have breached a fundamental tenet of Good Medical Practise 2013 (‘GMP’) and that there was repeated dishonesty on your part. He argued that dishonesty is serious misconduct and that it undermines public confidence in the profession. 52. He submitted that your admissions and candour in providing the reasons to conceal information about your past employment to the Trust demonstrates some insight and that you also expressed regret. It is difficult to remediate dishonesty and there is no evidence to suggest you have done so other than your admissions to the charges against you and your expression of regret. He argued that you had sought to minimise your actions by relying on your personal circumstances, namely your eagerness to obtain employment, and also your evidence that you had been advised by Kettering Hospital not to disclose your employment with the Board. Repetition is highly likely based on the fact that you had repeatedly been dishonest over a number of months. For all these reasons, he argued, your fitness to practice is currently impaired by your misconduct 53. He submitted that you do not have the necessary IELTS results as required for a doctor to practice in the UK and therefore you are impaired by reason of your lack of knowledge of the English language. 54. During his submissions he directed us to the following authorities:

Roylance v General Medical Council (No.2) [2000]1 AC 311 (UKPC); Meadow v General Medical council [2007] 1 AII ER 1 (Auld LJ); Naheed v General Medical Counsel [2001] EWHC 702 (Admin) (Parker J);



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General Medical Council v The Queen (on the application of Dr Iheanyi Chidi Nwachuku) [2017] EWHC 2085 (Admin) (O’Farrell J); CHRE v NMC, Grant [2001] EWHC 927 (Admin) (Cox J); and Cheatle v General Medical Council [2009] EWHC 645 (Admin) (Cranston J).

Submissions on your behalf 55. Mr Rich highlighted that you admit all the charges that had been put before this tribunal. You concede misconduct by reason of your dishonest behaviour and that your fitness to practise is currently impaired by reason of your misconduct on public interest grounds. He submitted that you had made a bad decision and that you understand the seriousness of these charges. He noted that you had stated that you would not repeat your actions in the future. He argued that the dishonest acts are completely out of character. 56. He noted that there were no charges relating to clinical practice being pursued. There are no clinical or performance errors and you have provided references from former colleagues within exhibit D1 that speak of you in high regard. 57. He submitted that your actions were one of desperation to gain employment, that you had spent your life savings and had borrowed money to continue your training. He submitted that you had felt it important to get the appointment and then get to know people first prior to explaining the difficulties you had encountered with the Board, rather than be rejected at the application stage for the appointment with the Trust. 58. He submitted that your grasp of the English language is not what has brought you before this tribunal. You were continuing to learn, improve your English and understand the UK system, as demonstrated by your willingness to work at a lower level than you had been in the Netherlands. You had managed to operate in two UK hospitals with some difficulty but that you are aware you will need to reach the required standard of English. 59. He submitted that you had learned a hard lesson, that you have admitted your mistakes and regret them. He submitted that this process has been a salutary experience as you are aware it will be unlikely you will be able to continue your career in the UK for some time, because of one difficult period of employment that you tried to conceal. He submitted that in making the admissions you have shown insight into your misconduct and that you have given an undertaking that you would never repeat this behaviour again. He submitted that there is little risk of repetition and that you are of previous good character.



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The Tribunal’s Approach 60. In reaching its decision, the tribunal has taken account of all of the evidence placed before it, as well as the submissions made by Mr Mills on behalf of the GMC, and those of Mr Rich on your behalf. 61. Whilst the tribunal bore in mind those submissions, the decision as to whether your fitness to practise is currently impaired is a matter for this tribunal alone, exercising its own judgement. In so doing, the tribunal had particular regard to its statutory overarching objective, which includes:

protecting and promoting the health, safety, and wellbeing of the public; promoting and maintaining public confidence in the medical profession;

and

promoting and maintaining proper professional standards and conduct for members of the profession.

62. The tribunal also had consideration of the relevant paragraphs of Good Medical Practice (2013) “GMP” and the authorities, relied upon by Mr Mills. 63. The Tribunal has not allowed itself to be influenced by charges that have not been pursued or any potential inconsistency in relation to the dates that you have obtained qualifications. No adverse credibility findings within the present proceedings arise from these matters. Our decisions have been determined based only on the evidence adduced before us. The Tribunal’s Decision 64. The tribunal has considered your account of having been advised by a Consultant at Kettering Hospital not to disclose your employment with the Board. We reject this account. We do not find it credible that a senior medical practitioner, who has no personal relationship with you, would advise you to breach a fundamental tenet of good medical practice, namely honesty. We find that this is a dishonest attempt on your behalf to seek to minimise your culpability. 65. You assert that you had referenced Wales in your application form to trigger an enquiry. Again, we reject this evidence and conclude that you had again sought to mislead us. It is not credible that you would seek to trigger an enquiry in such a manner rather than raise it directly and your account that you had hoped that any enquiry would not be triggered until after you had secured employment is implausible given that you had included the “trigger” on the application form. We further note that there was an area upon the form to detail why you had left a previous employer and you could have detailed any problems but failed to do so. In his opening of the facts before us Mr Mills had suggested that you may have included accurate details initially on the application form before instead determining



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to mislead and that you had mistakenly failed to amend the details of your base. We find that this is a far likely explanation for the inclusion of Wales on the application for than the explanation that you pursued. 66. You asserted that you had intended to disclose the truth to Mr B but were unable to do so as he was not available. We reject that assertion for the following reasons:

(i) Your failure to detail the problems with the Board within your application form when you had the opportunity to do so;

(ii) Your failure to detail the problems during your interview with the Trust; (iii) Your failure to contact Mr B upon being offered employment and provided

with his e-mail address by letter, dated 19th February 2016; (iv) Your failure to make any attempt to contact Mr B in your first 10 days of

employment with the Trust; (v) Your failure to disclose details within the e-mails to Mr B; (vi) Your failure to seek to contact a suitable alternative member of staff at the

Trust upon learning of Mr B’s leave; (vii) The fact that within your e-mails you specifically stated that you were

seeking to contact him to make a good start in the role and that you wondered if you could shake hands with him;

(viii) The fact that when you spoke to Mr B you gave the explanation that you thought the investigation questions on the application form only referred to criminal investigations; and

(ix) Your failure to fully and candidly outline your dishonesty during the disciplinary hearing that Mr B attended.

67. We therefore find that you have sought to mislead us by dishonestly asserting that you had intended to tell Mr B of the problems you had arising from your employment with the Board. 68. In your oral evidence you did not accept that you had stated in your disciplinary hearing that language was a factor in providing inaccurate information within your application and DBS forms. It is clear from the notes of the disciplinary hearing that you had in fact sought to assert that you had failed to understand the form. 69. We find no reason to doubt the accuracy of the notes of the hearing nor do we believe that Dr C, who had been present, would then mistakenly summarise the information you had given within her subsequent letter to you. We therefore find as a fact that you sought to mislead us by seeking to disassociate yourself from comments that you had made during your disciplinary hearing. 70. The tribunal had before it a copy of a letter from the GMC Investigations Team dated 13 January 2016 advising you that an investigation into concerns raised



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by the Board in relation to you had begun. Additionally, it also had sight of email correspondence between you and GMC’s investigating officer in which you responded in relation to this matter and questions raised on 18, 20, 21 and 28 January 2016. The tribunal is in no doubt that you were fully aware that you were subject to a fitness to practise investigation at the time of your application. 71. The tribunal finds as a fact that you have repeatedly been dishonest from the time you submitted your application on 4th February 2016 for the appointment at the Trust, up to and including your oral evidence before us. You have been evasive and dishonest. It finds of fact that you have sought to deflect blame on to others. 72. As such we are not satisfied that your asserted regret is genuine. We also find that your repeated dishonesty shows a lack of insight. Whilst it is accepted that remediation for dishonesty is hard to show we find that you have instead continued to act dishonestly during your oral evidence. 73. Whilst the tribunal accepts you have acknowledged your actions and expressed regret, it finds your insight with regard to the extent of your reflection limited. When asked about the reflective steps you have taken since the events listed, you responded, “first I regret, I’m planning for work”. The tribunal found your reflection regarding matters of probity limited. 74. The tribunal went on to consider your understanding of the English language in relation to the standard required for doctor’s practising in the UK. The tribunal bore in mind paragraph 5 of the ‘Guidance for Medical Practitioners Tribunals on dealing with concerns about a doctor’s knowledge of English’, which states;

“The results of the IELTS test are the key factor in deciding if a doctor is impaired due to concerns that they lack the necessary skills knowledge of English to practise medicine safely. The test has four parts – listening, reading, writing and speaking – and for each skill, a band score of up to 9 will be awarded. The overall score will be calculated using the average score given to each skill, for which a maximum of 9 is achievable. To practise medicine safely, a doctor is expected to achieve a score of at least 7 in each of the four parts, and an overall score of at least 7.5.”

75. The tribunal had before it your IELTS test results dated 20th August 2016 in which you failed to meet the required standard. Your results from this test are set out in the charges admitted. The tribunal is aware you are continuing to work on your English and have taken further IELTS tests and that you are awaiting the results of the most recent test. 76. For all the reasons set out, the tribunal determined that your fitness to practise is currently impaired by reason of your misleading and dishonest behaviour which amounts to serious misconduct and by reason of your knowledge of English.



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Determination on Sanction - 18/10/2017 Dr Kalaf: 1. Having determined that your fitness to practise is impaired by reason of your misconduct and lack of knowledge of English, the tribunal has now considered what action, if any, it should take with regard to your registration. 2. In so doing, the tribunal has given careful consideration to all the evidence adduced before it, your oral evidence, the submissions by Mr Rich on your behalf and the submissions by Mr Mills on behalf of the GMC. 3. Upon the tribunal retiring to deliberate an application was made on your behalf to adduce documentation XXX. It was argued that it would be in the interests of justice to allow the admission of that evidence. Mr Mills did not object to the application. The application was therefore allowed in the interests of justice and the bundle of documents given the exhibit number of “D4”. Application to hear evidence in private 4. At the beginning of the sanction stage, Mr Rich indicated to the tribunal that you would be giving further oral evidence and requested that those matters discussed XXX be held in private. 5. Mr Mills had no objection to this application. 6. Under Rule 41(3)(b) of the Rules, the tribunal acceded to the application made, and determined that those matters XXX should be held in private. Oral Evidence XXX 8. You stated that you had applied to take an IELTS test which was to take place on 15 December 2016, but were unable to attend XXX. You sat a test in April 2017 but withdrew during the six hours test after 2 hours XXX. You confirmed that you had not sat the IELTS test between August 2016 and April 2017. XXX 10. You told the tribunal that you had used up all your savings and money loaned from the bank and that you have subsequently borrowed approximately £12,000 from friends.



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11. You told the tribunal that the medical regulator in Ireland is awaiting the outcome of this hearing before it determines if you can practise there. You also stated that you had been ‘deleted’ or ‘removed’ by the medical regulators in the Netherlands because of the fitness to practise investigation by the GMC. 12. You stated that there has been no disciplinary or clinical concerns raised regarding your fitness to practise in the Netherlands. GMC Submissions 13. In summary, Mr Mills submitted that erasure is the only proportionate sanction. A severe sanction is justified for misconduct and erasure is appropriate in this case due to the severity of the misconduct. He acknowledged that if the impairment was in relation to language alone then this sanction would not be appropriate. No undertakings have been agreed between the parties. 14. He submitted that personal mitigation carried some weight, but is far outweighed by the need to satisfy the overarching objectives, namely promoting and maintaining public confidence in the medical profession and promoting and maintaining proper professional standards and conduct for the members of the profession. 15. He relied upon the various authorities, extracts of which he included within a document; exhibit C3. 16. He submitted that compelling evidence of insight to satisfy the overarching objectives would need to be put before the tribunal for it not to impose a sanction of erasure. He highlighted that the tribunal had already found you to have limited insight. He referred the tribunal to Atkinson v General Medical Council (GMC) [2009] EWHC 3636 (Admin) (Blake J), which states;

“13 […] I would accept, that erasure is not necessarily inevitable and necessary in every case where dishonest conduct by a medical practitioner has been substantiated. There are cases where the panel, or indeed this court on appeal, have concluded in the light of the particular elements that a lesser sanction may suffice and it is the appropriate sanction bearing in mind the important balance of the interests of the profession and the interests of the individual. It is likely that for such a course to be taken, a panel would normally require compelling evidence of insight and a number of other factors upon which it could rely that the dishonesty in question appeared to be out of character or somewhat isolated in its duration or range, and accordingly there was the prospect of the individual returning to practice without the reputation of the profession being disproportionately damaged for those reasons.”



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17. He referred the tribunal to the case of General Medical Council v Theodoropoulos [2017] EWHC 1000 (Admin) (Lewis J), which states;

“36. Dishonesty will be particularly serious where it occurs in the performance of a doctor's duties or involves a breach of the trust placed in a doctor by the community: see Khan v General Medical Council [2015] EWHC 301 (Admin). Honesty and integrity are also fundamental in relation to qualifications and the system of applying for medical positions. Thus, in Makki v General Medical Council [2009] EWHC 3180 (Admin), the court dealt with a registered medical practitioner who had misrepresented the extent of his experience when applying for a post in a hospital. Irwin J. as he then was said at paragraph 44 of his judgment:

"The degree of dishonesty here and its nature, affecting not registration but qualification and the integrity of the system of job applications, affects something which is every bit as fundamental to the proper respect for the system, to the proper operation of the system of medicine and of appointments to medical positions, as is the system of registration."

18. He submitted the aggravating factors of the case are that you have been repeatedly and persistently dishonest. 19. He highlighted various paragraphs of the Sanctions Guidance (“SG”), including paragraphs 56 and 124:

“56. Tribunals are also likely to take more serious action where certain conduct arises in a doctor’s personal life, such as:

a. issues relating to probity – ie being honest and trustworthy and acting with integrity…”

“124. Although it may not result in direct harm to patients, dishonesty related to matters outside the doctor’s clinical responsibility (eg providing false statements or fraudulent claims for monies) is particularly serious. This is because it can undermine the trust the public place in the medical profession. Health authorities should be able to trust the integrity of doctors, and where a doctor undermines that trust there is a risk to public confidence in the profession. Evidence of clinical competence cannot mitigate serious and/or persistent dishonesty.”

20. He acknowledged that the mitigating factors in this case include your admissions to the facts; your candid evidence regarding your motives for your misconduct; that you have some insight, though it is limited; your expression of regret for your misconduct; XXX.



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21. He submitted that you are at a relatively early stage of your career in the UK, but that this carries less weight in a case of serious dishonesty. 22. He submitted that you had sought to minimise your actions and that it was likely that your dishonest behaviour would be repeated. Submissions on your behalf 23. Mr Rich relied upon the cases of Kamberova v Nursing and Midwifery Council [2016] EWHC 2955 (Admin) and Hassan v GMC [2013] EWHC 1887 (admin). Transcripts of these cases are identified as exhibit D3. 24. In summary, Mr Rich submitted that whilst authorities can provide guidance to the tribunal, a distinction must be made between legal principles and the individual comments made in relation to the specifics of a case as every case is different. He also urged the tribunal to be cautious of rhetoric in cases generally, specifically in cases that relate to professions other than the medical profession. 25. He submitted that the cases of Naheed and Theodoropoulos were in relation to job application forms in which qualifications were falsely provided, and so the facts are distinguishable to your case. 26. In summary, he identified that each case should be determined upon its own facts, as acknowledged at paragraph 33 of the case of Hassan. At paragraph 38 it is outlined that there are plainly relevant differences between professions and it is not appropriate to assume that the legal position in relation to one profession is necessarily the same as that in relation to another. 27. He accepted that dishonesty is always serious and noted that dishonesty in this case was conceded at the outset of the hearing. He accepted that dishonesty can lead to erasure especially if a doctor does not admit dishonesty; fails to engage in the process or repeats the misconduct. However, as outlined at paragraph 39 of Hassan it would be wrong to approach the question of sanction on the basis that there is only a small residual category of exceptional cases where erasure would be a disproportionate sanction. 28. In relation to impairment by reason of your misconduct, he submitted that whilst this is a public interest and public confidence case, a sanction of erasure is not necessary as this is not a case about public safety and there are no negative clinical findings. He submitted that it is in the public interest for a good doctor to be allowed to continue to practise, particularly given the lack of suitably qualified doctors in the United Kingdom.



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29. He argued that you made admissions in full and were candid in your evidence; that you accept the seriousness of the case overall; that it had been recognised by the tribunal that there was some insight, though limited; that it has had a truly devastating impact on you with the potential loss of your vocation; the financial XXX implications that you have experienced; and that you have lost the ability to work in the Netherlands. 30. He argued that the dishonesty is a single incident to obtain employment where you were otherwise unable to do so upon the backdrop of a GMC investigation arising from your employment with the Board which you consider to have been unfair and which has not ultimately led to charges being pursued. 31. For these reasons he submitted that a merciful and proportionate sanction would be a period of suspension and that this would best serve the overarching objective. 32. He submitted that the public might think a sanction of erasure would be too severe, but that a further sanction of suspension would satisfy the need to declare and uphold the reputation of the profession and to satisfy the public interest. 33. In relation to impairment by reason of your knowledge of English, Mr Rich submitted that you admit your English is not to the standard required by the GMC. You accept you will need to pass the IELTS test before you can practise again. Your language deficiencies have not resulted in clinical errors. Tribunal’s Approach 34. The decision as to the appropriate sanction to impose, if any, in this case is a matter for this tribunal exercising its own judgement. 35. In reaching its decision, the tribunal has taken account of the Sanctions Guidance. 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 sanctions may have a punitive effect. 36. Throughout its deliberations, the tribunal has applied the principle of proportionality, balancing your interests with the public interest. It has taken account of the statutory overarching objectives, namely to protect and promote the health, safety and wellbeing of the public; to promote and maintain public confidence in the medical profession; and to promote and maintain proper professional standards and conduct for the members of the profession. 37. The tribunal has already given a detailed determination on impairment and it has taken those matters into account during its deliberations on sanction.



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No Action 38. In coming to its decision as to the appropriate sanction, if any, to impose in your case, the tribunal first considered whether to conclude the case by taking no action. 39. The tribunal determined that having found your fitness to practise impaired by reason of your serious misconduct and knowledge of English, taking no action would not be sufficient to uphold the overarching objectives. In addition, the tribunal did not consider there were any exceptional circumstances to justify it taking no action. Conditions 40. The tribunal next considered whether it would be sufficient to impose conditions on your registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable and measurable. 41. The tribunal bore in mind that a doctor’s insight into the matters which brought them before a Fitness to Practise Panel / Medical Practitioners tribunal is a key consideration when determining whether conditions could be appropriate. As noted in its determination on impairment the tribunal has determined that you have not demonstrated that you have fully acknowledged the seriousness of your previous misconduct. It is also the tribunal’s view that you have not shown the necessary level of insight or reflection sufficient to address your current impairment. 42. The tribunal was mindful of its requirement to impose the least restrictive sanction, consistent with its requirement to meet the overarching objective. The tribunal determined that workable conditions could not be formulated in your case as persistent dishonesty is difficult to remediate or to measure. 43. The tribunal determined that imposing conditional registration on you would not be appropriate. It considered that conditions would not be in the public interest, and would not maintain public confidence in the medical profession. As such, the tribunal determined that it would not be sufficient nor proportionate to direct the imposition of conditions on your registration. Suspension 44. Having decided that conditions would be neither sufficient nor proportionate to protect the public, the tribunal then went on to consider whether a period of suspension would be an appropriate and proportionate sanction. 45. The tribunal considered paragraph 97 of the SG:



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

f. No evidence of repetition of similar behaviour since incident.

g. The tribunal is satisfied the doctor has insight and does not pose a significant risk of repeating behaviour…”

46. The tribunal notes that you have continued to be dishonest during the hearing which is a repetition of the behaviour that brought you under investigation, and that this demonstrates a lack of insight and as such demonstrates that you pose a significant risk of repeating your dishonest behaviour. 47. The tribunal has considered paragraph 72 of Good Medical Practice which provides:

“You must be honest and trustworthy when giving evidence to courts or tribunals…”

48. The tribunal also considered paragraph 107 of the SG which provides:

“The tribunal may erase a doctor from the medical register in any case – except one that relates solely to the doctor’s health and/or knowledge of English – where this is the only means of protecting the public.”

49. The tribunal found that the following subparagraphs of paragraph 109 apply to your case:

“Any of the following factors being present may indicate erasure is appropriate (this list is not exhaustive).

a. A particularly serious departure from the principles set out in Good

medical practice where the behaviour is fundamentally incompatible with being a doctor.

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

50. The tribunal also had regard to paragraph 128 which provides:



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“Dishonesty, if persistent and/or covered up, is likely to result in erasure.” 51. In mitigation the tribunal considered your admissions; engagement with the process and expression of remorse and regret for your actions. It also recognised that there were no clinical issues or patient safety concerns, you have no previous adverse findings against you by the MPTS and your actions were as a result of desperation borne out of the particular circumstances at the time. You have taken steps to improve your English. The tribunal also considered your personal mitigation which includes the effect upon your vocation and the financial XXX implications resulting from your suspension. 52. The tribunal accepted Mr Rich’s submission that each case must be determined upon its merits and that exceptional circumstances are not necessary to issue a sanction other than erasure. 53. The tribunal did, however, consider that the offences for which you were charged and admitted indicate repeated and persistent dishonesty over a period of approximately two months. It determined that you have sought to minimise your dishonest behaviour by blaming others and that you failed to tell the truth during this hearing, as outlined between paragraphs 64 to 69 of the determination on facts and impairment 54. It recognised that there is some insight, but that it is limited. Whilst it is hard to remediate against dishonest behaviour, there is no evidence before this tribunal of any remediation undertaken. Whilst you assert regret for your actions this is significantly undermined by your continued dishonesty within your oral evidence to the tribunal. The tribunal determined that there is a serious risk of repetition of dishonesty given that you have persisted to seek to mislead during the hearing itself. 55. Having considered all the circumstances of the case, the tribunal determined that your misconduct is fundamentally incompatible with continued registration to practise medicine. The tribunal is of the view that the overarching objectives, in particular that of public interest and confidence in the profession must be met. 56. The tribunal is therefore satisfied that erasure is the proportionate and appropriate sanction in the public interest and is necessary to maintain public confidence in the profession. It is the only means of protecting the public and is required to maintain the high standards expected of the profession. 57. The tribunal felt that patients should be able to communicate with their doctor and be clearly understood, that a doctor should be able to communicate with colleagues and fellow medical professionals of all levels. It is accepted that you have shown insight in relation to your level of English and that you have sought to improve this which demonstrates remediation. Had the only matter before the tribunal been in relation to your English language, a period of suspension would



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have been appropriate with a review upon which subsequent IELTS test results could be considered. 58. However, in light of the serious misconduct, and for all the reasons outlined above, the tribunal has determined that your name should be erased from the Medical Register. 59. The effect of this direction is that, unless you exercise your right of appeal, this decision will take effect 28 days from when written notice of this determination is deemed to have been served upon you. A note explaining you right of appeal will be supplied to you. Determination on Immediate Order - 18/10/2017 Mr Rich: 1. You informed the tribunal that Dr Kalaf was unable to attend the hearing today due to his financial difficulties. The tribunal took no adverse inference against Dr Kalaf in this matter. 2. Having determined to erase his name from the Medical Register, the tribunal considered in accordance with Section 38(1) of the Medical Act 1983, as amended, whether to impose an immediate order of suspension on his registration. 3. Mr Mills submitted that it is in the public interest and to maintain public confidence in the profession to impose an immediate order of suspension. He submitted that as Dr Kalaf had been suspended by reason of an interim order and given the findings on sanction by the tribunal, it would undermine the public’s confidence in the profession if he were to be allowed to practise. 4. You submitted that given the outcome of the tribunal’s findings, it would be inevitable that Dr Kalaf would not be permitted to practise again and therefore you had no further submissions. 5. The tribunal has determined that given the seriousness of its findings it is necessary both in the public interest and to maintain public confidence in the profession to impose an immediate order of suspension. Given Dr Kalaf’s level of English, an immediate order of suspension is also required in the interests of public safety. 6. The interim order of suspension currently on his registration is revoked. 7. The substantive direction for erasure, as already announced, will take effect 28 days from when written notification is deemed to have been served upon Dr Kalaf, unless an appeal is lodged in the interim. This order of immediate suspension



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takes effect from today. The immediate suspension will remain in force until the substantive sanction takes effect, or until such time as the outcome of any appeal is decided. 8. That concludes this case. Confirmed Date 18 October 2017 Mr Nathan Moxon, Chair

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