HEARING PARTLY HEARD IN PRIVATE*

Transcription

1 HEARING PARTLY HEARD IN PRIVATE* *The Committee has made a determination in this case that includes some private information. That information has been omitted from this text. TIWANA, Sukhjinder Singh Registration No: PROFESSIONAL CONDUCT COMMITTEE MAY 2018 Outcome: Erased with Immediate Suspension Sukhjinder Singh TIWANA, a dentist, BDS Lond 1996 was summoned to appear before the Professional Conduct Committee on 14 May 2018 for an inquiry into the following charge: Charge That being a Registered Dentist: 1. You have an adverse health condition set out in the attached Schedule For some or all of the period between 29 September 2017 and 3 January 2018 you failed to co-operate with an investigation conducted by the GDC. 3. On 18 February 2017, you prescribed medication whilst your registration with the GDC was suspended; 4. Your conduct in relation to allegation 3 was; a. Misleading; and/or b. Dishonest in that you knew you were not entitled to prescribe medication whilst your registration with the GDC was suspended. 5. On 18 February 2017, you amended a prescription written by another dental professional whilst your registration with the GDC was suspended. 6. Your conduct in relation to allegation 5 was; a. Misleading; and/or b. Dishonest in that you knew you were not entitled to amend the prescription whilst your registration with the GDC was suspended. 7. On 18 February 2017, you gave incorrect information to a Boots Pharmacist by saying words to the effect of; a. You had prescribed the medication yourself; and/or b. Someone else had prescribed the medication. 8. Your conduct in relation to allegation 7(a) and/or (b) was; 1 Please note that this schedule is a private document and cannot be disclosed. TIWANA, S S Professional Conduct Committee May 2018 Page -1/12-

2 a. Misleading; and/or b. Dishonest. 9. On 21 November 2017 you were convicted at Coventry and Warwickshire Magistrates Court for driving a motor vehicle with excess alcohol on 05 November 2017 contrary to section 5(1)(a) of the Road Traffic Act You failed to inform the GDC that; a. You were charged with an offence outlined in charge 9 above. b. On 21 November 2017, you were convicted of an offence outlined in charge 9 above. And that, in consequence of the matters set out above, your fitness to practise is impaired by reason of your misconduct and/or adverse physical or mental health and/or conviction. Mr Tiwana was not present and was not represented. On 16 May 2018 the Chairman announced the findings of fact to the Counsel for the GDC: Mr Tiwana was neither present nor represented at today s hearing. In his absence, the Committee first considered whether notice of this hearing had been served in accordance with rules 13 and 65 of the General Dental Council (Fitness to Practise) Rules Order of Council 2006 (the rules). The Committee received a copy of the Notification of Hearing, dated 13 April 2018, which was sent to Mr Tiwana s registered address by way of Special Delivery, first class post and . The Committee was satisfied that the letter contained proper notification of today s hearing, including its time, date and location, as well as notification that the Committee has the power to proceed with the hearing in the absence of Mr Tiwana. The Committee also had sight of an extract from the Royal Mail Track and Trace website, which shows that the item was signed for by TIWANA on 14 April The Committee was satisfied, having regard to the submissions made by Ms MacDonald, on behalf of the General Dental Council (GDC), and the advice of the Legal Adviser, that the notice of this hearing was served on Mr Tiwana in accordance with the rules. Proceeding in the absence of Mr Tiwana: The Committee then considered an application by Ms MacDonald to proceed in the absence of Mr Tiwana in accordance with Rule 54. The Committee was mindful that the discretion to proceed in the absence of Mr Tiwana must be exercised with the utmost care and caution as referred to in the case of GMC v Adeogba [2016] EWCA Civ 162. The Committee bore in mind that every registrant has the right to attend their hearing or be represented. The Committee considered all the circumstances of Mr Tiwana s absence, whether he had chosen voluntarily to absent himself, whether an adjournment would be likely to secure his attendance at a future hearing and the nature of the case against him, when reaching any decision regarding proceeding in his absence. Ms MacDonald referred the Committee to the information before it regarding the attempts made by the GDC to contact Mr Tiwana by post and . She further submitted that the notice of hearing had been sent not only to the address on the register but also to an TIWANA, S S Professional Conduct Committee May 2018 Page -2/12-

3 alternative address used by Mr Tiwana, demonstrating that all reasonable efforts had been made by the GDC to contact Mr Tiwana. The Committee accepted the advice of the Legal Adviser. Although none has been sought, the Committee considered it unlikely that an adjournment would serve any useful purpose, particularly in the light of Mr Tiwana s limited engagement with the GDC. There was no information before it to suggest that Mr Tiwana would be likely to attend any future listing, and the Committee concluded that he had voluntarily absented himself from the hearing. Having weighed the interests of Mr Tiwana with those of the GDC and the public interest in an expeditious disposal of this hearing, the Committee determined to proceed in Mr Tiwana s absence. Proceeding in Private At the outset of these proceedings, the Committee agreed to an application made by Ms MacDonald to hear parts of the case in private under Rule 53 of The GDC (Fitness to Practise) Rules She submitted that the hearing deals with some allegations relating to Mr Tiwana s health and that consequently parts of the proceedings should be dealt with in private. The Committee considered this and was satisfied that it was in the interests of Mr Tiwana to protect his private life and therefore granted the application. The charge [PRIVATE]. There are also allegations of misconduct, that Mr Tiwana failed to adequately cooperate with an investigation conducted by the GDC and failed to declare his criminal conviction to the GDC. Further, there are allegations of dishonesty relating to Mr Tiwana in that he prescribed medication whilst he was suspended and gave incorrect information to a Boots Pharmacist. The evidence Adverse Health condition [PRIVATE] Misconduct In relation to the allegation of misconduct, the Committee received the signed witness statement, and associated exhibits from an Assistant Prosecution Lawyer at the GDC- Witness NM. The Committee noted that the witness statement related to the production of correspondence between those acting for the GDC and the Registrant and as such was satisfied with its reliability. The Committee also had regard to a witness statement, and associated exhibits from a pharmacist employed at Boots-Witness NJ. Having considered the content of that statement, the circumstances in which it was made and the fact that it is unchallenged, the Committee accepted the factual content. Conviction In relation to the conviction allegation, the Committee had sight of a signed and certified copy of a certificate of conviction. TIWANA, S S Professional Conduct Committee May 2018 Page -3/12-

4 The Committee s Findings of Fact The Committee considered all the evidence presented to it. It took account of the submissions made by Ms MacDonald on behalf of the GDC and it accepted the advice of the Legal Adviser. The Committee considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the alleged facts are proved on the balance of probabilities. The Committee drew no adverse inferences from Mr Tiwana s absence from this hearing. I will now announce the Committee s findings in relation to each head of charge: 1. You have an adverse health condition set out in the attached Schedule. [PRIVATE] 2. For some or all of the period between 29 September 2017 and 3 January 2018 you failed to co-operate with an investigation conducted by the GDC. The Committee was satisfied that, as a registrant, Mr Tiwana had a duty to cooperate with the GDC s investigation into his fitness to practise in accordance with Standard 9.4 of Standards for the Dental Team It received and accepted the clear statement and documentary evidence from Witness NM of Mr Tiwana s nonengagement with the GDC between 29 September 2017 and 03 January The Committee noted that Mr Tiwana was given numerous opportunities to respond to repeated requests from the GDC to provide his consent to the release of his up to date medical records [PRIVATE] To date he has not done so. The Committee concluded that as a registered dental professional, Mr Tiwana was under a duty to co-operate fully with the GDC s investigations into his fitness to practise. It found that Mr Tiwana failed in his duty by not consenting to release his updated medical records, [PRIVATE]. 3. On 18 February 2017, you prescribed medication whilst your registration with the GDC was suspended; The Committee had regard to the submissions of Ms MacDonald who confirmed that Mr Tiwana s registration had been suspended since The Committee also had sight of a Notification of a Practice Committee review decision dated 8 November 2016 that confirmed his suspension was further extended until 21 May The Committee had regard to Witness NJ s statement which exhibited a copy of a prescription which appeared to be issued by Mr Tiwana. It was clear to the Committee that the prescription included Mr Tiwana s name, signature and the Practice name and address. The Committee further noted from NJ s witness statement that she stated upon receiving the prescription from Mr Tiwana, she observed that the date was missing TIWANA, S S Professional Conduct Committee May 2018 Page -4/12-

5 and asked Mr Tiwana to return with a dated prescription. Mr Tiwana left the store and returned in approximately five minutes with the same prescription that had been amended to include the date and informed her that he was the prescriber. The Committee accepted this evidence and was satisfied that Mr Tiwana had prescribed medication whilst suspended and therefore finds this charge proved. 4 Your conduct in relation to allegation 3 was; 4.a c. Misleading; and/or In view of the Committee s findings at heads of charge 3 above, it finds that Mr Tiwana prescribed medication when his registration was suspended. The Committee was of the view that his conduct in issuing a prescription would have misled the pharmacist into believing that Mr Tiwana was entitled to do so. Accordingly, the Committee finds this charge proved. 4.b Your conduct in relation to allegation 3 was; d. Dishonest in that you knew you were not entitled to prescribe medication whilst your registration with the GDC was suspended. In relation to the allegation that your conduct was dishonest, the Committee was referred to the Supreme Court judgment in the case of Ivey v Genting Casinos (UK) Ltd (t/a Crockfords) [2017] UKSC 67 where the legal test for dishonesty was revisited. This was as follows: "When dishonesty is in question the fact-finding tribunal must first ascertain (subjectively) the actual state of the individual's knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the (objective) standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest." As already found in Charge 3 above, Mr Tiwana was suspended from practising as dentist since The suspension order was then reviewed and extended until 21 May The Committee was satisfied that Mr Tiwana was aware that he was suspended from practising as a dentist. It noted from Dr [PRIVATE] report dated 18 December 2017 that Mr Tiwana was working as a receptionist in a dental surgery in Coventry. The Committee drew the inference from the fact that Mr Tiwana was working as a receptionist and not a dentist that he knew he was suspended. The Committee was further satisfied that Mr Tiwana knew that as a suspended dentist he was not permitted to prescribe medication. This can be inferred from his behaviour when challenged, namely he lied and told the pharmacist that someone TIWANA, S S Professional Conduct Committee May 2018 Page -5/12-

6 else had prescribed the medication. The Committee further concluded that Mr Tiwana s actions were dishonest by the standards of ordinary decent people. Accordingly, this charge is found proved. 5. On 18 February 2017, you amended a prescription written by another dental professional whilst your registration with the GDC was suspended. Not Proved In light of the Committee s findings in charge 3 above, this charge naturally falls away. 6. Your conduct in relation to allegation 5 was; a. Misleading; and/or b. Dishonest in that you knew you were not entitled to amend the prescription whilst your registration with the GDC was suspended. Not Proved In light of the Committee s findings in charge 3 above, this charge naturally falls away. 7. On 18 February 2017, you gave incorrect information to a Boots Pharmacist by saying words to the effect of; 7.a You had prescribed the medication yourself; and/or Found Not Proved The Committee has found that Mr Tiwana prescribed the medication (see charge 3 above) it was therefore not incorrect to tell the pharmacist that he had prescribed the medication himself. 7.b Someone else had prescribed the medication. The Committee had regard to Witness NJ s written evidence, including a contemporaneous pharmacy incident investigation form detailing the incident with Mr Tiwana. It noted from her evidence that when Witness NJ was handed the prescription, she looked up Mr Tiwana s registration details on the GDC website and found that Mr Tiwana s registration was suspended. Witness NJ challenged Mr Tiwana and asked him why he was ordering a prescription when he had been suspended from the GDC register Mr Tiwana had then responded that, the prescription had been written by someone else. The Committee accepted Witness NJ s written evidence and determined Mr Tiwana was the prescriber in charge 3 above. It was therefore incorrect to tell the pharmacist that someone else had prescribed it. Accordingly, this charge is found proved. 8. Your conduct in relation to allegation 7(a) and/or (b) was; 8.a e. Misleading; and/or Not proved in relation to 7.a otherwise found proved in relation to 7.b TIWANA, S S Professional Conduct Committee May 2018 Page -6/12-

7 In relation to 7.b the Committee finds that it was misleading to inform the Pharmacist that someone else had prescribed the medication when Mr Tiwana had prescribed it. Accordingly, the Committee finds this charge proved. 8.b Dishonest. Not proved in relation to 7.a otherwise found proved in relation to 7.b The Committee had regard to the test for dishonesty in the case of Ivey v Genting Casinos (UK) Ltd (t/a Crockfords) [2017] UKSC 67, as seen above in charge 4.b. The Committee found in charge 7.b above that Mr Tiwana when challenged had given incorrect information to the pharmacist at Boots by stating that someone else had prescribed the medication. The Committee concluded that his actions were dishonest in that he knew he was the prescriber and gave incorrect information to try and conceal this fact when challenged by the pharmacist. The Committee was satisfied that by objective standards, ordinary decent people would regard his conduct as dishonest. Accordingly, this charge is found proved. 9 On 21 November 2017 you were convicted at Coventry and Warwickshire Magistrates Court for driving a motor vehicle with excess alcohol on 05 November 2017 contrary to section 5(1)(a) of the Road Traffic Act The Committee had sight of a signed certified copy of the certificate of conviction. The facts are found proved in accordance with Rule 57 (5) which states; 57 - (5) Where a respondent has been convicted of a criminal offence (a) a copy of the certificate of conviction, certified by a competent officer of a court in the United Kingdom (or, in Scotland, an extract conviction) shall be conclusive proof of the conviction; 10 You failed to inform the GDC that; a. You were charged with an offence outlined in charge 9 above. b. On 21 November 2017, you were convicted of an offence outlined in charge 9 above. in its Entirety In accordance with Standard 9.3 of Standards for the Dental Team 2013, Mr Tiwana had a duty to inform the GDC that he was charged with and convicted of a criminal offence. It is clear from NM s witness statement that the GDC has no record of Mr Tiwana informing the GDC that he had been charged and/or convicted of a criminal offence. The Committee was therefore satisfied that he failed to declare this to the GDC in accordance with Standard 9.3. We move to Stage Two. TIWANA, S S Professional Conduct Committee May 2018 Page -7/12-

8 On 17 May 2018, the Chairman announced the determination as follows: The Committee took into account all of the evidence presented to it at the fact-finding stage. The Committee also took into account the submissions made by Ms MacDonald on behalf of the General Dental Council (GDC). It accepted the advice of the Legal Adviser. The Committee found proved that Mr Tiwana: - has an adverse health condition; - failed to adequately cooperate with the GDC s investigation; - prescribed medication and amended a prescription when not entitled to do so; - gave incorrect information to a Boots pharmacist; - was misleading and dishonest; and - failed to inform the GDC that he was charged with and convicted of a criminal offence. MISCONDUCT The Committee first considered whether the facts found proved against Mr Tiwana amounted to misconduct in relation to heads of charge 2, 3, 4, 7, 8 and 10. In doing so it had regard to the GDC publication Standards for the Dental Team (2013). It looked at the following sections in particular: 9.1 You must ensure that your conduct, both at work and in your personal life, justifies patients trust in you and the public s trust in the dental profession. 9.3 You must inform the GDC if you are subject to criminal proceedings or a regulatory finding is made against you anywhere in the world. 9.4 You must co-operate with any relevant formal or informal inquiry and give full and truthful information. The Committee was satisfied from the above Standards that Mr Tiwana had an unequivocal duty to co-operate with the investigation being conducted by the GDC and he clearly failed to do so over a prolonged period of time. The Committee found that Mr Tiwana has failed to respond to communications from the GDC between 29 September 2017 and 3 January 2018 and failed to provide consent to release his up to date medical records, [PRIVATE]. The Committee considered that his conduct has frustrated the GDC investigation into concerns relating to his health and undermined the effectiveness of the GDC s role in professional regulation. The Committee determined that Mr Tiwana s conduct in presenting himself as a practising dentist by prescribing medication, knowing his registration was suspended, is serious. Although this was a single issue, it led to deliberate dishonesty. Mr Tiwana attempted to conceal having written the prescription when he was challenged by the pharmacist at Boots, telling the pharmacist somebody else had written it. The Committee determined that this represents a significant departure from the standards expected of a registered dental professional. Mr Tiwana placed his own considerations before those of his regulator, other members of the profession and the public. The Committee considered that Mr Tiwana s failure to inform the GDC that he had been charged with and subsequently convicted of a criminal offence to be a serious breach of the standards expected of a registered dental care professional. The GDC has published TIWANA, S S Professional Conduct Committee May 2018 Page -8/12-

9 guidance, that is explicit in outlining his personal responsibility to inform the GDC of any criminal proceedings against him. It is also Mr Tiwana s responsibility as a professional to be aware of the content of the guidance. Taking the issues individually and collectively, the Committee is satisfied that fellow professionals would deem Mr Tiwana s conduct deplorable. It has determined that his conduct amounts to serious misconduct. IMPAIRMENT The Committee considered in turn whether Mr Tiwana s fitness to practise is currently impaired by reason of his misconduct, convictions and health. Misconduct The Committee was satisfied that Mr Tiwana s misconduct, in relation to charges 2, 3, 4, 7, 8 and 10 as found in this case, is such that it is capable of being remedied although this would be difficult in respect of the dishonesty. It considered that in order to demonstrate remediation, Mr Tiwana would need to embark on meaningful engagement with the GDC. However, the Committee has received no information on Mr Tiwana s current circumstances and importantly no evidence of insight on Mr Tiwana s part. There is nothing before the Committee to suggest that he has any understanding of his duty to co-operate with the GDC or declare his conviction. Whilst the Committee has not drawn any adverse inference from Mr Tiwana s absence from this hearing, the current factual position is that Mr Tiwana s lack of engagement is ongoing. [PRIVATE] Mr Tiwana s misconduct involved an abuse of his position as a dental professional in prescribing medication whilst suspended and later attempting to conceal it. The Committee considered that his actions were misleading and dishonest, could bring the profession into disrepute and were a breach of fundamental tenets of the profession. It was of the view that dishonesty is not easily remediable, given that it is a matter of character and attitude rather than of clinical practice. In the absence of any evidence of insight or remediation, the Committee considered that it is highly likely that Mr Tiwana would repeat the misconduct it has found. Whilst it took into account that no actual patient harm was found proved in this case, [PRIVATE]. In the Committee s view, Mr Tiwana s conduct demonstrates a disregard for the GDC s important role in the protection of the public. Further the issuing of prescriptions by those who are unregistered and not demonstrably up to date with Continuing Professional Development has the potential to put patients at risk. It therefore considered that a finding of impairment is necessary to protect the public. The Committee also decided that a finding of impairment is in the wider public interest to maintain public confidence and uphold proper standards of conduct and behaviour. Mr Tiwana has breached fundamental standards required by the GDC and has to date shown no insight into this serious matter. The Committee considered that public confidence in the dental profession and in the GDC as regulator would be undermined if a finding of impairment in relation to misconduct were not made in the circumstances of this case. Conviction The Committee bore in mind Standard 9.1 which states You must ensure that your conduct, both at work and in your personal life, justifies patients trust in you and the public s trust in the dental profession. It noted that the reputation of the dental profession can be damaged TIWANA, S S Professional Conduct Committee May 2018 Page -9/12-

10 when a registered dentist is convicted of a criminal offence. It considered Mr Tiwana s conviction, where it was noted his [PRIVATE] was more than twice the legal limit and his driving was of an unacceptable standard. He received a custodial sentence albeit suspended. The Committee determined his conviction involved putting the public at extreme risk and was of a serious nature. It noted that, in view of his three previous convictions for the same offence, this was not an isolated incident. The Committee determined that Mr Tiwana s conviction was harder to remedy than his misconduct. It considered whilst his personal circumstances may have contributed to the initial behaviour, it did not consider that this mitigated the serious nature of his conduct. The Committee noted that Mr Tiwana has received four convictions for driving with excess alcohol. In addition to the convictions there was also an occasion when he drove [PRIVATE], apparently under the influence of alcohol, despite being warned not to do so. There is no evidence to show that he acknowledges the seriousness of his behaviour or that he has taken steps to avoid driving with excess alcohol in the future. The Committee has seen nothing that shows that he has insight into the potential impact of his actions on public safety or public confidence. The Committee therefore determined that a finding of impairment was necessary on public protection and public interest grounds so as to declare and uphold proper standards and maintain public confidence in the profession. Health The Committee had found proved that Mr Tiwana has an adverse health condition. [PRIVATE]. [PRIVATE]. SANCTION The Committee considered what sanction, if any, to impose upon Mr Tiwana s registration. It bore in mind that the purpose of a sanction is not to be punitive, but rather to protect patients and the wider public interest. In considering sanction, the Committee took into account the Guidance for the Practice Committees including Indicative Sanctions Guidance (October 2016). It applied the principle of proportionality and balanced the public interest against Mr Tiwana s own interests. The Committee looked at the mitigating factors in this case. It noted that there was no evidence of actual patient harm and that there was information before it that Mr Tiwana was experiencing personal difficulties in a number of areas of his life. In terms of aggravating factors, the Committee noted the lack of evidence of Mr Tiwana s insight, the risk of harm to the public as a result of his impairment and his lack of engagement. His dishonesty (including his attempts to cover up wrongdoing), his breach of trust, his blatant disregard for the role of the GDC, his previous fitness to practise history, convictions and other adverse findings were further aggravating factors. Turning to the sanctions available to it, the Committee considered whether it would be sufficient to conclude the case with no further action. It determined that in the light of the serious findings it had made, concluding the case with no further action would not be an appropriate or proportionate response. TIWANA, S S Professional Conduct Committee May 2018 Page -10/12-

11 It next considered whether to issue Mr Tiwana with a reprimand. It determined that a reprimand would not be effective or proportionate bearing in mind the issues identified. It then considered whether conditions of practice could be formulated that would address Mr Tiwana s impairment. It determined that in the light of his lack of engagement, conditions would not be workable or sufficient. The Committee next considered whether to suspend Mr Tiwana s registration for a period of time. The Committee noted paragraph 7.28 within the Indicative Sanctions Guidance, which sets out the factors indicative of a suspension order: Suspension is appropriate for more serious cases and may be appropriate when all or some of the following factors are present (this list is not exhaustive): there is evidence of repetition of the behaviour; the registrant has not shown insight and/or poses a significant risk of repeating the behaviour; patients interests would be insufficiently protected by a lesser sanction; public confidence in the profession would be insufficiently protected by a lesser sanction; there is no evidence of harmful deep-seated personality or professional attitudinal problems (which might make erasure the appropriate order). The Committee considered the matter very carefully. It noted that the first four factors were engaged. However, it concluded that Mr Tiwana s abuse of his position as a dental professional in order to prescribe medication whilst suspended, dishonesty and his repeated non-engagement with his regulator were indicators of a deep-seated personality or professional attitudinal problem that rendered a suspension order inadequate in this case. The Committee took into account Ms MacDonald s submissions in respect of Mr Tiwana s fitness to practise history and noted that an order of suspension was initially imposed on Mr Tiwana s registration in The first review of that order took place in May 2015, the order was extended for a further 12 months. The second review was held in May 2016, the order was extended for a further 6 months. The third review was in November 2016, the order was extended for 6 months. The fourth review was in May 2017, the order was extended for 6 months. Lastly, the fifth review was in November 2017, whereby it was determined by the reviewing Committee to indefinitely suspend Mr Tiwana s registration. The Committee determined that Mr Tiwana has been suspended for approximately four years and breached his order of suspension by prescribing medication. It therefore considered that an order of suspension would be insufficient to protect the public or the public interest. The Committee then looked at paragraph 7.34 within the Indicative Sanctions Guidance. It considered the following aspects to be engaged: Erasure will be appropriate when the behaviour is fundamentally incompatible with being a dental professional: any of the following factors, or a combination of them, may point to such a conclusion: serious departure(s) from the relevant professional standards; TIWANA, S S Professional Conduct Committee May 2018 Page -11/12-

12 where a continuing risk of serious harm to patients or other persons is identified; serious dishonesty, particularly where persistent or covered up; a persistent lack of insight into the seriousness of actions or their consequences. In all the circumstances of this case the Committee concluded that Mr Tiwana s serious departure from the relevant professional standards, including his misleading and dishonest conduct, lack of full insight into the seriousness of his actions, is fundamentally incompatible with him being a registered dentist. The Committee concluded that the only appropriate and proportionate sanction is that of erasure. The Committee determined that erasure of Mr Tiwana s registration was necessary in order to safeguard patients and maintain public confidence in the profession. The Committee has determined and herby directs, that Mr Tiwana s name be erased from the register. Decision on immediate order of suspension The Committee took account of the submissions made by Ms MacDonald that an immediate order should be imposed on Mr Tiwana s registration. The Committee accepted the advice of the Legal Adviser. Having directed that Mr Tiwana s name be erased from the register, the Committee had to consider whether to impose an immediate order to cover the appeal period, or until any appeal against the outcome is heard. The Committee was satisfied that an immediate order of suspension was necessary for the protection of the public and it was otherwise in the public interest. The Committee concluded that given the seriousness and the nature of its findings and its reasons for the substantive order of erasure, including Mr Tiwana s lack of insight and the identified risk of repetition, to direct otherwise would be inappropriate. The Committee considered that, given its findings, if an immediate order were not made in the circumstances, public confidence in the profession and in the GDC as its regulator would be undermined. If, at the end of the appeal period of 28 days, Mr Tiwana has not lodged an appeal, this immediate order will lapse and will be replaced by the substantive direction of erasure. If he does lodge an appeal, this immediate order will continue in effect until that appeal is determined. Unless Mr Tiwana exercises his right of appeal, his name will be erased from the register 28 days from the date upon which this decision is deemed served on him. That concludes this case. TIWANA, S S Professional Conduct Committee May 2018 Page -12/12-