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Record of Determinations – Medical Practitioners Tribunal PUBLIC RECORD Dates: 09/01/2017 – 11/01/2017 Medical Practitioner’s name: Dr Jan Carsten RADEKE GMC reference number: 4493923 Primary medical qualification: State Exam Med 1990 Johann-Wolfgang Goethe Universität Frankfurt Type of case New - Determination by other regulator Outcome on impairment Impaired Summary of outcome Suspension, 5 months. Review hearing directed Tribunal: Lay Tribunal Member (Chair) Mrs Joy Hamilton Medical Tribunal Member: Dr Martin Johnson Medical Tribunal Member: Dr Neil Smart Legal Assessor: Mr David Marshall Tribunal Clerk: Miss Miriam Bonabana Attendance and Representation: Medical Practitioner: Not present and represented Medical Practitioner’s Representative: Mr Martin Forde, QC, instructed by Weightmans Solicitors Ms Rosalind Emsley-Smith, Counsel GMC Representative: Allegation and Findings of Fact That being registered under the Medical Act 1983, as amended: MPT: Dr RADEKE 1 Record of Determinations – Medical Practitioners Tribunal 1. On 31 July 2014, the Professional Conduct Committee ('the Committee') of the General Dental Council ('GDC') determined that your fitness to practise was impaired by reason of your misconduct. Admitted and Found Proved 2. On 2 June 2016, the Committee determined: a. that your fitness to practise was currently impaired; Admitted and Found Proved b. to suspend your name from the dental register for a period of 12 months. Admitted and Found Proved And that by reason of the matters set out above your fitness to practise is impaired because of the determination by the GDC. Attendance of Press / Public The hearing was all heard in public. Determination on Facts and Impairment- 11/01/2017 Mr Forde QC: Facts Admissions 1. On behalf of Dr Radeke, you admitted paragraphs 1 and 2 of the allegation in its entirety. The Tribunal announced these facts as admitted and found proved. Tribunal’s findings 2. The Tribunal has made the following findings on the facts: 3. That being registered under the Medical Act 1983 (as amended): 1. On 31 July 2014, the Professional Conduct Committee ('the Committee') of the General Dental Council ('GDC') determined that your fitness to practise was impaired by reason of your misconduct. Admitted and Found Proved 2. On 2 June 2016, the Committee determined: b. that your fitness to practise was currently impaired; Admitted and Found Proved MPT: Dr RADEKE 2 Record of Determinations – Medical Practitioners Tribunal b. to suspend your name from the dental register for a period of 12 months. Admitted and Found Proved Impairment 4. Having announced its findings on the facts, the Tribunal has now considered whether, on the basis of the facts found proved, Dr Radeke’s fitness to practise is currently impaired by reason of the determination of the GDC. The Tribunal has taken into account all the evidence before it and the submissions made by Ms Emsley-Smith on behalf of the General Medical Council (GMC), those made by you on Dr Radeke’s behalf and the advice given by the Legal Assessor. Background 5. The Tribunal noted that Dr Radeke qualified in Germany as a Doctor of Medicine and of Dentistry and he was employed by King’s College Hospital London (KCH) from 2002, first as a staff grade oral surgeon and then from May 2008 as a full-time consultant in Oral Surgery in the Department of Oral and Maxillofacial Surgery. He held registration both with the GMC and the GDC and he was on the GDC Specialist List for Oral Surgery. 6. On 17 May 2013 the GDC received a referral from KCH NHS Foundation Trust (the Trust). Allegations relating to Patient X, Patient Y and Patient Z were referred to a Professional Conduct Committee (PCC) of the GDC for consideration. In July 2014 the PCC went on to make a number of findings of fact in respect of Dr Radeke’s clinical performance and honesty, and found that they amounted to misconduct. Dr Radeke’s fitness to practise was found to be impaired at that time and it was directed that his name be erased from the GDC’s register. Dr Radeke appealed against that order and an appeal hearing was held between 17 and 19 February 2015. On 24 March 2015, Mr Justice Turner handed down the judgement of the court. The PCC’s finding of dishonesty was quashed, and the case was remitted back to the GDC to reconsider sanction. Dr Radeke’s case was heard in June 2016 by a differently constituted PCC. At that hearing, the PCC determined to suspend Dr Radeke’s registration for a period of 12 months. GMC submissions 7. Ms Emsley-Smith reminded the Tribunal that the GDC determined in June 2016 that Dr Radeke’s fitness to practise was impaired and deemed it necessary to suspend his registration for a period of 12 months to protect both patients and the wider public interest. Ms Emsley-Smith submitted that the incidents which gave rise to Dr Radeke’s last hearing occurred in and before 2012 and that Dr Radeke has been subject to investigations since then. She accepted the impact these ongoing proceedings would have on Dr Radeke. Nonetheless, she submitted that the Tribunal’s primary focus should be the protection of patients and the public interest. MPT: Dr RADEKE 3 Record of Determinations – Medical Practitioners Tribunal 8. Ms Emsley-Smith drew the Tribunal’s attention to the transcript where the PCC had considered the Judgement of Dame Janet Smith in CHRE v NMC & Grant [2011] EWHC 927 (Admin) in which guidance is given about considering whether or not a doctor is impaired. Ms Emsley-Smith submitted that Dr Radeke did put patients at unwarranted risk of harm, one of whom subsequently died. She submitted that his actions had brought his profession into disrepute and also breached fundamental tenets of the profession. She submitted that, notwithstanding the action taken by the GDC, this Tribunal was still under an obligation to protect patients and the wider public interest, as the concerns also related to matters governed by this regulatory body. 9. Ms Emsley-Smith referred the Tribunal to Good Medical Practice (GMP) (November 2006 Edition) and to the relevant paragraphs contained within. She submitted that the failures identified by the GDC, made clear that Dr Radeke breached fundamental tenets of both the medical and dental profession, thereby bringing them into disrepute. She stated that in order for the Tribunal to form a view as to whether Dr Radeke’s fitness to practise is currently impaired, the Tribunal should take account of the way in which he has acted in the past. She reminded the Tribunal that Dr Radeke is still subject to suspension by the GDC and submitted that a finding of impairment must be made, irrespective of remediation, in order to protect patients and the public interest. She submitted that it cannot be right for this Tribunal to take no action on the basis that the GDC has already taken action in response to the failures identified. 10. Ms Emsley-Smith submitted that this Tribunal has not had the benefit of hearing from Dr Radeke and therefore was not in a position to test his evidence or hear directly from him about his insight and remediation. She submitted that his lack of insight applies to all the failures identified. In respect of remediation, she referred to the recent 2016 Continuing Professional Development (CPD) provided by Dr Radeke and submitted that the Tribunal does not have evidence demonstrating that he has reflected on the articles he has read, the extent of this reading and any plans he has to return to any form of medical practice. Ms Emsley-Smith referred to Dr Radeke’s witness statement in which he accepts that he is now deskilled. However, she submitted that even if the Tribunal considered that he has demonstrated insight, it has no sufficiently robust current information before it which it could rely on to say that Dr Radeke would be safe to engage in unrestricted practice. Doctor’s representatives submissions 11. You told the Tribunal that Dr Radeke being deskilled is not a factor for this Tribunal to take into account when determining the question of impairment. You submitted that it must make a decision on impairment based upon the facts found proved. You also told the Tribunal that Dr Radeke would not return to practice without some period of re-skilling. MPT: Dr RADEKE 4 Record of Determinations – Medical Practitioners Tribunal 12. You submitted that Dr Radeke wanted to apologise for his non-attendance at these proceedings. You told the Tribunal that Dr Radeke has not worked since 2014 XXX. You referred the Tribunal to the transcripts and findings made by the GDC. 13. You referred the Tribunal to the CPD Dr Radeke provided and submitted that he undertook an enormous amount of personal development. You submitted that Dr Radeke had demonstrated genuine remorse and referred to his witness statement in which he submitted that he has reflected further since the GDC hearing. You submitted that the CPD addressed all the deficiencies identified. You submitted that since Dr Radeke’s registration is currently suspended he is limited as to what CPD he can undertake and has therefore resorted to reading articles. The recent 2016 CPD covers both dental and surgical matters. You finally submitted that taking all the matters into account there is ample evidence to determine that Dr Radeke is not currently impaired. Tribunal’s decision 14. The Tribunal took account of the findings made by the GDC, as varied on appeal, as follows: 1. Between 20 and 23 August 2012 you provided treatment and advice to Patient X. 2. During this period you failed to ensure that an adequate note was made in relation to: (a) Patient X’s medical history, including her intake of medication drugs and alcohol; (b) Patient X’s dental history; (c) Patient X’s current drug therapy; (d) Patient X’s presenting condition and complaints; (e) any intra oral examination; (f) a diagnosis for the teeth to be extracted and/or Patient X’s mouth ulcers; (g) justification for the treatment provided; (h) the risks and benefits of the proposed treatment; (i) the different options for the patient’s treatment; (j) radiographic examination and/or blood test results. 3. On 23 August 2012 you: (i) extracted five teeth; and (ii) used laser treatment for the ablation of mouth ulcers. 4. Prior to providing the treatment described you: MPT: Dr RADEKE 5 Record of Determinations – Medical Practitioners Tribunal (a) failed to take properly into account the contents of the patient’s discharge summary from Croydon University Hospital; (c) failed to contact directly other health professionals to ascertain the appropriateness of the treatment you intended to provide; (d) failed to ensure informed consent was obtained for the treatment you proposed; (e) wrongly categorised the patient as ASA 2; (f) failed to obtain a diagnosis in respect of the patient’s ulcers prior to undertaking invasive treatment. 5. In undertaking the procedures described on 23 August 2012 you: (a) in respect of 3(i) failed to assess the patient appropriately; (b) in respect of 3(i) failed to take adequately into account the patient’s needs; (c) in respect of 3(i) and (ii) failed to take adequately into account the patient’s medical presentation; (d) in respect of 3(i) and (ii) failed to provide palliative care while establishing the patient’s medical status; (e) in respect of 3(i) failed to take adequate account of the results of the blood tests which revealed that the patient was gravely ill; (f) in respect of 3(i) managed the patient in accordance with the departmental Warfarin protocol which was inappropriate in the circumstances; (g) in respect of 3(i) and (ii) provided treatment which was inappropriate in the circumstances of the patient’s medical condition; (h) in respect of 3(i) and (ii) provided treatment which was not in the patient’s best interests; (i) in respect of 3(i) and (ii) put the safety of the patient at risk. Dr Radeke’s accounts of his treatment of Patient X 6. During the course of King’s College Hospital’s (“KCH”) investigation into the circumstances of the death of Patient X you were interviewed by Staff Member A on 17 October 2012. 7. During the course of that interview and thereafter when you returned the documentation to him you explained to him that: (a) your assessment before this operation upon this patient was that she was ASA2 or ASA3; (b) you then accepted with hindsight that she should not have been categorised as ASA2 and should have been categorised as ASA3 or ASA4; MPT: Dr RADEKE 6 Record of Determinations – Medical Practitioners Tribunal (c) it was your normal practice to fill in the safer surgical checklist before you started the procedure and you saw no reason why you should not have done so on that day; (d) you had circled ASA2 and you had indicated on the form that the bleeding risk was ‘no’. 8. On 21 June 2013 you gave evidence on oath before HM Coroner at an inquest into the death of Patient X. 9. During the course of your evidence you stated that: (a) your view prior to operating was that the patient was ASA3 or ASA4; (b) the entry on the operation record that the patient was ASA2 was a mistake which you did not correct; (c) the entry showing that the patient was ASA2 was written by an assisting nurse. 10. The Coroner in his determination relied upon your evidence and accepted that the notation of ASA2 was made in error and that your real assessment of this patient was that she was ASA3 and probably better classified as ASA4. 11. Your evidence to the Coroner on 21 June 2013 in respect of your assertions set out at each of paragraphs 9(a) to 9(c) was: (a) inaccurate in respect of charge 9(c) 12. [No Finding]: Patient Y 13. On 19 July 2010 Patient Y consulted you having been referred in relation to a cyst upon her mandible and you operated upon her on 24 August 2010. 14. In relation to the consultation on 19 July 2010 you: (a) failed adequately to record your clinical examination; (b) failed to record a differential diagnosis; 15. Prior to performing the operation on 24 August 2010 you: (a) failed to contact directly other health professionals to ascertain the appropriateness of the treatment you intended to provide; (b) failed to obtain any previous diagnosis relevant to your treatment; MPT: Dr RADEKE 7 Record of Determinations – Medical Practitioners Tribunal (c) failed properly to consider a differential diagnosis; (e) failed to ensure that you had available to you a radiology report from a CT scan performed on 22 July 2010. 16. Following the operation on 24 August 2010 you: (a) noted that the cavity was empty and you submitted tissue for histopathology; (c) failed to follow up the results of the histopathology which you had requested; Patient Z 17. On 2 April 2012 Patient Z consulted you in relation to a lump on her upper lip. 18. In relation to your note of the consultation on 2 April 2012 you: (a) failed to make an adequate record of the history of the lump; (b) failed adequately to record a dental history; (c) failed adequately to record your clinical examination; (d) failed to record a differential diagnosis; (e) failed to record the options for her care. 19. On 17 April 2012 you undertook a laser excision of moles and excision of a tumour on her left lip. 20. Prior to performing this operation you: (b) failed to take account of the likely aetiology and risk of a malignant condition in the upper lip; 21. The operation you performed on 17 April 2012: (a) was not in the best interests of the patient; (b) put your patient at risk of harm. 22. Following the operation on 17 April 2012 you noted that a review should take place in two months’ time and: (a) in view of the risk of a malignant lesion your review interval was inappropriate; (b) you failed to follow up the results of the pathology which you had requested. MPT: Dr RADEKE 8 Record of Determinations – Medical Practitioners Tribunal 15. In reaching its own view on the question of impairment, the Tribunal considered transcripts of the evidence presented to the GDC which underpinned the findings set out above. 16. The Tribunal has considered the GMP (November 2006 Edition), in particular paragraphs 2(a), 2(c), 3(a), 3(b), 3(c), 3(f), 3(i) and 36 as follows: 2 Good clinical care must include: (a) adequately assessing the patient’s conditions, taking account of the history (including the symptoms, and psychological and social factors), the patient’s views, and where necessary examining the patient … (c) referring a patient to another practitioner, when this is in the patient’s best interests. 3 In providing care you must: (a) recognise and work within the limits of your competence (b) prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health, and are satisfied that the drugs or treatment serve the patient’s needs (c) provide effective treatments based on the best available evidence … (f) keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment … (i) consult and take advice from colleagues, when appropriate 36 You must be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment or involve patients in teaching or research. Usually this will involve providing information to patients in a way they can understand, before asking for their consent. You must follow the guidance in Seeking patients’ consent: The ethical considerations, which includes advice on children and patients who are not able to give consent. MPT: Dr RADEKE 9 Record of Determinations – Medical Practitioners Tribunal 17. The Tribunal noted the failings identified by the GDC and considered that its primary responsibility at this stage of the hearing is to reach a conclusion that will ensure the protection of patients and the maintenance of public confidence in the medical profession. The Tribunal also considered the reasons cited by the court when determining if the doctor’s fitness to practise is currently impaired. 18. The failures identified by the GDC are as applicable to medical practice as they are to dental practice. They included such matters as record keeping, obtaining clinical information prior to treatment, consulting with colleagues, and obtaining informed consent. The Tribunal considered that members of the public would be concerned to learn that Dr Radeke’s registration with the GMC was unrestricted at a time when he was subject to a suspension order from the GDC for these failures. It considered that the maintenance of public confidence in the medical profession required the Tribunal to make a finding that Dr Radeke’s fitness to practise with GMC registration was impaired. 19. The failures identified had also clearly posed a risk to patients at the time. The Tribunal noted that as recently as June 2016 the PCC of the GDC had judged that a finding of impairment was necessary for the protection of the public as well as in the wider public interest. The Tribunal did not consider that it could or should depart from that finding. It considered that the finding was justified on the basis of the material available to the PCC. The Tribunal took into account the additional remedial action taken by Dr Radeke since June 2016. He submitted a witness statement and a file of CPD documents. These indicated that he had undertaken extensive reading on a wide range of topics. The Tribunal was encouraged by his actions. It accepted that his opportunities for CPD may have been limited by his suspension from the GDC XXX. However, the result was that the Tribunal had only limited information about developments since June 2016. The Tribunal could not be confident that no risk to patients remained. The Tribunal concluded that a finding that Dr Radeke’s fitness to practise under GMC registration was impaired was also justified for the protection of the public. 20. In all the circumstances the Tribunal has therefore concluded that Dr Radeke’s fitness to practise is currently impaired by reason of the determination by the GDC. Determination on Sanction - 11/01/2017 Mr Forde QC: 1. Having determined that Dr Radeke’s fitness to practise is impaired by reason of the determination by the GDC, the Tribunal has now considered what action, if any, it should take with regard to his registration. The Tribunal has given careful MPT: Dr RADEKE 10 Record of Determinations – Medical Practitioners Tribunal consideration to all the documents adduced, together with Ms Emsley-Smith’s submissions on behalf of the GMC and those made by you on Dr Radeke’s behalf. Submissions 2. In making her submissions, Ms Emsley-Smith referred the Tribunal to the relevant paragraphs within the Sanctions Guidance (SG) (July 2016), drawing the Tribunal’s attention to the factors it should consider when determining which sanction, if any, to impose. She reminded the Tribunal that Dr Radeke has been subject to various investigations and submitted that it is clear from the evidence that he has co-operated with the investigation carried out by the police. She also submitted that he has engaged with both the GDC and GMC, albeit through you. Ms Emsley-Smith submitted that Dr Radeke has made expressions of understanding and insight and provided testimonials speaking to his positive characteristics. She reminded the Tribunal that although there has been a lapse of time and expressions of regret have been made, the circumstances of this case are aggravated by the serious nature of the failings identified which she submitted related to the risks to patients and the unfortunate consequence in respect of Patient X. 3. Ms Emsley-Smith submitted that the appropriate sanction to impose in this case is of suspension in order to protect the public and to maintain the reputation of the medical profession. 4. You also referred to the SG and reminded the Tribunal that Dr Radeke has accepted his mistakes. You drew the Tribunal’s attention to the evidence before it, in particular, concerning insight demonstrated by Dr Radeke. 5. You reminded the Tribunal of Dr Radeke’s dual registration and submitted that this is a case where the public is protected by the sanction imposed by the GDC and for that reason this Tribunal could find a degree of exceptionality in order to take no action. You told the Tribunal that on 2 June 2016, Dr Radeke was made subject to a 12 month suspension imposed by the GDC and as he did not appeal, that suspension commenced on 30 June 2016 and will expire on 30 June 2017. You submitted that the failings occurred in a dental context and that nothing would be added by the imposition of a sanction by this Tribunal. You submitted however that if the Tribunal is minded to impose a sanction, suspension would be the only realistic option. Tribunal decision 6. The decision as to the appropriate sanction, if any, is a matter for this Tribunal exercising its own judgement. In reaching its decision, the Tribunal has taken account of the SG and the statutory over-arching objective, which includes protecting the health, safety and wellbeing of the public, maintaining public confidence in the profession, and promoting and maintaining proper professional MPT: Dr RADEKE 11 Record of Determinations – Medical Practitioners Tribunal standards of conduct for the members of the profession. The Tribunal recognised that the purpose of a sanction is not to be punitive, although it may have a punitive effect. Throughout its deliberations, the Tribunal has applied the principle of proportionality, balancing Dr Radeke’s interests with the public interest. No action 7. The Tribunal first considered whether to conclude this case by taking no action on Dr Radeke’s registration. The Tribunal has already determined that Dr Radeke’s fitness to practise is impaired by the determination of the GDC and that the failings identified by the GDC were equally applicable to medical practice. Although this case is unusual, in that Dr Radeke is already subject to a sanction imposed by the GDC, the Tribunal did not consider that this case fell into the exceptional category where no sanction was required. Dr Radeke’s fitness to practise as a GMC registrant has been found to be impaired and action is required in relation to his GMC registration. The Tribunal determined that it would be wholly inappropriate to conclude this case by taking no action as to do so would be neither proportionate nor sufficient to protect the public and would not otherwise be in the public interest. Conditions 8. The Tribunal next considered whether to impose conditions on Dr Radeke’s registration. It has borne in mind that any conditions imposed would need to be appropriate, proportionate, workable, measurable and sufficient to address the public interest. 9. The Tribunal noted that Dr Radeke is suspended by the GDC and is not currently working. The Tribunal has not had the benefit of hearing oral evidence from Dr Radeke as to what he plans to do in the future and whether or not he wishes to return to practice. In these circumstances, the Tribunal was not able to formulate appropriate conditions. You did not submit that an order for conditions would be workable in this case. The Tribunal has therefore concluded that it would not be possible to impose conditions. Suspension 10. The Tribunal then considered whether a period of suspension would be appropriate as a sanction to impose on Dr Radeke’s registration. It took account of the paragraphs in the SG that deal with suspension, including 85, 86 and 91. 11. Paragraphs 85 and 86 state: “Suspension has a deterrent effect and can be used to send out a signal to the doctor, the profession and public about what is regarded as behaviour unbefitting a registered doctor. Suspension from the medical register also has MPT: Dr RADEKE 12 Record of Determinations – Medical Practitioners Tribunal a punitive effect, in that it prevents the doctor from practising (and therefore from earning a living as a doctor) during the suspension, although this is not its intention. Suspension will be an appropriate response to misconduct that is so serious that action must be taken to protect members of the public and maintain public confidence in the profession. A period of suspension will be appropriate for conduct that is serious but falls short of being fundamentally incompatible with continued registration (ie for which erasure is more likely to be the appropriate sanction because the tribunal considers that the doctor should not practise again either for public safety reasons or to protect the reputation of the profession).” 12. Additionally the Tribunal took account of paragraph 91 in particular subparagraphs (a), (b) and (f) which state that suspension may be appropriate when: “A serious breach of Good medical practice, but where the doctor’s misconduct is not fundamentally incompatible with their continued registration, therefore complete removal from the medical register would not be in the public interest. However, the breach is serious enough that any sanction lower than a suspension would not be sufficient to protect the public or maintain confidence in doctors. In cases involving deficient performance where there is a risk to patient safety if the doctor’s registration is not suspended and where the doctor demonstrates potential for remediation or retraining. … No evidence of repetition of similar behaviour since incident” 13. The findings made by the GDC did amount to serious breaches of GMP. However, the Tribunal concluded that this breach was not fundamentally incompatible with continued registration. In deciding this, the Tribunal took into account the evidence before it, which included evidence demonstrating steps Dr Radeke has taken to address the failings identified. In addition, there was nothing to suggest that there has been any repetition of similar behaviour since the incidents occurred. The Tribunal acknowledged that although harm did come to patients, Dr Radeke, subsequently sought to minimise this risk by taking steps to address his failings. The Tribunal has therefore concluded that although there remains some risk of repetition, this risk is relatively low. 14. In all the circumstances, the Tribunal has determined that a period of suspension is the appropriate, sufficient and proportionate sanction. It will signal to Dr Radeke, to the profession and to the public that the Tribunal regards the failings identified by the GDC as serious and unacceptable. MPT: Dr RADEKE 13 Record of Determinations – Medical Practitioners Tribunal 15. Having determined that suspension would be the proportionate, appropriate and sufficient sanction, the Tribunal then considered the length of the order. It has balanced the necessity in the public interest to mark the seriousness of the findings made by the GDC with Dr Radeke’s own interests. When considering the duration of Dr Radeke’s suspension, the Tribunal bore in mind the nature of the failings identified and the sanction that has already been imposed by the GDC. The Tribunal considered that Dr Radeke is making progress in addressing his failures and has demonstrated some insight and remediation. It is aware that he is due to appear before the GDC in early June 2017 for his review hearing. The Tribunal considered that the period of suspension should correspond to the suspension already imposed by the GDC so that both cases can be reviewed at about the same time. If the GDC lifts the suspension at its review hearing, it could be unfair for Dr Radeke’s GMC registration to remain suspended for a substantial period thereafter. 16. The purpose of a sanction is to serve the public interest and to maintain public confidence in the profession. The Tribunal has determined that this may be achieved by suspension of Dr Radeke’s name from the Medical Register for a period of five months. Allowing for the 28 day appeal period, this order will end shortly after the end of the current GDC order. The Tribunal did consider whether erasure would be the appropriate sanction and took account of the relevant paragraphs within the SG. The Tribunal concluded that in all the circumstances it would be unnecessary and indeed disproportionate to erase Dr Radeke’s name from the Medical Register. 17. A Tribunal will review Dr Radeke’s case at a review hearing to be held before the end of the period of suspension. It will then consider whether any further action in relation to Dr Radeke’s registration is required. Dr Radeke will be informed of the date of that meeting, which he is encouraged to attend. The Tribunal reviewing his case will be assisted by receiving: Further reflection on the failings identified by the GDC Evidence of any other steps taken by Dr Radeke of remediation Information about the outcome of the GDC review hearing, which will be essential to assist the Tribunal reviewing Dr Radeke’s case. 18. It would be of assistance to the Review Tribunal if Dr Radeke was able to attend to enable him to give his evidence in person. 19. The effect of the foregoing direction is that, unless Dr Radeke exercises his right of appeal, his registration will be subject to suspension 28 days from the date on which written notice of this decision is deemed to have been served upon him. MPT: Dr RADEKE 14 Record of Determinations – Medical Practitioners Tribunal Determination on Immediate Order - 11/01/2017 Mr Forde QC: 1. Having determined that Dr Radeke’s registration be suspended for five months, the Tribunal next considered in accordance with Section 38 of the Medical Act 1983, as amended, whether to impose an immediate order on suspension his registration. 2. Ms Emsley-Smith made no submissions on behalf of the GMC. 3. You also made no submissions on Dr Radeke’s behalf. 4. The Tribunal has considered all the circumstances of this unusual case. It noted that Dr Radeke has been subject to a sanction of suspension by the GDC for the last six months. The Tribunal, having exercised the principle of proportionality, has determined that it is not necessary to impose an immediate order of suspension. 5. The substantive direction for suspension, as already announced, will take effect 28 days from when notice is deemed to have been served upon Dr Radeke. 6. That concludes this case. Confirmed Date 11 January 2017 MPT: Dr RADEKE Mrs Joy Hamilton, Chair 15 MPT: Dr RADEKE 2 Record of Determinations – Medical Practitioners Tribunal MPT: Title SURNAME 1